When Is Someone Really, Truly Dead?

The World Brain Death Project Seeks a New Answer


After your heart beats one last time, but before your body begins to decay, your life will come to an end. Strange as it seems, physicians around the world can’t agree on the exact moment death finally occurs.

A project aiming to find consensus on human mortality has now published its recommendations on what should constitute minimum clinical standards qualifying an individual as officially deceased.

Given the sheer diversity of legal, religious, and moral values different cultures use to frame perspectives on death, it’s unlikely that any single report will unite conflicting opinions.

It’s not the first time researchers have sought a universal definition of death founded in medical science, either.

But the World Brain Death Project’s senior author, University of Southern California medical director Gene Sung, argues the contents of his team’s report are a good place to start.

“This is an important, complex subject. Reaching this kind of consensus across so many organisations is a first,” says Sung.

“With this paper and its 17 supplements – virtually a textbook – it’s a foundation that we hope will minimise diagnostic errors and build trust.”

The recommendations aren’t so much a single column of boxes to step through, or a concise definition, but rather a way for medical communities from diverse backgrounds to find clear lines of agreement.

Through a mix of flow charts, check lists, and decision trees, the report categorises the observations necessary in weighing up whether a patient’s condition is potentially reversible.

Many of these are recognisable to most medical professionals, and include looking for an absence of facial reactions to uncomfortable stimulations, fixed pupils, no gag reflexes, and no spontaneous breaths when blood acidity drops far enough.

There are also some sensible suggestions, such as checking for existing conditions that could mask or mimic brain death – say, the neurological disease Guillain-Barré syndrome, or drugs or treatments that might confuse a diagnosis. 

Children, the paper advises, should receive a second neurological exam, given their young brains can recover from some conditions differently to adults.

The paper also takes resource availability into account, as well as the legal and cultural differences various medical communities will be subjected to.

As an expert on brain death and a physician intimately familiar with the impact traumatic brain injuries can have on his patients and their loved ones, Sung understands too well the importance of having clear guidelines on when to call it final.

“That’s why I started this project – we still have some difficulty in dealing with and understanding these problems,” says Sung.

In days long gone, death was the long, eerie silence of a still chest. Unable to feel a pulse or witness a breath, a doctor could gamble that an unconscious body was ready for the grave.

Of course, mistakes happened. And still do happen. A lot. More often than we might want to admit. So the search has continued for criteria that could prevent the nightmarish error of sending a living person to the morgue.

What’s more, with the advent of ventilators and improved methods for resuscitation helping us bring ‘the recently dead’ back to life, the medical world was desperate for a better way to distinguish a point of no return.

By the 1960s French neurophysiologists expanded on definitions of comas to include what would come to be seen as brain death. The first official criteria for diagnosing a relative lack of neurological function were published in 1968, commonly known as the Harvard Brain Death Criteria.

Medical communities around the world have since prioritised their own subtle differences in involuntary movements, blood flow, brain wave patterns and locations of residual electrical activity, leading to a number of very different sets of brain death criteria.

Religious sensitivities on how long to wait for mortuary preparations weigh in on decisions around the world. Legal precedents also make a difference in the rights of the dead and dying.

Trust in the medical system is paramount, with complex views on the timing and prioritisation of organ donation affecting how we see a doctor’s decisions around diagnosing an end to a life.

With so many variables to take into consideration, Sung and his team saw they needed to rely on more than medical literature and clinical experiments for finding a consensus.

Taking into account the advice of medical experts across disciplines and from different cultures around the world, their report has been endorsed by dozens of eminent medical societies.

Not without a hint of irony, a universal definition on death needs to be embedded in a living document, one that evolves not just with advances in scientific knowledge, but with an awareness of the communities who need to put their trust in it.

Complete Article HERE!

On reckoning with the fact of one’s death


A friend is sending me documents needed to make me the executor of his will. He does not expect to die from this pandemic but he has enough weaknesses in his body to be fairly sure he would not survive the virus if it gets to him. He is not as old as I am but he is not young either. He is clear-sighted enough to know what he must do now: stay at home. He is also clear-sighted enough to admit into his thinking the common fact of death.

And common fact it is — about 160,000 Australians die in the course of each year —though every death is a particular death and no single death can be quite like another. From a certain distance, it looks as if we must all enter this darkness or this blinding light by the same gate when we die, and from that point of view our common destination is undeniable.

But from another point of view, the one taken in Kafka’s famous parable, Before the Law, each of us stands at a particular gate made for us, a gate no other person can go through. Making a similar point, “Death is a black camel that kneels at every person’s gate”, goes a Turkish proverb.

I am a little shocked by my friend’s matter-of-fact approach to the idea of his death; and I am comforted by his attitude as well. At least he is not leaving matters to bureaucrats or stolid workers who might think his death is much the same as all other deaths.

As a friend, I have always valued him for the no-nonsense realism he brings to bear on our lives, and for the creativity with which he has approached every experience of his life. I tell him I will be happy to sign the documents and, if needed, to act as his executor. He says it will be simple. He has everything in labelled boxes and files.

When I talk to another friend who is a doctor at a Melbourne hospital, she speaks of the bruise on her nose from wearing a tight mask all day every day, of the sweating inside her protective plastic garments, of washing and disinfecting her hands after taking off each item of protective clothing at the end of a shift.

