For a Human-Centered AI


March 16, 2021

A reflection to restore dignity to the lonely deaths of the pandemic

On the sad day in which Italy reached 100,000 deaths since the beginning of the pandemic (out of a total of 2.5 million in the world) FBK per la Salute organized a webinar in which Dr. Marina Sozzi offered a touching reflection on what meant and means dying of covid for the patient, the family members and the doctors who provide up to the last assistance.

Paradoxically, facing death is a way to discover life. It forces us out of our shell of narcissism and presumed earthly omnipotence in which we have locked ourselves up in recent decades, comforted by the enormous progress of an increasingly widespread and cutting-edge medicine. To us who thought we were to dye elderly, surrounded by the affection of our loved ones, following a natural serene path of accompaniment to the end of life, a tiny virus hit the dismay of a solitary, isolated, aseptic death in the face.

In March 2020 we were annihilated by the funeral bulletin issued daily by the Civil Protection while, a year later, we almost got used to the death count, three-digit numbers that are read as the weather forecast, every day. Like modern Antigoni, those who have experienced these losses in the first person, on the other hand, have suffered a trauma that is still alive due to the impossibility of burying their loved ones decorously, having to be contented, when possible, with hasty funeral ceremonies marked by rules aimed at stemming a further contagion, a possible cause of other diseases and other deaths.

Furthermore, the possibility of reconciliation that the ultimate contingency of a person’s life often offers, the opportunity to pronounce important words, often decisive for the subsequent elaboration and acceptance of pain, has also been lacking. A mourning in mourning has therefore arisen in a subtle and inescapable way.

Dr. Marina Sozzi, currently the coordinator of the Palliative Care Promotion Center at the Oncological Network of Piedmont and Valle d’Aosta and author of three volumes on death and illness, accompanied us in a heartfelt reflection, starting from wondering with which approach to physical loss we have reached the 2020 pandemic. In the last century, in fact, death has become a conscious avoidance within society rather than a repression (a proper term of psychoanalysis) or a taboo (a term that draws on the sacred), with the illusion of having freed themselves of the memento mori thanks to advances in surgery and medicine and to be able to reach old age without first having dealt with death. Similarly, even the ceremonies have been reduced in form and duration as well as visits to the cemetery, more and more thinned out due to the tendency to prefer the memory of one’s loved one in life. Above all to non-believers the rites appear as meaningless repetitions of patterns and, at least for the moment in Italy, there are no shared lay rites. In some extreme situations, the dying themselves are left alone for refusing to interface with imminent death, contrary to what was introduced by palliative care in the new century.

With the advent of covid, society suddenly found itself facing a collective and daily anxiety of death. The grotesque slogan “Everything will be fine” and the euphoric chants from the balconies of the first wave were an initial attempt to exorcise the situation together with the transformation of the sanitary workers into superheroes with face masks instead of the magic cloak on the shoulders: it was a reaction aimed mainly to not wanting to see the disorientation of medicine, the lack of an effective and proven cure or antidote. Summarizing to the bone, and perhaps trivializing: we all know that we will have to die, someday, but no one is willing to do it now, here, immediately and consequently escape mechanisms from reality are put in place.

The emergency has unfortunately made it necessary and inevitable to set aside the approach of palliative care, giving way to solitary deaths – both those from covid and not- last greetings through the pitiful screen of a mobile phone and death notices often entrusted to staff not adequately trained, especially to do it at a distance, in turn tried and exhausted by grueling work shifts.

Especially in the first wave there was a total lack of the funeral rite, at most hastily celebrated, without contact or the possibility of seeing loved ones one last time, hurriedly locked in anonymous coffins. This made us understand how funerals are not really pleonastic but essential to mourning because they conclude the series of events that led to the ultimate loss and therefore allow a new beginning. The ritual itself offers the opportunity to express and share the emotions one feels and is a tribute to loved ones, it helps to consolidate family and friend networks and is the first step to build the memory of those who are no longer there. It is a ceremony that serves those who remain, but it is also consoling for those who are about to leave, trusting to receive a worthy burial.

Historically, it was not the first time in history that the funeral rite has been set aside: think of the plague of the 17th century and the wagons loaded with corpses described by Manzoni through the eyes of the characters of I promessi sposi. In the eighteenth century the dead were buried outside the city walls as a solution to the foul-smelling miasma that came from the corpses and only with Napoleon did they begin to rethink a regulated and structural organization of the cemetery as a place of worship.

In any case, the de-ritualization of death originates a real trauma, worsened by the sense of guilt of not even having been able to assist the patient, of not having been able to “take care”. Today’s technology comes to the rescue, with the digital celebration of funerals in streaming or via whatsapp, which in all probability will remain as a parallel methodology even after the pandemic, to meet the needs of a globalized world where many people move and live among multiple countries.

The need to commemorate the dead also led to considerable ritual creativity, for example in Turin last summer in a hospital the operators organized a symbolic funeral rite in the courtyard of the structure, burying and watering trees and naming all the dead aloud, briefly telling the life stories of each. Some commemorative monuments of the pandemic have also arisen, the first in Codogno, one of the most affected centers of the first pandemic wave, where now stands a monument bearing the words “Resilience – Community – Restart”. In Casal Pusterlengo, an architect involved the citizens by asking them to collect stones on the bank of the river Po on which to write the names of loved ones who have disappeared and a commemorative message. A tower was then built with these stones in the town square where people can express their condolences and reflect on what has happened and is, unfortunately, still happening.

They are simple but powerful ways to oxygenate mourning, to put it in the words of the psychologist Nicola Ferrari, that is to make it breathe deeply, express, assign a place to it.

It would be desirable, when allowed, to organize a real institutional public ceremony, such as that of the burial of the unknown soldier after the First World War, where a generation of young people disappeared under the bombs while, today, we lose one of the elderly and we must preserve the memory of what they left us. There is therefore a strong, overbearing need to restore flesh and blood to these dead, to save the memory of their lives through a collective social process. In a word, to restore dignity: to those who are no longer there and have gone away feeling alone and vulnerable, to those who have remained but also to those who have committed themselves and closed the eyes of these patients, with the fear of contagion and the weariness of a new and trying role.

For better or for worse, the Covid-19 pandemic will inevitably leave aftermath but also some lessons that, if we have the humility to preserve, can help restart a health care and a society that is mindful of what it has been.

The author/s