Monday, October 26, 2009

In the Bedroom

In the Bedroom is a 2001 film, based on the short story "Killings" by Andre Dubus. I don't recall anyone mentioning it, but definitely another one we should include as a top palliative care movie.

Frank Fowler is a young man spending the summer with his parents in Maine before he heads off to graduate school. He meets an older woman, Natalie, with two children and a violent ex-husband. Although he tells his mother this is just a summer fling, he seriously contemplates staying and taking a year off school.

He has just made the decision to go back to school when he is shot and killed by Natalie's ex-husband. The remainder of the film focuses on his parents, Ruth and Matt, as they try to pick up the pieces of their lives after the murder of their only child. This is made much more difficult when Frank's murderer gets out on bail and they see him walking around town, smiling at them. They find out that he will likely only be charged with manslaughter, as he claims the shooting was an accident. This pushes Matt and Ruth emotionally over the edge. We see a little of what ordinary people might be capable of in a very bad situation. I won't ruin the ending.

I really loved this movie. I loved that I felt we got to know and like Frank before he died. Although the movie was about the aftermath of his death, I felt that he was a main character from the beginning and remained a main character even after he was gone.

I loved the pace of this movie. It very slowly and carefully puts the story together and I think it makes it more real. It mixes in a lot of short scenes that at the time seem insignificant but aren't really. After Frank's death, the pace seems to slow down more, like the pace of grief. It does build to a climactic sort of ending, but after the action is over, it slows back down again. You see Matt in bed and Ruth yelling up to see if he wants coffee, just so normal.

The majority of the film deals with grief and the process by which these two people are trying to move through it. You see profound sadness, anger, guilt, blame, all the emotions you might expect. At first no one is talking to anyone. Just a lot of silent evenings in front of the TV. Then there are big blowups and finger pointing. The grief seemed very realistic to me. Ruth has an eloquent description of grief. "It comes in waves. And then nothing. Like a rest in music. No sound but so loud." (I loved the writing in this movie. Like poetry.)

So what's with the title? It seems provocative at first glance. (Again, I love the writing. So clever.) At the beginning of the film (in one of the scenes that seemed insignificant at the time), Matt, Frank and one of Natalie's children are out on a boat, trapping lobster. They find one with only one arm and this is how Matt explains what happened. "See the trap has nylon nets called heads. Two side heads to let the lobster crawl in and inside what they call a bedroom head to hold the bait and keeps them from escaping. You know the old saying twos company threes a crowd? Well, it's like that. You get more than two of these in the bedroom and chances are something like that's going to happen."

Monday, October 26, 2009 by Amber Wollesen, MD · 0

Monday, October 19, 2009


Heartwarming movies are always a plus for me. Add to this a documentary with good end of life themes and I'm snagged.

Young@Heart (2007)
is just this. It is a documentary about a singing group in Massachusetts who covers such artists as Coldplay, Sonic Youth and James Brown. The twist is that the average age of the members in the group is 81.

The movie follows the group of 24 for 6 weeks through a series of rehearsals and performances. Intermixed through the rigors of learning new songs like "Schizophrenia" by Sonic Youth, are laughable moments and trials from the health issues of chorus members.

The lessons in the film are abundant, and most center on how to make "living" more worthwhile. The singers have a sense of purpose with the group, they feel their minds are sharper as they learn and memorize songs and the necessity of being with other people during the day helps them live longer, more quality lives.

The most poignant moment for me was the night of the concert. One of the members had died, and the soloist himself is in poor health. His oxygen hisses in bursts as he sings Coldplay's "Fix you". The lyrics, which were written portraying the emotions of the death of someone dear, strike a different feeling sung by a group so familiar with death and so close to death.

The chorus member sings, "And the tears come streaming down your face/When you lose something you can't replace/When you love someone but it goes to waste/Could it be worse?"

I especially like the realness of this film. Aging is not hidden, the real battles of poor health, memory loss and death are present, however life is celebrated at all times. When I think of palliative medicine being about living life to its fullest, this movie represents that to a tee.

Following is the trailer of the film from YouTube, if the link doesn't appear as a subscriber, head to the original post to see. Also follow this link directly to Youtube to see the performance of "Fix You" I spoke of earlier.

Monday, October 19, 2009 by Amy Clarkson · 2

Monday, October 12, 2009

The Woman in the Room

When most people think of Stephen King, they think of killer cars, haunted hotels, and prom nights gone wrong. Palliative care isn't generally the first thing that comes to mind. I don't usually read Stephen King as I'm not a big fan of the horror genre. When I read "The Woman in the Room" my first thought was that King had moved away from horror for this short story. But on second thought, I think it is actually a movement from supernatural horror to a real life type horror. (The picture is from the short film made in 1983.)

John is a loving son dealing with his mother's terminal cancer and severe pain issues. It is written in the third person and most of the story is like a description of an internal dialogue as John is trying to make a difficult choice. He has found a bottle of "Darvon Complex"(propoxyphene with aspirin) in his mother's medicine cabinet and he is wondering if he could end all of her suffering.

