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The Symptoms of Protracted Dying

By SARA MANNING PESKIN, M.D.

[G]eraldine was warmly opinionated and, along with her husband, she’d raised her four daughters to be the same.

When work settled and time allowed, she melted into the couch next to any of her children who were home and turned on the Hallmark channel. If a movie showed people who couldn’t care for themselves, she would remark, “I don’t want to live like that,” or “if that’s me, don’t bother doing all that.”

On May 25, a clot blocked a blood vessel in Geraldine’s heart. Her husband performed CPR. She was whisked to the hospital, where her heart survived, but lack of oxygen launched her brain into uncontrollable seizures. At age 56, her melodic Irish accent was silenced.

Her lips sagged around a breathing tube when I met her three weeks later. Her limbs lay wherever we put them. Kinked gray hair stood in all directions from her scalp, pushed aside by electrodes that recorded brain activity.

In the small conference room in our neuro intensive care unit, we discussed Geraldine’s prognosis with her family.

“We can place a long-term breathing tube in her neck and a feeding tube in her stomach,” I said, “but there are no cases in the medical literature of someone like her living independently again. The best we could hope for is a life of near-complete dependence.”

“When we first came to the hospital, doctors told us my mom might be brain-dead,” one of Geraldine’s daughters countered. “Now, she takes breaths on her own sometimes. She’s already improving.”

Just as Geraldine was stubborn and exceptional in life, her family believed she would be exceptional in beating her prognosis.

“It might be different if my mom was 70 or 80,” her daughter went on, “but she’s only 56.”

For Geraldine’s family, the immediate fear of watching her die outweighed the unfamiliar pain of sustaining her on machines and watching her disappear in a long-term care facility.

Our medical team had seen hundreds of people like Geraldine, most of whom returned to the hospital month after month to manage complications of immobility. Sparse cases of recoveries were overwhelmed by painful, expensive, drawn-out deaths, ones we would never wish for ourselves or our own families.

But for Geraldine’s family, every decision was new. For them, nobody was like Geraldine.

In every other part of medicine, doctors make recommendations for medications, lifestyle changes and surgeries. We don’t offer cancer patients six different chemotherapy regimens and ask them to weigh the pros and cons. Yet when it comes to end-of-life decisions, doctors are terrified of violating patient autonomy. We are scared of our own medical opinions.

Instead of saying, “I recommend…,” we often offer a platter of life-prolonging measures, most of which are unlikely to improve a patient’s quality of life, but which offer the possibility of hope. The patient’s heart will still beat. Her personality will be gone, but her chest will still rise and collapse. Families see an opportunity for loss to be delayed, perhaps even dodged. Then we are surprised when they take us up on the offer to prolong dying.

“I think she would want more time to try and recover,” Geraldine’s daughter said.

So we kept Geraldine alive. A plastic breathing tube sprouted from her neck and a feeding tube with peach-colored formula buried itself in her stomach.

In the hospital, Geraldine’s family learned the common complications of immobility: infection, blood clots and bedsores.

When the infection started, a fever sounded the alarm. We counted the possible causes. Geraldine had a breathing tube in her windpipe, a feeding tube in her stomach and an IV line in her neck, each an access road for bacteria. Lying in bed put her at risk for pneumonia and urinary tract infections. Like mosquitoes in standing water, infections proliferate when the body is still.

Geraldine’s blood clots weren’t a surprise. Medical students are inculcated with the famous triad of conditions that predispose patients to clots, and Geraldine had all of them. Her body was inflamed and torn from the heart attack, infections and procedures that caused her blood vessels to release molecules that helped blood to clot. Lying in a hospital bed, not moving anything unless it was moved, her circulation slowed. Pools of static blood dried into a thick paste in her blood vessels.

Thanks to aggressive nursing care, when Geraldine developed a bedsore it was managed at an early stage. But the term “bedsore” is an understated euphemism. It recalls the annoyance of a cold sore or the tenderness of muscles after the gym. The grotesque image of bone pressing through skin is hidden.

