The Final Chapter

By Melissa Red Hoffman, MD

The first time I saw a death certificate, I was 19 years old. The cause of death was listed as “laceration of the trachea and esophagus, also laceration of heart and lungs with fractures and bleeding caused by two gun shots in the neck and chest.” The death certificate belonged to my father, killed by a terrorist while on a business trip in Cairo. By the time I laid eyes on it, the certificate only served to confirm a very painful truth: My father’s story had come to a very tragic and bloody end.

It’s 26 years later and I’ve managed to use this tragedy to inspire a career focused on both trauma and hospice and palliative medicine. In the simplest terms, I spend half my time trying to save lives and the other half trying to ensure a good death. For me, it works. But there’s no denying that my father’s legacy is always lingering in the background, whether I am in the trauma bay or at a patient’s bedside. The cause of death imprinted on that death certificate, along with the fear, pain and suffering that I assume it caused my dad, and the grief, sadness and never-ending longing that it evoked within me and many members of my family, is never far from my mind. And for reasons that I don’t fully understand, I have reread that death certificate more times than I can count.

That being said, the first time I was actually handed a death certificate to complete, I was well into my yearlong hospice and palliative medicine fellowship, and my only response was, “What am I supposed to do with this?” Despite 10 years of training including medical school, general surgery residency and critical care fellowship, I had never seen this form in the hospital, much less received any guidance on how to complete it. My hospice attending provided some cursory instruction and assured me she was available if I had questions, and that was that.

Since then, I’ve filled out more than 100 of these forms; when I work as a hospice attending, it’s not unusual for me to fill out a half-dozen death certificates during an eight-hour shift. The CDC publishes a free guide ( www.cdc.gov/ nchs/ data/ misc/ hb_me.pdf) that has proven to be helpful to me as I’ve attempted to correctly determine and report the cause of death. State medical boards stress that physicians should exercise their best clinical judgment when filling out the form and that lawsuits involving death certificates are exceedingly rare, but I still sometimes find it nerve-wracking to determine the exact steps that led to a patient’s ultimate demise. While completing a death certificate presents an intellectual challenge and demands a short, but not insignificant, time commitment, I have recently come to view the process as something more profound than another item on my to-do list. Because this form is required for both burial and cremation, I now regard it as both the final chapter of a patient’s life story and the first chapter of a family’s bereavement narrative.

I often think of my father when filling out these forms and it always gives me pause. When I open the medical record, I’m usually touched by the thought that I’m very likely the last physician who will ever study this information. Reading through the chart, I like to linger for a moment or two and think: Who was this patient? What did he do for work? Who did she love, and, just as importantly, who loved her? I also find myself wondering what happened. What, if anything, could we have done differently or better? Could we have caused less suffering? Provided more comfort? Consulted palliative care earlier or at all?

Last week, while I was working at the local inpatient hospice facility, a female patient, five years younger than me and recently diagnosed with metastatic cancer, died before I had the opportunity to round on her. When I went to view her body, I was struck by the stark difference between the glowing, robust woman pictured in a photo hanging above her bed and the bald, gaunt corpse lying curled up on her side. “She truly had nothing left to give,” I commented to the nurse and the chaplain as they gathered her few belongings to return to her family. As I was getting ready to leave for the day, the funeral director arrived to collect her body and asked if I had a few minutes to complete her death certificate. I knew almost nothing about this woman—she had been under my care for only a few short hours—and yet I was tasked, and blessed, with signing off on the final chapter of her life. With this last act of patient care, I was able to support her family in the first steps along their grief journey.

As a surgeon trained in hospice and palliative medicine, my personal narrative has changed from “There’s nothing more I can do” to “Let me walk with you.” Taking the time to complete a death certificate is another way for me, and all surgeons, to follow a patient’s story to the very end.

Complete Article HERE!

This is what a good death could be

By Larry Beresford

Recently, a neighbor and friend of mine died. After her cancer was diagnosed as incurable, she was referred to hospice care, and family members traveled long distances to spend quality time with her during her last month of life.

