01/30/16

How To: Avoid Family Conflict When There’s No Estate Plan

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6 ways a family can settle a loved one’s estate and still want to speak to each other afterwards

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Estate Plan

In a perfect world, someone dies and leaves behind pages of clear directives on everything from where the finances go to who gets Great Grandma Annette’s rocking chair, and an official executor makes sure the process goes smoothly and everyone loves each other dearly forever more.

But what is there’s no will left behind? How much money do you think it would take to tear your family apart? In her case, documentary filmmaker Amanda Brown knows the answer:

$51,283.50.

In her film Black Heirlooms, Brown tells the story of her grandmother Edna Mae “Mee Mah” Royal, a mother of eight and matriarch of a large extended clan. When Mee Mah suffered a stroke that left her unable to communicate, the formerly close family became irreconcilably fragmented, with members suing each other for control. Years later, the family remains split into two camps, with nothing but silence between them.

Your family would never have such a tragic breakdown, right? Don’t be so sure. AsBrown says, “Money is a catalyst for a number of things,” In her case, it compounded older issues that led to larger and more complicated disagreements.

As a financial therapist, the story of the Brown/Royal family breaks my heart. But it‘s far from unique. Beyond the usual disagreements about a loved one’s wishes or fairness, there’s a natural inclination to project interpersonal aspects of the relationship (emotional closeness, caretaking responsibilities, who was a “good” child vs. a “bad” one) onto the distribution plan. Couple that with emotions amplified by grief, and it’s clear the real challenge is getting the family through probate unscathed and intact.

With that in mind, here are six ways to help your family settle a loved one’s estate and remain sane:

1. Forget the word “right.” Be careful about being so certain you know what your loved one wanted. Even if he or she communicated something specific to you, it’s totally possible different wishes were shared with another family member at another time. In fact, it happens pretty frequently. Unless you have something in writing, be open to all points of view.

2. The word “fair” doesn’t exist. As an experiment, I did a quick social media poll on people’s idea of what a “fair” inheritance plan looks like. Some said everything divided up equally, others argued for a need-based system (those with more obligations/lower income receiving larger portions than more financially well-off family members), and some wanted everything  to go to charity. See? The concept of “fair” varies widely from person to person. And it’s impossible to win an argument when someone has a different definition than you.

3. Be clear about your own objectives. If it seems like the process is becoming tense or adversarial, suggest everyone take a beat to think about what exact outcome they’re pursuing. Sure, it may start with a certain division of assets, but it likely won’t end there as feelings get bruised and old factions or grudges come into play. Think long-term: how do you want this process to impact your family? What do you want the outcome to be, even after the assets are dispersed? And will it be worth the consequences?

4. Avoid the family narrative trap. As in the case with Brown’s family, any one argument has the potential to trigger a narrative that may go back decades. “Of course Little Sister thinks she should get X,” the thinking goes. “Mom always bailed her out so she didn’t have to struggle like the rest of us.” This can especially true when a family is dispersed and ideas about people are outdated. When you find yourself seeing present-day actions as a confirmation of something that is “always true” about someone, take a step back, breathe, and remind yourself to stay collaborative.

5. Go for consensus, not a win. Sometimes even when inheritance questions are decided in your favor, it can create significant damage to relationships in the family. During the process, make sure all stakeholders feel included and heard. Explore various options before settling on a course of action, even if it seems like there’s a clear majority in favor of a particular approach. If everyone feels like their points were respected and they had a chance to contribute to the process, it can go a long way in soothing damaged feelings and disappointed hopes afterward.

6. Get help. Please. Settling an estate without clear instructions from the deceased is a complicated, emotional minefield. I hope those last three words encourage you to work with one of the many professional mediators trained to help families work through the process. It’s certainly cheaper than the cost of litigation.

Obviously, the best option is to avoid this situation before it happens. A number of resources can help guide your family through some forward thinking, such as figuring out how to bring up the topicbasic planning and legal documents that should be put in place, and dealing with the emotional aftermath of inheritance. This is a process nobody should have to go through, or end up in, alone.

Complete Article HERE!

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01/29/16

Meeting Death with Words

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Meeting-Death-With-Words

Memoirs rarely tremble with such life as when expressing their author’s death.

A memoir of dying is exceptionally wrenching because we know the end at the beginning, and so meet with an effortful, pulsing person who will soon be neither. Pages rarely tremble with such life as when expressing their author’s death.

End-of-life memoirs have become increasingly prevalent of late. Christopher Hitchens wrote of his demise with customary pugnacity. Oliver Sacks recorded his fading remembrances, as did Tony Judt. Jenny Diski is currently chroniclingthe indignities of her last stretch, while Clive James composes newspaper columns on his future disappearance. Our aging population, granted so many extra years by medical science, anxiously tiptoes toward the dark matter, guided by those articulate enough, unlucky enough, to know what to say.

Often, the memoir starts with a prominent author declaring the diagnosis in a major periodical (Hitchens in Vanity Fair; Sacks in the Times; Diski in The London Review of Books). The diagnosis is usually terminal cancer, whose time frame may lend itself to contemplation, though not to more extensive pursuits. Typically, the author recites the markers of tragedy: foreboding symptoms overlooked, a collapse, the condemning scans, the switch to the wrong side of the window between healthy and ill. Some writers embody Hitchens’s line about “living dyingly,” straining to remain themselves, expressing dark humor and secular defiance, downshifting from existential fears to the banal process of death. Others pore over what they’ve had, been, seen. Touchingly, both Judt and Sacks cite nostalgia for gefilte fish. Food—that first pleasure—can be so important at the end, even when it cannot be swallowed.

Another mode is the lyric goodbye, typified by the poetry of James, particularly “Japanese Maple,” a rare popular hit for contemporary verse when it was published in The New Yorker. Of the maple tree, he wrote:

Come autumn and its leaves will turn to flame.
What I must do
Is live to see that. That will end the game
For me, though life continues all the same.

