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Death to Dust: What Happens to Dead Bodies?

2002; Elsevier BV; Volume: 13; Issue: 3 Linguagem: Inglês

10.1580/1080-6032(2002)013[0232

1545-1534

James A. Wilkerson,

Grief, Bereavement, and Mental Health

I suspect I was asked to review this book because I am a pathologist, and pathologists are assumed to be uniquely knowledgeable about death and dying. Although I am honored to follow as a reviewer such an esteemed pathologist as Joe Davis, former Chief Medical Examiner for Dade County, FL (Miami), who reviewed this publication for The Journal of the American Medical Association, the fallacy behind that assumption is clearly exposed by the author's credentials. Dr Iserson is Professor of Surgery at the University of Arizona Health Sciences Center and Director of the Arizona Bioethics Program at that institution. He practices emergency medicine and is medical director of southern Arizona's major search-and-rescue program. Death to Dust is an encyclopedic source of information about everything to do with death…except, of course, its causes. It is a reference, not a book to be read straight through. Plowing through it for this review was sometimes similar to reading a dictionary, even though some sections were fascinating. (According to the dust cover, the first edition was selected as Best Reference Book of 1994 by the New York Public Library.) A detailed index and a large number of literature citations enhance its value as a reference. A few chapters seem more useful than others. The discussion of organ, tissue, and whole-body donations describes the priceless value of such gifts and carefully addresses many reservations surviving relatives and friends may have. Individuals asked to approve donations should find this information reassuring. (The author rightly makes little attempt to dissuade those convinced their religions proscribe such practices.) Importantly, he points out clearly that individuals must inform family members of their desire to be a donor to avoid delays during the few minutes after death when organs can be successfully harvested. A number of chapters deal with rituals that surround death, particularly those commonly practiced in the United States. Embalming, including the embalming of mummies, is described in detail…everything except why it is done. The writer points out that embalming and viewing the dead are limited almost entirely to the United States and are considered absurd in most of the rest of the world. Furthermore, typical embalming serves only to preserve the body long enough for the funeral. More permanent preservation is a full-time job for a team of workers—witnessed by the efforts required to maintain Lenin's body. Cremation should answer most questions about that very reasonable practice. In particular, Dr Iserson assures readers that direct cremation is perfectly legal and acceptable and points out that the insistence on embalming or caskets is nothing more than the unscrupulous extortion by individuals the writer compares to used-car salesmen. The chapters on funeral and memorial services, and on burial, contain much highly useful information. However, few individuals suffering the distress of a loved one's loss would be able to avail themselves of that resource during the hours immediately after death when decisions about such matters must be made. Physicians should familiarize themselves with funeral practices so they can counsel the families of the deceased if arrangements have not been made beforehand. Physicians’ obligations to their patients are not limited to the individuals immediately under their care and do not cease abruptly with their demise. Caregivers can provide a substantial final service by protecting those who have entrusted them from predacious assaults on their financial resources during a time of emotional anguish. Some funeral directors, although not all, seem conscienceless. Other chapters address topics that are more subjects of curiosity than practical concern. The number of individuals in developed nations who are worried that they may not be truly dead when they are buried must be limited. The various functions of autopsies are described, and the procedure is covered in some detail. The discussion points out the large number of diagnostic errors that examination consistently discloses, but unfortunately, it makes little effort to persuade physicians to request more autopsies and improve their diagnostic accuracy. The problem of lawyers enriching themselves with such information is not considered. An example of the completeness of this text is a chapter on words, sayings, and poetry about the dead that includes tombstone inscriptions, many humorous. Considerable space is devoted to cannibalism, although that is largely a listing of “who ate whom.” I do not think I would have opened this book if I had not been asked to review it, which would have been my loss. The depth of information it contains surprised me. It does have a few problems. The author has tried to address physicians and nonphysicians, which on occasion has resulted in simplified explanations being juxtaposed with technical terms only a medical dictionary would contain—sometimes in the same sentence. A few factual errors have crept in, such as the term “viremia” for a disseminated bacterial infection. I would have preferred a deeper appraisal of the role of funeral services in bringing to a close the initial, “denial” phase of a typical grief cycle. Finally, the author hints that organized religion is only a contrivance to comfort those unwilling or afraid to face the cold, hard reality of death and the end of their existence as individuals. I would have welcomed a bolder, more thorough consideration. Every hospital library should include a copy of this book, because it contains information every physician, with the possible exception of pathologists, occasionally requires. Family physicians and internists would appreciate the convenience of a copy in their offices. Public libraries should have a copy on their reference shelves to be consulted before the need for such information arises. As Dr Davis observes, this book would be an unconventional gift.