Category: Death Curiosities

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What People Actually Say Before They Die

Insights into the little-studied realm of last words.

By Michael Erard

Mort Felix liked to say that his name, when read as two Latin words, meant “happy death.” When he was sick with the flu, he used to jokingly remind his wife, Susan, that he wanted Beethoven’s “Ode to Joy” played at his deathbed. But when his life’s end arrived at the age of 77, he lay in his study in his Berkeley, California, home, his body besieged by cancer and his consciousness cradled in morphine, uninterested in music and refusing food as he dwindled away over three weeks in 2012. “Enough,” he told Susan. “Thank you, and I love you, and enough.” When she came downstairs the next morning, she found Felix dead.

During those three weeks, Felix had talked. He was a clinical psychologist who had also spent a lifetime writing poetry, and though his end-of-life speech often didn’t make sense, it seemed to draw from his attention to language. “There’s so much so in sorrow,” he said at one point. “Let me down from here,” he said at another. “I’ve lost my modality.” To the surprise of his family members, the lifelong atheist also began hallucinating angels and complaining about the crowded room—even though no one was there.

Felix’s 53-year-old daughter, Lisa Smartt, kept track of his utterances, writing them down as she sat at his bedside in those final days. Smartt majored in linguistics at UC Berkeley in the 1980s and built a career teaching adults to read and write. Transcribing Felix’s ramblings was a sort of coping mechanism for her, she says. Something of a poet herself (as a child, she sold poems, three for a penny, like other children sold lemonade), she appreciated his unmoored syntax and surreal imagery. Smartt also wondered whether her notes had any scientific value, and eventually she wrote a book, Words on the Threshold, published in early 2017, about the linguistic patterns in 2,000 utterances from 181 dying people, including her father.

Despite the limitations of this book, it’s unique—it’s the only published work I could find when I tried to satisfy my curiosity about how people really talk when they die. I knew about collections of “last words,” eloquent and enunciated, but these can’t literally show the linguistic abilities of the dying. It turns out that vanishingly few have ever examined these actual linguistic patterns, and to find any sort of rigor, one has to go back to 1921, to the work of the American anthropologist Arthur MacDonald.

To assess people’s “mental condition just before death,” MacDonald mined last-word anthologies, the only linguistic corpus then available, dividing people into 10 occupational categories (statesmen, philosophers, poets, etc.) and coding their last words as sarcastic, jocose, contented, and so forth. MacDonald found that military men had the “relatively highest number of requests, directions, or admonitions,” while philosophers (who included mathematicians and educators) had the most “questions, answers, and exclamations.” The religious and royalty used the most words to express contentment or discontentment, while the artists and scientists used the fewest.

MacDonald’s work “seems to be the only attempt to evaluate last words by quantifying them, and the results are curious,” wrote the German scholar Karl Guthke in his book Last Words, on Western culture’s long fascination with them. Mainly, MacDonald’s work shows that we need better data about verbal and nonverbal abilities at the end of life. One point that Guthke makes repeatedly is that last words, as anthologized in multiple languages since the 17th century, are artifacts of an era’s concerns and fascinations about death, not “historical facts of documentary status.” They can tell us little about a dying person’s actual ability to communicate.

Some contemporary approaches move beyond the oratorical monologues of yore and focus on emotions and relationships. Books such as Final Gifts, published in 1992 by the hospice nurses Maggie Callanan and Patricia Kelley, and Final Conversations, published in 2007 by Maureen Keeley, a Texas State University communications-studies scholar, and Julie Yingling, professor emerita at Humboldt State University, aim to sharpen the skills of the living for having important, meaningful conversations with the dying. Previous centuries’ focus on last words has ceded space to the contemporary focus on last conversations and even nonverbal interactions. “As the person gets weaker and sleepier, communication with others often becomes more subtle,” Callanan and Kelley write. “Even when people are too weak to speak, or have lost consciousness, they can hear; hearing is the last sense to fade.”

I spoke to Maureen Keeley shortly after the death of George H. W. Bush, whose last words (“I love you, too,” he reportedly told his son, George W. Bush) were widely reported in the media, but she said they should properly be seen in the context of a conversation (“I love you,” the son had said first) as well as all the prior conversations with family members leading up to that point.

At the end of life, Keeley says, the majority of interactions will be nonverbal as the body shuts down and the person lacks the physical strength, and often even the lung capacity, for long utterances. “People will whisper, and they’ll be brief, single words—that’s all they have energy for,” Keeley said. Medications limit communication. So does dry mouth and lack of dentures. She also noted that family members often take advantage of a patient’s comatose state to speak their piece, when the dying person cannot interrupt or object.

Many people die in such silence, particularly if they have advanced dementia or Alzheimer’s that robbed them of language years earlier. For those who do speak, it seems their vernacular is often banal. From a doctor I heard that people often say, “Oh fuck, oh fuck.” Often it’s the names of wives, husbands, children. “A nurse from the hospice told me that the last words of dying men often resembled each other,” wrote Hajo Schumacher in a September essay in Der Spiegel. “Almost everyone is calling for ‘Mommy’ or ‘Mama’ with the last breath.”

It’s still the interactions that fascinate me, partly because their subtle interpersonal textures are lost when they’re written down. A linguist friend of mine, sitting with his dying grandmother, spoke her name. Her eyes opened, she looked at him, and died. What that plain description omits is how he paused when he described the sequence to me, and how his eyes quivered.

