Category: After Death Care

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The daunting task of holding an Islamic funeral in a pandemic

For some Muslims, the pandemic strips away their ability to mourn

COVID-19 has upended the Islamic burial.

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Grieving is difficult. Grieving during a pandemic even more so.

In the Islamic tradition, a person’s passing is marked with an elaborate and symbolic funeral. But what happens to those traditions when the world is put on pause, and when tragedy seems never-ending?

Two Muslim leaders, Ahmed Ali and Payman Amiri, share their stories on how they’ve had to adjust their practices in the time of COVID-19, and how mourning has changed in their communities. They tell Scienceline about the symbolism involved in a typical Islamic funeral, what the transition has been like as the pandemic has ramped up and their experiences of having to deal with the dead while mourners grieve from afar.

Hannah Seo: Each of our lives are marked with landmarks in time: birth, maybe a graduation, perhaps a marriage and a few anniversaries…In the Islamic tradition, one of the most important of these events is actually someone’s death.

Payman Amiri: In our culture and tradition. Dying is part of life.

Hannah Seo: This is Payman Amiri, he’s the chairman at the Islamic Cultural Center of Northern California, where he also works as an Imam. Imams are community leaders in Islam whose duties include teaching the Quran, leading prayers, and generally guiding the members of their communities. One of his duties is managing Islamic funeral services.

Payman Amiri: When somebody dies, you know, we try to sort of do that celebration of life, you know, like very formal in a big event and you just look at these family members that they are traveling with their loss.

Hannah Seo: But since COVID-19 spread across the nation, these funerals look vastly different.

(Guitar music)

Hannah Seo: This is Distanced, Scienceline’s Special Project about how different communities are responding to the coronavirus pandemic. In this installment, we’re looking at how the Islamic community has had to adapt its funeral services, which are important religious events.

Hannah Seo: Islamic funerals aren’t simple. They’re involved, meaningful, and the whole process can span up to several days.

Payman Amiri: The services include the washing of the body for the deceased person has to be washed in a proper way and they get treated with proper spices and herbs is a traditional thing for you. You put it on your skin and then you cover them in a white shroud…

Hannah Seo: He says that all the steps in a proper funeral service are imbued with history and symbolism.

(Guitar fades out)

Payman Amiri: So in our tradition, we believe we came from God, and our return is towards God. And so when you want to give them back, you want them to be washed clean. It has to be a white shroud, it has to be simple because every man and woman will go back to that white shroud. So it’s a symbol of humility.

Hannah Seo: Every aspect of an Islamic funeral is thought through, even the material…

Payman Amiri: It has to be cotton, it’s just everyone is treated equally because, you know, in God’s eye, everyone is equal.

Hannah Seo: Once the body is washed, the next part of the ritual can begin.

Payman Amiri: The body gets transferred to the cemetery, the body gets buried, facing toward Mecca, which is the direction all Muslims pray. And then you get the family members to, to say goodbye by putting flowers in the grave.

Hannah Seo: Or at least, that’s how things are supposed to be done.

(Guitar music)

For Payman, everything changed starting in early February, when he got a surprising call from a family in Santa Clara.

Payman Amiri: When she passed away and her family contacted us. It was the first case of community infection, and so it was a big deal.

Hannah Seo: Azar Ahrabi, a 68-year-old muslim woman from Santa Clara, California was initially diagnosed with pneumonia, but passed away from COVID-19 on March 9th. At the time, people thought she was the very first case of local community transmission of the new coronavirus in the county, but later, local health officials found two other cases who passed away before Azar’s case even came to light.

(Guitar music fade out)

Originally, Payman was supposed to arrange Azar’s funeral. But the virus, and fear of transmission meant that everyone had to take new precautions.

Payman Amiri: What happens if somebody dies with COVID they have to be in body bags, which were a thick bag with a zipper, and the body was in there. And then there are certain people who could only handle the body they have to be fully covered in PPE.

Hannah Seo: PPE is personal protective equipment: masks, gloves, etc. Suddenly mourning went from something close and intimate to something clinical, impersonal.

Payman Amiri: In our tradition, when somebody passes away, you greet the family with hugs and kisses and you hold on tight. And, of course, post COVID-19 nobody could do this.

Hannah Seo: And the moment that helps bring closure to the whole thing is usually a gathering.

