Monday, April 26, 2010

You Don't Know Jack

No, not the game show or video game. When I first saw the name of this HBO film, You Don't Know Jack, I thought the title seemed a bit casual for a movie about Jack Kevorkian and assisted suicide. The word flippant came to mind. What I realized as I starting watching the film was that I really don't know Jack. So, maybe an appropriate title (and probably intentionally flippant). I have heard about his work, his court case but I never really knew anything about the man. This film focuses on the years Kevorkian spent as "Dr. Death" but also gives a lot of personal insight into his life, relationships, personality. It shows him as an eccentric man who knowingly gave up his freedom for his cause.

Below is the trailer for this film which just premiered on HBO this past weekend.


Regardless of how you may feel about the topic, you can not (if this film is an accurate portrayal) argue the passion he feels for his cause. He so believed in this cause that he put his own freedom on the line with every death. The last death was not actually an assisted suicide but euthanasia. He went into this knowing it would force a court case.

He pleads a sympathetic case for his cause. The terms he uses are ones that we would be familiar with: death with dignity, quality of life, end suffering. He speaks about why must someone make the decision to have their feeding tube removed and die slowly when we could just end things quickly, humanely. Who are we as doctors to make someone go through that when we have the ability to spare them?

One statement I found interesting: "terminally ill is not a definable term". I would love to hear what everyone thinks of that.

I wondered when I started watching the film how the story would be slanted. It was clearly pro Dr. Kevorkian. I was left wishing for more balanced view of the issues. I felt those against what he had done were vilified and painted as overly religious. (I know very nonreligious people who are against assisted suicide.) I have always seen this as a very complex issue. To just get one side does not do it justice. I was left feeling a bit like the media was trying to manipulate my views rather than just trying to entertain me or even educate me. I would like to see a palliative care perspective. Is death all we have to offer?

From a film perspective, this is very well acted, starring Al Pacino (a remarkable resemblance to Dr. Kevorkian), John Goodman, Susan Sarandon. Intermixed with the main storyline are interesting personal relationships between Jack and his best friends, sister and lawyer. He struggles with the issues that brought him to embrace assisted suicide in the first place, the suffering and death of his mother.

One line in the movie describes Dr. Kevorkian as "the last doctor you'll ever need". My thought was, does that describe me too?

Monday, April 26, 2010 by Amber Wollesen, MD · 7

Monday, April 19, 2010

Susan W. Reynolds

Today's post is a potpourri of sorts. We talk much on this blog about how grief serves as an impetus for art. We've reviewed poems, visual art, music and films that trace back to an individuals personal story. Today I am going to interview Susan W. Reynolds, someone acquainted with grief personally, and then take a look at both a piece of artwork and poem she's done. She's involved in a new concept for me, something called "Redesign". It's yet another tool to use in palliative care. In typical interview fashion you'll see the question followed by her response.

AC: Tell me about a bit about your story and your loss?

SR: My husband died at 59, due to lymphoma, five years ago. He died at our lake home, by the water and without our children present, just as he had requested. Hospice was not involved in his care, although a close family friend was an excellent hospice nurse.

I had been a physical therapist in the early years of marriage and loved patient education and working with the team approach in stroke rehab. Most of my married life I was a stay at home mom, having moved our family ten times due to his job changes. Three months before my husband died, both our daughters graduated from college and moved away from home. At 49 I was a widow and now truly an empty nester.


By chance I saw an article about interior redesign and staging and then enrolled in the program to become certified in both. I began doing one day room makeovers for clients, color consulting, transitioning some clients to smaller homes. As I reviewed my clients, I found that the majority of them had recently experienced a large loss, mostly from the death of a spouse or child and some from divorce.

AC: Wow, that's an interesting insight about your clients. What IS redesign exactly?

SR: Redesign simply uses art, furnishings and accessories that one already owns and loves and recombines the elements into a soothing, functional and supporting space. Sometimes items are moved from room to room. Other times items may be taken away. The person utilizing the space is interviewed as to what they love about the space, how they use the space and how the space makes them feel. In working with clients on the grief journey, decisions are make together (myself and the griever) which is different from a typical redesign when the client is off premises and I do the work alone. Allowing the client to acknowledge and support his or her needs without feeling they are dishonoring the memory of their loved one is one of the core of redesign directions, but even greater than that is to revive yourself (the bereaved) and place yourself in surrounding that support you, whether it be the bedroom, your office, your car or the first visit to a restaurant since your loss.

