COVID, Corn Hole, and The Complexities of Death

Cornhole on the Beach
Photo credit: Chris Martino

I went down to Texas this last week to attend the funeral of one of my uncles. He had struggled for the last couple of years with T-cell lymphoma, a dreadful autoimmune cancer that caused him to itch relentlessly. Eventually, he was overcome by constant infections, kidney failure, and congestive heart failure.  I tried to work things out so I get could to Texas just before he died, but I missed it. Thankfully, I was able to talk to him on Facetime and tell him that I loved him while he could still hear me.  He died early on the morning I was planning on starting the long drive from Indiana to our family ranch.

My cousin/sister was my uncle’s full time caregiver during his battle with cancer.  During that time she and I had so many conversations about death, about what quality of life means, and when it’s time to stop fighting and just rest. We talked about all of the family dynamics that have shaped us and influenced how we feel about death, about our loved ones, and our ability to grieve well. In the few weeks before my uncle’s death, I was apprehensive about how the end would play out, and I didn’t know what I would encounter when I arrived home. But to my surprise and joy, what I came home to was better than I could have ever hoped for.  This hard, scary thing of death seemed to show what it truly can be, behind all the outer trappings of fear and suffering and unknowns…it was a calm, gentle river that carried my uncle to the other side,  and members of my family to a new place of unexpected peace and acceptance.

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During the days before my uncle’s funeral, my cousin and I discussed logistics of the services that were planned for him, as well as how we envisioned our own funerals one day. We both agreed that we want to be cremated, and our ashes spread over some place that is meaningful to us.  Neither of us judge those who want a traditional funeral, casket, and graveside burial, but we know that we want to take up as little space as possible when we leave this world.  Also, my cousin couldn’t bear the idea of her decomposing self ruining the inside of a coffin.

My cousin remarked that she wants her funeral to be a time of celebration of her life, not a time of crying and mourning. She made the absurd suggestion that we fill a hackey sack with her ashes and get after it.  Or better yet, fill a bunch of bean bags with her ashes and have a rip-roaring match of corn hole.  I nearly spit out my coffee when she threw out these suggestions,  laughing so hard, but I thought they were brilliant ideas. My cousin and I can regularly border on the edge of morbid in our conversations, but underneath our ridiculous banter is a serioius undertone. In our jokes about being entirely irreverant with our ashes, we aren’t belittling our lives or the sanctity of life. We weren’t saying that we don’t matter or that dealing with death and grief should be silly and superficial. We are saying that we know our lives have held tremendous meaning, that we have overcome so much, and that death is just a transition to the next thing. It is not the ultimate finality to us. It is a moving on that can be accepted, and even welcomed, without terror and despair.

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Now that I’ve joked about death, probably in a very inappropriate fashion to some, I’m going to switch back and say that I take death very, very seriously. In fact, I think that a huge part of life is learning how to prepare for death.

During the last six months, death has been on my mind even more than usual with the appearance of COVID.  When I have sat next to dying patients in the hospital, separated from friends and loved ones by isolation rules, death did not seem very funny at all. It was no joke to feel sobered by the hope that by me holding the hands of these people…maybe I could serve as a shoddy substitute for the ones that they really needed by their side. It was no joke that I was hoping and praying that I could hold them up to the Light in my own individual way and have that be enough to carry them over the threshhold in grace. It was no joke having to call family members to tell them that their loved one had passed.  And it was no joke to walk in on a patient in isolation, just to discover he’d died alone within the short time you stepped out to check on your other patients.

I may joke about death, but death itself is not a joke.

