Books bound in human skin?

A UCLA librarian on why you’ll want to read about them

Books bound in skin, which feature in “Dark Archives: A Librarian’s Investigation Into the Science and History of Books Bound in Human Skin.”

By Leslie Pariseau

That a librarian has written a book about rare leather-bound books and a major literary imprint has published it is a triumph for bibliophiles everywhere — especially when you consider the source of the hide.Dark Archives,” a deep dive into the history and mechanisms of sourcing, tanning and binding human skin into books, won’t be everybody’s cup of tea. But if you take comfort in reading Stephen King and Shirley Jackson on a stormy night or watching medical procedures on YouTube or you were the kind of kid who stole off to the occult section of the library (130 in the Dewey Decimal System, if I remember correctly), then Megan Rosenbloom’s strange history might be for you.

With sincere curiosity and clear-eyed analysis, Rosenbloom, a librarian at UCLA with a specialty in the history of medicine, unfurls the stories of the binders of the skins and their previous inhabitants: Mary Lynch, a young Irish widow who in 1868 died of trichinosis in a dreary Philadelphia hospital, her thigh skin saved in a chamber pot for decades; a Civil War soldier whose skin was stolen by Dr. Joseph Leidy and eventually became the binding for his “Elementary Treatise”; the highway robber George Walton, who planned for his own transformation into two books after his execution in 1837.

Over Zoom Rosenbloom jokes that she didn’t set out to be the “human skin book lady.” But her interest in rare books, combined with an early job in a medical library, led her down a winding path. “The things that I learned were just so shocking,” she says. “You mean medical students used to literally dig up graves and steal bodies, and their teachers were pretty fine about that?” Indeed, a good deal of “Dark Archives” engages with questions of consent around human bodies, especially during and after death — down to the most banal-seeming of our organs.

Growing up in a working-class Irish Catholic family in Philadelphia, Rosenbloom was attracted and repelled by “darker things” from an early age. This specific curiosity was first piqued in 2008 as she wandered around the Mütter Museum at the College of Physicians of Philadelphia, which houses (among other bodily obscura) Einstein’s brain and a chunk of John Wilkes Booth’s vertebra. Rosenbloom came upon a case of leather-bound books whose display text claimed they were made of human skin — via a process called anthropodermic bibliopegy, practiced by 19th century doctors who wanted to give their own collections a special touch.

“A dead person’s skin had become a by-product of the dissection process,” Rosenbloom writes, “like a piece of animal leather after a butcher’s slaughter, harvested solely to make a doctor’s personal books more collectible and valuable.” Imagine a veterinarian keeping her feline patients’ hides and then covering her most prized medical books with them — except, in this case, the veterinarian would also be a cat.

In earnest pursuit of answers, Rosenbloom formed the Anthropodermic Book Project, which sets out to test as many books purported to be bound in human skin as possible. So begins her jaunt across through the U.S. and Europe to harvest samples. Rosenbloom’s project takes her to the library at the Los Angeles County Medical Assn., the site of a book supposedly bound in the skin of a white man captured by Native Americans; to Harvard, whose library holds not one but two prospects; to Cincinnati, home to a copy of Phillis Wheatley’s poems bound in 1934; and elsewhere, with often surprising test results.

Her travels extended to other relevant sites, from an old-fashioned tannery in upstate New York to understand the leather-making process to a Cleveland nonprofit dedicated to preserving tattooed skin once its (consenting) owner’s soul has departed their earthly vessel.

Rosenbloom is well aware that morbid curiosity can read as glibness. “The book walks a line,” she says, acknowledging the timing of the book’s release, in a year of multifarious horrors, with characteristic good nature. “I thought it was effective to have a guide because you should have someone you can trust.”

The author earns that trust. The result of Rosenbloom’s probing travelogues, lively histories and deep study of book stewardship is an incongruously bright-eyed view of a subject that, in the hands of another scholar, might be either plodding or gruesomely sensationalistic. The true story of how people became books is surprisingly intersectional, touching on gender, race, socioeconomics and the Western medical establishment’s colonialist mindset.

“Every time I tried to research a book, I would almost always find a doctor involved,” Rosenbloom says. “And the sort of disconnect between the way our society views doctors and then how this got done … is fascinating to me.” She says she spent time with texts like Ruth Richardson’s “Death, Dissection and the Destitute” to understand the rift between famous male doctors and the patients they treated: “People who didn’t have access to assert themselves or have agency around their bodies. What of them? It’s a harder story to tell.”

