Tag: Death And Dying

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Washington passes bill to become first state to compost human bodies

“We’re making about a cubic yard of soil per person,” the founder of the company Recompose said.

Finished materials from the human-body composting process.

By Ben Guarino

It may soon be legal for the dead to push daisies, or any other flower, in backyard gardens across Washington state. The state legislature recently passed a bill that, if signed by the governor, allows human bodies to be composted — and used for mulch.

As the nation ages, U.S. funeral practices are changing. Rates of cremation surpassed 50 percent in 2016, overtaking burials as the most popular choice. The Census Bureau, in a 2017 report, predicted a death boom: 1 million more Americans are projected to die in 2037 than they did in 2015. Human composting, its supporters say, is an eco-friendly option that can meet this growing demand. A Seattle-based company called Recompose plans to offer a service called “natural organic reduction” (it has two patents pending) that uses microbes to transform the departed — skin, bones and all.

“We have this one universal human experience, of death, and technology has not changed what we do in any meaningful way,” said state Sen. Jamie Pedersen (D), who introduced the bill, which passed with bipartisan support on April 19. “There are significant environmental problems” with burying and burning bodies, he said.

Joshua Trey Barnett, an expert on ecological communication at the University of Minnesota at Duluth, listed the flaws in conventional burials: “We embalm bodies with toxic solutions, bury them in expensive caskets made of precious woods and metals and then indefinitely commit them to a plot of land.” Though incineration has a smaller ecological footprint, estimates suggest the average cremated body emits roughly 40 pounds of carbon and requires nearly 30 gallons of fuel to burn.

The bill awaits Gov. Jay Inslee (D), who placed climate change at the center of the presidential bid he announced in March. “The bill passed the legislature with bipartisan support and appears to be eco-friendly,” said Tara Lee, a spokeswoman in Inslee’s office. Inslee has 20 days to review the bill, which arrived on his desk Thursday. “He has not stated how he will act on this,” Lee said.

Burial practices are largely matters of state, not federal, law. The bill, which would take effect on May 1, 2020, also would legalize alkaline hydrolysis. That method turns bodies to liquid using a base such as lye. In the past decade, more than a dozen states have approved it.

Pedersen said he would be “shocked, frankly,” if the governor did not sign the bill into law.

Recompose founder Katrina Spade met Pedersen in a Seattle coffee shop last year and pitched the idea of legalizing human composting. The company’s system, she said, is a souped-up version of natural microbial decomposition. “It is actually the same process happening on the forest floor as leaf litter, chipmunks and tree branches decompose and turn into topsoil,” Spade said

The company’s service, which would include a funeral ceremony, will cost about $5,500, she said (more than the average cremation but less than burial in a casket). Microbes go to work within a large vessel, about eight feet tall and four feet wide, that fits a single body along with alfalfa, straw and wood chips. Over the course of 30 days, as temperatures in the vessel rise to 150 degrees, decomposition destroys the body, along with most pathogens and pharmaceuticals, Spade said.

Pacemakers would be removed beforehand; artificial joints or other implants sifted out afterward. “We’re making about a cubic yard of soil per person,” Spade said. Families would be allowed to take the compost home, or, because it’s a lot of soil, donate it to conservation groups in the Puget Sound region. Restrictions on where the soil could be applied would mirror rules for scattering ashes — broadly speaking, only on land with an owner’s permission.

The decomposition technique “is now a fairly common procedure” used to dispose of livestock carcasses, said Lynne Carpenter-Boggs, a soil scientist at Washington State University and an adviser to Recompose. During an outbreak of avian flu, Carpenter-Boggs helped farmers implement a similar method to destroy potentially infected poultry.

Carpenter-Boggs recently oversaw a pilot study in which Recompose composted six donated cadavers. The results are still unpublished, but Recompose claimed in a news release the soil met safety thresholds set by the state’s ecology department.

“The material we had, at the end, was really lovely,” Carpenter-Boggs said. “I’d be happy to have it in my yard.”

