A happy belated 200th birthday to Edgar Allan Poe. (An event with brought out some controversy over which city can call itself Poe's hometown: Boston, Baltimore, Richmond, New York, or Philadelphia. There has also been talk of which city has claim on Poe's remains.)

Poe was born in Boston, January 19, 1809. I think we all know Poe for his horror writings, but he is also contributed greatly to the science fiction genre and is considered a founder of the detective-fiction genre.

To say Poe had loss in his life is an understatement. Both of Poe's parents died before he turned three. He was taken in by a wealthy merchant family, but the relationship with his foster father was often a rocky one and eventually Poe was disowned. His beloved foster mother and older brother both died when Poe was in his early 20's.

At age 27, he married his 13 year old first cousin, Virginia Clemm. Several years later, she became ill with tuberculosis. Around that time, Poe began to drink more. It's thought that his wife's illness was the inspiration for one of his most famous poems, The Raven. Virginia eventually died. The recurrent theme of dying young women (Annabel Lee, Lenore)in his work has been contributed to Virginia's illness and death and to the death's of other women (mother, foster mother) in his life.

After Virginia's death, Poe became very unstable. Two years later, he was found wandering delirious through the streets of Baltimore. He died soon after and the exact cause of his delirium and death has remained a mystery. He was buried in an unmarked grave in Baltimore but his remains were later moved.

Since 1949, the Poe Toaster (an unknown gentleman dressed in black) has been visiting the grave marker of Edgar Allan Poe's original burial site each year on his birthday. He toasts Poe and leaves behind a half bottle of cognac and three red roses.

I'll close with my favorite Edgar Allan Poe poem, Eldorado. (I don't know what that says about me. A sucker for hopeless causes?)

                Gaily bedight,
            A gallant knight,
        In sunshine and in shadow,
            Had journeyed long,
            Singing a song,
        In search of Eldorado.

            But he grew old-
            This knight so bold-
        And o'er his heart a shadow
            Fell as he found
            No spot of ground
        That looked like Eldorado.

            And, as his strength
            Failed him at length,
        He met a pilgrim shadow-
            "Shadow," said he,
            "Where can it be-
        This land of Eldorado?"

            "Over the Mountains
            Of the Moon,
        Down the Valley of the Shadow,
            Ride, boldly ride,"
            The shade replied-
        "If you seek for Eldorado!"

This self-released, indie rock/ambient album's title should grab the palliative medicine community. Peter Silberman spent a year in isolation from friends, then another year to write about his experience in this album that was released March 3rd, 2009.

The tone of the album is dark and dream-like. Silberman creates a symbolic figure named Sylvia...taking inspiration from the macabre world of Sylvia Plath, as well as a fictional Sylvia depicted in the novel "Sylvia" by Leonard Michaels. Both Sylvias have tragic lives, burdened by degrees of mental illness, depression and death. Perhaps it is their illness coupled with their tortured relationships that allows Silberman to draw inspiration... regardless "Hospice" dwells on the ending of a claustrophobic relationship by portraying death, nightmares and illness.

The only clue to the title comes from Silberman's blog of the album's process. He leaves a post with the definition"hospice n 2: a program of medical and emotional care for the terminally
ill".

In the song "Kettering or, bedside manner" we encounter a woman dying of cancer (Memorial Sloan Kettering Cancer Center) and a hired caregiver. The song, in medical terms, has a crescendo/decrescendo flow. It swells, peaks in sound and settles again. You can listen to the song at the artist's myspace page here. The lyrics are as follows:

I wish that I had known in that first minute we met, the unpayable debt that I owed you. Because you'd been abused by the bone that refused you, and you hired me to make up for that. Walking in that room when you had tubes in your arms, those singing morphine alarms out of tune kept you sleeping and even, and I didn't believe them when they called you a hurricane thunderclap.

When I was checking vitals I suggested a smile. You didn't talk for awhile, you were freezing. You said you hated my tone, it made you feel so alone, and so you told me I ought to be leaving. But something kept me standing by that hospital bed. I should have quit, but instead I took care of you. You made me sleep and uneven, and I didn't believe them when they told me that there was no saving you.

The album is definitely dark, with lyrics about waking up in a morgue and being buried alive in "Epilogue". And from "Shiva" the opening line is "Suddenly every machine stopped at once, and the monitors beeped the last time. Hundreds and thousands of hospital beds, and all of them empty but mind." You can read all the lyrics to the album here.

Although just released, the album is getting a lot of press. In fact NPR's All Songs Considered has named "Hospice" as the best album of 2009, so far.

So take a listen and let us know what you think.

Thanks to one of my nurses, Linda, for telling me about this film. Westerns aren't my usual movie fare but hearing about the plot of this one along with the all-star cast (John Wayne, Jimmy Stewart, Lauren Bacall, Ron Howard, Harry Morgan) convinced me to check it out.

John Wayne plays JB Books, an aging gunfighter, who comes to Carson City seeking a second medical opinion. He has gotten the diagnosis of cancer and comes to see a trusted physician, Doc Hostetler (played by Jimmy Stewart). In one of my favorite scenes, Books is told the bad news and is given about 2 months to live. (I couldn't find a clip, but below is the dialogue.)

Doc:Books, every few days I have to tell a man or a woman something I don't want to. I've been practicing medicine for 29 years and I still don't know how to do it well.
Books: Why don't you just say it flat out?
Doc: Alright, you have a cancer. Advanced. [portion removed]
Books: Can't you cut it out doc?
Doc: I'd have to gut you like a fish.
Books: Well, what can you do?
Doc:There's just very little I can do. When the pain gets too bad I can give you something.
Books: But you're trying to tell me is...
Doc:Yeah
Books: Damn
Doc: I'm sorry Books.
Books: You told me I was strong as an ox.
Doc: Well even an ox dies.
Books: How much time do I have?
Doc: 2 months, 6 weeks, less. There's no way to tell.
Books: What can I... What will I be able to do?
Doc: Anything you want at first. Then later on you won't want to.
Books: How much later?
Doc: You'll know when.

In another conversation with the doctor, Books asks about how it is going to go. Doc Hostetler tries to evade the question at first but then tells him "There'll be an increase in the severity of the pain in your lower spine, your hips, your groin. Do you want me to go on? The pain will become unbearable. No drug will moderate it. If you're lucky you'll loose consciousness and until then you'll scream." He goes on to tell Books, "I would not die a death like I just described... Not if I had your courage." This leads Books to try to go out in a blaze of glory. Hastened death by gun fight.

Much of the film is Books coming to grips with his terminal illness, fighting off those who want to take advantage of his death, settling his affairs, and imparting words of wisdom to a young man, Gillom (Ron Howard). Below is the film trailer.

This movie came out in 1976 and it was John Wayne's last film. It came out 12 years after he was diagnosed with lung cancer and 3 years before he died of gastric cancer. In many ways, the lives of Books and Wayne are very similar. Both very famous, facing illness and the end of their careers.

Also, Lauren Bacall (who stars as a sort of platonic leading lady in the film) had lost her husband, Humphrey Bogart, to esophageal cancer many years earlier. I wonder how this effected her performance in the film.

Something interesting from a historical palliative care perspective, they use laudanum (opium mixed with alcohol) for pain control. When Books takes a swig out of the bottle, the question is asked, "That's habit forming, isn't it?" Some things are timeless.