What to Do When a Loved One Dies — Checklist

Practical steps you need to take in the early days

by Leanne Potts

When people die, they leave behind a life that must be closed out. The funeral must be planned, bank accounts closed, pets rehomed, final bills paid.

When someone you love dies, the job of handling those personal and legal details may fall to you. It’s a stressful, bureaucratic task that can take a year or more to complete, all while you are grieving the loss.

The amount of paperwork can take survivors by surprise. “It’s a big responsibility,” emphasizes Bill Harbison, a trusts and estates lawyer in Nashville, Tennessee. “There are a lot of details to take care of.”

You can’t do it alone. Settling a deceased family member’s affairs is not a one-person task. You’ll need the help of others, ranging from professionals like lawyers or CPAs, who can advise you on financial matters, to a network of friends and relatives, to whom you can delegate tasks or on whom you can lean for emotional support. You may take the lead in planning the funeral and then hand off the financial details to the executor. Or you may be the executor, which means you’ll oversee settling the estate and spend months, maybe even years, dealing with paperwork.

To marshal the right help, you’ll need a checklist (see below) of all the things that need to be done, ranging from writing thank-you notes for flowers sent to the funeral to seeing a will through probate.

To Do Immediately After Someone Dies

Get a legal pronouncement of death

If your loved one died in a hospital or nursing home where a doctor was present, the staff will handle this. An official declaration of death is the first step to getting a death certificate, a critical piece of paperwork. But if your relative died at home, especially if it was unexpected, you’ll need to get a medical professional to declare her dead. To do this, call 911 soon after she passes and have her transported to an emergency room where she can be declared dead and moved to a funeral home. If your family member died at home under hospice care, a hospice nurse can declare him dead. Without a declaration of death, you can’t plan a funeral, much less handle the deceased’s legal affairs.

Tell friends and family

Send out a group text or mass email, or make individual phone calls, to let people know their loved one has died. To track down all those who need to know, go through the deceased’s email and phone contacts. Inform coworkers and the members of any social groups or church the person belonged to. Ask the recipients to spread the word by notifying others connected to the deceased. Put a post about the death on social media, both on your account and the deceased person’s accounts, if you have access.

Find out about existing funeral and burial plans

“Ideally, you had the opportunity to talk with your loved one about his or her wishes for funeral or burial,” writes Sally Balch Hurme, an elder law attorney and author of Checklist for Family Survivors. If you didn’t, she advises you look for a letter of instruction in the deceased’s papers or call a family meeting to have the first conversation about what the funeral will look like. This is critical if he left no instructions. You need to discuss what the person wanted in terms of a funeral, what you can afford and what the family wants.

Within a Few Days of Death

Make funeral, burial or cremation arrangements

• Search the paperwork to find out if there was a prepaid burial plan. If not, you’ll need to choose a funeral home and decide on specifics like where the service will be, whether to cremate, where the body or ashes will be interred and what type of tombstone or urn to order. It’s a good idea to research funeral prices to help you make informed decisions.

• If the person was in the military or belonged to a fraternal or religious group, contact the Veterans Administration or the specific organization to see if it offers burial benefits or conducts funeral services.

• Get help with the funeral. Line up relatives and friends to be pallbearers, to eulogize, to plan the service, to keep a list of well-wishers, to write thank-you notes and to arrange the post-funeral gathering.

• Get a friend or relative who is a wordsmith to write an obituary.

Secure the property

Lock up the deceased’s home and vehicle. Ask a friend or relative to water the plants, get the mail and throw out the food in the refrigerator. If there are valuables, such as jewelry or cash, in the home, lock them up. “You have to watch out for valuable personal effects walking out,” Harbison says.

Provide care for pets

Make sure pets have caretakers until there’s a permanent plan for them. Send them to stay with a relative who likes animals or board them at a kennel. The pet will be grieving, so be sure they’re with someone who can comfort them.

Forward mail

Go to the post office and put in a forwarding order to send the mail to yourself or whoever is working with you to see to the immediate affairs. You don’t want mail piling up at the deceased’s home, telegraphing to the world that the property is empty. This is also the first step in finding out what subscriptions, creditors and other accounts will need to be canceled or paid. “The person’s mail is a wealth of information,” Harbison says. “Going through it is a practical way to see what the person’s assets and bills are. It will help you find out what you need to take care of.”

Notify your family member’s employer

Ask for information about benefits and any paychecks that may be due. Also inquire about whether there is a company-wide life insurance policy.

Two Weeks After Death

Secure certified copies of death certificates

Get 10 copies. You’re going to need death certificates to close bank and brokerage accounts, file insurance claims and register the death with government agencies, among other things. The funeral home you’re working with can get copies on your behalf, or you can order them from the vital statistics office in the state in which the person died.

Find the will and the executor

Your loved one’s survivors need to know where any money, property or belongings will go. Ideally, you talked with your relative before she died and she told you where she kept her will. If not, look for the document in a desk, a safe-deposit box or wherever she kept important papers. People usually name an executor (the person who will manage the settling of the estate) in their will. The executor needs to be involved in most of the steps going forward. If there isn’t a will, the probate court judge will name an administrator in place of an executor.

Meet with a trusts and estates attorney

While you don’t need an attorney to settle an estate, having one makes things easier. If the estate is worth more than $50,000, Harbison suggests that you hire a lawyer to help navigate the process and distribute assets. “Estates can get complicated, fast,” he says. The executor should pick the attorney.

Contact a CPA

If your loved one had a CPA, contact her; if not, hire one. The estate may have to file a tax return, and a final tax return will need to be filed on the deceased’s behalf. “Getting the taxes right is an important part of this,” Harbison says.

