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Death Sentences 

Book review: Companions for the Passage by Marjorie Ryerson

After my father's death, it was weeks before I could bring myself to write down the words, "Daddy died." In the six years since my mother's death, I've written hundreds of pages about losing my parents, and about how that loss has changed my life. But I've shied away from describing what I know of their actual dying. Too scary, I thought. Too sad. Too clinical. And, too arbitrary. As monumental as their dying has been, I've never ascribed particular significance to the medical moments of their demise. I've always assumed my squeamishness was fairly typical.

In her new book, Companions for the Passage: Stories of the Intimate Privilege of Accompanying the Dying, Randolph author Marjorie Ryerson suggests that keeping our distance from death deprives us of an invaluable opportunity to deepen our appreciation for life. A secondary premise is that lots of people have had these experiences, and are just waiting for the chance to share them. She reinforces this theme with her format: 13 first-person accounts transcribed from face-to-face interviews.

Ryerson, who teaches photojournalism at Castleton State College, has taken this approach before. She "orchestrated" her 2003 book Water Music by pairing her own photographs of water with aqueous memories and musings solicited from an array of world-class musicians. Compan-ions for the Passage was inspired by the death of her father, which she describes in her introduction. She assembled her contributors through personal acquaintances and word of mouth. This baker's dozen of "deadheads" -- all drawn from northern New England, with a disproportionate number of them working in health care -- discuss their close encounters with the deaths of spouses and lovers, children, parents, patients and friends.

A college student talks about how her junior year in Ghana was filtered by the knowledge that her mother was battling cancer back home. A grown daughter reflects on the challenge of guiding her father through her mother's last days. Tim Palmer, the former director of Vermont CARES, rails about the insensitivity of a doctor at the Albany Medical Center, where Palmer's partner died of AIDS in the mid-1980s. A hospice worker details the gritty particulars of caring for her dying friend -- down to the "rotten-meat smell" of the woman's last gasps and the morphine suppository the caregiver mistakenly slipped up her friend's vagina.

In most of these cases, the "passage" of the book's title begins with the fatal diagnosis and ends sometime after the death, at whatever stage of grief the speakers had reached when Ryerson found them. The New Hampshire poet Donald Hall discusses losing his wife, the poet Jane Kenyon, to leukemia in 1995. Her death inspired his 1998 poetry collection, Without. A memoir published just this month, entitled The Best Day The Worst Day, is an extended version of the same story he tells Ryerson.

A man of words, Hall translates his grief into garrulousness. In his first months of widowhood, he says, he couldn't stop talking about it: "I would... go into a diner and the man next to me would say, 'Can I have the ketchup?' and I'd say, 'Here. My wife liked ketchup. She died of leukemia.'" But voicing his loss only took him so far. "You think the dying is the worst thing," Hall comments. "But that's something you can do something about, because you can scream your bloody head off or you can cry all the time. Four years later, though, the person you loved is still dead, and you can't do anything about it. That is the hardest part."

Another writer, Archer Mayor of Newfane, the author of the Brattleboro-based Joe Gunther mysteries and an EMT, provides the collection's most detached perspective -- a professional necessity, he admits. "In dealing with death, year in and year out," he says, "you've got to park your feelings somewhere... If you don't have that awareness, you're a cold-hearted bastard. If you feel too much emotion, you can't do your job." Not surprisingly, Mayor's observations are also markedly unsentimental. "I've held a lot of people when they've died," he reports, "and I have read and heard reflections about the soul leaving or about a sense of passage. I have to be perfectly honest ... I've never, ever experienced any sign of anything other than someone just dying."

He seems to be just about the only person in Companions who hasn't. Formal religious rites play no part in these proceedings, and only one person is identified as subscribing to a specific faith -- a Christian who reassures her dying husband, "You'll finally get to see the Lord's face. What a gift." Never-theless, the narratives tend to take on a spiritual, quasi-mystical tone. One woman reports that after her mother died, the appearance of a rare bird gave her goose bumps. "People can say what they want. My husband, who does not believe in anything like that, was even struck by the experience of it," she says, sounding defensive. "I know it's corny, but I can't help but feel that in some way, somehow, that bird is a gesture from her."

Elsewhere, a widow calls the timing of her husband's death "perfect," explaining, "I felt that at this point his spirit was ready." And in yet another section, a mother avows that in the moment before her infant died in her arms, "The expression on her face was absolute, total bliss... as if she was saying, 'Can you see it, Mom?'"

Ryerson gives the last word to Ira Byock, who directs Palliative Medicine at Dartmouth-Hitchcock Medical Center and is the author of the influential end-of-life advice book Dying Well. Byock, who has made a career of witnessing deaths and hearing deathbed descriptions, adds his authority to the awed attitude that infuses Companions. "I don't know where the electrons go, where the energy, the spirit, the soul go, when someone dies," Byock admits. "I have a sense ... that the density of consciousness that life... represents does not vanish, at death."

He goes on to discuss the "dozens" of stories he's heard about people being unaccountably aware of the moments when their distant loved ones died. "These stories are not fantasy," Byock asserts. "I think that they are one of the little pieces of empirical evidence that life is more than it appears on the surface, that this life -- our current physical existence -- is not all there is. Beyond that, I don't know." The MD also says he's seen "a large handful of people" die within a few minutes of having been given permission to do so, and many more shift at such moments from stress to a more peaceful physiology. "That's so common," Byock states, "that to think that that's not real would be folly."

For many people, thoughts such as these can be enormously comforting. Readers facing the loss of a loved one will also appreciate the practical tips scattered through the interviews, such as Byock's counsel about how to visit someone who's dying: "Name your own feelings," he suggests. It's OK to simply say something such as, "I'm really worried," or "Gee, this is hard." Grieving survivors who can't believe they'll ever get back to their lives can take heart from reading the honest accounts of those who have. And at a time when end-of-life issues have become a political hot button, Ryerson's humane collection offers a helpful addition to the discussion.

For all its plusses, however, Companions for the Passage is far from perfect. One problem is structural. Throughout, Ryerson seems to channel more than report. After briefly introducing each speaker -- job, relationship to the deceased, something notable about the death, and how Ryerson found the person -- she basically turns on the tape recorder and sits back. It's a respectful, democratic approach: All her subjects get equal billing, individual voices come through, and no one seems judged. But the hands-off stance has its down side. Like the live speech they transcribe, these raps can be rambling and repetitive. And within the wide washes of words Ryerson allows, compelling details and unexpected insights get lost.

Finally, the stories Ryerson's subjects provide feel sanitized, or at least scrupulously selected. As much as her informants convey the physical and emotional anguish of dying, none seems to have been troubled by any of the myriad distractions that can color this critical event. Where are the worries about soaring medical costs and widening insurance gaps? The anxiety surrounding medical decisions and the dying person's wishes? The ethical dilemmas that accrue from the choice to passively or actively end a life? The interpersonal conflicts that so often flare up in families at times of crisis?

Granted, such concerns are beyond the scope of this book. But by ignoring them completely, Ryerson seems to suggest that the only thing standing between the reader and an enriching deathbed encounter is a willingness to remain open to the experience. The flip side of that promise is the implication that someone who has squandered this "intimate privilege" has missed out -- or, worse, failed. Losing a loved one is hard enough without the added pressure to get it right.

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