With respect to end-of-life care, physicians’ likelihood of dying at home is similar to that of nonphysician patients, a Canadian study suggests.
“Overall, they did not consistently opt for less-aggressive care but instead used both intensive and palliative care more than nonphysicians,” Hannah Wunsch, MD, from the University of Toronto, Canada, and colleagues write in an article published online July 24 in JAMA Network Open.
Intensive end-of-life treatment is common in North America, often going against patients’ previously reported preferences. Previous studies have suggested that physicians in the United States are somewhat less likely to die in the hospital than other patients, suggesting they may be better able to match their care with their preferences.
To see if that pattern held true in a system with universal healthcare, Wunsch and colleagues compared the intensity of treatment received by physician and nonphysician patients at the end of life in Ontario, Canada.
“The primary outcome was location of death, with the hypothesis that physicians are more likely to receive less-intensive end-of-life care,” the authors write.
The researchers analyzed medical and death records of 2507 physicians and 7513 nonphysicians who died between 2004 and 2015.
They found that physicians were no more likely to die at home than nonphysicians (42.8% vs 39%; adjusted relative risk [aRR], 1.04; 95% confidence interval [CI], 0.99 – 1.09). However, physicians were more likely to die in an intensive care unit (ICU) (11.9% vs 10%; aRR, 1.22; 95% CI, 1.08 – 1.39).
The data also showed that, in the 6 months before death, physicians were less likely to visit an emergency department (73% vs 78.4%; aRR, 0.96; 95% CI, 0.94 – 0.98), but more likely to be admitted to an ICU (20.8% vs 19.1%; aRR, 1.14; 95% CI, 1.05 – 1.24), and to receive palliative care (52.9% vs 47.4%; aRR, 1.18; 95% CI, 1.13 – 1.23).
However, a subgroup analysis of patients with chronic conditions showed that physicians (n = 1375) were more likely to die at home than nonphysicians (n = 4117) (35.2% vs 30.7%; aRR, 1.12; 95% CI, 1.04 – 1.22). Among those with cancer in this subgroup, physicians were also more likely to die at home (37.6% vs 28.6%; aRR, 1.30; 95% CI, 1.13 – 1.50), and to receive chemotherapy in the last 6 months of life (37.9% vs 29.8%; aRR, 1.28; 95% CI, 1.13 – 1.46).
In an interview with Medscape Medical News, study coauthor Robert A. Fowler, MDCM, MS(Epi), also from the University of Toronto, was struck by how his group’s findings differed from the US studies.
“We wondered whether this might relate to differences in payment systems for healthcare services in the United States, in comparison to Canada where we have a theoretically universal healthcare system for in-hospital care, yet often have more limited options for home-based and palliative care at end of life.”
Overall, Fowler expressed surprise at the findings of both the US and Canadian studies — “chiefly, that many elements of end-of-life care are, despite some differences, remarkably similar among physicians and the general population.”
This was different from his group’s original hypothesis that physicians would opt for much less inpatient care.
“It was interesting that we did see that physicians were both more likely to receive treatment in an ICU, known for its use of technology-laden care,” he added, “and also more likely to receive palliative care at the end of life.”
According to Fowler, this offers a more nuanced perspective of what physicians may perceive to be optimal care at the end of life, as opposed to a simplistic notion of ‘more’ or ‘less’ being better: “Sometimes, more aggressive care is warranted,” he said, “yet, at other times, focusing more squarely on comfort is best.”
Rachel O’Neill knew her mother had terminal cancer, but there was never a timeline put on it
Rachel O’Neill with her mother Marie: ‘No matter what happens, a mother’s love lasts forever’
by Rachel O’Neill
I’ve six months to live.”
Five words that turned my life upside down.
I always knew that terminal cancer was something I would have to deal with. But because there was never a timeline put on it, it was something I didn’t have to think about. Sure, Mum had incurable cancer, but it wasn’t something that was going to affect me right this second.
And then suddenly it was there, affecting every part of my life.
In the time it took to say those five little words, my entire status changed. I was no longer someone whose mother was sick, I was someone whose mother was dying. Life as I knew it was officially on pause.