Her neighbors in our condo building clamored for slots in her packed social calendar. Two days before her death, she held a socially distanced open house for people lined up six feet apart outside her door to come in for a few minutes, one and two at a time, to say their goodbyes. Then we received an email telling us she had gone, quietly, at home, in the presence of family. All in all, the kind of good death promised by hospice care at its best. And yet there’s something about how it unfolded that I’m having trouble wrapping my head around.

I had spoken with my friend a couple of weeks earlier, and she told me that she was going through the steps to obtain medical aid in dying – which became legal in California through the 2015 End-of-Life Option Act. It requires two oral and one written request to a physician for a lethal dose of medication, with a 15-day waiting period and confirmation of eligibility by a second physician. My neighbor complained to me about the bureaucratic hoops, knowing that I am a medical journalist who has written extensively about hospice and end-of-life care and trusting that I could listen non-judgmentally.

I told her that the regulatory hurdles, rightly or wrongly, were crafted to prevent the appearance of abuse for a procedure that continues to generate controversy in medical ethics. Advocates say terminally ill patients should have the right to choose the time of their deaths and to opt-out of the pain and suffering of living with an advanced illness. Opponents argue that good hospice and palliative care can obviate that pain and suffering and thus the need for patients to request a medical escape from this precious life. There is little room for compromise between those two views, but the option is now legal in California and eight other states.

Some hospices and hospitals will not participate in the end-of-life option, and it can be hard to find a doctor willing to sign the necessary forms. Very few terminally ill patients actually go through with obtaining and consuming the lethal medication. Only 551 Californians started the process in 2018, and 337 took the medication to hasten their deaths, according to state records. There are also questions about the choice of medication, which may include a combination of morphine, diazepam, and propranolol, a beta-blocker that slows the heart.

My parents died of cancer or cancer-related complications. I was present in my mother’s hospital room when death came to claim her. I was a hospice volunteer for more than 20 years and sat with a number of cancer patients in their final days. In other words, I feel familiar with the process by which cancer, which kills more than 600,000 Americans every year, makes its terminal advance.

Some patients may pursue oncologic treatments until the end, trying to stave off that advance. For others, hospice provides an option to step off the medical treadmill and receive care at home with the support of an interdisciplinary team of end-of-life experts who focus on comfort, symptom management, and maximizing opportunities for dignity and peace. Either way, terminal cancer is relentless.

With good palliative medical management, many – but not all – of the worst side effects and symptoms of terminal cancer can be managed. It can also be very messy, with incontinence, other bodily fluids, and unpleasant odors. All bodily functions will fail by the end. Most of the time, it unfolds on the disease’s timeline, as it has throughout human existence.

When someone dies of cancer, there is a retrospective sense of its inevitability, that this is what had to be. Those who witnessed its relentless advance can find comfort in that inevitability. It wasn’t a cosmic mistake that cancer has taken their loved one; it was part of the natural order of things. The loss and grief for those left behind are real, but the memories, hopefully, can be free of recriminations.

The end of life can also be a time to focus on expressing what Dr. Ira Byock calls “the four things that matter most” as one faces life’s end: please forgive me, I forgive you, I love you, thank you – plus a fifth, saying goodbye. Some have found that life becomes singularly precious when its ending looms, with opportunities for the most poignant kinds of resolutions.

To me, this is what a good death could be, one grounded in the reality that the cancer could not be denied but with doors opened for meaningful interactions along with the mess and pain. And there’s the ineffable profundity of a loved one’s final moment of transition from this world, such a huge, terrible mystery, yet guaranteed to everyone who lives. That should command our respect.

What happened to my friend? A peaceful, natural passing from the cancer? Or did she avail herself of the end-of-life option to make it happen a little sooner? If the latter, was it pain, or loss of control over the messy details, or an unwillingness to continue living with the existential awareness that death was lurking around the corner? Was she tired of living, that tiredness magnified by the cancer, or tired of talking about it? I’ll never know what she chose. It’s really none of my business. My admiration for her is unaffected, undiminished.

But I find to my surprise, thinking it might have been the case, that something feels missing. It doesn’t seem final, or quite so real. With COVID, her memorial gathering was transferred to Zoom. To me, it just doesn’t feel like the same thing, death’s natural advance versus a medical intervention to check out early, even if the outcome is more or less the same.

