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Through life’s meridian bound,
In silent pain I weep;
What joy on earth is found!
Too slow the minutes creep.
O death! Thy aid I crave,
Advance to my relief;
Consign me to the grave,
And banish all my grief.
(An Invocation to Death 21-28)

This is an excerpt taken from the poem "An Invocation to Death" by Jane Cave Winscom. In the 1790s, Winscom wrote three poems ("Written the First Morning of the Author’s Bathing at Teignmouth, For the Head-Ach", "The Head-Ach or An Ode to Health" and "An Invocation to Death") describing living with chronic headache pain. In the above lines, she describes the silent agony she is feeling. The pain is so bad, she craves the "aid" of death to relieve her suffering.

Jane Cave Winscom is somewhat of an obscure poet. Not much is known about her life outside of her poetry. Winscom first published "The Head-Ach" in a newspaper in 1793 as a plea to readers.

Live’s one on earth possess’d of sympathy,
Who knows what is presum’d a remedy?
O send it hither! I again would try,
Tho’ in the attempt of conqu’ring I die.
(The Head-Ach 45-48)

Although written over 200 years ago, some of Winscom's sentiments may seem familiar to modern times. In her three poems, she describes her agonizing pain, multiple treatments she has tried, and a frustration with the medical community who apparently promise much but deliver little.

Physicians, and ye crowd,
Who boast of physic-skills;
I may proclaim aloud,
You’re but a splendid ill!
In vain I’ve sought for cures,
As tortures still confine:
What fruitless pounds are yours!
What pain and anguish mine!
(An Invocation to Death 9-16)

Something that strikes me about Winscom's poetry is the evolution of hope. In the first poem, she seems hopeful that her pain can be can be relieved by bathing in the Teignmouth (a popular treatment at that time for many different illnesses).

I chid my fears—my cowardice was nipped,
And next below the wave my head was dipped:
A strange sensation—in a second o’er,
And I quite braced, much happier than before;
When I bathe next, I’ll have two dippings more.
(Written the First Morning of the Author’s Bathing at Teignmouthlines 18–22 )

By the time she writes the last poem, her hope has changed. She no longer believes in the physicians or other practitioners who have tried in vain to relieve her pain. She now places her hope in death. Through dying, she may finally be at peace.

And ye of tend’rest tye,
To whom I yet am dear!
Heave not a fruitless sigh,
When you behold my bier!
But join me to the dead:
Rejoice my days are o’er;
And say,—“that peaceful head
Shall bow with pain no more.”
(An Invocation to Death 41-48)

Winscom is not alone in using poetry to express physical pain. The American Pain Foundation has more contemporary poems written by those suffering from chronic pain.

References: McKim, A. Elizabeth, "Making Poetry of Pain: The Headache Poems of Jane Cave Winscom" Literature and Medicine 24, no. 1 (Spring 2005) 93–108

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

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

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

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

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

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


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

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

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

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If you're looking for a feel good movie, this is definitely not for you. The Seventh Seal is a 1957 Swedish film directed by Ingmar Bergman. There is a lot going on in this movie, so I'm writing about some of the main points. You could easily analyze each scene.

A knight and his squire return from the crusades to a plague ravaged Europe. When Death comes to take the knight, he challenges Death to a game of chess, with the stakes being the knight's life. The scene below is taken from the beginning of the movie and sets up the plot of the movie. (In subtitles for those who don't speak Swedish.)



The title of the film comes from the first line of the movie, which is a taken from the book of Revelations. This passage is repeated at the end of the movie. The movie is full of religious references and symbolism, as the knight struggles with death and his belief in God.

The chess game is worked in throughout the movie as the knight travels through the countryside, witnessing the horrors of the plague and how people react with facing their own mortality. Groups of people roam the country whipping themselves in penance and begging for God's mercy. A women accused of being a witch is burned for fear that she brought on the plague. (Did I mention this was a dark movie?)

In the end, the knight distracts death so that others may escape. After the chess match, he asks Death to reveal his secrets. Death responds "I have no secrets...I am unknowing." When death comes back for him, he is welcomed into the knight's home with a mixture of fear and awe (maybe even some happiness) by the knight and his friends.

I see the knight as a man who has essentially just gotten a terminal diagnosis. He makes a wager with Death, bargaining for his own life. He tries to buy more time.


But in the end, no one escapes Death (or death).

So, what are the pieces on our modern day chess board? Are modern medicines just more moves to buy time in a losing chess match? Interesting movie, but it doesn't leave you with the most pleasant thoughts.

