You’re going to die.

So now what are you going to do about it?

My position on death? I’m against it.

That said, I will concede I lose that argument, and that moreover, my opinion has never even mattered. Die I will.

And I am not alone in this — you will die, too. After all, death, darn it, just happens. Globally, about 65 million people die each year, 180 per day, 120 each minute. 108 billion people have walked the planet, and then died. That’s a lotta dying, and while it’s incredibly difficult and tragic — this last year especially so — that doesn’t mean we shouldn’t talk about it. Avoidance is not a solution.

Indeed, I’d argue that death is a grand mystery — sacred and important — and this last physical act of our lives can either go pretty well, like a graceful well-rehearsed piano solo or free-throw, or it can go pretty darn badly. Some of how it plays out is beyond our control, but not all of it. Some of it we can prepare for — and if anything deserves our full attention, some preparation, or some renewed clarity, death might be it.

So, the deal is: Tax Day is April 15. But I’d argue the real task — and probably the less miserable one — is to get our stuff in order for Healthcare Decisions Day, which is April 16.

I know: no one wants to do it.

I know: you’re probably starting to X out this essay, or skim it, or scowl at it.

But I’m begging you — and so are your peeps — to take a few hours now in order to save them potentially hundreds of hours. Yes, hundreds of hours. And possibly a lifetime of regret or heartache.

Getting basic and important documents done, and your simple wishes on paper, can literally be your great parting gift.

We all knew someone who left behind a mess — and we all promised ourselves not to be that person. Which means we have to set aside some time and get this stuff done.

First, there’s the medical and legal stuff – Advance Directives and a will – and making sure they’re done, signed, and accessible (they’re really no help if no one can find them). Plus, heck, just leave a note with a trusted person about where some of your stuff is and what you basically want done with it. A great place to start is The Conversation Project.

But in my death-positive work (stemming from my book Making Friends with Death: A Guide to your Impending Last Breath), I advocate writing an ethical will, too — what you stood for, your best and worst times, any reckoning or forgiving or venting or whatever you need to do.

Basically, it’s a “Goodbye letter to life,” if you will. My guess is that doing so will bring you a lot of peace, and will provide peace to those around you, too. Ideally, you don’t want to write this when you’re under duress – write it when you’re feeling great, write it on a lovely spring day, write it on April 16!

Finally, our last task is to advocate simple and direct communication about end-of-life care with those that will likely be involved with it. What looks good to you? What do you want to avoid, if possible? Get clear on what “a good death” looks like for you. Me? I’ve come to believe that a good death is simply one that has been claimed, to the extent possible. For me, that will involve: My medical wishes and decisions being respected (such as my DNR wishes being followed); I would like to die outside, or with a view of nature; I’d like to be with my children and loved ones, if possible; I’d like to be as fully informed about what’s going on, to the extent possible; I want people to be honest with me and I want to be honest with them; and I wouldn’t mind the smell of vanilla or sage and a taste of good whiskey on my lips. Such wishes are written down in about 10 different places, all accessible; my children roll their eyes when I bring it up and say, “Yes, yes, we know, Mom.”

What does yours look like? And who have you told?

Completely bizarre to me is this: A recent Pew Research Center study on end-of life issues found that less than half of people over 75 had given much thought to the end of their lives, and incredibly, only 22% of them had written down or talked to someone about medical treatment at the end of their lives. However, the same Pew study finds a sharp increase in all adults putting something in writing (six in 10 of us) and thinking through our deaths, which indicates that percentage-wise, it’s the slightly younger folks who are preparing now. Attitudes are shifting, too: an unprecedented 66% of us now think there are instances in which doctors should allow a patient to die (instead of doing everything possible to save a patient’s life). A tipping point, it seems to me, has been reached—and we’d like a more mindful, respectful death. We are reclaiming the ancient art of dying.

But there is much to be done. Indeed, though our culture is death-avoidant and confused, I am heartened by the increasingly popular “Death Cafés” and new movements such as “Slow Medicine,” and I’m grateful for April 16, which is the day we should all admit that our life belongs to us, but it also belongs to everyone we interact with, and we owe them the gift of directing an honest gaze at our demise.

But best of all, spending some time now might leave us thinking of death as more of a friend rather than a spooky stranger. With our newfound peace, we can then spend our precious time really living.

Complete Article ↪HERE↩!

