Monday, July 28, 2008

Ars Moriendi

Many hospice organizations have printed up little booklets for families to read giving a "what to expect" of the dying process. This idea is by no means a new concept. In fact, one of the first books printed with movable type back in the 1400's was just such a book. "Ars Moriendi" (The Art of Dying) was a book written by an anonymous Dominican friar in 1415. It was THE book on how to prepare to die and how to die well. You can be the judge of how relevant such a book would be for today.

The book describes the five temptations that dying people face. In 5 different scenes a devil invites the temptations of lack of faith, despair, impatience, vanity and greed. The next 5 scenes depicted are the solutions to these temptations, what one must seek to die well: Faith, hope, patience, humility and generosity. This line drawing is from the artist Master E.S. from 1440, one of the earliest depictions of the Ars Moriendi text, entitled "Impatience". Note the chachetic look of the dying man, his ribs clearly visible. See the table knocked down and the dying mans leg kicking a caregiver in the back. When I see this picture I think of delirium, or terminal restlessness that we see in the dying process. I suppose labeling it impatience was the best reason they had to give such extreme behavior.

The artist Hieronymus Bosch also depicted this theme in his painting entitled "Ars Moriendi"(1490). In this illustration he attempts to depict the struggle between
good and evil. The angel is on the dying man's deathbed attempting to direct his eyes upward to the crucifix illuminated in the window by divine light. Meanwhile a little devil is attempting to give the man a purse of money. We are left not knowing which path this man will take, as death sneaks into the room with an arrow in his hand.

What would a picture of Ars Moreindi look like today? How would we in modern times communicate what it means to die well? Perhaps the ideas of
faith, hope, patience, humility and generosity are still components of the process even now.

Works: Master E.S.(1440) "Impatience"
Bosch, Heronymus(1490) "Ars Moreindi"

Monday, July 28, 2008 by Amy Clarkson · 3

Monday, July 21, 2008

Nessun Dorma

I wanted to write a follow-up on a movie I had posted on previously, "The Sea Inside". As I was writing about "The Sea Inside", Amy (who is much more musically inclined than I) pointed out to me the significance of the song playing during the dream sequence. The song (or aria, to be more precise) is entitled Nessun Dorma or None Shall Sleep. It's from the final act of Giacomo Puccini's opera Turandot.

Here's the plot in a nutshell. Turandot is a princess in ancient China who challenges her suitors with three riddles. If they can answer, they win her hand. If not, they are beheaded. The Prince of Tartary falls for Turandot and correctly answers all three of the riddles. Turandot is very upset that he has succeeded, so the Prince gives her an out. If she can guess his name by morning, he will be put to death. If she can't guess, she will have to marry him. The Princess declares, "This night, none shall sleep in Peking! The penalty for all will be death if the Prince's name is not discovered by morning." The song is Nessun Dorma is sung by the Prince awaiting the morning.





Below is Luciano Pavarotti singing Nessun Dorma. In 1990, Pavarotti's version of this song actually hit #2 on the UK Singles Chart, which is said to be the highest ever achieved by a classical recording. (Songs that made it up to #1 on UK charts that year included Ice Ice Baby, Turtle Power, and Hangin' Tough. Hard competition for Nessun Dorma.)







Puccini died from complications of throat cancer prior to finishing the opera and it had to be finished to by one of his contemporaries, Franco Alfano. Although Alfano did have some of Puccini's sketches to work from, no one knows exactly how Puccini would have ended the opera. There have been a couple different reworkings of the ending since that time.

I recently heard (thank you NPR) that the ending was going to be rewritten again. Apparently, the opera Turandot was never played in China as they believed the blood thirsty Chinese princess cast a bad light on the country. To celebrate the opening of the National Center for Performing Arts in Beijing, a Chinese composer, Hao Weiya, was hired to rewrite the end of Turandot. It seems to have been met with some mixed reviews.

Here is the common translation of Nessun Dorma.

No one sleeps, no one sleeps
Even you, o Princess,
In your cold room,
Watch the stars,
That tremble with love
And with hope.
But my secret is hidden within me;
My name no one shall know, no, no,
On your mouth I will speak it
When the light shines,
And my kiss will dissolve the silence
That makes you mine.
No one will know his name
And we must, alas, die.
Vanish, o night!
Set, stars!
At daybreak, I shall conquer!

As the Prince stays awake all night, he awaits a morning that might bring his own death or the fulfilment of his dream (desire) to be with the Princess Turandot. Ramon Sampedro felt that he was being denied "sleep", but in his case, it was the sleep itself he desired. What an appropriate choice of music!

