Monday, June 30, 2008

"Starlight" by Muse

Songs about loss are rarely upbeat enough to get you moving in your car, but for me "Starlight" by the English alternative/progressive rock band Muse manages to combine sorrow and loss with rock and roll supported by a driving bass line to make a catchy song with some deeper meaning. Muse is a band whose music leans towards more sullen material, and some critics of the band chastised this song for being too pop-oriented. Overall their music style is defined by the music genome project as frequent use of minor key tonality, subtle use of piano and some electronica influence. This song exemplifies these traits well with simple piano and guitar melodies, with more space-rock bridges breaking the song into two very different feels.

Here is the video from YouTube. The visuals of the video below are not highlighted in this post. Pay more attention to the audio and lyrics.

(If the video does not display click the title of the post)

In "Starlight" the band makes use of outer space, a common theme on this album, as a metaphor for loss and distance. The ship taking the singer 'far away' could be an allusion to disease, especially one like Alzheimer's which erases the memories of the important people in your life. Or more generally, the decreased level of consciousness as someone gets closer to death.

"Chasing a starlight" can have multiple meanings in reference to end of life. On a very obvious level 'seeing the light' is commonly perceived as an experience of someone near death. And then when combined with star, the light could be a thinly veiled reference to the 'stars in heaven.' But why would the protagonist of the song be 'chasing the starlight?' Here you can start to explore many different questions.

Could the 'starlight' be thought of an ideal, perfection, purity or some unobtainable goal? This impression makes more sense when he wonders if the effort "is worth it anymore." Is trying to be good and perfect the reason to get to a wonderful afterlife? Or is the person reflecting on the good (starlight) he has striven for which now appears to 'mean nothing' since he is dying? I will note the band stated this is a "a love song about missing someone, friends, family, someone you love" and therefore not explicitly about dying.

MUSE Band PhotoThe bridge/chorus gets more aggressive with crunchy guitar chords, as if he is fighting the loss, with the lines, "I'll never let you go, if you promise not to fade away." This line switches the perspective as most people working with Alzheimer's see the patient as the one slipping away, but if you (as the patient) are slowly losing your memory and ability to communicate, it can also seem like everyone else is fading away from you. Much like some weird palliative care Doppler effect; who is fading from whom?

"Black holes and revelations" is the name of the album and also a key lyric in "Starlight." This is made even more important when paired with the line of "our hopes and expectations." Palliative care is about finding 'hope' and managing 'expectations' when discussing the uncertainty of the future of a medical illness. But when patients and families 'hopes and expectations' are not managed well it may seem like 'hope' get dashed into a 'black hole' never to escape. Any information contrary to current 'expectations' then becomes a dramatic 'revelation.' Other influences regarding spirituality and end of life issues could be made with the Biblical Book of Revelations, or the unknowable of what exists in a black hole, echoing the uncertainty about what happens after death.

For those who liked this song, some of Muse's other songs highlight issues relevant to palliative care and spirituality including "Thoughts of a Dying Atheist," "Sing for Absolution," "Time is Running Out" and others.

"Starlight" by Muse (Bellamy) from the album "Black Holes and Revelations" (2006) from Warner Bros. Records.


Far away
This ship is taking me far away
Far away from the memories
Of the people who care if I live or die

I will be chasing the starlight
Until the end of my life
I don't know if it's worth it anymore

Hold you in my arms
I just wanted to hold
You in my arms

My life
You electrify my life
Let's conspire to re-ignite
All the souls that would die just to feel alive

But I'll never let you go
If you promised not to fade away
Never fade away

Our hopes and expectations
Black holes and revelations
Our hopes and expectations
Black holes and revelations

Monday, June 30, 2008 by Christian Sinclair · 2

Monday, June 23, 2008

1832 Paris Cholera Outbreak

It's hard to imagine the panic of a sudden epidemic. Heinrich Heine was a German poet living in Paris as a journalist in 1831 covering the development of democracy and capitalism in France. His journals recount many things, including the beginning of the Paris Cholera epidemic of 1832. His descriptive account of the frenzy and sudden deaths served not just as historical information, but also as an inspiration for the artist Alfred Rethel. Having read the following passage of the account of the outbreak, the German artist Rethel went to work on his engraving “Death as the Cutthroat”

