It is 4:00 Thursday afternoon and the male patient in room 113 is dying as expected. Earlier in the day nurses had moved him to a private room, because a door is easier to close on the dead than drawing a curtain in a crowded ward. By 10:30 Thursday evening the patient in room 113 was dead. Within fifteen minutes a temporary death certificate had been signed pending confirmation of cause of death. The body was washed, wrapped in a sheet, and labeled. An orderly removed the body to the hospital morgue. At noon of Friday, the autopsy and legal forms completed, the late occupant of room 113 was delivered to the mortuary. His blood was drained, he was embalmed, waxed, rouged, shaved, dressed placed in a casket. At 3:30 Monday afternoon, after a 40-minute church service, the casket was lowered into a grave at the local cemetery.

Every day more than 6,000 Americans die. Some succumb at home; others are killed in accidents and riots; more than 75 percent are routinely processed through the corridors of crowded hospitals. However death comes, Americans must find ways to cope with it.

The Apprentice

My first experience with death occurred when I worked part time at a mortuary while going to college. Later on, I worked full time, first as an apprentice, then as a funeral director, and in the following years as an executive. For fifty years I observed how people responded to death and moved through the grief process, first denying and eventually coming to accept the reality of death. I learned that the funeral is not only a custom associated with our culture, but one that satisfies the religious beliefs of the survivors. And I saw how some families were finding alternatives to the conventional funeral ] service.

When I started working in 1934, death was not commonplace. Today television viewers can't always tell the difference between a real death shown on a newscast and a death fabricated in a film studio. Hundreds of deaths appear on televisions screens in a 24-hour period. The war in Vietnam brought combat deaths into the American living rooms for the first time. What had been witnessed perhaps once or twice in a lifetime, is now graphically displayed in living color.

Death was once a mysterious, metaphysical event. In church I was taught it was a summons from above. Today it is an engineering problem for the managers of death: the physicians, the morticians and statisticians who record nature's planned obsolescence.

The funeral profession I joined in 1934 exists today because Americans have assigned death to professionals. The English essayist J. B. Priestley once observed, "Mankind is frightened by the mere word `death,' and nowhere more than in America." People switch off the subject as though they were changing television channels. Historian Arnold Toynbee wrote, "Death is un-American. It is an affront to the American dream that every citizens is entitled to life, liberty and the pursuit of happiness." The profound experiences of separation by death and the confrontation of death itself are too much for most people to openly discuss or even subjectively contemplate.

Despite an attempt by most Americans to sweep death under the carpet, every day thousands of American families must face the trauma of death. Death divides husband from wife, a father from son, a mother from daughter. It threatens all with the emptiness that comes from being forsaken. Terminal illness is accompanied by the fear of abandonment. The most frightening thing about dying for most people is the feeling of being alone, of having to face the unknown without any of the familiar props that usually sustain us in times of great change. (Kubler-Ross)

One of the most disastrous effects of a terminal illness is that it isolates the patient from his or her normal identity in the community, and where once an active member, he or she is now helpless. The modern hospital insulates the patient still further, with the assignment to a site peculiar to the disease: the heart ward or the cancer ward. By the time death occurs, the patient will have been placed in a private room. There the patient dies, usually alone.

By comparison I remember sixty or more years ago when the majority of deaths occurred in the home. No heroic measures were taken to prolong a life determined to be hopeless. Grandfather died in familiar surroundings and often in the presence of his wife, sons, daughters, and grandchildren.

In making funeral arrangements I have heard families complain about the lack communication with the doctor and, more important, between the dying patient and the doctor. In all probability a deceased's last contact with a human being is with a nurse. The most frightening thing about dying for most people is the feeling of being alone, of having to face the unknown without any of the familiar props that usually sustain in times of great change. (Kubler-Ross)

The way death is faced and how the dead are cared for is largely determined by the culture. As every society gives shape to life, so does it give shape to death. Belief that an immortal soul has occupied the body and has now departed dictates the diverse rites that help the family to re-stabilize and find relief from bereavement. Anthropologists have found that procedures have existed for assuring the proper treatment of the dead in almost every society. Like birth and marriage, death is a rite of passage, marked by rituals and beliefs that dictate how the dead and mourners are to be dealt with.

Funeral ceremonies generally involve events that symbolize the transitional stage or separation of the deceased from his or her former status and the assumption of a new role in the afterlife.

Death in American society stops the orderly process of daily life and requires the reconstruction of personal and social attachments which death dislodges. Societies vary, however, in the way their members act in bereavement and in the way they dispose of their dead. These patterns may change over a period of time, although basic beliefs remain fundamentally unchanged. The source of American funeral practices date back several thousand years to early Judeo-Christian beliefs as to the nature of God, man, and the hereafter. These beliefs may even have been influenced by even older practices.

It would be difficult to establish that the American reverence for the dead and their decent and proper treatment have changed to any material extent since the Civil War. A variation that occurred about 1863 was the introduction of embalming, making it possible to return the bodies of soldiers to their families. Beyond that innovation, basic beliefs and ideas about death and funerals have not changed to any appreciable degree.

In early American culture the individual could assuage his anxiety with the belief widely accepted that each human being is sacrosanct because of the soul. Even although he was a Deist, Benjamin Franklin looked forward to another life as evidence by the epitaph he composed for his grave in Christ Church in Philadelphia:

The Body of
B Franklin Printer,
(Like the Cover of an Old Book
Its Contents torn out
And stript of its Lettering & Gilding)
Lies here, Food for Worms
But the Work shall not be lost;
For it will, (as he believ'd) appear
once more,
In a new and more elegant Edition
Revised and Corrected
By the Author

The Christian dogma of life after death and the immortality of the soul is based upon the resurrection of Jesus Christ, the essence of the Christian faith. The New Testament insists that the death of Jesus was real and that the same end awaits all people. In John 11:25 Jesus said, "I am the resurrection and the life. Whoever believes in me will live, even though he dies, and whoever lives and believes in me will never die."

