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Do Mexicans accept death better than other cultures?

Day of the Dead diffuses the grieving process for loved ones, but it’s still a difficult loss

Funeral procession with taxi in Tenango del Valle, México state. More common in towns and rural areas, processions are rare in Mexico City.

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Oddly, we’d had a casual conversation about Licha’s condition a few weeks ago, when my husband Alejandro assured me that things were OK with his sister-in-law’s cancer treatment.

Then, a few days ago, I hear him talking on the phone with that tone of voice that transcends all linguistic barriers. You know the one — half hushed and 150% serious.

Licha’s death on June 19 was my second experience with a death in Alejandro’s family; the first was 12 years ago. My experiences with these events contrast somewhat with a lot of what is written in English about death in Mexico. The idea that death is dealt with differently here, more easily and readily, might be a little simplistic.

Such writings focus on Day of the Dead and its festive skeletons. It is true that Mexicans have their own way of relating to the general concept of death, but it is not a devil-may-care attitude, especially when it hits home.

As a United States-raised Protestant, both deaths I experienced caught me a bit by surprise because there had been no frank talk beforehand about the serious medical issues both women had.

Funeral at a church in San Francisco Tlaltenco, in Mexico City. The requirement to dress up or wear black seems to vary by region and social status.

In the case of Alejandro’s sister, Lupita, this was kind of understandable as she was only 45 years old. I do not know to this day how much Alex knew of her condition before she went into the hospital for the last time; I think Lupe herself kept most of it secret from the rest of the family.

Licha was in her early 70s — still too young though not quite so tragic — but a similar scenario played out. Everything was OK, or not so bad, until it wasn’t.

Like everywhere else, once death comes in Mexico, ritual and tradition take over. They seem to vary greatly in the details depending on a family’s socioeconomic status.

To get it out of the way, I’ll say that my husband, Alejandro, comes from a lower-working-class urban family — Catholic, but not overwhelmingly so. My husband believes in God but not so much in the church.

In Alex’s family, death is immediately followed by a flurry of phone calls among distant family members discussing decisions whether or not to travel. Mexican families don’t tend to scatter like U.S. ones do, and the need to travel long distances is still rare enough the families might not take this into consideration when making funeral arrangements.

Alex’s family is somewhat scattered in central Mexico, so the decision was made for him to travel to Guadalajara while I would stay in Mexico City.

Like many other cultures, Mexican funeral rites have a wake, or viewing period (although this can be optional), and some kind of ceremony related to the disposal of the body. The details of how these are done vary by local and family traditions along with the economic situation of the family.

There is also a novena, or period of prayer, unless the family is not Catholic.

The wake can last anywhere from 24 to 72 hours, depending on whether the body is embalmed. If not, the body must be buried or cremated within 24 hours.

Aside from this, regulations are not as strict or as pervasive as in other countries, and there is some flexibility in how and where a body is set for viewing. Family members can participate in the preparation of the body, such as applying makeup to the face, with viewings happening in funeral parlors or in people’s homes.

The body is laid out in a coffin and usually separated from viewers by a pane of glass or translucent shroud, though an open casket allowing mourners to touch the body is not unheard of.

Someone is usually with the body day and night at this time, often with one or more people praying. But there is often food and conversation going on as well, especially in the areas farther away from the deceased.

Final rites can be held in the same funeral parlor as the wake or at a church, with the latter being more common in more rural areas — as are processions. In the almost 15 years I have lived in Mexico City, I have never seen any sort of funeral procession, but I have seen them (motorized and on foot) in towns.

In the case of my husband’s sister, the final service was in the funeral home, with only immediate family accompanying the body to the crematorium. Burial is far more traditional, but the lack of space in places like Mexico City has made cremation more acceptable. Burial or the depositing of ashes is often done with a small ceremony.

If you are not from a Mexican Catholic family, the biggest difference for you will be the novena — a nine-day period after the burial when family and close friends gather at least once a day — often after work — to recite the rosary and other prayers for the deceased.

This is done in the deceased’s home or that of a close family member. It often means a crowded house, full of people eating tamales and drinking atole once the somber task of praying for the soul is completed.

