Category: All Saints

From the perspective of bureaucracy and administrative documents, our life begins registering a birth at the register Office and ends with a death certificate. In an excellent article in the New Yorker, Kathryn Schulz uncovers the story of death certificates and the list of death causes, from around 81 in the 17th century, to 14.000 in the latest WHO list. With a mortality rate of 7.89 per thousand, in 2014 there will be around 50 million deaths with 25 million death certificates issued where a cause will be specified. Schulz points that this death bureaucracy is the consequence of modern democracy, “if everyone counts, everyone must be counted”.

The antecedent of modern death certificates are the Bills of mortality, weekly lists of the plague deaths. By 1629 parish clerks were ordered to report deaths from other causes than plague. In 1662, John Graunt, a pioneer demograph, published ”Natural and Political observations made upon the Bills of Mortality” where he analized the mortality rolls in order to prevent bubonic plague from spreading. He compiled a list of 81 causes classified in four categories, “chronic diseases, epidemic diseases, conditions that killed children and outward griefs”. In 1893, an international commitee leaded by Jacques Bertillon would enlarge the list up to 161 causes classified in 14 categories following anatomical criteria. Today the list is managed by the World Health Organization and codes around 14.000 causes classified in 22 groups following anatomical criteria.

The ICD10 (the 10th revision of the International Statistical Classification of Diseases and Related Health Problems) lists the following diseases groups: (I) infectious and parasitic diseases, (II) Neoplasms, (III) Diseases of the blood, (IV) Endocrine, nutritional and metabolic diseases, (V) Mental and behavioural disorders, (VI) Diseases of the nervous system, (VII) Diseases of the eye, (VIII) Diseases of the ear, (IX) Diseases of the circulatory system, (X) Diseases of the respiratory system, (XI) Diseases of the digestive system, (XII) Diseases of the skin and subcutaneous tissue, (XIII) Diseases of the musculoskeletal system, (XIV) Diseases of the genitourinary system, (XV) Pregnancy, childbirth, (XVI) Conditions originating in the perinatal period, (XVII) Congenital malformations, (XVIII) other non classified.

External casues are listed in (XIX) Injury, poisoning and certain other consequences of external causes (by the way, an excellent source of inspiration for crime fiction writers) and (XX) External causes of morbidity and mortality. Other codes are (XXI) Factors influencing health and (XXII) other codes for special purposes. In Catalonia, the most common causes are tumors and heart diseases, which add up to more than 60%.

The question “why” we die or “from what” we die is not easy to answer, particularly if we want to identify, not only the “immediate cause” such as rupture of myocardium, but also the “underlying cause” which would be Atherosclerotic coronary artery. Reporting the underlying cause is difficult, and not only because lack of training but mainly because in most cases, the rellevant information is not available. Schulz goes on discussing the issue quoting Harvey Fineberg from the Institute of Medecine: “if someone dies of a heart attack, you don’t say he died of high cholesterol, sedentary life style and a forty-pack-year history of smoking”. And, notwitstanding, a 1993 paper by Foege and mcGinnis, showed that half of all deaths in US in 1990 could be attributed to nine causes not included in death certificates: tobacco, diet and physical activity, alcohol, microbial agents, toxic agents, firearms, sexual behavior, motor vehicles, and illicit use of drugs. Omitting them is not without consequences as health policies can be focused to new drug research instead of promoting healthy habits.

If the question that interests physicians is about the “cause” of death, the question that the bereaveds pose is “how” someone died. We want to know if “a loved one suffered or was at peace, or if her death was meaningful, or wheter we could have prevented it”. About this, Katrhyn Schulz concludes,  the death certificate can’t say anything, it is not Auden’s elegy for Yeats. “We die because we were born; because we are mortal; because that is, after all, life”.

Debre Libanos, perhaps the most revered monastery in Ethiopia. At a funeral, the men carry the coffin on the shoulders. Behind, some women mourn and cry. We are told that there are people close to the family, not paid mourners as the ones found in other cultures.  In Spain, “plañideras” are back, after being banned by the church (news). In Queretaro (Mexico) there are even contests. In rural Ethiopia, all the community is involved in the ceremony. Each family contributes to a common fund and burial expenses are shared.

