Monday, December 27, 2010

Gallery: "Quality of life"

This is another installment to our Gallery Series. As a reminder, I generally pick something related to palliative medicine and then begin an online hunt to find art work and poetry with this word or phrase in the title.  Hopefully this becomes a stepping point for further thought and exploration.

All art work is copyrighted to the artist (often only a screen name is known), and listed in sequential order at the end. For further Gallery posts, links are provided for convenience at the bottom.

Today's Gallery theme is "Quality of Life", so picked secondary to this phrase's essential part in the definition of palliative care.

The definition of QOL from
Quality of life (n): Your personal satisfaction (or dissatisfaction) with the cultural or intellectual conditions under which you live (as distinct from material comfort).

"Quality of Life" copyright Harley.

Pain roils within me, without
Despair assails me, and doubt
What is the use of all this striving for survival?
What is the quality of this persistent life?
A Fleshy form twisted into tangled knots
And mind cramped with bitter regret
The sun shines, but darkness covers me with futility
Soul stripped to the bone
Thousand-yard stare fixed on far horizon
Sane men call me mad

"Quality Of Life - Poem" (Aug. 2000) by A.K. Whitehead

I have lived a life-- or two,
depending where the line is drawn.
What has been accomplished
is, as if it were, undone,
and what remains undone 
is the heel that kicks the spur. 
Life, time, accomplishment
define each other...
and their exclusions
rising like pale mountain ranges
whose heights perceptibly increase
with their proximity

Finally a poem read by the author herself.  This is "Quality of Life" by poet Harryette Mullen. It is a part of her 5th collection, the book entitled Sleeping with the Dictionary (2002)

Art work displayed:
"Quality of Life" (2010) Sandy Brooke
"Quality of Life" (2007) spotandbones
"Quality of Life Painting" (2007) Patrick Sheridan

Past gallery posts: "Itch", "Dysphoria","Last Breath", "Pain", "Afterlife", "Restless","Stillness" and "Grief"

Monday, December 27, 2010 by Amy Clarkson · 4

Monday, December 20, 2010

Jimmy V

I seem to find palliative care topics everywhere. Most recently it was while watching basketball. Well, while my husband was watching basketball. The tournament he was watching on December 7th was the Jimmy V Basketball Classic. During the game they advertised Jimmy V Week. So it got me wondering, who was Jimmy V?

Jimmy V (or Jimmy Valvano) was a famous college basketball coach and sports broadcaster, known for being the head coach at North Carolina State University when they one the 1983 NCAA Basketball Tournament. (He is especially known for running around after that game, looking for someone to hug.) In 1992, he was diagnosed with bone cancer.

After his diagnosis he co-founded the V Foundation for Cancer Research with ESPN. Since it was founded in 1993, the V Foundation has raised more than $100 million for their cause.

Below is a famous ESPY Awards speech given by Valvano in 1993 (the very first ESPY awards) while receiving the Arthur Ashe Courage and Humanitarian Award. This speech was given just 8 weeks before he died. It was during this speech that Valvano announced the formation of the V Foundation. He ends this speech with, "Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul. And those three things are going to carry on forever. I thank you and God bless you all."

Sports stories are not my usual topic but when I saw the speech he gave, I knew it was a Pallimed Arts story. You could tell when he walked up onto the stage that he was not really doing well. But when he spoke, he had so much energy and humor that I found myself forgetting about the cancer.

Monday, December 20, 2010 by Amber Wollesen, MD · 0

Monday, December 13, 2010

Photographer Jack Radcliffe

Jack Radcliffe is a photographer based in Baltimore, Maryland.  Known for his documentary style, black and white photographs, he has excelled at photo series of family members and friends over a span of time.  His images display intimacy allowing the viewer an empathetic connection at once.

It is no surprise, then, that Jack was asked in 1996 to become a part of an exhibition and book supported by the Corcoran Gallery of Art , entitled "Hospice: A Photographic Inquiry" (Bulfinch Press, 1996).

The book incorporates the works of 5 photographers; Jack Radcliffe, Jim Goldberg, Nan Goldin, Sally Mann and Kathy Vargas.

Jack acknowledges his fear when first asked to be a part of the project saying, "When I began I wasn't really sure what hospice was. I only knew that it had to do with death."  He got in contact with a hospice in York, PA called York House AIDS Hospice and the director Joy Efema granted him permission to come photograph. The York House was a three bed inpatient facility that no longer exists.  Primarily taking care of AIDS patients, Jack writes how fortuitous it was to start this project after the death of his own mother, "My mother had just died, and my father was dying. I wasn't dealing at all with my loss. Being with Joy and the nurses at York House - seeing their devotion to patients, both physically and spiritually- helped me to view death as a part of life. It was a cathartic transformation for me, and eventually I was able to grieve for my parents as well as the patients I came to know."

When you look through the photographs on Jack's website, you'll find a narrative below the pictures from Barbara Ellen Wood, who was assigned as an intern to keep a journal during the project.  I found the little vignettes and descriptions added to the visual story presented.

The project took 4 years to complete, and artistically, using just 3 rooms over and over again proved a different challenge for the photographer.  Attempting to reveal the relationship with the subjects' environment, without causing the viewer to notice the repetitive background caused Jack to move in closer and change perspective, which ultimately changed his long term photographic style.

