In general, the probability of death is pretty simple to calculate. It’s 100 percent. We all die.
But the devil is in the details. Humans fear catastrophe and disaster, and accordingly, tend to worry about horrifying events: gunfire, a terrorist attack, lightning strikes. The fact that such grisly ends rarely come to pass—especially if you stay inside during thunderstorms—doesn’t seem to reduce such concerns.
Every year, the U.S. Centers for Disease Control and Prevention publishes a compendium of how many Americans died the year before. There’s plenty to be learned about freak accidents—two people died in 2014 from “ignition or melting of nightwear”—but the data also shows how exceptionally hardy human beings are.
In any given year of their lives, Americans far more likely to keep chugging along than not. Even at the frail age of 85, you have a 92 percent chance of surviving to the next year.
Pretty good odds! But this is where probability comes in. After all, life is not a single roll of the dice, but thousands. Survival is rarely dependent on a single, cataclysmic moment of chance, but years of smaller risks — the 0.089 percent chance of heart disease at age 50, then 0.098 percent at 51, and 0.109 at 52.
In the end, it’s the additive power of probability that kills us. And at each turn of the calendar, the odds usually go up.
Here’s an experiment. Using CDC data from 2009 through 2014, we coded a program that simulates a person’s lifespan and calculates the odds of dying at any given year. For every year of life, it runs this virtual person through the litany of ways to expire. If their number isn’t called, they advance to the next year.
Of course, one lifetime isn’t very informative. So it repeats the experiment 10,000 times, creating a whole town of clones.
Running this simulation for someone of your own demographic characteristics may prove interesting; comparing your risks to those who have different traits, though, is likely to prove even more illuminating. Different segments of the American population face radically different challenges as they move through life.
There are crucial implications to that simple fact. Every day, policymakers steer resources toward addressing some of these risks, and as a result, away from others. At the same time, Americans who face different risks may back political candidates who address their needs, or donate their time and money to causes that seek to combat the diseases most likely to strike them or those around them. Resources may not end up where they do the most good; often, they wind up devoted to the risks facing segments of the population best-positioned to secure them. Striking the proper balance among these competing demands is among the hardest puzzles facing politicians, policymakers, and the general public.
This isn’t a perfect simulation, as it uses current data across many years of life to generate a new lifespan. For instance, people born today are probably far less likely to die of lung cancer than current 80-year-olds, thanks to the decline in smoking. It uses data on Americans, who face different risks than other populations. And because of CDC data restrictions, the simulation only runs until the virtual person’s 100th birthday.
Even so, the lesson is clear: Lives are defined by the little risks we take, not the big ones. And to paraphrase T.S. Eliot, we’re far more likely to die not with a bang, but a whimper.
The narrow, inscrutable zone between undeniably still here and unequivocally gone includes a range of states that look like life but may not be: a beating heart, a functioning digestive system, even moving fingers and toes. Death is less a moment then a process, a gradual drift out of existence as essential functions switch off, be it rapidly or one by one.
It was exactly midnight when Colleen Burns was wheeled into the operating room at St. Joseph’s Hospital Health Center in Syracuse, N.Y. She had been deep in a coma for several days after overdosing on a toxic cocktail of drugs. Scans of electrical activity in her brain were poor, and oxygen didn’t seem to be flowing. Burns was brain dead, her family was told; if they wanted to donate her organs, now was the time to do it.
But there, under the bright lights of the prep room in the OR, Burns opened her eyes. The 41-year-old wasn’t brain dead. She wasn’t even unconscious anymore. And doctors had been minutes away from cutting into her to remove her organs.
This is the nightmare scenario, the one that sends doctors and neurologists into cold sweats. It’s the reason that, in 2010, the American Academy of Neurology issued new guidelines for hospitals for determining brain death – the condition that legally demarcates life from whatever lies beyond. Those standards, according to Yale University neurologist David Greer, who worked on them, are meant to ensure that no patient is declared dead unless they really are beyond all hope of recovery.
“This is truly one of those matters of life and death, and we want to make sure this is done right every single time,” he told NPR.
But five years later, according to a study led by Greer that was published in the journal JAMA Neurology Monday, not all hospitals have adopted the guidelines.
Of the nearly 500 hospitals Greer and his colleagues surveyed over a three year period, most facilities did not require that someone with expertise in neurology or neurosurgery be present to determine brain death. At more than half of hospitals, the person who makes the call doesn’t even have to be the patient’s attending physician. A majority also didn’t require doctors to test for hypotension (abnormally low blood pressure) or hypothermia, both of which can suppress brain function which could mimic the appearance of brain death.
There were large improvements in standardization of brain death assessments across hospitals since the 2010 criteria were published. The survey also looked at standards, not practices.
But the lingering lapses are still worrying, Greer told NPR.
“There are very few things in medicine that should be black and white, but this is certainly one of them,” he said. “There really are no excuses at this point for hospitals not to be able to do this 100 percent of the time.”
Burns’s near-disastrous declaration of death happened in 2009, before the new guidelines were released, though a U.S. Department of Health and Human Services report on the incident found that St. Joseph’s had failed to meet previous standards for assessing death. Hospital staff missed several signs that Burns’s brain was still functioning the night she was due for organ donation surgery: her nostrils flared, her lips and tongue moved, she was breathing “above the ventilator” (meaning, taking breaths of her own accord). And when a nurse performed a reflex test, scraping a finger along the bottom of Burns’s foot, the woman’s toes curled inward, according to the Syracuse Post-Standard.
Doctors failed to order repeat CT scans and inexplicably and inaccurately said that she suffered from cardiac arrest when she hadn’t. Crucially, they also failed to measure whether the drugs she had taken still lingered in her system, preventing her from exhibiting even the most primitive reflexes expected of someone with brain activity.
This is a widespread problem, Greer’s report indicates: only about 32 percent of hospitals surveyed required drug tests to rule out toxic levels that can mimic the loss of primitive reflexes associated with brain death.