She says she thinks it is only a matter of time before she will be infected with the virus. She is young and her chances of survival are high, she says. I am shocked all over again by the way she thinks — or must think if she is to continue to do this work.

This fearful companion

Another day and there are nearly 2,000 people from aged care homes sick with the virus, and a record number of deaths reported for two days running. Grieving families are interviewed on television and on the radio.

I am living at home now with my death a definite shadow in my mind. I am 70, which makes me vulnerable. Many of us, I know, are in our homes with this fearful companion so full of its own patience and fierce focus.

One mercy is that I don’t have to be worrying about my parents, who both died three years ago after reaching their nineties. Their deaths followed the familiar pattern: a series of falls, an illness that brings pneumonia with it, a descent into morphine assisted sleep, then days of dragging in those last breaths as though they are being counted down.

But their deaths were particular too. My father was exhausted, I believe, and my mother was not ready to go. She fought through to those last breaths with all the fight she had in her.

In 1944 Carl Jung suffered a heart attack after breaking his foot, and was in a coma for three weeks. In a brief memoir of this experience, he describes floating out into near space where he could look down on the planet, then entering a light-filled rock that seemed to be a temple with a room inside where he was sure he would meet all the people who had been important to him, and where he would finally understand what kind of life he had lived.

At the entrance to this room, his doctor called him back to earth where there seemed to be a continuing need for his presence. He had to forego the experience of death, he wrote. He was 69 and he would live for another 17 years. For those who were caring for him, he might have looked like any patient in a coma and near death, but for him this was a particular moment of reckoning and even joyous anticipation.

Watching my parents die was its own shock after witnessing the deterioration in their bodies and minds as they aged, the reduction of their lives to a hospital bed, closed eyes, machines attached, the days-long struggle to breathe. It was almost unbearable to be near this and almost impossible to keep away as the time left became shorter.

Now in the time of this virus a painful new imposition bears down upon the families of the dying for they cannot even stand by the bed of a dying parent or grandparent or partner. The sadness of this immeasurable.

In an essay about death, called On Practice, Michel Montaigne mentioned that “practice is no help in the greatest task we have to perform: dying.”

In this matter we are all apprentices. But is there some way of breaking ourselves in for death, or must we always work and work to keep both death and the thought of death at bay?

When my sister died of cancer at 49, I remember her patting our young daughter’s hand the day before she died, saying to her, “Don’t cry, I’ll be all right. I promise you I will be all right.”

At the time I thought she was in denial, or that perhaps she thought that she needed to protect us from the heavy presence of death.

But now I think she might have been looking past us and even past herself: we do die and it is all right — and every living thing that moves only moves under the condition of its coming death. She might have been seeing this well enough to embrace its truth. I don’t know.

‘A second, a minute, longer’

Today the sun was out, a low winter sun sparkling through the twisted branches of our back yard ornamental pear trees, and I could not resist going out into the sunshine to weed around the carrots and beetroot, and take up the last of the autumn leaves from under the parsley bushes. I felt lucky to have these few minutes with the warmth of the sun on the back of my neck.

I have been reading Svetlana Alexievich’s Chernobyl Prayer, and somewhere near the end she records the words of a physicist dying of cancer from the Chernobyl fallout. He said,

I thought I only had days, a very few days, left to live, and I desperately wanted not to die. I was suddenly seeing every leaf, bright colours, a bright sky, the vivid grey of tarmac, the cracks in it with ants clambering about in them. ‘No,’ I thought to myself, ‘I need to walk round them.’ I pitied them. I did not want them to die. The aroma of the forest made me feel dizzy. I perceived smell more vividly than colour. Light birch trees, ponderous firs. Was I never to see this anymore? I wanted to live a second, a minute longer!

This reaction is deeply understandable, and each of us shares this feeling, even if only faintly, every morning that we find we have the world in our world again — for perhaps a whole day. Each time I read that paragraph I misread “I desperately wanted not to die” as “I desperately wanted to die”.

This urge to stay at home is almost matched by the urge to be out in the world rubbing shoulders with crowds. The desire to save my own life is mixed somehow with a desire to have it over with. My misreading troubles me, but it keeps happening.

A woman I know who is 30 years old answers, when I ask her how she feels about the growing numbers of aged victims to this pandemic, that there need to be more public “death-positive” campaigns in order to make death a more natural part of life in our culture — to make of it something we need not fear so much or become so angry over.

Though she speaks as if death belongs to other kinds of being than her, she makes some good sense because this is the other side of our attitude to death. Sometimes I lie in bed and count the likely number of days I might have left to me, and it always seems both a lot and not enough. And then I forget what the number was because after all, how can there even be a world without me in it?

Some years ago our dear neighbour Anna said she had decided it was time for her to die. There was nothing else she wanted. We had watched her nurse her husband through dementia for a decade, we had many afternoon teas with her as she fussed over our children and showed us the latest thousand-piece jigsaw puzzle she was completing. She talked about the books she was reading. And then one day she was ready to go.

Not long after that I visited her, more or less unconscious in a hospital bed. My amazement at her decision to go. But now, as I inch closer to old age, I imagine I might be able to understand how her decision was as much a matter of the mind as the body.

An American news service has reported that across 24 hours one person every minute died in the United States from Covid-19. I am not sure how to understand this kind of counting. It conjures images of queues of bodies, of frantic funeral directors and grieving families. It speeds up the mind and produces in me a feeling of panic.