Take the will to probate

Probate is the legal process of executing a will. You’ll need to do this at a county or city probate court office. Probate court makes sure that the person’s debts and liabilities are paid and that the remaining assets are transferred to the beneficiaries.

Make an inventory of all assets

Laws vary by state, but the probate process usually starts with an inventory of all assets (bank accounts, house, car, brokerage account, personal property, furniture, jewelry, etc.), which will need to be filed in the court. For the physical items in the household, Harbison suggests hiring an appraiser.

Track down assets

Part of the work of making that inventory of assets is finding them all. The task, called marshaling the assets, can be a big job. “For complex estates, this can take years,” Harbison says. There are search firms that will help you track down assets in exchange for a cut. Harbison recommends a DIY approach: Comb your family member’s tax returns, mail, email, brokerage and bank accounts, deeds and titles to find assets. Don’t leave any safe-deposit box or filing cabinet unopened.

Make a list of bills

Share the list with the executor so that important expenses like the mortgage, taxes and utilities are taken care of while the estate is settled.

Cancel services no longer needed

These include cellphone, streaming services, cable and internet.

Decide what to do with the passport

You have a couple of options on how to deal with your family member’s passport. You do not have to return it; you can keep it as a memento, with the stamps on its pages reminding you of past adventures. If you’re worried about the possibility of identity theft, mail the passport to the federal government along with a copy of the death certificate and have it officially canceled. If you want the canceled passport returned, include a letter requesting that be done. You can also request the government destroy the passport after it’s canceled.

Notify the following of your loved one’s death:

• The Social Security Administration: If the deceased was receiving Social Security benefits, you need to stop the checks. Some family members may be eligible for death benefits from Social Security. Generally, funeral directors report deaths to the Social Security Administration, but, ultimately, it’s the survivors’ responsibility to tell the SSA. Contact your local SSA office to do so. The agency will let Medicare know that your loved one died.

• Life insurance companies: You’ll need a death certificate and policy numbers to make claims on any policies the deceased had.

• Banks, financial institutions: If you share a joint account with your deceased loved one, you’ll need to notify the bank they’ve died. Most bank accounts carry automatic rights of survivorship, which means if your name is on the account, you have full access to the funds when your loved one dies. You become the sole owner on the date of your relative’s death. Most banks will require a death certificate to remove the relative from the account.

If the deceased person was the sole owner of a bank account, the bank will release funds to the person named beneficiary once it learns of the account holder’s death. Many banks let their customers name a beneficiary or set the account as Payable on Death (POD) or Transferable on Death (TOD) to another person. You’ll need to show the bank a death certificate to get the funds released. If the owner of the account didn’t name a beneficiary or POD, things get more complicated. The executor will be responsible for getting the funds to repay creditors, pay bills and divide funds according to the dead person’s will.

• Financial advisers, stockbrokers: Determine the beneficiary listed on accounts. Depending on the type of asset, the beneficiary may get access to the account or benefit simply by filling out appropriate forms and providing a copy of the death certificate (no executor needed). While access to the money is straightforward, there are tax consequences to keep in mind. You will be responsible for paying any taxes earned by the account once your loved one dies. Keep in mind, the tax burden could be significant on a well-funded investment account.

• Credit agencies: To prevent identity theft, send copies of the death certificate to one of the three major credit bureaus: Equifax, Experian or TransUnion. You only need to tell one of them, and it will tell the others.

Cancel driver’s license

This removes the deceased’s name from the records of the department of motor vehicles and prevents identity theft. Contact the agency for specific instructions, but you’ll need a copy of the death certificate. Keep a copy of the canceled driver’s license in your records. You may need it to close or access accounts that belonged to the deceased.

Close credit card accounts

Contact customer service and tell the representative that you’re closing the account on behalf of a deceased relative who had a sole account. You’ll need a copy of the death certificate to do this, too. Keep records of accounts you close and inform the executor of any outstanding balances on the cards. Credit bureaus, as part of their regular reporting process, will also send card issuers an alert that your relative has died. But if you want credit accounts notified faster, contact them directly. Be sure to cut up your dead loved one’s credit cards so they aren’t lost or stolen.

If the credit card account is shared with another person who intends to keep using it, keep the account open but notify the issuing bank your relative has died so the deceased’s name can be removed from the account. Destroy any cards with their name on them to prevent theft and identity fraud.

Terminate insurance policies

Contact providers to end coverage for the deceased on home, auto and health insurance policies, and ask that any unused premium be returned.

Delete or memorialize social media accounts

You can delete social media accounts, but some survivors choose to turn them into a memorial for their loved one instead. Twitter, Facebook and Instagram all allow a deceased person’s profile to remain online, marked as a memorial account. On Facebook, a memorialized profile stays up with the word “Remembering” in front of the deceased’s name. Friends will be able to post on the timeline. Whether you choose to delete or memorialize, you’ll need to contact the companies with copies of the death certificate. TikTok does not offer a memorial option for a deceased user’s account.

Close email accounts

To prevent identity theft and fraud, shut down the deceased’s email account. If the person set up a funeral plan or a will, she may have included log-in information so you can do this yourself. If not, you’ll need copies of the death certificate to cancel an email account. The specifics vary by email provider, but most require a death certificate and verification that you are a relative or the estate executor.

Update voter registration

Contact your state or county directly to find out how to remove your dead relative from the voting rolls. Here’s a state-by-state contact list. The rules vary by state. Some states get notifications from state and local agencies and will remove your dead relative from voter registration rolls automatically. States will also remove voters if a relative notifies them of the death. Depending on where your loved one was registered to vote, you may need to give notice of the death in writing, by affidavit or with a death certificate.