In people who are immobilized, bedsores develop under bony prominences like the heels and the skull. At first, the skin becomes red. If the bedsore progresses, the skin’s outer layer, then the inner layer, breaks down. Finally, in the most severe stage, bone, muscles and tendons are exposed. The entire process can happen in just a few days.

Sixty days after her heart attack, Geraldine was stable enough to leave the I.C.U. She was in a persistent vegetative state — unresponsive to external stimuli. She opened her eyes, as if she were about to say something, but nothing ever came out. Her gaze roved around the room. An ambulance took her to a long term care facility, where she was dependent on machines and people.

“When you first hear someone you love is sick, you think it’s a short term thing,” her daughter told me over the phone a month later. “It’s adjusting to the long term aspect that’s hard.” Geraldine’s daughter woke up at 5 a.m. every day to spend time with her mom before work.

“I think it’s more of a disappointment for my dad,” she said. “He told us that if he ever gets sick, he doesn’t want any of this.”

Geraldine’s family lived between hope and guilt, with the weight of each side in flux. “If my mom knew what we were doing right now, she’d probably be mad at us,” her daughter reflected a few weeks ago.

Yet in the same breath, her voice rose and she said: “My mom’s a fighter, so I think she would be happy with us giving her a shot. We’re hoping for this miraculous turnaround.”

It did not come. Geraldine died of sepsis earlier this month, after more than four months of care.

“People don’t know what they’re in for,” Geraldine’s daughter reflected after the funeral. “It hurt all of us to see her like that.”

In the final days of Geraldine’s life, a doctor asked if the family of another patient in the I.C.U. could visit Geraldine to see what prolonged dying looked like. Geraldine’s family was kind enough to agree.

The visiting family chose to transition their loved one to hospice care.

Complete Article ↪HERE↩!

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‘Memento Mori’: USU exhibit focuses on the art of death and mourning

Michael Wolgemut’s 1943 piece “The Dance of Death”

By Sean Dolan

[D]ylan Burns doesn’t dwell on the fact that he will eventually die, but he is aware of the inevitable.

That’s one of the side effects of spending several months preparing an art exhibit that celebrates the macabre. Burns, the digital scholarship librarian at Utah State University’s Merrill-Cazier Library, is the curator of, “Memento Mori: The Art of Death and Mourning.”

The exhibit itself is a reminder of death. Black curtains beckon the viewer to stand in the center of tall white boards arranged in the shape of a coffin. Inside the display, images of skulls and centuries-old drawings of dancing skeletons hand-picked from rare books in the library’s special collections invite the silent contemplation of death.

“The whole exhibit asks this question — implores people to ‘memento mori,’ which is ‘remember that you’ll die,’” Burns said. “And that’s something that I think we don’t do that often in our contemporary world.”

Bruns found inspiration for the exhibit in a collection of Compton Studio photographs, a family-run company founded in Brigham City in 1884. In addition to documenting life in Utah, the Compton Studio took elaborate funeral photos.

Dylan Burns

In one photo, three young children stare bleakly into the camera as their deceased sibling lies motionless in a cradle.

“They’re extraordinarily striking and intimate,” Burns said.

At the time, Burns said funerals and the handling of the deceased was generally left to the family. When a grandmother died, for example, the body would be washed, dressed and displayed in the parlor. Friends would come and pay tribute.

Over the past 100 years, Burns said death has become more sterile. As soon as someone dies, they are whisked away and embalmed behind closed doors, only to be seen briefly by the family.

“We have funeral homes and they take care of everything and it’s all kind of sanitized and it’s out of the home and out of the family,” he said.

Burns isn’t suggested that everyone should go out and wash their next dead family member, unless they want to. But there is a movement in some funeral homes called, “The Order of the Good Death,” which encourages people to approach death with a different attitude. Instead of fear and anxiety, this movement reminds people that death is a part of life.

“It’s sad, but it is what it is,” Burns said.

Using the funeral photos as a jumping off point, Burns then took a deep dive into the library’s special collections to find old sources that reminded one to “memento mori.”

