Discussion Post for THE LOST ART OF DYING, Chapter 1, pages 17-23

In this post, I will quote passages in Dr. Dugdale’s text that I find especially discussion worthy, pose questions about those passages, and share some of my thoughts. I invite you to reply in the “comment” box below, responding to what I or others have posted, or to any part of Dr. Dugdale’s book that we have read together this week.

Although the plague regarded no person as exempt, some of the wealthy did manage to escape–often to private villas outside urban centers.

Page 18

They went out for strolls carrying flowers or sweet-smelling herbs, which they held up to their noses.

Page 19

Everywhere the people of Florence looked, they saw death.

Page 19

I think Dr. Dugdale wrote her descriptions of bubonic plague in this chapter before 2020. So she probably didn’t intend any comparison to our present “plague.” But I can’t read this without making that comparison. More specifically, I find telling comparisons between her descriptions of plague-struck Florence in the mid 1300s and New York City during the height of our outbreak last Spring.

Dr. Dugdale’s accounts of the escape from Florence by the wealthy, and the use of flowers and herbs to prevent contagion remind me of similar flights from New York, and our use of masks and sanitizers. I find her remark about the omnipresence of death more telling. We have been made increasingly aware of deaths in New York. You probably heard about the mass burials at Hart Island, and COVID-19 death tolls continue to be reported daily. But the great majority of people haven’t seen those corpses. We have remained segregated from actual death in a way that is markedly different from just about any place or time in the pre-modern world, let alone plague-ridden Florence.

No one gathered at the deathbed. No one waited outside the home to shoulder the coffin in a funeral march.

Page 20

Again, in ways similar to plague-struck Florence in the 1300’s, many of the familiar practices attending our experience of death have been interrupted. Visitors to hospitals have been restricted; funeral rites have been delayed. But our practices are different. They take place within specialized institutions and those present are usually a tighter community of family and friends. What do we think of those differences? Are some of our contemporary practices attending death and dying better that those of medieval Florence? Are some worse? Both? Neither?

A central premise was that in order to die well, you had to live well. Part of living well meant anticipating and preparing for death within the context of your community over the course of a lifetime.

Page 21

Dr. Dugdale says this about the ars moriendi books that “began to develop throughout the 1400s.” The assertion that “in order to die well, you have to live well” recurs frequently in this book and headlines the back cover. Of course, “dying well” must refer to the quality of the end of one’s life. Dr. Dugdale isn’t talking about what happens to a person after death, or the presence of supernatural grace at the moment of death. When she talks about “dying well,” she is talking about how we conclude the task of living. Her point, following the ars moriendi, seems to be that, in order to conclude our lives well we must live well now, and part of living well now means living with a view to that conclusion. We will have further opportunities in our reading of this book to think about this and discuss it, but Dr. Dugdale invites us to formulate some initial thoughts as we read this first chapter. If you would like to share some of those, please feel free.

Dr. Dugdale also speaks of “accepting and preparing for death in the context of your community.” What does it mean to accept death? What are some specific ways that we prepare for death in the context of our communities? In my Dominican community, we pray daily and by name for our deceased brothers on the anniversary of their deaths.

Over the centuries, the original ars moriendi grew into a sizable literary genre. It shaped practices related to living and dying in the West for more that four hundred years, succumbing only to the arrival of an early twentieth-century society fixated on ushering in a modern age. . . . Not only did we stop thinking about how to die well; our very culture became inhospitable to the art of dying.

Page 21

Dr. Dugdale makes this assertion toward the end of this first chapter. She will surely expand on this in later chapters, explaining how she thinks our culture has become inhospitable to the art of dying. Again, we will have further opportunities to consider this, but we are invited to start thinking about this now. I suggest we try to think of specific examples of inhospitable practices in our culture. One example that occurs to me is the way we speak about death: our use of vague expressions like “passing away,” or our avoidance of the subject all together.

We do not die well, and conveyor-belt medicine will continue to carry us to bad deaths unless we hit “pause” in the system. Changing the way we die takes work.