But a complication followed—among the only pleasant complications available to a terminal patient: James failed to die. Indeed, he continues to write, having survived that maple flaming twice over. In his new column for the Guardian, called “Reports of My Death,” he confesses to a twinge of embarrassment, as if he’d duped everyone with that guff about dropping dead. (A famous case of this desirable awkwardness involved the humorist Art Buchwald, who moved into a Washington hospice, in 2006, expecting to die, only to thrive there, dining on McDonald’s and holding court for months before ultimately moving back out.)head:heart

Other end-of-life writing is hortatory: memoirs with lesser literary aspirations but greater motivational ones, such as “The Last Lecture,” by Randy Pausch, a computer-science professor; the book, a parting address about achieving childhood dreams, was a best-seller. Another example is “Chasing Daylight: How My Forthcoming Death Transformed My Life,” by Eugene O’Kelly, an executive at the accounting firm KPMG who spent his final hundred days eschewing his hard-driving ambition in lieu of moral fulfillment. What most end-of-life memoirists share is a desire to wring the essence from what they’ve been—either to clasp on to it or, finally, to release it. These are works of defiance, sometimes escapism. Above all, they are expressions of the noble delusion: create because nobody endures, and create in order that you endure.

A compelling, crushing addition (and, sadly, a subtraction) is “When Breath Becomes Air,” by Paul Kalanithi, a neurosurgeon of immense promise who died of lung cancer, in March, at the age of thirty-seven, having labored on a memoir that stands as a manifesto for the genre, pressing readers to look at the impending darkness. “The fact of death is unsettling,” he writes. “Yet there is no other way to live.” When Kalanithi saw the CT scans of his chest, he surveyed a map of his own death. Others, including his shattered father, insisted that the young man would beat it. Kalanithi was too talented a diagnostician to concur. But a question pursued him: How long have I got left? This prompted a much shared Times Op-Ed that became the seed of his book.

In past centuries, those who were dying might have known that the end neared, but nobody had the tools to estimate when. Today, we have Kaplan-Meier survival curves, and yet doctors grow coy when pressed for a number. Keep up your hope! Kalanithi himself had dodged the subject with patients. When he becomes one himself, he aches to know. His oncologist refuses even to discuss it.

But it is time itself that conditions our behavior, even our identity. When we consider ancient populations whose life expectancy was less than forty years, we picture wretches, limited in scope, and fundamentally different from us as a result. Presumably, our descendants will view us in the same way, as being cursed with the appallingly brief span of eighty-something. For now, that is our anchoring point, an acceptable innings, with seventy too soon, sixty unfairly so, and so on. It’s a pact that the secular make with nothingness: we’ll accept just this life, but give us our share! While healthy, Kalanithi had divvied up his remaining years: twenty as a surgeon and scientist, followed by twenty as an author. Abruptly, he had to recalculate. If ten years remained, he’d devote himself to science. If two, he’d write. Which was it to be?

Raised in suburban New York, then in a small town in Arizona, Kalanithi was a bright son of southern-Indian immigrants, his father a cardiologist, his mother a trained physiologist, although she is recalled in his book more as her son’s minister for education. Her academic urging propelled him toward English literature at Stanford, which he studied along with human biology. At the graduate level, however, literary studies frustrated him, touching on the stuff of life, but with wool rather than with steel. The scalpel called. Soon, he was dissecting cadavers at Yale Medical School, where, he remembers, a surgeon drifted in to explain various scars on a corpse, his elbows leaning on the dead man’s face. Kalanithi returned to Stanford for his neurosurgical residency, and he excelled. He stood at the brink of a glittering career. But there was the weight loss, the back pain, the suspicions batted away. Chances are it’s just …

When the elderly face death, they dread losing what they’ve had. When the young face death, they dread losing what they haven’t had. Which is worse? Kalanithi’s wife worries that, if they conceive a child, it could render his farewell more excruciating. But life, he argues, is not about avoiding suffering.

Meds stabilize his disease for a spell. He soldiers through the completion of his residency. On a subsequent scan, a large new tumor appears. “I was neither angry nor scared. It simply was. It was a fact about the world, like the distance from the sun to the earth.” He conducts his last case as a doctor, his final walk from surgery, witnessing the dissolution of an identity so arduously attained. Kalanithi attended the birth of his newborn daughter, and grew deeply attached to her. “I hope I’ll live long enough that she has some memory of me.” Cady was eight months old when Kalanithi died. “Words,” he writes, “have a longevity I do not.”

The literary world has been circling the subject of death for at least a decade, notably via acclaimed accounts of bereavement such as Joan Didion’s “The Year of Magical Thinking” and “Blue Nights”; Kay Redfield Jamison’s “Nothing Was the Same”; and Joyce Carol Oates’s “A Widow’s Story.” Academic thinkers are joining in, too; among the volumes appearing this past year are “The Worm at the Core: On the Role of Death in Life,” by the psychology professors Sheldon Solomon, Jeff Greenberg, and Tom Pyszczynski; “The Work of the Dead: A Cultural History of Mortal Remains,” by Thomas W. Laqueur, a historian; and “The Black Mirror: Looking at Life Through Death,” by Raymond Tallis, a former professor of geriatrics.

All this attention comes not from a greater understanding of mortality but from a greater ignorance of it. The promises of religion are replaced by the promise of science, yet medicine fails to vanquish its ultimate foe, instead rendering death more obscure, a matter for procrastination. The preëminent thanatophobe of our day, the novelist Julian Barnes, wrote a two-hundred-and-fifty-page memoir on his fear of nonexistence, “Nothing to Be Frightened Of.” The title isn’t intended to be soothing: by “nothing” he means “nothingness.” He writes, “If death ceased to be talked about when it first really began to be feared, and then more so when we started to live longer, it has also gone off the agenda because it has ceased to be there, with us, in the house.”

In richer parts of the world, death is likely to arrive in a nursing home, or in a hospital—precisely where we most dread spending our dwindling hours. The exit from life, as Atul Gawande observes in his treatise “Being Mortal,” has become overly medicalized in recent decades, causing us to forget centuries of wisdom. We have ended up with a system that treats the body while neglecting its occupant. But the discontent is mounting, Gawande says: “We’ve begun rejecting the institutionalized version of aging and death, but we’ve not yet established our new norm. We’re caught in a transitional phase.”

How much should each of us be pondering death? Some people flee the topic. (Few of them, I suspect, have read this far.) Others brood over it. As a matter of preparation, the death-minded aren’t necessarily better off, since they are so unlikely to predict their manner of departure. (How many flight-phobics will fall to earth clutching their chests?) Nor does one know the person to whom one’s own death will occur, given how the violence of disease changes a patient.

