Discussing Death Over Dinner
In late January, in an Arts and Crafts house on a hill in Point Reyes, California, about 40 people—friends and family of Michael Hebb—gathered in a candlelit room at dusk. There, they witnessed pallbearers carrying the open, handmade cedar coffin in which Hebb was laid out, completely in white.
For the better part of three hours, those attending the ceremony, including Hebb's 15-year-old daughter, took turns expressing what he meant to them. There was wailing and even some occasional levity as those assembled went around in a circle sharing "Michael stories."
His eyes closed and his body motionless for the full three hours, Hebb heard every word that was said about him.
This was a living funeral.
What began as a funny aside in an email chain eventually grew into a ceremony of gravity, a serious alternative to a 40th birthday party. Hebb's personal mission is to help remove the taboo surrounding death, and so some friends thought it only natural that the Grim Reaper visit him for his milestone birthday. Once Hebb gave his consent, other friends then suggested he dress in white. He agreed. When he arrived for his funeral, he was escorted to a dark room, where he found, to his surprise, a custom coffin. In he went.
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Hebb had no second thoughts about having his teenage daughter attend the ritual. "We had a real hard time when she was 14, a rift in our relationship," says Hebb. "Instead of that chasm growing, we have gotten closer. She spoke passionately about how much she admired her Dad."
How we end our lives, Hebb concluded, “was the most important and costly conversation America was not having.”
When he was 14, Hebb lost his father to Alzheimer's, an initiation into adulthood that set him apart from most of his peers for whom death was still something remote. In his mid-30s, on a train from Portland to Seattle, two doctors told him 75 percent of Americans say that want to die at home, but only 25 percent do. The light bulb went off almost instantly. How we end our lives, Hebb concluded, “was the most important and costly conversation America was not having.”
Hebb was schooled in architecture, and from his experience bringing Portlanders together in tea houses, and starting restaurants, he believed in the transformative power of the table. Still thinking about that conversation on the train, Hebb and his life partner, Angel Grant, started a non-profit—deathoverdinner.org—to gather people around a dinner table to talk about death, a subject many people studiously avoid until circumstances warrant.
Hebb estimates that since 2013, more than 100,000 death over dinners have been held in 30 countries. Last week in a lovely home, tucked into a Cambridge, Massachusetts courtyard, Hebb led a death over dinner discussion, hosted by the founder of a health care/tech lab, Christian Bailey. Nine of us, ranging from 33 to 64 years old—most who work in the health care space—sat around a long rectangular table, drinking wine and eating a sumptuous meal, while talking about death.
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The day before the dinner, Hebb sent homework, including neurologist Oliver Sacks’s farewell column in the New York Times, written a few months before his death. In the piece, Sacks quotes philosopher David Hume ("It is difficult to be more detached from life than I am at present.")
At the dinner, Hebb began by asking everyone around the table to “acknowledge a person who's no longer with us, somebody who had a positive impact on your life.” After each name, we toasted the departed person and clinked glasses.
“When we go to a funeral today in the way the U.S. lets us die, everyone in that space has been through an extraordinary amount of hell.”
There were stories about the nutrition professor's 98-year-old father who died two years ago and how “not a day goes by where I don't remember something he said.” And the cancer researcher's father, a pre-eminent Nobel Prize-nominated scientist who developed leukemia but refused all experimental drugs. “Are you crazy? Let’s try everything and keep you alive,” the son pleaded with his father. “The whole family wanted him to fight and he didn’t. A lot of that was from not talking about death … we all handled it terribly. It affected some of my family for five or ten years. I think there is still unresolved pain.”
Among the nine people at dinner, no two experiences were quite alike. One person received a call from Belgian police at 8 in the morning who said matter of factly, “I’m calling to tell you your father has died.” That was the sum total of the end-of-life experience his family had with his workaholic father. He then traveled to Belgium to identify the body at the morgue. “They pulled him out. And when I saw his actual body, it was probably the first time I cried in a long time.” It took this experience to realize a father who had been too much apart from his son's life was “actually incredible to us. He was so selfless. He would do anything for us.”
