A Pangbourne GP has made a film about the experiences of a family dealing with the death of a loved-one to help others in the same situation
A tearful new film shows how one Berkshire daughter was able to ensure her mother could die at home and with minimum pain.
The film is called A Good Death and features a daughter Judy speaking of the death of her mother Molly who lived for many years in Pangbourne and died in June in her own home.
Health service commissioners in Berkshire West are now asking families to ask their loved ones about their wishes and not to be afraid to discuss end-of-life plans with their doctor.
Pangbourne GP and Thames Valley Strategic Clinical Network End of Life lead Dr Barbara Barrie said: “Our job isn’t just about health and survival.
“This new film is a great example of what can be achieved through good end-of-life care.”
What is your view on end-of-life plans? Tell us in the comments section below.
Factors most important to people at the end of their life often include having pain and other symptoms managed effectively, being surrounded by loved ones and being treated with dignity.
Dying in a preferred place is important too. In a recent survey only three per cent of respondents said that they wanted to die in hospital yet, nationally, 52 per cent of deaths among those between 75 and 84 take place in hospital.
Dr Barrie said: “The proportion of people dying at home or in care homes continues to increase, but there’s more to be done.
“Early conversations with patients and their carers is vital.”
Local health commissioners are working to ensure patients’ wishes are respected.
Electronic palliative care record
Alongside encouraging early discussions, doctors in the area are using an ‘electronic palliative care record’.
This means that vital information about carer’s details, patient’s wishes on resuscitation and preferred location for death is available to every professional caring for someone at the end of their life.
The new film, available on YouTube, tells the story of Molly and the care team that surrounded her towards the end of her life.
Dr Barrie said: “Molly got to die at home, her dignity preserved and with no unnecessary medical interventions. All families in Berkshire should expect the same level and quality of care shown in this film.”
“People close to dying often speak in metaphor and say they are going ‘home.’ Home is no longer a place, but a passage. Death then, becomes the vehicle in which we make safe passage.” These lines come from a dissertation entitled “Dreaming Out Loud: Initiating Plans for a Community-based Home for the Dying,” written by oncology social worker Elise Lark, who has been working to make this dream a reality in the Mid-Hudson Valley.
Lark is the founder of Circle of Friends for the Dying (CFD), a non-profit group that has purchased a Kingston house they plan to convert into a residence available to people needing compassionate care at the end of life. Instead of spending their final weeks or days in the isolating atmosphere of a hospital, the dying will be able to make their transition in the comfort of a home, attended by family, friends, and volunteer caregivers.
“In order to have a good death,” said CFD board member Gai Galitzine, “you need to be living while you’re dying.”
A century ago, observed Lark, who works at the Oncology Support Program at HealthAlliance in Kingston, death was part of everyday life. “People died in community. It was a social, not a medical event. In the 1950s, people started to die more often in the hospital, which is considered the best setting — a sterile environment, safe, convenient to doctors. But we believe people should die in a non-institutional setting, with a sense of everyday life, where they can enjoy the rituals of having meals together, sitting with a group of people, participating in life.”
The hospice movement has made strides in this direction, often bringing patients home from the hospital and providing support and education that allow the family to ease the dying over the divide. But a home death is not always possible. Often the patient needs round-the-clock care, which family members may not be able to provide if they live out-of-state, have to work, or are raising children. Some patients live alone. If home care isn’t an option, the only alternative in Ulster and Dutchess Counties is a nursing home.
The Home for the Dying in Kingston will be run by volunteers who will provide skilled care and companionship for people nearing death. If family members are available, they can spend time with their dying relative in a warm, relaxed atmosphere — at no charge.
Hospice agencies in some areas have established residences or hospital-based hospice units for the dying, but a study done in the Mid-Hudson Valley concluded that a structure dedicated to hospice was not feasible in our area. When Lark was working on her doctorate at Antioch University, she studied options for community-based care. She visited the closest hospice residence to her Kingston job, an eight-bed unit in Newburgh, but found it didn’t fit her vision for a modest, homely setting. Then she discovered the Home for the Dying model, which started with a Home in Rochester in 1984, organized by lay Carmelites. There are now 25 of these Homes in New York State. It turns out that a facility with more than two beds is considered an institution, subject to rules and regulations. The Home in Kingston will stick to two beds, so they’ll be free to provide the most appropriate care.
Community-based end-of-life care is a boon to volunteers as well as to the dying and their families. “I had deaths in my family where I wasn’t able to be there, and it stayed with me,” said Galitzine. “I had a good experience with my mother where I was able to get to her in time even though she’d had a stroke. The reassurance she felt when I was there was one of the most beautiful things. I could see it in her eyes, although she couldn’t speak. I love the idea of being able to help other people in that situation.”
“Death is not an emergency,” Lark pointed out. “It happens every day. It’s as normal as birth. Some people won’t like this idea, but I see death as a sacred rite of passage. To be present to that is an amazing experience, a gift.”
One study shows that 80 to 90 percent of Americans say they prefer to die at home — but only 25 percent actually get to do it. Hospice is offered when patients are told they have six months left to live, but most people only take advantage of hospice services for the last few days of life, when life support measures are abandoned, and palliative care takes over, doing everything possible to relieve pain and make the patient comfortable. Hospice shifts the focus from preserving life at all costs to enhancing quality of life. But the reluctance of doctors and family members to address the prospect of death is an impediment to getting end-of-life care in a timely manner.
“Medical culture operates on a culture of hope,” said Lark. “You can’t hold hope in one hand and the fact that people are nearing the end of life in the other hand. Doctors are not trained to have end-of-life discussions. People get on hospice late, so they don’t get to reap the benefits of hospice, which provides support to the caregiver. Unless we can have these conversations with our loved ones, we’ll keep prolonging the dying process.”
CFD has joined the international Death Café movement, organizing monthly informal gatherings in which people sit in small groups to talk about the subject most of us tend to avoid — how our lives will end. Death Cafés in the Woodstock area are run by psychotherapist Laurie Schwartz and social worker Barbara Sarah, founder of the Oncology Support Program at HealthAlliance. For people who are fearing death, grieving for relatives, or wondering about the mystery of end-of-life passage, the conversations provide a forum for sharing often unspoken thoughts and worries. The underlying purpose, said Galitzine, “is to create a culture where death is part of everyday life, to bring the act of dying back into people’s lives, so they won’t fear it and will talk about it.”
The Home for the Dying in Kingston will be available to people with three months or less to live. In addition to two bedrooms for patients, equipped with hospital beds for comfort, there will be a wing with quarters for family members who wish to stay overnight. Meals can be prepared in a full eat-in kitchen. A wraparound deck and garden will be accessible by wheelchair from the client bedrooms, which will have sliding doors to the outside.
Presently CFD volunteers are cleaning and refurbishing the house to rent it out for a year while the organization raises money for renovations. A capital campaign will begin in the spring, with plans to have the home in operation in 2017.
