Instructor for the UVM End of Doula Certificate program

I can finally let the word out! It was an honor to be able to contribute to this exciting course for End of Life Doulas, the first to be linked to a major medical school! Apply by August 15th to be a part of the first class! Read all about it here: https://learn.uvm.edu/program/end-of-life-doula-certificate/

Developed in association with the UVM Larner College of Medicine, the University of Vermont has partnered with Cabot Creamery to launch a fully online End of Life Doula Professional Certificate that will prepare you to meet the growing demand for end of life support as people live longer and the course of the average dying process continues to become increasingly gradual and anticipated.

Curriculum

The University of Vermont developed the online End of Life Doula Certificate curriculum to provide a comprehensive program covering the essential skills and knowledge to prepare you to embark on your new End of Life Doula role.  In association with the UVM Larner College of Medicine, we created an interactive and supportive online program that will prepare you to provide a holistic approach to your compassionate care work with your clients.

Learning Objectives

  • Understand how to best work in harmony with your client’s chosen care team, heightening a client’s feelings of empowerment and self-efficacy
  • Develop effective communication skills to have meaningful conversations with clients
  • Learn key ethical principles and patient rights
  • Understand common terminal conditions and diseases, pain management practices, the active dying process, and helpful interventions to ease pain and suffering
  • Learn how to practice Universal Safety Precautions while providing hands-on care
  • Understand the role and scope of an End of Life Doula and apply core skills to provide unconditional positive regard and non-judgmental support for your client
  • Recognize and support psychosocial development states and the stages of grief
  • Become familiar with a client’s network of organizations and professionals offering support to increase your ability to provide comfort to your client
  • Gain the skills to provide bereavement support to a client’s family and friends after death
  • Learn about meaningful activities for client visits and creating an environment of calm

Weekly Module Topics

Week 1: Introduction to End of Life Work, Hospice, and Palliative Care; Personal Death Awareness

Week 2: Introduction to the Grief Continuum; Commonalities in EOL Experiences, Dignity Therapy

Week 3: Understanding the Patient Experience; Terminal Illnesses/Diseases; Pain Assessment and Interventions, Active Dying Process; Introduction to Hands-on Care

Week 4: The Role and Scope of the End of Life Doula; Companioning and Serving; Appropriate Professional Boundaries; Holding Space and Honoring Sacred Space

Week 5: The Needs of Clients: Providing Comfort Care; Caregiving Considerations; “Turning Toward”

Week 6: Religious/Cultural Beliefs and Practices; After Death Options, Effective Referral Practices

Week 7: Preparing for Loss: Life Review, Completion Work, Legacy Projects and Grief Support

Week 8: Activities, Techniques, and Tools for Client Visits; Creating an Environment of Calm; Vigil Sitting; Personal EOL Wishes

 

 

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Three and a Half Feet Under: Cemeteries Are Wary of Green Burials By Terri Hallenbeck @terrivt

It was an honor to be featured in this piece by Seven Days , Burlington Vermont’s weekly newsletter. Although the burial depth bill I wrote passed unanimously, I’m still hard at work making green burial accessible to ALL Vermonters. Public education is key. Look for a post about the non-profit I’ve founded, Green Burial Vermont, soon.

“Fred Cheyette plans to be buried in a hayfield next to his house in the town of Orange. His body will be wrapped in a simple cotton sheet and placed three and a half feet deep in the earth, with an oak sapling planted atop the grave.

“So my body feeds the tree,” said the 86-year-old retired engineer and psychotherapist, who is peppier and more youthful looking than his years suggest.

Cheyette has arranged what is known as a green, or natural, burial — rejecting the standard procedures of cemetery interments. There will be no embalming, no varnished coffin, no concrete vault, no polished headstone. He wants his body in the dirt and close to the surface.

Despite a state law that took effect this month to make it easier for Vermonters to choose a green burial, Cheyette’s arrangements are possible only because he will be buried on his own property. He received permission from his town’s Board of Health.

For others, planning a natural burial poses greater challenges: Advocates of green burials say they know of no cemeteries in Vermont that yet allow the green interments they envision.

Passing the new law — which allows burials at a mere three and a half feet, where a more active biological soil mix facilitates rapid and natural decomposition — appears to have been the easy part. Now, supporters of the practice have to persuade dozens of cemetery operators to change policies. Many Vermont cemeteries require a five-foot burial depth and that coffins be placed inside buried concrete vaults, rules that preclude the simpler burials.

But Michelle Acciavatti of Montpelier and a half dozen other green-burial advocates stand ready to convince cemetery operators to change their policies. They are forming a nonprofit organization, Green Burial Vermont, which will produce a manual of best practices.

