Toni Morrison is dead. So are D.A. Pennebaker and Aretha Franklin, and Philip Roth, Stephen Hawking, Ursula K. Le Guin, Milos Forman and too many others to name, even when limited to artists and writers who have perished in the past few years alone. By some accounts, two people die every second, thousands every hour, tens of millions every year. But at this moment in American life, the death of our best people has become a collective lifeline and refuge for our anxieties. It sometimes seems that the obituary is the only news that makes us feel whole.
Morrison was our essential conscience, a writer of narrative brilliance and moral clarity. The magnitude of her loss, at this moment in our descent into barbarism, is incalculable. But to spend time today with her work, with memories of her life and the testimony of those who knew her, is infinitely more rewarding than reading about all the other terrible things that have happened in the past few days. The deaths of artists and other creators make us reflective, and we live at a moment when looking back is much easier than looking forward.
We also crave the reassurance that we are not, as a species, entirely spent. Morrison died only days after two mass shootings, which are not only a regular fixture of American life, but also a recurring reminder of our political paralysis and the corruption of our democracy. We are in the midst of a trade war, markets have plunged, Greenland is hemorrhaging ice and our president tweets racism to inflame a hungry audience of white nationalists who dream of a world without people like Morrison in it.
Death and remembrance, at least, come with the customs and norms that have been shredded in most of the rest of public life. If nothing else, death still inspires a pause in ordinary life and, in the case of artists, a respectful consideration of their habitually ignored accomplishments. The reflective look back on a life and a body of work such as Morrison’s is ultimately celebratory, a chance to think the best of another person and, by extension, ourselves. Artists, performers, scientists, writers and other creators rarely “make news” in the same way politicians do, even though their influence on our culture is greater, deeper and more meaningful. The obituary is a belated observation and acknowledgment that people like Morrison, in fact, made news every day through their work. They formed the deeper part of the minds that our pollsters seek to measure and quantify in the frenzied haste of the news cycle. They are the atmosphere of American culture, while all else is merely weather.
Obituaries are a paradox of sorts, a distraction toward meaningfulness, a diversion to what really matters. The response to the rest of the news is often an impulse to escapism, a turning away. But while Morrison shares space with the usual firehouse of bad news, her passing offers at least one impulse to go deeper, to read more, dig in, think more critically and disconnect from the ephemera. Obituaries like the ones that have been written about her in the past day are even better than the usual “good” news, which is often little more than a reminder that somewhere, somehow, someone has done an unnecessary kindness; obituaries are redemptive on a grander scale.
We seem capable of only two modes of existence: panic and sadness, the former fast-paced and full of collateral damage to the world around us, the latter at least sometimes constructive and reflective. America has experienced periods of intense reflection around death in the past, as when the last remaining veterans of the Revolutionary War were dying in the middle of the 19th century, leaving people to wonder whether there were any steady voices and clear heads to steer us away from, or through, the accumulation of civil strife and political violence. The deaths of those who fought in World War II offered an occasion to think about the fraying of the old 20th-century social contract, the dissolution of the bond between the generations enshrined in key social-welfare programs, and the extinction of American optimism — that we might live in a society without poverty, without unnecessary suffering, with genuine opportunity and social mobility.
But the death of an artist is different from the loss of political leaders, no matter how wise or benevolent, or the larger passing of a generation, which has continued since the beginning of time. Morrison’s work remains with us, intractable, urgent and uncompromising, and it is no less effective today than it was on Monday. It is curious to listen to people on television debating the effectiveness of this policy or that plan, often arguing themselves into the absurdity that because nothing has yet worked, therefore nothing new should be attempted.
Meanwhile, the work of artists outlives them, operating on minds too young to be cynical. Politicians die and, if they’re lucky, are memorialized for having fixed something in the broken world they inherited. Artists die, and we flock to what they left behind, reanimating it, refreshing its meaning and reincorporating it into the body politic.
If you want to change the world, authentically and for the better, would you live your life like a politician, or a businessman, or a pharmaceutical executive or Donald Trump? Or would you live it like Toni Morrison?
On a recent flight home after visiting family in Florida, I sat in between my two boys with my eyes closed. I knew as soon as I took out a book someone would need something so I just sat and listened. Admittedly, I enjoy people watching and conversation eavesdropping anyway.
As I listened to a woman and man in the row across the aisle, I conjured up their personal stories in my head. At first I thought they were a couple. Quickly and succinctly I realized I was wrong due to my honed in eavesdropping skills. While everyone was preparing for take off I learned that the woman was married and had two little girls. I was unable to tell if he was married, but he did have an older son. The engines whirred to life, safety demonstrations were given and my son’s ear started to bother him. Not very productive in the people watching and eavesdropping department. Things did calm down and I settled back in.
With my eyes closed, I put all my energy into listening. The background noises, however, made it difficult to hear anything other than random words mixed with the lilting of their voices. I was unable to decipher their full conversation.
The feeling was so familiar to me. It took a moment to place why the feeling was so reminiscent, but once I did it made sense. Only able to hear bits and pieces of conversations prevented me from being able to process the entirety of their stories. Much like when an individual is grieving and their brain is consumed with grief.
For the first year, at least, after losing my son my brain was on constant overload. People would speak to me and I would listen, but was only able to grasp bits and pieces of what they said. The distractions — my sadness, pain and grief — prevented me from processing in its entirety. Oftentimes at night I would dream about what I had spoken to someone about that day. The next morning I would revisit the topic with them, able to process it slightly better because my subconscious had worked it over while I was sleeping.
The concept fascinates me. My brain simply cannot handle all of the stimulation. To this day, I become overstimulated much easier than I did in the past. Multitasking is much more difficult for me. Furthermore, my dreams have always been extremely vivid but now they are so vivid I have to ask others if it really happened. These changes are undoubtedly due to the trauma.