Later, in another funeral, maybe someone wealthier, some men are on horseback, and at one point, the women jump in a synchronized manner:

I am fascinated by this way of expressing an emotion, collectively, with the body. Some days later, in the south, in Turmi, in a Hamer community, and in a very different cultural context, I see again women jumping, this time on occasion of the famous bull jumping ceremony when a boy has to walk over the back of a some bulls in a row  without falling. You can feel the impact of the women on the floor.

Why is that this form of expressing emotions can be found in two relatively different areas and cultures? What would be the map of it?

It makes me wonder about  the similarities between the forms of devotion in the Ethiopian Orthodox Church and Judaism or Islam. The cult is not only indoors, but also in the open space surrounding the building, usually circular or octagonal: It has an important role, similar to that found in mosques. People must remove their shoes, as Jews and Muslims, too.  Before entering the compound, people stop at the door, touch the wall and pray. Despite the differences in what is believed, the form of worship is much closer to Jews and Muslims than to the Catholic or Greek Orthodox Church. Could this be explained by climate? By the fact that they are fundamentally pastoralists?

In this 1 min video there is a chant recorded in a church compound; ullulation at 40’’.

In the north, graves in cemeteries are protected by railings. In the south, graves are scattered; it seems that people can be buried in the land where the family lives.

Some cemeteries in Barcelona offer tombstones with qrcodes so that visitors can learn more about the deceased just following the link in their smartphones.

Sometimes when wandering along niches in a cemetery, I read the names, dates, and I wonder about the lives of the people who are buried there, unknown names. When it is the case of a young boy or girl, or a child, I can not help thinking that they had to leave “too early”, perhaps because of a disease or an accident. All the others, what sort of life did they have? What did they do, what kind of events happened to them? No life is insignificant or worthless. Every one of them could have been the subject of a biography that no one wrote.

Just for an instant, I imagine that, suddenly, these rows of niches become the shelves of a library, with volumes of biographies, and perhaps personal diaries, and photo albums. Wandering among the aisles and shelves, I could open up a volume at random.

In a brief biography there could be something like:

• 1947: Finds a job as librarian at the Faculty of Physics
• 1955: Marries Joaquim Jove
• 1956: Has a son who will be christened Angel.

In a diary or memoirs, perhaps there could be something like “I was twelve, and our class had been visiting the zoo. I was going back with a friend, walking along the harbor, when a woman that was selling tickets at the “Golondrinas” booth (boats in Barcelona’s harbor), called us and offered us free tickets for a ride because it was her birthday. I would always remember her kindness to us.”

There is no such a thing as an insignificant life. For every person we watch, we can imagine his past or his future (Post about four ages). In every instant, so many things happen that no biography nor memoir could fetch all this wealth. Not even the most compulsive diarist could record everything. For example, the joy that we feel when commuting to work, just because the wet heat of the summer is over and the first fresh autumn breeze arrives.

And even if they could exist, these infinite memoir volumes, no one could ever get to read even the most small fraction of them. There would be too many and too little time. Not even each of us about ourselves! We cannot keep track of everything that happens. It is sane let things go, as if we travelled with a small backpack, with room for the daily needs and just some light souvenirs, instead of a huge warehouse where all can be stored forever.

Anyway, I like the idea that no one is insignificant and uninteresting, and that these biographies could have been written and I could browse them.

The type of residence in the cemeteries, of course, follows the same style we had in life:

Those living in rent apartments in a normal neighborhood go to simple niches.

Those living in mansions, go to pantheons.

With a some black humor, we could say that we leave the cemetery of the living to move to the city of the dead.

cementeriodeleste.blogspot.com/ is an excellent blog about Poblenou cemetery . There are some remarkable sculptures such as the famous “Death’s kiss”.

Others are very unusual, as this homage to someone belonging to the Roman Heredia family, a natural size marble sculpture, complete with sunglasses and whiskey bottle.