Every minute across each day of the year about seven babies are born in the USA. A lot happens in a minute across a whole nation. Numbers tell a certain kind of story, the heart tells another, but sometimes the numbers are aimed at the heart.

If not death-positive, then perhaps we could be death-realistic. Svetlana Alexievich talked to children in cancer wards. A dying child named Oxana spoke of what she desired: “When I die, don’t bury me in a graveyard. I’m afraid of cemeteries. There are only dead people there, and crows. Bury me in open countryside.”

It is possible to know we are afraid, and know at the same time that this fear is a fear up to the brink of death, and beyond that we can go with our imaginations into an open countryside.

I am afraid, as we all are. When my daughter asks what she should do with my ashes after I am gone, the fiction we play at is that I will care what happens to “my” ashes, that it will make a difference to me, and that “I” will still be somewhere when she makes that decision.

I can never compose a clear set of instructions for her, though I know that putting those ashes somewhere in nature, perhaps out on water or under a tree, would fit with an idea I have of how the journey is best completed.

Intense light

With a state of disaster formally declared and a curfew at night for all the citizens of our city, the word, “disaster”, might seem to mark an endpoint. But it has become the sign for a new beginning and a new campaign.

With these new plans in place, drastic though they are, the possibility opens for believing, perhaps naively, that there will be a time when death does not dominate our thinking, that the virus will be a memory of a time we negotiated, a dark passage of intense narrowness before coming out of it into an open countryside. Perhaps as faltering human beings we must live this way: repeatedly imagining in hope of further scenes of rebirth.

When we know as fully as it can be known that we are each on a sure way to our own particular death, perhaps then we are already in that open countryside. My partner Andrea and I walked in the sunshine today to a park where we met, briefly, with our son, who stood well away from us, all of us in masks.

We talked about everything that is small, inconsequential, funny and ordinary in our lives. Two of us will have birthdays under this extended lockdown. We did not mention death, but everything we said was bathed in its intense light.

Our duties

I receive emails offering support and good wishes from friends interstate and around the world for the six weeks of lockdown. There is a shift in attitude and mood away from blame and towards support. We have a difficult time ahead of us. The street falls still and silent at night. I have a list of books to read, old papers to go through and throw out, but before that I find I wake up ill.

When I ring a doctor friend for advice he tells me he is COVID-19 positive himself, contracted in one of Melbourne’s aged care homes, and is in quarantine at home for two weeks. So far, into day six, he is feeling not too bad. In anticipation of this he says he has been keeping fit, eating well, and taking zinc tablets. My friend advises me to go to an emergency ward at a nearby hospital, and I do, though with much nervousness.

I am the only person in the emergency waiting area when I arrive, and am soon inside with a nurse in a cubicle, having urine and blood tests. Everyone is in plastic, masked, and across the aisle from me there are three police officers guarding a prisoner with shackles at his ankles and one arm pinned by a padlock to a wide leather belt. All three police are masked and one wears bright orange ocean swimming goggles as well.

In the emergency centre, I feel that I am both in the midst of an unfolding crisis and present at a theatre-in-the-round performance. A woman in a wheelchair asks loudly what everyone’s name is and what their job is. When one man says he is the director of the emergency centre she laughs loud and long, as though she has somehow caught the biggest fish in the river and doesn’t believe it.

Someone asks her if she wants some lunch, and she announces that she is starving and could they make up a bacon and fried egg sandwich for her followed by a crunchy peanut butter sandwich.

I am released from the emergency ward with blood and urine samples left for analysis, but without being tested for COVID-19 because I showed no specific symptoms.

My time in the hospital is a reminder to me of how far I am from the world now. A workplace, I realise afresh, can be dizzyingly busy, chaotic, packed with humanity and with unpredictable moments of basic care for fellow humans, of suffering, and those bizarre sights worthy of a circus or an opera. I have become so used to moving between two or three rooms at home and going outside only to go into the garden, that I am in a panic here in the hospital over doorknobs, sheets, chairs or curtains that I’m touching — and at the same time I feel that this closeness to others is what being alive is really about.

Returning home I have to keep reminding myself that it is in this quiet, almost passive way of living that I am doing something needed. It might be that this social isolation, one from another, is a plague response from the middle ages, but without it, we are told, modern hospitals, ventilators and ICUs will be overwhelmed. There is an intimate, human response needed to this virus. It forces an honesty upon us.

If this social isolation is now one of life’s duties, it goes along beside all the other duties, and among them is the fact that dying is one of our duties. This is an old thought, and perhaps a pagan thought.

Seneca the Younger wrote of this duty in the first century of the Christian era. Would it be too heartless to say that in the presence of so much death and illness we might now be capable of being driven into a new and eerie awareness of what it is like to be alive?

I can envy the vivid, raw consciousness of the man Alexievich quoted, the man who “desperately wanted not to die”, while feeling something desperately hopeless for him too. Perhaps a part of this being alive to dying is being able to hold and carry more than one feeling at once, and especially the contradictory feelings.

This morning Andrea called me to come and look at our second yellow poppy bursting out from her planter box in the back yard. It stands slender on its hairy stalk, its papery petals a shocking splash of colour against its perfect background, a winter sky.

Complete Article HERE!

The surprising benefits of contemplating your death

Now is the perfect time to face your fear of mortality. Here’s how.