Specialists and therapists have said that the brain is a self-healing organ. In my experience this is true. It will continue to heal, but will never go back to being what it once was. There will likely always be “airplane” conversations when I am overstimulated. The daily grief that will forever be a part of my life is not as persistently intense as it once was. When the waves of grief wash in, however, they knock me right down.
My processing abilities have changed, but so has everything else. It would be a wonder if these abilities were not affected. Healing doesn’t mean that things go back to the way they were, but rather the changes are not as intense anymore. In the nearly five years that have passed I have learned nothing if not to adapt to change.
“Next to birth, death is one of our most profound experiences—shouldn’t we talk about it, prepare for it, use what it can teach us about how to live?” So begins A Beginner’s Guide to the End, a new book that provides insights on how to move through every part of the dying process as a patient or a loved one. In this excerpt, authors BJ Miller, M.D., and Shoshana Berger reflect on the stigmas surrounding heartache and grief, and how we can move through these emotions while honoring our own mental and physical health.
Grief can be isolating.
Rebecca Soffer, a cofounder of the Modern Loss website and community, was 30 when her mother was killed in a car accident. Soffer took two weeks off after her mother’s death and had barely started to grieve before returning to her job as a television producer. Three years later, she received a call from someone asking her to arrange to get her father’s body picked up; he’d had a fatal heart attack on a cruise ship while traveling abroad.
Stunned by the trauma of losing both parents within a few years of each other, she again dove back into work shortly thereafter. “Honestly, after each loss I felt like I was dying inside myself, and so few people knew what to do with me,” she says. “Unless you’re an incredibly empathic human being, if you haven’t gone through profound loss yourself, it can really be difficult to effectively connect with someone moving through it. I felt like a pariah because this topic felt so taboo. If someone asked where my parents were, I’d say, ‘In Philadelphia.’ I didn’t clarify that they were, in fact, underground there. It was just so much easier to be vague.”
When she did come clean to people who asked about her family, it felt as though the space around her was getting sucked into a black hole. “There are few better ways to silence a conversation than to say, ‘My mom just died,'” she says. “All I wanted was to feel like I could comfortably talk about my reality, not like people felt I might be contagious just because I’d used the word dead.”
Taking care of yourself.
You never “get over” the death of a loved one—that’s not the goal. Living on is. Here are a few ideas that may help:
1. Take time off work.
Sadly, businesses are not required to offer paid bereavement leave, but many do provide three to five days off for the death of an immediate family member. Talk to your HR department about what’s possible for you.
2. Seek out clergy, chaplains, and faith-based services.
Faith traditions have time-tested practices around death, dying, and mourning. Chaplains and clergy are trained to counsel those in bereavement. Hospital chaplains in particular are intimately familiar with supporting people of all faiths and of none. And many churches, synagogues, mosques, and other houses of worship have free programs and groups for grief support.
3. Contact your local hospice provider.
They are required to offer bereavement services to the community, whether or not your loved one was enrolled with their program. Despite the legal mandate, the funding for bereavement programs is paltry, so the services may not be robust, but they’re a good place to start. Hospice agencies are terrific local resource centers as a rule and will often keep a list of psychotherapists and grief counselors in the community who may be of further help to you.
4. Attend support groups or find them online.
Being with others who are working through grief can bring relief (no more pretending everything is OK). These are generally facilitated by mental health care professionals or other counselors. Less formal peer groups can be wonderfully helpful as well. The common thread is a safe place, real or virtual, where you can air your thoughts and feelings and be with others who are in a similar place. Here you are more likely to be seen and heard, not judged. Inquire with the hospice agency or your clinical team or hospital, or search for local groups online.
5. Try psychotherapy.
If you’re prone to clinical depression or anxiety or are experiencing suicidal thoughts, don’t mess around. It can be difficult to tease out grief from depression, so err on the safe side and get help. Therapy can work wonders, even if you’re not depressed.
6. Ritualize.
American culture has largely lost touch with the grief rituals of the past and the wisdom behind them: hanging crepe in the windows, wearing black, wearing an armband, to name a few. These physical symbols buy some space for you and everyone around you. People are more forgiving and respectful; expectations of you adjust. With traditional rituals, you’re tapping into a time-tested collective understanding of what you’re going through.
With these tracks already laid, you get to step away from your swirling mind and follow an old pattern of action without the burden of thought. If, however, you don’t want to follow tradition, you might gain an important but different power by creating your own ritual, a touchstone whose meaning you will always understand.
7. Journal.
Each day before you go to bed, write down one thing you’ve managed to do (even if it was just waking up). Or just write about your experience. There’s no need to keep what you write; just get it out and throw it away if you like. Writing, much like talking with other people, is a way to understand and process what you’re going through, and it can also help you not take your thoughts too literally; your mind in grief might suggest all sorts of odd things to you.
8. Get fundamental.
Since grief is discombobulating, it pays to remember the basics of life. Try taking your shoes off, and feel the ground beneath you; take slow, deep breaths; drink water; eat good food (and really taste it); sleep.
9. Make some new “family rules.”
If you’ve lost a central part of your nuclear family, it can shake the very foundation of the unit. Writing down some family rules in a place where everyone can see them is one way to introduce much-needed stability.
Things such as forgiveness, getting plenty of sleep, respecting one another’s feelings, working together to get things done, and remembering to ask for help when you need it are great reminders that you are all in this together.
The sooner we realise we are all going to die the better – it gives us time to get used to the idea
‘It took the death of a neighbour down the road when I was in my 20s to make me realise that one day I myself would die.’
by Padraig O’Morain
The first time I experienced death as real was when I watched a donkey being put down at the crossroads beside the farm I grew up in.
I was probably about seven or eight at the time. The donkey had been around for a few days and nobody knew where she had come from.
Somebody got in touch with somebody and a man came out from Naas to deal with the situation. He must have come to our house first because I remember following him up to the crossroads.
He stopped in front of the donkey and quietly took the humane killer, as it is called, out of a bag. This instrument is like a gun that drives a spike into the brain. He patted the donkey’s head, put the humane killer against her forehead, and killed her.
