Connecting Dying to Living: What End-of-Life Can Teach Us About Life

From fantasy coffins in Ghana to children’s hospice in South Africa to Māori tangihanga in Aotearoa, Samara Gordon-Wexler traces how cultures around the world weave dying into the fabric of community, revealing that death, when embraced collectively, is less a medical event than a deeply human act of care.

When I was growing up, the days that my dad was home for dinner were the most anticipated. My sisters and I would gather around our dining room table, anxiously awaiting the week’s stories, tales from his adventures as an emergency medicine physician.

I was entranced by the patterns within diagnosing, the drama of a trauma, and the heroics of his many saves. From a young age, storytelling and medicine were inseparable in my understanding of what it meant to be a doctor.

As an undergraduate at Middlebury College, I studied poetry as an English major while completing the pre-medical track. My two courses of study informed one another, leading me to explore qualitative clinical research through a position as a research assistant in a renowned pediatric palliative care lab.

I spent two years working within this lab, inspired by my team’s ceaseless efforts toward the creative use of palliative care to improve the quality of life for seriously ill children.

At the same time, I was experiencing an internal conflict. In my role as a research assistant, I was responsible for reviewing charts and extracting data, often encountering the label “DECEASED” at the top.

The charts seemed to tell a story of escalating and intensive intervention as death neared, rather than preparation for the inevitable outcome. The absence of end-of-life care narratives made me question why things were this way in the United States and whether they might be different elsewhere.

I applied for and received a Thomas J. Watson Fellowship to travel for a post-undergraduate year and understand what it means to die well, from both medical and cultural perspectives, in seven countries around the world.

In Teshie, Ghana, I apprenticed at the Kane Kwei Fantasy Coffin Shop, learning the art of fantasy coffins. This tradition allows families to choose a shape for the coffin that represents the person’s life force, the spirit of how they served their community.

A family might request a fish for a fisherman or a syringe for a doctor. The coffins become symbols of a person’s life and reminders that members of a community labor for one another, and that this must be celebrated above all else.

Funerals in Ghana can be described as celebratory, but that does not mean they are devoid of grief. Instead, space is made for every emotion over multiple days. There are days for sadness and mourning, days for anger, and days for celebrating both the person’s life and the community’s efforts to memorialize them.

I joined my host family many times during my stay in Ghana, dancing through the streets and humming along to songs and chants as we followed a fantasy coffin, sometimes for miles, to the burial.

As I saw it, a funeral is first and foremost an act of community building.

In rural South Africa, I volunteered and lived at Butterfly Palliative Home, a hospice and foster home for children who had been abandoned because of terminal illness.

Founder Tarryn Bell has a unique ethos for the environment cultivated at Butterfly: The children have choices within their treatment.

Butterfly emphasizes the importance of young people’s voices in their care. I watched children run, play, learn, and develop as children, not because they were unaware of their diagnoses, but because their precious time could be spent simply being children rather than remaining bedbound through futile treatment.

I spoke with six-year-olds who were more articulate about life and death than many adults. With each day, I witnessed the joy that is possible when we create a culture of honesty and openness about disease with young people rather than paternalistically determining their care.

At Pallium India, a World Health Organization demonstration site for community palliative care throughout the state of Kerala, I joined a multidisciplinary team of doctors, nurses, social workers, and psychologists as we piled into vans and traveled to treat palliative care patients in their homes.

To help the team navigate such a geographically diverse region, Pallium relies on an extensive network of community volunteers. These volunteers work tirelessly to keep Pallium’s operations running smoothly and meet families’ needs beyond medical care.

Speaking with a volunteer one day, I expected to learn that most had a personal connection to Pallium, perhaps a family member who had benefited from its services.

Instead, I discovered that most volunteered simply for the “love of their community” and with the understanding that one day, all of us may need palliative care.

In Aotearoa, I spent my time learning about Māori beliefs surrounding death. I was invited to a tangihanga, a funeral, to experience some of these traditions firsthand.

The feeling on the marae, the meeting grounds, as the body enters is sacred and spiritual. The silence is broken by a visceral wailing that I can only describe as a carnal representation of grief.

There are women within the community who attend every tangihanga to perform this wailing, opening space for grief so loudly that all other grief becomes safe. Since childhood, their role has been to hold this sacred space for their people, welcoming grief in and placing it at the center.

These are only a few of the stories I carried home with me.

In so many of the places I visited, death was not siloed within hospitals or made into something to fear. It was a labor of love carried by everyone and understood as a return, a natural and human transition.

I now see my future role as a doctor as encompassing far more than medicine. Being a doctor is inseparable from receiving the stories from which love and connection can be born.

I see my role as creating community with my patients and ultimately becoming an amicus mortis, a friend through death.