Page 22

I think Dr. Dugdale invites us to consider changes in how we think and act as individuals, families, and communities. She also wants us to consider changes to our health care system. What could it mean to “hit ‘pause’ in the system”? It’s clear that Dr. Dugdale isn’t thinking of minor alterations or current best practices. She’s calling for real, hard change.

14 thoughts on “Discussion Post for THE LOST ART OF DYING, Chapter 1, pages 17-23”

  1. In 2020 Just as Dugdale described, the wealthy could “escape”…so, too, those who could..ran from the city…to their second homes, vacation homes, in laws, and so forth….leaving the poor , the struggling, the largest population of the city’s largely middle and lower middle class in the City to fend against the pandemic. There were “food lines” in Corona (for example)…on the nightly news showing catholic charities had “run out” of supplies long before they ran out of hungry people…deeply touching…deeply sad. The refrigerated container trucks…this spring…(likely now standing ready should they be needed for a second surge)….removing any “specialness” from a person’s passing….no mass, no viewing, etc. My mom was an Irish immigrant, poor ..a large family…6 children.. who came through Ellis Island….her father was a carpenter….died when she was a young teen.She told my sisters and I her story that her dad was “waked” at home (in their railroad flat walk up in Yorkville) …I assumed this was a matter of lack of finances…although perhaps it was the ars mroendi of things in the late 1920s. ..”at home” She always told me that he “made the coffins during the plague……………….and many of the people had to go to Potters Field.”….honestly, I had no idea there really was a Potters Field, or where it was, (Hart Is.) I likely assumed for years that it ws a “metaphor”…and, ,as a young impressionable child…in parochial school, we experienced our own grandparents funeral mass….black vestments, on the priest and on the coffin….how dark, how sad…..until the “white” life/baptism dying into new life came into vogue. Similarly, this year, no visitors were permitted…for the hospitalized…whether for covid or anything else….(as my husband was “in” in an emergency situation..and I had to leave him there..grateful I had at least gotten an ambulance to respond)…. Dying well/living well…a true fact of life…having been witih my elderly maiden aunt, a devout catholic, …at her passing/final breath ….her eyes were fixed …almost “glowing”…supernatural grace Dugdale mentions..maybe??as pointed out in the book. My sister, deceased last year after a lifetime of combatting cancer and related illnesses…had shared with me a poem some months before her final bout about the “dashes” on a prayer card she had received at someone’s wake.. e.g.19 ___ – 19___ meaning the” time in between”…..that is the significant /important part when we share prayer cards in honor of our loved ones. Community prepartion today, absent a pandemic, might include the “group healing mases”….”annointing of the sick, group style, or individually…which many times brings together a variety of neighbors and parishioners….with obvious and not so obvious afflictions…..yet, preparatory nevertheless. Our language surely needs upgrading too….a friend some years ago corrected me and said “I (she) did not “lose” her husband …and followed it up with …if I had lost him, I would have found him. We all “dance” around it! Likely the most valuable “work” I’ve done in my life thus far (and I’ve had several careers) would be the Eucharistic Ministry at the local hospitals in New York as well as later on in a Rehab facility. As a current caretaker for my husband, I had thought I’d like to resume that ministry again, but God has had other plans…right now. I always felt that those Communion days always “gave ” me way more than I gave them..yet somehow,nevertheless, I was definitely aware that I always felt grateful to “run out the doors” into the fresh air….healthy !! leaving behind what I had seen, heard, felt or experienced in some of the units, ,etc. …while that was some years ago, I think having spent time with my aunt, my sister and others ….I would no longer be inclined to “run”..Hitting “pause” may already be taking place in some ways within our society…as more people must “caretake” due to the pandemic as caretakers are not freely available nor should they necessarily be “within” our homes….as covid CDC requirements suggest…the pandemic has taken many “people” out of the work force….perhaps they, too, are “caretaking”…one of the component parts of changing/modifying how we view sickness and death.