While his images, which were taken over a decade ago, should be overly familiar to us in palliative care, I found myself touched and moved more than expected. Perhaps these photo's actually allow me to step back and feel the emotion captured more than my typical myopic view in the midst of daily work.

All images copyrighted to Jack Radcliffe. Quotes from the blog Camera Obscura (2009)

Monday, December 13, 2010 by Amy Clarkson · 0

Monday, December 6, 2010

Aidan's Monsters

I found this story in a recent CNN article. Five year old Aidan Reed was diagnosed with leukemia in September of this year. Aidan immediately began treatment. With a new baby at home (born 12 days after Aidan's diagnosis), his father had to take leave from work to help out. Financially, things quickly got bad for Aidan's family and they even discussed having to sell there house.

Aidan loves to draw and he loves to draw monsters. (To the right is Gillman, one of Aidan's favorite monsters to draw.) After his aunt received some of his drawings, she had an idea of how to financially assist Aidan's family. She set up an Etsy account called Aidan's Monsters and began selling Aidan's art. For those of you not familiar, Etsy (one of my favorite websites) is an online forum for people to sell there homemade art, clothes, jewelry etc. Aidan's monsters were so popular that the family made $83,000 in just a few weeks. You can see more of Aidan's art on his blog.

A few things I found interesting about this story. First is the very clever use of Etsy for fundraising (again, one of my favorite websites). Aidan's aunt is only selling the pictures (prints) for $12 each and managed to sell around 7000.

Another thing was the obvious parallels people were making with Aidan drawing monsters while fighting a "monster" himself. I even read somewhere that the monsters were some kind of subconscious manifestation of his fight. Really? Can't he just be a five year old boy who really likes to draw monsters. Wouldn't that be a much more likely explanation.

Reading this story also introduced me to a series I hadn't read on, entitled Empowered Patient. It was started by Elizabeth Cohen after her newborn daughter accidentally got an unnecessary spinal tap. She writes on different topics like how to get the most out of your doctors visit and how to talk to children about illness.

Monday, December 6, 2010 by Amber Wollesen, MD · 0

Monday, November 29, 2010

Custom Coffins

Humans have been placing their deceased loved ones in coffins for centuries.  The word "coffin" is ultimately derived from the Greek word ko-pi-na ,(basket) which as a word appeared in manuscripts as far back as 1300 B.C.!

In the US, the design has stayed relatively the same over the years, except for that brief time in the 1800's that people were afraid of being buried alive and a crop of "safety coffins" popped up.

The same is not true in Ghana, Africa, where for the last 60 years the Ga tribe in the coastal region of Ghana have celebrated an individual's life by designing custom coffins.

When I say custom coffin I do not mean painting a traditional coffin in personalized colors or designs as the company Colorful Coffins in the UK, or Happy Coffins in Singapore does.  Although these coffins are beautiful and individualized, they still hold to the traditional Coffin form.

In Ghana, however, "custom" implies bold and different, as a handful of wood workers have created a unique craft, actually molding the wood into individual objects that represent the deceased's life.  This can range from a soda bottle, seashell, fish, or shoe to represent an item the person sold for a living. Or the coffin may be a symbol of something loved, like a cigarette, Mercedes, airplane or ice cream bar.

The colorful coffins take weeks to months to prepare and can cost a year's salary for a Ghana resident. If the deceased hadn't planned ahead enough for the coffin to be ready- the body sometimes must be refrigerated the length of time it takes to finish.  Other delays can come with family disputes on what item should actually represent the deceased.

They say that more and more foreigners are purchasing these type of coffins, thought whether the purchase is purely for art or if this trend is beginning to catch on for actual burial practices is unknown. In case you are interested eShopAfrica actually offers the Ga coffins for purchase on-line and shipped to your door. (You may also enjoy seeing other ideas)

So, what do you think?  Does the idea of personalizing your coffin as the other two companies listed above do, appeal to you?  Do you think the idea of a over-sized wooden object as a coffin will catch on in the US?

Monday, November 29, 2010 by Amy Clarkson · 3

Wednesday, November 24, 2010

Engage with Grace 2010 - Things we are grateful for this year

For three years running now, many of us bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace – a movement aimed at making sure all of us understand, communicate, and have honored our end-of-life wishes.

The rally is timed to coincide with a weekend when most of us are with the very people with whom we should be having these unbelievably important conversations – our closest friends and family.

At the heart of Engage With Grace are five questions designed to get the conversation about end-of-life started. We’ve included them at the end of this post. They’re not easy questions, but they are important -- and believe it or not, most people find they actually enjoy discussing their answers with loved ones. The key is having the conversation before it’s too late.

This past year has done so much to support our mission to get more and more people talking about their end-of-life wishes. We’ve heard stories with happy endings … and stories with endings that could’ve (and should’ve) been better. We’ve stared down political opposition. We’ve supported each other’s efforts. And we’ve helped make this a topic of national importance.

So in the spirit of the upcoming Thanksgiving weekend, we’d like to highlight some things for which we’re grateful.

Thank you to Atul Gawande for writing such a fiercely intelligent and compelling piece on “letting go”– it is a work of art, and a must read.

Thank you to whomever perpetuated the myth of “death panels” for putting a fine point on all the things we don’t stand for, and in the process, shining a light on the right we all have to live our lives with intent – right through to the end.

Thank you to TEDMED for letting us share our story and our vision.

