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

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

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

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

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


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

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

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

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

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

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

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Summer is late, my heart.
Words plucked out of the air
some forty years ago
when I was wild with love
and torn almost in two
scatter like leaves this night
of whistling wind and rain.
It is my heart that's late,
it is my song that's flown.
Outdoors all afternoon
under a gunmetal sky
staking my garden down,
I kneeled to the crickets trilling
underfoot as if about
to burst from their crusty shells;
and like a child again
marveled to hear so clear
and brave a music pour
from such a small machine.
What makes the engine go?
Desire, desire, desire.
The longing for the dance
stirs in the buried life.
One season only,
and it's done.
So let the battered old willow
thrash against the windowpanes
and the house timbers creak.
Darling, do you remember
the man you married? Touch me,
remind me who I am.

Thanks to Catherine Ellsworth for sending me a link to this poet

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"I came to learn what is means as a poet to be the person who can sit with those profound, profound, essential human experiences, and to let them happen, and to not fight them, and learn from them.   

I never would have thought before that it was a privilege for someone to let you be intimate with them as they move towards dying.   

But it was.  And I think I understood that because I was having and raising these little babies." 

Neonatology 

"[...] birth is like jazz,

from silence and blood, silence
then everything,  
jazz."

and then Autumn Passage. 

"On suffering, which is real.

On the mouth that never closes,
the air that dries the mouth.
On the miraculous dying body,   
its greens and purples. [...]" 

Crave Radiance: New and Selected Poems 1990-2010 Publisher: Graywolf Press Date: 2010 Language: English Available at: amazon.com graywolfpress.org

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This is another installment to our Gallery Series. As a reminder, I generally pick something related to palliative medicine and then begin an online hunt to find art work and poetry with this word or phrase in the title.  Hopefully this becomes a stepping point for further thought and exploration.

All art work is copyrighted to the artist (often only a screen name is known), and listed in sequential order at the end. For further Gallery posts, links are provided for convenience at the bottom.

Today's Gallery theme is "Quality of Life", so picked secondary to this phrase's essential part in the definition of palliative care.

The definition of QOL from thefreedictionary.com:
Quality of life (n): Your personal satisfaction (or dissatisfaction) with the cultural or intellectual conditions under which you live (as distinct from material comfort).


"Quality of Life" copyright Harley.


Pain roils within me, without
Despair assails me, and doubt
What is the use of all this striving for survival?
What is the quality of this persistent life?
A Fleshy form twisted into tangled knots
And mind cramped with bitter regret
The sun shines, but darkness covers me with futility
Soul stripped to the bone
Thousand-yard stare fixed on far horizon
Sane men call me mad




"Quality Of Life - Poem" (Aug. 2000) by A.K. Whitehead


I have lived a life-- or two,
depending where the line is drawn.
What has been accomplished
is, as if it were, undone,
and what remains undone 
is the heel that kicks the spur. 
Life, time, accomplishment
define each other...
and their exclusions
rising like pale mountain ranges
whose heights perceptibly increase
with their proximity

Finally a poem read by the author herself.  This is "Quality of Life" by poet Harryette Mullen. It is a part of her 5th collection, the book entitled Sleeping with the Dictionary (2002)



Art work displayed:
"Quality of Life" (2010) Sandy Brooke
"Quality of Life" (2007) spotandbones
"Quality of Life Painting" (2007) Patrick Sheridan

Past gallery posts: "Itch", "Dysphoria","Last Breath", "Pain", "Afterlife", "Restless","Stillness" and "Grief"

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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.

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The exact origins of Memorial Day are not exactly agreed upon. Many cities claim to be the founders of this holiday. The tradition, however, dates back to Civil War times. At one time Memorial day was known as Decoration Day, as it was the day families and friends of fallen Civil War soldiers would choose place flowers and "decorate" the graves.

The first official Memorial Day was May 30th 1868, after the day was declared by General John Logan, commander of the Grand Army of the Republic (a veterans' organization). The holiday was adopted by Michigan and New York and then by all the Northern states through the late 1800's. The Southern states had there own days they observed and did not recognize this holiday until after WWI (several Southern states still have a separate Memorial Day type holiday to honor confederate soldiers). Apparently the date, May 30th was chosen as it was not the anniversary of any battle.