“Dark Archives” confronts the myth of Nazis turning human skin into gruesome objects, concluding the infamous lampshade (whose existence remains unproven) had become “an outsize emblem of the brutality of the Nazi regime.” She turns this conflation of history into an ironic twist on the banality of evil: “It’s easier to believe that objects of human skin are made by monsters like Nazis and serial killers, not the well-respected doctors the likes of whom patients want their children to become someday.” More than a tromp through a bizarre subset of bibliophilia, “Dark Archives” is a truth-telling expedition.

Rosenbloom’s nuanced approach is intertwined with her work as the cofounder of the Death Salon, an organization whose mission is to “[encourage] conversations on mortality and mourning and their resonating effects on our culture and history.” Styled after an 18th century salon, the event series is part of the Order of the Good Death, a group that works to promote the death positive movement — which aims to destigmatize dying.

“Basically everything that you take for granted and think is normal around death is totally culturally relative,” says Rosenbloom. She remembers having “a seed of fear” planted after attending an uncle’s funeral around 11, observing family members as they approached and retreated from the open casket. Eventually, she understood the necessity of confronting her own anxieties around mortality from an intellectual perspective. “I’m a bit of a control freak, anxious person, and if there’s something I can do or if I can learn about things and try to understand them, that helps with the anxiety thing.”

In many ways, “Dark Archives” feels like an extension of Rosenbloom’s death positive work, urging us to confront not just what happens to physical bodies after they die but the memory of people who occupied them — and a society that has systematically brushed them aside. “We can’t go back in time and stop anthropodermic books from being created,” writes Rosenbloom, “but since they exist, they have important lessons to teach us — if we’re willing to reckon with their dark past and all that it tells us about the culture in which they were created.”

Complete Article HERE!

How Death Doula Alua Arthur Gets It Done

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In 2012, Alua Arthur quit her legal career to become a death doula. The problem was that she had no idea such a job existed. “All I knew was that there had to be a better way to give support during one of the most lonely and isolating experiences a person can go through,” she says. Now 42, she is a leader in the field of death work and has guided thousands of people and their loved ones through the end-of-life process. She has also trained hundreds of other death doulas through her company, Going With Grace, and is on the board of directors at the National End-of-Life Doula Alliance (NEDA)

This year, as COVID has forced so many Americans to cope with sudden loss and their own mortality, Arthur has been inundated with new clients and students as well as larger questions about how to handle constant grief. She lives in Los Angeles. Here’s how she gets it done.

On her morning routine:
I usually get up around 8:30 or 9:00 a.m. I’m a night owl, and it helps me in my work because people tend to die between 2:00 and 5:00 a.m. I’m not sure why; there are a lot of different theories about it. But I’m most awake and alert at that time. The witching hours. I love to burn my incense at 4:00 a.m. and greet the crows.

Most mornings I meditate right after I get up. After I meditate, I fill up my gallon jug of water and exercise. I need to sweat and move. I love anything where the instructor is like, “Faster! Go! Only ten more seconds!” Since we can’t do group fitness in person right now, I have to re-create it in my house. It doesn’t work quite the same, because I will stop and eat snacks in the middle of a video. But I’m trying. Exercise and meditation are the things that keep me sane and grounded. They’re the baseline.

On being drawn to end-of-life care:
Being around death has made me more honest. I see that what we don’t say chokes us as we die. People always think they have more time, and when they realize that they don’t, they have regrets about things they haven’t done. I try to do what I feel like doing right now. And if that means eating white-cheddar Cheetos for breakfast, I will. Which is what I did this morning. I won’t always be able to taste delicious things, so let me do it now.

On managing her clients:
I don’t take on more than one client at a time who is imminently dying, because I want to be on call for them. Whatever they need, I will do. When a client with just a couple of weeks or months left first comes to me, we’ll go through the long list of items to consider in death and dying, and then we’ll create a plan. That usually happens over the phone. Then I go to visit, put my hands on them, really see what their physical condition is, and see what kind of support they have.

I continue to visit every week or so until their condition starts deteriorating fast, and then I’m there more often. I might be there when they die, and if I’m not, I’ll come sit with their family or caregivers afterward until the funeral home comes. I may also help wrap up practical affairs — possessions, accounts, life insurance, documents. It’s exhausting for a family to have to think about that when they’re also grieving, and I’m equipped to help. I’ll sit on hold with insurance companies, make funeral arrangements, all that stuff.

