Feb/Mar 2018

Nowhere Fast

Three books confront the inevitable

Charlotte Shane

From Here to Eternity:

Traveling the World to Find the Good Death

by Caitlin Doughty

W. W. Norton & Company

$24.95 List Price

For more info visit:
Amazon • IndieBound • Barnes & Noble

You Can Stop Humming Now:

A Doctor's Stories of Life, Death, and in Between

by Daniela Lamas

Little, Brown and Company

$28.00 List Price

For more info visit:
Amazon • IndieBound • Barnes & Noble

With the End in Mind:

Dying, Death, and Wisdom in an Age of Denial

by Kathryn Mannix

Little, Brown and Company

$27.00 List Price

For more info visit:
Amazon • IndieBound • Barnes & Noble

No one chases death like the young. Goth teens, sure, and kids on social media who ask the Pope to murder them with sex, and anyone for whom a death wish is mainly a style or a meme. But non-elderly Americans are killing themselves at a staggering rate, and it’s increasingly difficult to tell what’s accidental and what’s intentional. The November overdose of twenty-one-year-old rapper Lil Peep was exemplary in its ambiguity: His Instagram posts just before he died swung between resignation and struggle, between “fucc it” and “one day maybe I won’t die young.” His death was self-inflicted but perhaps not deliberate. Did he want to die or did he want to live? Like many, he wanted both at the same time: a life, but not a life like this. (A perpetual 2017 headline: “US Drug Overdose Deaths Reach New Record High.” A popular headline in 2016: “US Suicide Rate Surges to a 30-Year High.”)

Exasperated adults sometimes maintain that young people embrace the idea of death because they feel so far from it, or that they kill themselves because their baby brains don’t understand true consequence. But in light of the proliferation of bullying-induced suicides in recent years, waving away kids’ proclivity for death is indefensibly negligent: Children as young as eight are shooting or hanging themselves. For Americans between the ages of fifteen and thirty-four, the second most common way to die is by their own hands. For those between ten and fourteen, suicide is the third most common cause of death. “Push me to the edge / All my friends are dead” was the refrain of 2017’s biggest song, written by a twenty-three-year-old. To say that death doesn’t seem real to young people not only denies reality—many kids have known people who have died, and may be devising ways to hasten their own ends—but also implies that older adults treat their mortality more reverently, which is obviously untrue. Suicide rates have surged among the young and the middle-aged. Only two demographics are left reliably clinging to life: the especially megalo-maniacal (Silicon Valley billionaires and high-ranking politicians) and the especially ancient. The sole age group for which suicide rates have declined is that of people seventy-five or older.

Moving through death is a nonnegotiable component of being alive: Soil is made of remains, we eat dead things to stay alive, our own passing is inescapable, and all that. But the particular way in which we are now steeped in death can be attributed to downward mobility and a pervasively dismal quality of life. Farmers, impoverished and relatively isolated, kill themselves at twice the rate of veterans. Researchers ascribe the frequency of middle-aged suicides to financial insecurity. Functionally indentured with no hope of a decent wage, recent college graduates attend the funerals of friends who couldn’t afford basic medical assistance—especially mental-health care. These deaths are all preventable, but prevention is not a priority of those in power, which means the numbers rise.

In her new book, From Here to Eternity: Traveling the World to Find the Good Death, a survey of how various cultures handle, understand, and mourn their dead, insistently chipper mortician Caitlin Doughty cites scholar Elizabeth Harper, who has observed that cults of the dead are “most noticeable during times of strife,” especially among those who “lack access to power and resources.” Harper is referring to Neapolitans who venerated anonymous, exhumed graveyard skulls shortly before the turn of the nineteenth century: petitioning them for favors, building shrines, and otherwise treating them like spiritual relics—much to the consternation of the Catholic Church. But her analysis applies across time and place; Doughty sees the same dynamic at work in present-day Bolivia, where a matriarchal culture of skull appreciation thrives. It might also explain some of what’s happening among disenfranchised young(ish) adults on social media, where jokes about yearning for death are relentless. Few of us have access to skulls, but most of us have access to skull emoji.