Dress codes for public funeral rites vary quite a bit, and it seems mostly to have to do with socioeconomic status. People may wear anything from the most formal attire, preferably in black, or the clothes they wear every day. In my husband’s family, somewhat more formal attire in a darker color suffices.

Although the rites observed in the hours and days after a loved one dies are very important, they don’t seem to take on the sense of urgency that they have in my family. Probably because of Day of the Dead (when many funeral rites are repeated), it is not necessary to show all of your grief immediately.

So, yes, funerals in Mexico are about saying goodbye, but that goodbye is not as absolute as they are in Anglo-Protestant cultures. On Day of the Dead, you have a chance each year to relate to those who have gone before, a psychologically healthy way to deal with lingering grief.

Complete Article ↪HERE↩!

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How to Support a Colleague Who Just Lost a Baby

The loss of a baby is an undeniably singular and terrible loss. And for those who haven’t experienced this type of loss, it can be difficult to know what to say or do or how to help. But social support is one of the ways that humans get through grief, and how you respond to your colleague affects their experience of returning to work and overall well-being. Distilled from the experiences of grieving parents, the author offers ways to best support team members who face this devastating loss. While there is nothing you can do to take away your employee’s pain, you can make their return to work more tolerable. By offering flexibility, compassion, and patience, and following their cues, you can help your colleagues feel both validated and supported.

by Dina Smith

Tragic. Heartbreaking. Unbelievable. Whatever words we may choose, they fall pitifully short of the devastating reality of losing a baby.

Sadly, this unthinkable heartache occurs more than we may care to know. In the United States alone, approximately 45,000 people lose their babies to stillbirth or infant death each year. Tens of thousands more lose wanted pregnancies to spontaneous miscarriage. Still others are faced with the gut-wrenching decision to terminate their pregnancy for medical reasons.

The loss of a baby is an undeniably singular and terrible loss. For pregnant employees, there is a physical experience that comes along with the emotional challenge. Even with losses before the 20th week of pregnancy, it can take weeks to months for the body to recover and return to normal.

Further, many people can’t understand or might not acknowledge baby loss as a real loss. It is a disenfranchised grief, a term coined by bereavement expert Kenneth Doka to capture the experience that comes from losses that are not openly acknowledged, socially mourned, or publicly supported. Worldwide, grieving parents often feel that they can’t talk about their loss and even unentitled to feel the way they do. It is a hidden, lonesome sorrow.

But as I know from losing our daughter, Anya, when she was only three days old, losing your baby can bring you to your knees. It is a trauma and full grief. Life after Anya died was heartrending, disorienting, and very lonely.

Amid the grief and the physical and emotional challenges that accompany this unimaginable loss, the return to work can feel daunting and nearly impossible. And for those who haven’t experienced this type of loss, it can be difficult to know what to say or do or how to help.

But social support is one of the ways that humans get through grief, and how you respond to your colleague affects their experience of returning to work and overall well-being. Distilled from the experiences of the many parents I’ve met as a member of the club no one wants to join, here are ways you can best support team members who face this devastating loss.

Express your condolences simply.

When someone experiences a loss, it’s human nature to want to alleviate their pain. This can lead us to reach for platitudes such as “Time heals all wounds,” or “You’ll have more kids,” or “I know how you feel.” While well intended, these statements are unhelpful. They minimize the person’s loss and can make them feel even more isolated.

Instead, express a simple message of condolence and don’t press for details. For example, you might say “I am so sorry for your loss, I wish there was more I could do. I’m here if you want to talk or if I can help with anything.”

Consider sending flowers or donating to a relevant foundation, such as the March of Dimes or one that plants trees in memoriam. And keep in mind that losing your baby is often a crisis at home. Grieving parents face unimaginable decisions and a cascade of painful communications, so consider practical support like organizing a meal train.

Offer flexibility.

This grief is unique and different for everyone. While your company may have an official bereavement policy, your best move is to take the individual’s lead on when and how they return to work.

The workplace often contains triggers, and your colleague may need space and time before returning. Pregnant colleagues, office baby showers, and photos of co-workers’ babies adorning their desks can be excruciating reminders of what they no longer have.

Others may be ready to return sooner but want to ramp up over time or prefer to start from home. According to psychologist Dr. Donna Rothert, some grievers find it satisfying to return to a job that they’re good at, where they have some control and their efforts lead to results: “It is the opposite experience of losing your baby, where so much is outside of your control.” Work can also provide a welcome break with something to focus on other than grief.

