Monday, March 7, 2011
This is the final selection on this mini series on children's books that deal with grief. I'm sure we'll review more books in the future, however these were the 5 books my local rural library had on hand. It ended up being a nice eclectic mix and hopefully illustrates the variety out there.
Grandma I'll Miss You is written by Kathyrn Slattery and illustrated by Renee Graef. The book was published by Chariot Books in 1993 and is listed for ages 4-8.
The main character in this book is Katy, who is dealing with some very mixed emotions. She is aware her grandmother is dying and she is also anticipating the birth of a new sibling. This book uniquely brings in the idea of birth being similar death.
The beginning of the book is very story like, spending most time on Grandma's life. I suppose you could say this is the life review portion, as Grandma shares memories from her life. As in the last two books reviewed, one of the big questions Katy has is "What will happen to Grandma when she dies? and Is there really such a place as heaven?" Unlike the other books these are just thoughts Katy has and aren't directly addressed.
What is refreshing is that Katy actually asks her grandma, "are you afraid about dying?" This leads to a creative illustration linking death and birth together. The grandma admits her slight fear, but then tries to put herself into the unborn babies shoes, as the baby too has no concept of what it will soon experience.
The next pages are very Christian based in concepts about heaven, and about getting a new body there. Katy and her Grandma wrap up the conversation and then the very next morning the Grandma dies. I did appreciate the statement on the book's last page, "Death, in its way, was as natural a part of life as birth", something we in palliative care definitely understand.
The illustrations in this book are simple and realistic. There isn't any thing that stands out in color scheme or medium used.
In terms of recommendation, this book probably has the most narrow audience of the one's we've reviewed. If it is line with a family's personal beliefs, then it would be a good conversation book, though it seems geared to older than the quoted 4-8 yr. old. I did enjoy the normalization of death as similar to birth, and think there could be some other concepts related to that link to help grieving kids.
To sum up these last 5 book reviews, it seems that a common theme for children's books are the "What happens after?" questions. 3 books had different answers, and if that is the question your child is asking, it would be important to find a book with the answer you want to share! The other type of book seems to be about grief itself - normalizing feelings and emotions one goes through in the process.
I hope to keep reading and familiarizing myself with what's out there so that when families ask me what to do, I'll be able to delve into the issue of concern, and make some more informed recommendations!
Monday, March 7, 2011 by Amy Clarkson · 3
Monday, February 14, 2011
This next book in our series may be chosen by some simply for the beautiful illustrations. This is one reason I wanted to spend time reviewing some books on childhood grief. Although great lists exist out there, we don't often get to see inside the book itself. Having a toddler myself, I am aware that it is often the illustrations that spark her interest in reading.
Somewhat like our last review on Maria Shriver's book What's Heaven?, author T.A. Barron describes this book as autobiographical. The personal nature of the story definitely adds to the sincerity of the story.
Where is Grandpa? is written by T.A. Barron and illustrated by Christ K. Soentpiet. The book was published by Philomel Books in 2001 and has the age group listed as 4-8.
The voice is first person, and the plot follows a young boy on the day of his Grandpa's death. Much of the story is told in memories, as each family member shares about a favorite time with Grandpa. However, when it is the boy's turn he is speechless. After being prompted by his mother about a story he thinks, "Even if I did, I didn't feel like telling it."
Although the family tries to think of suggestions, I appreciate that the boy is allowed to remain silent. The boy then works up the courage for the big question, "Where is grandpa now?"
The final pages attempt to answer this question. Although the word heaven is used, the father quickly adds, "heaven means different things to different people. And it's hard to explain." Ultimately it is described as "any place where people who love each other have shared some time together." This allows the boy to get out of his sad funk and begin to think of the places he shared a memory with his grandpa. In fact the last illustration of the book shows the boy actually smiling.
As mentioned, the illustrations are exquisite. Done with a very realistic feel, there are a lot of nature scenes with special attention on the lighting. Most of the story takes place at dusk, and the illustrator actually moves us subtly through a sunset to darkness during the book.
