Tag: Death Meditation

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What matters in the end?

Couple chronicles life’s final chapter in new book

Photo of Irvin and Marilyn Yalom in the entry hall of their Palo Alto home.

Authors Irvin and Marilyn Yalom probe questions around love, loss

by Chris Kenrick

Is it possible to plan a “good death?” Can one gracefully leave this world to the next generation? Can one live meaningfully until the very end?

Prompted by a serious medical diagnosis, longtime Palo Alto residents Irvin and Marilyn Yalom probe these questions in “A Matter of Death and Life,” which the duo wrote just before Marilyn died by medically assisted suicide in 2019.

Married 65 years, both Yaloms already were widely published authors — translated into many languages — when they began writing their book in spring 2019 after Marilyn was diagnosed with multiple myeloma, a cancer of the plasma cells.

Irvin, a psychiatrist and leader in the field of existential psychotherapy, had some 20 fiction and nonfiction titles to his name. Marilyn, a cultural historian, French professor and early director of Stanford’s Center for Research on Women, had published at least 10 books.

With her prognosis bleak, Marilyn persuaded her husband that they should document, in alternating chapters, the experience of her illness and likely demise from the disease.

“We now live each day with the knowledge that our time together is limited and exceedingly precious,” the two, both in their late 80s, write in the preface. “This book is meant, first and foremost, to help us navigate the end of life.”

As scholars, both Yaloms are steeped in the great philosophers’ contemplations on exemplary life and death, and have wrestled in their own work with themes of mortality.

In “American Resting Place,” co-authored with their son, the photographer Reid Yalom, Marilyn documented how 400 years of gravestones, graveyards and burial practices reflect changing American ideas about death, class, gender and immigration.

As a psychotherapist, Irv had counseled countless patients, including many with terminal illnesses, about facing death, and written extensively about their — and his own — death anxieties.

“Of all the ideas I’ve employed to comfort patients dreading death, none has been more powerful than the idea of living a regret-free life,” Irv recalls in the book.

Sitting together in their yard, admiring the trees, “Marilyn squeezes my hand and says, ‘Irv, there’s nothing I would change,'” he writes. With four children, eight grandchildren and extensive world travels in addition to their professional accomplishments, both Yaloms feel they’ve seized their days to the fullest.

Even as death approaches, the pair celebrate “magic moments,” such as the evening they abandon television and Marilyn pulls “Martin Chuzzlewit” down from the bookshelf and begins reading aloud. “I purr in ecstasy, listening to each word,” Irv writes. “This is sheer heaven: What a blessing to have a wife who delights in reading Dickens’s prose out loud.” He recalls the day — more than 70 years before — when the two had first bonded over their mutual love of books as classmates at Roosevelt High School in Washington, D.C.

When chemotherapy fails and Marilyn is placed on immunoglobulin therapy, she begins inquiring about medically assisted suicide — legal in California since 2016 — in the event the new treatment does not work.

Irv is horrified, but Marilyn is at peace. Though sad to leave the people she loves, “The idea of death does not frighten me,” she writes. “I can accept the idea that I shall no longer exist. … After 10 months of feeling awful most of the time, it’s a relief to know that my misery will come to an end.”

After some weeks the couple is told the immunoglobulin therapy, too, has failed.

Marilyn accepts various tributes and goes about saying her goodbye, and giving away her treasured books to a large network of friends and colleagues. “It’s weird to realize that if I want to do anything, I’ll have to do it quickly,” she writes.

Ultimately, about a week before Thanksgiving 2019, she chooses to end her life, ingesting lethal medication in the presence of Irv, their four children, a physician and a nurse. (She was among the 405 people to use California’s End of Life Options Act in 2019, according to the annual tally from the state health department.)

Shortly before, Marilyn had reviewed the writings of Greek and Roman philosophers on how to live and die well. “For all the philosophical treatises and all the assurances of the medical profession,” she writes, “there is no cure for the simple fact that we must leave each other.”

The final chapters are written by Irv, recounting the agony of grief and his halting attempts to resume some kind of normal life — including venturing out to a Barron Park Senior Lunch at the Corner Bakery.

After more than 70 years with Marilyn beside him, he struggles with the idea that “something can have value, interest and importance even if I am the only one to experience it, even if there’s no Marilyn to share it with.

“It’s as if Marilyn’s knowing about a happening is necessary to make it truly real,” he writes.

He rails at the irrationality of this. “I’ve been a full-time student, observer and healer of the mind for over 60 years, and it is difficult to tolerate my own mind being so irrational,” he writes.

Reached at his home in late May, two months after the book’s publication, Yalom said he’s been busy with the “strong feedback,” including virtual book talks with large audiences all over the world. The book is licensed for publication in 25 countries, some already in print and others likely between now and the end of next year, according to literary agent Sandra Dijkstra.

Yalom, who turns 90 this month, continues to work on his next book and also to do single-hour therapy consultations.

“I’m growing old now and my memory’s beginning to disappear,” he said. “I’m not seeing ongoing patients anymore but I think I’m able to do a lot for some people just in the single hour.”

His new book is intended as a training manual for young therapists. “I’m always writing, and as long as I’m writing I feel very well,” he said.

He also takes walks daily to a nearby park, where he’s had a bench installed in memory of Marilyn. Yalom said he enjoys sitting on the bench, taking in the surroundings and thinking of her.

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Questions of Life and Death During the Coronavirus Pandemic

— A Medical Anthropologist’s View

By Isono Maho 

Cultural anthropologist Isono Maho left academia last year and set out as an independent-minded commentator to question the conventional wisdom influencing views on to living and dying. We spoke to her about the competing priorities of “saving lives” and social connections during the COVID-19 pandemic and the importance of listening to the reservations many people feel about the impersonal approach of modern medicine.

The Right to Say Goodbye

As the coronavirus pandemic has raged around the world, how many people have died alone in isolated hospital wards, separated from their loved ones? How many people have suffered the anguish of not being allowed to visit a family member to share a few last moments together? Most people have accepted this tragedy as an unavoidable aspect of the ongoing crisis. But is it really necessary or desirable to prioritize the risk of infection ahead of all other concerns?

Medical anthropologist Isono Maho argues that medical authorities have been far too ready to ban hospital visits for patients in extremis. She admits there are good reasons why a hospital might restrict visits to coronavirus patients, not least of which is the risk of a Covid cluster breaking out. “Visitors will likely want to talk to and touch their loved one,” she explains. “This increases the likelihood the infection will spread, and it’s understandable why hospitals have chosen to ban visitations.” Even so, she questions whether it is appropriate for the same restrictions to be placed on patients not suffering from the coronavirus. “It raises the question whether the risk really justifies keeping each and every dying patient from their family members and forcing them to spend their last days alone without a chance to say goodbye.”

Isono argues family members have a right to be close to relatives who are approaching the end of life, and that current medical practices unnecessarily deprive people of the opportunity to gather and say farewell to loved ones in their final days.

“Words often fail when a family member is approaching the end of their life,” Isono observes. “Instead, communication becomes tactile. It doesn’t happen overnight, though, but is a gradual process, taking families time to develop a sense of how it will work for them. She notes that even if family members are allowed to visit in the last few days before a person dies, the separation up to then has deprived them of the chance to observe and process the physical changes in their loved one. “To be suddenly confronted by these can be overwhelming. In many cases, such final visits are extremely upsetting and can even hamper the mourning process.”

