The first of a thousand decisions

 I have written before about the importance of having a will, Power of Attorney, and a Health Care Directive. You can find this installment of "Tales from the Trenches" here. These documents are essential for every adult. The wishes and instructions included in each of these documents free your loved ones from the burden of second-guessing their decisions regarding your health and well-being, specifically in the face of life and death decisions. Unfortunately, when someone passes away, the volume of decisions needing to be made only increases as the days pass. When Andrew died, I distinctly remember driving to my parents' house to drop off our son. My parents were taking him to preschool each day because that had been Andrew's responsibility when he was alive. I remember it was a Wednesday, and after Mr. M was safely in the house, I turned to my dad and asked him if I had to make any decisions that day. Five days after sitting with my husband as he breathed his final breath, and I could not comprehend making any more decisions, big or small. When my dad informed me that, no, on this day I didn't have to make any decisions, I nearly cried in relief. 

Death makes people uneasy. Thinking about it feels morbid, talking about it feels like inviting the beast to dinner and hoping it doesn't get you in the process. However, one thing I am certain of is this: life on earth has a mortality rate of 100%. I will die. You will die. Odds are that someone who cares for you deeply will be left with the thousands of decisions that have to be made when you die. The more pieces you can put into writing regarding your final wishes, the less decisions your loved ones will be required to make. These are awkward conversations (trust me, there is no good way to segue into these.) If you have strong feelings about what happens to your body after death, then please let your loves ones know them. If you don't have strong feelings, let your loved ones know that. If you're one of those people who thinks, 'This is so silly...why does it matter?', I am here to tell you, it matters to those who have to eventually make those decisions for you. So, let's start that conversation, shall we?

Here is where I put my disclaimer that I am not a funeral director, mortician, lawyer, or expert. I am most certainly not any of these things. I'm just me. A young widow who had to bury her husband unexpectedly, and learned a thing or two (or twenty-two) along the way. 

Conversation #1: Donation
If someone dies suddenly outside of a hospital setting, there is really not much that can be done regarding organ, bone, or tissue donation. If death is imminent for a person in a hospital, then the medical staff will have a conversation with loved ones regarding organ, bone, and tissue donation. In the state of Minnesota, LifeSource is the organ donation agency that works within hospitals. The men and women of this organization led me step-by-step through the donation process when Andrew passed, and I am indebted to them. From the first conversation in the ICU to a personal telephone call the morning after Andrew passed to inform me about the recipients of his organs, LifeSource very literally held my hand.

One thing I learned during the donation process was that I, as Andrew's wife, had the final say in what and how many organs, bones, and tissues were offered for donation. Andrew was an organ donor, and he had not specified what or how many organs, bones, and tissues he wished to donate. That was a decision I had to make. I gave LifeSource permission to use anything and everything they could. Andrew wasn't going to need it any more. In the end, Andrew donated both his kidneys, his heart, and his lungs. Due to his age and other factors, his bones and other organs and tissues weren't able to be donated. Two women received a kidney from Andrew, and his heart and lungs were donated to the University of Minnesota to be used in their research of cardiac arrest and aspiration.

If you wish for your body to remain in-tact following death, let your loved ones know about your decision. If you wish for your body to be considered for organ donation, let your loved ones know those wishes. If you decide to be a donor and there are parts you do not want offered for donation, let your loved ones know this, also. I have let my loved ones know (and it is written in my Health Care Directive) that every available piece of me is to be offered for consideration of donation. I'm not going to need it any more. Bottom line: record your wishes regarding donation, and let your loved ones know what they are.

