The Whole Death Catalog Read online

  Firstborn of a set of triplets, she weighed barely two pounds at her birth in 1926 and was not expected to survive—a circumstance to which she partly attributed her later preoccupation with death. By sixth grade, she had resolved to become a physician. During her teenage years, she hitchhiked through war-ravaged Europe, helping to set up typhoid and first-aid stations. It was during a visit to the Majdanek concentration camp in Poland that she fixed on her life’s goal. Profoundly affected by the suffering of the survivors, she decided to become a psychiatrist who helped people deal with death.

  After receiving her medical degree in 1957, she practiced briefly in the Swiss countryside before marrying American neuropathologist Emmanuel Ross and moving with him to the United States. She interned at a hospital on Long Island, then accepted a research fellowship at Manhattan State Hospital, where she was appalled by what she perceived as the neglect, even abuse, of dying patients. A two-year stint at the University of Colorado Medical School in Denver, where she taught psychiatry and treated schizophrenic patients, helped her refine interviewing techniques that would prove vital in her later work with the terminally ill.

  The turning point in her career—and in the evolution of modern approaches to the palliative care of the dying—occurred during her tenure as professor of psychiatry at the University of Chicago, beginning in 1965. When some theology students approached her for help in studying death, she initiated a series of teaching seminars in which dying patients were invited to come in and speak about their thoughts and feelings to a group of doctors, nurses, and social workers, along with the theology students and their chaplains. This seemingly simple procedure was, in fact, a major breakthrough, shedding unprecedented light on a subject shrouded, even for medical professionals, in fear and denial.

  It was from these groundbreaking sessions that Kübler-Ross identified her now-famous “five stages of grief,” the supposed sequence of emotional responses that people typically pass through when diagnosed with a terminal illness. As summed up by journalist Holcomb B. Noble, “Denial is the first stage. As his condition worsens and denial is impossible, the patient displays anger, the ‘Why me?’ stage. That is followed by a bargaining period. ‘Yes, I’m going to die, but if I diet and exercise, can I do it later?’ When the patient sees the bargaining will not work, depression often sets in. The final stage is acceptance, a period in which the patient is ready to let go.”

  Kübler-Ross’s findings, laid out in her 1969 best seller On Death and Dying, made her an international celebrity, a scientist of worldwide repute who helped shatter taboos against the open discussion of death, nurtured the creation of the modern hospice system, and established thanatology as a legitimate medical discipline. In her later years, however, she squandered a good part of her credibility when she grew obsessed with finding proof of an afterlife existence and became involved with a self-proclaimed “spirit medium” who took sexual advantage of his gullible followers.

  It is sometimes suggested that what we really mind is the process of dying. But I should not really object to dying if it were not followed by death.

  —THOMAS NAGEL

  Ars Moriendi

  Nowadays, the how-to sections of bookstores are crammed with titles like The Art of the Deal, The Art of Seduction, The Art of Happiness, and The Art of Staying Young—works that reflect our contemporary preoccupations with materialism, sex, personal fulfillment, and eternal youthfulness. Back in the late Middle Ages, people read how-to books, too. But in that death-obsessed era, just decades after the bubonic plague devastated Western Europe, the best-known works in the genre fell into the category known as ars moriendi: guides that taught readers the art of dying.

  The earliest work in this tradition, called Tractatus artis bene moriendi (Treatise on the Art of Dying Well), appeared in 1415. Composed by an anonymous Dominican friar and aimed at both priests and laymen, it contained six chapters that offered religious consolation as well as specific rites, prayers, and rules of behavior to be followed by both the dying person and those attending him. A widely circulated abridged version—consisting of woodcut illustrations depicting the spiritual struggles of a dying man beset by soul-snaring temptations—was published in 1450.

  Over the next two centuries, dozens of similar guidebooks, designed to teach readers how to prepare for a good death, appeared throughout Western Europe. The most famous is The Rules and Exercises of Holy Dying (1651) written by the “Shakespeare of divines,” Jeremy Taylor, chaplain to King Charles I. Universally regarded as the one true literary masterpiece in the tradition, Taylor’s book sets forth in rich, poetic prose what he describes as “the first entire body of directions for sick and dying people”—a systematic program that stresses the importance not only of proper deathbed behavior but also of righteous daily living.

  Dying man surrounded by attendants. Attributed to Albrecht Dürer, 1509.

  Though the ars moriendi eventually faded as a vital literary genre, it appears to be making something of a comeback. A recent example is Patricia Weenolsen’s The Art of Dying: How to Leave This World with Dignity and Grace, at Peace with Yourself and Your Loved Ones (St. Martin’s Press, 1996), a practical, straightforward guide that covers everything from how to inform relatives of impending death and preparing for a possible afterlife to the “Twenty-seven Rules for Dying the ‘Right’ Way.”

  Death at the Dinner

  Table: Talking About

  the Inevitable

  In the wise words of Joshua Slocum, executive director of the Funeral Consumers Alliance: “It’s time to have death at the dinner table.” No, he’s not suggesting that you call up the Grim Reaper and invite him over for some of your special Yankee pot roast. He means that we need to become comfortable with death as a topic of ordinary conversation. More particularly, he means that aging parents and their adult children should be able to have free and easy discussions about funeral planning—that the subject should be no more taboo than any other family-related matter.