“There will be no white uniforms,” said Lark. “No one is confined to their room. They can use the whole house as if it were their own house. A good place to die is also a good place to live.”
When a cat or dog gets lucky, they can spend over a decade in a home with abundant affection. They are accustomed to unconditional love; they’re used to getting their belly rubbed and love to snuggle on their favorite part of the couch. Until one day, everything changes, and these animals are ripped out of their home and dumped at the shelter.
If a pet’s owner dies and nobody planned ahead, this could lead to problems. Animals are often dumped at the shelter or just thrown out. The Shenandoah Valley Animal Services Center said this is a problem; they’ve recently saw more animals come in because their elderly owner died, in situations where none of the children could or would take care of them. Often, these animals do not survive at the shelter.
“Once they come here, the chance of them making it out is slim,” SVASC Assistant Director Tracey Meadows said. “When they come into a shelter environment, it’s very stressful for them. Sometimes they can’t overcome. They grieve themselves to death.”
Sometimes animals at the shelter miss their human so much, they won’t eat or drink. It is an entirely different lifestyle for them that they cannot get used to.
“I think they’re heartbroken. They’ve been with their family their whole lives and all of a sudden their routines changed, it’s not the same,” SVASC worker Hope West said. “They give up. They feel like they have nothing else to live for.”
They can develop medical issues and even die as a result of being depressed. Dr. Leti Hansen, a veterinarian at Greenbrier Emergency Clinic in Charlottesville, explained.
“I think the hardest issue that animals face when entering the shelter after leaving a home is depression,” Hansen said. “The shelter is a very stressful place to live. The staff works extremely hard to decrease the stress of its animals but it is impossible to replicate the home environment that these animals have come left. Animals that become depressed when entering a shelter can become immunocompromised, rendering them more susceptible to some of shelters’ more common upper respiratory diseases such as kennel cough or upper respiratory diseases of various causes in cats.”
“Depression can lead to anorexia. Anorexia in cats can cause a condition called hepatic lipidosis. Hepatic lipidosis is a condition where the liver is overwhelmed by the attempt to metabolize the body’s fats in order to create energy for the body. These cats will become systemically ill and risk dying if left untreated,” she added.
The shelter affects behavior as well. For an older animal, they just can’t take the stress and change of lifestyle and shut down.
“Dogs will often become reclusive when spending time in a shelter. It is very difficult for a potential adopter to understand how this dog will behave outside the shelter,” Hansen said. “This high stress environment often causes behavioral changes in the dogs, such as tail biting, hiding in the back of their run, loud barking, and anorexia.”
Young or old, death does not discriminate. Shelter officials said the most important aspect is to be prepared. If a pet owner is prepared, cases like this will not happen as much. They recommended people write a living will with a special clause for their pets.
“We take care of our kids in our wills, we need to take care of our animals,” West said. “If people aren’t prepared at all, they end up here. A lot of them, this is where they spend their last moments. Some, they get so old and they’re so devastated, this is the last place they see. It’s sad because they’ve been in a home. Somebody loved them.”
When somebody does their will, they should ask which family member is able to take on the responsibility of their animal, SVASC members explained. This way, everything is planned for and there is no fight or confusion. If no family member steps up, they recommended people ask friends or neighbors. Again, if nobody is able, people can search online for local rescue groups that help senior animals.
“Go a little bit above and beyond. Try to rehome them to somebody before just dropping them off at your local shelter. Try to find them a home. Being in this cage is just not fair for them,” West mentioned.
If pets lose their owner, they lose their life, Meadows said. This is why it’s so important to have a plan. Hansen agreed.
“I strongly recommend people talk to their families ahead of time to ensure that their pets will have a safe home in the event of their owner’s death. Adding a clause to your will is also recommended. We see a lot of animals come into the shelter after an owner has passed away because provisions were not made ahead of time. To those family members that step up to take care of their loved ones pets, we extend our gratitude,” she stressed.
People need to be prepared, and expect the unexpected, West said, adding that animals are a commitment for life and beyond. If a pet loses its owner, it doesn’t need to lose its freedom as well and end up in a cage.
“I think people don’t take it seriously. It’s like taking care of an elderly parent. If you’re going to commit you need to commit for life. If not, don’t adopt,” West said.
West said it is up to the owner and children to make sure their furry friends are safe if the unexpected happens. With the right precautions, people can rest assured that everything will be taken care of.
“Take your parents in consideration. If your parents had these cats from the time they were kittens until they’re 13 or 14 years old, apparently they loved them,” she explained. “You parents wouldn’t want to see them in a shelter—nobody wants to see them here. They waste away to nothing a lot of them just grieve themselves. I just don’t think people think it through.”
“I decided to donate Bryson’s milk and turn my tragedy into a blessing,” states Amy Anderson, from Caribou, Maine.
In the fall of 2010, Anderson lost her son Bryson at 20 weeks gestation. Trusting her intuition, she disregarded her physician’s advice to “bind your breasts and take Sudafed.” Instead, she began to pump the breast milk that would have nourished Bryson.
“At the time, I didn’t know what I would do with the milk, but I knew I needed to stop trying to prevent my body from lactating,” remembers Anderson.
She began to research and quickly discovered there was a great need for donor breast milk, especially with regard to the best practices of care employed to save the lives of prematurely born babies.
As we celebrate the holiday season, and in honor of the newly opened breast milk bank at the Children’s Hospital of Philadelphia (CHOP), the following interview with Anderson provides important reflections on gratitude and grief.
Furthermore, Anderson’s experience of being discriminated against at work when seeking to have breastfeeding laws apply to her situation necessitates the need for legislative change. Certainly, lactating surrogates and bereaved mothers who pump breast milk deserve not only respect but also legal protection.
Amy, tell me about yourself.
I live in Caribou, Maine — up north by the Canadian border. I married my high-school sweetheart. We have two living children (ages 8 and 2-and-a-half) and four “angel babies” in between them. Currently, I am a work-at-home mom. I also volunteer online for Mothers’ Milk Bank Northeast (MMBNE) while working toward completing my certification as a breastfeeding consultant.
Tell me about your son Bryson.
We lost our third child, whom we named Bryson, in 2010. We discovered at 15 weeks gestation that our son had a lower urinary tract obstruction (LUTO). Tragically, the morning before our appointment to finally schedule his surgery, Bryson died in utero. His heart couldn’t handle the pressure that was building up in his bladder. I delivered his body at the age of 20 weeks.
I am so sorry to hear about your loss. Your son died right before the fall and winter holiday season, right?
Yes. Bryson’s body was delivered on Oct. 30, and the holidays that year were simply unbearable. My grief was heavy, and while I found comfort in expressing milk in his name, no one in my family dared to talk about my baby. However, that is actually what I needed the most.
A mother’s love is a mother’s love regardless of whether or not her child lives or dies.
What inspired you to begin pumping breast milk following Bryson’s death?