Barnett said the media often inflates the “ick factor” of human composting. “Very few people I talk with have this response,” he said. He added: “If most folks knew the ins and outs of embalming, I suspect they would find it much ickier in fact than composting

Spade said she has been deluged by emails from those who want to be composted, with particularly enthusiastic correspondents from California, Colorado and Vermont, and overseas from Brazil, the Netherlands and Australia.

“I have a few friends at some of the assisted-living facilities here in Seattle,” Spade said, “and these folks are in their mid-80s saying: ‘Look, we want these options. … We care about the last gesture we leave on this earth.’ ”

Complete Article ↪HERE↩!

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A Good Death Is Not a Failure, But a Gift

By Linda R. Duska, MD, MPH

I am a gynecologic oncologist and I’m boarded in palliative care. As a result of my training and 20+ years of clinical experience, I feel strongly about caring for the whole patient throughout the clinical course: spiritually, emotionally, and physically. In those 20+ years, I have experienced the end of life with many patients and families. Although everyone handles it differently, I’ve observed some common themes. It is difficult to stop treatment, to accept the inevitable with dignity, to die “well”—not just for the patient and her family, but for her providers as well.

This past Christmas, I experienced the death of a loved one both as a family member and a health care provider, acting in the stead of the health care providers who were absent at the end of life. The experience of my father in law’s passing brought home to me that inappropriate aggressive measures at the end of life are not limited to patients with cancer, but affect us all.

I met my husband when we were freshmen in college, and we spent a lot of time at his father’s home together. My husband has a big Catholic family who are all rabid Eagles fans; I am a Jewish liberal girl raised on the Boston teams. They accepted me unconditionally. I shared Sunday dinner with his family, brought my laundry over, watched movies on his dad’s TV. When my husband and I were married in a Jewish ceremony in Boston, everyone in his family came to the wedding and thoroughly enjoyed the ceremony and dancing the hora at the reception.

My husband’s family, and particularly his father, were an important part of both of our lives. My father-in-law, Ron, was a philosophy professor and a brilliant man who loved to argue (he would say debate) with his children. While he and I disagreed about many things, I never felt judged by him, or by anyone else in the family.

In the last few years, I could tell that Ron was sick, but he was private about the details and I didn’t pry. I did know that he had multiple stents placed in his cardiac vessels. This past year, though, there had been a significant deterioration in his condition. He had to stop golfing due to fatigue, and he was in and out of the hospital with shortness of breath and chest pain.

In December, I visited the community hospital where Ron was receiving care; his third prolonged admission in as many weeks. I found him sitting in a chair wrapped in a heavy blanket in an overheated room. He had lost a lot of weight and looked frail. He had to lean forward to breathe. A few weeks before my visit, he had undergone another cardiac catheterization (there was nothing more to stent) and a renal artery catheterization that showed bilateral significant occlusion.

Ron told me he expected to get better and get back to the golf course. I told him I wished for him to get well enough to go home and stay out of the hospital.

I had spoken to his wife on the telephone before the renal artery catheterization. I talked with her about requesting a palliative care consult as Ron was clearly suffering. We discussed the hard questions I was hoping would be addressed. I don’t know if she asked these questions. I do know that the doctors convinced her that the renal artery catheterization might help him. I know that they didn’t offer a palliative care consultation and I know that they didn’t tell my in-laws that Ron would not get better—that his current state was the best they could hope for.

On Christmas morning, my husband and I received a panicked call from Ron’s wife. When we arrived, he was clearly in distress. An episode of melena (that apparently wasn’t new) needed to be managed urgently. I spoke to his primary physician on the phone, who suggested we bring him to the ED. I asked him if the ED was the best decision; wouldn’t hospice be a better option? Yes, he said, it would. In fact, he said he had been thinking about this for the past two months. This revelation shocked me. Why, I asked him, had he not said anything to the family? Why was he continuing to recommend and pursue aggressive care in this 81-year-old man who was clearly declining? There was no good answer to this question.

