James Browning:
There's accumulated grief in our country, that I'm waiting to see how it explodes. 

Jolyon Thomas: 

If nothing else, if we're going to be present or if we're going to be facilitating somebody's passage, then I think that one of the things to do is just to ask them the very simple question of what do you need? 

James Browning: 

People say well, when they went beyond, when they passed on, and I'll say can you use the word die or death? And they're like well, we're... And I'm like just say the damn word. It's not all that hard, gang. Just say it. 

Speaker 3: 

189,076. 189,076. At the time of recording, that is the number of people in the United States who have died from the novel coronavirus since January. That is a minimum of 189,076 people who are also in mourning, with that number likely being in the millions. The grief of family members, friends, work associates, the barista down the way, the shopkeeper on Main Street, the doctor who cared for them, the list goes on. Death ripples and it echoes, and it doesn't ask to be dealt with so much as demands it. 

Speaker 3: 

So, in this edition of Understand This, which brings together different disciplines to approach shared problems, we tackle the biggest problem of them all, death. Today we're joined by Jolyon Thomas, Assistant Professor of Religious Studies in the School of Arts and Sciences, and Chaplain James Browning, Director of Pastoral Care at the Hospital of the University of Pennsylvania. Together, we talk about grappling with this immense scale of death, how death has historically been dealt with in other religions or cultures, and how we can do a better job of talking about death at all. 

Jolyon Thomas: 

My name is Jolyon Thomas, I am an Assistant Professor of Religious Studies in the School of Arts and Sciences at Penn, and my area of specialization is the religions of Japan, and Asia more broadly, and the United States. I do work on religion in media, looking at religion in comic books and cartoons, as well as doing work on religion and politics and law. So I've published a book on religious freedom as a facet of US foreign policy, and I'm currently working on a book on religion and public schooling in both Japan and the United States. 

Speaker 5: Jim? 

James Browning: 

All right. Yeah. My name is Jim Browning. I'm the Director of Pastoral Care and Education at the Hospital of the University of Pennsylvania in Philadelphia. Been here for about 10 years as a director of the department. I was director of pastoral care at a retirement community for 16 years in Mechanicsburg, Pennsylvania, a place called Bethany Village. Prior to that I did a fellowship in Supervisory Education to become a VP supervisor educator, and that was at the University of Tennessee in Knoxville. Prior to that, I was the oncology chaplain at Methodist Health Systems in Memphis. And then prior to that, I had two experiences, one as director of pastoral care at St. Jude Children's Research Hospital in Memphis for five years, and then prior to that, I was a Catholic priest in the inner city ghetto parish of Memphis. So I've had the experience of a lot of different things. So I'm glad to be here today. Thanks for asking me. 

Speaker 5: 

Yeah. So you have a very unusually intimate relationship with death, because it's literally your day job, in a sense. So I guess in this clime, how have you observed people coping? 

James Browning: 

Well, I guess the first thing to say is in my 40 years of ministry, I've never had two families or two patients' families, staff, deal with death the exact same way, meaning that everybody finds their own way. As a chaplain, it's always been my job to try and navigate what and how people tell me how they understand death. That's where the real learning takes place. They're constantly telling me how they experience and understand death and what is important for them. I constantly rely upon their insights into their own narratives. And then today, I just see that we're just so swamped by fear around all kinds of different things, even our own mortality, that we've reached a new level of anxiety and we're trying to figure out what that anxiety means to us, each person. 

Speaker 5:
And what do those one-on-one conversations look like? 

James Browning: 

I'm not really quite sure how each conversation's ever going to go, depending on what the person's narrative and what their story, their history is. And what might seem very simple becomes very complex when we're talking about death. How do they understand where they currently are, and do they understand any of afterlife or anything of that nature? I've learned that death is an incredible revealer of shame. It touches our shame very fast, almost like a flash fire, and we end up dealing with that towards the end of our lives. 

Speaker 5:
Did you ever expect that whenever you went into this? 

James Browning:
No. And I don't know... Jolyon, I'm not quite sure how he's experiencing people right now. 

Jolyon Thomas: 

Yeah. Well, I mean I'm not in a clinical, pastoral setting. My job is less of a hands-on approach to religion and more of an academic approach, a descriptor approach. But what you're talking about actually reminds me of something personal that I witnessed last summer. My mother-in-law passed away last summer, and what you were just saying about shame was bringing something to mind. She had a pulmonary disease, and so my wife and I cut a trip short to be at her bedside for her last moments, and one of the things that was really striking was that she was very insistent on passing on specific messages to each person, each loved one, around her. It was very hard to hear her because she was on like a full mask of oxygen and so forth, she had a lot of trouble speaking. 

