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March 31st marks the 5 year anniversary of the death of Terri Schiavo. The case that got so many families talking about their end of life preferences comes back into the media now in an unexpected way.

To commemorate the anniversary, Family Guy, a Fox Network animated series, aired a short spoof on the case, Terri Schiavo: The Musical. Below is the episode. (It's just the first minute or so of the episode.)



Tasteless? Insensitive to all parties concerned? Disrespectful of the deceased? You can be the judge. I guess we all have different senses of humor. Not quite historically accurate. (I pointed out to my husband how it was medically incorrect. His response was "Amber, I think they were going more for rhyming than medical accuracy.") But is it too soon? Will it always be?

Having watched Family Guy before, I think that it is clearly meant to shock. To make us say out loud "They did not just do that?". As I am sure there will be some upcoming media about this anniversary, Family Guy probably sees that all press is good press. And they have gotten press over this. Schiavo's family was understandably enraged by the episode and many different family members have been quoted stating as much, calling for Fox to drop the series.

Family Guy isn't the only animated series to take on this topic. March 30, 2005, just 12 hours before Schiavo's death, South Park aired the episode "Best Friends Forever" (This is the link is to the episode. It may be offensive to some viewers as South Park always is.), also a spoof of the controversial case. They actually won an Emmy for this episode. There is some interesting commentary on the state of modern medicine. Even if South Park isn't your taste, I recommend watching it. It actually seems to be more making a point than trying to shock the audience.

So am I offended? Not really. I likely would be if it was my family member they were talking about. It honestly makes my inner palliative care doctor cringe a bit to think of the family having to see this, regardless of what my views may be. But I have seen much more offensive material come out of both of these series. They have poked fun at about every controversial issue out there and will continue to do so. No one would even bother if these issues didn't not raise so much emotion already. Maybe it should be an honor to get this kind of attention. It means enough people care.

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If you ever write a 9 minute song you would hope it would be a good one. There are only a few 9 minute plus songs in my song collection but "The Trapeze Swinger" by Iron and Wine is one that stands out. If you have any familiarity with it you may remember it from the end credit sequence in the moderately memorable movie "In Good Company."

Hypnotically repetitive, I would occasionally put this song on repeat to fall asleep to when I lived alone during my palliative medicine fellowship (and my wife had to be in another city for her fellowship.) At first I took the 'please, remember me' line to be more about my long-distance relationship with my wife, but as I continued to listen to it falling asleep after long days of being surrounded by dying people at the hospice house the meaning clearly evolved.

Since the song is so long go ahead and start listening to it as you read the rest of this post.


Iron and Wine is really a one man band led by Samuel Bean. The simple strong structure repeats through the song with little accents placed on each verse by different instruments or Bean's voice. The back and forth nature of the song structure reminds me of being at the beach watching the waves come crashing in and then slowly recede.

The intro begins with soft wind chimes and what sounds like sea shells or a rain stick followed by the basic guitar melody and a chorus of 'oohhh-ohhhhhs.' As the song advances we hear a ton of different instruments: slide guitar, bass guitar, wood blocks, tom toms, percussive metal, an organ played in reverse, tympani drums, upright bass (around 4:53 - my favorite part!), a song played in reverse, piano, and finally a toy whistle. All of these instruments begin to layer into an increasingly complex sound. I can't imagine being the sound mixer on this song!

The lyrics obviously focus on a theme of rememberence and like the instrumentation the repetitive nature allows for different takes on the same theme. here are the first lines of all the verses laid together.

Please, remember me happily
But please, remember me fondly
And please, remember me that Halloween
So please, remember me mistakenly
And please, remember me as in the dream
But please, remember me, my misery
And please, remember me seldomly
So please, remember me finally

The perspective of the dying person wanting to instruct those still alive on how to keep the memory (and the legacy) alive is commonly seen in hospice and palliative care. How we as friends, family or staff enhance or suppress this legacy building is not often talked about as openly as this song manages. How would caring for a person who is dying be different if we spent some time with them asking how they would like to be remembered?