Payman Amiri: Usually a lot of people show up in these memorial services, and it’s always the dinner. At the dinner table a lot of people share memories of the deceased person and it sort of helps the survivors put an end to that  chapter.

Hannah Seo: But of course the pandemic has rendered these practices impossible. With mosques, funeral homes, and various businesses shut down, that closure is hard to come by.

Payman’s struggles in the throes of the pandemic are not unique — far from it. Imams across countries have had to adjust in ways they never imagined.

Ahmed Ali: We had to go in people’s home, pick up the deceased. We went into the hospitals, we pick up bodies from there.

Hannah Seo: That’s Ahmed Ali, an imam in Brooklyn, NY. He says imams, as leaders of the community, have had to step up and show up for their people. Masjids and mosques, the usual places of worship and congregation for muslims, closed. Communities were left floundering, and only a few people were left to pick up the slack. For Ahmed, it’s been a lot to take over.

Ahmed Ali: Usually the imam’s job is to just lead the funeral prayer and rest the work is done by the funeral home, but all the employees left in the very beginning of this pandemic. And people were scared because they didn’t know how to protect themselves from this virus and nobody knew what actually this virus is. So, they called me and they say, ‘Imam, can you come and help?’ 

Hannah Seo: Shouldering all the roles himself, Ahmed became body collector, mortician, funeral director — you name it. And at times, it was gruesome.

Ahmed Ali: When we receive the body from hospital, usually they have all the IVs attached. And if the person was in critical condition, then they have tubes inside their mouth. And some time, when we remove the IVs, the blood start coming.

(Guitar music)

Hannah Seo: Ahmed says there were times he’d have to enter storage units with racks of bodies, checking toe tags to find the right person. It took its toll, and the burden was immense.

Ahmed Ali: It’s not an easy thing. So you can say it takes about two hour to wash one body. This was really difficult because picking up a body and taking it into the funeral home then unload it then put on a table, wash it, put inside the piece of cloth and then put it back inside the casket, then take it for the funeral prayer, then go to the cemetery lower down the body inside the grave. So this all work is actually really difficult.

Hannah Seo: If this seems like so incredibly much for one person to take on, that’s because it is. But Ahmed couldn’t turn away…

Ahmed Ali: I didn’t say no because this is a responsibility of an imam, that whenever things go, this kind of pandemic, then we have to show that we actually care for our community.

Hannah Seo: Comforting others is easier said than done, especially when you see your community hurting, with no power to change things.

Payman Amiri: I get emotional when [I know when] I do these services to start with because you see, you know, the family is crying and grieving when you feel for them.

(Guitar music fade out)

Hannah Seo: Recreating that connection and support during the pandemic, a time of intense disconnection, is challenging. The emotional burden of conducting a funeral is hard enough without the impediments of social distancing and Zoom preventing everyone from mourning the way they deserve to.

Ahmed Ali: Well, a lot of family members, they did use the Zoom and FaceTime and other apps to show the funeral service to their families around the world. I think, that’s an honor for me that I was able to help those families.

Hannah Seo: Ahmed Ali has led countless services all by himself, with no mourners or relatives around to claim the decedent as their own.

Ahmed Ali: Whenever I got a body with no family member, then I used to record a clip when we lower the body inside the cemetery.

Hannah Seo: Ahmed recorded these services in case friends or family came later, in case they came and wanted something to remember their loved one’s passing.

Ahmed Ali: But there are many clips I recorded and nobody ever asked for them. It’s sad because, you know, I was leading the prayer, I don’t know that person. But I was just there because, you know, I know that that person is a Muslim and a family to me.

Hannah Seo: With many states reopening, Payman and Ahmed’s lives have returned to some form of normalcy. In fact Payman recently had to organize the burial for another COVID-19 victim; this time, however, he was able to carry out a full service for the grieving family.

Things may have gotten better, but Payman and Ahmed are still anxious about the situation. The worst may be behind them, but  helping families process their loss is work that is never done.

Ahmed Ali: I as an imam just was able to stand next to them and tell them that, you know, this is reality of life. And now all we can do is pray for this deceased brother or sister.

(Prayer and guitar music in background)

Hannah Seo: This episode was reported by Jonathan Moens and me, Hannah Seo, for Scienceline. Thanks to both Payman Amiri and Ahmed Ali for sharing their stories.