I’ve always remembered that the donkey was dead when she hit the ground.
I don’t know what happened next. I suppose the man went off, that I inspected the donkey, that the kennels of the Kildare Hunt took her away to feed hounds. That was how we got rid of dead cattle and other large animals.
Spread a tablecloth by the graveside, bring a picnic basket with the cucumber sandwiches, the homemade apple tart, the wine and the lemonade and enjoy
I was no stranger to animals dying, and every year we killed turkeys for the Christmas market. I was able to approach these deaths in a pragmatic manner.
What had really struck me about the donkey was that she died as she fell. I had never realised how quickly life could disappear.
Shortly after the death of the donkey, I found two white candles wrapped up inside a drawer in a sideboard in our gloomy sitting room.
I immediately assumed the candles were for use when either of my parents died.
In all probability, the candles had been put aside for a power cut but, as I say, the room was gloomy. Also, the sideboard has come from a priest’s house in Allenwood where, some years previously, a maidservant was possessed by the Devil. She had had to be exorcised to stop her breaking plates and furniture and terrifying the priest. We called the sideboard “the Devil’s sideboard” and we imagined Satan was inside.
Gloomiest possible conclusion
So it’s understandable I came to the gloomiest possible conclusion.
But that realisation – and I still recall the chill of it – was about the death of other people. It took the death of a neighbour down the road when I was in my 20s to make me realise that one day I myself would die.
This realisation comes to everybody sooner or later and I think sooner is better than later. It gives you time to get used to the idea. It becomes like a shadow, sometimes behind you and sometimes in front of you but you get used to it. I suspect if it comes too late in life it can hit hard, shattering your protective illusion that death happens to the rest of humanity but not to you.
I was led to these thoughts by Laura Kennedy’s recent article in The Irish Times in which she advised that the inevitability of death should motivate us to get on (within reason) with what we want to do.
I agree with her and I would add two points. First, it’s okay to be afraid of dying because to be unafraid of dying is not natural.
Second, if you want to get more out of life, remember that you don’t have to go skydiving, mountain-climbing or jet-skiing unless you want to. For some, going to the movies once a week would make a really big difference to their quality of life. For others, to make a difference, they might have to sail around the world. One type of person is not better than another type of person.
So spread a tablecloth by the graveside, bring a picnic basket with the cucumber sandwiches, the homemade apple tart, the wine and the lemonade and enjoy. And when the time comes I wish you as quick a step out of this world as the donkey had.
People die every day—and yes, that includes when they’re traveling. It’s not something most of us think about when planning a trip, but for some, it’s an unfortunate reality. But what do you do if you’re traveling with someone and they pass away? It’s not like you can Weekend-at-Bernie’s them and fly them back on their original coach ticket—so what are your options?
In short, it depends on the circumstances of the person’s death and where it happens. Though it’s important to remember that each situation is different, here are a few tips to help get you started.
Acknowledge your grief
If the deceased is a family member, friend, partner or colleague, you are likely in shock and grieving. According to Robert Quigley, M.D., senior vice president and regional medical director of International SOS, the world’s largest medical assistance and security company, your first step should be to address the fact that you’re grieving. “It’s important that you’re emotionally stable when you start this process, because the process is extremely complicated,” he tells Lifehacker.
Take into consideration the circumstances surrounding the death
If there was any foul play suspected in the person’s death, then the authorities—meaning the local police or embassies—first need to sign off on any paperwork before the body is transported anywhere, Quigley explains. In this case, it could take weeks for the body to be released and cleared to travel.
But for the purpose of this article, let’s go with a hypothetical scenario that doesn’t involve foul play—like a relative having a sudden heart attack and dying while you are traveling together. More information on what to do in the case of a suspicious death—and pretty much every other scenario imaginable—is available in a detailed whitepaper from International SOS. The organization assists with the transport of approximately 2,500 deceased individuals each year, Quigley says, and has seen it all over the course of their 36 years in business.
Connect with a local funeral home
If someone dies while traveling, they will likely end up at a local hospital where they will be pronounced dead by a doctor or medical examiner, who will then fill out the appropriate paperwork. Since you are not from the area, the hospital should be able to put you in touch with a local funeral home. From this point on, the funeral director will be your main point of contact in the process of transporting the person back home.
If the death occurs abroad, Quigley says that there is huge variation in the quality of funeral homes and services around the world in terms of how they prepare and transport the bodies, taking into consideration different cultural and religious traditions. This includes factors like whether or not they embalm bodies, or if cremation is an option.
At this point, you may want to seek help from a medical assistance company like International SOS or Global Rescue to help you make local connections and the arrangements necessary for the remains to cross borders. Medical assistance companies work closely with insurers and hospitals to provide the medical services people may require while traveling—including in the event of their death. Like insurance policies, the cost of these services varies significantly, depending on where you’re traveling, your age, your health, the length of your trip and other factors. Your best bet is to either visit the company’s website or contact them directly for a quote.
If the death occurs in the United States and you are looking to transport the body to another location in the United States, it’s a little more straightforward.
Chances are, the funeral home has done this before and has a good idea of which local airlines are the best options, given that each have different criteria for transporting human remains. Quigley says the funeral director will ask you questions regarding how you’d like the remains handled (i.e. embalmed, not embalmed or cremated)and let you know how much it’s going to cost—more on that later.
According to Elizabeth Fournier, a funeral director in Oregon, in her experience, most dead bodies traveling within the United States are transported on Delta or American Airlines. Typically, funeral homes contact the cargo department of a particular airline and make a reservation. The ticket is not purchased until the body actually arrives at the airport, she says, because plans change all the time. For example, sometimes a family member decides at the last minute they want to be on the flight with the body, or there may be a delay with the paperwork. A body must arrive at the airport at least two hours prior to the flight’s departure. In addition, there has to be a funeral home lined up at the final destination, which will then claim the body from the cargo area of the airport, she explains.
