It was a relief to find others like me; it removed the stigma and alienation. These were practitioners shifting our relationship with death, pulling the shroud off our deathways and getting to the hard work of facing the inevitable.
This work drove me internally. Externally, I was just the body-van driver. Three times a week I would drive my eleven corpses up the I-5 from San Diego and pass through the immigration checkpoint. My large, unmarked white van moved slowly toward the front of the inspection line, looking far more suspicious than the Priuses and Volvos in the other lanes. I would find myself hoping to be stopped, if only as a break from the monotony. In my mind, this is how the scene would go:
“You don’t got any inmigrantes back there, do ya, missy?”
“No inmigrantes, Officer. Just eleven people,” I’d reply, and, whipping off my sunglasses, “former US citizens.”
“Former?”
“Oh, they’re dead, Officer. Real dead.”
Unfortunately, every time the van rolled up and the officer saw a young white woman at the wheel, he or she would wave us right on through. I could have smuggled hundreds of Mexicans into the country in cardboard cremation containers. I could have been a drug mule. I could be a rich woman by now.
With as much time as I was spending on the road, my main fear was getting into an accident, crashing on the freeway. I imagined the back doors of my van flying open, all eleven passengers hurling out. The police show up amid chaos and confusion. Eleven fatalities—but why are these people so cold, with no signs of bodily trauma?
Once the smoke cleared and they discovered that all these fatalities were pre-dead, I’d become an Internet meme, my little head grimacing in a Photoshopped Wizard of Oz–style corpse tornado.
But every day I made it back to the crematory with my eleven bodies. When I pulled up behind the warehouse, Emiliano would be playing his accordion in the parking lot along with the Norteño music blasting from the stereo in his Cadillac. The soundtrack to my body unloading.
But the day I almost died, I wasn’t in the body van. I was driving my ancient Volkswagen through Salton Sea, California. Salton Sea is a man-made saltwater lake smack dab in the middle of the Southern California desert. One idea in the 1960s had been to redesign it as a resort destination, an alternative to Palm Springs. Now, instead of martinis, Hawaiian shirts, and water-skiing, abandoned mobile homes line a morass of brown water with an unbelievable stench. Massive fish die-offs have littered the shoreline with fish and pelican corpses. The satisfying crunch of the sand beneath your feet comes courtesy of thousands of dried bones. I had made the four-hour pilgrimage from Los Angeles to visit this monument to decay. Some consider it gauche to visit so-called ruin porn, but I like to witness firsthand the way nature will declare war against our hubris, building in places unintended for human habitation.
As I drove toward the northern shore of the thirty-five-mile-long Salton Sea, I chanced upon a dead coyote by the side of the road. This wasn’t one of the petite, doglike coyotes sometimes found in urban Los Angeles—it was a beast with a blackened tongue and distended stomach. I made a U-turn and returned to inspect him, undaunted by the suspicious locals in their trucks and ATVs.
Perhaps this coyote was an omen. The coyote and/or the fish graveyard at the Salton Sea. And/or the old women riding golf carts in pink Juicy Couture tracksuits. They all might have been omens.
Darkness had fallen before I departed for Los Angeles. The four westbound lanes of the I-10 freeway passed through Palm Springs, filled with Sunday revelers heading home. I was driving my Volkswagen in the far-left lane at a steady 75 miles per hour. The back left side of the car began to shake, and I felt the dull thud of a tire blowout. I put on my blinker to move into the median, miffed at my bad luck.
But it turned out a flat tire wasn’t the problem. The bearings had slipped loose and the entire wheel had begun spinning off the axle. Finally, bolts snapped and off it came, leaving a gaping hole where the wheel once was.
With only three wheels, the car spun wildly out of control. I spiraled across four lanes, raising a rooster tail of sparks as bare metal scraped against asphalt. Time seemed to slow as the Volkswagen performed its deadly dance across the highway. There was a complete, throbbing silence inside the car. The lights from oncoming traffic whirled in a blur around me, the vehicles missing me as if blocked by some miraculous buffer.