But death contemplation is more than prep work. It’s a world view, with nothingness conferring meaning on what precedes, just as a novel gains meaning from its conclusion and would lose sense were it to patter on interminably. Writers—perhaps from a vocational need for endings—seem especially attuned to the looming conclusion of themselves. Or maybe it’s the other way around: those gripped by thoughts of death are prone to artistic pursuits, in the hope that something of themselves will remain.

When medieval painters incorporated memento mori into their compositions—the skull dabbed into a portrait of courtly gents, say—they were proclaiming, “Beware earthly delights, for hell is everlasting!” In our times, the skull has become a fashion accessory or an attempt at irony in dreary artworks. The contemporary emblem of death is the bucket list, inverting the memento mori into “Partake of earthly delights, for life won’t be everlasting!”

The problem is not a lack of spirituality, though. The problem is how to partake of earthly delights. Should one engage in pleasures at the end? Should one strive for lasting accomplishment? The answer depends on what haunted Kalanithi: How long have I got? The answer is so hard to find, harder still to admit. Paradoxically, time is precisely where our society errs in handling death, having licensed our doctors to extend existence, irrespective of the character of the additional weeks. Unfortunately, dying is something we are figuring out only through doing. And now perhaps through the telling, too.

Complete Article HERE!

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01/27/16

The Disappearance of a Distinctively Black Way ​to Mourn

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By Tiffany Stanley

A funeral procession in Monroe, Georgia, for George Dorsey and Dorothey Dorsey Malcolm, who were lynched in 1946.

A funeral procession in Monroe, Georgia, for George Dorsey and Dorothey Dorsey Malcolm, who were lynched in 1946.

As many African American-owned funeral homes close, the communities they serve are losing a centuries-old means of grieving—and protest.

As a child, Richard Ables played hide-and-seek with his brother among the caskets. He has spent his entire life in the family business, the Hall Brothers Funeral Home, founded in Washington, D.C., by his uncles in 1938. Along with the funeral parlor down the street, they once buried nearly everyone in LeDroit Park, the historically African American neighborhood in the heart of the nation’s capital.

Now 73, Ables still runs Hall Brothers, though the business isn’t what it once was. Its historic brick row home is aging alongside its proprietor. There’s water damage on the ceiling tiles, and the front parlor’s carpet is matted down to a threadbare pile. The steep stairs out front aren’t accessible for all customers, and the property taxes are high. Ables wants to make improvements, but he says it’s hard to get loans for the space’s upkeep. “I would like for the firm to continue on and on and on,” he says, “but that’s up in the air.”

For more than a century, black funeral directors have been serving black communities in the United States, keeping African American funeral traditions alive. But now those institutions, which withstood segregation and prospered through it, are struggling to survive as market forces change. The largest black trade group in the industry, the National Funeral Directors & Morticians Association, or NFDMA, does not track the number of black-owned funeral homes in the U.S. But the organization’s director, Carol Williams, says its membership is shrinking—today, the NFDMA represents 1,200 members, compared to a reported 2,000 members in 1997. Many, she says, “cannot afford to keep their doors open.”

Black funeral traditions are distinctive from other burial rituals in American culture. Funeral directors have long preserved the African American tradition of homegoings, as these Christian ceremonies are often called: Bodies are typically viewed in an open casket, and a richly adorned one at that, with large floral arrangements and ornate fabrics. There are limousines and nice cars to escort families, which lends a sense of pride and pageantry to the lengthy rituals.

“To give a peaceful, celebratory homegoing, it’s the whole idea of a celebration of life,” says Karla F.C. Holloway, a professor of English, law, and African American studies at Duke University. It’s become part of black burial traditions, she says—even though “it is a contradiction to the ways in which many black bodies come to die.”

Homegoings can offer black Americans the respect in death that they don’t always receive in life. Black funeral spaces also provide refuge for the living: A family in mourning can be comforted and understood within a community institution, away from an often-racist world. Mourners can feel at home during an otherwise disorienting moment, knowing their traditions will be honored without question. “Culture and practice and ritual are known and remembered in a black funeral home,” Holloway says. “And that matters in a time of grief.”

Untimely death and dying marked the African American experience at its beginning—from mortality-plagued transatlantic voyages to the violence of forced labor and the privation of the slave quarters. Surrounded by these unnecessary deaths, funeral ceremonies were an urgent and central rite in slave communities. They also formed the foundation of the black church tradition.

From their earliest incarnations, black funerals were political, subversive—a talking back to the powers that be. Particularly in the 17th and 18th centuries, if slaves were allowed to bury their own dead and craft their own rituals, away from the overseeing eyes of whites, they could plan for their freedom, spiritually and physically.

In Richmond, Virginia, in 1800, a slave named Gabriel plotted an insurrection at an enslaved child’s funeral, according to Suzanne E. Smith, the author of To Serve the Living: Funeral Directors and the African American Way of Death. “Slave masters then cracked down, and they created a lot more rules about slave funerals,” says Smith, a professor at George Mason University. “They often insisted masters had to be present.”

Three decades later, Nat Turner led a slave revolt in Virginia. “It was never shown that Nat Turner had organized anything at a funeral, but there were rumors he had,” Smith says. In response, Virginia passed new legal restrictions on slave activities, including funerals. The fear of rebellions prompted similar laws curtailing unsupervised slave gatherings across the South.

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The end of slavery, and the war that brought it about, transformed American funerals across races. It was the massive death toll of the Civil War—the bloodiest conflict in U.S. history—that brought the modern American funeral industry into being. With so many soldiers dying on battlefields far from home, families scrambled to ship bodies home. Until the war, embalming was practiced primarily by doctors and scientists. During the war, undertakers set up shop near battlefields, selling their wares and ensuring embalmed bodies could make the long journey home without decomposing. As for the many soldiers whose bodies remained where they’d fallen, black soldiers were often assigned the lowly task of burying the war’s dead.