At first the holiday was just to honor the Civil War dead. After WWI, Memorial Day changed to honoring all of Americans who died fighting in any war. Now it is often seen as a day to remember all who have died. (I remember going to the cemetery to decorate the graves of family members on Memorial Day when I was young.) In 1967, the name of the holiday was officially changed to "Memorial Day" and in 1971 the National Holiday Act changed the date of the holiday to the last Monday in May, creating a very convenient 3-day weekend. There has been for several years a push to move Memorial Day back to May 30th in order to try to give some meaning back to the day (so it's not just the long weekend when the pools open).

The top photo is from Arlington National Cemetery. Every year around Memorial Day, the 3rd U.S. Infantry Regiment or The Old Guard, in a tradition called "Flags In", places small flags in front of all graves in the cemetery.

The Fredericksburg National Cemetary hosts an annual Luminaria each year for Memorial Day. Approximately 15,300 candles are placed by volunteers on each of the graves (80% of which are unknown soldiers).

I have often wondered about the significance of the red flowers being given out for donations around this time every year. Inspired by the poem, "In Flanders Fields" (poem below) by Canadian WWI veteran and poet John McCrae, the Veterans of Foreign Wars take donations for their "Buddy" Poppy every year around Memorial Day. Theses poppies are assembled by disabled and needy veterans. Since 1922 this program has been raising money for veterans and their families through the poppies.

In Flanders Fields

In Flanders fields, the poppies blow

Between the crosses, row on row,

That mark our place; and in the sky

The larks, still bravely singing, fly

Scarce heard amid the guns below...

We are the Dead. Short days ago

We lived, felt dawn, saw sunset glow,

Loved, and were loved, and now we lie

In Flanders fields...

Take up our quarrel with the foe:

To you from failing hands, we throw

The torch; be yours to hold it high.

If ye break faith with us who die

We shall not sleep, though poppies grow

In Flanders fields...

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Today's post is a potpourri of sorts. We talk much on this blog about how grief serves as an impetus for art. We've reviewed poems, visual art, music and films that trace back to an individuals personal story. Today I am going to interview Susan W. Reynolds, someone acquainted with grief personally, and then take a look at both a piece of artwork and poem she's done. She's involved in a new concept for me, something called "Redesign". It's yet another tool to use in palliative care. In typical interview fashion you'll see the question followed by her response.

AC: Tell me about a bit about your story and your loss?

SR: My husband died at 59, due to lymphoma, five years ago. He died at our lake home, by the water and without our children present, just as he had requested. Hospice was not involved in his care, although a close family friend was an excellent hospice nurse.

I had been a physical therapist in the early years of marriage and loved patient education and working with the team approach in stroke rehab. Most of my married life I was a stay at home mom, having moved our family ten times due to his job changes. Three months before my husband died, both our daughters graduated from college and moved away from home. At 49 I was a widow and now truly an empty nester.

By chance I saw an article about interior redesign and staging and then enrolled in the program to become certified in both. I began doing one day room makeovers for clients, color consulting, transitioning some clients to smaller homes. As I reviewed my clients, I found that the majority of them had recently experienced a large loss, mostly from the death of a spouse or child and some from divorce.

AC: Wow, that's an interesting insight about your clients. What IS redesign exactly?

SR: Redesign simply uses art, furnishings and accessories that one already owns and loves and recombines the elements into a soothing, functional and supporting space. Sometimes items are moved from room to room. Other times items may be taken away. The person utilizing the space is interviewed as to what they love about the space, how they use the space and how the space makes them feel. In working with clients on the grief journey, decisions are make together (myself and the griever) which is different from a typical redesign when the client is off premises and I do the work alone. Allowing the client to acknowledge and support his or her needs without feeling they are dishonoring the memory of their loved one is one of the core of redesign directions, but even greater than that is to revive yourself (the bereaved) and place yourself in surrounding that support you, whether it be the bedroom, your office, your car or the first visit to a restaurant since your loss.

AC: You have a blog as well, RevivalRedesign, that I understand was encouraged by a discussion with a bereavement group as a way to put these ideas down and in a sense move forward. Are their other expressive things you've done on your grief journey?