No one prepared me for what would happen to my breasts after Bryson was born. In fact, I was told that it was way too early for breast milk to be produced by my body. But this was a horrible misconception. Within a couple days after delivering Bryson, my milk came in. My rock-hard chest was throbbing, and milk saturated everything. No one suggested the option of donating Bryson’s milk.
I knew I wasn’t supposed to pump, as breastfeeding is based on a supply-and-demand relationship. But I was in horrid pain, so I decided to pump “just a little” to relieve my body. Six ounces of colostrum milk were expressed during a couple minutes of that first pumping session. I felt such relief.
As I expressed the milk, a real sense of calm descended. I felt a powerful closeness to my Bryson, which reminded me how much I loved the breastfeeding relationship I had shared with my eldest son. Pumping milk in Bryson’s memory felt so very right. All life has meaning, and my son’s life was no different. I decided to embrace his life’s purpose.
Tell me more about “his life’s purpose.”
At first, I couldn’t understand why Bryson was taken. I would hear of parents who didn’t want their children, who would beat them, and nothing made sense. Yet, through pumping and donating his milk, I came to see that Bryson’s death held a blessing in disguise.
Because Bryson was so early, my milk was deemed “preterm breast milk” and was very nutrient-rich. In fact, it was considerably healthier than full-term breast milk, as my body made it to sustain the life of a significantly premature baby. It is normal practice for the milk bank to combine the milk of three or more donors, but they kept Bryson’s milk separate and gave it to the highest of high-needs babies. It really was off the charts how phenomenal his milk was. I pumped for eight months to the day. Just imagine how many lives his nearly 92 gallons of milk saved!
How do you hold space for both your grief and gratitude?
The grief of losing my son is a reflection of the love I have for him. I couldn’t give my love or milk to Bryson, as he wasn’t there in the physical sense. Yet I was able to express my love for him through expressing and donating his milk. It was very healing both physically and emotionally.
While there are definitely still tears, my heart fills with mother’s pride as I share his story. Through my grief, I have found gratitude, and my sense of gratitude continues to multiply. I’ve learned to always look for the blessing in a situation, though it quite possibly is disguised. Honestly, I could, and will, talk about his legacy forever.
What specific benefits do premature babies receive through donor breast milk?
I wanted to do everything I could by donating Bryson’s milk to help families avoid the heartbreak of baby loss. As I researched, I learned about necrotizing enterocolitis (NEC), which is an excruciatingly painful bowel disease that causes parts of the intestines to die. NEC is the second-leading cause of death for premature babies.
According to the NEC Society, the use of a human milk diet [mother’s own milk or donor milk] can lower the risk of necrotizing enterocolitis by 79 percent. As Diane L. Spatz [Ph.D., RN-BC] writes: “In the NICU, human milk must be viewed as a medical intervention that is just as important as IV nutrition or a ventilator.”
Premature babies suffer when given formula, which is incredibly unhealthy for their immature digestive system. Human breast milk is by far the better option. It absolutely saves lives. In this sense, donating breast milk isn’t so different from organ donation. Bereaved lactating women can offer irreplaceable life-saving nutrients in honor of their precious angel babies.
You pumped for eight months and worked outside of the home during this time. As a lactating bereaved mother, how were you treated?
These words stung like a second grief. Whether or not I had a baby, I was a lactating woman with physical needs.
The terminology in our federal law relating to the rights of breastfeeding mothers at work is a real problem. Federal law stipulates that breaks to express milk only apply to “nursing mothers” who pump “for her nursing child.” While I wasn’t expressing milk for a living, nursing child of my own, I was expressing milk for many high-risk infants who may otherwise die without a supply of healthy donor milk.
While I have completely moved forward from this workplace experience, I am dedicated to changing the terminology of the federal law to be formally inclusive of all lactating women. Currently, bereaved and surrogate mothers who chose to express breast milk can be excluded from the protection of the federal mandate due to the terminology used. However, all lactating women deserve the same rights.
In addition to contacting our legislators about this topic, what more can be done to support bereaved mothers?
I am trying to encourage professionals involved in caring for pregnant women to discuss lactation following birth — including lactation after loss. I realize that donating through grief is not right for everyone. But for bereaved women to make an informed choice about the matter, they first need to know that pumping and donating their baby’s milk is an option.
Amy, I’ve so enjoyed speaking with you, and I thank you for your time. Do you have any final thoughts to share before we conclude?
As Bryson’s mother, it is such an honor to have this opportunity to bring support and advocacy to mothers faced with lactation following the devastation of baby loss. Equally as important is the education of individuals about the benefits of this unique form of organ donation that can be completely life-changing for the many precious recipients of donor milk.
What kind of care do you want at the end of your life?
Stanford University researchers put that question to members of three major ethnic groups in the San Francisco Bay area and found little variation in their responses.
“There is a common humanity – people want to live as long as they have good quality of life. When it is their time, they want to be consulted so they die in a way that they are respected, and they don’t want their families burdened,” said the study’s lead author, Dr. V.J. Periyakoil, director of the Stanford Palliative Care Education and Training Program and associate director of palliative care services at the VA Palo Alto Health Care Center.
Regardless of ethnicity, however, the researchers found that access to high-quality end-of-life care is often hampered by lack of financial means, poor communication with health providers, cultural mores and family conflicts. The study, involving more than 300 white, Asian and African-American seniors, was published Nov. 18 in the Journal of Palliative Medicine.
Periyakoil, whose earlier research focused on how doctors discuss end-of-life care with patients from different cultures, said physicians often believe that talking about end-of-life care with patients of certain ethnic groups is taboo and that patients and their families are reluctant to have these sensitive conversations. The new study, though small and limited in geographic scope, suggests otherwise. The participants may have been more affluent and better-educated than their counterparts nationwide, given the region’s demographics, Periyakoil noted.
The researchers interviewed 315 people over 50 at senior centers in Fremont, Palo Alto, San Francisco, San Jose and Walnut Creek. The group included 38 African-Americans, 160 Asian-Americans and 117 Caucasians. Interviews, conducted in English, Burmese, Hindi, Mandarin, Tagalog and Vietnamese, examined participants’ attitudes toward end-of-life care and whether they had experienced barriers to getting quality end-of-life care for relatives or others in their community.
Researchers are still collecting data on Latino participants and plan to publish a separate study on their views, Periyakoil said.
While all of the participants in the study said they valued high-quality end-of-life care, about 60 percent said they had experienced barriers to getting it, most notably financial difficulties and a lack of adequate health insurance. Medicare typically covers only short-term nursing home care and offers hospice benefits to patients whose doctors certify they have six months or less to live and who are willing forgo treatment intended to cure their terminal illness.
There were no statistically significant differences among ethnic groups in reporting barriers to care. But participants with less education were more likely to report that their biggest barrier to care was financial. Patients with more education were more likely to cite doctor behaviors that hampered end-of-life communication. And women were more likely than men to cite barriers to care overall, perhaps because they were more likely to be direct caregivers and have more experience with end-of-life needs.