 

Jolyon Thomas: 

But the last thing that she was most insistent about was having her hair washed. She knew she was going to die. She felt, though, that she needed to be prepared physically, and I think also emotionally, for that transition. Without casting aspersions on my mother-in-law, she was a very vain person. I think that she wanted to enter the next phase, whatever that was, feeling like she was both physically and sort of emotionally prepared. And I've never seen anything quite like that before, but it was a really striking moment. And I think somehow paired with this notion of wanting to transmit to her daughter, my wife, particular ideas, and to her son, my brother-in-law, particular ideas about what she felt like she'd always wanted to say to them but never had been comfortable doing. So that's a personal story. 

Jolyon Thomas: 

And I think otherwise, it's just we're all surrounded by the capriciousness of death right now. I could rattle off any number of things not pandemic-related, like even if we set aside coronavirus, that make us all think about how present death is. There are wildfires in California, there's a hurricane bearing down on Louisiana, there are other invisible threats like toxic pollutants in our city that are killing us slowly, the ongoing threat of police violence and so forth. So I think that all of us are kind of in this moment. I like the word you used, Jim, of anxiety, that we are surrounded by threats to our livelihood and wellbeing, and I think it makes sense that a lot of us are quite anxious and trying to figure out how to face death with equanimity. 

Speaker 5: 

It sounds like your mother-in-law was looking for some sort of cleanliness there, in the literal sense with the hair, but also sort of that clean break in the passing, right? [crosstalk 00:09:58] Linking back to the shame thing, not leaving things undone, which is sort of hard to grapple with in this time. Death is uncertain as it is, but you throw in this variable of a pandemic and this sort of invisible villain, and how do you grapple with that? It's a control thing, right? 

Jolyon Thomas: 

Yeah. Totally. And I'll be curious to hear what you have to say, Jim, about how people are trying to reassert control. One of the other things that goes on is, for me... And again, I didn't expect to be speaking personally, but one thing that I'll say is that my father is battling cancer right now, and due to the coronavirus I can't travel back to Iowa to see him. So he's doing as well as he can, he's in good spirits and so forth, but there's this sort of thing of being out of control, like not being able to just go and spend quality time with my father, who's about to celebrate his 50th wedding anniversary this weekend, and I can't go and be there with my parents. So there's like this sense that all of these things that are beyond our control, really interrupt our ability to handle the reality of death and mortality. 

James Browning: 

One of the ways that I look at... On my body, I have certain scars from where something happened and I got cut, or rub up against something, and it took a while for it to heal. And I can look back and see where the scar has healed, and it takes me right back to that moment, almost. I don't concentrate on it all the time, but I carry the scars of those losses. And what happens is when there's a community sense of loss that took place... We talked when the space shuttle blew up, this was back in the '80s, my God, everybody was crying. Well, there were seven people that were lost on the space shuttle, and it allowed for public mourning. It allowed for people who hadn't dealt with some prior grief just to cry. Well, I'm crying because of that and it's a horrible situation, but I think they had just kind of stored up their own grief. 

James Browning: 

And I'm trying to figure out how we, as a society, are storing up 170,000 deaths in our country and what we're going to do with those. That's three times the amount of people that died in Vietnam. And you're like wait a minute, but it's only been six months, not over a 10 year period. So there's accumulated grief in our country, that I'm waiting to see how it explodes. And I'm not quite sure how we're going to do that yet. It's going to be one of the things we will learn about ourselves and our collective grief in years to come about how we handle all of the deaths from the COVID. That's a lot. The space shuttle was seven lives, and that was a lot. We're talking 170,000 spread out over 50 states. That's a lot of grief, and that's a lot of sadness. Where is that going? How is it going to feed back into the country? That's what I'm waiting to find out, see what it's going to do. 

Jolyon Thomas: 

It's really interesting you mentioned that, because I was an elementary school student in the '80s, and the Challenger launch was this big deal, so our teachers all wanted us to watch it. So they had all wheeled in this television, we were all sitting in the classroom, and then I watched in real time, not only as this space shuttle exploded, but then as the teachers tried to figure out how to handle the immediacy of grief. Not the long-term thing, but just how they dealt with their own grief, and then all the kids were crying and trying to figure out this sort of thing. 

