Month: August 2019

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Working Too Hard For A Good Death

Has Competitive Dying Become A Thing?

By Howard Gleckman

We Americans love to compete. We bet in March Madness office pools on who will win the annual college basketball championship. We pay a pretty penny for the best manicured lawn in the neighborhood or the biggest flat screen in the condo.  Some of us will pay bribes to get our kids into the best colleges.

And, now it seems, there is a growing need to compete over who will have the best death. You know, the one where we are at home, pain-free but alert, surrounded by our loving families, singing our favorite songs, fully at ease with our last moments of mortal life.

For many of us, the reality will be quite different. Despite everyone’s best efforts, we may die in a hospital. The kids may not make it in time from their homes in LA or Chicago. The medications that relieve our pain may also slow our thinking. And we may not have resolved all those family issues that lingered inexplicably for decades.

More guilt

What’s troubling about this drive for a good death (or, perhaps in our competitive world, the best death) is that many of us never will achieve it—often for reasons out of our control. And that may leave our surviving loved ones with an even bigger sense of guilt than they already have. And paradoxically, those who cared the most may end up feeling the most guilty and depressed.

Failing at some ideal of death may even make dying more difficult. Dr. Andreas Laupacis, a palliative care physician and professor of medicine at the University of Toronto, shared this concern in a wise 2018 essay about the idea of good death: “I worry that the term makes people who die with pain or psychological distress think that it is partially their fault…. They haven’t tried hard enough or aren’t tough enough.”

He even suggests it may add to the psychological burden of their doctors: “I worry that health care practitioners who have provided their best possible care will feel inadequate.”

A good life

Just as troubling: An excessive focus on the last hours of life shifts attention from the months or even years before that. Many older adults will die after living a long time with chronic conditions. It would be nice, as we focus on a good death, if we also think about a good life, especially during the time when it may include some level of disability.

The idea of competitive dying may be counterproductive in part because there is no true good death. Or rather, there are millions of them. For decades, clinicians have tried, and largely failed, to establish some agreed-upon norms. And researchers have no real idea how many people do in fact die a good death, by whatever measure.

Physicians and surviving family members, it turns out, often have different ideas of a good death than those who are doing the dying. For example, family members are much more likely than patients to say that maintaining dignity is important at the end of life.

But this uncertainty isn’t slowing us down. Google “good death” and you’ll get 1.97 million hits. Search Amazon, and you’ll find dozens of books. Bloggers blog on their own impending deaths or that of their relatives. A 2016 literature review turned about three dozen peer reviewed articles on what constitutes “successful dying.”

Better to watch a sunset

One Amazon reviewer wrote that she had read 60 books on a good death to prepare for her own passing. I don’t know if she was living with a terminal disease or just thinking way ahead. But I can’t help but wonder if her time would have been better spent watching a sunset, going to a concert, or having dinner with friends instead of being so focused on how to do death right.

This trend is by no means all bad. We are thinking—and talking—about a topic that for too long has been taboo in the US. But like those parents who were bribing college officials to get their children into the best schools, we may be going overboard. And we may be setting unrealistic, and counterproductive, expectations for ourselves and our families.

We absolutely should be proactive when it comes to preparing advanced directives, choosing health care proxies, and talking to one another about death. Especially talking. But we also need to recognize that, sometimes, circumstances mean that many of us will die alone, or in some pain, or with unresolved family issues. All we can do is our best. And nobody should be keeping score.

Complete Article ↪HERE↩!

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What’s healthy dying?

6 steps on the path for doctors to know

By Timothy M. Smith

Most Americans die in hospitals, but acute care settings are by default focused on saving lives and therefore struggle to deal with death as something other than the unfortunate outcome of having no interventions left to try. An expert in end-of-life care notes that death is an essential part of life for patients and their families and suggests several steps physicians can take to make death a “healthy” experience.

For starters, Chapple said, one should acknowledge that the aim of acute care settings is to rescue patients, to avoid death at all costs.