March 30, 2021March 29, 2021

Behind Closed Doors

— ‘the Difficulty and the Beauty’ of Pandemic Hospice Work

Javier Urrutia, a home hospice music therapist, celebrating Josniel Castillo’s 11th birthday in Queens.

“I did not really understand when people would ask, ‘Why me and why my family?’” a hospice chaplain said. “Now I was asking the same questions.”

By James Estrin

This year was different.

The coronavirus pandemic dramatically changed Ms. Saoui’s work as a home hospice nurse in New York. Safety precautions created a physical distance between her and her patients and even cut some of her hospice colleagues off from their clients’ homes altogether last year. It deprived families and caretakers of ways to grieve together, and confronted hospice workers, however familiar with death, with a staggering scale of loss.

Through all the pressures, Ms. Saoui and other workers continued to provide solace and even moments of happiness to dying patients and their families.

“You sit down and you listen,” she said. “They express their fear, they express their emotions, and you guide them and tell them what to expect.” After a patient dies, she added, “I often want to hug the family members, but I cannot do that now.”

Instead, Ms. Saoui said, “I pray and do the best I can.”

More than half a million Americans have died from the coronavirus, and many have died in pain, isolated from their families. Ms. Saoui contrasted those conditions with what she called a good death: “peaceful, pain-free, at home and surrounded by their loved ones.”

While nurses have continued in-person home visits, some chaplain, social work and therapy sessions moved online because families preferred it. By August, most of that care switched back to in-person visits but with strict precautions, including wearing full P.P.E. at times and keeping six feet apart whenever possible.

Ms. Saoui examining Pedro Torres, while his wife, Gloria, and his son, Darron, look on.

Though a vast majority of Ms. Saoui’s patients in the last year did not have the coronavirus when they entered hospice, challenging restrictions have been placed on all patients and caregivers. Home hospice care can last for many months, and workers often develop close relationships with patients and their families.

But the pandemic has meant fewer occasions for families — and hospice workers — to mourn together in person at funerals or memorial services. For over a year, the size of those gatherings has been strictly limited by many states to try to stem the spread of the virus.

Nurse Hanane Saoui visits Diane Wilcox at her home in Queens.Credit…

When hospice patients die, their caretakers often work through their own grief and loss in weekly staff meetings and gatherings with colleagues who shared the same client. These staff meetings are now online, but the loss of being able to hold each other and shed tears together has deeply affected hospice workers, said Melissa Baguzis, a social worker who specializes in pediatric cases. She has developed her own ways to handle the loss of her young patients.

“I take a moment, light a candle and read their favorite book or listen to their favorite song,” she said. “I have my own time for them. We do become connected with their families, but when I’m in their houses, that is their grief and I’m going to support them. I need to process my own loss outside of that.”

A nurse, Ozail Bennett, dressing in protective equipment before going to see a home hospice patient that has the coronavirus. Mr. Bennett also contracted the virus last April.

The hospice workers in the MJHS Health System, a nonprofit that covers New York and Nassau County, are comfortable around death in a way that many Americans are not. But the pandemic has put an extra weight on them and their patients, Ms. Baguzis said. “We all share in each other’s grief now more than ever,” she said.

The Rev. Christopher Sigamoney, an Episcopal priest who is a hospice chaplain, said he has tried to be there for his patients “even with their frustration, anger, hopelessness, depression and anxiety.”

Father Christopher Sigamoney talks with Joseph Lai.

He often told patients’ family members that it was “OK to be angry at God” over the loss of their loved one. But he said that the death of a beloved cousin from the coronavirus had changed his understanding of his work.

Father Sigamoney and his family were unable to be with his cousin, a retired doctor visiting from India, during the three days while she was on a ventilator in the hospital at the end of her life. He and a handful of relatives said “a few prayers” in the funeral home, he said, but they were unable to have a “proper burial” or ship the body home to India because of virus restrictions.

Father Christopher Sigamoney prays with patient Diane Wilcox at her home in Queens.

“I did not really understand when people would ask, ‘Why me and why my family?’” he said of the time before his cousin’s death. “Now I was asking the same questions. I said to God, ‘Now I’m angry at you, and I hope you can forgive me.’” Father Sigamoney said he was slowly recovering through prayer and helping his patients.

