From the cool devices in our hands, to the software on our screens, to the smooth stylings of Jony Ive’s Apple product video voiceovers, it’s clear this is the era of design. Since design has touched and changed so many parts of our lives, isn’t it time that we redesigned death? The chief creative officer at one of the top design firms in the world thinks it is:
With just a little attention, it seemed — a few metaphorical mirrors affixed to our gurneys at just the right angle — he might be able to refract some of the horror and hopelessness of death into more transcendent feelings of awe and wonder and beauty.
From Jon Mooallem in California Sunday Magazine: Death, Redesigned. (I like where you’re going with the embalming and the eternal darkness, I just think it could pop a little more.)
A week ago, Paul Kalanithi, who was 37, died from lung cancer. He had recently finished his neurosurgery residency at Stanford and was a father to an infant daughter.
In this video, he talks about how time changes as you face your mortality. “Clocks are now kind of irrelevant to me,” he says. “Time, where it used to have kind of a linear progression feel to it, now feels more like a space.”
My dad’s retirement home was not quite so high tech but it was designed to provide a certain level of creature comforts with minimal inputs from him. Set it and forget it. An X-10 system turned most of the lights on and off on a schedule. Some of this was pretty straightforward “Turn on the porch lights after dark.” and some was a bit more esoteric “Turn off the office lights at 10 pm so that I’ll know it’s time for bed.” He knew the ruleset. I did not. I’d be working on an article or reading a book and suddenly be plunged into total darkness. I’d poke at some wall switches that would sometimes turn the lights back on.
The system was controlled by a laptop. The laptop died. I removed the hard drive to get at the config files. This project went on a lengthy To Do list and never rose to the top. The lights kept turning on and off. Over time their schedules got out of sync. The driveway lights would stay on for days. The porch lights would never come on, or turn on at 6:15 pm and then off at 6:27. Sometimes they’d just blink on and off and we’d be all “Did you see that?” My sister and I kept lists, tried to discern patterns. I pulled the switches off the walls, only to find that they were just stuck on with tape, with no actual wires underneath. Somewhere in some wall there was a transmitter sending out signals that only the lights could hear.
It’s oddly comforting that even in the digital age, our loved ones can still haunt us from their graves.
In their latest full episode, Radiolab examines the concept of worth, particularly when dealing with things that are more or less priceless (like human life and nature).
This episode, we make three earnest, possibly foolhardy, attempts to put a price on the priceless. We figure out the dollar value for an accidental death, another day of life, and the work of bats and bees as we try to keep our careful calculations from falling apart in the face of the realities of life, and love, and loss.
I have always really liked Radiolab, but it seems like the show has shifted into a different gear with this episode. The subject seemed a bit meatier than their usual stuff, the reporting was close to the story, and the presentation was more straightforward, with fewer of the audio experiments that some found grating. I spent some time driving last weekend and I listened to this episode of Radiolab, an episode of 99% Invisible, and an episode of This American Life, and it occurred to me that as 99% Invisible has been pushing quite effectively into Radiolab’s territory, Radiolab is having to up their game in response, more toward the This American Life end of the spectrum. Well, whatever it is, it’s great seeing these three radio shows (and dozens of others) push each other to excellence.
Astonishing, if you think about it: that a person could live half his life without coming face-to-face with the one thing that unites us all. And I don’t think I’m alone in this.
Atul Gawande’s new book about medicine and death, Being Mortal, is out today. Two excerpts of the book are available online, The Best Possible Day:
I spoke with more than 200 people about their experiences with aging or serious illness, or dealing with a family member’s — many of them my own patients, some in my own family. I interviewed and shadowed front-line staff members in old age homes, palliative-care specialists, hospice workers, geriatricians, nursing home reformers, pioneers, and contrarians. And among the many things I learned, here are the two most fundamental.