The simple fact is that one size does not fit all. Consult with your team member regarding a return-to-work plan and let them come back on a timeline and in the ways that they can.

Seek guidance on what to communicate.

Consult with your colleague about what they would like communicated to the team and by whom. Ask if they would like you to send a message to the team or if they’d prefer to communicate directly or have a trusted colleague do so. Be careful not to make announcements you’re not authorized to share.

Especially in larger companies, news may travel slowly, and it can be helpful to share cues for what the person wants. For example, some people don’t want to be asked about their loss. Others want to be asked so they can say their baby’s name and remember them.

There is no right or wrong. Rather, it’s about respecting their personal needs and wishes and the rituals they have chosen.

Follow their lead.

Grief doesn’t operate in neat stages on a prescribed timeline. There can be a wide variety of responses to grief and a person’s needs and feelings fluctuate. Your best course of action is to regularly check in for how you can best support them.

You might say, “I’m glad you’re here and I imagine it’s not easy. Is there anything more that you need from me or the team?”

Some people want the welcome distraction of their work. Others might need a slower pace or fewer responsibilities for a while. Don’t make assumptions and alter their work without consulting with them first.

Returning to work can be an intense experience for grieving parents, so proactively communicate that it’s perfectly okay to take breaks, get out for walks, call their partner, or check in with trusted colleagues over the course of the day. And that if they need to suddenly leave a meeting or go home, to do so.

Remember, too, that at this point your employee may be questioning just how important work really is. While your team member will navigate to the other side of this crossroads in time, your support in the interim can ease their recovery and increase levels of organizational commitment.

Honor the memory of their child.

If your team member has expressed willingness and interest in talking about their loss, don’t back away from the conversation. But be there to listen, not talk. If they have shared their baby’s name with you, you might also ask simple questions such as, “How did you choose that name?” that allow them to remember and talk about their baby.

UCSF clinical professor of psychiatry Dr. Catherine Mallouh recommends continuing to check in every three months or so. Asking, “How are you doing?” or “Would you like you tell me more?” signals you care and haven’t forgotten.

Recognize that the anniversary of a baby’s death can be a very emotional day. Mark your calendar and proactively offer your team member the day off.

While there is nothing you can do to take away your employee’s pain, you can make their return to work more tolerable. By offering flexibility, compassion, and patience, and following their cues, you can help your colleagues feel both validated and supported.

Complete Article ↪HERE↩!

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Facing death

— A medical student experiences the first death of a patient

By Ileana Varela

Every medical student has felt apprehensive about facing death at some point, right? Maybe you have experienced someone dying before, or maybe it is something you have never seen and only rarely contemplated. Regardless, there is a subtle tension lurking during your first two years of pre-clinical studies, during which disease and death are intellectualized and abstract. Then clerkships start. Working throughout the hospital, you feel that death is lurking just around the corner. It is palpable. It is hearing a code blue being called on the overhead speaker. It is entering the room of a comatose patient who is technically “alive” but not truly “living.” Whatever one’s experience has been with death, I am confident I am not alone in having felt apprehension and anxiety towards the idea of watching a patient die for the first time.

I managed to get through half of my third year without even being near a patient who died. As I began my rotation in trauma surgery, my anxiety about the experience had evolved into dread. I was certain that whenever I did finally see someone die, it would surely result in panic. In a weird way, I wanted to just get it over with. I could hear one of my professors saying, “We all go through it, it is best just to rip the band-aid off.” As it happened, on just my second night of trauma surgery, a level 1 rolled into the bay. Five gunshot wounds – one to the arm, one to the leg, three to the abdomen. He was in and out of consciousness by the time he got to us. When he was able to speak, he only sputtered out short phrases about being scared. In almost no time, he was sedated, intubated and on his way to the OR. We scrubbed in as fast as we could.

The operation lasted five hours, but it felt much longer. For the most part, it never really looked good. His bowels were shredded from bullet fragments and every time we closed one bleeding artery, we found another. It seemed no amount of epinephrine or fluids could keep his blood pressure up. About two hours into the operation, he coded. The attending surgeon barked an order at me and I started doing chest compressions. They defibrillated him. He still had no pulse. Back to compressions. I felt the crunch of his ribs fracturing beneath my palms. My face shield fogged up from my own labored breathing and I felt sweat building up in my skin-tight surgical gloves.