But there are no descriptions of the basics of last words or last interactions in the scientific literature. The most linguistic detail exists about delirium, which involves a loss of consciousness, the inability to find words, restlessness, and a withdrawal from social interaction. Delirium strikes people of all ages after surgery and is also common at the end of life, a frequent sign of dehydration and over-sedation. Delirium is so frequent then, wrote the New Zealand psychiatrist Sandy McLeod, that “it may even be regarded as exceptional for patients to remain mentally clear throughout the final stages of malignant illness.” About half of people who recover from postoperative delirium recall the disorienting, fearful experience. In a Swedish study, one patient recalled that “I certainly was somewhat tired after the operation and everything … and I did not know where I was. I thought it became like misty, in some way … the outlines were sort of fuzzy.” How many people are in a similar state as they approach death? We can only guess.

We have a rich picture of the beginnings of language, thanks to decades of scientific research with children, infants, and even babies in the womb. But if you wanted to know how language ends in the dying, there’s next to nothing to look up, only firsthand knowledge gained painfully.

After her father died, Lisa Smartt was left with endless questions about what she had heard him say, and she approached graduate schools, proposing to study last words academically. After being rebuffed, she began interviewing family members and medical staff on her own. That led her to collaborate with Raymond Moody Jr., the Virginia-born psychiatrist best known for his work on “near-death experiences” in a 1975 best-selling book, Life After Life. He has long been interested in what he calls “peri-mortal nonsense” and helped Smartt with the work that became Words on the Threshold, based on her father’s utterances as well as ones she’d collected via a website she called the Final Words Project.

One common pattern she noted was that when her father, Felix, used pronouns such as it and this, they didn’t clearly refer to anything. One time he said, “I want to pull these down to earth somehow … I really don’t know … no more earth binding.” What did these refer to? His sense of his body in space seemed to be shifting. “I got to go down there. I have to go down,” he said, even though there was nothing below him.

He also repeated words and phrases, often ones that made no sense. “The green dimension! The green dimension!” (Repetition is common in the speech of people with dementia and also those who are delirious.) Smartt found that repetitions often expressed themes such as gratitude and resistance to death. But there were also unexpected motifs, such as circles, numbers, and motion. “I’ve got to get off, get off! Off of this life,” Felix had said.

Smartt says she’s been most surprised by narratives in people’s speech that seem to unfold, piecemeal, over days. Early on, one man talked about a train stuck at a station, then days later referred to the repaired train, and then weeks later to how the train was moving northward.

“If you just walk through the room and you heard your loved one talk about ‘Oh, there’s a boxing champion standing by my bed,’ that just sounds like some kind of hallucination,” Smartt says. “But if you see over time that that person has been talking about the boxing champion and having him wearing that, or doing this, you think, Wow, there’s this narrative going on.” She imagines that tracking these story lines could be clinically useful, particularly as the stories moved toward resolution, which might reflect a person’s sense of the impending end.

In Final Gifts, the hospice nurses Callanan and Kelley note that “the dying often use the metaphor of travel to alert those around them that it is time for them to die.” They quote a 17-year-old, dying of cancer, distraught because she can’t find the map. “If I could find the map, I could go home! Where’s the map? I want to go home!” Smartt noted such journey metaphors as well, though she writes that dying people seem to get more metaphorical in general. (However, people with dementia and Alzheimer’s have difficulty understanding figurative language, and anthropologists who study dying in other cultures told me that journey metaphors aren’t prevalent everywhere.)

Even basic descriptions of language at the end of life would not only advance linguistic understanding but also provide a host of benefits to those who work with the dying, and to the dying themselves. Experts told me that a more detailed road map of changes could help counter people’s fear of death and provide them with some sense of control. It could also offer insight into how to communicate better with the dying. Differences in cultural metaphors could be included in training for hospice nurses who may not share the same cultural frame as their patients.

End-of-life communication will only become more relevant as life lengthens and deaths happen more frequently in institutions. Most people in developed countries won’t die as quickly and abruptly as their ancestors did. Thanks to medical advances and preventive care, a majority of people will likely die from either some sort of cancer, some sort of organ disease (foremost being cardiovascular disease), or simply advanced age. Those deaths will often be long and slow, and will likely take place in hospitals, hospices, or nursing homes overseen by teams of medical experts. And people can participate in decisions about their care only while they are able to communicate. More knowledge about how language ends and how the dying communicate would give patients more agency for a longer period of time.

But studying language and interaction at the end of life remains a challenge, because of cultural taboos about death and ethical concerns about having scientists at a dying person’s bedside. Experts also pointed out to me that each death is unique, which presents a variability that science has difficulty grappling with.

And in the health-care realm, the priorities are defined by doctors. “I think that work that is more squarely focused on describing communication patterns and behaviors is much harder to get funded because agencies like NCI prioritize research that directly reduces suffering from cancer, such as interventions to improve palliative-care communication,” says Wen-ying Sylvia Chou, a program director in the Behavioral Research Program at the National Cancer Institute of the National Institutes of Health, who oversees funding on patient-doctor communication at the end of life.

Despite the faults of Smartt’s book (it doesn’t control for things such as medication, for one thing, and it’s colored by an interest in the afterlife), it takes a big step toward building a corpus of data and looking for patterns. This is the same first step that child-language studies took in its early days. That field didn’t take off until natural historians of the 19th century, most notably Charles Darwin, began writing down things their children said and did. (In 1877, Darwin published a biographical sketch about his son, William, noting his first word: mum.) Such “diary studies,” as they were called, eventually led to a more systematic approach, and early child-language research has itself moved away from solely studying first words.

“Famous last words” are the cornerstone of a romantic vision of death—one that falsely promises a final burst of lucidity and meaning before a person passes. “The process of dying is still very profound, but it’s a very different kind of profoundness,” says Bob Parker, the chief compliance officer of the home health agency Intrepid USA. “Last words—it doesn’t happen like the movies. That’s not how patients die.” We are beginning to understand that final interactions, if they happen at all, will look and sound very different.

Complete Article ↪HERE↩!