Complete Article ↪HERE↩!

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What was a funeral like 8,000 years ago?

Newly discovered child burial site reveals ancient secrets

Entrance to Makpan cave, Alor Island, where the burial was discovered.

By John Anderer

Humanity has done a pretty good job of recording its collective history over the past two or three thousand years. Earlier time periods, though, are still very much shrouded in mystery. Now, a groundbreaking new archeological discovery in Indonesia is revealing secrets from 8,000 years ago.

Archeologists from The Australian National University have discovered an ancient child burial site located on Alor Island, Indonesia. While a funeral for a child is no doubt a morose and depressing event in any century, this unearthing is providing some invaluable insight on early mid-Holocene era cultural and burial practices.

Stunning burial practices unearthed

Articulated left foot (bottom left) and right foot (center) excavated in the ANU laboratory.

According to lead researcher Dr. Sofia Samper Carro, it’s clear that the child was laid to rest with a formal ceremony of some kind. The research team estimates the child was between four and eight years-old at the time of death.

“Ochre pigment was applied to the cheeks and forehead and an ochre-colored cobble stone was placed under the child’s head when they were buried,” she says in a university release. “Child burials are very rare and this complete burial is the only one from this time period,”

“From 3,000 years ago to modern times, we start seeing more child burials and these are very well studied. But, with nothing from the early Holocene period, we just don’t know how people of this era treated their dead children. This find will change that.”

Of particular note is the fact that the child’s arms and legs appear to have been removed and stored elsewhere before the rest of the body was buried. This sounds rather odd from a modern perspective, but researchers say it isn’t wholly unprecedented.

“The lack of long bones is a practice that has been documented in several other burials from a similar time period in Java, Borneo and Flores, but this is the first time we have seen it in a child’s burial,” Dr. Carro adds.

Why did ancient cultures remove arms and legs before burials?

The answer is probably lost to the sands of time, but researchers theorize some form of religion or spiritual belief is a likely explanation.

“We don’t know why long bone removal was practiced, but it’s likely some aspect of the belief system of the people who lived at this time,” Carro adds.

While teeth examinations project the child as being around six to eight years-old, the full skeleton appears to be closer to four or five years-old.

“We want to do some further paleo-health research to find out if this smaller skeleton is related to diet or the environment or possibly to being genetically isolated on an island,” the lead researcher comments. “My earlier work from Alor showed adult skulls were also small. These hunter-gatherers had a mainly marine diet and there is evidence to suggest protein saturation from a single food source can cause symptoms of mal-nourishment, which affects growth. However, they could have been eating other terrestrial resources such as tubers.”

“By comparing other adult burials we have found from the same time period with this child burial in a future project, we hope to build a chronology and general view of burial practices in this region from between 12,000 to 7,000 years ago which at the moment is still scant.”

Complete Article ↪HERE↩!

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In the midst of deep grief, a scholar writes how Hindu rituals taught her to let go

Hindu cremation being performed on the banks of the River Ganges in Varanasi, India.

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Cultures have built elaborate rituals to help humans process the grief of losing someone.

Rituals can hold the core beliefs of a culture and provide a sense of control in an otherwise helpless situation. I came to understand this when I lost my mother last year and participated in the primary Hindu rituals of death and grief.

The cultural practices and experiences helped me find meaning in my loss.

Body and soul

Many Eastern religions do not bury their dead; instead, they cremate them. Most Hindus consider this to be the final sacrifice of a person.

The Sanskrit word for death, “dehanta,” means “the end of body” but not the end of life. One of the central tenets of Hindu philosophy is the distinction between a body and a soul. Hindus believe that the body is a temporary vessel for an immortal soul in the mortal realm. When we die, our physical body perishes but our soul lives on.

The soul continues its journey of birth, death and rebirth, in perpetuity until a final liberation. This is at the heart of the philosophy of detachment and learning to let go of desires.

Scholars of Indian philosophy have argued about the importance of cultivating detachment in the Hindu way of life. An ultimate test of detachment is the acceptance of death.

Hindus believe that the soul of the deceased stays attached to its body even after its demise, and by cremating the body, it can be set free. As a final act, a close family member forcefully strikes the burning corpse’s skull with a stick as if to crack it open and release the soul.