Last month, Josniel Castillo was hooked up to a battery of medical machines and monitors, surrounded by his parents and a multitude of stuffed animals, as Javier Urrutia, a music therapist, and Ms. Baguzis entered his cramped bedroom. Despite his declining medical condition because of a rare genetic disease, this was a happy day. It was Josniel’s 11th birthday.

Mr. Urrutia launched into “Las Mañanitas,” a traditional Mexican birthday song. Josniel’s mother and father, Yasiri Caraballo and Portirio Castillo, joined in. Ms. Caraballo wiped away tears. They were, she said, “tears of joy” because she had not expected her son would live to be 11.

She requested another tune, and played tambourine as Mr. Urrutia launched into “Que Bonita Es Esta Vida.” They sang the final chorus together, part of which can translate to:

Oh, this life is so beautiful

Though it hurts so much sometimes

And in spite of its sorrows

There’s always someone who loves us, someone who takes care of us.

Afterward, Mr. Urrutia said most people are “unaware of what’s happening behind closed doors, both the difficulty and the beauty.”

Melissa Baguzis, a MJHS hospice social worker, visiting Josniel Castillo on his 11th birthday.

This year in countless homes, there has been “a lot of pain and suffering, it cannot be denied,” he said. But in hospice work, he said, “you also see all of the heroes out there doing the simple things of life, caring for each other. The husband taking care of his wife or the mother taking care of her son.”

“Dying is a part of life,” he added. “Only living things die.”

Complete Article ↪HERE↩!

March 28, 2021March 27, 2021

Every time one of my patients dies I buy a plant in their memory

Every time a patient passed away, I’d go to the garden centre and search either for a plant with their name or for a plant I thought represented them

By Katie Hodgkinson

When I started work as a doctor two years ago, I was living alone with one sad succulent and a pot of thorn-filled roses my boyfriend had given me.

I’d always liked plants, but I’d never been able to keep anything alive longer than a few weeks – in fact, my dad had been watering our fake one for years!

On my first rotation, I started on a combined cardiology and stroke ward, which, as you can imagine, sees quite a few patients with life-changing conditions. I’d made friends with one of the hospital palliative care sisters and she often came to help us with patients who were experiencing breathlessness, pain and agitation.

The first woman I met in a hospice, when told she’d have weeks to live, was insistent that the only thing she wanted to achieve in her remaining time was to ‘see the flowers bloom in spring’.

The staff bought her bulbs, and I’m told she lived long enough to see the first ones flower. It really struck me that after a lifetime in this world, the thing that mattered most to her was seeing the colours and life that comes with a new season – I’d never really thought of plants in that way before.

In my first few weeks, I started to develop relationships with some of our longer-term patients. There was one woman who I took blood from every morning and for whom I requested countless tests, scans and meetings.

Her family weren’t local, and we’d often share a giggle over the comings and goings of other women in her bay; I ended up being her most regular visitor.

One weekend I checked her blood results to see what we’d really been hoping not to see – she’d grown a nasty bacteria in her blood, and would need at least a further five weeks of antibiotics.

Sadly, we never managed to get on top of the infection. We gave her stronger drugs, blood transfusions and called her family in to be with her. She passed away peacefully, and that evening I went with the palliative care sister to a garden centre.

It was meant to just be an escape from long days on the ward and my first close patient death, but the centre had named all their plants – and when I saw one with her name on, it felt like some sort of sign. It was a bright and bold Calathea, with vibrant pink stripes that cheered me up instantly. I took it home with me.

Naturally in a busy city hospital, more of my patients died despite our best efforts. We brought in families, arranged a wedding for a terminally ill patient, and I even smuggled in someone’s new puppy inside my jacket (infection control approved, of course.)

I was 24 and seeing more death than most people see in a lifetime – but although it was horrible, it was also an honour to be a part of a team that could help these people have a good death.

No one wants to think of their life coming to an end, everyone wants to be comfortable and surrounded by the people they love, and it was so rewarding to be able to offer that.

Every time a patient passed away, I’d go to the garden centre and search either for a plant with their name or for a plant I thought represented them. I wanted to remember them.

I became better at looking after the plants in my flat. I developed a watering schedule, bought plant food, repotted them into pretty jars I’d found in shops, took them for showers if I thought they were dry – anything I could do to emulate the kind of care I was trying to give to my patients.

Most doctors have something they do to remember the people they’ve cared for – whether it’s lighting a candle, a quiet moment at the end of the day or debriefing with friends. I’ve heard of people planting trees – but I think individual plants might be one of the more unusual coping mechanisms!