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Not all Americans have a fair path to a good death – racial disparities are real

By and

What does it mean to “die well”?

The world got an idea recently from the 92-year-old Buddhist monk and peace activist Thich Nhat Hanh, who popularized mindfulness and meditation in the U.S. The monk returned to his home in Vietnam to pass his remaining years. Many admired his desire to live his remaining time in peace and dignity.

Researchers from the University of California, San Diego recently did a literature search to understand what Americans might consider to be a “good death” or “successful dying.” As can be expected, their findings varied. People’s views were determined by their religious, social and cultural norms and influences. The researchers urged health care providers, caregivers and the lay community to have open dialogues about preferences for the dying process.

As scholars who study social health and human services psychology, we found something missing in these conversations – how race impacts life span.

It’s important to recognize that not everyone has an equal chance at “dying well.”

Black population and ill health

Take the disease burden of the African American population.

African Americans experience an earlier onset and greater risk of what may be referred to as lifestyle-related diseases, including cardiovascular disease, stroke and diabetes. More than 40% of African Americans over the age of 20 are diagnosed with high blood pressure, compared to 32% of all Americans.

In addition, the Centers for Disease Control and Prevention reports that the likelihood of experiencing a first stroke is nearly twice as high for African Americans compared with whites. African Americans are more than two times more likely to experience a stroke before the age of 55. At age 45, the mortality rate from stroke is three times higher for blacks compared to whites.

This disease burden consequently leads to their higher mortality rates and overall shorter life expectancy for blacks compared to whites.

And while the life expectancy gap differs by only a few years, 75.3 for blacks and 78.9 for whites as of 2016, research suggests that African Americans suffer more sickness. This is due in part to the increased prevalence of high blood pressure, obesity and diabetes in this population.

Genetics, biological factors and lifestyle behaviors, such as diet and smoking, help explain a portion of these differences. However, researchers are still learning how race-related social experiences and physical environments affect health, illness and mortality.

Access to health care

factor is that African Americans have historically underutilized preventive medicine and health care services. They also delay seeking routine, necessary health care – or may not follow medical advice.

One study found that during an average month, 35% fewer blacks visited a physician’s office, and 27% fewer visited an outpatient clinic compared with whites.

“The only time I go to the doctor is when something is really hurting. But otherwise, I don’t even know my doctor’s name,” said a young African American male during a research study in Chicago, Illinois.

There are reasons for this mistrust. Researchers who study medical mistrust argue that high-profile cases of medical experiments are still playing a role in how African Americans view health care systems and providers. In the past, physicians have intentionally done harm against people of color. A well-known case is the Tuskegee Study of Untreated Syphilis in African American men, which lasted from 1932 to 1972.

In this clinical study, 399 African American men, who had already contracted syphilis, were told that they were receiving free health care from the government. In fact, doctors, knowing their critical condition, were awaiting their deaths to subsequently conduct autopsies and study the disease’s progression.

Even though penicillin had been proven to treat syphilis by 1947, these men were denied the treatment.

Why discrimination matters for health

Other studies suggest that regardless of their knowledge of past medical abuse, many African Americans have low levels of trust in medical establishments.

“Doctors, like all other people, are subject to prejudice and discrimination,” writes Damon Tweedy, author of “Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine.” “While bias can be a problem in any profession, in medicine, the stakes are much higher.”

Unfortunately, these fears are underscored by empirical evidence that African Americans are less likely to receive pain medication management, higher-quality care or survive surgical procedures.

In addition, a growing body of literature has established that experiences of discrimination are extremely harmful for physical and mental health, particularly among African Americans.

This research adds to the body of evidence that experiences of discrimination harm people’s health and may contribute to the increased rates of premature decline and death among blacks.

What does it take to die well?

As African American scholars, we argue the “art of dying well” may be a distant and romantic notion for the African American community.

African Americans are also exposed to earlier and more frequent deaths of close loved ones, immediate family members and friends.

Their increased “vulnerability to untimely deaths,” writes Duke University scholar Karla Holloway, shows African Americans’ lack of access to equitable and fair paths in life.

Before defining “a good death,” American society must first begin to fundamentally address how to promote quality living and longevity across all racial groups.

Complete Article ↪HERE↩!

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Former Ottawa paramedic on his experience with death…

‘I’ve got a busload of people up here in my head’

J.P. Trottier in 2006, when he served with Ottawa Paramedic Service.

By Bruce Deachman

J.P. Trottier was with the Ottawa Paramedic Service for 36 years – 21 as a frontline paramedic and 15 as public information officer. He retired in January 2017.

“I don’t know how many deaths I’ve seen, but it’s in the hundreds. I remember one shift doing three vital-signs-absent calls in a row. That was a busy eight hours.

“You just never know where you’re going to be in five minutes. Are you going to be in the middle of a crime scene? Are you going to be in somebody’s living room, somebody with abdominal pain? Somebody having a heart attack?

“Sometimes, it’s just the daily grind. It can be very humdrum, and then all of a sudden your next shift will be just crazy. You’ll do a shooting, you’ll do an elderly gentleman who’s collapsed at home and his vital signs are absent, you’ll do a childbirth call … you’ll do a whole bunch of different things.”

“You have some really horrible moments in the job, and you have some absolutely spectacular moments. Paramedics have what they call the holy-shit call. They take a look at the person and they know they’re in trouble — that that person is in deep trouble and probably minutes from dying. We call that the holy-shit call. It’s like, get to work. And you can tell after a little bit of experience — you walk into a room and look at somebody. And then it becomes a bit mechanical; your training kicks in and you don’t really think about it. But when you see them like that and 10 minutes later you’ve given your medication and taken your vital signs, or your partner’s taking the vital signs and you’ve slapped the oxygen on them or maybe put in an IV and put the medication in when all the vital signs are OK and off you go. And 10 minutes later when they’re looking much better, it’s an amazing thing to see. It’s absolutely beautiful. It’s absolutely the best part of the job.”