Flemish anatomist Andreas Vesalius’s 1543 publication called, “De Humanis Corporis Fabrica,” depicts scientifically accurate sketches of skeletons with an artistic flare.

Burns said Vesalius was a doctor who made a significant contribution to the world’s medical knowledge. In addition to scientific experiments and dissections, Vesalius posed and sketched skeletons in ways that gives the appearance of contemplation of demise and death.

‘Memento Mori’: The art of death and mourning

“Yeah, they’re weird,” Burns said. “The point that I’m making here is I’m talking about these memento moris, which are these objects that remind you that we are going to die.”

One of the most striking, and locally significant, example of a memento mori is the skull of Old Ephraim, the mightiest grizzly bear known in Logan Canyon.

“We’re reminded that even the most powerful can’t escape death,” Burns said.

Another section of the exhibit is devoted to the allegory of the Danse Macabre, or the Dance of Death, which depicts motifs of skeletons dancing with the living. The exhibit displays the work of Hans Holbein, a 16th century German artist. Holbein drew skeletons interacting with powerful people, like the Holy Roman Emperor and the Pope.

“No matter who you were, it came for everyone,” Burns said.

The exhibit, which will remain on display until Dec. 10, coincides with the library’s Family Art Day this Saturday. The event’s theme is, “Telling a Spooky Story — With Art!”

Children are invited to create Halloween-themed silhouettes from 11 a.m. to 2 p.m. If they desire to explore the morbidity of death, kids can check out the adjacent “Memento Mori” exhibit.

Burns said part of his intention was to just invite people to think and talk about death. It’s going to happen to everyone, but it’s rarely discussed.

“I don’t think it’s healthy for it to be a taboo subject that we never talk about,” Burns said.

Complete Article HERE!

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We need to address questions of gender in assisted dying

Gendered risks challenge the idea that women will always be acting autonomously.

By

[O]ne of the principal motivations behind current efforts to legalise assisted suicide in Victoria and New South Wales (and most jurisdictions) is patient autonomy. However, research suggests “gendered risks” may thwart women’s autonomy in end-of-life decisions, making them uniquely vulnerable to assisted suicide laws.

While eligibility under the Victorian and NSW bills requires that a patient must be suffering from a terminal illness from which they will likely die in 12 months, the concern for women is that the final decision to end their lives may nevertheless be influenced by risk factors that challenge the rhetoric of “choice”. Here are some of those “gendered risks”.

Longer life span

Women tend to live longer than men. This means they are more likely to develop diseases and disabling conditions, or experience elder abuse and discrimination, both of which could motivate the desire for assisted suicide.

The Australian Law Reform Commission’s report on elder abuse recognised that women are significantly more likely to be victims than men, and that the rate of neglect of older women could be as high as 20%.

More likely to experience their partner’s death

Women are also more likely to experience the death of a partner or spouse due to their relative longevity, and to be deprived of this support and companionship in older age. A 2013 Australian study found that living alone is an important predictor of suicide in older adults.

A 2016 US study found that loneliness was a key motivation for assisted suicide requests of patients with “psychiatric” disorders in the Netherlands. Of the cases reviewed, 70% were women and 76% were 50 years or older. One women in her 70s “without health problems” said she experienced life without her husband as a “living hell” and “meaningless”.

Fewer economic resources in old age

Women have fewer economic resources when they are older, the time when decisions about assisted suicide are most likely to occur.

This entrenched economic disadvantage limits their options for care and means they are more likely to face other financially related adversities.

Women are also more likely to have to pay for care than men due to their male partners and families being less likely to care for them.

All these factors could influence a decision on assisted suicide.

More self-sacrificial and less assertive

Women are arguably more self-sacrificial and less assertive than men, whether by nature, socialisation or simply in terms of society’s ideals about femaleness.

So, they may be more likely to request assisted suicide to spare their loved ones the burden of caring for them, or be persuaded that their life is unworthy of others’ care and their family’s resources.