If the body is traveling within the United States, Fournier says you just need a death certificate and a permit. However, other regulations involving the type of transportation and the condition of the remains vary from state-to-state, so make sure to check local laws before doing anything. Usually the local funeral home is familiar with the laws on their end and can help you navigate any other legal questions.
And as Quigley explained previously, you’re arranging for human remains to be transported internationally, you’ll need additional documentation from authorities in both the origin and destination countries. This can become even more complicated if the person died abroad of an infectious disease (another topic addressed in the International SOS whitepaper). In these situations, those handling the remains must balance respect for the deceased, with the health and safety of those who come in contact with the remains, like a coroner or mortician. Depending on the type of the infectious illness, the body may be placed in quarantine, in compliance with local regulations and public health authorities. For example, the remains of those who had smallpox, plague, botulism, Ebola, Lhasa fever, Junin fever or any viral hemorrhagic fevers are typically treated with more caution. Those with yellow fever, encephalitis, HIV, tuberculosis, shigella, Nipah virus or Hanta virus may also require special handling or quarantining, though do not pose as much of a danger to the people who come in contact with the body as the illnesses in the first category.
Preparing the body
Again, the funeral home will handle any preparations necessary for the body before it is transported. This is another case of checking state laws: some allow unembalmed bodies to travel, while others require embalming or cremation.
According to Fournier, prior to a flight, the average deceased person would be embalmed and then placed in an air tray—a wood-bottom tray with a lid made of cardboard. The body may or may not be wearing clothing. She recently shipped a body from Portland, Oregon to Austin, Texas. They were unembalmed and they flew on Southwest—one of a handful of airlines that permit unembalmed bodies (yes, in addition to considering state laws, you also need to check on airline regulations).
That said, the process of preparing the body for a flight is relatively straightforward, according to Fournier. First she double-wrapped the body in plastic, then packed it into an air tray filled with cooling gel packs. Typically, caskets aren’t used in this process, she explains, because there’s a good chance the casket could get damaged during travel. Instead, caskets are usually purchased from the funeral home on the receiving end of the flight. Once the body has reached its final destination, the receiving funeral home will take over the rest of the arrangements.
The costs of shipping a body
Initially the funeral home—either the one shipping or receiving the body—pays for the cost of transporting the body and that expense is then added to the rest of the cost of the arrangements. Like plane tickets for the rest of us, fares vary for shipping human remains. For example, the ticket for the body Fournier sent to Texas from Portland cost $750, while shipping another person from Portland to Idaho a few months ago cost $500. Cargo passage to the Netherlands from Oregon costs nearly $2,000, she says.
If a person dies while traveling for business, Quigley says that oftentimes the deceased’s employer will assist the family with bringing their loved one home. They may even bridge the gap in costs if the person’s insurance doesn’t cover the transport of their remains, which, he says, is pretty typical. If this is coverage that you do want, he suggests reading the fine print on your insurance policies—including any life, health or travel insurance (including policies that come with certain credit cards) you may already have—though note that most policies don’t cover all of the multiple steps involved with transporting human remains. For example, one of your insurance policies may cover the plane fare, but not the cost of embalming. Or, it may have a sub-limit on the cost of the coffin, or stipulations on coverage based on the cause of death, according to the International SOS whitepaper. But, as is the case with other types of insurance policies, Quigley says that you can purchase a rider specific to your needs.
Transporting cremated remains
If the deceased has been cremated prior to traveling, it is much easier to transport the remains. Most U.S. domestic airlines allow you to bring human ashes in your carry-on, but again, this is something you should check with the airline first. However, it is important to select a TSA-approved urn in order to make the process as smooth as possible. It is illegal for TSA employees to open the urn in order to determine what’s inside—even if requested by the passenger—so it must be X-rayed. As a result, select an urn that is easily X-rayed, like one made out of a light-weight structure like wood, cardboard, fiberboard or plastic—even if it’s only temporary.
Though TSA doesn’t require that you disclose that you’re carrying human remains, if you’re worried about being stopped for having a suspicious powder substance, you may want to bring the deceased’s death certificate or other documentation from the funeral home as proof.
Hospice and palliative care physician Bruce (B.J.) Miller has made it his mission to help people “live well in the face of death.”
A hospice and palliative care physician at the University of California Helen Diller Family Comprehensive Cancer Center and former executive director of the Zen Hospice Project, Miller speaks nationally about end-of-life care, including the benefits of hospice and palliative care, and was featured in the Netflix documentary short film, End Game.
His new book, A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death, co-authored with journalist Shoshana Berger, is designed to educate the public about the options and obstacles that patients and families encounter at the end of life.
Miller’s has experienced palliative medicine both as a clinician and as a patient. An accident during his college years resulted in the amputation of one arm below the elbow and both legs below the knees.
“Part of the reason that I wound up becoming a doctor is that I came close to death in my own life, earlier than expected and in a dramatic enough way that I had little choice but to sit up and take notice,” Miller wrote in the book.
Miller spoke with Hospice News about perceptions of death in our society and its influence on patients’ choices, including hospice election, how patients should be cared for at the end of life, as well as the policy, practical and financial considerations that can impact that care.
“Hospice is a business too, and is affected by the same mundane staffing issues as any other: Illness, vacations, car trouble. The difference here is that a long wait for a bad latte will never be comparable to a late nursing visit when you are in desperate need for help,” Miller and Berger wrote in the book. “The hospice system is a part of our stressed health care system and that means it is stressed too. Burnout and turnover are significant problems across the industry; meanwhile, training programs struggle to impart the sort of knowledge and grizzled experience that good patient care requires.”
Regarding your book, A Beginner’s Guide to the End, what factors led you to decide that a resource like this was needed?
Being a clinician working in the hospice and palliative care space, I see patient after patient and family after family languish and suffer due to lack of information. This is certainly true anywhere in health care, but especially in our field because our explicit mission is to ease suffering. And this has proven very tricky. Most people don’t know what palliative care is. Many people know what hospice is, but they have so many misunderstandings of it.