The most popular tomb is that of Francesc Canals, el Santet del Poblenou (the little saint of Poblenou), about whom there is not much known other than he worked at “El siglo” store and was very kind to everyone. He died in 1899 at the age of 22 and very soon people started to believe that he helped those in need that asked for some favor. This popular devotion is still alive today. Lots of candles and images are found around his tomb. People write what they need in little pieces of paper. One day I was talking with a woman that had just lit some candles. A couple of them were for some particular favors she asked but the other ones, she brought them to the “Santet” for other people that could be in a distress. Isn’t that a generous attitude?

Another nice attitude can be found in Cassen’s tomb, Casto Sendra Barrufet, a comic actor: Quien bien te quiere te hará reir. In Spanish they say “Quien bien te quiere te hará llorar” (those who care about you will make you cry), as if education, or the way to a right life could only be taught by punishment. He changed it to “Those who care about you will make you … laugh”. I couldn’t agree more.

Near the cemetery there is a marble workshop where they can make either a kitchen countertop or a tombstone. They work for the cemetery of the living and for the city of the dead. I wonder if I could ask to transform my kitchen countertop in my own tombstone with an engraving “here was lunch and dinner prepared …”.

In the last post we mentioned the “frank talks” at life’s end, when sometimes one has to decide between life-extending therapies, and pain palliative care. The question was about how much are we willing to go through to have a shot of being alive and what level of being alive is acceptable. ¿What would we answer if we were told that we would be mentally aware, able to read, hold a conversation, but walking or normal feeding would be impossible and we would be dependent on pain relievers?

Let’s imagine that this kind of talk would be possible at life’s beginning, before birth, as if we were a indeterminate non-being that can choose about going into existence (let’s forget for an instant the paradox of an indeterminate identity having to choose).

We would be informed about the equipment and conditions of our earthly stay, our genetic code, the strengths and weaknesses: “If you want to enter into existence now, those are your options, you will be a male, medium height, medium intelligence, not exactly an athlete, nor a genius.” We would be informed too about the social environment, in what kind family and in which country are we going to be raised, whether it is  in the developed world or the undeveloped. ( the TV series Quantum Leap proposed a similar approach ).

(from Dürer’s Dresden Sketchbook on Human Proportion)
Perhaps we would not be satisfied with just that piece of information, the cards that are dealt out to us. Before betting on the game of life we would inquiry about whether we are going to have a happy life, or an interesting one, whether we are going to experience pain, or frustration; how long are we going to live. Probably a honest answer would not be a completely  reassuring one. Some amount of confusion, pain and disappointments are guaranteed. But the list of possibilities of knowing, discovering and enjoy is endless. Saul Bellow said it wonderfully in Ravelstein. If we can, for example, feel the fresh, cold morning air when we open the window to ventilate the bedroom, or the taste of olive oil on a toast, talk with a friend, is that enough?

We could imagine that we are buying the tickets for a certain kind of life trip. Success is not guaranteed and it’s really the ultimate adventure trip, engaging into existence in a particular time, place and human condition. If this was like planning a hike, a hypothetical guide could certainly tell that along the way we are going to find traps, injuries and at the same time, delicious fountains, unexpected views, wonderful presents. But no map with white or black points is given. We can miss wonders placed along the way just because we are still recovering from our last misstep.

We could also imagine that instead of having the choice of entering into existence or not, we would be able to choose what kind of life. This is what Plato considers at the end of the Republic in the myth of Er.

After death, souls are given the chance of choosing a particular kind of life for another cycle, a tyran, an animal, a normal man. Before being born again, souls pass through the plain of Forgetfulness and drink the water from the river of Unmindfulness, so that they don’t remember the process. I wonder what could I choose for my next cycle, or what was I thinking when I opted for my present life.