Here Heinrich Heine recounts the Paris scene:

"That night, the balls were more crowded than ever; hilarious laughter all but drowned the louder music; one grew hot in the chahut, a fairly unequivocal dance, and gulped all kinds of ices and other cold drinks--when suddenly the merriest of the harlequins felt a chill in his legs, took off his mask, and to the amazement of all revealed a violet-blue face. It was soon discovered that this was no joke; the laughter died, and several wagon loads were driven directly from the ball to the Hotel-Dieu, the main hospital, where they arrived in their gaudy fancy dress and promptly died, too...[T]hose dead were said to have been buried so fast that not even their checkered fool's clothes were taken off them; and merrily as they lived they now lie in their graves.

Rethel depicts the scene as he envisioned it. Death plays its instrument with a human bone, the costumed dancers struck dead mid dance at Death's feet. We see disease symbolized as a shrouded female figure sitting in the background, while musicians scurry from the scene with terror in their eyes.

Contrast this with an illustration from the US National Library of Medicine, a picture done by J. Roze entitled "Le Cholera a Paris". This engraving also depicts the cholera epidemic, but from a different perspective.

Which of the two stands out to you? One is more a symbolic representation, one more of a reality. One depicts terror, the other grief. Does either piece of art allow the viewer to experience the experiences of a sudden epidemic, or do Henrich Heine's words give a clearer picture?

Works: Rethel, Alfred "Death as Cutthroat"( 1851)
Roze, J "Le Cholera a Paris" (1832) US National Library of Medicine
Sources: Athanassoglou-Kallmyer, Nina "Blemished physiologies: Delacroix, Paganini, and the cholera epidemic of 1832- portrait of Niccolo Paganini by Eugene Delacroix" The Art Bulletin (Dec 2001). Here

Monday, June 23, 2008 by Amy Clarkson · 1

Monday, June 16, 2008

"The Sea Inside"

“A freedom that ends life is no freedom at all.”
“And a life that ends freedom isn’t a life either.”

“The Sea Inside” is a Spanish film, based on the true story of Ramon Sampedro, a quadriplegic who fought for 28 years for the right to end his own life. It won an Academy Award in 2004 for Best Foreign Language Film.

Ramon sustained a spinal cord injury in his youth, after a diving accident. Since that time, he was completely dependent on his family (mostly his sister-in-law Manuela). The story revolves around his relationship with 2 different women, his lawyer Julia, who is herself dealing with a life-threatening illness, and Rosa, a single mother who is trying to find meaning in life and hopes to help Ramon do the same.

As Ramon struggles to convince a judge that he has the right to take his own life, he also struggles to convince his family, friends, and clergy. In an interesting scene, Ramon debates euthanasia with a quadriplegic priest (scene quoted above).

This clip shows the power of Ramon's mind to escape his crippled body. He is able to stand up, walk to window and fly away. His mind could be free even while still a prisoner, similar to themes in "The Diving Bell and the Butterfly" (the movie was released on DVD in April).

His mind also keeps going back to the moment after his accident, the moment he almost dies and is pulled back into life. He seems so peaceful in the water up until the moment he is pulled out. Very symbolic that this scene is repeated at the end of the movie.

Warning: Spoiler ahead. Highlight to see.

*SPOILER: Compare the different decisions made by Ramon and Julia and the effects of those decisions. Julia says that she will help him die and then take her own life. She changes her mind and decides to go on living, leaving Ramon in the prison which his life. In the second to last scene, Ramon is finally released through death (with the help of the women who had set out to give his life meaning). The scene that follows shows Julia. She is now herself a prisoner of life. She has become so impaired from strokes that she no longer even remembers Ramon (her worst fears about her illness come true). She decided to live and is now the prisoner while Ramon who always wanted to die has been released. His poem to her is beautiful. I wonder if it loses much in the translation?*

To me, quality of life was the overriding theme of this film (even more than hastened death). Regardless of ones views on hastened death, Ramon’s story is a great demonstration of how quality of life can mean different things to different people. To Ramon, life as a quadriplegic had no dignity. The priest saw that just living was enough. I wish we knew more about why Julia made her decisions (fear of death? love for her husband?).

