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A few weeks back, when my husband and I were on vacation in London, we came across an interesting tour. There were lots of tours we saw advertised but this actually came highly recommended by friends. It was the Jack the Ripper Tour (there are actually several of them by different companies). It is a nighttime tour that goes through the streets and alleys of the Whitechapel area to sites of the famous murders. We ultimately didn't end up taking the tour. I thought I could go without experiencing London through the eyes of a serial killer. I've never felt the need to stand at the site of a famous murder. But many do enjoy this. This led me to do a little but of research on the topic.

Did you know that for $225-250 you can stay in infamous accused murderer Lizzie Borden's actual bedroom? You can take a tour of the house (now bed and breakfast) and museum. In Chicago, you can take the Devil in the White City Tour, which looks at serial killer Henry H. Holmes. In LA you can take a Helter Skelter bus tour to see the sites of the Manson murders. This Obit Magazine article talks about a Boston tour that plays up the sites of South Boston mob boss James “Whitey” Bulger.

So where does historic interest turn into some morbid type of voyeurism? People visit sites like Auschwitz all the time. I've never really thought twice about this, as it seems like something that needs to be seen. (To me, I guess. Others may think differently.) So what makes this ok and the Helter Skelter Tour seem so wrong? Is it time passing? (How much time does need to pass before it is socially acceptable to start a bus tour?) The historic value of the site? A lesson you might take away?

I know that there are people who are just serial killer and famous murder buffs. Just like my husband loves WWII history and my sister is obsessed with the British monarchy, there are those that just find this sort of thing fascinating. It's a personal taste thing, I suppose. Maybe I just don't get why someone would want to be reminded of such horrible things. Isn't life difficult enough as it is?

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Artist Ray Johnson is mainly regarded as a correspondence artist, having founded something called the The New York Correspondence School, which basically is an ever changing group of people who send each other art work through the mail.

During 1963-65 Johnson produced 12 unbound pages of mail art for something called "A Book About Death". He sent these one page essays about death to other artists in the correspondence school. Johnson committed suicide in 1995 and in an effort to commemorate him the art project "A Book About Death" was started.
In 2009 artist Mathew Rose, taking inspiration from Johnson's death themed art pages, organized a massive exhibition of similar mail art.  The call went out to artists all across the world to submit postcards on the theme "A Book About Death".  The artists were to create 500 postcard copies of their pieces and mail them to the gallery of the exhibition.  During the show, which was held in September 2009, visitors could then collect postcards from the hundreds of artists and take the postcards home to create their own unique book about death.

Since the original ABAD show, there have no been 23 installments, as the project continues to move around the world with new additions continually.  Each ABAD exhibit is slightly different, some like the recent exhibit in May at the Willo North Gallery in Phoenix, Arizona called for postcards with a memento accompanying it.


The most recent ABAD project is open now, July 31- Sept 2 at the Second Avenue Firehouse Gallery in Long Island.  This unique exhibit is entitled "A Book About Death: The Ties That Bind".  The curator of the event LuAnn T. Palazzo asked artists to submit larger works on pages, one copy to be displayed on the wall for the exhibit and the other to be bound in a book on display during the show.


I've enjoyed browsing the images for the different shows, a few which are included here.  The interpretations on death are as diverse as they come.  Some of the pieces are accompanied by poems, like this piece below with image on one side, and the poem on the back of the post card.


I wonder if there would be a place to do some collage work as a self care session for hospice and palliative care in this way, or perhaps a work shop at a national convention resulting in a Hospice and Palliative Medicine edition to A Book About Death?

Art work credits from top to bottom:
Steve Dalachinsky
Laura Sharp Wilson
"The Call" Sophia Oldsman
"Sustenance" Kim Triedman

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This HBO documentary looks into the life and death of Diane Schuler. In 2009, Diane was involved in a head on collision that killed her daughter, 3 nieces, 3 men in the other vehicle and herself (her son was the only survivor). It analyzes Diane's life through her friends and the hours leading up to the accident through cell phone calls, police, eye witnesses and surveillance video. She had been noted to be driving erratically and then drove the wrong way on an interstate for 1.7 miles. An autopsy of Diane revealed a blood alcohol level of 0.19 and high level of marijuana in her system.

To Diane's grieving husband, she was a perfect wife and mother. He is adamant that she would never have drank while in the car with the children and that the results of the autopsy are false. He has contested these findings even after the discovery of a bottle of vodka in the car. He grasps at any possibility (a tooth abscess she had several years ago causing her to have a stroke which led to her drinking the alcohol by mistake).

What interested me are all of the interviews of the family members on both sides. Her husband, family members and friends reminiscing about the Diane they knew and looking for any answers, any other medical reasons she behaved the way she did. On the other side, the family members of the 3 men killed in the vehicle she hit, angry that her husband continues to deny what the evidence shows. (The parents of the three nieces killed did not participate in the documentary.) It even goes into the grief and trauma of the witnesses to the accident.