“If there is an intervention to try, that’s what we’re going to do,” Chapple said, noting that this urge is reinforced by health care payment mechanisms, as well as by family members’ anguish. “So, it’s very difficult to move in a different direction. It’s like a train that you can’t jump off of.”

Trying everything, however, can undermine our cultural and clinical capacity to acknowledge the importance of dying, Chapple said. She suggested taking the following steps to reinforce the concept of dying in a healthy way.

Focus on patient safety and autonomy. “I worry that patients are overmedicated or undermedicated, that we’re not reacting to what’s really happening to the patient,” Chapple said. “Healthy dying is when patients themselves get to choose the agenda and get to take their own time—as long as they’re not suffering at all, or they appear not to be suffering—and we all just take their timetable and let it happen.”

Acknowledge death as a part of life. This begins with making the most of what Chapple called the “critical present” by suggesting that family members take time to reflect on the patient’s life. “It’s sort of antithetical to the way acute care is set up, which is doing all the time, rather than being, rather than existing and noticing the existential significance of where we are right at this moment,” she said.

Reset loved ones’ expectations. In critical care, Chapple often tells families, “This person has never died before, and this is our chance to make it the best dying they can possibly have.” She suggested preparing family members for what might happen logistically, such as transferring the patient to a step-down unit, and noting that the active dying phase can last several days.

Encourage family members to talk to patients. Hearing is thought to be one of the last senses to go in dying patients, so it may help to share memories. “Families may not talk to each other because they think the family knows all the stories,” she said, so members of the care team can help initiate this by asking about significant events in the patient’s life.

Note the importance of religious rituals. Ceremonies, prayers and songs can help make this time meaningful too.

Suggest loved ones say goodbye in their own ways. Let family members know the following, Chapple suggested: “If you want to … say to the person something that you’ve always wanted to say and never had the opportunity or you certainly want them to know before they die, this is the time to do that.”

Complete Article ↪HERE↩!

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Obituaries are the only redemptive news anymore

By Philip Kennicott

Toni Morrison is dead. So are D.A. Pennebaker and Aretha Franklin, and Philip Roth, Stephen Hawking, Ursula K. Le Guin, Milos Forman and too many others to name, even when limited to artists and writers who have perished in the past few years alone. By some accounts, two people die every second, thousands every hour, tens of millions every year. But at this moment in American life, the death of our best people has become a collective lifeline and refuge for our anxieties. It sometimes seems that the obituary is the only news that makes us feel whole.

Morrison was our essential conscience, a writer of narrative brilliance and moral clarity. The magnitude of her loss, at this moment in our descent into barbarism, is incalculable. But to spend time today with her work, with memories of her life and the testimony of those who knew her, is infinitely more rewarding than reading about all the other terrible things that have happened in the past few days. The deaths of artists and other creators make us reflective, and we live at a moment when looking back is much easier than looking forward.

We also crave the reassurance that we are not, as a species, entirely spent. Morrison died only days after two mass shootings, which are not only a regular fixture of American life, but also a recurring reminder of our political paralysis and the corruption of our democracy. We are in the midst of a trade war, markets have plunged, Greenland is hemorrhaging ice and our president tweets racism to inflame a hungry audience of white nationalists who dream of a world without people like Morrison in it.

Death and remembrance, at least, come with the customs and norms that have been shredded in most of the rest of public life. If nothing else, death still inspires a pause in ordinary life and, in the case of artists, a respectful consideration of their habitually ignored accomplishments. The reflective look back on a life and a body of work such as Morrison’s is ultimately celebratory, a chance to think the best of another person and, by extension, ourselves. Artists, performers, scientists, writers and other creators rarely “make news” in the same way politicians do, even though their influence on our culture is greater, deeper and more meaningful. The obituary is a belated observation and acknowledgment that people like Morrison, in fact, made news every day through their work. They formed the deeper part of the minds that our pollsters seek to measure and quantify in the frenzied haste of the news cycle. They are the atmosphere of American culture, while all else is merely weather.