As a side note, the painting referred to by the knight in the film clip is one in the Taby Kyrka, a medieval Swedish church, painted by Albertus Pictor in the 1480's. This is said to have inspired Bergman in the making of the film.

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Knowing the context of a composition can transform the listening experience, especially for classical music, that has no words. Such was the case for me when I heard a brief history of Gustav Mahler's 9th symphony prior to listening to the Chicago symphony preform it. Perhaps you will say the same after this post.

Let us look at an intricate interconnection of events that eventually leads to the final complete symphony of Mahler. First we must look back to a German poet named Freidrich Ruckert. In a 2 week span Ruckert lost two of his five children to scarlet fever, Luise age 3 and Ernst age 5. As a way to grieve their loss he wrote a series of 425 poems in a collection called "Kindertotenlieder" or Songs on the Death of Children completed in 1834. These were of a private nature, and only published after his death in 1872.

Gustav Mahler came across these poems and found in them an inspiration for composing his own 5 song cycle entitled Kindertotenlieder (1901-1904). This was an unusual time for Mahler to be writing songs about children dying. He had just married Alma Schindler in 1902, and the birth of two daughters soon followed: Maria Anna(1902) and Anna (1904). Many found it difficult to understand his ability to be interacting with his own new young children and yet focused on such a haunting theme in composition. Mahler's wife was even appalled, "What I cannot understand is bewailing the deaths of children who were in the best of health and spirits...hardly one hour after having kissed and hugged them." (Gartenberg)

It was Ironic then when in 1907, his beloved daughter Maria Anna contracted diphtheria and at the young age of 4, died. 1907 was also the year Mahler himself was diagnosed with infective endocarditis. Grief stricken and with a new life limiting illness he began work on symphony No. 9.

We are not surprised then to hear these themes in Mahler's 9th symphony. Listen to the beginning of this 1st movement. It begins subtlety, even hesitantly. Can you envision Mahler at a picnic with his daughters, the merriment of life abounds. Then the intrusion begins, an ominous discord like a storm on the horizon. The climax is ushered in with trombones piercing the calm, as death appears in the midst of joyous life. The strings then follow as a voice crying in sorrow.

It is in the 4th movement that Mahler finds his conclusion. He uses a theme from his earlier Kindertotenlieder cycles in this movement. Although when he originally wrote it he had to imagine the loss, it was now more poignantly real. The poem of that 4th cycle speaks to the recognition of the tricks the mind can play when we've lost someone dear. Yet in the lines that follow you'll note the resolution, in the term "those heights" which Mahler changed to a German word meaning "heaven". From cycle #4. Oft denk' ich, sie sind nur aus gegangen:

"Often I think they've gone outside! / Soon they will get back home again! / The day is lovely! Don't be anxious, / They're only taking a long walk / .... They've only gone out before us, / And will not long to come home again. / We'll catch up with them on yonder heights / In the sunshine! / The day is fine on yonder heights!"

As you listen to this part of the 4th movement, hear the words of the poem. The sadness behind the strings slowly resolving into resolution. Mahler himself perhaps finding his own peace, not only in the loss of his little girl, but in his own mortality. Do you hear the theme saying, "It'll be okay", the grief is still present, but "the day is fine yonder heights"


Sources: Gartenberg, Egon. "Mahler:The Man and his Music" (New Tork: Schirmer, 1978), 288.
Rushing, Randal "Gustav Mahler's Kindertotenlieder: Subject and textual choices and alterations of the friedrich ruchert poems, a lecture recital, together with three recitals of selected works of F. Schubert, J. Offenback, G. Finzi and F. Mendelssohn" Here
Works: Mahler, Gustav "Symphony No. 9"

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


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


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

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

In the third, he seems to focus on certain facial attributes, like his ear and nose. His eyes seem to be more prominent than in the second. His brow seems furrowed. The background looks almost architectural. Maybe attempting to create a space?


In the last painting, there are very few recognizable features left. The entire image is very abstract. His nose and ear are still somewhat prominent. His eyes are absent or distorted. His mouth is barely penciled in.


Per the New York Times article, William Utermohlen no longer paints. As of the time of the article, he was living in a nursing home. An exhibit of his art has been on tour around the world entitled ‘Inside Alzheimer’s: Portraits of the Mind'.

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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"

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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!

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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.

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)

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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.

The 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

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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

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“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.

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Finding 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?

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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.

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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)

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“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.

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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.

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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.

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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.