Suddenly, the “how’s your Mum doing?” questions become a lot harder to answer. I’m a very open person which means everyone tends to know everything that goes on in my life. I’m also a terrible liar. If someone asks me how Mum is doing, I will answer it very honestly. So honestly, that it can make people uncomfortable. I’ve had people squirm after I’ve told them that Mum is dying. I’ve had people shuffle awkwardly from foot to foot, desperately thinking of something to say that won’t upset me or them.
Now I’ve adopted a very simple tactic to counteract the awkwardness. I minimise what’s going on by joking about it instead.
Minimise, minimise, minimise.
Never let people see how badly you are struggling with it. I must never drop the facade that I’m managing to hold it together when in reality this is the worst thing I’ve ever had to face.
To make people comfortable, I tell them that my mother is dying and follow it with a quick “it’s fine”. I’ve joked about how I might finally be able to get on the property ladder with the inheritance. I quickly change the subject when I can feel people getting nervous, even if I’m bursting to talk about what’s happening. I’ve done everything I can to make people feel more comfortable around me because if I can joke about it, it means they can relax a little.
Nobody is truly comfortable with death.
Despite the fact that we “do death well” in Ireland, it’s still a subject that many of us won’t talk about. Confronting the fact that someday, we will cease to be here is something we’ll spend a lifetime trying to come to terms with. Many of us never do.
Knowing that myself and Mum have so little time left together is hard. I am terrified of regret, of saying the wrong thing, of not asking the right questions, of not making enough of our time together. It now feels like every conversation feels like it has to be meaningful in some way. I feel like if a moment with her isn’t memorable, I’ve wasted it. It’s a suffocating pressure to be under.
What has stood out to me is the endless kindness I’ve experienced from every corner of my life
The pressure manifests itself in many ways. For example, I’ve been in a perpetual state of anticipatory grief for the last few months. I’m grieving the life we won’t have together. I’m grieving that she won’t see me get married or meet her grandchildren. I’m grieving the advice she won’t be able to give me, the questions I won’t be able to ask her and the adventures she will never get to have.
That is a very painful process which your body does everything to protect yourself from. I’m constantly tense because I’m bracing myself for an impact that I know is coming, despite not being sure when it’ll hit. I feel like if I can process this pain now, it won’t be as painful when the inevitable comes. It’s the only way I know how to prepare for what’s coming.
Some people struggle to understand my approach. Some have even said to me that I need to move past the grief. They’ve said that my mum needs me to be upbeat and strong for her. To me, that feels fake. Anxiety and depression are in my DNA so worrying about the future and being down about it are things I’m very used to doing. It’s a coping mechanism that some people just don’t understand. They feel that I’m doing Mum a disservice, that I should pretend to be okay when in reality I am struggling badly with everything that’s happening. What I say to those people is that there’s no “right” way to grieve. It’s a uniquely personal process, best left to those undergoing it.
What has stood out to me over the past few months is the endless kindness I’ve experienced from every corner of my life. People offering food, time, shoulders to cry on and a kind ear to listen. People encouraging me to open up when I can and who treat me like a normal human being when I can’t. The empathy and kindness have been utterly overwhelming but serves as a reminder that people really do care. It gives me hope that when I come out the other side of this, I’ll have people who will help me build myself back up again.
Having discussed with Mum what happens when this is all over, she told me something that I’ll hold dear to my heart forever.
“Just let yourself be loved. It’s no more than you deserve and always carry with you that you are my beloved child. Always and forever.”
No matter what happens, a mother’s love lasts forever.
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.
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?
Inside the poignant, bizarre, and necessary world of tending to the belongings of the deceased.
By Shane Cashman
We park the box truck in the dead man’s yard like a six-ton hearse and knock on the front door. A disheveled middle-aged woman answers, still in her pajamas.
“I forgot you were coming,” she says, leaning out the door to see the truck. Emblazoned on the side: William J. Jenack: Estate Appraisers & Auctioneers.
“I’m a mess,” she says. “My mother’s dying.”