Undertakers had once been tradesmen who simply made coffins and buried bodies. After the Civil War, the craft professionalized. More Americans were dying in hospitals, not in homes, and families gladly handed off the job of caring for bodies at life’s end. Owning a funeral home became a profitable business, and one that attracted African Americans looking for economic opportunities. In 1912, the funeral industry’s major trade association began excluding blacks from membership, officially segregating the industry. Black funeral directors worked to serve and retain black customers, who relied on them to give their loved ones respectful burials, as Jim Crow deepened racial divisions.

The funeral industry created a class of African American millionaires, as Smith notes in her book. In 1953, Ebony magazine headlined an article, “Death is Big Business,” declaring that “Negro undertakers gross more than $120 million for 150,000 [black] funerals each year.” The next year the publication ran an essay by a prominent black undertaker called, “How I Made a Million.” With growing clout, funeral directors often went into politics, and served as mayors, pastors, and community leaders.Funeral directors also played a key role in the civil-rights movement. Not only did they care for those who died in lynchings, protests, and other conflicts, but they also staged large-scale funerals—for Emmett Till, Medgar Evers, and others—that galvanized Americans to the civil-rights cause. They provided bail money when activists were jailed, and offered their premises for meetings. Hearses and funeral-home cars became a way to ferry civil-rights leaders, including Martin Luther King, Jr., around the South inconspicuously. On the night that King was assassinated, a funeral-home worker, acting as his chauffeur, was one of the last people to see him alive.

But those in the industry, both black and white, also faced scrutiny for their perceived profiteering. In 1963, the British writer Jessica Mitford published a muckraking volume The American Way of Death, which sharply criticized the excesses of the then-$1.6 billion dollar funeral business. Writing in what was then The Atlantic Monthly, Mitford’s article “The Undertaker’s Racket” called out swindling funeral directors for their unscrupulous sales methods. In shock at the money being taken from the living, ostensibly on behalf of the dead, she wrote, “The cost of a funeral is the third largest expenditure, after a house and a car, in the life an ordinary American family.” The average funeral in 1963, according to Mitford, cost $1,450 (about $11,000 in today’s dollars).

Mitford’s findings prompted an examination of the industry. But black funeral directors reacted somewhat dismissively to the book, according to Smith. She paraphrases their thinking like this: “Nobody is going to tell us we can’t have an elaborate funeral. We are the ones came when the lynching happened and we picked up the bodies off the ground. We have an elaborate funeral because that’s our tradition and that’s our way of honoring people.”

Today, the overall industry is thriving—it takes in about $16 billion per year, according to the latest data from the National Funeral Directors Association (which is different from, and much larger than, the NFDMA). But the model has changed: Chains and corporations have swallowed up much of the business. Since the 1990s, the largest chain—Service Corporation International, along with its Dignity Memorial products—has bought up competitors and small businesses to amass more than 1,500 funeral homes and more than 20,000 employees across North America, with $3 billion in revenues. The Houston-based SCI is often dubbed the Walmart of death-care, but it rarely passes along its cost-savings to consumers, instead charging more than many small companies, according to reporting from Bloomberg Businessweek. American funerals run an average of $7,000, but top-of-the-line caskets can cost more than $10,000.

Many African American homegoings, though, are still handled by small, family-owned businesses, and these continue to be elaborate, sometimes expensive affairs. Although African Americans are typically much more averse to cremation than other Americans, a growing number of people are choosing this option, which avoids the cost of a casket, burial plot, and embalming. Cost-effective cremations cut into the profits for funeral homes—one of many challenges family-owned firms are facing.

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Large chains can more easily absorb profit losses because of their size—and because they have capitalized on the cremation industry. SCI, for instance, bought up the largest cremation organization and dozens of crematories. The dominance of chains portends the struggles of many small businesses, which contracted during the recession in 2008. Those issues are compounded for black-owned companies, which are less likely to get loans and comprise only about 7 percent of U.S. small businesses. Black owners often start out with less capital, as the wealth gap between black Americans and white Americans continues to widen. Without money for upkeep, the owners of small funeral homes are finding themselves losing customers to nicer, newer facilities, which are increasingly run by chains.

Richard Ables’s storefront in D.C. is facing these economic issues: Hall Brothers Funeral Home is in a neighborhood whose demographics have shifted. It’s now across from a renovated theater and a row of new restaurants. Ables’s closest competitor, Frazier’s Funeral Home, was shut down in 2008 and its building was converted to luxury apartments. Much of his black clientele has decamped to Maryland or other more affordable places, and his area is now full of new, white residents. In his experience, few whites cross the so-called color line to ask for his services. “Maybe it’s time to move from here to somewhere else,” he says, adding that he will soon need a less expensive location.

His story is not unusual. Where once many black funeral homes catered to black clients across the economic spectrum, some are now located in areas that are increasingly segregated by wealth and race. Low-income residents can’t afford many of their services, and as neighborhoods gentrify and see an influx of white residents, these businesses are left with even fewer patrons. In an effort to broaden their customer base, some black funeral directors are trying to market to white clientele or incoming immigrant families.The challenges of the industry may explain why the heirs of funeral home owners are increasingly moving away from the family business. Carol Williams of NFDMA, the black funeral-home trade association, says succession planning is one of the biggest issues facing her members. Historic black funeral homes have typically been passed from generation to generation, but eager successors are hard to find as the lucrative work dries up. “When [owners] don’t have a succession plan, and something happens when they can no longer operate it themselves, they end up closing,” Williams says.

As Smith, the professor at George Mason, says, “When these funeral homes disappear, you lose all that history. It’s just gone.” But their decline is also a cultural loss for the present moment. Black Americans are still eight times more likely than white Americans to die by homicide. They are more likely to die at younger ages. Last year, young black men were five times more likely to be killed by police than white men of the same age. Directors of historic, black funeral homes know this better than anyone: They’ve tended to these bodies, and those of their loved ones. They understand that even if the moment of death is tragic or violent, care for the dead can be different.

This resonates with the personal experience of Holloway, the Duke professor. In 1999, she was working on a book about African American mourning when her own son died. At the time, he was serving 95 years in prison for a string of crimes, including rape and attempted murder, which she traces in part to his unraveling mental state. He was on a work detail in a prison cotton field when he and two other inmates took off running, attempting to escape. A corrections officer fired 19 shots. Holloway is still haunted by an aerial image taken from a helicopter, shown on the news: a white sheet in the middle of the field, and under it, the body of her black son.