Beyond those who are imminently dying, I often have several clients who need end-of-life planning consultations. I can take on a couple of those at a time. That could be someone who has just gone on hospice and it doesn’t look that bad yet, or someone who just received a diagnosis and wants to prepare.

On winding down after an intense day:
I’ll drink wine and hang out with a lover. I’ll go out dancing until 5:00 a.m. Sometimes I just want to shut the brain off after a long day, and the best way to do that is by spending time with friends and people who tickle me. But it’s also good to spend a lot of time alone, which is the default these days. I like silence.

On becoming a death doula:
I spent the bulk of my career in legal services in L.A., working with victims of domestic violence. Then there were some big budget cuts, and I wound up getting stuck doing paperwork in the courthouse basement. I was already depressed and burnt out, but it blossomed into an actual clinical depression. So I took a leave of absence and traveled to Cuba. While I was there, I met a German woman who had uterine cancer and was doing a bucket list trip. We talked a lot about her illness, and her death. She hadn’t been able to discuss a lot of those things before, because nobody in her life was making space for her to talk about her death. Instead, they’d say, “Oh, don’t worry. You’re going to get better.” I came back from that trip thinking I wanted to be a therapist who worked with people who were dying.

I applied to schools to become a therapist, but in the meantime, my brother-in-law got very sick. So I packed up and spent two months in New York with him. That experience gave me a lot of clarity on all the things we could be doing better in the end-of-life processes. It was so isolating and I couldn’t understand why. Everybody dies — so why does it feel so lonely? After that, I did a death doula program in Los Angeles, called Sacred Crossings, and then I founded my company, Going With Grace.

On leaving her law career (and a steady paycheck):
It wasn’t a hard decision to leave my job as an attorney. The challenging part had more to do with identity and what achievement means. I was born in Ghana, and we’re all raised to be doctors and lawyers and engineers. So I was going against societal expectation and parental expectation. It was also tough to be broke for a long time. My student loans were in forbearance. I spent a lot of nights lying on my mom’s couch wondering how I was going to make things work. If my friends were going out, they’d have to pay for me or else I couldn’t join them. To support myself while I was starting my business, I worked part-time jobs at a hospice and a funeral home.

Eventually, I started hosting small workshops about end-of-life planning. I charged $44 dollars for people to come together and learn how to fill out the necessary documents. Now I have my own doula training programs. I have about 100 students at the moment, all online.

On charging for her services:
I have to navigate the financial conversations with a lot of directness. Part of the challenge is that our society doesn’t see the financial value of having somebody be kind and supportive. Being able to hold so much compassionate space when somebody’s dying — that is a skill. It needs to be compensated highly.

On living with grief:
I’m constantly grieving with and for my clients and their family members, all the time. There’s no fixing it. I have to be present with my feelings and let them wash over me, in whatever expression they take. If I try to shut off that part of myself, it becomes much harder to function in everyday life. Grief doesn’t always look like crying. Sometimes it looks like anger, promiscuity, or eating everything under the sun. Like all things, it’s temporary.

On how COVID has changed her work:
We have to rely much more heavily on technology and remote communication. There’s also a lot more interest in the death doula training program. Death is on a lot of people’s minds, and I’ve seen a lot more people starting to do their end-of-life planning — mostly healthy people in their 40s with young kids. A lot of people have seen younger people die suddenly, and it’s changed their perspective.

On her own end-of-life plan:
I would love to be outside or by windows. I want to watch the sunset for the last time, and I want to have the people I love around, quietly talking, so that I know they’ve got each other after I leave. I want to have a soft blanket and a pair of socks because I hate it when my feet are cold. I want to smell nag champa incense and amber. And I want to hear the sound of running water, like a creek. I’d love to enjoy all those senses for the last time. And when I die, I want everybody to clap. Like, “Good job. You did it.”

I want my funeral to be outside, and I want all my jewelry to be laid out. As guests come in, they grab a piece and put it on. I want my body to be wrapped in an orange and pink raw silk shroud. They’ll play Stevie Wonder — “I’ll be loving you always” — and everyone will eat a lot of food and drink whiskey and mezcal and red wine. There will be colorful Gerber daisies everywhere, and they’ll take me away as the sun goes down. And when they put my body in the car, the bass will drop on the music, and there will be pyrotechnics of some sort. I hope my guests have a grand old time and dance and cry and hug each other. And then I want them to leave wearing my jewelry.

