ELDER MUSIC: Joseph Haydn
A TGB READER STORY: The Fine Art of Dying

Advice for Future Corpses

”We walk around with a blinkered, partial denial of death. Yes, we will die, but not now, not here. This dissonance is strong and strange – to absolutely know this will happen, and against all evidence to the contrary, to absolutely not know.”

The woman who wrote those words, Sallie Tisdale, is well-known as an award-winning author of nine books. She is also an essayist, a nurse, a teacher and a Buddhist practitioner with a decade of working in palliative care.

AdviceForFutureCorpsesCover_Her most recent book, Advice for Future Corpses and Those Who Love Them is subtitled, “A Practical Perspection on Death and Dying.” I prefer to call it a user manual for dying, and it's about damned time we had one.

You would think that a subject so big, so taboo in certain circles, so frightening and fraught would need a doorstop-sized book. But not in Tisdale's hands.

These 240 pages cover a remarkable amount of territory from a discussion of what a good death may or may not be, what to expect in the last months, weeks, days and hours of life, advice on caregiving during end of life and a lot of smart, information for every step along the way.

When asked, most of us say we want to die quietly at home in our sleep. Few of us do and Tisdale gives us another perspective to consider:

The fantasy of a quiet leave-taking in complete control is, for the most part, just that: A fantasy. Our ideals about the so-called good death are constricting. Death is not something at which we succeed or fail, something to achieve. Life and death are not possessions...

“We die in breathtaking solitude. The value of a death doesn't depend on what anyone else thinks about it. My death belongs only to me; its value is known only by me.”

Tisdale, who has accompanied many people during their dying, advises us on how to think about our own deaths:

”I want to meet death with curiosity and willingness. What do you want to do? Do you want to meet death with devotion, love, a sense of adventure, or do you want to rage against the failing light? Cultivate those qualities now. Master them...

“When I find myself in a new situation, when I'm scared, I try to feel curiosity even in the middle of fear...If I experience curiosity in the midst of fear often enough, it will be there when I need it most.”

And then, she pulls no punches about what to be prepared for at the end:

”As peaceful as the dying body can seem, would we be surprised to discover this is a time of great chaos? We are undone. Consciousness is no longer grounded in the body; perception and sensation are unraveling.

“The entire braid of the self is coming unwound in a rush. One's point of view must change dramatically. Being comfortable with surprise allows us to meet the unexpected, both in events and with ourselves.

“This curiosity will serve us well when there is nothing else to be done.”

There is a terrific chapter for visitors and caregivers on communication – what not to say to a dying loved one, but also what to say and how to say it. If he or she is hungry, for example:

”Do they want to eat something? If so, be clear. Vanilla or chocolate ice cream? is easier to answer than Is there anything you want to eat?

As to that dying at home stuff that rarely happens, Tisdale explains that good hospitals these days can sometimes be better than home and she knows this because, she says, “I've been the nurse in rooms like this – and I always knock before I enter.”

”While you're getting ready to kick the bucket and head for room temperature, we'll tell jokes if you like. When you're about to check into the Motel Deep 6, the coffeepot will be fresh and the muffins full of butter.

“All of this is possible, but a lot of it happens because you insist. Because you and I and all the rest of us insist that there be enough chairs for everyone, that the curtains will close tightly when you want to sleep, and the room will smell fresh and sweet.

“And you will be comfortable, because in the good hospital your pain medication comes on time and the nurse who brings it knows how to read dying, knows what's to be expected and what can be fixed and what can't.

“In the good hospital, strong hands will clean you up when you can't make to the toilet any longer and no one will make a face or say things that are better not said as you shuffle off the mortal coil.

“What a wonderful turn of phrase that is. When you're ready for your dirt nap and you've bought your one-way ticket, the nurses will take their time. They won't rush.

“They will come in quietly and wash you carefully and brush your hair and clean up and slip away again.”

Tisdale also takes readers through the necessary particulars of death and dying from the biology of it, end-of-life document samples, assisted death which is legal in six states, several European countries, Canada and Australia.

She also covers organ and tissue donation and the growing number of new kinds of burial. She does all this with honesty, humor, compassion and understanding.

It's a tough subject but she even touches on something I came to know – if only for the flash of a moment or two - during my treatment last year for pancreatic cancer:

”At some point, most of us shift from realizing that sooner or later some future self will die to realizing that this very self, me, precious and irreplaceable me, will die.

“It's a terrible thing to grasp and though this insight may last a mere second, it changes your life...”

Yet this passage gives me hope that with diligent working toward growth, I can attain acceptance of a conscious death when the time comes:

”To accept death is to accept that this body belongs to the world. This body is subject to all the forces in the world. This body can be broken. This body will run down. 'Golden lads and girls all must, / As chimney sweepers, come to dust.' (except, maybe me.)”

This is an important book and there is nothing else quite like it to compare but has not gotten nearly enough coverage.

The New York Times review is here. There is an interview with Sallie Tisdale including a fairly lengthy excerpt from the book at Tricycle magazine.


Comments

Thank you for sharing this, Ronni.