The historical resonance of his state-sanctioned death also haunts her. “After all, the pitiful traverse from plantation landscape to prison cotton fields was only the short matter of a century and a few score years,” she wrote in her resulting book Passed On: African American Mourning Stories, a Memorial.

“I don’t mitigate at all the violence and trauma that my son inflicted on his victims,” Holloway says. “But in the end, he was our son and we were left to bury his body.” She and her husband specifically wanted to work with a black funeral home after their son’s death—it was one way of getting assurance that their son’s body would be treated with respect. “We expected them to treat him as a child who was loved,” she says. “I don’t think I could have had that conversation with a white funeral director.”

Complete Article HERE!

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01/26/16

This doctor helped dying people end their lives with dignity. Then he was diagnosed with cancer.

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By Brooke Jarvis

doctor and cancer

Peter Rasmussen was always able to identify with his patients, particularly in their final moments. But he saw himself especially in a small, businesslike woman with leukemia who came to him in the spring of 2007, not long before he retired. Alice was in her late 50s and lived outside Salem, Oregon, where Rasmussen practiced medical oncology. Like him, she was stubborn and practical and independent. She was not the sort of patient who denied what was happening to her or who scrambled after any possibility of a cure. As Rasmussen saw it, “she had long ago thought about what was important and valuable to her, and she applied that to the fact that she now had acute leukemia.”

From the start, Alice refused chemotherapy, a treatment that would have meant several long hospitalizations with certain suffering, a good chance of death, and a small likelihood of truly helping. As her illness progressed, she also refused hospice care. She wanted to die at home.

Six months after Rasmussen started seeing Alice, he wrote in her chart about his admiration for her and her husband: “Together they are doing a wonderful job not only preparing for her continued worsening and imminent death but also in living a pretty good life in the meantime.” But there were more fevers and bleeding and weakness. In late January, she asked him to write her a prescription for pentobarbital.

Three days later he arrived at her farmhouse with four vials of bitter liquid. Though the law didn’t require it, he liked to bring the drug from the pharmacy himself, right before it was to be used, so that there would be no mistakes.

Over nearly three decades as a physician in Oregon, Rasmussen had developed many strong beliefs about death. The strongest was that patients should have the right to make their own decisions about how to face it. He remembers the scene in Alice’s bedroom as “inspiring, in a sense” — the kind of personal choice that he’d envisioned during the long, lonely years when he’d fought, against the disapproval of nearly everyone he knew and all the way to the U.S. Supreme Court, for the right of terminal patients to decide when and how to die.

By the time he retired, Rasmussen had helped dozens of patients end their lives. But he kept thinking about Alice. Her pragmatism mirrored the image he had of how he would face such a diagnosis. But while he had often conjured that image — had faced it every time he walked a dying patient through a list of inadequate options — he also knew better than to fully believe in it. How could you be sure what you would do before the decisions were real?

“You don’t know the answer to that until you actually face it,” he said later — after his own diagnosis had been made, after he knew that he had cancer and that he would soon die. “You can say you do, but you don’t really know.”

The knowledge hid in the back of Rasmussen’s mind — a flitting worry you don’t look at directly — for a few days before he really comprehended it.

He was on his way home from a meeting of the continuing-education group he had joined after his retirement. One of the group’s members had asked him to let the others know that she had been diagnosed with a glioblastoma — a type of brain tumor whose implacable aggression he knew well. A glioblastoma can cause seizures, memory loss, partial paralysis, even personality changes. You can treat the tumor with surgery, chemotherapy, and radiation, but it will always come back, often in more places. The timeline can be uncertain, but the prognosis never is. The median period of survival after diagnosis is seven months.

As Rasmussen drove away from the meeting, his left hand was draped on the wheel of his Tesla. It felt, as it had for several days, oddly numb, as if he’d been holding a vibrating object for too long. He’d ignored the feeling, chalking it up to spending too much time power-washing pinecones off his cedar-shake roof.

Maybe it was what had happened at the meeting, or the clarity of a wandering mind. All at once he focused on the sensation — on how localized it was, on the fact that it hadn’t gone away — and he knew. Something was wrong. “I’ve either got MS,” he thought, “or I’ve got a brain tumor.”

Instead of driving home he went straight to an urgent-care clinic, where a doctor sent him to the E.R., where another doctor gave him an MRI, which showed a tumor. It was, he learned later, a glioblastoma about an inch in diameter. Barring an accident, it would be the thing that killed him, sometime in the suddenly too near future.

Eight days after his MRI, Rasmussen went to the hospital to have part of his skull cut away and his tumor sliced out. He had considered whether having surgery violated his usual advice about not wasting one’s final months seeking painful and unlikely cures, but because his tumor was localized and fairly accessible, he and his surgeon decided that the odds were good enough to try.

The surgery was a success — though Rasmussen lost the use of his left arm, the entire visible tumor was removed, and he was able to leave the next day. Of course, success was only a slower form of failure: He was still going to die. He never let himself, or anyone around him, forget that his reprieve was temporary. “It’s not if I pass away,” he corrected his lawyer, his accountant, his friends. “It’s when I die.”

Before he retired, Rasmussen had often tried to help his patients and their families think of the process of dying as an opportunity, a chance for clarity and forgiveness, for thoughtful, meaningful goodbyes. He hoped to hold on to that belief for himself. When he pictured a good death, the image was simple: calm and peace, without much physical suffering, and his family with him in the house where he’d lived for 18 years with Cindy, his wife; where the kids had grown up; where the windows looked out on his bird feeders and his flowers.

It wasn’t time yet. Five months after the surgery, he stopped chemo and radiation. He began to feel better, stronger, and was even able to use his left hand a little. Still, every time he had a headache or nausea he wondered whether the tumor was growing back. But whenever he started to feel sorry for himself, he’d administer a stern mental shake: “We all die,” he’d tell himself. “It’s never fair to anybody. So buck up.”

Privately, he had no idea whether or not he’d take advantage of Oregon’s assisted suicide law. He consulted a list that he’d kept of his Death With Dignity patients. At first most had been urgent cases: people with all kinds of terminal diseases, who were suffering intensely and wanted to take the drug right away. As time passed, people began coming to him sooner after their diagnoses, before they knew how their diseases would develop. Some only asked questions, and others wanted to have the pentobarbital handy, a just-in-case comfort that made them feel more in control. The majority of his patients never took the medication.