To fully liberate the soul of its mortal attachments, the ashes and remaining bone fragments of the deceased are then dispersed in a river or ocean, usually at a historically holy place, like the banks of the River Ganges.

Knowledge within rituals

Someone from a different tradition might wonder why a ritual should ask mourners to destroy the body of their loved ones and dispose of their remains when one should be caring for all that remains of the dead?

As shocking as it was, it forced me to understand that the burning corpse is only a body, not my mother, and I have no connection left to the body. My Ph.D. studies in cognitive sciences, a field that seeks to understand how our behavior and thinking are influenced by interactions between brain, body, environment and culture, made me look beyond the rituals. It made me understand their deeper relevance and question my experiences.

Rituals can help us understand concepts that are otherwise elusive to grasp. For example, scholar Nicole Boivin describes the importance of physical doorways in rituals of social transformation, like marriage, in some cultures. The experience of moving through doorways evokes transition and creates an understanding of change.

Through the rituals, ideas that were abstract until then, such as detachment, became accessible to me.

The concept of detachment to the physical body is embodied in the Hindu death rituals. Cremation creates an experience that represents the end of the deceased’s physical body. Further, immersing ashes in a river symbolizes the final detachment with the physical body as flowing water takes the remains away from the mortal world.

Dealing with the death of a loved one can be incredibly painful, and it also confronts one with the specter of mortality. The ritual of liberating the soul of the dead from its attachments is also a reminder to those left behind to let go of the attachment to the dead.

For it is the living who must learn to let go of the attachment to the dead, not the long-gone soul. Cultural rituals can widen one’s views when it is difficult to see past the grief.

Standing at a place where millions before me had come and gone, where my ancestors performed their rites, I let go of my mother’s final remains in the holy waters of the river Ganges.

Watching them float away with the waves of the ancient river helped me recognize that this was not the end but a small fragment in the bigger circle of life.

As the Hindu text, the “Bhagavad Gita” – The Song of God – says of the soul,

It is not born, it does not die;
Having been, it will never not be.
Unborn, eternal, constant and primordial;>It is not killed, when the body is killed.

Complete Article ↪HERE↩!

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Couples Care for Stillborn Babies for Weeks While Grieving, & We Need to Be OK With That

By Sabrina Rojas Weiss

When Chrissy Teigen lost her baby Jack last week, some disapproved of the fact that both she and her mother shared images of themselves holding him. Those people may be surprised to learn that some parents go even further when grieving a stillborn baby, choosing to visit and hold them for days or weeks. As October is Pregnancy and Infant Loss Awareness month, we want to help spread the word that this is one of many ways to grieve and memorialize a miscarriage or stillborn child.

“She was a fully grown baby and I kept thinking that she would wake up at any minute,” British mother Jess Mayall told the Sun of her stillborn daughter Ava. Her hospital in the U.K. allowed her to keep Ava in a refrigerated device call a CuddleCot for two weeks. That meant that she and her partner could hold her, take pictures with her, and even take her on walks in a stroller to say goodbye.

“The hospice was a life saver for us,” Mayall said. “The support they offered us really changed our experience and we are so glad that we were able to make two weeks’ worth of memories with her before laying her to rest.”

This is a practice some hospitals and pregnancy-loss organizations have recommended for bereaved parents, even sometimes suggesting they bring the baby home for a short time. While in the U.K., most hospitals have CuddleCots, there are parents and others hoping to bring more of them to the U.S., where often parents don’t even get to see or hold their infants after losing them.

The prospect of holding and caring for a deceased infant is not for everyone, though. We hope to help normalize many ways to cope with this tragedy. Here are some other ways to grieve and memorialize pregnancy and infant loss:

Seek the help of a doula. BirthWaves.org has doulas in five states who provide free help for parents during delivery of a stillborn child as well as with all the difficult things that come after they return home, from lactation support to funeral arrangement.

Hire a photographer who is comfortable with bereavement photos, or take pictures yourself.

Frame an ultrasound picture or create art with their footprint.

Buy a customized Molly Bear that is the weight of your baby.

Fill out a special memorial baby book.

Create a customized book for you and your other children to read together.

Make a memory box.

Reach out to a local or online support group.

Share your feelings with friends and family. No one needs to go through this alone. You may also be surprised to learn that someone close to you suffered from miscarriage or stillbirth without telling anyone until you did.

Read about other beautiful ideas from Still Standing magazine.