My father died in the Intensive Care Unit at the local VA hospital; my mother died in a nursing home. In both cases, the staff was...words fail me. Profoundly compassionate, and indeed, very competent and unobtrusive. Their presence was a true blessing. I remember especially one aide at the nursing home who cracked open the window in my mother's room to let her soul go free.

Oh now here's a wonder of a book that I cannot wait to read! Thank you so much, Ronni!

I like Mary’s comment “left the window cracked...
Marilyn

In my youth, i always thought that I would like to go out kicking and screaming or in a blaze of glory.
It's funny how age, time and circumstances can change all of that.
Laying in a hospital bed, facing life-saving surgery,questions concerning death arose.
What if I never woke up from that surgery? Would I know that I was dead? What happens to my body?
And then a nice nurse came in and gave me some pills and told me that they would calm me down. And in a few minutes I could not have cared less about death or dying. You gotta love those nurses.

I will get and read this book. I know there are hospitals (and hospices) where they have the time, the resources, the caring to do as you quote, but do your research first. Nurses are my heroes! But there are more and more understaffed, over worked employees of the medical industrial complex who can't provide this environment.

I still kinda like the idea of going out on the woods with a blanket and whatever I can stockpile plus a large bottle or two of booze!

Thanks for a wonderful reference, Ronni. After years of working in aging and health care settings, i couldn't agree more about dying in a Good facility (hospital, nursing home, or hospice) as opposed to dying at home. Let us all begin to think about this now and engage those close to us in our planning. I have and it's a great relief - to me and to them. Ann

Just noteworthy:
There was an hour long interview with Portland author, Sallie Tisdale, regarding her book on PBS Radio's "Think Out Loud'' on June 19, 2018. It can still be accessed on their website. OPB.org

When I was 27 I fell off my roof while trying to finish nailing shingles over the kitchen. I was impaled on a rusty piece of angle iron that had once been a ground for a CB radio. It took the EMTs quite a while to decide how to get me free. All the while I listened to them talking to the Dr. in the Emergency Room over the radio. I heard them reporting my blood pressure as it continued to drop. When it was 40/0 I realized that dying was a real possibility. My life didn't flash before my eyes but I did think about my kids growing up without a father and wondered how my wife would manage without me. I made all kinds of deals with God. If you let me live I will go to church every day. I will never complain about anything. I will live with whatever limitation this puts on me.

As I was wheeled into surgery and transferred to the operating table, I was finally able to let go of the responsibility of not dying and hand it over to the medical team. It was odd to realize that I could die and the world would go on without me. Strangely I found that comforting.

When I finally regained consciousness, it felt like a new chance to live, a re-birth. For years I marked the passing of time from that date. There was before MY accident and after MY accident. Every day was a gift, another chance to feel grateful and welcome whatever came along. As I approach my 70th birthday this week, I still awake every morning feeling hopeful and wondering what the day will bring. Living with the knowledge that someday you WILL die makes every day precious, even the awful ones. You know in your heart that the day is a gift you could have missed. Life is good and getting better.

(Once I could finally get around, I did go to church every day for several months. I didn't make it nearly that long without complaining.)

I sure hope one of my doctors is associated with a "good hospital." I wonder if anyone has compiled a list of the "good" ones. There are lots of lists rating hospitals by how well they treat different diseases and conditions, but not how they treat dying.

Ordered this book. "Be curious." Best advice ever.

This post could not be more timely! I just ordered the book onto my kindle on my I-pad. My mother, 97.5 yrs, had a heart attack 10 days ago and is now in the hospital's hospice facility. Of course, I have been very sad, but death is something she has been eagerly awaiting. She is virtually non-verbal right now, though a couple days ago she did say "Dying is taking too long, I want to be obliterated," then "wrap me in a shroud"! As soon as the physician knew that we were prepared for death and she welcomed it, he increased her medications. The nurses have been compassionate and she is receiving excellent care. I now feel confident enough that I don't need to be there 24/7 as my brother and I were at the beginning of this journey. I have been curious to watch her changes as she "climbs the golden staircase" (her words several days ago). I hope to be with her when she takes her last breath and discover what I experience.

Thanks for this Ronni. I am one of those strange folks who hate summer. I have counted the days until September and onward, until I realized I don't have that much time to waste counting days, and I'd better find a good way to live each one!

Years ago, when my husband died--in the hospital--I was, like some of your readers, so very touched by the care he had, the compassion for him and for us, his family. If he had insisted on dying at home, it would have been a nightmare. As it was, those nurses surrounded us and carried us. There's a nursing shortage now--my daughter is a nurse--and I hope that kind of care is still possible here in Washington state.

This could not have come at a more opportune time. My husband was just diagnosed with a stroke in the right frontal lobe. Still lucid, thankfully. We are now setting up all the legals of our estate.

Up to now he thought himself invincible.

We’ll both be reading this book.

Thank you.

A thousand thanks for talking about this book, Ronni, which I've now ordered.