Conversation #2: What happens when you die
No, this isn't where I insert the "where will you go when you die?" message. This is not the time or place (however, if you would like to have that discussion, please reach out!)I did some very preliminary research for my own state, and in the great state of Minnesota, a human body must be transferred to a licensed mortician or mortuary following death. This isn't a ploy to rope you into the billion dollar funeral industry; its much more practical than that. Every human being born alive in the state receives a certificate of birth. Every human being that dies in the state also needs a certificate of death. A death certificate is a legal document, just like a birth certificate. Only a licensed mortician or mortuary has the ability to transfer the necessary information to the Department of Health, who, in turn, issues a certificate of death. Additionally, licensed mortuaries have the ability to notify the Social Security Administration. This notification invalidates the Social Security number of the deceased, and makes it much more difficult for unscrupulous individuals to steal the identity of the deceased. (Technically, you could do this yourself, however, if you have had any interaction with the SSA, you know that the less time you have to spend with them, the better off your mental health is. If someone else can do it for you with two clicks of a computer...let them.)

When the time came for me to select a funeral home, I was grateful that I didn't have to make those calls myself. My father did the leg work for me. I did have some non-negotiable requests, which became the deciding factor in selecting the funeral home I did work with. I knew Andrew wanted to be cremated. There were some letters and photographs that I wanted to be cremated with him. Some crematories only allow the body of the deceased to undergo cremation. My father found a crematorium that would allow the letters and photographs to be cremated with Andrew's body. If you have specific wishes and requests regarding your preparation and burial, make them known to your family. Many funeral homes allow for preplanning and pre-payment of funeral expenses. You get to be choosy when it is your funeral (or someone you love). Just be sure to record all your wishes and/or plans so your family knows what to do (and who to call) when the time comes.

Conversation #3: Caskets or cremation
This is one of those conversations that is deeply personal and varies person-to-person. You may have different wishes than your spouse, and that is ok. After you pass away, and the funeral home or mortuary has your remains, something has to be done with them. I will only talk about the two more "common" options. 

If you choose to be cremated, the funeral home or mortuary will arrange the cremation with a licensed crematorium. There are pretty specific regulations governing crematoriums, and cremation is definitely not a DIY operation. I really don't think you could even gain access to the remains to do a DIY. It's a health code, safety thing. When Andrew passed, I chose cremation because that was his wish. I also am choosing to be cremated when I pass. Cremation is less expensive than a casket funeral. If I am remembering correctly, it took about a week to receive Andrew's remains. At the funeral home, I had the opportunity to choose whether or not I wanted scattering bags (small baggies of ashes designed for sharing with others or scattering) and how many. I had the option of turning some of the ashes into jewelry or getting fingerprints made for fingerprint impression jewelry. 

Cremation also gave me, as the widow, the opportunity to choose when I wanted the memorial service to occur. Andrew passed a week before Thanksgiving, and I did not want his funeral to be connected with the Thanksgiving holiday for the rest of my life. Andrew's memorial service was three weeks after he passed, which I could do because he was cremated.

If cremation isn't an option for you (ethically, religiously, or personal preference), you can choose to be prepared and buried in a casket. Casket burial is more expensive than cremation; some of the costs associated with a casket burial include embalming, preparing the body for viewing, the actual casket itself (which can cost as much as a new car if you really want to go out in style), and storage and transportation of your remains. Minnesota has laws regarding casket burials, and I'm sure every other state does, as well. Casket preparations are more time-sensitive when it comes to funerals or memorial services. Even with embalming, the body begins to decompose immediately after death. I'll leave it at that. 

Regardless of which option you choose, do some research. Make some calls. Investigate how your wishes can be met in the hereafter. Record those wishes. Be specific. And then let someone know what those wishes are. 

Conversation #4: Your final resting place
If you choose a casket burial, the casket must be interred somewhere. There are traditional cemeteries, where caskets are interred below ground in a vault. For a casket burial in a cemetery, you need to purchase a plot within the cemetery. Once a plot is purchased, you will have to arrange for the burial of the casket. There are rather significant costs associated with a cemetery burial. A large hole will need to be dug. Within that hole, a vault will be placed. At the time of burial, the cemetery will lower the casket into the vault, and seal it with the vault top. The earth is then placed back over the hole. 