Obituaries are a paradox of sorts, a distraction toward meaningfulness, a diversion to what really matters. The response to the rest of the news is often an impulse to escapism, a turning away. But while Morrison shares space with the usual firehouse of bad news, her passing offers at least one impulse to go deeper, to read more, dig in, think more critically and disconnect from the ephemera. Obituaries like the ones that have been written about her in the past day are even better than the usual “good” news, which is often little more than a reminder that somewhere, somehow, someone has done an unnecessary kindness; obituaries are redemptive on a grander scale.

We seem capable of only two modes of existence: panic and sadness, the former fast-paced and full of collateral damage to the world around us, the latter at least sometimes constructive and reflective. America has experienced periods of intense reflection around death in the past, as when the last remaining veterans of the Revolutionary War were dying in the middle of the 19th century, leaving people to wonder whether there were any steady voices and clear heads to steer us away from, or through, the accumulation of civil strife and political violence. The deaths of those who fought in World War II offered an occasion to think about the fraying of the old 20th-century social contract, the dissolution of the bond between the generations enshrined in key social-welfare programs, and the extinction of American optimism — that we might live in a society without poverty, without unnecessary suffering, with genuine opportunity and social mobility.

But the death of an artist is different from the loss of political leaders, no matter how wise or benevolent, or the larger passing of a generation, which has continued since the beginning of time. Morrison’s work remains with us, intractable, urgent and uncompromising, and it is no less effective today than it was on Monday. It is curious to listen to people on television debating the effectiveness of this policy or that plan, often arguing themselves into the absurdity that because nothing has yet worked, therefore nothing new should be attempted.

Meanwhile, the work of artists outlives them, operating on minds too young to be cynical. Politicians die and, if they’re lucky, are memorialized for having fixed something in the broken world they inherited. Artists die, and we flock to what they left behind, reanimating it, refreshing its meaning and reincorporating it into the body politic.

If you want to change the world, authentically and for the better, would you live your life like a politician, or a businessman, or a pharmaceutical executive or Donald Trump? Or would you live it like Toni Morrison?

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What Airplane Conversations and a Grieving Brain Have in Common

By Cara Martinisi

On a recent flight home after visiting family in Florida, I sat in between my two boys with my eyes closed. I knew as soon as I took out a book someone would need something so I just sat and listened. Admittedly, I enjoy people watching and conversation eavesdropping anyway.

As I listened to a woman and man in the row across the aisle, I conjured up their personal stories in my head. At first I thought they were a couple. Quickly and succinctly I realized I was wrong due to my honed in eavesdropping skills. While everyone was preparing for take off I learned that the woman was married and had two little girls. I was unable to tell if he was married, but he did have an older son. The engines whirred to life, safety demonstrations were given and my son’s ear started to bother him. Not very productive in the people watching and eavesdropping department. Things did calm down and I settled back in.

With my eyes closed, I put all my energy into listening. The background noises, however, made it difficult to hear anything other than random words mixed with the lilting of their voices. I was unable to decipher their full conversation.

The feeling was so familiar to me. It took a moment to place why the feeling was so reminiscent, but once I did it made sense. Only able to hear bits and pieces of conversations prevented me from being able to process the entirety of their stories. Much like when an individual is grieving and their brain is consumed with grief.

For the first year, at least, after losing my son my brain was on constant overload. People would speak to me and I would listen, but was only able to grasp bits and pieces of what they said. The distractions — my sadness, pain and grief — prevented me from processing in its entirety. Oftentimes at night I would dream about what I had spoken to someone about that day. The next morning I would revisit the topic with them, able to process it slightly better because my subconscious had worked it over while I was sleeping.

The concept fascinates me. My brain simply cannot handle all of the stimulation. To this day, I become overstimulated much easier than I did in the past. Multitasking is much more difficult for me. Furthermore, my dreams have always been extremely vivid but now they are so vivid I have to ask others if it really happened. These changes are undoubtedly due to the trauma.

Specialists and therapists have said that the brain is a self-healing organ. In my experience this is true. It will continue to heal, but will never go back to being what it once was. There will likely always be “airplane” conversations when I am overstimulated. The daily grief that will forever be a part of my life is not as persistently intense as it once was. When the waves of grief wash in, however, they knock me right down.