•

“You don’t forget many of them. The difficult ones you don’t forget. I tell people that I’ve got a busload of people up here in my head, waiting to step out. It’s not being haunted; it’s just that you will never be able to forget that eight-year-old boy who played chicken with a train and lost. You’ll never be able to forget that. If anybody were to come to me and say, ‘Oh, I can handle it … ” Yeah, OK, maybe you can handle it differently than I can, but there’s no way you’re going to be able to forget that. The young boy who comes home from school for lunch and finds his mother dead upstairs because she put a shotgun in her mouth. You’ll never be able to forget that. Never. But they don’t haunt me.

“Very early in my career I had one of those horrible calls – it was a young girl, six or seven years old, crossing the street and was struck by a car. She died en route, and every time I drive by there, it’s like, ‘This is where it happened.’ And it’s no more than that. But they’re with you.”

•

“There’s that horrible side where you can’t help … they’re in a car crash, pinned, and the paramedics are trying to put the IV in and they’re doing a whole bunch of different things, and you’re waiting and waiting, and the blood pressure is coming down and down and down, and you can’t stem the bleeding because you can’t access where the injury is.

“So yeah, sometimes you can’t resuscitate them, and that’s the moment that you turn your attention to the family. They’re not the patients, you’re not there specifically for them or because of them, but all paramedics will do this; they will turn their attention to the family.

“I used to do presentations for career days at high schools, and they would ask what’s the most important thing about your character that would make you a good paramedic, and I would say two things. The first was that you really have to be a caring person, because that’s what you do. That’s your job, you’re caring for people — their emotional needs, their physical needs. And the second part is good communications skills. You must have good communications skills because of instances like this, where a family member has passed away and you need to inform them. And don’t use any jargon, don’t use any of that nonsense. ‘I’m sorry he passed away. We couldn’t do anything.’ And you don’t give them a lot of info, because they’ll forget most of it after you tell them.

“We have to be careful what we tell them, because they will remember that moment, forever. It really demands respect, and I don’t care if they’re gang members or whatever the case may be. We don’t care; it’s a patient and they have friends or family, and there’s a mother or father somewhere, maybe, or children, grandchildren or great-grandchildren, and all of them will be affected by this.”

•

“I would often turn my attention to people’s rooms to give me an idea of the life they led. The older generation especially will have a lot of photographs on their dressers or in the bedroom. Even if I don’t know these people, it kind of puts you there. Look at the clothes they’re wearing. Look at the cars they were driving. It gives you a bit of a glance at their lives. There are pictures of their children and grandchildren. It kind of gives you a quick bio of them.

“The ones that really stand out for me are ones where someone’s standing next to a Spitfire, because you know they served. Did he fly planes? Was he in the war? Was he a mechanic? You can sometimes ask the family a little bit about them — you have to tread carefully there, because they may not take it very well. But in some instances I was able to ask the family. ‘Oh, he served?’ — because there’s a picture of him. ‘Yes, and he went to this battle and that battle,’ and of course they’re proud of that. And sometimes I take a minute to thank them for their service to their country. Sometimes you’ll see their medals on the wall, and you can talk about that a little bit.

“It can be fascinating. You don’t know about this person or the life they led, if they discovered a cure for something. You just never know.”

•

“Has my view of death changed over the years? Yes. I think just because of the sheer number of calls that we do with death and near-death … a patient you were able to get back from the grip of death that they were in. The shootings, the stabbings, the crib deaths — Sudden Infant Death Syndrome — for sure, gave me a better understanding of death. You’re more aware of death and what it means and why it happens, a little bit — we can never know why, really. But it gives you a better appreciation of it, and thus a better understanding of it.”

“You see a lot of circumstances. The suicides are sad. And you also see the murder-suicides, and those are weird. There was one I did where this man had custody of his child during the weekend, and he decided on Sunday night that the child was not going back home to his mother, and threw him off the balcony and then jumped himself.

“So you get to the scene and you’ve got this to deal with. And you only know the circumstances after the fact, but you have a damn good clue that at three o’clock in the morning, when the OC Transpo driver found him when going out to his shift, that the kid, maybe two or three years old, didn’t wake up fully dressed at three o’clock in the morning to jump off of the balcony. So now you’ve got that anger issue. You want to kill yourself? That’s somewhat understandable. But to take an innocent child away from his mother and his life? It’s just … it’s weird. There’s this brain storm happening there in your head, in my head, that’s very difficult to deal with and make sense of. So those are very difficult to do.

Complete Article ↪HERE↩!

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This is what it’s like to be a death doula

The founder of Going With Grace, Alua Arthur, shares how she found her way into death work and how she manages not to take her work home with her.

Alua Arthur

By Anisa Purbasari Horton

For many people, the thought of being surrounded by death (and have that be a central part of how they earn their living) can seem quite morbid. But for Alua Arthur, the founder of the end-of-life planning service Going With Grace, it feels exactly the opposite.

Arthur is a death doula—also often referred to as a “death midwife.” Arthur’s journey to becoming a death doula is a profoundly personal one, but she represents a number of professionals who are active in the growing “death wellness” and “death-positive” movement. As Fast Company‘s Rina Raphael previously reported, this movement rests on the notion that having a good death is “part of a good life.”

Fast Company recently spoke to Arthur about her motivations for becoming a death doula and how she copes with work-life balance as she helps others through the grieving (and often stressful) administrative process that comes before and after a loved one’s death. The interview has been edited for length and clarity.

