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Archive for the ‘Death & Dying’ Category

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 She has some great videos called, “Ask A Mortician.” She has a Facebook page A Twitter feed @TheGoodDeath ( with 16,000 followers. And lots of photos on Instagram, 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.


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”


Straight to the Heart of Danger

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[NOTE: I wrote this in 1999]

“Go straight to the heart of danger, for there you will find safety.”  Chinese Proverb

It was meant to be a nice three-day hike in the Green Mountains of Vermont the first week of October.

When I was asked to come and speak at a conference on the eastern shore of Lake Champlain on the first Saturday in October I jumped at the chance. And I automatically thought of a way to squeeze in a couple days backpacking at the same time.

Everything seemed to be going fine. I got the speaking completed and then stayed with friends in Burlington on Saturday night. We dropped off my rental car at the north end of my hike and they dropped me off nineteen trail miles to the south at Appalachian Gap. Though it was eleven o’clock in the morning, it was still cold and the wind roaring through the gap added to the chill. Pleasantly, once I got into the woods and away from the gap, it was quite warm . . . T-shirt weather.

This is the most rugged trail I have ever hiked. Yep. More rugged than any 14er in Colorado. The high altitude in the Rockies makes the hiking harder but the trail itself in Vermont was just more difficult. Like straight up the side of a mountain, no switchbacks and over rocks and boulders and back down again. At one spot an aluminum ladder was chained in place to help the hiker past an impossible rock face.

Little did I know I would be depending…

Sunday afternoon was quite enjoyable. Occasionally I got a glimpse of the ridge stretched out in front of me all the way to my final challenge, The Camel’s Hump, ten miles away. I finally arrived at a lean-to shelter 5.5 miles from the highway. It featured an “open-air privy” which literally was a toilet seat in the woods on a wooden box over a shallow hole . . . no outhouse, no privacy. Two cousins from Maine, men perhaps in their late fifties or early sixties, had already occupied the small shelter. I found them quite enjoyable. They were out for two weeks and were planning on finishing in Canada four or five days later. Each night they played the totally incomprehensible game of cribbage. Ken, his wife and dog hiked the entire Appalachian Trail (over 2,000 miles) a couple of years ago. Little did I know I would be depending on these two men as my margin of safety.

I heard Ken and Bob rustling around about 3, 4 or 5 in the morning saying something about snow. At first light I found out what the commotion was all about. There was an inch of snow on the ground and it was still coming down. I made my coffee and ate my pop tarts. I stayed warm in my sleeping bag as long as possible and turned over in my mind my options.

I could turn back over the mountains I hiked the day before and try to hitch a ride to my car. I could stay put for a few hours and hope for a break in the weather. But if it didn’t break then I would have a late start on the day and I for sure wanted to have Ken and Bob hiking behind me. Or I could push on and hope to make it over the Camel’s Hump and on to the cabin on the other side. It was going to be an ambitious day in the best of circumstances. I packed up and pushed out ahead of my bedfellows.

At the end of hardest backpack day EVER

The trail continued to be as equally difficult as the day before . . . only more so with a layer of snow and ice. The sky did not let up and snow turned to sleet. As I crossed Burnt Rock Mountain, even finding the trail became difficult. It was marked with a painted blaze of white paint. On the treeless summit the trail marks were on the rocks beneath my feet. Rocks, snow, white trail marks, sleet, rocks . . . where the hell am I going? Later when Ken and Bob caught up with me they thanked me for finding the trail over the mountaintop.

To prepare for the event of losing my footing, I developed a technique of going down the rocky trail.  In what appeared to be the slipperiest places I tried to position myself above a tree or bush that could provide a handhold. I once was holding on to such a tree and my footing gave way. I found myself leaning above perhaps a fifteen-foot drop over rocks to the snow below. I figured I had two choices. Let go of the tree and tumble down with my pack. Or I could unhook my pack and let it take the tumble without me. Duh????

As I put my pack back on while standing on terra firma, I actually felt quite satisfied that I can do this safely even if my pack takes a beating. Eventually Ken and Bob caught up with me. They had decided to stay in the cabin short of the Camel’s Hump. They suggested I do the same. The problem with that was it would leave me with an 8-mile hike the next day, through the snow, over the mountain and I had a 2:00 PM plane to catch. They correctly guessed that there was probably a short cut down to the road where I could hitch a ride.