When the pandemic hit, I was working in elective orthopaedics and my ward was the first to start accepting Covid-19 patients. Despite all the research, the treatment plans were often simple – oxygen, more oxygen, steroids and if needed, machines to take over breathing when patients became too tired.

We sent patients to ITU, and those who deteriorated we made comfortable. We took over the role of the families who weren’t allowed in, lest they put people in danger.

We held hands with patients while they passed away and we held up screens so their families could be there until the end. It was devastating knowing that pre-pandemic, we’d have had crowded side rooms filled with loved ones, and yet because of the risks they had me in full PPE, unable to even hold a hand without horrible sweaty gloves.

When I started my Covid-19 work I had about 15 plants and a watering can made out of an old sauce jar. Then garden centres closed in the first wave, but I ordered more plants online.

After eight months, I started to run out of room in my flat, and my friends suggested buying one plant per week rather than per patient. It didn’t feel right – not the level of acknowledgement I wanted for these people who had lived such full lives.

I started planting seeds, lighting, candles – anything I could to still feel like I was acknowledging the loss of so many people. I asked for help on Twitter, and people suggested planting trees, donating plants, getting an allotment – but none have felt quite right just yet.

Thankfully I live alone, so the ever-expanding wave of greenery wasn’t too annoying – but I have started letting my fiance choose where we put some of them! It’s lovely to be surrounded by so much new life and I get so excited whenever I see a leaf start to unfurl – I am reminded every time to appreciate it by the woman who wanted to see the flowers bloom in spring. I like to think she’d be just as thrilled.

Now I work in a different hospital, and thankfully fewer people are dying. I’ve been able to propagate my existing plants to grow smaller baby plants for my friends.

I still have a plant for every patient who passed away while I was their doctor; it looks like I live in a jungle, with more than 60 plants, but I’m starting to prune and take cuttings so that other people can share the joy.

For some of my paediatric patients, I’ve decorated pots with stickers of their favourite things – Peppa Pig, octopi, even one covered in fingerpaint.

The time I spend looking after my plants has become the time when I can reflect on everything that’s happened and all the people I’ve cared for.

Sometimes it’s a sad experience, and sometimes it’s a more joyful process where I can think of those that got to go home.

I think of all the things I have yet to learn, how far I’ve come, and how many more patients I will get to meet. I think I’ll always dedicate a plant to a lost patient; I just might need to move to somewhere with a garden.

Complete Article ↪HERE↩!

March 22, 2021March 21, 2021

As death approaches, our dreams offer comfort, reconciliation

As death approaches, relationships can be resurrected, love revived and forgiveness achieved.

By Carine Mardorossian

One of the most devastating elements of the coronavirus pandemic has been the inability to personally care for loved ones who have fallen ill.

Again and again, grieving relatives have testified to how much more devastating their loved one’s death was because they were unable to hold their family member’s hand – to provide a familiar and comforting presence in their final days and hours.

Some had to say their final goodbyes through smartphone screens held by a medical provider. Others resorted to using walkie-talkies or waving through windows.

How does one come to terms with the overwhelming grief and guilt over the thought of a loved one dying alone?

I don’t have an answer to this question. But the work of a hospice doctor named Christopher Kerr – with whom I co-authored the book “Death Is But a Dream: Finding Hope and Meaning at Life’s End” – might offer some consolation.

Unexpected visitors

At the start of his career, Dr. Kerr was tasked – like any and all physicians – with attending to the physical care of his patients. But he soon noticed a phenomenon that seasoned nurses were already accustomed to. As patients approached death, many had dreams and visions of deceased loved ones who came back to comfort them in their final days.

Doctors are typically trained to interpret these occurrences as drug-induced or delusional hallucinations that might warrant more medication or downright sedation.

But after seeing the peace and comfort these end-of-life experiences seemed to bring his patients, Dr. Kerr decided to pause and listen. One day, in 2005, a dying patient named Mary had one such vision: She began moving her arms as if rocking a baby, cooing at her child who had died in infancy decades prior.

To Dr. Kerr, this didn’t seem like cognitive decline. What if, he wondered, patients’ own perceptions at life’s end mattered to their well-being in ways that should not concern just nurses, chaplains and social workers?

What would medical care look like if all physicians stopped and listened, too?