I will end this post with a quote from Ramon from the beginning of the movie. (This scene would be excellent to play in a talk about dignity or quality of life).

“I want to die because life for me in this condition…life like this has no dignity…I understand that other quadriplegics might get offended when I say that life like this has no dignity. I don’t judge anyone. Who am I to…to judge those who want to live? That’s why I ask that neither me, nor the person who helps me die, be judged.”

Monday, June 16, 2008 by Amber Wollesen, MD · 0

Monday, June 9, 2008

"What Sarah Said" by Death Cab for Cutie

Photo of PianoFinding this song about death in the ICU almost seems too easy when you consider the name of the band, Death Cab for Cutie (DCFC), but I had actually listened to this song for a long time before my friend Laura Morrison made me listen closely to the lyrics at a palliative care conference. (For your indie-rock Jeopardy knowledge, the name of the band comes from a send-up of Elvis in The Beatles Magical Mystery Tour.)

For those of you that don't know any 20-somethings, Death Cab for Cutie is an alternative rock band from Washington State, often hailed as a darling in independent/alternative music circles. The common themes of DCFC's music are love and loss with some very catchy melodies and intelligent lyrics quite distant from most pop cliches.
A critic noted Ben Gibbard, the lead singer/songwriter, often writes to

'immortalize watershed moments. Whether that moment for each of us is the moment love begins or ends, passing romances, death or chance encounters, there is a Death Cab for Cutie song about it.'
Therefore you can see the popularity amongst teens and young adults.

(For subscribers, If you do not see the Immem widget for listening to the song, click on the title to go to the original post on Pallimed: Arts & Humanities)

DCFC have a few songs to be featured in upcoming posts, but for now we will focus on "What Sarah Said," from the 2005 album "Plans." (I highly recommend the whole album.) It opens with a haunting piano melody reminiscent of the repeated beeping from telemetry monitors in a hospital. Within the repeating melody you hear a second melody beginning with ascending notes with a hopeful sound, that slowly fades and descends into a soft melancholy plateau in the background. The same ascending/descending 2nd melody comes back again in the second verse with the ascending portion coming with the only positive emotion in the lyrics "But I knew that you were a truth..." The ascending portion of that melody never makes its presence again in the song until near the very end. Every line in this song represents the difficulty of being the family or friend of someone ill and dying in the ICU. The two lines I find most insightful are:
"And it came to me then that every plan is a tiny prayer to Father Time"
"And I looked around at all the eyes on the ground as the TV entertained itself"
Even making a simple plan of what you will do in the next five months, five hours, or five days, is dependent on actually surviving. Father Time and the Grim Reaper are connected by their tool, the scythe, which marks the end for one year's crop so another may grow. And it is nearly impossible to walk through a hospital without finding a television left on in a room where no one is paying any attention, and so it sits blaring reality shows and local news, everyone oblivious to its constant chatter. Even the patient for whom the TV is left on, will often dismiss the importance of leaving it on. The final lines encapsulate what palliative care staff see daily as family and friends witness the dying as a final act of love by just being present.
"But I'm thinking of what Sarah said that "Love is watching someone die."So who's going to watch you die?.."
This presence at the bedside of a dying person can be a demonstration of your love, but it can also tax and exhaust family. A variation on this line ("Love is watching someone die") is occasionally heard from palliative care professionals to allow family credit for the 'work' involved in being present at the deathbed. It is interesting to take the line "So who's going to watch you die" out of a palliative care context, as people may have a much different perception. It would be relatively easy to assume you are watching an action movie and the villain is saying this as some sort of threat to the good guy. Superficial, threatening, maybe hateful. But in the right context the same words can bring forth thoughts of love, loss and tears.

