Friday, February 26, 2010

AAHPM Conference this week

The annual assembly for the AAHPM is this week in Boston, MA. There are a few plugs we wanted to put in for the Pallimed family if you'll be attending.

1) Palliative Themes in Music: An Educational and Self-Care Exercise: Co-Editors Amber Wollesen, Christian Sinclair and myself will be presenting this interactive 1 hour session on using music as a tool in our daily work. Be watching for a post on the day of our talk, Thursday March 4th with the highlights and songs we discussed. For those in Boston, the talk is from 2:45-3:45.

2) This Republic of Suffering: Death and the American Civil War by Drew Gilpin Faust. As mentioned in Amber's post here; Christian, Amber and I will also be at the Book Club discussion on this amazing book looking at death during the Civil War. It's on Saturday March 6th from 12:15-1:15pm

3) Finally Friday night March 10th at 7pm will be the 4th annual Pallimed meet and greet. This year we are joining with friends at GeriPal for a combined networking experience. Location yet to be determined, but check back here or find us at the conference for details.

Friday, February 26, 2010 by Amy Clarkson · 0

Monday, February 22, 2010

Walt Whitman

This post was inspired by a book I recently read, This Republic of Suffering: Death and the American Civil War by Drew Gilpin Faust. If you happen to be attending the AAHPM Annual Assembly next month, this is the book that will be talked about in the first ever AAHPM Book Club (link to AAHPM blog that talks about the book) (Saturday, March 6 from 12:15-1:15). I know from the Pallimed group Amy, Christian and I will all be in attendance, so read the book and come join us!

American poet, Walt Whitman, was born in 1819. He is perhaps best known for his collection of poetry Leaves of Grass which is perhaps best known for its controversial sexual themes. Whitman initially published this collection of poetry in 1855 but he continued working on it, adding more poetry until right before his death in 1892. What I didn't know about Whitman until reading Faust's book was his involvement in the American Civil War and how his experiences shaped his poetry.

Whitman's brother was a soldier in the Union Army. When Whitman heard that he had been wounded, he hurried to Virginia to be with him. His brother had only minor injuries but he found many who were much worse off. He began visiting the soldiers. He would spend time with them and write letters home for them. He would also write letters to soldiers family members to tell them of the soldier's death, providing reassurance that they had had a good death. His poetry reflected this experience.

Below is the poem "Pensive on Her Dead Gazing, I Heard the Mother of All", written after the end of the war.

PENSIVE, on her dead gazing, I heard the Mother of All,
Desperate, on the torn bodies, on the forms covering the battle-fields gazing;
(As the last gun ceased—but the scent of the powder-smoke linger'd;)
As she call’d to her earth with mournful voice while she stalk’d:
Absorb them well, O my earth, she cried—I charge you, lose not my sons! lose not an atom;
And you streams, absorb them well, taking their dear blood;
And you local spots, and you airs that swim above lightly,
And all you essences of soil and growth—and you, my rivers’ depths;
And you, mountain sides—and the woods where my dear children’s blood, trickling, redden’d;
And you trees, down in your roots, to bequeath to all future trees,
My dead absorb—my young men’s beautiful bodies absorb—and their precious, precious, precious blood;
Which holding in trust for me, faithfully back again give me, many a year hence,
In unseen essence and odor of surface and grass, centuries hence;
In blowing airs from the fields, back again give me my darlings—give my immortal heroes;
Exhale me them centuries hence—breathe me their breath—let not an atom be lost;
O years and graves! O air and soil! O my dead, an aroma sweet!
Exhale them perennial, sweet death, years, centuries hence.

In this poem, Whitman hears the "Mother of All" mourning the loss of the fallen soldiers. She asks the earth to absorb them well and hold on to them for her so that they are part of the earth for centuries, immortal as part of the air and soil.

Whitman was also very moved by the death of Abraham Lincoln. He wrote the famous poem "O Captain! My Captain" in response to his death.

O Captain my Captain! our fearful trip is done,
The ship has weathered every rack, the prize we sought is won,
The port is near, the bells I hear, the people all exulting,
While follow eyes the steady keel, the vessel grim and daring;
But O heart! heart! heart!
O the bleeding drops of red,
Where on the deck my Captain lies,
Fallen cold and dead.

O Captain! my Captain! rise up and hear the bells;
Rise up--for you the flag is flung for you the bugle trills,
For you bouquets and ribboned wreaths for you the shores a-crowding,
For you they call, the swaying mass, their eager faces turning;
Here Captain! dear father!
This arm beneath your head!
It is some dream that on the deck,
You've fallen cold and dead.

My Captain does not answer, his lips are pale and still;
My father does not feel my arm, he has no pulse nor will;
The ship is anchored safe and sound, its voyage closed and done;
From fearful trip the victor ship comes in with object won;
Exult O shores, and ring O bells!
But I, with mournful tread,
Walk the deck my Captain lies,
Fallen cold and dead.