SR: My first outward expression of grief started with my trying a dance form in which I did not need a partner. The dancing introduced me to a new music genre to listen to and helped me express both wanted and unwanted emotions. I also carved some walking sticks and started painting. I had not painted since high school and had never carved. Working with my hands, freed my mind for short periods of time. This past year, I finally hung two of my paintings, they moved from sitting in a closet to the walls of my home. I also began to write. I still do not enjoy writing, but it consumes me, and expectantly allows inner thoughts and desires to seep forth and hence my blog and now a book is on the way.

AC: This artwork piece to the right you did is an encaustic piece. Can you explain the process

SR: Encaustic art is a very old art form using hot beeswax and plant extracts to color it. Beeswax is still used but other pigments are added for color in its present application. The hot wax is painted onto a surface and the layers fused together with a blowtorch. Colors can meld together with the heat or you can use parceled segments painted and lightly torched to adhere them to the surface. The layers can be scraped away with tools to reveal layers below and/or highly polished.

AC: It would seem the process itself is like grief?

SR: Encaustic painting is a bit like life, layering experiences one upon another. In grief, the layers are all there and we are presented with a chance to reassess and decide which layers to expose or rediscover of ourselves. We may decide which ones to let go as well. My artwork here represents growth toward the surface from the bottom of a darker and murkier sea. Rising to the light also required me scraping some of the layers away and deciding what to keep so as to make my painting visually pleasing for me.

AC: You also use poetry as a form of expression. This piece entitled "On the Bolt, Fabric of Life" found on your blog, is at first glance about sewing and fabric. What did the poem symbolize for you?

SR: The salvage of the fabric is often overlooked and not deemed useful in sewing. In grief we salvage what we have learned from the past. We can stitch it down and cover it up without creativity or growth or in salvaging our lives we can accept our own frailty and weave new experiences into the old patterns. Another piece of beauty arises, incorporating both the old and the new.

AC: Finally, as someone on the grief journey, what comment/advice would you share?

SR: My trials and errors speak for themselves. Don't take yourself too seriously. I had no idea that writing would prove to be my greatest "healing" tool. Try something new. It may lead to an unexpected delight or to another door that opens. Do not limit yourself from the baseline of your past. Find what lifts your spirit now and know that this too can change. Allow room for change and some fun doing it!

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This post was inspired by a book I recently read, This Republic of Suffering: Death and the American Civil War by Drew Gilpin Faust. If you happen to be attending the AAHPM Annual Assembly next month, this is the book that will be talked about in the first ever AAHPM Book Club (link to AAHPM blog that talks about the book) (Saturday, March 6 from 12:15-1:15). I know from the Pallimed group Amy, Christian and I will all be in attendance, so read the book and come join us!

American poet, Walt Whitman, was born in 1819. He is perhaps best known for his collection of poetry Leaves of Grass which is perhaps best known for its controversial sexual themes. Whitman initially published this collection of poetry in 1855 but he continued working on it, adding more poetry until right before his death in 1892. What I didn't know about Whitman until reading Faust's book was his involvement in the American Civil War and how his experiences shaped his poetry.

Whitman's brother was a soldier in the Union Army. When Whitman heard that he had been wounded, he hurried to Virginia to be with him. His brother had only minor injuries but he found many who were much worse off. He began visiting the soldiers. He would spend time with them and write letters home for them. He would also write letters to soldiers family members to tell them of the soldier's death, providing reassurance that they had had a good death. His poetry reflected this experience.

Below is the poem "Pensive on Her Dead Gazing, I Heard the Mother of All", written after the end of the war.

PENSIVE, on her dead gazing, I heard the Mother of All,
Desperate, on the torn bodies, on the forms covering the battle-fields gazing;
(As the last gun ceased—but the scent of the powder-smoke linger'd;)
As she call’d to her earth with mournful voice while she stalk’d:
Absorb them well, O my earth, she cried—I charge you, lose not my sons! lose not an atom;
And you streams, absorb them well, taking their dear blood;
And you local spots, and you airs that swim above lightly,
And all you essences of soil and growth—and you, my rivers’ depths;
And you, mountain sides—and the woods where my dear children’s blood, trickling, redden’d;
And you trees, down in your roots, to bequeath to all future trees,
My dead absorb—my young men’s beautiful bodies absorb—and their precious, precious, precious blood;
Which holding in trust for me, faithfully back again give me, many a year hence,
In unseen essence and odor of surface and grass, centuries hence;
In blowing airs from the fields, back again give me my darlings—give my immortal heroes;
Exhale me them centuries hence—breathe me their breath—let not an atom be lost;
O years and graves! O air and soil! O my dead, an aroma sweet!
Exhale them perennial, sweet death, years, centuries hence.