My processing abilities have changed, but so has everything else. It would be a wonder if these abilities were not affected. Healing doesn’t mean that things go back to the way they were, but rather the changes are not as intense anymore. In the nearly five years that have passed I have learned nothing if not to adapt to change.

Complete Article ↪HERE↩!

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Self-Care While Grieving The Death Of A Loved One

by Shoshana Berger

“Next to birth, death is one of our most profound experiences—shouldn’t we talk about it, prepare for it, use what it can teach us about how to live?” So begins A Beginner’s Guide to the End, a new book that provides insights on how to move through every part of the dying process as a patient or a loved one. In this excerpt, authors BJ Miller, M.D., and Shoshana Berger reflect on the stigmas surrounding heartache and grief, and how we can move through these emotions while honoring our own mental and physical health.

Grief can be isolating.

Rebecca Soffer, a cofounder of the Modern Loss website and community, was 30 when her mother was killed in a car accident. Soffer took two weeks off after her mother’s death and had barely started to grieve before returning to her job as a television producer. Three years later, she received a call from someone asking her to arrange to get her father’s body picked up; he’d had a fatal heart attack on a cruise ship while traveling abroad.

Stunned by the trauma of losing both parents within a few years of each other, she again dove back into work shortly thereafter. “Honestly, after each loss I felt like I was dying inside myself, and so few people knew what to do with me,” she says. “Unless you’re an incredibly empathic human being, if you haven’t gone through profound loss yourself, it can really be difficult to effectively connect with someone moving through it. I felt like a pariah because this topic felt so taboo. If someone asked where my parents were, I’d say, ‘In Philadelphia.’ I didn’t clarify that they were, in fact, underground there. It was just so much easier to be vague.”

When she did come clean to people who asked about her family, it felt as though the space around her was getting sucked into a black hole. “There are few better ways to silence a conversation than to say, ‘My mom just died,'” she says. “All I wanted was to feel like I could comfortably talk about my reality, not like people felt I might be contagious just because I’d used the word dead.”

Taking care of yourself.

You never “get over” the death of a loved one—that’s not the goal. Living on is. Here are a few ideas that may help:

1. Take time off work.

Sadly, businesses are not required to offer paid bereavement leave, but many do provide three to five days off for the death of an immediate family member. Talk to your HR department about what’s possible for you.

2. Seek out clergy, chaplains, and faith-based services.

Faith traditions have time-tested practices around death, dying, and mourning. Chaplains and clergy are trained to counsel those in bereavement. Hospital chaplains in particular are intimately familiar with supporting people of all faiths and of none. And many churches, synagogues, mosques, and other houses of worship have free programs and groups for grief support.

3. Contact your local hospice provider.

They are required to offer bereavement services to the community, whether or not your loved one was enrolled with their program. Despite the legal mandate, the funding for bereavement programs is paltry, so the services may not be robust, but they’re a good place to start. Hospice agencies are terrific local resource centers as a rule and will often keep a list of psychotherapists and grief counselors in the community who may be of further help to you.

4. Attend support groups or find them online.

Being with others who are working through grief can bring relief (no more pretending everything is OK). These are generally facilitated by mental health care professionals or other counselors. Less formal peer groups can be wonderfully helpful as well. The common thread is a safe place, real or virtual, where you can air your thoughts and feelings and be with others who are in a similar place. Here you are more likely to be seen and heard, not judged. Inquire with the hospice agency or your clinical team or hospital, or search for local groups online.

5. Try psychotherapy.

If you’re prone to clinical depression or anxiety or are experiencing suicidal thoughts, don’t mess around. It can be difficult to tease out grief from depression, so err on the safe side and get help. Therapy can work wonders, even if you’re not depressed.

6. Ritualize.

American culture has largely lost touch with the grief rituals of the past and the wisdom behind them: hanging crepe in the windows, wearing black, wearing an armband, to name a few. These physical symbols buy some space for you and everyone around you. People are more forgiving and respectful; expectations of you adjust. With traditional rituals, you’re tapping into a time-tested collective understanding of what you’re going through.