The project begins

So at the sight of dying patients reaching and calling out to their loved ones – many of whom they had not seen, touched or heard for decades – he began collecting and recording testimonies given directly by those who were dying. Over the course of 10 years, he and his research team recorded the end-of-life experiences of 1,400 patients and families.

What he discovered astounded him. Over 80% of his patients – no matter what walk of life, background or age group they came from – had end-of-life experiences that seemed to entail more than just strange dreams. These were vivid, meaningful and transformative. And they always increased in frequency near death.

They included visions of long-lost mothers, fathers and relatives, as well as dead pets come back to comfort their former owners. They were about relationships resurrected, love revived and forgiveness achieved. They often brought reassurance and support, peace and acceptance.

Becoming a dream weaver

I first heard of Dr. Kerr’s research in a barn.

I was busy mucking my horse’s stall. The stables were on Dr. Kerr’s property, so we often discussed his work on the dreams and visions of his dying patients. He told me about his TEDx Talk on the topic, as well as the book project he was working on.

I couldn’t help but be moved by the work of this doctor and scientist. When he disclosed that he was not getting far with the writing, I offered to help. He hesitated at first. I was an English professor who was an expert in taking apart the stories others wrote, not in writing them myself. His agent was concerned that I wouldn’t be able to write in ways that were accessible to the public – something academics are not exactly known for. I persisted, and the rest is history.

It was this collaboration that turned me into a writer.

I was tasked with instilling more humanity into the remarkable medical intervention this scientific research represented, to put a human face on the statistical data that had already been published in medical journals.

The moving stories of Dr. Kerr’s encounters with his patients and their families confirmed how, in the words of the French Renaissance writer Michel de Montaigne, “he who should teach men to die would at the same time teach them to live.”

I learned about Robert, who was losing Barbara, his wife of 60 years, and was assailed by conflicting feelings of guilt, despair and faith. One day, he inexplicably saw her reaching for the baby son they had lost decades ago, in a brief span of lucid dreaming that echoed Mary’s experience years earlier. Robert was struck by his wife’s calm demeanor and blissful smile. It was a moment of pure wholeness, one that transformed their experience of the dying process. Barbara was living her passing as a time of love regained, and seeing her comforted brought Robert some peace in the midst of his irredeemable loss.

For the elderly couples Dr. Kerr cared for, being separated by death after decades of togetherness was simply unfathomable. Joan’s recurring dreams and visions helped mend the deep wound left by her husband’s passing months earlier. She would call out to him at night and point to his presence during the day, including in moments of full and articulate lucidity. For her daughter Lisa, these occurrences grounded her in the knowledge that her parents’ bond was unbreakable. Her mother’s pre-death dreams and visions assisted Lisa in her own journey toward acceptance – a key element of processing loss.

When children are dying, it is often their beloved, deceased pets that make appearances. Thirteen-year-old Jessica, dying of a malignant form of bone-based cancer, started having visions of her former dog, Shadow. His presence reassured her. “I will be fine,” she told Dr. Kerr on one of his last visits.

For many kids, their only experience with death is with family pets, and the return of deceased animals can be comforting.

For Jessica’s mom, Kristen, these visions – and Jessica’s resulting tranquility – helped initiate the process she had been resisting: that of letting go.

Isolated but not alone

The health care system is difficult to change. Nevertheless, Dr. Kerr still hopes to help patients and their loved ones reclaim the dying process from a clinical approach to one that is appreciated as a rich and unique human experience.

Pre-death dreams and visions help fill the void that may otherwise be created by the doubt and fear that death evokes. They help the dying reunite with those they have loved and lost, those who secured them, affirmed them and brought them peace. They heal old wounds, restore dignity, and reclaim love. Knowing about this paradoxical reality helps the bereaved cope with grief as well.

As hospitals and nursing homes continue to remain closed to visitors because of the coronavirus pandemic, it may help to know that the dying rarely speak of being alone. They speak of being loved and put back together.

There is no substitute for being able to hold our loved ones in their last moments, but there may be solace in knowing that they were being held.

Complete Article ↪HERE↩!

March 18, 2021March 17, 2021

I want my dying patients to have good deaths. I grieve for all those who died alone this year.