Monday, July 21, 2008 by Amber Wollesen, MD · 7

Monday, July 14, 2008

Edvard Munch and Death

How much of our temperament is based on genetics, and how much is experiential? For Edvard Munch it may have been more of his life circumstances that shaped his morose outlook on life, than the fiber of who he was at birth. Born in 1863 in Norway, Edvard was the second child of five. His early life was tainted with the death of his mother at age 5 and his beloved older sister when he was 14. As if this weren't tragedy enough, a younger sister was diagnosed with mental illness and institutionalized most of her life. His father, a physician, dealt with the loss of his wife by instilling religious fear into the hearts of the remaining children. Edvard considered himself ill as well, and wrote, "Without anxiety and illness, I am a ship without a rudder....My sufferings are part of my self and my art. They are indistinguishable from me, and their destruction would destroy my art."

Although Munch is best known for his painting
"The Scream"(1893), his other works are worthy of examination. Because of his early experiences with death, many of his pieces explore his emotional responses to the memories of his childhood.

The first piece to exam in entitled "The Dead Mother and Child"(1897-1899) or the later version known as just "The Dead Mother"(1899-1900). What's interesting about these pieces are the differences. In the earlier painting we see the entire room, perhaps from Munch's perspective as he came to his mother's deathbed. Relatives are mourning in the background quite separate from the child. Munch's sister in red, eyes wide in horror, has her hands covering her ears, in an effort to block out something; maybe the reality of the situation, maybe the sounds in the room? His sister's mouth is open mid sob, or mid scream. In fact this posture is not unlike his most famous painting, "The scream"(1893). Contrast this version with "The Dead Mother"(1899-1900) done a year or so later. The viewer is now up close, and the child, still ears clasped with her hands, looks less horrified and more defiant. She's less emotional, implied also by her pale blue dress as opposed to the red dress of the other painting. Red is often used to symbolize passion. Using a cooler color fits well with this more composed painting.
Could this be Munch working through the memory? Often painful things at first are recalled with intense emotion, and as we replay and retell things, while still significant, the initial emotional response can lessen.

What does the piece say about child grief? Experts use words for young children experiencing death such as confusion, disorientation, and fear. Those words fit well for these pieces don't they?

Edvard Munch said "The angels of fear, sorrow and death stood by my side since the day I was born". Because he was shrouded in early life with the losses of important people in his life, many of his works focus on sickness, death or mental anguish. In upcoming posts we'll take a look at these other dark themes, and how Munch's choice of paintings reflect his inner struggle.

Source: Lubow, Arthur "Edvard Munch: Beyond The Scream" Smithsonian Magazine (2006) Here
Works:Munch, Edvard. "The Scream"(1893)
Munch, Edvard. "Dead Mother and the Child"(1897-1899)
Munch, Edvard. "Dead Mother" (1899-1900)

Monday, July 14, 2008 by Amy Clarkson · 0

Monday, July 7, 2008

My Sister's Keeper

This is the first novel we've written about on Pallimed: Arts & Humanities. It would be impossible to completely review every detail of such a long and complicated work. I'll try to hit some of the more interesting aspects of the characters and plot.

My Sister’s Keeper is a novel by Jodi Picoult. This is the story of a family dealing with the chronic, life-threatening illness of one of their daughters. Kate was diagnosed with a rare form of leukemia at age 3. In desperation for a donor for Kate, her parents decide to have another baby, Anna, who is created to be a perfect genetic match for Kate. The story goes back and forth between present day (when Anna is 13) and the past, reviewing the history of Kate’s illness and how that has effected Anna's life. The present day storyline follows Anna as she files to become medically emancipated from her parents. After years of donating parts of herself to Kate, Anna decided to draw a line. She did not want to be forced into donating a kidney.


Picoult puts a lot of work into developing the characters of the book. Chapters of the novel are written from the perspectives of the different characters. Brian (Anna’s father) is a firefighter. His role seems to be putting out the fires that his family members start (literally and symbolically). Brian is also a star buff. The author incorporates star mythology into the story. Anna’s name is actually Andromeda, the princess in Greek mythology who was to be sacrificed to a sea monster as punishment for her mother’s bragging. Like the princess Andromeda, Anna was also giving up her life for her mother, who has been driving all of Kate's medical care.

Through her court case, Anna is forced to confront her parents with the real reasons she filed her lawsuit. Her mother has to come to terms with Kate’s illness and the possibility that Kate might die.


Warning: Spoiler Ahead. Highlight to read.

*The story takes a sudden and dramatic turn when, after winning her court case, Anna is involved in a car accident and is declared brain dead. Her kidney is donated to Kate and their parents are left to turn off the ventilator. (It actually seemed a bit too dramatic for me.)

Making parents turn off the ventilator themselves makes for good drama in a novel but not so realistic. Also, this happens after they donate her organs. It talks about feeling her pulse stop and the monitor flatline. Did they just donate her kidney? Not her heart? And they bring her back to the ICU after the donation so that the ventilator can be shut off? Not very realistic with the organ donation process.