We ask if she wants us to come back another time.
“No, please come in.”
She’s been living in the dead man’s house for the last two years, a white Victorian-style home with blue shutters and ivy reaching up the side. She’d known the dead man, Stanley, her whole life. He was on Broadway and she used to sit in the garden as a little girl and watch him sing show tunes. Before he passed, she promised to take care of his home, which is decorated like Stanley’s still around. His photos hang on the wall; open songbooks are displayed on the piano.
You learn a lot about a dead man rifling through his house – lifting his furniture, clearing his walls, going through his closets, finding out which psalms are dog-eared in his Bible – searching for anything that might be worth selling at auction. It feels like trespassing.
One of the many rooms inside the houses of a seller, Alan. This house was used for storage only and was covered wall-to-wall with items he had picked up in his years working estates.
Sometimes the most genuine reflection of a person’s identity is found in the inscriptions they’ve written in books. Inside one of Stanley’s he wrote a note to himself titled Self Esteem:
I’m a handsome, wonderful human being who deserves a good life. I grabbed a mirror, gave it a big smooch and said, “I love you. You are the man, Yessur.”
Stanley’s neighbor drops by. He’s 85, bent over a cane, and speaks with a thick Ukrainian accent. He came over because he saw our truck. Now he’s asking for Stanley’s address book. But the lady tells him she threw it out years ago.
“You put him in a cemetery or you cremate him?” he asks.
“Cremation,” she says. “His ashes went to North Carolina with his wife.” She died fourteen years ago on Independence Day. She and Stanley never had kids.
The author moves a box of glassware from an estate.
In the garden we’re shown the four-foot-tall cast-stone fountain. Stanley’s house sitter says it stopped spitting water just before he died. We yank it out of the ground. Fat bugs crawl out from underneath.
“Stanley was gonna leave me a fortune,” she claims. “He said I’d never have to work again.”
“What happened?”
“It was never in writing…The lawyer was gonna come to the house on a Tuesday…to put it in writing. Stanley died that Monday. Of course, right? So I mourned the loss of my friend…and the loss of my fortune.”
Before we leave we even take Stanley’s mailbox, almost erasing him from the block’s history. The woman says she’ll call us when her mother dies so we can come get her stuff too.
At the beginning of a pick up in Parksville, New York, the truck was completely empty. Over five hours later, it was stuffed with more to be taken and a second pick up to be scheduled.
As auction gallery furniture movers, we do pickups year-round. My partner, Ryan Wagner, is 29, six-foot-two and 250 pounds. His size is crucial whenever we have to move things like 900-pound hand-carved marble Foo Dogs. Once, on a dare, he pushed the box truck across a parking lot with his bare hands. People tend to watch us move stuff like we’re in a sideshow. See the two men lift, sling, tip, slide, drag, tilt, duck, pivot and coffin things into a truck!
We start in the basement and work our way up through the house. We lift up mattresses, kick aside small tumbleweeds of hair and carry bedframes down the hall. We pack Halloween costumes and wedding dresses into banana boxes. We climb out bedroom windows onto roofs to see if weathervanes are worth anything. We step into decayed barns and collapsed sheds and pull tackle boxes, snow blowers, and tractor parts from the wreckage.
In March we traveled to the home of ninety-year-old Barbara Harris, who lived alone, save for her nurse, in Rock Tavern, New York. She was dying of Parkinson’s and couldn’t afford her farmhouse anymore.
Barbara was still in bed and the nurse led us around telling us what to take – portraits of horses, the dining room table, her rugs, her safe, and the crystal lamps on her mantle.
Four skulls and a few other miscellaneous bones from humans and animals are inspected at an estate. The current owner, Alan, came into possession of the skulls from working on the estates of doctors.
We heard Barbara struggling to lift herself out of bed and into her wheelchair. The nurse ignored the moans coming from Barbara’s room. “Take the stuff and go, go, go,” the nurse said. This was odd, so we stopped and waited for Barbara. “You’re not going fast enough!” the nurse yelled.
Barbara rolled herself into the living room.
“How are you, Barbara?” Ryan asked.