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In recent weeks, graphics have been ciruclating around FB that attempt to visualize the overall impact of COVID on the United States using absolute numbers.  Here’s are two examples:

Image may contain: text that says '47313,367 Tests Given USA COVID NUMBERS As of July 19, 2020 4,370,863 Cases 142,000 Deaths Numbers from edc.gov One Dot equals 100,000 citizens. Ohio Liberation'

Image may contain: text that says 'NEW POLL ASKED AMERICANS HOW MANY PEOPLE IN THE COUNTRY HAVE HAD COVID-19 OR DIED FROM IT THEIR ANSWER 20% Americans have hadit 9% Americans have diedfrom # MapVisumlization: REALITY: 1% Americans have hadi 0.04% Americans have died fromi Unbiased America'

May I just say that images like these freaking piss me off to no end.  Not because I don’t like a good graph or statistics, but entirely because these posts reduce the value of life down to numbers, monetary value, and impersonal percentages. I’m all for showing people how their misperceptions of data can lead them to overblown conclusions, but I’m not OK with it when the data is spun in such a way that it causes further minimization and marginalization of hurting people.

It’s like that line in You’ve Got Mail where Joe tells Kathleen that “It wasn’t personal” when his mega bookseller pushes her small bookstore out of business.  She responds with “What is that supposed to mean? I am so sick of that. All that means is that it wasn’t personal to you. But it was personal to me. It’s *personal* to a lot of people. And what’s so wrong with being personal, anyway?”

These kinds of graphics impersonalize COVID. They ignore the literal deaths and other deaths that coinicde with physcial deaths and can cause just as much trauma:  loss of jobs, loss of housing, loss of social networks, loss of safety, loss of anticipated gatherings/life rituals/memories, loss of long term health…and very importantly, the ambiguous loss described by Pauline Boss on the On Being podcast.  All of these deaths MATTER and they are all personal.

These graphics, and this way of thinking, allows us to cavalierly say “COVID has not yet affected me in any significant way, therefore I will minimize it’s impact in my mind, and I will continue to live the way I want with little regard for how your life has been shot to hell or very much has the potential to be shot to hell by my actions or lack of concern.”

Note: the episode included below is an amazing chat with Pauline Boss on the trauma of ambiguous loss and the myth of closure. I welcome you to take the time to listen to it.

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I’ve chatted with so many old folks who knew they were nearing the ends of their lives.  When it feels appropriate, I often ask them how they look back on their life.  Was it a good life in their opinion?  Are they satisfied with what they’ve accomplished?

The answers I tend to get don’t expound on amazing adventures or huge successes or how they knew and interacted with powerful people.  No one seems to mention the money they’ve made.  Throughout my life, when I’ve had these kinds of conversations with people, they usually describe their lives in terms of who they loved, how they treated people, and whether or not they had done things (jobs or hobbies) that gave them joy and made them happy.  The people that were able to tell me that they had loved well and been loved well seemed to be the most ready to go…the least afraid.

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Death is complicated to talk about because of the complexity that surrounds it. Some people welcome death, while others feel it snatched away loved ones before it was their time. Some deaths are peaceful and calm, others are violent and horrific. And how we deal with the deaths we face can be paradoxical.  On one hand, we need to celebrate lives well lived, and recall fond memories with laughter and joking. On the other hand, we need to hold space for ourselves and others to be able to grieve what we lost in those deaths, or the pain that those deaths represent…and we need to be able to grieve as long as necessary. As Boss said in the On Being episode, to hurry or pressure another through grief because of our own discomfort or impatience with it is nothing less than cruel. We must absolutely remember this wisdom in the time of COVID.

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Life and death are a cycle, and grieiving is a cycle, and we must learn to accept each as they come to us, and let go when it is time for them to pass. But I totally believe we need ritual and grace for ourselves and others to accomplish this.

We need to allow ourselves to integrate within ourselves all that comes with death and not feel like we have to comparmentalize what is going on within us to make ourselves more palatable for those around us.

I’ve been to a billion funerals in my life. Ok, a bit of hyperbole there…but, I’ve been to A LOT. And it always seems to me that people are allowed to be really sad during the wake, during the funeral, and maybe even the mealtimes that follow a funeral, but then it’s time to snap out of it and rejoin the current programming of our lives.  It’s like an on/off switch.  You’ve cried…ok, now it’s time to put that stiff upper lip back on and jump straight back into the tasks of everyday life.

I’ve spent some time in West Africa, and one thing that they often do there that I like is postponed funerals. This used to kind of boggle my mind…like, why would you have a funeral a year after someone died?  And, really, how could all of the people in the community come to a funeral so far after the fact and actually cry and wail and mourn the person? Well…I think it’s because, unlike many native-grown Americans, they understand that  grief doesn’t end right after the funeral.  And more importantly, they realize that grief is not only individual, it is collective.

