Thursday, October 8, 2009

Cause of Death Matters

Elizabeth Barrow was 100 years old and lived in a nursing home in Dartmouth, Massachusetts. She was in pretty good health, but it was hardly a surprise that she died last month. Hundred year old people die. What was a shock was how she died. She was strangled in her bed and a plastic bag was placed over her head and tied in place with a shoelace. When her family first learned of her death, they assumed that the bag had been placed there by someone trying to cover her body up, and that she had died of natural causes. The medical examiner suspected she might have killed herself. Now that it is clear that the cause of death was strangulation, a criminal investigation has been undertaken.

I don't think I've ever read about a situation that more clearly demonstrated the difference between trauma and grief. Obviously, Ms. Barrow's family was saddened by her death. She was a fixture in the family and they will miss her. But they were not shocked by her death initially. There was nothing particularly unexpected about a 100 year old person dying. As best as I can tell from various interviews that her son has given, the family experienced her death as a loss but also took time to celebrate her life, as we so often do when someone very old dies.

When the autopsy results ruled her death a homicide, the family was thrown out of the natural grieving process and straight into trauma reactions. Trauma also challenges what we think we know about life and death. In this case, that challenge was very literal -- the family thought they understood how Ms. Barrow had died, and then, all of a sudden, they didn't. It didn't help matters that the news that her death had been ruled a homicide was released to the press before the family, so the family learned of it from reporters. Several articles covering this story have used the word "reeling" to describe the family's reaction.

The reaction of the nursing home, while not terribly well worded, also hints at the way the cause of death in this case has thrown everyone for a loop. A statement released yesterday said,
We prepare for these eventualities as persons caring for the elderly who die of natural causes. This situation is especially tragic because the exact chain of events may never be known.
And that is the heart of the matter. Yes, a death is a death. But a traumatic death offends our sensibilities, and we want to understand how it could happen. I hope the Barrow family gets their answers.


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Naomi Zikmund-Fisher
is a clinical social worker, former school Principal and a Crisis Consultant for schools and community organizations. You can learn more about her at
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