First, in medicine and society, we have failed to recognize that people have priorities that they need us to serve besides just living longer. Second, the best way to learn those priorities is to ask about them. Hence the wide expert agreement that payment systems should enable health professionals to take sufficient time to have such discussions and tune care accordingly.
You don’t have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help. The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. These days are spent in institutions — nursing homes and intensive-care units — where regimented, anonymous routines cut us off from all the things that matter to us in life.
Too many books to read! Gotta make time for this one though.
Thirteen Ways of Looking at Greg Maddux is not really a story about Greg Maddux. Or sports. It’s about Jeremy Collins’ friend Jason Kenney, demons, self-control, determination, friendship, competitiveness, and loss.
Jason kept a picture of Maddux above his desk in our dorm room at Young Harris College in the north Georgia mountains. A beautiful athlete, the best on campus, Jason played only intramurals and spent serious time at his desk. A physics workhorse and calculus whiz, he kept Maddux’s image at eye-level.
Shuffling and pardoning down the aisle to our seats, Jason stopped and squeezed my shoulder. “Look,” he said.
Maddux strode toward home, hurling the ball through the night.
It’s 2014. I’m thirty-seven. My wife and daughter are both asleep. I’m a thousand miles from the stadium-turned-parking-lot. On YouTube, Kenny Lofton of the American League Champion Cleveland Indians looks at the first pitch for a ball. Inside, low. I don’t remember the call. I remember all of us standing, holding our breath. Then I remember light. Thousands of lights. Waves of tiny diamonds. The whole stadium flashing and Jason, who would die five months later on the side of a south Georgia highway, leaning into my ear and whispering, “Maddux.”
Great, great story. As Tom Junod remarked on Twitter, “Every once in a while, a writer throws everything he’s got into a story. This is one of those stories.”
Sometimes, bees don’t want to be domesticated. The rules of nature, laid down in genetic code and behavioral norms over hundreds of thousands or even millions of years, are difficult to bend. John Knight discovered this while exploring beekeeping as a new hobby.
While a newborn queen may seem ruthless, the success of a beehive hinges on allegiance to its queen. Though she can mate with an average of 12 different drones, there is only one queen, which makes for a hive of closely related bees. As a new queen begins to produce her own pheromones, the hive slowly aligns with her as the old bees die and new workers hatch. In a sense, the hive is genetically wired to be loyal to the monarchy. If the hive was to raise multiple queens, or if the workers were to start laying eggs, the interests of the population would slowly fracture.
Surgeon and New Yorker writer Atul Gawande has a new book about death coming out in October called Being Mortal.
Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.
Gawande, a practicing surgeon, addresses his profession’s ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person’s last weeks or months may be rich and dignified.
This piece Gawande wrote for the New Yorker in 2010 was probably the genesis of the book. I maintain a very short list of topics I’d like to write books about and death is one of them. Not from a macabre Vincent Price / Tim Burton perspective…more like this stuff. Dying is something that everyone has to deal with many times during the course of their life and few seem to have a handle on how to deal with it. That’s fascinating. Can’t wait to read Gawande’s book.
And even though Emily Bem had supported her mother’s decision, this date — the cold reality of it — was very hard to accept.
“I said she seemed too well and it seemed too soon. I felt really angry. I felt they were all wrong,” Emily says.
And so to ease the process for their daughter and their friends, Sandy and Daryl announced that the Sunday before, everyone would gather to honor Sandy.
“We thought that would be a nice thing,” says Daryl Bem. “It made a lot more sense than a funeral where she wouldn’t be.”
On that Sunday, family and friends sat on the white couch in the living room to talk about Sandy’s life, much of which, according to Emily, Sandy had by that point forgotten.
“She just listened and listened and listened, and at the end she would say, ‘Wow, I did that? Amazing. Amazing!’ “
Emily says when she showed up at the meeting she was still very angry, convinced that her mother should hold on. Emily, who also lives in Ithaca, has a toddler. She wanted more time with her mother. But over the course of the meeting, this feeling began to ebb.