And of course, thank you to everyone who has taken this topic so seriously, and to all who have done so much to spread the word, including sharing The One Slide.


We share our thanks with you, and we ask that you share this slide with your family, friends, and followers. Know the answers for yourself, know the answers for your loved ones, and appoint an advocate who can make sure those wishes get honored – it’s something we think you’ll be thankful for when it matters most.

Here’s to a holiday filled with joy – and as we engage in conversation with the ones we love, we engage with grace.

To learn more please go to This post was written by Alexandra Drane and the Engage With Grace team.

Wednesday, November 24, 2010 by Christian Sinclair · 0

Monday, November 22, 2010


Ten years ago, Mark Hogancamp was attacked outside of a bar by 5 men. He was badly beaten and nearly died. It took 9 days for him to wake up after the attack and as a result Mark lost most of his memories and had severely impaired motor function. For his own therapy, physical as well as emotional, Mark created his own world which he calls Marwencol.

Marwencol is a fictional 1/6 scale WWII era Belgium town. The town's inhabitants are all dolls. Mark has created a doll for himself (named Hogie) and many of his family and friends are also represented. Mark poses the dolls in various scenes and then takes photos to tell the story. His storyline: Nazis, romance, torture, a time traveling witch (?).

His dolls and props are made to be very realistic. To enhance this effect, Mark actually places his characters in his model jeep and pulls it along side him when he takes a walk, giving them authentic wear and tear.

A local photographer saw Mark walking with his jeep and asked Mark what he was doing. Mark then shared his photographs. This discovery has led to a lot of publicity for Marwencol, including an art show in New York and now a documentary. Unfortunately the documentary is only playing in a select few cities nation wide and Kansas City is not one of them. But the trailer gives you a good feel (below).

So my question, after looking through some of the Marwencol photos is, when does this therapy cross the line and become pathological? The photos are wonderful. The scenes Mark puts together are amazingly life-like. But many of the scenes are about murder and torture. Hogie's wedding scene had dead Nazis hung up in the back ground. I just couldn't help but think that the Nazis are perhaps the 5 men who took his life away. Is he really just reliving his trauma over and over rather than adjusting his life to move past it? Making his make believe world exactly what he wants his real world to be?

On the other hand, maybe this is giving him the only life that he would be able to have. Maybe without it he wouldn't have a reason to go on after the terrible trauma he went through. If living in his own world is the only thing that is keeping him going, who am I to say that it's bad?

The Marwencol website gallery posts some of Mark's photos along with his captions to tell the stories. In the last postings, Hogie and his wife Anna (apparently in the image of his ex-wife) have been assassinated. The following is the collected captions of this most recent installment. I leave you with this because I think it says a lot.

"Meanwhile the SS are downstairs having drinks. They're celebrating that the King and Queen of Marwencol are dead. Now it's easy to take over the townspeople-they don't have leaders or anything. Then Anna and I stick our heads over the railing of the balcony. We look down at the Nazis down there. And they look up and they're floored. And Anna and I hug. And the Nazis realize that they can't kill me. They can't kill Anna or I because we're going to live forever. We're immortal. I won."

Monday, November 22, 2010 by Amber Wollesen, MD · 5

Monday, November 15, 2010

Death on a Pale Horse

One of the things I enjoy about "the arts" is the ability to continually stimulate more art. Art imitates life, life imitates art, and art even imitates art.

The theme of this post centers on a piece I saw recently at the Art Institute of Chicago. Delving in to find out some background I found a convoluted web of paintings, poems, and etchings inspired from one another.

The story starts not at the beginning as in the Bible's first words, "In the Beginning..." but actually in the final book of the Bible; Revelations. This symbolic and often macabre portrayal of the apocalypse has a chapter in which some seals are opened and four horsemen ride out.

One of the four is Death riding a Pale horse being followed by Hell. The specific verse reads, "I looked, and there before me was a pale horse! It's rider was named Death, and Hades was following close behind him." (Rev. 6:8 NIV)

While the images of Revelation had been depicted in distilled illustrations as seen in the upper right(taken from a manuscript done in the 11th century) it was Albrecht Durer's "Four Horseman of the Apocalypse" (1497-98) to the left, that first put some macabre drama into the idea. With sudden motion and danger, Death, Famine, War, and Plague come riding across the page.

It is widely believed that it is from Durer's image that artist John Hamilton Mortimer got his inspiration for his drawing "Death on a Pale Horse"(1775). He embellished the image further, pulling the horseman away from the group and adding an even more frightening tone.

While Mortimer's original image is lost, his apprentice John Haynes did an exact etching from the drawing of the same name, which was published in 1784 by Mortimer's widow, and is housed at the Art Institute of Chicago. (Image to left)

From here the path splits. First is artist William Blake(1757-1827) an ardent admirer of Mortimer, whose version "Death on a Pale Horse" (1800) is felt to share similar composition styles with Haynes/Mortimer, though undoubtedly less grim. (Image to right)

Haynes etching on Mortimer's drawing also inspired the poet Charles Baudelaire who wrote "Une Gravure Fantastique" (A Fantastic Engraving) (1861) specifically about the art work. It is translated below by Jacques LeClercq and printed in Baudelaire's Flowers of Evil:

This eerie specter wears no clothes at all./A dreadful crown, reeking of carnival,/sits weirdly on his naked skull. Without/Or spurs or whip, he wears his charger out/ (A ghostly and apocalyptic nag,/ Nose foaming like an epileptic hag)./ The hideous pair plunge ruthlessly through space,/ Trampling infinity at breakneck pace./ The horseman's flaming sword, as on they rush,/ Fells victims that his steed has failed to crush,/ And, like a prince inspecting his domain,/ He scans the graveyard's limitless chill plain/ Where, in a dull white suns's exhausted light,/ Lies every race since man emerged from night.