Most of what they present is from the view of Diane's husband and sister-in-law. You find yourself wanting to buy into their blind faith in Diane, even though you know what the evidence shows.

The documentary is very well put together. It easily moves from the accident to the distant past to the present. They integrate the medical and other evidence along with psychiatric assessments of the Diane and her family. (The graphic accident photos I could have done without). It's a medical mystery along with a unique perspective on grief. What happens if the person you are grieving is possibly at fault in the loss? Was she really the person that everyone thought they knew?

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British graphic designer Ross Mackintosh lost his father in 2009 to prostate cancer.  Like many artists before him, he turned to art to process the events. In fact, he told Deborah Vankin in an interview for the Los Angeles Times, "I created the comic for myself, as a way of removing pictures and phrases from the maelstrom in my head. The secondary purpose was a subconscious need to express to my mom and brothers that the awful events didn't just happen quietly"

The medium he chose, however, was not his usual computer based work, but that of cartoon. Many of his memories and experiences were so visual that he decided to draw them out. The outcome is a stunning and beautiful tribute to Mackintosh's father. The graphic novel, published by Com.x in April is entitled "Seeds".

I was drawn immediately to the images;their minimalist nature serves the heavy topic well. The reader journeys from time of diagnosis to time of funeral. Interspersed in the narrative of the events are deeper concepts such as genetics, relationships and purpose.  Also accompanying the story are the very real moments of humor and tragedy. It is this combination that allows the reader to connect and perhaps even find their own personal stories in this work.

Mackintosh's father spent time in hospice and there is a great conversation where the physician communicates prognosis by saying "When people in your father's position deteriorate monthly, they usually have months to live....When they deteriorate weekly, they usually have weeks to live.... Your father has been deteriorating daily..."

The medium of cartoon really forces the themes and concepts to be whittled down to absolutes... gone is the ability to hide in verbose prose or get lost in mundane details. This really makes this graphic novel quite raw, and most of the reviewers I read mentioned reading with lumps in their throats, as the images and few words struck familiar nerves of mortality and loss.

This certainly is one that should be considered for our personal and/or palliative medicine libraries and it may very well attract unsuspecting readers going through the experience of loss.

All images are Copyright Ross Macintosh.

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I discovered Redemption Song on the Rolling Stone top 500 songs list. It is listed as #66, stuck between #65 Sunshine of Your Love by Cream and #67 Jailhouse Rock by Elvis Presley. I had never heard it before, as I have never been acquainted with Bob Marley's music.

The song Redemption Song is the final song on Bob Marley's album Uprising, the last album that was released during his life time. (One more album, Confrontation, came out after his death.) The lyrics for the song were taken from a speech given by journalist and orator, Marcus Garvey. "We are going to emancipate ourselves from mental slavery because whilst others might free the body, none but ourselves can free the mind."

At the time Marley wrote Redemption Song, he had already been diagnosed with melanoma. He was already dealing with a lot of pain issues and his own mortality. Many consider it to be a sort of summing up of Marley beliefs and it is considered some of his best work.

Marley died in 1981 at age 36.




Old pirates, yes, they rob I;
Sold I to the merchant ships,
Minutes after they took I
From the bottomless pit.
But my hand was made strong
By the hand of the Almighty.
We forward in this generation
Triumphantly.
Won't you help to sing
These songs of freedom?
'Cause all I ever have:
Redemption songs,
Redemption songs.

Emancipate yourselves from mental slavery;
None but ourselves can free our minds.
Have no fear for atomic energy,
'Cause none of them can stop the time.
How long shall they kill our prophets,
While we stand aside and look? Ooh!
Some say it's just a part of it:
We've got to fulfill the Book.

Won't you help to sing
These songs of freedom?
'Cause all I ever have:
Redemption songs,
Redemption songs,
Redemption songs.

Emancipate yourselves from mental slavery;
None but ourselves can free our mind.
Wo! Have no fear for atomic energy,
'Cause none of them-a can-a stop-a the time.
How long shall they kill our prophets,
While we stand aside and look?
Yes, some say it's just a part of it:
We've got to fulfill the book.
Won't you have to sing
These songs of freedom? -
'Cause all I ever had:
Redemption songs -
All I ever had:
Redemption songs:
These songs of freedom,
Songs of freedom.

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According to the National Funeral Directors Association, the cremation rate in the United States in 2009 was 36.86%, that's up from 25.04% in 1999.  The NFDA also predicts that the cremation rate will be just shy of 59% in 2025! With the rising trend in cremations, it's about time we did a post on urns.  We already know that we can be creative, as explored in our post on custom coffins, so it should be no surprise that custom urns also exist.

The urn itself is simply a vessel or vase without handles. The urn was used in ancient Greek and Roman times for oils, as well as cremation ashes.