Families have generally accepted the restrictions on visitations during the pandemic, seeing them as unavoidable. Still, Isono stresses that people only have one chance to say goodbye to a dying family member. “We have to ask whether it is really right for hospitals to deprive families of this important rite. Does the objective of preventing further infections really take precedence over everything? My feeling is that there is still room for debate.”

Isono says that such restrictive measures to minimize COVID-19 infections have been framed as necessary to “save lives,” a correlation she is uncomfortable with. “It’s become akin to a moral doctrine that no one is even allowed to question.”

Modern Medicine and Death

Isono started out studying exercise physiology with the aim of becoming a physical trainer, but says she struggled to come to terms with the approach to human health in the natural sciences, which she found treated people as mere things to be studied. “The tendency is to reduce the human body to numerical data,” she argues. “Just more grist for the analytic mill.” Despite her doubts, she traveled to the United States for further studies. It was there that she discovered cultural anthropology. “I think the main appeal of the field for me was the way it tries to find deep, philosophical explanations for complex phenomena in what seem to be insignificant everyday events.”

What made the field fundamentally different to her is its grounding in fieldwork. “A lot of other academic disciplines use abstract ideas from the outset,” she says. “Cultural anthropology, on the other hand, seeks to develop ideas about life based on observations of mundane, everyday phenomena.” She points to people in Japan rushing out to buy toilet paper and basic foodstuffs before the government declared the first state of emergency in April 2020 as an example. “What social factors and what kind of information that was available drove that behavior? I think just about anyone would find the field fascinating—the questions it asks are so closely connected to daily life.”

Attitudes to life and death are one of the major focuses of cultural anthropology. The field also provides rich resources that can serve as “tools” for helping Isono to articulate her misgivings about modern science and medicine, another major reason why she chose to change the focus of her studies.

“The field has built up a vast storehouse of information on how different cultures and ethnic groups deal with death,” she explains. “In many cultures, a so-called good death is not simply a matter of living as long as possible. It is seen instead as part of the cycle of life and determined by connections between the living and the dead. There is a kind of universality in ideas like this. By contrast, modern medicine tends to prioritize longevity as something desirable in its own right. The value of life is converted into numbers and ‘evidence.’ My misgivings about this approach stem in part from the tendency to discount all the many cosmologies devised by diverse ethnic groups that connect the living and the dead.”

Blaming Everything on the Pandemic

One focus of Isono’s research is the clinical settings where healthcare is provided. She has interviewed numerous doctors, nurses, and caregivers in an attempt to understand the opinions of front-line healthcare workers—particularly those whose roles might go unrecognized. By talking to these people, Isono wanted to learn more about how healthcare provisions actually work and how they might be improved.

“Many of the individuals I spoke with expressed reservations about the way things are run,” states Isono. “For instance, they might see an elderly patient, bed-ridden and hooked to an artificial respirator for weeks on end, and wonder about the tendency of modern medicine to prioritize life support above all else.” She points out that many healthcare workers struggle with these doubts, but typically keep them to themselves. “My focus is tapping into the potential of cultural anthropology to recognize the value in these doubts and put them to positive use.”

Isono says that the close proximity of medical workers and caregivers to their patients can lead to uncomfortable feelings regarding the way that treatment plans are decided according to the convenience of the hospitals and other authorities. “I think their misgivings about this approach to medical care contain the seeds of a new perspective that can bring us closer to the real concerns of patients and their families, potentially leading to a better way of doing things.”

During the pandemic, it has become common for the media to highlight the harsh conditions healthcare workers labor under. Isono, however, says that not all medical workers like the image being portrayed of them as heroes risking their lives to help others. “Quite a few of people have their doubts about at least some aspects of the narrative,” says Isono. “They say they don’t really need illuminations of landmarks like the Tokyo SkyTree or fly-overs by the Blue Wave fighter planes as ways of showing appreciation and support. And quite a few people are uncomfortable with the way in which everything seems to center on preventing infection at all costs.”

Isono is skeptical about the tendency to blame the structural problems of the Japanese healthcare system for worsening the coronavirus crisis. The media is quick to pounce on issues like bed shortages for COVID-19 patients and the large numbers of nurses quitting their jobs. These problems, she stresses, are nothing new. “Poor coordination among hospitals and clinics and chronic staff shortages, including large numbers of nurses leaving the profession, predate the current crisis. I think the media should take more care in pointing this out to people. Misunderstanding the situation and blaming everything on the pandemic will only make it more difficult to improve the areas that need fixing. If we’re not careful, nothing will change and the problems will still be here after the current crisis is over.”

Correctly Assessing Risk

Over the past year or more, the numbers of new coronavirus cases and fatalities have become a fixture on the daily news. Isono points out that Japan is one of only a few countries that has managed to keep the number of infections relatively low—even though the government has not introduced any impressive policy measures, or used extraordinary legal powers to contain the crisis.

In terms of overall fatalities, the number of deaths from all causes actually fell in 2020 for the first time in 11 years. “In this sense, it’s fair to say that lives are being protected,” says Isono. “But the public and the media typically don’t pay much attention to this fact. They prefer to dwell on the risks of infection and the problems with government policies. The fear of the virus is leading some households to forego support services for seniors and others, including visits from nurses and caregivers. Often, the result is that the rest of the family becomes exhausted, exacerbating the frailty of the person requiring care.”

Isono points out that the unfamiliarity of the pandemic has meant that people are easily swayed by misleading information that fans anxieties about the risk of infection. “Take the flu as an example,” she says. “Most people have personal experience of the illness and know if they’re sick or not. If they come down with the flu, they might take a week or two off work to recuperate. At schools, classes might be cancelled for a few days if too many students get sick. But with the coronavirus, people lack the real-life context that would enable them to assess the risk accurately.” She notes that the constant barrage of news reports telling the public how quickly case numbers are escalating distorts the situation. “In reality, the overwhelming majority of people have not been infected. and the number of serious cases is even smaller still. But there is so much negative information that it becomes difficult for people to respond in a level-headed manner.”

Isono admits that even with vaccinations, the risk of infection and infecting others will not go away completely. “We will probably have to learn to live with the coronavirus for a long time to come. This makes it important to work to control excessive fear and panic over this one particular disease—both on the part of the media and of the people consuming news.” She hopes that society will move in a direction that helps people to mitigate their risk of contracting the disease while permitting individuals to carry on with their lives in a fashion that allows for other important considerations.

Learning to Live with Uncertainty

No one denies the importance of taking reasonable efforts to avoid falling ill. But Isono says that the public needs broaden its focus from trying to live as long as possible to think more deeply about life and death.

“All of us will die one day,” she declares. “Even so, we try to avoid thinking seriously about death. As social animals, we humans see connections with other people as an important part of life. However, individuals are giving up the spiritual nourishment they get from social contacts out of a fear that they might catch the virus.”

She says that living in a community means recognizing other’s individuality and accepting unpredictability into our lives. These uncertainties increase as a person approaches death, and it is family and friends who take on the responsibility of accompanying them in their final days. “In an environment of excessive risk control, though, people are stripped of the opportunity to face up to uncertainties and deal with them together. Their chance to find a way to come to terms with them is taken away from the start.”

Isono warns that there is a risk that even our imaginations might be controlled by a constant flood of information. “I sometimes worry that the deluge of information is affecting our emotional state. I’m terrified by the idea of people being so overwhelmed by the information that is broadcast at them that even their imaginations fall victim to it. Being moved and touched by something is personal—these things should be left to the freedom of the individual.” She says she would like people to think more about the manipulative structure of a system that feeds information to the public in a very one-directional way. “I think we need to think more about the intentions of those who are broadcasting this information, and what it means for us on the receiving end.”

