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Archive for the ‘Death & Dying’ Category

Never Let a Good Plague Go to Waste

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“Come to terms with death. Thereafter, anything is possible.” —Albert Camus

First, I did. Then, I didn’t. Now I am back thinking about dying. Blame it on COVID…and my men’s group.

In a bygone era — say February or March — the word was people like me, 72 with asthma, were dying in greater numbers than others. Yet, some were going on ventilators and surviving. I told my wife at the time, “If I get COVID, try me on a ventilator for a while.” Then I updated my end-of-life paperwork and wrote a letter to my family about the disposition of my journals. Life got back to normal.… or what now passes for normal.

The news and I have shifted. Though you still hear stories of old people getting off vents and surviving, many do not. Some get off and face years of disability. There actually is some good news in the news, too. Docs are finding less aggressive ways to treat respiratory failure with some success. My new instructions — “No CPR and no vent for me.”

So, I am back to thinking about dying.

It really could happen in short order if I get COVID. And the men’s group? I have been in this group for 28 years. We meet every Thursday at 6AM Eastern time. We have decided to let each guy take a week and retell his life story. Revisiting my story has encouraged me to think like a hospice patient.

I’m going big this time thinking about dying — I’m in life review. Where have I been? What has been the meaning of my life? What is the purpose of human life? What are my regrets? I ask myself the question I have posed as a hospice chaplain to many dying souls: “If you were to die today is there anything that would be left undone?”

In 1585, Michel de Montaigne took his family and fled Bordeaux, France, where he was mayor, to avoid the bubonic plague. (How many mayors around the world today would like a vacation in the country right now?) His term in office was about to end and he had one last official duty in town, attending the transition ceremony. A recent piece in the New York Times continued, “He rode his horse to the city’s edge and wrote to the municipal council to ask whether his life was worth a transition ceremony. He did not seem to receive a reply and returned to his chateau. By the time the plague subsided, more than 14,000 people — about a third of the city’s population — had died horrible deaths. As for the former mayor, he returned to a far more pressing task: the writing of essays.”

He is now regarded as the originator of the modern form of literature we call “the essay.” Like any philosopher worth his salt, Montaigne contemplated death. Early on in my work with the dying, I kept finding him quoted in the literature on death and dying. He titled one piece, “To philosophize it to learn how to die.” Here’s an excerpt:

Knowing how to die gives us freedom

“To begin depriving death of its greatest advantage over us, let us adopt a way clean contrary to that common one; let us deprive death of its strangeness; let us frequent it, let us get used to it; let us have nothing more often in mind than death. At every instant let us evoke it in our imagination under all its aspects.… To practice death is to practice freedom. A man who has learned how to die has unlearned how to be a slave. Knowing how to die gives us freedom from subjection and constraint. Life has no evil for him who has thoroughly understood that loss of life is not an evil.” Michel de Montaigne, c. 1533-1595

Even before the plague, like anyone in the 16th century, he was quite familiar with death. Besides disease taking lives, Protestants and Catholics were killing each other periodically. It is curious to me that he even felt the need to encourage his readers to contemplate death. How could you NOT in a world surrounded by death? The human capacity to ignore or put off contemplation of death is huge.

I am convinced that I will never fully face my own death until I have a terminal diagnosis. Not only being given the diagnosis, but also having the felt sense in my body that I am checking out. But still, I am trying. COVID has helped move the process forward. I could die. I must be ready. I have decided not to let a good plague go to waste.

 

Photo by Veit Hammer on Unsplash

Life and Death as Metaphor – Part 2

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I continue to gather these quotes on life and death as metaphor. Most were found on the WeCroak app:

  • “Our life is a faint tracing on the surface of mystery.”  —Annie Dillard
  • For life and death are one, even as the river and the sea are one.”  —Kahlil Gibran
  • “Not success. Not growth. Not happiness. The cradle of your love of life … is death.”  —Stephen Jenkinson
  • “Life is a spark between two identical voids, the darkness before birth and the one after death.”  —Irvin D. Yalom
  • “Life is a succession of misunderstandings, leading us on to the final truth, the only truth.”  —Roberto Bolano
  • “We only get to be in our bodies for a limited time, why not celebrate the journey instead of merely riding it out until it’s over?”  —Jen Sincero
  • “Yet, in a bizarre, backwards way, death is the light by which the shadow of all of life’s meaning is measured. Without death, everything would feel inconsequential, all experience arbitrary, all metrics and values suddenly zero.”  —Mark Manson
  • “Death is our friend precisely because it brings us into absolute and passionate presence with all that is here, that is natural, that is love.”  —Rainer Maria Rilke
  • “Life’s but a walking shadow, a poor player, that struts and frets his hour upon the stage, and then is heard no more.”  —Shakespeare

Life and Death as Metaphor

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I am a collector of quotations about life and death. (BTW, I found a great source for these in an app called WeCroak.)