What were the unmanaged issues to make ending it sooner seem the right answer? Could something have been done to make her more comfortable, more willing to stay for a natural end? Could there have been more poignant farewells, more reflections, more stories? Could I have had one more chance to talk with her about what she was seeing from her vantage on the rim of eternity? Could I have heard her laugh one more time? And am I selfish to want that? That’s what I can’t get my head around.

Complete Article HERE!

‘These Are Real People Dying’ —

Why an Artist Filled His Yard With Flags

Plastic flags, each representing a Texan who died from Covid-19, outside the home of Shane Reilly, an artist in Austin

Shane Reilly plants a flag for each Texan who dies of the coronavirus. As the national death toll nears 200,000, The New York Times used an image of his memorial to illustrate the staggering scale of loss.

By

In May, when Shane Reilly, an artist in Austin, Texas, started planting one flag in his yard for every Texan who died from the coronavirus, the state had fewer than 1,000 deaths.

Now, Texas is approaching 15,000 people dead, and the nation will soon hit 200,000.

For passers-by and those who have seen pictures of the memorial, including an image featured on the front page of Monday’s New York Times, Mr. Reilly’s yard serves as a sobering reminder of the losses so many American families have endured this year.

I spoke to Mr. Reilly recently to ask how his project started, and where it stands today. Portions of our conversation have been edited for clarity.

Take me to the beginning. What made you want to do something so public? And how did you land on flags as the way to tell this story?

I’ve got an immunocompromised son, so when the coronavirus hit, I started paying close attention to it. We live on a corner, so I see people walking by every day and I would notice that they just weren’t wearing masks, and I thought, something’s not hitting home with them.

These are real people dying, real Texans dying, and I’ve got a kid in quarantine here at home and people are acting like this is almost a vacation.

So I thought, what could I put out there that would wake people up and make them say, “Oh, this is real, this is something we should pay attention to”?

Where do you get the flags?

I started getting them from Lowe’s and Home Depot. Lowe’s carries orange and pink, and Home Depot carries red and white. When I started this project we were at 850 deaths here in Texas. I thought, “Wow, 850 flags in this yard is really going to wake people up.” So I bought 1,000 just to be on the safe side.

And now we’re at roughly 15,000 deaths.

As I’m talking to you I see a guy and a girl outside, taking photos of my yard. I get a lot of that. I get a lot of people walking by and taking photos.

Coronavirus Schools Briefing: It’s back to school — or is it?

The response has been pretty amazing. I’ve had several handwritten letters in my mailbox, no name on it, no return address. Just, “Thank you for doing this, I’m a first responder and I’ve seen a lot of deaths from this.” Or, “My mother died of this, thank you so much.” Other people have left bundles of flags outside. It’s been pretty touching.

For people who haven’t seen this in person, can you explain how your yard has changed over time?

In the beginning I was trying to space everything out in an even pattern. I thought that would have more of an impact, to see this uniform field of flags.

Now I’m at the point where there are so many flags I just kind of walk in between rows until I can find a large enough space, and I just plop a bunch of them down. When I hit 3,000, I had people telling me, “You’re going to run out of space.”

What started just in the corner now covers the entire front yard and the entire side yard. I put flags out about every other day, but there were certain times when Texas was spiking that I couldn’t wait two or three days because there would be 1,000 more flags I would have to put out if I waited that long.

Now that you’ve been doing this for so long, does it still carry the same emotional weight?

I never lose sight of the fact that these are people’s lives. That stays with me every time. The other day I put out 300 flags and, you know, that hits you. But also I’m looking out at this sea of flags and it seems never-ending.

I can’t keep carrying that weight like I did earlier in this project, so I’m starting to build a callous. That sounds awful, but I do have to remind myself sometimes that this was someone’s mom, this was someone’s lover, this is real.

As the nation approaches 200,000 deaths, how are you grappling with that?

My first emotion is anger. There was a plethora of information out there to suggest that we could have done things differently, but people in charge chose not to. They actively went in the other direction.