In a study of assisted suicides where the majority of cases were women, the fear of being a burden was a prominent reason for deciding for death. The ethic of self-sacrifice was summed up by a friend of one of the suicides, who said:

She felt it was a gift to her family, sparing them the burden of taking care of her.

Preference for passive suicide methods

Women demonstrate a stronger preference for more structured, passive methods of suicide, with significant physician participation.

It is clear that increasing numbers of women decide to die when offered the more passive options of assisted suicide. The rate of assisted death of women in the Netherlands, Oregon and elsewhere is nearly four times that of the usual female suicide rate.

One explanation might be that decisions for assisted suicide fit in with cultural expectations of women as passive and compliant, and play out gender expectations of subordination and dominance in a profession where physicians are still predominantly male.

More likely to attempt suicide

Women are more likely to attempt suicide than men, as they are more prone to psychological problems such as depression.

While mental illness does not qualify a person for assisted suicide under the Victorian and NSW bills, neither does it disqualify them.

If assisted suicide is legalised, women’s greater propensity to attempt to take their lives as a result of psychological problems, coupled with their preference for more passive methods of suicide, could have a harmful compounding effect on women’s decisions to die. This may already be evident in the 2016 American study.

Entrenched patterns of violence against women

Female assisted suicide needs to be considered in light of pervasive male violence against women, particularly against intimates. Research indicates striking similarities between the broader patterns of male violence against women and at least one kind of assisted death: “mercy killing”.

American and Australian studies indicate that there are more female mercy killings in those countries, mostly by men, who are most often the woman’s partner, and these are characterised by the same themes of domination, possessiveness and control as other gender-based violence.

The prevalence of violence against women in Australia (particularly intimate partner violence) is a serious problem, and so it is vital that we understand whether the dynamics underlying other forms of gendered violence that result in the deaths of women may sometimes also underlie female assisted suicide.

Taking into account gender differences in health care is important. And if there is potential for gendered risks in legalising assisted suicide, this requires further consideration and research in advance of any legislative change.

These insights challenge the presumption that women who decide for assisted suicide are always exercising autonomy. Legalisation could in fact compound oppressive sociocultural influences and facilitate the last of many non-choices for some women.

Complete Article HERE!

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Dying a good death—what we need from drugs that are meant to end life

There are a few drugs that can end life, and how we want to die should be considered.

by And

[G]enerally speaking, health care is aimed at relieving pain and suffering. This is also the motivation behind euthanasia – the ending of one’s own life, usually in the case of terminal illness characterised by excruciating pain.

There has been debate in Victoria about the drugs that should be used to end life if euthanasia is legalised. So which medications can we ensure would facilitate the best, medically-supervised death?

Medicine as poison

When it comes to the question of which medicines can, or even are meant to, kill us, the most important thing to remember is the old adage:

“The dose makes the poison.”

This concept is one on which the whole discipline of toxicology and medicines is founded. This is the meaning of the well-known symbol of the snake, wound around the bowl of Hygeia (the Greek goddess of health), representing medicine, which you see in pharmacies and medical centres around the world. The intertwining of poison and is a longstanding concept in the therapeutic use of medicines.

This is a very intricate science, and the reason we conduct clinical research. We need to trial different doses of new drugs to meticulously establish a safe but effective threshold for use.

In more practical terms, this means too much of any medicine can cause harm. Take, for example, the humble paracetamol. When taken following correct guidelines, it is a perfectly safe, effective pain killer used by millions of people worldwide. But taken in excessive quantities, it can cause irreparable liver damage, and if the patient is not given an antidote in a hospital, could lead to death.

What drugs are used in assisted dying?

The group of drugs most commonly used to end life is called the barbiturates. They cause the activity of the brain and nervous system to slow down. These drugs, used medicinally in small doses, can be taken short-term to treat insomnia, or seizures in emergencies. In different doses and administration techniques, these preparations can also be used as anaesthesia, to make us sleep through surgery.