I was reading through my collection the other day and noticed many of the quotations contained metaphors for life and death. Here are a few of my favorites:

  • “Our lives are as bubbles in boiling water, which appear, rise to the surface, pop, and disappear.”  —Leo Tolstoy
  • “No matter how much you’ve been warned, Death always comes without knocking. Why now is the cry. Why so soon? It’s the cry of a child being called home at dusk.”  —Margaret Atwood
  • “Another way to get a sense of your life moving continuously towards death is to imagine being on a train, which is always traveling at a steady speed—it never slows down or stops, and there is no way that you can get off. This train is continuously bringing you closer and closer to its destination: the end of your life.”  —Sangye Khadro
  • “Death is the sound of distant thunder at a picnic.”  —W.H. Auden
  • “Death is not waiting for us at the end of a long road. Death is always with us, in the marrow of every passing moment. She is the secret teacher hiding in plain sight. She helps us discover what matters most.”  —Frank Ostaseski
  • “Dying is a wild night and a new road.”  —Emily Dickinson

Photo by Paul Jarvis on Unsplash

Holding the Space for Grief

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Caitlin Doughty has done it again! She produced another knock out book that I took way too long to read.

I blogged about her first book, Smoke Gets In Your Eyes, confessing my narrow range of interest (mostly death and dying and spirituality stuff) and my slow reading. Her “new” book came out in 2017 and I just finished it yesterday. No matter…if you haven’t read it yet, it is new to you.

From Here to Eternity: Traveling the World to Find the Good Death is a travelogue about ways people around the world honor the dead and help the bereaved carry their grief. As with her first book, this one comes with a WARNING: there are graphic descriptions of dead bodies and of what happens to these bodies after death. I personally was not offended by this and do feel the descriptions are an essential part of her narrative.

Doughty is a mortician, owner of a nonprofit funeral home, Undertaking L.A., and a leader in the Death Positive movement. The movement seeks to change the way we do death and dying in Western culture. We tend to hide death, remove it from view, and make it unnatural. Our hospitals and funeral homes can be the greatest obstacles to a more positive view of death.

There is no shame in a public expression of grief

One of the common characteristics of all the unusual death and funeral practices described in the book is the openness of grief—there is no shame in a public expression of grief for years after a death. Families in Indonesia may keep the mummified body of a relative in their homes for months or years. In Bolivia, human skulls are decorated and given a prominent place in dwellings. In Colorado, a whole community turns out to witness the open-air cremation of one of their own.

In the West we want people to “get over their grieving,” “to find closure,” to “move on.” The truth is, we never stop grieving. Other cultures have established rituals around death that bring grief into the light.

Hold the space is to create a ring of safety

Doughty ends her book, “No matter what it takes, the hard work begins for the West to haul our fear, shame, and grief surrounding death out into the disinfecting light of the sun.” What is needed is “holding the space” for the dying person and their family. “To hold the space is to create a ring of safety around the family and friends of the dead, providing a place where they can grieve openly and honestly, without fear of being judged.”

Photo by Kent Pilcher on Unsplash

 

The “Comfort” of Nothingness

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“When I’m dead, I’m dead.… and I just sail off into nothingness, and that brings me a lot of comfort. That doesn’t bring everyone comfort but it brings me comfort.”  —Caitlin Doughty, author of Smoke Get in Your Eyes, from an interview on the documentary “Into The Night: Portraits of Life and Death.”

Some people are okay with death being the end.

Their dead father sent a snowstorm

I haven’t run into too many people like that because I have spent so much of my life around folks who believe just the opposite. Many, if not most people, both religious and nonreligious, have some sense that their lives will continue in some form after death. I even had one family insist their dead father sent a snowstorm.

This family had asked me to conduct the funeral service for this man who was one of our hospice patients. I had never met the man nor his family before, since they all claimed they were not religious and did not want a visit from the chaplain. So, he dies and they have no relationship with any church but needed someone to lead the service. Happens a lot in hospice. I was glad to help out.

Through a phone conversation with family members I planned the service which was to take place at the funeral home. They described the recently departed man as very shy and private. He was also a giving and generous man who loved his family dearly.

The night before the scheduled service we had a major snowstorm. I felt I could make it to the funeral home, as did the family, so the service was held as planned. No burial was needed since the man had been cremated.

Only one person showed up for the service besides the few family members.

This lack of turnout did not bother the family in the least. They said, “It’s just like Dad. He was so private that he sent a snowstorm to keep people away.”

