Natalie Perlov
Philadelphia, Pennsylvania, United States

Like many people, my first experience with death was losing a grandparent. I remember my parents organizing my late grandfather’s affairs, noting our religious practice of having as few people as possible touch the body before the burial. Our culture emphasizes community and togetherness in life, yet my grandfather died and would remain dead in permanent solitude. He died alone, was handled by the bare minimum of people, and would be buried across the ocean from his children and grandchildren. When I first visited his grave, I left a shiny, smooth pebble on his tombstone. I wanted something more permanent than ephemeral flowers to fill in for my absence.

In her memoir, Smoke Gets in Your Eyes, mortician Caitlin Doughty challenges our society’s “death values” and fear of facing our own mortality. A moderate amount of squeamishness around death makes sense.¹ But at a time when the fastest-growing segment of the US population is over 85, Doughty avers, “a culture that denies death is a barrier to achieving a good death,”² one in which we are “prepared to die, with [our] affairs in order…without having to endure large amounts of suffering and pain.”³ Doughty argues that the embrace of media vita in morte sumus—amid life we are in death—is essential in living more genuine, enriching lives. This attitude could be normalizing conversations about advance directives or delineating funeral plans and breaking our “culture of silence.”⁴

I naturally began to think more deeply about death when I encountered it a second time in cadaveric dissections in medical school. We were introduced to the cadavers—called “human gifts”—on a Friday afternoon in August. We wore sun dresses and shorts, ready to enjoy a long summer weekend; our “gifts” were clad in chemical-laden rags to preserve their modesty. Gingerly, we uncovered our “gift’s” face, his glassy eyes staring up at us, his teeth rotted into a smile.

We decided to keep his face covered until when we would dissect the head and neck. With his face covered, I could be a calculated butcher. He was an anatomic treasure trove, a beautiful coalescence of tissue, nerves, and vessels. After skinning, slicing, and dicing, I took care to wrap his hands in new rags soaked with formaldehyde. Somehow, I could expose this naked body, cut into its delicate creases, yet the act of holding a hand felt even more intimate and unnerving. If I closed my eyes, I felt my grandfather’s chubby, rough hands in mine. Did his undertakers hold his hands as they prepared him? Did they know how he gently brushed my hair when I was a little girl, or how he maneuvered his hands around a chess board?

This idea of embracing the link between how we live and how we die is what touched me most about Doughty’s memoir. Doughty’s statement that “the earth is expertly designed to take back what it has created”⁵ resonates with the comforting sense of togetherness I so craved when my grandfather died. As a little girl, I took solace in the idea that we all came from stardust, that our molecules were recycled and shared. (One of the many perks of having an astrophysicist for a mother was getting watered down cosmology for bedtime stories.)

Doughty’s memoir is not a panacea for approaching death, yet I think reading it is a worthwhile exercise. By ditching lofty euphemisms and confronting our inevitable ends head-on, we can usher our patients to “reclaim [their] mortality”⁶ and have autonomy over how they spend the rest of their days. By acknowledging death, we can empower our patients and ourselves to live with purpose.

End notes

1. Caitlin Doughty, Smoke Gets in Your Eyes (New York: Norton, 2015), 239.
2. Doughty, 232.
3. Doughty, 222.
4. Doughty, 228.
5. Doughty, 234.
6. Doughty, 234.