“Horrible,” she said. “I have an aide here who is so bossy. She’s taking everything off the walls.”
“We don’t want you to feel that we’re taking things out from beneath you,” Ryan said, even though we were there to do just that.
“I’m not comfortable with anything with her here,” Barbara said, trying to point at her nurse – her hand just trembled a little above the armrest.
“You can’t pay to heat your house,” the nurse scolded in response. “You’re going to freeze to death in here.”
Barbara wept. Ryan knelt down and put his arm around her.
Maybe the nurse was right, but we didn’t like the way she was talking to Barbara. Ryan asked the nurse to leave until we were done.
I wanted to leave something behind for Barbara, anything she could hide so she could at least have one piece of her old life to hold onto. But there was nothing. All her things, furniture and paintings, were squeezed like Tetris pieces into the back of the truck. We didn’t know it at the time, but a few months later, Barbara would be moved into a senior citizen home.
We left the house empty. Just Barbara and her nurse.
The William J. Jenack Auction Gallery is an aluminum-covered steel frame that looks like a green airplane hangar flanked by mountains in Chester, New York, fifty miles north of Manhattan. It is divided into three large spaces: the Fine Art showroom, the Town & Country showroom, and the sale room set between the two.
William Jenack, 70, and his wife Andrea, a certified gemologist, own the place along with Kevin Decker, who specializes in eighteenth- and nineteenth-century artifacts. They appraise and inventory everything Ryan and I bring back to the gallery. Everything is siphoned through to the back and stored away. Large items like grandfather clocks, sofas, armoires, and credenzas stay in one of the four trailers behind the gallery. Works of art are stacked by the hundreds on shelves in the back room. Smaller pieces – angelfish skeletons, vintage dental molds, African masks – are lined up along their own special shelves. Items that aren’t worth much are divvied up into boxes and stored upstairs in what is like a morgue of personal belongings. Single items in the world of auctioneering are called “lots.” They can sell on their own, but the things upstairs are called “box lots” – many bidders love the thrill of sifting through a box lot as if they’re a kind of cardboard treasure chest.
William J. Jenack Estate Appraiser and Auctioneers in Chester, New York holds an average of three auctions every month.
It’s a strange feeling having to tell someone that the things they thought were worth a lot aren’t worth much at all. William, after nearly thirty years in the business, says to this day, “It’s difficult to tell someone that her prized possessions are worth a hill of beans.”
William and Andrea were antique collectors for a decade before William began auctioneering in 1988. In those days, they stored their antiques in a garage, and when they’d amassed enough stuff for a big sale, they’d rent a firehouse or church and hold an auction.
William has walked through thousands of homes in the region, appraising people’s things, while coming to know old-timers who collect esoteric mechanical pencils or Edison light bulbs or vintage silhouettes. These types of collectors tend to drive to the gallery with a trunk full of their prized collections in a fit of downsizing. Inevitably, the same people will then preview the upcoming sales, looking for anything to add back to their collection.
Potential buyers look at the upcoming items in the preview room before an auction.
On auction day, after everything is catalogued, numbered, and put on display, both in the showroom and on our website, we open the showroom for “preview” – when clients observe the upcoming sale the way one would walk through a museum.
At preview I learn about strange world history from clients. We once had an ancient Roman tear catcher for sale. A client taught me that Roman mourners would cry into bottles and place them in the tombs of those they loved. One ninety-year-old Englishman, always in a suit and cap, has told me the same story at every preview for the last four years – how he worked in a coalmine in England during World War II, how he remembers the sounds of the British warplanes flying overhead filled with bombs. “They sounded heavy,” he’ll say. He remembers the engines flying home later with less drag.
Military-themed sales draw good crowds in any economic climate. We lay out carpets, hang chandeliers, line up rows of shotguns and rifles on the gun racks, and arrange swords and daggers in showcases. William shows up with his grey manicured mustache and the charm of a yacht captain about to take his clients for a three-hour tour through Russian icons, high-end cowboy boots, and Nazi paraphernalia. On pickups we come across more Nazi coins and medals and Mein Kampf copies with personal inscriptions than I ever imagined we would – even in Jewish households. My partner Ryan says he knows of Jewish people who buy Nazi memorabilia just to destroy it. I’ve also heard of Jewish people who buy it as proof to refute Holocaust deniers.