Nikki Mirghafori has a fantastically unusual career. After getting a PhD in computer science, she’s spent three decades as an artificial intelligence researcher and scientific advisor to tech startups in Silicon Valley. She’s also spent a bunch of time in Myanmar, training with a Buddhist meditation master in the Theravada tradition. Now she teaches Buddhist meditation internationally, alongside her work as a scientist.

One of Mirghafori’s specialties is maranasati, which means mindfulness of death. Mortality might seem like a scary thing to contemplate — in fact, maybe you’re tempted to stop reading this right now — but that’s exactly why I’d say you should keep reading. Death is something we really don’t like to think or talk about, especially in the West. Yet our fear of mortality is what’s driving so much of our anxiety, especially during this pandemic.

Maybe it’s the prospect of your own mortality that scares you. Or maybe you’re like me, and thinking about the mortality of the people you love is really what’s hard to wrestle with.

Either way, I think now is actually a great time to face that fear, to get on intimate terms with it, so that we can learn how to reduce the suffering it brings into our lives.

I recently spoke with Mirghafori for Future Perfect’s limited-series podcast The Way Through, which is all about mining the world’s rich philosophical and spiritual traditions for guidance that can help us through these challenging times.

In our conversation, Mirghafori outlined the benefits of contemplating our mortality. She then walked me through some specific practices for developing mindfulness of death and working through the fear that can come up around that. Some of them are simple, like reciting a few key sentences each morning, and some of them are more … shall we say… intense.

I think they’re all fascinating ways that Buddhists have generated over the centuries to come to terms with the prospect of death rather than trying to escape it.

You can hear our full conversation in the podcast here. A partial transcript, edited for length and clarity, follows.

Sigal Samuel

You’ve worked in Silicon Valley and you still live near there, so I’m sure you’ve encountered the desire in certain tech circles to live forever. There are biohackers who are taking dozens of supplements every day. Some are getting young blood transfusions, trying to put young people’s blood in their veins to live longer. Some are having their bodies or brains preserved in liquid nitrogen, doing cryopreservation so they can be brought back to life one day. What is your feeling about all these efforts?

Nikki Mirghafori

It’s the quest for immortality and the denial of death. Part of it is natural. Human beings have done this for as long as we have been conscious of the fact that we are mortal.

A person who really put this well was Ernest Becker, the author of the seminal book The Denial of Death. I’d like to offer this quote from him:

This is the paradox. A human is out of nature and hopelessly in it. We are dual. Up in the stars and yet housed in a heart-pumping, breath-gasping body that once belonged to a fish and still carries the gill marks to prove it. A human is literally split in two. We have an awareness of our own splendid uniqueness in that we stick out of nature with a towering majesty, and yet we go back into the ground a few feet in order to blindly and dumbly rot and disappear forever. It is a terrifying dilemma to be in and to have to live with.

There is a whole field of research in psychology called terror management theory, which started from the work of Ernest Becker. This theory says that there’s a basic psychological conflict that arises from having, on the one hand, a self-preservation instinct, and on the other hand, that realization that death is inevitable.

This psychological conflict produces terror. And how human beings manage this terror is either by embracing cultural beliefs or symbolic systems as ways to counter this biological reality, or doing these various things — cryogenics, trying to find elixirs of life, taking lots of supplements or whatnot.

It’s nothing new. The ancient Egyptians almost 4,000 years ago, and ancient Chinese almost 2,000 years ago, both believed that death-defying technology was right around the corner. The zeitgeist is not so different. We think we are more advanced, but it comes from the same fear, same denial of death.

Sigal Samuel

It seems like in the West, we really have a bad case of that denial. I think we rarely talk about death or are willing to face up to the reality that we’re going to die. We seem to be wanting to always distract ourselves from it.

You are a Buddhist practitioner and you have a practice that is very much the opposite of that, which is mindfulness of death, or maranasati. You’ve done trainings and led retreats around this subject. But some people might say this is too morbid and depressing to think about. So before we actually delve into the mindfulness of death practices, could you entice us by telling us a few of the benefits of doing them?

Nikki Mirghafori

First and foremost, what I found for many people, myself included, is that facing the fact that I am not going to live forever really aligns my life with my values.

Most people suffer what’s called the misalignment problem, which is that we don’t quite live according to our values. There was a study that really highlighted this, by a team of scientists, including Nobel Prize winner Daniel Kahneman. They surveyed a group of women and compared how much satisfaction they derived from their daily activities. Among voluntary activities, you’d probably expect that people’s choices would roughly correlate to their satisfaction. You’re choosing to do it, so you’d think that you actually enjoy it.

Guess what? That wasn’t the case. The women reported deriving more satisfaction from prayer, worship, and meditation than from watching television. But the average respondent spent more than five times as long watching television than engaging in spiritual activities that they actually said they enjoyed more.

This is a misalignment problem. There’s a way we want to spend our time, but we don’t do that because we don’t have the sense that time is short, time is precious. And the way to systematically raise the sense of urgency — Buddhism calls it samvega, spiritual urgency — is to bring the scarcity of time front and center in one’s consciousness: I am going to die. This show is not going to go on forever. This is a party on death row.

Sigal Samuel

So the approach here is to bring to the forefront of our consciousness how precious our time is, by impressing upon our minds how scarce it is. And that helps align our life with our values.

