Monday, July 28, 2008

Ars Moriendi

Many hospice organizations have printed up little booklets for families to read giving a "what to expect" of the dying process. This idea is by no means a new concept. In fact, one of the first books printed with movable type back in the 1400's was just such a book. "Ars Moriendi" (The Art of Dying) was a book written by an anonymous Dominican friar in 1415. It was THE book on how to prepare to die and how to die well. You can be the judge of how relevant such a book would be for today.

The book describes the five temptations that dying people face. In 5 different scenes a devil invites the temptations of lack of faith, despair, impatience, vanity and greed. The next 5 scenes depicted are the solutions to these temptations, what one must seek to die well: Faith, hope, patience, humility and generosity. This line drawing is from the artist Master E.S. from 1440, one of the earliest depictions of the Ars Moriendi text, entitled "Impatience". Note the chachetic look of the dying man, his ribs clearly visible. See the table knocked down and the dying mans leg kicking a caregiver in the back. When I see this picture I think of delirium, or terminal restlessness that we see in the dying process. I suppose labeling it impatience was the best reason they had to give such extreme behavior.

The artist Hieronymus Bosch also depicted this theme in his painting entitled "Ars Moriendi"(1490). In this illustration he attempts to depict the struggle between
good and evil. The angel is on the dying man's deathbed attempting to direct his eyes upward to the crucifix illuminated in the window by divine light. Meanwhile a little devil is attempting to give the man a purse of money. We are left not knowing which path this man will take, as death sneaks into the room with an arrow in his hand.

What would a picture of Ars Moreindi look like today? How would we in modern times communicate what it means to die well? Perhaps the ideas of
faith, hope, patience, humility and generosity are still components of the process even now.

Works: Master E.S.(1440) "Impatience"
Bosch, Heronymus(1490) "Ars Moreindi"

Monday, July 28, 2008 by Amy Clarkson · 3

Monday, July 21, 2008

Nessun Dorma

I wanted to write a follow-up on a movie I had posted on previously, "The Sea Inside". As I was writing about "The Sea Inside", Amy (who is much more musically inclined than I) pointed out to me the significance of the song playing during the dream sequence. The song (or aria, to be more precise) is entitled Nessun Dorma or None Shall Sleep. It's from the final act of Giacomo Puccini's opera Turandot.

Here's the plot in a nutshell. Turandot is a princess in ancient China who challenges her suitors with three riddles. If they can answer, they win her hand. If not, they are beheaded. The Prince of Tartary falls for Turandot and correctly answers all three of the riddles. Turandot is very upset that he has succeeded, so the Prince gives her an out. If she can guess his name by morning, he will be put to death. If she can't guess, she will have to marry him. The Princess declares, "This night, none shall sleep in Peking! The penalty for all will be death if the Prince's name is not discovered by morning." The song is Nessun Dorma is sung by the Prince awaiting the morning.

Below is Luciano Pavarotti singing Nessun Dorma. In 1990, Pavarotti's version of this song actually hit #2 on the UK Singles Chart, which is said to be the highest ever achieved by a classical recording. (Songs that made it up to #1 on UK charts that year included Ice Ice Baby, Turtle Power, and Hangin' Tough. Hard competition for Nessun Dorma.)

Puccini died from complications of throat cancer prior to finishing the opera and it had to be finished to by one of his contemporaries, Franco Alfano. Although Alfano did have some of Puccini's sketches to work from, no one knows exactly how Puccini would have ended the opera. There have been a couple different reworkings of the ending since that time.

I recently heard (thank you NPR) that the ending was going to be rewritten again. Apparently, the opera Turandot was never played in China as they believed the blood thirsty Chinese princess cast a bad light on the country. To celebrate the opening of the National Center for Performing Arts in Beijing, a Chinese composer, Hao Weiya, was hired to rewrite the end of Turandot. It seems to have been met with some mixed reviews.

Here is the common translation of Nessun Dorma.

No one sleeps, no one sleeps
Even you, o Princess,
In your cold room,
Watch the stars,
That tremble with love
And with hope.
But my secret is hidden within me;
My name no one shall know, no, no,
On your mouth I will speak it
When the light shines,
And my kiss will dissolve the silence
That makes you mine.
No one will know his name
And we must, alas, die.
Vanish, o night!
Set, stars!
At daybreak, I shall conquer!

As the Prince stays awake all night, he awaits a morning that might bring his own death or the fulfilment of his dream (desire) to be with the Princess Turandot. Ramon Sampedro felt that he was being denied "sleep", but in his case, it was the sleep itself he desired. What an appropriate choice of music!

Monday, July 21, 2008 by Amber Wollesen, MD · 7

Monday, July 14, 2008

Edvard Munch and Death

How much of our temperament is based on genetics, and how much is experiential? For Edvard Munch it may have been more of his life circumstances that shaped his morose outlook on life, than the fiber of who he was at birth. Born in 1863 in Norway, Edvard was the second child of five. His early life was tainted with the death of his mother at age 5 and his beloved older sister when he was 14. As if this weren't tragedy enough, a younger sister was diagnosed with mental illness and institutionalized most of her life. His father, a physician, dealt with the loss of his wife by instilling religious fear into the hearts of the remaining children. Edvard considered himself ill as well, and wrote, "Without anxiety and illness, I am a ship without a rudder....My sufferings are part of my self and my art. They are indistinguishable from me, and their destruction would destroy my art."