Today after cremation, the options are quite diverse on what is done with the ashes. Many people scatter ashes, so have no need for an urn.  Other people use the urn for the ashes and have the entire thing buried in a cemetery plot or placed above ground in the cemetery columbarium (a specific place within a mausoleum for urns). Just like eco-friendly coffins, they also make bio-degradable urns. Another choice is to bring the urn with the ashes home, keeping the departed's remains with you at all times.

When an urn is used, there really is no industry standard. The typical size for an individual may be to hold 170-350 cubic inches, whereas the popular couple urns hold 400-500 cubic inches of ashes. Materials used range from paper, glass and wood, all the way to metals, ceramics and marble.  And if you thought shape mattered, this too is up for negotiation. Urns can look traditional and vase like, or look like an item. I even saw examples for photo frame urns and music box urns.

Looking around online I found several types of urn dealers.  First there is the mega market dealers.  These urns offered on these sites can be very unique, like these cowboy boot urns, and it's true that these mega market dealers have a lot of inventory, but you can also find these same urns on multiple sites. Therefore, the uniqueness is more in design and not truly a one of a kind urn. The urn's from these large scale dealer's are some of the most economical.


Next are the hand made artisan urns. These urns are made individually by artists. Sybil Sage, for instance does mosaic urns, embedded with personal items such as business cards and photos.

Portrait urns like the kind done by artist Ruby Lindell, are hand painted ceramic urns such this example on the right.

Then, of course, there are the eco-friendly urns. Traditionally eco-friendly urns are made of paper. Though I did find sand  urns meant to place in water.  There is also company known as the "Great Burial Reef" which designs an urn made of natural concrete. The idea is that the urn can be placed on the ocean floor and can foster marine life for future generations.

Unlike coffins, urn's offer an extremely wide variety of creative options, allowing a very personalized urn if desired. What I find interesting is that some of the urns look so much like traditional home decor, that the memorial could easily blend in, completely disguised to house guests.

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June 25th, 2011 marked the second anniversary of the death of Michael Jackson. I find it very interesting how iconic celebrities like Jackson are commemorated.

The town of Gary, Indiana, Jackson's boyhood home, has promised a yearly tribute to the King of Pop. This outdoor event includes music, vendors and ends in a candlelight vigil at dusk. It's held at the old Jackson family home. On the first anniversary of his death the city unveiled a monument to Jackson.

Jackson's "Thriller" jacket (the red jacket worn in his Thriller video, seen above) was auctioned off for $1.8 million this year on the June 25th. Apparently a portion of the proceeds will go to the Shambala Preserve, home to Jackson's two Bengal tigers, Thriller and Sabu.

But my absolute favorite way that Jackson was commemorated was various dancing flash mobs. (Flash mobs have made the news a lot lately as there are apparently stealing flash mobs where a group mobs a store and just walks out with merchandise.) These are large groups of people getting together and suddenly breaking into dance. Since his death, these have occurred all over the world from China to Mexico. The video below was taken in Stockholm, Sweden in the weeks after Jackson's death. I found it impressive.



The video below was in San Francisco, this year.

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Paul Hill is regarded as one of the most influential photographers of Great Britain and is best known for his work "White Peak, Dark Peak". (1990 Cornerhouse)  He has spent his life photographing and teaching photography near his home is in Derbyshire, Northern England.  One of the unique things he and his wife, Angela, did was in1976 to establish "The Photographer's Place", a location for photographers to gather for study, retreat, and a workshop environment.


After 40 years of marriage, Angela was diagnosed with cancer, and in 2006, 2 years after her diagnosis, died from the disease. Her husband then began his journey into an uncertain world without her.  His photographs became his response to the grief he was experiencing. His work was published in November and is entitled "Corridor of Uncertainty" (2010 Dewi Lewis Publishing)

The title itself is steeped in metaphor.  Although those of us in the states may be unfamiliar with the phrase, it actually comes from the sport of cricket, and refers to a place that a batsman struggles most to determine whether to play the ball or leave.  Apropos for someone mourning...  Paul Hill writes, "Bereavement, for me, is being between two states: what has been and what may take place in the future. The work that I have made mirrors this interstice"

We have seen other artists document death, but I found it interesting that he writes about his images, "Of course they are informed by the harrowing experience of my wife's fatal illness, but I did not - could not- document her decline directly."

When I glance through the images I am struck by the emotional nature of the pictures. Even had you not known his wife had died, looking through the images as a collection, you'd surely have felt that something tragic had occurred. The images are quite raw and intimate and I'm grateful that Paul Hill decided to share his process with us.

His book is not the end of the matter either, in fact, it seems to be just the beginning. Currently Paul Hill is involved in a research project looking at photography, bereavement and grief. A website at De Montfort University explains the hopes for the project.

I encourage you to take a minute to glance through some of the images from his book, follow this link to do so.

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Watching the evening news a while back I enjoyed the interview of music legend Paul Simon with Brian Williams on NBC.  My ears pricked up when I heard the following part of the interview:

PS: "I'm not crazy about dying"
BW: "I don't know a big fan...."
PS: "No, not too many.  I'm trying to come...  I'm trying to not be pissed off about that"  and a little later...
PS:  "We were always told that your capacity for thinking sort of diminishes as you get older...but now I'm 69 years old and  I think the opposite, I think that it's better. So I look forward to seeing what more time will reveal."

