What Teaching Death Education in High School Taught Me About Life

So it is the early spring of 2012 at Flintridge Preparatory School, and I have a free period in between classes. I decide to take a walk on campus, and the weather is just starting to get warm, and the roses on the senior lawn are blooming.

For a moment, I am overcome with a sense of calmness and stillness and quiet.

Then I hear this loud scream, and then silence, and then another loud scream, more silence. So I head to Room 30, where I hear these screams coming from, and I realize that it isn’t screaming. It’s chanting. More specifically, it is the chanting of seventh-grade voices.

So I get closer and closer and closer until I can finally make out what they are saying.

“Penis!”

Silence.

“Vagina!”

“Clitoris!”

And this, I realized, was the first day of seventh-grade sex education.

One of the really special things about the school where I teach, Flintridge Prep, is that the entire fourth quarter of seventh-grade science is dedicated to sex education.

Now, while I think this is wonderful, you can imagine that the 55 13-year-olds who make up the seventh grade are terrified. So the seventh-grade life science teacher, Hillary Thomas, decides to face this nervousness head-on by having students scream terms like “penis” and “vagina” and “clitoris” as loudly as they can on the first day of class.

Now, you may think this is silly. I believe that this is pedagogically brilliant.

I think that it’s brilliant for two reasons. Number one, it sends a clear message to students that these are not bad words. These are not words that need to be whispered. These are not words to be ashamed about. These are topics that we can discuss in a comfortable way.

Second, it sets the tone for the class. It says this class is going to be silly, not awkward, not intimidating.

This is the approach that I want to bring to death education.

Now, I’m not saying I want you to take to the streets and start screaming, like, “Hospice!”

But I do want us to be able to approach discussions around grief and death and dying and make them comfortable and approachable and educational.

So let me take you back to 2015, when I first developed an interest in end of life and death. I was an undergraduate at USC, and I was double majoring in cognitive science and philosophy, and I had just joined the Huntington Hospital Bioethics Committee in Pasadena.

Now, the Huntington Bioethics Committee is unique in that it’s comprised of three factions. The first group of people are bioethicists, so people who have PhDs in bioethics. The second group is MDs, so doctors at the hospital. And then the third group is called community members, and it is open to anyone from the community with a demonstrated interest in bioethics.

So when I joined, I was the fifth community member, and the other four were all retired nurses from the hospital.

Whenever there is an ethical, bioethical dilemma at the hospital, the head of bioethics, Dr. Wendy Kaste, emails the entire committee to see who can come in as soon as possible, making sure that at least one person from each of the three factions is being represented.

So the first time I got the email, I jumped on it. I called out of work, and I didn’t go to any of my classes, and I took three Metros from USC to Huntington.

I was ushered into this small room with the head of bioethics, Dr. Wendy Kaste, and the head of the ER, Dr. Ulick, and we were briefed on the case.

There was a patient. He was in his 70s, and he was experiencing multiple organ failure. In the past 48 hours, he had gone through 52 units of blood. This is unheard of. You know, you’re supposed to go through, max, like two units of blood in a 24-hour period.

So it was clear that his body was shutting down, and the hospital was recommending hospice.

However, the patient had two daughters who were at the hospital, who were both in their 40s, and one of the daughters had two children, a grandson who was about 17 years old and a granddaughter who was 20.

They did not want hospice. They believed that their father was going to pull through, and they wanted dialysis.

So this was the case. The three of us went into a room with the family, and we began a discussion that would become one of the most emotionally charged hours of my entire life.

We told them that dialysis would be medically ineffective, and they said, “You don’t know that if you haven’t tried.”

We said dialysis would cause undue harm to the body, and they said, “Pain is worth it if it keeps our father alive.”

I will never forget that there was this one moment where one of the daughters looked at me and said, “You are killing my father.”

I mean, I was, like, totally speechless. I had nothing to say.

Thankfully, Dr. Kaste stepped in on my behalf, and she said, “We are not killing your father. Your father is dying.”

So it went on like this for an hour, and everyone had spoken except one person.

Finally, the 17, 18-year-old grandson spoke, and he said, “Grandpa wouldn’t have wanted this. He never wanted to be in hospitals. He definitely never wanted any sort of tubes coming out of him, and he wanted to die at home.”

It was like a switch was somehow flipped. The daughters agreed with him, and they agreed to hospice.