A Filipino woman comes in looking to inspect the Indonesian dagger before the sale starts. She must’ve seen it on our online catalogue and couldn’t wait to hold it. There are two in the sale, but she’s interested in the longer blade that’s shaped like a snake. She unsheathes it, holds it up to the light and counts the curves of the blade.
“Seven,” she says and smiles. She stabs the air with the dagger and twists it into an invisible victim. “Seven curves are good. When you twist it in you, all of your belly comes out.”
Another young woman hovers over the showcase. Her hair is pulled back into a bun, nose-pierced, and she is shy around the swords. Some guy jokes, “You don’t seem like the military dagger type.” An older man in a sleeveless shirt with long white hair and a long white beard, inspecting a Nazi air force officer’s dagger, intervenes. “You never know,” he says. “I have a neighbor and she can put an axe through the center of that picture over there.” His name is Mark Bodnarczuk, and another gentleman at the sale tells me that he is “the sword expert.”
Bodnarczuk laughs. He says he doesn’t need any more swords, yet here he is. His collection started piling up five years ago with a Union Civil War sword. He says it’s a disease. He picks up the three-foot sword of a German Imperial officer – a highly regarded status symbol for pure Aryan members of the Third Reich’s armed forces. Now it’s being passed back and forth between me – I was raised Jewish – and Bodnarczuk, a pleasant man with faded crescent moon tattoos on his arm, who looks like he’d pal around the Renaissance Faire. It’s important for Bodnarczuk to come to the sale in person to feel the blades, see if the scabbards fit, and “look in the nice little red eyes of the lion” on the handle of the Imperial sword.
However, Bodnarczuk came today specifically for the Civil War artillery sword. It is heavy and made of brass with a wide blade that’s just over two feet long. “The idea with these swords,” he says, holding the handle against his chest so the sword points out, “was when you were on your back on the ground, and the cavalry’s coming at you, you’d hold the sword up and hit the horse in the chest.”
Guns and antique military paraphernalia were the featured items at the August 21 auction. During the preview time, potential buyers inspect every aspect of the lots to ensure they know what they are bidding on.
A crowd begins to form around the Nazi memorabilia. Some people turn away quickly, like they see someone urinating in public. But there are plenty who’ve come strictly to hold – and bid on – the Nazi swords. Tom Coulter, 72, is an avid collector of German World War II memorabilia. He’s here for the German paratrooper gravity knife, which looks like a small, plain wood handle that’s missing a blade. But the hand guard doubles as a secret button. Earlier, other men asked to see the gravity knife and none could figure out how to open it. Coulter turns it upside-down, clicks the hidden button, and out slides the ten-inch blade. “Gravity,” he says to anyone listening.
William says the appeal of Nazi memorabilia is in the craftsmanship, and collectors are excited by “the whole heraldry of owning something that was involved in that time.” It’s legal to sell Nazi paraphernalia in some military shows and auctions in the United States, but it’s illegal to sell certain Nazi items on eBay. It’s also banned in France, Israel, Austria and Germany.
Coulter tells me to grab the American trench knife – basically a pair of brass knuckles welded to a twelve-inch blade – and the German gravity knife.
“Which one would you want to fight with?” he asks.
My fingers are slipped through the brass knuckles of the trench knife. It’s heavier than the gravity knife.
“The trench knife,” I say.
He points to the gravity knife. “This is practical,” he says. You can cut yourself from your parachute tangled in a tree with it. However, he says pointing to the trench knife, “This is to kill somebody. The back end is for cracking skull. The knuckles are for punching face and this is for stabbing.”
Coulter, who was a marine in Vietnam and had one-third of his lungs removed thanks to Agent Orange – you can hear the damage in his voice – says his house is stuffed with Gestapo rings, German helmets, swords, Luger pistols, and a small painting of a church steeple by Adolf Hitler. He’s traveled the country, and even to Europe, to purchase many of these items. He only visits our gallery when we have a good deal of Nazi pieces in a sale.
