One of the things I enjoy about "the arts" is the ability to continually stimulate more art. Art imitates life, life imitates art, and art even imitates art.

Since the last gallery exhibit was entitled "restless", I wanted to explore the opposite notion of stillness.

There are moments when I walk into a patient's room that the stillness is so prevalent I have to check to see if the patient is still actually breathing. While the traditional thought of stillness is an absence of motion, stillness also refers to a quietness or calm that can actually occur in motion. I've experienced this form of stillness in dying patients' rooms as well.

It seems the most traditional way of depicting stillness in art is to display water. It is easy to capture the idea of non-movement with still water. Add some mist and a boat and you've got the most common symbol for stillness, as this photograph from unknown source depicts.

The following 3 photographs I've collaged together for better formatting, but to see the originals follow the title links. On the upper left is a variation of the water concept, sans boat and instead lovely grass sprouting from perfectly still water and reflected below. This work "Stillness" is by photograph Gunther Dippe. The next, in lower left is a photo by Kris Schirmer entitled "Stillness- and the sun shines in my heart." A fallen flower petal symbolizes an ending to me, thus this piece resonated the type of stillness I feel in the room of someone dying. Finally from a Flikr photostream by Qmanes is "Stillness" shot with an extremely long shutter speed. The motion of the water and clouds is perfectly juxtaposed to the stationary object in the lower right.



I found this abstract work to the left by Linda Cole of encaustic wax on screen entitled "Stillness in Motion" To me the motion is symbolized with the circle, while the stillness is represented by the linear portion.

Finally, sticking with the tradition of finding a sculpture, I found a digital print series that at least looks like sculpture. The series can be found at Gladys Triana's website. Of the four listed, it is "Stillness XIII"2007 that is displayed on the right.

Looking back at the art work from "restless" and comparing it to these is an exercise in itself. The emotional response the art evokes seems synonymous to the titles.

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

Francisco Goya (1746-1828) was one of Spain's greatest artists and his works have become a chronicle of Spanish history. By painting the aristocrats' idyllic lives in portraits, his paintings serve as a visual account of this important time in Spain's past.

In 1792 however, at the height of his career, Goya contracted cholera with subsequent sequelae of paralysis, partial blindness, vertigo, tinnitus and eventual deafness. Gone were his colorful happy portraits, and what followed were new dark and macabre paintings.

We can get a glimpse, possibly, into his psyche with his etching "?De que mal morira?" ("Of what illness will he die?") (1796-97). The physician depicted as a donkey in a suit may be how Goya viewed the medical community at the time. In the background we see the hooded figures waiting for this gentleman's death, while the physician can do nothing but take the man's pulse.

Although Goya survived his illness, he was left permanently altered. Many believe he suffered an encephalopathy of sorts from the high fevers during his earlier illness causing a degree of madness. Most indicative of this dark period are the "Black Paintings", done at the age of 74, they are a series of 14 works done in fresco style on the walls of his house.

The very method of painting on your own walls, implies a privateness to the pictures. They weren't painted to be viewed by anyone but the artist himself, as a kind of visual diary to the thoughts and images he was experiencing in his older age.

In this series is "Two Old People Eating"(1820), these 2 men both pointing at who knows what, could have been Goya's only companions for his meals. The figure on the right is almost skeletal, and both seem to be taunting the artist.

These next two pictures in the Black Paintings collection framed one of the doors downstairs, with "Two Old Men"(1820) on the left and "A Manola"(1820) on the right. Here we see the possibility of Goya as an old man with the call of death being whispered in his ear. Whereas in the next scene the manola is in mourning clothes, resting on a grave- maybe Goya's? It says much to know Goya painted these on a doorway to which he was forever walking through. Perhaps reminding himself daily of his own mortality.


Providing yet another glimpse into his world, Goya left us with "Self-portrait with Dr. Arrietta" (1820). Once again a commentary on the physician-patient relationship, this time the doctor offers compassion with his embrace and cup of kindness to the artist himself. The haunting figures are still present, but the doctor acts as a barrier of protection. The painting is inscribed on the bottom with "Goya in gratitude to his friend Arrieta for the skill and care with which he saved his life in his acute and dangerous illness suffered..."

Illness abruptly changed the nature of Goya's paintings, just as terminal illness changes the reality of our patients' lives. What images would we see depicted if our patients' narratives could be portrayed, like Goya, in works of art?

For a look at more Goya paintings see the Black Paintings and a large collection at Olga's Gallery.

One of our readers sent this link of an amazing website devoted to pain. Palliative Medicine is no stranger to pain and the Pain Treatment Topics site has a plethora of information regarding pain topics. What our reader pointed out, however, was the website's gallery devoted to patients' portrayals of personal pain.

The site is quick to point out that many of their pieces are borrowed from yet another website called the Pain Exhibit. The Pain exhibit is devoted to personal artwork related to pain. The brainchild of Mark R. Collen, who himself suffered years of under treated pain, he found that art did more to communicate about pain than words themselves. The site is organized into themes such as "Suffering", "God and Religion", and "Hope and Transformation" to name a few.

What I appreciate most about both websites are the inclusion of statements from the artists. It adds so much more to be able to read something from the person who created the piece and the one suffering from the pain.

I'm including just a few of my favorites here. But be sure to follow the links and do some exploring yourself.

Title: Self Portrait, Green Shirt by artist Sterling Ajay Witt.