Jolyon Thomas: 

Fast forward however many years later, I can't do the math rapidly, 14, 15 years later, I'm then doing my teacher training as an elementary school teacher when 9/11 happened, and a teacher runs into the room and whispers to me that planes had hit the World Trade towers. At that time, I couldn't even process that, but then suddenly it became my job to be the teacher to handle the confusion and the grief of the children in the classroom, and none of us really knew what was going on at that point. Eventually kids were released from school and so forth. 

Jolyon Thomas: 

So that's the immediacy, that's just like that moment, that event, but I really think that what you're saying about the long-term effects, we can look back now on things like Challenger or 9/11 and see the way that those have been seared into national consciousness, and the way that they allowed for a sort of public mourning and grieving. But I think there are also ways that the events that you're talking about allow for a selective type of mourning and grieving. 

Jolyon Thomas: 

So just to latch onto one thing that you mentioned about the total number of deaths that we've had thanks to... Thanks to, that's definitely not the way to put it, due to COVID-19, we're nearing 180,000 now, and that's three times the number of Americans who died in Vietnam, but it doesn't include the number of Vietnamese people who died in Vietnam and then in Laos and so forth. 

Jolyon Thomas: 

 

And I think that we really have to pay attention as we talk about death and to recognize that we run a risk as soon as we put things in terms of the national frame, and to think about our grieving in terms of nation and nationhood and so forth, because these are things that do not respect national boundaries. A pandemic doesn't respect national boundaries. So as important as it is for our political leaders and so forth to sort of perform the act of public mourning on behalf of the nation, I also think that we have a sort of duty of care to think about the much broader global community and so forth. 

James Browning: 

Yeah. You're right on with that. I'm not sure what the number of death is for the world with the pandemic, but how are we going to respond? How is the world collectively going to respond to that, and what's going to be the side effects of it? What's going to be the moral injury of the society for the deaths that we're encountering? 

Speaker 5: 

Yeah. I think two observations I would make is one, the kind of cultural tendency to delay our grief, which might be what's happening at the moment with COVID and all these deaths. We may not have control over death itself, but we do manage how we deal with it. And two, something that's probably, in your purview, Jolyon, is the idea of using grief as a channeling in of something else. Like I know you've written about religion as a sort of scapegoat for other conflicts and tensions that arise, and I kind of wonder if we could eventually see that happen even in a political sense in terms of international conflict, that sort of thing, or cultural strife. Certainly 9/11, the responses that came later, nobody could have saw those things coming and you have to wonder how much of that was a lack of processing grief and death and anger. 

Jolyon Thomas: 

Yeah. So the definition in question and the thing that it brings to mind is we've been talking mostly about the United States, but it happens to be timely that just earlier this month, there was the 75th anniversary of the bombing of Hiroshima and Nagasaki, which is an opportunity for people to reflect not only on the many, many lives that were lost in the first use of atomic weaponry in human history, but also the many months of fire bombing of virtually every major Japanese city that preceded those bombings. Hundreds of thousands of people died. And according to the estimates on the raid on Tokyo on March 9th and 10th of 1945, it was close to 100,000 people that died in a city that was mostly made of paper and wood at that time. 

Jolyon Thomas: 

I'm thinking about this in political terms based on what you said, because the ways that Japanese people have memorialized all of those dead have become hotly contested in the years since. So there's this shrine in Central Tokyo called Yasukuni Shrine, which is one of the places that's sort of been set aside since the 19th century as a place for people to collectively memorialize and venerate the dead, but it's contested because it's also associated with Japan's own military aggression. It's contested because Japanese Class-A war criminals are enshrined there, actually deified there, and it's contested because some people who have also been deified there are Korean laborers who were brought to the Japanese mainland against their will and so forth. 

Jolyon Thomas: 

 

So if you have some people on the Japanese political right, they'll say every Japanese person has a duty to worship at Yasukuni to remember our war dead, and then if you have some people on the Japanese left are people who are from Korea or China, places that had been colonized by Japan, they'll say tear that place down immediately. You don't have a right to mourn your dead because you're actually violating the memory of the people we lost. 

Jolyon Thomas: 

And I think that there's something really instructive there about the politics of memory and what some people call post-memory, the memories that people [inaudible 00:21:13] don't necessarily have, but they're sort of dealing with the echos of that. It's a very complicated situation with no easy answer. But I think that, to bring it back to the United States, we've seen very similar things about Confederate memorials in the United States recently, this year. Do you take it down, do you leave it up? What sort of ideals are you commemorating by leaving that monument in place, and what sort of ideals are you commemorating by tearing it down? 