Immediately I wondered about Simon's contemplation on aging and death. I went to work looking at his repetoir of songs to find out what he's been saying in his lyrics about death over the last 4 decades.

The first I found was released in 1972 entitled "Mother and Child Reunion".  From an interview with Rolling Stone that same year Simon explained the inspiration; "Last summer we had a dog that was run over and killed....It was the first death I had ever experienced personally....I felt this loss - one minute there, next minute gone, and then my first thought was, "Oh, man, what if that was [my wife] Peggy? What if somebody like that died? Death, what is it, I can't get it"

Knowing the inspiration then, the lyrics to the song fit, "I can't for the life of me/ Remember a sadder day/ I know they say let it be/ But it just don't work out that way/ And the course of a lifetime runs/ Over and over again."  However, just listening to the melody and upbeat tempo, you'd be hard pressed to hear this and think it was a mournful song.


In 1977 Simon released "Slip Slidin' Away".  There is not a lot of background known as to the inspiration for this piece, but clearly, there are palliative care themes in this.  Many think the "destination" described in the chorus represents death, others may quip that it is a metaphor for any goal or hope for one's life. Regardless the 4th stanza that says "God only knows/ God makes his plan/ The information's unavailable/ To the mortal man/ We work our jobs/ Collect our pay/ Believe we're gliding down the highway/ When in fact we're slip slidin' away"  sounds a lot like someone who is aware of their own mortality.


"The Late Great Johnny Ace" was released in 1983 and is very autobiographical.  Simon was 42 when this was released, and you can sense his maturity in the song.  We are taken on a journey revolving around death and life.  The song opens with Simon as a 12 year old hearing about Johnny Ace's death. Too young to really comprehend this reality, yet somber still the same, the song then shifts dramatically in tempo and melody to a more joyous time of the 60's. The listener has the sense that Simon feels young and immortal. The final third part changes back to the opening melody as Simon hears of John Lennon's death. He connects the news back to the late Johnny Ace's death, except now the sentiment is more personal. I find it haunting that the song concludes with a Phillip Glass instrumental piece, bringing an emotional climax to mortality, as one can imagine in the pulsating melody a clock ticking one's life away.


Finally we turn to Simon's recent album So Beautiful, or So What released this April. Just as the opening interview with Brian Williams suggested, Simon, now 69 years old, is even more aware of issues regarding aging and death. There are a couple of songs on this album that deal with death and mortality.  In "The Afterlife" he pokes fun at death with the opening words, "After I died, and the makeup had dried, I went back to my place" and near the end "After you climb, up the ladder of time, the Lord God is near. Face to face, in the vastness of space, your words disappear."

The more serious is "Love and Hard Times", which though not directly discussing death, is certainly a life reflection. The beginning sets up the human condition with a narrative about God coming and then deciding to disappear, "anyway, these people are slobs here".  The song then moves into a love ballad, and three stanzas cover their first meeting, hard times when love was gone and finally a present moment of gratitude.  The last verse could easily be someone on their death bed, in a still room, "The bedroom breaths in clicks and clacks/ Uneasy heartbeat, can't relax/ But then your hand takes mine/ Thank God, I found you in time"


All in all when I reflect over these works that cover 40 years I get the sense that Paul Simon has often been reminded that life is short. I get the feeling that this awareness allows him to focus on the important things. His statement then "I'm not too crazy about dying" may be less a fear or denial of death, than a realization that he has much more life to live, because life is good these days.

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Breaking Bad is an AMC television show that I recently discovered. It is starting it's fourth season this summer, so it's not a new series. But after I watched most of the first season, I knew it had to be a post.

Walter White is an over qualified chemistry teacher with a 15 year old son with cerebral palsy and a wife who is 7 months pregnant. He discovers that he has terminal lung cancer. Knowing his time is likely short (I think 18 months is what was mentioned in the show). He sets out to make money to pay for expensive treatments to support his family after his death. He does this by joining with a former student, putting his chemistry knowledge to use, to make meth.

Overall the show is a drama with a lot of drug dealing and violence. Walter turns out not to be the mild mannered chemistry teacher type. But I found the cancer angle to be very interesting. There are some very interesting palliative care type scenes. Early on in the show (Season 1) Walter was refusing to talk about treatment. His family had an intervention to discuss his choices with him.

I wasn't able to find the exact clip of his intervention but below is a "Minisode" (essentially the highlights of season 1 episode 5). The scene starts at 3:18. It isn't the complete scene but hits most of the key points. Marie is Walter's sister-in-law (who is actually a doctor) and Hank is her husband (who is a DEA agent, the plot thickens). Please forgive the brief advertisement.



Here is a clip of series creator Vince Gilligan talking about how emotional this particular scene was to make.