An overdose of barbiturates is fatal. A large dose will effectively make the brain slow down to a point where it stops telling the body to keep the respiratory system working, and breathing ceases.

Both secobarbital capsules and pentobarbital (usually known as the brand name, Nembutal) liquid – (not to be mistaken for epilepsy medication phenobarbital) have been used either alone or in combination for physician-assisted suicide or euthanasia. They are also used in injectable forms for animal euthanasia.

These two products are tried and tested, have the advantage of years of use with the benefit of knowing the exact dose range needed, and with few adverse effects reported (such as unexpected pain, drawn-out death or failed death).

Their safety and efficacy in inducing a peaceful, swift and uneventful death has been proven around the world. They are the preferred drugs in the Netherlands, Belgium, Switzerland and some USA states where euthanasia is legal.

Other options exist, whether in combination or alone, but have limited evidence of use in euthanasia. Some drugs that cause excessive muscle relaxation and respiratory distress can end life, as can some pain killers commonly used in palliative care.

Drugs can also be used that fatally lower , cause heart attack, or block messages from the brain to the muscles, causing paralysis.

While all of these drugs are legally available in Australia, they could cause a long, protracted , with many more side effects that could cause distress and suffering at the end of life. Nembutal and its relatives are less likely to do so, with greater evidence from international practices than any other drugs that can end life.

The ‘best’ death

In Australia, Nembutal and secobarbital can be used for animals, but are illegal for human use. This makes implementation of the newly proposed euthanasia law in Victoria slightly more difficult. The proposed legislation does not seek to legalise the use of Nembutal and its relatives – but suggests a “drug cocktail” be concocted by a compounding pharmacist.

The Victorian government has reportedly approached Monash University’s pharmacy department to research the kind of pill that could be developed if the legislation passes. Therefore, no final description of this product has been released.

Some have suggested the mixture will be in powder form made with to induce a coma and eventually cause respiratory arrest. It may also use sedatives and muscle relaxants, a drug to slow down the heart, and an anti-epileptic to prevent seizure and induce relaxation of muscles. The constituents and doses are yet to be determined.

It’s difficult at this early stage to predict how this concoction would work and whether it would be easier or safer to use than drugs already tried and tested. This proposed product would need to be tested and results compared, as all are.

What is needed is a or a mixture of drugs that produce a painless, relatively quick and peaceful passing. We do not wish to see further suffering in the form of seizures, prolonged distress and pain. If no solution is certain, it would be wise to fall back on simply legalising what is already tried and tested.

Complete Article HERE!

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“I couldn’t tame grief, but I could tame a hawk”

– Helen Macdonald talks her new BBC documentary

In a new BBC documentary, the author of H for Hawk explains how she became obsessed with training a goshawk following the death of her father

 
Ahead of her new BBC2 documentary H is for Hawk – a New Chapter, author Helen Macdonald explains how the death of her father led to an obsession with training a notoriously difficult to tame goshawk.

[T]en years ago my father, the renowned photo-journalist Alisdair Macdonald, had a heart attack while out on a photo assignment on a London street. His sudden, unexpected death at the age of 67 left me and my family reeling.

Everyone has different ways to cope with grief, but mine was hugely eccentric. I didn’t turn to drink, find solace in religion, or see a therapist. Instead I felt compelled to train a hawk. Not just any hawk, but a goshawk, one of the most hard to tame of all birds of prey.

I’d been a falconer for many years, but I’d never before wanted anything to do with goshawks. They had a reputation as moody, unpredictable, highly-strung and murderous creatures, more like leopards than birds. Something about their wildness chimed with the wildness of grief inside my heart. And while I knew I couldn’t tame grief, I knew I could tame a hawk.

So one August morning I picked up a ten-week-old female goshawk from a hawk breeder called Andy on a Scottish quayside. I drove her home, called her Mabel, and began the delicate process of winning her trust. It turned out to be the beginning of the strangest, darkest and most beautiful episodes of my life.

Growing up, I’d always loved birds, birds of prey most of all. I was as obsessed with birdwatching back then as my father had been with planes-spotting when he was small.