As soon as Burns opened her eyes, she was rushed back into the ICU and her doctors resumed treatment. She ultimately recovered from her overdose and was discharged two weeks later. But 16 months after the near-miss in the OR Burns committed suicide, her mother told the Post-Standard.
Burns’s mother, Lucille Kuss, said that depression, not what happened at the hospital, is what drove Burns to her death.
“She was so depressed that it really didn’t make any difference to her,” Kuss said of the incident.
Cases like Burns’s are increasingly rare, but they are emblematic of an anxiety at the root of all discussions about brain death. If death is a process, at what point in the process is the person no longer alive?
For most of history, this question was mostly moot. In the Victorian era, for example, doctors couldn’t keep blood pumping through a permanently unresponsive person’s body, even if they wanted to, and a person who lost brain function would surely quit breathing shortly after. Determining the exact point of death was less a medical necessity than a philosophical diversion: In the early 1900s, Boston doctor Duncan MacDougall recruited a number of terminally ill patients to lie down on a massive scale during their final moments. By measuring fluctuations in their weight at the moment they died, MacDougall claimed, he could determine the mass of the soul.
The advent of organ donation procedures in the 1960s changed that. That period of collapse as functions failed became not only a tragic inevitability, but a vital window when organs could be taken from a dead body and used to keep another alive. Yet defining that window is medically and ethically complicated. Open it too early, as Burns’s doctors almost did, and you risk sacrificing a patient who might have survived. Too late, and the organs will deteriorate along with the life they once sustained.
This is how we arrived at a definition of death as brain death, the complete and irreversible loss of brain function, including in the brain stem (which controls the heart and lungs). It comes largely from a 1968 definition written for the The Journal of the American Medical Association by an ad hoc Harvard Medical School committee, and then affirmed by a blue ribbon medical commission just over a decade later. A person can also be declared dead if they suffer an irreversible cessation of respiratory and circulatory functions – in other words, their heart and lungs permanently stop.
Some critics of brain death as a barometer for organ donation worry that it might encourage doctors to give up on their patients too soon.
Of course, the extraction of organs from a failing body is not the only reason to come up with a legal definition of death. It also helps hospitals to determine when and how to end life-saving interventions and remove a patient from life support.
The logic behind marking brain death as the end of life is that existence without a brain isn’t living.
“The brain is the person, the evolved person, not the machine person,” Cornell University neurologist Fred Plum said at a symposium on comas and death in 2000, according to the New Yorker. “. . . We are not one living cell. We are the evolution of a very large group of systems into the awareness of self and the environment.”
The brain is the person, the evolved person, not the machine person
But not everyone agrees. Cultural and legal definitions of life and death vary – in an interview with NPR, Georgetown University medical ethics professor Robert Veatch called defining death “the abortion question at the other end of life.”
Right now, the family of Jahi McMath, a California teenager who was declared brain dead two years ago but has been kept on life support, is suing to have her death certificate invalidated according to the Associated Press. The McMaths are devout Christians, their lawyer wrote in a brief, who believe that “as long as the heart is beating, Jahi is alive.”
McMath is currently on a ventilator in New Jersey, where state law allows hospitals to take a family’s religion into consideration when making decisions about end-of-life procedures.
Yet despite the legal, medical and moral complexities in determining brain death, there is no federally mandated procedure for doing so, according to the New York Times. There are only the guidelines issued by neurologists, and how hospitals choose to apply them.
That they do so inconsistently only exacerbates the anxieties people have about death and organ donation, Leslie Whetstine, a bioethicist at Walsh University in Ohio, told NPR.
“If one hospital is using a testing method that’s different from another hospital,” she said, “people might wonder: ‘Are they really dead?’”
Adam Conover’s truTV show Adam Ruins Everything is airs the perfect episode this week: “Adam Ruins Death.” Among the death-related subjects Conover breaks down in the episode is how the American funeral industry takes advantage of grief for huge profits, and if Conover has his way, a whole lot of people will be making — or revising — their own funeral plans.
Traditional statuary and memorials were among the products on offer. In Japan, death is an opportunity for growth. Business growth, that is.In a country with many more deaths than births each year, Japanese companies are looking to maximize the amount of money people spend on shuffling off their mortal coil, from preparing “ending notes” and choosing coffins to arranging to have their ashes blasted into space or turned into diamonds.
“I want to promote our products because we have almost 1.2 million people dying each year but we sell only 60,000 of these mats,” said Koichi Fujita, a representative of a company selling tatami liners and pillows for coffins. He was using slightly outdated death figures: Japan said goodbye to 1.3 million citizens last year but hello to only 1 million new babies.
Fujita’s was one of the scores of companies touting their wares at Endex, an expo devoted to planning for the end of one’s life, held at a huge exhibition center in Tokyo.
“Japanese people spend their lives on tatami mats,” Fujita said, referring to the straw flooring in traditional Japanese rooms. “And there’s a saying that they want to die on a tatami mat, meaning die at home. But so many people die in the hospital, so at least they can have a tatami mat in their coffin when they are sent off.”
Japan has the fastest-aging population in the world. Slightly more than one-quarter of the population is 65 or older, and the Health Ministry forecasts that the proportion will hit 40 percent by 2060.
Many aspects of Japanese life are now geared toward senior citizens. Go into any drugstore and you will find shelves of diapers and sippy cups — for the elderly. Banks and post offices have reading glasses on the counters for customers with failing eyesight, while big pedestrian crossings have buttons to push for those who need extra time to get across the road.
Panasonic has a line of easier-to-use household appliances — including washing machines, microwaves and rice cookers — targeted at the elderly, while convenience stores sell packaged food in smaller portions for seniors.
But the business of actually dying is a whole other opportunity. There is even a term for it here: “shukatsu,” or preparing for death. It is a play on a more common homophone for job-hunting.
“The government estimates that in 2038, 1.68 million people will die,” said Midori Kotani, a social scientist at the Dai-ichi Life Research Institute, part of a major insurance company. “Because there are so many more people dying, people see business opportunities there.”