Broadening Shared Spaces

The tendency to prioritize preventive medicine is only likely to increase after the current crisis subsides, which is why Isono says she intends to continue using a cultural anthropology approach to questioning accepted views.

“I think we are entering an age in which statistics-based ethics and value systems that prizes longevity for its own sake will become even more dominant. Life’s choices will be boiled down to the health risks involved and everything will be shown in figures.” She warns that this presents a slippery slope for humanity. “I think more than a few people are uncomfortable with such an approach, lay people as well as healthcare workers. I want to get a message out to such people and help create a platform for thinking together about what it means to live our lives, based on real-life examples that are easy to relate to.”

Isono feels strongly that people should not let go of their right to decide for themselves about what it means to live. “One recent trend in medicine is the practice known as social prescribing, whereby doctors refer patients who are cut off from society to a range of non-medical social services. Of course, it’s only proper for a doctor to notice if a person might be struggling with loneliness and isolation and try to do something to alleviate that situation. But I think those of us outside the medical system also have a right to express our doubts about the way it is done. Have we really reached a stage where we can’t forge social connections without a prescription from a specialist? I can’t help feeling uncomfortable with the expectation that we should simply sit back and gratefully endorse the idea of outsourcing even our social connections to experts.”

In 2020, Isono left her post as an associate professor and launched a series of online seminars on the subject of exchanges with others. Around 300 people of all ages and backgrounds, including medical and social workers as well as teachers and students, have participated. Participants say the thought-provoking discussions and the opportunity to exchange views with people from different walks of life deepened their understanding of issues. In June 2021, a second series of seminars will start under the theme of developing the power to listen.

“Cultural anthropology has a power to push back against conventional wisdom,” Isono asserts. “There is a version of what is correct and acceptable that is put out by people in authority that everyone is supposed to go along with. We still need to question this accepted wisdom and ask if it leads us in a direction we want to go. The discipline can encourage people to express their doubts and perhaps put a brake on the tendency to go along with the loudest voice in the discussion. At the same time, it’s not caught up in making easy judgements about right and wrong. In that sense, I think the field can help to widen the space that we share with others. Through my activities, I want to do what I can in my own little way to bring this attractive side of the field to as many people as I can. That’s my ambition.”

Complete Article ↪HERE↩!

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The Secret to Happiness?

Thinking About Death.

In an excerpt from his new book, journalist Michael Easter travels to Bhutan to learn about how confronting death head-on can lead to a more fulfilled life

By Michael Easter

In his new book, The Comfort Crisis, Michael Easter investigates the connection between modern comforts and conveniences and some of our most pressing problems, like heart disease, diabetes, depression, and a sense of purposelessness. Turns out, engaging with a handful of evolutionary discomforts can dramatically improve our mental, physical, and spiritual wellbeing. One of those fruitful discomforts? Thinking about dying.

Death has always been the most uncomfortable fact of life. And as modern medicine, comforts, and conveniences have given us more years, we’ve seemingly become less and less comfortable with life’s only guarantee. Roughly seven out of ten Westerners say they feel uncomfortable with death. Only half of people over 65 have considered how they want to die.

After someone dies we’re encouraged to stay busy to take our mind off it. A dead person’s body is immediately covered and sent to a mortician where it is prepared to look as youthful and alive as possible before one final, hour-long viewing, after which it is dropped into the ground of a perfectly manicured cemetery.

But new research is showing that death awareness is good for us. For example, scientists at the University of Kentucky had one group of people think about a painful visit to the dentist and the other contemplate their death. The death thinkers afterward said they were more happy and fulfilled in life. The scientists concluded, “death is a psychologically threatening fact, but when people contemplate it, apparently the automatic system begins to search for happy thoughts.”

The country of Bhutan has made it part of its national curriculum to think about death anywhere from one to three times daily. The understanding that we’re all going to die is hammered into Bhutan’s collective conscience, and death is part of everyday life. Ashes of the dead are mixed with clay and molded into small pyramids, called tsa tsas, and placed along heavily trafficked areas like roadsides, in window sills, and public squares and parks. Bhutanese arts often center around death; paintings of vultures picking the flesh from corpses, dances that reenact dying. Funerals are a 21-day event where the dead body “lives” in its house before being slowly cremated over fragrant juniper trees in front of hundreds of friends and relatives.

All of this death is doing anything but bumming out the Bhutanese. Despite being ranked the 134th most developed nation on earth, extensive studies conducted by Japanese researchers have found that Bhutan is among the world’s 20 happiest countries. But what you probably don’t know is how morbidity contributes to their feelings of happiness. And neither did I.

After four flights across 48 hours, 14 time zones, and 9,465 miles, I stepped off an aging 737 onto a runway 7,333 feet above sea level at Bhutan’s Paro International Airport. THE thin air filled my lungs as the sun illuminated the surrounding snow-capped Himalayan foothills. I was there to find out how Bhutan’s uncomfortable intimacy with death might improve my life—and maybe yours too.

I’d arranged to meet with a host of characters, including government leaders who study happiness in Bhutan. But the most compelling men I met with were both leaders in the Buddhist faith.

The first was Khenpo Phuntsho Tashi. He knows as much about death as a living human can. He’s one of Bhutan’s leading Buddhist thinkers, and he’s found a niche in the study of death and dying. The Khenpo is the author of a 250-page book called “The Fine Art of Living and Manifesting a Peaceful Death.” And unlike many of Bhutan’s monks, the Khenpo is intimately familiar with what ails people in the West. Before he dedicated himself to his spiritual practice he lived in Atlanta, with a girlfriend who was the Dalai Lama’s translator. He, I thought, would be able to get to the heart and consequences of the West’s fear of death.

My boots kicked up a low-hanging dust as the Khenpo’s cliff-side shack came into view. It was wooden, tin-roofed, and in the shadow of Dakarpo. Dakarpo is an ancient Buddhist monastery built on an outcropping that overlooks the Shaba valley. Fifteen or so people walked clockwise around the white, fortress-like monastery. They chanted as they carefully stepped around its rocky terrain. Bhutanese mythology says a person will be cleared of all of his or her sins by circumventing the Dakarpo 108 times. Each lap takes roughly 25 minutes. The full 108 takes most pilgrims about four full days, a relatively small fee for absolute absolution.

The scent of burning incense crawled into my nose as I peeled back the heavy orange embroidered silk drape leading into the Khenpo’s room. Light was entering the room through a hazy window, catching smoke. It obscured a small altar anchored by a three-foot statue of the Buddha. Around it were smaller Buddhist statues, photographs, and burning sticks of champa. Through the smoke I saw the profile of a face. It was the Khenpo.

“Welcome,” said the Khenpo, his voice a heavily accented butter. I bowed and sat. “You want to talk about death?”

I nodded. “Hmmmm,” he said. His chest slowly rose and fell in the silence.

“You Americans are usually ignorant,” he said, using a word often seen as an insult in the United States, but that by definition means “lacking awareness.” In Bhutan and other Buddhist countries, “ignorance” is the rough English translation of “Avidyā.” That’s a Sanskrit word that means having a misunderstanding of the true nature of your reality and the truth of your impermanence. “Most Americans are unaware of how good you have it, and so many of you are miserable and chasing the wrong things.