Complete Article HERE!

The essential role of music therapy in medical assistance in dying

By Amy Clements-Cortés and Joyce Yip

In Western society, we spend a lot of time celebrating and welcoming new life, but very few cultures celebrate when a person dies. While death is not as taboo as 50 years ago, death is still a topic that many individuals are not comfortable speaking about in conversations. Even more off-limits, people are less likely to talk about physician-assisted suicide in their social circles. There are many reasons to this phenomenon such as religious beliefs, personal beliefs, and advocacy for life. In fact, an ethical challenge is the conundrum of ending a life, as these professionals strive to enhance the quality of life and cure or alleviate illness, rather than to end it.

What constitutes a good death? To answer this question, several common responses include: being surrounded by family and friends, avoiding the prolongation of death, not being in pain, and achieving control. But what happens to the patient when the suffering becomes too much? Who determines the suffering is great enough to warrant suicide? How does the medical community ensure an individual is cognizant of their choice to end their life? These questions can be considered in conversations about Medical Assistance in Dying.

Medical Assistance in Dying (MAiD), as;described by Noushon Farmanara, is a process that permits individuals with grievous and incurable physical or psychological suffering to voluntarily end their life in the presence of medical and health professionals. At present, MAiD is legally available in Europe, South America, Australia, and North America. Particularly in Canada, the passing of Bill C-14 on June 17, 2016 permitted MAiD as a legal procedure for Canadians who meet rigid requirements. Although Bill C-14 advocates the legalization of assisted suicide in Canada, there are ethical implications to consider in the perspective of the patients, the medical and healthcare professionals, as well as the community, who may be affected by the legislation.

Music therapy, an allied healthcare discipline that is growing in its awareness and significance in hospice and palliative care, is essential in helping patients explore the meaning of a good death as they move through their decline. Music therapists may be called to provide music and holistic care for the patients prior to MAiD, as it is a logical extension to include music therapists in the discussions and procedures of MAiD.

The clinical interventions facilitated by certified music therapists are spread across a continuum of passive to active interventions such as lyric discussion and analysis, songwriting, improvisation, guided imagery and music, and musical life review. The techniques that assist in the realization of patient-directed goals exist in spiritual, psychosocial, cognitive, emotional, and physical domains. As well, patients can create legacy songs to convey an important sentiment for their loved ones to cherish and listen to after their passing, such as “I love you.”

Music can also offer potential interventions which can keep a patient calm and relaxed at the time of injection. While Bill C-14 does not include music therapists as a valid healthcare professional in MAiD, having these holistic approaches can allow the patient to feel safe and celebrate their life. In fact, the absence of music therapy could increase the potential for harm as music therapy can contain and support emotions that might be very intense at this time.

A hypothetical case example followed a patient in a Canadian public-hospital who was considering live music by a music therapist during her MAiD procedure. As her physical symptoms worsened and despite the intake of medications, music therapy potentially offered healing and autonomy for her physical suffering in this difficult time. As music is non-invasive, it provides a creative outlet for patients to document their internal feelings, relationships, and stories prior to their death.

When integrating music therapy with MAiD, ethical considerations should be explored, such as recommended policies and guidelines that could promote music therapists as an essential to legalized death. As these professionals use music as a holistic intervention to clients, the facilitator may experience emotional hardship similar to the medical professionals in MAiD. This may result in immediate replacements and strain in the client-healthcare relationship. Further, limited resources are currently available to healthcare professionals to engage in circumstances around MAiD.

To provide these viable solutions, a team of music therapists and psychiatrists have written a set of clinical guidelines for music therapists to effectively engage with patients interested in MAiD. These guidelines explore the potential of music therapy in MAiD through an evidence-based methodology of qualitative studies and recommended practices that were designed to address the dynamic nature of Bill C-14 and the Code of Ethics of the Canadian Association of Music Therapists. This included suggested interventions and clinical goals for the patient, as well as supportive roles in the music therapy sessions. Further, annual hospital training and education for re-certification of any healthcare profession may be viable options to explore resources available for patients at their time of death.

Music therapy is a natural fit with MAiD as this healthcare discipline has demonstrated significant impact in work with the dying. In Canada, while Bill C-14 has provided patients with a degree of autonomy, it has created ethical concerns for the medical and healthcare professional and their community. To address these concerns, policies and guidelines have recommended music therapy as a crucial practice in the dying process and have provided viable solutions to combat these restrictions through empirical research. By continually creating resources about MAiD, the conversations about this topic will diminish its taboo and, ultimately, visualize death as a celebration of life and care.