  All too often, people die without conveying their final wishes to their nearest and dearest. The issue is so fraught with anxiety that they don’t want to talk—or even think—about it. As a result, their survivors are left in a state of confusion. Should we cremate Mom or bury her? Donate Dad’s organs or leave his body intact? Have a formal service conducted by a member of the clergy or a simple graveside ceremony with close friends sharing their memories?

  Of course, there are certain people who honestly don’t care what happens to them once they’re gone. As far as they’re concerned, funerals are strictly for the living. Whatever kind of send-off the kids want to throw is fine by them.

  The poet-undertaker Thomas Lynch heartily endorses this attitude. “There is nothing, once you are dead, that can be done to you or for you or with you or about you that will do you any harm or good,” he writes in his lovely essay collection, The Undertaking (Norton, 1997). “Once you’re dead, put your feet up, call it a day, and let the husband or the missus or the kids or a sibling decide whether you are to be buried or burned or blown out of a cannon or left to dry out in a ditch somewhere. It’s not your day to watch it, because the dead don’t care.”

  Most of us, however, do have preferences, often quite specific ones. And even if you don’t, it’s pretty inconsiderate to drop the whole messy problem in the lap of your loved ones, particularly at a moment when they’re dealing with their own grief. If you really want to make life easier for your survivors—and add to your own ultimate peace of mind—you should make your final wishes clear in either conversation or writing.

  Here’s a checklist of things to consider, based on recommendations by the Funeral Consumers Alliance:

  Do you want your organs donated? Which ones? Should they go to any particular medical school?

  Do you want to be buried? Where?

  What kind of coffin do you prefer? A cheap pine box? The best casket money can buy?

  Do you want to be embalmed? Do you want an open-casket viewing o
f your body?

  What sort of funeral do you want? Who should officiate? Is there a specific funeral home you wish to handle the arrangements?

  Do you want a memorial service? Where and what kind—in church, at home, graveside? Are there specific instructions—favorite poems to be read, special music to be played, et cetera?

  What sort of grave marker do you want, if any? What should the inscription say?

  Would you prefer cremation? What about your ashes—do you want them preserved? Or should they be scattered? Where?

  Who should be notified of your death? Who should be invited to the funeral/memorial service?

  What information should be included in your obituary?

  Given how discomforting it is to contemplate our own deaths, it’s no surprise that when it comes to funeral preplanning, most of us are prone to the Scarlett O’Hara syndrome: “I’ll think about it tomorrow.” But it’s important to keep in mind that making these decisions—and communicating them to your family—is good for everyone concerned. It will give you the grown-up satisfaction of taking charge of your own destiny. And it will relieve your loved ones of a terrible burden at a time when they’re least capable of coping with it.

  Of course, even that argument holds no water with Thomas Lynch. “Why shouldn’t I be a burden to my children?” he wonders in his book, Bodies in Motion and at Rest (Vintage, 2001). “My children have been a burden to me. Lovely burdens, every one of them…. And when I die, bearing the burden of burying me or burning me or blasting me into cyberspace should be theirs to do.”

  Did Lincoln Dream of

  His Own Death?

  People who believe that it’s a bad omen to dream about your own death often point to the example of Abraham Lincoln, who reportedly had the following nightmare not long before his assassination.

  About ten days ago, I retired very late. I had been up waiting for important dispatches from the front. I could not have been long in bed when I fell into a slumber, for I was weary. I soon began to dream. There seemed to be a death-like stillness about me. Then I heard subdued sobs, as if a number of people were weeping. I thought I left my bed and wandered downstairs. There the silence was broken by the same pitiful sobbing, but the mourners were invisible. I went from room to room; no living person was in sight, but the same mournful sounds of distress met me as I passed along. I saw light in all the rooms; every object was familiar to me; but where were all the people who were grieving as if their hearts would break? I was puzzled and alarmed. What could be the meaning of all this? Determined to find the cause of a state of things so mysterious and so shocking, I kept on until I arrived at the East Room, which I entered. There I met with a sickening surprise. Before me was a catafalque, on which rested a corpse wrapped in funeral vestments. Around it were stationed soldiers who were acting as guards; and there was a throng of people, gazing mournfully upon the corpse, whose face was covered, others weeping pitifully. “Who is dead in the White House?” I demanded of one of the soldiers, “The President,” was his answer; “he was killed by an assassin.” Then came a loud burst of grief from the crowd, which woke me from my dream. I slept no more that night; and although it was only a dream, I have been strangely annoyed by it ever since.

  This dream certainly seems prophetic. Unfortunately, there is no way of determining its authenticity since it comes from only a single unverifiable source—a book written many years after the assassination by Lincoln’s friend and bodyguard, Ward Hill Lamon.

  ASK DR. DEATH

  Dear Dr. Death:

  Someone told me recently that it’s impossible to dream about being dead without actually dying. Now I’m afraid to go to sleep at night because I might die in a dream and never wake up. Help!