The other famous poet, seemingly inspired by the Haynes/Mortimer image is Percy Bysshe Shelley. One of the most famous of Shelley's works is "The Masque of Anarchy" written in 1819 following the Peterloo Massacre, and claimed by some to be one of the greatest political poems ever written in English. In the midst of the poem we find the reference to the etching:

...Last came Anarchy: he rode/On a white horse, splashed with blood;/He was pale even to the lips,/Like Death in the Apocalypse.

And he wore a kingly crown;/And in his grasp a sceptre shone;/On his brow this mark I saw-/'I AM GOD, AND KING, AND LAW!'

With a pace stately and fast,/Over English land he passed,/Trampling to a mire of blood/ The adoring multitude....

There are certainly other artists inspired by the original Revelation verse, such as Benjamin West's "Death on a Pale Horse" (1796) and J.M.W. Turner's "Death on a Pale Horse" (1825-1830). However, I found it more interesting to trace the inspiration from one landmark piece of work that in turn inspired so many others.

I suppose the lesson learned is that you just never know what things in your life will wind up inspiring generations that follow! 

Monday, November 15, 2010 by Amy Clarkson · 0

Monday, November 8, 2010

My Life Without Me

My Life Without Me has been on my To See movie list for a long time. This weekend I finally had the opportunity.

Ann is 23 years old. She lives in a trailer in her mother's back yard with her husband and two young girls. She works nights cleaning the university. After having a fainting spell at home, she discovers that she has ovarian tumors that have spread to her stomach and liver. She is given about 2-3 months to live. One of the first things she does is sit and make a list of all the things she wants to do before she dies.

1. Tell my daughters I love them several times.
2. Find Don a new wife who the girls like.
3. Record birthday messages for the girls for every year until they're 18.
4. Go to Whalebay Beach together and have a big picnic.
5. Smoke and drink as much as I want.
6. Say what I'm thinking.
7. Make love with other men to see what it's like.
8. Make someone fall in love with me.
9. Go and see Dad in Jail.
10. Get false nails. And do something with my hair.

She never tells anyone about her diagnosis. She says she does this as a gift for her husband and children as she doesn't want their last memories of her to be doctor appointments and hospitals. For the same reason she refuses any treatments or further tests. She works to complete her list, while making tapes for all of her loved ones to explain her choices and offer some final words.

She has a unique relationship with her doctor, Dr. Thompson. When he is telling her the bad news about her cancer, he sits beside her in a waiting room chair. He admits to her that he has to sit beside her because he can never look someone in the eye when he tells them they are going to die. In the end, Ann entrusts him with all of the tapes she made for her daughters as she knows he will remember to send them. He agrees to do this as long as Ann will continue to come and see him weekly, saying "Dying is not as easy as it looks, you know, but there's no need for you to have to feel terrible all the time."

The story is often run through Ann's inner monologues, what she is thinking about life and death as she does the grocery shopping, or walks down a busy street. Below is from the beginning of the movie as she is standing out in the rain.

"This is you. Eyes closed, out in the rain. You never thought you'd be doing something like this, you never saw yourself as, I don't know how you'd describe it... As like one of those people who like looking up at the moon, who spend hours gazing at the waves or the sunset or... I guess you know the kind of people I'm talking about. Maybe you don't. Anyway, you kind of like being like this, fighting the cold, feeling the water seep through your shirt and getting through your skin. And the feel of the ground growing soft beneath your feet. And the smell. And the sound of the rain hitting the leaves. All the things they talked about in the books you haven't read. This is you, who would have guessed it? You."

At then end the film, Ann lies in bed watching her neighbor (also named Ann) joyfully interact with her husband and children as the neighbor helps them make dinner. She tells them she is bed suffering from a bad case of anemia.

"You pray that this will be your life without you. You pray that the girls will love this woman who has the same name as you and that your husband will end up loving her too. And that they can live in the house next door and the girls can play dollhouses in the trailer and barely remember their mother who used to sleep during the day and take them on raft rides in bed. You pray that they will have moments of happiness so intense that all their problems will seem insignificant in comparison. You don't know who or what you're praying to but you pray. You don't even regret the life you're not going to have because by then you'll be dead and the dead don't feel anything. Not even regret."

This is a very sad but beautiful movie. (I will admit that I may have shed a couple tears at the end.) As Ann moves through her last days, you really get to feel you know her. It's an interesting perspective on dying young and poor. For what little she has, Ann accomplishes a lot in her last few days and weeks.

Monday, November 8, 2010 by Amber Wollesen, MD · 7

Monday, November 1, 2010

"Final Exam" by Pauline W. Chen

Okay, I am probably late on this one since the book was published initially in 2007, but I have finally had a chance to read Pauline Chen's "Final Exam: A Surgeon's Reflections on Mortality(Knopf, 2007; Vintage, 2008).