Helping people become clear on what death looks like

A death doula is a non-medical professional who provides holistic support for the dying person of the family and the family members. I help the people who are close to death on what it looks like. After that, I help family members deal with their affairs.

I also work with healthy people. The way I conceive it, as soon as someone comes into any recognition that one day they’re going to die, that’s the time to start preparing for that, so I help them with an end-of-life plan. It’s where we write down all the stuff that’s going to be a pain. We get clear for what their desires are for life support, and who’s going to make the decisions for them. We walk through important information and documents, like where’s their birth certificate? Where is their retirement account? Where do they bank? 

I also help people who are terrified of death. I find that people are more afraid of the dying process than death itself, so with them, I do death meditations. This looks like us going through the eventual decline of the body, their systems shutting down, and their breathing becoming ragged. It’s an opportunity for the person to lay there with whatever it is they experienced. A lot of times, people experience a sense of peace after going through this process.

The desire to build a career around death

Growing up, I wanted to be lots of things. I really wanted to be an astronaut. I loved to read and immerse myself in another world. I also wanted to be a conductor. I applied to a music conservatory, but I ended up in a liberal arts school that had an okay music program. I got involved in student government and decided to go to law school. I worked in property law, starting with government benefits, and then I moved to domestic violence and then not-for-profit development. I fumbled around for 10 years and started getting really depressed, so I took a medical leave of absence. That’s how I found death work.

I met a woman in Cuba. She had cancer and was traveling, and we bonded. We spent 14 hours on the bus together, and I asked all the difficult questions. What would be undone in her life if the disease killed her? What does she think happens after she dies? Did she live with the recognition of death constantly? They were questions I never really had myself. That was the first time it hit me that death was very real and that we don’t talk about it enough. It became clear that I wanted to spend my career talking about death.

That was solidified when my brother-in-law got sick and died. It showed me how all the ways that we do it now are broken. We had so many questions—how do we transfer the title for his vehicle, and what should we do with his leftover medication? There was nobody to answer them.

A day in the life of a death doula

A typical day always includes a lot of emails. So many emails. The part of my job that stresses me out is the business part. God, it’s the worst! I need to go back to my vision of helping people feel less alone to keep me in clear focus.

I start my day checking on various things—with the people who are dying, how things were over the course of the night. I’ll also check on plans for any funeral procession. I do a lot of phone calls and talk to therapists who work with people that are dying. If I do have clients that are dying, I see them in the afternoon, or I will see my end-of-life planning clients.

These days, I also do a lot of education around death and dying. I’m doing a lot of talks to reach people about how to do this work because we’re all going to have to do it for somebody in our lives.

When it comes to work-life balance, I do things like meditate daily, exercise regularly, and drink a gallon of water every day. I just got my nails done. I don’t deny myself pretty things.

On death and relationships

I talk about death all the time with my friends and family. I think sometimes I can be a little bit annoying because I want people to be authentic in their decision-making. I tend not to tell people what to say or do, and I listen actively. My best friend and I, we always have challenges because she always wants to tell me what to do. It is a struggle for my friends who have a hard time with the concept of their own mortality, because I’m talking about it all the time.

I don’t push the issue with my friends who are uncomfortable, but with my family members, I do. For my dad, he first had to come around to the idea that I wasn’t going to be practicing law anymore. Being an African parent, he wanted me to be either a lawyer, doctor, or engineer. I was like, how about death? He was like, how about what? That was a little tricky. But eventually, we got around to talking about it. After all, I’m the one who’ll have to deal with it when it happens.

I think people actually want to talk about death, but they feel like they don’t have permission to do so because it’s “heavy.” Well, it’s a regular part of living. Without death we wouldn’t have life. It’s funny: when I meet someone for the first time and I tell them I’m a death doula, so many of them say, “Oh, when x died, I wish that you had been there.”

Complete Article ↪HERE↩!

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People in western China smoked marijuana to bury their dead 2,500 years ago

— the oldest evidence of weed smoking in human history

In a tomb in western China, scientists discovered human remains and evidence of marijuana use from 2,500 years ago.

By Aylin Woodward

It appears people have been smoking weed for more than two millennia.

Researchers reported on Wednesday that they’ve found some of the earliest evidence of ritual cannabis smoking in the archaeological record.

The evidence comes from stone-filled braziers — a device used to burn a plant and fill the air with its vapors — that were unearthed in eight tombs at the Jirzankal Cemetery in the Pamir Mountains of western China.

Preserved in the 2,500-year-old braziers were traces of cannabinol (CBN), the compound that forms after tetrahydrocannabinol (THC) comes in contact with the air. THC is the most potent psychoactive agent in marijuana.

This wooden brazier with burnt stones in the center provides some of earliest evidence of ritual cannabis smoking.

The authors published their findings in the journal Scientific Advances. The chemical signature of THC residue in the tomb, they said, indicates that people in this region of China likely smoked marijuana during burial ceremonies, perhaps as a way to communicate with the dead.

“It’s the earliest strong evidence of people getting high” on marijuana, Mark Merlin, a botanist at the University of Hawaii, told USA Today.

This marijuana was potent

Marijuana is one of the most widely used psychoactive drugs in the world today, but the legacy of its use and cultivation spans millennia. The earliest known cultivation of cannabis plants occurred in Eurasia roughly 6,000 years ago, but it was used as a food crop and for hemp material — not smoked for psychoactive effects.

Previous evidence of ancient cannabis smoking came mostly from historical anecdotes, not archaeological evidence. Greek historian Herodotus wrote about ritual and recreational pot use around the same time that these braziers were buried in distant China.