More than the loss of control, more than the crushing loneliness of contemporary life, this was my worst fear, what Buddhists and medieval Christians referred to as “the bad death”—a death for which there is no preparation. In the modern era it takes the form of bodies ripped apart in a searing crunch of metal. Never to tell their loved ones how passionately they are loved. Affairs out of order. Funeral desires unknown.
Yet, as I spun and my hands pulled the wheel in some attempt at control, my mind was miles away. At first, a voice said, Ah, here we go, and a gentle peace descended. The “Moonlight Sonata” played and slow motion began. I had no fear. I realized as the car spun that this would not have been a bad death. My four years working with bodies and the families attached to them had made this moment a transcendent experience. My body went limp, waiting to accept the violent impact. It never came.
I slammed into a dirt hill bordering the shoulder of the highway. Facing oncoming traffic head-on, upright, and alive, cars and semis whizzed by me at dizzying speed, any (or many) of which could have hit me during my swirling journey across the highway. But they hadn’t.
Once I had been terrified at the thought of my body being fragmented. No longer. My fear of fragmentation was born from fearing the loss of control. Here was the ultimate loss of control, flung across the freeway, but in the moment there was only calm.
THE ART OF DYING
There is a mid-fifteenth-century German woodcut entitled Triumph over Temptation that depicts a man lying on his deathbed. The denizens of heaven and hell surround him, fighting over his mortal soul. Demons with twisted porcine faces, claws, and hooves reach toward the bed to drag him down to the fiery underworld; above him, a horde of angels and a floating crucified Jesus pull a tiny version of the man (presumably his soul) upward to heaven. In the midst of all this commotion, the dying man looks positively blissed-out, filled with inner Zen. The little smirk on his face tells the viewer what he is thinking: “Ah yes, death. I’ve got this.”
The question is: how do we get to be that guy? The one who is facing his own death with complete calm, ready to get on with the moving-on.
The woodcut represents a popular genre in the late Middle Ages: the Ars Moriendi, or the Art of Dying. Ars Moriendi were instruction manuals that taught Christians how to die the good death, repenting mortal sins and allowing the soul to ascend to heaven. This view of death as an “art” or “practice,” rather than an emotionless biological process, can be tremendously empowering.
There is no Art of Dying manual available in our society, so I decided to write my own. It is intended not only for the religious, but also for the growing number of atheists, agnostics, and vaguely “spiritual” among us. For me, the good death includes being prepared to die, with my affairs in order, the good and bad messages delivered that need delivering. The good death means dying while I still have my mind sharp and aware; it also means dying without having to endure large amounts of suffering and pain. The good death means accepting death as inevitable, and not fighting it when the time comes. This is my good death, but as legendary psychotherapist Carl Jung said, “It won’t help to hear what I think about death.” Your relationship to mortality is your own.
I recently sat next to a middle-aged Japanese man on a flight from L.A. to Reno. He was reading a professional magazine called Topics in Hemorrhoids, complete with a large-scale photographic cross-section of the anal canal on the cover. Magazines for gastroenterologists do not mess around with metaphorical cover images of sunsets or mountainscapes. I, on the other hand, was reading a professional magazine that proclaimed “Decay Issue!�
� on the cover. We looked at each other and smiled, sharing a tacit understanding that our respective publications weren’t for popular consumption.
He introduced himself as a doctor and medical-school professor, and I introduced myself as a mortician trying to engage the wider public in a conversation about death. When he found out what I was working on, he said, “Well, good, I’m glad you’re talking about this. By 2020 there will be a huge shortage of physicians and caretakers, but no one wants to talk about it.”
