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In 2005, artist Christina Symanski fractured her neck diving into a swimming pool. She was pulled out by her boyfriend but has been a quadriplegic since that time.

Symanski continued her art, using her mouth and an iPad. More of her art can be seen here. The effect her injury had on her art is obvious.

She wrote about her experience in her blog, Life; Paralyzed. She also wrote a book about her experience. In April 2011(not posted until December), Symanski wrote a blog post entitled Quality vs. Quantity. In that post, she writes about what quality of life means to her and discusses the importance of having an advanced directive, how she wished she had had one prior to her accident.

"Because I didn't think things through before hand, or have a living will, I created a very difficult life for myself (unintentionally), by having to live within the confines of paralysis. Living with paralysis (at my level-C4/C5 complete) means I have very few options. In order to stay alive, I HAVE to take medications, accept help from others (for EVERYTHING), and tolerate unbearable (to me) treatments, like having an indwelling catheter, and bowel program. I HAVE to do all of those things, just to survive. That doesn't include coping with the loss of freedom, lack of privacy, loss of sensation, loss of dreams, aspirations and having to deal with constant compromise. It also doesn't account for the physical pain, discomfort, and sickness, that comes along with living with paralysis, and ultimately autonomic dysreflexia.

I have come to a point in my own life, where I'm struggling with the question "is this life worth living for ME, or am I just prolonging my own suffering?"

It is a very interesting and well thought out post about her life and the decisions she was making.

Christina Symanski's life made headlines when she died on December 1, 2011 after she decided to stop eating in order to end her suffering.

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On May 4th 2011, Derek Miller, writer/editor/blogger, posted his last post on his blog. Miller had been blogging since 2000 on the website penmachine.com. In 2007, he was diagnosed with stage 4 colorectal cancer and he often blogged about his cancer and treatment.

In a post entitled "The endgame", in November 2010, Miller writes about the discussing his prognosis with his physician:

It's good that Thursday, November 25, wasn't Thanksgiving Day in Canada (it was in the U.S.), because that's when I found out. Doctors are notoriously reluctant to predict life expectancy, and for good reason—they're often wrong. But, with my wife Air in the exam room at the B.C. Cancer Agency with me, I drew it out of my oncologist, Dr. Kennecke.

"Do you expect I'll still be alive to visit you here in two years?" I asked, straight up.

"Honestly, no," he said.

There was more to it, of course, but that was the moment. It was no surprise.

He ends the post "I'm not ready to die just yet, but I'm ready to prepare for it. Off we go."

Miller died on May 3rd, 2011. He wrote his last post before he died and had friends post "The last post" on May 4th. It begins "Here it is. I'm dead, and this is my last post to my blog."

It's a sweet but sad read. Miller talks about his wife and two daughters, his experience dying, his views on the afterlife. Miller is a very talented writer and I'm sure this last post will be cherished by his family. What is sad is that the comments on the post really focused on Miller's views of the afterlife (he doesn't believe in one) rather than his beautiful last message to the one's he loved.

The world, indeed the whole universe, is a beautiful, astonishing, wondrous place. There is always more to find out. I don't look back and regret anything, and I hope my family can find a way to do the same.

What is true is that I loved them. Lauren and Marina, as you mature and become yourselves over the years, know that I loved you and did my best to be a good father.

Airdrie, you were my best friend and my closest connection. I don't know what we'd have been like without each other, but I think the world would be a poorer place. I loved you deeply, I loved you, I loved you, I loved you.

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(cross-posted from the Main Pallimed Blog)

For the many readers of Pallimed who have not commented on the any of the blogs (Main, Arts, or Cases) I would really encourage you to break your silence and be proud to say 'long time listener, first time commenter.' Here are some of the reasons why you should comment on blog posts:

1. Comments Are Peer-Review: Discussing a counter-argument to the original post helps balance the viewpoint and encourages the writer and other comments to better define the original point.