With these tracks already laid, you get to step away from your swirling mind and follow an old pattern of action without the burden of thought. If, however, you don’t want to follow tradition, you might gain an important but different power by creating your own ritual, a touchstone whose meaning you will always understand.

7. Journal.

Each day before you go to bed, write down one thing you’ve managed to do (even if it was just waking up). Or just write about your experience. There’s no need to keep what you write; just get it out and throw it away if you like. Writing, much like talking with other people, is a way to understand and process what you’re going through, and it can also help you not take your thoughts too literally; your mind in grief might suggest all sorts of odd things to you.

8. Get fundamental.

Since grief is discombobulating, it pays to remember the basics of life. Try taking your shoes off, and feel the ground beneath you; take slow, deep breaths; drink water; eat good food (and really taste it); sleep.

9. Make some new “family rules.”

If you’ve lost a central part of your nuclear family, it can shake the very foundation of the unit. Writing down some family rules in a place where everyone can see them is one way to introduce much-needed stability.

Things such as forgiveness, getting plenty of sleep, respecting one another’s feelings, working together to get things done, and remembering to ask for help when you need it are great reminders that you are all in this together.

Complete Article ↪HERE↩!

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When your time is up, I hope you drop like the dead donkey

The sooner we realise we are all going to die the better – it gives us time to get used to the idea

‘It took the death of a neighbour down the road when I was in my 20s to make me realise that one day I myself would die.’

by Padraig O’Morain

The first time I experienced death as real was when I watched a donkey being put down at the crossroads beside the farm I grew up in.

I was probably about seven or eight at the time. The donkey had been around for a few days and nobody knew where she had come from.

Somebody got in touch with somebody and a man came out from Naas to deal with the situation. He must have come to our house first because I remember following him up to the crossroads.

He stopped in front of the donkey and quietly took the humane killer, as it is called, out of a bag. This instrument is like a gun that drives a spike into the brain. He patted the donkey’s head, put the humane killer against her forehead, and killed her.

I’ve always remembered that the donkey was dead when she hit the ground.

I don’t know what happened next. I suppose the man went off, that I inspected the donkey, that the kennels of the Kildare Hunt took her away to feed hounds. That was how we got rid of dead cattle and other large animals.

Spread a tablecloth by the graveside, bring a picnic basket with the cucumber sandwiches, the homemade apple tart, the wine and the lemonade and enjoy

I was no stranger to animals dying, and every year we killed turkeys for the Christmas market. I was able to approach these deaths in a pragmatic manner.

What had really struck me about the donkey was that she died as she fell. I had never realised how quickly life could disappear.

Shortly after the death of the donkey, I found two white candles wrapped up inside a drawer in a sideboard in our gloomy sitting room.

I immediately assumed the candles were for use when either of my parents died.

In all probability, the candles had been put aside for a power cut but, as I say, the room was gloomy. Also, the sideboard has come from a priest’s house in Allenwood where, some years previously, a maidservant was possessed by the Devil. She had had to be exorcised to stop her breaking plates and furniture and terrifying the priest. We called the sideboard “the Devil’s sideboard” and we imagined Satan was inside.

Gloomiest possible conclusion

So it’s understandable I came to the gloomiest possible conclusion.

But that realisation – and I still recall the chill of it – was about the death of other people. It took the death of a neighbour down the road when I was in my 20s to make me realise that one day I myself would die.

This realisation comes to everybody sooner or later and I think sooner is better than later. It gives you time to get used to the idea. It becomes like a shadow, sometimes behind you and sometimes in front of you but you get used to it. I suspect if it comes too late in life it can hit hard, shattering your protective illusion that death happens to the rest of humanity but not to you.

I was led to these thoughts by Laura Kennedy’s recent article in The Irish Times in which she advised that the inevitability of death should motivate us to get on (within reason) with what we want to do.

I agree with her and I would add two points. First, it’s okay to be afraid of dying because to be unafraid of dying is not natural.