I squarely place a lot of these deaths on them. Proper leadership could have saved tens of thousands of lives.

It’s shocking and saddening and infuriating. And every day, people walk by my house still not wearing masks.

Complete Article HERE!

In his life and death, my uncle taught me the real meaning of bravery

By

For her Loading Docs short Going Home, film-maker Ashley Williams paid tribute to her late uncle Clive by learning to fly.

Some people say I was brave to fly. I tell them my Uncle Clive was the one who had courage.

He was diagnosed with terminal pancreatic cancer at the age of 50. He had no choice about dying. But he made a choice about how and when he wanted to die.

When I was funded by Loading Docs to make a personal documentary about Clive, I knew I had to challenge myself to do something adventurous, something he would do. He always loved to fly, so what better way to honour him than take to the sky myself and paraglide.

This year marks 10 years since he passed. I wanted to make a film that both honoured Clive’s memory for those who knew him, and shared his story with those who didn’t. In a year when New Zealanders are voting on the End of Life Choice Act, I believed the timing was right, and could offer insight to those that need it.

In preparation for the documentary, as well as the flight, I buried myself in my uncle’s legacy – as a photographer, an adventurer, a scientist and a spiritual seeker. I dug out his old photos and read the letters he wrote over his final year, letters that were integral to the making of this documentary. What struck me most was his courage in facing a terminal illness, dealing with his own loss, yet managing and helping others in their grieving too. Now that is brave.

Making this film I learnt a lot more than just whether or not I could fly. I discovered it’s not just about the big, bold moments when we are brave. It’s about things like kindness in the face of adversity, being able to laugh when things don’t go to plan, standing up for what you believe in and being honest with yourself and others.

Clive taught me that life is about the little adventures along the way. So much of life is out of our control – there will always be the possibility the wind direction might change. So for the days you can, you fly! And oh, how I flew. Up there, among the clouds, being a bird. I realised why I had to do this and it changed me forever.

It also helped me understand what it must have been like for Clive, to have been caged in his bed near the end, watching out his window as the wind blew the clouds across the sky. To have known it was a perfect day to fly, or just go for a walk, but not be able to. When you’re that close to dying, surely you must know a thing or two about living. Clive was always the wise one.

Through Clive’s life and his decision about how he died, when he had only days to live, I hope viewers will consider those who no longer have a choice about whether they die or not, who are asking for the right to die with dignity.

I also want to encourage everyone to read the Act before voting. It’s designed for those suffering from a terminal illness that is likely to end their life within six months, for those who have significant and ongoing decline in physical capability, who have unbearable suffering that cannot be eased, and who are able to make an informed decision about assisted dying. This law could bring real support for people who need it in their time of pain and suffering, and in doing so also provide support and care for those left behind.

My hope is that if I ever face terminal illness I can do it with as much courage and grace as my Uncle Clive. I also hope I’ll have a choice that affords me the dignity I deserve.

Complete Article HERE!

Why Indians of all faiths commemorate the dead with food

An excerpt from ‘Turmeric Nation: A Passage Through India’s Tastes’ by Shylashri Shankar.

By

Each February, on the lunar day my father passed away, I wake up at dawn, bathe and drive over to my mother’s house. I enter the kitchen and begin sorting the vegetables. I wash the spinach and soak it in salted water. The bhindi, I pat dry. I remove the mud clinging to the arbi, rinse the green chillis, ginger and coriander leaves. Then I make a cup of tea for my mother who is unwell, and sit at the dining table to choreograph my cooking moves this year. Sixteen dishes have to be made by half past ten when the priests will arrive. Four hours to wash, chop, chiffonade, boil, cook, simmer, combine, soak, grind and fry vada, knead dough for puris, pickle the mango, roast the arbi over a low flame for half an hour, make the rice, kheer and mango chutney. Everything has to be done from scratch – no preparations can be made the previous day. Even the vegetables have to be cut on the day.