The epilogue is written from Kate’s point of view after Anna’s death. Kate blames herself as Anna wouldn't have been in the car if it had not been for the lawsuit.

So in the end, who is the “sister” of the title My Sister's Keeper? Is it Anna who is the keeper of Kate or Kate who is the keeper of Anna? Anna’s donations kept Kate alive for years. Throughout the story I always assumed that Anna was her “sister’s keeper”. In the end, Anna still lives on through all she has donated to Kate. So Kate is essentially keeping Anna alive.
*


The story brings up ethical issues of genetics and creating “designer babies”. Apparently Jodi Picoult became interested in the topic while doing research on eugenics. It balances this with the plight of parents who would do anything to save their dying child. It also deals with the rights of children to have say over their own bodies and make their own health care decisions. It seems at first that this is the predominant theme in the book. Later it is apparent that it’s more about parents coming to terms with their daughter's potentially terminal illness. When is it ok to say enough?

This is just a superficial overview of this book. Despite a couple medical inaccuracies at the end, I would recommend it. There is a plan to turn this novel into a film later this year.

Monday, July 7, 2008 by Amber Wollesen, MD · 0

Monday, June 30, 2008

"Starlight" by Muse

Songs about loss are rarely upbeat enough to get you moving in your car, but for me "Starlight" by the English alternative/progressive rock band Muse manages to combine sorrow and loss with rock and roll supported by a driving bass line to make a catchy song with some deeper meaning. Muse is a band whose music leans towards more sullen material, and some critics of the band chastised this song for being too pop-oriented. Overall their music style is defined by the music genome project as frequent use of minor key tonality, subtle use of piano and some electronica influence. This song exemplifies these traits well with simple piano and guitar melodies, with more space-rock bridges breaking the song into two very different feels.

Here is the video from YouTube. The visuals of the video below are not highlighted in this post. Pay more attention to the audio and lyrics.

(If the video does not display click the title of the post)



In "Starlight" the band makes use of outer space, a common theme on this album, as a metaphor for loss and distance. The ship taking the singer 'far away' could be an allusion to disease, especially one like Alzheimer's which erases the memories of the important people in your life. Or more generally, the decreased level of consciousness as someone gets closer to death.

"Chasing a starlight" can have multiple meanings in reference to end of life. On a very obvious level 'seeing the light' is commonly perceived as an experience of someone near death. And then when combined with star, the light could be a thinly veiled reference to the 'stars in heaven.' But why would the protagonist of the song be 'chasing the starlight?' Here you can start to explore many different questions.

Could the 'starlight' be thought of an ideal, perfection, purity or some unobtainable goal? This impression makes more sense when he wonders if the effort "is worth it anymore." Is trying to be good and perfect the reason to get to a wonderful afterlife? Or is the person reflecting on the good (starlight) he has striven for which now appears to 'mean nothing' since he is dying? I will note the band stated this is a "a love song about missing someone, friends, family, someone you love" and therefore not explicitly about dying.

MUSE Band PhotoThe bridge/chorus gets more aggressive with crunchy guitar chords, as if he is fighting the loss, with the lines, "I'll never let you go, if you promise not to fade away." This line switches the perspective as most people working with Alzheimer's see the patient as the one slipping away, but if you (as the patient) are slowly losing your memory and ability to communicate, it can also seem like everyone else is fading away from you. Much like some weird palliative care Doppler effect; who is fading from whom?

"Black holes and revelations" is the name of the album and also a key lyric in "Starlight." This is made even more important when paired with the line of "our hopes and expectations." Palliative care is about finding 'hope' and managing 'expectations' when discussing the uncertainty of the future of a medical illness. But when patients and families 'hopes and expectations' are not managed well it may seem like 'hope' get dashed into a 'black hole' never to escape. Any information contrary to current 'expectations' then becomes a dramatic 'revelation.' Other influences regarding spirituality and end of life issues could be made with the Biblical Book of Revelations, or the unknowable of what exists in a black hole, echoing the uncertainty about what happens after death.

For those who liked this song, some of Muse's other songs highlight issues relevant to palliative care and spirituality including "Thoughts of a Dying Atheist," "Sing for Absolution," "Time is Running Out" and others.

"Starlight" by Muse (Bellamy) from the album "Black Holes and Revelations" (2006) from Warner Bros. Records.