Anonymous bones are just one facet of what we’re denied access to these days. “Due to the corporatization and commercialization of deathcare, we have fallen behind the rest of the world when it comes to proximity, intimacy, and ritual around death,” Doughty writes. In her view, we’ve been robbed of proximity to, intimacy with, and ritual around dead bodies, which compromises our understanding of death as a whole. Doughty is a convincing opponent of the corpse-disposal industry, which grossly overprices services and is rarely concerned with honoring a family’s pain or cultural beliefs. “The funeral system in the United States is notorious for passing laws and regulations interfering with diverse death practices and enforcing assimilation toward Americanized norms,” she explains, citing government hostility to open-air pyres like those preferred by Hindus, as well as conflicts between Muslim practices and US embalming requirements. Such damning details are interspersed throughout the text. The nation’s largest funeral corporation has trademarked the word dignity, and when Benedictine monks organized to sell low-cost caskets in the wake of Hurricane Katrina, Louisiana’s board of funeral directors issued a cease and desist order. Across the country, bodies are swiftly confiscated and embalmed or burned, leaving family members no time to sit with those they’ve lost. Preparing the deceased for burial was once an in-home, family-led affair, but few bereaved Americans are still afforded time and space to “see the corpse not as a cursed object, but as a beautiful vessel that once held their loved one.”

It doesn’t have to be this way, as Doughty’s tour proves. In Colorado, a group of volunteers perform open-air cremation for only $500, keeping costs low by having families help with body preparation and transportation. In Tokyo, some mourners use chopsticks to collect the pieces of a family member’s postcremation skeleton into an urn. In Indonesia, mummified bodies are removed from their “house-graves” to be lovingly brushed by their families, who are “ecstatic” to reconnect with the deceased, “even for a moment, even in this state.” These vignettes, captured in charming illustrations by Landis Blair, are moving and funny and only occasionally ghoulish. (A corpse in sunglasses isn’t scary; it’s cute.) Doughty is an impassioned advocate for grieving families, and her mission to establish kinder, more transparent death care is righteous. But when she ended with the message that “death avoidance is not an individual failing; it’s a cultural one,” I was troubled by how much was left unsaid. We exist in a void of sensitive and honest public conversation about death, but that’s not the same as a culture-wide aversion. We are a country perpetually at war, in which recordings of police killing unarmed civilians regularly go viral, and it’s nearly impossible to watch TV or movies without being exposed to a tremendous amount of violence. It’s hard to agree that we merely avoid death, as if it were vomit on a sidewalk one could simply skirt around, when we instead primarily seem to swing between two extreme impulses: offing ourselves in droves or refusing to die even when the time is clearly nigh.

Click to enlarge

Illustration by Landis Blair for Caitlin Doughty’s From Here to Eternity, 2017.

From Here to Eternity is one of many recent entries in the “look at our mortality, just look at it!” genre. Most, like Atul Gawande’s hugely successful 2014 offering, Being Mortal, are written by doctors grappling with advances that can prolong lives well past the point of desirability. The culture of “death avoidance” to which Doughty refers is better exemplified by physicians who are unwilling to let even the most compromised bodies expire than it is by morticians who keep the dead relatively estranged from their families. “I was surprised and somehow insulted,” writes Daniela Lamas in You Can Stop Humming Now: A Doctor’s Stories of Life, Death, and in Between, when an elderly patient asked to go home to die rather than be kept alive and confined to his hospital bed: “He didn’t want our kind of better.” Lamas admits that she feels hypnotized by life-extending technologies, so when she refers to “the sparkling forward march of medical advance,” I can’t tell if she’s being sardonic or sincere. She knows there’s a lack of wisdom at work in refusing to step away from an ailing body, and yet “the technology blazed so bright” that, sometimes, she could “barely see beyond it.”

Some of the scenes detailed in You Can Stop are more gruesome and alarming than those in From Here to Eternity, a testament to the fact that living can be so much uglier than dying. A peaceful passing is more pleasant to imagine than is Lamas’s description of a young mother undergoing a lung bypass while awaiting a transplant: She’s awake for weeks while her blood streams from a large catheter in her groin and is deposited back in—through a second large catheter, in her neck—after it’s been oxygenated. Lamas quotes a colleague who says of this procedure, extracorporeal membrane oxygenation, “In the scope of what we do to humans, this is the kitchen sink.” And truly, it is a dramatic encapsulation of the extremes of human capability—awesome and terrifying and brutal and crafty, all at once.