Complete Article HERE!

In the midst of deep grief, a scholar writes how Hindu rituals taught her to let go

Hindu cremation being performed on the banks of the River Ganges in Varanasi, India.

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Cultures have built elaborate rituals to help humans process the grief of losing someone.

Rituals can hold the core beliefs of a culture and provide a sense of control in an otherwise helpless situation. I came to understand this when I lost my mother last year and participated in the primary Hindu rituals of death and grief.

The cultural practices and experiences helped me find meaning in my loss.

Body and soul

Many Eastern religions do not bury their dead; instead, they cremate them. Most Hindus consider this to be the final sacrifice of a person.

The Sanskrit word for death, “dehanta,” means “the end of body” but not the end of life. One of the central tenets of Hindu philosophy is the distinction between a body and a soul. Hindus believe that the body is a temporary vessel for an immortal soul in the mortal realm. When we die, our physical body perishes but our soul lives on.

The soul continues its journey of birth, death and rebirth, in perpetuity until a final liberation. This is at the heart of the philosophy of detachment and learning to let go of desires.

Scholars of Indian philosophy have argued about the importance of cultivating detachment in the Hindu way of life. An ultimate test of detachment is the acceptance of death.

Hindus believe that the soul of the deceased stays attached to its body even after its demise, and by cremating the body, it can be set free. As a final act, a close family member forcefully strikes the burning corpse’s skull with a stick as if to crack it open and release the soul.

To fully liberate the soul of its mortal attachments, the ashes and remaining bone fragments of the deceased are then dispersed in a river or ocean, usually at a historically holy place, like the banks of the River Ganges.

Knowledge within rituals

Someone from a different tradition might wonder why a ritual should ask mourners to destroy the body of their loved ones and dispose of their remains when one should be caring for all that remains of the dead?

As shocking as it was, it forced me to understand that the burning corpse is only a body, not my mother, and I have no connection left to the body. My Ph.D. studies in cognitive sciences, a field that seeks to understand how our behavior and thinking are influenced by interactions between brain, body, environment and culture, made me look beyond the rituals. It made me understand their deeper relevance and question my experiences.

Rituals can help us understand concepts that are otherwise elusive to grasp. For example, scholar Nicole Boivin describes the importance of physical doorways in rituals of social transformation, like marriage, in some cultures. The experience of moving through doorways evokes transition and creates an understanding of change.

Through the rituals, ideas that were abstract until then, such as detachment, became accessible to me.

The concept of detachment to the physical body is embodied in the Hindu death rituals. Cremation creates an experience that represents the end of the deceased’s physical body. Further, immersing ashes in a river symbolizes the final detachment with the physical body as flowing water takes the remains away from the mortal world.

Dealing with the death of a loved one can be incredibly painful, and it also confronts one with the specter of mortality. The ritual of liberating the soul of the dead from its attachments is also a reminder to those left behind to let go of the attachment to the dead.

For it is the living who must learn to let go of the attachment to the dead, not the long-gone soul. Cultural rituals can widen one’s views when it is difficult to see past the grief.

Standing at a place where millions before me had come and gone, where my ancestors performed their rites, I let go of my mother’s final remains in the holy waters of the river Ganges.

Watching them float away with the waves of the ancient river helped me recognize that this was not the end but a small fragment in the bigger circle of life.

As the Hindu text, the “Bhagavad Gita” – The Song of God – says of the soul,

It is not born, it does not die;
Having been, it will never not be.
Unborn, eternal, constant and primordial;>It is not killed, when the body is killed.

Complete Article HERE!

Is fear of dying taking over your life?

7 ways to manage death anxiety

A ‘healthy’ fear of death is normal – but what happens when it tips into full-blown anxiety? Lisa Salmon seeks some expert advice

WHILE it’s natural for all of us to be afraid of death, particularly right now with the backdrop of a global pandemic, for some, death anxiety – or thanatophobia – can become a real problem.

“Most people will experience death anxiety at some time in their lives,” says clinical psychologist Dr Anna Janssen (drannajanssen.co.uk), who specialises in the care of people with cancer and terminal illness. “Some have a way of dealing with it which causes them less anxiety, perhaps through their culture or religion or their own ideas about death.