It may hurt to write it. And reading it? For some, that’s the worst part. The world might spin a little, and everything familiar to you might fade for a few minutes. But remember, remind yourself as you stand there, you are the lucky one.
And that’s not because you aren’t dead. You were selected. You get to stand, face the group, the family, the world, and add it up. You’re being asked to do something at the very moment when nothing can be done. You get the last word in the attempt to define the outlines of a life. I don’t care what you say, bub: That is a gift.
This rule surprised me:
You must make them laugh. Laughs are a pivot point in a funeral. They are your responsibility. The best laughs come by forcing people not to idealize the dead. In order to do this, you have to be willing to tell a story, at the closing of which you draw conclusions that no one expects.
You’ve probably already read this or have at least been urged to read it, but this New Yorker piece by Roger Angell about growing old is lovely, moving, and insightful. Set aside 15 minutes of your day to read it; it’s worth it.
“Most of the people my age is dead. You could look it up” was the way Casey Stengel put it. He was seventy-five at the time, and contemporary social scientists might prefer Casey’s line delivered at eighty-five now, for accuracy, but the point remains. We geezers carry about a bulging directory of dead husbands or wives, children, parents, lovers, brothers and sisters, dentists and shrinks, office sidekicks, summer neighbors, classmates, and bosses, all once entirely familiar to us and seen as part of the safe landscape of the day. It’s no wonder we’re a bit bent.
Angell is part of the New Yorker’s Great Span: his mother Katharine White worked at the magazine almost from the beginning in 1925, so did his stepfather E.B. White, and Angell himself wrote and edited for every single editor-in-chief the New Yorker has ever had, from founder Harold Ross to current chief David Remnick.
You have to take really exceptional care of your cadaver, so that it stays workable, free of pathogens, and easy to learn from. Towards the end, this care became very ritualistic for my lab team, and nearly reverent. She had been a very small lady, and so we had to be so careful. In the end, there is a very simple ceremony students can attend honoring the life, contribution, and cremation of our subjects. It was overwhelmingly emotional and I remember my lab partner reached over and held my hand, and though I almost hesitate to say so, there is a way that we felt like her family. She had shared so much of herself. It wasn’t something we talked about, but it was a palpable feeling.
The Euthanasia Coaster is designed to thrill the hell out of its passengers just before it kills them.
Each inversion would have a smaller diameter than the one before in order to inflict 10 g to passengers while the train loses speed. After a sharp right-hand turn the train would enter a straight, where unloading of bodies and loading of passengers could take place.
The Euthanasia Coaster would kill its passengers through prolonged cerebral hypoxia, or insufficient supply of oxygen to the brain. The ride’s seven inversions would inflict 10 g on its passengers for 60 seconds — causing g-force related symptoms starting with gray out through tunnel vision to black out and eventually g-LOC, g-force induced loss of consciousness. Depending on the tolerance of an individual passenger to g-forces, the first or second inversion would cause cerebral anoxia, rendering the passengers brain dead. Subsequent inversions would serve as insurance against unintentional survival of passengers.
She’s holding the pole [of the IV drip]! Marc, it was a pole with four wheels on the bottom, and we’re riding around this hospice, and you could hear the goddamn wheels jangling and banging; it was insane.
And then I pass the front door, and all these nurses are standing out front, and they’re all crying. They’re watching us, and they’re crying. And I didn’t know why they were crying. I was like, Why are they crying? I didn’t get what they were seeing. I didn’t know. Because I was just in it; I was living it. I knew my wife who had suffered, she was a prostitute, she was a freakin’ heroin addict, she was beaten by pimps — this was her past — and then she ends up with AIDS, and she’s dying, and all she wants is a goddamn ride on my motorcycle.
So the next thing you know we’re on I-95, because women, it’s never enough for them. We’re on I-95, and she unhooks the pole, and she’s holding the morphine bag over her head with her gown that’s flying up in the air so you could see her entire naked, bony body with the morphine bag whipping in the wind, and we’re passing by these guys in their Lamborghinis, and I’m looking at them like, What the hell kind of life are you living? Look at me, I’m on top of the world here.
