Death and Dying American Style
Often not up close and personal
In many countries, most people die at home. But in America, many people are not present at the death of their loved ones because death in America rarely occurs at home.
Most Americans die in hospitals where visitation rules limit who and how many people can be in the dying patient’s room.
According to the Stanford School of Medicine,” 60% of Americans die in acute care hospitals, 20% in nursing homes and only 20% at home” even though 80% would prefer to die at home.
Death in America is usually expensive, clinical, and prolonged by machines or other palliative methods. Dying alone can be very frightening.
According to a 2019 survey conducted by Statista:
- 11% of people are very afraid of death,
- 31% are somewhat afraid,
- 27% are not very afraid,
- 25% were not afraid,
- and 7% said they don’t know.
When one of my very religious aunts was in her 90s, her greatest fear was that she would die. She claimed to be certain of her personal salvation and certain to go to heaven, but she didn’t want to die. Like many, she wanted to go to heaven, but just not right now.
Are younger people equally afraid of dying? According to author George D. Campbell III in his book, EXIT STRATEGY: A Textbook on Death & Dying, a survey of teenagers regarding death showed that, “50% of the students” were afraid to die.
Their fears were based on:
- not wanting to go through the dying process,
- the worry about what will happen after death such as will you be stuck in a place you do not like forever,
- or the concern about leaving people behind that love and/or need you.
Campbell III’s survey asked teens “how they would prefer to die:”
- 40% chose in their sleep in a quiet, peaceful, and painless manner” while
- “30% chose a traumatic death, something that would be quick and would instantly eliminate dwelling on the fear of death while facing certain death.”
The survey also revealed that death was rarely, if ever, discussed at home according to 50% of the respondents. So young people rely on popular culture to discuss death.
Has the volume of gruesome cinematic deaths and digital video game deaths numbed most young people to the horror or even sometimes the banality of death?
Have sentimental movie scenes of loved ones gathered around the dying person and deathbed confessions created a more fictional than realistic picture of death in America?
In fact, many American deaths are more like what Dr. Elizabeth Kubler-Ross describes in her book, On Death and Dying, saying the terminal patient “May cry for rest, peace, and dignity, but he will get infusions, transfusions, a heart machine, or tracheotomy if necessary.”
He may want one single person to stop for one single minute so that he can ask one single question — but he will get a dozen people around the clock, all busily preoccupied with his heart rate, pulse, electrocardiogram or pulmonary functions, his secretions or excretions, but not with him as a human being.”
Often, no one is there when the end comes after loved ones, who have been waiting for days, run home to shower while praying and hoping their loved one will somehow survive until they return.
In general, Americans don’t like to even approach death, not even when they speak of it.
Americans use a variety of euphemisms to avoid the dreaded D word, such as:
- Dirt nap
- Kicking the bucket
- Flatline
- Bought the farm
- Checked into the Horizontal Hilton
- Croaked
- Cashed in his/her chips
- Bit the dust
- Crossed over
- Deceased
- Six feet under
- Expired
- Entered the Pearly Gates
- Got his/her wings
- Gave up the ghost
- Knocking on heaven’s door
- Left the building and so on
Anything but DIED.
Not only do we not want to talk about death, we certainly don’t want to think about our own.
Sigmund Freud said, “we cannot conceive of our own death.”
The younger we are, the more difficult it is to imagine ourselves dying.
According to National Center for Health Statistics, infant mortality is quite high compared to other ages until you reach ages 55–64. There is a sharp increase in deaths beginning at 15–24 years.
In many ways, we keep death as far away from us as possible.
Many people have never seen a dead body except at a funeral. Cemeteries are often walled and guarded.
Scary stories about seeing ghosts in the graveyard prevent most people from frequenting them at night and some in the daytime as well.
For most of us, death is experienced second hand. Yet historically, this is an aberration.
In colonial America and mostly up until the Civil War, funerals and preparation of the body took place at home. The body was washed and prepared by a family member.
Often friends of the family sat vigil over the body in the evening before the funeral and burial. Funerals were attended by the whole community, not just close family and friends.
Though this is a subject no one wants to talk about, it is important to discuss with those close to you what you want if you are not able to make end of life decisions for yourself.
Do you want to be kept alive on machines indefinitely in case you have a chance of recovery, or in case you are conscious, but unable to communicate?
We should face the possibility of death by making these difficult end of life decisions so our families don’t have to make them for us.
Americans should consider creating new rituals around deaths in hospitals to make it less clinical and more personal. Maybe hospitals should reconsider rules regarding visitors and other formalities for the families of the dying.
For those who face death, I would like to share something I found written on the title page of a used book I bought in a book sale:
Pranja Paramita Sutra
Regard this fleeting world like this:
Like stars fading and vanishing at dawn,
Like bubbles on a fast moving stream.
Like morning dew drops evaporating on blades of grass,
Like a candle flickering in a strong wind, echo, mirages, and phantoms, hallucinations, and like a dream.