Regardless of ethnicity, patients felt that “doctors were just too busy to initiate [end-of-life] conversations, reluctant to listen to their concerns and questions about EOL decision making, and often gave vague responses, making it difficult for the patient to comprehend their choices and make informed decisions,” the researchers wrote.
An estimated 2.6 million Americans die every year, but how the American health care system handles their last days is problematic across ethnic groups, according to “Dying in America,” a landmark report released in 2014 by the Institute of Medicine. Too many people end up having aggressive treatment that is ineffective and expensive and doesn’t contribute to the patient’s quality of life, the report found. Other research examiningracial gaps in attitudes toward hospice care and other studies has found differences among ethnic and religious groups in how they approach end-of-life decisions.
But people want to talk about it regardless of background, says Dr. Steven Pantilat, a University of California, San Francisco professor of medicine and director of UCSF’s palliative care program, who was not involved in the study.
“What this study tells us is that all of our patients want us to have these conversations,” Pantilat said. “They’re waiting for their doctors to bring it up, to not be rushed, to communicate sensitively.”
A new federal policy may make those conversations easier – and more routine. Starting in January, Medicare will reimburse physicians for discussing end-of-life care. That policy infamously – and incorrectly – was derided as promoting “death panels” during the debate over the Affordable Care Act and a version of it was dropped from the legislation. The counseling will cover what kind of medical care patients want to receive as they approach their last days.
Periyakoil urges patients of all backgrounds to prepare for these conversations, and new planning tools are available in different languages to help. Among them is the Stanford Letter Project, which helps patients write a letter to their doctors about the end-of-life care they do and don’t want in languages including English, Spanish, Mandarin, Vietnamese, Hindi, Urdu, Tagalog and Russian.
In one redacted letter provided by Periyakoil, a woman named Patricia writes: “I do not want my longevity to be more important than my comfort.”
Pantilat advises the doctors he trains that they don’t need deep knowledge of the beliefs of every religion and culture they might encounter, because every patient, of whatever ethnicity, has different goals.
“If we come in with true curiosity, respect and openness, we can learn a lot about how to take care of someone in a sensitive way,” he said. We need to ask: “What do I need to know about your culture and your family to take good care of you?”
“Death is natural — but that’s precisely why we should be open to talking about it.”
By Susannah Keogh
Grief is all around us. It’s not something tangible, not something you can necessarily see or pinpoint. The tentacles of grief have no expiry point; no magic moment where it stops. It can subside, sure, but leave? Never.
One in every 1,500 secondary school pupils dies each year. One in seven Americans will lose a parent or sibling before the age of 20. So why aren’t we, as a society, talking about grief?
Perhaps it’s because, like anything new, we are scared. Scared of saying the wrong thing, of offending someone, or just of showing any signs of weakness in a society where being perfect is valued above all else.
Of course, it’s easy to argue that death is inevitable, a natural part of life and not something weneed to be made aware of. And to a certain extent, this is true. Death is natural — but that’s precisely why we should be open to talking about it, and the grief that comes with any bereavement. By not raising awareness of an issue that is a huge part of so many people’s lives and has a huge effect, especially in adolescence, society is doing everyone a disservice.
Grief can be neglected not out of malice, but simply out of how it’s perceived as being alien territory. But seriously, it’s OK not to know how to approach someone suffering the loss of a loved one. There are no magic words you can say to make their pain go away, no instant guidelines to follow. Every person’s grief is different, but with today being Children’s Grief Awareness Day, here is what to bear in mind, based on my own experiences:
1. Don’t ignore the elephant in the room.
If you or a friend is suffering from grief, acknowledge it. I don’t mean asking your friend 24/7 whether they need to talk, but it’s important to reach a happy medium point. You don’t want to push someone into talking if they’re not ready yet pretending nothing’s happened and carrying on as normal can be just as harmful.
Even now, eight years on from the death of my dad, there’s still that awkward silence whenever I mention him to people other than my closest friends. It’s that sense ofohgodIdon’tknowwhattosaysoI’llsaynothing. Check with your friend whether talking about their loss makes them feel uncomfortable. Above all else, if you’re not sure what to say, then say that. Explain that you are there for the person suffering, even if you might not have the words. As the old saying goes, actions speak louder than words. In the case of grief, they really do.
2. Grief is normal.
Think about it. You’ve lost someone who was a part of your life. Come on, what are you expected to do? Continue on as if nothing has happened? Dealing with the emotions associated with that lossis okay. You can cry, shout, throw yourself into work and should be able to do what feels normal to you without judgement. No one should be able to dictate to you what is grief and what isn’t. Grief just is.
3. Don’t be afraid to ask for help
My father died before I was a teenager. Looking back, if it had happened say now, when I’m in college or when I was in high school, I honestly don’t know whether I would have point blank refused the kind offer of counseling from the family support worker at the local hospice. Point is, there are so many different support networks out there. Take advantage of them — what have you got to lose?
Caitlin Doughty, who was about to open her first funeral parlor, in Los Angeles, gazed at a skull that she had put on display above the desk in her office. Although it was plaster, the skull was a provocative presence in a room where Doughty planned to receive grieving families. It was mid-June, and that afternoon John Gettys, a field representative of the California Cemetery and Funeral Bureau, was coming to give the business a final inspection. Doughty, who is thirty, said, “I want the office to look like me, but I don’t want it to look too Arty Death Hipster.” This was possibly a futile hope. She grabbed the skull and sat contemplating it; in her vintage wooden swivel chair, she looked like a noble in a memento-mori portrait. “I don’t want the state inspector to think I’m testing him,” she said. “Maybe I’ll put it on a lower shelf. That way, I will stay true to myself.” She checked her phone: Gettys was running late. “Maybe he died,” she said. “How funny would that be?”
Doughty’s office, which is in a medical building on the gritty end of Santa Monica Boulevard, has a view of the 101 from one window and a glimpse of the Scientology campus from the other. On one wall hangs a painting, by a high-school friend, of a coffin that has been bent in half and placed atop a chaise longue, in the manner of Magritte’s “Perspective: Madame Récamier by David.” The bookshelf bears volumes of poetry, including Whitman’s “Leaves of Grass,” as well as a compendium of nineteenth-century funeral practices titled “The Victorian Book of the Dead.”
When Gettys finally arrived, Doughty rose to shake his hand. She is six feet one in ballet flats, and has pale skin, long mahogany hair with bangs, and a penchant for vintage dresses with nipped-in waists. (Today’s outfit was emerald green, which matched her eyes.) Gettys read through her price list, which offered a biodegradable willow casket for thirteen hundred and seventy dollars and, for a hundred and twenty dollars, a newborn’s casket made from recycled paper embedded with pressed flowers. Doughty considered her business an “alternative funeral service” that would bring mourners into closer contact with the dead by helping people to tend to corpses at home. She did not plan to offer embalming services, although she was qualified to do so, having graduated in 2010 from the mortuary-science program at Cypress College. Regulations of funeral homes vary from state to state, and in California one can go into business without having taken a class in embalming, or even having learned how to securely close the eyes of a corpse. (A piece of cotton from the end of a Q-tip slipped under the eyelid usually does the trick.)