I love the talking pillow. Hmm, may use that in a family meeting. I really like the speech Walter gives at the end. Choosing to do nothing is itself a choice and was actually a much more thought out one than his family anticipated. While I wouldn't really call this series completely palliative care, it is an excellent drama with excellent acting.

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This post topic came to me thanks to my Google alerts (a way you can get email updates on your choice of topic). It's a great way to get updates on topics you are interested in without having to periodically Google them.

Fereydoun Ave, a modern Iranian artist recently displayed his newest works, entitled "Recent Works" at the Khak Gallery in Tehran. Ave's work before this had included collages that merge the figures of Iranian wrestlers with ancient reliefs of Persian kings and warriors. He had focused a lot on ancient masculine figures. So what does this have to do with palliative care, you may ask?

This show marks a departure from Ave's earlier work. This show illustrates his own personal history after surviving a long illness. I couldn't find exactly what his long illness was (the doctor in me sooo wanted to know). I only found that this work is meant to tell that story.

Ave's latest show includes 11 mixed media pieces and 7 sculptures. "Each of the mixed-media works begins with haphazard schemas and splashes of watercolor. The artist then prints familiar snapshots of daily life. Finally he over-paints them with new watercolor splashes." His sculptures have an archaeological feel to them.

I leave the interpretation of modern art up to the reader. Ave doesn't provide any explanation for each piece. His different pieces show flowers, a world map with superimposed flowers, a photo of a chair by a window with blinds, a chalice, and a family portrait. I would be interested to know what you think.

More of Ave's work can be seen here at the Khak Gallery website.

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I finally got around to seeing Rabbit Hole, which just came out on DVD in April.  It stars Nicole Kidman and Aaron Eckhart, who portray a couple that has lost their young son to a tragic accident.    The teaser from Rotten Tomatoes says it "is a vivid, hopeful, honest and unexpectedly witty portrait of a family searching for what remains possible in the most impossible of all situations"  Simple translation: This is a movie about grieving.

The couple deals with their grief in two totally different ways. Becca (Kidman) seems to want to erase everything that reminds her of her son and rarely shows emotion. In one scene her husband Howie (Eckhart) confronts her about this, "You're trying to get rid of him.......You have to stop erasing him. You have to stop it!"  To which she answers "Do you really think that I don't see him every second of every day?.........It feels like maybe I don't feel badly enough for you. Maybe I'm not feeling enough. What do you want from me?"

Howie has several angry outbursts in the movie, which seem to be part of his grieving process. He also strikes up a friendship with a woman from his grief group, played by Sandra Oh.

The grief group has some stereotypic characters, including another couple who has spiritualized the loss of their own child. Becca's confrontation of this made me smile.  The couple shares that the reason their daughter died was because God "needed another Angel"  to which Becca pipes up, "Why didn't He just make one?... I mean He's God after all?!?  Why didn't He just make another Angel?"

Interestingly we learn that Becca's brother died years prior, so Becca's mother Nat(Dianne Wiest) has great potential to be of comfort, if Becca would allow her to be. Finally towards the end, Becca connects with her mom and their exchange is one of my favorite moments of the movie. I love how Nat describes grief.

Becca: Does it ever go away?

Nat: No, I don't think it does. Not for me, it hasn't, and that's goin' on eleven years. It changes, though.

Becca: How?

Nat: I don't know....the weight of it, I guess. At some point, it becomes bearable.It turns into something that you can crawl out from under and...carry around like a brick in your pocket. And you... you even forget it, for a while. But then you reach in for whatever reason and - there it is. Oh right, that. Which could be awful- But not all the time. It's kinda...not that you like it exactly, but its' what you have instead of your son, so you don't wanna let go of it either. So you carry it around. And it doesn't go away, which is...."

Becca: What?

Nat: Fine...actually.

Overall, I thought this was a good movie about grief. The characters do heal during the movie, which is always nice to find your characters growing. I also enjoyed the sub context looking at the question of where one finds comfort in grief. This was mentioned and explored outwardly in many ways, from looking to religion, to other relationships, and even to parallel universes.

If you haven't seen it, check it out and do let us know what you think.

Also, here's the trailer if you want to get a feel for the movie visually.

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On May 4th 2011, Derek Miller, writer/editor/blogger, posted his last post on his blog. Miller had been blogging since 2000 on the website penmachine.com. In 2007, he was diagnosed with stage 4 colorectal cancer and he often blogged about his cancer and treatment.

In a post entitled "The endgame", in November 2010, Miller writes about the discussing his prognosis with his physician:

It's good that Thursday, November 25, wasn't Thanksgiving Day in Canada (it was in the U.S.), because that's when I found out. Doctors are notoriously reluctant to predict life expectancy, and for good reason—they're often wrong. But, with my wife Air in the exam room at the B.C. Cancer Agency with me, I drew it out of my oncologist, Dr. Kennecke.

"Do you expect I'll still be alive to visit you here in two years?" I asked, straight up.