Second, if you want to get more out of life, remember that you don’t have to go skydiving, mountain-climbing or jet-skiing unless you want to. For some, going to the movies once a week would make a really big difference to their quality of life. For others, to make a difference, they might have to sail around the world. One type of person is not better than another type of person.

So spread a tablecloth by the graveside, bring a picnic basket with the cucumber sandwiches, the homemade apple tart, the wine and the lemonade and enjoy. And when the time comes I wish you as quick a step out of this world as the donkey had.

Complete Article ↪HERE↩!

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How to Transport a Dead Body by Plane

By Elizabeth Yuko

People die every day—and yes, that includes when they’re traveling. It’s not something most of us think about when planning a trip, but for some, it’s an unfortunate reality. But what do you do if you’re traveling with someone and they pass away? It’s not like you can Weekend-at-Bernie’s them and fly them back on their original coach ticket—so what are your options?

In short, it depends on the circumstances of the person’s death and where it happens. Though it’s important to remember that each situation is different, here are a few tips to help get you started.

Acknowledge your grief

If the deceased is a family member, friend, partner or colleague, you are likely in shock and grieving. According to Robert Quigley, M.D., senior vice president and regional medical director of International SOS, the world’s largest medical assistance and security company, your first step should be to address the fact that you’re grieving. “It’s important that you’re emotionally stable when you start this process, because the process is extremely complicated,” he tells Lifehacker.

Take into consideration the circumstances surrounding the death

If there was any foul play suspected in the person’s death, then the authorities—meaning the local police or embassies—first need to sign off on any paperwork before the body is transported anywhere, Quigley explains. In this case, it could take weeks for the body to be released and cleared to travel.

But for the purpose of this article, let’s go with a hypothetical scenario that doesn’t involve foul play—like a relative having a sudden heart attack and dying while you are traveling together. More information on what to do in the case of a suspicious death—and pretty much every other scenario imaginable—is available in a detailed whitepaper from International SOS. The organization assists with the transport of approximately 2,500 deceased individuals each year, Quigley says, and has seen it all over the course of their 36 years in business.

Connect with a local funeral home

If someone dies while traveling, they will likely end up at a local hospital where they will be pronounced dead by a doctor or medical examiner, who will then fill out the appropriate paperwork. Since you are not from the area, the hospital should be able to put you in touch with a local funeral home. From this point on, the funeral director will be your main point of contact in the process of transporting the person back home.

If the death occurs abroad, Quigley says that there is huge variation in the quality of funeral homes and services around the world in terms of how they prepare and transport the bodies, taking into consideration different cultural and religious traditions. This includes factors like whether or not they embalm bodies, or if cremation is an option.

At this point, you may want to seek help from a medical assistance company like International SOS or Global Rescue to help you make local connections and the arrangements necessary for the remains to cross borders. Medical assistance companies work closely with insurers and hospitals to provide the medical services people may require while traveling—including in the event of their death. Like insurance policies, the cost of these services varies significantly, depending on where you’re traveling, your age, your health, the length of your trip and other factors. Your best bet is to either visit the company’s website or contact them directly for a quote.

If the death occurs in the United States and you are looking to transport the body to another location in the United States, it’s a little more straightforward.

Chances are, the funeral home has done this before and has a good idea of which local airlines are the best options, given that each have different criteria for transporting human remains. Quigley says the funeral director will ask you questions regarding how you’d like the remains handled (i.e. embalmed, not embalmed or cremated) and let you know how much it’s going to cost—more on that later.

According to Elizabeth Fournier, a funeral director in Oregon, in her experience, most dead bodies traveling within the United States are transported on Delta or American Airlines. Typically, funeral homes contact the cargo department of a particular airline and make a reservation. The ticket is not purchased until the body actually arrives at the airport, she says, because plans change all the time. For example, sometimes a family member decides at the last minute they want to be on the flight with the body, or there may be a delay with the paperwork. A body must arrive at the airport at least two hours prior to the flight’s departure. In addition, there has to be a funeral home lined up at the final destination, which will then claim the body from the cargo area of the airport, she explains.