These polarities are apparent throughout Lamas’s book. She shows caring, committed professionals toiling to deliver modern miracles for desperate families. But she also uncovers much evidence of the conviction that because death is so heinous, there are virtually no limits to what we’ll do to stave it off. This is a type of death cult, too, one in which those closest to passing away are kept from it by measures that preclude comfort and peace. Doctors are very good at stabilizing a body in acute crisis but cannot always heal it once it’s been pulled out of that death drop. The chronically critically ill spend a lot of time weak and delirious, in intense discomfort while locked between death and recovery. And why? Probably to spare their loved ones, or perhaps because they are unlucky enough to have a doctor who doesn’t make clear the unlikelihood of meaningful improvement.

Palliative-care provider Kathryn Mannix, author of With the End in Mind: Dying, Death, and Wisdom in an Age of Denial, is the sort of physician who would tell them the truth. She has markedly less patience with so-called advances than does Lamas, declaring that the application of new technology “is a triumph of denial over experience. . . . Instead of dying in a dear and familiar room with people we love around us, we now die in ambulances and emergency rooms and intensive care units, our loved ones separated from us by the machinery.” In doing so, we make our deaths worse, not better. If sheer longevity is all that’s required to have a good life, then these measures are sensible, but otherwise their justification is unclear. “The death rate remains 100 percent,” she adds dryly. (Imagine a doctor cheerfully promising a new ICU intake’s family, “I’ve never saved a patient yet!”)

With the End in Mind is one of the loveliest books I’ve ever read. It’s part memoir and part self-help manual, part practical advice and part professional credo. Mannix’s compassion is bottomless and her scrupulousness unimpeachable, and because of these qualities her account of one death after another has a reassuring, even soothing effect. “People have come to associate the idea of dying with pain and indignity, [but that is] rarely the case,” she writes, before describing how the process unfolds when it’s allowed to progress “without intervention.” The relative sameness of her patients’ passings, in spite of their (vividly rendered) disparate circumstances—one is a cat-loving bachelor, one an exuberant teenage daughter, another a devout Muslim mom—affirms her claim. (Spoiler alert: You start sleeping a lot more, occasionally dipping into a coma, and eventually you don’t return from unconsciousness.)

But one minor moment jarred. “It has become taboo to mention dying,” writes Mannix, and like Doughty, she’s half right. When it comes to the deaths of those we didn’t know well, we often speak in euphemisms. When we’re anticipating the deaths of those we love, the intensity of imminent sorrow makes direct conversation hard to bear. (As Mannix shares, she’s seen people come very close to wasting their last moments with their beloveds because they couldn’t bring themselves to admit that the end was near.) But for an American millennial like me, mentions of death are nearly inescapable. To my peer group, Mannix’s suggestion that “you can begin a legacy that calls death by name, accepts that it is a part of life, and encourages others to do likewise” is a little squirm-inducing; I don’t know many people who need more encouragement. Death is already on my Facebook feed, where a friend recently posted that she was back home after a suicide attempt and where another acknowledged the one-year anniversary of a sibling’s attempt that had achieved its goal. It’s in viral tweets from ailing strangers who beg congressmen to vote no on a bill that guts Obamacare. It’s in my conversations with other childless friends about the nearly unfathomable rapidity of climate change. In 2017 it felt like death was draped over every day.

We want to die as we want to live: free from pain, connected to people we love, with agency and dignity. Modern life doesn’t just rob us of those joys in the final weeks, when age or disease draws death near; it threatens them even when we’re in what’s supposed to be our prime. We’re all conscripted into a death cult by a society that demands nearly endless work for nearly no reward, that shrugs in the face of mounting addiction and mental-health crises, that accepts schoolchildren having to practice active-shooter drills and dying from afflictions that could be cured or managed, if only their families could afford to do so. When these psychic and somatic burdens pile up, the strongest tethering force is the urge to stay present for others—the same instinct seen in so many pre-death patients who are determined not to desert their children or spouses or parents until the time feels more right. “There is all that love to be communicated,” Mannix writes, as she coaxes her readers to think now about what they’d like to communicate before they die. Yes; then there is all that love.

Charlotte Shane is a cofounder of TigerBee Press.