Wednesday, May 27, 2009

A Lock

On Tuesday, Diane on the Good Mourning Glory Blog posted some very nice pictures from Ebay auctions of Victorian mourning jewelry that include locks of hair from the deceased.  Jewelry and other art and craft work made from hair was very popular in the Victorian era, and as Diane notes, it was not limited to the hair of the deceased or to mourning pieces.

There are number of sites that cover this topic very well.  In addition to the Good Mourning Blog at 
and The Victorian Hairwork Society at

A lock of hair seems to capture a moment in time.  I've seen the lock of hair my mother took from me as a baby, curly and red in a way that it never was again.  My wife and I have a couple locks of our daughter's hair.  One was taken as soon as her hair got long enough to make a lock, and the other was from the time she tangled up the brush so tightly in her hair that it had to be cut out.   We don't look at these locks very often, but they bring back happy memories for us when we do.  So,  I think I can appreciate how the Victorians felt about an art form that gives most people the creeps today.  

Locks of hair are still requested by grieving families.  Several years ago I worked with a wonderful one.  The widow was from the states, but had met her husband in Southeast Asia, where he was a physician.  She told me about him as we sat together in the small visitation rooms that were common in the Pacific Northwest where I worked at the time.  This vibrant man had worked very hard to earn the funds to pay for his education.  His energy and  drive took him all over very rough terrain to administer health care to the very poor in his country.  This sacrifice had serious consequences and he contracted hepatitis from a needle prick in the course of his work.   Another sacrifice he made was for his wife.  They returned to her home in Portland, but his credentials were never recognized in this country, and this man who had worked so hard to be a doctor had to look for other work.  The couple were nonetheless very active in working for the causes they believed in, even while he was losing his weight and energy, and eventually his life, to the cancer that followed his hepatitis.  
I was fortunate enough to spend several hours on both of the visitation days that we held for this man at the funeral home, mostly hearing about his strength, sacrifice, and the love shared by the two of them.  At the end of the second day before his casket would be closed and his cremation would take place, she asked me for a lock of his rich black hair.  "It's the only thing about him that the illness didn't change." she said.

Saturday, May 23, 2009

Fear Of Losing The Existence: Photography of John Clang

In his series 'fear of losing the existence', photographer John Chang examines the fear that many of us feel when contemplating or experiencing the death of loved one.  We hold on tightly in our fear of losing these precious memories.   We try to picture our loved ones and struggle to recall all of the details of our time together.  In December,  I posted a related piece, 'Dad's Hands', featuring an excerpt from the blog 'Born a Girl' in which the writer finds details of her lost father slipping from her memory.  She finds, however, that ultimately the important feelings and memories are never lost.  In  'A Grief Observed', author, C.S. Lewis encounters the same situation after losing his wife.  After a devastating loss, the thought that even our memories may fade away, makes that loss seem even more difficult to bear.  Lewis found, though, that when he stopped trying so hard to cling to his memories, and to picture clearly his beloved wife, that the images and memories came back to him.      

"The subject of this series is my parents-in-law.  They are currently in their 60’s, getting older and weaker each day.  We are separated by thousands of miles and I only get to see them once a year.  Each time I see them, they look different.  Their faces change with more wrinkles, their hair has grown thinner and they have become more fragile.  A sign of aging.  Sometimes when I miss them really badly, I realize I have difficulty in picturing their faces accurately in my mind. I’m very afraid that one day I will not be able to remember their faces anymore and we will become total strangers." -John Clang

Monday, May 18, 2009

Ask the Undertaker: Ashes and Apple Trees


Dear Pat,
So I was thinking, people have things buried with them all the time, right? Is there a right or wrong list for what is acceptable? I remember the Ripley's 'believe it or not' story about the apple growing out of the grave that it was buried in... Anyway, I want to be cremated and my wife wants to be buried. She also wants us to be together. Can our daughter bury my ashes with her if I go first? Also, as a businessman, would you charge extra in that case for putting two people into one grave?
Thanks! Ari