Speaker 5: 

You mentioned post-memory, and it reminds of a report, I think, from The Economist I heard or listened to on a podcast recently about how there's an active effort in Japan to literally train people to carry on the memories, sort of like an oral tradition, of Hiroshima and the experiences of the few people who are actually left, and it's based on there not being a 100th anniversary of those people being around. It's just sort of a fascinating thing to think about in how we deal with death and kind of teaching people to carry somebody else's grief into the next generation. 

James Browning: 

You're talking kind of a collective consciousness. And then what I end up dealing with in the hospital is the individual in the community that they live in. So one time I was working with a Hindu patient and the person would not accept any pain medication, and it was driving the whole staff nuts. Here's this guy just crying out in pain and we can save him, we can give him pain [inaudible 00:22:55], so they finally called me in and said well, go talk to him. So I go in and talk to him and he says you don't know me, you don't know what I believe. And I said no, but I want to know what you believe. So he tells me that he doesn't want any pain medication that's going to make him unconscious because in his belief system, the higher he is at the actual time of death, the consciousness, that the higher his place will be in the afterlife. 

James Browning: 

So I come out and I look at all the staff, they're all kind of looking at me, and I said this guy's not going to take any pain medication that's going to knock him out. So we got to figure out a way to keep him pain free without knocking him out so he can remain conscious. The staff just got all really invigorated with this, and the anesthesiologist says I can do an epidural, and then the pharmacist says well, I've got this great concoction I've been working on that will help him with the pain, and then we did massage therapy and all this. 

James Browning: 

And for about two days, he was conscious. He was very alert, pain free, and died peacefully. And we were like well, we helped him with our job, we helped him die revelantly, and we helped him die with his belief system intact. That's hard. That's hard to do in our world, to help someone maintain their own understanding of the afterlife, or their death, or whatever, and what it means. And yet we do it. We do it on a daily basis as well as we do the collective stuff with the community's death. 

Speaker 5:
That's respect, though. That's sort of the ideal. What you're doing is a good work there. 

James Browning: 

Well, I think we're all called to do that good work, because I'd say if we're going to do good living, we got to do good dying, flat out. Let's be consistent right across the spectrum. So we always say you got a good life. Well, then I'm going to help them lead a good death, whatever that means. I want to try to work with them in that, and sometimes that's possible. But in my life, that's what I've always tried to do. I try to live that with them and say we're going to make this a good death. You don't hear that a lot. But I'm saying let's be consistent. Come on, let's do it right across the board. Good living, good dying. 

Speaker 5: Yeah. 

Speaker 3: 

Wrote Walt Whitman in Burial, from the Leaves of Grass. The children come hurried and weeping, and the brothers and sisters are sent for. Medicine stands unused on the shelf. The camphor smell has long pervaded the rooms. The faithful hand of the living does not deserve the end of the dying. The twitching lips pressed lightly on the forehead of the dying. The breath ceases and the pulse of the heart ceases, the corpse stretches on the bed and the living look upon it. It is palpable, as the living are palpable. The living look upon the corpse with their eyesight. But without eyesight lingers a different living, and looks curiously on the corpse. 

Speaker 5: 

Jolyon, you're sort of our expert here on Buddhism. I know they have a particular take on how to deal with the mourning period. 

Jolyon Thomas: 

Yeah. So a couple of things that come to mind. What I hear in what Jim is saying is dying with dignity and being able to die with equanimity. And the Buddhist tradition has a couple of well-established traditions for helping people do that. There's a sort of famous text that goes by the name, in the United States, The Tibetan Book of the Dead, which is a sort of guided meditation for people who are on their deathbed, helping them understand what they're experiencing as they come close to death. 

Jolyon Thomas: 

And then also, according to the Buddhist tradition, their consciousness lingers even after their breath has expired. So there's a sort of guided meditation through that process as well. In East Asia, there have been these traditions of people gathering on somebody's deathbed so that they can actually have... This goes back to Jim's story, have their minds set on the highest aspirations for their next rebirth so that they will be born auspiciously, preferably as a human, so that they can actually achieve full awakening in a Buddhist sense. 