I am very concerned about individuals in this time of COVID.  The families that weren’t able to hold funerals because of location….the ones who couldn’t attend funerals because they personally were in the hospital with COVID…the families that were able to hold services but not in the way they really needed to, the way they hoped.

At some point, when this pandemic has subsided, maybe when a vaccine is available….we will so direly need a time of national and collective mourning.  If we emerge from this pandemic and rush straight back into our mindless way of doing things, I’m afraid our country could in many ways be done for. If we can’t mourn in a meaningful way for those who have been devasated by COVID and recognize all that they have lost, then we have lost our collective soul as a nation.

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I’ve returned from Texas now, following my uncle’s funeral, and I’m so grateful to have been able to go.  Yes, there were annoyingly frustrating moments, like people wearing ill-fitting masks, or refusing to embrace my need for social distancing and forcing themselves upon me.  But I was reminded that while the months and days leading up to death can be so scary and uncertain, death itself is just a crossing over, just a walking through a door, just a slipping through a veil.  It can be a terrible event, but it can also bring about redemption and reconciliation in a family that is struggling with old wounds and hurts.

Life and death are so complicated.  I think that’s all I can say with complete certainty after this long, meandering post.

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I’m only 40, but I have lived a damned good life. I have loved others fiercely, and I have been loved fiercely.  I have failed miserably so many times, but I’ve also triumphed over things that I thought would always conquer me.  I’ve forgiven, and I’ve been forgiven to a greater extent. And while I’ve got alot of stuff left that I want to do, I’m OK when death says it’s my time.

My cousin and I talked about what we would want said at our funerals.  I told her I thought it would be great to have an open mic, not just so that people could recall all the things they like about me, but also so people could talk about how much they disliked me, or how I had hurt them, or what a moron they thought I was.  My cousin laughed, but I was serious.  I want people to process any trauma I’ve caused them, be able to have their say without anyone arguing with them about why they shouldn’t feel the way they do, maybe remember a few of the good things about me….and then go out afterwards and kick a hackey sack full of my ashes…knowing that all is well, and I am well.

It’s Actually An Interesting Process to Donate Your Body to Medical Science

cadaver
Photo Credit: Shannon Carabajal 

Disclosure: For those who avoid morbid light-heartedness and sarcasm, perhaps you won’t enjoy this post.

Over the last year and a half, since getting divorced, I’ve been getting my  “affairs” in order.  I don’t plan on kicking the bucket any time soon, but in case I do, I want things to be in place for my boys.  So, I’ve designated a power of attorney, set up an estate trust, gotten ample life insurance, and set up a living will and advanced directives…you know, adulting kind of stuff.

Having gone to about a billion funerals in my life, and helping plan a few, I realize how expensive and stressful funerals can be. Even the cheapest, absolute bare bones funeral home services and coffin package costs several thousand dollars.  Even cremation comes with a noticeable price tag.

In many areas of my life, I’m pretty frivolous and excessive.  But when it comes to me dying, I have always aimed to be as practical as possible.  Salvage what you can for those needing transplants, and let medical students hack away on the rest of me. Morbid as it may sound, I’ve just never been keen on being stuck in a box in the ground or set in an urn on a fireplace mantel somewhere.

I made my wishes clear to my power of attorney in the unforeseen event of my demise and may have daydreamed a tiny bit of how my earthly self might help further the causes of medical research.  That is until I talked with a local hospital marketing employee who told me that in Indiana, it’s actually sometimes more difficult than you would think to bequeath your freshly dead self to science.  I was really disappointed, both regarding my fantasies of my altruistic sacrifice, but also because my plans to make things super easy on my kids and family when I die shriveled up before my eyes.   Just to be on the safe side, I decided to look into the process, and here are a few random but interesting facts I stumbled across on The Google.