Hear the word of Lachesis, the daughter of Necessity. Mortal souls, behold a new cycle of life and mortality. Your genius will not be allotted to you, but you choose your genius; and let him who draws the first lot have the first choice, and the life which he chooses shall be his destiny. […] When the Interpreter had thus spoken he scattered lots indifferently among them all, and each of them took up the lot which fell near him, all but Er himself (he was not allowed), and each as he took his lot perceived the number which he had obtained. Then the Interpreter placed on the ground before them the samples of lives; and there were many more lives than the souls present, and they were of all sorts. There were lives of every animal and of man in every condition. And there were tyrannies among them, some lasting out the tyrant’s life, others which broke off in the middle and came to an end in poverty and exile and beggary; and there were lives of famous men, some who were famous for their form and beauty as well as for their strength and success in games, or, again, for their birth and the qualities of their ancestors; and some who were the reverse of famous for the opposite qualities. And of women likewise; there was not, however, any definite character them, because the soul, when choosing a new life, must of necessity become different. But there was every other quality, and the all mingled with one another, and also with elements of wealth and poverty, and disease and health; and there were mean states also.  Let each one of us leave every other kind of knowledge and seek and follow one thing only, if peradventure he may be able to learn and may find some one who will make him able to learn and discern between good and evil, and so to choose always and everywhere the better life as he has opportunity. […] A man must take with him into the world below an adamantine faith in truth and right, that there too he may be undazzled by the desire of wealth or the other allurements of evil, lest, coming upon tyrannies and similar villainies, he do irremediable wrongs to others and suffer yet worse himself; but let him know how to choose the mean and avoid the extremes on either side, as far as possible, not only in this life but in all that which is to come. For this is the way of happiness. …] The soul which obtained the twentieth lot chose the life of a lion, and this was the soul of Ajax the son of Telamon, who would not be a man, remembering the injustice which was done him the judgment about the arms. The next was Agamemnon, who took the life of an eagle, because, like Ajax, he hated human nature by reason of his sufferings. About the middle came the lot of Atalanta; she, seeing the great fame of an athlete, was unable to resist the temptation: and after her there followed the soul of Epeus the son of Panopeus passing into the nature of a woman cunning in the arts; and far away among the last who chose, the soul of the jester Thersites was putting on the form of a monkey. There came also the soul of Odysseus having yet to make a choice, and his lot happened to be the last of them all. Now the recollection of former tolls had disenchanted him of ambition, and he went about for a considerable time in search of the life of a private man who had no cares; he had some difficulty in finding this, which was lying about and had been neglected by everybody else; and when he saw it, he said that he would have done the had his lot been first instead of last, and that he was delighted to have it. […] and when they had all passed, they marched on in a scorching heat to the plain of Forgetfulness, which was a barren waste destitute of trees and verdure; and then towards evening they encamped by the river of Unmindfulness, whose water no vessel can hold; of this they were all obliged to drink a certain quantity, and those who were not saved by wisdom drank more than was necessary; and each one as he drank forgot all things. Now after they had gone to rest, about the middle of the night there was a thunderstorm and earthquake, and then in an instant they were driven upwards in all manner of ways to their birth, like stars shooting.

Plato. Republic. Book X

‘Well, if I’m able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive. I’m willing to go through a lot of pain if I have a shot at that.’

That was the unexpected answer that a professor emeritus with a terminal disease gave to the question: “how much you’re willing to go through to have a shot at being alive and what level of being alive is tolerable to you”.

It was a conversation between a palliative-care specialist and a patient. When facing the last months of one’s life, quite often we must choose between therapies focused in extending life, involving costly and aggressive hospital care, and options focused in relieving pain…

This conversation is quoted in an excellent essay by Atul Gawande, Letting Go, What should medicine do when it can’t save your life (New Yorker, 02/08/2010 ). The convenience and legislation about this kind of conversations were discussed also in Frank Talk About Care at Life’s End (New York Times, 24/08/2010).

The American healthcare system is “excellent at trying to stave off death with eight-thousand-dollar-a-month chemotherapy, three-thousand-dollar-a-day intensive care, five-thousand-dollar-an-hour surgery”. A kind of care that often ends with the patient lying attached to mechanical ventilator, mind and body shutting down and no chance for saying goodbye to people we care about. On the other hand, surveys show that the top priorities would be “in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others.”