And so it fell to me to tell Ron’s wife that he wasn’t going to get better, and that she had to make a choice: take him to the ED, where he was likely to be admitted to the hospital for another prolonged—and futile—stay, or keep him at home and call hospice. I will admit that I supported avoiding the hospital, and for better or worse, I influenced that decision.

I talked to Ron that morning during the intermittent periods that he was awake. He asked me how I knew he was dying. (A good question, but I just knew, an instinct honed over two decades of caring for patients with cancer.) He seemed genuinely surprised to hear that his condition would not improve. He told me he wasn’t ready to die, he had a lot of things left to do. (I asked him to make a list, but he couldn’t stay awake long enough to accomplish this task.) He said he was afraid. He had only that one morning to process impending death, and he never really got to say all of his goodbyes.

Ron died early that afternoon. I was with him. His death was peaceful. He was in his own home, surrounded by his (completely oblivious) grandchildren. It was what we call in medicine a “good death.”

But his family was angry. They weren’t prepared, they hadn’t known, they didn’t realize it would happen so fast. For the most part, they had all believed that he would get better. More than half of them didn’t make it to the house to say goodbye before he died.

I was angry, too. I was furious at Ron’s care providers that day. They never communicated clearly with him or his wife that he was dying, that his chances of getting better were slim. They didn’t discuss quality of life or goals of care. They offered aggressive procedures that were potentially life shortening and unlikely to be helpful, and the family didn’t feel empowered to decline. Their approach was the opposite of everything I believe in as a palliative specialist, an oncologist, a fellow human being.

Unfortunately, this type of aggressive care at the end of life happens often. We live in “a very peculiar, death denying society.”1 As providers, we spend far too much money on procedures at the end of life (chemotherapy, ICU, catheterizations) that are unlikely to benefit our patients, and in fact are likely to decrease quality of life and hasten death.

Why do we do this? Are we afraid to tell patients the truth? Are we reluctant to admit to ourselves that sometimes medicine has nothing more to offer and that death is unavoidable (for all of us)? Maybe it feels too much like failing to say that there’s nothing more we can do, even when there are other options (such as palliative care and/or hospice) that are far preferable to aggressive medical procedures and prolonged hospital stays.

A few weeks after Ron died, his wife called me. She wanted to talk about the decision we made to keep him home. She wanted to know if this was the right choice: if she had taken him to the hospital that day, would things have been different?

I told her honestly that yes, things would have been different—they would have been horribly worse. Ron would not have lived longer, and he certainly wouldn’t have died at home, in his bedroom, in his recliner, surrounded by his family. We could have painfully prolonged the dying process, by a few hours or a few days at most, but we could not have stopped it. She had made the right decision.

Here is the fact that we cannot avoid: We are all going to die. Whether we cheer for the Eagles or the Patriots, whether we are philosophy professors or medical professionals (yes, even us). I believe it is fair to say that most of us want to die that “good death,” surrounded by our family and friends, not attached to machines in a sterile hospital environment.

As providers, we must take that extra step to be honest with our patients and prepare them for the truth. To do less—to gloss over the inevitable end of life and deny them the opportunity for a good death—is to do our patients a profound disservice. For myself and for my family, I hope that our own health care providers will be honest with us about what medicine can and cannot accomplish in improving all aspects of health.

My pain at losing Ron is mitigated in a small way by knowing that I helped to spare him from discomfort and loss of dignity in the final hours of his life. I am so glad that, as a palliative care provider and cancer physician, I had the training and experience to do this small thing for the man who welcomed me so wholeheartedly into his family.

Complete Article ↪HERE↩!

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‘Natural death may not be kind, easy or peaceful for pets’

Cruel to be kind: animal hospice gives pets better way to die

To help pet owners make decisions about end-of-life care, Villalobos developed a decision tool based on seven indicators. The scale is often called the HHHHHMM scale.

By Tara Parker-Pope

Nearly 14 years ago, my daughter and I were grieving the death of my mother, and it seemed nothing could lift our spirits. Then we got Fluffy, a bouncing bundle of gray and white puppy, and everything changed.