“You act like life is fulfilling a checklist. ‘I need to get a good wife or husband, then I get a good car, then I get a good house, then I get a promotion, then I get a better car and a better house and I make a name for myself and then …’” he rattled off more accomplishments that fulfill the American Dream. “But this plan will never materialize perfectly. And even if it does, then what? You don’t settle, you add more items to the checklist. It is the nature of desire to get one thing and immediately want the next thing, and this cycle of accomplishment and acquisitions won’t necessarily make you happy—if you have ten pairs of shoes you want 11 pairs.”

The Khenpo then pointed out that by pursuing this checklist, we’re often forced into acts that take us away from that higher reality and happiness. He was echoing a sentiment shared among many leaders in the tradition of Vajrayana Buddhism. Sogral Rinpoche in his 1992 work The Tibetan Book of Living and Dying called this checklist phenomenon “Western laziness.” It consists of “cramming our lives with compulsive activity, so that there is no time at all to confront the real issues … If we look into our lives, we will see clearly how many unimportant tasks, so-called ‘responsibilities’ accumulate to fill them up … Going on as we do, obsessively trying to improve our conditions, can become an end in itself and a pointless distraction.”

The average American works 47 hours a week. Our entrepreneurs and “productivity gurus” preach that a “grind” and “shut up and work harder” mentality is the secret to satisfaction. This upset in our work/life balance—or, perhaps, our problem integrating our work into our life and not the other way around—factors into why other research has shown that America is, in fact, less happy than it was decades ago.

“So this checklist plan does not make you truly happy. Then what?” said the Khenpo. He was silent. Left it open for me to ponder.

“I don’t know. I’m an ignorant American,” I said and smiled.

“Then you could be happier!” he responded with a chuckle. “Whereas if you understand this cycle and nature of mind and you prioritize mindfulness then everything will be ok. Even if you don’t become rich. Fine, you’re mindful. Even if you don’t get a perfect wife? Fine, you’re mindful.”

Ah, yes. “Mindfulness.” That squishy, what-the-fuck-does-that-even-mean word that’s so hot in America today but has, in fact, been a part of Eastern traditions since before Christ. It’s roughly defined as purposefully paying attention to what’s happening in the present moment without judgment, according to Jon Kabat Zinn, a profes-sor at the University of Massachusetts Medical School and pioneer of mindfulness in the Western world. In other words, it’s being aware of what’s going on upstairs.

The Khenpo made mindfulness sound akin to jamming a stick into the spokes of the checklist and developing a state of okayness. In other words, whether I’m rich or poor or famous or a nobody, I should avoid becoming caught up in the narratives my mind spits out and just accept the direction of things. This will help me go beyond the checklist and be just fine.

The woman who took me through the cleansing ritual entered the room. She placed a plate of sliced cucumbers and mandarin wedges on the floor between the Khenpo and me. “All organic!,” he said and grabbed a spear of cucumber. It crunched as he bit into it.

“Well, the Bhutanese, we also have ignorance, anger, and attachment. We have the same problems of the checklist. But I think less. This is because we apply what we call mindfulness of the body. We remember that everyone is dying right now,” said the Khenpo. “Everyone will die. You are not singled out. Do you know this? To not think of death and not prepare for it … this is the root of ignorance.”

Pretend you are walking along a trail, he explained, and there is a cliff in 500 yards. The catch: The cliff is death and we will all walk off it. “Buddha died. Jesus died. You will die. I will die. I would like to die on that bed,” said the Khenpo, pointing to a twin mattress on the floor.

“Don’t you want to know that there’s a cliff?” he asked. Because only then can we change our course. We could take a more scenic route, notice the beauty of the trail before it ends, say the things we truly want to say to the people we’re walking it with.

“When you start to understand that death is coming, that the cliff is coming, you see things differently. You change your mental course—you naturally become more compassionate and mindful,” said the Khenpo. “But Americans, they don’t want to hear about the cliff. They don’t think about death. After a funeral, they want to get their mind off the death and just eat cake. The Bhutanese, they want to know about the cliff and they will be happy to talk about death and ruin the cake eating.”

“So remember,” he continued. He was able to sustain the perfect upright lotus position while I was slumping and couldn’t feel my legs. “We are all dying right now. To develop this mindfulness of death you have to think of Mitakpa.”

“Mitakpa?” I asked.

“Yes,” he said. “Mitakpa.”

Before I could probe the Khenpo on Mitakpa—what it is and what it might be able to do—his time was up and I was back in Dorji’s hatchback. We were like bouncy balls in the seats as gravity aggressively pulled the car over all the rocks and ruts that once thwarted us. As we descended I asked, “Dorji, what is mitakpa?” He looked at me and shook his head. “Mi-tak-pa,” I said.

“Oh. Mitakpa,” he replied, pronouncing the word less like an ignorant American. “Takpa ‘permanent,’” he said. “Mi ‘no.’ Mitakpa ‘no permanent.’”

I began to ask him to explain further, but a Bhutanese traffic jam interrupted me. A herd of seven bulls and cows ambled up the one-lane road. Dorji pressed into the brake to slow the car to a crawl. The half-ton animals lazily parted around us. Their bells clanked as they slid down the length of the hatchback.

The next day, I headed into an apartment in the city of Thimpu to meet Lama Damcho Gyeltshen. He doesn’t ponder death in any abstract sense—he experiences it every day. He’s the head Lama at the Jigme Dorji Wangchuck National Referral Hospital, the main hospital in Bhutan. It’s there that he councils the dying. After the Khenpo elucidated the problem and hinted at some solution, the Lama, I figured, might be able to expand.

The Lama was sitting on a platform that was covered in silk meditation pads. He hopped off of it as we entered. He and I shook hands and did a lot of smiling and nodding. He was bald, short, and doughy, with wire-framed glasses. His bright white smile popped against his blaze orange robes. He sat back atop the platform, in the lotus, while Jigme and I sat on the floor. Jigme explained what I was there to talk about. Death, dying, and the Bhutanese death complex.

“Well first I’d like to thank you for coming and reminding me of death because it is important for the mind,” said the Lama. His words, naturally, set me up to ask why.

“When people come into my hospital there is a chance they leave,” he said. “But there is also a high chance they do not leave. My job is to help people prepare for death. I have found that the people who have not thought about death are the ones who have regrets on their deathbeds. Because they have not used a necessary tool that could have made them live a fuller life.” An American study conducted across various hospitals like the Yale Cancer Center, Dana -Farber Cancer Institute, and Massachusetts General Hospital supports this notion. It found that dying patients who had open conversations about their death experienced better quality of life in the weeks and months leading to their passing, as judged by their family members and nurse practitioners.

“The mind is afflicted with many delusions. But they come down to three,” continued the Lama. “And those are greed, anger, and ignorance. When your mind is not taken care of these three things have an advantage. The dying people I council … they suddenly do not care about getting famous, or their car or watch, or working more. They don’t care about the things that once angered them.” In other words: When a person realizes death is imminent, their checklist and everyday bullshit becomes irrelevant and their mind begins to center on that which makes it happy. Research from Australia found that the top regrets of the dying include not living in the moment, working too often, and living a life the person thinks they should rather than one they truly want to.

“Whereas those who have thought of their death and prepared for it,” said the Lama, “they do not have those regrets. Because they have often not fallen so much into those delusions. They have lived in the moment. Maybe they have accomplished a lot. Maybe they have not. But regardless it has not affected their happiness as much …” He expanded on this phenomenon, explaining that a sort of cosmic psychic shift often occurs in the dying. It brings them closer to the things that matter in the end. A living person who thinks of dying will, yes, initially face mental discomfort, but they’ll emerge on the other side having stolen a bit of this end-of-life magic.