Doughty has a low, mellifluous voice and an ironical manner. “Are you going to give us a cool license number? Like, all the same digits?” she asked. Gettys, a middle-aged man whose pants and shirt were both of an olive hue, was not perceptibly amused, and replied that the number would be up to the bureau, in Sacramento. “We plan to be massively compliant,” Doughty told him. Her funeral parlor does not have its own crematory, so she and Gettys drove to examine the nearby facility that she planned to use. Gettys told her that, thirty years ago, he’d entered the business as an apprentice embalmer. “The funeral industry doesn’t change a lot—it’s been around for a long time,” he said. “Everybody tries to reinvent the wheel. Well, let me tell you something. The wheel has already been invented. O.K.—there are little permutations that can be done to the business model, but by and large the idea is to dispose of dead bodies.”
It was clear that Gettys was not aware of Doughty’s public profile—that he had not, for example, come across her popular series of online videos, “Ask a Mortician,” in which she fields such viewer questions as “Are these really my mother’s ashes?” and “What is the best way to write into my will that my children will receive no inheritance unless they have my dead body taxidermied and propped up in the corner of the living room?” In 2014, she published a best-selling memoir, “Smoke Gets in Your Eyes: And Other Lessons from the Crematory.” (“A girl always remembers the first corpse she shaves,” it begins.) And she is the founder of the Order of the Good Death, a mostly online meeting place for morticians and academics who are interested in exploring new ways to guide mourners through the experience of death.
A week after Gettys’s visit, Doughty posted on Twitter an image of an official letter that she had received from Sacramento. It began with a cheery “Congratulations!” Doughty tweeted, “I am a funeral home owner. There can be miracles, if you believe.”
Doughty grew up in Hawaii, on the island of Oahu. When she was a teen-ager, she fantasized about opening a funeral home that would combine retro charm with up-to-date service. As she writes in her memoir, she even came up with a name for her imaginary establishment: La Belle Mort. She saw herself creating tailored events that celebrated the life of the deceased in a highly personalized manner: sending cremated ashes into space, or shooting them out of a gun, or compressing them into a gemstone.
After graduating from the University of Chicago, she worked for about two years at Pacific Interment, a mortuary and crematory in an industrial district of Oakland. Without ceremony, she processed corpses through preparation and incineration. This work changed her vision of the ideal funeral practice. “When I first thought I wanted to get into the industry, I thought people needed a more friendly death—for death to be more accessible,” Doughty told me. “That changed very quickly. Now I think people need to get closer to it. It should be up in your face, not ‘Let’s turn Mom into a diamond.’ ”
Her new funeral parlor has a blunt name: Undertaking L.A. Along with Amber Carvaly, her business partner, Doughty intends to help people take care of their own dead, rather than outsource the task to professionals. “When I found myself in all these big industrial warehouses, alone with all these bodies, I thought, If I’m doing all this, there are all these other people who aren’t doing this,” Doughty said. “That’s too much death for one person and not enough for all those other people.” Among the services offered by the fledgling company are help with home funerals, in which the body is bathed and dressed, then kept on ice for a few days, while the family grieves; natural burials, without casket or marker, at a green burial ground in Joshua Tree; and witness cremations, which permit family members to help load the body into the cremation machine and push the button that starts the fire.
Sherwin B. Nuland, in his 1994 best-seller, “How We Die,” wrote, “Modern dying takes place in the modern hospital, where it can be hidden, cleansed of its organic blight, and finally packaged for modern burial.” Doughty’s goal is to end our deliberate estrangement from the dead body. “There really are so many places in our culture where we demand something unnatural,” she told me. “As of right now, what most people find acceptable is either no body at all or something that has been highly mediated. Someone comes in, they take the body away, and, the next time you see it, it has been disinfected and treated and made safe and beautiful.” A dead body is not immediately dangerous, except in cases such as Ebola, and in those instances infectious-disease protocols apply. “And maybe a dead body doesn’t need to be pretty,” Doughty went on. “Maybe we need to look and say, ‘Wow, let’s look at this beautiful, natural corpse.’ ” The conventional funeral industry has given people the impression that death is an emergency. “But death is not an emergency,” Doughty said. “Death is the opposite of an emergency. Look at the person who died—all that stress and pain is gone from them. And now that stress and pain can be gone from you.”
The professionalization of death care in America didn’t get under way until the second half of the nineteenth century. Modern embalming—in which the bodily fluids inside a corpse are drained, through an incision in a vein, and replaced with a preservative solution, through an incision in an artery—was popularized during the Civil War, as a means of allowing the bodies of fallen soldiers to last long enough for them to be shipped home for burial. Embalming became the signature skill of the professional mortician, setting his services apart from those of people—usually women—who had previously been responsible for preparing a dead body for the grave, by bathing it, anointing it, and dressing it, often in a shroud. In 1863, Louisa May Alcott, who served as a nurse during the Civil War, wrote of an encounter with the body of a soldier whom she had tended until death. “The lovely expression which so often beautifies dead faces, soon replaced the marks of pain,” Alcott wrote. “I longed for those who loved him best to see him when half an hour’s acquaintance with Death had made them friends.”
As Gary Laderman, a professor of religion at Emory University, explains in his 2005 book, “Rest in Peace: A Cultural History of Death and the Funeral Home in Twentieth-Century America,” the first embalmers made house calls. Early techniques were sometimes primitive: in 1898, an article in the Journal of Medicine and Science complained that the arsenic used to preserve corpses had leached into the soil and the groundwater near cemeteries. The article cited a critic of the practice—“Gallons of poisonous solutions are squirted into bodies indiscriminately”—and called for the establishing of standards in the handling of corpses. Around this time, the first mortuary schools were established, and the National Funeral Directors Association, which is still the leading industry association, was founded.
The turn of the twentieth century saw the emergence of the first funeral homes—literally the homes of professional morticians, who lived over their shops. It became the norm to remove a body from a home or a hospital as quickly as possible. The death industry boomed: a survey published in 1928 revealed that between 1900 and 1920 the number of funeral directors grew by more than fifty per cent. (The annual number of deaths increased by only 2.3 per cent in the same period.) For most of the twentieth century, the majority of funeral homes were family businesses that were passed from father to son—and rarely to a daughter. In the seventies, ninety-five per cent of funeral directors were men, and even by 1995 there were still almost twice as many male mortuary-science students as female ones.