We know that media vita in morte sumus or, “in the midst of life we are in death.” We begin dying the day we are born, after all. But because of advances in medical science, the majority of Americans will spend the later years of their life actively dying. The fastest-growing segment of the US population is over eighty-five, what I would call the aggressively elderly. If you reach eighty-five, not only is there a strong chance you are living with some form of dementia or terminal disease, but statistics show that you have a 50-50 chance of ending up in a nursing home, raising the question of whether a good life is measured in quality or quantity. This slow decline differs sharply from times past, when people tended to die quickly, often in a single day. Postmortem daguerreotypes from the 1800s picture fresh, young, almost lifelike corpses, many of them victims of scarlet fever or diphtheria. In 1899, a mere 4 percent of the US population was over sixty-five—forget making it to eighty-five. Now, many will know that death is coming during months or years of deterioration. Medicine has given us the “opportunity”—loosely defined—to sit at our own wakes.
But this gradual deterioration comes at a terrible cost. There are many ways for a corpse to be disturbing. Decapitated bodies are fairly gruesome, as are those dredged from the water after several days afloat, their green skin sloughing off in strips. But the decubitus ulcer presents a unique psychological horror. The word “decubitus” comes from the Latin decumbere, to lie down. As a rule, bedridden patients have to be moved every few hours, flipped like pancakes to ensure that the weight of their own bodies doesn’t press their bones into the tissue and skin, cutting off blood circulation. Without blood flow, tissue begins decay. The ulcers occur when a patient is left lying in bed for an extended period, as often happens in understaffed nursing homes.
Without some movement, the patient will literally begin to decompose while he or she is still living, eaten alive by their own necrotic tissue. One particular body that came into the preparation room at Westwind I will remember for the rest of my life. She was a ninety-year-old African American woman, brought in from a poorly equipped nursing home, where the patients who weren’t bedridden were kept in cheerless holding pens, staring blankly at the walls. As I turned her over to wash her back, I received the ghastly surprise of a gaping, raw wound the size of a football festering on her lower back. It was akin to the gaping mouth of hell. You can almost gaze through such a wound into our dystopian future.
We do not (and will not) have the resources to properly care for our increasing elderly population, yet we insist on medical intervention to keep them alive. To allow them to die would signal the failure of our supposedly infallible modern medical system.
The surgeon Atul Gawande wrote in a devastating New Yorker article on aging that “there have been dozens of best-selling books on aging but they tend to have titles like ‘Younger Next Year,’ ‘The Fountain of Age,’ ‘Ageless,’ ‘The Sexy Years.’ Still, there are costs to averting our eyes from the realities. For one thing, we put off changes that we need to make as a society. . . . In thirty years, there will be as many people over eighty as there are under five.”
Year after year my seatmate, the gastroenterologist and professor, encountered firsthand a new crop of students terrified of their own mortality. Even though the elderly population continues to soar, he has fought for years to implement more classes in geriatrics (the study of diseases and treatment in the elderly), and is repeatedly denied. Medical students just aren’t choosing geriatric care; the income is too low, the work too brutal. No surprise, medical schools turn out plastic surgeons and radiologists by the boatload.
Gawande, again: “I asked Chad Boult, the geriatrics professor now at Johns Hopkins, what can be done to ensure that there are enough geriatricians for our country’s surging elderly population. ‘Nothing,’ he said. ‘It’s too late.’”
I was impressed that my doctor-seatmate (and bit of a kindred spirit, really) took such an open approach. He said, “I tell dying patients that I can prolong their lives, but I can’t always cure them. If they choose to prolong, it will mean pain and suffering. I don’t ever want to be cruel, but they need to understand the diagnosis.”
“At least your students are learning that from you,” I said, hopeful.
“Well, OK, but here’s the thing: my students don’t ever want to give a terminal diagnosis. I have to ask, ‘Did you fully explain it to them?’”
“Even if someone is dying, they just . . . don’t tell them?” I asked, shocked.
He nodded. “They don’t want to face their own mortality. They’d rather take an anatomy exam for the eighth time than face a dying person. And the doctors, the old guys, guys my age, they’re even worse.”