“What is mitakpa?” I asked. “Someone told me it translates to ‘no permanent…’”

“Close. Mitakpa is impermanence,” said the Lama. He raised an arm and finger, like a professor making a point. “Impermanence, impermanence, impermanence.” This, he said, is the cornerstone of Buddhist teachings. Nothing lasts and, therefore, nothing can be held onto. By trying to hold on to that which is changing, like our life itself, we ultimately end up suffering. Buddha’s final words were on impermanence, a reminder that all things die. “All things change. Whatever is born is subject to decay…” he said. “All individual things pass away.”

“It’s important to preserve this precious understanding of mitakpa in your mind. It will significantly contribute to your happiness,” said the Lama. He echoed the Khenpo’s sentiment. He explained that not thinking of mitakpa often leads a person to believe that “things will be better when I do X.” Or with a false sense of permanence that causes a person to put off the things they truly want to do because “I can do that when I retire.”

“But when you understand that nothing is permanent you cannot help but follow a better, happier path,” he said. “It calms your mind. You tend not to get overly excited, angry, or critical. With this principle, people interact with others and it improves their relationships. They become more grateful and gratuitous. Because they realize all their material goods and status will not matter in the end.” And not just in Bhutan. A study in Psychological Science discovered that people who thought about their death were more likely to show concern for people around them. They did things like donating time, money, and even their blood to blood banks.

“How often should I be thinking about mitakpa?” I asked.

“You must think of mitakpa three times each day. Once in the morning, once in the afternoon, and once in the evening. You must be curious about your death. You must understand you don’t know how you will die or where you will die. Just that you will die. And that death can come at any time,” he said. “The ancient monks would remind themselves of this every time they left their meditation cave. I, too, remind myself of this every time I walk out my front door.”

We talked for a half-hour more about death and his work at the hospital. Then it was time for me to leave.

“Remember,” said the Lama as we were saying goodbye. “Death can come at any time. Any time.”

The next day I spent the morning hiking five steep miles to Paro Taksang, “The Tiger’s Nest,” a sacred 15th-century Buddhist monastery built in the traditional Bhutanese Dzong style. The monastery sits at 10,240 feet above sea level and clings to a cliff like a reptile on a vertical wall. It’s the location where in the eighth century Padmasambhava, a man considered the “Second Buddha,” meditated in a tiger-filled cave for three years, three months, three weeks, three days, and three hours.

I’d come to see the monastery’s famous artwork, much of which depicts death. It holds various images and statues of, for example, Mahakala, a protector god whose crown is ringed with skulls and whose sash is strung with severed heads. His Sanskrit name translates to “beyond time” or, more simply, “death.”

As I exited the monastery and put my shoes back on, Dorji, my driver (Bhutanese law requires all tourists to hire a guide and a driver … my guide had conked out due to the altitude), hurriedly approached me. “Someone sick,” he said in his broken English. He pointed up the trail, to a set of steep stairs cut from a cliff that lead up to a small meditation hut next to a waterfall. Towards the top of the steps, a group of people huddled. They were all wearing either traditional Bhutanese ghos or monk robes. Dorji jogged towards the group. I followed. As I quickly stepped up the thin stairs I could see feet hanging from the edge of the steps.

A monk—bald head, thin glasses, maroon robes—was down on the steps, unconscious. I recalled some basic emergency wilderness training I took and checked his spine for signs of fracture. Nothing. A general understanding arose within the group. The man needed to be moved to flat ground so he could be airlifted out.

The stairs were too steep and thin for a group carry. So we carefully propped the monk onto the back of the largest driver, who hoofed him down the steps. With the help of the group, he laid the monk onto a flat grass patch along the cliffside trail.

The monk’s eyes were rolled back as if he was scrutinizing the brain above them. “I’m going to do CPR,” I slowly told the group. They only partially understood me. As I knelt in front of him two tiny women, a mother and daughter who were both doctors in Hong Kong, were suddenly at my side. They were hiking to the monastery when they walked into this scene.

They pressed their fingers to the man’s neck to check vitals and agreed that CPR was needed. These two were surely better trained. But I was the only person with any training who was also large enough to optimally execute CPR on the 200-pound monk.

I tore open his robe, revealing a gold t-shirt. I dug my knees into the dirt, overlapped my hands, and placed the heel of my right hand on the monk’s sternum. Then I began hammering into his chest; 100 beats a minute as the daughter doctor began a timer.

I was unsure of the cultural implications of giving a monk mouth-to-mouth. So the younger Hong Kong doctor quickly instructed one of the other monks, a woman, on how to do it. She breathed into him, repeatedly pushing air into his lungs. Then I was back to compressing his chest.

“Time is 10:26,” said the daughter. A crowd had formed around us, and a driver who was on the phone stepped into the group. “Helicopter cannot come,” he told us. There was nowhere to land, and the cliffs were too close for an airlift.

The daughter checked the monk’s vitals. She shook her head. I continued pressing. Pressing, pressing, as hard as I could, thinking that if I could push hard enough it might kickstart his heart. We hit the fifteen-minute mark. His face was distant. “20 minutes 11 seconds,” said the doctor. “You can stop.” He was gone.

Here was a man who just minutes ago had hiked five steep miles. And he was joking and laughing and talking with friends along the way. Death can come at any time.

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How the light gets in

by

When palliative care doctor Rachel Clarke looked back over her notes typed hastily pre-dawn in the midst of a global pandemic, she expected to find only darkness—an unrelenting stream of death and despair. To her surprise, her insomniac’s diary was “illuminated by pinpricks of light”. “People began to organise, street by street, village by village, to make sure that their most vulnerable neighbours…were safe and fed and kept from harm”, writes Clarke. Rainbows appeared in windows up and down the country in support of key workers, volunteers set to work sewing masks and manufacturing visors, and a retired British Army officer approaching his 100th birthday united a divided nation by walking laps of his garden to raise money for the National Health Service (NHS).

Clarke, who embarked on a career as a current affairs journalist before beginning medical training, has since punctuated her medical career with writing—from Your Life in My Hands, charting her experiences as a newly qualified doctor, to Dear Life, exploring death, grief, and the things that truly matter at the end of life. Her latest work, Breathtaking: Inside the NHS in a Time of Pandemic, spans the 4 months from New Year’s Day 2020 to the end of April that same year—a fleeting snapshot of a time during which life in the UK changed immeasurably.

“Pacing the kitchen and tapping a keyboard became a kind of nocturnal therapy”, she explains. These notes, typed “fast and furiously” while her family slept, open a window to life in the UK in its darkest hours. Turning the pages of Breathtaking, we relive the angst and uncertainty of those early months. The anguish about personal protective equipment (PPE) and testing, death tolls rising too high to take in, and the sudden, unexplained obsessions with baking bread and accumulating toilet paper that swept the nation. But, for those of us who know COVID-19 in only an abstract sense, following the news from the safety of our homes, Clarke gifts us a unique glimpse of life in the eye of the storm. As the crisis evolved, day by day, week by week, we learn, in real time, what life was truly like for those on the frontlines—those who risked everything, not knowing that they would see the other side. “To us”, she explains, beyond statistics and modelling, “the pandemic is a matter of flesh and blood. It unfolds one human being at a time”. In these darkest of times, Breathtaking shows us that the greatest sources of light came from within the NHS.