This is another book I would recommend. It is lighter than some of the other books reviewed, not tackling as many concepts or questions. However, I appreciate the simplicity and hope offered in the story. Like the Shriver book, because this is based on a personal story, we encounter this family's personal beliefs/opinions and one should be comfortable in the concepts presented.
One more to book to go... stay tuned.
Monday, February 14, 2011 by Amy Clarkson · 0
Monday, January 31, 2011
This next book in our series of children's books that deal with grief has a famous author, which will often add to the appeal in buying a book. Perhaps from the media's input, I had also already heard of this book before actually getting it from the library.
The author, Maria Shriver, points out on the back that this book came from actual discussions with her 6 year old, at the time of the daughter's great-grandmother's death. I think knowing that perspective helps in the review as well, since the previous books Tear Soup and When Someone Dies was written by a hospice worker and grief counselor, respectively.
What's Heaven? is written by Maria Shriver and illustrated by Sandra Speidel. Published by Golden Books in 1999, the age listed for reading 4-8.
Although the title would imply a book all about Heaven there are definitely other topics covered. The plot line follows Kate who comes home to find her mother sad and news that her great-grandmother has "died and gone to Heaven". This prompts not questions about death or what "died" means but questions about what Heaven is. The concepts specifically in question are: Where Heaven is?, Are animals there? and How do you get there? I think these are questions I myself would like to know!
There is also discussion about what a funeral is and thanks to cousin Bobby, questions about the actual casket. Here's an example of a conversation Kate has with her mom: "Bobby told me we are going to a funeral where we are going to bury Great-grandma in a box. Why are we going to do that? Will it hurt Great-grandma? How will she breathe in the box? What if she wants to get out?"
As is typical of little ones, there are many more questions than answers in the book. As parents have learned, it's more about the concept we are sharing than the specifics of each question. This book is similar, the general message is one of hope; that after death there is a distant, safe place where all the best parts of someone goes... that it's okay to be sad and it won't last forever and that by remembering our loved ones they remain alive in us.
The illustrations are done in pastels, with a more vibrant feel than some of the grief books I've seen. The pastel's also allow for a dream like or memory like quality, as sharp details are left out. There are a lot of words on each page, and no paragraphs, perhaps emulating the way children can move from one topic to another in stream-less fashion. Each page does have one phrase that is doubled in font size, I suppose then if just browsing the book you could pick up on the highlights.
If you have a child with some of these specific questions, it would be a great book! What's challenging in these types of personal stories, is that your family may not agree with all of the concepts presented. For instance if you don't want to teach your child, "when your life is finished here on earth, God sends angels down to take you up to Heaven to be with him" Then you'd have to either skip the page or do some other teaching on what your family concept is.
In comparison with the other books reviewed thus far, this book is by far the most specific in terms of one family's beliefs and/or opinions. And rightly so, as the author makes no presumption of being an expert, but simply using her own experience to share with others...
Stay tuned, we have a few more to review!
Monday, January 31, 2011 by Amy Clarkson · 2
Monday, January 17, 2011
As mentioned in the first in this series on children's literature dealing with grief, there is an abundance of material out there to recommend to families with children dealing with grief. In fact, it's often overwhelming with so many choices. Hopefully this random sample from my local library will, if nothing else, illustrate the wide variety of books out there.
Often until you actually see inside the book yourself, it's hard to know which book is the right one. In fact, if you went on just book lists, the book I'm reviewing today is by far on more lists than any other books I'm reviewing, making me assume it is very popular. Yet without reading it, as you may see, I wouldn't have discovered it's unique style, different than Tear Soup, or even The Goodbye Boat reviewed in an earlier post.
When Someone Dies is written by Sharon Greenlee and illustrated by Bill Drath. Published in 1992 by Peachtree publishers it is written for a reader aged 8-12.