Every death was different, though most had details in common: reminiscing in advance, goodbyes filled with love, family members saying that it was OK to stop struggling. There was the death with the Harley-Davidsons: He’d pulled up to the house and there were motorcycles everywhere, people in leather drinking beer on the lawn, just the party his patient wanted.

Of course, not everyone wanted a party, and he respected that too. Often there were only a few family members, and sometimes it was just him and the patient, alone together at the last. Only once did someone ask to die completely alone, in quiet privacy behind the closed door of a bedroom.

He remembered a woman whose mastectomy had not stopped her breast cancer from metastasizing to her lungs. Her huge family came in for the weekend. They had a picnic on Saturday, went to church on Sunday, and then all the kids and grandkids filed through her bedroom to say goodbye. He waited outside the door until they were done and then he brought her a dose of pentobarbital. She drank it and died. That one stuck with him: “It was about as ideal a death as I possibly could have imagined.”

In July of last year, Rasmussen went in for a new MRI. The scan showed the tumor, the same size and back in the same place it had been the year before. He consulted with his surgeon, who told him that the tumor was once again a good candidate for removal. Rasmussen would most likely lose the use of his left arm altogether, but if all went very well, he would have a one-in-three chance of living to the second anniversary of his diagnosis.

“I’ll leave tomorrow for the trip,” he told Cindy after meeting with the surgeon — meaning a cross-country road trip that he’d been talking about. Cindy was stunned. She hadn’t thought he’d actually go. But he was adamant, and then he was gone.

He drove east through Idaho, Montana, South Dakota, along long, open stretches of quiet road. He brought recorded lectures to keep him company: one about St. Francis, a series on the Higgs boson, and a particularly interesting lecture about gnosticism.

As he drove, he tried to visualize what his life would be like if he underwent surgery or stopped treatment altogether. He imagined losing more of the use of his left side and eventually ending up in hospice, bedbound. That part didn’t bother him so much. He knew it was coming no matter what. But he didn’t like thinking about stopping treatment, not yet. It was too passive, too final. It just made him too sad.

Somewhere around the ninth day of his trip, he had a thought that excited him. “The task of learning to be a hemiparetic person,” of living with paralysis on his left side, could be an adventure, another learning experience. “To take on a challenge is always satisfying,” he explained later. Relief washed over him. He had made a decision.

He wasn’t planning to have the surgery right away, but an hour after arriving home he had a seizure. Four days later he was back in the O.R., and surgeons were once again scooping a tumor from his brain. He woke to find himself paralyzed not just in his arm, but throughout the left side of his body. For days he was noticeably quiet. After three days he moved to a nursing-care facility. The first morning there, he called Cindy to tell her that he’d been very sad the night before. “Did you cry?” she asked.

“No, I didn’t cry,” he replied. “But I was mourning the loss of my independence.”

On Oct. 1, he was admitted to the hospital for a new MRI. The results showed that his tumor had not only grown back but expanded into the middle of his brain. “I want to go home,” he said.

Cindy set up a hospital bed in the living room looking out over his gardens. His stepchildren arrived from New York and Seattle. For four nights Cindy and the kids stayed by his bed, each night thinking it would be the last. Instead, he grew stronger for a time — a month that Cindy calls “one of the most meaningful experiences I’ve ever had and probably will ever have.” He visited with friends and family, watched a slide show of old pictures, listened as music therapists played his favorite songs on the ukulele.

Rasmussen had already started the paperwork for Death With Dignity, but he didn’t want to add the final touch, his own signature. Near the end of October, he was speaking only a few labored words at a time. One day he asked Cindy to help him stand so he could get up to go to the bathroom, something he hadn’t done in weeks. He was so weak and frail that Cindy told him it was impossible. She says she saw the realization happen then: “This is it.”

On Oct. 29, Rasmussen signed the paperwork and his siblings flew in from Wisconsin, Illinois, and North Carolina. He planned to take the drug the next week, after what Cindy calls “a memorial service while he was still alive.” Sixteen people gathered around Rasmussen; one by one they told him what he had meant to them and what they would remember about him.

He was alert but not talking much on the morning of Nov. 3. His family intertwined their arms in a circle around him and put piano music on the stereo. He raised the cup of secobarbital mixed with juice — papaya, orange, and mango, his favorite — and drank it down. His eyes closed. Cindy, sobbing, realized how similar the scene was to what he used to describe when he came home from someone else’s death. “It was awful,” she says. “But at the same time, I was glad that he was able to end his life on his terms.”

Half an hour later, he quietly stopped breathing.

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01/25/16

‘Today We Are His Family’: Teen Volunteers Mourn Those Who Died Alone

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Brendan McInerney (front, from left), Noah Piou, Emmett Dalton and their fellow students from Roxbury Latin boys' school carry the casket of a man who was left unclaimed by family to a grave site in Fairview Cemetery on Friday.

Brendan McInerney (front, from left), Noah Piou, Emmett Dalton and their fellow students from Roxbury Latin boys’ school carry the casket of a man who was left unclaimed by family to a grave site in Fairview Cemetery on Friday.

On the drive to Fairview Cemetery in the Boston neighborhood of Hyde Park, six seniors from Roxbury Latin boys’ school sit in silent reflection. Mike Pojman, the school’s assistant headmaster and senior adviser, says the trip is a massive contrast to the rest of their school day, and to their lives as a whole right now.

Today the teens have volunteered to be pallbearers for a man who died alone in September, and for whom no next of kin was found. He’s being buried in a grave with no tombstone, in a city cemetery.

“To reflect on the fact that there are people, like this gentleman, who probably knew hundreds or thousands of people through his life, and at the end of it there’s nobody there — I think that gets to all of them,” Pojman says. “Some have said, ‘I just gotta make sure that never happens to me.’ “

The students, dressed in jackets and ties, carry the plain wooden coffin, and take part in a short memorial. They read together, as a group:

“Dear Lord, thank you for opening our hearts and minds to this corporal work of mercy. We are here to bear witness to the life and passing of Nicholas Miller.