 

Jolyon Thomas: 

One of the other things that I teach about and I find really fascinating as a Buddhist practice is actually just confronting death, the reality of death, and the impermanence that surrounds us always, that nothing is abiding or unchanging. And one of the classic ways that Buddhists have dealt with this is to actually meditate on corpses. Now, it's uncertain the extent to which people actually did this as a real practice, where they were going to charnel grounds and staring at corpses or whether it was just a meditation. The meditation guides will say if you're a person of... Basically, if you're a smart person you can do this all in your head, but if you're a dull person, then you need to actually go to the charnel ground and do this. 

Jolyon Thomas: 

So basically, the idea is that we all have attachments. We all have attachments to objects of our desire, which might be people or our favorite foods or whatever, and we all are disappointed because those things inevitably leave us. Whatever pleasures we have are always fleeting. So the way to confront that is to look at a corpse and to watch it as it bloats. There are nine stages they have here. I'll run through them very quickly. As it bloats, as it disintegrates, as bodily fluids ooze out of it, as it putrefies, as it turns discolored, as animals devour it, as it becomes scattered and is reduced to bones, and then is finally cremated. This is really gruesome, and the meditation guides get as gruesome as they possibly can with it. They describe all of the viscera bursting out and like blood flowing and stuff like that. Gross. 

Jolyon Thomas: 

But the point is actually to help people be equanimous about their own mortality, to help people feel that they could go at any time and they would be okay. I think that that can be a little counterintuitive, but it's also kind of brilliant. We're all surrounded by death, we're all scared of it, we're all anxious to go back to that [inaudible 00:30:03] word, and yet what if you were to just confront it head on, and to think about what it's like to see a body going through the process of death and decomposition, and how might that help you feel a little less attached to your own life, and perhaps a little more compassionate for those around you. 

James Browning: 

In the Christian tradition, the Benedictine monks are asked to take time in their daily worship and think about their own dying. So it's kind of incorporate that, and that was in the about 13th century, and that tradition's been kind of passed down. But we, in America, and again, I'm going to kind of machinize this, we don't like to do that kind of stuff. We're living. We're going to fight. I've heard all kinds of stories. When I was at the retirement community, this old guy, he was really struggling. And one day he looks at me and he goes I'm going right to hell. And I was like well, what makes you say that? And he goes well, only the good die young. And he believed that. 

James Browning: 

And he says well, it says that in the scripture. And I was like no, I don't think so. I think it's a Billy Joel song, Only the Good Die Young. And he goes really? I thought that was a scripture, and I'm old, so I'm not good. I'm bad. I was like man, is this dementia, or what's kind of going on here? But that's what he believed. And I was like okay, well let's kind of reframe this a little bit. So maybe you're good, and maybe you're okay, but I don't think that says that in the scriptures. So encountering what the person believes and then going is that all right? Does that serve you well? He was actually kind of relieved that he had a chance of going to a good place, because he sure as hell thought he was going to hell because he was old and only the good die young. [crosstalk 00:32:24] 

Speaker 5: 

A dialogue about that. That's really difficult to, on the spot, figure out what to do with, because you don't want to be antagonistic and overly question their belief, but something like that, when there's an actual correction to be made, sort of... 

James Browning: 

Let's look at the reality here. Is that a sound belief, or is that serving you well right now? And a lot of times, at the time of their death as they're refiguring, reframing things. When I was at St. Jude's, a young child started seeing ancestors above his bed. This was really freaking out the rest of the family, and I was like maybe he's seeing them because they're welcoming him into the afterlife. It's just a possibility for him. And then all of a sudden, the ancestors were allowed in the room. But up until then they were like he's seeing grandpa and grandma and it's horrible. And I was like maybe it's not too horrible, maybe they need to be here. Maybe this is a good thing for them and for him, and all of a sudden, the whole mood of the room changed and they were like well, grandma and grandpa are here and that's okay. And again, listening to what the narrative is, the belief is, and trying to normalize it as best as possible, or reframe it. 

Jolyon Thomas: 

Yeah. That's really fascinating. I think one of the things that I'll just add to that, a small thing, as somebody that studies religion in popular culture is how Billy Joel becomes scripture, first of all. And I mean it's easy to laugh at that, but it's actually quite true. We get our messages as this giant hodgepodge of information that we get from Hollywood and the novels we've read and so forth, and that all comes together in some amalgamation that really influences us when we're on the deathbed. So I think that it's easy to sort of dismiss this [inaudible 00:34:42] of thing unorthodox, which is not what I'm saying you were doing, but I would say, in the spirit of what you just said, take people where they are and think about what's true for them, and sometimes it is, like Billy Joel tells me what's right. 