"Honestly, no," he said.

There was more to it, of course, but that was the moment. It was no surprise.

He ends the post "I'm not ready to die just yet, but I'm ready to prepare for it. Off we go."

Miller died on May 3rd, 2011. He wrote his last post before he died and had friends post "The last post" on May 4th. It begins "Here it is. I'm dead, and this is my last post to my blog."

It's a sweet but sad read. Miller talks about his wife and two daughters, his experience dying, his views on the afterlife. Miller is a very talented writer and I'm sure this last post will be cherished by his family. What is sad is that the comments on the post really focused on Miller's views of the afterlife (he doesn't believe in one) rather than his beautiful last message to the one's he loved.

The world, indeed the whole universe, is a beautiful, astonishing, wondrous place. There is always more to find out. I don't look back and regret anything, and I hope my family can find a way to do the same.

What is true is that I loved them. Lauren and Marina, as you mature and become yourselves over the years, know that I loved you and did my best to be a good father.

Airdrie, you were my best friend and my closest connection. I don't know what we'd have been like without each other, but I think the world would be a poorer place. I loved you deeply, I loved you, I loved you, I loved you.

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We've discussed some of the more unique ways people are being buried these days, like custom coffins or eco-friendly burials.  I am waiting for the recumbent effigy to regain popularity as well.

An effigy is traditionally known as a representation of a person, and as a form of funerary art, first began appearing in the 7th century BC. It was the Etruscan Civilization of northern Italy that really excelled in portraying humans and this art evolved from just a representation of a human head, to entire figures placed on the lid of the sarcophagus.  This picture on the right is taken from the Louvre. It is entitled "Sarcophagus of the Spouses" from 520-510 BC. The detail of clothing and jewelry from a time thousands of years ago is astounding, but so too is the contemporary way this person was honored in death.

This art form re-emerged in the 12th century, and by the 14th century the effigies began to include hands clasped together in prayer. I find this fact interesting, considering that it was in 1415 that the Ars Moriendi text appeared as a directive from the church on how to die well, focusing on prayer for traits of faith, hope, patience, humility and generosity.

A slight variation on the recumbent effigy was seen in the later Middle Ages, depicting the effigy in the form of a decomposing corpse.  Often called "transi" or "corpse tombs", the purpose was to remind the living that the "good" life was indeed temporary.  These funerary monuments often were in double-decker style, with the proper effigy on top, in robes and crowns, and the rotting corpse statue below.  This picture from Fyfield in Berkshire is from Sir John Golafre who died in 1442.

As the centuries progressed more effigies were done in life like poses, often the deceased depicted reading a book, at a banquet and often depicted in younger days.  This example on the right,contained in Paris at the Louvre, is a classic example of this, as the woman appears quite comfortable reading her book with her dog near by.  Notice though, the "Transi" here, with the naked decaying relief showing an older woman below the effigy.

The most recent recumbent effigies I found were of Herbert Kitchner (1850-1916), pictured to the left, which is housed at St. Paul's Cathedral in London and that of Sun Yat-sen (1866-1925) in Nanjing, China.

So, has this funerary art form that has existed for thousands of years finally died off?  Or should we consider the embalming and preservation of such icons as Mao Tse Tung and Vladimir Lenin as modern day variations?  Perhaps even postmortem photography could be considered a branch? Or what of the technique of  plastination... there are plenty of rumors swirling about Zsa Zsa Gabor and Michael Jackson's bodies being plastinated.  If so, this permanent effigy just may be the 21st century's answer to recumbent effigies.

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I've been looking for a good blues song to post. I found it in an unusual place. The White Stripes (a rock group) do a cover of the song "Death Letter" (also called "Death Letter Blues". This song was originally performed by American blues singer Eddie James "Son" House. (Apparently House greatly influenced their music and they dedicated their first album to him.)

"Death Letter" is a song about a man who receives a letter that his love has died. He doesn't realize how much he loves her until he sees her being . He goes home grief stricken and missing his love. He then decides he needs to change his way of living so he "don't have to cry no more." I think the death, grief and regret aspects do well sung to the blues.

Interestingly, I found several different lyrics for this song. The ones below don't completely match the song performed below. Apparently House would often change the tempo and lyrics of his songs and would even perform the same song more than once in the same concert. The lyrics are apparently a long version of the song. If you are interested in hearing The White Stripes version, there is a video here which is quite good depending on what you like.