We gloried in how uncool our interests were. I always carried a pair of binoculars, he always carried a camera, and we were always watching the skies. We’d go out for long nature walks, turning over rocks to find snakes and bugs, collecting things to be identified back home. Dad taught me to see all the beauties of the natural world.

But he taught me much more. He was a patient, quiet, kind, gentle man. Those were the qualities I needed to tame and train my hawk. I had to put aside all the chaos and horror of grief in favour of patience, kindness, quietness, gentleness.

Falconry is not about the domination of a wild creature. You can’t menace or mistreat a hawk. You tame them through courtesy, positive reinforcement and gifts of raw meat.

In only a few weeks Mabel went from being a wild creature terrified of me to a playful, tame companion. We developed an incredibly close bond. I taught her to fly to my gloved fist for food, first on a line, and then completely free. I wanted her life to be as close as possible to that of a wild hawk, and flew her for hours every day out on the hillsides near my home. Every night she fell asleep on a perch on my living-room floor.

My life with Mabel made me wilder and wilder. There was no grief in my heart as I flew her, no future or past. Everything fell away. All that was left was the present moment, caught up in her barred wings as they flickered across frosty fields and slopes.

It was an all-consuming and beautiful life, but it wasn’t good for me. I became a muddy, thorn-scratched hermit. Mabel was everything I wanted to be: solitary, self-possessed, free from human hurts and grief. Only at my dad’s memorial service did I remember that human hands are for other human hands to hold, that they shouldn’t be reserved solely as perches for hawks.

With the help of family, friends, and a doctor, I found my way back home. I kept flying Mabel, but in a much less obsessive manner. My relationship with her took me to a wilder world and brought me back much changed.

It was an experience that will mark me forever. I don’t regret a single minute. I flew Mabel for several more seasons before a sudden untreatable infection carried her away. I still mourn her loss.

I ended up commemorating her and my dad in the book H Is for Hawk. As I wrote it I didn’t think anyone would read it, but to my surprise and joy it became a bestseller (it also won the 2014 Samuel Johnson prize for non-fiction).

Now I’ve met readers all over the world who have shared their own stories of loss and wildness with me. They’ve taught me that while grief is the loneliest thing in the world, we all go through it. It’s part of what it means to be human. I treasure the new friends I’ve made after the book’s success, but only wish my dad were here to see it. He was a good friend, a wonderful father.

I still miss him to bits.

Complete Article HERE!

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Sitting Up With the Dead: Lost Appalachian Burial Customs

By Hope

[F]rom the peaks of the Blue Ridge and the Great Smoky Mountains, to the river valleys of the French Broad and Catawba, North Carolina has a long history that is steeped in rich Appalachian traditions. Despite the Hollywood “hillbilly” stereotype, Appalachians carry a sense of pride for their culture, language, and heritage.

Isolated from the outside world, Appalachian regions have long struggled with rough rocky terrain for farming and plagued with poverty. Immigrants from Europe began migrating to the area in the 18th century with a large proportion of the population being Ulster Scots and Scotch-Irish. Many pioneers moved into areas largely separated from civilization by high mountain ridges and our pioneer ancestors were rugged, self-sufficient and brought many traditions from the Celtic Old World that is still a part of Appalachian culture today.

If you grew up Appalachian, you usually had a family relative who was gifted and could foresee approaching death, omens or dreams of things to come.

 
There was always a granny witch to call on when someone was sick and needed special magic for healing. Superstitions about death were common and were considered God’s will. One thing for sure, no matter how hard you fought it, death always won.

Appalachian folks are no stranger to death. For the Dark Horseman visited so frequently, houses were made with two front doors. One door was used for happy visits and the other door, known as the funeral door, would open into the deathwatch room for sitting up with the dead. Prior to the commercialization of the funeral industry, funeral homes and public cemeteries were virtually nonexistent in the early days of the Appalachian settlers.