Things get worse when she is admitted to the hospital for pain control. She has a procedure that he calls a 'cortotomy' in which a needle is placed into the pain center in the brain and that area is "blown out"(This story was written in the '70s.). This procedure leaves her paralyzed but still in pain. John continues to toy with thought of giving her the pills as he visits her daily.

"She imagines the pain. But it is nonetheless real. Real to her. That is why time is so important. Your mother can no longer count time in terms of seconds and minutes and hours. She must restructure those units into days and weeks and months." What does the doctor mean when he says this? Prepare for the long haul? Since the pain is so bad, don't focus on the now, focus on the future?

John carries the pills around with him for awhile. He tells no one of his plan. He tries to talk himself out of it. If she has a roommate, then he'll be off the hook. If she says anything about the pills he gives her, he'll just put them back. In the end, everything falls into place. He gives her six Darvon tablets and then leaves the hospital to wait for the phone call.

I'll pretend for the sake of this post that six Darvon is a fatal dose. (Although I'm doubtful that it would cause any more than ringing in the ears (from the aspirin). But I'll admit that I've never given anyone six Darvon to know.) I'm not writing about this story to endorse John's actions or judge him either way but to acknowledge the sentiment. I have often heard "Isn't there something we can give that will make this go faster?" and "It's not fair. If my dog was suffering we could put it out of it's misery, but we can't do that for my mom?" It comes up so frequently I would categorize it as a very normal feeling.

It seems King's inspiration for the story may have come from his own life.

"Perhaps it is his fault anyway. He is the only child to have been nurtured inside her, a change of life baby. His brother was adopted when another smiling doctor told her she would never have any children of her own. And of course, the cancer now in her began in the womb like a second child, his own darker twin. His life and her death began in the same place: Should he not do what the other is doing already, so slowly and clumsily?"

King also has only one brother, who was adopted, and his mother died from uterine cancer in 1974. He is also reported to have had drinking problems around the time of his mothers death, another similarity to John in the story.

Works referenced:"The Woman in the Room" Night Shift by Stephen King.

Monday, October 12, 2009 by Amber Wollesen, MD · 3

Monday, October 5, 2009

Dying in the Opera

I saw my first Opera, Puccini's "Madame Butterfly", at the age of 9. Instantly mesmerized by the music, I was a bit shocked that Butterfly dies in the final scene. Where was the happy ending I was used to in Hollywood films?

Unbeknownst to me at the time, tragedy and death are common in opera. In fact, some would say that opera as an art form is obsessed with death, and has been since its inception. The first known operatic works of "Euridice" (1600) and "L'Orfeo"(1607) both have tragic deaths, with Euridice stepping on a venomous snake and dying, and Orfeo searching for his beloved in Hades, finding her and then having her vanish from his sight for eternity.

Many feel that part of the obsession has to do with the cultural beliefs surrounding death in the 18th and 19th centuries, when most operas we enjoy today, were written. It was in the 18th century that death began to be viewed not as a natural fate, but traumatic rupture. This morbid fascination with death became a part of the romanticism of the 19th century. It is no surprise then that this time frame produced such death themed classics as Carmen, La Traviata, Rigoletto, Aida, Tosca, La Bohème, Madama Butterfly, and The Tales of Hoffmann.

To our death defying culture, it seems strange that not only are operas packed with people dying, but the deaths don't hold the same negativeness or sadness that we're used to. The deaths portrayed seem more about redemption, reunion, and transcendence. This romanticized view of dying becomes a thing of beauty, in line with the Greek belief of kalos thanatos (beautiful death).
These beautiful deaths, however, are not just a form of art, composers such as
Richard Wagner tried to live it. He wrote to a friend:

"We must learn to die, and to die in the fullest sense of the word. The fear of the end is the source of all lovelessness; and the fear is generated only when love begins to wane. How came it that...all that mankind did, ordered, and established, was conceived only in fear of the end!"

As byproduct of the death centered operas we get to enjoy haunting aria's given to the heroes or heroines, often contemplating death or mourning a life lost. Perhaps one of the most famous is the final aria from
Aida, "O Terra Addio"

In this opera by Giuseepe Verdi, the heroine Aida is an Ethiopian princess who falls in love with her enemy Prince Radames. As punishment Radames is sentenced to be buried alive unless he denounces his love for Aida. He refuses and in the final scene we find that Aida has snuck into the tomb to be buried alive with him. They sing together "O Terra Addio" the lyrics below:

Farewell earth, farewell valleys of tears. Dreams of joy that vanish in grief. Heavens open to us, wandering souls who fly to the rays of eternal day.

You can see this song on Youtube as sung by Placido Domingo and Aprlie Millo at the end of this post. Visit the main pallimed arts site if the link doesn't appear.

The prevalence of dying in opera is so common, that now when I attend the opera I glance at the synopsis not wondering if their will be death, but how much and in what dramatic fashion.

Monday, October 5, 2009 by Amy Clarkson · 1