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“We love stories and we want the world to know what inspires us.” - Brandon Oldenburg, co-director, Moonbot Studios

Clinicians working with patients and families in hospice and palliative settings understand the power of story.  At our roots is the value of authentic listening.  It bestows respect, meaning and importance to people who may feel at times that nothing is going their way.  Many of the blog posts in Pallimed: Arts and Humanities are really about the story behind the artistic expression. This exploration of the meaning in art correlates with authentic listening.  When you slow down and appreciate and discover art in all its forms you amplify the meaning and importance, even if just to you as an individual.

In this digital age, my children (now almost 7) love playing on my iPad, sometimes Angry Birds, sometimes some educational apps.  One particular beautiful app caught my eye last year, The Fantastic Flying Books of Mr. Morris Lessmore (iOS only).  When I first saw it in the app store, it seemed so familiar to me, and after some exploration online I realized I had heard about this app from its earlier incarnation as a 2012 Oscar winning short film by the same name.
 

A quick diversion to the inspiration of the short film: The screenplay was penned by William Joyce, noted children’s author (The Guardians of Childhood) and directed by Joyce and Brandon Oldenburg. Both Joyce and Oldenburg are featured in the Oscars nomination clip. As Joyce shares in the ‘making of’ video, he created this story in the Fall of 2003 as he was going to visit the man who inspired it, William C. Morris, who was in poor health. Mr. Morris only lived a few short days after hearing the tale dedicated to him.  Mr. Morris was a strong proponent of children’s literature as noted by Michael Cart in The ALAN Review in 2003:

"He was that and more: he was also its heart. Bill loved good books; he loved their readers; he loved his work, and he loved HarperCollins. In return he was, himself, universally loved."

The story never was published and was not fully formulated until Joyce was able to experience Hurricane Katrina and its’ aftermath.  One can easily see how it inspires the early “Oz” like storm and resulting chaos and debris. Joyce received a grant to interview people affected by Katrina and describes the impact of seeing the blank stares on people’s faces which left a heavy impression. As strong evidence of the human spirit, Joyce was able to see their faces come to life as they shared their personal stories with him.   Co-director Brandenburg echoed the motivation for the project: “the curative power of story and that it can change lives”


The app description reinforced my ‘good parent’ motivations: ‘a story of people who devote their lives to books and books who return the favor.’  After a short download, my son and daughter proceeded to walk through the hybrid app/book.  The story begins with Mr. Morris Lessmore reading scores of books when a storm blows him and all his books away.  The muted earth tones of New Orleans architecture give way to a bleak gray landscape littered with debris and empty books.  In the background of this silent film, “Pop Goes the Weasel” repeats, but uses many different themes and tempos to reflect the myriad of moods depicted in the action: sorrow, joy, disillusionment, whimsy, hope.  Morris eventually comes to a library where the inhabitants are books who take him in, share stories, and enable him to spread the love of books to others.

If you have not watched the film ($3 iTunes), read the book (less than $15), or used the app ($5 iOS), I highly encourage you to purchase at least one of them and support the artists who made it.  You could find the film on YouTube from copyright violators, but if you do, I hope you purchase it anyway after you see how wonderful it is.

OK...YOU WERE WARNED.

Well, as I sat playing through the app with my children, I began to sense things were going to get more emotionally heavy at the end.  Mr. Morris works with these books and barely interacts with any other humans, he begins to age, and the seasons change.

I found the scene where he repairs a book in a surgical amphitheater particularly moving when taken in a palliative context.  The book old book flat lines on the EKG and can only be revived once he is read by Morris.  What an amazing allegory depicting how reading someone’s story actually brings them to life?

A short cameo of honor is also given to author Colleen Salley, who died in 2008.  You see her as the first woman Morris gives a book to.  Salley was a strong supporter of children’s literature who also understood why stories matter.  

“She believed in the power of story to change a life, and I feel like she needed to be in this short as well” - Joyce

At the end of the short, Morris completes his book, presumably his biography.  As he sets off to say goodbye to the books and leave the library, the books surround him in a transformational cocoon, and in a moment appears his younger self. Morris then jets through the sky, led by a squadron of flying books much the same way as the young woman encountered early in Morris’ post-storm journey.  At the closing scene we see Morris in a picture on the wall along with the flying book lady and a few other off-screen characters.

So as I watched this with my kids, I asked them what happened to Mr. Morris.  They floored me in saying, “He died,” as though it were a simple matter of fact.  I was expecting them to not pick up on the symbolism of death, but they saw it pretty straight forward.  They were a little sad at the end, but were eager to go through the app again.  On the second time through they asked me if the flying book lady was also dead.  After multiple viewings, I am not sure if this post-storm world is real life, a limbo, or an imagining of heaven. It was a fascinating conversation with my kids, and one that I imagine countless others may have had with their families after watching this amazing short.  