The book is considered plot-less, with each page making more of a conversational statement in second person. This approach seems to lend itself to a normalizing of the emotions and issues surrounding grief. The statements center around feeling sad and mad, but also about concepts of dreaming of your loved one, and worrying if other people around you will die too. For example, here are some of the statements:
"If the person who died was very important to you, you get to worrying that all the other important people might leave too. I've never heard of it happening that way, but it's hard not to think about it"
"When people die, they can't come to your house anymore. You wonder what they'd look like now, and you do all you can to make a picture of them in your mind."
Towards the second half the author begins to task the reader to actually do some things such as finding someone to cry with and writing a letter to the person who died.
Besides normalizing grief with the second person speech, I noticed that the word "dies" is used 10 times out of a total of 15 pages of statements. I can't help but think even using the word is a way to normalize the experience. No metaphors in this book, death is definitely the main character.
The illustrations use a washed out almost dull tone, adding to the mellow nature of the book. One thing I found interesting is that all of the scenes are out doors in nature and the people all Caucasian, which doesn't do much to normalize to a wide audience.
I think for certain children, this type of writing style is what is needed. Due to this books popularity on many of the lists out there, it's definitely good to be familiar with it!
Stay tuned again for more books coming up...
Monday, January 17, 2011 by Amy Clarkson · 2
Sunday, January 9, 2011

An Indie store near you

Borders

In Europe
at CD WOW
Sunday, January 9, 2011 by Unknown · 2
Monday, January 3, 2011
If you look at any bibliography of childhood grief books, it is likely to be quiet extensive! Take for instance the bibliography on the Child Grief Education Association website, here. The good news is that there is no shortage of literature available.
My question is, though, with so many choices- which ones are the best? This answer probably has much to do with the child's age, the questions they are asking and simply the child's personal preferences in books. A simple title of a book won't give any insight into the intricacies of the book, thus we must rely on word of mouth or websites such as BarrHarris.org, Childlife.org or the many other hundreds of grief websites that give a synopsis of the books. But even this doesn't give a clear understanding of what the book is like.
The best option, would be to read them all ourselves. While a lofty goal that I have not yet achieved, this week I did the best I could; I went to my local library in rural America and checked out all the books I could find on childhood grief. Hopefully the reviews of these books, with illustrations and story plot will give you a more thorough idea of some of the children's books out there.
For this first post I have chosen a book that has great appeal for adults as well as children. I would consider it a "cross-over" book, and may in fact be more of an adult book disguised as a children's book.
Tear Soup is written by Pat Schwiebert and Chuck Deklyen, Illustrated by Taylor Bills. Published as a 3rd Rev. edition by Grief Watch in 2005, the age level listed for reading is age 4-8.
The main character is Grandy, who has suffered a 'great loss'. She spends the pages working on her tear soup, which serves as a marvelous symbol of grief. The universal statements packed into the book are so subtle, sometimes it takes a moment to recognize them. For example, "It seems that grief is never clean... To make matters worse, grief always takes longer to cook than anyone wants it to"
She deals with adding memories to the pot and even the profound concept of the time that memories seem to run out, and the emptiness felt then. There are interactions with neighbors and friends, as Grandy says, "They filled the air with words, but none of their words took the smell of tear soup away." Or when she comments that, "most people can tolerate only a cup of someone else's tear soup."
The book also approaches faith issues, as Grandy "demanded to know where God was when she was feeling so all alone."
As one might guess, Grandy works through her grief until she realizes it's time to eat something else instead of only tear soup. The book ends with a nice summary of Grandy's journey, "I've learned that grief, like a pot of soup, changes the longer it simmers and the more things you put into it. I've learned that sometimes people say unkind things, but they really don't mean to hurt you...and most importantly, I've learned that there is something down deep within all of us ready to help us survive the things we think we can't survive."
This book has wonderful illustrations and while I am not sure a pre-school child would understand the significance of all the metaphors, it would certainly provide a starting point for topic discussions. It may also serve as a great recommendation for a family with an adult who has been resistant to dealing with their own grief... by innocently entering into the realm of a kid's book, they may be surprised to have issues raised within themselves.
Stay tuned over the next weeks for more reviews of children's literature and feel free to leave your own favorite children's books about grief in the comment section below.