In this poem, Whitman hears the "Mother of All" mourning the loss of the fallen soldiers. She asks the earth to absorb them well and hold on to them for her so that they are part of the earth for centuries, immortal as part of the air and soil.

Whitman was also very moved by the death of Abraham Lincoln. He wrote the famous poem "O Captain! My Captain" in response to his death.

O Captain my Captain! our fearful trip is done,
The ship has weathered every rack, the prize we sought is won,
The port is near, the bells I hear, the people all exulting,
While follow eyes the steady keel, the vessel grim and daring;
But O heart! heart! heart!
O the bleeding drops of red,
Where on the deck my Captain lies,
Fallen cold and dead.

O Captain! my Captain! rise up and hear the bells;
Rise up--for you the flag is flung for you the bugle trills,
For you bouquets and ribboned wreaths for you the shores a-crowding,
For you they call, the swaying mass, their eager faces turning;
Here Captain! dear father!
This arm beneath your head!
It is some dream that on the deck,
You've fallen cold and dead.

My Captain does not answer, his lips are pale and still;
My father does not feel my arm, he has no pulse nor will;
The ship is anchored safe and sound, its voyage closed and done;
From fearful trip the victor ship comes in with object won;
Exult O shores, and ring O bells!
But I, with mournful tread,
Walk the deck my Captain lies,
Fallen cold and dead.

In Faust's book, she points out that Lincoln's grand funeral was like a surrogate funeral for all those who died in the war who did not have a "proper burial". Their families didn't have the opportunity to say goodbye in that way. Often they didn't even know the exact fate of their loved one. They were just presumed dead. Whenever I have read "O Captain! My Captain" in the past, I always read it pertaining just to Lincoln. Now I wonder if it doesn't have a broader meaning. Maybe Whitman wasn't just thinking about Lincoln, but about all the civil war dead.

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Henry Wadsworth Longfellow was born February 27th 1807. In 1831, he married Mary Storer Potter. In 1835, Mary had a miscarriage and died a few weeks later. Several of Longfellow's later works were influenced by his grief over this loss. One such work was "Mezzo Cammin" (below).

Half my life is gone, and I have let
The years slip from me and have not fulfilled
The aspiration of my youth, to build
Some tower of song with lofty parapet.
Not indolence, nor pleasure, nor the fret
Of restless passions that would not be stilled,
But sorrow, and a care that almost killed,
Kept me from what I may accomplish yet;
Though, half-way up the hill, I see the Past
Lying beneath me with its sounds and sights,--
A city in the twilight dim and vast,
With smoking roofs, soft bells, and gleaming lights,--
And hear above me on the autumnal blast
The cataract of Death far thundering from the heights.

Mezzo Cammin translates to middle journey. It comes from the opening line of The Divine Comedy. "Nel mezzo del cammin di nostra vita" ("halfway along our life's path") (Longfellow was the first American to translate The Divine Comedy and you could make parallels between the two poems.)

While poetry is definitely open to interpretation, I think this poem has a sad but still hopeful message. Longfellow sees that he has not accomplished all that he aspired to do in his youth. He attributes this not to any flaw in his character, but to "sorrow, and a care that almost killed", likely the death of his wife. But there is still hope that he may yet accomplish his goals.

Now, half way through his journey, he looks back at the Past. Maybe it's not so bad? "A city in the twilight dim and vast, with smoking roofs, soft bells, and gleaming lights." He looks up to the future and sees Death but it is far away.

When I first read this poem, my immediate impression was that Longfellow saw himself at a turning point in his life. He had been living with his grief for some time and he felt he could not be productive. It feels like he is passively looking behind him at the past and ahead to the future and seeing that he can still go on and accomplish what he has set out to do. He is starting to find hope again after a great loss. He sees (actually he hears) his end but this is far into the future. Realistic but not pessimistic.

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William Butler Yeats was both a poet and a dramatist. Born in Dublin in 1865, he was awarded the Nobel Prize in Literature in 1923. Unlike many award winners, his greatest works were actually completed after winning the Nobel with collections of The Tower(1928) and The Winding Stair and Other Poems (1933).