“The goal of the nonprofit is promoting environmental and socially conscious burials in Vermont,” Acciavatti said.

The group’s efforts could change the traditional image of graveyards.

Carl Anderson of West Berkshire, a wildlife biologist who is a member of Green Burial Vermont, said he envisions existing cemeteries adding green sections, as well as new graveyards that will use proceeds from the sale of natural plots to conserve surrounding acres. The dead could share space with sugaring operations, tree farms or hayfields.

But first, the organization has to allay a host of fears: that coyotes would scavenge for shallower, unprotected bodies; that some types of soils would inhibit decomposition; and that changing the layout of a graveyard to something other than rows of mowed grass dotted with shiny headstones would pose logistical challenges.

“There are just unknowns,” said Patrick Healy, manager of Montpelier’s city cemeteries and president of the Vermont Cemetery Association. “We just want to know what the best practices are.”

“A lot of the pushback is coming from the cemetery operators,” said Acciavatti, who toured the state last fall and winter advocating for the legal change. “There are a lot of misconceptions.”

For Acciavatti, 34, dealing with death is a passion and a vocation. She runs a business called Ending Well, which offers end-of-life planning and counseling. She’s also a hospice volunteer and co-facilitates a monthly “death café” in Montpelier, where attendees sip tea and converse about mortality.

She set out to become a neuroscientist. Then two close friends died in accidents shortly after she graduated from college. A year later, she was in a close-call crash herself.

“The first thing the trooper said was, ‘You’re so lucky you didn’t die.’ That percolated inside me for a while,” Acciavatti said. Before she knew it, Acciavatti was making a business of the thing most people don’t want to talk about.

With a soothing, nonjudgmental manner, Acciavatti manages to make talking about death easy. She hopes to take such conversations out of the shadows and into living rooms and dining rooms. “I used to joke that I was constantly ruining holiday dinners,” she said. “Now I’m everybody’s death friend.”

On a beautiful Tuesday evening in June, a dozen like-minded people gathered at a Montpelier tea shop for the death café. Heavy at times, the conversation also focused on uplifting moments families share as a loved one approaches the end.

Cheyette is a regular attendee. He readily shared plans for his own burial. Having what he sees as an environmentally friendly afterlife plan is a comfort, he told the group.

He, too, wants to change the notion that death is a taboo topic. “It makes me feel alive,” he said later, of the death café discourse. “I feel really good when I leave there.”

Acciavatti said green burials pair well with her desire to open up discussion about death. “We’ve become so cut off from death,” she said. “It’s been medicalized. It’s been commercialized. It’s been taken out of the home.”

In a traditional burial, an embalmed corpse is placed in a casket, which is then lowered five feet deep into a concrete vault and covered. The body decomposes, but the lack of contact with soil slows the process, wildlife biologist Anderson said. In the meantime, water interacts with the casket’s metal, varnish and paint, which pose a risk of contaminating groundwater, he said.

Green burials are intended to bring the body into closer contact with the soil. The unembalmed corpse is buried with no casket or in an unadorned wooden coffin. There is no concrete vault. Decomposition of soft tissue typically takes place within two years, depending on soil and hydrology, though bones take longer, Anderson said.

“With a green burial, you’re trying to put the body as close to active biological layers as you can without letting scavengers get at it,” he said. Hundreds of green-burial sites around the country do that at three and a half feet, without a scourge of scavengers, he noted. Vermont requires that deceased livestock be buried under two feet of soil.

But convincing cemetery operators to change their policies will take time, said Calais cemetery commissioner Jennifer Whitman. She joined the movement after hearing Acciavatti speak and would like her town to allow natural burials.

“This is a slow process,” Whitman said. “This is going to be the next 10 years.”

Just collecting contact information for the many cemetery operators throughout the state was a challenge, she said. Now, Green Burial Vermont’s goal is to help them work through logistical concerns.

People have many definitions of what constitutes a green burial, Whitman noted. Some want to be buried in the woods with no markers; others prefer a plain pine box in a shallow grave with a natural gravestone. Each cemetery’s operators have to figure out what they can accommodate, Whitman said.

Cemetery commissions would have to change long-standing policies, such as requirements for concrete vaults. Calais has such a rule, Whitman said.

That policy exists for good reason — to keep graves and caskets from collapsing, Healy said. When workers dig graves and mow cemetery grass, they often use heavy machinery, he noted.

Healy said that practice is one of the concerns he has about reserving part of a cemetery for green burials. He is not persuaded that wild animals won’t dig up natural graves, though advocates insist the fear is unfounded. And he wonders what the protocol would be for transporting a body to a gravesite without a casket.