I felt there was a need to get a general book out there to cover the waterfront, the hope being that essentially that we could raise the floor. We are not going to blow off the ceiling, but at least we can raise the floor and level the playing field so most everybody has some access to sound, up-to-date information. That was the impulse.
At several points in the book it’s mentioned that there is a kind of taboo around the topic of death. How do you think that influences people’s choices at the end of life, including electing hospice?
Our language gives us away. We have this old-fashioned notion that life is a fight against death, as though death were a foreign invader instead of a natural thing that is completely entwined with life.
We talk about death as a failure. In medicine we say, “He failed treatment.” That they “lost the battle,” and so forth. So we find all these exotic ways to keep the subject at a distance, and in daily life it has become easier and easier to become distracted from this. And it means that so many people wait way too long to elect hospice. And if they do enter hospice at all, it’s often in the final days where there is not much time to do all that we can to bring life to a close and provide some comfort.
Even beyond the election of hospice I think if we built awareness of our mortality into our daily lives, my guess is that we’d be much kinder to ourselves and to each other and much more appreciative of the life we have while we have it.
How do you see the hospice and palliative landscape changing? How you think the space could be different five years from now?
My hope would be that medical training in general absorbs the principles of hospice and palliative medicine and drives this kind of care earlier into the picture. Just about any clinician of any stripe should have some kind of basic facility with these concepts — eventually 100% of their patients are going to die.
My hope is that our workforce grows to meet the rising demand, and that payment gets worked out so people are incentivized to pursue careers in this important field. From a policy standpoint, hopefully there will be some legislation passed promoting training for hospice and palliative care.
I do think we in the field also really have to take quality seriously. We used to be able to just absorb the idea — it was just a fact that hospice in particular provided superior quality care as a medical model — and that’s still largely true. But we have to be careful, it’s not just about getting more people into the field; we have to keep our eyes on quality.
Do you think that current payment models for hospice, in particular the Medicare Hospice Benefit, are copacetic with the mission of providing multidisciplinary person-centered care in accordance with patients’ goals and wishes for end of life?
I think in general the hospice benefit does a very good job. I think its sticking points are the requirement that patients have six months or less to live and the idea of all the things that you can’t do while you are on hospice.
Those things made sense in 1982, but they don’t make much sense anymore. For example there are a ton of treatments that might be considered life extending that are actually palliative in nature. I see a lot of patients who are fully aware of all these trade offs and forestall their hospice election because they want access to certain treatments that could maybe help them live longer but also could make them feel better.
So those two sticking points are ripe to be revisited. Otherwise I think the hospice benefit is very sound, but I wonder how much longer the hospice benefit will look like the hospice benefit of today.
How do you feel about a possible Medicare Advantage carve-in for hospice?
I am not a policy expert, and there may be some counter arguments. but I wonder what the unintended consequences of that would be.
Right now Medicare sets the guidelines, and therefore there is a centralized power and policy hub. In sending the hospice benefit to private companies, will Medicare Advantage plans be allowed to dictate their own hospice benefit? If so, I have to imagine quality would go down due to cost-cutting measures which ultimately would also be quality-cutting measures.
You have spoken about how the health care system has diseases rather than people at its center. Do you think that is starting to change and how can the health care community accelerate that change?
I believe it’s starting to change in that the phrase “patient-centered care” is pretty well known and recognized, and I don’t hear anyone arguing against patient-centered care. So I think there’s an opening dialogue around it.
But I also watch some of my medical colleagues roll their eyes at it, and for good reason: Our population, health, and disease and treatments are so complex that it’s practically impossible for patients to make an informed decision, because we haven’t done a very good job of educating them. So it’s unrealistic to say that we can do whatever the patient wants.
What it is realistic is a shared decision-making model in which your clinician is your advocate and together you are working on a plan that’s realistic for the options in front of you, and together you make decisions. I think that’s the golden chalice we are trying to find.
A good example is that if you were to follow patient satisfaction surveys — if those were the gold standard of a patient-centered system — data show that patients prefer doctors who prescribe more medications because that feels like their doctor cares, but more medications is not always the best clinical choice.
That’s a case in point where it’s much more complicated than the satisfaction of the patient or the family, so I think the refinement here is to elevate the patient’s voice in the decision-making process and do the listening on our side as clinicians and encourage patients to speak up for what’s important to them, and together move forward. That is how things should work.
One of the most pervasive barriers to bringing patients into palliative care and hospice is awareness. Most people simply don’t know what these things are. What can hospice and palliative care providers do to move the needle on that issue?
No one seems to understand the difference between hospice and palliative care, and I wonder what policy could come along to help smooth out these false divides. I keep waiting for someone to organize a kind of mass public service announcement, explaining to the public what the solutions are and explaining the field.
As a clinician I am explaining the distinctions to people all the time, and I struggle to do it in a succinct manner; so I think that you need some real communications expertise. It’s a very tricky and complicated communications challenge to distinguish between these concepts in a way that is understandable and relatable, especially when for a lot of people it’s inborn to want to look away.
I would love to see some sort of mass public communication effort. That would go very far even among the health care community. Many of my doctor and nurse colleagues themselves couldn’t tell you the difference between hospice and palliative care. That is very common, so we have a massive communications problem that will take a multimillion dollar effort to get past.
You have spoken about the need to bring intention and creativity into dying. Where does hospice fit into that?
Dying is way bigger than a medical event. Hospice begins with a conversation about what is important to the patient and what is not important to them, and just the nature of that conversation helps people to live with intention.
You help and encourage them to think through what is important, what can they live with, what can they live with, coming to terms with the finitude of their time, and then you can work from there and to some level design your days. Hospice facilitates those conversations all the time.
I think the creative spark is a way of life, a way of thinking in which daily life is a creative act, including at the end of life. We are all improvising all the time, bobbing and weaving, checking our plans versus the reality on the ground. Creativity often flows from reaction to limitations, and this is our limitation: We don’t have endless time.
