Living With Dying articles

Teaching The Next Generation To Face Death … And Life

By Leah Carey
April 11, 2017

“Our parents’ generation were pretty carefully taught not to talk about death. Death is taboo … People don’t make plans until the health problems are knocking at the door. And they even ignore the health problems until death is knocking at the door.” 

So says Dr. Norma Bowe about how we prepare for death in today’s culture. She’s doing her part to make sure that the next generation has more skills and tools for both death and life.

Bowe is a former psychiatric nurse with a masters in health administration and a PhD in community health policy.

She is also a professor at Kean University in Union, New Jersey, where she teaches “The Death Class.” It’s an intense course that demystifies death for her students.

“I inherited the class from someone who was retiring at my university,” Bowe said during a phone interview this week. “When I look at the syllabus and looked at the outline, I literally threw it away. It was about theory and it was about religion.”

She wasn’t interested in discussing abstract concepts when “death is very concrete – it’s going to happen to all of us.”

In fact, in a class that’s populated primarily by people in their early 20s, death was already very concrete.

When she asked her class, “How many of you know someone who has died?” every student raised their hand.

How many knew someone with a terminal illness? Three quarters.

Attempted suicide? Half.

Successful suicide? Half.

How many knew someone who had been murdered? Three quarters of the class.

“I think that young people have a lot of grief,” she said. “I believe that grief is often the root cause of a lot of mental health issues. So the class is preparing people to face grief and death.”

Bowe re-imagined the class as part bereavement group, part lecture, and part field trips.

Preparing an obituary 80 years in advance

“The class opens a safe space to explore life,” Bowe said. “We do an obituary for when they’re 100. To write your obituary, you have to kind of create a life map when you’re in your 20s and doing this crazy assignment. You have to figure out, what will people say about me? What kind of career will I have? Who will be around me when I die? Who will be taking care of me by then? Will I have grandchildren?”

This assignment and others like it open up avenues of conversation for the students. And, Bowe said, those openings bleed into their family lives as well.

“They take the class home with them. All of a sudden now the whole family is discussing death,” she said. “It’s opening up a dialogue about – Mom and Dad, what do you want? Do you want to be cremated? Do you want to be buried? Do you have a preference about hospice? It’s creating conversations that I think are so vitally important so that we’re not so burdened when someone dies.”

The biology of dying

“There are signs of the active dying process about four weeks out,” Bowe said.

One of the lectures that she gives the class is about the physical processes of dying, so that they understand what it looks like.

“I tell them exactly what happens in the body starting a month before you die, all the way to the moment of death, so they recognize the signs and symptoms of organ failure,” she said. “Most of us, if we knew someone was going to die in the next four weeks, we might change our schedule a little bit. We might rearrange our priorities and spend some time with people that are dying.”

Because missing the opportunity to say goodbye to a beloved friend or family member can be a huge source of trauma.

“The ‘shoulda-woulda-couldas’ are that look back where there’s no rewind button and you can’t do anything over,” Bowe said. “It can really be torturous.”

Field trips

On their fields trips, students confront death in ways that most of us never will.

Bowe takes them on a scavenger hunt of a cemetery (find an example of true love in the graveyard), to a casket show room (where a student can “try on” a casket), and to view the “retort” chamber where cremations happen.

And then they get to the autopsy field trip.

“The autopsy trip is really where I think students get that life is short and precious,” Bowe said.

There is a girl in her class who is addicted to prescription drugs. When they visited the autopsy room last week, there were 13 drug overdoses on the tables.

“She sat there and held my hand and said, ‘I’m never using drugs again. I’m stopping this. I’m going to call my doctor today. I’m going to get clean, this is not going to happen to me. This is not going to be my father coming to identify my body,” Bowe said.

They see victims of gang violence, suicides and more.

“It’s just a very profound moment,” she said. Facing death gets students thinking about how they want to live their lives. “That’s what the students always say at the very end. They’re always like, ‘Dr. Bowe, this isn’t really a class about death, it’s a class about living. We have to live!’”

For all ages

“I think it’s very effective for kids this age when they’re very open to talking about their losses,” Bowe said. “But I also run grief workshops around the country and I’ve had 40, 50, 60, 70 year olds – I had an 80 year old in this death class at one point!”