Fluffy kept us busy with pee pads and squeaky toys. She made us laugh in spite of our sadness, and the gray clouds of grief began to recede

Over the years, our 10lb fluff ball was a constant in our lives. We dressed her up in holiday sweaters, celebrated her birthdays and scolded her for sneaking food from the cat’s dish. But in recent weeks, as our walks slowed down and her naps grew longer, it became clear that our time together was limited. I hoped that in the end, Fluffy would have a natural death, drifting off to sleep for good on her favorite pillow

A natural death is what many of us hope for with our pets. They are members of our family, deeply enmeshed in our lives, and for many of us, thoughts of euthanasia seem unfathomable, so we cling to the notion that a natural death is desirable.

In most cases, a natural death, she said, means prolonged suffering

But my veterinarian said that my end-of-life scenario for my dog wasn’t realistic. In most cases, a natural death, she said, means prolonged suffering that we don’t always see, because dogs and cats are far more stoic than humans when it comes to pain.

Dr Alice Villalobos, an oncology veterinarian in California, said that many pet owners idealise a natural death without thinking about what a “natural” death really means. A frail animal, she noted, doesn’t linger very long in nature. “When animals were domesticated, they gave up that freedom to go under a bush and wait to die,” Villalobos said. “They become very quickly part of mother nature’s plan due to predators or the elements. And yet in our homes we protect them from everything so they can live a long time – and sometimes too long.”

I had reached out to two at-home vet services that both offered compassionate guidance and confirmed my fears that no treatments were available to improve her condition

Villalobos has dedicated her career to helping pet owners navigate end-of-life issues. She created an animal hospice program she calls “pawspice.” She coined the name because she doesn’t want to confuse end-of-life care for animals with the choices we make for human hospice.

Her program is focused on extending a pet’s quality of life. That might mean treating a cancer “in kind and gentle ways,” she said. It can mean supportive care like giving fluids, oxygen or pain medication. In some cases, it might mean hand-feeding for frail pets or carrying an animal to a water dish or litter box. And finally, she said, it means a “well death.”

Villalobos has advocated what she calls “bond-centered euthanasia,” which allows the pet owner to be present and play a comforting role during the procedure. She has also championed sedation-first euthanasia, putting the animal into a gentle sleep before administering a lethal drug.

To help pet owners make decisions about end-of-life care, Villalobos developed a decision tool based on seven indicators. The scale is often called the HHHHHMM scale, based on the first letter of each indicator. On a scale of zero to 10, with zero being very poor and 10 being best, a pet owner is asked to rate the following:

HURT Is the pet’s pain successfully managed? Is it breathing with ease or distress?
HUNGER Is the pet eating enough? Does hand-feeding help?
HYDRATION Is the patient dehydrated?
HYGIENE Is the pet able to stay clean? Is it suffering from bed sores?
HAPPINESS Does the pet express joy and interest?
MOBILITY Can the patient get up without assistance? Is it stumbling?
MORE Does your pet have more good days than bad? Is a healthy human-animal bond still possible?

Villalobos said pet owners should talk to their vet about the ways they can improve a pet’s life in each category. When pet owners approach end of life this way, they are often surprised at how much they can do to improve a pet’s quality of life, she said.

By revisiting the scale frequently, pet owners can better assess the quality of the pet’s hospice care and gauge an animal’s decline. The goal should be to keep the total at 35 or higher. And as the numbers begin to decline below 35, the scale can be used to help a pet owner make a final decision about euthanasia.

“Natural death, as much as many people wish it would happen, may not be kind and may not be easy and may not be peaceful,” Villalobos said. “Most people would prefer to assure a peaceful passing. You’re just helping the pet separate from the pack just as he would have done in nature.”

Complete Article ↪HERE↩!