“Okay,” I thought.

What do I know? Maybe the recently departed do have the power to send snowstorms. My point is that the belief in living beyond the grave is pervasive whether or not it has a religious aspect to it.

Yet, in my years at the bedsides of the dying and their families, I have gathered enough evidence that some people can be okay with the idea that the last breath is the end. I have seen scores of people face their deaths peacefully even while they have no belief that they are “going to a better place” or are going to be reunited with departed family members.

Many people agree with Caitlin Doughty that death is the end. But, I did find her use of the word “comfort” something I have not heard a lot from those who accept that there is nothingness after death.

I do hear “comfort” from those expecting to see deceased relatives or to be in the presence of God. I can’t tell you the number of times I sat with a family around the bed of a dying relative and someone says, “I don’t know how people do this without faith in God?” Caitlin seems to have an answer to that question.

How is the thought of nothingness “comforting”?

Another way of asking that question is, “How is the thought of nothingness ‘comforting’?”

We know humans, at some point, became conscious beings in our prehistoric past. A major hint of this emerging consciousness is the fact that we buried our dead with tools and other items to help the departed in the next life. This becomes a sign of consciousness because we know our ancient ancestors had the brain capacity to understand that they were going to die and they had figured out a way to deal with it.

Religions grew and flourished as they offered an answer to the mystery of death. What happens to us when we die? The religious answers of life after death do offer many people great comfort.

Let me suggest a two ways that, perhaps, the thought of nothingness is comforting:

  1. For Caitlin Doughty to say that knowing there is nothing after death, “brings me a lot of comfort,” first shows that she, too, has found an answer to this mystery of death and its meaning. There is comfort in settling the question in one’s own mind and heart. Mystery solved. Of course, it is different than a more traditional religious answer but having the question settled is comforting nonetheless.
  2. The second way nothingness after death is comforting grows out of that first reason. If there is nothing after death, that means this life is all there is. And if this is all there is then that makes this life all the more meaningful. This is it. This is not preparation for another life. Therefore, we must live this life abundantly. Enjoy it to the fullest and help our fellow humans by relieving their suffering and contributing to their joy. After all, this is all there is, they say. The incredible wonder and joy of living this one life brings the comfort.

 

As Doughty points out, “That doesn’t bring everyone comfort but it brings me comfort.” I have to take her at her word.

Photo by Greg Rakozy on Unsplash

The Country of Sickness

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“I have never been anywhere but sick. In a sense, sickness is a place, more instructive than a long trip to Europe, and it’s always a place where there’s no company; where nobody can follow. Sickness before death is a  very appropriate thing and I think those who don’t have it miss one of God’s mercies.” —Flannery O’Connor, 1956.

The southern and Catholic author was diagnosed with lupus in 1951, the same disease that killed her father when she was a teenager. She died in 1964 having lived and suffered and wrote and thrived with lupus for 13 years.

Books ONLY from My Brother

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I do not like people giving me books

I do not like people giving me books to read that I have not requested. I have like 100 books on my wish list and when family members ask me what they can give me for a gift I go to the list and send several suggestions. I think of myself as a slow reader with a somewhat narrow range of interests and don’t want people cluttering up my reading pile with books I previously had no interest in.

So I drove from Virginia to Florida for Christmas with a stop at my brother’s rural home near Tallahassee. He handed me a gift. You guessed it. A book. A book I had not requested. But he was generous and I do not give my do-not-give-me-a-book speech right after the kindness of a gift.

I just finished reading all 241 pages. That comes out to about 4 pages a day since I accepted the book. See…slow.

Turns out it has become one of my all time favorite books. Of course it is in the death and dying genre. Right in my narrow range of interest.

NOTE to family and friends: Only my brother Dennis can give me books I have not asked for.

A memoir of a young mortician

Smoke Gets in Your Eyes and Other Lessons from the Crematory is a memoir of a young mortician, Caitlin Doughty. Oh goodness, where do I start.

A full disclosure WARNING about the book. It contains very graphic detail about the condition of bodies of the deceased, their preparation, and what cremation actually looks like. This book is not for everyone. That said, I still would recommend it for everyone. Push through it and you find a wonderful story of a young woman finding a calling to help us all in the end.

Do yourself a favor and visit Doughty’s Web site “The Order of the Good Death” at http://www.orderofthegooddeath.com/. She has some great videos called, “Ask A Mortician.” She has a Facebook page https://www.facebook.com/OrderoftheGoodDeath. A Twitter feed @TheGoodDeath (https://twitter.com/TheGoodDeath) with 16,000 followers. And lots of photos on Instagram, thegooddeath (http://instagram.com/thegooddeath).