Dear Ari,
Personally, I would love to have an apple tree grow out of my grave, but I'm not sure who would want to eat the apples! This question actually comes up a lot, and many people put things in caskets or send items along with a person to the crematory. I think that it can be a great way for people to express how they feel about their loved one, and a way to honor things that were important to them. The only guidelines I would worry about are safety for the living and respect for the dead. I posted an article on this subject in November called "You Can take it with you". As far as the plans for you and your wife, it all depends on who dies first. If you die first, your family can just hold on to your cremated remains until your wife dies. Then, a family member or the funeral director can place your cremated remains in her casket for burial together. This is a practice that has become pretty popular these days, and there should be no additional charge for this from the funeral home. You may end up with an additional administrative fee from the cemetery for record keeping, as they are required to maintain their records forever. Most cemeteries will allow at least one additional cremated remains to be buried in the same space, so if your wife dies first, you should still be able to be buried together. Check with your cemetery to find out their policy. Usually limits on the number of burials in one grave are based on leaving enough room for everyone's name on the marker, rather than how many remains could actually fit in the grave. If your ashes are buried on top of your wife's casket, you will have an additional opening and closing charge for that service from the cemetery, and the charge from the funeral home for their services at the cemetery as well. Most cemeteries and funeral homes will charge a lower fee for their services in the case of cremated remains because there is less labor and equipment required. Sometimes, burial requests get even more complicated. In November, I posted another story, 'Together Forever' about a mother and child who died only a few days apart. The family wanted them to be buried in the same casket.
Best regards,
Pat McNally, Undertaker

Friday, May 15, 2009

Memorial Tattoos

Mention the word 'tattoo' and the first image that comes to mind may be the iconic 'Mother' tattoo.   This is one of the original memorial tattoos.  You might ask  'would your mother want you to have that tattoo?', but what would you think about a tattoo that a mother gets in memory of a baby who died at birth?  Is that a trashy and reckless mutilation of skin, a touching gesture of remembrance, a careless gesture that will be regretted later, a meaningful reminder? Tattoos are no longer the taboo they once were. In the small town where I live, there are two tattoo parlors right next to one another, right across from our historic town hall; and they both seem to be busy all the time.  More and more of all kinds of people are getting tattoos today, from grandmothers to politicians, and the tattoos are as varied as the people who get them. 

A new twist on an old favorite by artist Phil Young of New Haven, CT

Memorial tattoos are, quite simply, tattoos that are made in memory of a loved one who has died.  There are whole sections devoted to them on tattoo websites, and they show up on discussion boards and blogs by grieving mothers too.  Whether they are a good idea or not, all kinds of people choose to memorialize a loved one permanently in this way.  Here are some creative ways people have found to memorialize their loved ones with tattoos: 

I was very touched by this design made on a mother's feet.  I can imagine her thinking of her child with every step she takes through life.

This tattoo was made using the client's own handwriting in memory of a brother.  The tattoo was done on the day of his tragic death.  There are very few words here, but their choice and presentation convey a unique and very personal message.
This tattoo was made in memory of a miscarried child for blogger Heidi Reed.  Can a permanent reminder of a fleeting life help a mother move forward?  For the story behind it, visit

This tattoo is a memorial to a father.  The piece is based on a photo of his racing helmet.  I hope that the funeral services held for this man were as personal and meaningful as the tattoo. -by artist Jeff Johnson of Newbury Park, CA

This tattoo was made in memory of the client's grandparents, from a tiny picture taken of them at Coney Island.  It makes me think of a memory that has moved from the inside, out to the surface of this grandchild's body -another piece by tattoo artist Phil Young of New Haven, CT

Honoré Sharrer

Nursery Rhyme, 1971

Honoré Sharrer, a noted American artist of the 1940s and afterward whose bold, witty, incisive paintings documented the daily experiences of ordinary working people, died in Washington on April 17. She was 88 and had lived in Charlottesville, Va., for many years.

The cause was complications of dementia, her son, Adam Zagorin, said. Ms. Sharrer’s family did not announce the death until last week.

In an era in which many of her contemporaries had begun to explore Abstract Expressionism, Ms. Sharrer remained committed to figurative art as a powerful vehicle for social criticism. Known for their jewel-like colors and painstaking attention to detail, her paintings were purposely flat, hyperrealistic and strongly narrative in their depiction of everyday life. Her visual style seemed to embrace the old masters and the Ashcan school in equal measure; in later years, it also incorporated a dash of deliberate strangeness that some critics described as magic realism.

from the New York Times obituary

Tuesday, May 5, 2009

How Do You Do? I'm Sorry For Your Loss

The words we say when trying to comfort others can often be misunderstood or over-analyzed.
When I was in kindergarten, my friend Alex was knocked over, along with his block tower, by another student who was haplessly running through the area.  When I felt bad or was hurt, my parents often said 'I'm sorry', and that was what I said to Alex when he got up crying.  Alex wasn't comforted by my words though, instead he sounded surprised and angry.  "You didn't do it!  What are you sorry about?"