Complete Article ↪HERE↩!

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The Newly Legal Process for Turning Human Corpses to Soil

Reusable eight-by-four-foot steel cylinders, packed with wood chips, straw, and alfalfa, present an eco-friendly alternative to traditional burial

By Corinne Purtill

There’s an empty warehouse 20 miles south of Seattle that, if everything goes as planned, will soon be full of dead people.

The facility belongs to Recompose, the first U.S. company to compost human bodies indoors, through a process known officially as natural organic reduction. Washington state became the first — and so far, only — U.S. state to legalize the practice in May 2019. Recompose opens in November. It’s designed to hold the bodies of up to 10 recently deceased people at a time, each of them quietly decomposing into a loamy, nutritious soil, just as their previous owners wanted.

At the most basic level, decomposition is not a new technology; microbes have been doing it extremely well for just about as long as organic matter has existed. But it’s a part of death that Western funeral practices have traditionally gone to great lengths to evade: Embalming a corpse in chemicals with the goal of preserving a “natural” (that is, not dead) look; hawking expensive caskets that claim to seal out nature’s corrupting forces.

Recompose takes the opposite approach.

Against an attractive millennial pink background, the company’s website plainly explains the eco-friendly setting in which clients will decay. Instead of in a single-use casket, bodies rest temporarily in a reusable eight-by-four-foot steel cylinder, packed snugly in a cocoon of wood chips, straw, and alfalfa. For 30 days the dead human and living microbes stay in the vessel together, lying alongside fellow Recomposers in the warehouse’s hexagonal wooden frame, while the microorganisms slowly break down the corpse. At the end, after a brief turn in a curing bin to cool and dry out excess moisture, what once was a human body is now about a cubic yard of fertile, nutrient-rich soil, which can be returned to loved ones or scattered according to the decedent’ wishes. (The company will deliver all or part of the soil free of charge to Bells Mountain, a protected wilderness in southern Washington.) The service costs $5,500 — more than a typical cremation and service costs in the U.S., but about half the cost of burial. Some 275 people have already signed up for the service since reservations opened a month ago, said customer and communications manager Anna Swenson.

“There are a lot of signs and signals that are somewhat apocalyptic that kind of turn you back to your mortality.”

Why hack death? Cremation releases more than 500,000 tons of greenhouse gases annually in the U.S. alone, along with significant levels of mercury emissions. Traditional burial shoves truckfuls worth of metal, concrete, wood, and formaldehyde beneath the ground each year. Cities around the world are running out of traditional cemetery space, and preserving any unmolested open space is hard, even if you’re not trying to get permission to plant corpses in it. Human composting and its kindred green death technologies distill the body from a large, unwieldy, decomposition-prone state to one that is smaller, shelf-stable, and portable, with negligible environmental cost along the way.

There are existential reasons as well. As a pandemic rages and wildfires burn and a general feeling of doom pervades the air, “there are a lot of signs and signals that are somewhat apocalyptic that kind of turn you back to your mortality,” said Jeff Jorgenson, who owns green funeral homes in Seattle and Los Angeles.

“We look at what we’re doing and how disconnected we are from the earth and realizing that we’ve created this mess. We’ve allowed this to happen. And I think that informs decisions and perspectives on death.”

Recompose founder and CEO Katrina Spade was raised in a family of doctors “where it was fairly normal to talk about death and dying at the dinner table,” as she explained in a 2016 TED Talk. That frank approach to life and its end followed her to architecture school, where she became fascinated by a particular design question: How to dispose of her own physical body when she was no longer living in it, without — as she put it — “destroy[ing] the possibility of giving back after we die.”

She admired the example of green cemeteries, where nonembalmed bodies are wrapped in biodegradable materials and buried in a grave about three or four feet deep in which, over the course of about two years, tissues decompose into matter that nourishes the surrounding soil. (Bones can take up to 20 years more to fully disintegrate, according to the Green Burial Council.)

Green cemeteries are lovely places, with trees and plants growing freely without the austere manicuring of a traditional cemetery. There just aren’t very many of them. Only a few hundred of the thousands of cemeteries in the U.S. offer any green burial option, including many Jewish and Muslim cemeteries, whose burial practices traditionally forgo embalming and nonbiodegradable caskets. With composting, the body can go through the same process as it would beneath the soil of a green cemetery, even if there’s no open space for miles.