If the body is traveling within the United States, Fournier says you just need a death certificate and a permit. However, other regulations involving the type of transportation and the condition of the remains vary from state-to-state, so make sure to check local laws before doing anything. Usually the local funeral home is familiar with the laws on their end and can help you navigate any other legal questions.

And as Quigley explained previously, you’re arranging for human remains to be transported internationally, you’ll need additional documentation from authorities in both the origin and destination countries. This can become even more complicated if the person died abroad of an infectious disease (another topic addressed in the International SOS whitepaper). In these situations, those handling the remains must balance respect for the deceased, with the health and safety of those who come in contact with the remains, like a coroner or mortician. Depending on the type of the infectious illness, the body may be placed in quarantine, in compliance with local regulations and public health authorities. For example, the remains of those who had smallpox, plague, botulism, Ebola, Lhasa fever, Junin fever or any viral hemorrhagic fevers are typically treated with more caution. Those with yellow fever, encephalitis, HIV, tuberculosis, shigella, Nipah virus or Hanta virus may also require special handling or quarantining, though do not pose as much of a danger to the people who come in contact with the body as the illnesses in the first category.

Preparing the body

Again, the funeral home will handle any preparations necessary for the body before it is transported. This is another case of checking state laws: some allow unembalmed bodies to travel, while others require embalming or cremation.

According to Fournier, prior to a flight, the average deceased person would be embalmed and then placed in an air tray—a wood-bottom tray with a lid made of cardboard. The body may or may not be wearing clothing. She recently shipped a body from Portland, Oregon to Austin, Texas. They were unembalmed and they flew on Southwest—one of a handful of airlines that permit unembalmed bodies (yes, in addition to considering state laws, you also need to check on airline regulations).

That said, the process of preparing the body for a flight is relatively straightforward, according to Fournier. First she double-wrapped the body in plastic, then packed it into an air tray filled with cooling gel packs. Typically, caskets aren’t used in this process, she explains, because there’s a good chance the casket could get damaged during travel. Instead, caskets are usually purchased from the funeral home on the receiving end of the flight. Once the body has reached its final destination, the receiving funeral home will take over the rest of the arrangements.

The costs of shipping a body

Initially the funeral home—either the one shipping or receiving the body—pays for the cost of transporting the body and that expense is then added to the rest of the cost of the arrangements. Like plane tickets for the rest of us, fares vary for shipping human remains. For example, the ticket for the body Fournier sent to Texas from Portland cost $750, while shipping another person from Portland to Idaho a few months ago cost $500. Cargo passage to the Netherlands from Oregon costs nearly $2,000, she says.

If a person dies while traveling for business, Quigley says that oftentimes the deceased’s employer will assist the family with bringing their loved one home. They may even bridge the gap in costs if the person’s insurance doesn’t cover the transport of their remains, which, he says, is pretty typical. If this is coverage that you do want, he suggests reading the fine print on your insurance policies—including any life, health or travel insurance (including policies that come with certain credit cards) you may already have—though note that most policies don’t cover all of the multiple steps involved with transporting human remains. For example, one of your insurance policies may cover the plane fare, but not the cost of embalming. Or, it may have a sub-limit on the cost of the coffin, or stipulations on coverage based on the cause of death, according to the International SOS whitepaper. But, as is the case with other types of insurance policies, Quigley says that you can purchase a rider specific to your needs.

Transporting cremated remains

If the deceased has been cremated prior to traveling, it is much easier to transport the remains. Most U.S. domestic airlines allow you to bring human ashes in your carry-on, but again, this is something you should check with the airline first. However, it is important to select a TSA-approved urn in order to make the process as smooth as possible. It is illegal for TSA employees to open the urn in order to determine what’s inside—even if requested by the passenger—so it must be X-rayed. As a result, select an urn that is easily X-rayed, like one made out of a light-weight structure like wood, cardboard, fiberboard or plastic—even if it’s only temporary.

Though TSA doesn’t require that you disclose that you’re carrying human remains, if you’re worried about being stopped for having a suspicious powder substance, you may want to bring the deceased’s death certificate or other documentation from the funeral home as proof.

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