This is not just a child's reaction.  In mortuary school, another fellow student and apprentice funeral director had been out to some one's home after a death.  He told the widow that he was sorry about her husband, and her response was quite similar to Alex's, "What are you sorry about?  You didn't even know him!" She was angry and felt that his comment was not genuine; just another line handed out to everyone without thought or sincerity.  
Just as I didn't know how to respond to Alex, the apprentice didn't know what to say back to the widow, other than that he was sorry, and that hadn't worked very well the first time. 

Unfortunately, the apprentice vowed that he wouldn't ever say he was sorry to a grieving person again.  I hope that by now, he has changed his mind, because I know that what he was really trying to communicate was that as just another person, whether he knew the deceased or the family or not, he was sorry that such a sad thing had happened to her.  Surely humans have not grown so callous that they cannot feel for strangers in their grief.  In saying "I'm sorry for your loss" or 'I'm sorry about your mom" we are expressing our sadness about the situation and it's effect on another person, not pity or guilt, and not a claim that we know the depth or the unique personal feelings involved in this loss. 

In a language filled with expressions that are not always meant literally; in which 'How do you do?' is not a question at all, but means 'Nice to meet you'; and the response is 'How do you do?' again, meaning 'Nice to meet you too', perhaps 'I'm sorry for your loss' may be the closest our words can approach the meaning that underlies them.
There will always be anger and misunderstandings where language is concerned, but I believe that when delivered with the correct tone, even a statement like 'How are you' will be understood by a hurting person to be an expression of caring and interest, and not the unthinking blunder that it otherwise could be taken for.
We need to continually be conscious and careful about the words we use with the grieving, but we should never stop telling them that we are sorry, that we care, and that we feel for them in their loss. 

Monday, May 4, 2009

Ghost Month

In April I posted a story about a housing development in Taiwan that was abandoned because ghosts are thought to inhabit it.  Recently, I found this related video about Ghost month as it is observed in Taiwan.  Ghost month is in August, but I couldn't wait 'til then to post this video.

What I find most interesting is the level of involvement that the people in this video have with their dead and with the dead in general.  The belief that the spirits of the dead regularly inhabit the same world that we do can make a big difference in how we look at death and how we lead our lives.    

Sunday, May 3, 2009

The Bearers of Bad Tidings

Casualty Notification Officers (CNO) of the U.S. military branches, and Doctors are regulary charged with the task of delivering the worst of news.  "Your son was killed" or "You have terminal cancer" are words that no one can bear to hear, but must be delivered by someone.  Ideally this horrible news should be conveyed with tact, clarity, and sensitivity.  The medical establishment and the military have both taken a lot of critisism about the manner in which these communications have been made, and there are efforts to educate doctors and CNOs to improve their graveside manners.  

In the case of the military, just the fact that there are CNOs is a step in the right direction.  At one time, notification of death came via the Western Union boy or a taxicab driver in the form of a telegram.  Here are two accounts of recent notifications. 

Maj. Scott Sanders, an Army officer, recently performed a casualty-notification mission for a 101st Airborne Division Soldier.  Notification duty officially begins when a Soldier receives a prepared statement and is told to inform some one's parents that their son or daughter has been killed in the line of duty. Sanders got the job when his name came up on a roster.   On his way to the parent's home, he wondered if there was any way to soften the words that would surely be the most devastating these people had ever heard. He began practicing his statement aloud and altered the tone several times, knowing there was no right or wrong way. Nothing was going to change what had happened. Sanders also contemplated rumor-mill stories that had circulated about other notifications; one family grabbed the notification officer and cried, while another refused to allow the notification officer into their home for several hours. One father claimed the notification officer was at the wrong address, refusing to believe the casualty was his son. 
"Many notifications have been made late at night, as mine was," Sanders said. The Army's concern is that some one other than an Army representative might deliver the news unprofessionally and without accurate information. The closer Sanders came to the Soldier's home, the more he prayed that no matter how the family reacted, he'd act professionally. Finding the right house was difficult. And after much futile pounding, a neighbor suggested Sanders try knocking on the back door, since the family entered and exited from there. As he approached the entrance, Sanders' stomach seemed to fall to his feet, and his whole insides ached. Then the door opened. Concentrating on the words he was going to say was difficult, he said, as a middle-aged couple looked at him, taken aback by his presence, especially at such a late hour. 
Mustering as much courage as he could, Sanders read his prepared statement, as his hands trembled. Etched in his memory forever was a father who simply stared at him, too shocked to do anything else, while the mother pounded the table with her fists in anger. -from an article by Renita Foster on for the full text,visit