Dr.Chen is a surgeon who does both liver transplants and liver cancer surgery.  Most recently on faculty of UCLA department of surgery, she speaks nationally and writes a column for The New York Times.  

Her book, as the title implies is a autobiographical reflection of her experiences regarding death; beginning in medical school and moving through various training periods. We in palliative care, of course, deal with death frequently, thus reading this book you will surely find things that resonate with you as well as things that frustrate you. 

Her writing style is very engaging in its authenticity and narrative form. I read about patients that could easily have been people I have taken care of in my own training. The honest insight into her thoughts is refreshing. I enjoyed watching the transformation of her own avoidance of death, to a timid acceptance of death.

There are fundamental ideologies that she depicts that are very entrenched in our medical system as the following quotes illustrate:

"Along the way, then, we learn not only to avoid but also to define death as the result of errors, imperfect technique, and poor judgment. Death is no longer a natural event but a ritual gone awry.....By evading death, we miss one of the best opportunities for us to learn how "to doctor" because dealing with the dying allows us to nurture our best humanistic tendencies" (p95)

"Over time we come to believe so deeply that sublimating our fear of death makes us better doctors that some of us will skip around the very word during our conversations with terminal patients."(p205)

She records poignant questions around the idea of when to stop curative measures, and when care becomes more about doing something "to" someone instead of "for" someone in vignettes about Sam, a young man with brain mets and Max, and infant born with gastroschisis who required a liver and bowel transplant. Having had these conversations with people, I found myself wanting to answer Sam's wife when she wonders, "When do you know....when you have done enough?" (p145)

Because Dr. Chen was so honest in recording conversations I at times felt a surge of agony as prognosis questions were avoided. One example of this follows as she talks to one of her liver failure patients:

"Your liver is struggling" I said. But Franks's liver was not struggling; it was failing. I knew that in the next few days he would likely fall into a coma and die....I could not bring myself to describe that outcome." (p187) 

She ends her conversation with a hopeful remark about checking the labs tomorrow to see if they improve.
It was moments such as those I wanted to jump into the pages and say " can do it... you can be honest to Frank in a compassionate way!"

The final story is I suppose the transformation Dr. Chen makes. She recounts a patient with cholangiocarcinoma who wanted to die at home. As he gets sicker and she realizes his prognosis, she allows him the decision to decide his outcome, whether to head to the ICU for more invasive interventions or head home to die.  There is no surprise that he opts to go home. I found it interesting that still, in the final paragraphs of the book that she continued to struggle with his death. She closes out the book with these words: 
"I began to speak, saying what I always did with grieving loved ones. I wish I could have cured him, I wish I could have done more....It was then I realized that I had done more. I had comforted my patient and his family. I had eased their suffering, I had been present for them during life and despite death." (p211)

If I had one wish about the book, I would have hoped to read more about palliative care. In so many of these examples I longed for their presence to offer guidance in communication and discussions about goals. While it is refreshing that Dr. Chen is being transformed as a physician to have these talks in a compassionate way, the truth is, most health care workers still find themselves trapped in the ideologies about death and prognosis discussed in the beginning chapters. While it is lovely to envision a medical education system that trains up physicians comfortable with death, it remains an ideal at best.  In the meantime, let's get those palliative care teams involved!

Overall, this is a book I would absolutely recommend; an engaging narrative that we can all identify with!  

Monday, November 1, 2010 by Amy Clarkson · 3

Monday, October 25, 2010

My Lovely Man by the Red Hot Chili Peppers

The rock band Red Hot Chili Peppers was initially formed in 1983 with four members, Anthony Kiedis (vocals), Michael Balzary (aka Flea, bass), Jack Irons (drums), and Hillel Slovak (guitar). In 1988, Hillel Slovak died of a heroine overdose at the age of 26. (Picture to the left is Slovak.)

In the bands recent biography, An Oralivisual History by the Red Hot Chili Peppers, Kiedis (who was also addicted to heroine) talks about the loss. "I denied it and didn't allow myself to feel the true nature of grief and loss until I go out of rehab. I went to visit his grave site, and started speaking to his ghost, and then I realized, 'Oh shit, my partner is gone.'" The loss led Kiedis into rehab. Irons couldn't take staying in the group after his friend died and eventually left.

Slovak was replaced by guitarist John Frusciante and the group has gone on to great success in his absence. In 1991, the group released the album Blood, Sugar, Sex, Magik (which is really their breakout album). One of the songs on this album, "My Lovely Man" was written as a tribute to Slovak.

Even if the Red Hot Chili Peppers aren't your musical style, the lyrics to this song are a very sweet, emotional tribute to a lost friend. The lyrics are fairly self explanatory and are at the end of the post. (FYI, Slim was a nickname for Slovak.)

On a previous album, Mother's Milk, the band released another song "Knock Me Down". Which is was also a tribute to Slovak. One of the lines of the song, "I'm part of you, you're part of me. Why did you go away?"

