Christian Wiman, editor of  Poetry magazine since 2003, was recently interviewed by Bill Moyers about his journey with cancer, falling in love and finding faith in the midst of death. Wiman was diagnosed with Waldenstrom's macroglobulinemia 6 years ago.  He's recently undergone a bone marrow transplant and tells Moyers he's in the "wait and see" phase.

As only a poet can do, Wiman's experience of being in danger of dying has allowed him to capture sentiments many of our dying patients may identify with.  His latest book of poems, "Every Riven Thing" (Farrar, Straus and Giroux, 2010) captures these moments so artistically that it's easy to resonate with each word.

In the interview with Moyers found here, Wiman reads a poem he wrote while in the hospital. It was right before chemotherapy started, and written in just one day.

It begins,  "Love's last urgency/ is earth and grief is all/ gravity and the long fall/ always back to earliest/ hours that exist/ nowhere but in one's brain."

The poem later ends with "mystery mastering fear,/ so young, standing unstung/ under what survives of sky./ I learned too late how to live./ Child, teach me how to die."


Wiman goes on to talk about the opening line of the poem saying, "I think there's a notion that  when you're sick, when you're in danger of dying, that you want to get beyond. You know, you would think you want experience that takes you beyond earth. You want some since of an afterlife or ...beyond. But My experience has been the opposite, that when you feel threatened, what, in fact, you want is the earth. You want concreteness.That's what rescues you."

How profound. I also identified with the concept of going back to "earliest hours that exist", don't we experience this in palliative care? We often counsel families to not be alarmed when hearing a strange story from a loved one. It actually may be a memory that existed, "nowhere but in one's brain."

Besides being confronted with mortality, Wiman has also experienced excruciating pain throughout his disease process and treatment. He said that this even more than the idea of death has impacted him.

An essay he wrote related to pain was published in the Harvard Divinity Bulletin for Winter/Spring 2012  and Wiman read it during the interview. In the words below I am struck with his isolation but also with the final effect of desire for God in the aftermath.

"Six years have passed since I wrote the first words of these notes. I have been in and out of treatment, in and out of the hospital. I have had bones die; joints lock in my face and arms and legs so that I could not eat, could not walk; cancer pack[ed] my marrow to the point that it began to expand excruciatingly inside my bones. I ... filled my body with mouse antibodies, small molecules, chemotherapies eating into me like animate acids. I have passed through pain I could never have imagined, pain that seemed to incinerate all my thoughts of God and leave me sitting there in the ashes, alone. I have been islanded even from my wife, though her love was constant, as was mine. I have come back, for now, even hungrier for God, for Christ, for all the difficult bliss of this life I have been given. But there is great weariness too. And fear. And fury."

Thanks to Chris Okon for steering me to the interview. For those, like me, who had not read Christian Wiman's poetry or prose, this will be someone to add to your collection.

61 year old jewelry maker Susan Braig was diagnosed with breast cancer in 2004. Braig had private insurance but was under-insured and left many thousands of dollars in debt. She found a unique way to combine her illness and her art to help pay off her medical bills.

In 2007, Braig went to a medical themed art exhibit and got the idea to use her own leftover pills in her jewelry. "I bought my first round of medicine and it cost $500 out of my own pocket," she said. "I looked at the drugstore receipt and then at the little pills and wondered if they were precious gems." One of her first pieces was a princes tiara made from her cancer medications. Now Braig gets old medications donated to her by friends to transform into her jewelry art. She launched a line of jewelry called Designer Drug Jewelry.

My first thought, is this even legal? Apparently, she seals the pills so that they are unusable. (I wonder if she has rules about what pills she uses, like no Schedule IIs.) As she uses pills and gel caps, some of the jewelry is very fragile and heat intolerant. She uses old medication bottles and with cotton balls to package her jewelry.

I was intrigued by the story because I liked the symbolism. She has turned her old medications into "precious gems". Turning somethings that are likely symbols of her illness into something very unique and beautiful. I never saw pills, with all their different colors and shapes, as beautiful before. (I guess that's why she's the artist.) Also it just amuses me to see a necklace with "Zofran" written on it. Apparently her Viagra necklaces are quite popular.

Braig's story was recently featured in the LA Times which is where I found it. She has also been on NPR in the past, talking about her cancer debt and being under-insured.

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.

Cordula Volkening was born in Germany, and attended the School of Art and Design in Kiel, Germany. She immigrated to New York in 1985, but it wasn't until she was diagnosed with stage 4 brain cancer that art changed from a passion to a career.

Prior to her diagnosis in the summer of 2007, she worked mainly in interior construction design and renovations and raised her two children. Once diagnosed and given a one year prognosis, she literally began sketching right in the hospital and then when discharged went to work painting- creating 30 new works in the first three months after her diagnosis.

She wrote on her Myspace page in Nov. 2007, "I paint in between my radiation, chemotherapy and my daily session of are you kidding me... "

She did multiple art shows, often with fatalistic titles such as "Would You Like an Invitation to My Destination?" and "Transition: May We Go to the Places that Scare Us"

In January of 2009 the disease had progressed, and when given the option to prolong life with more chemo, yet render her too weak to paint, the decision was clear; no more treatments. A true palliative decision, since she valued making art over quantity of days.