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Hospice Care & Palliative Care – When to use Them

Hospice a word that is synonymous with “end of life” care. Palliative – a little more confusing and often confused with ‘end of life’. The two are very different therapies but Palliative Care is an offshoot of Hospice.

by Petr Horcik

Hospice is a service for patients who are terminally ill and have decided not to take any more medication that might “cure” them (i.e. chemotherapy for a cancer patient). The focus becomes relief from pain and symptoms and not a cure. There are some who say that going into Hospice means you’re giving up or that you will no longer receive the medical care you need. That is not true – you have chosen to focus on your quality of life not the quantity and the medication used is to do just that.

A Hospice team usually includes a doctor, nurse, social worker and chaplain (if you wish). They work together to meet the patients physical, emotional and spiritual needs. This team also cares for the family who can be against the choice to, in their eyes, “give up.” There is counseling, hugs and support from a good Hospice team – my Mother’s team was unbelievable and supported and counseled our entire family through the last three days of her life.

To qualify for Hospice your doctor must state that the patient’s death is expected in 6 months or less. If a patient chooses Hospice then changes his or her mind it isn’t an issue. The patient simply goes back into the curative therapy with their doctor. You can also change your mind again and be readmitted . . . there is no pressure – it’s about what you, the patient want.

Palliative Care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illness. This type of care is focused on providing relief from the pain, symptoms and stress of a serious illness for both the patient and family.

Again, it’s a team of specially-trained doctors, nurses and other specialists who work in partnership with the patient’s other doctors to provide an extra layer of support. It can be used at any age and at any stage in a serious illness. The services are offered in tandem with the curative treatment. A good example of Palliative Care use is in Parkinsons or Multiple Sclerosis when there are flare ups.

Both Hospice and Palliative Care are paid for by most insurance companies including Medicare and Medicaid. Both are offered in your home, nursing homes, assisted living centers, hospitals and provide respite care when the caretaker family needs a break.

What these two services offer us are choices in treatment for serious illnesses. We each have our own journey and whilst none of us hope it comes to either of these services, we can make informed decisions for us or our loved ones knowing that they exist. No matter how strong you are physically and emotionally – watching a loved one suffer is often intolerable. There are teams out there to support and comfort. Use them if you need them.

Complete Article ↪HERE↩!

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Common myths about grief

By Gary Roe

Most of us have some strange ideas when it comes to grief.

I was five years old. I had just experienced what I assume was my first case of bullying. I was shocked and confused. I felt sad and angry. I was deeply disappointed. 

I had other disappointments before that, and I’ve had many since. More bullying, conflicts, failures, break-ups, rejections, estrangements, losses, and deaths. Each time, I experienced that heavy assault of shock, sadness, confusion, and anger. In some cases, the hurt went deeper, and bored its way into my heart. These deeper wounds came with added upset, anxiety, fear, and even depression. 

I was grieving. In each case, something occurred that stunned my heart. I had lost something, or someone. 

When we hear the word “grief,” most of us think of death. Grief, however, is the response of our hearts to any loss. Grief is everywhere, but it’s not a popular subject. It’s is one of those things we would rather not talk about. 

When something isn›t talked about, a stigma often becomes attached to it. When it comes to grief, myths abound. 

Here are five common myths about grief.

Myth #1: Grief is something to be conquered and overcome.

When we view grief as something to be conquered, we’ve labeled it an enemy. Like some unwelcome villain, it lurks in the shadows to trip us up and steal our happiness.

In reality, grief is a natural response to a loss of any kind, real or perceived. Our expectations are shattered. Life has surprised us. We’re hurt and wounded.

Grief is universal. Rather than something to be overcome, it is to be experienced and processed. We don’t conquer it, but move through it to heal and grow.

We have hearts. Grief is natural.

Myth #2: Grief is negative and we should get rid of it as soon as possible.

Because we associate grief with pain, we see it as inherently negative. No one wants it. Everyone flees from it. And if we›re in it, we want to get out of it as quickly as possible.

Painful things happen in life. If we don›t feel that pain, we become callous, bitter, and perhaps abusive. Denying or avoiding grief sets us up for a world of frustration and dysfunction.