You may also notice that with the first mention of "So who's going to watch you die", the music is relatively absent except a few piano chords, until the keyboards come back in with a insistent driving rhythm, followed all together with a guitar strum (inhaled breath), a fingerpicking guitar melody (will to live), cymbals/hi-hat (neurological activity), organs (the EKG), snare drum (interventions of medicine), the main piano melody (emotions and love), and the lifting second piano melody (hope). All this as if the person had been brought back to life one last time. But then sadly just as the instruments regain some strength they begin to fade again each one going out one by one. To help you see what I hear, I have made a video to show these different elements. (To hear all the instruments clearly, use headphones and an original recording.)

Now available on You Tube (8/5/8) if you want to embed it on your site or see it in full screen version.
(Removed because of YouTube's copyright rules 12/08 - but still available on Google Video)

Yes there is a two-tone sound reminiscent of a doorbell at the end of the song. It is hard to hear in this video clip, but it is there. Do you hear anything different in the instrumentation?

DCFC's new album "Narrow Stairs" came out in May 2008. (It is very good.)

"What Sarah Said" by Death Cab for Cutie (Gibbard/Walla) from the album "Plans" (2005) from Atlantic Records.


And it came to me then that every plan is a tiny prayer to Father Time
As I stared at my shoes in the ICU that reeked of piss and 409
And I rationed my breaths as I said to myself that I’ve already taken too much today
As each descending peak on the LCD took you a little farther away from me (Away from me)

Amongst the vending machines and year-old magazines in a place where we only say goodbye
It stung like a violent wind that our memories depend on a faulty camera in our minds
And I knew that you were a truth I would rather lose than to have never lain beside at all
And I looked around at all the eyes on the ground as the TV entertained itself

'Cause there’s no comfort in the waiting room&
Just nervous pacers bracing for bad news
And then the nurse comes ‘round and everyone lift their heads
But I’m thinking of what Sarah said,

"That love is watching someone die."

So who’s gonna watch you die?

Monday, June 9, 2008 by Christian Sinclair · 46

Monday, June 2, 2008

Isle of the Dead

In 1880, Marie Berna had only been married a short time when her husband, Dr. George Berna died. To commemorate his life she visited the then unknown artist, Arnold Bocklin at his studio in Florence to commission a painting. He at first suggested he’d paint something to cheer her up, a happy scene. She preferred something more serene, as a theme of her bereavement.

Arnold Bocklin referred to his work as A Still Place, A Silent Island and Island of the Graves. He told Madame Berna, "Its influence is so quiet that one is startled if there is a knock at the door." Later an art dealer by the name of Fritz Gurlitt provided the title, which it is now known by: Isle of the Dead.

We see a boatman rowing into the darkness. At the center a figure in white stands over a coffin draped in white. The stillness of the work has touched many over the years. In fact Adolf Hitler purchased one of Bocklin's five versions. It was hanging on the wall of his study in the bunker he committed suicide in. Vladimir Lenin and Sigmund Freud had reproductions on their walls as well.

What is it about this painting that such infamous people in history have owned it? What in this work haunts the viewer? Sergei Rachmaninoff saw a black and white reproduction in a gallery in Paris in 1907 and immediately went to work on his own musical expression entitled, "Isle of the Dead". Listen to this clip from his 1909 work while you study the painting, and hear the lapping waves against the ferryman's boat as he enters the Isle of the Dead.

One must ask, are we left with the same peaceful stillness the artist intended? Or a foreboding since of doom?

Sources: Burroughs, Bryson. "The Island of the Dead by Arnold Bocklin" The Metropolitan Museum of Art Bulletin. (1926)21:146-48
Gurewitsch, Matthew "Music: A visual Requiem that inspired Rachmaninoff" in the New York Times: here
Works: Bocklin, Arnold, "Isle of the Dead"(1880)
Rachmaninoff, Sergei, "Isle of the Dead" Symphonic Poem, Op.29 Orchestral Musice (Slatkin)

Monday, June 2, 2008 by Amy Clarkson · 8