Avid collector and former Vietnam veteran Tom Coulter holds a Nazi military dress dagger that was up for auction. Coulter explained that shiny knives and swords were meant for dress only as reflections could draw the eyes of enemies in battle.
“No American stuff?” I ask him.
“Well, they’re just not unique,” he responds. “I have American stuff. I have my Marine bayonets. They’re nice, sure, but the Germans carved eagles into everything.”
“What would you say if someone came over to your house and saw all the swastikas and felt uncomfortable?” I ask.
“I’d say, ‘every weapon is a hate item. They’re all hate items.’” He says it’s for the love of history.
The Nazi daggers are beautifully crafted, but it is hard for me to divorce them from the black and white photos of the Holocaust that are also in this sale – naked prisoners with theirs hands over their genitals standing like skeletons behind barbed wire, and men shoveling human bones into a brick crematorium.
The sale begins and most people follow William into the middle room where he takes his place at his podium. It looks like church. The weapon collectors loiter behind in the showroom, inspecting the weapons one more time, squinting down the barrels of rifles like telescopes. The guns and swords are the headliners of the sale, though it will be a few hours before they’re up for bidding. Weapon-lovers never seem eager to sit through the bidding on pottery, costume jewelry or vintage seltzer bottles.
William auctions off a mechanical baby in a crate. It’s a two-foot glass-eyed doll that was an advertisement for a soap company in the 1940s. All of its limbs used to move, like a baby stuck on its back, but now only one arm and one leg work. “I hope somebody plugged it in for ya,” William says. “He lights up…and he turns his head.”
It goes for $450.
Another item for sale is a vintage Ku Klux Klan panoramic photograph, dated 1925. Hundreds of men and women and children in white robes and pointed hoods stand in front of the nation’s capitol. Not too far in the background, sitting on window ledges, are black children watching the scene. When the photo sells for $225, William looks at it and says, “I haven’t seen that many dunces in one place in a long time.”
A box lot of doll heads sits on a table waiting to be sorted and sold at a future auction.
William auctions off two hundred lots in two hours before reaching the portion of the sale where certain people are leaning forward, white-knuckled on their bidder number paddles, hoping to win their guns and swords of choice.
Mark Bodnarczuk stands. Tom Coulter pulls his Vietnam vet hat down low. As the auction goes on, others side-glance, trying to see who they’re bidding against. Then there are people like Sal Vargetto who rushes in near the end of the sale, bids on two shotguns, wins, runs into the preview room, takes them off the rack, aims them at the ceiling and pretends to shoot with a long, unlit cigar hanging from his mouth.
Bodnarczuk doesn’t get the brass Civil War artillery sword. It goes for higher than he is willing to spend. But he does buy a Japanese sword. Coulter wins the gravity knife, and I see the Filipino woman leave smiling with the Indonesian dagger in her hand.
The next day we clean up and begin to organize a new sale. There are now antique Russian menorahs in place of the Nazi swords.
What doesn’t sell after a few tries is either donated or brought to the dump – the great American intestine. Everything that winds up here at the Orange County Transfer Station is flattened, cubed and shipped out on trucks heading for the landfill behind it. I’ve seen Darwin’s On The Origins of Species and Suzanne Somers’ Fast & Easy cookbooks destroyed in unison here.
The filled box truck is driven into an enormous shed with a cement floor. There are beat-up American flags on the wall and gnarled teddy bears tied to the grills of dump trucks – things employees have pulled from the trash. The shed has its own atmospheric pressure and smells of thick, hot rotting. A mist falls from the ceiling so the place doesn’t spontaneously combust. There are smashed pianos and old refrigerators and dead televisions and shattered glass and old dirty mattresses, which the man operating the excavator grabs with the claw of his machine and uses as a broom to make way for our new pile of trash.
The dump weighs the box truck on our way in, and subtracts the weight we lose on our way out. Our last trip here was with Barbara Harris’ unwanted stuff. By now we had gone back one last time to clear out her old barns in the backyard. Most of it was in such bad condition it went right to the dump. In five minutes we threw out 3,500 pounds of her life.