Lyrics

Far away
This ship is taking me far away
Far away from the memories
Of the people who care if I live or die

Starlight
I will be chasing the starlight
Until the end of my life
I don't know if it's worth it anymore

Hold you in my arms
I just wanted to hold
You in my arms

My life
You electrify my life
Let's conspire to re-ignite
All the souls that would die just to feel alive

But I'll never let you go
If you promised not to fade away
Never fade away

Our hopes and expectations
Black holes and revelations
Our hopes and expectations
Black holes and revelations

Monday, June 30, 2008 by Christian Sinclair · 2

Monday, June 23, 2008

1832 Paris Cholera Outbreak

It's hard to imagine the panic of a sudden epidemic. Heinrich Heine was a German poet living in Paris as a journalist in 1831 covering the development of democracy and capitalism in France. His journals recount many things, including the beginning of the Paris Cholera epidemic of 1832. His descriptive account of the frenzy and sudden deaths served not just as historical information, but also as an inspiration for the artist Alfred Rethel. Having read the following passage of the account of the outbreak, the German artist Rethel went to work on his engraving “Death as the Cutthroat”

Here Heinrich Heine recounts the Paris scene:

"That night, the balls were more crowded than ever; hilarious laughter all but drowned the louder music; one grew hot in the chahut, a fairly unequivocal dance, and gulped all kinds of ices and other cold drinks--when suddenly the merriest of the harlequins felt a chill in his legs, took off his mask, and to the amazement of all revealed a violet-blue face. It was soon discovered that this was no joke; the laughter died, and several wagon loads were driven directly from the ball to the Hotel-Dieu, the main hospital, where they arrived in their gaudy fancy dress and promptly died, too...[T]hose dead were said to have been buried so fast that not even their checkered fool's clothes were taken off them; and merrily as they lived they now lie in their graves.

Rethel depicts the scene as he envisioned it. Death plays its instrument with a human bone, the costumed dancers struck dead mid dance at Death's feet. We see disease symbolized as a shrouded female figure sitting in the background, while musicians scurry from the scene with terror in their eyes.

Contrast this with an illustration from the US National Library of Medicine, a picture done by J. Roze entitled "Le Cholera a Paris". This engraving also depicts the cholera epidemic, but from a different perspective.

Which of the two stands out to you? One is more a symbolic representation, one more of a reality. One depicts terror, the other grief. Does either piece of art allow the viewer to experience the experiences of a sudden epidemic, or do Henrich Heine's words give a clearer picture?



Works: Rethel, Alfred "Death as Cutthroat"( 1851)
Roze, J "Le Cholera a Paris" (1832) US National Library of Medicine
Sources: Athanassoglou-Kallmyer, Nina "Blemished physiologies: Delacroix, Paganini, and the cholera epidemic of 1832- portrait of Niccolo Paganini by Eugene Delacroix" The Art Bulletin (Dec 2001). Here




Monday, June 23, 2008 by Amy Clarkson · 2

Monday, June 16, 2008

"The Sea Inside"

“A freedom that ends life is no freedom at all.”
“And a life that ends freedom isn’t a life either.”

“The Sea Inside” is a Spanish film, based on the true story of Ramon Sampedro, a quadriplegic who fought for 28 years for the right to end his own life. It won an Academy Award in 2004 for Best Foreign Language Film.

Ramon sustained a spinal cord injury in his youth, after a diving accident. Since that time, he was completely dependent on his family (mostly his sister-in-law Manuela). The story revolves around his relationship with 2 different women, his lawyer Julia, who is herself dealing with a life-threatening illness, and Rosa, a single mother who is trying to find meaning in life and hopes to help Ramon do the same.

As Ramon struggles to convince a judge that he has the right to take his own life, he also struggles to convince his family, friends, and clergy. In an interesting scene, Ramon debates euthanasia with a quadriplegic priest (scene quoted above).

This clip shows the power of Ramon's mind to escape his crippled body. He is able to stand up, walk to window and fly away. His mind could be free even while still a prisoner, similar to themes in "The Diving Bell and the Butterfly" (the movie was released on DVD in April).






His mind also keeps going back to the moment after his accident, the moment he almost dies and is pulled back into life. He seems so peaceful in the water up until the moment he is pulled out. Very symbolic that this scene is repeated at the end of the movie.

Warning: Spoiler ahead. Highlight to see.

*SPOILER: Compare the different decisions made by Ramon and Julia and the effects of those decisions. Julia says that she will help him die and then take her own life. She changes her mind and decides to go on living, leaving Ramon in the prison which his life. In the second to last scene, Ramon is finally released through death (with the help of the women who had set out to give his life meaning). The scene that follows shows Julia. She is now herself a prisoner of life. She has become so impaired from strokes that she no longer even remembers Ramon (her worst fears about her illness come true). She decided to live and is now the prisoner while Ramon who always wanted to die has been released. His poem to her is beautiful. I wonder if it loses much in the translation?*


To me, quality of life was the overriding theme of this film (even more than hastened death). Regardless of ones views on hastened death, Ramon’s story is a great demonstration of how quality of life can mean different things to different people. To Ramon, life as a quadriplegic had no dignity. The priest saw that just living was enough. I wish we knew more about why Julia made her decisions (fear of death? love for her husband?).