I used to shout
Across the room to you
And you'd come dancin'
Like a fool
shuffle step
You funky mother
Come to me
All warm as covers

Rest with me
My lovely brother
For you see
There is no other
Memory so sad and sweet
I'll see you soon
Save me a seat

Well I'm cryin'
Now my lovely man
Yes I'm cryin'
Now and no one can
we never fill the
The hole you left my man
I'll see you later
My lovely man if I can

In my room
I'm all alone
Waiting for you
To get home
Listen to Roberta Flack
But I know you won't come back

Well I'm cryin'
Now my lovely man
I'll see you later
My lovely man if I can

Just in case
You never knew
I miss you slim
I love you too
See my heart
It's black and blue
When I die
I will find you

Well I'm cryin'
Now my lovely man
Yes I'm cryin'
Now and no one can
we never fill the
The hole you left my man
I'll see you later
My lovely man if I can

Well I'm cryin'
My lovely man
Well I'm cryin'
My lovely man
I'll see you later
My lovely man
We have some good time
My lovely man

Monday, October 25, 2010 by Amber Wollesen, MD · 0

Monday, October 18, 2010

"Before I die, I want to...."

I stumbled across a gem of a website this week. "Before I die, I want to...." is the brain child of
photographers/artists KS Rives and Nicole Kenney. Both started the project partly with the
news that Polaroid would be discontinuing products, allowing a symbolic death of this
iconic product.

However it goes deeper than this. In contemplating a tool used by the medical community called "safety contracts" for suicidal individuals, they were struck by the power of verbal commitment. The simple notion of someone being asked to promise not to harm themselves until help comes, etc, with the verbal agreement from the individual has been shown to actually work.If there is power in this verbal connection, what if someone made a verbal commitment as they contemplated death, about something they hoped to achieve? Would the act of

documentation make any difference they mused?

Thus a project was born, using the immediate art of a Polaroid camera with no "re-do's" and a person's own words/handwriting outlining what it is they want to do before they die.

As you can imagine there is much to be examined in terms of values as related to age, culture and life experiences.

The two have traveled internationally posing this question and have even visited a hospice in NY to ask those closer to death about their wishes/hopes.

All in all they've captured over 1,200 photos. They have plans in the future to attempt contact with each individual to see if they've achieved their goal and also to ask for a narrative once they have.

The website has the photos divided by location; US, India and Hospice. There are also interesting insights the photographers have from their experience as the "documentarians". I enjoyed reading their observations as they contemplate cultural differences, including Americans often unease of the question, as it brings up dying.

The project is ongoing and they even accept Polaroid's taken from others - with instructions on the website how you can submit your own "Before I die, I want to..." Polaroid.

I hope you can take some time to browse the photos, making your
own insights on what you see. They mention they've yet to find someone who has said "nothing", it seems we can all think of something we want to do before we die.

What would your caption say?

All images are copyrighted 2008-2010 to Nicole Kenney + KS Rives

The translation from the final photo taken in India reads "I want to make a pilgrimage to Mecca"

Monday, October 18, 2010 by Amy Clarkson · 3

Monday, October 11, 2010

The Big C

I recently saw the pilot for a new Showtime series, The Big C, which premiered in August. Cathy Jamison is a middle aged school teacher with a new diagnosis of advanced melanoma. She could do chemo but she feels it would only be buying her little time and everyone would be taking care of her. She sets out to make the most of her last year, in her own way.

She kicks out her imature husband and sets out to be the more spontaneous, liberated one herself. She essentially begins to build herself her a to do list in this first episode. She begins to have a pool installed so she can swim with her son as she did when she was young and she begins to reign in her unruly teenage son. She starts to help an overweight teenager quit smoking and lose weight. She pours wine on her couch, something she sees as a symbol of how uptight she was in the past, and plans to burn it in the yard.

Several times during the pilot she tries to tell her family about her diagnosis. Each time she changes her mind at the last minute. At the very end of the episode she tells her neighbor's dog.

One of my favorite scenes in the show is when Cathy goes out to eat lunch with her young doctor. She wants to know how it feels for him to deliver bad news and he divulges that she is the first person he has ever had to tell such news. He nervously asks how he did.

"Very professional and matter of fact but detailed. You dumbed it down enough to be clear but not insulting. And underneath it all you seemed sad and I appreciated that. But after you left the room I heard you joking with the nurse about putting the doughnuts too close to the urine samples and is that what your supposed to wash it down with... it made me doubt your sincerity."

End of life issues aside, I found the pilot to be entertaining. I have always liked Laura Linney (who plays Cathy) and I think she does an excellent job of balancing funny and serious, more on the funny side. I'm looking forward to watching more of this series.

There is an excellent article on the series in Obit Magazine written from the point of view of someone who has been diagnosed with cancer. Trailer below.

Monday, October 11, 2010 by Amber Wollesen, MD · 2

Monday, October 4, 2010

Gallery: "Itch"

This is a continuation of the Gallery series of different artworks that roughly have a theme of something we encounter in Palliative Medicine. This Gallery addition is on "Itch"; unfortunately I couldn't find any pieces entitled "Pruritis". The pieces are all copyrighted to the artist and listed in sequential order at the end of the post.

For links to other issues of the Gallery series see below, they are included for your convenience.

The definition of itch (n):
1. An irritating skin sensation causing the desire to scratch.
2. Any various skin disorders, such as scabies, marked by intense irritation and itching.
3. A restless desire or craving for something

"Unscratchable Itch" by Shel Siverstein

There is a spot that you can't scratch
Right between your shoulder blades,
Like an egg that just won't hatch
Here you set and there it stays.
Turn and squirm and try to reach it,
Twist you neck and bend you back,
Hear your elbows creak and crack,
Stretch you fingers, now you bet it's
Going to reach- no that won't get it-
Hold your breath and stretch and pray,
Only just an inch away,
Worse than a sunbeam you can't catch
Is the one spot that
You can't scratch.

