1: Urgent Needs in the First Hours

When my father died in 2019, it wasn’t a surprise. He had diabetes for years and had been in decline. But I was surprised by the state of his paperwork and finances and everything. Whenever I asked about his plans he told me everything was “taken care of.” After he died, we discovered this was only half-true and I watched my stepmother struggle to make decisions while she was grieving her husband of 30 years. She was frustrated. And angry. I am sure it all contributed to her death just five weeks later. I don't want to do that to anyone when I die. And I don't want you to, either. 

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This is Dying Kindness, a podcast about the details of death and dying. I'm Cianna Stewart, and I'm going to die someday. You will too. So let's all learn what we need to do, and make some key decisions before we die, in order to be kinder to those we'll leave behind.

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Since this is the first episode, I figure I should start by telling you a little bit about who I am. Really that starts with who I’m not. I’m not a doctor or a lawyer or a funeral director or a death doula or any other kind of professional in the death industry. My interest in this topic is because I’m going to die someday. Beyond that, I do happen to be more comfortable talking about death than most people, maybe because I’ve known so many people who have died throughout my life, relatives and friends, of all ages from infancy to old age, from accidents, illnesses, and causes unknown. Some were expected, and some not. The first time I can remember doing a formal independent study of death practices I was 14, for an anthropology class. Then I worked in HIV in the 1990s, and was the primary caretaker for my roommate as he died from AIDS. A decade later I did research and wrote for a documentary series about pandemic diseases - that set me up well for having lots of opinions about COVID, by the way. I’m now in my 50s and many of my peers are grappling with more of the practical aspects of death, both their own and their aging parents. More than once, I’ve helped friends find a mortuary, plan a memorial, empty out a home. Yeah, I’m that friend.

For the purposes of this podcast, though, I’m going to play the role of reporter and host because, really, I’m not an expert in anything except being curious. I’m here to learn what is useful for you and me to know about death and dying, and how best to plan ahead in order to be kind to those we’ll leave behind.

I’m going to get pretty frank on this show, directly speaking to my future death and to yours. I hope that you can hang with that. It’s a powerfully grounding practice to contemplate our own deaths. It can clarify what we want to do while we’re alive, bring things into focus.

To understand my motivation for this podcast, imagine what your loved ones will be going through when you die. Put yourself in their shoes. They’re going to have an emotional reaction to your dying. They’ll be grieving or angry or shocked or who knows what? They’ll be stressed. And that means they won’t be thinking so clearly. They can get easily overwhelmed and be at risk of making poor decisions. You can help them. You can make a written record of your information and decisions and keep it organized. I am putting all of mine into what I call a death binder. It’s a literal 3-ring binder that I’m storing in a fireproof file cabinet that my brother can access since he’s my executor.

I truly believe it’s an act of kindness to take care of this stuff. I know it can be hard to think about our own deaths, but avoiding it is like outsourcing the discomfort, like dumping it on other people - the people we say we care about. So let's all make it a little bit easier on them by facing the hard decisions ourselves and being sure that all of our information is in a place that they can find.

As I go through the following list, I’m guessing you might want to grab a pen and paper. You could also download this info later from my website, DyingKindness.com. That way you can just listen and keep doing whatever it is that you’re doing - driving, cleaning, taking a walk, whatever. I like to picture you thinking about this stuff while you’re doing everyday things. Talking about death shouldn’t be precious. We should strive to restore seeing death as part of life instead of hiding from it, putting it behind closed doors. 

I believe our culture here in the U.S. has become too disconnected from death and dying. We’ve moved away from having families handle everything and towards a professional industry of death management. We talk about “traditional” funerals being an open casket and burial in a commercial cemetery, but even though we call it “traditional,” it’s really only dominant here in the U.S. Truth be told, we haven’t been doing it very long here, either. And all these practices are continuing to change. More on that in the future. I can go on and on, but I want today to be more practical. I’ll save the history lessons for future episodes.

Today’s focus will be on what would be needed in the first hours if you had an accident or a heart attack or something else sudden and unexpected happened to you. Some of this is necessary for all deaths, but things are different when the dying process is drawn out and there’s time for conversation. Also, accidents can happen to anyone at any age and I’d like to encourage everyone to do this work now. We need to stop thinking that death planning is only for the old or the critically ill.

OK enough preamble. Let’s begin. I’m going to start by inviting you to picture yourself in this scenario so that you can get clear on what you do and don’t have organized. Ready?

Imagine you’re on your own somewhere in a city and you get into an accident. You’re unconscious and seriously injured. Someone has called 911. You get taken to a hospital and it’s touch and go. What’s next?

In an accident, the first thing emergency personnel or hospital staff or whoever needs to is to know who to call. These days, they’re most likely going to look for your cell phone to find your emergency contact. Do you have that stored in your phone? If you have an Apple or Android phone -- or probably any phone -- you do this through your Settings menu. You can also put in any key medical history or medication info that they’ll need. You should do this because they can get to this without having to unlock your phone.

Also, make sure that your emergency contact knows how to reach other critical people in your network. Many of us have a relative as our main contact, even if they don’t live nearby. You don’t want to make them struggle to figure out how to reach your friends or even which friends to contact. If you’re anything like me, you have multiple friend circles and they don’t all know each other. So create a list somewhere to help them get the word out.