Beyond the inestimable challenges of treating a new disease, acquiring knowledge on the run as patients lurched from one physiological crisis to the next, health-care workers fought—through the physical barriers of masks, gowns, and distance—to restore the humanity to their practice that COVID-19 so cruelly stripped. Overnight, hospitals cleared of visitors, carparks emptied. For Clarke, whose work in palliative care has made her all too aware of the power of human connection, seeing patients isolated from their loved ones feels like a psychological assault. “Covid even steals the patients’ names. So great are the risks of communication in PPE that it is safer for the nursing team to use bed numbers to refer to the human beings for whom they care”, she writes. Humanity is restored by any means possible: medical students volunteer to liaise with patients’ families, many of whom are self-isolating and alone; hearts knitted by volunteers are used to symbolise the connection between patients and their families; health-care workers add laminated photos of their faces to their plastic gowns. “Our tools are uncertain and improvised”, she writes. “We use whatever we can to draw people back together and we refuse to settle for despair.”

Clarke’s style is intimate and generous, opening up to us her own home and family life. We join her pacing in her kitchen—glued to her phone—as she watches events unfold, first in Wuhan, then Lombardy, and finally on her doorstep. We watch her conceal her anxiety from her husband, guilty at even an insignificant deception. We feel her exasperation as PPE at the hospice runs perilously low. We feel her overwhelming desire to help, which drives her to volunteer on the frontlines. Misty-eyed, we’re there as she attempts to quell the fears of her 9-year-old daughter, terrified of losing her mother. “How can I possibly tell her I have volunteered, that I want to be the one helping these patients?”, she asks.

Although not yet over, the opportunity to reflect on these early pandemic months is at once cathartic and deeply humbling. Powerful personal stories allow us to grieve the loss we have suffered as a nation, far beyond the statistics, as well as to appreciate the sacrifices made by NHS workers and volunteers who put helping others above all else. Although Clarke cannot conceal her blistering anger at the failings of those in charge, at its core Breathtaking brims with pride and positivity. “Every single day, the grit and devotion of colleagues astounded me”, she writes. “In the 11 years I have practised as a doctor, I have never been prouder of nor more humbled by the NHS and its people.”

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Writing of death is private art and public therapy

Eulogy, newspaper article, novel, poem… the obituary epitomises communal mourning, another aspect of being human that has been wrenched from society by Covid-19 restrictions.

By: Percy Mabandu

At the heart of every culture’s funerary ceremonies lie rites meant to guide ritual accounting of the meaning, in death, of the deceased. The obituary and its cousin, the eulogy, is a literary document clearly conceived to be read out loud. It is often the central aspect of rituals of reckoning for gathering communities of bereaved audiences. The performance that is the reading of an obituary sets the tone for how shared memories of the dead unfold.

The onslaught wrought by the Covid-19 pandemic has occasioned death on a historic scale for humanity. Beyond the massive corporeal loss of life, the coronavirus is marking myriad cultural losses for mankind. This season of industrious dying is ironically denied much of the ritual usually associated with death. The funeral, central in every culture as a ceremony for communal mourning, and perhaps the commencement of a shared acceptance of healing, has been cancelled or at best curtailed by policies meant to curb the virus’ outbreak.

As a result, many families lose out on the chance to gather and remember their loved and departed members, barred as they are from sharing the crucial ritual of reminiscences.

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The obituary is a form of portrait, the reading of it performance art denied its customary audience by Covid-19 funeral restrictions. Those with means have found a way to connect with physically distanced mourners over social media platforms. The result is a new content regime in which private quarrels generated by grief become larger public spectacles as a result of streaming. In an earlier time, these would have been the preserve of gathered friends and family, at worst gossip fodder for the immediate community.

At the height of the initial strict lockdown, social media gave us an example of this kind of contentious occasion. The Rakgadi meme exploded on to our smartphones after Semati Moedi contradicted decorum at the memorial service for her brother, the tombstone king Lebohang Khitsane. Driven by grief, Rakgadi, the eldest aunt of the family, attacked his widow with accusations of infidelity. The farce and fervour that followed pried open age-old debates about decorum, trauma and the limits of righteous indignation. Close behind were questions about why obituaries always read like sanitised versions of the dead, deviant in life now made darlings after death.

The obituary as newspaper feature

Beyond the funeral gatherings that make theatre of tributes, the obituary exists as a cherished newspaper feature. In this mode, it becomes a potentially polemical memorial. A public letter occasioned by the death of a notable figure to contest crucial social issues.

When larger-than-life American star Little Richard died in May last year, the world went into overdrive with debates about the Black roots of rock and roll, its appropriation by white America and the neglect of the real progenitors of the multibillion-dollar art form, Richard among them. Centrepieces of the debate were defined by the proliferation of newspaper obituaries published globally in the wake of his death.

In Mzansi, Bongani Madondo led the charge against culture vultures. “Richard died last Saturday at the age of 87 and the world lost its marbles. Lord ha’ mercy, what we gonna do? For one, we can all claim we loved him madly. That he was our darling queer avatar,” wrote Madondo, taking issue with the public’s propensity to posture fake care for the dead who suffer neglect in life. At once, the obituary campaigned against pop culture’s social hypocrisies, and dared to settle historic racial scores for the credit of Black creative genius.

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Following the death in 1964 of Sophiatown’s beer-beaten golden boy of letters, Can Temba, his friend and fellow writer Lewis Nkosi sat down to write his obituary. The article was headlined “The will to die” after one of Temba’s short stories. It opens with an epigraph composed of a statement Temba made at an unnamed friend’s funeral: “This son of bitch had no business to die… [sic].” What followed is a study of the horrible state of life in apartheid South Africa. Nkosi highlights the devastation borne by the suicides of creative people such as Nat Nakasa and Ingrid Jonker to understand the death of his friend Temba.

In less lofty instances, the newspaper obituary has been seen as an inconsequential space filler. This point was made by former Sunday Times newspaper editor Ken Owen in a brutal albeit memorable put-down of journalist Chris Barron. The pair were part of a larger media brawl with biographer Ronald Suresh Roberts.

Responding to what was then Barron’s latest op-ed attack against Roberts, Owen took his famous shot: “In his eagerness to smear Ronald Roberts, Barron has misquoted me … He should stick to writing obituaries – the subjects will not complain.”

In this way, Owen shored up the form’s propensity to be inconsequential content. To be balanced, though, Barron’s LinkedIn profile professes that “he turned what was a moribund and largely ignored obituaries section into one of the most eagerly read pages in the newspaper”.

A form and genre

There have been grand moments of glory for the form. The New York Times celebrated the newspaper obit as a genre in 2016 by sharing highlights from its archive. The editors noted proudly that since 1851, more than 200 000 people had been the subjects of obituaries in the paper.

Arguably the most notable was a piece announcing the death of Christopher McCandless. The account of McCandless’ fate stands as a monument to the power of the newspaper obit. McCandless died in the Alaskan wilderness during an ill-fated journey to sever ties with all he had known.

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The first paragraph cloaked him in mystery and tragedy, turning him into a folkloric figure: “No one is yet certain who he was. But his diary and two notes found at the camp tell a wrenching story of his desperate and progressively futile efforts to survive.” It was a short newspaper obituary. But it unleashed an industrious mining for meaning into the life and death of McCandless that would yield further feature articles internationally, at least two bestselling books and a Hollywood biopic called Into the Wild. The film starred Emile Hirsch and Kristen Stewart, with Sean Penn as the director. It was nominated for best editing and best supporting actor awards at the Oscars.

