peer perspectives (47)

I interviewed three people: Kim, a half-norwegian half-brasilian 15 year-old, who comes from an atheist family; Barbara, a brasilian 17-year old from a spirit family; and Catarina, also brasilian, from a catholic family. These interviews showed me different reactions to death, reflecting different cultures and religions.

Barbara and Catarina both have the same cultural background, but different religions. And their families’ reactions to death reflect that perfectly. Barbara's first contact with death was when her grandfather died . She was only 5, too little to remember anything. She comes from a family of spiritists, she was taught to face death in a natural way, and not to feel weird if any contact happens. “I’ve always been used to knowing that death is ‘a trip’ to the spiritual world”.

She said she had a contact, about three years ago, with that grandfather, in a dream. He asked her to talk to her mother, telling her he was okay. They hugged and “mataram saudades” (the translation for this is impossible, but it is something like ‘killing the nostalgia’ – their nostalgia for each other). I asked her how could she be sure, she answered he was wearing his favorite clothes. Her mother was the one who realized that when Barbara later described the contact to her. She had no idea which were his favorite clothes, that was enough proof for her.

            Her response to death, to the contact, and to the interview, was visibly calm (extremely different from Catarina’s family). Spiritists have a special way to handle death because of their belief in life after death and in reincarnation. Death is not the end, it is just part of a cycle. They know that their loved ones are ‘on the other side’ and that they can even be contacted if it is necessary.

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Catarina’s first contact with death was when her cousin died in an accident. He was riding a boat that crashed against a rock on a beach. Her whole family was devastated and, by that time, she worried about her aunt, who took months to recover. Catarina felt it wasn’t fair, why did her cousin have to die so young? She felt death is a random wave that takes people without coherence. It was hard for her, as a catholic, to forgive god.

Later, her dad’s sister died. She had cancer and fought it for years. But when the doctors told her she couldn’t resist any longer, already determining how long she still had left, she started organizing things for her death. She prepared legal documents, made a testament… but what really stands out on this story is that she also prepared a full freezer, an year worth of her food so her family could eat her special dish for a long time after she had left.  Although this was an extreme and probably not really common reaction, it reflects the catholic's point of view on the theme.
           This time wasn’t as hard on Catarina, maybe because she was older, maybe because it wasn’t such a sudden, unexpected death. She saw her aunt struggling with treatments and surgeries… in this case death was probably a relief. 
             Catarina says death is a way to get closer to god. She thinks that something must happen after death.  Ortega y Gasset, a spanish liberal philosopher, once said: “one of the great limitations, and we should even say shame, of all of the cultures that existed until today, is that none taught men to be what he is for constitution; which is, mortal.” . Being a mortal means giving life substance, facing the inexorable idea that we will all die some day. And to avoid exactly this idea of inexorable body deterioration, the catholic church gives christians consolation against the fear and terror of death, facing it as a passage to ‘true life’.                 (attitude that can be easily proved:

                                                   For St. Augustine, those who suffer the                                                   death of a loved one have not learned to love. The spirit                                                 must not be attached to the fugacity of the mortal world,                                                  the identity cannot be tied to the transitory”)

            “Death, far from taking sense out of life, turns into its foundation, cause and invitation to value even more life as it is. Men, being illuminated by this realization, shall give himself the duty to enjoy the most his loved ones, make friends, evolve compassion and tolerance, always working to generate more life, love, and more happiness, fighting to promote justice and peace on earth.”

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         For my last interview i have Kim, an atheist. He said he first faced death when he was seven; his cat, Menina, died. She was run over by a car, and got an infection, but they couldn’t afford any ‘pet care’. A week later, he found her lying on the front porch. “She looked at me, peed, and then died… I cried and laughed at the same time”. 

         His second death experience was when his great-grandmother died, she was already 100 years old. “One day, when I got home, my father asked me if I wanted to see her before the burial" - she was still alive by then. But they forgot to tell him when she died, he only found out she was dead when she was already being buried. The whole family was sad for weeks. But this time he didn't cry. Now he is older he believes that “death is a way to give back to earth what was given to us.”  He doesn’t believe in prolonging grief.

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Some people kill themselves slowly, throughout life. Drinking, smoking, specially using hard drugs, or even maintaining an unhealthy way of thinking, which could cause predisposition to sadness and unhealthiness. What could be called an “unconscious suicide”. Other people, by the end, just give up, or simply decide to put an end to life, stop resisting. That’s why the psychological is important on the care of patients facing life-threatening illnesses. But this makes me wonder: Can a good psychological state allow you to resist death for longer?

family perspectives (48)

            The most recent death experience in my family was the death of my grandpa. It was a slow and painless death. He was a diabetic. Over time diabetes can lead to nerve damage, which caused him, among other symptoms, muscle weakness, insensitivity to pain, and sweating.