Complete Article ↪HERE↩!

May 21, 2022May 21, 2022

The US Civil War drastically reshaped how Americans deal with death

– Will the pandemic?

An art installation by Suzanne Brennan Firstenberg in remembrance of Americans who have died of COVID-19, near the Washington Monument in Washington, D.C.

By Gary Laderman

More than 1 million people living in the United States have died of COVID-19 during the past two years.

The numbers paint a clear picture of devastation, though they can’t capture the individual and familial pain of losing loved ones – which will no doubt transform many more millions of Americans’ lives.

The impact of this mass death on American society as a whole is less clear, especially since the pandemic is not over. While there have been a few moments of public remembrance – 700,000 white flags placed on the National Mall, and President Joe Biden’s brief words noting the “one million empty chairs around the dinner table” – the country is only beginning to grapple with the shared grief of so many deaths.

Instead, there is public discord surrounding those who died. In a country divided over basic facts about the virus, deaths have been exploited for political purposes, or wrapped into conspiracy theories.

As a scholar of religion who has studied the history of death in America, I am quite preoccupied with how the country makes sense of, honors and remembers the COVID-19 dead. The magnitude of death today immediately brings to my mind the event that killed the second-highest number of Americans: the Civil War.

My first book, “The Sacred Remains,” looked at the conflict’s impact on Americans’ attitudes toward death, during another period of extreme division and overwhelming loss of life.

Preserving the dead

Roughly 750,000 people died in the Civil War, or 2.5% of the country’s population at the time – the equivalent of 7 million Americans dying today.

The unprecedented death toll had profound consequences on American cultures of death for generations, particularly through the emergence of the funeral industry.

Throughout the 19th century, most Americans died, and had their bodies tended to, at home. Last moments with the corpse were with loved ones, who were responsible for washing and preparing it for the final rituals before burial, generally in local churchyards.

But the Civil War provided an opportunity for a game-changing development. Embalming was an innovative method of preserving bodies that allowed some Northern families to have their war dead retrieved from the mostly Southern battlefields and brought back to be buried in Northern soil.

The display of President Abraham Lincoln’s embalmed body after his assassination was a pivotal moment in this transformation. His corpse was transported on a train from Washington, D.C., to Springfield, Illinois, with frequent stops in many Northern cities where it was put on display for grieving Americans.

A black and white illustration shows a line of people paying respects at a funeral. — A drawing depicts Americans viewing Abraham Lincoln’s body at City Hall in New York City in 1865.

As embalming became more common, it helped legitimize a new class of professional experts: funeral directors, whose homes became a mix of business, mortality, religion and their own domestic life. By the early 20th century, this new business had established a fairly standard American way of death, centered on the viewing of an embalmed body to bring a community together.

Americans’ relationship to their dead would never be the same. The intimacies the living had with the dead before the Civil War gradually disappeared, as funeral homes managed the care of more and more bodies.

Meaning-making

One of my intellectual heroes, sociologist Robert Hertz, wrote a famous essay about death and society in 1907. He argued that social groups represent themselves as immortal, capable of overcoming the death of any member. The community’s survival depends greatly on transcending death, so it transforms the dead into sacred symbols of group identity and social cohesion.

Hertz’s studies focused on death in small societies in Borneo. Yet his exploration of the relationship between the death of the individual and the life of the social group is pertinent now, in the context of the pandemic – as it was in the aftermath of the Civil War.

The victorious Union turned dead soldiers into symbols of the nation. Their deaths were seen as sacred sacrifices to preserve the country. For religion scholars, this is a clear example of American civil religion. In the U.S., civil religion is a patriotic culture that sees America as a sacred, exceptional country, built on shared ideals, myths and traditions.

But the Northern victors did not “control the narrative,” as we say these days. Indeed, a very striking and still-present counternarrative soon developed among the vanquished Confederates after the war. The losers built an alternative civil religious culture, what historians refer to as “the religion of the Lost Cause.”

Women in white dresses and skirts stand in front of a war monument in a black and white photograph. — Daughters of the Confederacy unveil the ‘Southern Cross’ monument at Arlington, Va., in 1917.

For many white Southerners, the battlefield dead did not signal God had abandoned their cause but rather illuminated his support for values associated with the Confederacy – values the United States is still grappling with today. They saw the loss as a temporary setback, but believed that ultimate victory would come if they maintained some form of Southern cultural purity based on notions of racial, regional and religious superiority.

Looking ahead

The politicization of death is not uncommon in American history, particularly during times of profound social crisis. And since the start of the pandemic, the same has happened with COVID-19 victims.

Death during a pandemic is obviously different from death during a civil war. In both cases, however, it is difficult for a divided country to experience unity in the face of an enormous loss of life and to agree on what those deaths mean for the nation.

Unique aspects of the pandemic make national mourning, and united healing, even more complicated. For example, the virus has not taken an equal toll across the country. The death toll shows significant disparities among different economic and racial groups. And the need to prevent contagion has intensified the physical separation between the living and the dead, making some meaningful rites of mourning difficult or impossible.

Many communities have made efforts to commemorate the pain of the pandemic, such as through Dia de los Muertos, a Mexican holiday honoring those who have died. But there have been minimal efforts to help make sense of the deaths on a national level: to rally around a compelling public narrative about the tremendous loss of life and grief. It remains to be seen if Americans will eventually incorporate the losses into a unifying civil religion, or only use them to reinforce polarization.

One million dead and counting will certainly require more efforts, more reflection and more soul-searching to help American society overcome and indeed draw strength from this unimaginable number.