Share this one with your team, your family and share your thoughts with us in the comments below.

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Araya Rasdjarmrearnsook is an art teacher and one of Thailand's' foremost female artists.  She had her first solo show in New York last month with a video exhibition showing historic art history pieces from western culture to rural and religious people in Thailand in an exhibit titled "Two Planets/ Village and Elsewhere"

However, for me, it is her previous work I wanted to touch on for this post.  Araya first made headlines in the US with an group exhibit in 1996. More controversy came in late 1990's and early 2000's when her exhibits began incorporating corpses.

In works such as "The Class II" Araya is seen on video lecturing a classroom of corpses. The topic for this lifeless class? Death.  You'll see her ask the dead bodies, "Did you die in autumn?"  You can see this video on YouTube here. I was struck by the seriousness of her tone as she interacts with the class on a topic they surely must know.




 In "Conversations I, II and III" she meanders through a room of corpses humming.  In "This is Our Creations" she actually lies down next to the bodies and is heard saying, "I came here to know you, lying here motionless. Once my father sent me a postcard from very far away. Its sentence: only a still pond can reflect the starts."

My first thought was, what experiences has this woman had with death that has led her to express herself in this way? I had to do much searching to find the answer, but in an interview in 2005 with Oliver Benjamin, she told her story.

Her father was a physician, and at the age of 3, as her mother labored in childbirth with her father as physician, her mother died.  A week later the young sister born also died. In the following 3 years she lost a step sister aged 18 months, her grandmother and great grandmother. As she said in her interview, "From this reason, I guess, I have been interested in examining death"

When you look back, even to her etching "The Dream of Mother" in 1990,  you can see the processing of her life events.

Sometime in there, her father then died of cancer. In response, new pieces such as "The Dinner with Cancer I" and "Th Dinner with Cancer II" were done.

Araya has used art as a way to deal with death. Specifically in her words, "I choose art as process of thought for the meaning of death".  Araya spoke of that meaning in an interview with Brian Curtin in 2007 saying "In reality, life and death should not be understood as opposites. People deal with death by trying to hide it. They hide death behind ritual or hope to prevent it with medicine. I want people to have more imagination and confront reality!"

In the interview with Oliver Benjamin in 2005 she concluded talking about the topic with, "I'm tired of death! May be too much."  That's the goal isn't it? To work with our patients and families to process through it? For now the artist does seem done with death, as her art has moved on to exploration of different ideas.

Whether you are repelled or connected to Araya's work with death, it's what I love about art - a vehicle to express ideas which then stimulate the viewers mind.

To see works listed up until 2002 visit this site. For those 2002 and on visit here.


Oliver Benjamin interview published in Citylife magazine Oct. 2005
Brian Curtin interview published in Art Signal Oct. 2007
Works in order of appearance "Conversation I" (2005),  "The Dream of Mother" (1990) and "The Dinner with Cancer I" (1993)

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by Elliot Bennett

A couple  months back a friend of mine posted a link on her Facebook page while she was caring for an aging furry friend. The photos and the movie about the photographer, Isa Leshko, and her work is called "Elderly Animals." For me, the eyes of her subjects reflected the profound strength and frailty that paradoxically coexist in humans and other animals. The images are powerful and honest, and were a way the artist explored her feelings after caring for her mother with Alzheimer's disease. Here is an excerpt from her statement about the project on her website.

"I am creating these photographs to gain a deeper understanding about what it means to be mortal and to exorcise my fears of aging. I have come to realize that these images are self-portraits, or at the very least, they are manifestations of my fears and hopes about what I will be like when I am old. My intention is to take an honest and unflinching look at old age and I want these images to inspire others to become aware of and to engage with their own attitudes toward aging and mortality." - Isa Leshko


Both the photos and the movie about Isa are worth a look.

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I finally got around to seeing Rabbit Hole, which just came out on DVD in April.  It stars Nicole Kidman and Aaron Eckhart, who portray a couple that has lost their young son to a tragic accident.    The teaser from Rotten Tomatoes says it "is a vivid, hopeful, honest and unexpectedly witty portrait of a family searching for what remains possible in the most impossible of all situations"  Simple translation: This is a movie about grieving.

The couple deals with their grief in two totally different ways. Becca (Kidman) seems to want to erase everything that reminds her of her son and rarely shows emotion. In one scene her husband Howie (Eckhart) confronts her about this, "You're trying to get rid of him.......You have to stop erasing him. You have to stop it!"  To which she answers "Do you really think that I don't see him every second of every day?.........It feels like maybe I don't feel badly enough for you. Maybe I'm not feeling enough. What do you want from me?"