It is doubtful McCandless would have gained this posthumous fame and glory were it not for that compelling newspaper obituary. It launched him as a symbol of youthful renunciation of modernity in search of a lost, liberated, prehistoric purity of man.

The obituary in literature

American novelist Ann Hood published an aptly titled piece of historical fiction, The Obituary Writer, in 2013. Its plot zeroes in on the cathartic benefits of writing obituaries. In part, the book tells the story of Vivien Lowe, an obituary writer, who by telling the stories of the dead not only helps others cope with their grief but also begins to understand the ravages of her own losses.

The Obituary Writer shores up Hood as a discerning novelist who manages to magnify the underlying feature of the obit as a cultural artefact. It converges the needs of the individual with the requirements of community for mutual healing during times of death.

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There are few poets who’ve had to contend with the meaning of death and personal loss like Ted Hughes. His first wife and fellow poet Sylvia Plath killed herself after Hughes left her for another woman, Assia Wevill, who also killed herself along with their four-year-old daughter Shura. The tragedy of Plath’s death, for which Hughes was blamed, would become the subject of one of his most memorable poems. This in part because of the legend that surrounds its discovery more than a decade after he died.

Titled Last Letter, the poem is an account of the night Plath died. The various versions of the previously unknown poem were published in the New Statesman magazine, in part to report and register the historically unacknowledged torment Hughes lived with following the death of Plath and also to bear witness to his repeated attempts to perfect his poetic account of the night she died. 

In the poem, which was read live on BBC Channel 4 News by actor Jonathan Pryce, Hughes recalls the night of Plath’s suicide, even the phone call that delivered the dark news: 

What happened that Sunday night?
Your last night? Over what I remember of it… 
Then a voice like a selected weapon
or a carefully measured injection
coolly delivered its four words deep into my ear
your wife is dead.

In this way, the writing of the poem as a private obituary, along with the promise of a probable audience in some future, allowed Hughes to live productively with grief in a way that writing about dead loved ones makes possible. 

It is the singular power of the obituary, the making into artful verse the painful episodes in our personal universes. We write obituaries, read them out loud to gathered friends, to make certain that we are not alone in our hour of need. The legislated dearth of community in dealing with death during the Covid-19 pandemic denies us this connection. The omission of audiences for obituaries is central to the larger loss of our time.

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On the ‘art’ of dying

— ‘If you want to die well, then first – live well’

Over the past 15 long months, the pernicious effects of a contagious microscopic pathogen have taught us a lot about the state of relationships in our world, in our families and communities.

By Sean O’Connor

If used as a kind of illuminating lens, to paraphrase the Ugandan priest Gideon Byamugisha when discussing what HIV and Aids can teach us, Covid-19 shows us where our relationships are weak and where they are strong, it shows us where they are corrupt or broken and where they need mending.

Power relationships and patterns of privilege have become especially visible. In this sense, Covid-19 has shone a light on the unequal ways that many of us live in relation to each other. It has also highlighted the “unnatural” ways that many people have died, behind closed doors, away from home and without their loved ones who are unable to say goodbye, complicating their bereavement. Our experience with Covid-19 has shone a light on the end of life, for many a light that has been obscured for a long time, through a combination of mainstream death denial and a prevailing feeling, perhaps, that to die means that you have somehow failed to stay alive – that death itself is antithetical to life.

Just as Covid has revealed some of the uglier sides of human nature, with predictable fear and distrust and a swirl of conspiracy and corruption, so too in many places has it highlighted our resilience and compassion, and our status as social animals who need each other not just for survival but for our mental and spiritual wellbeing.

I feel that it has taught us to value those we love for death can take them at any time, just as it always could, just as it has taken so many. (Multiply the number of global dead by five or six to get an index of active grief visited upon the world right now. That is a true index of suffering, I believe, and not the bald statistics of lives lost.)

For many millions grieving, their grief has been attenuated, disrupted, titrated into what is permissible and what is not under lockdown regulations. For millions and millions of people, this experience of loss has caused us to look at death more closely and invited us to consider how we ourselves might wish to die one day. For the privileged, Covid-19 may have slowed things down, and for those who can afford to ask the question, invited people to ask what they want from life, beyond the task of mere survival.

The lens provided by Covid-19 has also brought into focus this nascent idea of having “a good death”, whatever that means. It is this idea, which is both absolutely necessary and deeply flawed, I believe, that holds the possibility of heralding a healthy interrogation of mortality and what it means to cherish life, and what it means to fear death, too.

But it also romanticises death and encourages us to feel that we can expire on our terms, which is mostly not the case. It’s not about the elegant fluttering of a white handkerchief and aptly chosen final words. Just like birth, which can also be beautiful, I happily concede, I suspect that death is usually a bit of a messy struggle, and like birth, more associated with bodily fluids and end of pain.

Still, “what is a good death, and how could you increase your chances of having one?” was a popular discussion point at the Death Cafes I gained so much from attending. I liked to say my father had one – quick, and in a place he loved, after saying he was ready to go and had enjoyed a wonderful life. He was 67. Some people pulled in their breath when they heard that. Certainly, I’ve heard of painful deaths, drawn-out deaths, and others – sad deaths, horrible deaths, and deaths that are extremely difficult for the living, or the dying, to accept.

How are we to die? Do we have any choice in the matter? This question is animating legislators and activists locally and abroad, as they revisit laws to compass or deny the quite reasonable, in my opinion, perspectives of the “right to die with dignity” movement. At present, it seems that many governments around the world, ours included, simply do not trust their subjects to make the informed choices that are in their best interests. For now, however, I will skirt this rather vexed issue and instead indulge in a quick survey of available resources on this idea of a “good death”, and for this, invite you back quite some way.

Ars moriendi (The Art of Dying) was originally published in Latin as two related texts, a longer and a shorter, in around 1415 and 1450, and gave advice on how to “die well” according to Medieval Christian precepts. It appeared in more than 100 editions in most Western European languages. It’s an early example of “death lit”, traceable back from the present, a genre that seems to be having a bit of a moment right now with personal accounts of loss and reflections on mortality high on the bestseller lists – Atul Gawande’s Being Mortal being the most obvious (and excellent) example.

Originally written by an unknown Dominican friar in the aftermath of the Black Death (which halved Europe’s population), and within the profound social, religious and political upheaval of the Middle Ages, the Ars moriendi might be seen as evidence of a shift in the way people experienced and understood death. No doubt this genre is set to explode, given our collective experience of grief in these times.

The Ars moriendi were recently updated, signalling another shift. The Catholic Church has done so to “assist terminally ill people and their loved ones deal with death”, according to this article in The Guardian. The Art of Dying Well website includes animations with a voiceover by Vanessa Redgrave, who is said to have had a stiff brush with mortality and a wish to die after health complications. A slew of other books and articles entitled The Art of Dying clog the digital ether.

Is dying really an art then?

I guess it depends on what you think art is. Perhaps the simplest definition involves the idea of “skill” in grasping the world, and that whatever art is, it’s quintessentially human. As a reflection of human experience then it is subject to notions of value, as good or bad, worthwhile or not. So, can dying be an art? Can it be skillful, if it is so utterly happenstance and beyond our control, and also so banal – so normal – that every single one of us does it?