Complete Article ↪HERE↩!

May 20, 2022May 19, 2022

‘Being the Smoke’: One Man’s Choice to Be Cremated Under the Open Sky

A small Colorado town maintains the country’s only public outdoor funeral pyre. Philip Incao saw it as his own perfect ending.

The cremation of Dr. Philip Incao at the country’s only public open-air funeral pyre in his adopted hometown, Crestone, Colo. His shrouded body was laid on a metal grate and covered completely with wood.

By Ruth Graham

Philip Incao was about 6 years old when he asked his mother if it was true he would die. Yes, she replied. And what happens afterward? he asked.

“Nothing,” she said. “You just die, that’s all.”

It was a profoundly unsatisfying answer, and one that Dr. Incao later identified as the starting point for a lifetime of study.

He pursued a path that wound through medical school, training in holistic healing and devotion to the early 20th-century esoteric Rudolf Steiner, a polymath who theorized that the spiritual world could be explored through scientific methods.

Decades of searching led him all the way to an unconventional decision about what would happen to his body after his death.

Before Dr. Incao died of prostate cancer on Feb. 28 at age 81, he arranged for a cremation in his adopted hometown, Crestone, Colo., at the country’s only public open-air funeral pyre.

“All the old forms, all the old rituals, are being loosened up,” he explained in interviews in the months before his death. And through this type of cremation, he planned to be a part of that shift.

He knew his body would be wrapped into a simple shroud, carried on a wooden stretcher into an enclosure, and placed on a platform a few feet from the ground. His sons and his wife would light the fire and watch his body burn for several hours. The next day, they would collect the ashes. He had attended several cremations at the pyre, and he was ready.

Dr. Incao’s family members carried his body to the pyre.

The pyre itself is a utilitarian structure: two waist-high stuccoed concrete walls lined inside with firebrick, and spanned by a plain metal grate.

About 70 people have been cremated at the pyre in Crestone since it opened more than a decade ago. Its services are restricted to residents and landowners in Saguache County, with a population of less than 7,000 people spread across some 3,000 square miles.

Set inside a circular wooden fence a few miles out of town, with the Sangre de Cristo range of the Rocky Mountains looming in the background, the pyre itself is a utilitarian structure: two waist-high stuccoed concrete walls lined inside with firebrick, and spanned by a plain metal grate.

The simple design represents a defiant upending of American death rituals. Instead of a body being whisked away by a funeral home, it stays on view at home for several days. And rather than being chemically “preserved” and placed in a sealed coffin, it remains on ice, but otherwise in its natural state.

“Burial as a practice in the U.S. is basically designed so that the American family doesn’t have to deal with the dying,” Dr. Incao reflected in December. By then, he was mostly confined to his bed, where he rested, met with friends, sorted through his belongings, and read books about reincarnation and near-death experiences.

More than half of Americans are cremated after death, a remarkable change from the 20th century, when it was “completely against American sensibilities,” said Gary Laderman, a professor in the department of religion at Emory University. But Crestone’s approach goes even further, defying one of traditional cremation’s core promises, to make the body disappear quickly and invisibly. A body on the pyre turns into ash and smoke while friends and family keep vigil for hours under the open sky.

Community cremation sites are commonplace in some parts of India, but they remain taboo in the United States. A Buddhist retreat center in northern Colorado maintains a private pyre, but efforts to open public sites like Crestone’s have faltered, running up against squeamish cultural sensibilities about death.

“Burial as a practice in the U.S. is basically designed so that the American family doesn’t have to deal with the dying,” Dr. Incao reflected in December.

Dr. Incao spent his life exploring the teachings of Rudolf Steiner, which guided his interest in philosophy and spirituality as well as his approach to his medical career.

“Folks who haven’t had direct experience of open-air cremation, whether it’s in Colorado or in Asia, can have some pretty strange associations,” said Angela Lutzenberger, a hospice chaplain who bought 63 acres of land in Dresden, Maine, that she hopes to turn into a pyre site. “They build up creepy ideas about what it could be.”

It is not a coincidence that Crestone is the pyre’s home. About 200 miles south of Denver, the former gold mining town has attracted a population drawn to Eastern religious practices and wisdom traditions for decades. Its reputation solidified in the 1980s, when a Danish-born spiritual seeker and her oil magnate husband established a sprawling development just outside town that bills itself as the “largest intentional, interreligious and sustainable living community in North America.”

The winding roads around that development — with street names like Serene Way and Jubilant Way — lead to several towering Buddhist shrines, retreat centers and a spiral ziggurat commissioned in the 1970s by the father of Jordan’s Queen Noor. Some locals refer to a “vortex” of energy in the area.

“There’s no other place quite like this in America,” said Dr. Incao’s son Sylvan, who visited his father there often over the years.

Sylvan had come to Crestone on a chilly week in March that would culminate in his father’s cremation. Fliers with information about the ceremony were posted at the health food store and the cafe next door, which function as the town’s social center. “Please carpool whenever possible,” the flier read. “Pyre lit at 8 AM.”

Bruce Becker, left, and Noah Baen, treasurer of the Crestone End of Life Project, stood in the smoke during Dr. Incao’s cremation.Credit…

A vista of the San Luis Valley above Crestone.

Dr. Incao had moved to Crestone with his second wife, Jennifer, in 2006, after practicing “anthroposophic” medicine — a Steiner-inspired holistic approach that many mainstream physicians characterize as pseudoscience — in upstate New York and Denver.