When he got signs of sickness, before that whole “near death” alertness, my parents took the whole family (grandpa, grandma, uncles and aunts, kids and even a baby) to our farm, this was the only time he ever went there. It was, actually, the only time the whole family went there together.

During that trip, one night, he started seating. It was a cold sweat – which is usually related to fear, pain or shock. In that case it was pain, but the diabetes neuropathies, which often get worse at night, made him insensitive to pain.

When back to the city he went to a hospital and the doctor told him he had a heart attack over the weekend and explained:

Although diabetes is characterized by high levels of sugar in the blood, a side effect to the diabetes treatment is periodical hypoglycemia (low sugar levels), so patients who are receiving large doses of evening insulin may be especially prone to nocturnal hypoglycemia. Heart failure can also cause low blood sugar levels, particularly in a person who is already being treated for diabetes, and especially if it is a person of age. Patients with diabetes experiencing nocturnal hypoglycemia may have night sweats without other hypoglycemic symptoms. My grandfather was in all of the higher risk groups, therefore all he experienced was sweat.

A recent event of hypoglycemia in diabetics was a major predictor of heart attack, stroke and death, a just-finished study by the Department of Veterans Affairs found.” (2008) - http://www.usatoday.com/news/health/2008-06-09-diabetes-hypoglycemia_N.htm

            The doctor asked for tests that would determine if heart surgery was necessary. This would take about ten days, but before that he had his second heart attack. This time, being in town, he was able to go to a hospital. He went through an emergency superficial surgery and stayed for a week in the intensive care unit.

It was a really uncomfortable week for him, he was alone, among half dead people and he simply couldn’t trust that the doctors would always remember he was a diabetic and therefore needed special care. He hated that place and never wanted to come back. Back home he started taking some medicine to control his heart’s functions and make him stronger so he would be prepared for a major heart surgery.

            But the only way out of the major surgery would be staying a few more days at the intensive care unit, and he already had made his mind about that. So, at home, he stopped taking the pills and hid them all under his mattress. The doctor was waiting for his recovery to book the surgery, while he was home planning what would happen to himself and his belongings. He listed everything he had and wrote down how he would like it all to be distributed. He decided to be cremated, without any ceremony. He only agreed to make (a brasilian version of) a “requiem mass” for his friends to be able to reach his family.

            A week later he had another heart attack. The family was gathered, trying to celebrate my cousin and uncle’s birthday. He started sweating again. Someone called the ambulance, knowing he could be in risk. They took him into surgery; the family was all home in circle, sitting on the floor, saying everything was alright and that he could choose whatever was best for him, and that this was all that mattered for us. We were trying to send him this energy, trying to give him closure. In the middle of this “family meditation” the phone rang, he had died.

            Two days after his death we received his aches and made a private ceremony in our garden. Only family members and the closest friends were present. Grandmother asked all her grandchildren to spread his aches in her chapel, where she would always be able to talk to him. But there was so much of him that we actually spread him all over the land (a land where the whole family lives). She told us she can talk to him from anywhere now. (:

            My grandfather’s death was the end of a fulfilled life. He rose his children and was able to see his grandchildren. It was the end of the cycle for him. He decided himself to stop the medication – without anyone knowing. He didn’t want doctors postponing his death for his family’s sake. By the end, everything actually came out the way he wanted.

            In Brasil, families usually suffer deeply because of death. For my family it was different. We know life is not forever, so why bother making a scandal? My dad always says when his time comes we’ll have to accept it. As an atheist he doesn’t want a funeral, he has already written a document determining he wants to be, as his father, cremated. He thinks church controls people by fear. He also doesn’t want a lot of people bringing their own suffers to my mom, which is completely reasonable.

my initial thoughts on the care of the dead (46)

Death is the end of a cycle. A large cycle that involves various species of animals, plants and the complex, interdependent communities they form. The cycle of life. It depends on the maintenance of a number of delicate balances within and between a series of complex physical, chemical, biological processes, and in case of humans, social too.

Death is when a person ‘ends’ - on our reality, i wont get into the post-death topic. It determines, for the people around, the last breath, the last talk, the last warm and therefore conscient touch. It could mean the last chance to ask any questions, a chance to get redemption, to tell a truth that has never been mentioned. A chance to get closure, to make peace. 

But saying that it is a moment when a person "ends" doesn't mean that from now on he/she simply doesn't exist anymore. It is by far more profound than that. After all, the people who just lost a loved one are still around. For them, it is a time filled with great emotions all at once. Emotions that can feel stronger and deeper than ever. From getting scared, worried, angry or sad, to feeling in shock, unprepared, confused or guilty. You could experience denial, exhaustion, relief... All of which could lead to trouble with eating, sleeping and concentrating, and consequently with studying. Which could lead to drinking or eating disorders and maybe even nausea as a reaction to grief.