Implicit in these and other more conventional understandings of death, however, as well as this idea of a “good death” and dying as an “art”, is the veiled assumption that death is some sort of final performance. In one sense only is this true. But death is not just an occurrence, I think.

Certainly, the idea of a “good death” has gained in mainstream popularity and become widely aspired to. It was a feature article in a recent issue of Fair Lady magazine. This I understand as a natural backlash to a prevailing culture of death denial, of avoiding death at any costs, which is shifting, as people everywhere tire of the false and dehumanising promises of the consumer capitalism and recoil at the same time from the scientific tendency for overmedicalisation (is that a Scrabble word?) at the end of life. Still, in our own peri-Western culture, suffused as it is with a plurality of local African and other belief structures, death remains very much a taboo and what my friend Peter Fox calls “an unwelcome visitor”.

In a useful little online essay, “The Dangerous Myth of a Good Death”, blogger and nurse Kathleen Clohessy quotes from Frank Ostaseski’s lovely treatise, The Five Invitations: What Death Can Teach us about Living Fully. He says: “We treasure the romantic hope that when people pass away, everything will be tied up neatly. All problems will have been resolved, and they will be utterly at peace. But this happens rarely. Very few people walk toward the immense challenge of dying and find peace and beauty there… who are we to say how another should die?”

I think this is the risk inherent in ideas of a “good death” – that it’s up to the dying person to do it well, or not, imposing some kind of value judgement on it. Think of all those people you’ve met, bleating “but oh, I’m not creative at all!” now being informed that their dying was meant to be done with artful skill, done well. Wasn’t school hard enough, relationships, and all the rest? Now we must excel at death too?

Clohessy writes: “Placing expectations on the dying is an easy mistake to make. But when we do so, we limit our ability to open our hearts to what is happening and be truly present with the person who is making the journey in the here and now… When we impose our beliefs about what death ‘should’ look like on someone who is dying, we deny them unconditional love and acceptance they need and deserve.”

So, calling death an art may well make things more difficult. This is not to say one should not prepare for death – by all and every means, prepare for the inevitable by talking about it and doing what you can to make it easier for you and your loved ones. Complete your advanced-care directive and fill in your organ donor card, update your will and try to find peace. Speculate about your death with the people you love no matter how hard that might be and let them know how you wish to be disposed of and how to be remembered.

Perhaps it’s simply about doing death better. The “death positive” movement, with the redoubtable Caitlin Doughty, possibly the world’s most popular mortician as its high priestess, is a growing community that has some really useful things to say about this in a manifesto of sorts on its website. The Order of The Good Death, which she co-founded, has a mission to “make death a part of your life”.

Implicit in these and other more conventional understandings of death, however, as well as this idea of a “good death” and dying as an “art”, is the veiled assumption that death is some sort of final performance. In one sense only is this true. But death is not just an occurrence, I think.

Instead of seeing it as “the end”, my discovery, which is hardly unique, is that consciousness of it provides the means to live a full life. Without wishing to intrude on the province of the suffering, I understand that I am already dying, and that every day death is with me. It is in every cell of skin that falls from me, in each expiring blood cell that perishes within. I’m slowly dying, inside and out. Death surrounds me and I am in it and with it, as much as I am alive and in life too. It is in the grief of my friends, in my own grief, too. In my own dying I find my vitality. Death sharpens my appreciation of life.

So it’s a lifelong process, this dying shtick, kicked off at the moment of birth. Carl Jung reminds us that “life is a short pause between two great mysteries. Beware of those who offer answers.” Perhaps it’s a voracious scientific urge towards a complete system of knowledge that wants to dominate this unknown province, this final mystery – in fact, to cheat it, to perhaps even bypass it entirely – the next big tech “disruption”.

Gimme a break! I do well to remember that death is a mystery and something that mystifies. It’s also easy to theorise and extrapolate upon. Until it happens to oneself.

Consideration of death immediately brings life into focus. But a good death? An artful expiration? If you really must have one, then, to paraphrase Dr Kathryn Mannix, a palliative care doctor and author, if you want to die well, then first – live well.

That’s about as much as one can do, I think.

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A Virtual Memorial for Those We’ve Lost

The special project “What Loss Looks Like” presents personal artifacts belonging to those who have left us and explores what they mean to those left behind.

Readers submitted photos of items that reminded them of loved ones who died in the past year.

By Jaspal Riyait

As the art director of the Well desk, I’ve spent the last year looking for images to reflect the devastation of the pandemic and the grief it has wrought. As the crisis has stretched on, I’ve thought of all the people who have lost loved ones to Covid-19 — not to mention those who have lost loved ones, period — and how they were cut off from the usual ways of gathering and grieving. Watching the numbers rise every day, it was easy to lose sight of the people behind the statistics. I wanted to find a way to humanize the death toll and re-establish the visibility of those who had died.

To help our readers honor the lives of those lost during the pandemic, we decided to ask them to submit photographs of objects that remind them of their loved ones. The responses were overwhelming, capturing love, heartache and remembrance. We heard from children, spouses, siblings, grandchildren and friends — people who had lost loved ones not only to Covid-19 but from all manner of causes. What united them was their inability to mourn together, in person.

Dani Blum, Well’s senior news assistant, spent hours speaking with each individual by phone. “It’s the hardest reporting I’ve ever done, but I feel really honored to be able to tell these stories,” she said. “What struck me the most about listening to all of these stories was how much joy there was in remembering the people who died, even amid so much tragedy. Many of these conversations would start in tears and end with people laughing as they told me a joke the person they lost would tell, or their favorite happy memory with them.”

The photographs and personal stories, published digitally as an interactive feature, was designed by Umi Syam and titled “What Loss Looks Like.” Among the stories we uncovered: A ceremonial wedding lasso acts as a symbol of the unbreakable bond between a mother and father, both lost to Covid-19 and mourned by their children. A ceramic zebra figurine reminds one woman of her best friend, who died after they said a final goodbye. A gold bracelet that belonged to a father never leaves his daughter’s wrist because she is desperate for any connection to his memory.

For those who are left behind, these items are tangible daily reminders of those who have departed. These possessions hold a space and tell a story. Spend time with them and you begin to feel the weight of their importance, the impact and memory of what they represent.

Museums have long showcased artifacts as a connection to the past. So has The New York Times, which published a photo essay in 2015 of objects collected from the World Trade Center and surrounding area on 9/11. As we launched this project, we heard from several artists who, in their own work, explored the connection between objects and loss.

Shortly after Hurricane Sandy, Elisabeth Smolarz, an artist in Queens, began working on “The Encyclopedia of Things,” which examines loss and trauma through personal objects. Kija Lucas, a San Francisco-based artist, has been photographing artifacts for the past seven years, displaying her work in her project “The Museum of Sentimental Taxonomy.”

“Saved: Objects of the Dead” is a 12-year project by the artist Jody Servon and the poet Lorene Delany-Ullman, in which photographs of personal objects from deceased loved ones are paired with prose to explore the human experience of life, death and memory. And the authors Bill Shapiro and Naomi Wax spent years interviewing hundreds of people and asking them about the most meaningful single object in their lives, gathering their stories in the book “What We Keep.”

As the pandemic continues to grip the nation, the Well desk will continue to wrestle with the large-scale grief that it leaves in its wake. Other features on this topic include resources for those who are grieving, the grief that’s associated with smaller losses, and how grief affects physical and psychological health. As for “What Loss Looks Like,” we are keeping the callout open, inviting more readers to submit objects of importance, to expand and grow this virtual memorial and provide a communal grieving space.

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