AC: You have a blog as well, RevivalRedesign, that I understand was encouraged by a discussion with a bereavement group as a way to put these ideas down and in a sense move forward. Are their other expressive things you've done on your grief journey?

SR: My first outward expression of grief started with my trying a dance form in which I did not need a partner. The dancing introduced me to a new music genre to listen to and helped me express both wanted and unwanted emotions. I also carved some walking sticks and started painting. I had not painted since high school and had never carved. Working with my hands, freed my mind for short periods of time. This past year, I finally hung two of my paintings, they moved from sitting in a closet to the walls of my home. I also began to write. I still do not enjoy writing, but it consumes me, and expectantly allows inner thoughts and desires to seep forth and hence my blog and now a book is on the way.

AC: This artwork piece to the right you did is an encaustic piece. Can you explain the process

SR: Encaustic art is a very old art form using hot beeswax and plant extracts to color it. Beeswax is still used but other pigments are added for color in its present application. The hot wax is painted onto a surface and the layers fused together with a blowtorch. Colors can meld together with the heat or you can use parceled segments painted and lightly torched to adhere them to the surface. The layers can be scraped away with tools to reveal layers below and/or highly polished.

AC: It would seem the process itself is like grief?


SR: Encaustic painting is a bit like life, layering experiences one upon another. In grief, the layers are all there and we are presented with a chance to reassess and decide which layers to expose or rediscover of ourselves. We may decide which ones to let go as well. My artwork here represents growth toward the surface from the bottom of a darker and murkier sea. Rising to the light also required me scraping some of the layers away and deciding what to keep so as to make my painting visually pleasing for me.


AC: You also use poetry as a form of expression. This piece entitled "On the Bolt, Fabric of Life" found on your blog, is at first glance about sewing and fabric. What did the poem symbolize for you?


SR: The salvage of the fabric is often overlooked and not deemed useful in sewing. In grief we salvage what we have learned from the past. We can stitch it down and cover it up without creativity or growth or in salvaging our lives we can accept our own frailty and weave new experiences into the old patterns. Another piece of beauty arises, incorporating both the old and the new.


AC: Finally, as someone on the grief journey, what comment/advice would you share?


SR: My trials and errors speak for themselves. Don't take yourself too seriously. I had no idea that writing would prove to be my greatest "healing" tool. Try something new. It may lead to an unexpected delight or to another door that opens. Do not limit yourself from the baseline of your past. Find what lifts your spirit now and know that this too can change. Allow room for change and some fun doing it!

Monday, April 19, 2010 by Amy Clarkson · 1

Monday, April 12, 2010

I Don't Want to Die (In the Hospital)

If you attended our talk at the Academy meeting, you will recognize this song. I Don't Want to Die (In the Hospital) by Conor Oberst and the Mystic Valley Band was released in 2008 on his album Conor Oberst. I think it's a fun listen in general and especially for anyone in the hospice and palliative care field. I thought it deserved its own post. Enjoy!



The first thing that strikes me about this song is the upbeat music for such a serious topic. It's not the tone you would expect for talking about how one would like to die. With the same lyrics but different music, it could be a very different song. In an interview with Oberst, he talks about what he was thinking when he wrote this song.

"I think it has a sort of comedic aspect to it. The juxtaposition of the music and what's being sung about I suppose. ... I just think of sort of a stubborn old cowboy man that just wants to go lay in the grass and, you know, die out by the tree or something. "

The comical lyrics make me realize how I take the hospital experience for granted. Horrible gowns, bad TV, small sterile rooms, unable to do the things you enjoy most. Put that way, probably not the setting I would choose to spend my last days in. To some, this would be like a prison.

As the song gets closer to the end, the singer begins to sound more desperate. At one point he changes "I don't want to die in the hospital" to "I don't want to die". His voice sounds a bit crazed at times. Is there some terminal delirium there at the end?