Howie has several angry outbursts in the movie, which seem to be part of his grieving process. He also strikes up a friendship with a woman from his grief group, played by Sandra Oh.

The grief group has some stereotypic characters, including another couple who has spiritualized the loss of their own child. Becca's confrontation of this made me smile.  The couple shares that the reason their daughter died was because God "needed another Angel"  to which Becca pipes up, "Why didn't He just make one?... I mean He's God after all?!?  Why didn't He just make another Angel?"

Interestingly we learn that Becca's brother died years prior, so Becca's mother Nat(Dianne Wiest) has great potential to be of comfort, if Becca would allow her to be. Finally towards the end, Becca connects with her mom and their exchange is one of my favorite moments of the movie. I love how Nat describes grief.

Becca: Does it ever go away?

Nat: No, I don't think it does. Not for me, it hasn't, and that's goin' on eleven years. It changes, though.

Becca: How?

Nat: I don't know....the weight of it, I guess. At some point, it becomes bearable.It turns into something that you can crawl out from under and...carry around like a brick in your pocket. And you... you even forget it, for a while. But then you reach in for whatever reason and - there it is. Oh right, that. Which could be awful- But not all the time. It's kinda...not that you like it exactly, but its' what you have instead of your son, so you don't wanna let go of it either. So you carry it around. And it doesn't go away, which is...."

Becca: What?

Nat: Fine...actually.

Overall, I thought this was a good movie about grief. The characters do heal during the movie, which is always nice to find your characters growing. I also enjoyed the sub context looking at the question of where one finds comfort in grief. This was mentioned and explored outwardly in many ways, from looking to religion, to other relationships, and even to parallel universes.

If you haven't seen it, check it out and do let us know what you think.

Also, here's the trailer if you want to get a feel for the movie visually.

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My Life Without Me has been on my To See movie list for a long time. This weekend I finally had the opportunity.

Ann is 23 years old. She lives in a trailer in her mother's back yard with her husband and two young girls. She works nights cleaning the university. After having a fainting spell at home, she discovers that she has ovarian tumors that have spread to her stomach and liver. She is given about 2-3 months to live. One of the first things she does is sit and make a list of all the things she wants to do before she dies.

1. Tell my daughters I love them several times.
2. Find Don a new wife who the girls like.
3. Record birthday messages for the girls for every year until they're 18.
4. Go to Whalebay Beach together and have a big picnic.
5. Smoke and drink as much as I want.
6. Say what I'm thinking.
7. Make love with other men to see what it's like.
8. Make someone fall in love with me.
9. Go and see Dad in Jail.
10. Get false nails. And do something with my hair.

She never tells anyone about her diagnosis. She says she does this as a gift for her husband and children as she doesn't want their last memories of her to be doctor appointments and hospitals. For the same reason she refuses any treatments or further tests. She works to complete her list, while making tapes for all of her loved ones to explain her choices and offer some final words.

She has a unique relationship with her doctor, Dr. Thompson. When he is telling her the bad news about her cancer, he sits beside her in a waiting room chair. He admits to her that he has to sit beside her because he can never look someone in the eye when he tells them they are going to die. In the end, Ann entrusts him with all of the tapes she made for her daughters as she knows he will remember to send them. He agrees to do this as long as Ann will continue to come and see him weekly, saying "Dying is not as easy as it looks, you know, but there's no need for you to have to feel terrible all the time."

The story is often run through Ann's inner monologues, what she is thinking about life and death as she does the grocery shopping, or walks down a busy street. Below is from the beginning of the movie as she is standing out in the rain.

"This is you. Eyes closed, out in the rain. You never thought you'd be doing something like this, you never saw yourself as, I don't know how you'd describe it... As like one of those people who like looking up at the moon, who spend hours gazing at the waves or the sunset or... I guess you know the kind of people I'm talking about. Maybe you don't. Anyway, you kind of like being like this, fighting the cold, feeling the water seep through your shirt and getting through your skin. And the feel of the ground growing soft beneath your feet. And the smell. And the sound of the rain hitting the leaves. All the things they talked about in the books you haven't read. This is you, who would have guessed it? You."

At then end the film, Ann lies in bed watching her neighbor (also named Ann) joyfully interact with her husband and children as the neighbor helps them make dinner. She tells them she is bed suffering from a bad case of anemia.

"You pray that this will be your life without you. You pray that the girls will love this woman who has the same name as you and that your husband will end up loving her too. And that they can live in the house next door and the girls can play dollhouses in the trailer and barely remember their mother who used to sleep during the day and take them on raft rides in bed. You pray that they will have moments of happiness so intense that all their problems will seem insignificant in comparison. You don't know who or what you're praying to but you pray. You don't even regret the life you're not going to have because by then you'll be dead and the dead don't feel anything. Not even regret."