Inside the poignant, bizarre, and necessary world of tending to the belongings of the deceased.
By Shane Cashman
We park the box truck in the dead man’s yard like a six-ton hearse and knock on the front door. A disheveled middle-aged woman answers, still in her pajamas.
“I forgot you were coming,” she says, leaning out the door to see the truck. Emblazoned on the side: William J. Jenack: Estate Appraisers & Auctioneers.
“I’m a mess,” she says. “My mother’s dying.”
We ask if she wants us to come back another time.
“No, please come in.”
She’s been living in the dead man’s house for the last two years, a white Victorian-style home with blue shutters and ivy reaching up the side. She’d known the dead man, Stanley, her whole life. He was on Broadway and she used to sit in the garden as a little girl and watch him sing show tunes. Before he passed, she promised to take care of his home, which is decorated like Stanley’s still around. His photos hang on the wall; open songbooks are displayed on the piano.
You learn a lot about a dead man rifling through his house – lifting his furniture, clearing his walls, going through his closets, finding out which psalms are dog-eared in his Bible – searching for anything that might be worth selling at auction. It feels like trespassing.
One of the many rooms inside the houses of a seller, Alan. This house was used for storage only and was covered wall-to-wall with items he had picked up in his years working estates.
Sometimes the most genuine reflection of a person’s identity is found in the inscriptions they’ve written in books. Inside one of Stanley’s he wrote a note to himself titled Self Esteem:
I’m a handsome, wonderful human being who deserves a good life. I grabbed a mirror, gave it a big smooch and said, “I love you. You are the man, Yessur.”
Stanley’s neighbor drops by. He’s 85, bent over a cane, and speaks with a thick Ukrainian accent. He came over because he saw our truck. Now he’s asking for Stanley’s address book. But the lady tells him she threw it out years ago.
“You put him in a cemetery or you cremate him?” he asks.
“Cremation,” she says. “His ashes went to North Carolina with his wife.” She died fourteen years ago on Independence Day. She and Stanley never had kids.
The author moves a box of glassware from an estate.
In the garden we’re shown the four-foot-tall cast-stone fountain. Stanley’s house sitter says it stopped spitting water just before he died. We yank it out of the ground. Fat bugs crawl out from underneath.
“Stanley was gonna leave me a fortune,” she claims. “He said I’d never have to work again.”
“What happened?”
“It was never in writing…The lawyer was gonna come to the house on a Tuesday…to put it in writing. Stanley died that Monday. Of course, right? So I mourned the loss of my friend…and the loss of my fortune.”
Before we leave we even take Stanley’s mailbox, almost erasing him from the block’s history. The woman says she’ll call us when her mother dies so we can come get her stuff too.
At the beginning of a pick up in Parksville, New York, the truck was completely empty. Over five hours later, it was stuffed with more to be taken and a second pick up to be scheduled.
As auction gallery furniture movers, we do pickups year-round. My partner, Ryan Wagner, is 29, six-foot-two and 250 pounds. His size is crucial whenever we have to move things like 900-pound hand-carved marble Foo Dogs. Once, on a dare, he pushed the box truck across a parking lot with his bare hands. People tend to watch us move stuff like we’re in a sideshow. See the two men lift, sling, tip, slide, drag, tilt, duck, pivot and coffin things into a truck!
We start in the basement and work our way up through the house. We lift up mattresses, kick aside small tumbleweeds of hair and carry bedframes down the hall. We pack Halloween costumes and wedding dresses into banana boxes. We climb out bedroom windows onto roofs to see if weathervanes are worth anything. We step into decayed barns and collapsed sheds and pull tackle boxes, snow blowers, and tractor parts from the wreckage.
In March we traveled to the home of ninety-year-old Barbara Harris, who lived alone, save for her nurse, in Rock Tavern, New York. She was dying of Parkinson’s and couldn’t afford her farmhouse anymore.
Barbara was still in bed and the nurse led us around telling us what to take – portraits of horses, the dining room table, her rugs, her safe, and the crystal lamps on her mantle.
Four skulls and a few other miscellaneous bones from humans and animals are inspected at an estate. The current owner, Alan, came into possession of the skulls from working on the estates of doctors.
We heard Barbara struggling to lift herself out of bed and into her wheelchair. The nurse ignored the moans coming from Barbara’s room. “Take the stuff and go, go, go,” the nurse said. This was odd, so we stopped and waited for Barbara. “You’re not going fast enough!” the nurse yelled.
Barbara rolled herself into the living room.
“How are you, Barbara?” Ryan asked.
“Horrible,” she said. “I have an aide here who is so bossy. She’s taking everything off the walls.”
“We don’t want you to feel that we’re taking things out from beneath you,” Ryan said, even though we were there to do just that.
“I’m not comfortable with anything with her here,” Barbara said, trying to point at her nurse – her hand just trembled a little above the armrest.
“You can’t pay to heat your house,” the nurse scolded in response. “You’re going to freeze to death in here.”
Barbara wept. Ryan knelt down and put his arm around her.
Maybe the nurse was right, but we didn’t like the way she was talking to Barbara. Ryan asked the nurse to leave until we were done.
I wanted to leave something behind for Barbara, anything she could hide so she could at least have one piece of her old life to hold onto. But there was nothing. All her things, furniture and paintings, were squeezed like Tetris pieces into the back of the truck. We didn’t know it at the time, but a few months later, Barbara would be moved into a senior citizen home.
We left the house empty. Just Barbara and her nurse.
The William J. Jenack Auction Gallery is an aluminum-covered steel frame that looks like a green airplane hangar flanked by mountains in Chester, New York, fifty miles north of Manhattan. It is divided into three large spaces: the Fine Art showroom, the Town & Country showroom, and the sale room set between the two.