Trucks line the parking dock outside of the William J. Jenack auction house.
There’s a sign at the weigh station when you leave that reads, Thank you for your garbage.
We sweep out the box truck before a new pickup. A trumpet player is dead. His family rented a giant dumpster for everything that won’t be going to auction. His place must be emptied, no evidence left of him whatsoever, to stage the house for sale.
I find his résumé in his office desk. He played with the band on “The Tonight Show” with Johnny Carson. He played with Sinatra and Buddy Rich. I find studio recordings of him on cassette. I put them in his stereo and let his trumpet echo through the empty house and out the open doors into the street where his neighbors walk by. They do a double take as if their old neighbor is back from the dead to perform one last time.
Once we’ve packed all his sellable stuff in the box truck, we climb into the big dumpster. We jump up and down on his trash to make sure it doesn’t overflow.
It’s a 55-and-up gated community. The neighbors aren’t amused. Chances are we’ll be back soon for them too.
In 2010, the American Heart Association, American College of Cardiology, the American Geriatrics Society and other prominent groups issued a statement indicating that the deactivation of a pacemaker, an implantable device used to speed up slow heart beats, is ethically permissible.
By Jennifer Friedlin
For the past month, my mother and I have been advocating for the deactivation of my father’s pacemaker. Yet despite my parents having taken every measure to ensure that they would control the ends of their lives, two months since a severe stroke destroyed whatever quality of life my father, who was already suffering from advanced dementia, had left, his heart continues to beat against my family’s wishes.
In 2010, the American Heart Association, American College of Cardiology, the American Geriatrics Society and other prominent groups issued a statement indicating that the deactivation of a pacemaker, an implantable device used to speed up slow heart beats, is ethically permissible. Reaffirmed last year, the statement says, “Legally, carrying out a request to withdraw life-sustaining treatment is neither physician-assisted suicide nor euthanasia.”
Nevertheless, the team of medical professionals at Parker Jewish Institute for Health Care and Rehabilitation has given us the runaround. Most recently, my mother and I met with my father’s team of medical professionals to discuss moving my father into hospice as well as deactivating the pacemaker so that my father could live out his days naturally. During the course of the meeting, my mother, who is my father’s proxy, made clear that this would be my father’s wish.
According to the law, the request is my mother’s prerogative. In 1990, in Cruzan vs. Director, Missouri Department of Health, the Supreme Court ruled that a competent patient could refuse life-sustaining treatments, including nutrition and hydration. This case gave rise to advance directives so that a proxy could carry out the patient’s will. In a later case, the Court affirmed the right of competent patients to refuse therapy.
The medical team agreed to hospice, but has so far refused to carry out the request to deactivate the pacemaker. We have had several long conversations with the medical team, and, while they seem to agree with our desire to give my father a dignified end, they offer confusing explanations as to why they will not carry out my dad’s wishes.
At one point, a staff member told me that because a pacemaker does not prolong life, we should leave it. But my father’s pacemaker is working 53% of the time to correct his condition, known as bradycardia, which can result in heart failure. I fail to see how this device is not prolonging my father’s life or, at the very least, interrupting the possibility for his natural demise.
We are certainly not the first family to confront the medical community’s refusal to deactivate a pacemaker. Katy Butler, author of “The Art of Dying Well,” has written extensively about her efforts to give her father the death he wanted by deactivating his pacemaker. Butler also uncovered other horrors, such as cardiologists recommending pacemakers for elderly people with advanced dementia.
Much of the motivation, Butler noted, seemed to stem from the financial rewards of treating people, even the terminally ill. Simply put there’s no money in death. And yet in its current design, at $450 a day for room and board alone, institutions like the Parker Institute rake in millions annually from people whose lives are being maintained artificially. The medical system could quite literally bankrupt healthy family members to keep a dying one alive.