I begin the dance between the tasks like a Sufi dervish, meditatively and fluidly. These were my father’s favourite dishes – keerai, kootu, rasam, puris (we used to compete over how many puris we could eat), bhindi fry, crispy arbi with rice flour and spices, the mango and gur boiled in its own juice, and the mint chutney. These dishes were made on the tenth day after his death, and each year my mother and I make these dishes on his death anniversary. As I cook, I also think of others whom I loved who have passed away – my aunt who lived with us and was famous for her coconut barfis and chikkies, my perima who made the most delicious chutneys, pickles, papads and pastes and sent them to us from Shimoga every couple of months, my favourite uncle who was born on the same day as me and who lived a simple and contented life. I remember the things they did, and what we shared. There is a sense of calm, of peace, of unhurried movement. I salt and spice by instinct, not by taste. I cannot speak over the food, and I cannot taste it – it would be polluting. The priests arrive. After a short chant, they are ready. I serve everything course by course, on a banana leaf. They eat everything and take second helpings. I cook only occasionally, so you’d think the spices would be off, but instinct serves me well on this day. Or is it the emotions and memories infusing the cook?

Research shows that rituals can help in relieving people of their grief and other feelings that torment the spirit. A ritual, whether it is a religious one or something you have made up, helps to restore a sense of control to the mourner, control we have lost in the unexpectedness and the suddenness of the tragedy. A ritual involving cooking returns that control to you as you decide when the coriander seeds have been roasted enough, when the vegetable is done to a crunchy bite, and when the chana is cooked.

It is not surprising that many traditions contain rituals where the person who has passed on is remembered through food. The bereaved are comforted by other mourners who bring dishes like fried chicken, biryani, sandwiches and so on. The Koran, for instance, discourages the family of the dead from cooking but urges the community to bring food to the family. In Hyderabad, Muslims bring biryani, haleem, kebabs and dahi baday. Across the pond in Sri Lanka, visitors dressed in white deliver food to the mourners and the monks. The Buddhist ceremony, Daane, involves eating parupu (dal), kiri bath (rice and coconut milk) and gotu kola sambol. Pitru paksha of Hindus observed during the dark half of the lunar calendar uses food to commemorate the dead. So do similar festivals in other parts of the world: All Souls Day in Italy and Sicily where marzipan delicacies are crafted in the form of fruit and vegetables, and the Day of the Dead in Mexico where sugar skulls, candied pumpkin and mole negro are prepared for the souls of the dead.

Why are these dishes and not some others used in the formal rites? Is it because they create a sense of calm, some succour to the grief-stricken mourners? Is it ethnicity, religion or the geographic location that makes a dish or particular ingredients comforting to a mourner? In India, religion plays a key role in deciding whether vegetarian or non-vegetarian foods can be served to a mourner. Unlike Muslim and Christian mourners, Hindu mourners eat vegetarian meals even if chicken and fish are part of their daily diet. Why? It could be because death is involved in the act of eating meat (dead animals) since in Hindu culture a person is both bodily and morally what he or she eats.

But in a study of mortuary rites in Benares, Jonathan Parry highlights how some aspect of the deceased is symbolically digested not only by the ghost but also by the ‘chief mourner, by the impure Funeral Priests (a specialist subcaste known as Mahabrahmans) and by the pure brahmans’. Parry points out that in some instances, as in the funeral rites of the Raja of Nepal, the Funeral Priest was fed the deceased’s ground-up bone in a preparation of kheer (concentrated milk and sugar), and was laden with gifts and banished from the kingdom. By digesting the deceased, his pure essence is distilled and translated by the digestive fire of the stomach to the other world, while his impure sins are eliminated. The ghost is converted into an ancestor, or pitr. The food served to the group consists of rice boiled without salt but garnished with milk and horse bean lentils (urad dal).On the thirteenth day, the mortuary feast is prepared.

Nirad Chaudhuri narrates an incident where a wealthy relative had to rubber-stamp the backs of peoples’ hands to prevent them from eating twice, many having trekked over 50 miles to attend the feast. It is not just the wealthy who have to feed hundreds of people to mark the end of mourning. The poor have to do it as well, and usually incur high debts as they sell their bullocks and grain and borrow at exorbitant rates of interest to meet the expense of feeding the village. For the Gonds and the Bhumias, the death feast is the most expensive ceremony.