Monday, January 3, 2011 by Amy Clarkson · 8
Monday, November 1, 2010
Dr.Chen is a surgeon who does both liver transplants and liver cancer surgery. Most recently on faculty of UCLA department of surgery, she speaks nationally and writes a column for The New York Times.
Her book, as the title implies is a autobiographical reflection of her experiences regarding death; beginning in medical school and moving through various training periods. We in palliative care, of course, deal with death frequently, thus reading this book you will surely find things that resonate with you as well as things that frustrate you.
Her writing style is very engaging in its authenticity and narrative form. I read about patients that could easily have been people I have taken care of in my own training. The honest insight into her thoughts is refreshing. I enjoyed watching the transformation of her own avoidance of death, to a timid acceptance of death.
There are fundamental ideologies that she depicts that are very entrenched in our medical system as the following quotes illustrate:
"Along the way, then, we learn not only to avoid but also to define death as the result of errors, imperfect technique, and poor judgment. Death is no longer a natural event but a ritual gone awry.....By evading death, we miss one of the best opportunities for us to learn how "to doctor" because dealing with the dying allows us to nurture our best humanistic tendencies" (p95)
"Over time we come to believe so deeply that sublimating our fear of death makes us better doctors that some of us will skip around the very word during our conversations with terminal patients."(p205)
She records poignant questions around the idea of when to stop curative measures, and when care becomes more about doing something "to" someone instead of "for" someone in vignettes about Sam, a young man with brain mets and Max, and infant born with gastroschisis who required a liver and bowel transplant. Having had these conversations with people, I found myself wanting to answer Sam's wife when she wonders, "When do you know....when you have done enough?" (p145)"Your liver is struggling" I said. But Franks's liver was not struggling; it was failing. I knew that in the next few days he would likely fall into a coma and die....I could not bring myself to describe that outcome." (p187)
She ends her conversation with a hopeful remark about checking the labs tomorrow to see if they improve.
It was moments such as those I wanted to jump into the pages and say "No...you can do it... you can be honest to Frank in a compassionate way!"
The final story is I suppose the transformation Dr. Chen makes. She recounts a patient with cholangiocarcinoma who wanted to die at home. As he gets sicker and she realizes his prognosis, she allows him the decision to decide his outcome, whether to head to the ICU for more invasive interventions or head home to die. There is no surprise that he opts to go home. I found it interesting that still, in the final paragraphs of the book that she continued to struggle with his death. She closes out the book with these words:
If I had one wish about the book, I would have hoped to read more about palliative care. In so many of these examples I longed for their presence to offer guidance in communication and discussions about goals. While it is refreshing that Dr. Chen is being transformed as a physician to have these talks in a compassionate way, the truth is, most health care workers still find themselves trapped in the ideologies about death and prognosis discussed in the beginning chapters. While it is lovely to envision a medical education system that trains up physicians comfortable with death, it remains an ideal at best. In the meantime, let's get those palliative care teams involved!
Overall, this is a book I would absolutely recommend; an engaging narrative that we can all identify with!
Monday, November 1, 2010 by Amy Clarkson · 3
Monday, January 25, 2010
A young boy's parents are violently murdered. His mother, in fact, died protecting him from the murderer (Voldemort). His is sent to be raised by a family who at best neglects him, at worst abuses him. He continues to be stalked through his adolescence by the same murderer who took his parent's lives. Some pretty heavy stuff, especially for a series of children's books. In the Harry Potter series the theme of death comes up over and over again. (If you're not familiar with the series, please read the Wikipedia page linked to above.)
In one interview the author, JK Rowling, commented, "My books are largely about death. They open with the death of Harry's parents. There is Voldemort's obsession with conquering death and his quest for immortality at any price, the goal of anyone with magic. I so understand why Voldemort wants to conquer death. We're all frightened of it." Given that so much of her books are about death, I wanted to take a closer look at how death is viewed within the series.