It was in that moment that I realized we had all been arguing about the wrong thing. We had been arguing and making appeals to logos and ethos, but at the core of this case was pathos. It was the emotions and feelings that were at the center of this.

So I went home, back to USC, and I was a mess. I mean, I was a total wreck. I called out of work for the rest of the week. I couldn’t go to my classes. I didn’t want to see friends.

It was only later that I found out that the two daughters had asked for 24 hours before the hospital started hospice, and the hospital acquiesced. Their father actually died while on life support that night.

So the entire conversation was, in a way, unnecessary.

Now, the main thing I learned from this experience, the main thing I learned about, was the advance directive.

For those of you who don’t know, an advance directive is a form that you can fill out that tells doctors how you want to be treated if you are unable to communicate, like if you’re in a coma.

It tells them things like what type of life-saving treatment you do or do not want, whether or not you want to be intubated, whether or not you want to receive nutrients through a G-tube.

I found out that if that patient had completed an advance directive, that conversation would not have had to happen.

If there had been an advance directive, none of the yelling and the pain and the guilt that those daughters might have felt from having to make decisions about end of life for their father, none of that would have had to happen.

If there had been an advance directive.

I believe there is no greater gift you can give your loved ones than completing an advance directive.

By filling out one simple form, you save them from having to guess what your wishes are. You save them from having to bear the burden, the responsibility and the potential guilt of having to make decisions about your life and your death.

And yet, only 37 percent of Americans have completed their advance directives.

So this was the beginning of my crusade to have everyone complete their advance directives.

Let’s bring it back to the present. I’m a high school English teacher. I teach 10th-grade American literature and a senior course on Joan Didion. My Didion students are actually here in the audience today.

Hi.

For those of you who don’t know, in 2005 Joan Didion published a memoir, The Year of Magical Thinking, about the sudden death of her husband from cardiac arrest at the dinner table.

Before we dive into this text in my class, we take a week off and study about a century’s worth of grief theory, starting with Freud’s Mourning and Melancholia, moving on to Kübler-Ross, tackling more contemporary theories like continuing bonds, the dual process model, meaning reconstruction, so on and so forth.

Then, when we read the text, rather than trying to analyze it as literary scholars, we try to dissect Didion’s psychology. We try to put her on the couch and understand what is happening.

We ask questions like: Is she experiencing Freud’s mourning or melancholia? Is she going through the stages of the Kübler-Ross cycle? If so, in what way or in what order?

Then, toward the end of the unit, I take a day off of class to teach what I call death education.

I’ve used this phrase “death education” a few times now, but I want to break down what I really mean here.

I view death education as having three parts.

Part one is death literature, things like grief theory, grief memoirs like The Year of Magical Thinking.

Part two is the dying process, understanding what actually happens when we die, understanding the difference between hospice and palliative care, understanding what different types of death look like.

Then part three is what I call key forms: POLST forms, DNRs and, of course, the advance directive.

I know that the idea of teaching death education to high schoolers is scary.

But we will all encounter death and dying, and we need to be prepared.

Death is one of the most emotional and complex experiences we will have in life, so we ought to learn about it in a non-emotional, educational and safe environment: high school.

This is obviously really sensitive subject matter, so before we start the unit, I email all of my students’ parents to let them know what we’re going to be studying.

The first year when I taught this, I was really nervous about the parent response. So I sent out the email, and I got some emails back. I got a lot of emails back.

Every single one of the emails was a thank you.

They were thanking me for teaching this material, and they were thanking me for having these discussions with their children that they did not feel comfortable having with their own children.

Then I started realizing one other thing that was coming through from these emails, which was parent after parent after parent kept saying the same thing: “I wish I had this when I was in high school.”

After a while, I realized we can do something about this.

So I collaborated with my friend Hillary Thomas, the seventh-grade sex education teacher from earlier, and we created these death education workshops for adults where we not only teach death education, but where we also complete our advance directives together.

As I leave you, I want to leave you with three final notes.

Number one, I deeply believe that the key to accomplishing what we all want to accomplish here is eliminating the taboo around death.

We need to make death something that we can talk about in comfortable, non-emotional and educational settings.

Number two, I want to invite you all to know that you have the power to teach death education yourselves. It does not have to be in a formal way, like I do it in my classroom. It can be as simple as inviting some friends over to your home to discuss end of life.

And third, I will repeat myself: There is no greater gift you can give to your loved ones than completing your advance directive.

So go home. Complete your advance directive.

Thank you.