By Roshni Kakaiya

February marked one year since I last saw somebody die in our hospital surrounded by their loved ones. To give you some context, I am a physician in training in the South Bay — a community that was hit particularly hard by the novel coronavirus that can lead to COVID-19. As a family medicine resident, I take care of patients in our clinic, admit them to the hospital, care for them in the ICU, and even deliver their babies. As such, I am no stranger to the never-ending cycle of birth, illness and death, especially during the pandemic.

Yet I can tell you that a few moments of clarity shine bright against the haze of this past year. This memory of my patient’s death stands out so strikingly to me because of the comparison with what came down just a few days later, when our lockdown began and our hospital policies changed.

One year later, I can close my eyes and still picture this patient and her family. The patient was in her 80s and the matriarch of her family. The day before she died, she had woken up with some energy and was able to speak with her daughters who were at bedside most of the day. We see this sometimes in the days before people pass — they get a burst of vivaciousness that sometimes fools us into thinking they are doing better.

The day my patient died, her daughters were holding hands and all touching some part of their mother, grieving together and comforting each other. Their husbands and children were somberly in attendance, intermittently wiping away tears. There must have been at least nine people in that room, something I can barely imagine now with our limited visitor policy. The daughters sang the patient’s favorite hymn, and they were even able to play part of a sermon their mother loved. Every time I walked into the room to check on this patient, I immediately felt the warmth, the love and the comfort the family was bringing to each other. This was a good death. This was a death filled with love, and touch, and warmth, and solidarity, and connection, and presentness. This was a death the family could remember and discuss as needed as its members mourned, which, as we have come to know, is crucial to processing such a significant event. This was a natural death of a woman in her 80s who had lived a long and wonderful life.

As a physician in training, it initially felt counterintuitive how much time we spend thinking and talking about death with our patients in both the hospital and clinic setting. However, I’ve come to realize that some of my most important work comes in the form of advocating for my patients to have a good death. A death they would have wanted, maybe even that they could have chosen for themselves — a peaceful death or a death with a fighting spirit up until the very end.

As I see our patients dying mostly alone in our hospital, with only family being able to visit, one or two at a time in the hours before a person is about to die, or looking at their loved ones through the window as they are intubated and sedated, I grieve for our community. I grieve for those who have had so many good deaths taken away from them — and had them instead replaced with a screen from which to watch their loved ones slowly dwindle away. I grieve the good death, the death that comes with a natural closure. Yet I am hopeful that one day we will return to this good death — the death that is filled with touching, hugging, crying, laughing, and snot flying everywhere. One day, togetherness will not be the vector for more deaths and more grieving. It will be the balm that heals us from the most difficult year of our lives. This is the death I wish unto you and your families in the future: the good death, a death worth dying for.

Complete Article ↪HERE↩!

March 16, 2021

Breathing new life into dying

— our moral imperative to reckon with the concept of death

A 16th-century drawing by Hand Baldung Grien depicts a German mercenary speaking with Death. As pandemics swept Europe, stories of hungry and vengeful undead grew in German-speaking lands and may be reflected in burial practices.

By Madeline Hsu

Death is ever-present these days; now, one in three Americans personally knows someone who has died of COVID-19. Before the pandemic, we heard about incidences of mass deaths due to illness in the context of far corners of the globe, safely out of reach. We were insulated from death and could afford to ignore it, sweeping it into a corner of our uneasy minds. Now, death is close to home, and the time is right for dealing with the cultural discomfort it engenders.

There are multiple problems with the way we view death as a culture, and the pandemic poses an opportunity to evolve in how we think about death and practice death-related rituals. This unique moment is also an apt time to examine our history and try to understand how exactly we came to be this way.

One pressing concern about our death practices is the deleterious effect on the environment that they have.

“You might be surprised at how much environmental damage a person can do after they’re dead,” Erin Blakemore writes for the Smithsonian Magazine.

The prevalent use of embalming chemicals is of chief concern, as pumping these toxic and carcinogenic chemicals into the environment runs the risk of polluting groundwater and harming the living. While certain groups within the U.S. do not embalm, such as those from Orthodox Jewish communities, a disturbing majority of American burials do.

Many of us are relieved about the promise of a reversal in climate policy after watching with horror for four years as the Trump Administration systematically unraveled hard-won environmental protections and regulations. The administration of President Biden has made a commitment to taking ambitious measures to mitigate climate change. With our new commitment to sustainability as a nation, the time is right to consider the environmental impact of the dead and find new, greener solutions.