Your description makes me think this book's message might be putting into words exactly what I have been struggling towards on my own. Curiosity, yes. I really hope my last coherent thought can be, "Oh, now, that's interesting!"

But, we get what we get. Other people, old and young, die every day. I'm not so special that I'll be different. Whether it's a "good" or "bad" death, eventually it'll be over. The world will carry on. The little part of it that I have affected will, on the whole, I think, be better because of me... and I want the the people I love to be able to hang on to that part.

I hope to die in comfort (I don't want to be in agonizing pain or experience other frightening end-of-life symptoms) and in a manner least disruptive to my family. Although in the past I've vacillated between dying at home vs. in the hospital (if my death is protracted) I know I don't want to die in the ICU! An in-hospital hospice probably would be my choice on a practical as well as a personal level. Although I hope the HMO we belong to operates a "good" facility, I won't have a lot of choice at the time.

I've never been much of a fuss-and-feathers type in life, and I don't think that's likely to change as I near death. Like Sylvia, I'm not so special that my death will be different or leave a huge void in the world. Although I'm sure Ms. Tisdale's book is excellent, it may be a bit on the "New Age-y" side for me, I think, from reading the excerpt.

Elizabeth Rogers (and others?)

Just to be clear, Sallie Tisdale's book is nothing like what people call "new age-y". She has been a professional nurse all her life, she has worked in palliative care for more than a decade. She is thoroughly versed on the biological and psychological facts of death and dying - of both the patients and caregivers - along with such practical aspects of end-of-life documents, organ and tissue donation, the merits of various kinds of burials and much more.

Is is contradictory to fact to call any of this new age-y.

What a beautiful book. I ordered it this morning after reading about it here. My sister died three years ago from cancer and while other family members helped out, I lived with her during her illness. I cried twice during that time and the first time I did when she was diagnosed, my sister said if I was going to cry, then I had to go home. What struck me at that moment was this was my sister's journey and I could only go along to help. Having that perspective made me able to sit quietly and listen, anticipate without words, or inforce her wishes without guilt. Caring for her was a profound experience that I am greatful to have in my memories.

Thank you Ronnie. So grateful to you.
o/

As always, Time Goes By gives us perspectives that we don’t get anywhere else. I’ll probably buy this book because god knows I need a guide to this unknowable time of life. What makes me feel sorry for myself 😂 is that I know there are no “good hospitals” to which I have access for this rite of passage.

In order to have the best vision and heart specialists I always choose an HMO affiliated with a major teaching hospital, which serves too much of the region’s population to offer private rooms. In the past, this has made hospitalization a nightmare involving roommates who were insane or religious freaks or both, some of whom held huge gatherings in “our” room. Under post-op circumstances, this has been nearly unbearable. If I were dying, my need for privacy would make it impossible, so I might take Meg’s way out and take a blanket and a bunch of medications to the woods.

Of course this latter alternative presupposes knowing when the thing is going to happen, and the thesis of the Tisdale book seems to be that we are not going to be conveniently handed this information. The nursing home or assisted living facility option would mean making the decision now, while I still feel fine in my own home, where I prefer to be. Maybe if I leave it to chance, as I’ve left almost everything else involved in aging, I might be so out of it that I won’t know where I am.

I wrote about my experience when my children and the doctor thought I was dying. I said it was chaotic. All I felt was that it was taking too long. I wanted it to be over with.

I did realize that I would no longer exist and it gave me a weird feeling. I didn't feel fear or even curiosity. I think I should get this book because it sounds like I need a new perspective on how to die. I know it will happen sooner rather than later.

This comes at the right time for me. I've been thinking about death, feeling close to it and being curious about it. Only I wish death had a different ending. Practice death maybe. Or audition for a starring role. And lucky me, I'm not good enough to get the part.

I just read this book two weeks ago. Very glad you featured it. So many more will read it now and benefit from it. Thank You!

My father worked the day he died--irrigating his beloved cotton fields. He came in, late in the day, told my mother he didn't feel well. Laid down. She called the doctor, who in those days, came to the house, and told my mother there was nothing he could do. They sat there and my dad slipped away. Two months before his 60th birthday. Never spent a day in the hospital.

I want to work the day I die. I want to go out doing the things I love.

Obviously, I should have kept my opinion to myself, at least until such time as I've read the book in its entirety. I drew what may be inaccurate conclusions from reading the excerpt in Tricycle. I'll never be a Zen practitioner, but that's only a small part of Ms. Tisdale's experience and background. I stand admonished and corrected.

Excellent review of what is an important book for all of us. You pulled out "breathtaking solitude" which struck me because at our wedding the Rabbi Donna selected said among other things how getting married was one of life's major events we do with someone. We are born alone and die alone but marriage is with someone.

When Donna was diagnosed with with Stage IV cancer and told she had six months to live I began the vigil of witnessing her death. She live for nearly three years. I missed her death in hospice by a few minutes thanks to a cab driver who got lost. She died alone but to this day I see myself as docent for her death.

"Love is Watching Someone Die" is a post I wrote about Donna, me, and hospice.

Thank you all you share and your keen insight.

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