The formal rites also involve other offerings in the soul’s passage from being a ghost to becoming an ancestor. Hindus offer rice or flour balls known as pindas. Some castes leave these pindas outside and hope that a crow will eat it. If it does, the ghost has become an ancestor. In Mysore, some middle castes throw three balls of butter at the idol beseeching it to open the gates of heaven (vaikuntha samaradhana).

Death need not be only of the body. The death of a relationship can be quite brutal. In mourning for the ‘we’ that has died, you may turn to your favourite dishes and binge-eat day after day. Well, don’t. In randomised trials of over 45,000 participants, London-based researchers discovered that eating meals high in vegetable and fiber and cutting back on junk food eased depression. But not anxiety. Also these meals worked better on women than men. They are trying to figure out why. NIH research has found that enhanced recovery from depressive disorders is delivered by oysters, mussels, seafood and organ meats, leafy greens, lettuce, peppers, cauliflower, cabbage, and broccoli. Now we have an Antidepressent Food Score, a nutrient profiling system to give dietary recommendations for mentally ill people.

What about foods that can increase and worsen depression? These typically are sugar-rich foods – cookies, doughnuts, red meats, fried chicken and soft drinks – that create a high followed by a crash. But dark chocolate, thank god, enhances the mood by releasing endorphins to the brain and promotes a sense of well being. I tested it over a two-week period of nibbling two slices of chocolate after lunch. Godiva’s 78 per cent cacao made me perky while Cadbury’s Crunchie left a claggy sensation in my arteries. Either there is some truth to it or I may be exhibiting the recency effect – remembering best whatever I have read or encountered most recently.

The moral of the tale is to treat grief as a natural phenomenon and address it through rituals, simple or elaborate, and eat foods that produce equanimity.

Complete Article HERE!

The Upside Of Virtual Grieving

By Caitlin Stall-Paquet

I attended my first Zoom funeral this past June. My husband Aaron’s aunt Maria, who lived in Pennsylvania, died of breast cancer, but her passing was still defined by the pandemic. Sitting in front of a laptop at the dining-room table in my mom’s house in southeastern Quebec, Canada, we, along with a dozen or so others who couldn’t be there in person, watched our American family gather for the small service.

Despite a few to-be-expected technical issues — people not knowing how to mute or talking over each other — it was incredibly moving. I could see the faces of all the other online participants at once, noticing their collective grief more than I ever would have in person, a mournful mosaic. Towards the end, the funeral organizer asked if anyone joining remotely wanted to share a story. Everyone in attendance turned towards the laptop screen and the grief of the absent unexpectedly took the spotlight. Though I didn’t share, I felt more visible than I ever have attending a funeral, aside from when I delivered my father’s eulogy. It was unlike any service I’ve been to, in a good way.

COVID-19 has forced us to reassess everything in our lives these past few months, but especially our relationship to death and grief. It’s the great force hanging over this pandemic, the thing we fear, what we’re fighting to stave off, while it’s simultaneously thrust in our faces on a daily basis via news reports and press conferences. Though this proximity to loss is a new experience for those who have been luckily shielded from saying goodbye to a loved one, we can all use it to become better at handling grief beyond the pandemic. There have been a lot of calls for not returning to “normal” post-COVID, and the way we mourn deserves to be part of that change.

In part, because many of us aren’t great at dealing with death.When my father died from cancer when I was 29, barely anyone knew how to talk to me about it. (Though it comes from a good place, “I’m sorry for your loss” can start feeling impersonal after a while.) Three-and-a-half years later, I’ve gotten used to my sadness being awkwardly side-stepped or ignored.

There are a few who are willing to dive into the grief weeds with me, who ask questions about my dad and understand that, though the years pass and the pain changes, it never goes away. But many people act like even mentioning someone I love who has died is a faux pas, turning the individuals themselves into taboos. Though grief will always be a personal experience, it doesn’t need to be an isolated one. I’ve never met anyone who wants to be forgotten after they’re gone, so it’s no stretch to assume that the dead want their names in our mouths, shared times in our minds, and swells of feelings in our hearts.