This is a very sad but beautiful movie. (I will admit that I may have shed a couple tears at the end.) As Ann moves through her last days, you really get to feel you know her. It's an interesting perspective on dying young and poor. For what little she has, Ann accomplishes a lot in her last few days and weeks.

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Departures (2008) is a Japanese film that is a must see for those in the palliative care field. I first learned of it from a family member of a patient I was caring for. The son felt it so necessary that I see the film that he acted out part of the movie, dropping to his knees to act out a scene while I was rounding.

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I first watched this movie at a slumber party when I was in my early teenage years. It was long before I ever got into medicine and even longer before I even knew what palliative care was. I haven't seen or thought of this movie in awhile. So when I pulled it out and watched it again recently my first thought was, wow, what crazy 1990's hair. My second thought was, this is not nearly as scary as it was when I was 13. My third thought was how interesting this movie is from a palliative care perspective.

Flatliners was released in 1990 with the tagline "Some lines shouldn't be crossed" (Flatliners. Get it?). A group of 5 medical students are trying to answer that truly age old question (not to be cliche), what happens after death?

Nelson, played by Kiefer Sutherland, is the ringleader and starts the movie off with the line "Today is a good day to die". When asked why Nelson would do this he responds, "...To see if there is anything out there beyond death. Philosophy failed. Religion failed. Now it's up to the physical sciences. I think mankind deserves to know." They go about this by inducing clinical death for one to several minutes followed by a quick resuscitation by their colleagues. At first things go well and they feel very reassured that there is something out there.

The movie is categorized as a Thriller. The trouble starts when the students who have experienced near death begin seeing physical manifestations of their pasts while they're awake. "Somehow we've brought our sins back physically. And they're pissed." Coming to terms with their pasts (and getting beaten up a bit by them) seems the price they have to pay for the knowledge they want.

It's interesting to put this movie into the context of the times . In a 1990 review of the film, Rita Kempley of the Washington Post stated, "Movies about dying, grief and life after death are cropping up like corn in the Field of Dreams as a response to on-screen violence, a reaction to AIDS, a desire for something beyond materialism." Is she saying this is backlash from the '80s? It would be interesting to know if that were really true. Were there really more movies about dying at that time? And for those reasons? Or maybe its just like why there are so many vampire movies, books, television series coming out now: it just cycles through.

Some critics felt that Flatliners really pulled the punch when addressing life after death. It doesn't really answer the question of what is out there, the question that the medical students risked so much to find out. Others felt we are meant to believe that after death is a purgatory, a place to atone for one's sins. I tend to think that a campy '90s thriller probably isn't the best venue for such a debate.

Interesting movie trivia: Writer Peter Filardi was apparently inspired by the near death experience a friend had while on the operating table.

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Happy 2nd Anniversary!


Another year has come and gone, and we here at Pallimed Arts like to celebrate with top 10 lists. We did the top 10 palliative care films in 2008, and the top 10 palliative care songs in 2009. Although we are growing up- this is our 2nd anniversary- we thought we'd get "younger" with this years top 10. We're listing our favorite children's films that have good palliative care themes.



Plot summaries are courtesy of IMDB and the links will take you to a trailer of the films. As before we hope you comment with your own ideas of children's films we left off our list.



10. The Never Ending Story (A troubled boy dives into a wonderous fantasy world through the pages of a mysterious book)



9. My Neighbor Totoro (When two girls move to the country to be near their ailing mother, they have adventures with the wonderous forest spirits who live nearby)



8. Bridge to Terabithia (A preteen's life is changed after befriending the new girl at school)



7. Mr. Magorium's Wonder Emporium (Molly Mahoney is the awkward and insecure manager of Mr. Magorium's Wonder Emporium, the strangest, most fantastic, most wonderful toy store in the world. But when Mr. Magorium, the 243 year-old eccentric who owns the store, bequeaths the store to her, a dark and ominous change begins to take over the once remarkable Emporium)



6. Up (By tying thousands of balloon to his home, 78-year-old Carl Fredricksen sets out to fulfill his lifelong dream to see the wilds of South America. Right after lifting off, however, he learns he isn't alone on his journey, since Russell, a wilderness explorer 70 years his junior, has inadvertently become a stowaway on the trip)



5. Lion King (Tricked into thinking he killed his father, a guilt ridden lion cub flees into exile and abandons his identity as the future King)



4. My Girl (Vada Sultenfuss is obsessed with death. Her mother is dead, and her father runs a funeral parlor. She is also in love with her English teacher)



3. Bambi (Animated film about a young deer, Bambi, growing up in the wild after his mother is shot by hunters)



2. Old Yeller (A boy brings a yellow dog home. The dog loves the family as much as they love him, but can the love last?) *no trailer found, link is to a scene from the movie.



