Although it is natural to worry about our loved ones, and even the least delay can cause us to run horrendous scenarios through our head, deep down we never really believe that the unthinkable will happen—not to us—and we do not actively plan for the worst. However, if the worst does happen, the first thing we will be asked to do is to make a series of important decisions, including some with irreversible consequences, not an easy task when we are in a state of profound shock and deep sorrow. This is true for everyone, but as expats we have the added difficulties of not being surrounded by close family, not knowing local laws, and maybe not having a good mastery of the language.
Catherine Mathieu and Otaviano Canuto have just gone through one of the most feared experiences of every parent; they have lost one of their children in a car accident, their 22-year-old son, Pedro. Many of us may remember Catherine as our dynamic and devoted Welcoming Chair. Some may know that she is now our new WBFN Coordinator. Those who attended the “Celebration of Pedro’s Life” were deeply moved by the support and love that flowed between Catherine and Otaviano and among the two of them and their children. We knew that the steps they had taken during the previous few days were many and difficult. In the hope of possibly helping others, we have asked Catherine and Otaviano if they would agree to share with WBFN some of their experience, and we are very grateful that they have accepted.
Let’s have a look at the Canuto family’s experience to see if anything could make us “better prepared” for a tragedy.
THE FIRST SHOCK
It is early Saturday morning; the day is like any other, and then two policemen show up on your doorstep with the news: your son has been in a car accident and taken to Suburban Hospital. Your mind is swimming with questions. “Why didn’t they call me immediately? How badly is he hurt? Is he at the right hospital, with the right doctors? How can I get to him? What happened? Where is the car?” The police do not answer any of these questions.
Otaviano says he was not surprised that he was not consulted about where his son would be taken and stresses, “After an accident, each second may be crucial. There is no time to consider other options or look for other opinions.” Catherine adds that she had long ago taken WBFN’s advice of researching hospitals in her area, learning their specialties and driving by them. The hospital had likely been chosen by the paramedics based on its proximity to the accident and/or the fact that it is the biggest trauma center in the area.
Are you familiar with the area hospitals?
You arrive at the hospital and are taken to see your son in the emergency room but are soon pulled away to fill in forms and asked for evidence of health insurance coverage.
We periodically hear that a hospital will refuse treatment unless you can first show proof of health insurance coverage. Otaviano assures us, though, that, “In the case of a life threatening emergency, they will not leave you out to die.” In fact, he found that, although he had come prepared for the paperwork, the doctors at Suburban gave priority not only to trying to save Pedro’s life, but also to attending to the family’s pain and anxieties, allowing them into the emergency room. The hospital doctors were even willing to accept calls from their family doctor, should he have questions. The request for the inevitable paperwork did come, but only after they had seen Pedro.
Do you carry your health insurance card with you at all times?
One of the questions the hospital asks is whether your son has a living will. You had never thought of needing such a document for a 22-year old.
You may have been informed of the importance of establishing a “living will” but may not have thought of it for a younger person. And yet, how can one decide what is the right course to take, especially for a loved one, and especially in such an emotionally difficult situation? The “living will” includes the individual’s directives for the use of artificial life support machines, burial vs. cremation, etc. Catherine tells us, “Pedro did not have a living will, and you know I thought about that too during the 24 hours before they confirmed that his condition was not capable of supporting life: What if he were to be kept on a machine for ten years? Would we be able to make the decision?”
Have you ever had an open family discussion about living wills?
BUT WHAT HAPPENED?
The police who initially brought the news had handed you the name and contact information of the investigator in charge of the case, but would not give you any details. You try to contact the investigator, but it ends up taking several days to connect.
Contacting the officer in charge proved not to be easy for Otaviano and Catherine. They only managed to get an appointment five days after the accident, and this only thanks to friends who went in person to the investigator’s office in Gaithersburg and made the appointment. The investigator told Otaviano the results of the investigation to date and said he would send a written interim report at a later date.
Do you have a support network?
The investigator also asks if you have car insurance and informs you that the car has been impounded and the family will not have access to it until the investigation is over, which could be six weeks or longer. If there are possessions in the car that you need, you can ask for them to be brought to the police station and an immediate family member (not a friend) can pick them up.
The hospital had given the Canutos five days to contact their car insurance company, report the accident and give the hospital the claim number, since this insurance would be involved in covering the costs. They had learned, however, that they could not finalize their insurance claim until they had the final police report. They were astonished to learn also from friends that while the accident was being investigated they could incur storage charges for the car.
Does your car insurance cover you for such an eventuality?
THE NEXT STEPS
The doctors finally inform you that there is, unfortunately, no more that they can do and ask you if you are aware of your son’s wishes.
Pedro’s driver’s license showed that he had chosen to be an organ donor. Catherine and Otaviano had discussed organ donation with their children with the view that “we all want to save lives.” However, little did they know that Pedro’s choice, a decision he took by himself, would provide such an incredible source of comfort to them during their grieving process, particularly the knowledge that Pedro’s gift would not only help to save up to eight lives, but it would also help many others—patients in need of bones, ligaments and skin grafts, as well as medical research and development, contributing to life in the future. In Catherine’s words, “I felt proud of him for this choice, and this helped to give me tremendous strength. Everyone needs a source of strength to endure an event as tragic as this, and for me this was it.”
Catherine acknowledges, however, that organ donation may not be the choice of everyone. Although many European countries have laws which by default make everyone an organ donor unless the person has chosen to “opt-out”, England, for example, in November 2008 tried to pass a law to the same effect which was rejected. Brazil reversed its policy of “by default” organ donors in 1998, fearing body snatching. In the United States, like in many other countries, you must state your wish to be an organ donor, and this wish is written on your driver’s license. The legal age in most states to get a driver’s license is 16, so this is the time when most people in the US make their decision, even without consulting their parents, although in some cases, families have the right to refuse the donation of organs, despite the wishes of the donor.