I will end this post with a quote from Ramon from the beginning of the movie. (This scene would be excellent to play in a talk about dignity or quality of life).

“I want to die because life for me in this condition…life like this has no dignity…I understand that other quadriplegics might get offended when I say that life like this has no dignity. I don’t judge anyone. Who am I to…to judge those who want to live? That’s why I ask that neither me, nor the person who helps me die, be judged.”

Monday, June 16, 2008 by Amber Wollesen, MD · 0

Monday, June 9, 2008

"What Sarah Said" by Death Cab for Cutie

Photo of PianoFinding this song about death in the ICU almost seems too easy when you consider the name of the band, Death Cab for Cutie (DCFC), but I had actually listened to this song for a long time before my friend Laura Morrison made me listen closely to the lyrics at a palliative care conference. (For your indie-rock Jeopardy knowledge, the name of the band comes from a send-up of Elvis in The Beatles Magical Mystery Tour.)

For those of you that don't know any 20-somethings, Death Cab for Cutie is an alternative rock band from Washington State, often hailed as a darling in independent/alternative music circles. The common themes of DCFC's music are love and loss with some very catchy melodies and intelligent lyrics quite distant from most pop cliches.
A critic noted Ben Gibbard, the lead singer/songwriter, often writes to

'immortalize watershed moments. Whether that moment for each of us is the moment love begins or ends, passing romances, death or chance encounters, there is a Death Cab for Cutie song about it.'
Therefore you can see the popularity amongst teens and young adults.



(For subscribers, If you do not see the Immem widget for listening to the song, click on the title to go to the original post on Pallimed: Arts & Humanities)

DCFC have a few songs to be featured in upcoming posts, but for now we will focus on "What Sarah Said," from the 2005 album "Plans." (I highly recommend the whole album.) It opens with a haunting piano melody reminiscent of the repeated beeping from telemetry monitors in a hospital. Within the repeating melody you hear a second melody beginning with ascending notes with a hopeful sound, that slowly fades and descends into a soft melancholy plateau in the background. The same ascending/descending 2nd melody comes back again in the second verse with the ascending portion coming with the only positive emotion in the lyrics "But I knew that you were a truth..." The ascending portion of that melody never makes its presence again in the song until near the very end. Every line in this song represents the difficulty of being the family or friend of someone ill and dying in the ICU. The two lines I find most insightful are:
"And it came to me then that every plan is a tiny prayer to Father Time"
"And I looked around at all the eyes on the ground as the TV entertained itself"
Even making a simple plan of what you will do in the next five months, five hours, or five days, is dependent on actually surviving. Father Time and the Grim Reaper are connected by their tool, the scythe, which marks the end for one year's crop so another may grow. And it is nearly impossible to walk through a hospital without finding a television left on in a room where no one is paying any attention, and so it sits blaring reality shows and local news, everyone oblivious to its constant chatter. Even the patient for whom the TV is left on, will often dismiss the importance of leaving it on. The final lines encapsulate what palliative care staff see daily as family and friends witness the dying as a final act of love by just being present.
"But I'm thinking of what Sarah said that "Love is watching someone die."So who's going to watch you die?.."
This presence at the bedside of a dying person can be a demonstration of your love, but it can also tax and exhaust family. A variation on this line ("Love is watching someone die") is occasionally heard from palliative care professionals to allow family credit for the 'work' involved in being present at the deathbed. It is interesting to take the line "So who's going to watch you die" out of a palliative care context, as people may have a much different perception. It would be relatively easy to assume you are watching an action movie and the villain is saying this as some sort of threat to the good guy. Superficial, threatening, maybe hateful. But in the right context the same words can bring forth thoughts of love, loss and tears.

You may also notice that with the first mention of "So who's going to watch you die", the music is relatively absent except a few piano chords, until the keyboards come back in with a insistent driving rhythm, followed all together with a guitar strum (inhaled breath), a fingerpicking guitar melody (will to live), cymbals/hi-hat (neurological activity), organs (the EKG), snare drum (interventions of medicine), the main piano melody (emotions and love), and the lifting second piano melody (hope). All this as if the person had been brought back to life one last time. But then sadly just as the instruments regain some strength they begin to fade again each one going out one by one. To help you see what I hear, I have made a video to show these different elements. (To hear all the instruments clearly, use headphones and an original recording.)




Now available on You Tube (8/5/8) if you want to embed it on your site or see it in full screen version.
(Removed because of YouTube's copyright rules 12/08 - but still available on Google Video)

Yes there is a two-tone sound reminiscent of a doorbell at the end of the song. It is hard to hear in this video clip, but it is there. Do you hear anything different in the instrumentation?