“He died alone with no family to comfort him.

“But today we are his family, we are here as his sons

“We are honored to stand together before him now, to commemorate his life, and to remember him in death, as we commend his soul to his eternal rest.”

Each of the young men in turn read a poem, verse of scripture, or passage about death. Emmett Dalton, 18, reads “A Reflection On An Autumn Day,” which ends “death can take away what we have, but it cannot rob us of who we are.”

From left to right, funeral director Rob Lawler; Roxbury Latin students Emmett Dalton, Noah Piou and Chris Rota; Roxbury Latin assistant headmaster Mike Pojman, and Roxbury Latin students Brendan McInerney, Liam McDonough and Esteban Enrique conduct a graveside prayer service for Nicholas Miller on Friday at the Fairview Cemetery.

From left to right, funeral director Rob Lawler; Roxbury Latin students Emmett Dalton, Noah Piou and Chris Rota; Roxbury Latin assistant headmaster Mike Pojman, and Roxbury Latin students Brendan McInerney, Liam McDonough and Esteban Enrique conduct a graveside prayer service for Nicholas Miller on Friday at the Fairview Cemetery.

After the ceremony, the seniors share their thoughts about an experience— in the middle of a school day — that has hit them hard.

“I know I’m going back, and I’m going to go to school and take another quiz,” says 18-year-old Brendan McInerney, “but all that work, you can get caught up in it. … When you kind of get out of that bubble that you can kind of stuck in, you get perspective on what’s really important in life.”

Roxbury Latin seniors Chris Rota, Liam McDonough, Emmett Dalton, Esteban Enrique, Brendan McInerney and Noah Piou, and assistant headmaster Mike Pojman, listen as funeral director Bob Lawler explains the circumstances of the death of Nicholas Mlller, whose body was unclaimed, at the Robert J. Lawler & Crosby Funeral Home.

Roxbury Latin seniors Chris Rota, Liam McDonough, Emmett Dalton, Esteban Enrique, Brendan McInerney and Noah Piou, and assistant headmaster Mike Pojman, listen as funeral director Bob Lawler explains the circumstances of the death of Nicholas Mlller, whose body was unclaimed, at the Robert J. Lawler & Crosby Funeral Home.

Mike Pojman was inspired to start bringing students to these funerals by a similar program at his alma mater, St. Ignatius High School in Cleveland. He turned to local funeral home Lawler and Crosby — which, by coincidence, is one of the very few funeral homes in the state that steps in to help with these kind of burials.

“It’s the right thing to do,” says funeral director Robert Lawler. “You know, you can’t leave these poor people lying there forever.”

Funeral director Bob Lawler sits alone in a visitation room with the casket of Nicholas Miller as he waits for students from Roxbury Latin school to arrive and act as pallbearers for the burial.

Funeral director Bob Lawler sits alone in a visitation room with the casket of Nicholas Miller as he waits for students from Roxbury Latin school to arrive and act as pallbearers for the burial.

When there are no family members or volunteers available, it’s just Lawler by himself, saying a prayer at graveside. After doing this for 42 years, he appreciates the effect it has on people like 17-year-old Roxbury Latin senior Noah Piou. Today’s ceremony for Nicholas Miller was the first funeral he’s attended.

“That’s my first real moment presented with some form of death before me, and I was kind of at a loss for words at the time,” he says. “I’ve never met Mr. Miller before, but even within that I kind of had a connection with him, and I could feel that.”

After the brief ceremony the students laid flowers. Then they piled back into the van, driving back to school in time for their next lesson.

Funeral director Bob Lawler walks back into the Robert J. Lawler & Crosby Funeral Home after the burial at the Fairview Cemetery on Friday.

Funeral director Bob Lawler walks back into the Robert J. Lawler & Crosby Funeral Home after the burial at the Fairview Cemetery on Friday.

Complete Article HERE!

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01/25/16

Cat Funerals in the Victorian Era

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By Mimi Matthews

inconsolable-grief-by-ivan-kramskoi-18841

Inconsolable Grief by Ivan Kramskoi, 1884.

During the early 19th century, it was not uncommon for the mortal remains of a beloved pet cat to be buried in the family garden.  By the Victorian era, however, the formality of cat funerals had increased substantially.  Bereaved pet owners commissioned undertakers to build elaborate cat caskets.  Clergymen performed cat burial services.  And stone masons chiseled cat names on cat headstones.  Many in society viewed these types of ceremonies as no more than an amusing eccentricity of the wealthy or as yet another odd quirk of the elderly spinster.  Others were deeply offended that an animal of any kind should receive a Christian burial. 

In March of 1894, several British newspapers reported the story of a Kensington lady “of distinction” who held a funeral for her cat, Paul.  An article on the subject in the Cheltenham Chronicle states:

“Except that the Church did not lend its sanction, the function was conducted quite as if it had been the interment of a human person of some importance.  A respectable undertaker was called in, and instructed to conduct the funeral in the ordinary way; the body was to be enclosed in a shell which would go inside a fine oak coffin.  There were the usual trappings, including a plate on which was inscribed the statement that ‘Paul’ had for seventeen years been the beloved and faithful cat of Miss —, who now mourned his loss in suitable terms.  The coffin, with a lovely wreath on it, was displayed in the undertaker’s shop, where it was an object of intense interest and not a little amusement.”

Though Paul’s burial service was not sanctioned by the Church, this did not stop other cat funerals from adopting a religious tone.  An 1897 edition of the Hull Daily Mail reports the story of a clergyman who held a funeral for his cat.  This particular cat is described as an obese, black and white female who was known to go for walks with her master.  Upon her death, the clergyman and his household were “thrown into mourning.” The Hull Daily Mail reports:

“For three days pussy, whose remains were placed with loving care in a beautiful brass-bound oaken coffin, with inner linings of silk and wool, lay in state in the drawing-room.  At the termination of this period, the rev. gentleman hired a cab, drove to the station, and took a train for the North, bearing with him the oak coffin and the precious remains.  Where the funeral took place seems to be somewhat of a mystery – at least there are conflicting accounts – but of one thing people seem to be certain.  The ceremonial respect which had been accorded to the deceased was maintained to the last, and the burial service, or part thereof, was recited at pussy’s grave.”