“Will the public be able to handle seeing bodily fluids on shrouds?” he asked.

Nevertheless, Healy has had requests for green burials, and the Montpelier Cemetery Commission is considering what to do. One option is to phase in changes. “I think our first step may be pine boxes without vaults,” he said.

The Burlington Cemetery Commission is pondering the same questions.

“I would like to do more research and see if there’s a way to make it possible,” said cochair Allison Curran.

Burlington requires vaults and a five-foot grave depth at its two active cemeteries, Lakeview and Greenmount. Last week, Acciavatti asked the city commission for an exemption for a terminally ill client who wants a green burial. Commissioner Emma Swift expressed reservations about granting exemptions before setting a green burial policy, according to minutes of the meeting. The panel plans to consult the city’s attorney.

Meetinghouse Hill Cemetery in West Brattleboro may come closest to offering a green-burial option. The graveyard has a separate section where vaults and embalming are not required, manager Andrea Mitchell said. Three bodies have been buried there.

To the chagrin of green-burial advocates, however, the cemetery is unwilling to place bodies at depths of less than five feet. “The fella that digs our graves doesn’t want it, and I don’t want it. I think it’s too shallow,” Mitchell said. Asked why, she said, “I don’t know, but I don’t want to find out.”

Meetinghouse Hill charges $1,000 for a green plot, more than the $700 for a traditional one, because maintaining gravesites that are more prone to sinking is expected to be an additional challenge, Mitchell said.

If green burials gain traction in Vermont, the trend could give cemeteries a needed boost. Business is lagging, Healy conceded, as more Vermonters opt for cremation. Cemeteries are encouraging families to bury cremated remains, he said, but many choose to scatter or keep the ashes.

According to the Vermont Department of Health, slightly more than two-thirds of Vermont’s dead were cremated in 2014. Green burial advocates say cremation generates too much greenhouse gas.

Chris Palermo, owner of Perkins-Parker Funeral Home in Waterbury and president of the Vermont Funeral Directors Association, said that when he started in the business 40 years ago, about 15 percent of his customers chose cremation. Now, he said, 80 percent do.

He’s not yet had any customers ask for a green burial, but Palermo said he supports giving families the options they seek. Most importantly, he said, people should tell their families what they want, because, too often, they don’t.

“My sense is, people are becoming more comfortable with the discussion,” he said.

Cheyette is at ease talking about such matters. His wife, Sage Blue, who died in 2004, was cremated. Cheyette spread her ashes on their property, he said.

He hasn’t shared his burial plan with his three children but said he met with a group of close friends to explain what he wants. “It’s also posted on my refrigerator,” he said, next to his advance directive and do-not-resuscitate orders.

He explained why he wants his remains to nourish an oak tree. “I don’t want my body to be wasted,” he said.”

What living with a chronic illness has taught me about being with people at the end of life

(Image from Be Stigma Free )

I don’t think I’ve written about the fact that I have a traumatic brain injury, but I do. In my first semester of grad school, getting my degree in neuroscience, I was rear-ended in while stopped in traffic by a vehicle going somewhere between 50-70mph. Living with a TBI has helped me be better about being with people at the end of life. Because my illness is invisible I realize there are many symptoms people experience that are hard to explain, interpret, and/or predict due to the changes in brain function as people approach death.

Sensory input even in the form of loving touch can be incredibly overwhelming, painful, and overstimulating. If you are working with someone who can still communicate always ask before touching them (you should be asking because you should also never touch someone without their consent, but I digress). Ask every time because it may change. Even if the person can’t communicate verbally it is important to ask and look for body signals for clues as to whether or not touch is welcome or soothing. It can be both difficult for both patient and loved ones/caregivers to not use touch, but there are other ways to make someone feel loved and safe.

Sensory input goes beyond touch as well- auditory, olfactory, and visual stimulation can also be unpleasant. Again be sure to let your patient be your guide- they will either tell you or show you the safest and gentlest ways to interact with them. Understand this and help your patient and their families understand that there is nothing to be ashamed of in accommodating their stimulation responses.

Communication is often difficult. Finding the right mode of communication- speaking, writing, non-verbal communication- is essential for being a good end of life doula. Most of all, remember that patience is a crucial part of communication. Speak slowly, clearly, and directly. Don’t rush or mumble. Don’t shout. Watch to see how what you are saying is being received. Let your patient have the time they need to answer you and make a real effort to ensure you understand what they have said. (See my post on communicating with dementia patients for other tips on communicating.) Being heard is something that makes us feel like humans with value.