  1. You have to apply to donate your body, and…you might be rejected.  In general, having things like cancer, arthritis, or dementia won’t exclude your bodily donation from being accepted.  However, if you have a communicable disease, hepatitis, HIV, are taller than six feet, or weigh more than about 200 pounds, your chances of being selected to grace the cadaver table of a med school gross anatomy lab are slim to none.  Apparently, the embalming process adds another 100 to 150 pounds of weight to a corpse, making them wieldy to handle.
  2. Who would have thought that airline mergers would have any bearing on gifting yourself to a research institution? But it does. According to US Funerals Online, the changes in major airline companies have made getting donations to where they need to go more costly and cumbersome. If you’re concerned about the transportation industry ruining your post-mortem travel plans, consider pre-registering with a for-profit cadaver company to donate your body so you’ll know ahead of time what your options are.
  3. Donating your body to medical science isn’t free. In some places, like Indiana, where I live, there is a 24-hour phone line to call with inquiries about donating a recently deceased person. A quick phone screening by the Anatomical Education Program of Indiana University School of Medicine will determine eligibility for donation. If the family of the deceased requests it, the program will come pick up the body, use what it can, and cremate the remains.  If the family doesn’t want the ashes back 18-24 months later, there is a cemetery specifically designated as an eternal resting place for them..the ashes, not the family.  This is all done with no expense to the family.  However, it costs the School of Medicine significant funds to carry out this program.  But an added perk?  You can donate funds along with yourself when you die to ensure that the program will be able to afford to dissect you, for educational and medicinal purposes, of course.
  4. Supply of cadavers for research and medical school is low, even as many medical schools are moving away from using cadavers. In the past, it was legal to use unclaimed bodies as research cadavers. Perhaps you’ve even heard stories of grave robbers and body snatchers. Here’s an interesting bit of history and social injustice surrounding that. Now, in states like New York, years old traditions have been upended by new laws requiring explicit consent by family to use a body for research.
  5. Body farms – enough said.  A few years ago I started reading Stiff: The Curious Life of Human Cadavers by science writer Mary Roach. In one chapter she described exploring an outdoor scene where corpses lay in various degrees of decay.  I had forgotten all about the detailed imagery in her book until reading articles for this blog about body farms.  This is the less glorious side of donating one’s body to science.  Rather than be sliced and incised by a fresh-faced doctor wanna-be, bodies are laid out on plots of land so forensics specialists can learn about how bodies decompose over time and when exposed to the elements.  However, the noble side of body farms is they can help provide justice for victims of abuse. Also, on a lighter note, if you get rejected as a body donation by a medical school, you might be welcomed at a body farm.
  6. You might not be accepted as both an organ donor AND a whole body donor. Organ donors are more common than whole-body donors, and it seems more culturally accepted here in the United States.  But many places, like the Mayo Clinic, won’t accept a body for donation after organs have already been removed for other purposes.  So, another reason to plan ahead of time which rite of passage is most important to you?- transplants or research.
  7.  There are alternatives to traditional funerals and cremation through funeral homes. Apparently, there is a trend called “green burials“, which is legal in all 50 states, where one can be allowed to decompose naturally without the use of embalming chemicals like the carcinogenic formaldehyde.  There are 30 or so specific “green burial” cemeteries across the United States.  And unbeknownst to me, you can still be buried in your backyard on private land as long as proper protocols and rules are followed.  This sort of necessitates pre-registration as well to ensure all the necessary paperwork is filed before you die.  Finally, only seven states require that a funeral director presides over the comings and goings of a person who has died. In all the other states, body preparation and services can all be performed at home.   Kind of like a home birth…but the other direction.

In reading up for this post I found quite a number of humorous articles related to body donations, as well as sites of companies that ironically make money off of body donations by taking them and piecemealing body parts out to needy institutions.  But the overall lesson? Body donation is not always a firm guarantee, so deciding on a backup plan for your body’s final destination is a good idea.

As a last side note, consider setting up an advanced directive for how medical care should be organized in the event you can’t make decisions for yourself.  It’s not difficult, it sure helps healthcare professionals and your loved ones when hard, emotional choices are required, and it’s a good way to maintain your self-agency in death instead of letting the courts have authority over who makes decisions concerning you and your care.