For Whom the Bell Tolls…

In small Appalachian villages, the local church bell would toll to alert others a death has occurred. Depending on the age of the deceased, the church bell would chime once for every year of their life they had lived on this earth. Family and friends quickly stop what they were doing and gather at the deceased family’s homestead to comfort loved ones. Women in the community would bring food as the immediate family would make funeral preparations for burial. The men would leave their fields to meet together and dig a hole for the grave and the local carpenter would build a coffin based on the deceased loved one’s body measurements.

Due to the rocky terrain, sometimes dynamite was used to clear enough rock for the body to be buried. Coffins used to be made from trunks of trees called “tree coffins”. Over time, pine boxes replaced the tree coffins. They were lined with cloth usually made from cotton, linen or silk and the outside of the coffin was covered in black material. If a person died in the winter, the ground would be too frozen to dig a grave. In this case, the dead would simply be placed in a protected area outdoors until spring.

After the bell tolls, every mirror in the home would be draped with dark cloth and curtains would be closed. It was believed that by covering the mirror, a returning spirit could not use the looking glass as a portal and would cross over into their new life. The swinging hands on the clock were stopped not only to record the time of death, but it was believed that when a person died, time stood still for them.
Preparing the Body

Before the use of embalming, the burial would be the next day since there were no means of preserving the body. To prepare the body, the deceased would be “laid out” and remained in the home until burial. The body would be placed on a cooling board or “laying out” board. Depending on the family, the “laying out” board might be a door taken off the hinges, a table, ironing board or piece of lumber. Many families had a specific board for the purpose of laying out the body that had been passed down from generations.

The “laying out” board would then be placed on two chairs or sawhorses so the body could be stretched out straight. Depending on what position the person was in when they died, sometimes it was necessary to break bones or soak parts of the body in warm water to get the corpse flat on the board. As rigor mortis began to set in, some folks have actually heard bones cracking and breaking which would cause the corpse to move as it began to stiffen. The board would then be covered with a sheet and a rope was used to tie the body down to keep it straight and to prevent it from suddenly jerking upright.

Post-mortem picture of the body placed on a cooling board or “laying out” board.

Scottish traditions used the process of saining which is a practice of blessing and protecting the body. Saining was performed by the oldest woman in the family. The family member would light a candle and wave it over the corpse three times. Three handfuls of salt were put into a wooden bowl and placed on the body’s chest to prevent the corpse from rising unexpectedly.

Once the body was laid out, their arms were folded across the chest and legs brought together and tied near the feet. A handkerchief was tied under the chin and over the head to keep the corpse’s mouth from opening. To prevent discoloration of the skin, a towel was soaked in soda water and placed over the face until time for viewing. Aspirin and water were also used sometimes to prevent the dead from darkening. If the loved one died with their eyes open, weights or coins were placed over the eyes to close them.

Silver coins or 50 cent pieces were used instead of pennies because the copper would turn the skin green. Once the corpse was in place, the body would then be washed with warm soap and water. Then family members would dress the loved one in their best attire which was usually already picked out by the person before they passed. The body of the dead is never left alone until it was time to take the deceased for burial.

Sitting Up With the Dead

After the body has been prepared, the body is placed in the handmade coffin for viewing and placed in the parlor or funeral room. The custom of “sitting up with the dead” is also called a “Wake”. Most times a handmade quilt would be placed over the body along with flowers and herbs. The ritual of sending flowers to a funeral came from this very old tradition. The aroma from the profusion of flowers around the deceased helped mask the odor of decomposition.

Flowers as a form of grave decoration were not widely used in the United States until after the mid-nineteenth century. In the Southern Appalachians, traditional grave decorations included personal effects, toys, and other items such as shells, rocks, and pottery sherds. Bunches of wildflowers and weeds, homemade plant or vegetable wreaths, and crepe paper flowers gradually attained popularity later in the nineteenth century. Placing formal flower arrangements on graves was gradually incorporated into traditional decoration day events in the twentieth century.