Many of us aren’t great at dealing with death. When my father died from cancer when I was 29, barely anyone knew how to talk to me about it. Though it comes from a good place, ‘I’m sorry for your loss’ can start feeling impersonal after a while.

This loneliness we feelwhen faced with death can be exacerbated by the way we mourn. Although Christianity has been on the decline in the US, our society’s handling of grief has been largely shaped by that faith’s solitary and stoic traditions. For many, grief is seen as something best talked about behind closed doors, and if you’re lucky, in therapy. We’re told to “stay strong” and have been taught to treat mourning as a disease to cure ourselves of within a tidy time frame. After that, we’re mostly silent about our pain rather than reflecting on its shape-shifting, life-altering nature.

This was partially why the Zoom funeral felt so important. It reminded me that, though they’re held to honor the dead, funerals are mostly for the living, one of the few times we’re allowed to mourn openly. The virtual service drove home the importance of coming together even though physical distance felt more impassable than ever. There was also something surprisingly reassuring about attending a funeral at home, surrounded by familiar comforts, with the option of turning off the camera or stepping away from the screen if we needed a moment. It’s unique to be forced to grieve in this new way, so privately and publicly at once. It was something I didn’t realize I’d needed.

For years, I’ve been envious of people who participated in Mexico’s Día de Muertos (Day of the Dead), the holiday that honors those who’ve passed, year after year, long after they’re gone. The celebration reminds me of a trip I took in 2015 to central Bali, just before the one-year anniversary of my uncle John’s death. My visit in the mountains coincided with a Hindu-Balinese cremation ceremony known as ngaben: It started with a long procession through the village for which people wore bright clothes adorned with tons of flowers, and it culminated in an outdoor cremation.

The closest I’ve come to that communal celebration of death was when I was nine years old and my family held a haphazard shiva after my zaida died. As per the Jewish week-long mourning tradition, we covered the mirrors in his Montreal apartment, and people dropped by to sit in uncomfortable chairs. But more importantly, I had a lot of time with my extended family during which zaida’s passing could settle in and move us through a spectrum of emotions, tears, and jokes, solidifying our relationships in the process. That’s the thing about mourning, when it’s shared openly, it brings people together.

Taking the time to let grief sink in feels natural in a pandemic when we’re alone with so much time on our hands.During quarantine, I got more recognition for my sadness than I have in the past, too. Maybe that’s because we were mourning all sorts of things — the normalcy of our lives, our lost connection to each other, the tenuous future. With our everyday fast-paced routines stopped in their tracks, it became painfully obvious how much we craved the contact we’ve taken for granted. Isolation also seemed to make many better at paying attention to what truly matters. On what would have been my father’s 66th birthday, my friend Catherine left me flowers on my doorstep. Another friend left me a voicemail playing one of my father’s favorite songs in its entirety, a gesture that made me laugh-cry like I never had before, and I felt closer to both of them for it.

It’s a cliché that death is the great unifier, but COVID-19 has given us the opportunity as a global population to reflect on what that means and empathize like never before. We can use our times of solitude — as we might have to go back into isolation periodically — to contemplate and appreciate the lives we get to live, while paying our quiet dedication to those who are gone. Allowing the loss to redefine us while also moving on is surprisingly healing, and that in the end is the greatest tribute we can give.

Complete Article HERE!

What happens to a bank account when someone dies?

By

The old saying goes “you can’t take it with you,” but that leaves the question: What happens to the bank accounts that you leave behind? While the departed aren’t concerned, their heirs are affected by how the deceased set up their bank accounts.

What happens if the sole owner of an account dies?

If someone is the sole owner of a bank account, what happens next depends on a few factors.

Many banks allow their customers to name a beneficiary or set the account as Payable on Death (POD) or Transferable on Death (TOD) to another person. If the account holder established someone as a beneficiary or POD, the bank will release the funds to the named person once it learns of the account holder’s death. After that, the financial institution typically closes the account.

If the owner of the account didn’t name a beneficiary or a POD, the process can get more complicated. The executor, or person who administers a person’s estate when he or she dies, will become responsible for using the money to repay creditors and dividing the remaining funds according to the deceased’s will.