DCFC's new album "Narrow Stairs" came out in May 2008. (It is very good.)

"What Sarah Said" by Death Cab for Cutie (Gibbard/Walla) from the album "Plans" (2005) from Atlantic Records.

Lyrics:


And it came to me then that every plan is a tiny prayer to Father Time
As I stared at my shoes in the ICU that reeked of piss and 409
And I rationed my breaths as I said to myself that I’ve already taken too much today
As each descending peak on the LCD took you a little farther away from me (Away from me)

Amongst the vending machines and year-old magazines in a place where we only say goodbye
It stung like a violent wind that our memories depend on a faulty camera in our minds
And I knew that you were a truth I would rather lose than to have never lain beside at all
And I looked around at all the eyes on the ground as the TV entertained itself

'Cause there’s no comfort in the waiting room&
Just nervous pacers bracing for bad news
And then the nurse comes ‘round and everyone lift their heads
But I’m thinking of what Sarah said,

"That love is watching someone die."

So who’s gonna watch you die?

Monday, June 9, 2008 by Christian Sinclair · 46

Monday, June 2, 2008

Isle of the Dead

In 1880, Marie Berna had only been married a short time when her husband, Dr. George Berna died. To commemorate his life she visited the then unknown artist, Arnold Bocklin at his studio in Florence to commission a painting. He at first suggested he’d paint something to cheer her up, a happy scene. She preferred something more serene, as a theme of her bereavement.

Arnold Bocklin referred to his work as A Still Place, A Silent Island and Island of the Graves. He told Madame Berna, "Its influence is so quiet that one is startled if there is a knock at the door." Later an art dealer by the name of Fritz Gurlitt provided the title, which it is now known by: Isle of the Dead.

We see a boatman rowing into the darkness. At the center a figure in white stands over a coffin draped in white. The stillness of the work has touched many over the years. In fact Adolf Hitler purchased one of Bocklin's five versions. It was hanging on the wall of his study in the bunker he committed suicide in. Vladimir Lenin and Sigmund Freud had reproductions on their walls as well.

What is it about this painting that such infamous people in history have owned it? What in this work haunts the viewer? Sergei Rachmaninoff saw a black and white reproduction in a gallery in Paris in 1907 and immediately went to work on his own musical expression entitled, "Isle of the Dead". Listen to this clip from his 1909 work while you study the painting, and hear the lapping waves against the ferryman's boat as he enters the Isle of the Dead.

One must ask, are we left with the same peaceful stillness the artist intended? Or a foreboding since of doom?

Sources: Burroughs, Bryson. "The Island of the Dead by Arnold Bocklin" The Metropolitan Museum of Art Bulletin. (1926)21:146-48
Gurewitsch, Matthew "Music: A visual Requiem that inspired Rachmaninoff" in the New York Times: here
Works: Bocklin, Arnold, "Isle of the Dead"(1880)
Rachmaninoff, Sergei, "Isle of the Dead" Symphonic Poem, Op.29 Orchestral Musice (Slatkin)

Monday, June 2, 2008 by Amy Clarkson · 8

Monday, May 26, 2008

Symbolism in Graveyard Art

The term Graveyard art sounds morbid, I know, but people have been using art to mark burial sites for thousands of years. The art demonstrates how they honor and grieve the deceased. The symbolism abounds. Ancestry Magazine had a great article about all of the different symbols seen in cemeteries and what they mean. A lion symbolizes courage, eternal guarding, while a rose stands for completion or brevity of earthly existence.


The hand is a common symbol on gravestones and other art. In some Native American cultures, it signifies a healer. In the Shaker religion, a hand holding a heart meant welcome. A hand is also a symbol of protection or power. On this gravestone from the Key West Cemetery, the finger pointing upward probably signifies a pathway to heaven. It seems to be pointing to the words "At Rest" while the words "In God We Trust" are at the base. It looks like the hand is resting on a book. The Bible would be the most likely book. So it could be demonstrating that the person is at rest in heaven, with God and trust in God as their support.

The urn stands for immortality. In the ancient Egyptian culture vital organs were placed in urns with the belief that life could be restored through them. The urn with a flame stands for undying remembrance (like the Eternal Flame by JFK's gravestone). The flowers surrounding the urn signify beauty and life and their temporary nature. The urn rests on top of a sword which is a common symbol for martyrdom or the military (often crossed). Given that the sword is facing down (towards the deceased) it probably stands for relinquishing victory, or maybe submitting to death.




Also from Key West, some humor in the cemetery. As far as graveyard humor goes, this is actually a somewhat common one. Gravestones in Texas and New Jersey carry the same message. Spike Milligan (an Irish comedian) had "I told you I was ill" (in Gaelic to make it church appropriate) engraved on his.