At the first Endex, or “Life Ending Industry Expo,” more than 200 companies were trying to get a bigger chunk of the industry, which the expo’s organizing committee said was now valued at a whopping $41 billion.
There were the usual coffins and tombstones, plus the latest-model hearses. But there were also Buddhist monks touting for business — people are not keeping up with the annual rituals these days — and coffee retailers hoping to sell their products as gifts for funeral attendees, which is a custom here.
There was also a mobile pet cremator offering to pull up his furnace-loaded van in front of your apartment building and turn Fido into ash. A 20-pound dog costs about $300 and takes about an hour to cremate. A hamster, considerably less on both counts.
There were also some novel products for humans.
“Some people have long wanted to go into space,” said Hirohisa Deguchi of Galaxy Stage, a company that will send a small metal container of ashes up in a rocket. (Funnily enough, his surname means “exit.”) “We can put them in this capsule and launch them on a rocket.”
Five people have had some of their remains sent into space, and another five are scheduled for liftoff next month .
The cheapest “space memorial” — being launched into space and burning up on reentry — costs about $3,700, or you can go into orbit on a satellite, where your family can track you with GPS for 240 years, for $8,000. The deluxe model — having your ashes left in a capsule on the moon — costs an out-of-this-world $21,000.
For those who want to stay on the ground, the Heart in Diamond company offers to turn a person’s hair or ashes into a gemstone. The company offers a range of colored diamonds — including orange, blue and green, in various sizes and carats — starting at $3,000 and going up to $20,000.
Most customers are women wanting to keep their mothers close, said Naoto Kikuchi, a company director, as he manned his busy stall.
There is a special reason this “mourning jewelry” appeals to Japanese women, he said: “If you’re married, you are buried with your husband’s family, not with your own family.” That makes jewelry a way to keep your birth family close, he said.
But there is another reason people in the shukatsu business need to innovate: Even as the number of deaths goes steadily up, the money that people spend on funerals and other such expenses is going steadily down. That means the overall industry is stagnant, said Kotani, of the Dai-ichi institute.
“In a place like Tokyo, about 30 percent of people who die don’t even have funerals — they just go straight to cremation. Plus, how much people spend on one funeral is declining,” Kotani said, adding that people are becoming increasingly frugal and are not wanting to cause stress for their families left behind.
“So people in this business have to find ways to maximize the amount of money spent on each death,” Kotani said. “That’s why we’re seeing video messages from deceased people and offers to send ashes into space.”
One of the 22,000 people who were checking out the options at the expo was Mariko Saito, a 68-year-old widow from Tokyo. “I learned about this on television,” she said as she perused small Buddhist urns.
“I don’t want to be buried in the same grave as my [deceased] husband as I don’t have a good relationship with his side of the family,” she said with a laugh. “So I’d like to think about what I want to do with my money and about my ending and share it with my daughter when she visits for New Year’s holidays.”
For businesses, there is a strong incentive to cater to people such as Saito, to be innovative and come up with new ways to make money. As Kotani puts it, “After all, you only die once.”
I’m going to start running a series called “101 Ways to Say Died.” In this project, I will be cataloging all the synonyms for “died” that appear in early American epitaphs.
In order to qualify, the word/phrase must appear in the main part of the text, not the verse. That is to say, I’m looking at the part where it says, “Here lies John Doe, died January 1, 1750,” rather than the poetic epitaph that sometimes appears after the primary epitaph. If I can’t make it to 101 with this criterion, I’ll look at the verses. Similarly, I’m going to limit eligibility to pre-1825 stones with the option to extend that to 1850 if I fall short of 101.
A skeleton which has been used for years by a school’s art and science departments is to be given a proper funeral after it was discovered to be real human remains.
Haydock High School in Merseyside has been using the bones – affectionately know as ‘Arthur’ – to allow children to practice their drawing and learn about the body for at least 40 years.
But when an art technician at the school was having a clear-out of the cupboards, she decided to have the bones tested to see if they were real.
She was shocked when the tests came back positive, with experts believing the bones belong to an Indian man who suffered from curvature of the spine and was aged between 17 and 30 when he died in the 1900s.
Sandra Dixon, the school worker behind the discovery, said she found the bones while reorganising the department and thought they should be investigated.
Due to the age of the skeleton, it is currently unclear how the mystery bones ended up in the classroom. It is also not known how the man died or whether he came to Britain before or after his death.
Pictures show he is missing his right leg, the lower section of his left leg and the top of his skull.
Local undertakers Haydock Funeral Service have now offered to provide a full funeral including a wicker coffin, hearse and bearers free of charge.
‘Arthur’ will finally be given a send-off tomorrow at Greenacre Woodland Burials in Rainford, Greater Manchester, at a ceremony attended by staff and pupils from Haydock High.
Ann Ashburner, the school’s head of art, said: ‘When we found out it was a real human skeleton that we had in the school for 50 years, we knew that, by law, a burial was the only way we could correctly dispose of the remains.’
Ms Ashburner added: ‘He was a human being and it is our duty as a Christian school to do our best for him because all lives are sacred and you have to be respectful when he has served us for so long.
‘You would do the same for any stranger so we owe it to him to lay him to rest properly.’
Ms Ashburner has been at the school for 17 years and has shared a room with the skeleton since the science department replaced him with a plastic one in recent years.
She insists that the funeral has doubled up as an ‘educational tool’ as well as fulfilling a legal obligation.
Ms Ashburner said: ‘The children have been really respectful and have not treated it as a laughing matter at all.
‘They have been asking me where he is all the time and it is really useful educational tool.’
She added: ‘As part of their PHSCE studies, the children have to learn about death and it is a difficult subject to cover in a classroom environment.
‘But this will allow the children to experience traditional Christian and Hindu burials without the grief of it all.
‘It is the first time I have heard of a school doing something like this but I am sure that there are plenty of schools with real skeletons who have no idea about it.’