Once the hospital reaches your emergency contact, here are other urgent things that they’ll need to know and that you should have already discussed and set up:

• First: Do you have a Health Care Directive? Do Not Resuscitate Order?
• I’ll go into these in detail in future episodes. Your takeaway for now is that you need to be sure you’ve communicated what level of effort you want put into keeping you alive if, say, your heart is still beating but your brain shows no activity, that kind of thing.
• Next: Who are your dependents and where will they go if you can’t be there today?
• I’m talking about children, elderly relatives, pets - those who depend on you for daily necessities like food, medicine, or shelter. Don’t forget to include if you’re taking care of someone who doesn’t live with you and maybe others don’t know about, like a neighbor.

Now let’s imagine that we’re back in the hospital. Thankfully, your key people had time to get there. They’re gathered in the waiting room. After a long wait, eventually the doctor comes in and lets them know that you died. Here are the next things that they’re going to be asked about:

• Organ donation 
• More on this in a future episode, but you should be aware that if you intend to be an organ donor, the window for this is really short, like a matter of minutes or hours, so the pressure to decide whether or not to do this can be intense. If you die outside of a hospital or if you’ve been dead for a few hours most of the opportunities for organ donation are gone. If you die in a way that organ donation is possible, it’s best if you’ve already discussed this with your loved ones so that they’re prepared psychologically and emotionally for being asked about it. It can be super-intense and pretty awful if they feel like they have to guess what you’d want. Spare them that.
• On to the death certificate - where is the information to fill that out?
• The critical info like cause of death is completed by the coroner or doctor, but they will still need some additional details. 
• Of course they’ll need your legal name and social security number, and if you served in the military, they’re going to want your discharge or claim number.
• The form also asks for the mother’s and father’s legal names and birthplaces. The easiest is to pull this from your birth certificate. But if that’s not available, be sure to write it down, especially if you don’t have a parent or sibling who would know. My friends certainly don’t know this information so I’ve included it in my death binder.
• (As an aside: I’m pretty sure forms in most places haven’t caught up with non-traditional family configurations like if you have more than one father or mother. I’m also not sure what happens when your gender is not accurately reflected on your birth certificate. And I’m only talking about U.S. death certificates here. I’ll look into all this more and report back.)
• Last is something that will take up several episodes in the future, but for now, just know that they’re going to ask: What was your plan for your body?
• Where your body is taken can depend a lot on what kind of funeral services you want (or, say, if you don’t want them). The most common option is to call a funeral director to pick up the body. Most people have little or no direct experience with mortuaries and funeral directors, so it can be hard to even get started on choosing one. This lack of experience plus the stress of grief can leave people wide open for being taken advantage of. Help protect them by thinking this through in advance while you’re still healthy, there’s no time pressure, and everyone is clear-headed.
• I’ll note that while a funeral director is the most common option, my understanding is that they’re actually not legally necessary. If your loved ones wanted to take your body home themselves, they are allowed to do that just about anywhere in the U.S. I’ll discuss this more in future episodes on alternative and green burials, and caring for the dead at home.
• Something that gets pushed by the death industry is what’s called a “pre-need” purchase. They promote purchasing caskets, funeral arrangements, cemetery plots, flowers, etc, before you need them - meaning while you’re still alive. I’m definitely going to devote more time in the future to discussing these pre-need options. For now, I’ll just say that if you have paid for things in advance then your people need to know that. It saves them wondering who to call. Note that if you chose one of those super-efficient pre-need cremation outfits, they pick up the body directly from the hospital or wherever. If your loved ones aren’t with you when you die, then they won’t end up seeing your body at all. They’ll just get the ashes. Prepare them for this. My dad and stepmom chose to do this and I found it both very helpful and disorienting.
• Another note: if your top choice is to do a body donation for science, be aware that sometimes this doesn’t end up being possible because of how someone died. You need to have a backup plan just in case. I’m looking into body donation for myself, and I’m also figuring out an alternate option if that doesn’t work out. I don’t want to burden my brother with that decision.

OK take a deep breath. Come back to noticing yourself alive right now. How are you feeling? Was that a lot? That only covers the first few hours. I’ll remind you that now that you’re aware of what’s needed, you have time to take care of it. 

Here’s a quick review of what we discussed:

• Emergency contact, stored in your phone
• A list of who needs to know
• Health Care Directive
• Interim or permanent care for your dependents
• Organ donation
• Death Certificate information
• Where to take your body

In the next episode, I’ll cover what your loved ones will need to know after those first hours, in the first few days after your death, like funeral or memorial services and how to handle the finances.

Remember you can get these lists and more at my website, DyingKindness.com. I would also love to hear what you thought about this episode, if you noted things I missed, or any questions about death and dying that I might be able to help get answered. 

I’m just getting started and I have so much more planned for this podcast! I’m going to cover a wide range of topics, from the extremely practical and straightforward, to issues that are sensitive and complex. On some episodes (like this one), it’ll just be me, but in others I’ll talk with experts in various industries like legal, financial, medical. I’ll try to get answers to your questions and have conversations we don’t usually have.

I hope that you stick around and check it out!

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Thank you for joining me on Dying Kindness. The music is by Blue Dot Sessions, Thanks to Melody Chang for the beautiful graphics. Everything else was done by me. You can find show notes and more resources at DyingKindness.com.

Until next time, I'm Cianna Stewart, and I'm going to die someday - but hopefully not before the next episode. 

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Today’s death poem is from “Song of Myself” by Walt Whitman

I wish I could translate the hints about the dead young men and women,

And the hints about old men and mothers, and the offspring taken soon out of their laps.

What do you think has become of the young and old men? 

And what do you think has become of the women and children?

They are alive and well somewhere,

The smallest sprout shows there is really no death,

And if ever there was it led forward life, and does not wait at the end to arrest it,

And ceas’d the moment life appear’d.

All goes onward and outward, nothing collapses,

And to die is different from what any one supposed, and luckier.

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