The poem "Death" was published in The Winding Stair and Other Poems. It was actually written in reaction to the assassination of his political friend Kevin O'Higgins, which is referenced in the later part of the poem.

What I really like about W.B. Yeats is that I have to reread his poems a few times to really grasp what he's trying to say.

Death

NOR dread nor hope attend
A dying animal;
A man awaits his end
Dreading and hoping all;
Many times he died,
Many times rose again.
A great man in his pride
Confronting murderous men
Casts derision upon
Supersession of breath;
He knows death to the bone --
Man has created death.

The sentiment in the first part of the poem is that simple profound truth; that we as humans, unlike other animals, are cognizant of our own mortality. As far as we know, birds are not flitting around the sky worrying about death, or even experiencing hope for the future.

It is this fact that allows us the material we write about in this blog. People contemplating death and grief give us music, art, poetry, books, etc.

Although the next line "Many times he died,/ Many times he rose again" may sound like reincarnation, I think more accurately Yeats has something like this in mind, from his poem "Under Ben Bulben":

Many times man lives and dies/
Between his two eternities

There are many symbolic deaths we go through in life, only to rise again and continue.

Although the last portion is in direct relation to his friend, it relates to the inescapable nature of dying. Mr O'Higgins had played a role in the executions of some IRA members, his assassination being in retaliation to this. He said to his wife, "Nobody can expect to live who has done what I've done."

The image of a man looking head on towards certain death, in fact casting scorn at the idea of avoiding or replacing death (casts derision upon/ supersession of breath), may be a maturing from the initial feeling of dread at dying or hope to avoid it seen in the beginning of the poem.

As for the last line that "Man has created death", it's often quoted out of context from the poem.
There are two thoughts I have for this. The first, when thought of with the beginning idea of the poem, that animals are unaware of their own mortality, well then it is we, "man" by our own awareness of dying that indeed we have created the concept of "death". Second, he simply could be referring to his friend Mr. O'Higgins, who by his own admittance, undertook actions that led to his death, thus perhaps he actually "created" his own death?

Any other thoughts?

Jeffares, AJ "W.B Yeats, man and poet" 1996

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A happy belated 200th birthday to Edgar Allan Poe. (An event with brought out some controversy over which city can call itself Poe's hometown: Boston, Baltimore, Richmond, New York, or Philadelphia. There has also been talk of which city has claim on Poe's remains.)

Poe was born in Boston, January 19, 1809. I think we all know Poe for his horror writings, but he is also contributed greatly to the science fiction genre and is considered a founder of the detective-fiction genre.

To say Poe had loss in his life is an understatement. Both of Poe's parents died before he turned three. He was taken in by a wealthy merchant family, but the relationship with his foster father was often a rocky one and eventually Poe was disowned. His beloved foster mother and older brother both died when Poe was in his early 20's.

At age 27, he married his 13 year old first cousin, Virginia Clemm. Several years later, she became ill with tuberculosis. Around that time, Poe began to drink more. It's thought that his wife's illness was the inspiration for one of his most famous poems, The Raven. Virginia eventually died. The recurrent theme of dying young women (Annabel Lee, Lenore)in his work has been contributed to Virginia's illness and death and to the death's of other women (mother, foster mother) in his life.

After Virginia's death, Poe became very unstable. Two years later, he was found wandering delirious through the streets of Baltimore. He died soon after and the exact cause of his delirium and death has remained a mystery. He was buried in an unmarked grave in Baltimore but his remains were later moved.

Since 1949, the Poe Toaster (an unknown gentleman dressed in black) has been visiting the grave marker of Edgar Allan Poe's original burial site each year on his birthday. He toasts Poe and leaves behind a half bottle of cognac and three red roses.

I'll close with my favorite Edgar Allan Poe poem, Eldorado. (I don't know what that says about me. A sucker for hopeless causes?)

                Gaily bedight,
            A gallant knight,
        In sunshine and in shadow,
            Had journeyed long,
            Singing a song,
        In search of Eldorado.

            But he grew old-
            This knight so bold-
        And o'er his heart a shadow
            Fell as he found
            No spot of ground
        That looked like Eldorado.

            And, as his strength
            Failed him at length,
        He met a pilgrim shadow-
            "Shadow," said he,
            "Where can it be-
        This land of Eldorado?"

            "Over the Mountains
            Of the Moon,
        Down the Valley of the Shadow,
            Ride, boldly ride,"
            The shade replied-
        "If you seek for Eldorado!"