  2. The way we live our life on earth , to a large extent, is how we prepare for death. We make ongoing efforts to remain in God’s grace – In addition, our prayers, charitable works and a commitment to love and care for others in our community take priority. Our faith teaches that by trying our best to stay on this track, we will be ready when death comes for us. Some Americans do not like to talk about death , the end of life on earth is a depressing topic. Preparing for death merely comes into play when confronted with old age, serious illness or external threats. Dr, Dugdale encourages us to reflect on our finitude and prepare to die well,

  3. “We do not die well, and conveyor-belt medicine will continue to carry us to bad deaths unless we hit “pause” in the system. Changing the way we die takes work”. I totally agree with this reflection. As a palliative care physician, I work with patients and their families on a daily basis who are on the conveyor belt, heading towards a bad death. Indeed, changing the way we die does take work. Others have written well highlighting the fact that in the United States, the given response to a person’s death is a well orchestrated and intense effort to bring the person back from death. CPR, defibrillation, CPR, epinephrine, CPR…And yes, at times this is good. Think of the person who collapses at the high school basketball game and is successfully resuscitated. Thank you EMS. Yet for those in the throws of end-stage illness, those in whom their bodies are deteriorating and on the inevitable decline to death, unless otherwise specified, the end-of-life process remains the same. CPR, defibrillation, CPR, epinephrine, CPR…While I agree with the sentiment that a “pause in the system” will help stem the tide (I would like to think this is what I do), my humble opinion is that the problem runs deeper than this.

    A new medical protocol or health care dictum dispersed among the troops from the upper echelon of hospital administration will not effectively halt this relentless conveyor belt. I contend that real change begins in the home, and among those closest to each and every one of us. When we dispel the fear, and begin to freely talk about our life and death with those we love, then we will be in a much better place to allow for a more natural and happy death. Those of us in the Catholic faith should be especially ready to come to the end of our lives in hopeful expectation of fulfilling our true end, eternal life and union with God. For my part, I offer a response to my own charge by opening the conversation of dying within my own home, and with my adult children. And while their initial response may be, “Dad, this is kind of morbid…”, I can follow with an agreement that yes, while it may seem unusual at first, it is important and necessary. If you have made it this far, thank you for taking note time to read my musings. God bless you.

  4. I think people avoid the dying part of death. For example, watching aging adults lose their, independence. Older people are afraid or unable to ask for help. They are dying slowly and people do not want to watch. You see their homes fall apart, they don’t take care of themselves. We have nursing homes and some community services but these fall short of helping people separate from this life in a supportive way. It’s is this progress toward death that is intolerable to think about. You can prepare for it by yourself but as the dying process intensifies it is hard to live through alone and viewed as strain for others to support. I agree with the author that we need to face the cultural barriers to accepting death and dying to improve community attention and support. Helping would have to be viewed as a privilege rather than a burden.

  5. As a Catholic optimist, I believe that “passing away” is dying well. Rather than focusing on the empty finality of human death, “passing away” allows us to look beyond this life to our eternal salvation. If the people I touch in this lifetime feel that I have earned a heavenly reward at the end of my mortal life, then I will have truly lived well. So other people can go ahead and “drop dead,” but I hope to someday “pass away!” (For those of you who don’t know me, please be assured this word play is intended for light amusement and not meant to offend anyone).

  6. “No one gathered at the death bed.” I think this statement sums up perhaps the worst part of dying during the Covid pandemic: patients in overburdened hospitals were not allowed visitors, and had to spend their final moments with relative strangers or with loved ones present only by video chat. I saw this on my internal medicine rotation at the Brooklyn VA in August, when Covid numbers were low, but restrictions on visitors meant that only those with a few days left to live (even those dying from other causes than Covid) were allowed even a single visitor. The palliative care team at the VA was great, and often knew when it was the appropriate time to switch gears to preparing for imminent death, but logistics and extensive family discussions meant that more than once we missed the “window of opportunity” during which a very sick patient was stable enough to be transferred out of the hospital to die at home or in a hospice.
    I contrast these lonely deathbeds with my experience of my grandmother’s dying from lung cancer. She opted for hospice care in her home, and I was able to visit her weekly during her last months. As she drew her last breaths, she was surrounded by her husband and children praying the rosary. I think this is one example of Dr. Dugdale’s comment that dying well requires living well: for decades my grandmother showed great love to her children, and devotion to her faith, such that the prayerful presence of her family and the hope of heaven at the very end were a great comfort to her.