  Believes Everything She Hears

  Dear Believes Everything:

  Rest easy! Plenty of people experience their own deaths while dreaming and wake up the next morning to tell about it. To be sure, there are cultures that regard such dreams as a bad sign—a premonition of impending disaster. Modern psychiatry, however, dismisses this belief as an old wives’ tale and interprets these dreams as a mirror of unconscious feelings: everything from unresolved death anxieties to the hidden wish for a new and different life.

  Wills: Last and Living

  Most of us accept, in a vague and abstract kind of way, that we probably won’t live forever. Deep down inside, however, we find it hard to believe that our time here on earth is depressingly short and that, before we know it, we will be permanently and definitively dead.

  One unfortunate consequence of this denial is a tendency to put off all-important end-of-life decisions, sometimes until it’s too late. According to one study, roughly 70 percent of American adults don’t have a will. This is good news for the legal profession (as one proverb puts it, “The man who dies without a will has lawyers for heirs”). But it’s a potentially disastrous situation for everyone else concerned, particularly the spouses, children, siblings, and other relations of those who die intestate (i.e., with no valid will; literally, “without testifying to their wishes”).

  It’s not just your loved ones who are likely to suffer if you die intestate. It’s in your own best interest to leave a will. Without one, you won’t have a say in how your property however meager, gets distributed upon your death. The state will make those decisions for you—and rarely in the way you would prefer.

  Let’s say you’re a twenty-year-old college student whose most precious possession is your 2001 black-and-orange Harley-Davidson Sportster 1200 motorcycle. If you should happen to die without a will, the bike will go not to the person most worthy to receive it—say, your best buddy, Wayne—but to your parents, who may give it to someone you hate, like your obnoxious cousin Steve. In their comprehensive book, Wants, Wishes, and Wills: A Medical and Legal Guide to Protecting Yourself and Your Family in Sickness and in Health (Financial Times Press, 2007), Wynne A. Whitman and Shawn D. Glisson offer this striking example of what can happen when a person dies without a will:

  In Kentucky, if you die intestate and own real estate, your real estate will first pass to your children or the descendants (your grandchildren or great-grandchildren) of any child of yours who has already died. If you have no children, it passes to your father and mother, or the survivor of them. If neither of your parents is living, it goes to your brothers and sisters or their descendants if they’re not then living. And if you don’t have siblings, your real estate goes to your spouse. If your spouse isn’t living or you’re not married, it’s left to your grandparents or their descendants (which means your aunts and uncles or your cousins). So let’s think about this. If you’re married and you own real estate in your name only, and you don’t have a will, your spouse will only receive your property if you aren’t survived by your children, your parents, your siblings, or your nieces and nephews. This may be what you want—but we bet a lot of you would rather have your spouse receive your real estate before some of your nieces and nephews.

  Having a will not only gives you control over the posthumous disposition of your possessions but is a great opportunity to let your family and friends know exactly what you think of them. Bestowing a precious possession on a friend or relative along with a last loving word—“To my dear niece, Suzie, I leave my collection of Victorian bootlace hooks because I know how much she’s always coveted them”—can be profoundly meaningful to the recipient. Conversely, what better way to tell your wife how little she meant to you than by bequeathing her your “second-best bed,” as Shakespeare famously did? And just think of how satisfying it will be to look down from heaven and see the expression on the face of that greedy, good-for-nothing grandkid who couldn’t wait for you to kick off and now discovers, at the reading of your will, that you haven’t left him one red cent!

  As any financial advisor will tell you, every adult over the age of eighteen—whether single or married, healthy or ill, wealthy or of modest means—should have a will. A will doesn’t necessarily have to be c
omplicated (“All to wife” is officially listed as the world’s shortest will, according to the Guinness Book of Worlds Records). If you lead a simple life and don’t have a whole lot to leave, there are various do-it-yourself options. The simplest is a standard fill-in-the-blanks form, available at any reasonably well-stocked stationery store. Attorney Michael Trachtman has put together something called My Will Book (Sterling, 2007), a handsomely bound volume that, when completed according to directions, witnessed, and notarized, is intended to serve as a legal last will and testament in every state. You can also purchase software, such as Suze Orman’s Will and Trust Kit, that will lead you through the process of creating a will, or make wills online at sites such as LawDepot (www.lawdepot.com), FindLegalForms (www.findlegalforms.com), and LegalZoom (www.legalzoom.com).

  Most experts agree, however, that it’s best to use an attorney (even if you rely on a do-it-yourself form, you should get a lawyer to review the completed document). A general law practitioner will suffice if your estate is uncomplicated. Otherwise, you’ll need a certified estate-planning specialist in the state where you live.

  Back in the old days, a last will and testament was the only end-of-life document you had to worry about. Nowadays, thanks to advances in medical technology, experts agree that everyone should also leave a living will. Also known as an advance directive for health care, a living will is a document that specifies the kinds of life-sustaining medical treatments you do not wish to receive if you are terminally ill, catastrophically injured, in an irreversible coma, or in a persistent vegetative state with no hope of recovery.