My grandmother Lucile Caple was eighty-eight when her mind shut down, even though, technically, her body lived on to the age of ninety-two. She had gone to the bathroom in the middle of the night and fell, hitting her head on the coffee table and developing a subdural hematoma—medical-speak for bleeding around the brain. After a few months in a rehabilitation center, sharing a room with a woman named Edeltraut Chang (whom I mention only because hers was the greatest name ever assembled), my grandmother came home. But she was never the same, transformed by her brain damage into something of a loony tune—if I may throw around another fancy medical term.
Without medical intervention, Tutu (the Hawaiian word for grandmother) would have died shortly after her traumatic brain injury. But she didn’t. Before her mind was blunted, she had insisted, “For heaven’s sake, don’t let me ever get like that,” yet there she was, stuck in that depressing place between life and death.
After the subdural hematoma, Tutu would tell long, fantastical stories to explain how she had fallen and hurt herself. My favorite was that the city of Honolulu had commissioned her to paint a mural at the entrance to City Hall. While leading her merry team of painters on an artistic quest up a mangrove tree, a branch had broken and she plummeted to the ground below.
One memorable evening Tutu thought my father, whom she had known for forty years, was a maintenance man attempting to make off with her jewelry. My grandfather, who had died several years prior of Alzheimer’s, would pay her postmortem visits to share classified information from the beyond. According to Tutu, the government had assassinated Grandpa Dayton to cover up the fact that he alone knew the structural reason the levees had failed after Hurricane Katrina.
Tutu was what you’d call a “tough old broad.” She drank martinis and smoked until the day she died, yet her lungs remained as pink as a baby’s bottom (results not typical). She grew up in the Midwest during the Depression, forced to wear the same skirt and blouse every day for an entire year. After she married my grandfather, they lived all over the world, from Japan to Iran, settling in Hawai’i in the 1970s. Their house was one block away from mine.
After the accident, Tutu spent her remaining years living like the Queen of Sheba in her retirement condominium downtown. She had 24/7 care from a Samoan woman named Valerie, who bordered on sainthood. Even toward the end of Tutu’s life, as my grandmother slipped further and further into the fog, Valerie would get Tutu out of bed every morning, bathe her, dress her (never forgetting the pearl necklace), and take her on outings about town. When Tutu wasn’t well enough to leave the house, Valerie lovingly propped her up with her cigarettes and left CNN on the television set.
The unfortunate truth, and one of the reasons why openly acknowledging death is so crucial, is that most people who linger into extreme old age are no
where near as lucky as Tutu, with her good retirement plan, devoted caretaker, and Tempur-Pedic adjustable memory-foam bed. Tutu is the exception that proves the tragic rule. Because this ever-growing geriatric army reminds us of our own mortality, we push them into the shadows. Most elderly women (our gender represents the distinct majority of elderfolk) end up in overcrowded nursing homes, waiting in agonizing stasis.
By not talking about death with our loved ones, not being clear through advanced directives, DNR (do not resuscitate) orders, and funeral plans, we are directly contributing to this future . . . and a rather bleak present, at that. Rather than engage in larger societal discussions about dignified ways for the terminally ill to end their lives, we accept intolerable cases like that of Angelita, a widow in Oakland who covered her head with a plastic bag because the arthritic pain of her gnarled joints was too much to bear. Or that of Victor in Los Angeles, who hung himself from the rafters of his apartment after his third unsuccessful round of chemotherapy, leaving his son to discover his body. Or the countless bodies with decubitus ulcers, more painful for me to care for than even babies or suicides. When these bodies come into the funeral home, I can only offer my sympathy to their living relatives, and promise to work to ensure that more people are not robbed of a dignified death by a culture of silence.
Even with the knowledge that they may die a slow, grueling death, many people still wish to remain kept alive at all costs. Larry Ellison, the third wealthiest man in America, has sunk millions of dollars into research aimed at extending life, because, he says, “Death makes me very angry. It doesn’t make sense to me.” Ellison has made death his enemy and believes that we should expand our arsenal of medical technology to end it altogether.
Smoke Gets in Your Eyes: And Other Lessons from the Crematory Page 19