1. Charlotte's Web (Wilbur the pig is scared of the end of the season, because he knows that come that time, he will end up on the dinner table. He hatches a plan with Charlotte, a spider that lives in his pen, to ensure that this will never happen)

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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?

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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.

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Iris is a 2001 film based on the life of Irish writer Iris Murdoch taken from the book Elegy for Iris, written by Iris Murdoch's husband, John Bayley. Murdoch died in 1999 after several years of suffering from Alzheimer's disease. The movie jumps back and forth between Murdoch's youth and the beginning of her relationship with Bayley and the later years of their marriage, as Murdoch's mind begins to slip away.

Iris Murdoch was an intelligent and independent young woman when she met John Bayley, a somewhat proper Oxford professor. He has a difficult time coming to terms with her free spirited nature and shady history(at least for the time) with men. He comments about the all different worlds Iris lives in. Later in life, as her Alzheimer's is getting worse, he again speaks about the different world she is falling into.

The film expresses the frustration and sadness of John as he watches his very intelligent wife slip into her own world. (Imagine a literary genius sitting in front of the television watching Teletubbies.) Things begin to fall apart as Iris at times becomes agitated and wanders off. John starts to fall apart as well. Below is a section from the movie. You can see how the issues of the past and present are interwoven. You can see how his frustration turns to rage and how events of the past seem to fuel this.


The way the film is structured, flashing back and forth, it compares the incidents of the past with those of the present. It compares the young, vibrant Iris with the older, demented Iris. One scene shows Iris riding on a bike with John trying to catch up with her. Then it shows the elderly John driving around town trying to find Iris who has wandered off. You see a young Iris swimming naked, carefree, then jump to an older Iris, with her husband struggling with her in the water as she becomes agitated.

I thought this movie was a good palliative care film because of how it deals with a chronic illness I see so often, Alzheimer's disease. It shows the extreme frustration that caregivers of people with dementia often feel. I also loved they way they meshed together the past and the present. I think it's intent is to bring out that even though Iris has changed so much, she is still the same person.

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In the Bedroom is a 2001 film, based on the short story "Killings" by Andre Dubus. I don't recall anyone mentioning it, but definitely another one we should include as a top palliative care movie.

Frank Fowler is a young man spending the summer with his parents in Maine before he heads off to graduate school. He meets an older woman, Natalie, with two children and a violent ex-husband. Although he tells his mother this is just a summer fling, he seriously contemplates staying and taking a year off school.

He has just made the decision to go back to school when he is shot and killed by Natalie's ex-husband. The remainder of the film focuses on his parents, Ruth and Matt, as they try to pick up the pieces of their lives after the murder of their only child. This is made much more difficult when Frank's murderer gets out on bail and they see him walking around town, smiling at them. They find out that he will likely only be charged with manslaughter, as he claims the shooting was an accident. This pushes Matt and Ruth emotionally over the edge. We see a little of what ordinary people might be capable of in a very bad situation. I won't ruin the ending.

I really loved this movie. I loved that I felt we got to know and like Frank before he died. Although the movie was about the aftermath of his death, I felt that he was a main character from the beginning and remained a main character even after he was gone.

I loved the pace of this movie. It very slowly and carefully puts the story together and I think it makes it more real. It mixes in a lot of short scenes that at the time seem insignificant but aren't really. After Frank's death, the pace seems to slow down more, like the pace of grief. It does build to a climactic sort of ending, but after the action is over, it slows back down again. You see Matt in bed and Ruth yelling up to see if he wants coffee, just so normal.

The majority of the film deals with grief and the process by which these two people are trying to move through it. You see profound sadness, anger, guilt, blame, all the emotions you might expect. At first no one is talking to anyone. Just a lot of silent evenings in front of the TV. Then there are big blowups and finger pointing. The grief seemed very realistic to me. Ruth has an eloquent description of grief. "It comes in waves. And then nothing. Like a rest in music. No sound but so loud." (I loved the writing in this movie. Like poetry.)

So what's with the title? It seems provocative at first glance. (Again, I love the writing. So clever.) At the beginning of the film (in one of the scenes that seemed insignificant at the time), Matt, Frank and one of Natalie's children are out on a boat, trapping lobster. They find one with only one arm and this is how Matt explains what happened. "See the trap has nylon nets called heads. Two side heads to let the lobster crawl in and inside what they call a bedroom head to hold the bait and keeps them from escaping. You know the old saying twos company threes a crowd? Well, it's like that. You get more than two of these in the bedroom and chances are something like that's going to happen."

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Heartwarming movies are always a plus for me. Add to this a documentary with good end of life themes and I'm snagged.

Young@Heart (2007) is just this. It is a documentary about a singing group in Massachusetts who covers such artists as Coldplay, Sonic Youth and James Brown. The twist is that the average age of the members in the group is 81.