Never make assumptions. Both the most obvious and easiest to forget. Things that people may have relied on in the past to bring comfort may now serve as painful reminders of things they can no longer do or are leaving behind. Something that wasn’t an issue yesterday may be a major issue today. A big part of the mantra “meet your patient where they are” is allowing your patient to teach you about where they are in each moment.

Be not just willing, but truly able to settle in and be present with your patient. This ability to be fully present and aware of your patient and their needs is what will allow you to meet them in the most supportive and loving manner for them at that time. And that makes all the difference.

 

 

Planning and Preparing: Read about me in NY Magazine!

It has been a very busy year for me so far, but I am happy to report it’s also been very productive. The burial depth bill I wrote about in my last post passed and went into effect on July 1. Green burial is now fully legal in Vermont.

As I work with more people to plan for their end of life I am continually amazed and grateful for the privilege. It was a great honor to be interviewed and featured in NY Magazine’s “The Science of Us” series as an end of life planner.  “The Professionals who want to help you plan your death”

Please read and feel free to share. I love how Amy and I have such different approaches to advance care planning. I always try to find what is the best fit for my client, (even though I am attached to my own method), so don’t be surprised if I recommend Good to Go to you!

I have a bunch of exciting announcements that it’s hard not to share them all at once, but please keep checking back to see what else I’ve been up to. There is also a website re-design to reflect all the positive changes in the works!

If you have questions or want to be in touch there is a contact form on the blog, and you can follow me on Twitter and Facebook I’d love to hear from you!

 

 

 

Life Doesn’t End With Death: Why I Wrote a Burial Depth Bill

I tell people my goal is to help everyone plan (and hopefully experience) their own good death- whatever that means to them- and that includes the right to choose a manner of disposition in accordance with their own ethics and values.

It came as some surprise when I learned that Vermont was one of only 2 states that had a required minimum burial depth, and that that depth, (at least 5 feet) meant that green burial wasn’t really an option for Vermonters. I happened to speak about this at the conference I held to launch my business in August and a Calais cemetery commissioner was in the audience.

At the end of the day she asked me to come to her town’s cemetery commission meeting because they had gotten requests for green burial and wanted to know what they could do to make that happen.

So, many people are probably thinking that burial depth doesn’t have anything to do with green burial. That what matters is being buried without embalming, in a biodegradable container or shroud, and without a vault (grave liner). While it’s true that these steps mitigate many of the harms caused by our current burial practices they don’t do a lot to also increase the benefit of burial. After-all the definition of green burial is two-part:

  1. Minimize harm to the environment
  2. Maximize benefit to the environment

At 5 feet or deeper there is not enough heat or oxygen for aerobic decomposition, the process is anaerobic, slow, and has by-products that aren’t very pleasant to think about. Nor is there a microbial community, insects, or root structures that could return any of the body’s nutrients to the soil above.

But at 3.5 feet the body is very close to the active layers of the soil, where there is a lot of insect activity, a robust microbial community, roots, oxygen, and sunlight to warm the soil. This adds up to rapid, aerobic decomposition with an efficient exchange of the body’s nutrients with the soil above. This is a way to allow the natural decomposition process to happen while still protecting the body from scavengers.

That’s right. For those of you worried that 3.5 feet is too shallow- it’s not. Part of the amazing thing about soil is what an excellent filter it is. The same properties of soil that fix and break down things like chemotherapy drugs, antibiotics, and trace amounts of heavy metals found in bodies also prevent the odors of decomposition from escaping in noticeable amounts. Humans can’t smell anything and scavengers aren’t drawn to the body. Burials at or around 3.5 feet are happening  in 29 states certified by the green burial council and have been for almost 30 years and none of them have ever reported an issue with scavengers.

Aside from oxygen, heat, insects, and microorganisms, here’s no magic recipe necessary for green burial- it’s natural decomposition, exactly as our ancestors were returned to the earth. And, the way many of our farm animals are today.

But as of today it’s not legal in Vermont.

Imagine my surprise, when after a meeting with the Calais Cemetery Commission in which I told them they would have to revise their by-laws to make vaults optional IF the law ever changed they said their representative would sponsor legislation to change the law and change the required minimum burial depth to at least 3.5 feet-  provided they wrote the bill.

So we wrote a bill.

So far, Vermont Bill H.3 (An Act Relating to Burial Depth), which was introduced in January, has passed unanimously out of the House committee charged with considering it and passed out of the House to the Senate with a majority voice vote. I’ve spent these past months learning how to negotiate the State House and touring the state to educate people about burial depth and green burial.

But all that has more to do with how I came to write a bill and less to do with why.