My mother gave me a hard time

After my last letter describing my climbing the 14ers in Colorado, my mother gave me a hard time and lectured me on how I need to be more careful. I explained to her the precautions I felt I had made for my safety. So, Mother, again I made sure people knew where to find me and I always kept hikers behind me to offer aid if I were injured alone. I was prepared for the cold weather, after all it was October and Vermont. Even so, after three weeks, the big toe on my right foot has not fully recovered from a touch of frostbite . . . but it’s getting better Mom.

But you know, in the midst of the cold, snow, sleet, sweat and some anxiety, the walk was stunningly beautiful. The Fall leaves and the snow made quite a contrast. When the walking was easy I could hear the crunch of the winter ground beneath my feet. As I did walk out the last day, besides the leaves dotting the snow, there were animal tracks everywhere.  Much of the walking was alone. The last day was especially serene as I walked toward the road. The trail was a gentle slope downward and I could drink in the wonder of the world.

We were discussing death anxiety among our patients

I am sure some of the enjoyment of such adventures is in overcoming discomforts and hazards. The gentle walk out was such a contrast to eight to ten hours of hard work the previous day. The warmth of dry clothes were such a luxury. My new hiking “partners” added more than just safety to my trip. Had I hurried back home after speaking I would have missed all that.

Fall leaves in Vermont snow

I flew home on Tuesday afternoon and had a hospice counseling staff meeting at 9:00 AM on Wednesday. We were discussing death anxiety among our patients, their families and in ourselves as we accompanied them on their journey. We knew we were among the privileged few who had the opportunity be close to this final journey yet are spared it leading to our own death or the death of one we love . . . at least at this time.  One of my colleagues shared with us a quote she had learned in school and has never forgotten, “Go straight to the heart of danger, for there you will find safety.” We observe our patients going straight into the heart of danger and often they have a sense of safety. Being around this danger I feel safer.  Not unlike the safety I felt walking in a New England wood blanketed with snow.


Choosing Death Over a Paralyzed Life

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It is so easy to theorize about what you would do. What if you were on life support with the prospect of spending the rest of a long life as a quadriplegic on a ventilator.  Would you say “good bye” to your wife who is carrying your unborn child and ask them to turn off the vent?

That is exactly what Tim Bowers did. Click here for the telling of the story.

Just over a week ago Bowers was hunting and fell sixteen feet to the ground from a deer stand. He fractured three vertebrae and damaged his spinal cord. The medical team advised his family that he would be paralyzed from the shoulders down and probably dependent on machines to breathe for him for the rest of his life. The family wanted to see if the patient could participate in the decision-making process.

“Do you want this?”

When he woke up from the sedatives that had kept him unconscious he could not speak but could answer yes-and-no questions. “Do you want this?” they asked, meaning “Do you want to be kept alive on this machine?” He shook his head “No.” They removed him from the ventilator and he died a day after the accident.

Well. Well?

This is what we in the medical community have been advocating. NOT that people be allowed to die. What we want is for patients to be involved in the decision-making that might end his or her life. They woke Bowers up and asked and he essentially said, “Let me die.”

As soon as I read this story I thought, “I know many paralyzed people on vents who might say he made the wrong decision.” Think Stephen Hawking.  Sure enough I found one blogger who is paralyzed who took issue with how this case was handled.

Perhaps the decision came too soon after the injury. Law professor Thaddeus Pope wonders whether Bowers had “sufficient decision making capacity at the time he made the decision?” In states where physician assisted suicide is legal there is a waiting period from the first request for life-ending medication to a second and final request. Pope asks whether or not Bowers was fully informed about the “options and possibilities of life as a paralyzed individual.”

Give a little time

I tend to agree. Give a little time. If the patient persists in his request to be taken off the machine, by all means, comply.

Years ago I was called to the beside of a heavily sedated man on a ventilator after a heart attack. His wife explained that he had been on a vent before with his heart condition and wrote a living will so he would never be on a breathing machine again. I told the ICU nurse about my conversation and she said, “It is too soon to think about that.”

Well, he was able to get off the vent and out of ICU. I visited him a few days later. He was walking around his hospital room gathering things as he prepared for a transfer to another hospital to have a defibrillator implanted in his chest. I asked him, “How do you feel about being on a ventilator again?”

He said, “I am so glad they did?”

There you go.

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