I love this story. The podcast from which it was taken is available here.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen-that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
People don’t know how to die anymore…advances in technology and medicine have lulled us into believing we can fix anything that’s wrong with our bodies, pain and expense be damned. And sometimes we can and do, and it’s that “what if” that makes it so difficult when thinking about what to do.
I am interested in cultural death denial, and why we are so distanced from our bodies, and especially how death denial leads to funeral practices that harm the environment — using formaldehyde and pink make-up and all that to make your loved one look vibrant and alive, so that you can imagine they’re just sleeping rather than actually dead. The US government recently upgraded formaldehyde from a probable carcinogen to a known carcinogen, so by trying to preserve the body we poison the living.
So I was thinking, what is the antidote to that? For me the answer was this mushroom - the Infinity Mushroom. It is a symbol of a new way of thinking about death.
Dudley Clendinen has ALS, aka Lou Gehrig’s disease, and has a short time to live. Which is fine by him; he’s got a plan.
There is no meaningful treatment. No cure. There is one medication, Rilutek, which might make a few months’ difference. It retails for about $14,000 a year. That doesn’t seem worthwhile to me. If I let this run the whole course, with all the human, medical, technological and loving support I will start to need just months from now, it will leave me, in 5 or 8 or 12 or more years, a conscious but motionless, mute, withered, incontinent mummy of my former self. Maintained by feeding and waste tubes, breathing and suctioning machines.
No, thank you. I hate being a drag. I don’t think I’ll stick around for the back half of Lou.
I think it’s important to say that. We obsess in this country about how to eat and dress and drink, about finding a job and a mate. About having sex and children. About how to live. But we don’t talk about how to die. We act as if facing death weren’t one of life’s greatest, most absorbing thrills and challenges. Believe me, it is. This is not dull. But we have to be able to see doctors and machines, medical and insurance systems, family and friends and religions as informative - not governing - in order to be free.
And that’s the point. This is not about one particular disease or even about Death. It’s about Life, when you know there’s not much left. That is the weird blessing of Lou. There is no escape, and nothing much to do. It’s liberating.
He was in the hands of medicine. He was hopeful but realistic. He will come to feel increasingly like a member of the audience in the theater of his own illness. I’ve been there. There were times when I seemed to have nothing to do with it. One night, unable to speak, I caught the eye of a nurse through my open door and pointed to the blood leaking from my hospital gown. She pushed a panic button and my bed was surrounded by an emergency team, the duty physician pushing his fingers with great force against my carotid artery to halt the bleeding. I was hoisted on my sheet over to a gurney, and raced to the OR. “Move it, people,” he shouted. “We’re going to lose this man.”
Anderson Cooper asked Hitchens whether he’d been moved by the prayer groups supporting him to pray himself:
“No, that’s all meaningless to me. I don’t think souls or bodies can be changed by incantation.” There was a catch in his voice, and the slightest hint of tears. That was the moment — not the cancer or the dying — that got to me. Prayer groups also prayed for me, and I was grateful and moved. It isn’t the sad people in movies who make me cry, it’s the good ones.
Hitchens added that if there should be reports of his deathbed conversion, they would be reports of a man “irrational and babbling with pain.” As long as he retains his thinking ability, he said, there will be no conversion to belief in God. This is what I expected him to say. Deathbed conversions have always seemed to me like a Hail Mary Pass, proving nothing about religion and much about desperation.
I wrote this at Snarkmarket at the beginning of the week:
Recent efforts by Tony Judt, Christopher Hitchens, Atul Gawande, following on slightly older ones by Joan Didion and Phillip Roth, make me wonder whether we’ve achieved a new breakthrough in our ability to write about death — perhaps especially protracted death, death within the context of medical treatment, in a secular context, which as Gawande reminds us, is comparatively new and certainly much more common.