This is a foot stone from my own family cemetery. My grandparents received a card with this poem and had it engraved on my uncle’s foot stone. The poem (written below for easy reading) compares life to a rose that grows beautiful and strong until it follows a beam of light through a crevice in a wall. It continues on the other side, just as beautiful but out of our site.

Looking at how others grieve and memorialize their departed loved ones makes me think about how we, in the field of hospice and palliative care do the same for patients we have lost.





The Rose Beyond the Wall

Near a shady wall a rose once grew,
Budded and blossomed in God's free light,
Watered and fed by the morning dew,
Shedding it's sweetness day and night.

As it grew and blossomed fair and tall,
Slowly rising to loftier height,
It came to a crevice in the wall
Through which there shone a beam of light.

Onward it crept with added strength
With never a thought of fear or pride,
It followed the light through the crevice's length
And unfolded itself on the other side.

The light, the dew, the broadening view
Were found the same as they were before,
And it lost itself in beauties new,
Breathing it's fragrance more and more.

Shall claim of death cause us to grieve
And make our courage faint and fall?
Nay! Let us faith and hope receive—
The rose still grows beyond the wall,

Scattering fragrance far and wide
Just as it did in days of yore,
Just as it did on the other side,
Just as it will forevermore.

By A. L. Frink

Monday, May 26, 2008 by Amber Wollesen, MD · 4

Saturday, May 17, 2008

Top 10 Palliative Care Films

We hope over the upcoming weeks and months you will enjoy learning and exploring the more "creative" side of palliative medicine! As a way to get things rolling we thought it'd be fun to spend some time thinking about our top 10 palliative minded films. As you may imagine, the decision was tough. There are actually a lot of movies out there that deal with things like death, grief, mortality, etc. We tried to have each film cover a particular unique theme. We'll undoubtedly spend time in future posts exploring these great films.

Please comment if you have used these in teaching, or there are films you think should be in the top 10, or if you think the list should be reordered.

For now, here's Pallimed: Arts & Humanities top 10 palliative care films:

Plot summaries courtesy of the Internet Movie Database; Titles link to the film preview
10. One True Thing (A career woman reassesses her parents' lives after she is forced to care for her cancer-stricken mother.)

9. The Fountain (Spanning over one thousand years, and three parallel stories this is a story of love, death, spirituality and the fragility of our existence in this world)

8. Big Fish (A story about a son trying to learn more about his dying father by reliving stories and myths his father told him about himself)

7. Life as a House (When a man is diagnosed with terminal cancer, he takes custody of his misanthropic teenage son)

6. The Diving Bell and the Butterfly (The true story of Elle editor Jean-Dominique Bauby who suffers a stroke and has to live with an almost totally paralyzed body; only his left eye isn't paralyzed)

5. The Sea Inside (The real-life story of Spaniard Ramon Sampedro, who fought a 30 year campaign in favor of euthanasia and his own right to die)

4. On Our Own Terms: Moyers on Dying (Four part PBS series by journalist Bill Moyers that focuses on end-of-life care in the US)

3. Two Weeks (In this bittersweet comedy, four adult siblings gather at their dying mother's house in North Carolina for what they expect to be a quick, last goodbye)

2. The Doctor (Jack Mckee is a doctor with it all: he's successful, he's rich, and he has no problems...until he is diagnosed with throat cancer)

1. Wit (A renowned professor is forced to reassess her life when she is diagnosed with terminal ovarian cancer)

Saturday, May 17, 2008 by Amy Clarkson · 34

Thursday, May 1, 2008

Welcome

Art is much less important than life, but what a poor life without it.
Robert Motherwell

As this is the first post of the Pallimed: Arts & Humanities Blog, I wanted to take this opportunity to tell all of you why we feel this topic important. Why art and palliative care? What do the two topics really have to do with each other?

First of all, themes common to palliative care such as death, grief, and chronic illness are also common themes in the arts. People have been getting sick and dying since the beginning of time and they have been making art to memorialize the occasion for almost as long. It seems like such a great fit to talk about these topics together.

In palliative care, we deal with (and experience) a lot of emotions: anger, sadness, frustration, relief, sometimes even joy. The arts are a great outlet for emotions. Many people journal or write stories to deal with emotional issues. We use art therapy to help our patients deal with their illnesses. As lovers of the arts, we see writing this as a little bit of self-care (an emotional outlet for us). We hope that reading this blog is a little bit of self-care for you, the reader, as well.

Just writing this will be a great learning experience for us. We hope you will learn something and then teach us something new through your comments. We’re definitely not art experts, just interested palliative care doctors, so we’re open to hear if you agree or disagree with the things we write. Ultimately, we hope this builds your interest in palliative care and the arts so you can share your enthusiasm with those around you.