Grief is actually positive. It declares that we have hearts. As we learn to process it in healthy ways, we discover our grief reveals what›s important to us.

Myth #3: Grief should be quick and easy.

We have this idea that grief should be over in a few days. If the loss is especially close or painful, perhaps a few weeks is acceptable. Anything more than that, however, and something is wrong. After all, life goes on. Better to buck up and get over it rather than waste away in sadness.

The truth is that grief has no timetable. Grieving isn’t a task to check off a to-do list. It’s a dynamic, somewhat unpredictable process.

Intense feelings surface. We suddenly find ourselves on an emotional roller-coaster full of unforeseen twists, climbs, and falls. This ride isn’t over in 90 seconds either. Grief is more of a marathon than a sprint.

Almost all the grief we experience is relational. Most losses tend to involve another person somehow. These losses hurt, and some can alter our personal worlds forever.

Most of us are grieving on some level. We’re constantly dealing with the results of what has happened to us. Grief is far from quick, and it’s never easy.

Myth #4: There are right ways to grieve.

If we must grieve, we naturally want to standardize the process. We want a recipe — a foolproof handbook for managing loss and hardship. We long for a checklist to measure our progress so that we when the last box is checked we can breathe a sigh of relief and say, “Done with that!”

We’re not robots. Each loss is unique. Circumstances, relationships, and hearts are all one-of-a-kind. Though there are patterns and similarities here and there, every single grief process is an individual adventure.

Though there is no right way to grieve, there are healthy and unhealthy ways of grieving. We learn, heal, adjust, and grow when we take our hearts seriously, practice good self-care, and stay connected to people who are helpful to us. If we instead choose to ignore and stuff our grief, it will leak out in ways we’ll most likely regret. Grief will be expressed, one way or another.

Grief is universal, but every grieving heart is unique.

Myth #5: Strong people don’t grieve.

We tend to confuse strong with stoic. Strength is synonymous with hard and impenetrable.

We’re not made of steel. Our hearts are not bulletproof. Strength doesn’t come from evading reality and ignoring emotions. We grow stronger as we face obstacles with the courageous resolve to do the grief work necessary to heal and grow.

Strong people are authentic and pursue integrity. What you see is what you get. They choose relational honesty over hiding. They grieve from the heart in healthy ways.

We love, and so we grieve.

Grief is natural and universal. It is a normal and healthy response to loss. When it comes, nothing strange or weird is going on. Grieving well, far from being negative, is the way we heal. It’s a process that takes time and effort. Each loss is unique and every person’s grief process is somewhat different. Grieving in healthy ways takes courage and internal strength.

Life is full of loss because it is also full of love. We love, and so we grieve. If you’re grieving today, please take your heart seriously. Look inside and process the hits well. Get around people who are helpful to you. Limit your exposure to critics and fixers. Be patient with yourself.

Many of us are hurting. Let’s grant one other the compassion we all need and long for. Grief is lonely, but the road of loss is well populated. Though we’re all unique, we can still travel together.

Complete Article ↪HERE↩!

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Why Victorians Loved Hair Relics

Victorians were mesmerized by the hair of the dead — which reveals something about about how they saw life.

A case of memorial jewelery made from human hair

By: Matthew Wills

This year marks the 200th anniversary of Walt Whitman‘s birth. To celebrate, the New York Public Library and the Grolier Club are hosting exhibits, both of which will include samples of Whitman’s actual hair. Yes, hair.

In the Victorian era, jewelry made with hair was all the rage. In 1854, the novelist Wilkie Collins wrote that bracelets made of human hair were “in England one of the commonest ornaments of woman’s wear.” Ten years later, Charles Dickens wrote that a man’s watch fob made of hair was the real mark of middle-class respectability.

Victorians on both sides of the Atlantic were particularly mesmerized by the hair of the dead. Victorian literature scholar Deborah Lutz explores “the materiality of death and its artifacts” of the era, finding antecedents in the Christian reliquary tradition, when body parts of saints were considered magical. Protestantism and secularization shifted this fascination toward the sought-after body parts of royals and the very famous (like Napoleon, whose penis is supposedly now in New Jersey). By the middle of the nineteenth century, this long Western tradition had become “increasingly secular, personal, and private.” And concentrated on hair.