Are there other benefits to practicing mindfulness of death?

Nikki Mirghafori

The second benefit is to live without fear of death for our own sake. That way, we don’t engage in typical escape activities. And it frees up a lot of psychic energy. We have more peace, more ease in our lives.

The third benefit is to live without fear of death for the sake of our loved ones. We can support others in their dying process. Usually the challenge of supporting a loved one is that we have a sense of grief for losing them, but a lot of that grief is actually that it’s bringing up fear of our own mortality. So if we have made peace with our own mortality, we can be fully present and support them in their process, which can be a huge gift.

My mom passed away two years ago. And for me, having done all of these practices, I could be with her by her deathbed, holding her hand and supporting her so that she could have a peaceful transition. She didn’t have to take care of me so much and console me. She could be at peace and take delight in this mysterious process that we just don’t know what it’s like. It might be beautiful, might be graceful. We don’t know — there might be nothing; there might be something.

Sigal Samuel

Now I feel sufficiently enticed to learn about the actual practices of mindfulness of death. Let’s start with one that seems simple: the Five Daily Reflections, sometimes called the Five Remembrances, that are often recited in Buddhist circles. Would you mind reciting those?

Nikki Mirghafori

Happy to. These are the Five Daily Reflections that the Buddha suggested people recite every day.

Just like everyone, I am of the nature to age. I have not gone beyond aging.

Just like everyone, I am of the nature to sicken. I have not gone beyond sickness.

Just like everyone, I am subjected to the results of my own actions. I am not free from these karmic effects.

Just like everyone, I am of the nature to die. I have not gone beyond dying.

Just like everyone, all that is mine, beloved and pleasing, will change, will become otherwise, will become separated from me.

Allow whatever arises to come up. It’s okay. These contemplations can bring a lot up. So just be with them as much as possible.

Sigal Samuel

I’ve done these reflections before, but every time I do them, I notice that some are much harder for me to absorb than others. The fourth one — I’m of the nature to die — does not terrify me. Maybe that’s weird, but that’s not the one that really scares me. The one that I find impossibly hard is the fifth one. Everyone that I love and everything that I love is of the nature to change and be separated from me.

It’s really the death or the separation from the people I love that I find much harder to face than the death of myself. Because if I’m going to die, you know, then I’ll be gone. There won’t be any me to miss things.

Nikki Mirghafori

Yes. So appreciate and make space for the one that really touches you.

Also I would say that with the fourth one, making peace with our own death, I’ve done the practice and sometimes I’m like yeah, sure, whatever. And then I’ve really stayed with it, and thought, “This could be my last breath.” When the practice really takes hold and becomes alight with fire, it’s like, “Oh, my God, I am going to die!” It really hits home.

Sigal Samuel

Just to clarify, this is a separate mindfulness of death practice, where you contemplate with every breath, “This could be my last inhale. This could be my last exhale.”

Nikki Mirghafori

Yes. And to bring the historical context into it: This particular teaching is what’s called maranasati. Marana is death in Pali, the language of the Buddha. Sati is mindfulness. The mindfulness of death sutra, that’s where the Buddha taught it, and it’s actually quite a lovely teaching.

The Buddha comes and asks the monks, “How are you practicing mindfulness of death?” And one of them says, “Well, I think I could die in a fortnight, in a couple weeks.” Another one of them says, “Well, I think I could die in 24 hours.” Or “Well, I could die at the end of this meal.” Or “Well, I could die at the end of this bite of food I’m eating.” And another one says, “Well, I could die at the end of this very breath.”

And the Buddha says, “Those of you who said, two weeks, 24 hours, whatever — you are practicing heedlessly. Those who said right at this breath, you are practicing heedfully, correctly. That is the practice.”

There are ways to really bring the sense of immediacy and urgency to all this. It’s not out of the question that there could be an aneurysm or that a meteor could just hit the Earth in this moment. Use visualizations; be creative.

Sigal Samuel

Another thing I find really helpful is remembering the idea of impermanence. Which, of course, is the theme of our whole conversation — that our whole life is impermanent — and that’s a very central Buddhist teaching. But also any emotion that I’m feeling is impermanent. So if I’m feeling an intense surge of fear as I do a practice, that’s impermanent, too.

Nikki Mirghafori

Yeah, I love that. When I teach impermanence, there are little impermanences that come and go, and then there is the big impermanence, which is your life! I’m chuckling because this is a case where impermanence is on your side. Impermanence is just a rule of how things run in this world. It’s impersonal. It’s just the way things are. But in our perspective, it’s either working for us or against us.

Sigal Samuel

Can you tell me about another kind of contemplation — the “corpse contemplation” or “charnel ground contemplation”? Charnel grounds are these places where, after people have died, their bodies are left to decay above ground, to rot in the open air. And Buddhist monks would go and observe them up close, right?

Nikki Mirghafori

Many monks do that, especially in Asia. In order to become more intimate with a sense of mortality, the practice is to go to the charnel ground and to actually see a corpse. And the contemplation is: My body, this alive body, is just like this body that is decaying. It’s in different stages of being a body, of decomposing.

A specific practice in the Buddhist canon is to contemplate a corpse in different stages of decay. This particular practice requires a sense of stability of mind. Do the other ones first. I only teach it on a retreat when there’s a container of safety, holding people and supporting them through it.