In Faust's book, she points out that Lincoln's grand funeral was like a surrogate funeral for all those who died in the war who did not have a "proper burial". Their families didn't have the opportunity to say goodbye in that way. Often they didn't even know the exact fate of their loved one. They were just presumed dead. Whenever I have read "O Captain! My Captain" in the past, I always read it pertaining just to Lincoln. Now I wonder if it doesn't have a broader meaning. Maybe Whitman wasn't just thinking about Lincoln, but about all the civil war dead.

Monday, February 22, 2010 by Amber Wollesen, MD · 3

Monday, February 15, 2010

Pallimed: Arts and Humanities? There's an App for that!

Can't always get to a computer to get to Pallimed?  Well now iPhone (and iTounch and iPad) users have an option to read Pallimed and Pallimed: Arts and Humanities (including comments to both blogs) with the very first Pallimed FREE iPhone app.

The FREE Pallimed app gives you one-click access to the blog content (Main and Arts) without any of the extra sidebar content that could make browsing the site via a smartphone a bit difficult.  You can even post a comment via the iPhone app.  There are two bugs we have found so far and we are working to get them hashed out (can't email author nor email the blog post).

We even have one review so far and the app was only published last week.
by Pixel 196,5

Simple, well thought-out, a great way to keep up with the latest information in palliative care. I've never read this blog before but I'll be following it regularly now! Thank you for doing this.
You are welcome Pixel 196,5!

If you have an iPhone we encourage you to get the FREE Pallimed iPhone app and review it.  Maybe it will rise in the standings and more Pallimed naive people may get the app and learn more about hospice and palliative medicine issues.

Monday, February 15, 2010 by Christian Sinclair · 0

Gallery: "Grief"

If you were to non-verbally depict the emotion of grief, I would assume many would strike a pose of head in your hands. This simple gesture I found in countless photographs and paintings as I searched for this weeks art collection of pieces with the title "Grief".

I tried to find less traditional images, however, I've always liked this oil painting by Gene Gould, "Grief" (c1965). Though with that same pose, it conveys much with the colors used and the drips of paint.

With similar color scheme and graphic representation of body posturing is this piece to the right by Gustave Miller entitled "Grief".

Both of these imply a solitary grief, but consoling and shared grief is also important. I found an artist named Linda Branch Dunn who keeps a website of her pieces. She works mostly with fabrics. This was an interesting look at an artist's work in progress. The first photo to the left is a fabric piece entitled "Grief" (2007), depicting 2 people in embrace. She mentions being inspired by a photo after a bombing. Click on the image to see the exquisite detail of the stitching.

What is interesting is that she mentions just framing it, but then changes course, as she adds much more color and fabric, leading to a different piece, the title changing to "Fractured" (2007). I find the pieces completely different, even though you still see the original in Fractured. Which one do you like better?

Moving into a bit more abstract is this piece by Pat Goslee, a mixed media on paper called "Grief Underneath" (2008). The impression the piece leaves me with is that of someone, again head down, clutching their gut. However, as is the case with more abstract works, you may see something completely different. The color scheme is less gloomy the the first 2 pieces.

For the sculpture contribution to this gallery edition, I've chosen the work by Henri Laurens (1885-1954) called "Le Douleur (Grief)". What is ironic is that it adorns the grave of it's creator in Paris. Did Henri have in mind his own death as he worked on the piece? Perhaps it was anticipatory grief, a phenomenon we talk of often in palliative medicine. Again the figure hunches inward, grasping what seems to be a pillow.

The common theme of most of the works does seem to be physically posturing inward. Is that because emotionally grief brings us inward?

If you like these gallery posts do check out the previous installments of "Last Breath", "Pain", "Afterlife", "Restless", and "Stillness".

by Amy Clarkson · 2

Monday, February 8, 2010

Roadside Memorials

Every time I make the 4 1/2 hour drive to see my parents, I can't help but notice the large number of crosses, flowers, even teddy bears and balloons that adorn the roadside. Some are very well maintained, even beautiful while others make me wonder where memorials cross the line into littering. (The photo to the right is a memorial placed on the roadside where a murdered women's body was found.) When I've encountered a particularly eye catching memorial, I will admit to slightly slowing down to check it out. What I never realized until I started researching this post is how very controversial these memorials are.

The Room for Debate Blog, run by the New York Times, had a very interesting post about the ongoing battles being had over these sites. They brought in several different experts to argue both sides of the issue. Are they memorials or distractions? Beautiful folkart or driving hazards?

Attorney Robert Tiernan successfully defended a man who was accused of illegally removing a roadside memorial. He argues that these memorials are themselves illegal. They use public property for private uses. Crosses and other Christian symbols placed in public places are a violation of the separation of church and state. Memorials are a distraction and a hazard as mourners will commonly stop at inappropriate places to visit and maintain them. They are often elaborate and anchored to the ground which could be a hazard if a motorist lost control and hit one.