Dr. Incao graduated from the Albert Einstein College of Medicine in New York City, but his career radically changed course when he was introduced to alternative medicine and Steiner’s work. Steiner lectured widely on topics including philosophy, Christianity, finance, architecture and art. His ideas about education led to the Waldorf school movement; his thinking on agriculture inspired biodynamic farming.

Steiner’s view of medicine was a revelation for Dr. Incao. He went on to spend his life exploring the teachings of Steiner, whose work guided not just his interest in philosophy and spirituality but his medical career.

He believed in reincarnation, which he felt gave a sense of purpose to life. And he was devoted to the idea of what he considered a “natural” approach to medicine.

For Dr. Incao, that meant choices that would seem extreme to many, even some members of his family. He strongly opposed vaccination, publishing articles and offering testimony against childhood vaccines and eventually opposing the Covid-19 shots. When he became sick, he declined traditional treatments for his cancer, including chemotherapy. He was at home in Crestone, where many residents are skeptical of traditional medicine.

Dr. Incao believed that the moment of death was just the beginning of “the process of separation of the human identity,” which he said took about three days.

And why be cremated outdoors? “You do it because it makes a lot more sense than the alternative, which is giving the body over to the undertaker,” he said. He decided on cremation after moving to Crestone, and officially signed up about four years ago.

Sylvan, 49, and his brother Sebastian, 47, supported their father’s plans, which they saw as in keeping with his spiritual sensibility and nonconformist streak. “He loved nature,” said Sebastian, an acupuncturist in New York. “It seemed like a very powerful way to liberate his spirit.”

Sebastian, right, and Sylvan supported their father’s plans, which they saw as in keeping with his spiritual sensibility and nonconformist streak.

Stacks of cedar are carried to the clay oven.

Their older brother, Quentin, 51, was not so sure. He knew his father was a nonconformist, but he was still shocked when Dr. Incao told him about his intentions, on one of Quentin’s visits from his home in Montana. “It just didn’t make sense to me, I couldn’t understand it,” he recalled. He had agreed to be a pallbearer, but he was dreading the action of physically placing his father’s body on the pyre.

At a memorial service a few days before the cremation, the three brothers, their families and others gathered in Jennifer’s backyard art studio for a ceremony and eulogy delivered by a priest from the Christian Community, a small religious movement inspired by Steiner.

Dr. Incao’s body lay in repose at the front of the room, with wreaths of fresh carnations and other flowers on his body. “Into the calm of soul being walks the soul of our dear Philip,” the priest said, reading from a hand-transcribed book of sacred texts. “He is now on the other side of the threshold but his love has not stopped.” At the small outdoor reception afterward, deer grazed in the yard.

“It’s one of the most beautiful volunteer activities,” said Fane Burman, who has assisted at about a dozen cremations, helping stack the wood and tending to it as it burns. The nonprofit that operates the pyre, the Crestone End of Life Project, provides about a dozen local volunteers for each cremation. Although Mr. Burman does not always know the person who has died, “once the fire gets burning it brings tears to my eyes.”

Funeral guests delivered offerings of flowers and juniper boughs atop Dr. Incao’s body.

About 70 people have been cremated at the pyre in Crestone since it opened more than a decade ago.

On a cool Saturday, the family gathered at 7 a.m. to accompany Dr. Incao’s body from his home to the pyre about four miles west. A volunteer had wrapped the body in a shroud of sheets the night before and covered it in roses. The stretcher was carefully loaded into the back of Sylvan’s black pickup truck, and Quentin and Sebastian rode in the back with their father — “our last moments with him,” Quentin said. The truck slowly turned right at a small hand-painted sign reading “Pyre.”

By 7:30 a.m., about 70 people lined the path into the pyre site. A volunteer rang a bell to signify the start of the ceremony, and another played a tune on his handmade flute as the procession wound its way to the inside of the fence. The pallbearers laid the stretcher on the metal grate.

Dr. Incao’s ceremony began with family members and friends laying juniper branches and flowers on the body. Incense burned in a terra cotta pot tended by a volunteer, while others added logs until they were piled above the rim of the pyre. Then Jennifer and Dr. Incao’s sons lit large sticks in the incense pot and ignited the pyre together.

As the fire started to burn, Sylvan put his arm around Sebastian. A harpist played a tune as the flames crackled. Quentin wiped tears from his eyes, from smoke or emotion or both.

Smoke billowed thickly for about 10 minutes, and died down. By then, fire was putting off enough heat to warm the circle. Flaky ashes swirled in the air, which smelled of incense.

A “threshold choir,” which specializes in singing for the dying, performed some of the tunes they had sung for Dr. Incao in his last few months. “Safe passage, pilgrim of the spirit,” they sang. “We are all just walking each other home.”

Sylvan spoke about how he had always teased his father about wearing so many layers, always being cold. “With the fire going, he’s warm enough,” he concluded with a smile. Another friend performed a “hallelujah” — another Steiner concept — in which she solemnly circled the pyre, lifting and lowering her arms, moving forward and backward.

Quentin, who had questioned his father’s plans from the start, watched the ceremony quietly and intently. “It was almost like a weight lifted, to know he’s moved on,” he said later, as the crowd dispersed and the ashes smoldered.

He knew, in the end, it was what his father had wanted.

“He was looking forward to being the smoke.”

Complete Article ↪HERE↩!

May 18, 2022May 18, 2022

Coming to terms with a patient death

By Ben Pilkington

Death, of course, is a part of life for everybody. And for doctors, death comes with the territory of being a healer. Despite enduring more exposure to death than most, physicians still experience strong and lasting emotional reactions to it, including intense feelings about their own professional responsibility and competence.

COVID-19 brought this burden on doctors and other healthcare workers into sharp focus. Healthcare workers are dealing with mass mortality at a time when patients need more help than ever, but fewer resources are available to treat them.