“There’s nothing unusual about being apprehensive about death, and worrying about it a bit, but those worries become more clinically concerning if the anxiety starts to have an impact on day-to-day functioning. When it starts to dictate much of how you live, and is to the detriment of other meaningful things or your wellbeing, it’s more concerning.”

Grief counsellor and funeral director Lianna Champ (champfunerals.com), author of How To Grieve Like A Champ (RedDoor Publishing, £9.99), adds: “The current pandemic has made us think of death – having deaths reported daily in the news can make our anxiety external, giving us a sense of panic.

“Having a fear of death is quite normal and stems from our natural instinct for survival. But what happens when an irrational fear of death begins to seep into our thoughts and takes over our rational thinking? Death anxiety is a very real concern for some, affecting their day-to-day functioning, and while we can’t change what is, we can change how we feel about it.”

Here, Janssen and Champ suggest seven ways to manage death anxiety…

1. Acknowledge your feelings

Don’t try to ignore your feelings about death – talk, think and reflect on them in a safe space, maybe even in therapy, suggests Janssen. “You can look at what your thoughts and feelings really are and get some coherence, so you feel less overwhelmed by how you feel,” she says. “Understanding what you’re thinking and feeling is sometimes a direct route to coping.”

Champ says: “Acknowledge the effect the anxiety has on your life physically and emotionally. Once we acknowledge that we may be engaging in habits or thoughts that aren’t good for us, we can begin to take steps to change them.”

She suggests writing down honestly what you’re feeling, and thinking about events in your past that may be linked to the anxiety. By doing this, you might be able to identify what was emotionally unfinished about the linked event, which might help.

2. Identify the trigger

Champ suggests asking yourself about all the things that make you anxious about death. Is it missing out on being with your loved ones – even though they’ll eventually all die too? Being in a black nothingness (which you probably won’t be aware of)? Or just the not knowing what happens? “If we understand why we’re feeling the way we do, we can take back control,” she says.

3. Limit your news consumption

Champ advises people who have death anxiety not to read or listen to the news too much. “Keep in mind that the media can hold a tragic event in the news for ages,” she says. “Yes, we see disasters, but we can also see many good and great things happening. Everything needs balance.”

Janssen adds: “The fear of death fluctuates in different people’s lives and may be triggered by an experience of a difficult death, or things people may see or hear about death that add uncertainty, or make the potential of death less deniable.”

4. Share your thoughts

Giving a voice to your feelings can help put worries into perspective, says Champ, who suggests: “Find someone who won’t try to ‘fix’ you or change how you feel, but can give you the tools to work it out yourself. If you can’t think of someone you can trust, reach out to a professional.”

Janssen adds: “It can just be about being heard and feeling less stigmatised. Very often, we don’t talk about death or how worried we are about it, so sometimes just having a relationship where someone can bear witness to your feelings about death can be enough. Sometimes knowing you’re not the only one who feels like this can be helpful.”

5. Remember some anxiety about death can be good

“Our survival instinct is driven by the fear of what might end our lives, so we’ll all have an undercurrent of fear of death, and that’s no bad thing because it’s how we survive,” Janssen stresses.

Champ adds: “A ‘healthy’ fear of death can make us change our beliefs and behaviours for the better. An awareness that we aren’t immortal can make us better people too, as it can make us think about how we’d like to be remembered.”

6. Learn to accept it

Through her work, Janssen says she sees people facing death, or who’ve lost someone to illness, and they readily talk about it. “I also see people who speak about their acceptance of death,” she says. “Some people are very much able to accept their life is ending and they feel ready for that ending, and that’s often linked to what they think death is and what they think will happen next.

“Some are very clear this is not the end of everything, so the meaning attached to death isn’t one of threat. They’re comfortable with it, and think they’re going to a safe place and to meet people that have already passed away. It’s really about the meaning we attach to death.”

Champ adds: “By really grasping that dying is an inescapable truth, we can live a better life. We really can live each day as if it’s our last.”

7. Seek help if necessary

If, after trying to tackle your anxiety, you’re still feeling overwhelmed and thinking excessively about death, seek professional help, advises Champ.

Janssen suggests: “If you have trauma that reminds you of how unsafe we are in this world, you can come through it with specialist therapy.”

Complete Article HERE!