The movie follows the group of 24 for 6 weeks through a series of rehearsals and performances. Intermixed through the rigors of learning new songs like "Schizophrenia" by Sonic Youth, are laughable moments and trials from the health issues of chorus members.

The lessons in the film are abundant, and most center on how to make "living" more worthwhile. The singers have a sense of purpose with the group, they feel their minds are sharper as they learn and memorize songs and the necessity of being with other people during the day helps them live longer, more quality lives.

The most poignant moment for me was the night of the concert. One of the members had died, and the soloist himself is in poor health. His oxygen hisses in bursts as he sings Coldplay's "Fix you". The lyrics, which were written portraying the emotions of the death of someone dear, strike a different feeling sung by a group so familiar with death and so close to death.

The chorus member sings, "And the tears come streaming down your face/When you lose something you can't replace/When you love someone but it goes to waste/Could it be worse?"

I especially like the realness of this film. Aging is not hidden, the real battles of poor health, memory loss and death are present, however life is celebrated at all times. When I think of palliative medicine being about living life to its fullest, this movie represents that to a tee.

Following is the trailer of the film from YouTube, if the link doesn't appear as a subscriber, head to the original post to see. Also follow this link directly to Youtube to see the performance of "Fix You" I spoke of earlier.

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When I posted on Eulogy, someone commented that it seemed a lot like this movie, Death at a Funeral. I decided to check it out.

Death at a Funeral is a dark comedy that came out in 2007. Like Eulogy, the movie surrounds the death of a family patriarch and the secrets that come out in the aftermath. The entire movie takes place the day of the funeral.

The film focuses on a few of the family members. The deceased's son, Daniel is always playing second to his famous brother, Robert. He is trying to get away by moving himself and his wife out of the family home. He is to deliver the eulogy, but everyone really wants to hear from Robert.

A niece Martha with her fiancee Simon are planning on using the funeral to make a good impression on Martha's father before they announce their engagement.

Things start to go haywire when Simon takes a pill thought to be Valium but which is actually a designer hallucinogenic drug. Then a mysterious little person (I think this is correct term) shows up with a secret about the deceased and attempts to black mail his sons. I won't ruin the end but the trailer below gives some away.

Like Euology, this film also has a similar, dramatic eulogy scene at end, and the message of the two is also similar. He wasn't perfect, but he was still a good man who loved his family and did the best he could. Below is the eulogy.

"My father was an exceptional man! He may not have been a perfect man, but he was a good man, and he loved us. All I wanted to do today was to give him a dignified send-off. Is that really so much to ask? So, maybe, maybe he had some things he liked to do. Life isn't simple, it's complicated. We're all just thrown in here together, in a world full of chaos and confusion, a world full of questions and no answers, death always lingering around the corner, and we do our best. We can't only do our best, and my dad did his best. He always tried to tell me that you have to go for what you want in life because you never know how long you're going to be here. And whether you succeed or you fail, the most important thing is to have tried. And apparently no one will guide you in the right direction, in the end you have to learn for yourself. You have to grow up yourself. So when you all leave here today, I would like you to remember my father for who he really was: a decent, loving man. If only we could be as giving and generous and as understanding as my father was. Then the world would be a far better place."

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Eulogy is a 2004 comedy surrounding a "dysfunctional" family dealing with the death of the family patriarch. I've seen it described as a "black" or "dark" comedy. Probably fits.

The film begins with the family finding out about the death of Edmund Collins and then heading home to his funeral. Some members are upset over the death, some are upset about the inconvenient time. It is focused around the granddaughter Kate, a college freshman (and possibly the most normal person of the group) who has been asked to deliver the eulogy at her grandfather's funeral. Amongst the group of 4 children and 6 grandchildren, Kate seems to be the only one really concerned over Edmund's death. The rest of the family seems preoccupied with their old fights and issues.

Meanwhile, Charlotte, the widow, who is seemingly distraught over the death of her husband and her children feuding, attempts suicide. More than once.

During the course of the film, secrets come out about the surviving family members and about the departed. If I had to sum up the theme of the movie it would be, "We may be screwed up but in the end we're family." I'm not going to give away the end, but Kate finds a way to eulogize the grandfather who no one really ever completely knew. I like the funeral scene.

This film made me think a lot about dysfunctional families. It's not a term I use lightly. After seeing a lot of different types of families, I have begun to think that what we call "dysfunction" is often just functioning differently than the norm. What is normal anyway?

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Thanks to one of my nurses, Linda, for telling me about this film. Westerns aren't my usual movie fare but hearing about the plot of this one along with the all-star cast (John Wayne, Jimmy Stewart, Lauren Bacall, Ron Howard, Harry Morgan) convinced me to check it out.