Keely Thompson, of Greenacre Burials, said: ‘We are delighted to provide a final resting place for Arthur. It’s a beautiful place of burial.’
Caitlin Doughty, who was about to open her first funeral parlor, in Los Angeles, gazed at a skull that she had put on display above the desk in her office. Although it was plaster, the skull was a provocative presence in a room where Doughty planned to receive grieving families. It was mid-June, and that afternoon John Gettys, a field representative of the California Cemetery and Funeral Bureau, was coming to give the business a final inspection. Doughty, who is thirty, said, “I want the office to look like me, but I don’t want it to look too Arty Death Hipster.” This was possibly a futile hope. She grabbed the skull and sat contemplating it; in her vintage wooden swivel chair, she looked like a noble in a memento-mori portrait. “I don’t want the state inspector to think I’m testing him,” she said. “Maybe I’ll put it on a lower shelf. That way, I will stay true to myself.” She checked her phone: Gettys was running late. “Maybe he died,” she said. “How funny would that be?”
Doughty’s office, which is in a medical building on the gritty end of Santa Monica Boulevard, has a view of the 101 from one window and a glimpse of the Scientology campus from the other. On one wall hangs a painting, by a high-school friend, of a coffin that has been bent in half and placed atop a chaise longue, in the manner of Magritte’s “Perspective: Madame Récamier by David.” The bookshelf bears volumes of poetry, including Whitman’s “Leaves of Grass,” as well as a compendium of nineteenth-century funeral practices titled “The Victorian Book of the Dead.”
When Gettys finally arrived, Doughty rose to shake his hand. She is six feet one in ballet flats, and has pale skin, long mahogany hair with bangs, and a penchant for vintage dresses with nipped-in waists. (Today’s outfit was emerald green, which matched her eyes.) Gettys read through her price list, which offered a biodegradable willow casket for thirteen hundred and seventy dollars and, for a hundred and twenty dollars, a newborn’s casket made from recycled paper embedded with pressed flowers. Doughty considered her business an “alternative funeral service” that would bring mourners into closer contact with the dead by helping people to tend to corpses at home. She did not plan to offer embalming services, although she was qualified to do so, having graduated in 2010 from the mortuary-science program at Cypress College. Regulations of funeral homes vary from state to state, and in California one can go into business without having taken a class in embalming, or even having learned how to securely close the eyes of a corpse. (A piece of cotton from the end of a Q-tip slipped under the eyelid usually does the trick.)
Doughty has a low, mellifluous voice and an ironical manner. “Are you going to give us a cool license number? Like, all the same digits?” she asked. Gettys, a middle-aged man whose pants and shirt were both of an olive hue, was not perceptibly amused, and replied that the number would be up to the bureau, in Sacramento. “We plan to be massively compliant,” Doughty told him. Her funeral parlor does not have its own crematory, so she and Gettys drove to examine the nearby facility that she planned to use. Gettys told her that, thirty years ago, he’d entered the business as an apprentice embalmer. “The funeral industry doesn’t change a lot—it’s been around for a long time,” he said. “Everybody tries to reinvent the wheel. Well, let me tell you something. The wheel has already been invented. O.K.—there are little permutations that can be done to the business model, but by and large the idea is to dispose of dead bodies.”
It was clear that Gettys was not aware of Doughty’s public profile—that he had not, for example, come across her popular series of online videos, “Ask a Mortician,” in which she fields such viewer questions as “Are these really my mother’s ashes?” and “What is the best way to write into my will that my children will receive no inheritance unless they have my dead body taxidermied and propped up in the corner of the living room?” In 2014, she published a best-selling memoir, “Smoke Gets in Your Eyes: And Other Lessons from the Crematory.” (“A girl always remembers the first corpse she shaves,” it begins.) And she is the founder of the Order of the Good Death, a mostly online meeting place for morticians and academics who are interested in exploring new ways to guide mourners through the experience of death.
A week after Gettys’s visit, Doughty posted on Twitter an image of an official letter that she had received from Sacramento. It began with a cheery “Congratulations!” Doughty tweeted, “I am a funeral home owner. There can be miracles, if you believe.”
Doughty grew up in Hawaii, on the island of Oahu. When she was a teen-ager, she fantasized about opening a funeral home that would combine retro charm with up-to-date service. As she writes in her memoir, she even came up with a name for her imaginary establishment: La Belle Mort. She saw herself creating tailored events that celebrated the life of the deceased in a highly personalized manner: sending cremated ashes into space, or shooting them out of a gun, or compressing them into a gemstone.
After graduating from the University of Chicago, she worked for about two years at Pacific Interment, a mortuary and crematory in an industrial district of Oakland. Without ceremony, she processed corpses through preparation and incineration. This work changed her vision of the ideal funeral practice. “When I first thought I wanted to get into the industry, I thought people needed a more friendly death—for death to be more accessible,” Doughty told me. “That changed very quickly. Now I think people need to get closer to it. It should be up in your face, not ‘Let’s turn Mom into a diamond.’ ”
Her new funeral parlor has a blunt name: Undertaking L.A. Along with Amber Carvaly, her business partner, Doughty intends to help people take care of their own dead, rather than outsource the task to professionals. “When I found myself in all these big industrial warehouses, alone with all these bodies, I thought, If I’m doing all this, there are all these other people who aren’t doing this,” Doughty said. “That’s too much death for one person and not enough for all those other people.” Among the services offered by the fledgling company are help with home funerals, in which the body is bathed and dressed, then kept on ice for a few days, while the family grieves; natural burials, without casket or marker, at a green burial ground in Joshua Tree; and witness cremations, which permit family members to help load the body into the cremation machine and push the button that starts the fire.