There's a place
that I cannot reach
it moves like an itch
down my back
and I know
if I could only stretch
far enough
to touch it
I would have
the most exquisite feeling
like a cold glass
of lemonade
the ice cubes
dancing like little fairies
in the glass
like the smell of the ocean
the salt hanging heavy
in the morning rain
like all explorers
it's never far enough.

Artwork displayed:

Past gallery posts: "Dysphoria","Last Breath", "Pain", "Afterlife", "Restless","Stillness" and"Grief"

Monday, October 4, 2010 by Amy Clarkson · 0

Monday, September 27, 2010

On Borrowed Time by Henrik Malmstrom

Photographer Henrik Malmstrom's sister, Maija, was diagnosed with ovarian cancer at the age of 20 in 1999. In 2007, when she was re-hospitalised, Malmstrom began the photographic documentation of the last months of her life. In March of 2010, (two years after Maija's death) he published his photographs in a book entitled On Borrowed Time.

The title of the book is from a quote from Maija from 2003. “…We live on borrowed time. We borrow some time here on earth, we borrow some consciousness…”

In his photos, Malmstrom tries to capture the emotions of what is going on around him. They are all black and white. Many of the photos are slightly out of focus. There are photos of his sister and other family members but also photos from around the hospital. There are some nature photos but they all have a sad, bleak quality to them. The photo above is one of my favorites. The blurry IV pole and checked tile floor could come out of any hospital. The too skinny legs to guide the pole around add a human touch to these symbols of the sterile hospital.

Taking these photos was a way for Malmstrom to stay close to his sister while she was sick. The time he spent putting the book together was a way of working through his grief after her death. "The two years I worked on it after my sister's death have come to define all of my future work. This was my sorrow work, and I am now free to move on."

More photos can be seen in this article and on Henrik Malmstrom's website. Thanks to Paul for tipping me off about these great photos.

Monday, September 27, 2010 by Amber Wollesen, MD · 0

Monday, September 20, 2010

Bedrich Smetana "Piano trio in G minor"

I must admit that Bedrich Smetana (1824-1884) is not one of those composers I go around mentioning or hear brought up in conversation much. In fact, the name didn't even sound familiar when I first started researching this piece. However, his 'Piano Trio in G minor" is familiar, and the story of it's inception is worthy of a post for this blog.

Smetana was a Czech composer who lived in the 1800s. A pianist foremost, he gave his first public performance at the age of 6. He began writing orchestral work in his early 30's and continued to compose until a year before his death at age of 60. Outside of his homeland he is best known for the opera The Bartered Bride and the Moldau from the song cycle Ma Vlast.

Smetana married his childhood friend Katerina Kolarova in 1849. They then had 4 daughters between 1851-1855. Tragedy struck in 1854 when his 2nd daughter died of TB, then in 1855 his favored eldest daughter Bedriska died of scarlet fever. It was in the midst of this grief that he wrote the Piano Trio in G minor in memory of Bedriska. The piece took 2 months to write and premiered Dec. 3, 1855 with Smetana himself as the pianist.

The piece is written in three movements with three voices of piano, cello, and violin. The first movement, "Moderato assai' communicates Smetana's emotional anguish, opening with a violin solo that I find truly haunting. This motif continues throughout the first movement echoed by both cello and piano. It is often not subtle, and if you listen it feels as if the grief is angry or about to burst. The cello attempts a 2nd motif, as a solo around minute 2 of the video below. Though still sorrowful, it seems more controlled, an outsider perhaps speaking reason to the unabashed 1st motif.

The second movement 'Allegro ma non agitato' strays from the usual style of having the second movement slow like an adagio. It is in fact more of a polka-like allegro, and is said to be written more as a dedication to his daughter, absent the emotional grief. You'll hear the first motif from the 1st movement played at the beginning in staccato fashion. It certainly looses some of the sadness when played in this fashion.

The final movement, 'Finale: presto' starts off with restless energy with themes borrowed from earlier works that Smetana wrote. As this movement is to give closure to his daughter's death, I find it interesting that 3/4 of the way in (around min. 6:35 below) one of the secondary themes evolves itself into a funeral march (7:10 especially) and then just as suddenly we're back to the impassioned quick paced melody from the beginning of the movement with the biggest surprise, ending gustily in the major key of G (less gloomy, perhaps grief resolved).

The listener may have the distinct impression that this piece is the story of his grief, rather than being in the midst of his grief. This may be because we know historically that he re-worked the Piano Trio 2 years later. I wonder how different that original piece was, played just months after his daughter's death than the version heard today.

Below are the three separate movements in order from YouTube. If you have little time, I'd encourage you to at least hear the first 30 sec's of each, to sense the difference.

Monday, September 20, 2010 by Amy Clarkson · 1

Monday, September 13, 2010

Dead by They Might Be Giants

I found this song when I was doing research on strange songs people wanted to have at their funerals. I don't know if it's funeral worthy but it is an interesting song. Dead by They Might Be Giants came out on their album Flood in 1990. Dead, like many of their songs is... quirky. (The song is below and you can see the lyrics at the end of the post.)

My initial thought was that it is sung from the point of view of a person who died young or wasn't ready to die-"Accidently taken off the shelf before the date stamped on myself". (Reincarnated as a bag of groceries?) He expresses a lot of regrets about the things he won't ever get to do and wonders how the event (his death) was taken.