A quote from a New York Times article by Corey Killgannon profiling her in Feb. 2009 states, "She said the terminal illness has simplified things, washing away the worry and petty preoccupations that almost made life harder when she had plenty of it. And she has never felt more connected to the canvas and to her creativity."

Other quotes from the article:

"she calls every painting a "gift" from the cancer"

"her painting style is shaped by one thing, 'I have nothing to lose'"

Cordula died April 22nd, 2009.

To see more of her paintings visit a slide show "A Passion for Art, Through Cancer", or Cordula's MySpace page. Also, interviews with her on Youtube. This first set done earlier in her disease is quite a contrast to the NY Times video done a few months before her death.

To reality TV fans out there, this post is probably old news. However, I recently was alerted to this clip from the TV show "So You Think You Can Dance". This show is a competition where dancers compete, are judged, then eliminated. On Wednesday July 22nd, there was a piece done as a tribute to those battling breast cancer.

The piece was choreographed by Tyce Diorio and preformed by Ade Obayomi and Melissa Sandvig with music by Maxwell's cover of Kate Bush's "This Woman's Work". The choreographer said he was inspired by his friend Michelle's battle this year with breast cancer.

The music is a beautiful accompaniment. Starting with what sounds like crying, the dancers mimic the emotion of sorrow at the diagnosis. The lyrics to the portion of the song played:

Pray to God you can cope
I stand outside
This woman's work
This woman's world
Oooh, it's hard on the man
Now his part is over
Now starts the craft of the father

I know you have a little life in you yet
I know you have a lot of strength left
I know you have a little life in you yet
I know you have a lot of strength left

I should be crying but I just can't let it show
I should be hoping but I can't stop thinking
All the things I should've said that I never said
All the things we should of done that we never did
All the things I should've given but I didn't

Oh darling make it go
Make it go away

There are beautiful moments symbolizing the friendship and strength of those who come along side someone with cancer. The dancer with cancer falls in exhaustion, her partner catches her; she dives out in trust and he catches her; she pounds on his chest in anger, and you watch him struggle privately. Ultimately she rises as he lifts her in resolution onto his shoulders.

Dance is yet another creative way to express emotions and narrative. The clip below is from the episode with some introduction, then the 1:20 min dance, followed by the tearful responses of the judges. Hope you enjoy! Subscribers, if you have trouble viewing the video please go to the original Pallimed post to view.

There are many movies out there with palliative themes, as we can attest to with our top 10 movie post, which garnered much comments. One of my all time favorites, also made number 1 on Amber and I's original list; Wit.

I first saw this movie in medical school. In fact, according to the IMDb, this movie is known for being shown at medical schools as an example of how not to practice medicine. Also, the plot deals with dying, so it's all the more relevant to those of us who care for dying patients.

The plot is this: An English lit prof., known for her high expectations and little compassion in the classroom is diagnosed with ovarian cancer. The movie shows her experiences from diagnosis to death. Her last weeks are spent in the hospital, undergoing rigorous treatment. She is alone, except for the nurses, attending and fellow who treat her. Through her reflections and memories there is a definite parallel between her heartless days teaching and the heartless medical system she is now in.

The movie is based on a play by Margaret Edson and this monologue, play-like background is the inspiration for the screenplay, making it unique. The soundtrack is simple with only 4 pieces listed. My favorite piece is "Speigel im speigel" or 'Mirror in a mirror' by Arvo Part. It is played often in the movie, the simplicity of the cello and piano is also melancholy, leaving the viewer with the feeling of being alone, just as the main character is.

I love this movie not just for it's ability to pierce me with its sad realities of the medical world, but also for it's subtle sub theme about death. All through out the movie we are bombarded with a certain text from a John Donne's Holy Sonnet 10. The main character was a John Donne expert and specifically recalls the punctuation differences pointed out at the end of this poem by her mentor.

The last line of the sonnet entitled "Death be not proud" is "And death shall be no more, Death thou shalt die." The version our main character had found was different "And Death shall be no more; Death thou shalt die!"

Here is the discussion with her mentor on the punctuation differences, talking about the version with the comma:
"Nothing but a breath, a comma separates life from life everlasting. Very simple, really. With the original punctuation restored Death is no longer something to act out on a stage with exclamation marks. It is a comma. A pause. In this way, the uncompromising way one learns something from the poem, wouldn't you say? Life, death, soul, God, past present. Not insuperable barriers. Not semi-colons. Just a comma. "

If only the main character's death could have been so simple. Yet of the many ways death is portrayed in films, her portrayal is haunting. No one should have to die like this, without dignity and respect (ignoring her DNR)...alone in a hospital. Yet it is haunting, because of how real this type of death is. It is the antitheses of a palliative care death.

I've included two clips from youtube. (For email subscribers click the title above to go to the web page to view) In the first, our main character (Emma Thompson) is thinking out loud. It's a lovely introspection of what's she's dealing with. The second is a beautiful moment when our character actually gets her one and only visitor, her old hard-nosed mentor. The simplicity of human connection in the clip, with the Arvo Part soundtrack accompanying, makes me tear up every time.





I'd also suggest reading John Donne's Holy Sonnet 10 "Death be not proud" (This version uses a semi-colon and no exclamation!)

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.