There is no harder task than to knock on the door of a fallen Soldier’s family.  The family sees the dress uniform and knows their hearts are about to be broken.  I have notified two families.  You receive the call when you least expect it.  The voice is almost apologetic when you are asked if you are able to perform Casualty Notification Officer duty.  You say “Yes” as your stomach sickens.  They give you the initial report.  A Soldier’s name, when he died, where he died, and the phone number of the Chaplain that will go with you. Your next phone call comes from the Casualty Assistance Center (CAC).  They are less apologetic.  I’m sure it comes from having to make similar phone calls all day long.  They give you the family’s address.  The nausea grows as the conversation goes on.  The CAC asks for your email address so they can send all the paperwork. The paperwork has a script you should read. “I have an important message to deliver from the Secretary of the Army…” 

As you get dressed your mind races.  You try to remember the class you were given on how to notify families.  You try to remember what other Soldiers have told you about notifying families.  You try to remember to breathe.
When I told the wife, she cried for a half hour on her couch.  I sat there in silence listening to her cries, and her repeated “Why?”  There is no answer to ease her pain, or to heal her heart.  And, there never will be. The mother answered the door and knew immediately.  I broke the hearts of the parents as they held each other.  As you sit at the table and explain the circumstances, you measure each word based on the extent it will hurt the family.  You use the Soldier’s first name.  You never use the word “remains” or “body”.  Every reference to the Soldier is spoken in the present tense.  And you hold back your own tears, as the parents ask repeatedly if there has been a mistake.  As much as you wish it was, you assure them there is no mistake.
 The second time was different, but no easier.  The Soldier was 19 years old and had been in Afghanistan for only a month.  At 6:30 am, no one answered the door.  As the Chaplain and I sat waiting in the driveway, the older brother saw us.  He knew why we were there… two Soldiers in dress uniforms at 6:30 am isn’t hard to understand. The parents were out of town.  He didn’t give me their phone number, instead, it was his sister that called the parents.  They drove 500 miles back to Michigan.  I can’t imagine the pain they felt with each mile.  When I officially notified the parents, the house was full of relatives.  The mother and father were composed and grateful.  They shared his first letter from Afghanistan, it had come two days earlier.  Casualty Notification and Casualty Assistance Officers stand on doorsteps and deliver the most heart-wretching news imaginable.  We stand there sick to our stomaches and burdened with guilt.  We stand there not as a duty, but as a commitment to the Soldier’s and the family’s sacrifice.  It’s what we would want for our family.

The question of how the CNO best communicates the fact of death to families is not a relevant point in this case because the reason for the CNO visit seems to be apparent to the family as soon as the soldiers in dress uniform are seen.  Afterward there is a protocol for how the news and details are delivered, and the demanor and emotion that the soldiers are allowed to express.  While it could be argued that more extensive training be given, the military formality and the importance that is placed upon notifying the families as soon as possible are understandably priorities that may preclude a more studied comunication of the news.

For doctors, little in the way of training or protocol has traditionally been taught in medical school,  but this may be changing as the following excerpts illustrate.