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Then there was the story of Nicky the Greek, a larger-than-life friend of one of the dinner participants, who kissed his wife good-bye one morning, headed for the golf course and “with no other indication he was in fear or pain, he literally dropped dead on the sixth hole.” It was the first time our fellow dinner partner had been to such a celebratory funeral. “Why was this so different?” she wondered. “Because when we go to a funeral today in the way the U.S. lets us die, everyone in that space has been through an extraordinary amount of hell.” After this experience, she decided “I want to drop dead on a golf course.” And she doesn’t know how to play golf.
As the dinner moved on, Hebb tossed out this scenario for people to consider: "You just found out you have 30 days to live. You can’t argue with the prognosis. You will be able-bodied, but in 30 days it’s over. Are you pissed? Do you feel it’s unjust? Are you at peace? How do you spend your time? Who’s around you?"
The first to take a crack at it was one of the youngest people at the table, a 34-year-old health-care policy director dedicated to strengthening the relationship between patients and caregivers. “I would try in those last 30 days to find every single person who I feel I have wronged to express how much I value them. If I have 30 days left, there’s no pride, no grudges. If I can make their life happier, that's my legacy. I made them feel they had some bright spot in their life and they are a good person.”
“It’s all those things and in many ways it's what gives our lives meaning—the fact that we’re mortal.”
Lest you think the concept of a death dinner is too much of a downer, there was enough laughter and many one-liners sprinkled amid the sober discussion of end-of-life challenges. Despite the title, a death dinner shouldn’t be avoided out of some misplaced fear of being too morbid. That said, you should go prepared to be vulnerable and open. To a person, the participants were heartfelt and at times displayed raw emotions and even they may have surprised themselves. One participant at our dinner got so choked up that his eyed welled up and he had to take a long pause, as he thought about the excruciating loss of his father ten years earlier, and then considered his own mortality and how his daughter might be scarred by it.
The timing of deathoverdinner.org's launch was fortuitous, as it coincided with the topic of death, long discussed in hushed tones, coming out of the shadows and into the mainstream. Surgeon and New Yorker writer Atul Gawande's book Being Mortal, scolding his own profession for letting patients down at the end of life, has become a best seller. This year for the first time, Medicare began providing codes to pay doctors and other healthcare professionals to have end-of-life conversations with their patients. This week, the John A. Hartford Foundation released a survey of primary care physicians and specialists who regularly see patients 65 and older. Virtually all the physicians (99 percent) said it's important that health-care providers have advance care planning conversations with their patients, but less than one third (29 percent) reported having any formal training on how to talk with patients about end-of-life-care. And only 14 percent of the respondents who have fee-for-service patients have actually billed Medicare for this discussion. Later this year, California will become the largest state to permit doctors to prescribe lethal doses of drugs to the terminally ill who want to hasten their deaths.
Since death and taxes are life’s two guarantees, April 16, the day after taxes are usually due (April 18 this year) has been for a number of years called National Healthcare Decisions Day when people are encouraged to make decisions about their end of life care wishes. In that spirit, deathoverdinner.org and The Conversation Project, the advocacy group that encourages people to organize their end-of-life plans, are teaming up to suggest people turn the week of April 16-22 into a national dinner party where the topic of death is the main course.
Four hours after the first wine was poured, glasses clinked one last time to toast host Christian Bailey and deathoverdinner.org cofounder Michael Hebb, who was off to Utah the next day to talk death over dinner. He’s heading to Australia next month to work with a government agency on a death over dinner model down under, and he's started to work with Blue Cross-Blue Shield and other health care leaders in this country. Later this year, after being approached by a group of rabbis, Hebb will be launching versions of death over dinner tailored to Jewish groups and hopes to engage other faiths in these discussions with specific platforms.
“For us, the discussion of end-of-life is not just a medical or financial conversation, not just an emotional psychologically healthy conversation,” Hebb said. “It’s all those things and in many ways it's what gives our lives meaning—the fact that we’re mortal.”
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This article was originally published on The Atlantic.