First off, death in the series is irreversible. No spell can bring back the dead. In a world with so much magic, death seems to be one of the few absolutes. There are ghosts who are said to have feared death so much they didn't cross over. There is magic that allows the dead to be seen. But nothing that brings them back.
For the most part death is something carried out by the evil on the good. This is a tendency of many children's books/movies. Even given this, death isn't always portrayed here as the ultimate bad. "To the well-organised mind, death is but the next great adventure." (Sorcerer's Stone) There are conversations that suggest there are worse things than death, namely being unable to love.
Voldemort, the bad guy, has a fear of death and seeks to escape it, even to the point of killing others to achieve immortality. He even calls his followers Deatheaters. Interesting that this quest for immortality, seeing death as the worst thing that could possibly happen to you, is an evil quality in the books.
One issue that I did have with the books, the deaths tended to be glazed over a bit. When major characters are killed off, there is some initial anger, a little sadness, but then it really doesn't dwell too much. Maybe I'm expecting too much depth from a children's book.
Overall, I think Rowling handles a difficult topic reasonably well and in an entertaining fashion. I would probably give it an A for entertain value, a B for the treatment of death, but a C for the emotional follow-through. I would be interested to know how children reading the books would view it.
Monday, January 25, 2010 by Amber Wollesen, MD · 2
Monday, October 12, 2009
When most people think of Stephen King, they think of killer cars, haunted hotels, and prom nights gone wrong. Palliative care isn't generally the first thing that comes to mind. I don't usually read Stephen King as I'm not a big fan of the horror genre. When I read "The Woman in the Room" my first thought was that King had moved away from horror for this short story. But on second thought, I think it is actually a movement from supernatural horror to a real life type horror. (The picture is from the short film made in 1983.)
John is a loving son dealing with his mother's terminal cancer and severe pain issues. It is written in the third person and most of the story is like a description of an internal dialogue as John is trying to make a difficult choice. He has found a bottle of "Darvon Complex"(propoxyphene with aspirin) in his mother's medicine cabinet and he is wondering if he could end all of her suffering.
Things get worse when she is admitted to the hospital for pain control. She has a procedure that he calls a 'cortotomy' in which a needle is placed into the pain center in the brain and that area is "blown out"(This story was written in the '70s.). This procedure leaves her paralyzed but still in pain. John continues to toy with thought of giving her the pills as he visits her daily.
"She imagines the pain. But it is nonetheless real. Real to her. That is why time is so important. Your mother can no longer count time in terms of seconds and minutes and hours. She must restructure those units into days and weeks and months." What does the doctor mean when he says this? Prepare for the long haul? Since the pain is so bad, don't focus on the now, focus on the future?
John carries the pills around with him for awhile. He tells no one of his plan. He tries to talk himself out of it. If she has a roommate, then he'll be off the hook. If she says anything about the pills he gives her, he'll just put them back. In the end, everything falls into place. He gives her six Darvon tablets and then leaves the hospital to wait for the phone call.
I'll pretend for the sake of this post that six Darvon is a fatal dose. (Although I'm doubtful that it would cause any more than ringing in the ears (from the aspirin). But I'll admit that I've never given anyone six Darvon to know.) I'm not writing about this story to endorse John's actions or judge him either way but to acknowledge the sentiment. I have often heard "Isn't there something we can give that will make this go faster?" and "It's not fair. If my dog was suffering we could put it out of it's misery, but we can't do that for my mom?" It comes up so frequently I would categorize it as a very normal feeling.
It seems King's inspiration for the story may have come from his own life.
"Perhaps it is his fault anyway. He is the only child to have been nurtured inside her, a change of life baby. His brother was adopted when another smiling doctor told her she would never have any children of her own. And of course, the cancer now in her began in the womb like a second child, his own darker twin. His life and her death began in the same place: Should he not do what the other is doing already, so slowly and clumsily?"
King also has only one brother, who was adopted, and his mother died from uterine cancer in 1974. He is also reported to have had drinking problems around the time of his mothers death, another similarity to John in the story.
Works referenced:"The Woman in the Room" Night Shift by Stephen King.