There’s also the question of one’s final resting place. A body placed in a green cemetery becomes, effectively, a part of that particular expanse of earth. One of the benefits of cremation is that the deceased or their survivors can dispose of the resulting “ashes” however they see fit: scattered in a meaningful spot, divided amongst children, even shot out of a cannon if that feels most appropriate.

Wouldn’t it be nice, Spade thought, to rot closer to home, to turn back into something that feeds the earth instead of takes from it, and to have a say in where the soil made from you goes?

Agriculture has been using natural organic reduction for decades to dispose of dead cows and other livestock on farms. For her master’s thesis in architecture, Spade laid out the idea for a facility where humans could be composted this way, indoors, in a setting that would be both dignified and sanitary.

Upon graduation, she began in earnest to make the business a reality. In 2018 she partnered with the Washington State University Soil Science Department for a study using six donor bodies to confirm that soil produced from human composting would be pathogen-free. The heat produced by the composting process kills almost all pathogens; the only people who will not be eligible for composting at Recompose are those who die with prion conditions, like Creutzfeldt–Jakob (“mad cow”) disease, as the proteins that cause those conditions can remain toxic in soil for years.

Recompose’s vessel is not the only relatively new advance in the disposal of human corpses. The law that made Washington the first (and so far only) state in the U.S. to legalize human composting also explicitly legalized alkaline hydrolysis, also known as chemical cremation.

The novelty of Recompose got more attention, as alkaline hydrolysis was already legal in more than a dozen U.S. states. But because the technology fits so easily into existing crematoriums, chemical cremation, which was also originally developed to dispose of dead cattle, may be the more accessible option at the moment for people without access to a green cemetery or reduction facility.

More than half of the people who die in the U.S. each year are cremated, a process that emits more than 500 estimated pounds of carbon dioxide per body. In alkaline hydrolysis, a body is placed inside a vessel containing a solution of water and the caustic base potassium hydroxide that’s then heated and pressurized. Over about three hours, the pressurized liquid dissolves the body’s soft tissues as fire does in a traditional crematorium. Because there’s no combustion, there are also no greenhouse gas emissions.

The end result of both processes is the same: Bones that are then pulverized into what are typically referred to as the “ashes” of the deceased. Traditional cremains are the color of gray sand. The remains of a chemically cremated body are the pure white of seashells.

Green death tech also expands to engineered materials that line coffins and wrap corpses, and that sell themselves as accelerating the conversion of the former, resource-consuming you into matter that feeds other life forms, the ideological opposite of traditional burial marketing.

“People want their deaths to mean something. They want their bodies to be useful in some way.”

These include the offerings of designer Jae Rhim Lee’s company Coeio, which sells burial garments laced with a mixture of mushrooms and other organic matter that claim to speed decomposition and break down the toxic compounds the body releases. (According to his wishes, actor Luke Perry was buried in one after his 2019 death from a stroke at age 52.) The Italian designers Anna Citelli and Raoul Bretzel created Capsula Mundi, a biodegradable, egg-shaped urn whose creators say should be buried in the ground, with a tree as a grave marker.

New technologies for disposing of bodies allow new ways of mourning the dead. Even before Covid-19 disrupted the ability to gather in mourning, it was a challenge to convene dispersed loved ones and choose a specific place to lay to rest a person who lived their life in multiple cities or countries. The share of people who identify with organized religion has fallen. Secular services that fill the need for mourning rituals have grown in their place.

Recompose is also a funeral home, and eventually, the business hopes to move to a facility large enough to allow for memorial services where loved ones can participate in the process of placing the body in the vessel. The company also plans to offer franchising opportunities in a few years. While patents are pending on the specific design of their vessels, composting itself is not a proprietary idea. In the future, rather than calling the church to organize a service, one may call the closest organic reduction facility.

“People want their deaths to mean something. They want their bodies to be useful in some way,” said Nora Menkin, executive director of the People’s Memorial Association, a Seattle-based nonprofit cooperative funeral home. Over the last six months, there’s been a jump in calls to the organization from people contemplating their mortality while riding out the pandemic at home. They want options, she said, so that “your last act on earth isn’t polluting it.”