There are many religious references in the song, but each of them comes with a little bit of the singer's reality. Imagining the heaven with obscene graffiti, or rushed angels who want to get all the new souls through the door place an potentially unknowable realm in earthly terms.

Overall, Bean gives us a bit of poetry mixed with american folk and indie pop that allows you to discover a little something new with each listen. Please share any lines in this song stand out the most to you.

Lyrics by Iron and Wine (aka Samuel Bean) 2004

Please, remember me happily
By the rosebush laughing
With bruises on my chin, the time when
We counted every black car passing
Your house beneath the hill
And up until someone caught us in the kitchen
With maps, a mountain range, a piggy bank
A vision too removed to mention

But please, remember me fondly
I heard from someone you're still pretty
And then they went on to say
That the pearly gates
Had some eloquent graffiti
Like "We'll meet again" and "Fuck the man"
And "Tell my mother not to worry"
And angels with their great handshakes
Were always done in such a hurry

And please, remember me that Halloween
Making fools of all the neighbors
Our faces painted white
By midnight, we'd forgotten one another
And when the morning came I was ashamed
Only now it seems so silly
That season left the world and then returned
And now you're lit up by the city

So please, remember me mistakenly
In the window of the tallest tower
Calling passers-by but much too high
To see the empty road at happy hour
Gleam and resonate, just like the gates
Around the holy kingdom
With words like "Lost and found" and "Don't look down"
And "Someone save temptation"

And please, remember me as in the dream
We had as rug-burned babies
Among the fallen trees and fast asleep
Aside the lions and the ladies
That called you what you like and even might
Give a gift for your behavior
A fleeting chance to see a trapeze
Swinger high as any savior

But please, remember me, my misery
And how it lost me all I wanted
Those dogs that love the rain and chasing trains
The colored birds above their running
In circles around the well and where it spells
On the wall behind St. Peter
So bright, on cinder gray, in spray paint
"Who the hell can see forever?"

And please, remember me seldomly
In the car behind the carnival
My hand between your knees, you turned from me
And said, "The trapeze act was wonderful
But never meant to last", the clown that passed
Saw me just come up with anger
When it filled with circus dogs, the parking lot
Had an element of danger

So please, remember me finally
And all my uphill clawing
My dear, but if I make the pearly gates
I'll do my best to make a drawing
Of God and Lucifer, a boy and girl
An angel kissing on a sinner
A monkey and a man, a marching band
All around a frightened trapeze swinger

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In putting together our talk for the academy meeting (music with palliative themes for self care) we had a lot of material to work with. We couldn't possibly talk about all of the music we know to have these themes. There were a lot of... I won't say rejects, as they are still great songs. We'll call them honorable mentions. I want to give an honorable mention today to the Canadian folk rock indie band The Weakerthans and their album Reconstruction Site.

This 2003 album is structured around three songs, which are conveniently placed within parentheses so you know which ones they are, (Manifest), (Hospital Vespers), (Past Due). All three songs are written in more of a sonnet form then a typical song. To me they seem more like poetry than songs. The lyrics are even written out on their website in a paragraph form, not the typical form used for song lyrics.

The first of the three songs, (Manifest), starts out as some type of call to action. Maybe its the beginning of a life philosophy. Like wanting to see and notice everything. Take nothing for granted. The song is very upbeat, optimistic about life. It has an almost military type beat that makes it seem even more like a call to arms. Here is a link to the album and the lyrics are below.

I want to call requests through heating-vents, and hear them answered with a whisper, "No." To crack the code of muscle, slacken, tense. Let every second step in boots on snow complete your name with accents I can't place, that stumble where the syllables combine. Take depositions from a stranger's face. Paint every insignificance a sign. So tell me nothing matters, less or more. Say, "Whatever we think actions are, we'll never know what anything was for." If "Near is just as far away as far," and I'm permitted one act I can save, I choose to sit here next to you and wave.

The middle song, (Hospital Vespers) is below.