We don’t have -Gawande says- an updated Ars Moriendi. It was a medieval text with advice about a good death. I couldn’t agree more. I wonder what kind of training should doctors receive in order to be able to teach patients in Ars moriendi. The thing that fascinates me is the diversity of possible answers to the question “what level of being alive is tolerable”. For someone, anything but death is acceptable, for others, if you are not able to feel the adrenaline of extreme sports, life is not worth living. People that commit suicide after an economic reversal, cannot imagine a life without a certain level of comfort. We realize that is not possible to elaborate an Ars Moriendi without writing at the same time an Ars Vivendi. Being mentally aware, to be able to watch the changing forms of clouds in the sky through a window, the lines traced by swallows in spring, a cup of tea and a piece of cake, or some cheese and red wine, watching a comedy or a musical on TV, a conversation with agreements and disagreements.

Ars moriendi gallery at Bibliodissey

The last service we will receive from the microbial community that stays within us throughout our life since we are colonized at birth -in the womb we were microbe free- will be to be consumed by it when we die. This statement by Dr. J. Gordon in the paper quoted in the last post, strikes as shocking. But soon we realise that nature is sage, and features cleaning procedures when this complex process that is human life is no longer feasible. For a 70 year old life, the body will have renewed around 7 times its 10¹³ cells; excluding the microbes that go along with it. We can think of the body as a community of 10¹³individuals lasting 7 generations ( the average age for our cells being 10 years as I commented two posts ago). A noteworthy figure, the whole mankind along 2.500 generations will amount “just” around 100.000 million people, 10¹¹.

Regarding housecleaning and recycling, our environment of artificial items is not as effective as nature. When we die we leave behind a heap of things, furniture, table service, wear, papers, books, tools, photo albums, video tapes, letters, frames. And somebody will have to be responsible for getting rid of all. Those who had to empty the apartment of a deceased friend or relative can tell that this is a hard job. What could we do in order to ease things for the people to come? Get rid of unnecessary things in advance? Perhaps there are letters o writings that we want to keep while we are alive but are so private that we would not like them to be read by strangers. What do we think it would be worth preserving? Should we point where do we keep legal documents?

New digital media present a new version of the same problem. Today we don’t leave behind shoe boxes filled with old letters and pictures, or notebooks with personal diaries and travelogues, folders with drawings, etc; we leave files. Files in our hard drive, files in mail servers, in social networks, posts in blogs, pictures in Flickr or Picasa. We still don’t have a clear idea about what we should do with them. Should everything be preserved ? Or everything deleted after a certain time has elapsed? Maybe there are valuable websites that are going to disappear when a certain domain or hosting is no longer paid. Some of them may still be retrieved through backup copies from Google or the internet archive that regularly takes snapshots of some sites. Who is entitled to claim for a certain digital legacy? Imagine the case of a writer or thinker that dies without heirs. Can Scholars ask for hard drive an email access? Perhaps today Kafka would have given his laptop to Max Brod asking him to delete everything after reading.

But in most cases, our contents are not the equivalent of a Proust manuscript, an Egon Schiele sketch or a Clifford Brown recording. So, when present users start to die, gigas and gigas of digital garbage will be left. In the “offline” world, our heirs will have access to our belongings, apartments or bank accounts, either because we had given it beforehand, either because they receive a legal entitlement afterwards. What can we do in the digital world? We can subscribe Legacylocker services where we can set the recipients who are going to receive the passwords to our accounts once our decease is verified. But does this solve the problem? What are they going to do? Backup it? Delete it? Browse it all and make a selection? It’s impossible to dedicate to this task so much time. And what is to be done with social networks accounts? Facebook offers to memorialize it if someone proves that the user has passed away. This means that further logins are prevented and access limited to confirmed friends. The wall remains open so that friends and family can leave posts in remembrance.

For those really provident, my wonderful life allows you not only preparing your funeral, writing your obituary, and designing your headstone (!), but also writing letters to people you love, listing where your stuff is, listing your favorite music, memories, photos, etc. and give instructions about taking care of your pets. I cannot help thinking that, if we really want to communicate something to somebody, or share our musical, art or cooking discoveries, we could start doing it right now while we are still alive, there is no need to keep waiting our friends and relatives for an email with a link to our digital legacy when we will have passed away. On the other hand, I have serious doubts about whether we should want to leave a permanent legacy, as if this could help in relieving our anxiety for the fact that our life is ephemeral. Perhaps it’s better to exit discreetly, without loud noise and leaving no burdens behind. My daughter said once that our imprint could be like that of a rain that has fallen. I like this idea very much, an easy rain, that wets the soil, waters the plants, and leaves no visible trace. I’d rather be like a rain that comes and goes, than a plastic bottle that is going to stay forever.