Monday, October 12, 2009 by Amber Wollesen, MD · 3
Monday, September 7, 2009
Bringing food to neighbors or friends after a death is a custom still seen as a part of our grieving practices. It may have started with the ancient rituals of bringing food for the deceased. In Egyptian history it was expected that the dead were given bread, beer, birds and beef. Even now, in Tibet, at all the Buddhist monasteries you will find piles of food gifts for the former Lamas.
The cultural and regional differences abound for what people typically bring. Fried chicken in the South and Jello salad's in the North. There are even names associated with foods like funeral beans, funeral potatoes and funeral pie.
Looking for some music on the subject? Kate Campbell actually wrote a folk song about funeral food. It's on her 2007 release "Sing Me Out". The lyrics are below with a link to a YouTube video of a live performance. I must say it's a very catchy song. The actual song starts about a minute and 34 seconds in, if you want to skip the talking... and as always you can go to the main pallimed site if the link doesn't show up.
It's so good for the soul
Funeral food
Monday, September 7, 2009 by Amy Clarkson · 2
Monday, August 24, 2009
Ronald Munson is a bioethicist who has worked for such esteemed organizations as the National Institutes of Health and the National Cancer Institute. He has also authored several non fiction books, as well as one of the most widely used medical ethics texts in the United States. His newest book "The Woman Who Decided to Die: Challenges and Choices at the Edges of Medicine" was published in 2009 by Oxford University Press.
When I read the prologue, describing that the flow of the book would be ten scenarios of real world moral dilemmas faced by Munson himself, I was pretty eager to jump in.
While the stories themselves were extremely well written and even page turning in their narrative form I was surprised with how common place I found them. I was expecting moral and ethical dilemmas that would spur hours of discussions amongst my colleagues. What I found were stories more geared to a non medical audience. For those of us in the trenches, these are a part of our daily experiences.
For instance, there was a 31 year old woman who opted to not pursue further chemo. Now it was a little edgy that she decided not to bring her husband into that decision, but I'm pretty used to people not wanting to pursue chemo, even if doctors know it will help or even with a chance of cure.
Another woman with a schizophrenic break, was a suicide risk and was committed against her will into a psych unit. Yep, pretty standard.
I'm probably sounding too critical. It is a very well written book, I just think it is my career in palliative medicine that skews the "wow" factor.
Probably the most interesting story I found was about an inmate who had been convicted of murder (that of a woman and her child), who was admitted from prison in need of a heart transplant. I did find myself wondering what the outcome would be, as different states have actually taken different approaches to this exact scenario. California has transplanted an inmate to the tune of an estimated cost of 2 million to the state, while as Arkansas denied a transplant to a inmate, who then died of liver failure. You'll have to read the book to see what Munson suggested at an emergency ethics meeting regarding this case.
This review would not be complete without mentioning the narrative I had the most trouble with. The story was of a man with throat cancer, who had communicated with family and friends that he wouldn't want to be kept alive if his quality of life was not an acceptable one. Things progressed, he had a final surgery which removed most of his tongue and half of his face (both upper and lower parts of his jaw) and was on life support after surgery. He was dying anyway of cancer, and his wife stepped up to advocate his wishes.
What happened next is what troubled me. In this situation I would expect a palliative care consult, a review with medical staff and nurses for a planned extubation with family at bedside for the switch to comfort measures. Instead something clandestine occurred. We aren't quite sure, but the doctor was in the room alone, and then comes out saying his bleeding had worsened, blood pressure dropped and he died. WHAT? The implications was that this doctor actually did something to hasten death. Even more alarming were these last sentences in this chapter;
"Patients are given large doses of morphine to reduce their pain. The drug also slows respiration, so an amount effective in controlling pain can, in a weakened patient, hasten death"
I nearly jumped from my chair. Morphine used as an amount to effectively control pain does not hasten death! When will such fallacies quit embedding themselves into literature and the media. I expect such things from a non-medical author, but clearly Ronald Munson,while not a clinician, is experienced in the medical world.