Sherwin B. Nuland, in his 1994 best-seller, “How We Die,” wrote, “Modern dying takes place in the modern hospital, where it can be hidden, cleansed of its organic blight, and finally packaged for modern burial.” Doughty’s goal is to end our deliberate estrangement from the dead body. “There really are so many places in our culture where we demand something unnatural,” she told me. “As of right now, what most people find acceptable is either no body at all or something that has been highly mediated. Someone comes in, they take the body away, and, the next time you see it, it has been disinfected and treated and made safe and beautiful.” A dead body is not immediately dangerous, except in cases such as Ebola, and in those instances infectious-disease protocols apply. “And maybe a dead body doesn’t need to be pretty,” Doughty went on. “Maybe we need to look and say, ‘Wow, let’s look at this beautiful, natural corpse.’ ” The conventional funeral industry has given people the impression that death is an emergency. “But death is not an emergency,” Doughty said. “Death is the opposite of an emergency. Look at the person who died—all that stress and pain is gone from them. And now that stress and pain can be gone from you.”
The professionalization of death care in America didn’t get under way until the second half of the nineteenth century. Modern embalming—in which the bodily fluids inside a corpse are drained, through an incision in a vein, and replaced with a preservative solution, through an incision in an artery—was popularized during the Civil War, as a means of allowing the bodies of fallen soldiers to last long enough for them to be shipped home for burial. Embalming became the signature skill of the professional mortician, setting his services apart from those of people—usually women—who had previously been responsible for preparing a dead body for the grave, by bathing it, anointing it, and dressing it, often in a shroud. In 1863, Louisa May Alcott, who served as a nurse during the Civil War, wrote of an encounter with the body of a soldier whom she had tended until death. “The lovely expression which so often beautifies dead faces, soon replaced the marks of pain,” Alcott wrote. “I longed for those who loved him best to see him when half an hour’s acquaintance with Death had made them friends.”
As Gary Laderman, a professor of religion at Emory University, explains in his 2005 book, “Rest in Peace: A Cultural History of Death and the Funeral Home in Twentieth-Century America,” the first embalmers made house calls. Early techniques were sometimes primitive: in 1898, an article in the Journal of Medicine and Science complained that the arsenic used to preserve corpses had leached into the soil and the groundwater near cemeteries. The article cited a critic of the practice—“Gallons of poisonous solutions are squirted into bodies indiscriminately”—and called for the establishing of standards in the handling of corpses. Around this time, the first mortuary schools were established, and the National Funeral Directors Association, which is still the leading industry association, was founded.
The turn of the twentieth century saw the emergence of the first funeral homes—literally the homes of professional morticians, who lived over their shops. It became the norm to remove a body from a home or a hospital as quickly as possible. The death industry boomed: a survey published in 1928 revealed that between 1900 and 1920 the number of funeral directors grew by more than fifty per cent. (The annual number of deaths increased by only 2.3 per cent in the same period.) For most of the twentieth century, the majority of funeral homes were family businesses that were passed from father to son—and rarely to a daughter. In the seventies, ninety-five per cent of funeral directors were men, and even by 1995 there were still almost twice as many male mortuary-science students as female ones.
Today, sixty-five per cent of mortuary-school graduates are women. The gender shift reflects a significant change in funeral practices. Rates of burial—and, hence, of embalming—have undergone a drastic decline. In 1960, fewer than four per cent of corpses were cremated. Today, the cremation rate is forty-five per cent. (Industry projections estimate that it will reach seventy per cent by 2030.) The image of the funeral director has undergone a parallel evolution. Although undertakers are still often portrayed as black-suited men in possession of dour scientific expertise, the funeral director has emerged as a member of the caring professions.
Until recently, it was common to believe that women were not physically capable of doing removals. Though such sexist fictions have been upended—lifting a dead body is mostly a matter of technique—explanations for the recent rise in women’s “death work” are often no less dependent on restrictive stereotypes. Women in the industry often declare that they have an innate empathy for others, and that they excel at providing emotional support to the grieving. It’s also argued that women are especially skilled at dressing the dead—and at restoring the appearance of vitality through the tasteful application of cosmetics and styling of hair. “People are more comfortable about crying, about showing emotion, in front of a woman,” Erin Whitaker, a funeral director from South Carolina, told me. “And it’s easier, as a woman, to put your hand on their hand as a sign of comfort.”
With an increasing demand among baby boomers for customized funerals that reflect the individuality of the deceased, funeral directors are expanding into the business of event production. Today’s funeral director might stage a memorial service featuring the release of butterflies at the grave site, or with the deceased’s Harley parked ceremonially at the entrance to the chapel. In such instances, the skills of a funeral director can seem to fall somewhere between those of a nurse and a wedding planner.Mortuary Management, a trade magazine, offers articles about such innovations as the tribute blanket—an instant heirloom that incorporates photographs of the deceased into a custom-made tapestry—and urges funeral directors to be open-minded when faced with families who want pop songs played at a service. It’s a profitable strategy to, as a feeble witticism of the industry has it, “put the fun back into funerals.”
Since the nineteen-eighties, the National Funeral Directors Association has held an annual professional women’s conference. This year, it took place in Chicago, and it attracted more than two hundred women from across the country. They attended an embalming workshop and listened to speakers who delivered “Lean In”-style exhortations.
Many women at the conference were helping to run, or had taken over, their family’s funeral home, but there were also women who had been drawn to the work for other reasons. Patty Decker, of Woodstock, Georgia, who has been a funeral director for nearly thirty years, told me that she’d wanted to become one since she was eleven years old. “I just saw the respect that the funeral director in my home town had—how much he was admired,” Decker said. “You have to love this job. You are faced with your own mortality every day. We are like the directors of this show that no one wants to attend.” Maria Thomas, an apprentice embalmer in Virginia, had worked in the performing arts before starting her training. “The first time that a family threw their arms around me, thanking me for making their mom look so beautiful—that really touches something,” she said. Strangers were curious about her job, she said, and she welcomed it. “We worship youth and beauty—those are the things that are celebrated in our culture,” she said. “But we do have to accept that over here is the death corner, and you are not going to escape it. You might as well talk about it.”