  7. “Everywhere the people of Florence looked, they saw death.” I too am reminded of our current pandemic. Instead of seeing death in the streets, we heard the wailing of ambulances all day and all night. But unlike people in the 14th Century, we ARE anesthetized from death, unless we actually work with the sick and dying. But even in hospitals, the dead are whisked away and their room sanitized, as if they were never there. Before the rise of the funeral home industry, families laid out their own dead and sat vigil in their homes with the corpse. For everyone in a family, even the children, death was more familiar. When photography got started, people would have photos taken of their dead, especially of the children, not as morbid reminders of sadness but rather of their beloved’s life. As death has become much less familiar to look at and live with, I think our fear of it has grown as well. We avoid thinking about it: out of sight, out of mind. No wonder we are unprepared for our own demise!

    “Our very culture became inhospitable to the art of dying.”
    I think we have also become inhospitable to the dying themselves. The hospice movement, dating only from the early 1960’s, has done excellent work to make the process of dying as comfortable both for clients and their families as the process of living. We can adopt some of these hospice practices in our own homes and lives.

  8. It strikes me that modern society has only further embraced the idea of “living well.” You can’t go very far at all without seeing an advertisement or instagram post that touches on the topic. So how did this get separated from dying well? I wonder if it’s only a natural sequel to the fact that only recently (less than 100 years) do we have medical treatments that actually regularly prolong life. So, generationally speaking, we’re still getting used to the fact that our new technologies don’t always work. I think that they work just well enough that we have pushed death out of our minds, as much as we are able.

    In addition to the language about “fighting” or “beating” disease, language such as someone being “taken too soon” or “gone before their time” is also a recent development, secondary to this idea that medical advancement should give us more control over life and death. This language, and our medical capabilities, open us up to the possibility of treating death as abnormal – even in the face of the fact that it is unavoidable. Perhaps the dust will settle on the medical revolution we are still undergoing, and we will again learn to die well. I just couldn’t guess how long that will take.

  9. Dr. Dugdale is so very wise to ask us to look directly at our finitude and to know that it cannot be avoided as some of the Florentines did by hiding in their homes to try to escape the Plague. The “middle road” that Florentines who carried sweet smelling flowers or herbs took is a metaphor for our own journey towards death. We must live our lives as well as possible–with sweet smelling herbs, perhaps–but most importantly with the knowledge that the lives we lead now are not forever. Dr. Dugdale has done a masterful job of reminding us that part of living well is preparing for our ultimate end.

    I agree with Father Jonah that using the phrase “passing away” is one of the ways we try to avoid confronting death, as is incessant medicalization and hospitalization in an attempt to avoid the inevitable. I think one of the first ways we can hit “pause” is to think about how each of us wants to die…if not in a hospital, it behooves us to let our loved ones and physicians know what our preferences are.

    It is worth remembering that the practices of the Ars Moriendi lasted for 500 years. Perhaps our own 21st Century plague will trigger us to gently bring it back.

  10. Oh…I can’t stand the “passed away” language! It’s like speaking of putting one’s pet “to sleep.” There’s an understandable desire to both soften and sanitize the starkness and messiness of death. But, an essential part of the human experience is the recognition that everyone (and everything living) that we love dies.