This is not your old chaplain’s verses about “letting be.” She recently posted a photo of a greeting card, “If I had a choice to have sex with any celebrity, living or dead, I would probably choose living.”

She is irreverent but dead serious. Get it?

There is a small but growing army of folks like Caitlin Doughty out there who want to bring death into our everyday lives. She advocates for families preparing bodies for burial or cremation. She is a leader in the “Death Salon” movement holding public forums to talk about death and dying. She is not religious but encourages rituals to help families and friends of the newly dead grieve and cope in healthy ways.

Yesterday, I sent her copies of my books (unsolicited of course). I started the cover letter, “I am sorry I arrived so late to your party. Only now have I found out about all the fun you are having.”

Doctors Choose LESS Treatment When Dying

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Here is a great article from 3 years ago about physicians choosing less aggressive treatments as they are dying than does the general public.

http://www.wsj.com/articles/SB10001424052970203918304577243321242833962#

Hank

Photo by Online Marketing on Unsplash

Blind Spots

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Missed diagnoses. Denial. Blind spots.

What do they have in common?

It started a year ago. I was fishing behind my house on Goose Creek. I threw out a top-water lure—a “popper” in fly-fishing speak—and I saw two poppers instead of the one I had tied on my line. “That’s not right,” I thought.

“Mr. Dunn, I think you have had a stroke.”

So I went to an ophthalmologist and after many tests she said, “Mr. Dunn, I think you have had a stroke.” Then it was off to the neurologist and retina specialist, both of who ruled out stroke. The retina guy did say the retina in my right eye was tearing. There was nothing they could do about it at the time but we’ll, “keep an eye on it.”

In June the eye went black. I had two emergency surgeries to reattach a detached retina. Seems to be holding . . . which is the good news. The bad news is I am basically blind in the right eye. Light is coming in but the vision is very blurry and it probably cannot be corrected with a lens.

The double vision thing is still going on . . . most noticeable while driving. Often I put on a pirate patch on the eye to block out the distorted vision altogether.

I have learned a wonderful lesson about the human brain through all this. Most of the time I barely notice the blindness in my right eye. My brain basically ignores the bad eye and seems to dwell on the good information coming from the left eye. I function very well on one eye.

Doctors also have gaps in their knowledge

We know physicians sometimes fail to make a proper diagnosis and treat a patient for a condition that is really not the problem. Doctors also have gaps in their knowledge. Thaddeus Pope recently blogged about “Critical Gaps” in the legal knowledge of doctors practicing end-of-life medicine.

Like a good eye, they go with what they know. If there is an area of medicine for which they are unfamiliar they turn a blind eye toward it. The good eye is working so well.

In hospice and palliative care we see the oncologist who continues to recommend chemotherapy for a dying patient even though it offers no benefit, perhaps even makes life worse for the patient. They are blind to the benefits of stopping the chemo and shifting to improving quality of life in palliative care or hospice.

Patients and their families sometimes use denial as a blind spot. A patient is dying but no one considers death as a possible outcome of the current the disease. Believing that continued life is the only option they are “blind sided” when the patient dies.

Don’t get me wrong. Denial can serve a very good purpose for a time in helping people cope with a fatal prognosis. But it does bring in a huge blind spot in how one might spend their last days.

Can I “Like” a Death Announcement on Facebook?

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Great article recently in the New York Times about “Millennials” (those in their teens and twenties) and grief. Grief in the age of Facebook, texting, Instagram, and selfies. “An Online Generation Redefines Mourning,” by Hannah Seligson appeared in the March 20th edition of the Times.

Is there anything creepier

“My God, is there anything creepier than a post announcing someone lost a loved one and seeing ‘136 people like this’ underneath?” Ms. [Rebecca] Soffer said [in the article].

“The social norms for loss and the Internet are clearly still evolving. But Gen Y-ers and millennials have begun projecting their own sensibilities onto rituals and discussions surrounding death. As befits the first generation of digital natives, they are starting blogs, YouTube series and Instagram feeds about grief, loss and even the macabre, bringing the conversation about bereavement and the deceased into a very public forum, sometimes with jarring results.”

Here are some links I found through the article.

Modern Loss is a repository of essays, resources and advice that the founders try to edit so that it doesn’t sound glib, overly religious or trite. For instance, you’ll never hear, “At least they are in a better place.” (“Our least favorite line ever,” Ms. Soffer said.)

The Order of the Good Death is a group of funeral industry professionals, academics, and artists exploring ways to prepare a death phobic culture for their inevitable mortality.  It was founded in January 2011 by Caitlin Doughty, a mortician and writer in Los Angeles, CA.

OMG . . . “Selfies at Funerals”

Hank

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