An appropriate post for All Saints day!  perhaps this is going to be a series following last year’s post,  Death row, life row. Also related: Extending life span, New runners, last steps.

Every year by All Saints Day we remember the deceased and perhaps, just for an instant, think about death. A great deal all philosophy and religion is a meditation on death. In literature there is the recent Nothing to be frightened of by Julian Barnes.

Yes I do.  To my family, to my friends, and people who have accepted me for being the person that I am.  To the Sullivan and Hayden families, I do not come here with the intention to make myself out to be a person that I am not.  I never claimed to be the best person.  I am not the best father, the best son, or the best friend in the world.  I did the best I could with what I had.  I come with no hate in my heart or bitterness.  To my family and to you people, I can only apologize for all the pain I caused you.  May God forgive us on this day.  I am ready when you are.

Yes. I just want to let you all know that I appreciate the love and support over the years. I will see you when you get there. Keep your heads up. To all the fellows on the Row, the same thing. Keep your head up and continue to fight. Same thing to all my pen friends and other friends, I love you all. I can taste it.

Uh, I don’t know, Um, I don’t know what to say.  I don’t know.  (pauses)  I didn’t know anybody was there.  Howdy.

Actually sis answers to the question “What are you optimistic about and why”  in edge.org regard as a most desirable and positive feat the extension of life up to 120-150 years. To me it’s weird the emphasis on longevity rather than on quality of life.

(1) Too soon? Or too late?
Now, while the idea of prolonging life no matter how does not thrill me (one ancestor of mine used to say that she would rather not live very, very long, otherwise she would think that God had forgotten about her) I am not for putting an expiring date either, like yoghurts in the supermarket. The question would be, taken that death is unavoidable, how or when would you like to die? What age? What loss of abilities is still acceptable? I seems that, either we die “too soon”, still in full possession of our faculties, and that’s a pity, or in clear decay, after months or years of slow decline, which is also a pity; and that would be “too late”. When would be the right time? I don’t know, probably none.

(2) What about a renewal plan?
A hypothetical problem. Let’s assume that by year 3011, technology allows extending life up to 500 years. And let’s assume that the planet can support a limited population, for instance, 10 billion people. So, for the following next period of 500 years, we can choose between 5 sets of people living a 100 years span, or 1 set of people living a 500 years span. Or two sets of 250. What would be the best? Wisdom and experience and a world populated basically by venerable elders? A higher renewal tax? A mix of both? Let everyone choose and see what happens? I don’t know. But some day we will we asked to answer the question about how long are we supposed to stay on stage until this “last scene of all, that ends this strange eventful history, is second childishness and mere oblivion, sans teeth, sans eyes, sans taste, sans everything”. [As You like it II, vii]

(3) Living longer, what price?
It has been said, that half of all spending in health care is done in the last year of life, suggesting that medecine invests unreasonable efforts in trying to expand life. The statistics are not so evident according to a Medicare report but it is obvious that there is a border between what would be medical actions for assuring some quality of life and medical actions for mantaining vegetative functions of an organism. That’s what the “living will” is about.  On the other hand, the irruption of antiage treatments brings forth the issue of how to implement or fund them. It is going to be limited to those who can afford it? Are you going to live as long as you can pay for it?

(4) An aesthetic point of view
All in all it is a hard issue from the point of view of science, religion, philosophy, bioethics … There is no happy ending.
I believe that thinking about it from an aesthetic stance could help, as if we were assessing a screenplay for TV or scene, or the performance of a tune. If we had to write a good death for the main character, what would be a good way to die? A never ending scene that became boring like a tune that never stops while tired musicians play out of tune? A big bang finale? If I had to say it in musical terms, I’d rather have it like one of those jazz tunes when, after several chorus, the main theme is played and then a riff is repeated a few times, softer and softer until only a slight graze of the drums brushes is heard and then all vanishes.