Most people who work in death-related fields have seen examples of “people die the way they live,” or, as my mother-in-law says “we don’t change as we get older, we just get more so.”

Here in Vermont land is important to people. I mean, this is true everywhere, but it’s amazing to see the number of small farms, sustainable land practices, farm to table restaurants, ethical planting by cities, sourcing of everything from kefir to coffee beans by local companies, the sheer number of people that flock to farmer’s markets and CSAs or grow their own food. Add that together with the amount of outdoor recreation and the importance of ethical enjoyment of the outdoors, the beauty of our seasons, the number of people who are here because either they or their parents moved here in the 70s to get back to the land… and, well, what you get is a state with a population that is largely very conscious of its impact on the environment and doing what it can to make that impact a positive one. This is true of hunters, farmers, skiers, walkers, urbanites, and hermits alike.

It’s a huge part of why I’ve been drawn here twice in my life, first for college and then again 3 years ago to live. Vermont is a state where the land is not only a reflection of its people, but its people are a reflection of the land. We are all touched and shaped by living here.

So much so that many never leave. Many do their living here until the day they die. And over, and over, and over again what I have heard people say is that when they die they want to return to the land. They want to become a part of the land they love.

They want their final act, their disposition, to be an act of giving back.

And until the law changes, that’s not really possible the way they envision it.

And that’s why I wrote the bill.

 

(Data referred to in this post comes from the Green Burial Council, the book “Greening Death” by Suzanne Kelly, and “Soil Microbiology, Ecology, and Biochemisty” 4th edition, edited by Eldor Paul)

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For those of you who are curious I’ve written a lot about the bill at a website and blog I set up to support Bill H.3 including my vision for what green burial sites can be used for- pollinator meadows and forest conservation. Please check it out: vermontgreenburial.wordpress.com

If you’re reading this and you live in Vermont and want to know more, find out where my statewide tour is taking me next (or book me in your town), or support the bill by contacting your State Senators all that information is on the website too. You can also email vermontgreenburial@gmail.com with questions, concerns, offers of support, stories about why green burial is important to you, or anything else about Vermont, green burial, and you.

I’m working with a great team of fellow green burial advocates and we’ve gotten some good press. You’ll find it all posted on the blog at the website, but here’s my favorite:

Shallower, greener graves gain ground in Vermont by Joel Baird of The Burlington Free Press

 

 

 

 

REBLOG: Günter Grass: ‘When the time comes, we will rest on leaves’

An exclusive extract from the Nobel prize-winning author’s final work describes how he and his wife imagined their farewell

This is one of the most beautiful things I have ever read. A stunning meditation on mortality, green burial, and our place in the natural cycle of life….

from: https://www.theguardian.com/books/2016/nov/19/ By Günter Grass

“At long last, having discussed our joint project many times, testing and rejecting various ideas at the kitchen table, we had reached a decision; the master carpenter Ernst Adomait sat across from us. The conversation began over tea and cakes, hesitantly at first, but soon underway.

Adomait has worked for us for years. He’s built standing desks and bookcases, and various smaller items for my wife. We told him what we wanted, never defining it as our last will and testament. After looking through the French window into the summery, windless garden, he agreed to take the job and make the boxes. He suggested they be measured separately for length and width, and we agreed. He had no objection to our request for two different woods: pine for my wife, birch for me. The boxes would be of equal depth, but hers would be two metres 10 long and mine two metres. My box would be five centimetres wider, to match my shoulders.

When I said “not tapered toward the foot,” which was once standard and may still be customary, he nodded in agreement.

“A costly method,” he warned. Alternatively, screws could be inserted in carefully drilled holes. I favoured hammering in old-fashioned nails with solemnly resounding blows at a given signal. In the postwar years, I often put up gravestones in cemeteries while working as a stonemason, and once made a deal with a gravedigger: five Lucky Strikes for a good dozen hand-forged coffin nails; later, much later, they appeared as rusty assemblages in drawings, lying this way and that, a few crooked, each with its own shape. And every nail had a tale to tell from its past. Sometimes I added dead beetles lying on their backs, and bones large and small. In one drawing, nails and rope hinted at a death only humans could devise. Soft pencil, hard-line pen and ink drawings, all of them still lifes, a few found buyers intrigued by their cryptic nature.

Adomait seemed to follow my digressions more out of politeness than interest. Then we chatted about current affairs: the ludicrous rise in the price of petrol, the uncertain summer weather, the now-familiar bankruptcies. I set a bottle of mirabelle plum brandy beside the empty teapot and what remained of the cakes. “Just a small glass,” said the master carpenter, who still had to drive home in his truck.