William Jenack, 70, and his wife Andrea, a certified gemologist, own the place along with Kevin Decker, who specializes in eighteenth- and nineteenth-century artifacts. They appraise and inventory everything Ryan and I bring back to the gallery. Everything is siphoned through to the back and stored away. Large items like grandfather clocks, sofas, armoires, and credenzas stay in one of the four trailers behind the gallery. Works of art are stacked by the hundreds on shelves in the back room. Smaller pieces – angelfish skeletons, vintage dental molds, African masks – are lined up along their own special shelves. Items that aren’t worth much are divvied up into boxes and stored upstairs in what is like a morgue of personal belongings. Single items in the world of auctioneering are called “lots.” They can sell on their own, but the things upstairs are called “box lots” – many bidders love the thrill of sifting through a box lot as if they’re a kind of cardboard treasure chest.
William J. Jenack Estate Appraiser and Auctioneers in Chester, New York holds an average of three auctions every month.
It’s a strange feeling having to tell someone that the things they thought were worth a lot aren’t worth much at all. William, after nearly thirty years in the business, says to this day, “It’s difficult to tell someone that her prized possessions are worth a hill of beans.”
William and Andrea were antique collectors for a decade before William began auctioneering in 1988. In those days, they stored their antiques in a garage, and when they’d amassed enough stuff for a big sale, they’d rent a firehouse or church and hold an auction.
William has walked through thousands of homes in the region, appraising people’s things, while coming to know old-timers who collect esoteric mechanical pencils or Edison light bulbs or vintage silhouettes. These types of collectors tend to drive to the gallery with a trunk full of their prized collections in a fit of downsizing. Inevitably, the same people will then preview the upcoming sales, looking for anything to add back to their collection.
Potential buyers look at the upcoming items in the preview room before an auction.
On auction day, after everything is catalogued, numbered, and put on display, both in the showroom and on our website, we open the showroom for “preview” – when clients observe the upcoming sale the way one would walk through a museum.
At preview I learn about strange world history from clients. We once had an ancient Roman tear catcher for sale. A client taught me that Roman mourners would cry into bottles and place them in the tombs of those they loved. One ninety-year-old Englishman, always in a suit and cap, has told me the same story at every preview for the last four years – how he worked in a coalmine in England during World War II, how he remembers the sounds of the British warplanes flying overhead filled with bombs. “They sounded heavy,” he’ll say. He remembers the engines flying home later with less drag.
Military-themed sales draw good crowds in any economic climate. We lay out carpets, hang chandeliers, line up rows of shotguns and rifles on the gun racks, and arrange swords and daggers in showcases. William shows up with his grey manicured mustache and the charm of a yacht captain about to take his clients for a three-hour tour through Russian icons, high-end cowboy boots, and Nazi paraphernalia. On pickups we come across more Nazi coins and medals and Mein Kampf copies with personal inscriptions than I ever imagined we would – even in Jewish households. My partner Ryan says he knows of Jewish people who buy Nazi memorabilia just to destroy it. I’ve also heard of Jewish people who buy it as proof to refute Holocaust deniers.
A Filipino woman comes in looking to inspect the Indonesian dagger before the sale starts. She must’ve seen it on our online catalogue and couldn’t wait to hold it. There are two in the sale, but she’s interested in the longer blade that’s shaped like a snake. She unsheathes it, holds it up to the light and counts the curves of the blade.
“Seven,” she says and smiles. She stabs the air with the dagger and twists it into an invisible victim. “Seven curves are good. When you twist it in you, all of your belly comes out.”
Another young woman hovers over the showcase. Her hair is pulled back into a bun, nose-pierced, and she is shy around the swords. Some guy jokes, “You don’t seem like the military dagger type.” An older man in a sleeveless shirt with long white hair and a long white beard, inspecting a Nazi air force officer’s dagger, intervenes. “You never know,” he says. “I have a neighbor and she can put an axe through the center of that picture over there.” His name is Mark Bodnarczuk, and another gentleman at the sale tells me that he is “the sword expert.”
Bodnarczuk laughs. He says he doesn’t need any more swords, yet here he is. His collection started piling up five years ago with a Union Civil War sword. He says it’s a disease. He picks up the three-foot sword of a German Imperial officer – a highly regarded status symbol for pure Aryan members of the Third Reich’s armed forces. Now it’s being passed back and forth between me – I was raised Jewish – and Bodnarczuk, a pleasant man with faded crescent moon tattoos on his arm, who looks like he’d pal around the Renaissance Faire. It’s important for Bodnarczuk to come to the sale in person to feel the blades, see if the scabbards fit, and “look in the nice little red eyes of the lion” on the handle of the Imperial sword.
However, Bodnarczuk came today specifically for the Civil War artillery sword. It is heavy and made of brass with a wide blade that’s just over two feet long. “The idea with these swords,” he says, holding the handle against his chest so the sword points out, “was when you were on your back on the ground, and the cavalry’s coming at you, you’d hold the sword up and hit the horse in the chest.”
Guns and antique military paraphernalia were the featured items at the August 21 auction. During the preview time, potential buyers inspect every aspect of the lots to ensure they know what they are bidding on.
A crowd begins to form around the Nazi memorabilia. Some people turn away quickly, like they see someone urinating in public. But there are plenty who’ve come strictly to hold – and bid on – the Nazi swords. Tom Coulter, 72, is an avid collector of German World War II memorabilia. He’s here for the German paratrooper gravity knife, which looks like a small, plain wood handle that’s missing a blade. But the hand guard doubles as a secret button. Earlier, other men asked to see the gravity knife and none could figure out how to open it. Coulter turns it upside-down, clicks the hidden button, and out slides the ten-inch blade. “Gravity,” he says to anyone listening.
William says the appeal of Nazi memorabilia is in the craftsmanship, and collectors are excited by “the whole heraldry of owning something that was involved in that time.” It’s legal to sell Nazi paraphernalia in some military shows and auctions in the United States, but it’s illegal to sell certain Nazi items on eBay. It’s also banned in France, Israel, Austria and Germany.