This article examines how patients’ deaths affect their physicians, and how deaths from once-in-a-generation catastrophes like COVID-19 have complicated these encounters. We look at the stigma surrounding doctors and their emotions, and how such attitudes jeopardize healthy coping. Finally, we explore strategies that doctors can use to deal with patient death.

How do patient deaths affect physicians?

Even the most experienced physicians can have difficulty coping when a patient dies. Despite this—and despite the fact that physicians are confronted with death more than the average person—there is scant research examining how exposure to death affects them.

Available literature suggests that more exposure to patient death is strongly linked with more work-related stress, according to an article published in BMC Medical Education. Stress caused by the death of a patient at work can lead to burnout, which data suggests affects nearly half of all doctors treating terminally ill patients. To make matters worse, a high level of stress negatively impacts the quality of patient care, note the authors of a study published in BMJ Supportive and Palliative Care.

Sometimes, doctors feel the effects of a patient’s death long after it occurs. Feelings of numbness, guilt, and stress after a patient dies are common in the short term, but when surveyed, 61% of physicians reported that the most memorable patient death they witnessed continued to be a source of emotional distress for them in the long term, noted the BMC authors.

Patient deaths in the emergency department (ED) can be especially tough for doctors to deal with. There is typically no established patient-doctor relationship and death can occur suddenly, even in young and otherwise healthy patients, leading to more distress and emotional trauma for the healthcare workers tasked with preventing death from occurring, the authors added.

This takes its toll. According to a survey cited in the BMC article, 28% of ED doctors have considered quitting and 32% have thought about changing professions.

COVID-19 made it harder to cope with patient deaths

Dealing with medical emergencies means ED doctors are typically exposed to more sudden deaths than other physicians. But with the outbreak of COVID-19, doctors were confronted with unprecedented levels of patient death alongside increased demand for healthcare services, fewer resources per patient, and less time to do their jobs.

Together, these stressors are sometimes referred to as “cumulative grief,” a phenomenon that data from the US Department of Health and Human Services (HSS) suggests negatively impacts physicians’ health and the care they provide.

“Under normal circumstances, healthcare workers have more time to grieve and manage stress following the death of a patient. With increased deaths, the behavioral health impact of grief and the risk of burnout increase. This can result in compassion fatigue, low morale, exhaustion, burnout, and errors that could harm patient care,” according to the HHS report. You can read more about compassion fatigue and burnout here.

Systemic attitudes toward physician grief

Physicians recognize the need to help a patient’s bereaved family members and friends cope with death—breaking bad news is part of the job. But there is no standard advice for physicians who need that same support.

Traditional medical culture hasn’t looked kindly upon doctors’ emotional responses to death, notes psychologist, speaker, and author Elaine Kasket of London Metropolitan University, in a blogpost with BoardVitals.

“It is socially ingrained through medical school, and the cultures in both the UK and US medical establishments see a physician’s emotional response to death as a sign of weakness and even incompetence,” she said. “It feeds into this popular image of the physician as some kind of superhuman ultimate rescuer of human life; unable to do his or her job if they give in to or even acknowledge their emotions.”

Confronting this issue requires a fundamental change in the medical community’s perspective and policy. “There needs to be a sea change in medical culture to make support available,” she said, “and for it not to be stigmatized, to help physicians cope with grief, depression, despair or sadness.”

Strategies for coping with patient death

Out of necessity, and often in the place of a glaring absence of strategies in their training, physicians often develop their own ways of coping with their patients’ deaths. Sometimes, these coping mechanisms are unhealthy, such as when a doctor dons a morbid sense of humor (although some researchers maintain humor is healthy), tries to become numb to death, or externalizes the problem, as with alcohol abuse or overeating, according to the BoardVitals blogpost. Click here to read more about the drinking habits of doctors and the pandemic.

According to an article published in the Journal of Graduate Medical Education, oncologists at Memorial Sloan Kettering Cancer Center in NYC responded to the dearth of resources for physicians coping with death by introducing their own method, known as “Patient Death Debriefing Sessions.” Introducing these short sessions gave resident oncologists and other members of the treatment team a practical way to address their emotional needs after a patient died.

Patient death debriefing sessions were less than 10 minutes long, held within 24 to 28 hours of the death, consistently held after each patient death, and led by the attending physician. The sessions focused on residents’ emotional reactions to patient deaths, guided by a pocket card tool.

Memorial Sloan Kettering residents reported finding these sessions to be helpful and educational.

There is no shortage of techniques available—including yoga, mindfulness, exercise, and healthy hobbies—to help physicians relieve some of the stress and personal grief they feel when a patient dies. Read about some of those techniques here. And, of course, any physician needing support can lean on family members and friends, reach out to a counselor, and/or find a grief support group.

Just as important, however, is that doctors must give themselves permission to grieve—and society and the medical establishment can help take pressure off physicians by realizing they may need to grieve in the face of death, like any other human being.

Complete Article ↪HERE↩!

May 12, 2022May 12, 2022

We Need to Talk about Mortuary Makeup

Societal beauty standards follow us to the grave.

By Sumiko Wilson

It’s impossible to aestheticize death, but we still try. Shortly before the pandemic reached lockdown level last year, my 101-year-old grandmother died. When my mom proposed that I help her dress the body for the viewing, I obliged despite the fact that I creep out with ease. My grandmother was such a central figure in my life and I wanted a more private opportunity to say goodbye.

The experience fulfilled that expectation, but it also taught me that the process of prepping a body for burial is a vivid reflection of our relationship with societal beauty standards—an interminable dance that continues even after we die.