Hair was a very tangible reminder, memento, souvenir, and keepsake of a life, and of a body.

Loved ones and relatives could give hair as tokens of love and friendship. Family members or lovers could twine their hair together. After a person’s death, their hair remained; as the Whitman exhibits show, well-preserved hair can last a long time. Hair was a tangible keepsake of a life, and of a body. Perhaps it imparted a sense that you might meet again.

Lutz writes that such relics “work as traces of a life and body completed and disappeared, in this sense something like last words, by they also serve as frames or fragments of the moment of loss.” These present reminders of those who have died speak of a “desire to see death as not permanent, in that material remains might be proof that the loved one still exists somewhere, somehow.” Relic worship also shows a willingness “to dwell in and with the moment of loss itself, to linger over this evidence of death’s presence woven into the texture of life at all turns.”

Romanticism, the Evangelical revival of the 1830s-40s, and Spiritualism’s rise in the 1850s-1860s, all contributed to this “after-death narrative” and the mid-century popularity of “hairwork.”

Lutz reminds us of the passage in Emily Brontë’s Wuthering Heights (1847) when Heathcliff switches his rival Linton’s hair from the locket around the dead Catherine’s neck and replaces it with his own. “Rather than gathering a memento of Catherine for himself, Heathcliff sees to it that a material fragment of his body will go down into the grave with Catherine’s corpse, to intermingle with her flesh.” The notion of the “good death” merges here with the palpable eroticization of death. Of course, Heathcliff’s plans are foiled by Nelly Dean, who twines Linton’s lock around Heathcliff’s—opening “the possibility of a postmortem storm of jealousy.”

Fiction mirrored the times. After her husband’s death in 1861, Queen Victoria had at least eight pieces of jewelry made that incorporated Prince Albert’s hair. The Victorians “found in relic culture a means to respect the irreducible self.” Such a culture, Lutz says, “sees death, and the body itself, as the beginning of stories, not their end.”

Complete Article ↪HERE↩!

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‘People have been frightened for me to tell their loved one they’re dying, in case they die quicker’

An intensive care doctor has written an honest book about her experiences.

NONE OF US want to end up in intensive care. But if we do, we should hope we end up with a doctor like Aoife Abbey.

The UK-based Irish doctor has written a book about what it is like being an intensive care doctor, exploring the emotional moments she has experienced. It’s a book that might just change how you think about death – and how you talk to your family about it.

After reading the book, Seven Signs of Life, you’ll want to sit down with your nearest and dearest to discuss what might happen to you should end up needing intensive care. Talking about death or serious illness is a taboo that still persists, but Dublin-born Abbey – who is in her mid-thirties – wants us to confront it.

“I appreciate people need to talk about death more because what I often say is, people come into intensive care, they don’t know they’re going to be there – it’s a surprise to everybody, they’ve had an accident or something,” she explains. “And you say to their family ‘what do you think they would have wanted?’ And the answer is ‘God, I don’t know. We haven’t talked about it.’ Why would you?”

This avoidance can lead to big questions being unanswered. “How would the patient feel about risking being alive and not being able to talk, how would they feel about organ donation? There’s lots of things people don’t discuss, and I think we need to discuss them more,” says Abbey, who graduated from the University of Warwick in 2011.

She advises people to have those difficult conversations with loved ones. “But what I would say is that it can often be difficult to imagine yourself in situations, so people might say ‘oh I would hate to have dementia. I’d rather just drop off.’,” she cautions. “When actually they don’t know that it’s true, because they’re not in that situation. So I think we have to be careful when we have conversations about life and death and what you’d like, in that we’re having general conversations and that we’re still not trying to pigeonhole people into certain decisions.”

Because often people will say ‘I would hate to live this way’ but actually then find an amount of joy and contentment living that way in the end because they have no other option. It is a difficult conversation.

