Reading List: Smoke Gets in Your Eyes

I majored in Anthropology during college. (That’s the study of human beings for those of you who have never heard of it). Coursework can be focused on anything from the cultures of modern people to the evolution of the human being from our ancient ancestors. During my junior year, I enrolled in a class called “Death & Dying: a Cross-Cultural Perspective.”

The course covered the various religious and cultural practices and beliefs of people around the world, as well as how they had evolved over time. “Smoke Gets in Your Eyes: And Other Lessons from the Crematory” by Caitlin Doughty reminds me greatly of this class. The author recounts her first job in the “death industry,” cleaning and cremating bodies at a funeral home in San Francisco, followed by building her career in the funeral industry.

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Her book offers the reader a glimpse the evolution of her experience with death: from young child to experienced funeral director. Then, finally, she ends with the founding of the Order of the Good Death, a “death positive” organization of people who want our modern culture to embrace death and encourage environmentally-friendly and natural funerary practices.

Though it may seem a macabre topic, physicians cannot avoid death. This is a topic she even covers in her book. She meets a medical-school professor who laments that his students do not want to deliver the news of a fatal diagnosis. His reasoning is that they fear their own death, and therefore do not want to confront their patient’s mortality (so as to avoid confronting their own).

My father’s side of the family does not avoid the topic of death. My grandmother (still living) enjoys exploring cemeteries and eating lunch on one of the benches. My father has always been explicitly clear on what he expects for his “funeral.” I guess you could say my family is fairly death positive. We prefer to be cremated and scattered or perhaps buried in one of the “green” tree pods that have been popular on the internet.

My primary concern with medicine is dealing with death. I have had patients die, but never in front of me and never as the result of care that I personally provided. Physicians are face-to-face with death every day. They may prevent death, delay death, or bring death closer (whether or not this was intentional). A rotation in palliative care particularly concerns me.

Death, to me, is a private matter. I never want a large funeral with hundreds of people weeping over a preserved corpse then buried in a big, expensive box. I want to have as many parts of me donated as possible (if possible) then planted or buried in a green cemetery by private memorial with only the closest family and friends. Discussing funerals, burials, and end-of-life care seems to be something involving family and possibly friends. I feel that in palliative care I would be placing myself into an intimate situation.

Overall, I want to strive for a “good death” for my patients when necessary. I am not so naive as to believe that I can defy death in every case. In fact, in some cases I would consider a gentle, painless death to be preferable to a short, futile struggle against, say, an aggressive cancer. There are some people who want “whatever means necessary” to prolong their lives. If that’s what my patient wanted, that’s what I would provide.

Physicians are often burdened emotionally with the death of their patients as a “failure” of their care. What we must realize and accept is that death is an inevitability, especially when we place ourselves in the position of a physician. Our jobs are to treat, cure, and prevent death and disease when possible, but our job is also to assist our patients in accepting their death and providing them a dignified death that respects their personal beliefs and desires whenever possible.

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