Although estimates vary, each year approximately 400,000 people — half over age 75 — get implantable cardiac devices, including pacemakers. Primary care doctors, cardiologists, and elder care attorneys should inform people about how these devices can affect their end of life and encourage them to include their wishes in advance directives.
Yet, even if they do, they may hit the same wall of refusal my family has faced. It seems that despite the legal rulings and the ethicists’ writings, doctors are committed to keeping pacemakers ticking.
It’s unfair to the terminally ill and their families that this view prevails. The refusal to deactivate means the sick family member is denied a dignified death, while the need for constant advocacy leaves family members feeling like they are making an unseemly demand.
As the debate about healthcare builds in the run up to the 2020 presidential election, I hope that the candidates will discuss reforms to improve end of life care. There should be dignity in death for the terminally ill and no healthy person should be forced into bankruptcy to keep a loved one alive against his or her will. There are certain people we should spare no expense to keep alive, in our family’s opinion my father is not one of them.
Researchers say non-human primates exhibit an awareness of death.
Non-human primates like monkeys and apes appear to have an awareness of death in the same way humans do, scientists have said. After analyzing over 200 years worth of research into how primates deal with death, they found common behaviors emerged—including carrying their dead, defending the deceased from threats and exhibiting a grief-like response.
There are many stories about apes and monkeys grieving for their dead. For example, a BBC documentary in 2017 appeared to show a group of langur monkeys grieving for what they believe is a dead baby—even though it was actually just a robotic spy monkey.
The same year, scientists observed a chimpanzee using tools to clean the body of a deceased group member. A female sat down with the dead male and used a firm stem of grass to clean his teeth. The practice, researchers say, suggests chimps may have a more sophisticated response to death than we currently know.
Andre Gonçalves from Japan’s Kyoto University and Susana Carvalho from the University of Oxford in the U.K. say there is a huge amount of anecdotal evidence relating to they way non-human primates deal with death—but a review of the literature to find specific characteristics and behaviors has been lacking.
“For the past two centuries, non-human primates have been reported to inspect, protect, retrieve, carry or drag the dead bodies of their conspecifics and, for nearly the same amount of time, sparse scientific attention has been paid to such behaviours,” they wrote in a study published in Biological Reviews.
In their analysis of 240 reports, Gonçalves and Carvalho showed that specific responses emerge among different non-human primate species. Often this involves carrying the dead around—especially mothers and their dead babies. Species that are unable to grasp objects—such as lemurs and tamarins—are observed trying to carry their dead even though they lack the ability.
A chimp cleaning the teeth of a deceased group member.
They also found that group members defend the bodies of the deceased and returning to the body or site of death: “Such places may hold residual information about the event which can arouse curiosity or emotional distress,” they wrote. This behavior tended to happen when an adult died, rather than a juvenile. The researchers speculate this could relate to attachments, with members needing to re-categorize from living to dead—a behavior they say is essential to the grieving process.
In one anecdote about a family of chimpanzees studied by Jane Goodall, a mother named Flo died before her son Flint had become fully independent. After her death, Flint would stare at the nest they shared and returned to the site of her death. He exhibited signs of clinical depression and stopped eating and interacting with other group members. Eventually his immune system became too weak and he also died.
In another case, an adult male howler monkey was observed staying close to the corpse of a female for five days after her death, “suggesting close proximity between these individuals in life.”
“Considering all these findings and given their cognitive abilities, we argue that non-human primates are capable of an implicit awareness of death,” Gonçalves and Carvalho wrote.
They say more research will be needed to confirm whether non-human primates are aware of death—and to what extent they are. “It’s not an all-or-nothing ability,” Gonçalves said in a statement. “Awareness of death includes things such as animate/inanimate distinction, or the sensory and contextual discrimination of living/dead. The concept of death is something we humans acquire between ages three to 10. We can infer that non-human primates have some aspects of death awareness but, thus far, only humans conceptualize it at a higher order.”
The researchers also say further investigation could help shed light on the evolution of our own funeral practices: “Given that there exists a considerable gap in the fossil and archaeological record concerning how early hominins might have interacted with their dead, extant primates may provide valuable insight into how and in which contexts thanatological behaviours would have occurred.”