The way we dispose of bodies says more about how we live. Embalming became popular in the Civil War, the first episode in U.S. history where people died en masse far from their homes and needed to be transported for burial. Cremation rates rose as the country became more mobile, and scattered families could not be convened fast enough for a burial. Today, more people seek options that don’t contribute to the environmental destruction we see around us, that allows our earthly remains to be shared by the people we loved or disposed of altogether. To embrace our final obligation, which is to return to the earth the substance that let us be ourselves.

Complete Article ↪HERE↩!

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How death doulas are helping people process grief during the pandemic

By Tracey Anne Duncan

Like so many people, I have spent much of this pandemic grappling with grief. I’ve lost people I love, and even now, people I care about are ill. Even if you haven’t personally lost someone, you’re likely tapped into the collective sense of mourning. It’s hard to know how to comfort people who are dying or the people who love them under any circumstances, but when you can’t be together, it makes it even harder.

That’s where death doulas step in. In case you aren’t familiar with the term, a death doula is like an end of life midwife. They help dying people by guiding them and their families through the dying process. They help people plan out their death experiences. They can aid in navigating the practical parts — like wills and funeral planning, and also the emotional aspects — like helping people figure out what kind of rituals will make grieving cathartic.

Many of the usual ways that dying people and those who love them deal with death — deathbed visits, meetings with spiritual advisors, grief counseling — are not available to us right now. We may not get to have much, if any, contact with a person dying of coronavirus. In this pandemic of mass uncertainty, death doulas can help us through the grieving process.

“Doulas are professionals who provide support and guidance to individuals and their families during transformative life changes,” Ashley Johnson, an Atlanta-based death doula and founder of Loyal Hands, a service that matches people with end-of-life doulas, tells me. These doulas can train family members in some of the practical aspects of caregiving, help people create support plans, and counsel those who are dying and the people who love them, Johnson tells me.

Death doulas are also educators, in a way. Most of us spend a lot of time trying not to think about death, and we aren’t well-versed with the death process. Most of us aren’t even aware that death is a process that can be charted. Death doulas help folks get familiar with the normal and natural stages of dying, Johnson tells me. In the terrifying and confounding moments when grieving people are wondering what happens next and how they can deal with it with dignity, death doulas can step in to fill in the blanks.

There’s kind of a new-age, woo-woo stigma surrounding the work that death doulas do. They aren’t priests and they aren’t psychiatrists, so their professional world is kind of murky spiritual-ish/life coach-ish territory. But some psychologists do think that death doulas can play an important role in helping people cope with grief. “A doula could help people figure out how they want to mourn,” says Aimee Daramus, a Chicago-based psychotherapist.

Daramus adds that people should be mindful that many doulas aren’t trained therapists, but because they are familiar with managing grief so they are generally able to tell when a clinical professional is necessary. For people who are spiritually inclined, but not formally religious, this middle ground can be a comfortable place to mourn without devolving into either over-medicalized melancholy or eccentric science-shunning spiritualism.

“A doula should be able to recognize when someone’s thinking or behavior is starting to go beyond the normal range of mourning experiences.” In this way, death doulas can be a touchstone for figuring out if a person is having a healthy grief response or if they may benefit from another type of help. There is no one right way to grieve, of course, but some people can sink into depression if they don’t process their grief as it’s playing out.

One of the benefits of working with a death doula is that you can shop around to hire someone who fits your needs and understands the cultural specifics of your background. “A professional should work to understand the unique cultural practices relevant to that individual or family,” says Thomas Lindquist, a Pittsburgh-based psychologist and professor at Chatham University. This is especially important, he says, during important life milestones.

A lot of folks in the hospice and funeral industries will likely have a passing knowledge of many kinds of death practices, but you can find a death doula who shares your beliefs, or who literally speaks your own language. Grieving, while it is a universal experience, isn’t generic, and Linquist says that it’s important for a family or person’s religious beliefs to be incorporated into their care plan.

But how can a doula help someone die with dignity if they can’t even be in the same room with them? “As doulas, we have had to get really creative about the ways we meet with people,” says Christy Moe Marek, a death doula in Minneapolis/St. Paul, and an instructor at International End of Life Doula Association (INELDA). Marek says that she has met with the families of dying people on their decks and porches, but that she has had to meet with most dying people via Zoom. It’s not ideal, she says, but adds, “it is opening up such possibilities given the constraints of the pandemic.”