There are several ways to do this. Of the sustainable burial practices that have emerged in recent years, several stand out as particularly good alternatives to the status quo. One example is the burial pod developed by Capsula Mundi, which uses a corpse’s process of decay to feed a growing tree. This example presents the comforting and poetic idea of creating natural growth, a concept which could perhaps offset the shock of the transition from the casket-and-embalm procedure.

Composting bodies is a concept that has gained momentum recently.

“Within months, your loved one can become soil for your garden,” Molly Glick writes for the Sierra Club. Once placed in a special cylinder that periodically rotates, a corpse is combined with “a blend of fungi, protozoa, and bacteria to accelerate the breakdown of remains.”

The environmental concern brought up by death goes hand-in-hand with a more ideological and existential concern. We go to great lengths and do harm to the environment to embalm and beautify corpses, giving them luxurious boxes that are sealed and prevent degradation of the body. In this way, we deny death. We refuse death and fight it, but what better time is there than in the midst of COVID-19 to reassess our relationship with death? Perhaps this is an opportunity to deal with its environmental repercussions as well as challenge our deep-seated discomfort and rejection of the fact of death in our lives.

Perhaps a cross-cultural comparison would yield some insights. Many of the inhabitants of our neighbor, Mexico, have historically observed Dia de los Muertos (Day of the Dead), which involves a celebratory rather than funereal attitude and embraces acceptance of death as an undeniable part of the life cycle. Pre-COVID-19, I was fortunate enough to attend a Day of the Dead celebration hosted by the San Francisco Symphony. Marveling at the revelry, I was struck by the positive emotional effect of combining music with costume, color and a sense of joyful spirituality to tackle this taboo topic. Whereas Mexican culture welcomes “spirits” who reunite once a year with the living, our culture fears and abhors the idea of the dead.

The only time we seem to set aside to deal with death as a culture is mainly in jest, at Halloween. We trivialize death and have no meaningful or unifying cultural practice to deal with this most basic and profound of human events, a universal event that touches all lives.

It isn’t completely our fault that we’re so ill equipped to deal with death. We have inherited a discomfort with the topic. It might be worth noting that certain religious views surrounding death help to explain why we’re so steeped in denial. The “life after death” concept crosses cultural and religious boundaries. Like the Egyptian pharaohs, we endeavor to take our worldly possessions with us, including clothing and makeup-enhanced features, as we voyage into the proverbial afterlife in comfy, cushy coffins. This attempt to simulate life-like conditions reflects our pervasive discomfort with the idea of death.

The bottom line is, we have a moral imperative to deal more responsibly with death. It is long overdue and COVID-19 has highlighted this reality. By gaining some comfort with the fact of death and confronting our resistance to dealing with it, perhaps we can gain some confidence about being able to handle the entirety of the life cycle and have some measure of acceptance where before there was only denial.

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March 10, 2021

From a prolonged pandemic, a rethink of life’s milestones?

By LEANNE ITALIE

Wedding anniversaries for Elizabeth O’Connor Cole and her husband, Michael, usually involve a dinner reservation for two at a fancy restaurant. Not this time around.

As the pandemic raged last May, the Chicago mom of four unearthed her boxed wedding gown from 19 years ago, got it zipped with help from one of her daughters and surprised her spouse.

Cole recreated their reception menu — a shrimp appetizer and beef tenderloin — and pulled out her wedding china and silver after enlisting another of her kids to DJ their first-dance song, “At Last,” for a romantic turn around the living room. And the priest who married them offered a special blessing on Zoom with friends and family joining in.

“Spontaneous and a bit chaotic,” O’Connor Cole pronounced the celebration. “Still, it was probably the most meaningful and fun anniversary we’ve had.”

As the pandemic enters its second year, there’s a pent-up longing for the recent past, especially when it comes to life’s milestones. When the crisis finally resolves, will our new ways of marking births and deaths, weddings and anniversaries have any lasting impact? Or will freshly felt sentiments born of pandemic invention be fleeting?

Some predict their pandemic celebrations have set a new course. Others still mourn the way their traditions used to be

Milestones, rituals and traditions help set the rhythm of our lives, from the annuals like birthdays and anniversaries to the one-timers like births and deaths, extending beyond those boundaries to more casual events like opening day (choose your sport), drinks out after work with colleagues and that first swim of summer.