The majority of historical reports on cat funerals from the Victorian era are recounted with humor.  Others show a darker response to pet burials.  A September 1885 article in the Edinburgh Evening News relates the story of an “old old woman” in Abercromby Street intent on giving her deceased cat, Tom, a “decent burial.”  She applied to the local undertaker to build Tom a suitable coffin and employed a gravedigger, by the name of Jamie, to dig a grave for Tom in the local burying ground.  As the article states:

“…the funeral, which took place in the afternoon yesterday, was largely attended.  Miss — carried the coffin, and on the way to the graveyard the crowd of youngsters who followed became exceedingly noisy, and being apprehensive that the affair would end in a row, ‘Jamie’ closed the iron gate with the view of preventing any but a select few from entering.  The crowd, however, became even more excited, scaled the wall, hooting and yelling vociferously, crying that it was a shame and a disgrace to bury a cat like a Christian.”

sorrow-by-mile-friant-1898

Sorrow by Émile Friant, 1898

Whether this uproar was truly a result of outrage over Tom being buried “like a Christian” or simply an excuse for rowdy youths to misbehave is unclear.  Regardless, the results of the riot that ensued were exceedingly unpleasant for Tom’s elderly, bereaved owner.  The Edinburgh Evening News reports:

“The coffin was afterwards smashed, and the body of the cat taken out, and ultimately the uproar became so great that the police had to be called to protect the gravedigger and the old lady.  The latter managed to get hold of the dead body of Tom, and with the assistance of Constables Johnston and Smith escaped into a house in the neighborhood, where she remained for some time.  In Abercromby Street, where she resides, a number of policemen had to be kept on duty till a late hour in order to protect her from the violence of the crowd.”

Perhaps the main cause of outrage lies in the fact that Tom’s owner was attempting to bury a cat in the human graveyard.  This was not an uncommon complaint.  Many graveyards did not allow pets to be buried in consecrated ground.  As a result, pet cemeteries were established.  One of the most well-known was the Hyde Park Dog Cemetery, opened in 1881.  As the name denotes, this was primarily a burial ground for dogs.  However, according to author Gordon Stables (qtd. in Animal Death 22), the cemetery also admitted the corpses of “three small monkeys, and two cats.”

Other pet cemeteries existed throughout Victorian England, both public and private.  The pet cemetery at the Essex seat of Sir Thomas Lennard had pet monuments dating as far back as the 1850s.  While the pet cemetery at Edinburgh Castle originated as a burial place for 19th century regimental mascots and officers’ dogs.  And I would be remiss if I did not mention author Thomas Hardy, who had a pet cemetery at his home at Max Gate in Dorchester in which all but one of the headstones were carved with the famous novelist’s own hands.

Unsurprisingly, the majority of headstones and monuments in pet cemeteries of that era are for dogs.  Dogs were incredibly popular pets during the 19th century.  They were typically viewed as selfless, devoted friends and guardians.  While cats were, to some extent, still seen as sly, self-serving opportunists (for more on this, see my article Peter Parley Presents the Treacherous 19th Century Cat).  In addition, as author Laurel Hunt points out in her book, Angel Pawprints:

“Queen Victoria’s fondness for dogs strengthened their role as companions in the Victorian era.”

This bias in favor of dogs had no effect on Victorian cat fanciers whatsoever.  Cat funerals continued to take place with just as much pomp and ceremony as dog funerals.  The public reaction to both was very much the same – amusement, outrage, and occasionally scorn.  One of my favorite examples of the latter is from an article in an 1880 edition of the Portsmouth Evening News which reports on a lady who sent out “black-edged funeral cards” upon the death of her dog.  As a sort of disclaimer, the article states:

“It is superfluous to affirm that the owner of that lamented Fido is a maiden lady.”

It does seem that a great many reports of pet funerals in the 19th century news involve some stereotypical variety of spinster – the Victorian cat (or dog) lady, if you will.  Though humorous, I do not believe this was the norm.  The simple fact is that, throughout history, there have been people who have grieved at the loss of their pets.  During the Victorian era, this grief took shape in elaborate pet funerals.  For cats, who were still persecuted in so many ways, these ceremonies strike me as especially poignant.

Elizabeth Platonovna Yaroshenko by Nikolai Yaroshenko, 1880

Elizabeth Platonovna Yaroshenko by Nikolai Yaroshenko, 1880

I close this article with poet Clinton Scollard’s 1893 elegy for his cat, Peter.  In her book Concerning Cats (1900), author Helen Winslow claims that this tribute to a deceased cat is the “best ever written.”  I’ll let you be the judge.

GRIMALKIN.
AN ELEGY ON PETER, AGED 12.

In vain the kindly call: in vain

The plate for which thou once wast fain

At morn and noon and daylight’s wane,

O King of mousers.

No more I hear thee purr and purr

As in the frolic days that were,

When thou didst rub thy velvet fur

Against my trousers.

How empty are the places where

Thou erst wert frankly debonair,

Nor dreamed a dream of feline care,

A capering kitten.

The sunny haunts where, grown a cat,

You pondered this, considered that,

The cushioned chair, the rug, the mat,

By firelight smitten.

Although of few thou stoodst in dread,

How well thou knew a friendly tread,

And what upon thy back and head

The stroking hand meant.

A passing scent could keenly wake

Thy eagerness for chop or steak,

Yet, Puss, how rarely didst thou break

The eighth commandment.

Though brief thy life, a little span

Of days compared with that of man,

The time allotted to thee ran

In smoother metre.

Now with the warm earth o’er thy breast,

O wisest of thy kind and best,

Forever mayst thou softly rest,

In pace, Peter.

In Memoriam by Alfred Stevens, (1823-1906)

In Memoriam by Alfred Stevens, (1823-1906)

Complete Article HERE!

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01/24/16

WELCOME TO THE TOWN OF THE DEAD

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For 75 years, Colma, Calif., has been steadily collecting bodies and it’s constantly getting deader. As of 2009, the city had 1,500 living residents and 1.5 million marked graves. Seventy-three percent of Colma’s land belongs to the dead with the rest occupied by people who have a great sense of humor. The town’s motto: “It’s Great To Be Alive In Colma.”

 

Complete Article HERE!

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