James Browning: 

And one of the biggest ones I get all the time is well, God never gives you anything you can't handle. And they really think that's a scripture, and I'm like it doesn't say that anywhere. This is what you believe. You take the garbage and the crap because you think that this is what God has given you. And I'm like it don't say that. So look at the narrative. Let's look at reframing this in some form. And they're like well, I've been living my life all along believing that. I'm like is it serving you well now? I don't know. It's listening to what people are holding on to, and it's like ah geez, let's let that one go if we can, maybe. I don't know. 

Speaker 5: 

But Jolyon, you had mentioned earlier the idea of death with dignity, right? And it's interesting, because I kind of want to see if we can unpack what that actually looks like when you try, at least, to look at it from an objective standpoint, because I feel like that's a term that's been co-opted a lot over the years. When I think about that, I think of everything from Dr. Kavorkian and assisted suicide, and I think about things as recently as this week at the RNC, when Republicans are trying to co-opt it into something 

altogether different and more American values oriented, I suppose. So I guess what does death with dignity actually mean? 

Jolyon Thomas: 

Yeah. That's a good question. Even as I said the word, I was thinking oh man, this is a can of worms. And I can lead with a can of worms because I was just talking about disintegrating corpses. Yeah. So I'm going to flip your question around and say what does an undignified death look like? An undignified death is being shot in your home by police officers with a no-knock warrant. That's an undignified death. Being kneeled upon by a police officer for nine minutes, undignified. An undignified death is also dying in a hospital surrounded by plastic sheeting where you can't actually just hug your loved ones goodbye. That intimacy, that physical touch that we all crave... Maybe not all of us, most of us crave, is sort of denied to us in this moment of the pandemic and fears of infection and so forth. And there are numerous others. 

Jolyon Thomas: 

An undignified death is being a school child going about your day and being shot. Right? So I think that when we're talking about death with dignity, first of all, we have to think just about what it means to be able to live in full human flourishing, whatever that means for each individual. And I think that this is tied to something that Jim was just saying a moment ago, which is that there's a sort of continuity between living a good life and then also having a good death. So I think one of the prerequisites is allowing people to just live in their full capacities, and then when it is their time, that they would be able to do that. 

Jolyon Thomas: 

But then let's get to the deathbed. I think we're a very diverse species, and so lots of different people are going to interpret what's an ideal passing in lots of different ways. There are the people who will say I never want to be old, there are the people who say I don't want to die sick, people who would prefer to just die instantly with like an aneurysm or something like that, where they wouldn't even know that it's happening. I think, to my mind, I don't want to impose upon all of that diversity a sort of orthodox way of death, or orthodox mode of death. I think that people should be entitled to their preferences, but they often don't get to choose. 

Jolyon Thomas: 

So if nothing else, if we're going to be present or if we're going to be facilitating somebody's passage, then I think that one of the things to do is just to ask them the very simple question of what do you need? This is a question that we ask far too infrequently. In other words, this is a question we should be asking everybody every day. Hey, what do you need? That's what contributes to human flourishing in life, and as people are preparing to pass, then that's also the thing that allows them to pass with equanimity. 

Jolyon Thomas: 

And Jim, you can correct me if I'm wrong, but I hear you saying that your job is basically to go and sit by somebody's bedside and ask them what they need, and then to find out well, how do we facilitate that? And your story of the Hindu patient is the perfect example of asking somebody what he needs, and then facilitating and providing that. I would call that dignified. I would call that dignity. 

 

James Browning: 

I think you're right on. On a personal side, I had a friend who was diagnosed with pancreatic cancer, and that's a hell of a diagnosis. And I asked, I said what do you need? He was like I don't want to be in a hospital. I was like okay. And between his wife, my wife... And he lived nine months and never spent one night in a hospital. We gave him what he wanted. He ultimately said I want to die in my home, in a bed with my dogs at my feet. Well, guess how he died? At home, with the dogs at his feet, and us around. Now, do I want that? I don't know. It was what he wanted, but I looked at what it did to the family that became the caregivers that were giving him his medicine and everything. I was like man, he asked a lot of us. We were able to do it, but there's a cost to that. 

James Browning: 

So I thought gee, I don't know if I want to die at home. Maybe I'll die at a hospice house, which is better. I'm not at home, I don't have to have somebody be there to help me with my medicines and then [inaudible 00:41:52] my wife to do this or my kids to do this. So in my family, we're still in dialogue with it. So the question is, what do I want? Well, depends on where I'm at at that point. But I often ask that question, what do you want? What can we do for you? How can we be with you in this? And that was one of the real struggles with the COVID-19. 

