In the Absence of Clouds, Artists and a Nurse Discuss Death and Dying (or The Art of the Death Panel)

Bones oil on canvas by jparadisi

Outside, it was a rare, January day of cloudless sunshine. Instead of enjoying it, I sat on a bench towards the back of an art gallery in a vacant storefront, where I estimate thirty artists sat in a circle talking about death and dying. I was there because the artist moderating the discussion is a friend of mine, and because I wanted to hear what people who are not health care professionals have to say about death and dying. Their ages ranged from twenty-something to seventy-something. Some had family members who are terminally ill. Some had lost parents, grandparents, siblings or friends. No one said they were battling life-threatening illness themselves, or had in the past. A couple of the artists were studying physics. As far as I know, I was the only artist working in health care. Because of that, I decided to listen without participating in the discussion. As an oncology nurse, I get to talk about death and dying all the time.

People shared their experiences of death, and then quickly shifted to ideas about their own deaths. One thirty-ish looking man admitted that he thinks about it all the time, and is saving money for cryogenics. He wants his body frozen when he dies. Another person, older than middle-aged, said he hoped to convince a friend or family member to drown him should he be a victim of dementia. Dementia seemed more feared by the group than pain. Another person thought you couldn’t really know when you’ll wish to die until it happens to you. Several people said they have signed POLST forms.  I found it interesting that no one brought up physician-assisted suicide, which is legal in Oregon and Washington states.

The topic of caring for dead bodies was lively. Most of the group couldn’t imagine washing a dead body, and a few insisted that they don’t care what happens to their own remains. This was the part of the discussion I found keeping my silence difficult. I have lost count of how many bodies I have washed and dressed. All of them have been infants or children. I was a pediatric intensive care nurse during that period of my life. While it was always sad, I feel that washing and dressing those small patients for their parents and families to hold and say good-bye to was the most sacred service I have provided my patients.

A young woman said that she learned in an anthropology course there’s a culture “I can’t remember the name of,” which believes each of us dies three deaths: First, we die physically. Secondly, when the last person who knew us dies, and lastly, when our name is no longer spoken. I’m not surprised I heard this for the first time in a room full of artists.

There was one statement I considered profound. An artist said she doesn’t know if there’s an after life or not. “If there isn’t, there’s nothing to be afraid of, but if there is, I am not afraid of that either, because in that case, I have already been there.”

I came away from the conversation believing that the people who know the most about death and dying are the dying themselves. Now that I work in outpatient adult oncology, I no longer attend at the bedside of the dying like I did as a PICU nurse, but many of my patients share their thoughts about their impending deaths with me. Most are at least a little frightened of the unknown. Some have said it all went by so quickly. I have heard young patients say that their bodies have become burdens of maintenance and they look forward to being done with them.  The last time I saw him, an elderly patient said to me, “My Juliette, parting is such sweet sorrow,” and he made me cry.

Oncology and Hospice Nurses Should Read this Article

       Okay, this isn’t the happiest subject to post on a beautiful Friday morning before a weekend, but the topic is important and it’s part of my job to know this stuff. Warning: it’s about end of life treatment for patients with terminal cancer.

      Oncology and Hospice nurses, please read this article in today’s Health section of the New York Times. Whether to turn off pacemakers in the face of terminal illness is a consideration in end of life discussions with patients and their families. Read the article:

Life Saving Devices can Cause Havoc at Life’s End

     Have any reader’s had experiences related to this? 

The Volcano Lover

Cinder Cone with lava field in the background photo: JParadisi

Cinder Cone with lava field in the background photo: JParadisi

     Recently, I walked to the top of a volcanic cinder cone in the Cascade Mountain range, in Oregon.  I have been in love with volcanoes for decades now, since I first heard of the ruins of Pompeii in the fourth grade, and  images of cataclysmic geology flowed  like molten lava within my ten year-old imagination. 

     I read the novel, The Volcano Lover, by Susan Sontag, simply because of its title.  It wasn’t  as much about volcanoes as it was about submerged passion and possession, but I enjoyed reading it.

     It was weird, walking on the top of a volcano, though it’s been more than a millenium since its last eruption. Volcanoes in the Pacific Northwest don’t conjure tropical images of the goddess Pele hurling showers of orange and red molten stone at the lovers who displeased her. Pacific Northwest volcanoes are more subtle. They simmer quietly for eons, occasionally belching benign plumes of white steam, seen for miles.

     I didn’t live in Oregon when Mount St. Helen erupted in May of 1980. But I have seen large spirals of steam billow up to the sky from it,  like no cloud I’d ever seen before.  It was a few years ago. I had just gotten off work, and was going to my car on the top of the hospital’s parking structure, when I saw it. A coworker of mine, who I occasionally ate lunch with (we liked the same bench in the hospital’s garden during good weather) was the only other person there to see it. We sat on the hood of his car, watching the phenomenon, and congratulating ourselves for having the best seats in Portland for this spontaneous performance. A year or two later, I can’t remember, this same coworker, who loved nature, his family, and his patients, was shot in the head by an intruder in his home, who stole the very car my now deceased friend and I had sat on that day, watching the volcano, and wondering what would happen next. 

     You never know what’s brewing underneath.

     I thought about all of this while walking the cinder cone. Life is unpredictable. One day you’re healthy, the next, you or someone you love is in an accident, or diagnosed with a life-threatening illness. Or you get a phone call from a stranger, telling you  “I’m very sorry to inform you ma’am, that your loved one was found dead…”

     With this in mind, I refrain from judging my outpatients who irritably or sheepishly ask me to let them go out for a smoke, between their infusions of chemotherapy. A diagnosis of cancer motivates some patients to quit, but others find it so stressful, they don’t have it in them. Some of them berate themselves with guilt, because of it.  I do my duty, and encourage them to quit, but I know first hand that a healthy lifestyle doesn’t guarantee a cancer free life, and out of compassion, I share this knowledge with them. 

     I think about safety, and how to avoid danger, and this quote, from the sci-fi movie Demolition Man bubbles up from memory:

 “I have seen the future. Do you know what it is? It’s a 47-year-old virgin sitting around in his beige pajamas, drinking a banana-broccoli shake, singing, ‘I’m an Oscar Meyer Weiner’.”

     I’m learning that the rules we make for ourselves only create an illusion of control. We have choices, but we don’t have control. Or rather, we have control until it’s taken away from us, through illness, accident, or a violent crime. We walk, not realizing the volcanic turmoil underneath the smooth surfaces of our lives, until an eruption occurs.

     You never know what’s brewing underneath.