 

 

Life and Death are Programmed Within: A Brief Reflection on Telomeres and Interdepedence

A few years ago, after just moving to the Boston area, I discovered that the Dalai Lama was going to speak downtown at TD Garden.  I wasn’t very familiar with the city yet or how to get around, but I hopped on a train anyway and made my way up to see him.  Until that time, I had read bits and pieces of his writings and listened to a few short YouTube videos that featured him being interviewed or teaching.

The stadium was packed when I arrived, drawing in crowds from all different backgrounds.  The funny thing is, I hardly remember a thing about what he actually said.  But what I do remember is that he basically made the throngs of people melt.  We sat still and quiet, hanging on to every word that he said, and giggling every time he laughed or made a joke. We didn’t just hear a talk by an amazing religious and political leader; we felt the presence of someone who was joyful, and compassionate and seemed to know something that most of the rest of us didn’t.

I fell in love with the Dalai Lama that day. He’s very high on my “People I desperately want to meet but there is very little chance of that happening in this life, gosh darn it!” bucket list.

I own several books written by the Dalai Lama, and was very excited to read The Book Of Joy, which records conversations between the Dalai Lama and his good friend, Archbishop Desmond Tutu, about what it means to live a joyful life.

the book of joy.jpeg

In one particular chapter, the Dalai Lama and Tutu discussed death and how we need to learn to face our own mortality, and the fact that things in life constantly change and cease to exist.  Here’s a short excerpt that caught my attention:

“In fact, as the Buddha reminds us, the very causes that have given rise to something, such as our life, have created the mechanism, or the seed, for that thing’s eventual end. Recognizing this truth is an important part of the contemplation on impermanence.” (p.165)

When I read this sentence, my mind immediately flew to cellular activity and little bits of DNA sequences called telomeres. When I think of telomeres, I envision health status or life remaining gauges that are common in video games.   Telomeres are short nucleotide sequences that “cap” the end of chromosomes in our cells to help keep them from effectively fraying or fusing with nearby chromosomes.  Another analogy here would be to think of those little plastic tips on the ends of shoelaces that hold the threads together to prevent splaying.

 

telomere
Chromosome highlighting telomere sequence

 

Telomeres can be lengthened with a special enzyme called telomerase, which is present during development in fetal tissue or in adult germ cells (think sperm and egg cells), or cancer cells. It is an important component of the “life-giving” cells, the ones that will reproduce and differentiate into new tissues.  In other normal adult cells, telomerase activity is diminished, meaning that telomeres will inevitably erode every time cells divide.  Ultimately then, each time a cell divides, it ages just a bit more.

Eventually, as a telomere shortens after repeated rounds of cell division, it reaches a critical length. This critical length affects a cell’s ability to divide and reproduce.  Certain tissues in our bodies “age” more quickly because of lots of cell division, like our skin and hair.

While telomere length is negatively correlated to aging (as length decreases, aging factors show increased appearance), shortened telomeres are not necessarily the primary cause of aging.  However, studies have shown that individuals with shortened telomeres have increased risk of things like heart disease or infectious disease. If you’re interested in reading a review of the subject, click here.

What I find intriguing about telomeres is how an old Buddhist saying reflects some biological truth.  A telomere is a seed or mechanism that is crucially involved in both life, and death.  Something that is needed for our development and growth (life processes) also inherently seems to program our length of life to some degree. Sure, we may be able to alter the timeframe a bit with lifestyle choices and staying away from copious amounts of radiation and things like that, but as of right now, we get what we get in regard to telomere length.  In other words, our death isn’t something that just “happens” to us because of external causes.  Death is inextricably part of the same processes that bring us life.

This all brings us back to the Dalai Lama and his reminder that all things that come into existence will end, and this is because everything is interdependent.  Nothing exists independently.

We, as Westerners, are often terrified by our mortality, and we do whatever we can to avoid it. But I think we can learn much about what it means to be human by understanding that nothing stays the same forever, and that the dying process is just as natural as living.  The key then, I think, is to learn how to go through both processes with meaning and joy.