Illustration by Günter Grass
Pinterest
Illustration: Günter Grass

I mentioned Wild West films in the course of which this sort of plain carpentry grew in demand. My sketch on a paper napkin proved unnecessary; the idea was clear enough. The boxes would be finished by autumn. We assured him we were in no hurry, but laced the conversation with hints about our combined age.

The style of the handles was still under discussion. I wanted something in wood. My wife favoured strong linen straps. In any case, there would be four on each side, to match the number of our children. The way the boxes would be sealed was left open for the time being. The conversation was down-to-earth at first, and dealt with practical details, but soon turned almost cheerful. When I suggested setting the lids loosely on top – “after all, the weight of the earth will hold them in place” – or fastening them down with carpenter’s glue, Adomait permitted himself a quickly fading smile, then declared pine and birch dowels more suitable.

By the time Adomait left, we’d decided on wooden dowels and rough linen handles on each side of the boxes. “We can count on him,” my wife said. “He has always delivered on time.” The interior decoration of the boxes hadn’t come up that afternoon, since it didn’t involve carpentry. The only thing we were sure of was that padded upholstery, cotton or down, was out of the question. That sort of expense might be customary in commercial coffins, but we weren’t looking for comfort.

It was only at breakfast, after my usual complaint that my mattress was too hard, and when the dishes had been removed and the tabletop was bare, that an idea came to me, somewhat vaguely at first, but soon assuming a clearer shape. I suggested that after the obligatory washing of our lifeless bodies, we be laid to rest on a bed of leaves, then covered with more leaves by our daughters and sons, using whatever Nature offered, according to the season. In spring, budding leaves would cover us; in summer, fruit trees – cherry, apple, pears and plums – could lend their lush green, mature abundance. Autumn, my preferred season, would make its brightly coloured offering. And dry, rustling leaves could deck our naked bodies in winter. The old walnut tree, the copper beech, the maple would provide variety. A handful of walnuts could adorn our leafy cover as an extra feature. Only the two chestnut trees outside our house, sickly for years, would be forbidden to add their rust-afflicted foliage. I also requested there be no oak leaves.

At any rate, when the time comes we will rest from head to toe on leaves and be decked with leaves. At most our faces will be free, perhaps with rose petals on our closed eyes, a custom I witnessed during our stay in Calcutta: there I saw some young men trotting along, carrying the body of an old woman on a bamboo pallet to a cremation site on a tributary of the Ganges. Bright green leaves were pasted over her eyes.

In addition, my wife chose not to forgo a shroud – one she said she would sew herself.

That seemed preparation enough. Over the course of a time no longer ours, all would decay, the box and its contents. Only bones large and small, the ribs and the skull might remain, unlike the bodies buried in the bog in Schleswig-Holstein, now placed on show under glass in the Schloss Gottorf Museum. Those bones turned soft; you could still see tissue, skin and knotted hair, as well as bits of clothing, relics of a ghastly prehistoric age, of scientific value, eagerly sought as fodder for bog-bodies stories, like the one of a young girl whose face was covered with a strip of cloth in punishment for some atrocity that could scarcely be imagined.

The skull, on the other hand, has always harboured a rich store of meanings, from the ingenious to the ludicrous. Piled high or fitted into walls, skulls rest in the vaults of monasteries. A skull adorns the pirate’s flag, serves as the logo of a soccer club. It signals a warning on cans of poisonous, explosive or flammable material and appears as a motif in the fine arts, in oil paintings and copper engravings like the one by Albrecht Dürer showing Saint Jerome in his study. Withdrawn from all worldly concerns, he bends over his books, while the fleshless skull beside them reminds us of the transience of all living things, that from birth on, death is a settled matter.

But we weren’t that far along yet, in spite of our increasing frailty. The planks for the boxes we’d ordered could be cut to size, but a few questions were still in the air that were harder to answer: what carpenter would build a refuge for the wandering soul, whose existence we both desired and doubted? What facade would reach high enough for the climbing ivy of immortality? How might we be reborn, as worm, mushroom, or resistant bacteria? What other beings might inhabit the void?

In addition to ivy, we could spend a rampant afterlife as weeds no gardener could control. And what of creatures that creep and fly? With Nature’s all-powerful help, I’ve always hoped to be reborn as a cuckoo, drawn to the nests of strangers. One year after another holds great promise. Even leaving God and his promises aside, speculations remain that won’t fit in our boxes. Only the transitory nature of their contents can be guaranteed: the rigidity of the corpse; the greenish-blue discolouration of the skin, gassy, bloated and soon bursting; the onset of mould and all the other signs of rot; the worms.