I was just listening to this song again as I write this post and I had a moment. I was remembering several experiences of confused patients in the hospital who just kept getting up trying to leave. (I have even had an experience where the patient was wanting to find his shoes so he could take off.) They just keep say "Help me get up. I've gotta go" over and over. Couldn't say where they wanted to go but just wanted to get out of the hospital. The repetitive lyrics of the song remind me of that. Maybe I should have listened more closely to what they were telling me.

Below are the lyrics to I Don't Want to Die (In the Hospital).

I don’t wanna die in the hospital
No I don’t wanna die in the hospital
No I don’t wanna die in the hospital
You gotta take me back outside

I don’t wanna hear all those factory sounds
Looking like the girl in the sleeping gown
I don’t wanna die in the hospital
You gotta take me back outside

Can you make a sound to distract the nurse
Before I take a ride in that long black hearse
I don’t wanna die in the hospital
You gotta take me back outside

Help me get my boots on
Help me get my boots on
Help me get my boots back on

Help me get my boots on
Help me get my boots on
Help me get my boots back on

I gotta go, go, go
Cause I don’t have long

Yeah I don’t give a damn what those doctors say
I don’t wanna spend another lonesome day
I don’t wanna die in the hospital
You gotta take me back outside

They don’t let you smoke and you can’t get drunk
All there is to watch are these soap operas
I don’t wanna die in the hospital
You gotta take me back outside

Can you get this tube out of my arm
Morphine in my blood like a slow sad song
I don’t wanna die in the hospital
You gotta take me back outside

Help me get my boots on
Help me get my boots on
Help me get my boots back on

Help me get my boots on
Help me get my boots on
Help me get my boots back on

I gotta go go go
Cos I don’t have long

Is there still a world at my windowsill
All there ever was I remember still
I don’t wanna die in the hospital
You gotta take me back outside

Don’t know when it’s day or when its night
All I ever see are florescent lights
I’m not gonna die in this hospital
You gotta take me back outside

They give me all these flowers & big balloons
But I’m not gonna stay in this little room
I’m not gonna die in the hospital
You gotta take me back outside

Are the stars still in the sky
Is that fat moon on the rise
Feel the earth against my feet
As the cold wind calls for me

I ain’t gonna die in the hospital
No I ain’t gonna die in the hospital
No I ain’t gonna die in the hospital
You gotta take me back outside

I ain’t gonna die in the hospital
No I ain’t gonna die in the hospital
No I ain’t gonna die in the hospital
You gotta take me back outside

Monday, April 12, 2010 by Amber Wollesen, MD · 6

Monday, April 5, 2010

Edvard Grieg's Ballade in G-minor

Edvard Grieg (1843-1907) a Norwegian pianist and composer from the romantic period is best known for his Piano Concerto in A minor. Like most artists, his compositions are a reflection of his life's journey. The Piano Concerto was written in one of the most peaceful periods of Grieg's life. He composed it as newlywed on vacation, after his only daughter Alexandra was just born.

Tragedy struck, though, when young Alexandra died in 1869 at the age of one. Near the time of Alexandra's death, Grieg's wife Nina miscarried. He wrote, "It is hard to watch the hope of one's life lowered into the earth, and it took time and quiet to recover from the pain," then commenting on art's healing ability he continued, "But thank God, if one has something to live for one does not easily fall apart; and art surely has—more than many other things—this soothing power that allays all sorrow!"

Music did provide the vehicle to deal with his despair. His parents both died in 1875, and this coupled with the realization that he and Nina would never be able to have children, set in motion a period of intense grief. He poured this sadness into his most ambitious piano piece, Ballade in the form of Variations of a Norwegian Folk Song in G minor, op 24. He said that it was written "with my life's blood in days of sorrow and despair."

The piece itself is built by taking one single theme and then doing small variations, 14 to be exact. Quite a task to take the same basic tune and change it around 14 different ways. He does it exquisitely. A description found here states, "The theme in itself, which is almost common in its melancholy, becomes, through Grieg's harmonizing with the chromatic falling bass line, the prologue to a spiritual drama which is heightened and unfolds through the following variations, before the work at last ends up with the theme, unresolved, and now in an ever darker, gloomier form."


So personal was this work, that Grieg never preformed it for a public audience.


Listen to the piece below preformed by Leif Ove Andsnes:




Monday, April 5, 2010 by Amy Clarkson · 0