Scientists also found cannabis seeds in a different 2,500-year-old Chinese tomb in 2006, but there was no evidence of smoking

Usually, wild cannabis ( Cannabis sativa) has lower levels of THC than its cultivated counterparts. But the residue in these Chinese braziers indicates that the type of cannabis smoked in them had higher THC levels than wild plants. It also had higher amounts of THC than the cannabis grown in ancient Eurasia, the authors of the new study noted in a press release

The authors aren’t sure whether the cannabis used in this region was intentionally cultivated to have higher amounts of THC (as it is today), or whether the people who conducted this burial had some other way of seeking out more potent plants.

Either way, they appeared to be aware that not all cannabis is created equal when it comes to its psychoactive qualities.

These tombs had evidence of human sacrifice

In the Jirzankal Cemetery, the archaeologists also found skulls and other bones with signs of fatal cuts and breaks, which they interpreted as signs of human sacrifice. They found a harp as well — an important musical instrument in ancient funerals and sacrificial ceremonies.

These clues from the past indicate that the burials had a ritual quality to them, and that smoking marijuana played a role in commemorating the dead.

The excavation of the tomb M12, in which evidence of the oldest ritual smoking of cannabis was found. In the photo, the cannabis brazier can be seen at the middle bottom edge of the central circle.

“We can start to piece together an image of funerary rites that included flames, rhythmic music, and hallucinogen smoke, all intended to guide people into an altered state of mind,” the study authors wrote.

Merlin told The Atlantic that this discovery does not suggest ancient Chinese people were into recreational drug use. Instead, he said, it was likely a spiritual practice — part of ushering the dead into the afterlife and helping the living commune with deities or the deceased.

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Aid in Dying Soon Will be Available to More Americans. Few Will Choose It.

By October, more than one in five U.S. adults will be able to obtain lethal prescriptions if terminally ill. But for those who try, obstacles remain.

By Paula Span

On Aug. 1, New Jersey will become the eighth state to allow doctors to prescribe lethal medication to terminally ill patients who want to end their lives. On Sept. 15, Maine will become the ninth.

So by October, 22 percent of Americans will live in places where residents with six months or less to live can, in theory, exercise some control over the time and manner of their deaths. (The others: Oregon, Washington, Vermont, Montana, California, Colorado and Hawaii, as well as the District of Columbia.)

But while the campaign for aid in dying continues to make gains, supporters are increasingly concerned about what happens after these laws are passed. Many force the dying to navigate an overly complicated process of requests and waiting periods, critics say.

And opt-out provisions — which allow doctors to decline to participate and health care systems to forbid their participation — are restricting access even in some places where aid in dying is legal.

“There are what I call deserts, where it’s difficult to find a facility that allows doctors to participate,” said Samantha Trad, the California state director of Compassion & Choices, the largest national advocacy group for aid in dying.

“We’re nearing a tipping point,” said Peg Sandeen, executive director of the Death With Dignity National Center, which oversaw the Maine campaign. “The issue, while still controversial, is less scary.”

The New Jersey bill had neared passage several times since it was introduced seven years ago, but derailed in 2014 when Chris Christie, the governor at the time, threatened a veto. Finally, legislators passed the Aid in Dying for the Terminally Ill Act this winter, and Gov. Philip D. Murphy signed it in April.

In Maine, the state legislature voted yes this spring, but supporters were unsure what the new governor, Janet Mills, would do. As in New Jersey, a Democratic governor replaced an outgoing Republican who had promised a veto.

Gov. Mills signed the law last month. “I do believe it is a right that should be protected by law — the right to make ultimate decisions,” she said.

What’s changed?

All these laws require states to track usage and publish statistics. Their reports show that whether a state has six months or 20 years of experience, the proportion of deaths involving aid in dying (also known, to supporters’ distaste, as physician-assisted suicide) remains tiny, a fraction of a percentage point.

California, for example, in 2017 received the mandated state documents for just 632 people who’d made the necessary two verbal requests to a physician, after which 241 doctors wrote prescriptions for 577 patients. More than 269,000 California in all died that year.

With such data showing no slippery slope toward widespread use or abuse, “a lot of the hypothetical claims our opponents made no longer carry so much weight with lawmakers,” said Kim Callinan, chief executive of Compassion & Choices.

Ms. Callinan also pointed to changing attitudes within the medical community, once a well funded source of opposition. In recent years, a number of national organizations and a dozen state medical societies have instead adopted neutral stances.

“It levels the playing field a little,” she said.

Opponents, including Catholic organizations and some disability activists, still denounce these laws. In March, an aid-in-dying bill passed the Maryland House of Delegates but failed after a tie vote in the Senate. Opponents are attempting a ballot initiative to repeal Maine’s new law and pursuing a slow-moving court case to invalidate California’s.

Public opinion polls consistently show broad support for aid in dying, however. Compassion & Choices says its upcoming legislative targets include Massachusetts, Maryland again, New Mexico, New York and Nevada.

But the persistently small number of users suggests that most Americans close to death would not personally choose to self-ingest barbiturates, even if they support legalizing that option. The low numbers may also reflect difficulty in actually using these laws.

A recent survey of 270 California hospitals, published in JAMA Internal Medicine, found that 18 months after implementation of the state’s End of Life Option Act, more than 60 percent — many of them religiously affiliated — forbade affiliated physicians to participate.

Compassion & Choices is intensifying efforts to persuade local health care systems, doctors and hospices to agree to consider patients’ requests.

Even aid-in-dying laws long on the books are beginning to draw renewed scrutiny.

For decades, the model has been the first-in-the-nation Oregon law, which took effect in 1997. It requires a terminally ill patient to see two doctors, make two oral requests for a lethal prescription plus one in writing, and face a 15-day waiting period.

Every state law but one incorporates those elements. (In Montana, a court legalized aid in dying, so there’s no statute.)