When we arrived at the funeral home the day before the viewing, the staircase leading us to the room where her body was kept felt like it spanned miles. What if she suddenly reanimates? If I tugged on a limb too hard, would it detach from the rest of her body? Once we got started, my anxieties were assuaged but my curiosity piqued. I knew that mortuary makeup was a common practice, but I didn’t anticipate how thorough the grooming would be; her skin had to look supple, her cheekbones had to look lifted and her complexion had to appear even and, at minimum, rosy-adjacent, given the circumstances.

The most shocking sight, though, was seeing the funeral director stuff my grandmother’s bra. After eight children and 101 years, the jig on perky breasts had long been up. So, what was the reason?

“I don’t know how I feel about stuffing bras, but it’s definitely something that embalmers do,” says L.A.-based funeral director Amber Carvaly. “It’s very commonplace and the idea is that people will look different laying down. But they’ll obviously look different because they’re dead and they’re lying in a casket.”

In a 2018 episode of Keeping Up with the Kardashians, Carvaly gave Kim Kardashian—who is, by many standards, an archetype of the eternal fascination with youth and beauty—a step-by-step on mortuary makeup. To elucidate the idea behind the practice to me, Carvaly compared it to the philosophy behind Kardashian’s controversial Balenciaga Met Gala look. Basically, we each have distinct signatures that we like to be known by while we’re alive and ideally, these become the attributes that we’re remembered by after we’re gone. Which means that it’s never ideal for a dead person to actually look dead.

“Kim’s image and who she is and what she looks like is so iconic that you don’t even have to see her face or an article of clothing. She can just be draped in black and you know exactly who she is. Like that’s her brand and her icon.”

In the funeral industry, this would be likened to a “memory picture”, a term Carvaly introduced me to during our chat. In essence, it refers to the lasting image of a decedent that’s ingrained in the minds of their loved ones. “It’s a memory of who they used to be,” she explains.

It wouldn’t be a stretch to liken our desire to make the dead look life-like to the ongoing obsession with looking younger, or to attribute the latter to a society-wide fear of dying. This is something that can’t be color-corrected, concealed, or glossed over.

“We are obsessed with image as society and as individuals,” Carvaly says. “But this idea is implanted while we’re alive. As women, we’re so obsessed with anti-aging and it sort of emerges from a fear of death.” Carvaly says that this even shows itself in how beauty trends evolve. “They change to keep us looking younger and if you wear a trend that’s from the past, it dates you,” she says.

We want the memory picture to capture our loved ones at their best, so the measures that we go to to bring corpses to a perceived standard are just symptoms of the widespread idea that younger is always better.

“We’re a death-denying society,” Carvaly adds. “We don’t like to talk about it, we don’t like to accept it, we don’t like to look at dead bodies because all of it just reminds us of our own mortality. We do so much of that while we’re alive, so of course it carries into death. We don’t even want to look at old ladies on screen—we only want to see people when they’re young and beautiful.”

But while this is a reflection of Western culture’s image-conscious underbelly, the process itself was therapeutic for me. My grandmother died overnight and I slept through my mom’s calls and texts to come to the hospital. Helping to dress her felt like an atonement for not being there, beckoning back to times when I would paint her nails, help to pick her church hats, or watch her apply baby powder with a glamorous, fluffy powder puff. It’s how I cared for her and how she cared for herself. “I think that from a standpoint of beauty as a ritual and beauty as a way to care for people, it’s something different. It’s grooming as a form of love instead of beautification to suit industry standards,” Carvaly tells me.

When Carvaly’s friend Maria passed away, applying makeup to her corpse was a way of honoring how she liked to be seen; while she was alive she was seldom seen without a red lip. “If someone had been like, ‘Don’t put lipstick on her!’ or, ‘She’s dead. Don’t glam her up,’ she would have haunted us,” Carvaly recalls.

Both my experience and the concept itself are multifaceted: I was comforted by the ritual, but alarmed at the extent to which it was practiced. We beautify the dead mostly with the living in mind: to filter the intensity of seeing a corpse, to create a comforting pre-funeral ritual, and to pacify the most pressing reminders of our own mortality. But our discomfort with aging and death is tampering with how we live, and that’s something that no amount of makeup can mask.

Complete Article ↪HERE↩!

April 30, 2022April 29, 2022

How burying the dead keeps the living human

By Dimitris Xygalatas

Olena Koval found out that her husband was dead via text message. He was shot by Russian soldiers inside their home in Bucha while she was sheltering nearby, their neighbors told Human Rights Watch. In the days that followed, despite the brutal cold and her spinal disability, she made repeated attempts to recover his body but was turned back each time by the soldiers’ threats.

As the atrocities escalated, Olena fled Bucha to save her remaining family. Before their departure, she left a note with a neighbor that marked where her husband’s body was, hoping someone could give him a burial.

War is synonymous with death, but its emotional toll extends beyond the loss of life. The inability to say farewell to one’s loved ones and lay them to rest can often be just as painful.

Humans have always cared for their dead – so much that archaeologists often consider mortuary rites among the traits that distinguish Homo sapiens from other species. In other words, it is a fundamental part of being human.

Paying respect

Humans’ close relatives also showed concern for the dead. The Neanderthals practiced burials, and other extinct hominids probably did too. Even chimpanzees appear to grieve over deceased relatives. But no other species goes to such extraordinary lengths to care for its dead.

As an anthropologist, I have spent two decades studying rituals, particularly those that can seem “extreme.” At first glance, these customs seem puzzling: They appear to have no direct benefits but can feel utterly meaningful. A closer look, however, shows that these seemingly senseless acts express deeper, profoundly human needs.