Today, sixty-five per cent of mortuary-school graduates are women. The gender shift reflects a significant change in funeral practices. Rates of burial—and, hence, of embalming—have undergone a drastic decline. In 1960, fewer than four per cent of corpses were cremated. Today, the cremation rate is forty-five per cent. (Industry projections estimate that it will reach seventy per cent by 2030.) The image of the funeral director has undergone a parallel evolution. Although undertakers are still often portrayed as black-suited men in possession of dour scientific expertise, the funeral director has emerged as a member of the caring professions.
Until recently, it was common to believe that women were not physically capable of doing removals. Though such sexist fictions have been upended—lifting a dead body is mostly a matter of technique—explanations for the recent rise in women’s “death work” are often no less dependent on restrictive stereotypes. Women in the industry often declare that they have an innate empathy for others, and that they excel at providing emotional support to the grieving. It’s also argued that women are especially skilled at dressing the dead—and at restoring the appearance of vitality through the tasteful application of cosmetics and styling of hair. “People are more comfortable about crying, about showing emotion, in front of a woman,” Erin Whitaker, a funeral director from South Carolina, told me. “And it’s easier, as a woman, to put your hand on their hand as a sign of comfort.”
With an increasing demand among baby boomers for customized funerals that reflect the individuality of the deceased, funeral directors are expanding into the business of event production. Today’s funeral director might stage a memorial service featuring the release of butterflies at the grave site, or with the deceased’s Harley parked ceremonially at the entrance to the chapel. In such instances, the skills of a funeral director can seem to fall somewhere between those of a nurse and a wedding planner.Mortuary Management, a trade magazine, offers articles about such innovations as the tribute blanket—an instant heirloom that incorporates photographs of the deceased into a custom-made tapestry—and urges funeral directors to be open-minded when faced with families who want pop songs played at a service. It’s a profitable strategy to, as a feeble witticism of the industry has it, “put the fun back into funerals.”
Since the nineteen-eighties, the National Funeral Directors Association has held an annual professional women’s conference. This year, it took place in Chicago, and it attracted more than two hundred women from across the country. They attended an embalming workshop and listened to speakers who delivered “Lean In”-style exhortations.
Many women at the conference were helping to run, or had taken over, their family’s funeral home, but there were also women who had been drawn to the work for other reasons. Patty Decker, of Woodstock, Georgia, who has been a funeral director for nearly thirty years, told me that she’d wanted to become one since she was eleven years old. “I just saw the respect that the funeral director in my home town had—how much he was admired,” Decker said. “You have to love this job. You are faced with your own mortality every day. We are like the directors of this show that no one wants to attend.” Maria Thomas, an apprentice embalmer in Virginia, had worked in the performing arts before starting her training. “The first time that a family threw their arms around me, thanking me for making their mom look so beautiful—that really touches something,” she said. Strangers were curious about her job, she said, and she welcomed it. “We worship youth and beauty—those are the things that are celebrated in our culture,” she said. “But we do have to accept that over here is the death corner, and you are not going to escape it. You might as well talk about it.”
Doughty didn’t attend the conference: she isn’t a member of the National Funeral Directors Association, and notes grandly in her book that the group “won’t comment on me.” But some of the funeral directors present were aware of her advocacy of alternative funeral practices. One afternoon, there was a roundtable discussion of ways that funeral homes might use social media.
“Who is going to follow a funeral home’s Twitter account, really?” one participant asked.
“Weirdos,” someone replied.
“Competitors,” added another.
Doughty’s online prowess came up, and one participant remarked that she thought it was healthy for the public to get a glimpse of a funeral director’s reality. But another participant expressed concern about Doughty’s perspective. “I feel like she’s the one who’s big on ‘You don’t need a funeral director,’ ” she said.
Affixed to the refrigerator in Doughty’s apartment is a photograph of the class of 1973 at the California College of Mortuary Science, which later became part of Cypress College. Forty-four men, nearly all of them white, are dressed in black tie; there are two women in the class. Hanging next to that image is a 2010 photo of Doughty’s class. Its thirty-one graduates form a racially diverse group, and twenty-two of them are women. At her new business, her colleagues are mostly female, too. “I don’t think it’s because we have some kind of helping gene—I don’t think it’s some deep need to nurture,” she told me. “For me, working with dead bodies is almost like a feminist act. I don’t want people to come in and say, ‘Oh, no, little lady, you don’t know what to do with this body,’ because they already say that about our reproductive systems. I know I am qualified to take care of this body.”
Many funeral directors like to say that they had a calling for the profession. Such statements are no doubt sincere, but it might also be convenient to characterize the career as having been thrust upon one: few people admit to being motivated by a deep interest in corpses and death. Doughty has no qualms in admitting to such a fascination. She says that she became “obsessed with death” in the nineties, while growing up as an only child in Kaneohe, on the east side of Oahu, where her father was a high-school teacher and her mother a real-estate agent. When Doughty was in grade school, she says, she witnessed a small girl tumbling from a height in a shopping mall. (Doughty presumes that the girl fell to her death, though she never found out for sure.) The incident made her conscious of her own mortality and that of everyone else. “Everybody has their moment when they realize that death is very real,” she says.
Doughty studied medieval history at the University of Chicago, and she eventually focussed on the cultural status of the corpse and the representation of dead bodies in art and religious iconography. “I was interested in how much they had a relationship with the dead,” she said. “If you went to a church in the Middle Ages, there would be bodies buried under the floor and in the wall and in pits outside the church, and absolutely everywhere. The church was the center of life, so you would go there and have sermons and plays and outdoor markets. Everything you did—you were surrounded by corpses. Of course, they feared Hell—it’s not like they were totally comfortable with death—but they were a lot more comfortable with the dead body than we are now.”
Upon graduation, in 2006, Doughty sought to convert her academic interest into real-world experience. At Pacific Interment, the Oakland crematory, she worked on bodies in the prep room and loaded them into the cremation machine. No special credentials were needed for the job, besides a tolerance for the brute facts of mortality. She gained intimate knowledge of the process of decomposition when it is unhindered by embalming: first comes a loosening of the skin, followed by bloating, putrefaction, and blackening. She chronicles her experiences in “Smoke Gets in Your Eyes,” which is filled with unflinching observations. (“The left side of her chest was caved in, giving the impression that someone had removed her heart in some elaborate ritual.”) Doughty learned that it is difficult to arrange the deceased’s facial features into a semblance of heavenly rest after rigor mortis sets in, a few hours postmortem. And she learned in what order corpses should be cremated when several must be processed in a single day. (Start with the heaviest decedent, when the cremation chamber is cold; if one waits until the chamber is hot, the body will burn too quickly, producing excessive smoke.)
For the most part, Doughty performed what is known as direct cremation, in which the body is removed from a hospital or a home, then incinerated without ceremony, the desiccated remains mechanically processed into unidentifiable fragments that are collected and given to a relative. This is the least expensive way of dealing with death: in the U.S., the cost of a direct cremation averages between seven hundred and twelve hundred dollars, whereas an in-ground burial typically costs about seven thousand dollars. Cremation gained in popularity in America largely in response to consumer groups that, starting in the nineteen-sixties, publicly questioned the expensive services of the funeral industry.