Coulter tells me to grab the American trench knife – basically a pair of brass knuckles welded to a twelve-inch blade – and the German gravity knife.
“Which one would you want to fight with?” he asks.
My fingers are slipped through the brass knuckles of the trench knife. It’s heavier than the gravity knife.
“The trench knife,” I say.
He points to the gravity knife. “This is practical,” he says. You can cut yourself from your parachute tangled in a tree with it. However, he says pointing to the trench knife, “This is to kill somebody. The back end is for cracking skull. The knuckles are for punching face and this is for stabbing.”
Coulter, who was a marine in Vietnam and had one-third of his lungs removed thanks to Agent Orange – you can hear the damage in his voice – says his house is stuffed with Gestapo rings, German helmets, swords, Luger pistols, and a small painting of a church steeple by Adolf Hitler. He’s traveled the country, and even to Europe, to purchase many of these items. He only visits our gallery when we have a good deal of Nazi pieces in a sale.
Avid collector and former Vietnam veteran Tom Coulter holds a Nazi military dress dagger that was up for auction. Coulter explained that shiny knives and swords were meant for dress only as reflections could draw the eyes of enemies in battle.
“No American stuff?” I ask him.
“Well, they’re just not unique,” he responds. “I have American stuff. I have my Marine bayonets. They’re nice, sure, but the Germans carved eagles into everything.”
“What would you say if someone came over to your house and saw all the swastikas and felt uncomfortable?” I ask.
“I’d say, ‘every weapon is a hate item. They’re all hate items.’” He says it’s for the love of history.
The Nazi daggers are beautifully crafted, but it is hard for me to divorce them from the black and white photos of the Holocaust that are also in this sale – naked prisoners with theirs hands over their genitals standing like skeletons behind barbed wire, and men shoveling human bones into a brick crematorium.
The sale begins and most people follow William into the middle room where he takes his place at his podium. It looks like church. The weapon collectors loiter behind in the showroom, inspecting the weapons one more time, squinting down the barrels of rifles like telescopes. The guns and swords are the headliners of the sale, though it will be a few hours before they’re up for bidding. Weapon-lovers never seem eager to sit through the bidding on pottery, costume jewelry or vintage seltzer bottles.
William auctions off a mechanical baby in a crate. It’s a two-foot glass-eyed doll that was an advertisement for a soap company in the 1940s. All of its limbs used to move, like a baby stuck on its back, but now only one arm and one leg work. “I hope somebody plugged it in for ya,” William says. “He lights up…and he turns his head.”
It goes for $450.
Another item for sale is a vintage Ku Klux Klan panoramic photograph, dated 1925. Hundreds of men and women and children in white robes and pointed hoods stand in front of the nation’s capitol. Not too far in the background, sitting on window ledges, are black children watching the scene. When the photo sells for $225, William looks at it and says, “I haven’t seen that many dunces in one place in a long time.”
A box lot of doll heads sits on a table waiting to be sorted and sold at a future auction.
William auctions off two hundred lots in two hours before reaching the portion of the sale where certain people are leaning forward, white-knuckled on their bidder number paddles, hoping to win their guns and swords of choice.
Mark Bodnarczuk stands. Tom Coulter pulls his Vietnam vet hat down low. As the auction goes on, others side-glance, trying to see who they’re bidding against. Then there are people like Sal Vargetto who rushes in near the end of the sale, bids on two shotguns, wins, runs into the preview room, takes them off the rack, aims them at the ceiling and pretends to shoot with a long, unlit cigar hanging from his mouth.
Bodnarczuk doesn’t get the brass Civil War artillery sword. It goes for higher than he is willing to spend. But he does buy a Japanese sword. Coulter wins the gravity knife, and I see the Filipino woman leave smiling with the Indonesian dagger in her hand.
The next day we clean up and begin to organize a new sale. There are now antique Russian menorahs in place of the Nazi swords.
What doesn’t sell after a few tries is either donated or brought to the dump – the great American intestine. Everything that winds up here at the Orange County Transfer Station is flattened, cubed and shipped out on trucks heading for the landfill behind it. I’ve seen Darwin’s On The Origins of Species and Suzanne Somers’ Fast & Easy cookbooks destroyed in unison here.
The filled box truck is driven into an enormous shed with a cement floor. There are beat-up American flags on the wall and gnarled teddy bears tied to the grills of dump trucks – things employees have pulled from the trash. The shed has its own atmospheric pressure and smells of thick, hot rotting. A mist falls from the ceiling so the place doesn’t spontaneously combust. There are smashed pianos and old refrigerators and dead televisions and shattered glass and old dirty mattresses, which the man operating the excavator grabs with the claw of his machine and uses as a broom to make way for our new pile of trash.
The dump weighs the box truck on our way in, and subtracts the weight we lose on our way out. Our last trip here was with Barbara Harris’ unwanted stuff. By now we had gone back one last time to clear out her old barns in the backyard. Most of it was in such bad condition it went right to the dump. In five minutes we threw out 3,500 pounds of her life.
Trucks line the parking dock outside of the William J. Jenack auction house.
There’s a sign at the weigh station when you leave that reads, Thank you for your garbage.
We sweep out the box truck before a new pickup. A trumpet player is dead. His family rented a giant dumpster for everything that won’t be going to auction. His place must be emptied, no evidence left of him whatsoever, to stage the house for sale.
I find his résumé in his office desk. He played with the band on “The Tonight Show” with Johnny Carson. He played with Sinatra and Buddy Rich. I find studio recordings of him on cassette. I put them in his stereo and let his trumpet echo through the empty house and out the open doors into the street where his neighbors walk by. They do a double take as if their old neighbor is back from the dead to perform one last time.
Once we’ve packed all his sellable stuff in the box truck, we climb into the big dumpster. We jump up and down on his trash to make sure it doesn’t overflow.
It’s a 55-and-up gated community. The neighbors aren’t amused. Chances are we’ll be back soon for them too.