“I guess in Ireland there’s always that thing of people say ‘don’t tempt fate’,” she says. Abbey and her family have had to deal with serious illness themselves. Her brother, Aaron, was a disability rights campaigner and died in October 2018. He was in and out of hospital a lot while the siblings were growing up.

“I’ve certainly had encounters where people have been frightened for me to tell their loved one that they are dying. And not just because they were worried that it would upset them emotionally, which is a very valid worry and I would worry the same thing,” says Abbey.

Because they would feel like that would mean they would die quicker. That crops up quite a lot, people say don’t tell them, because they’ll just give up.

‘It’s routine… until it isn’t’

The book was inspired by anonymous columns Abbey wrote for the British Medical Association, and the stories of the patients in the book are anonymised and amalgamated.

“I always loved intensive care and I loved it because there’s a lot of science there, you get to be specific, you get to care about the numbers,” says Abbey. “You have a lot of facilities, you know the nursing to patient ratio is one to one or one to two, you have all the numbers in front of you, everything is quite scientific.”

At the same time, this is juxtaposed against “the massive uncertainty of not knowing what somebody’s outcome is going to be”.

The level of pressure and responsibility builds the longer you work in intensive care.

There’s always an opportunity to ask for help. You learn as you go along and that’s how we do it, so it was never the case where I had to walk into an ICU and make loads of decisions.

She says that like everything in medicine, “all of this stuff is routine until it isn’t”. Indeed, in the book she details times when things did not go to plan. “If you intubate 100 patients and 99 of them are perfect, easy … it’s the one that’s difficult that’s the issue. So most things are routine, there’s always the potential for it not to be.”

When it comes to errors, the onus is on the doctor to make sure they learn from it.

“There’s nothing that makes you learn more than making a mistake,” she says. “You’re unlikely to ever do it again.”

The main thing is there is a culture, and it’s the right culture, where we don’t blame people when they make mistakes. And we’re supposed to recognise it’s a systems failure, and there’s lots of different explanations for why things go wrong, and it’s rarely one person’s issue; one person’s fault. But at the same time you have to figure out ways as a doctor to still accept and be OK with the fact also that you did make a mistake.

She includes in the book an incident where she missed something on a chest x-ray. It must have been nerve-wracking to write about when she first included it in a Secret Doctor blog post.

“It is still in numbers their most read blog. So it’s … I’m not going to say vindicated but there’s a need for that kind of discussion and people clearly had an interest or it struck a chord with them.”

She has never worked with the HSE, and describes the NHS as something that’s very much woven into national identity in the UK. “You have this service that’s free at the point of care, and people are very proud of it. It’s a very emotive topic,” she says, noting that “it doesn’t matter how angry the media is with the NHS at a given point, patients that I see behave the same. Most of them they are grateful, they’re frightened, they’re scared – they are just people, they are separate from political issues.”

Speaking of political issues, the big one for NHS workers and Irish emigrants like Abbey is Brexit. “If I wasn’t from Ireland I would have a huge amount of uncertainty and I’d be very worried,” she says. “You don’t really know what’s going on. You take so much for granted.”

But it’s not something that she lets take over her work. “I think you just learn to be very focused on what you’re doing. You have to let things in in the moment or else you’re not human, and you can’t engage with someone who’s being very emotional with you with a wall in front of you, because it’s not human and it’s not very nice for them either.”

She has learned to talk to her colleagues and friends about things that affect her, and not keep it bottled up. This is her eighth year in training, and in August 2020 she’ll be able to pursue a consultant job.

In the book she details very tender and emotional moments, such as when a dying man asks her to lift his head up so he can talk to her properly. It’s those intimate moments that leave an impact on her.

“There’s things you get exposed to but I guess in the moment it’s so much about what that person is feeling, you do feel a little bit humbled by the fact that you’re able to give them anything,” she says.

Because they’re going through something that is horrible. And you put it aside until you get home, or until you close the door of the room.

Seven Signs of Life is out now, published by Penguin Random House.

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