Doughty didn’t attend the conference: she isn’t a member of the National Funeral Directors Association, and notes grandly in her book that the group “won’t comment on me.” But some of the funeral directors present were aware of her advocacy of alternative funeral practices. One afternoon, there was a roundtable discussion of ways that funeral homes might use social media.
“Who is going to follow a funeral home’s Twitter account, really?” one participant asked.
“Weirdos,” someone replied.
“Competitors,” added another.
Doughty’s online prowess came up, and one participant remarked that she thought it was healthy for the public to get a glimpse of a funeral director’s reality. But another participant expressed concern about Doughty’s perspective. “I feel like she’s the one who’s big on ‘You don’t need a funeral director,’ ” she said.
Affixed to the refrigerator in Doughty’s apartment is a photograph of the class of 1973 at the California College of Mortuary Science, which later became part of Cypress College. Forty-four men, nearly all of them white, are dressed in black tie; there are two women in the class. Hanging next to that image is a 2010 photo of Doughty’s class. Its thirty-one graduates form a racially diverse group, and twenty-two of them are women. At her new business, her colleagues are mostly female, too. “I don’t think it’s because we have some kind of helping gene—I don’t think it’s some deep need to nurture,” she told me. “For me, working with dead bodies is almost like a feminist act. I don’t want people to come in and say, ‘Oh, no, little lady, you don’t know what to do with this body,’ because they already say that about our reproductive systems. I know I am qualified to take care of this body.”
Many funeral directors like to say that they had a calling for the profession. Such statements are no doubt sincere, but it might also be convenient to characterize the career as having been thrust upon one: few people admit to being motivated by a deep interest in corpses and death. Doughty has no qualms in admitting to such a fascination. She says that she became “obsessed with death” in the nineties, while growing up as an only child in Kaneohe, on the east side of Oahu, where her father was a high-school teacher and her mother a real-estate agent. When Doughty was in grade school, she says, she witnessed a small girl tumbling from a height in a shopping mall. (Doughty presumes that the girl fell to her death, though she never found out for sure.) The incident made her conscious of her own mortality and that of everyone else. “Everybody has their moment when they realize that death is very real,” she says.
Doughty studied medieval history at the University of Chicago, and she eventually focussed on the cultural status of the corpse and the representation of dead bodies in art and religious iconography. “I was interested in how much they had a relationship with the dead,” she said. “If you went to a church in the Middle Ages, there would be bodies buried under the floor and in the wall and in pits outside the church, and absolutely everywhere. The church was the center of life, so you would go there and have sermons and plays and outdoor markets. Everything you did—you were surrounded by corpses. Of course, they feared Hell—it’s not like they were totally comfortable with death—but they were a lot more comfortable with the dead body than we are now.”
Upon graduation, in 2006, Doughty sought to convert her academic interest into real-world experience. At Pacific Interment, the Oakland crematory, she worked on bodies in the prep room and loaded them into the cremation machine. No special credentials were needed for the job, besides a tolerance for the brute facts of mortality. She gained intimate knowledge of the process of decomposition when it is unhindered by embalming: first comes a loosening of the skin, followed by bloating, putrefaction, and blackening. She chronicles her experiences in “Smoke Gets in Your Eyes,” which is filled with unflinching observations. (“The left side of her chest was caved in, giving the impression that someone had removed her heart in some elaborate ritual.”) Doughty learned that it is difficult to arrange the deceased’s facial features into a semblance of heavenly rest after rigor mortis sets in, a few hours postmortem. And she learned in what order corpses should be cremated when several must be processed in a single day. (Start with the heaviest decedent, when the cremation chamber is cold; if one waits until the chamber is hot, the body will burn too quickly, producing excessive smoke.)
For the most part, Doughty performed what is known as direct cremation, in which the body is removed from a hospital or a home, then incinerated without ceremony, the desiccated remains mechanically processed into unidentifiable fragments that are collected and given to a relative. This is the least expensive way of dealing with death: in the U.S., the cost of a direct cremation averages between seven hundred and twelve hundred dollars, whereas an in-ground burial typically costs about seven thousand dollars. Cremation gained in popularity in America largely in response to consumer groups that, starting in the nineteen-sixties, publicly questioned the expensive services of the funeral industry.
In 1963, Jessica Mitford published “The American Way of Death,” a scathing investigation into the practices of funeral directors. They were, she suggested, “merchants of a rather grubby order, preying on the grief, remorse, and guilt of survivors.” Funeral directors lined their pockets, in part, by promoting questionable psychological arguments, such as the claim that the viewing of an embalmed corpse was a necessary step in the grieving process. They recommended “eternal sealer” caskets to protect the corpse from even greater ravages than death. Mitford championed cremation as a sensible alternative to burial, and her book, which became a best-seller, helped set in motion an investigation of the industry by the Federal Trade Commission. When Mitford died, in 1996, she was cremated, at Pacific Interment, for a cost of four hundred and seventy-five dollars. A decade later, Doughty took considerable satisfaction from the fact that she was operating the same machine in which Mitford had been reduced to ash.
Like Mitford, Doughty reviled the excesses of the funeral industry. But the longer she worked at Pacific Interment the more she found her own attitude toward the dead body at odds with Mitford’s approach, which struck her as unsentimental to the point of callousness. Doughty began to think that Mitford’s effort to combat the commercial excesses of the traditional funeral industry had ended up reducing the dead body to something to be dispensed with as cheaply and efficiently as possible. This approach swept aside an important aspect of human experience: that of tending to loved ones in death, just as in life.
All Caring Cremations, the company that handles the burning of bodies for Undertaking L.A., is in a bleak industrial area in the San Fernando Valley. When Doughty took me there, she pointed out a building down the block that had served as the exterior of the Dunder Mifflin paper company, on the NBC show “The Office.” “In an ideal world, this is not the neighborhood I would choose if we had the option to go with a wooded-stream crematory,” Doughty said. “But that’s not an option we have.”