She is particularly concerned about how death is affecting the aging population. “The Harvard Bereavement study calls it bereavement overload, or grief overload,” Bowe said. “For older folks who are now losing their friends and losing their spouse and losing their familiar surroundings. A lot of them are moving into nursing homes or assisted living – they leave their house. They have physical decline, so they’re losing some of their physical abilities, too.”

In fact, she said, depression and suicide are serious problems among the elderly population.

“Some of the highest rates of suicide are for people 65 and older,” she said. “We need more of a framework for elders.”

Having knowledge doesn’t mean it’s easy

Bowe is currently in the midst of her own challenges with helping a loved one navigate illness.

Her father began declining physically about a year ago. She is his primary caregiver, operating from several states away.

A few years ago she accompanied her mother through cancer treatments and then death. Before that, she was her grandmother’s primary caregivers.

“Yes, I am affected by the death of family members,” she said. “Even with all the knowledge that I have about it, it’s still difficult … It’s not any easier if you know all of this.”

“I was able to make decisions based on my knowledge that yes, she’s actively dying, I’m not leaving her bedside. I’m staying here,” she continued. “Some of the knowledge helped to know what you’re looking at, but it doesn’t help knowing that you’re going to lose somebody, or in knowing what the grief process is going to look like.”

Laying their burdens down

Knowledge may not make death less painful for those of us left behind, but it can make the process less scary and traumatic.

Facing death can also provide skills and tools that make engaging in life more attractive.

The evidence: there is a three-year wait list to get into Bowe’s class, “Death In Perspective.”

On the Kean University campus, Bowe has created a memory garden where students can sit, or plant some flowers, or leave a rock. She said that students use it “all the time.”

They’ve also created a rock labyrinth on campus.

“The Buddhists say that if yo have a trouble or a burden or a worry or a sorrow, if you walk in concentric circles slowly with intention, that by the middle of the circle you’ll be able to lay your burden down.”

In the center of the circle is a pile of small rocks with messages – some presumably to loved ones who have died, others about different kinds of burdens – laid down so that they can take the next step into life.

To read more about Dr. Norma Bowe’s class, check out Erika Hayasaki’s book “The Death Class : A true story about life.”

A Graceful Goodbye - Personal reflections from Leah

Speaking with Dr. Norma Bowe has gotten me thinking about the interplay between life and death in my own psyche.

When I was 26, my father died very unexpectedly. He was a private investigator, away on business, when he had a massive stroke in his hotel room. Everything about his death was shrouded in mystery. Several of his co-workers told me they didn’t believe he was dead, but that he had gone under deep cover on an investigation. His body was identified by an FBI agent and then immediately cremated so no one I knew and trusted could confirm that he was actually dead.

For five years, I lived in my own version of purgatory: waiting for him to reappear in my life one day and say, “Just kidding!”

I descended into a black hole of depression, unable to process his death. I was stuck, unable to move forward with my life.

Eventually I took the only step I could think of that would prove definitively whether my father was dead or not – ordering a photo from his autopsy.

After five years, it took only a few moments to confirm for myself that yes, my father was actually dead.

It didn’t happen overnight, but in the months after seeing that photo, I was able to rejoin my own life in progress.

When my mother died 16 months ago, it was a completely different story. I took care of her as her health declined and I was in the room as she died. There was no confusion whatsoever that she was gone.

I was sad – devastated, even – but there was no question that my life would continue to move forward. It’s what she would have insisted on. I would not descend into that same pit of despair that swallowed five years of my life after my father passed.

So I began writing this series.

Yes, I wanted to explore questions and issues around helping our loved ones to die. And yes, I wanted to open a space for conversation with you, dear readers.

But even more than that, I wanted a way to stay in contact with my mom in a healthy way. This series has been my anchor as I navigated this year of grieving.

Many of you have written in, asking for this series to be turned into a book. For much of this year, I assumed that would be the obvious next step.

But a couple weeks ago I had an epiphany: spending a year focusing so intensively on death is enough. The time and energy it would take to create and publish such a book would be astronomical. Instead, it’s time for me to start focusing on life again!

During our conversation, Dr. Bowe said that her favorite poet is Mary Oliver, and quoted a famous line from Oliver’s poem “The Summer Day.”

It reminds me of what I’m learning through these intensive experiences with death, and how I want to live this next part of my life.

“Doesn’t everything die at last, and too soon?
Tell me, what is it you plan to do
with your one wild and precious life?”

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