Belief in an immortal soul, however, is not the only or even the oldest method devised to alleviate the fear of death. One way has been to symbolize immortality through the sense of living on in one's own children. Another is through the natural state or the feeling that even though men and women may die, nature goes on. Further, a man or woman can continue to influence future generations through art or deeds, by memorializing with monuments and tombs as the Egyptian pharaohs did, the donation of a building or a chair to a university, and the establishment of a foundation.

The Grief Process

A belief in immortality, whether theological or humanistic, will not necessarily allay the universal human experience of grief. Grief is the strong emotion a person feels when faced with the death of someone who has been a part of his or unrevealed future; third is insecurity. Order has turned to disorder. So what can the distressed do to allay the self-awareness, the fear, and insecurity? Primarily the survivors must realize that death is as much a part of life as birth. As a person grows older the physical equipment begins to wear out. A world without death is impossible to conceive. Reasoned this way, death is natural and may help to banish fear and insecurity. Rational thought says that death should not be feared, that it is part of the normal order.

The Function of the Funeral

From the beginning of recorded history people have buried their dead with ceremony and the practice continues today. The extent of the ritual may range from the state funeral for the head of state to a funeral mass recited in a ghetto church attended by a family and a handful of friends.

That the funeral service provides a means of coping with the grief that accompanies a death is the point of view of David G. Mandelbaum. "Certain things must be done after a death. The corpse must be disposed of; those who are bereaved must be helped to reorient themselves." Eric Lindemann who pioneered the modern psychiatric understanding of grief wrote, "The funeral is psychologically necessary in order to give the opportunity for grief to work. The bereaved must be given the opportunity to work through grief if they are to come out of the situation emotionally sound. Finally, we need to see to it that those whom we serve are left with comforting memories."

The funeral is a way by which society provides symbols which express the feelings of those who mourn. Community funeral customs permit public expressions of feelings which need to be released. There is much more involvement than the immediate circle, since as a community rite it affects other participants depending on their feelings toward death and their relationship with the deceased.

The funeral service can be observed from four viewpoints:

First is the need to cope with death itself and the performing of the tasks necessary for the disposition of the body. Second is the societal phase in which the community or group seeks to give support to the bereaved. Third is the emotional adjustment of the bereaved in accepting the reality of death (the psychological view), and fourth, the relationship of the funeral ceremony to the theological and religious beliefs of the bereaved. Meeting the problems caused by death may only be accomplished when accompanied by an understanding of the person's religious beliefs. The most satisfactory funeral would be that which provides expression for all four: in addition to disposing of the body, the funeral brings together group or community support to the bereaved, helps in the acceptance of the reality of death, and finally in giving meaning to man's relationship to God.

The funeral ceremony provides the means by which the family witnesses the sharing by the community in the loss and manifest by attendance at the funeral. It is an opportunity to express appreciation for the life of the deceased and what he or she has contributed to the welfare of society.

For the past thirty years there has been an increase in the immediate disposal of the body and in virtually all instances by cremation. Sometimes, but not always, a memorial service is held later without the body present. The service may focus on the quality of the life of the deceased person and may be appropriate when there has been no religious affiliation. This does not relate to the instances when a community wishes to honor the memory of a valued member by conducting a commemorative service after the funeral.

Critics of immediate disposal claim that the absence of the body negates or delays the realization that death has occurred; that the grief needs of the survivors are often acute and that the funeral with the body present promotes the opportunity to verify the loss, to express real feelings, and to feel community support. Proponents point to the reduction in cost, since the body is usually cremated in an inexpensive casket or container.

My experience indicates that the practice of immediate disposal is increasing, particularly among higher income families, intellectuals and academicians and can often be defined according to residential areas. Lower income families are generally inclined to choose a conventional funeral, a custom usually dictated by their religious faith.

Final Resting Place

Burial and cremation are the oldest forms of disposition with several symbolic meanings. In one connotation, burial is a natural unity with the testimony, "Dust thou art to dust thou shalt return." Committal of the body to the earth is the natural denouement for the funeral, representing the finale, the conclusion of a natural life.

The burial of the body or ashes provides a point of reference for remembering the deceased. The site can be visited and revisited in remembrance of the deceased. On Memorial Day and Christmas cemeteries across the country are filled with flowers. Even with the body missing or at some other location, visitations to a designated site is a custom followed by millions, e. g., visitor to the tomb of the Unknown Solider at Arlington Cemetery and the Vietnam Memorial in Washington, D. C., and the memorial over the battleship Arizona at Pearl Harbor, Hawaii.

Although people do not want to think about death and may turn it off psychologically, at no time in the past has death been so much a part of people's lives as today: memories of the loses in two World Wars, the Holocaust, the Korean and Vietnam conflicts, passenger plane crashes and the ever-present knowledge of the Bomb hang over the future. Daily we read of murders. Television screens are packed with destruction unmatched in the past. More than 60,000 Americans are killed in highway accident annually.

While Americans may deny their own deaths and may not hold a fatalistic view toward their individual mortality, the stark reality exists that everyone will eventually die. Those who disavow their own deaths may nevertheless experience the death of a family member. If and when that occurs they will be forced to respond. Denial will no longer be an impromptu escape. Everyone, with few exceptions, eventually finds a way to cope with death. Hippocrates wrote that healing is a matter of time. Although this of little solace when that time seems interminable, reconciliation and acceptance ultimately occur.

Death has always posed a problem to our society. We will always be challenged to cope with it in the most forthright and compassionate way.