Caring For The Caregivers

By Nekee Pandya

When the United States recorded 100,000 deaths from the novel coronavirus, the New York Times (NYT) commemorated the lives lost by filling their front page with a list of the names of those who died, accompanied by descriptive phrases that gave small glimpses into their lives. Titled “An Incalculable Loss,” the piece helped remind us that those who perished from the virus were people, beloved members of our communities. Like many New Yorkers, I scrolled through the names on the list, trying to understand the scope of loss our city was experiencing. Like many New Yorkers, I came across a name I recognized. This name, however, wasn’t of a friend or family member, it was of one of the patients that I took care of when they got sick with COVID-19.

I work as a hospitalist at a large hospital in Manhattan. During the COVID-19 peak, I was redeployed to co-lead one of the pop-up intensive care units (ICUs) created to expand our ability to care for our sickest patients during the surge. It may not seem surprising that I came across the name of one of my patients on the NYT list, but the odds are actually exceedingly small. Although the article depicted an unimaginable amount of deaths over a few short months, the names represented only 1 percent of the total lives lost in the United States at that time. And while New York City has been the epicenter of the pandemic, Manhattan was relatively spared compared to the other NYC boroughs. And yet, we did not feel spared.

Within three weeks of admitting our first COVID-19 patient, we had filled all our existing ICUs with coronavirus cases and had started construction to create new ICUs to keep up with the number of critically ill patients. As one colleague described, it felt like we were imitating Wile E. Coyote as he frantically tried to lay down new train tracks before an oncoming train; as soon as a new ICU opened, it was filled within hours.

The name I came across in the article was one of my first patients in the newly created COVID-19 ICU where I was asked to work. As a hospitalist, I am trained as a doctor of internal medicine who cares for acutely ill hospitalized patients. Although I have worked in ICUs before, I am not critically care trained. Determined to provide my patients with the best care possible, I spent time training with our critical care colleagues, practicing procedures on mannequins, and watching countless videos aimed at brushing up on my ventilation management skills. I was partnered with an anesthesia attending and pulmonary critical care fellow to create a team that brought together different skills to ensure we could handle all aspects of the patients’ care.

Our 12-bed ICU was completely filled within 36 hours of its existence. The patient on the NYT list was one of five new patients with severe COVID-19 who came to us within four hours. We quickly realized that caring for these patients was a hospitalwide team effort. We had daily phone conferences to share our experiences, exchange ideas, and create new standards of care. We all became COVID-19-ists, united in treating just one disease. Yet, in other ways, the care of these patients was also incredibly lonely. I spent my days standing alone in the room of intubated and sedated patients, in layers of personal protective equipment, listening to the beeping of monitors and the hum of the negative pressure system, hoping that we had learned enough about this disease to help our patients survive. I often found my gloved hands holding theirs, knowing that they didn’t know I was there but hoping that my touch might make them, and me, feel less alone. 

I can remember every patient in our unit those first few weeks. The 40-year-old man whose old college friends sent us daily meals for three weeks; the 80-year-old man who had a wife dying of COVID-19 in another hospital; the man who survived discharge from the COVID-19 ICU only to die in a general medicine unit a few days later from a massive bleed; the sole woman being treated in the COVID-19 unit, who used to be a nurse. Some of them passed. Some of them stayed in our unit for weeks, went to our in-house rehabilitation unit, and were eventually discharged home. Some of them are still hospitalized today. And while the stories of all those patients stay with me, the patient whose name I came across in the article is especially meaningful. He was my first patient that died of COVID-19.

The day he died was also the day that my first patient with COVID-19 improved enough to be taken off a ventilator. Our whole team stood in a mass outside of the glass doors, watching as the respiratory therapist prepped to take the breathing tube out. It would be our first time seeing someone with such severe disease survive this infection. As soon as he was extubated, the resident on our team rushed into the room with an iPad to FaceTime the patient’s family. We could hear the cries and cheers of his family from outside. My resident, wanting the family to see the team that took care of their loved one, swung the iPad around and there we were 10 masked faces cheering from just outside the room. Six feet, a glass door, and an iPad apart, we all celebrated that moment together.

But within 10 minutes of this first success, I was standing in the room of my other patient, to be with him when he died. Up until a few days before his death, his story sounded exactly the same as the patient’s we had just extubated. He was a man in his fifties, with a few well-controlled medical problems, who came in with a dry cough and shortness of breath. Both men had been on the medical floor for a few days before they were intubated. Both spent the first few days on our unit deeply sedated, paralyzed, on high ventilatory settings. But for reasons unknown to me, or to the rest of the medical community, one of them was recovering, and the other was progressing to multi-organ failure.