“There’s too many roadblocks in the existing legislation,” said Ms. Callinan, whose organization has long promoted that legislation. “They’ve actually made it too difficult for patients to get through the process.”

Indeed, a study from Kaiser Permanente Southern California, a health system that supports patients who request and meet requirements for aid in dying, shows that at least a third of those who inquire about it become too ill to complete the process, or die before they can qualify.

Yet states are enacting even more supposed safeguards. Hawaii, whose law took effect in January, requires a 20-day wait; both its law and a proposed Massachusetts law add a mandated mental health consultation.

By contrast, the Oregon legislature recently approved an amendment waiving the waiting period in cases where the physician believes the patient will likely die within 15 days. Gov. Kate Brown has until Aug. 9 to sign it.

Perhaps, Ms. Callinan proposed, aid-in-dying laws shouldn’t require waiting periods.

“It takes people a long time to find a first doctor, to make an appointment, to find a second doctor, to find a pharmacist,” she said. “The process itself is a waiting period,” one often exceeding 15 days.

Since rural areas face physician shortages, Compassion & Choices has also urged that nurse-practitioners and physician assistants be allowed to provide aid in dying in states where they can legally write prescriptions.

In Oregon, a veteran state legislator has taken an even more audacious step toward expanding access.

State Rep. Mitch Greenlick has introduced several bills that would permit those in the early stages of dementia and other neurodegenerative diseases to use aid in dying, securing prescriptions they could then use later as their illnesses progressed.

“You could make the request when you were cognitively able to do it,” he said.

Every existing state law bars that. Those requesting aid in dying must have mental capacity; dementia patients will have lost it by the time they’re within six months of dying. National groups emphatically oppose Mr. Greenlick’s propositions.

Yet those at heightened risk for Alzheimer’s disease, the most common form of dementia, are already well aware of aid-in-dying laws, and some would opt to use them, researchers at the University of Pennsylvania recently reported.

They interviewed 50 older adults enrolled in a drug study, most with family histories of Alzheimer’s, all found to have elevated levels of the biomarker amyloid. “We describe it as an increased but uncertain risk of developing Alzheimer’s disease,” said Emily Largent, a Penn bioethicist.

The team’s interviews revealed that about two-thirds of the group would reject aid in dying and about 15 percent had ambivalent responses. But one in five said they would pursue it if they became cognitively impaired, were suffering or burdening loved ones.

Overall, “very few understood that they wouldn’t be eligible” for lethal prescriptions under current laws if they developed dementia, Dr. Largent said.

But they were strikingly open to legal aid in dying.

“It was important to have it available,” she said. “Even if they felt they wouldn’t choose aid in dying themselves, they weren’t opposed to it for others.”

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Could Trees Be the New Gravestones?

A California start-up wants to “redesign the entire end-of-life experience.” The answer to “eternity management”? Forests.

By Nellie Bowles

Death comes for all of us, but Silicon Valley has, until recently, not come for death.

Who can blame them for the hesitation? The death services industry is heavily regulated and fraught with religious and health considerations. The handling of dead bodies doesn’t seem ripe for venture-backed disruption. The gravestone doesn’t seem an obvious target for innovation.

But in a forest south of Silicon Valley, a new start-up is hoping to change that. The company is called Better Place Forests. It’s trying to make a better graveyard.

“Cemeteries are really expensive and really terrible, and basically I just knew there had to be something better,” said Sandy Gibson, the chief executive of Better Place. “We’re trying to redesign the entire end-of-life experience.”
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And so Mr. Gibson’s company is buying forests, arranging conservation easements intended to prevent the land from ever being developed, and then selling people the right to have their cremated remains mixed with fertilizer and fed to a particular tree.

The Better Place team is this month opening a forest in Point Arena, a bit south of Mendocino; preselling trees at a second California location, in Santa Cruz; and developing four more spots around the country. They have a few dozen remains in the soil already, and Mr. Gibson says they have sold thousands of trees to the future dead. Most of the customers are “pre-need” — middle-aged and healthy, possibly decades ahead of finding themselves in the roots.

Better Place Forests has raised $12 million in venture capital funding. And other than the topic of dead bodies coming up fairly often, the office is a normal San Francisco start-up, with around 45 people bustling around and frequenting the roof deck with a view of the water.

There is a certain risk to being buried in a start-up forest. When the tree dies, Better Place says it will plant a new one at that same spot. But a redwood can live 700 years, and almost all start-ups in Silicon Valley fail, so it requires a certain amount of faith that someone will be there to install a new sapling.

Still, Mr. Gibson said most customers, especially those based in the Bay Area, like the idea of being part of a start-up even after life. The first few people to buy trees were called founders.

“You’re part of this forest, but you’re also part of creating this forest,” said Mr. Gibson, a tall man who speaks slowly and carefully, as though he is giving bad news gently. “People love that.”

Sandy Gibson, the chief executive of Better Place Forests, in the start-up’s Santa Cruz location.

Bring Your Dog, Forever

Customers come to claim a tree for perpetuity. This now costs between $3,000 (for those who want to be mixed into the earth at the base of a small young tree or a less desirable species of tree) and upward of $30,000 (for those who wish to reside forever by an old redwood). For those who don’t mind spending eternity with strangers, there is also an entry-level price of $970 to enter the soil of a community tree. (Cremation is not included.)

A steward then installs a small round plaque in the earth like a gravestone.

When the ashes come, the team at Better Place digs a three-foot by two-foot trench at the roots of the tree. Then, at a long table, the team mixes the person’s cremated remains with soil and water, sometimes adding other elements to offset the naturally highly alkaline and sodium-rich qualities of bone ash. It’s important the soil stay moist; bacteria will be what breaks down the remains.

Because the forest is not a cemetery, rules are much looser. For example: pets are allowed. Often customers want their ashes to be mixed with their pets’ ashes, Mr. Gibson said.