Sigal Samuel

I definitely have not yet worked myself up to doing corpse contemplation by looking at images of actual human corpses. But when I go for a walk, whenever I see a dead bird or squirrel or mouse that’s been run over in the road, I actually pause and take a minute to look at it. I’m trying to ease my way into this practice.

Nikki Mirghafori

Brilliant. Similarly, another informal practice I wanted to share is having a memento mori. Like a little skull, or those bracelets that are all skulls. I just drew on a little Post-It a skull and bones, and posted it on my computer monitor, so I would remember: Life is short. I’m going to die.

I’ve had various memento moris on my desk throughout the years, and I invite people to have them. They don’t have to be sophisticated. On a piece of paper, just write out, “Life is short” or “You are going to die” or “Traveler, tread lightly.” Whatever works for you to keep death in your perspective. And I think it’s good to switch memento moris around so that your mind doesn’t get used to seeing the same thing all the time.

Sigal Samuel

I’m glad you brought this up because I was going to say the corpse contemplation reminds me a lot of that memento mori tradition, which is a centuries-long tradition in Christianity. So many different religious traditions have emphasized the importance of meditating on our death and have devised ways like the memento mori to try to keep forcing the ego to recognize its looming demise.

Nikki Mirghafori

Yes. And I know that for me, I feel most alive and I feel happiest and I feel most connected with myself, when I’m aware of my death. If it happens for a day or two that it’s not in the forefront for whatever reason, I’m not as bright, as sharp, as alive. So I just love bringing it back. It enlivens me. It supports me to live more fully and hopefully die with more delight and joy and curiosity.

Sigal Samuel

I’m wondering if you can help me with something else. I mentioned earlier that I’m not really scared of my own death so much, but I am scared of the death of the people I love. And especially during the pandemic, I think that’s causing a lot of anxiety for me and probably a lot of others. We’re scared about the potential death of our grandparents, our parents, our friends. Is there a way to free ourselves of the overwhelming fear of their death?

Grief is a natural part of the process. However, it is complicated by our own seen and unseen fear of death. So I invite you to actually work with the practice of making peace with your own death. That’s what’s underlying it. Even if you think you’re not afraid of your own death, you probably are.

When people are really at peace with their own passing, there is a different perspective. There’s a different way of being with the fear or sadness of losing others. There is still a pain of loss, but it shifts.

Complete Article HERE!

Dying in Your Mother’s Arms

A palliative care doctor on finding a “good death” for children in the worst situations.

A palliative care doctor on finding a “good death” for children in the worst situations.

by John Beder

If losing a child to an illness is one of the worst things that can happen to a family, Dr. Nadia Tremonti has made it her mission to make it better.

It’s not easy. But as a pediatric palliative care physician, she works to ensure that terminally ill children receive quality end-of-life care. Palliative care is sometimes misunderstood to shorten life expectancy, but it’s a method that increases quality of life, improves symptom burden and decreases medical costs. We follow Dr. Tremonti in the short documentary above as she works to make death less medical and more human. In the process she asks a critical question: When a child is terminally ill, how can we make the end of life a better one?

Complete Article HERE!

How To Handle Prolonged Grief for Pre-Pandemic Life

By Mary Grace Garis

Early on in this pandemic, many found themselves mourning the loss of normalcy that came with abiding by stay-at-home orders to fight the spread of COVID-19. In late March, a Harvard Business Review article explained this constant din of sadness to be grief about the disruption to life as we know it. That was five months ago, though. Even then, while steeped in grief, many still reserved hope that “back to normal” was a stone’s throw away, and hadn’t yet canceled those summer vacation plans or put other long-term life plans on hold. But here we are, still clouded by a mourning that’s grown so pervasive, it’s become more of a prolonged grief that is sadly beginning to feel normal itself.

The prolonged grief of mourning a former way of life isn’t akin to grieving life, of course. And this means the current situation isn’t necessarily indicative of having prolonged grief disorder, a condition marked by long-term grief in response to the death of a loved one. But, the prolonged grief felt for pre-pandemic life requires navigating a complicated tangle of emotions, nonetheless.

Furthermore, given that the stages of grief already mark a complicated, nonlinear process, how can you mourn something so ongoing and intangible as pre-pandemic life? Below, grief counselor Diane P. Brennan, LMHC, breaks down how to grieve effectively about missing the way things were.

Keep reading 5 tips from a grief counselor for dealing with the prolonged sense of grief about the loss of normalcy during the pandemic.

1. Acknowledge your grief

With so many tragedies transpiring, it may to feel natural to cope by intellectualizing your feelings and essentially disallowing yourself from feeling them. But recognizing that you’re grieving—even if what, specifically, you’re grieving seems silly—is the first step toward moving forward.

“Allow yourself to simply acknowledge that you are grieving, that this is okay and a normal response to an experience that is completely new and unprecedented for the entire world,” says Brennan. “Don’t deny that you miss your pre-pandemic life. Acknowledge that your are grieving and it is a legitimate response to the stressful events happening in the world.”

2. Validate your losses

Take inventory of your losses and seek to understand their dimensions. For example, I recently learned that my favorite pizza spot is shutting down, which led me to feel grief about never having another thin-crust slice with butternut squash, goat cheese, and balsamic drizzle. But upon deeper thought, I realized what I’m really mourning is a space that made family dinners not only tolerable, but throughly beautiful experiences that presented an opportunity to make memories.