John Wayne plays JB Books, an aging gunfighter, who comes to Carson City seeking a second medical opinion. He has gotten the diagnosis of cancer and comes to see a trusted physician, Doc Hostetler (played by Jimmy Stewart). In one of my favorite scenes, Books is told the bad news and is given about 2 months to live. (I couldn't find a clip, but below is the dialogue.)

Doc:Books, every few days I have to tell a man or a woman something I don't want to. I've been practicing medicine for 29 years and I still don't know how to do it well.
Books: Why don't you just say it flat out?
Doc: Alright, you have a cancer. Advanced. [portion removed]
Books: Can't you cut it out doc?
Doc: I'd have to gut you like a fish.
Books: Well, what can you do?
Doc:There's just very little I can do. When the pain gets too bad I can give you something.
Books: But you're trying to tell me is...
Doc:Yeah
Books: Damn
Doc: I'm sorry Books.
Books: You told me I was strong as an ox.
Doc: Well even an ox dies.
Books: How much time do I have?
Doc: 2 months, 6 weeks, less. There's no way to tell.
Books: What can I... What will I be able to do?
Doc: Anything you want at first. Then later on you won't want to.
Books: How much later?
Doc: You'll know when.

In another conversation with the doctor, Books asks about how it is going to go. Doc Hostetler tries to evade the question at first but then tells him "There'll be an increase in the severity of the pain in your lower spine, your hips, your groin. Do you want me to go on? The pain will become unbearable. No drug will moderate it. If you're lucky you'll loose consciousness and until then you'll scream." He goes on to tell Books, "I would not die a death like I just described... Not if I had your courage." This leads Books to try to go out in a blaze of glory. Hastened death by gun fight.

Much of the film is Books coming to grips with his terminal illness, fighting off those who want to take advantage of his death, settling his affairs, and imparting words of wisdom to a young man, Gillom (Ron Howard). Below is the film trailer.

This movie came out in 1976 and it was John Wayne's last film. It came out 12 years after he was diagnosed with lung cancer and 3 years before he died of gastric cancer. In many ways, the lives of Books and Wayne are very similar. Both very famous, facing illness and the end of their careers.

Also, Lauren Bacall (who stars as a sort of platonic leading lady in the film) had lost her husband, Humphrey Bogart, to esophageal cancer many years earlier. I wonder how this effected her performance in the film.

Something interesting from a historical palliative care perspective, they use laudanum (opium mixed with alcohol) for pain control. When Books takes a swig out of the bottle, the question is asked, "That's habit forming, isn't it?" Some things are timeless.

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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!)

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I will say, with some shame, that the book The Diving Bell and the Butterfly has been near the top of my need-to-read list for some time, but I haven't ever gotten around to it. When I heard they were making it into a movie, I was very excited. Watching the movie is just as good as reading the book, right?

In case you're not familiar, The Diving Bell and the Butterfly (Le Scaphandre et le Papillion) is a book written by Jean-Dominique Bauby. Bauby suffered from a stroke and developed locked in syndrome. The only part of his body not paralyzed was his eye (one of his eyes had to be sewn shut). He communicated entirely by blinking. His caregivers developed a system in which they recited the alphabet (in order of most to least commonly occurring) and he blinked when they said the right letter. He wrote an entire book about his experience with just one eye.

The movie starts when Bauby first awakens and is trying to figure out where he is and what is happening. When he first finds out the extent of his injury, he wants to die. He is filled with regrets about his life. A recurrent theme in the movie is Bauby imagining he is trapped in a diving bell.


He then realizes that his eye isn't the only part of him that still functions. He still has his memory and his imagination. Through these he is able to escape from his prison, thus the name of the film.


This is an excellent story about someone managing to find meaning and purpose in a very bad situation. Beyond that, this isn't just a story about how it must feel to be trapped in ones own body. It is the actual account of what Bauby felt and what he experienced. Part of that is a complete loss of control. Just look at the TV. The annoying test pattern screen left on all night. The game he is watching turned off. (It made me think of some of the crazy things we leave on in dying patient's rooms. What if they hate old westerns or Law and Order? To my family and friends, please don't leave CNN on all day to cycle the same stories over and over, and any CSI should not come on in the room at all. Maybe TV preferences should be included on an advanced directive.) You don't often get first hand accounts of things like this.

Maybe I'm a bit biased but while watching this movie, I couldn't help thinking "Where's the palliative care team?" "Does he want to go back to the hospital?" "Why isn't anyone asking him?"

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Married couple Ed Kashi, a photojournalist, and Juli Winokur, a filmmaker/writer, spent years working on their book "Aging in America: The Years Ahead". The book and photos, worthy of viewing, deal with the challenges facing the population over 65, but is also about America's collective denial of aging. Both agree that it was their experience with the project that helped them cope when they found themselves personally affected by the reality of aging in their own family.