The intensity of grief may be related to how close the person was to the one that was lost, and to how sudden or predictable the loss was. There are many steps of grieving, its process takes time and happens gradually. Different people take things differently, some religious people feel confused, indignated and doubtful in relation to faith, others feel even stronger on that matter. 

Some people can hold back their own grief or avoid talking about the person who died, maybe even to make it easier to others. Death involves profoundly the family as a hole, differently from birth, which only affects directly both parents. It is a time for profound reflection.

Death also means, for the dying person, closure too (of course!). I find it extremely important to give comfort and transmit only ‘good energy’ in someone's final moments. Encouraging him/her to do what’s best (for him/her), not feeling attached to this world.
It is also a time for that person to make a listing of properties, choosing what will happen with all that will be left of him/her on this physical world, what will be done with his/her body, and maybe with the organs, too. This will all be left for the heirs to take care, after his/her death:

First, the funeral itself, choosing what will be done with the body or, if the death was predictable, following that person's decisions. Family/social reunions, such as masses or others. Inheritances or debts (money), which could mean a lot of trouble and a good deal of time. The body, organs, or maybe even cells can be donated, for further human use or scientific research.

But what is the proportion of people who DO donate organs or cells for the benefit of others? What are the options (donating organs or cells or blood)? How will cells be used?

How do people usually die, nowadays (isolated from the family)? Is there a considerable amount of people dying completely left alone in hospitals? Are people's choices respected (in matter of how to die, not after death care)? And on the streets.. what is done to the bodies of the homeless?

There is a great discussion nowadays about the euthanasia (at least in Brasil). I would like to know more about both sides of the discussion. Doctors today prolongue lifetime with the use of medications even in those cases. People don't let others die with the excuse of "preserving" life, even though there is just no more life, but maybe suffering. It is so contradictory!

meeting Tina

You find yourself at a cocktail party with the author of the book you just finished reading. To demonstrate that you really read it, you say, "Hey - thanks for writing Birth, The Surprising History of how we are Born. Your thesis on humans’ behavior regarding birth throughout time, giving emphasis to the changes the process of delivering has gone through over the last few centuries, made me rethink pregnancy & birth. The way men suddenly invaded an all-women profession and, without any knowledge about birthing by the time, unnaturalized the process for both mother and child.

But the author, surprised to be talking to someone who instead of sharing their own birth story actually rephrased the main idea of the text she spent months giving birth to asks, "Really, which parts were most effective or important for you?" When you answer, "Well, in the last third of the book you focused on the postpartum period, which added another angle to the need to take birthing as a natural process, not an illness, further developing the idea of how unnatural men have made delivering in hospitals, which contradicts the way humans have acted up until only a few centuries ago, as you have described on the first 2/3rds of the book. But let me be more specific."

And then you listed the top 3 ideas/pieces of evidence/insights from that final third of the book (and somehow even listed page number references).

1. Bonding (228)

2. Breast-feeding (234)

3. Rooming-In (225)

“It is shocking how modern hospital procedures differ from the natural delivering process. How now we ignore the importance of breastfeeding, of the mothers bonding immediately to a newborn; how rooming-in is a relatively new habit, after the 20^th century. Natural delivery doesn’t solely influence the process of giving birth, but it benefits the mother, for it being a life-changing experience, and the immediate bonding – which benefits both – by breastfeeding and being able to “room-in”, could have long-term implications to the newborn.”

At this point, realizing that she's having a unique conversation with a serious reader of her/his book, the author asks - "But what could I have done to make this a better book - that would more effectively fulfill its mission?" You answer, "Well, let's be clear - your text sought to provide historical – retelling the history of being born since we started evolving to walking up straight and growing our brains, journalistic – adding important data of our recent behavior regarding birth, and policy analysis – relating different countries’ public policies responding to medical dictations throughout the last few centuries, even though those would often come from wrong assumptions, from the perspective of a mother and journalist for the book-reading-public to better understand pregnancy & birth in our culture. Given that aim, and your book, the best advice I would give for a 2nd edition of the text would be to better organize, chronologically, the historical facts. But I don't want you to feel like I'm criticizing. I appreciate the immense amount of labor you dedicated to this important issue and particularly for making me think about natural delivery & placenta eating. In fact, I'm likely to do a lot differently as a result of your book – such as look for natural pain relief, I’ll not consider any other option of delivery besides a natural birth (and why not a water birth?), which I could have considered if not reading your book, and I’ll take this book to Brasil to try to spread your words among my women." The author replies, "Thanks! Talking to you gives me hope about our future as a society!"