I stood at his bedside in disbelief that we weren’t able to help him survive. He was young, too young. He still looked robust, as if he was about to wake up and tell us to take the tube out. Like all hospitalists, I’ve taken care of many dying patients, but this death felt different. I was not used to seeing a young healthy person die of pneumonia. I was left feeling like I failed him and struggled to give him any semblance of a “good death” in the sterile, lonely ICU room.

My patient’s partner saw him for the last time over FaceTime. Family and friends texted the patient’s phone so we could read their messages aloud before he passed. I was struck by the contrast of his current situation to his last texts where he told people he was feeling fine but the doctors told him he needed to be intubated. We read him messages of love, thanks, and sadness from his family and friends, knowing that it was a poor substitute for their presence but trying to do whatever we could to imitate what a good death would look like in any other situation. I stood in the room with the nurse in silence, not knowing how long it would take for him to pass but not wanting to leave him alone. The nurse suggested it might be nice to play him some music. My goggles fogged up while I tried to find his most played list on Spotify. The music that played was upbeat and electric, completely at odds with his current situation. It made me imagine the type of person he was before he got sick, before COVID-19 took his life. An hour after his death, a new COVID-19 patient on the edge of death rolled into his now disinfected room, forcing us to quickly shift our attention to try to help this new patient survive.

When I saw the deceased patient’s name on the NYT list, feelings of hopelessness and guilt resurfaced once again. There were no proven treatments for COVID-19, so most of the time it felt like everything we were doing was just buying patients time. Buying them time to let their bodies either recover or succumb. We saved a lot of lives by buying them time, but we lost a lot, too. I clicked on his name in the article, and it led me to his obituary. I learned about his life and his passions and got a glimpse into the man who listened to that upbeat playlist. I hoped that our farewell was the good death he deserved.

A few weeks later, I was sent a video of our first extubated patient going home. He was walking out of a car, down the sidewalk, and up the stairs, all with an oxygen canister in tow. He had a big grin on his face as he looked at all his neighbors out on the doorsteps cheering him on. He probably wouldn’t recognize me if we met. He left our ICU almost immediately after he was extubated to make room for the next patient, and he never saw me without my mask and goggles. But seeing him take those steps brought me to tears. I shared the video with my team as a reminder of the meaning behind our work.

It is my colleagues that I worry about now. Every doctor in my hospital has stories like mine: stories of soaring highs and extreme lows. Doctors speak of being unable to do right by patients due to resource limitations or institutional policies. They tell stories of distress over equity in patient care and stories of rage about the societal and governmental response to this crisis. And now, with the rates of COVID-19 rising in the rest of the country, many more doctors will be dealing with these scars and collective trauma. Studies all over the world are finding higher than usual rates of burnout and depressive symptoms amongst doctors caring for COVID-19 patients. In New York, where we are just past the first wave of COVID-19, we are starting to think about how we can heal the healers. 

We have learned that we need to move beyond the impromptu office debriefing with colleagues and create formalized space and time for hospitalists to share and reflect on experiences. Our hospitalist group has started the process by allowing doctors to choose the format in which they would like to debrief. Everyone had the opportunity to meet in dyads, small groups, or large groups, to swap stories, cry through losses, celebrate victories, and vent about the things we had no control over and things that we could have done better. It has let many of us explore emotions that we did not have time to deal with in the moment and may not have even recognized that we were having. It also helped us lean on the people in our lives who truly understood our experience: each other.

Part of this process also included sessions with the hospitalist section chief to reflect as a group on the response to the crisis. Hospitalists were encouraged to have honest and open discussions about what did not work well organizationally, as well as to brainstorm and exchange ideas on how the group could do things differently moving forward. Having a leader at the table who was committed to listening and enacting change was key in combating the helplessness and isolation felt by individual practitioners.

Hospitals must start prioritizing—and devoting time and resources to—the well-being of their providers during the pandemic. Given the degree of trauma experienced by providers, if we don’t address the post-COVID-19 care of physicians now, we will find the consequences of burnout rippling through the medical field. Our community has already seen its first physician suicide amidst this crisis. Beyond the negative impact of burnout on providers, we know that patients’ care will also suffer. As we prepare for a potential second surge of COVID-19 infections, it is imperative that we invest in helping our physicians recover, so they can be prepared to provide the best care possible when they are asked to lead the fight once again.

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