Sidney Bloch, professor of psychiatry at the University of Melbourne, has been working for many years to improve doctor training in this important but neglected area. “During my time in medical school I was never taught how to communicate with patients about matters of gravity,” he recalls. “In my internship I faced dying patients from the very beginning, and to talk to these patients and their families was extremely daunting. We defended ourselves by developing thick skins. We adopted the stiff upper lip approach. This promoted dehumanisation, and this remains the case today in our hospitals.”
Later in his career, when teaching psychiatry registrars, he saw how difficult it was for them to empathise with patients. “They hadn’t been taught how to do it and, besides, there’s a school of thought that suggests you can’t teach empathy anyway, that some people naturally have it and others don’t.” While Sid agrees that some people tend to be more naturally empathic than others, he doesn’t believe that empathy can’t be taught. But, given that empathy is a feeling state rather than something that can be memorised from a textbook, how does one teach it? Sid Bloch’s answer is to use the humanities.
Married to an English literature graduate and having studied two years of an English degree as a young man, he had long been aware of the contribution of poetry and literature to our understanding of suffering and aloneness. 
Further to his teaching of psychiatry registrars, Professor Bloch has since designed and implemented an undergraduate course called Ethical Practice/Empathic Practice (or EP2). This course, compulsory for all medical students at the University of Melbourne, teaches empathy and ethics through the use of literary texts as well as academic writing. A short story by William Carlos Williams teaches students about the frustrations of examining a wilful, uncooperative child who is nevertheless gravely ill. Extracts from Joan Didion’s powerful memoir, My Year of Magical Thinking, speak to the experience of grief. Sid Bloch sees this course as an opportunity for medical students to reflect on what they have already observed in the hospital wards in an effort to develop better ways of responding to patients’ emotional needs.
“EP2 is the beginning of a lifelong set of practices, which one constantly examines and continues to improve,” he says. “Aristotle said the development of good habits is an important part of ethical practice. As doctors we need to develop good habits which, in time, become better with practice.” One of the EP2 tutorials is aptly titled “Truth-Telling and Conveying Bad News.” Sid comments, “Giving bad news is a good example of the ethical–empathic hybrid. When conveying bad news, a doctor needs to be aware of their ethical obligations” – to do good, to avoid doing harm and to respect a patient’s autonomy – “while also being empathic and caring.” As a warning note, he adds, “Doctors need to empathise appropriately and sensitively, but not too much, or it will wear you out.”
Balance these ethical and empathic demands with the need to provide up-to-date clinical knowledge and one begins to understand why giving bad news is a difficult task. But this doesn’t mean doctors shouldn’t try to improve their skills. We must dispense with the idea, embedded from our early medical training, that to give bad news is somehow an admission of failure. We must challenge the magical thinking to which our profession is somewhat prone: that is, we must realise that, in delivering a diagnosis of cancer or MND, we are not to blame for the patient’s disease. We should also be constantly mindful that the situation is far, far harder for the patient and their family members who sit before us. It is they who must make the difficult journey with their disease. As good doctors we must be there, from the very outset, to help them. 
-from an article by Dr. Jacinda Halloran on for the full text, visit-   her novel, Dissection is published by Scribe Publications

In addition to courses, a protocol of six steps has been developed to help doctors to deliver their bad news in a sensitive and helpful manner:

1. Getting started.
The physical setting ought to be private, with both physician and patient comfortably seated. You should ask the patient who else ought to be present, and let the patient decide. It is helpful to start with a question like, "How are you feeling right now?" to indicate to the patient that this conversation will be a two-way affair.
2. Finding out how much the patient knows.
By asking a question such as, "What have you already been told about your illness?" you can begin to understand what the patient has already been told, or how much the patient understood about what's been said, the patients level of technical sophistication, and the patient's emotional state.
3. Finding out how much the patient wants to know.
It is useful to ask patients what level of detail you should cover. For instance, you can say, "Some patients want me to cover every medical detail, but other patients want only the big picture--what would you prefer now?" This establishes that there is no right answer, and that different patients have different styles. 
4. Sharing the information.
Decide on the agenda before you sit down with the patient, so that you have the relevant information at hand. The topics to consider in planning an agenda are: diagnosis, treatment, prognosis, and support or coping.  Long lectures are overwhelming and confusing. Remember to translate medical terms into English, and don't try to teach pathophysiology.
5. Responding to the patients feelings.
If you don't understand the patient's reaction, you will leave a lot of unfinished business, and you will miss an opportunity to be a caring physician. Learning to identify and acknowledge a patient's reaction is something that definitely improves with experience, if you're attentive, but you can also simply ask ("Could you tell me a bit about what you are feeling?").
6. Planning and follow-through.
At this point you need to synthesize the patient's concerns and the medical issues into a concrete plan that can be carried out in the patient's system of health care. Outline a step-by-step plan, explain it to the patient, and contract about the next step. Be explicit about your next contact with the patient or the fact that you won't see the patient. Give the patient a phone number or a way to contact the relevant medical caregiver if something arises before the next planned contact.

-from the University of Washington Medical School, for the full test, visit

Bearing bad news will always be a challenge, no matter how much training or preparation a doctor or soldier has been given, but hopefully efforts will continue to improve the quality of communication and the empathy with which it is given.  

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Funeral service faces a crisis of relevance, and I am passionate about keeping the best traditions of service alive while adapting to the changing needs of families. Feel free to contact me with questions, or to share your thoughts on funeral service, ritual, and memorialization.