“By validating the living losses, we can experience a sense of relief. Allow your grief to be instructive and guide you toward a path of healing.” —grief counselor Diane P. Brennan, LMHC

So, to understand what it is you’re mourning and what primary feelings are being shaken up, do a similar deeper dive into your grief. What are you feeling? Sadness, fear, hurt, frustration? Be curious, and consider breaking out a pen and paper to keep track. “See if you can validate your losses and name them,” Brennan says. “By validating the living losses, we can experience a sense of relief. Allow your grief to be instructive and guide you toward a path of healing.”

3. Use rituals to acknowledge your losses

Across many religions, cultures, and ways of life, certain rituals are often invoked when someone dies, whether it’s a wake, funeral, shiva, memorial, three-paragraph-long Instagram eulogy, or otherwise. These practices honor what has been lost and symbolically mark an ending for those who remain. And the practices can still exist to help cope with living losses and feelings prolonged grief.

“Find ways to create personal rituals to help give meaning to your pandemic losses,” says Brennan. “You can write in a journal about your pandemic experiences; play music that makes you feel connected to your pre-pandemic life; create a collection of items that remind you of your pre-pandemic life and put them in a special place; or find ways to give to your community and make a difference for others in the post-pandemic world.”

4. Create realistic expectations for post-pandemic life

“Although life will be different, it doesn’t mean that it can’t be rewarding and meaningful,” says Brennan. “Begin to work on creating realistic expectations by shifting your mind-set by reimagining the world.”

Statements like, ‘It might be a very different world now, although let’s find new ways to…’ may help you reimagine what life can look like. For example, if you love to travel, you may feel extra frustrated about canceling or postponing all of your upcoming itineraries. But you can engage in new new hobbies, identify new interests, and connect with others in different ways. Maybe you can embrace RV life over jet-setting—which is a different adventure in itself.

5. Address existential concerns

It’s fair to assume that no matter what you had in mind for this year, it’s unfolded quite differently. Whether that means an upended career trajectory, a halted or spurred relocation, a shattered relationship, or actual human loss, resolving these big points of identity-centric existential grief is complicated. But, you can start rebuilding with a grounding mantra.

“Create a phrase or affirmation you can say to help you reconnect to purpose and meaning,” Brennan says. “For example, ‘I know it’s hard to understand how to navigate the uncertainty that the pandemic has brought to the world. It will not last forever, and I will begin to look for new ways to find meaning and purpose in my world.’”

And you will. Even if the way in which life is unfolding feels unfamiliar and scary, know that with every ending comes a new beginning. And with new beginnings come hope.

Complete Article HERE!

‘Spiritfarer,’ a game about the afterlife, seeks to ease the terror of death


By Elise Favis

“Goodbye, my friend,” said a deer named Gwen, holding me close in a final embrace as we sailed into the blood red waters of the River Styx. Despite the intense color of the sea, and the intensity of the moment, I felt calm. Flower petals drifted on the surface of the water, and white, lush trees swayed in a tranquil way. Gwen disappeared into thin air.

“Spiritfarer,” a game releasing later this year (on several platforms including Switch, PlayStation 4, Xbox One, PC and Stadia), is about guiding spirits to the afterlife. It hopes to make the subject of death comfortable, even cozy, by focusing on relationships and care in people’s last moments while guiding them to the other side. After playing for an hour, I came away feeling hopeful and uplifted, even after experiencing its somber themes.

You play as Stella (or Daffodil, her accompanying cat, if you’re player-two via local or online co-op), a young girl who becomes a new spirit guide to the dead after Charon, inspired by the ferryman of Hades in Greek mythology, retires from that same position. You sail a fantastical world, gathering spirits and convincing them to board your ship. You help them through their problems and encourage them to accept their fates. For creative director Nicolas Guérin, building a death-positive game was cathartic; a way to cope with his own mortality as well as the passing of loved ones.

“I’m terrified of dying,” Guérin told The Washington Post in a recent interview. “I’m terrified of leaving my daughter behind me. I’m terrified of losing my friends and my family.”

His whole team drew inspiration from their experiences with losing someone. The characters in the game are each inspired by grandparents, uncles and friends who died. They’re not “carbon copies,” Guérin said, but composite characters; a mix of traits, personalities, feelings and anecdotes derived from connections they’ve had with deceased loved ones.

Guérin and his colleagues at indie studio Thunder Lotus Games had “no idea at first” if they could pull off themes of death positivity in a management sim, saying he “lucked out” with how it all came together. He said it was important to combine normal, mundane tasks with the “extraordinarily, terribly gruesome moment we face when we know we’re going to die.”

In “Spiritfarer,” your ship evolves over time as you build different structures on top of one another like eclectic towers. Some of these are temporary homes for the spirits you gather, and others are stations for cooking, harvesting, gardening and more. Each character wrestles with something. A lion couple, for example, struggles to find happiness together when one of them is unfaithful. Others, like Stanley, a talking and walking mushroom with childlike traits, just wants to be cared for, so I made him his favorite meal: french fries. Some just want to be hugged. You spend time on and off the ship, completing quests for these spirits and finding out more about Stella along the way, too.