Speaker 5: 

Do you have any suggestions for how people who might be listening to this have not had that dialogue with somebody, how they might start it? 

James Browning: 

Ask a question. What do you need? I'll be honest, it is that simple. This is not rocket science. I can remember the first time when I was a chaplain that I used the term death. You're dying. How does that... And everything inside of me said well, I can't ask this. And now I'm like I got to ask it. But we don't want to ask death questions, because then we think that the person's given up and that's not the truth, and we get into this all should everything. The first thing to do is say what do you want? That's not hard, but it is hard, because we don't... Go ahead. 

Jolyon Thomas: 

No, and to answer your... I would just 100% say I'm not in the sort of pastoral care setting, but I think in all kinds of ways asking the question what do you need, it's the simplest, easiest... It's not easy, necessarily, but it's the simplest thing to do. A model that people can follow that's available sort of widely is there's this movie that came out a few years ago called Paddleton. It's a really touching film. It's about two friends who are kind of loners and they live in the same apartment building, and one of them gets a terminal diagnosis and sort of decides to go through with the physician-assisted suicide. Even suicide is not necessarily the right term here. In Japanese, there's this great term jigai, which is like self-death, and I think that that's more appropriate here. 

Jolyon Thomas: 

And this is not giving anything away, this story is just, it's really quite beautiful, but in the film, the close friend is like well, what do you need? And then promises to give the guy who's got the terminal diagnose what he needs, and it's really demanding on the friend. But also, the takeaway is that he would never trade it for the world. Neither of them would trade that experience. So I think if you're looking for a model of what this looks like for somebody who is facing death, that film provides one way... Not the only way, but one way of sort of narrating that and depicting that and showing the sort of stages that people might go through. 

James Browning: 

And even to use the word death. I'll be at an educational seminar, and people will say well, when they went beyond, when they passed on, and I'll say can you use the word die or death? And they're like well, we're... And I'm like just say the damn word. It's not all that hard, gang. Just say it. And then it's almost like you have to desensitize yourself to it, because I believe the person dying wants to talk about it, and no one [inaudible 00:45:43]. It's like the elephant in the room. So I'll say well, how are you with your dying? Everybody, ooh. I'm like no, we got to talk about this. 

Jolyon Thomas:
We're a very death avoidant culture, right? We're all about the anti-aging products, right? 

James Browning: 

Oh, without a doubt. Death is, even in the medical community, is something to be feared and all of that and not to be embraced. I've seen it done very well, and that's what I want. I'm going to keep doing it. But it can be a taxing reality for families, but I think it's important. 

Speaker 5: 

I guess speaking to the moment, is this maybe all kind of related to our delay of trauma with those 170, 180,000 deaths that we've seen, that we just haven't found the language to even process this sort of thing? 

James Browning: 

Yeah. We haven't. Culturally, we haven't had to deal with this. So I'm just waiting to see how it gets fleshed out in years, what our trauma brain does with this, because I think that we are being traumatized by this pandemic. All of us. If you know anything about trauma, it has a way of living in our brain and causing all kinds of after effects. 

James Browning: 

And until we turn that trauma into something... I don't want to say joyful, but something that's not trauma, whatever the opposite of trauma is, creativity or something along that line, until we make that jump, we remain in the trauma brain which is focused, which is narrow, which is chain driven, all of those things. And to make the shift from trauma to awareness, or creativity, or mystery, or whatever that is, is really our task, I think, as a culture, as a society. The move from trauma brain to whatever the other is. But that's hard. It is so hard work. So, so hard work. And we're still in the trauma. Still traumatized. 

Speaker 5: 

Well, it's interesting. From what it seems, a lot of religions do try to give people the tools to deal with death, but it doesn't seem like the people themselves necessarily use those tools. From my perspective, it's sort of like during the COVID-19 pandemic, something we should all be doing is obviously protecting ourselves and protecting others and keeping ourselves well, both mentally and physically, but part of that process, too, in the preparations, is dealing with the death part of this. The other harsher reality, the other layer of protection you can add to yourself, at least mentally, to prepare for these things. And it's interesting, again, just to kind of reiterate it with that, and maybe Jolyon, you can speak to this a bit, but that religions try to deal with death or encourage people to deal with death, that people don't anyways, and many Asians. 