Doctors played your dosage like a card-trick. Scrabbled down the hallways yelling "Yahtzee!" I brought books on Hopper, and the Arctic, something called "The Politics of Lonely," a toothbrush and a quick-pick with the plus. You tried not to roll your sunken eyes, and said "Hey can you help me, I can't reach it." Pointed at the camera in the ceiling. I climbed up, blocked it so they couldn't see. Turned to find you out of bed, and kneeling. Before the nurses came, took you away, I stood there on a chair and watched you pray.

Now, I won't tell you I completely understand every line. (Per internet lore, "The Politics of Lonely" may be an obscure reference to a chapter title of a book about an explorer. Who could know?) But a song is what the listener gets out of it. To me this speaks to a feeling of disconnect with the medical community. A lot of references to games "card-trick", "scrabbled", "Yahtzee" like the singer feels it's all one big experiment, like a game. I think the overall sentiment is that the hospital is dehumanizing. The patient feels the need to hide away themselves, emotions, spirituality from the hospital community (with the camera as the symbol for that community). Open to interpretation. The music becomes very strange, I thought a bit eerie.

The last song of the album, (Past Due), is much more obvious. The music lightens up. You hear tinkling bells. It sounds like a conclusion. I'll leave the interpretation to you.

February always finds you folding local papers open to the faces "passed away," to wonder what they're holding in those hands we're never shown. The places formal photographs refuse to mention. His tiny feet, that birthmark on her knee. The tyranny of framing our attention with all the eyes their eyes no longer see. And darkness comes too early, you won't find the many things you owe these latest dead: a borrowed book, that cheque you didn't sign. The tools to be believed with, beloved. Give what you can: to keep, to comfort this plain fear you can't extinguish or dismiss.

The album seems to be telling a story with these three songs as the plot: hope, loss, grief, then resolution. Rebuilding life after a loss. Reconstruction, if you will.

Some of the criticism this album got is that it may be a bit too literate. These songs aren't really meant to be sung in the shower. They are meant to be over thought, which is not always what I'm in the mood to do when listening to music. But when I looked at it more like poetry set to music, I think I appreciated it more. In these songs, nothing is accidental. Every word, every note is well thought through and gives meaning. That meaning may at times be so obscure that maybe we weren't meant to completely get what was in the songwriter's head. Maybe we were meant to interpret it for ourselves and give it meaning that is significant to us.

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In the despair of her lover's denouncement, his likely execution, and in the midst of thwarting Scarpia's aggressive tactics, Tosca sings the haunting prayer in the aria, "Vissi d'arte, vissi d'amore"

Lyrics: I lived for art, I lived for love/ I never did harm to a living soul!/ With a secret hand I relieved as many misfortunes as I knew of./ Always with true faith my prayer/ rose to the holy shrines./ Always with true faith/ I gave flowers to the altar./ In the hour of grief why, why o Lord?/Why do you reward me thus?/ I gave jewels for the Madonna's mantle/ and I gave my song to the stars, to heaven, which smiled with more beauty./ In the hour of grief why, why, o Lord, ah, why do you reward me thus?

Although Tosca herself is not dying, she is singing in the realization that she will soon lose her lover, and I see contemporary palliative care themes in this prayer. This type of plea could easily be whispered by family members at the bedside of one dying or by the patient them self.



First there is the accounting of worth. We reflect on our character and persona. For Tosca her list includes a passion for love and art, a humble generosity (secret hand relieving misfortunes), and a respect for others (no harm).

Second is an evaluation in accordance to our faith traditions. Tosca lists her offerings of flowers and prayers in the shrines and alters, and jewels for Madonna.

Finally is the assessment of career and external works. Tosca was a singer, so she reflects that she sung and the world was more beautiful from her contribution.

Aren't these classic elements of reflection? Who we are internally, externally and if appropriate, who we are in accordance to our faith tradition?

The purpose to Tosca's reflection, however, is really a question. What strikes most listeners, endearing this aria to audiences, is the timeless question, "why?". Why do bad things happen to good people?

Listening to this aria with the 'why?' in mind, you will hear the despair and the grief in Tosca's words. Perhaps this song can help us to explore with others those deeper areas for reflection.