In 1963, Jessica Mitford published “The American Way of Death,” a scathing investigation into the practices of funeral directors. They were, she suggested, “merchants of a rather grubby order, preying on the grief, remorse, and guilt of survivors.” Funeral directors lined their pockets, in part, by promoting questionable psychological arguments, such as the claim that the viewing of an embalmed corpse was a necessary step in the grieving process. They recommended “eternal sealer” caskets to protect the corpse from even greater ravages than death. Mitford championed cremation as a sensible alternative to burial, and her book, which became a best-seller, helped set in motion an investigation of the industry by the Federal Trade Commission. When Mitford died, in 1996, she was cremated, at Pacific Interment, for a cost of four hundred and seventy-five dollars. A decade later, Doughty took considerable satisfaction from the fact that she was operating the same machine in which Mitford had been reduced to ash.
Like Mitford, Doughty reviled the excesses of the funeral industry. But the longer she worked at Pacific Interment the more she found her own attitude toward the dead body at odds with Mitford’s approach, which struck her as unsentimental to the point of callousness. Doughty began to think that Mitford’s effort to combat the commercial excesses of the traditional funeral industry had ended up reducing the dead body to something to be dispensed with as cheaply and efficiently as possible. This approach swept aside an important aspect of human experience: that of tending to loved ones in death, just as in life.
All Caring Cremations, the company that handles the burning of bodies for Undertaking L.A., is in a bleak industrial area in the San Fernando Valley. When Doughty took me there, she pointed out a building down the block that had served as the exterior of the Dunder Mifflin paper company, on the NBC show “The Office.” “In an ideal world, this is not the neighborhood I would choose if we had the option to go with a wooded-stream crematory,” Doughty said. “But that’s not an option we have.”
The lobby of All Caring was decorated with anonymous good taste: wingback chairs, a low table. There was an unplaceable unpleasant aroma. A small chapel was painted in institutional beige, with chairs and a lectern and, up front, space for a casket. “They have said we could do some décor stuff in here—not, like, a feminine touch, but we might put up different art, a different color on the walls, better lighting,” Doughty said. We heard a noise that I first took to be the loud rumble of the air-conditioning system; it was the sound of the cremation machine at work.
Doughty and Carvaly, her business partner, expect that many clients of Undertaking L.A. will seek out their services because of their advocacy of home funerals. For a fee of three hundred and forty dollars, Doughty and Carvaly will come to the home of a dying person and consult with the family about the best way to take care of the body in situ. (Opening windows can be useful, and so is planning to place the body on a bed or a couch that can be reached without climbing stairs.)
A person who helps families with a home funeral is often called a death midwife. (In most states, the services of a professional funeral director are not required by law.) Clients who like the idea of not handing off a loved one’s body might not have the space or the stomach for caring for a corpse at home, and so a visit to All Caring’s prep room—hidden behind a door marked “Employees Only”—is available. There they can help with bathing and dressing the body, then proceed to the chapel and sit with the deceased in valediction.
Carvaly, who is also thirty, was a women’s-studies major at college, and worked at a homeless shelter for women before enrolling at Cypress College’s mortuary program, where she began corresponding with Doughty. She had aspired to be an embalmer, which she thought would combine science and art. But she was disillusioned after working briefly at Forest Lawn, the vast L.A. funeral complex that inspired Evelyn Waugh to write “The Loved One,” his satirical 1948 novel. “Forest Lawn was very competitive,” Carvaly told me, over lunch at the SteamPunk Café, not far from the crematory. “How many bodies can you do in a day? How quick and efficient are you? It’s a business, and you should be able to do it quickly and efficiently. But I didn’t like it.” Undertaking L.A. is in the process of registering as a nonprofit.
Doughty and Carvaly do not expect their services to become mainstream choices. The notion that the dead body is a source of pollution is a deeply ingrained belief in many cultures. In Jewish law, a kohein, or priest, is not permitted to be under the same roof as a corpse (except in the case of close relatives). In Japanese tradition, undertakers belonged to the burakumin, society’s lowest and most reviled caste.
It would be more commercially viable to embrace the trend of selling the funeral as a kind of farewell party. I recently spoke with an entrepreneurial funeral director named Paula Staab-Polk, from Chatham, Illinois. Having grown up in her family’s funeral home, she struck out on her own a few years ago and decided to combine funeral and hospitality services. “The way I look at it is: our death is an event, and our life needs to be celebrated when we pass from this life to the next,” Staab-Polk told me. A few years ago, she added a reception center to her funeral home. She has given a funeral luncheon that featured the favorite recipes of a woman who died at ninety-eight; she has held a service for a ten-year-old girl who died of cancer, at which guests were invited to “adopt” one of the many stuffed animals that had been sent to the sick child’s bedside. Staab-Polk offers floral services and bagpipers, and she also hosts non-funerary events. “I’ve got three high-school proms coming up,” she told me.
Doughty understands the appeal of Staab-Polk’s model. “People are afraid of death,” she said. “Do you want to go sit with the corpse or do you want to party? If you put it like that, it’s not a very hard question.” She is not denying that people can find great comfort in a personalized funeral ceremony. “But I would still argue that it doesn’t give you the full engagement with death and grieving that you need,” she says.
She is particularly skeptical of funerals that offer the bereaved a very brief look at an embalmed corpse. “If you are one of those people who, when you were eight, walked by a hyper-embalmed, preserved corpse, with the makeup and the suit, that quick glimpse in the casket can be scary, because there is no time to process it, and it stays with you, and the fear stays with you,” she told me. Spending time with a dead body in its natural state may be more challenging, she says, but it “normalizes” the experience. “When you talk about families that have worked with their dead body, and sat with their dead body, first they come in and just kind of touch the hand gently, like they are going to break Uncle Bob. Then, three or four hours later, they are telling jokes about Uncle Bob and giving him a hug.”
Doughty contends that elements of Undertaking L.A.’s approach can be applied to the most traditional of funerals. Carvaly recently participated in the funeral preparations for a friend named Marea Balvaneda, who had died suddenly, of cardiac arrest, at the age of thirty-six. “She had a traditional Catholic funeral, and she was embalmed,” Carvaly said. “The only thing that was different was that, the day before she was buried, I went to the funeral home with her sisters, and we dressed her body.”
At first, one of Balvaneda’s sisters, Ashley Wodke, lingered outside the prep room while the others worked. Carvaly told me, “It was, like, super-intuitive—they didn’t even need me.” Wodke said, “I knew I needed to do it, too. And it wasn’t as disturbing or traumatic as I thought it was going to be.” Balvaneda was the oldest of five sisters and had always taken care of her younger siblings; Wodke said that she felt a responsibility to take care of her sister in return. “We made sure her last outfit, and her last application of makeup, was done right,” Wodke told me, her voice breaking. “We made sure she had the right red lipstick. She wore a very vibrant red—a stoplight red. If we hadn’t done it, it wouldn’t have been the right red.”