Things we still need to think about – the final question: where should we be laid to rest? A good 30 years ago, when we were living in the city and first thought of looking for a plot, I favoured the cemetery in Friedenau. But my wife had something against Berlin as our final station. In the end I did too, since soon after the wall fell, the city’s claim to be the nation’s capital gave rise to too many shiny bubbles of loudmouthed boasting.

Having moved many times, we considered various cemeteries – with Lübeck as a cosy backdrop – but reached no decision. One near the railway station, where you could sense rows of graves hedged by boxwood trees, would have matched my endless longing to travel. But since we wished to be at rest, a double grave in our garden, between the studio window of my workshop and the shed, with nothing but the woods beyond, would have been our preference. But in spite of our country’s solemn canonisation of private property, burial on one’s own land is forbidden by law. Cremation remained the only way out, followed by a fake theft of the urns by our sons, so our ashes could eke out their shadowy existence behind the blackberry hedge or in the lilac bushes. But having no wish to deny the worms our mortal remains, we decided against ashes and agreed to talk with the pastor of Behlendorf about making the local village cemetery our final address. A meeting was easily arranged. The pastor, who turned out to be quite affable, if somewhat overburdened by the spiritual welfare of his current souls, understood our aversion to resting among the rows of graves, since as individuals and newcomers we were unfamiliar with the neighbourly or familial entanglements of the villagers at rest there. Even our tactful suggestion that as heathens we would feel out of place near the medieval outer wall of the chancel was, if not warmly received, at least quietly accepted.

We finally settled on a tall, solitary tree off to one side. Beneath its spreading branches I paced out a rectangle the size of a quadruple plot. The pastor told us that this was in an area bordering the cemetery, once a pastoral potato field, unused for some time now, lying fallow, so to speak, although at present it gleamed invitingly as a meadow.

During a pause in the conversation we pictured ourselves lying there, or as the survivor visiting the first to go. As decorative shrubbery I suggested herbs: marjoram, sage, thyme, parsley, anything used in the kitchen. On the eastern edge of the measured quadrangle, an erratic boulder would serve as a gravestone. The stonemason would have the job of carving our names and dates in cuneiform letters. “No other inscription or quotation, please.” The boulder would have a broad base that asserted its weight without being overpowering.

I paced out the approximate size of the plot again, this time farther from the root system of the tree. Getting the church council’s approval for what we wanted, the pastor assured us, would pose no difficulties.

When we got back home, we were a little tired. I treated myself to a coachman’s glass of calvados. On the kitchen radio the evening news reported various crises competing for the limelight. According to the weather forecast, rain would continue in the south only. We didn’t tell our dog about our successful search for a resting place.

One Saturday in mid-September, after the second pacemaker they’d implanted declined to give my heart the help it needed, and my lungs began to repay me for decades of self-indulgence in handrolled cigarettes and well-stuffed pipes, we were relieved to see the carpenter arrive with the boxes. Ready to use. The look of them, the bright wood, each with its own grain, put us in a good mood. Even Adomait, a serious man on principle, seemed satisfied, and confirmed his mood by attempting a smile.

We had cleared a temporary space for the boxes in the back of the cellar where we kept our garden tools and deckchairs. Plastic covers would protect the boxes from flyspecks and mouse droppings. Seeing them side by side like that reminded me of a special term for coffins from the old East German days: Erdmöbel, earth furniture. The eight handles stood at precisely measured intervals. Although well seasoned, the wood smelled new. Without lids the interiors beckoned invitingly.

Illustration by Günter Grass.
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Illustration: Günter Grass

Before leaving, Adomait did not rule out my now customary offer of a shot of plum brandy in celebration. On top of the bill, which was more than reasonable, he placed a clear bag of wooden dowels for the lids; he had drilled matching holes in the upper rims of the boxes. There were several extra dowels in the sack. As the carpenter had suggested, my wife stored them carefully in a drawer of her desk where, along with the usual odds and ends, she kept our passports, the dog’s vaccination certificate and other important papers.

The very next Sunday, with no visitors scheduled, we removed the protective covers, as well as the lids lying loosely on top, took off our shoes, and lay down in the boxes. They were the right length and shoulder width. We made no comment, so solemn was the anticipation of our laying out.

How strange to hear each other breathing. My wife helped me climb back out. When we had replaced the lids on the boxes, we spread the covers over our final homes and gave free rein to our thoughts, which remained, however, unspoken. Shortly afterward, my wife said she was sorry she hadn’t taken a picture of me in the box; she would be sure to have her camera with her next time. “You looked so content,” she said.