Thursday, May 1, 2008 by Amber Wollesen, MD · 0

Monday, March 17, 2008

Contributors

Amber Wollesen, MD

I received my medical training from the University of Missouri-Kansas City and graduated in 2003. I stayed on there for the 3 years of my internal medicine residency. In 2006, I was selected to be a Chief Resident. That was an important year for me. I discovered an interest in palliative medicine and got married to Wayne. In 2007, I ventured away from UMKC and joined a palliative medicine fellowship at Kansas City Hospice. Next year, I hope to work at a local hospital doing inpatient palliative care. My major palliative care interests are quality in palliative care and resident education.


Amy Clarkson, MD

I attended the University of Kansas for medical school and graduated in 2004. Family Medicine was an easy choice for residency and I completed 3 years with the Department of Family Medicine at the University of Kansas Hospital, finishing up my last year as a Chief Resident. After spending one day with the palliative care consult team, I knew I'd found my niche in medicine. I'm currently finishing a fellowship in palliative care with Kansas City Hospice and will join the physician group of that organization next year. Any free time not involved in medicine is spent with my lovely 16month old daughter and husband.

Monday, March 17, 2008 by Amber Wollesen, MD · 2

Disclaimer

The views expressed on this blog are solely the opinions of its contributors. They in no way reflect the views of our employers or any other institutions with which we are affiliated. Nothing on this blog is meant to be taken as medical or any other type of professional advice.

We do not host any of our own videos on this site. We do utilize already posted videos and we do post photos, quotes, and lyrics. If you have any questions or concerns about any of the material posted, please contact us. If you have the copyright on any of the material posted and object to it being used, we would be happy to take it down from our site or give proper credit.

by Amber Wollesen, MD · 0

Mission/FAQ

Thank you so much for visiting our blog. The Pallimed: Arts & Humanities blog is the second blog in the Pallimed family. As the name implies, our focus is a little different from our sister blog. Our aim is to explore how the arts and humanities influence and are influenced by topics in palliative care.

Our goal is not only to provide enjoyment for you, the readers, but also to have some practical uses in palliative care education, such as use of a movie clips or art in palliative care lectures. We will do this by choosing examples of art, music, cinema, literature, television, theatre or other media with themes related to palliative care (for example: end-of-life, chronic illness, ethics, grief). We will post a commentary about the work and its relationship to palliative medicine (this may be obvious).

Our target audience is anyone in the field of (or with an interest in) palliative care, medicine, the arts, or humanities. While some information may be palliative care specific and assume a familiarity with the field, we hope that those with medical and non-medical backgrounds alike will enjoy our writings.

Who is Pallimed:Arts & Humanities?

Amber Wollesen, MD

Amber(dot)wollesen(at)gmail(dot)com

Amy Clarkson, MD

Amylclarkson(at)gmail(dot)com

What are the arts and humanities?

We realize that art means something different to every person and culture. We generally think of the arts as the products of creative activity. Humanities are defined as "learning or literature concerned with the human culture". I think for the purpose of this blog, we will take a very broad interpretation to the definitions of arts and humanities. Any aspect of the human culture and it's creative activity are potential topics.

How do you choose the topics you write about?

It’s pretty much at random. We write about things that are interesting to us within the scope of this blog (arts and humanities). If you have things that you find interesting and you would like us to write about (or you would like to write about) please contact us.

How often do you post?

Our aim will be to post once per week.

Does Pallimed get referral fees for any of the links?

Pallimed does not get any referral fees for any of the links we provide. We do not participate in commercial advertising and so we do not accept any fees for advertising. We are all doing this on our own time without reimbursement.

What is a Spoiler?

A Spoiler is a line or paragraph that gives away the end or key plot element of a movie. We know that not all of our readers will have seen the movies we review. For that reason, we will hide any spoilers and place an asterisk on either side so you know they're there. We will also warn you when a spoiler is coming. It will look something like this: Warning: Spoiler ahead. Highlight to Read. *Spoiler info here*. Just highlight the text in between the asterisks if you want to know the end of the movie. Or watch the movie first and come back to read what we have to say.

How can I share my opinion?

Feel free to comment on any post. Pallimed has a comment function (at the bottom of each post) that allows you to give us feedback on each post. Just click on the link at the end of each post. We will also entertain guest posts if they fit into our aims.

We understand that the topics we write about are very subjective. You may agree or disagree with our interpretations. We hope you share your views with us.

Comment Disclaimer: Pallimed reserves the right to remove any comments we deem offensive/hateful, mean-spirited, commercial, or in any other way inappropriate.


by Amber Wollesen, MD · 1

Tuesday, January 1, 2008

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