Perhaps these were stories from the edges of medicine, but I'd almost guess that like the galaxy expanding, the edges he knew are now just generally accepted principles. It is the new edges we deal with now that I hope to someday see in print.
Monday, August 24, 2009 by Amy Clarkson · 4
Monday, June 29, 2009
There is a vast amount of children's literature available about death. I wanted to review one such book I came across recently. It is a visually beautiful book, with sweeping oil paintings depicting the metaphor of death as leaving on a boat. The book "The Goodbye Boat" is by author Mary Joslin and is illustrated by Clarie St. Louis Little.
There are few words in this book, leaving the message to be portrayed visually. Two grandchildren are depicted with their grandmother. At first they are at play in summer by the beach. Then in the sunset a ship approaches. The grandmother waves goodbye and as the climate turns to winter the boat sails away. However as summer comes again the message is clear, with the children once again playing on the beach and happy.
The final phrase of the book, "yet when the boat is gone from view it's surely sailing somewhere new" is meant to provide hope after all of the sadness.
I like that this book gives its message in short words like "wondering", "weeping" and "lonely days". These phrases coupled with the moving pictures would surely help instigate conversations with children reading it.
In fact, in one of the reviews on amazon.com, I noted a reviewer said she read this book to her grandnieces after a death, and they asked to re-read it multiple times, each time asking new thoughtful questions about death.I also like the various metaphors. The seasons that match the emotional responses is nice touch. The boat metaphor I like better than the "going to sleep" metaphor which can be confusing for young kids. However, this too can be confusing if the child assumes this as concrete fact. As one review pointed out, a child may assume the boat will come back... awaiting their loved ones return.
I also appreciated that the boat was seen approaching, long before the grandmother left on it. Although very much an ideal, it gives the sense that one can prepare and have a chance to say goodbye.
I think if I had to pick my favorite page of the book it would be this one below, with the words "wondering,". I encounter this feeling more often on a daily basis, doing palliative medicine work, than any of the other expected feelings of sadness, anger, etc. You can see the sad frustration and unknown in the expressions of the kids as well as the grandmother herself. Wondering is experienced by both patients and families, as well as with those of us in the medical world.
Joslin, Mary. "The Goodbye Boat" Eerdmans Books For Young Readers: Grand Rapids, Michigan. Copyright 1998
Monday, June 29, 2009 by Amy Clarkson · 0
Monday, March 9, 2009
In 2003, writer Joan Didion's husband died suddenly of a heart attack while sitting down for dinner. Didion wrote The Year of Magical Thinking detailing the year that followed his death. The book starts with the first words she wrote after her husbands death.
"Life changes fast.
Life changes in the instant.
You sit down to dinner and life as you know it ends.
The question of self-pity."
While grieving for the loss of her husband, Didion is also dealing with the critical illness of their only child who is in the ICU with pneumonia. They had, in fact, just come back from visiting her when John had the heart attack. Quintana's lengthy illness is a subplot throughout the book. While the illness definitely complicates Didion's grieving, it also seems to serve as a distraction. (Quintana died shortly after the book was published.)
Didion seems to describe every impulse and emotion of the first year of grief.
" ...Grief has no distance. Grief comes in waves, paroxysms, sudden apprehensions that weaken the knees and blind the eyes and obliterate the dailiness of life."
She weaves memories of her life with John and Quintana together with her present day grief in a way that could have seemed choppy if done by a lesser writer. Didion's account flows very naturally as if we were reading straight out of her mind. It feels that honest as well.
She has a remarkable insight into her own thoughts and feelings, her magical thinking. Below, she describes the painful process of clearing out her husbands things.
"I stopped at the door to the room.
I could not give away the rest of his shoes.
I stood there for a moment, then realized why: he would need shoes if he was to return.
The recognition of this thought by no means eradicated the thought.
I have still not tried to determine (say, by giving away the shoes) if the thought has lost its power."
As I read Didion's book, I couldn't help but think that writing it must have been painful but also like therapy for her. A way to process through her thoughts and her grief. While some may come off as self-absorbed, writing a book entirely about ones grief experience, I think Didion comes off as generous for sharing something so personal with us. At the end, she doesn't offer any answers to her grief, no big bright light at the end of the tunnel, but sort of sums up her life with John.
