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One of my favorite bands, Nada Surf, recently came out with a new album of covers and to whet my appetite before I could get my hands on some digital mp3's I went back to some of their old albums and listened to them all the way through.  One song kept sticking out to me because a few lines really resonated with a convergence of work/family overload I recently experienced.  But as I dug out from that overload I started to see the song differently and through the eyes of some of the family members of patients who were dying.


Here is a video of Nada Surf performing "Do It Again" live in a record store (there is no official video and check out the cool drum box the drummer is using, it is called a cajon and is very fun to play!):



The main lyric that first caught my attention was near the end of the song when the energy picks up from the mid tempo relaxed arrangement used for most of the song.  The lyric is:

Maybe this weight was a gift / Like I had to see what I could lift

Interestingly the name of the album is 'The Weight is a Gift.'  Which also echoes a sentiment I hear from patients, families and staff, which is that 'God will not give us more (weight) than one can handle.'  This saying may be rooted in I Corinthians 10:13:

No temptation has seized you except what is common to man. And God is faithful; he will not let you be tempted beyond what you can bear. But when you are tempted, he will also provide a way out so that you can stand up under it.

While it mentions temptations and not more specifically trials, you could see the basic sentiment exists that has launched many self-help books.  People endure many different hardships throughout their life and eventually most get through it but they have changed, some for good and some for worse.  How one emerges from the tough times is up to the individual and their support system, but it may sometimes turn out that 'the weight was a gift.'  Just don't tell that too them in the middle of their journey.  That is only something that should be self-discovered.

Lyrics: (2005 Barsuk Records - The Weight is a Gift)
Well I'd snap to attention / If I thought that you knew the way
I'd open my mouth / If I had something smart to say
I bought a stack of books / I didn't read a thing
It's like I'm sitting here / Waiting for birds to sing

Let's do it again
Come on let's do it again
Please let's do it again

The hum of the clock / Is a far-away place
The azalea air holding your face / You're lying down
And the moon is sideways / (From the hot to the cold It never gets old)

I spend all my energy / Staying upright
And I like the masking noise quiet / Of your breathing nearby

I want you lazy science / I want some peace
Are you the future? / Show me the keys

When I accelerate / I remember why it's good to be alive / Like a twenty-five cent game
Maybe this weight was a gift / Like I had to see what I could lift
I spend all my energy / Walking upright

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If you ever write a 9 minute song you would hope it would be a good one. There are only a few 9 minute plus songs in my song collection but "The Trapeze Swinger" by Iron and Wine is one that stands out. If you have any familiarity with it you may remember it from the end credit sequence in the moderately memorable movie "In Good Company."

Hypnotically repetitive, I would occasionally put this song on repeat to fall asleep to when I lived alone during my palliative medicine fellowship (and my wife had to be in another city for her fellowship.) At first I took the 'please, remember me' line to be more about my long-distance relationship with my wife, but as I continued to listen to it falling asleep after long days of being surrounded by dying people at the hospice house the meaning clearly evolved.

Since the song is so long go ahead and start listening to it as you read the rest of this post.


Iron and Wine is really a one man band led by Samuel Bean. The simple strong structure repeats through the song with little accents placed on each verse by different instruments or Bean's voice. The back and forth nature of the song structure reminds me of being at the beach watching the waves come crashing in and then slowly recede.

The intro begins with soft wind chimes and what sounds like sea shells or a rain stick followed by the basic guitar melody and a chorus of 'oohhh-ohhhhhs.' As the song advances we hear a ton of different instruments: slide guitar, bass guitar, wood blocks, tom toms, percussive metal, an organ played in reverse, tympani drums, upright bass (around 4:53 - my favorite part!), a song played in reverse, piano, and finally a toy whistle. All of these instruments begin to layer into an increasingly complex sound. I can't imagine being the sound mixer on this song!

The lyrics obviously focus on a theme of rememberence and like the instrumentation the repetitive nature allows for different takes on the same theme. here are the first lines of all the verses laid together.

Please, remember me happily
But please, remember me fondly
And please, remember me that Halloween
So please, remember me mistakenly
And please, remember me as in the dream
But please, remember me, my misery
And please, remember me seldomly
So please, remember me finally

The perspective of the dying person wanting to instruct those still alive on how to keep the memory (and the legacy) alive is commonly seen in hospice and palliative care. How we as friends, family or staff enhance or suppress this legacy building is not often talked about as openly as this song manages. How would caring for a person who is dying be different if we spent some time with them asking how they would like to be remembered?

There are many religious references in the song, but each of them comes with a little bit of the singer's reality. Imagining the heaven with obscene graffiti, or rushed angels who want to get all the new souls through the door place an potentially unknowable realm in earthly terms.

Overall, Bean gives us a bit of poetry mixed with american folk and indie pop that allows you to discover a little something new with each listen. Please share any lines in this song stand out the most to you.

Lyrics by Iron and Wine (aka Samuel Bean) 2004

Please, remember me happily
By the rosebush laughing
With bruises on my chin, the time when
We counted every black car passing
Your house beneath the hill
And up until someone caught us in the kitchen
With maps, a mountain range, a piggy bank
A vision too removed to mention

But please, remember me fondly
I heard from someone you're still pretty
And then they went on to say
That the pearly gates
Had some eloquent graffiti
Like "We'll meet again" and "Fuck the man"
And "Tell my mother not to worry"
And angels with their great handshakes
Were always done in such a hurry

And please, remember me that Halloween
Making fools of all the neighbors
Our faces painted white
By midnight, we'd forgotten one another
And when the morning came I was ashamed
Only now it seems so silly
That season left the world and then returned
And now you're lit up by the city

So please, remember me mistakenly
In the window of the tallest tower
Calling passers-by but much too high
To see the empty road at happy hour
Gleam and resonate, just like the gates
Around the holy kingdom
With words like "Lost and found" and "Don't look down"
And "Someone save temptation"

And please, remember me as in the dream
We had as rug-burned babies
Among the fallen trees and fast asleep
Aside the lions and the ladies
That called you what you like and even might
Give a gift for your behavior
A fleeting chance to see a trapeze
Swinger high as any savior

But please, remember me, my misery
And how it lost me all I wanted
Those dogs that love the rain and chasing trains
The colored birds above their running
In circles around the well and where it spells
On the wall behind St. Peter
So bright, on cinder gray, in spray paint
"Who the hell can see forever?"

And please, remember me seldomly
In the car behind the carnival
My hand between your knees, you turned from me
And said, "The trapeze act was wonderful
But never meant to last", the clown that passed
Saw me just come up with anger
When it filled with circus dogs, the parking lot
Had an element of danger

So please, remember me finally
And all my uphill clawing
My dear, but if I make the pearly gates
I'll do my best to make a drawing
Of God and Lucifer, a boy and girl
An angel kissing on a sinner
A monkey and a man, a marching band
All around a frightened trapeze swinger

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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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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

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There is not a lot known about the background of Sufjan Steven’s song “Casimir Pulaski Day”. Whether completely fictional, or based on some form of personal experience, the song easily resonates with the listener.