After listening to the song a couple times, I changed my view. Maybe it's not someone physically dead but someone who just feels that way. Or maybe he is dead and just lived a life very similar to being dead. "Now it's over I'm dead and I haven't done anything that I want or, I'm still alive and there's nothing I want to do"

They Might Be Giants don't really give a lot of clues as to what they were thinking with their songs. They have on occasion said that some of their songs really don't have a deeper meaning (or even a meaning) to the lyrics but this song seems like it does. Whether they speak of a physical death or more of a spiritual one is open to interpretation.


I returned a bag of groceries
Accidently taken off the shelf
Before the expiration date
I came back as a bag of groceries
Accidently taken off the shelf
Before the date stamped on myself

Did a large procession wave their (Did a)
Torches as my head fell in the basket, (large pro-)
And was everybody dancing on the casket? (cession dance?)

Now it's over I'm dead and I haven't done anything that I want (now it's over)
Or, I'm still alive and there's nothing I want to do

I will never say the word
"Procrastinate" again; I'll never
See myself in the mirror with my eyes closed
I didn't apologize for
When I was eight and I made my younger brother
Have to be my personal slave

Did a large procession wave their (Did a)
Torches as my head fell in the basket, (large pro-)
And was everybody dancing on the casket? (cession dance?)

Now it's over I'm dead and I haven't done anything that I want (now it's over)
Or, I'm still alive and there's nothing I want to do

(So) So I won't
(Sit) sit at home
(And) anymore
(And) and you won't
(And) see my head in
(And) the window
(And) and I won't
(And) be around
(And) ever anymore
(And) and I'll be up there on the wall at the store

I returned a bag of groceries
Accidently taken off the shelf
Before the expiration date
I came back as a bag of groceries
Accidently taken off the shelf
Before the date stamped on myself

Did a large procession wave their (Did a)
Torches as my head fell in the basket, (large pro-)
And was everybody dancing on the casket? (cession dance?)

Now it's over I'm dead and I haven't done anything that I want (now it's over)
Or, I'm still alive and there's nothing I want to do

Now it's over I'm dead and I haven't done anything that I want (now it's over)
Or, I'm still alive and there's nothing I want to do

Monday, September 13, 2010 by Amber Wollesen, MD · 2

Monday, September 6, 2010

Justin Roberts "Sand Castle" (2006)

I know Christian has mentioned before having ah-ha moments when listening to songs and finally really "hearing" the lyrics. This happened to me this week as I had the children's music writer/singer Justin Roberts on. On one of the slower songs on his album "Meltdown" (2006) I suddenly heard words that I realized were talking about dying.

Justin Roberts is known as a Children's Indie Rock singer/songwriter. While trying to make it in the Indie Rock Adult world with a group called 'Pimentos for Gus' in the 1990's, he took a day job in a preschool. Taking his guitar to entertain the kids, he began writing songs for them and produced his first album "Great Big Sun" (1997). Still unsure of his path, he headed to the University of Chicago to pursue a Ph.D. in religious studies. The music writing continued and was getting more attention than his studies, soon turning Roberts into a full fledged rocker with 7 albums released to date.

Many interviewers denote that Justin's music is often adored by adults as well as kids. Themes range from milestones such as getting glasses and picture day at school, to family dynamics of moving and sibling relationships with the song my kids love, 'My brother did it'.

Robert's isn't afraid to tackle the tough subjects either, as in 'Sand Castle' the song I was listening to with my kids. He wrote this song for a friend who lost his Mom. The music is mellow and slow and has a sorrow about the melody. In fact, I think it was this sense of sadness that made me stop to hear what the words were saying. The imagery is subtle, telling about this child and father out at the beach remembering and saying goodbye to the child's mom. The last lines "She slipped through our hands/Just like a balloon returns to the sky/So Dad and I/Knew you’d be somewhere out in the sea/In a million sandcastles to be"

I think kids are a unique population when it comes to dealing with death and loss, so to have stumbled across another possible resource was a delight. I'd be interested if anyone knows of other children's music that deals with death?

I've posted the song below to listen to with the lyrics here. For email/rss subscribers you may need to head to the original post site to hear the song (Scroll to the bottom of the page)

Sand Castle (2006)
Dad and me went out to the sea
Just to build it, just to build it
We dug our hands down in the sand
Then we filled it, then we filled it

Till you were just a sandcastle
When we watched you in front of those waves
That was like a real hassle
But you were beautiful and brave
You stood like a sandcastle
And I’ll never forget that day
I’ll never forget that day

We sang ba ba ba…

Dad and I heard planes in the sky
Engines roaring, engines roaring
We built a bridge and castles so high
They were soaring, they were soaring

Till you were just a sandcastle
When we watched you in front of those waves
That was like a real hassle
But you were beautiful and brave
You stood like a sandcastle
And I’ll never forget that day
I’ll never forget that day

We sang ba ba ba…

We didn’t want you to go
We just thought you should know
She slipped through our hands
Just like a balloon returns to the sky
So Dad and I
Knew you’d be somewhere out in the sea
In a million sandcastles to be

We sang ba ba ba…

Justin Roberts -web- -Facebook- -Twitter @MusicianJustin- -YouTube-

Monday, September 6, 2010 by Amy Clarkson · 2