Another one of the blog panelists, anthropologist Sylvia Grider argues that it is a very old practice, brought over to Mexico and the Southwest US in the 17th century from Spanish colonists whose custom was to mark the site of death with a small cross. They are called descansos. And she argues that these are sacred sites, not necessarily religious even though they may contain religious symbols.

"I regard the attempts of various authorities to legislate or regulate this custom as futile and misguided because those who feel the need to memorialize their loved ones near the roadways where they died will continue to do so, regardless of legislation or other attempts at control. In many cases, where authorities have removed roadside shrines, families and loved ones simply replace them. Tradition is a powerful force in society."

So where do the states come down on this issue? Some states like Colorado, Wyoming and West Virginia put up their own memorials to cut down on the safetly issues with mourners stopping to maintain sites. (To the left are the signs placed by the state of Wyoming.) In New Mexico, where the custom is so strong, it is a misdemeanor to remove or vandalize sites. California and Montana allow memorials but only if alcohol was involved. Wisconsin and New Jersey limit the amount of time a memorial can be up. Delaware has developed a sort of roadside memorial park at some highway exits with reflection pools and victims names engraved on red bricks. This is meant to discourage the placement of memorials by giving families a safer place to grieve. Currently, many states have laws regarding roadside memorials.

Below is a clip from "Resting Places" which is a documentary on roadside memorials. The three people interviewed are lawyer Robert Tiernan, roadside memorial investigator/photographer David Nance and a mother who made a roadside memorial to her son.

This is obviously a much hotter issue than I first realized. I'm not sure what side I come down on. On one hand, it's the job of state governments to keep public spaces clean and hazard free. On the other hand, do state governments cross a line when they dictate how people can and can't grieve? My thought is that there needs to be some sort of meeting in the middle, such as the memorial parks they have in Delaware or the memorial signs that Wyoming places. What do you think?

Monday, February 8, 2010 by Amber Wollesen, MD · 9

Monday, February 1, 2010

Visqueen: Message to Garcia

Rachel Flotard is front woman to a Seattle based indie pop group called Visqueen. Their most recent album "Message to Garcia" was released this fall on Rachel's own label Local 638 Records.

The album is really an epitaph to Rachel's father who died April 7, 2008. Rachel spent 7 years living with and care giving for her father who was diagnosed and ultimately died from prostate cancer. Their house was his hospice, and her album, though upbeat was really inspired by the journey she was on with him as he died.

She told Ari Shapiro in an interview on All Things Considered, "Where I was, was in a hospital, or watching Raiders of the Lost Ark for the fiftieth time with my dad and making him a meal he couldn't keep down, this is where I was"

The only slower ballad on the album, is also the song with overt ties to her fathers death, called "So Long". The lyrics are as follows:

I'm gonna live after your gone
and I'm sorry that it took so long

I'm gonna cry I'm gonna moan
but I want it to be on my own.

I'm gonna write while you're in bed
gonna say things for the first time with my own soft hand
I'm gonna tell them all about you
What you did for me all of my life
Now an epiphany, in one dark night
and I 'm sorry, so sorry
that it took so long

What we knew never rested, to stay
I could spend forever apologizing, for one last day
taking with you what you needed to know
that it's all right to turn around and watch me go

And I'm sorry, so sorry
that it took oh it took so long
so long. And I'm sorry that it took so long.

Finishing this song before her father's death, Rachel actually played it for him. She says in her interview with Ari, "I played it for my dad once.... not realizing that the lyrics were like 'you're going to die pal'... he was like "is that about me?" (she laughs as she finishes), "and I told him 'no' and I think we went upstairs and had pea soup." Ironic that the lyrics of the song say "I'm going to say things for the first time" implying an honesty and openness, that when it came down to it, was too difficult to acknowledge.

Even the title of the album honors her father. There was an essay written by Elbert Hubbard in 1899 entitles Message to Garcia. The essay was about a solider tasked to preform a daunting mission by getting a message to a Cuban general named Garcia. The key is that this solider asked no questions, made no objections, requested no help, but accomplished the mission. It extols an attitude of working without complaining.

Her father gave Rachel this essay when she was 18, and was constantly referenced by her father. Whenever facing challenges, he father would say, "Are you delivering it [the message to Garcia]" In other words, don't complain, you can accomplish this. Apropos then for a title of an album created in the grief and challenges of loosing a parent. She made no objections, kept working, and in this album, the mission was accomplished; a beautiful epitaph to George Edward Flotard Jr.

I recommend listening to So Long from a link on the left at the All Things Considered interview.
You can see an interview of Rachel and the band from CW11's Underground series below. Her father appears at mark 6:35 in the interview.

Photo of Rachel and father: copyright Steven Dewall

Monday, February 1, 2010 by Amy Clarkson · 0