Have you discussed organ donation with your family?
You know you will now need to make decisions about the burial and the funeral ceremony.
Following the death of a loved one, you will need to make many crucial decisions, both financial and emotional—whether to cremate or bury, which funeral home (and negotiate the fee), where and what kind of ceremony and burial, whether to serve food and how—all monumental tasks in themselves, but especially so while trying to cope with your own grief and that of your children. Otaviano and Catherine say they found themselves taking one step at a time and consider themselves extremely fortunate to have been surrounded from the start by friends and colleagues ready to help. For example, they were able to assign three friends the task of inquiring about, visiting and negotiating with funeral homes; others accompanied Catherine when she made the final decisions; yet others helped them locate the church for the service; and still others assisted with organizing the ceremony and the food. And again, when Pedro was finally transferred from the hospital to the funeral home, they faced a number of bureaucratic steps for which friends’ help proved invaluable.
Again, do you have a support network?
DEALING WITH FAMILY GRIEF
Friends from around the world email and call you, offering sympathy and words of wisdom.
Catherine reminded us at the memorial that a child who loses a parent is an orphan, a spouse who loses a partner is a widow or widower, but there are no words in any language in the world to describe parents who have lost a child, and that is because parents are always parents for their children. The same is true for siblings, and they will always be siblings. Catherine and Otaviano say they were very much helped by advice from friends who had been through similar experiences, which they summarized as: “Try to avoid feeling guilty or running ‘what if’ scenarios through your head; both are destructive tendencies. They do not take you anywhere; they do not add anything. Your most important task at such a time is to keep the family together, united and moving forward. Moreover, do keep in mind that while many will express their sympathies to the parents, your children, who are also grieving, might be ignored, and yet they also need such comfort.”
Catherine and Otaviano felt that by involving their children in the planning of the funeral and including them in the decision making, they were helping the grieving process as well, constantly reassuring them of the unity of the family. “During the days after the accident, we had family meetings everyday to decide what decision would make every member of the family feel more comfortable.” These translated into deciding upon an ecumenical ceremony, removing much of the formality, serving refreshments after the ceremony—the idea being that everyone would feel comfortable, regardless of age or religion; and it worked. It
"Our Angel"—Artist Patricia Secco uses the Mandala Circle symbolism to represent Pedro reaching out to eight people while his parents and four siblings draw strength from his generosity.
Let us not forget the grieving of the children.
CARPE DIEM
As a young child Pedro learned the expression “carpe diem” (literally: seize the day; make the most of the moment), and since then Catherine had used it with him at times of tender complicity. Otaviano added, “Our children’s presence among us is a gift. Spend more time with them, try harder to understand them, hug them often.”—carpe diem!
Catherine and Otaviano, we know it must have been a difficult decision to make, but we hope that sharing your experience has helped you somehow to take one more step in the grieving process. We know you know this, but WBFN shares in your pain and is here to support you and be the family you now need. A big hug and beaucoup de courage to you both and to your children in this time of saudade.
Where can help come from?
If Catherine and Otaviano, who had enormous emotional and practical help and support from their colleagues at work, the WBFN, the Brazilian Community, Catherine’s Batala friends, and many others, still describe having to organize everything on an ad hoc basis, following some pointers from the funeral home and advice from friends, it is hard to imagine how it would be for someone who may be alone, have no friends, or speak poor English, not to mention if only the children were left behind.
WBFN holds seminars about epidemics, terrorist attacks, living wills, and estate planning, and our publications Planning Makes a Difference, Welcome to WBFN, and the WBFN website also contain some information. But we realize how much more WBFN could be doing to prepare our members for emergencies. We know of no comprehensive, easily accessible, easy-to-follow guidelines covering the range of questions that might be asked by those new to the US.
We can also see a place for an institutional, objective, well-trained helping hand to accompany and help the bereaved from the international community throughout their ordeal, including avoiding the possibility of mistakes that could increase the grief and even end up being very costly.
You too can help. Do you have any advice, suggestions, personal experience that may help us to help others in case of a tragedy or bereavement?
Catherine and Otaviano share tips from their own experience
If you must change/cancel/buy air tickets, inform the airlines that it is due to a death in the family to avoid penalties.
If the police officer investigating the accident does not return your call, keep trying. He/she is the only one who can give you information.
Report the death as soon as possible to your consulate, especially if you plan to take the casket to your home country. Regulations and bureaucratic procedures may affect your decisions about funeral home services.
Inform the World Bank HR Service Center (202-473-2222; benefits@worldbank.org) about the death. The staff member must also update the records in the HR Kiosk.
Do not allow funeral homes to rush or pressure you into making a decision. Once you accept, you will not be able to change to another funeral home.
Do NOT go by yourself to funeral homes to get estimates. Bring a cool-headed person to be your advocate and help you make the right decisions.
Funeral homes are not the only venue for a gathering, memorial service and/or reception. Churches and community centers/clubs may be much cheaper options, and usually more personable and warm.
The funeral home issues the death certificate. Ask for several copies. You will need them for various documentation purposes.
Try to get back to your routine as soon as you can: eat, sleep, work, etc.
Do NOT make any radical decisions, such as returning home, leaving the U.S. It will take some time before your thinking is back to normal and you are able to make decisions with long-term consequences.
You may want to have some professional psychological help. It can be extremely helpful in guiding you through the grieving process.
by Gilda Dadush and Louise Shimizu