I got a letter this mornin how do you reckon it read?
It said Hurry, hurry, yeah, your love is dead
I got a letter this mornin I say how do you reckon it read?
You know it said Hurry, hurry, how come the gal you love is dead?
So I grabbed up my suitcase and took off down the road
When I got there she was layin on a coolin' board
I grabbed up my suitcase and I said and I took off down the road
I said but when I got there she was already layin on a coolin' board
Well I walked up right close looked down in her face
Said the good ol' gal got to lay here 'til the Judgment Day
I walked up right close and I said I looked down in her face
I said the good ol' gal she got to lay here 'til the Judgment Day
Looked like there was 10 000 people standin' round the buryin' ground
I didn't know I loved her 'til they laid her down
Looked like 10 000 were standin' round the buryin' ground
You know I didn't know I loved her 'til they damn laid her down
Lord have mercy on my wicked soul
I wouldn't mistreat you baby for my weight in gold
I said Lord have mercy on my wicked soul
You know I wouldn't mistreat nobody baby not for my weight in gold
Well I folded up my arms and I slowly walked away
I said Farewell honey, I'll see you on Judgment Day
Ah yeah oh yes I slowly walked away
I said Farewell, farewell, I'll see you on the Judgment Day
You know I went in my room I bowed down to pray
The blues came along and drove my spirit away
I went in my room I said I bowed down to pray
I said the blues came along and drove my spirit away
You know I didn't feel so bad 'til the good ol' sun went down
I didn't have a soul to throw my arms around
I didn't feel so bad 'til the good ol' sun went down
You know I didn't have nobody to throw my arms around
I loved you baby like I love myself
You don't have me you won't have nobody else
I loved you baby better than I did myself
I said now if you don't have me I didn't want you to have nobody else
You know it's hard to love someone that don't love you
Ain't no satisfaction don't care what in the world you do
Yeah it's hard to love someone that don't love you
You know it don't look like satisfaction don't care what in the world you do
Got up this mornin' just about the break of day
A-huggin' the pillow where she used to lay
Got up this mornin' just about the break of day
A-huggin' the pillow where my good gal used to lay
Got up this mornin' feelin' round for my shoes
You know I must-a had them old walkin' blues
Got up this mornin' feelin' round for my shoes
Yeah you know bout that I must-a had them old walkin' blues
You know I cried last night and all the night before
Gotta change my way a livin' so I don't have to cry no more
You know I cried last night and all the night before
Gotta change my way a livin' you see so I don't have to cry no more
Ah hush thought I heard her call my name
If it wasn't so loud and so nice and plain
Ah yeah
Mmmmmm
Well listen whatever you do
This is one thing honey I tried to get along with you
Yes no tellin' what you do
I done everything I could just to try and get along with you
Well the minutes seemed like hours hours they seemed like days
It seemed like my good old gal outta done stopped her low-down ways
Minutes seemed like hours hours they seemed like days
Seems like my good old gal outta done stopped her low-down ways
You know love's a hard ol' fall make you do things you don't wanna do
Love sometimes leaves you feeling sad and blue
You know love's a hard ol' fall make you do things you don't wanna do
Love sometimes make you feel sad and blue

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Trouble on the Mountainside (from nanofiction - Andrew Looney) "Death!" Chris cried triumphantly. Flashlight beams danced together on the plastic floor as rain pattered lightly on the canvas above. "Death by Chocolate means I win!" Suddenly there were noises outside. Everyone froze. A face peers in through the flap. "Lights out was an hour ago," said the scoutmaster, "and... hey, Fluxx! Can I play?"

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I'm doubtful there is anyone reading this who actually owns this CD.  I came across it doing some internet browsing.  The CD is "Dead and Gone # 2: Totenlieder - Songs of Death"  (1997).  Although released in Germany, the majority of songs are actually in English.

It's very eclectic, and reminds me of someone making a CD for a friend, just sticking a lot of random songs about death onto a disc.  I went on a little journey though, attempting to find some examples of some of the songs and was definitely introduced to some new music.  However, I still can't decide if this was a serious attempt at a compilation or a joke.

When I say eclectic, I am not exaggerating.  For instance the opening track comes from an alternative rock group from Australia named The Beasts of Bourbon.  You can listen to "Rest in Peace" on Youtube.  This is followed by a dark piece by the prolific poet, actress, singer/songwriter Lydia Lunch called "Gloomy Sunday"  The song, mostly spoken, seems to discuss suicide as the lyrics say "Soon there'll be candles and prayers that are said I know, but let them not weep, let them know that I'm glad to go"

Listening to some of the very old traditional songs like "Whisper Softly, Mother's Dying" (1928) I was struck with the potential history preserved on this album. You'll hear what I mean if you follow the link above to a short 30sec. clip of the song.

One of the most frightening songs of the album is a piece by avant-garde opera and jazz musician Diamanda Galas entitled "Cris D'Aveugle" (Blind Man's Cry) taken from a text written in 1873.  The song is full of whispers and screaming. Overall, the song seems more suited to a haunted house exhibit.