“This is it, this is the first patient I will see die.” The thought crept into my head for a split second, but there was no time for those thoughts or feelings — I had to do more compressions and another shock. Suddenly, he had a pulse! A brief wave of relief came over me. We operated for another hour, but despite our efforts, his pulse continued to become slower and weaker with each passing minute. Eventually, we found a hole in his aorta and it became clear to everyone in the room that there was likely no way to prevent this man’s death. Yet, we recognized the importance of striving towards the one-in-a-million chance to save a life; so, we continued to work.

But after another hour, the surgeon received a call. A child had fallen from a tree and required the team’s attention in the operating room across the hall. There was no longer the time or resources to work toward that minuscule chance of survival for the person on the table in front of us. The surgeon called off compressions. We stopped plugging holes, most of which at this point had little blood left to spurt out. Most of the team ripped off their surgical gowns and hurried off to start the routine over again next door. Suddenly, the only people in the room were me, an intern, a nurse and this man on his literal death bed.

His heart was barely beating, a mere technicality keeping him alive for a few more moments. My job was to keep my hand on his aorta and notify the surgeon when there was no longer a pulse so he could call the time of death. All of the monitors had been turned off and the room was silent. I held the now deflated tube of tissue between my fingers, closely focusing to detect the weak, irregular pulsations coming from a desperately failing heart.

Now, there was much more time and space for that dreaded thought to creep in. Surely, this is when I would recognize the reality of the situation and panic from the experience of witnessing death so intimately. Yet surprisingly, fear and dread were hardly present. Rather, I was simply sad. I was sad for this man I knew nothing about whose life was violently cut short. I was sad for his friends and family. At the same time, however, I was proud. I was proud to be feeling for this dying stranger rather than wrapped up in my own anxieties about death. More importantly, I was proud to have been part of what felt like the best effort possible to save this man’s life. My thoughts were interrupted when I recognized the stillness of the aorta. It was over. The surgeon came back to call the time of death and we sutured his wounds as neatly as we could. Even throughout this routine, I felt the gravity of the task at hand. My sense of pride persisted, knowing that we were still working hard to make the coming experience for his loved ones at least slightly less traumatic.

What made facing death more tolerable that day was the efforts made along the way. Feeling powerless is perhaps the most overwhelming aspect of death. But it is now abundantly clear that small efforts in the world of medicine provide a certain sense of empowerment and peace even in the face of horrific and inescapable outcomes. What I will remember from my first death is that we worked to provide a fighting chance and maybe even some eventual comfort to his loved ones. Efforts like these provide clinicians hope for a better outcome next time or, at least, help a family find some peace knowing that everything possible was done. They preserve patients’ dignity in both life and death. Now, I am sure that feelings like fear and anxiety will oscillate throughout my career — after all, medicine is imperfect, things go wrong and people suffer despite our best efforts. I recognize now, however, that the best way to combat our sense of powerlessness when facing outcomes that are out of our control is to appreciate the small differences we are able to make. Ultimately, these seemingly-minimal differences give medicine its meaning, make the hard times more tolerable and, more broadly, make this a field I am proud and confident to be joining.

Complete Article ↪HERE↩!

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What Oncology Nurses Should Understand About Medical Aid in Dying

Lisa Vigil Schattinger, MSN, RN, discusses her experience with medical aid in dying, and what oncology nurses need to understand when supporting patients at the end of their lives.

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For patients with cancer who are at the end of their life, being afforded the same level of autonomy in death as they experienced is life can be a vital component in providing quality care for the patient and their family, according to Lisa Vigil Schattinger, MSN, RN.

Schattinger is the founder and Executive Director of Ohio End of Life Options, a nonprofit organization that advocates for and provides education on medical aid in dying laws. In addition to being a nurse advocate, she also brings a unique personal perspective to her career.

Schattinger’s stepfather electively chose medical assistance in end-of-life care under Oregon’s Death with Dignity Act1 after he received a myelodysplastic syndrome diagnosis and learned he was not eligible for blood marrow transplant. He opted not to start chemotherapy but enrolled in hospice and received palliative packed red blood cell transfusions before electing to pursue a medically assisted death.