Jennifer Talarico, a psychology professor at Lafayette College in Pennsylvania who studies memory and personal experience, says certain events shape lives differently — and have been reshaped just as differently during the pandemic. Perhaps most devastatingly impacted, she says, are death and dying, sitting at bedsides to comfort and attending funerals to mourn as the coronavirus has killed more than 2.3 million people around the world.

“That’s being felt the hardest because it’s the hardest to replace,” Talarico says. “That’s probably going to have the most lasting impact.”

Renee Fry knows the feeling well. Her grandmother, Regina Connelly, died Dec. 6 of COVID-19 at her nursing home in Hollidaysburg, Pennsylvania. She had just turned 98. There was no dropping everything to be at her bedside. There was no large church celebration of her life followed by dinner for all.

“We had to rely on video conferencing,” Fry says.

But they also did something else. She and her sister, Julie Fry, put together a “memory book” shared with far-flung family and friends. They included Regina’s favorite prayer, the Hail Mary, and asked loved ones to recite it on her behalf. They filled pages with photos through the years, from a portrait of young Regina in a fine red dress (lipstick to match, gold pendant around her neck) to more casual shots with grandchildren.

The sisters — Renee in Quincy, Massachusetts, and Julie in Port Matilda, Pennsylvania — wrote the story of how Regina met her husband on a blind date, then lost him when he died in 2010 after 64 years of marriage. They wrote of how she spent most of her teen years caring for her two brothers after their mother died suddenly when she was 13. They included rosaries with each of the 32 booklets they mailed.

Judging from the response — a second cousin called to say thank you, and a caregiver for Regina wrote a two-page letter offering thanks as well — it made an impact. “It was incredibly meaningful,” Renee says.

Such a booklet will be created when the family faces death once again. The pandemic, Fry says, has proven that distance no longer denies lasting meaning.

Daryl Van Tongeren, an associate professor of psychology at Hope College in Michigan, studies meaning in life, religion and virtues. Rituals, symbols and milestones help provide structure to our worlds, he says, demarcating the passage of time or a significant accomplishment but more importantly lending meaning to life itself.

“One of the things that these milestones and these rituals do is they connect us with other people and things that are larger than ourselves,” he says

Sometimes left behind in a swirl of celebration is the core significance of something just as important — the events themselves. Students who missed out on the walk across the stage at their graduations remain graduates. Couples forced to elope or give up their dreams of weddings for 200 for smaller affairs still have their marriages to experience

While some predict a Roaring ’20s renaissance once the crisis has ended, “there are going to be a number of people who are changed,” Van Tongeren says. “They’re going to say, `I’m going to emerge from this pandemic with a new set of values and I’m going to live my life according to new priorities.'”

Last year, Shivaune Field celebrated her 40th birthday on Jan. 11 with a group of friends at a downtown restaurant in Los Angeles, where she lives. It was just weeks before the coronavirus made its way to the U.S. This year, when she turned 41, the adjunct professor in business at Pepperdine University simply took to the beach with her pals.

“It felt much more authentic, a nicer way to connect without all the bells and whistles,” she says. “I think it’s really nice to get back to that. It reminds me of childhood.”

Fields grew up in Melbourne, Australia, where she says her parents kept birthdays rooted in family outings to the beach or bike rides followed by a treat of ice cream.

“Weekend get-togethers are now in sneakers with dogs sitting on grass and picnic rugs rather than on stools in fancy restaurants,” she says. And Field is just fine with that.

Marking time has changed during the pandemic. There’s the ticking off of months based on trips to the hair salon and the length of pandemic beards. There’s Zoom creativity and socially distanced trips outdoors. Recreating celebrations of the past for major, time-marking events has been difficult as time blurred and safety restrictions took over.

“We have all of this cultural baggage, in a good way, around those events,” Talarico says. “It’s a reinforcing cycle of events that we expect to be memorable.”

Memorable has been hard to achieve. But the rethink has been important for many, and its effects may ripple long after the virus has ebbed.

“For those wanting to reminisce years later about important events that happened during the pandemic, there will likely be nostalgia mixed with more than a tinge of trauma,” says Wilfred van Gorp, a past president of the American Academy of Clinical Neuropsychology.

“It may remind us of the loneliness and isolation brought about by the pandemic, our fear of catching the virus, fear of dying, fear of losing loved ones and loss of any we knew who may have died from COVID-19,” he says. “And,” he adds, “recollections of what we didn’t have, what we missed, and the experiences we couldn’t share together.”

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