What happens to joint accounts when someone dies?

Most joint bank accounts include automatic rights of survivorship. In short, if one of the signers on the account passes away, the remaining signer (or signers) on the account retain ownership of the money in the account. That means that the surviving account owner can continue using the account, and the money in it, without any interruptions.

It’s worth noting that the death of an account holder can impact the insurance on an account. The Federal Deposit Insurance Corp. will continue to insure an account as if the decedent is alive for six months after his or her death. Once that time passes, the FDIC coverage stops. Joint accounts can receive up to $500,000 in protection; however, that amount will revert to the $250,000 in protection applicable to individual accounts if one of the joint account holders dies.

Still, if you’re a signer on a joint account, it’s worth checking with your bank to make sure that the account has automatic rights of survivorship. Some banks will freeze joint accounts if one of the signers dies, which could be a problem if you rely on the account for regular spending.

What happens to a bank account when someone dies without a will?

If someone dies without a will, the money in his or her bank account will still pass to the named beneficiary or POD for the account. If someone dies without a will and without naming a beneficiary or POD, things get more complicated.

In general, the executor of the state is responsible for handling any assets the deceased owned, including money in bank accounts. If there is no will to name an executor, the state will appoint one based on local law. The executor has to use the funds in the account to pay any of the estate’s creditors and then distributes the money according to local inheritance laws.

In most states, most or all of the money will go to the deceased’s spouse and children.

How do banks discover someone died?

Banks can discover the death of an account holder in a few ways.

Family member

One of the most common ways for a bank to discover that an account holder has died is for the family to inform the bank.

If a loved one has passed away, inform the deceased’s bank by bringing a copy of his or her death certificate, Social Security number, and any other documents provided by the court, such as letters testamentary (a court document giving someone legal power to act on behalf of a deceased person’s estate) provided to the executor.

Informing the bank lets it begin the process of distributing the deceased’s funds and closing the account.

Social Security

Often, funeral directors will take on the task of informing Social Security of a person’s death on behalf of the family. This saves the family the effort of telling Social Security about their loved one’s passing and makes sure that the heirs don’t have to deal with returning Social Security checks that shouldn’t have been issued.

If Social Security sent a payment for a month after the deceased’s death, the payment must be returned. Social Security will contact the bank that received the payment to ask for the return of funds. If the bank didn’t already know about the account holder’s death, receiving that request will inform it that the account holder died.

How to avoid complications

The last thing that people want to think about while grieving the loss of a loved one is money. There are some proactive steps that you can take to help your loved ones avoid complications if you die.

“Always have a will drawn up by an estate attorney and set up beneficiary designations or TOD, but the easiest way to deal with bank accounts is to simply have an authorized signer on the account so they don’t have to wait,” says accountant Eric Nisall, who has recent experience with handling the accounts of a deceased loved one advises. “They can just go in and take the money or wait and remove the decedent at a later time.”

If you have power of attorney for a loved one who is in poor health, you can add a joint account holder or a TOD to their accounts in preparation for the future.

Another important thing to do is to make sure that your family knows about all of your financial accounts. With the rise of online banking, it’s much easier for accounts to get lost in the shuffle.

“I think a common mistake is not knowing about all of the accounts,” says Nicole Rosen, a registered agent. “When my mom passed away, there was one account that didn’t have a POD. I couldn’t access this single bank account and it laid dormant. The bank charged enough fees to drain and overdraw the account.”

So, a good strategy is to consolidate your accounts as much as possible, leaving fewer accounts for your heirs to track down.

If you’re trying to find accounts left behind by a loved one, try checking your state’s unclaimed money database. Banks have to surrender unused accounts to the state after a period of time set by local law. The state then lists that unclaimed money for the original owners to find before escheating it for public use. You might be able to use these databases to find money that you or your loved one forgot about.

Bottom line

No one likes to contemplate their mortality but making basic preparations with your finances can save your loved ones from financial stress while grieving your loss. Make sure to use beneficiary and POD designations whenever possible and have a will drawn up by an attorney to outline your final wishes.

Complete Article HERE!