2. Comments Make a Community: By contributing you know are part of a small network of Pallimed commenters which provides a foundation for a growing community. Often times the commenters answer each other's questions before any Pallimed writer gets a chance to reply.

3. Comments Guide the Content: Sure blog topics are what we decide to write on, but how we decide to write on is influenced by great comments which open up new areas of interest.

4. Comments Are Currency: Comments help any blog writer realize they are not talking into thin air, which is what it feels like when you first press 'publish post.' And that currency can be cashed in as goodwill from any of the blog writers. If we get a request for more info or a favor from someone who comments often, we will be much more likely to reciprocate.

5. Comments Make a Better, Smarter Blog: Comments often lead to new resources, new links and new insights making the blog a better resource for everyone. Also like a huge crowd sourced editors desk, if you find a broken link, a misspelling, poor grammar, tell us. We'll fix it, then thank you for helping all future readers.

6. Comment Make you a Pallimed Author: Drew started this whole thing, but Thomas Quinn, Lyle Fettig and Christian Sinclair (me) all started out as commenters before becoming formal contributors.

Barriers to Commenting:

-Well now you know. And knowing is half the battle.

-See below.

-A comment doesn't have to be a long counter-point, it can express general agreement, a variation on a theme, a new question, a request for blogging on something different, etc.

-Comment anonymously. Don't say anything inflammatory. Say anything you would be willing to defend on the radio or in court. Talk about thing more generally. But using your own name actually establish you as a thought-leader and for continuity purposes lets us know who is doing the talking. Is anonymous one person or a 45 people?

How to Comment on a Blog Post:

Pallimed has a comment function (at the bottom of each post) that allows you to give us feedback on each post. Just click on the "comments" link at the end of each post (the link usually tells you how many comments have been left so it says, e.g., "0 Comments" or "1 Comment").

Comments Policy: The editors of Pallimed reserve the right to remove any comments we deem offensive/hateful, mean-spirited, commercial, or in any other way inappropriate. This blog is intended to foster collegial, well-informed discussions about research and news relevant to clinicians working with patients facing severe/life-limiting diseases: it is not a forum for discussing individual cases or airing complaints or concerns about specific cases (whether from the clinician, patient, or family perspective). Such comments will be removed at the discretion of the Pallimed editors. Any posts older than 14 days are moderated to reduce spam.

We ask that you refrain from providing specific details about cases because of HIPAA restrictions. But if you want to discuss a case more broadly, that would be more appropriate.

Our full comments policy is here.

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While looking through recent articles in Obit Magazine, I came across one about a cancer blogger, Leroy Sievers who died August 15, 2008. (I think blogging is a form of contemporary literature that we haven't brought up yet.) Sievers, who was an executive producer for Nightline, began blogging about his cancer experience in 2006 when he started writing commentary for NPR's Morning Edition.

Sievers was diagnosed with colon cancer about 4 years earlier. In 2005, he was found to have cancer in his lung and brain and was given 6 months to live. He participated in a Discovery Channel documentary entitled "Living with Cancer".

He used his blog to discuss his experiences with the medical community and how his diagnosis effected him emotionally and physically.

"My doctors are trying to poison me. Oh, they have the best intentions. They call the process chemotherapy. The idea is to poison the body enough to kill the cancer, but not quite kill the patient. Best I can tell, it's a difficult line to walk. " May 11, 2006

His commented on a lot of the daily issues and life changes that his cancer brought. Some of these topics included outliving his prognosis, keeping clean, giving up his beloved Jeep that he could no longer drive, and making the decision to sign on to hospice. The post below describes another big change.

"It pretty much fills the room. It took four of us, actually five of us, to get me into it.
It's my new bed.
The only really scary part was when I slipped and almost fell on the floor.
The bed's electric. It lets me do things I couldn't do before.
But let's be honest, too. It's a hospital bed. It was not an easy decision to bring it into the house.
But here I am, in it.
Cancer World brings another change." August 11, 2008


Sievers' wife Laurie Singer continues his blog.