Her stepfather’s death was incredibly peaceful and in accordance with his wishes: he was able to walk himself into his room, sit down on the bed, and be surrounded by family as he took the medication.

“He felt empowered,” she recalled, noting that the family was grateful that the state of Oregon had allowed them this option.

At that moment, Schattinger and her mother, who is also a nurse, recognized that this option is potentially groundbreaking for certain patients and their families. As a result, they decided to learn more about the processes in place and to share their own personal experiences. Recently, the duo presented on the topic at the 47th Annual Oncology Nursing Society Congress , specifically on the role of oncology nurses in end-of-life care and the key components of medical aid in dying (MAiD) or dying with dignity laws.

In an interview with Oncology Nursing News®, Schattinger provides a quick overview of her presentation and key takeaways for nurses seeking to provide quality care.

Oncology Nursing News®: Please provide a brief overview of medical aid in dying.

Schattinger: Medical aid in dying is a law that allows terminally ill and mentally capable adults the ability to request a prescription that will hasten their imminent death. The process is patient directed; it is a voluntary process that has multiple safeguards. It is for an [individual] who understands that they are at the end of their life, understands that they are dying, and wants to determine the time and the place and [the company present] at the end of their lives.

Each state can determine if they are going to pursue the process of passing an aid [with the establishment of a] dying law or medical aid in dying law. The first one that [was passed] was in Oregon, and it is called the Death with Dignity Act. I always consider that one as kind of a baseline. As other states passed [similar] laws, they put their “thumbprint” on that law— they made it work for their state.

Currently it is legal in Oregon, Washington, California, Hawaii, Colorado, New Mexico, Vermont, Washington, DC, New Jersey, and Maine. [In addition], there was a Montana State Supreme Court decision that allows [MAiD], but it is not exactly the same as in places that have actual laws.

[To qualify], patients have to be capable of making decisions. If there is any concern that the person is not capable of making decisions, then they can be referred for a mental health evaluation. Then there are timeframes in place [these vary by state, as well]. A patient also needs a written request that is witnessed by 2 people, of whom at least 1 cannot be related to or benefit in any way from the person’s death. Then, after qualifying for the prescription, they must wait 48 hours before filling. Patients must also be able to self-administer the medication.

Anybody involved in this process can opt out at any time, physicians, pharmacists, nurses, [or] any other care provider can opt not to participate [in the process]. Of course, the patient themselves can change their mind at any time and stop the process as well.

It is also important to note that when a physician gets this request, they must inform the person of all [available end-of-life options], including hospice care.

[Interestingly] we have learned that [approximately] a third of the [individuals] who get this prescription never end up taking it. There are a combination of things going on there. [Some] say that they can relax knowing that they are able to determine if [and when] their suffering becomes too great. Others, [unfortunately,] do decline in health. And [those] who are not able to self-administer, are no longer capable of making that decision.

Should oncology nurses only be familiar with these laws if they live in a state where it is legal? How might nurses support a patient who wants MAiD, yet lives in a state where it is not an option?

The American Nurses Association put out a statement saying that because so many people now have access to this option at the end-of-life that they feel nurses are ethically bound to be knowledgeable about it. This means being able to have non-judgmental conversations about MAiD, and to be able to [inform individuals] about what end of life options are available [including hospice care and pain management].

So if, as a nurse, you live in a state without a [MAiD] law, and someone asks you about it, [best practice] is taking a moment to really focus on that person and that request and ask: What does this mean to you? What does that request mean to you? Do you understand what all your options are for care at the end of life, and that we live in a state that does not have a law?

Then, if [end-of-life medical assistance] is important enough to patient, they [might consider if they’re willing] to move to a state with a law? This is a very big question. At the end of a person’s life, that is a really big step: to decide to pull out roots from their community, their community of support, and their healthcare community of support, and move to another area, to go through the process of establishing residency–depending on where you’re living—and finding 2 doctors who will participate in this program [is a big commitment].

However, some will decide that it is important enough to them and they do want to do that. But others [will not] and so everyone needs to understand what end-of-life care options are available to them. It is important to have that full conversation to understand that their personal beliefs, values, and goals are, and to see what types of care match their needs, as well as what is available in their community.