Jolyon Thomas: 

Yeah. There's a classic book from the '70s called Denial of Death, and I'm blanking on the author's name right now, but it's a functionalist argument that basically religion serves the purpose of helping us cope with the fact or mortality, and that that's the primary reason that religion exists. It's been a long time since I engaged with that book, so I might be sort of misrepresenting the argument a little bit, but I do think that one thing that we see with a lot of different traditions across the world is a sort of commitment to helping people develop some tools for confronting death. Some are more explicit about it than others. 

Jolyon Thomas: 

And my job is not to be prescriptive about what people should or shouldn't do with religion. I'm not going to tell people that they should all become Buddhists or Christians or any other tradition, but I do think that for those people who are in that moment of feeling insecure, as I think we all are, it's not a bad thing to take some time to reflect on one step in that daily practice, like the monks that Jim was mentioning, and like the Buddhist practitioners I was mentioning before. It's not a bad idea to think about what it is that your life would be like if somebody who's closest to you dies, and what you would want if you were on your own deathbed. I think that the more we push that stuff off, the harder it is when the moment actually comes. 

Jolyon Thomas: 

And that's not to say that we should all be morbid, it's not to say that we should all be dwelling on death all the time. In fact, I think that in the circumstances of the pandemic we also have a duty to live as much as we possibly can. I think it's really important to try to thrive, even under these constrained circumstances. But nevertheless, I do think that recognizing the fact of mortality and going to the sources where people have thought through those things is a helpful thing for people to do. There's lots of stuff of out there and various traditions that you can draw upon. 

Jolyon Thomas: 

For those who are members of faith communities, certainly their religious leaders will be able to guide them through those sorts of things. But I do think that you don't have to be religious, you don't have to even have any sort of commitment to any sort of empirically unverifiable beliefs or whatever to just think, what does a good death look like to me? What does the loss of a loved one look like? Am I truly confronting the impermanence that characterizes the world? If I'm not, then what might I do to confront that? And I think that that is not to be morbid, but actually to be empowered and can actually help one feel alive, paradoxically. [crosstalk 00:53:04] 

James Browning:
No, I agree 100%. Well said. 

Speaker 5: And just to leave this on an upbeat note, if we can, on a subject related to death, I just want to ask you. 

What is keeping you hopeful in this unusual time? What is something that's inspiring hope within you? 

James Browning: 

Personally, I think this is why I was born, to help people with this. People say you have a calling or whatever. I'm right where I need to be. This floats my boat. It sounds horrible, but if I can help people with this transition and have a good life and a good death, I'm a happy camper. So I'm okay with that. And that sounds really bizarre, but hey, I [crosstalk 00:54:10] 

Jolyon Thomas: 

That's great, and your answer is very similar to my own, which is that as a university professor, my job is to help young people who are, I think, many times confronting the realities of adult responsibility, the complexities of the world and so forth, and my job is to sort of help them through that and to get them some tools to navigate a world that is extremely complicated. As one of my students said last term, there are contradictions everywhere, being a human is confusing. She wrote that on a discussion board post without any punctuation. It was almost like all the words are crammed together. Contradictions abound and being a human is just utterly confusing. So for me, I have hope because my job means helping people, very promising young people, develop skills and tools for making sense of those contradictions. 

Jolyon Thomas: 

And another thing that just gives me hope is the act of helping. The quiet things of like putting somebody's name forward for something, or like helping somebody make a connection. Like all these little things that will help somebody flourish, and it's actually sort of more rewarding. The more you do for other people, the easier it is to feel like your life is full of meaning and self worth. So people do that in lots of different ways. It's charitable giving, it's just a kind word to somebody, it is a quiet nomination, whatever we can do to help other people, I think we actually all end up feeling better ourselves. So that's something that I've been doing personally and I think is really important, and it gives me hope. 

Speaker 5: 

All right. In light of all that we've talked about, I do hope that we will all remain well and continue to avoid death. I want to thank you all for your time and your insights. I really appreciate it. 

Speaker 3: 

Thanks for listening to the second episode of Understand This, a production of the office of the university communications at the University of Pennsylvania. Like what you heard and have a subject you'd like to hear discussed in a future episode? Send all notes and feedback to bkbaker@upenn.edu. For all the latest news, views, and breakthroughs, check out Penn Today at penntoday@upenn.edu. And for notifications about future episodes, subscribe on Apple Music or your preferred audio listening platform.