Once we’d had our trial lie-in, as we called our visit to the cellar, life went on as usual. While my wife was preparing supper – two perch with jacket potatoes – I sat in front of the TV watching the usual Sunday evening world news with its images from around the globe. When I saw the two fish lying side by side in the pan, with cucumber salad on the side, the comparison seemed so apt I couldn’t help joking about it.

The boxes have been waiting ever since. From time to time we remind ourselves how beautiful they are. I’m too shy to ask my wife if she’s finished sewing her shroud. But I know we’ll have plenty of leaves to clothe and cover us. They will always be available: newly fresh in spring, lush green in summer, brightly coloured from October on, faded and brittle through the winter.

So let another year or two pass. We’re not in any hurry. At the moment my pacemaker is doing its job, as promised. Even the children and grandchildren, when they come by for a brief visit and bring up the deckchairs from the cellar on sunny days, have grown used to the sight of our master carpenter’s custom work.

Lately my wife has started storing dahlia tubers and other flower bulbs in her box for the winter. Next March – we hope – we will plant them in the flower beds and cover them with fertilised soil from the garden.

Text and graphics copyright © Steidl Verlag and Günter & Ute Grass-Stiftung 2015, English translation copyright © Breon Mitchell 2016. Of All That Ends is published on 1 December by Harvill Secker. To order a copy for £10.65 (RRP £12.99) go to bookshop.theguardian.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99.

Thank you for your service

One year, one month, and eighteen days.

That’s all most of the people in his life know about his time in Korea.

But I know he volunteered. His father had driven an ambulance in World War I and his older brother had become a doctor so he became a medic. He was responsible for the health and well-being of the men on “his airstrip” a pit-stop for planes to refuel after unloading napalm before returning to their aircraft carriers safe at sea.

Once a Korean woman brought her baby to him. As he held its limp body he realized he had no way to tell her the child was already dead.

He is dying now, and though he loves his wife, his daughter, and his god fervently it is the face of that woman slowly realizing her baby was dead that he sees every night.

And has seen every night since that day.

But, until a few months ago he had never told anyone that story. He never told anyone that coming home from combat is “living in a nightmare only worse, because in a nightmare no matter how bad it gets you wake up. And, you never wake up from coming home from combat.”

When he first got home he built a wall between himself and his experiences with alcohol. Through sheer will he overcame his addiction. He found god and he found love. He found a calling. He will be the first to tell you that he has lived not just a good life, but a rich life, a beautiful life that still moves him to tears when he reflects back on it.

What he will never tell anyone is that nothing in his life makes up for the darkness of what he experienced during his “one year, one month, and eighteen days.”

Except me.

He doesn’t understand why these memories are so present now and understands even less what compels him to talk about them after a lifetime of leaving them untouched. Sometimes when his wife visits and hears us talking she shushes him, literally, and asks why he would want to waste his time remembering that.

I will not share any more of the secrets he has shared with me here. I will say he has happy stories, funny stories, the types of callow anecdotes you would expect about one’s first time away from home. Stories that make me laugh. But the stories he comes back to, the stories he needs to tell again and again are not like that. Those are the stories that when I finally say goodbye and make my way back to my care paralyze me with weeping.

Telling these stories is not therapeutic for him. They leave him feeling like his “bones are tired.” But he tells them anyways. Even when he is half-asleep I can hear him telling the stories. After a lifetime of not-telling, now he needs to speak, to share, sometimes even re-live.

He has sheltered me from a ground-assault; begged for a chance to give a young soldier penicillin instead of shipping him off to the surgeons for amputation; screamed as a plane came in too fast on his short landing strip and exploded in the jungle beyond. Then he comes back to his room, lost and shaken, impossible to comfort.

He wonders if he is a good man. He prays that his god will understand. It was combat. He did what he could. He didn’t hate anyone, but he didn’t want to die.

In my role of as an End-of-life Doula, I can only listen. I have known combat veterans- in my family, the parents of my friends, my peers. But I always been the one not told. The one, sheltered or deemed too removed to ever understand. I don’t know if every one who sees combat comes back with a part of themselves no amount of goodness can make feel better. But this man did. And so I stay present for his darkest moments.

He volunteered one year, one month, and eighteen days. But what he gave was his life. Not his mortality, cancer will take that, but his self. Because part of him never came home from Korea.

When today first became a national holiday it was to celebrate the 11th hour, of the 11th day, of the 11th month. Armistice Day. The beginning of the end of a war that was supposed to end all war. Now it seems war is an inevitable part of our reality and so today represents a day when we honor all those who have served.

I can’t help but wonder if we really understand what they sacrifice.