Probably the most musically pleasing song to me was the 4th track from the group Miranda Sex Garden.  The group is a female trio who generally sings a Capella madrigal music.  Their song "Gush Forth My Tears" has been remixed many times. The harmonies are beautiful and the lyrics quite simple; "Gush forth my tears/
and stay the burning/of my poor heart/or her eyes/choose you whether/o' peevish fond desire/alas my sighs
sighs out/still blow the fire"



Finally I must mention the closing song by Gary Floyd "From the Darkness to the Light" (1999).  Although meant to be uplifting, in the traditional up beat blue grass tempo, the song's meaning is much more macabre. The lyrics "We are moving from the darkness to the light. Rest has come, our battles done, we've won the fight" are discussing someones actual dying process. What I find a bit eerie is the way musically voices are added to the chorus, as if more and more people are dying.  The end, is even more haunting with 2 child voices finishing up this energetic melody, as if they too are happy to be dying.



In sum, a unique compilation of mostly unknown music.  If I think of each piece as 'art' rather than radio music material, I can enjoy it a bit more.

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61 year old jewelry maker Susan Braig was diagnosed with breast cancer in 2004. Braig had private insurance but was under-insured and left many thousands of dollars in debt. She found a unique way to combine her illness and her art to help pay off her medical bills.

In 2007, Braig went to a medical themed art exhibit and got the idea to use her own leftover pills in her jewelry. "I bought my first round of medicine and it cost $500 out of my own pocket," she said. "I looked at the drugstore receipt and then at the little pills and wondered if they were precious gems." One of her first pieces was a princes tiara made from her cancer medications. Now Braig gets old medications donated to her by friends to transform into her jewelry art. She launched a line of jewelry called Designer Drug Jewelry.

My first thought, is this even legal? Apparently, she seals the pills so that they are unusable. (I wonder if she has rules about what pills she uses, like no Schedule IIs.) As she uses pills and gel caps, some of the jewelry is very fragile and heat intolerant. She uses old medication bottles and with cotton balls to package her jewelry.

I was intrigued by the story because I liked the symbolism. She has turned her old medications into "precious gems". Turning somethings that are likely symbols of her illness into something very unique and beautiful. I never saw pills, with all their different colors and shapes, as beautiful before. (I guess that's why she's the artist.) Also it just amuses me to see a necklace with "Zofran" written on it. Apparently her Viagra necklaces are quite popular.

Braig's story was recently featured in the LA Times which is where I found it. She has also been on NPR in the past, talking about her cancer debt and being under-insured.

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When you look up "Country Music" you'll mainly find definitions about origin.  One unwritten stereotype, however, is the emotional narrative of the genre, that can at times feel as if the listener is being manipulated to tears.

There surely is a cathartic aspect to listening to songs that make you cry, as evidenced on a recent home visit of mine.  I was seeing a young cancer patient, and the TV was set on CMT, with country videos playing in the background.  What shocked me was that the patient's young wife and friends had me pause to watch part of a video in which the theme of the song was about death.  The wife commented, "We just love these songs, and sit here and cry with them all day" (As if there wasn't reason enough).

Well, there are plenty of country songs to cry about. In fact, there may be enough songs to actually form an unofficial sub-genre called 'Cancer Country' as mentioned by Ron Rosenbaum in a 2007 article published on Slate.com.

So, if you are a country music fan or have friends or patients who are, add these next songs to your repertoire of emotional songs about people with cancer.  The warning label on these should read "may induce tears"

The oldest on my list is Tim Mcgraw's "Live Like You Were Dying" written by Tim Nichols and Craig Wiseman in 2004.  The song is associated with Tim Mcgraw's father who was diagnosed with a brain tumor in 2003, living 9 months after diagnosis.  These lyrics set up the song, "I spent most of the next days, looking at the x-rays, Talking bout' the options and talking bout' sweet times. I asked him when it sank in, that this might really be the real end. How's it hit 'cha when you get that kind of news?"


In 2005 Rascal Flats released the single "Skin" written by Joe Henry and Doug Johnson. Known by fans as "Sara Beth" the song is about a girl with Leukemia going to her prom.  An example of the lyrics, "Sara Beth is scared to death, as she sits holding her mom, 'cause it would be a mistake for someone to take a girl with no hair to the prom"


Craig Morgan released his single "Tough" in 2007. This song is about a breast cancer surviver who teaches her husband a lesson about being 'tough'.  The lyrics say it all, "She wore that wig to church, pink ribbon pinned there on her shirt, no room for fear, full of faith, hands held high singing Amazing Grace. Never once complained, refusing to give up, and I thought I was tough"


Finally, Randy Owen, former vocalist in the band Alabama, released his first solo single in 2008 entitled "Braid My Hair" written by Chris Gray and Brent Wilson. The song is about a bald headed girl going through chemotherapy and dreaming about what she will do once she's well, as the lyrics state, "I'm gonna ride my bike, I'm gonna climb a tree. Gonna fly a kite, score running little league. I'm gonna go to school, make a friend, be able to run again. Take off my mask and just breath in the air. But most of all I'm gonna braid my hair."


Besides being about cancer, each of these songs has another central theme- one we in Palliative Medicine talk about a lot - the theme of 'quality of life' living.  Each central person is dreaming about and attempting to live a full life in the midst of disease.

Anyone know of any other "cancer country" songs that should be included?