The day after the Wake, the body would be loaded into a wagon and taken to the church for the funeral service. Family and friends walked behind the wagon all dressed in black. The church bell would toll until the casket was brought into the church. This would be the last viewing as friends and family walked past the casket to take a final look at the body. Some would place a variety of objects in the coffin such as jewelry, tobacco, pipes, toys, a bible and every once in an alcoholic beverage.

Today, a strong sense of community continues to dominate Appalachian burial customs even though the modern funeral industry has changed the customs slightly. The social dimension has changed completely since caskets are commercially produced and graves are seldom dug by hand. Modern funeral homes have made the task of burial more convenient but the downside is there is less personal involvement. Personalized care for the dead is an important aspect of family and community life in Appalachia. And we can certainly say for sure that the days of conducting the entire procedure necessary to bury a person, all done by caring neighbors, with no charge involved, are no longer practiced.

Complete Article HERE!

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Disney and Pixar films present opportunities for parents to discuss end-of-life with children

By Bert Gambini

[B]ambi’s mother, Mufasa from “The Lion King” and Elsa’s and Anna’s parents in “Frozen” represent some of the characters who die in Disney and Pixar animated films, and these potentially shocking moments for young audiences provide critical opportunities for adults to discuss end-of-life issues with children, according to a new study by a University at Buffalo researcher who specializes in end-of-life communication.

“These films can be used as conversation starters for difficult and what are oftentimes taboo topics like death and dying,” says Kelly Tenzek, a clinical assistant professor in UB’s Department of Communication. “These are important conversations to have with children, but waiting until the end of life is way too late and can lead to a poor end-of-life experience.”

Starting the end-of-life conversation with children early allows the dialogue to continue and develop throughout their lives, and the deaths in these film can actually help children relate to and understand death in ways that otherwise might be very challenging for them.

“We believe that Disney and Pixar films are popular and accessible for children and adults so that a difficult conversation can begin in a less threatening way earlier in life,” says Tenzek.

Tenzek and co-author Bonnie Nickels, a visiting lecturer at the Rochester Institute of Technology, analyzed 57 Disney and Pixar movies in which 71 character deaths occurred.  Four themes emerged from their analysis, each of which can serve as a platform for adults to discuss end-of-life issues with children.

The results of their research appear in Omega-Journal of Death and Dying.

Tenzek says the current study uses categories from research conducted in 2005 on end-of-life depictions in 10 Disney and Pixar films. That earlier research distinguished character’s status, such as antagonist or protagonist (Tenzek and Nickels added side characters to this category); cause of death; whether the death was presented on film or implied; the reactions of other characters; and if the death, within the context of the film’s plot, was permanent or a reversible, fantasy occurrence.

With that template and their expanded list of 57 films, the new analysis yielded four general opportunities, or themes, on which to base an end-of-life discussion:

“First, some of the portrayals of death are unrealistic, such as when the character returns or returns in an altered form,” says Tenzek. “But this is a chance for a child to better understand the difference between fiction and real life.”

Tenzek says managing the end of life, or the emotional response to death, could be helpful for children and adults.

“How the characters portray their responses to dying can help children understand the nature of expressing emotion,” she says. “‘Big Hero 6’ (2014) and ‘Inside Out’ (2015) specifically address emotional responses to death and dying which were not present in earlier films.”

The third and fourth themes dealing with intentions to kill and transformation and spiritual connection, with its moral sub-theme, are more complex. Religious and spiritual content are not always overly present in Disney and Pixar films, however, Tenzek says, the films can still serves as opportunities to discuss religious beliefs and end of life.

“We acknowledge that a child’s psychological development is important when considering these discussions,” says Tenzek. “It’s not our intent to have these conversations with a 3-year-old, but as children mature, then the films fit naturally into that growth.”

Many of the possible benefits arising from these films extends from parents’ power to engage children, according to Tenzek. The films can be a tool to help explain the difficult end-of-life process to children and help them make connections that lead to better understanding.

“I teach end-of-life communication,” says Tenzek. “My goal is to educate and help people become more comfortable with the end of life.

“One way to do that is through these films,” she says.

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