The lobby of All Caring was decorated with anonymous good taste: wingback chairs, a low table. There was an unplaceable unpleasant aroma. A small chapel was painted in institutional beige, with chairs and a lectern and, up front, space for a casket. “They have said we could do some décor stuff in here—not, like, a feminine touch, but we might put up different art, a different color on the walls, better lighting,” Doughty said. We heard a noise that I first took to be the loud rumble of the air-conditioning system; it was the sound of the cremation machine at work.
Doughty and Carvaly, her business partner, expect that many clients of Undertaking L.A. will seek out their services because of their advocacy of home funerals. For a fee of three hundred and forty dollars, Doughty and Carvaly will come to the home of a dying person and consult with the family about the best way to take care of the body in situ. (Opening windows can be useful, and so is planning to place the body on a bed or a couch that can be reached without climbing stairs.)
A person who helps families with a home funeral is often called a death midwife. (In most states, the services of a professional funeral director are not required by law.) Clients who like the idea of not handing off a loved one’s body might not have the space or the stomach for caring for a corpse at home, and so a visit to All Caring’s prep room—hidden behind a door marked “Employees Only”—is available. There they can help with bathing and dressing the body, then proceed to the chapel and sit with the deceased in valediction.
Carvaly, who is also thirty, was a women’s-studies major at college, and worked at a homeless shelter for women before enrolling at Cypress College’s mortuary program, where she began corresponding with Doughty. She had aspired to be an embalmer, which she thought would combine science and art. But she was disillusioned after working briefly at Forest Lawn, the vast L.A. funeral complex that inspired Evelyn Waugh to write “The Loved One,” his satirical 1948 novel. “Forest Lawn was very competitive,” Carvaly told me, over lunch at the SteamPunk Café, not far from the crematory. “How many bodies can you do in a day? How quick and efficient are you? It’s a business, and you should be able to do it quickly and efficiently. But I didn’t like it.” Undertaking L.A. is in the process of registering as a nonprofit.
Doughty and Carvaly do not expect their services to become mainstream choices. The notion that the dead body is a source of pollution is a deeply ingrained belief in many cultures. In Jewish law, a kohein, or priest, is not permitted to be under the same roof as a corpse (except in the case of close relatives). In Japanese tradition, undertakers belonged to the burakumin, society’s lowest and most reviled caste.
It would be more commercially viable to embrace the trend of selling the funeral as a kind of farewell party. I recently spoke with an entrepreneurial funeral director named Paula Staab-Polk, from Chatham, Illinois. Having grown up in her family’s funeral home, she struck out on her own a few years ago and decided to combine funeral and hospitality services. “The way I look at it is: our death is an event, and our life needs to be celebrated when we pass from this life to the next,” Staab-Polk told me. A few years ago, she added a reception center to her funeral home. She has given a funeral luncheon that featured the favorite recipes of a woman who died at ninety-eight; she has held a service for a ten-year-old girl who died of cancer, at which guests were invited to “adopt” one of the many stuffed animals that had been sent to the sick child’s bedside. Staab-Polk offers floral services and bagpipers, and she also hosts non-funerary events. “I’ve got three high-school proms coming up,” she told me.
Doughty understands the appeal of Staab-Polk’s model. “People are afraid of death,” she said. “Do you want to go sit with the corpse or do you want to party? If you put it like that, it’s not a very hard question.” She is not denying that people can find great comfort in a personalized funeral ceremony. “But I would still argue that it doesn’t give you the full engagement with death and grieving that you need,” she says.
She is particularly skeptical of funerals that offer the bereaved a very brief look at an embalmed corpse. “If you are one of those people who, when you were eight, walked by a hyper-embalmed, preserved corpse, with the makeup and the suit, that quick glimpse in the casket can be scary, because there is no time to process it, and it stays with you, and the fear stays with you,” she told me. Spending time with a dead body in its natural state may be more challenging, she says, but it “normalizes” the experience. “When you talk about families that have worked with their dead body, and sat with their dead body, first they come in and just kind of touch the hand gently, like they are going to break Uncle Bob. Then, three or four hours later, they are telling jokes about Uncle Bob and giving him a hug.”
Doughty contends that elements of Undertaking L.A.’s approach can be applied to the most traditional of funerals. Carvaly recently participated in the funeral preparations for a friend named Marea Balvaneda, who had died suddenly, of cardiac arrest, at the age of thirty-six. “She had a traditional Catholic funeral, and she was embalmed,” Carvaly said. “The only thing that was different was that, the day before she was buried, I went to the funeral home with her sisters, and we dressed her body.”
At first, one of Balvaneda’s sisters, Ashley Wodke, lingered outside the prep room while the others worked. Carvaly told me, “It was, like, super-intuitive—they didn’t even need me.” Wodke said, “I knew I needed to do it, too. And it wasn’t as disturbing or traumatic as I thought it was going to be.” Balvaneda was the oldest of five sisters and had always taken care of her younger siblings; Wodke said that she felt a responsibility to take care of her sister in return. “We made sure her last outfit, and her last application of makeup, was done right,” Wodke told me, her voice breaking. “We made sure she had the right red lipstick. She wore a very vibrant red—a stoplight red. If we hadn’t done it, it wouldn’t have been the right red.”
The death-care movement can be seen as echoing other attempts to celebrate the artisanal and reject the over-industrialized, over-sanitized, and over-medicalized way of life that prevailed in twentieth-century America. Home births, while still very much a minority choice, rose by more than fifty per cent between 2004 and 2012. The flourishing of farmers’ markets has supported local agriculture, and the eat-what-you-kill movement has emerged as an extreme critique of industrialized food. When Doughty adopts her exaggerated “Ask a Mortician” persona, it is so glibly morbid as to be almost a caricature of the Portland-Bushwick axis of cool. (In one episode, which explains that metal implants survive a cremation intact, she jokes, “My father has had to have both of his knees replaced, and if we decide to cremate him, guess what his beloved daughter will be keeping on her mantelpiece.”)