“Pets are a huge thing,” Mr. Gibson said. “It’s where everyone in your family can be spread. This is your tree.”

“Spreading” is what they call the ash deposit. The trench is a “space,” the watering can is a “vessel,” the on-site sales staff are “forest stewards.” When it comes to both death and start-ups, euphemisms abound.

Available trees are marked with ribbons. Multiple ribbons indicate type and size of the trees.

It’s all pretty low-tech: mix ashes in with dirt and put a little placard in the soil. But there is a tech element: For an extra fee, customers can have a digital memorial video made. Walking through the forest, visitors will be able to scan a placard and watch a 12-minute digital portrait of the deceased talking straight to camera about his or her life. Some will allow their videos to be viewed by anyone walking through the forest, others will opt only for family members. Privacy settings will be decided before death.

Death Is a Growth Industry

As cities are running out of room to bury the dead, the cost of funerals and caskets has increased more than twice as fast as prices for all commodities. In the Bay Area, a traditional funeral and plot burial often costs $15,000 to $20,000. The majority of Americans are now choosing to be cremated.

“The death services market is very big — $20 billion a year — and customer approval is low,” said Jon Callaghan, a partner at True Ventures, an investor in Better Places. “The product is broken.”

The firm’s other investments include Blue Bottle, Peloton and Fitbit, and Mr. Callaghan sees consumers of those products as ones who would be interested also in Better Place trees.

“Every industry seems to have its time when things get wild,” said Nancy Pfund, the founder and a managing partner at DBL Partners, which led early funding. “It’s been mobile apps, it’s been cars, it’s been fake meat, and now it is death care,” she said.

“But we have to come up with a better name than ‘death care.’ Maybe it’s legacy care,” she added. “Maybe it’s eternity management.”

Around 75 million Americans will reach the life expectancy age of 78 between 2024 and 2042, Better Place suggests. The company’s pitch is that tree burial is good for the environment, the location is more beautiful than a traditional graveyard — and it’s cheaper as well.

Ms. Pfund also sees these forests as a way to monetize conservation. Actively managing a forest is expensive, so much so that financially strained state park systems are having to turn down gifts of land. Conservation easements, an agreement between an organization and the government to preserve land, have become more popular as a solution.

“No one has really made a big business monetizing conservation, nothing that could scale,” Ms. Pfund said. “So a bell went off when we heard this pitch.”

Where’s Grandma?

Those tracking the death services industry are more skeptical about how disruptive it will be.

John O’Conner, who runs Menlo Park Funerals, said more than 90 percent of his clients opt for cremation.

“Most of my people scatter on their own,” Mr. O’Conner said. “They just go at night, scatter grandma, have a cup of champagne, and every day they drive by that park they know grandma is there. Why would they pay $20,000 to go to a memorial grove when they can scatter at any little park they want to for free?”

That act is, technically, illegal.

“Don’t ask, don’t tell,” Mr. O’Conner said. He said he knew of a few golf courses in the region that had to put up signs imploring people not to scatter guest remains there.

Ben Deci, a spokesman for California’s Cemetery and Funeral Bureau, said Better Place Forests’ activities do not fall under the bureau’s purview.

“It looks to me like they’ve just purchased large tracts for forest land and are allowing people to disperse their ashes, and they say here ‘This’ll be your tree or whatever,’” Mr. Deci said. “You don’t need our approval to do that.”

Mr. Gibson does have a permit from the state verifying him as a cremated remains disposer. “But that’s not quite the right way to think about it,” he said.

How to Choose the Right Forever Tree

One recent day, Mr. Gibson walked through his 80 acres of Santa Cruz forest where about 6,000 trees are available, many wrapped in different colored ribbons, waiting to be chosen.

“The last major innovation in cemeteries was the lawn cemetery in the ’50s and ’60s, basically so they could get a lawn mower through easier,” Mr. Gibson said.

To claim a tree, customers walk through the forest and find one that speaks to them. The Better Place brochure also guides them: Coastal redwoods are “soaring and ancient,” tan oaks are “quirky and giving,” while a Douglas fir is “stately and reverent.”

“Some people want a tree that is totally isolated, and some people really want to be around people and be part of a fairy ring,” Mr. Gibson said. “Some people will come in and they’ll fall in love with a stump.”

“People love stumps,” he said, pointing out a few trees people bought just for the nearby stumps. “They’ve got a lot of personality.”

Younger people often choose younger trees because they like the idea of growth.

Debra Lee, a retired administrative assistant in San Jose, felt immediate kinship with the madrone tree she chose.

“She’s about 60 years old, and I’m 63,” Ms. Lee said of the mature evergreen with dark red bark. “Looking at her growth pattern you can see things have been hard at times because she’s kind of curved, but she made it to the top to get to the sunlight.”

When a customer chooses her tree, as Ms. Lee did, she cuts the ribbon off in what Better Place calls the ribbon ceremony.

As Mr. Gibson hiked across the Santa Cruz forest in a sweater and work boots, he noticed a rhododendron, his mother’s favorite flower, growing out of a stump.

Both his parents died when he was young, and, at 12, Mr. Gibson was adopted by his half brother. He is now 36, and, since then, he has spent many afternoons in Toronto at his parent’s grave site, set on a noisy corner, with a shiny black headstone that reflects traffic.

“You remember them dying, you remember the memorial service, and you remember the image of their final resting place,” Mr. Gibson said. He was haunted by that badly designed grave site. “It’s comically bad.”

Visiting their grave in 2015, he decided to quit his job running a marketing automation company. He would make a better graveyard.

“A lot of investors laughed at us when I first pitched this,” Mr. Gibson said. “People don’t really like thinking about this.”

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