Take funerary rites. There is a practical need to dispose of a dead body, but most burial customs go far beyond that requirement. Among the Toraja people of Indonesia, for example, deceased family members are kept in their homes for months or even years. During that time, their relatives treat them as if they were still living: They offer them food, change their clothes, and bring them the latest gossip. Even after their funeral, their mummified bodies are exhumed, dressed up, and paraded around town on ceremonial occasions.

People walk in a long line under a huge red banner along a wooded path. — Residents participate in a funeral procession to honor ancestors in Tana Toraja Regency, South Sulawesi, Indonesia.

The Toraja are not alone. In Madagascar, I have visited communities where people lived in fragile reed huts, at the mercy of frequent deadly cyclones, as the only robust brick-and-mortar buildings in the area were used as tombs. And in the ancient city of Petra in Jordan, the architectural masterpieces carved into the rock by the Nabataeans two millennia ago were resting places for the dead.

Those practices may seem like outliers, but they are not. In all cultures, people clean, protect, embellish and carefully deposit their dead. Muslims wash and shroud the body before interring it. Hindus may bathe it with milk, honey and ghee and adorn it with flowers and essential oils before cremation. Jews keep watch over the deceased from the time of death until the burial. And many Christians hold wakes at which family members gather to pay tribute to the deceased.

Creating closure

Funerary rites are ostensibly about the dead. But their importance lies in the roles they play for the living: They allow them to grieve, seek comfort, face the reality of death and find the strength to move on. They are deeply human acts, which is why being deprived of them can feel devastating and dehumanizing.

This is what is happening in Ukraine.

In besieged cities, people cannot retrieve the bodies of their loves ones from the streets out of fear of being killed. In other cases, Ukrainian officials have accused the Russian army of burying victims in mass graves to hide war crimes. Even when they are retrieved, many of the corpses have been mutilated, making them difficult to identify. To people who have lost their loved ones, the lack of a proper send-off can feel like a second loss.

A woman in a black hat and jacket kneels next to a grave. — Tanya Nedashkivs’ka, 57, mourns the death of her husband at the site where he was buried in Bucha, on the outskirts of Kyiv, Ukraine, Monday, April 4, 2022.

The need for closure is widely recognized to be indispensable – not only by anthropologists and psychologists, but also first responders, governments and international organizations. This is why armies go to great lengths to return the remains of fallen soldiers to their families, even if that takes decades.

The right to a burial is acknowledged even for one’s foes. The Geneva Convention stipulates that belligerents must ensure that the bodies of enemies are “honorably interred” and that their graves are respected and “properly maintained and marked so that they may always be found.”

Given the importance of those rites, it is also striking that the Russian defense ministry has reportedly been reluctant to bring their own dead back home, because they are concerned with covering up the scale of the losses. This seeming indifference to the suffering of Russia’s own people and their need for closure may be yet another act of dehumanization.

Complete Article ↪HERE↩!

April 27, 2022April 27, 2022

These are the best and worst U.S. places to die, report shows

Your end-of-life experience may be very different depending on where you live, according to a Policygenius report.
The report ranks the best and worst U.S. places to die based on funeral costs and services, green burials, palliative care, Medicare providers, at-home deaths and probate shortcuts.

By Kate Dore, CFP®

Your end-of-life experience may be very different depending on where you live, according to a Policygenius report that ranks the country’s best and worst places to die.

The report gave each state and the District of Columbia a numerical score based on seven factors, including funeral costs and services, green burials, palliative care, Medicare providers, at-home deaths and probate shortcuts.

“I think the big takeaway of this project is to get people thinking about the costs associated with the end of life,” said Logan Sachon, senior managing editor of research at Policygenius. “Because some of them can be mitigated through planning.”

“If you look at the top 10 and bottom 10, there aren’t any specific things they all have in common,” Sachon said. “They are each kind of unique in their own way.”

Indeed, Vermont, ranked as the No. 1 place to die, was among the most expensive for funeral costs but scored highest for palliative care, which focuses on pain relief, management and emotional support.

Florida, known for its high population of retirees, came in last place, with the fewest Medicare providers per capita, and scored low for at-home deaths and palliative care.

The best places in the U.S. to die

Vermont
Utah
Idaho
Ohio
South Dakota
Maine
Colorado (tie)
Illinois (tie)
New Hampshire
Washington

The worst places in the U.S. to die

Florida
Alaska
Texas
Hawaii
New York
Georgia
New Jersey
North Carolina
South Carolina
Connecticut

It’s never too early for older Americans to prepare for end of life, Sachon said.

While the Covid-19 pandemic has boosted awareness about the need to be proactive, 67% of Americans still don’t have an estate plan, according to senior living referral service Caring.com.

Experts recommend an advanced directive, also known as a living will, covering your medical care preferences. You’ll also need a health-care proxy or power of attorney, naming someone to make medical decisions on your behalf if needed.

Estate planning

The report also focuses on each state’s probate process, which determines the cost and time it takes to settle your estate.

As of June 2021, only 17 states and the District of Columbia have an estate or inheritance tax, according to the Center on Budget and Policy Priorities.

With different laws in every state, a local estate planning attorney may share some options to protect your assets and carry out your wishes, depending on where you live.

There’s no federal estate tax on wealth below $12.06 million for individuals in 2022, and with proper planning, married couples can transfer their unused exemption to their surviving spouse, effectively doubling it to $24.12 million.

However, this reverts to an estimated $6 million exemption in 2026 when provisions from the Tax Cuts and Jobs Act sunset.

Complete Article ↪HERE↩!