Doughty’s business is not, she insists, a hipster lark or a “vanity project.” She explained, “There’s no vanity in funeral service—you are in rooms with corpses all day. This is not to make ourselves look good. If you want to look good, you start a really rad Instagram account, or bake gluten-free cupcakes. You don’t cremate people.”
Undertaking L.A.’s support of home funerals is aligned with the death-with-dignity movement, which advocates for the right of the terminally ill to die at the time of their choosing. Doughty is on the advisory board of Compassion & Choices, a group that campaigns for right-to-die laws, and she believes that the way we treat the dead body in our culture has a great influence on the way we think about the care of an individual close to the end of life, be it our loved ones or ourselves.
Being afraid of the sight of a dead body is quite different from being afraid of dying, which is the province of the confessional, the therapy suite, or the insomniac bedroom. But Doughty has found that spending time around dead bodies has helped her accept her own mortality. Working at a crematory led her to a realization: “O.K., this is going to be me—so this body is, so I shall be one day.” She explained, “If you have that opportunity with your family or community to come around the body, it is not only good to honor the dead person—they probably don’t really care—but it’s for you, too.”
In late June, Doughty took a road trip with her boyfriend, Landis Blair, to Crestone, a former mining town in Colorado. Doughty met Blair, an illustrator whose pen-and-ink drawings evoke the work of Edward Gorey, in 2012, after giving a lecture in Chicago. When she posted an item to her blog titled “My Morbid Art Crush on Landis Blair,” they struck up a relationship. They have lived together for a year, in an apartment filled with macabre Victoriana and the odd taxidermy specimen. Blair owns a unicycle that is usually propped up in a corner of the living room.
Blair is illustrating Doughty’s next book, a globally informed look at the future of death care, and he was serving as navigator. Crestone is about four hours south of Denver, and it is eight thousand feet above sea level, at the edge of a plain surrounded by mountains. Over the past several decades, Crestone, which at its most recent count had a population of a hundred and thirty-seven, has become the site of a wide variety of religious retreats. The landscape is thought to have a spiritual aura like that of the Himalayas. It is also home to an open-air funeral pyre, which was built by the Crestone End-of-Life Project, a small but avid group that champions natural funerals. Doughty was visiting it for the first time.
After arriving in town, we met up with Stephanie Gaines, the End-of-Life Project’s founder, and Paul Kloppenburg, a rugged Dutch expatriate who holds the title of fire-master. Kloppenburg told Doughty that the first open-air cremations in Crestone, in the early nineties, were conducted on a mobile pyre—a hundred cinder blocks and a metal grate that could be set up on an individual’s property. “I would see the eagerness of the people,” he explained. “I would pull up with my truck and build the hearth, and let them have it.” But after the group received a letter of complaint from local residents it built a pyre four miles outside of town, on land belonging to a Buddhist center. To a metropolitan eye, the site is in the middle of nowhere, but Gaines reported that a neighbor a mile away was not happy about being downwind of it. “And people didn’t want the traffic,” she told Doughty. “Six cars is a lot of traffic around here.”
The plain was spectacular in its vastness, and snow-crested mountains rose craggily in the middle distance. The cremation site was strangely beautiful. There was a circular enclosure, about seventy-five feet in diameter, fenced with bamboo palings. Standing inside it, you had a sense of safety and intimacy, yet the grandeur of the wider landscape remained visible. Inside the fence were four teak benches; they were arranged around a ring of large stones that had been set into the dusty ground. At the center of the ring was the pyre: a structure, about as high as a workbench, consisting of an iron grate suspended between two thick walls of concrete. The grate sagged slightly in the middle, like a well-worn mattress.
Affixed to the pine posts that supported the bamboo enclosure were copper plaques with the names of the fifty or so people who had been cremated in Crestone. Some of them had moved there specifically to die; these included a woman with cervical cancer. Others had grown up in the area, among them a twenty-two-year-old man who’d died in a car accident.
The ceremonies take place around dawn, before the wind whips up. The body, wrapped in a shroud, is placed on the grate, and then family members with flaming torches ignite logs that have been placed underneath. The body is also overlaid with logs and fragrant juniper branches, so that onlookers see only flame, not the body as it incinerates. For the first quarter of an hour, there is usually silence among the onlookers as the flames roar; as the fire matures, people chant, pray, beat drums, sing songs. It takes about two and a half hours for the body to be reduced to ash—hardly longer than a conventional cremation, Doughty noted with surprise. Gaines told her that mourners “say they are never the same after this.”
That afternoon, we had tea at the mountainside cabin where Gaines lives. She explained to Doughty that in Crestone a body is given a three-day period of repose before it is burned on the pyre: chilled gel packs help keep the body fresh, and the corpse is placed on a wooden pallet, obviating the need to lift it from a bed or a couch several days after death. Doughty talked about a recent trip that she had taken to Japan, where she’d visited a corpse hotel, which allows families with apartments too tiny for a home funeral to participate in the ritual preparation of a body. She liked the idea of setting up something similar with Undertaking L.A. “What I am really interested in is asking whether it is possible to have a communal center,” she said. “Family comes from out of town and it’s, like, a three-day wonderland process.”
Gaines, who is in her seventies, had a radiant air of calm. She explained that she was a devout spiritual practitioner: a contemplative with a special interest in the Gnostic traditions. Many of the other members of the Crestone End-of-Life Project had similar inclinations, but, Gaines explained, anyone was welcome to participate in the community of care, which embraced both the deceased and their survivors. “You want everyone to have this opportunity, because it is so filled with grace, and such an opening,” she said. “It is so transformational for everybody—not just for the person who died.”
Doughty nodded. “I am pretty secular, but the transformation from body to ash is still incredibly meaningful to me,” she said. “I may not think the soul is necessarily going anywhere—but just the physical transformation and the transformation of the mourners are transitions. It is ritual, and it is very real, and it is important, no matter what ideas of the body and the soul and the spirit the family comes in with.” She petted Gaines’s cat, which was moving promiscuously from lap to lap, sparing nobody. “It’s an exciting time to be in death,” Doughty said.