The death-care movement can be seen as echoing other attempts to celebrate the artisanal and reject the over-industrialized, over-sanitized, and over-medicalized way of life that prevailed in twentieth-century America. Home births, while still very much a minority choice, rose by more than fifty per cent between 2004 and 2012. The flourishing of farmers’ markets has supported local agriculture, and the eat-what-you-kill movement has emerged as an extreme critique of industrialized food. When Doughty adopts her exaggerated “Ask a Mortician” persona, it is so glibly morbid as to be almost a caricature of the Portland-Bushwick axis of cool. (In one episode, which explains that metal implants survive a cremation intact, she jokes, “My father has had to have both of his knees replaced, and if we decide to cremate him, guess what his beloved daughter will be keeping on her mantelpiece.”)
Doughty’s business is not, she insists, a hipster lark or a “vanity project.” She explained, “There’s no vanity in funeral service—you are in rooms with corpses all day. This is not to make ourselves look good. If you want to look good, you start a really rad Instagram account, or bake gluten-free cupcakes. You don’t cremate people.”
Undertaking L.A.’s support of home funerals is aligned with the death-with-dignity movement, which advocates for the right of the terminally ill to die at the time of their choosing. Doughty is on the advisory board of Compassion & Choices, a group that campaigns for right-to-die laws, and she believes that the way we treat the dead body in our culture has a great influence on the way we think about the care of an individual close to the end of life, be it our loved ones or ourselves.
Being afraid of the sight of a dead body is quite different from being afraid of dying, which is the province of the confessional, the therapy suite, or the insomniac bedroom. But Doughty has found that spending time around dead bodies has helped her accept her own mortality. Working at a crematory led her to a realization: “O.K., this is going to be me—so this body is, so I shall be one day.” She explained, “If you have that opportunity with your family or community to come around the body, it is not only good to honor the dead person—they probably don’t really care—but it’s for you, too.”
In late June, Doughty took a road trip with her boyfriend, Landis Blair, to Crestone, a former mining town in Colorado. Doughty met Blair, an illustrator whose pen-and-ink drawings evoke the work of Edward Gorey, in 2012, after giving a lecture in Chicago. When she posted an item to her blog titled “My Morbid Art Crush on Landis Blair,” they struck up a relationship. They have lived together for a year, in an apartment filled with macabre Victoriana and the odd taxidermy specimen. Blair owns a unicycle that is usually propped up in a corner of the living room.
Blair is illustrating Doughty’s next book, a globally informed look at the future of death care, and he was serving as navigator. Crestone is about four hours south of Denver, and it is eight thousand feet above sea level, at the edge of a plain surrounded by mountains. Over the past several decades, Crestone, which at its most recent count had a population of a hundred and thirty-seven, has become the site of a wide variety of religious retreats. The landscape is thought to have a spiritual aura like that of the Himalayas. It is also home to an open-air funeral pyre, which was built by the Crestone End-of-Life Project, a small but avid group that champions natural funerals. Doughty was visiting it for the first time.
After arriving in town, we met up with Stephanie Gaines, the End-of-Life Project’s founder, and Paul Kloppenburg, a rugged Dutch expatriate who holds the title of fire-master. Kloppenburg told Doughty that the first open-air cremations in Crestone, in the early nineties, were conducted on a mobile pyre—a hundred cinder blocks and a metal grate that could be set up on an individual’s property. “I would see the eagerness of the people,” he explained. “I would pull up with my truck and build the hearth, and let them have it.” But after the group received a letter of complaint from local residents it built a pyre four miles outside of town, on land belonging to a Buddhist center. To a metropolitan eye, the site is in the middle of nowhere, but Gaines reported that a neighbor a mile away was not happy about being downwind of it. “And people didn’t want the traffic,” she told Doughty. “Six cars is a lot of traffic around here.”
The plain was spectacular in its vastness, and snow-crested mountains rose craggily in the middle distance. The cremation site was strangely beautiful. There was a circular enclosure, about seventy-five feet in diameter, fenced with bamboo palings. Standing inside it, you had a sense of safety and intimacy, yet the grandeur of the wider landscape remained visible. Inside the fence were four teak benches; they were arranged around a ring of large stones that had been set into the dusty ground. At the center of the ring was the pyre: a structure, about as high as a workbench, consisting of an iron grate suspended between two thick walls of concrete. The grate sagged slightly in the middle, like a well-worn mattress.
Affixed to the pine posts that supported the bamboo enclosure were copper plaques with the names of the fifty or so people who had been cremated in Crestone. Some of them had moved there specifically to die; these included a woman with cervical cancer. Others had grown up in the area, among them a twenty-two-year-old man who’d died in a car accident.
The ceremonies take place around dawn, before the wind whips up. The body, wrapped in a shroud, is placed on the grate, and then family members with flaming torches ignite logs that have been placed underneath. The body is also overlaid with logs and fragrant juniper branches, so that onlookers see only flame, not the body as it incinerates. For the first quarter of an hour, there is usually silence among the onlookers as the flames roar; as the fire matures, people chant, pray, beat drums, sing songs. It takes about two and a half hours for the body to be reduced to ash—hardly longer than a conventional cremation, Doughty noted with surprise. Gaines told her that mourners “say they are never the same after this.”
That afternoon, we had tea at the mountainside cabin where Gaines lives. She explained to Doughty that in Crestone a body is given a three-day period of repose before it is burned on the pyre: chilled gel packs help keep the body fresh, and the corpse is placed on a wooden pallet, obviating the need to lift it from a bed or a couch several days after death. Doughty talked about a recent trip that she had taken to Japan, where she’d visited a corpse hotel, which allows families with apartments too tiny for a home funeral to participate in the ritual preparation of a body. She liked the idea of setting up something similar with Undertaking L.A. “What I am really interested in is asking whether it is possible to have a communal center,” she said. “Family comes from out of town and it’s, like, a three-day wonderland process.”
Gaines, who is in her seventies, had a radiant air of calm. She explained that she was a devout spiritual practitioner: a contemplative with a special interest in the Gnostic traditions. Many of the other members of the Crestone End-of-Life Project had similar inclinations, but, Gaines explained, anyone was welcome to participate in the community of care, which embraced both the deceased and their survivors. “You want everyone to have this opportunity, because it is so filled with grace, and such an opening,” she said. “It is so transformational for everybody—not just for the person who died.”
Doughty nodded. “I am pretty secular, but the transformation from body to ash is still incredibly meaningful to me,” she said. “I may not think the soul is necessarily going anywhere—but just the physical transformation and the transformation of the mourners are transitions. It is ritual, and it is very real, and it is important, no matter what ideas of the body and the soul and the spirit the family comes in with.” She petted Gaines’s cat, which was moving promiscuously from lap to lap, sparing nobody. “It’s an exciting time to be in death,” Doughty said.