Although Munch is best known for his painting
"The Scream"(1893), his other works are worthy of examination. Because of his early experiences with death, many of his pieces explore his emotional responses to the memories of his childhood.

The first piece to exam in entitled "The Dead Mother and Child"(1897-1899) or the later version known as just "The Dead Mother"(1899-1900). What's interesting about these pieces are the differences. In the earlier painting we see the entire room, perhaps from Munch's perspective as he came to his mother's deathbed. Relatives are mourning in the background quite separate from the child. Munch's sister in red, eyes wide in horror, has her hands covering her ears, in an effort to block out something; maybe the reality of the situation, maybe the sounds in the room? His sister's mouth is open mid sob, or mid scream. In fact this posture is not unlike his most famous painting, "The scream"(1893). Contrast this version with "The Dead Mother"(1899-1900) done a year or so later. The viewer is now up close, and the child, still ears clasped with her hands, looks less horrified and more defiant. She's less emotional, implied also by her pale blue dress as opposed to the red dress of the other painting. Red is often used to symbolize passion. Using a cooler color fits well with this more composed painting.
Could this be Munch working through the memory? Often painful things at first are recalled with intense emotion, and as we replay and retell things, while still significant, the initial emotional response can lessen.

What does the piece say about child grief? Experts use words for young children experiencing death such as confusion, disorientation, and fear. Those words fit well for these pieces don't they?

Edvard Munch said "The angels of fear, sorrow and death stood by my side since the day I was born". Because he was shrouded in early life with the losses of important people in his life, many of his works focus on sickness, death or mental anguish. In upcoming posts we'll take a look at these other dark themes, and how Munch's choice of paintings reflect his inner struggle.

Source: Lubow, Arthur "Edvard Munch: Beyond The Scream" Smithsonian Magazine (2006) Here
Works:Munch, Edvard. "The Scream"(1893)
Munch, Edvard. "Dead Mother and the Child"(1897-1899)
Munch, Edvard. "Dead Mother" (1899-1900)

Monday, July 14, 2008 by Amy Clarkson · 0

Monday, July 7, 2008

My Sister's Keeper

This is the first novel we've written about on Pallimed: Arts & Humanities. It would be impossible to completely review every detail of such a long and complicated work. I'll try to hit some of the more interesting aspects of the characters and plot.

My Sister’s Keeper is a novel by Jodi Picoult. This is the story of a family dealing with the chronic, life-threatening illness of one of their daughters. Kate was diagnosed with a rare form of leukemia at age 3. In desperation for a donor for Kate, her parents decide to have another baby, Anna, who is created to be a perfect genetic match for Kate. The story goes back and forth between present day (when Anna is 13) and the past, reviewing the history of Kate’s illness and how that has effected Anna's life. The present day storyline follows Anna as she files to become medically emancipated from her parents. After years of donating parts of herself to Kate, Anna decided to draw a line. She did not want to be forced into donating a kidney.

Picoult puts a lot of work into developing the characters of the book. Chapters of the novel are written from the perspectives of the different characters. Brian (Anna’s father) is a firefighter. His role seems to be putting out the fires that his family members start (literally and symbolically). Brian is also a star buff. The author incorporates star mythology into the story. Anna’s name is actually Andromeda, the princess in Greek mythology who was to be sacrificed to a sea monster as punishment for her mother’s bragging. Like the princess Andromeda, Anna was also giving up her life for her mother, who has been driving all of Kate's medical care.

Through her court case, Anna is forced to confront her parents with the real reasons she filed her lawsuit. Her mother has to come to terms with Kate’s illness and the possibility that Kate might die.

Warning: Spoiler Ahead. Highlight to read.

*The story takes a sudden and dramatic turn when, after winning her court case, Anna is involved in a car accident and is declared brain dead. Her kidney is donated to Kate and their parents are left to turn off the ventilator. (It actually seemed a bit too dramatic for me.)

Making parents turn off the ventilator themselves makes for good drama in a novel but not so realistic. Also, this happens after they donate her organs. It talks about feeling her pulse stop and the monitor flatline. Did they just donate her kidney? Not her heart? And they bring her back to the ICU after the donation so that the ventilator can be shut off? Not very realistic with the organ donation process.

The epilogue is written from Kate’s point of view after Anna’s death. Kate blames herself as Anna wouldn't have been in the car if it had not been for the lawsuit.

So in the end, who is the “sister” of the title My Sister's Keeper? Is it Anna who is the keeper of Kate or Kate who is the keeper of Anna? Anna’s donations kept Kate alive for years. Throughout the story I always assumed that Anna was her “sister’s keeper”. In the end, Anna still lives on through all she has donated to Kate. So Kate is essentially keeping Anna alive.

The story brings up ethical issues of genetics and creating “designer babies”. Apparently Jodi Picoult became interested in the topic while doing research on eugenics. It balances this with the plight of parents who would do anything to save their dying child. It also deals with the rights of children to have say over their own bodies and make their own health care decisions. It seems at first that this is the predominant theme in the book. Later it is apparent that it’s more about parents coming to terms with their daughter's potentially terminal illness. When is it ok to say enough?

This is just a superficial overview of this book. Despite a couple medical inaccuracies at the end, I would recommend it. There is a plan to turn this novel into a film later this year.

Monday, July 7, 2008 by Amber Wollesen, MD · 0