Here’s the section of Gawande’s recent New Yorker essay I was thinking of:
For all but our most recent history, dying was typically a brief process. Whether the cause was childhood infection, difficult childbirth, heart attack, or pneumonia, the interval between recognizing that you had a life-threatening ailment and death was often just a matter of days or weeks… [A]s the end-of-life researcher Joanne Lynn has observed, people usually experienced life-threatening illness the way they experienced bad weather—as something that struck with little warning—and you either got through it or you didn’t.
An unexpected cost of the secularization/medicalization of death is that we lose the language we need to talk our way through it:
Dying used to be accompanied by a prescribed set of customs. Guides to ars moriendi, the art of dying, were extraordinarily popular; a 1415 medieval Latin text was reprinted in more than a hundred editions across Europe. Reaffirming one’s faith, repenting one’s sins, and letting go of one’s worldly possessions and desires were crucial, and the guides provided families with prayers and questions for the dying in order to put them in the right frame of mind during their final hours. Last words came to hold a particular place of reverence.
These days, swift catastrophic illness is the exception; for most people, death comes only after long medical struggle with an incurable condition—advanced cancer, progressive organ failure (usually the heart, kidney, or liver), or the multiple debilities of very old age. In all such cases, death is certain, but the timing isn’t. So everyone struggles with this uncertainty—with how, and when, to accept that the battle is lost.
That’s one of the stunning things about Gawande’s essay — how much of what it describes is a failure of language. No one can speak, at least directly; we can only watch.
Almost all these patients had known, for some time, that they had a terminal condition. Yet they-along with their families and doctors-were unprepared for the final stage. “We are having more conversation now about what patients want for the end of their life, by far, than they have had in all their lives to this point,” my friend said. “The problem is that’s way too late.” In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.”
Warning: it’s good, but you’ll probably be crying by the end of this article.
My father didn’t die nearly so well. At 74, after a 50-year career as a professor of mechanical engineering, he lost his mind. At first he’d cover his mistakes with jokes-a forced punch line after slipping up on calculating the tip at dinner. Have you noticed how forgetful he’s getting? His second wife whispered to me in the kitchen after a family meal. I hadn’t. But it wasn’t long before his colleagues politely suggested that it was time for him to retire. He’d been spotted in the elevator, the doors opening and closing repeatedly, as he stood there incapable of deciding which button to push. He could no longer locate his car in the lot. The faculty feared he was a danger to himself. Not long after, my father left his office; it’s piles of professional journals and papers, and the poster hung on the back door, “I’M GOING TO BE AN ENGINEER LIKE MY MOM,” expecting to be back.
Joan Didion in The Year of Magical Thinking couldn’t throw away her dead husband’s shoes, for fear that he’d need them when he returned. After my grandfather died I used to fantasize that I could call him and he would answer. “Hey buddy,” he’d say. “I was just thinking of you.” But they changed the area code for that part of Pennsylvania, from 215 to 610, sold the house, and got rid of his clothes.
Number one on the list is “drive the biggest vehicle you can afford to drive”. And #10:
If anyone tries to force you into your car or car trunk at gun point, don’t cooperate. Fight and scream all you can even if you risk getting shot in the parking lot. If you get in the car, you will most likely die (or worse).
The author calls this “Black Swan avoidance”. (via lone gunman)
In the future, a famous person will die every fifteen minutes. Already it’s happening. The ascent of the microcelebrities, the 24 hour news cycle, citizen journalism, and our darkest fantasies all collide on Twitter now. The website’s rhetorical question “What are you doing?” sometimes feels more like “Who died today?”
Chances are in 15-20 years, someone famous whose work you enjoyed or whom you admired or who had a huge influence on who you are as a person will die each day…and probably even more than one a day. And that’s just you…many other famous people will have died that day who mean something to other people. Will we all just be in a constant state of mourning? Will the NY Times national obituary section swell to 30 pages a day? As members of the human species, we’re used to dealing with the death of people we “know” in amounts in the low hundreds over the course of a lifetime. With higher life expectancies and the increased number of people known to each of us (particularly in the hypernetworked part of the world), how are we going to handle it when several thousand people we know die over the course of our lifetime?