"I think about swimming with him into the cave at Portuguese Bend, about the swell of clear water, the way it changed, the swiftness and power it gained as it narrowed through the rocks at the base of the point. The tide had to be just right. We had to be in the water at the very moment the tide was right. We could only have done this a half dozen times at most during the two years we lived there but it is what I remember. Each time we did it I was afraid of missing the swell, hanging back, timing it wrong. John never was. You had to feel the swell change. You had to go with the change. He told me that. No eye is on the sparrow but he did tell me that."
References: The Year of Magical Thinking. Joan Didion. 2006.
Monday, March 9, 2009 by Amber Wollesen, MD · 2
Monday, November 24, 2008
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.
Monday, November 24, 2008 by Amber Wollesen, MD · 0
Monday, July 7, 2008
My Sister’s Keeper is a novel by Jodi Picoult. This is the story of a family dealing with the chronic, life-threatening illness of one of their daughters. Kate was diagnosed with a rare form of leukemia at age 3. In desperation for a donor for Kate, her parents decide to have another baby, Anna, who is created to be a perfect genetic match for Kate. The story goes back and forth between present day (when Anna is 13) and the past, reviewing the history of Kate’s illness and how that has effected Anna's life. The present day storyline follows Anna as she files to become medically emancipated from her parents. After years of donating parts of herself to Kate, Anna decided to draw a line. She did not want to be forced into donating a kidney.
Picoult puts a lot of work into developing the characters of the book. Chapters of the novel are written from the perspectives of the different characters. Brian (Anna’s father) is a firefighter. His role seems to be putting out the fires that his family members start (literally and symbolically). Brian is also a star buff. The author incorporates star mythology into the story. Anna’s name is actually Andromeda, the princess in Greek mythology who was to be sacrificed to a sea monster as punishment for her mother’s bragging. Like the princess Andromeda, Anna was also giving up her life for her mother, who has been driving all of Kate's medical care.
Through her court case, Anna is forced to confront her parents with the real reasons she filed her lawsuit. Her mother has to come to terms with Kate’s illness and the possibility that Kate might die.
Warning: Spoiler Ahead. Highlight to read.
*The story takes a sudden and dramatic turn when, after winning her court case, Anna is involved in a car accident and is declared brain dead. Her kidney is donated to Kate and their parents are left to turn off the ventilator. (It actually seemed a bit too dramatic for me.)
Making parents turn off the ventilator themselves makes for good drama in a novel but not so realistic. Also, this happens after they donate her organs. It talks about feeling her pulse stop and the monitor flatline. Did they just donate her kidney? Not her heart? And they bring her back to the ICU after the donation so that the ventilator can be shut off? Not very realistic with the organ donation process.
The epilogue is written from Kate’s point of view after Anna’s death. Kate blames herself as Anna wouldn't have been in the car if it had not been for the lawsuit.
So in the end, who is the “sister” of the title My Sister's Keeper? Is it Anna who is the keeper of Kate or Kate who is the keeper of Anna? Anna’s donations kept Kate alive for years. Throughout the story I always assumed that Anna was her “sister’s keeper”. In the end, Anna still lives on through all she has donated to Kate. So Kate is essentially keeping Anna alive. *
The story brings up ethical issues of genetics and creating “designer babies”. Apparently Jodi Picoult became interested in the topic while doing research on eugenics. It balances this with the plight of parents who would do anything to save their dying child. It also deals with the rights of children to have say over their own bodies and make their own health care decisions. It seems at first that this is the predominant theme in the book. Later it is apparent that it’s more about parents coming to terms with their daughter's potentially terminal illness. When is it ok to say enough?
This is just a superficial overview of this book. Despite a couple medical inaccuracies at the end, I would recommend it. There is a plan to turn this novel into a film later this year.
Monday, July 7, 2008 by Amber Wollesen, MD · 0