Julie's father, diagnosed with end stage dementia, got to a point he couldn't live alone. The couple, with their 2 kids in tow, opted to move from California to New Jersey, so they could become his full time caregivers. They became one of the estimated 15 million known as the sandwich generation, taking care of both their own parents and children at the same.

They spent the 18 months he was in the home documenting the experience in film and photos. They offer a 2 part short documentary entitled "The Sandwich Generation" that can be viewed freely online. Part I is 11 mins and takes place in the first months of his arrival. Part II is 16 mins and summarizes much of Part I, but then goes on to show a wiser, more tired family.

This is one of Ed Kashi's photos from the movie of Herbie Winokur, who died Jan. 5, 2008 in the family's home.

I was struck by three things in this wonderful documentary. In Part I, Herbie is taken to the hospital after a fall at home and seems to have a prolonged stay, meanwhile deteriorating. The family becomes restless with the hospital and at one point Ed Kahsi says "Get him home, make sure he eats and is stimulated, who cares what the diagnosis is". I thought how true this sentiment can be with the people we work with. There comes a tipping point at times when it's more important to be home than to have all the why's answered.

There is also a lovely contrast seen between part I and II with the granddaughter. She speaks in part I about how good it is that "poppy" is living with them. But in part II says to her mother "Should I be honest? Because I wasn't in the first part." Her mother then draws out some resentment and awareness of "how much things changed" in the household when Herbie came to live.

Finally, an emotion caretakers often have, frustration and anger comes out with Ed on a day that Herbie gets confused while out on a walk and doesn't want to go home. Ed gets in his face, frustrated that he doesn't remember the hired caregiver who's worked with him for 2 years. It's a very honest moment, and a good reminder on how tough care giving can be.

If you have the time, check out the links for the movies. I think it's a realistic look into care giving and causes me to be more aware of the stresses the families that I see everyday are going through.

References: The non profit group that houses much of Ed Kashi and Julie Winokur's work "Talking Eyes Media" at http://www.talkingeyesmedia.com/
Part I can be seen at http://www.mediastorm.org/0009.htm
Part II can be seen at http://assets.aarp.org/external_sites/caregiving/multimedia/LifeWithHerbie.html

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After re-watching this movie today, I had to go back to our original Top 10 Palliative Care Movies post to remember if we had included it in our list. We didn't, but maybe we should have.

The Savages is an independent film released in 2007 and has been called a "coming of maturity" story. It's a very real picture of a family dealing with the illness of a parent. Siblings Jon and Wendy Savage are busy with their own complicated lives when the death of their estranged father's girlfriend forces them to back into his life. Their father, Lenny, is diagnosed with dementia and Parkinson's. In a short time, they have to move Lenny from Arizona to New York and find a nursing home to place him.

Below is the movie trailer.

One of my favorite scenes is when Jon and Wendy have to discuss advanced directives with Lenny.

Wendy: Okay. In the event... In the event something should happen- Um- How- How do you want us to... Um-
Jon: Dad, what if you were in a coma? Would you- would you- would you want a breathing machine to keep you alive?
Lenny: What kind of question is that?
Jon: It's a question we should know, in case.
Lenny: In case what?
Jon: In case something happens.
Wendy: Nothings gonna happen. Right now. Nothing new.
Jon: Right, it's- it's just procedure. It's something they want for the records.
Lenny: Who?
Wendy: The people who run the place. The Valley View.
Lenny: What the hell kind of hotel is it?

Jon and Wendy sort out their own social lives while, for the first time, having to take on the responsibility of caring for their aging parent. I found that this movie hits pretty close to the mark of the normal American family. It's very realistic how Jon and Wendy deal with a crisis in completely different ways, one more logical, one more emotional. Wendy has a lot of guilt over placing Lenny in a nursing home, even though she know it's really the only choice. Below is Jon talking to Wendy as she tries to get Lenny into a more exclusive nursing home.

"...You are the consumer they want to target. You are the guilty demographic. The landscaping, the neighborhoods of care; they're not for the residents, they're for the relatives. People like you and me who don't want to admit to what's really going on here...People are dying, Wendy! Right inside that beautiful building right now, it's a f***ing horror show! And all this wellness propaganda and the landscaping, it's just there to obscure the miserable fact that people die! And death is gaseous and gruesome and it's filled with shit and piss and rotten stink!"

I was struck by all the losses Lenny experienced: his girlfriend, his mental faculties, his independence, his dignity, his privacy... Another very realistic aspect of the movie.

On a side note, the nursing home staff has a very interesting prognostic sign. Apparently toes curling under means someone only has a few days left.