The population pyramid for who the average American knows (or knows of enough to care) probably looks something like this:
That’s a lot of future death.
Update:On Twitter, Kurt Anderson quoted David Kipen:
Baby Boomers have created so many celebrities that, in the future, somebody famous will die every fifteen minutes.
This summer could come to be known as the summer when baby boomers began to turn to the obituary pages first, to face not merely their own mortality or ponder their legacies, but to witness the passing of legends who defined them as a tribe, bequeathing through music, culture, news and politics a kind of generational badge that has begun to fray.
Over the course of my life, I’ve probably seen 10,000+ people die, right in front of me. Ok, sure, they all died on TV & movie screens — never in real life. But after you’ve seen so much fake dying, you start to wonder: how realistic are these deaths? Hence my interest in this report from a Dr Beaurieux who witnessed the execution by decapitation of a man named Languille in 1905. The article and excerpt below are graphic, so tread lightly if you’re bothered by that sort of thing.
It was then that I called in a strong, sharp voice: “Languille!” I saw the eyelids slowly lift up, without any spasmodic contractions — I insist advisedly on this peculiarity — but with an even movement, quite distinct and normal, such as happens in everyday life, with people awakened or torn from their thoughts. Next Languille’s eyes very definitely fixed themselves on mine and the pupils focused themselves. I was not, then, dealing with the sort of vague dull look without any expression, that can be observed any day in dying people to whom one speaks: I was dealing with undeniably living eyes which were looking at me.
Yesterday he came down and remarked that it was the anniversary of the wreck of the Maine. He explained that he knew it because the ship had been blown up on his birthday and that he was 15 yesterday.
At once the girls began to tease him. They told him that on such an occasion he desereved a kiss, and every one of them vowed that as soon as office hours were over she would kiss him once for every year that he had lived. He laughingly declared that not a girl should get near him, and was teased about it all day.
As 4:30 o’clock came, and the boy’s work was over, the girls made a rush for him. They tried to hem him in, and he tried to break their line. Suddenly he reeled and fell, crying as he did so.
“I’m stabbed!”
A blade used for scraping ink was in Millitt’s breast pocket and caused the mortal wound. (thx, amid)
“Once I worked on an old man with a really bad moustache, like the kind a teenager would grow. It was really crooked and misshapen, so I shaved it off. At the funeral his family kept coming up saying, ‘Oh, where’s his moustache?’ Apparently, it was supposed to look that way.”
The closer to its living self a body looked, the happier a family would be. And keeping families happy, I’d learn as the night went on, was the main objective of Carla’s work, and a task she took very seriously.
Apparently watching every episode of Six Feet Under does not prepare you to be a funeral director.
The earliest of the three is a winged death’s head, with blank eyes and a grinning visage. Earlier versions are quite ornate, but as time passes, they become less elaborate. Sometime during the eighteenth century — the time varies according to location — the grim death’s head designs are replaced, more or less quickly, by winged cherubs. This design also goes through a gradual simplification of form with time. By the late 1700’s or early 1800’s, again depending on where you are observing, the cherubs are replaced by stones decorated with a willow tree overhanging a pedestaled urn.
In regards to your post on Gravestone Motif Analysis, I think that the most important text on the subject is still Graven Images: New England Stonecarving and its Symbols, 1650-1815 by Allen Ludwig. It was originally published in 1966, before the article that you linked to. However, Wesleyan University Press published a new edition in 2000 to help meet the rising demands of Material Culture Studies courses. Lots of helpful images and histograms showing the changing patterns of gravestones over that time period.
I *love* that the collective readership of this site knows what the definitive text on New England gravestone carving is. (big thx, fletcher)
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