Artist's comment: "Pain is the beginning and the end of every day for me. I have suffered from chronic pain for so long that I can't imagine life without it anymore. As by back pain increased and the brace came into my life, I found myself painting an increasing number of self portraits. Through them I try to express a feeling I cannot put into words, attempting to explain the torment I am going through. For me, creating art is just something I do to hemp me survive a life of constant pain. It's as if the paintings have become a record of my pain, giving a face to an otherwise faceless enemy." Copyright 2007 Pain Exhibit (PainExhibit.com)


Title: Chronic Pain - Life Distortion by artist Jenny Greiner

Artist's Comment: "I created my vision of what would represent my chronic pain. Beginning with the "eye being the window to the soul," I showed the clear, yet bloodshot eye, shedding the blood-stained tear. Then I realized that this whole living with chronic pain, is very disorienting. Things can start to spin out of control very easily. This represent my pain and the distortion and confusion it brings to my life." Copyright 2008 Jenny Greiner Http://www.drawthepaw.com

Title: CPII by artist Mark Collen

Artist's Comment: "This sculpture represents suffering from chronic pain." Copyright 2007 Pain Exhibit (PainExhibit.com)



This next piece below was actually featured on the cover of The Journal of Pain and Palliative Care Pharmacology (2007) Vol. 21 NO. 2 but is also found in detail at the Pain Exhibit website here.



Title: A Liar Is Not Believed Even Though He Tells The Truth by artist M.R. Shebesta

Artist's Comment: "The painting is a representation of the flesh being scraped from my body. Shards of metal appear to slide and cut into the fleshy oil painted canvas that is held into place by intricate lacing of fishhooks and taxidermy floss. The painting floats in the center of a custom wood frame similar to the visual effects of primitive tribes' techniques for cleaning and drying animal hides" Copyright 2007 Pain Exhibit (PainExhibit.com)

There is a certain theme surrounding much of the art and music discussed on these pages; that creation is often born of personal suffering. Perhaps no better example of this exists than the life and work of Frida Kahlo.

Born in 1907 in Mexico, Frida was aspiring to be a doctor, when at the age of 18, a tragic bus accident forever changed her life course. Having been impaled by a metal pole, suffering a fractured pelvis among other injuries, she spent her recovery time exploring the world of painting.

She later met and married a man 20 years her senior, a famous painter himself, Diego Rivera. Much of the tragedies she encountered during her life have been portrayed masterfully in Frida's surrealist paintings. Diego called her art, "agonized poetry", and certainly agonizing is one of many words people use to describe her work.

Frida had several great losses in her life. Due to the bus accident, she discovered she wasn't able to carry a pregnancy to term. Desperately wanting to be a mother, both the loss of actual pregnancies as well as the loss of the idea of being a mother come across in her works.
The painting "Henry Ford Hospital"(1932) was painted after one of her miscarriages. This was the very first time in art history that an artist created a painting specific to the death of an unborn child. The painting communicates more than this loss. It also portrays Frida's suffering and isolation which followed. Represented here are 6 objects symbolizing different aspects of her anguish: Model of female reproductive system, a male fetus, a snail (represents the slowness of miscarriage), pelvic bones responsible for the loss, an orchid (symbol of fertility) and an autoclave for surgical instruments.

Although the bus accident happened at age 18, Frida continued to have problems with her spine requiring extended periods at home in traction. This next painting "The Broken Column"(1944) was painted during a 5 month period that she wore a steel orthopedic corset. She wrote in her diary, "To hope with anguish retained, the broken column, and the immense look, without walking, in the vast path...moving my life created of steel".

Notice the cracked iconic column in place of her injured spine and her flesh pierced with nails. The background landscaped is also cracked and open as tears fall from her eyes.


The final painting of suffering to look at is "Without Hope"(1945). The name itself should give indication to the feelings portrayed in this painting. Here again is Frida, stuck in her four poster bed that she spent so much time in. The landscape has become even more barren than the 1944 picture. Above her is a funnel, force feeding her all types of meat products. Again the classic white tears fall.This time of constant pain and isolation from surgeries was more profound knowing that in 1940 she and Diego had divorced. He had not only been caught being unfaithful many times, but in fact had a yearlong affair with Frida's younger sister Cristina. This then was yet another huge loss in her life.

As she became more and more ill, she became very aware of her own mortality. She had had over 35 operations in her lifetime. She wrote of her own death, "I hope the departure is joyful, and I hope never to return". Frida Kahlo died in 1954, thought ultimately to have died of a pulmonary embolus.

If you're in California, the San Francisco Museum of Modern Art is hosting a Frida Kahlo exhibit until Sept. 28, 2008. For Online I suggest The Art History Archive which has over 70 of her works.

In 1995, American artist William Utermohlen was diagnosed with Alzheimer's. In an interview, Utermohlen's wife commented, “From that moment on, he began to try to understand it by painting himself.” He began a series of self-portraits that demonstrate not only the physical effects of the dementia on his brain, but also how he saw himself through the eyes of his illness.


The first self-portrait was done in 1967, while he was healthy. The other three were done after his diagnosis.


As his disease progresses, you can see how his artwork has less fine details. The lines are more blurred. In the second photo, Utermohlen's face is greyed, maybe showing what he felt was going on in his mind. Like there is a shadow cast over his face.

Later in his disease, his image becomes more and more distorted and abstract. His images also become more flat. They definitely lack the depth seen in the first.

Per the New York Times article, William Utermohlen no longer paints. As of the time of the article, he was living in a nursing home. An exhibit of his art has been on tour around the world entitled