So, it is the early spring of 2022 at Flint Ridge Preparatory school and I have a free period in between classes, so I decide to take a walk around campus. 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, stillness, and quiet. And then I hear this loud scream, then silence, 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. And 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’re 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 that I teach at, Flint 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. Um, so the seventh-grade life science teacher, Hilary Thomas, decides to face this nervousness head-on by having students scream terms like “penis,” “vagina,” and “clitoris” as loud as they can on the first day of class. Now, you may think this is silly, but 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 and 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, like, take to the streets and start screaming, “Hospice!” But, I do want us to be able to approach discussions around grief, death, and dying and make them comfortable, 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 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 Ph.D.s 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.
So I join, and whenever there is an ethical or bioethical dilemma at the hospital, the head of bioethics, Dr. Wendy Kohlhase, 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, uh, 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. And I was ushered into this small room with the head of bioethics, Dr. Wendy Kohlhase, and the head of the ER, Dr. Ulick. And we were briefed on the case. There was a patient, and 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. Um, 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 two children, um, a grandson who was about 17 years old and a granddaughter who was 20. And they did not want hospice. They believed that their father was going to pull through, and they wanted dialysis. So this was the case.
So 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. Um, we told them that dialysis would be medically ineffective, and they said, “You don’t know that if you haven’t tried.” And we said, “Dialysis will cause undue harm to the body.” And they said, “Pain is worth it if it keeps our father alive.” And 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.” And I mean, I was like totally speechless. Um, I had nothing to say. Um, and thankfully, Dr. Kohlhase stepped in on my behalf and she said, “We are not killing your father. Your father is dying.” And so it went on like this for an hour. And everyone had spoken except one person. And then, finally, the 17-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.” And it was like a switch was somehow flipped, and the daughters agreed with him, and they agreed to hospice. And it was in that moment that I realized we had all been arguing about the wrong thing. Um, 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. Um, 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. And it was only later that I found out the two daughters had asked for 24 hours before the hospital started hospice, and the hospital acquiesced. And 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 them, 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. And I found out that if that patient had completed an advanced directive, that conversation would not have had to happen. If there had been an Advanced 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. I believe there is no greater gift you can give your loved ones than completing an Advance Directive. [Applause] 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% of Americans have completed their advanced directives. So this was the beginning of my crusade to have everyone complete their Advance Directive.
So let’s bring it back to the present. Um, I’m a high school English teacher. I teach, yeah, um, I teach 10th-grade American literature and a senior course on Joan Didion. Um, my Didion students are actually here in the audience today! Hi. Um, and 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. So before we dive into this text in my class, we take a week off and we 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, 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?” And then towards the end of the unit, I take a day off of class to teach what I call death education. So I’ve used this phrase “death education” a few times now, um, but I want to break down what I really mean here.
So I view death education as having three parts:
Death literature: This includes grief theory, grief memoirs like The Year of Magical Thinking.
The dying process: Understanding what actually happens when we die, understanding the difference between hospice and palliative care, what different kinds of death looks like.
Key forms: This includes understanding POLST forms, DNRs, and of course the Advance Directives.
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 a really sensitive subject matter, so before I start the unit, I email all of my students’ parents to let them know what we’re going to be studying. Um, in the first year when I taught this, I was really nervous for the parent’s response. So I sent out the email, and I got some emails back. I got a lot of emails back, um, and every single one of the emails was a thank you. Um, and they, they were thanking me for teaching this material and for having these discussions with their children that they did not feel comfortable having with their own children. And 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, which was, “I wish I had this when I was in high school.” And so, after a while, I realized we could do something about this.
So I collaborated with my friend Hilary Thomas, the seventh-grade sex-ed teacher from earlier. I collaborated with my friend Hilary Thomas, 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.
Um, so as I leave you, I want to leave you with three final notes:
I deeply believe that the key to accomplishing what we all want to accomplish here, the key to that, is eliminating the taboo around death. We need to make death something that we can talk about in comfortable, non-emotional, and educational settings.
I want to invite you all to know that you have the power to teach death education yourselves. It doesn’t 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. [Applause] [Music]