Death doulas are finding new ways to support people. “So much of the way this works right now is in helping both the dying and their loved ones to manage expectations, reframing what they hope for, and to shift focus onto how the ways we are connected whether we are able to be together in person or not,” Marek says.

Marek says that helping people accept the reality of difficult experiences is really the whole point of her work. “During the pandemic, what is actually happening is different than we could possibly imagine and we may not like it. We may actually hate it with our whole being, but it won’t change what is. So we work with that,” Marek says, “And that is what ends up being the mark of a good death.”

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The Final Chapter

By Melissa Red Hoffman, MD

The first time I saw a death certificate, I was 19 years old. The cause of death was listed as “laceration of the trachea and esophagus, also laceration of heart and lungs with fractures and bleeding caused by two gun shots in the neck and chest.” The death certificate belonged to my father, killed by a terrorist while on a business trip in Cairo. By the time I laid eyes on it, the certificate only served to confirm a very painful truth: My father’s story had come to a very tragic and bloody end.

It’s 26 years later and I’ve managed to use this tragedy to inspire a career focused on both trauma and hospice and palliative medicine. In the simplest terms, I spend half my time trying to save lives and the other half trying to ensure a good death. For me, it works. But there’s no denying that my father’s legacy is always lingering in the background, whether I am in the trauma bay or at a patient’s bedside. The cause of death imprinted on that death certificate, along with the fear, pain and suffering that I assume it caused my dad, and the grief, sadness and never-ending longing that it evoked within me and many members of my family, is never far from my mind. And for reasons that I don’t fully understand, I have reread that death certificate more times than I can count.

That being said, the first time I was actually handed a death certificate to complete, I was well into my yearlong hospice and palliative medicine fellowship, and my only response was, “What am I supposed to do with this?” Despite 10 years of training including medical school, general surgery residency and critical care fellowship, I had never seen this form in the hospital, much less received any guidance on how to complete it. My hospice attending provided some cursory instruction and assured me she was available if I had questions, and that was that.

Since then, I’ve filled out more than 100 of these forms; when I work as a hospice attending, it’s not unusual for me to fill out a half-dozen death certificates during an eight-hour shift. The CDC publishes a free guide ( www.cdc.gov/ nchs/ data/ misc/ hb_me.pdf) that has proven to be helpful to me as I’ve attempted to correctly determine and report the cause of death. State medical boards stress that physicians should exercise their best clinical judgment when filling out the form and that lawsuits involving death certificates are exceedingly rare, but I still sometimes find it nerve-wracking to determine the exact steps that led to a patient’s ultimate demise. While completing a death certificate presents an intellectual challenge and demands a short, but not insignificant, time commitment, I have recently come to view the process as something more profound than another item on my to-do list. Because this form is required for both burial and cremation, I now regard it as both the final chapter of a patient’s life story and the first chapter of a family’s bereavement narrative.

I often think of my father when filling out these forms and it always gives me pause. When I open the medical record, I’m usually touched by the thought that I’m very likely the last physician who will ever study this information. Reading through the chart, I like to linger for a moment or two and think: Who was this patient? What did he do for work? Who did she love, and, just as importantly, who loved her? I also find myself wondering what happened. What, if anything, could we have done differently or better? Could we have caused less suffering? Provided more comfort? Consulted palliative care earlier or at all?

Last week, while I was working at the local inpatient hospice facility, a female patient, five years younger than me and recently diagnosed with metastatic cancer, died before I had the opportunity to round on her. When I went to view her body, I was struck by the stark difference between the glowing, robust woman pictured in a photo hanging above her bed and the bald, gaunt corpse lying curled up on her side. “She truly had nothing left to give,” I commented to the nurse and the chaplain as they gathered her few belongings to return to her family. As I was getting ready to leave for the day, the funeral director arrived to collect her body and asked if I had a few minutes to complete her death certificate. I knew almost nothing about this woman—she had been under my care for only a few short hours—and yet I was tasked, and blessed, with signing off on the final chapter of her life. With this last act of patient care, I was able to support her family in the first steps along their grief journey.

As a surgeon trained in hospice and palliative medicine, my personal narrative has changed from “There’s nothing more I can do” to “Let me walk with you.” Taking the time to complete a death certificate is another way for me, and all surgeons, to follow a patient’s story to the very end.

Complete Article ↪HERE↩!