  11. Dear all: the first quote hit me the hardest. It hit me like a ton of bricks because it was such a reminder of what I saw and still see in regards to covid. I saw people with moving trucks outside of their homes. I saw homes go empty and black of light at night as if there had been a mass fleeing to safer, less congested places. My brother saw a massive influx where he lives and it overwhelmed an area not ready for or expecting it. And in some cases as they fled : they brought covid with them . And not that fleeing to safety is not instinctive and necessary but I also very much then saw who was left behind and who could not flee or who choose to stay. And I will always feel a bond with those that did stay because we traversed those first few months together and that creates a bond. And we supported each other.And we encouraged each other to stay as safe as possible. And when one got weary, oh so weary of the effort , the lines, the lack of light at the end of the tunnel, we looked into each others eyes as said: “you can do this” and reminded each other that just because you can not see the light does not mean that it is not there. It is an ethical conundrum and a religious one too: do we stay behind /do we seek higher ground:when we know not everyone can…it even came down to who had backyards and front steps to sit outside and take a breath of fresh air on, and who did not. Who had essentials and who did not. Who stocked up and who did/could not . Who had to work as essential services providers and who worked from home or did not have to work. Who had savings to draw from and who had little or nothing . Who had technology and could tune into to Zoom and emails and religious services and who did not have technology .(Dare I say it: who had faith and who did not and how did faith help in navigating this terrain…) Who could risk venturing out for milk and who stayed safe for months and then were afraid to venture out and ventured, with help and support. Who had good neighbors to rely upon and who , in this city where so many don’t know anyone…had no one. Who manned the fire engines ,ambulances and police vehicles (sirens blaring) that passed by on their well to help and save and transport to medical care… that part was very reminiscent of 9/11: who rushed into the buildings as all others fled to safety…Who had family and loved ones in the direct line of fire covid wise, and who did not. To this very day: who lost loved ones and who, blessedly, almost miraculously , did not. I can’t really say how this impacted me because we still feel in the eye of the storm but I can say that lines emerged and they were stark lines (and some would say the lines were always there) . And I sense the lines are getting starker and I do wonder about the perspective of those that fled. And please forgive me if I ruffle feathers but today is Indigenous Peoples Day in some states and as a person devoted to the ideals of Laudato Si long before Laudato Si ever existed, are there lessons to be learned from our oldest brothers and sisters , from our oldest ancestors ? And by avoiding these lessons, are we dooming ourselves and successive generations to a repetition ,reaction wise, be it a modern day plague or tropical storm? And, forgive me yet again, but, can anyone flee a possible sixth mass extinction? By its definition some will seek and find higher ground , temporarily but by its very nature , if it hits as predicted, there will one day be no higher ground for any of the life upon this planet. And, if you gave me the privilege required to seek and find refuge in whatever higher ground there might initially be …would I want to take it and see the end unfold and the suffering unfold and be the last one here?

  12. When reading about the stench of death and the piles of corpses, I also couldn’t help but think about all the refrigerator trucks filling the parking lots during the height of the pandemic in NYC this Spring. Thanks to all of the Dominican friars who bravely continued their work of saving souls this Spring and Summer–despite great personal risk. And special thanks to the friar who drove through the city blessing all the dead bodies. I will forever remember the love and compassion you exhibited when nobody was watching.

    On a different note, we are taught frequently in the Bible to live our lives without fear. When my husband worked as a police officer, I received several notifications in the middle of the night that he had “a line of duty incident”–code for “rush to the hospital.” Night after night, year after year, I couldn’t escape the reality that each passing goodbye could be our last. As the hugs got longer and tighter, my husband simply told me that he could not do his job effectively if he thought he would be killed that night. He acknowledged that his job was dangerous. But it would be even more dangerous if he became distracted worrying about me. In this particular instance, just thinking about death could negatively alter the course of life. At what point in trying to live well have we actually become inhospitable toward death?

    1. I think people avoid the dying part of death. For example, watching aging adults lose their, independence. Older people are afraid or unable to ask for help. They are dying slowly and people do not want to watch. You see their homes fall apart, they don’t take care of themselves. We have nursing homes and some community services but these fall short of helping people separate from this life in a supportive way. It’s is this progress toward death that is intolerable to think about. You can prepare for it by yourself but as the dying process intensifies it is hard to live through alone and viewed as strain for others to support. I agree with the author that we need to face the cultural barriers to accepting death and dying to improve community attention and support. Helping would have to be viewed as a privilege rather than a burden.

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