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I came across this poem in The Pharos a few years ago. Dr Eugene Hirsch has been writing poetry since medical school. Although his background is in cardiology and geriatrics, He most recently has been teaching an end of life physician education program with residents and medical students in Pittsburgh. His teaching has enabled learners to reflect on their experiences in medicine and that of end of life care.

To the end of her life

Two flights up,
she cradled a swollen belly
in memorabilia,
in the bowels of her bed.

Her sallow face told me
how near to death she must be.

She paused and stared into space,
Asking not for medicine, but for prayers.
I led her to find those she knew.

I'd learned some, not others.
In my confusion, I searched
for a "likeness" of her God
(shaped with the palms of my hands)
to sit there beside her and smile. I led her
to tell Him what she wanted Him to know-
to take away her terrible pain,
to forgive,
to bless.

She wanted never
to be alone again, never
to die each day, never
to really die.

The poem describes an encounter, not unlike ones we've all had. A dying patient requesting a prayer. Instead of walking away the writer does the best he can. There is such honesty in the line "in my confusion I searched/ for "likeness" of her God". How true this is, for even if we attempt to join in the rituals of our patients, per their request, our attempt should be to find the likeness of their God. We know inherently that their comfort comes from their personal theology, and to bring maximal comfort we try to fit our words into their world view.

I love that his response then isn't to spout off his own words and prayers but to lead her to action. She is led to commune with her God, to ask, to cry out, etc.

At the end when the patient prays "never/ to die each day" I am struck with how deep her existential pain must be. I wonder how many of my patients feel as if the are dying each day, over and over again? And yet, she ends with the plea "never/ to really die", as if death will not bring the relief she is seeking either.

The skill in poetry is to take all of the emotions, thoughts, history and reality of an encounter and in very few words allow that situation to transcend to the reader. I'm sure the story of this moment could have been written out in prose, taking pages to recount. Yet, Dr. Hirsch leaves us with such a precise feeling of this patients struggle in just 22 short lines. Well done!

PDF version: Hirsch, EZ "To the End of Her Life". The Pharos. Winter 2007, pg 19

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This is not what I originally intended to post this week. Just something I felt like I needed to write today. Some self care.

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The amazing collaboration supported by the internet and user-created content never ceases to amaze me both in the inane and profound. The growth of video sharing sites has unearthed numerous media clips that would previously been lost to the ages or only held in the memory of a few people. A hat tip to Scott Lake for forwarding this clip titled "You're Going to Die" to me.

Anyway...to the clip itself. I find it to be an exercise in opposites. Go ahead and watch it first and then I will demonstrate some off those points of opposition. (Note the meat of it doesn't start until after 40 sec in). (For email subscribers click the title above to go to the web page to view)



The narration is done by Vito Acconci , a NY-based performance artist, and the entire work is often credited to him, although the words were written by Timothy Furstnau, and the video itself was done by Dennis Palazzolo.

Furstnau explains on his site his "text uses a strategy employed in much of my textual work of exploring one monolithic idea ad nauseum bonum, but with a bit of a children’s story tone." I could not find any reference to ad nauseum bonum, so one assumes it means an argument by repetition for a good cause. The calling to mind a children's book also strikes an opposing conventional eisdom to the subject of death. The narrarator does set up a pretty even cadence as you listen to the video more.

Some of the text appears to be condescending to those who 'say nice things to you, or tell you wild stories.' But the narrator is only trying to demonstrate his world view which is true to him. The comments on You Tube devolve into: the existence of heaven, the atheist/agnostic vs. Christian debate, how this is depressing to watch. The great part about the dismissal of the 'stories' we tell ourselves, is the narrator usaully says 'But this is OK too."

The deep montone voice of Acconci is devoid of any emotion. He statements are meant to be as such to emphasize these are the facts. I would imagine most people see discussions about dying as emotional and here Acconci plays it to the opposite extreme.

In the end this potentially depressing video strikes a completely opposite tone by stating the knowledge of death makes life meaningful. Which is really the important message here. Some more learned readers might pick up on some Buddhist references in this clip, so feel free to post your insights in the comments.

Piece: You're Going to Die (2000) (video)
Text: Timothy Furstnau
Narration: Vito Acconci
Directed by: Dennis Palazzolo