Other options for a casket burial are mausoleums (where a casket is interred in a wall vault inside a building or inside a brick structure) and private cemeteries (on family property, for example). Burial at sea is technically an option, but since I live in the Midwest and the nearest ocean is 1,500 miles away...that isn't really on my radar. 

If you choose cremation, there are also options. Cremated remains can also be interred in a cemetery. Like a casket burial, you first have to purchase a plot in a cemetery. Cremated remains, too, require a vault to be placed in the ground prior to burial, but the vault is much smaller (as is the hole). Burial itself is not cheap. Someone still has to dig the hole, install the vault, inter the remains, seal the vault, and cover the hole back over with dirt. Cremation burial costs less than casket burial, but there are still costs.

Cremains (as they are known), can also be interred in mausoleums or other above-ground vaults. However, you do not have to inter cremains at all. Some families choose to put the cremains in a urn and display the urn within the home. Other families inter the cremains in a garden or plot of land. Some scatter the cremains in different meaningful locations for the deceased. Cremains have more options in terms of final resting place than casket burials do. 

If you are considering a cemetery burial, weather is a contributing factor. In the great state of Minnesota, it is ridiculously cold and snowy for over half the year. Immediate burial in a cemetery may not be an option, depending on when someone passes away. Some cemeteries have ground thawing machinery to facilitate winter burial, but it is expensive. Most cemeteries will wait until the ground thaws to do burials. If you choose a casket burial, this will mean that your casket and remains will need to be stored in an appropriate facility until spring. When considering funeral homes or mortuaries, it is a wise idea to inquire about storage costs for caskets. If the cemetery is located in another state, make sure you discuss and address costs associated with transportation across state lines. You can't just load up a casket on a trailer and drive your truck somewhere. Caskets must be transported in a hearse, whether to and from the airport (if you fly the casket to the location) or to a cemetery in another state. If you choose cremation, then waiting for the weather to warm isn't an issue. You just need to make sure you store the cremains safely (and you remember where you stored them). You also don't need to worry about specialized transportation. 

Regardless of how you wish for your remains to be put to rest, there are things you can do right now to help your loved ones when the day comes. If you wish to be interred in a cemetery, do some research. Find one that you like (location, distance from family, proximity to other deceased family members), and inquire about available plots. If you have a partner or spouse, look for adjoining plots. Purchase them in advance. Don't rely on there still being available plots when you do pass away. My grandfather purchased our family plots in the cemetery where Andrew (and someday, me) is buried 40 years ago. He gifted plots to his children, and my aunt and uncle graciously deeded their plots to me when Andrew passed away. They have other plans for their final rest. Once you have secured plots in the cemetery, put the paperwork with your will/estate plan, Health Care Directive, and Power of Attorney. Include instructions for who to contact and the regulations of the cemetery regarding burial and markers (every cemetery is different). 

If your wish is not to be interred in a cemetery, let your loved ones know. If you choose to be cremated, and you wish your cremains to be scattered in a specific location, record that and let people know. You have the right to your wishes regarding your final place of rest (and form of final rest). However, if you don't tell anyone what those wishes are, there is no guarantee they will be carried out.

I get it. Talking about death and final disposition of remains is an awkward and anxiety-producing conversation. But it is so important. While I wouldn't recommend leading with these conversations over holiday gatherings, I do recommend doing your own research, making your decisions, and sharing them with your loved ones. If you are one of those people who prefer to not discuss such things with your loved ones, then make sure at least one person is aware of where you have written your wishes down. 

This is becoming my mantra, apparently, but these conversations aren't just for you. When someone passes away without expressed wishes, their loved ones are left to guess or speculate what he/she wants. Undoubtedly, there will be thoughts and worries of getting it wrong. There are innumerable decisions that must be made when someone passes. If you make these decisions for your loved ones, you are doing them a favor. They can move on to second-guessing their decisions on other topics.