It isn’t just through mechanics that “Spiritfarer” achieves a sense of serenity. The game has a calming atmosphere, with a striking art style inspired by Japanese painter Hiroshi Yoshida and from whimsical Hayao Miyazaki films like “My Neighbor Totoro.” This world about death is bright and colorful, rather than dark and morbid.

Having spent 15 years in the games industry, much of that time at Ubisoft working on franchises like “Assassin’s Creed,” Guérin wanted to explore death in a way that forces the player to think about it outside the bounds of a game. Instead of a fail state mechanic, death in “Spiritfarer” is the key to progress. Every time a character dies, they leave behind a room filled with beautiful, overgrown flowers. It’s a symbol of heritage, Guérin explained.

“You need to actually gather some of these flowers that are used as a token to pay a shark, to build upgrades on the ship,” Guérin said. “And those upgrades will allow you to go across specific barriers like ice or rocks.”

Guérin’s brother is the chief of staff for a geriatric ward in southern France. During early development for the game, Guérin spent a significant amount of time “documenting and understanding” what people think and feel during their final moments by meeting patients in hospice and end-of-life care facilities. As he visited the terminally ill, he noticed their drive to experience human connection or enjoy a peaceful moment. He wanted to convey this in “Spiritfarer,” rather than have characters give grand speeches or make sweeping life changes as they faced death.

“They just want to still wake up in the morning, brew themselves some coffee and spend time with their family, relatives and friends. And that’s it,” he said.

Complete Article HERE!

How to Say Goodbye When Someone is Dying

By Dr. Lynn Webster

Once, a patient with chronic pain due to an immunodeficiency made an appointment with me to say goodbye. For years, he had received intravenous therapies for his infections, but they had all stopped working. His other doctors had already told him that nothing more could be done, and he had little time left to live. He came to let me know that he appreciated what we had done for him.

It was a surreal moment. The young man wasn’t in agony, and he seemed to be at peace with the inevitability of his death. However, I was caught unprepared. Since I wasn’t sure how to respond, I simply acknowledged his words with a “thank you.” We shook hands and he departed. That was the last time I saw him.

Last week, a colleague of mine sent out an email to a small number of his professional associates. He told us that he is very ill. Clearly, his implicit message was that he might never see us again. 

As I reflected on his message, I felt unprepared again. I wondered how I should respond. How would I say goodbye? Should I even broach the topic? This might be my only chance to let him know that I’d always considered him a mentor. But would he become despondent if I appeared to eulogize him? Would it be hurtful to express my sadness that we might never speak again?

I certainly didn’t want to add to his suffering. Perhaps I should ignore the gravity of his illness and focus on how I hoped he would recover soon.

But that would be dishonest. He is a physician, too, and always modeled treating his patients with empathy and compassion This was the part of his character that I felt most drawn to. He is a doctor who healed as much by listening to his patients than by any other therapy.

Asking the Right Questions

I decided to tell my friend what an important role model he has been for me, but I also had a question for him. Having treated many terminally ill patients, I have learned that most people who are dying have hopes for themselves, as well as the loved ones they are leaving behind. Therefore, I asked my physician friend whether he had any hopes he wanted to share with me. He told me he had two wishes.

“As I have been reflecting upon my personal and professional life, my first hope is that my presence really made a positive difference in people’s lives. That would be my legacy. The outpouring of affection, goodwill and positive comments that I have received from ex-patients, friends, family and colleagues has made it clear that I have succeeded in that,” he said.

My friend also expressed his hope for a change in our political situation. He mentioned the anger, frustration and hopelessness he feels watching American society fall into two warring ideological camps. His hope is that the young people of today will lead us into a better future.

Opportunities for Closure

COVID-19 has forced me to think about the reality that death can catch any of us by surprise.

As I write this, we are in the midst of a pandemic that has infected more than 17 million people and taken more than 680,000 lives worldwide. Many of the COVID-19 victims died alone and didn’t get a chance to say goodbye to their loved ones.

Even in ordinary times, most of us don’t get to say goodbye. We often deny the reality of death as life draws to a close. “You’ll feel better soon,” we say, either to make ourselves feel better or to avoid the topic. Even when we are allowed to be at the bedside of someone who is dying, we often lack the courage to convey our true feelings. Honesty can be too painful during those moments.

I remember saying goodbye to my dying father. Lying with him on his bed in his home, I asked my father if he was afraid. Many of us refrain from expressing grief at moments like that, because we worry that we might make the dying person feel worse. But I could not keep from crying.

In The Four Things That Matter Most, author Ira Byock, MD, identifies the messages he considers most important to communicate to loved ones near the end of life: “Please forgive me. I forgive you. Thank you. I love you.” Expressing these sentiments can help create a sense of mutual peace and completion.

Saying goodbye does not wish death on anyone. It acknowledges the richness of the relationship that has been. That is what I felt when I told my dad I loved him, which at the time was my way of saying goodbye. It is also how I felt when I brought closure to the relationship with my friend who emailed me.

Congressman John Lewis, the noted civil rights leader, expressed hope for the future in a New York Times op-ed published shortly after his July 17th death. He said, “Though I am gone, I urge you to answer the highest calling of your heart and stand up for what you truly believe.”

Perhaps we should consider following Lewis’s example. By daring to acknowledge what is happening and to say goodbye, we are bravely addressing the highest calling of our hearts. We also have the opportunity to honor all those who touched us and made us who we are.

Complete Article HERE!