What are some misconceptions or things that nurses may not understand about MAiD that makes it difficult for them to support it?

A lot of times [individuals] do not understand [how it is] a self-directed process. This is the patient who wants this and it is vital that they determine what the end of their life looks like.

I remember a person who said, “When I got this diagnosis years ago, I knew that my treatment options would probably run out at some point. So, I became a partner with my health care team in making medical decisions moving through the course of my illness—I made decisions on what type of treatments [I took], what surgeries, and everything else that was possible.” When it came time for [the health care team] to say, there are no longer treatments for you, [the patient] said, “I made all of those decisions as a partner up to that point, why would it change?”

Please elaborate on the ethical value of medical aid and dying and the impact that it does have on the patient.

I think that concept of autonomy and self determination to some [individuals] is paramount. Its who they are. They want partners in their health care [team] who will work with them to provide that care. Some health care providers also believe that providing compassionate care is one that meets the [patient’s] goals.

Ultimately, the concept of suffering is for the patient to determine, not for us to judge.

Until we get to know these [individuals] and fully [understand] why they are making these requests [we cannot fully understand their needs]. Whatever a patient’s definition of suffering is, compassionate care means granting their requests to manage it.

Complete Article ↪HERE↩!

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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.

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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

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.

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We all deserve a good death

– especially people living with dementia

On International Nurses Day (May 12), I commend the contribution made by all nurses involved in the care of people living with dementia in residential, home and community care, in hospitals and through clinics and health centres.

By Maree McCabe

Dementia is a terminal illness and appropriate palliative care is an essential element of quality care and end of life care for people with dementia, and for their families and carers.

People living with dementia, their families and carers deserve specialist dementia support to plan for and manage their end of life with dementia.

While people living with dementia will unlikely to be able to communicate clearly at their end of life and we may never know how much they can hear, see, feel and comprehend at that time, we need to support them and include them in decisions about their care through the continuum of the disease right through to end of life.

People with dementia share with us they need to have confidence in the system and the people involved in their care because they know they may not have capacity at the end of life to express their wishes. They rely on their families, support networks and healthcare professionals to ensure they receive quality dementia care and experience a good death.

Caring for someone with dementia can be rewarding and emotionally, physically and financially challenging. Families and carers frequently report feeling stressed and confused as to how and where to access end of life care and services, and can feel pressured to make immediate decisions for their loved ones.

Dementia Australia is calling on all sides of politics to commit to a national dementia palliative care program modelled on an evidence-based, nurse-led model of palliative care already successful in South Australia.

The Nightingale Program is the leading specialist dementia palliative care program in Australia and with the support of a federal funding commitment could be expanded across the country.

I acknowledge the support of existing funders, The Rosemary Foundation for Memory Support and Country SA Primary Health Network Ageing Well in Place initiative.

The Nightingale Program clients have access to specialist nurses who provide palliative care strategies and advice to support those living with dementia and their families and care providers. There is a focus on promoting choice and well-being.

The specialist dementia nurses are trained to deliver a person-centred approach to enable people living with dementia to:

  • Stay at home longer and maximise their independence
  • Promote quality of life and positive relationships
  • Have a voice in their future care options and decision making
  • Avoid unnecessary presentations to acute hospital settings
  • Access clinical advice, including co-morbidity management, pain management, delirium and palliation.

The many benefits of the Nightingale Program include:

  • Specialist nursing advice
  • Comprehensive and holistic nursing assessment, which will identify current issues and anticipate changing needs
  • Referral to other service providers as needed
  • Continuity of care, offering a single point of contact for guidance
  • Advice provided in home, residential aged care, community and hospital settings
  • Consultation in the development of advance care directives for future health care needs
  • Education and emotional support to support family and carers
  • Interdisciplinary teamwork throughout the health and care networks.

I call on all sides of politics to commit to expanding this program nationally to ensure all Australians living with dementia are supported by staff trained and qualified to provide dementia-specific palliative care.

Improving palliative care for people with dementia, no matter where they live, must be a policy priority Australia-wide to provide peace of mind for the almost half a million Australians living with dementia and the 1.6 million people involved in their care.

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