I don't know how I missed this when it came out in August. It's a great piece. A must-read.
Atul Gawande explores what medicine should do when it can't save your life in Letting Go
Almost all these patients had known, for some time, that they had a terminal condition. Yet they—along with their families and doctors—were unprepared for the final stage. “We are having more conversation now about what patients want for the end of their life, by far, than they have had in all their lives to this point,” my friend said. “The problem is that’s way too late.” In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.”
People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.
Read Gawande encounters hospice for the first time with one of his two dying patients and what hospice nurse Lee Creed has to say about the difference between hospice care and ordinary medical care for a dying patient.
The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focussing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.
In comparing the deaths of his two patients Gawande writes:
Dave Galloway died one week later—at home, at peace, and surrounded by family. A week after that, Lee Cox died, too. But, as if to show just how resistant to formula human lives are, Cox had never reconciled herself to the incurability of her illnesses. So when her family found her in cardiac arrest one morning they followed her wishes and called 911 instead of the hospice service. The emergency medical technicians and firefighters and police rushed in. They pulled off her clothes and pumped her chest, put a tube in her airway and forced oxygen into her lungs, and tried to see if they could shock her heart back. But such efforts rarely succeed with terminal patients, and they did not succeed with her. Hospice has tried to offer a new ideal for how we die.
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People who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation, and to spare their family anguish.
"It was an honor that I was used for the big purpose"
A remarkable life of a man who risked his life for a "big purpose", suffered imprisonment and severe torture but never broke, who eschewed bitterness and who survived to live an exemplary life. It always amazes me to think about how much we owe to people we've never met.
Shortly after German troops invaded Belgium in 1940, Gaston Vandermeerssche, a Belgian university student, bicycled 800 miles to the south of France and became a spy.
Mr. Vandermeerssche, who died Nov. 1 at age 89 in Milwaukee, joined the resistance and ferried microfilm documents over the Pyrenees to Spain, where intermediaries sent the information on to London. Later in the war he helped organize the Dutch underground, which came to comprise hundreds of agents and safe houses.
After his network was penetrated by the Germans, he tried to escape, but was arrested near the Spanish border. He spent 24 months being interrogated in prison, but by his own account never broke. -- His German interrogators suspected his role in the Dutch underground, but couldn't prove it. "I was so young, the Germans did not believe that this kid was the head of that large network," he said in the oral history. "And I told them, 'Are you crazy? I couldn't have done this.' "
Months of brutal interrogation and solitary confinement failed to break Mr. Vandermeerssche's will. He was betrayed by another member of the underground, and was sentenced to death in a military trial. But he was freed by American troops near the end of the war.
Although shattered by his experiences in prison—he said he couldn't eat or sleep normally for a decade—Mr. Vandermeerssche resumed his studies, earning a Ph.D. in physics. He ran Ghent University's electron-microscope department. In 1965, he moved to the U.S. and later became an executive at the Joseph Schlitz Brewing Co.
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In the 1980s, he began visiting Europe to reconstruct his wartime activities, and recounted them in a 1988 book, "Gaston's War." He came to believe that his spy networks had been purposely exposed by his masters in London, as a diversion to convince the Germans that D-Day invasions were planned for the Low Countries instead of Normandy. He called it "le grand jeu"—the great game—in his memoir.
"Now I'm not bitter at all," he said in the oral history. "It was an honor that I was used for the big purpose."
Norse sagas suggest the Vikings discovered the Americas centuries before Columbus and the latest data seems to support the hypothesis that they may have brought American Indians back with them to northern Europe.
Research indicates that a woman from theNorth Americancontinent probably arrived in Iceland some time around 1000AD leaving behind genes that are reflected in about 80 Icelanders today.
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The genetic research, made public by Spain's Centre for Scientific Research, was due to be published in the American Journal of Physical Anthropology.
The twin sisters made a pact to commit suicide together in Colorado on the last day before one of them would be required to return to home to Australia.
The 29-year-olds each put a 22-caliber pistol to her head and pulled the triggers simultaneously at the Family Shooting Center at Cherry Creek State Park Monday afternoon.
One sister fell dead, and Thursday morning the other had recovered enough to tell investigators what happened.
But she would not say why during the emotional two-hour interview.
"We asked that question several times, and each time she declined to answer," said Capt. Louie Perea, of the Arapahoe County Sheriff's Department. "Obviously we can't make her tell us that."
He characterized her as "devastated, frustrated, distraught, angry at times."
Her parents are scheduled to arrive in Colorado Friday.
What one brother and sister found when clearing out the home of their recently deceased parents.
They put this 18th century Qianlong porcelain vase up for sale at an auction, thinking it may be worth as much as one million pounds and were stunned to receive a winning bid of 53 million British pounds or about $85 million.
It is understood to have been in the vendors’ family since the 1930s. The astronomical price was reached due to the rising demand for Imperial associated trophies among Chinese collectors.
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They (the vendors) had no idea what they had. They were hopeful but they didn't dare believe until the hammer went down.
"When it did, the sister had to go out of the room and have a breath of fresh air."
A lovely piece at The New Old Age at The New York Times, A Poet Well Versed in Grief about Thomas Lynch, the poet undertaker.
Born to a family who ran a funeral home in small-town Michigan, the poet Thomas Lynch began pondering aging and death at a young age, as a child leafing through the gory pages of his father’s mortician texts.
“A lot of 15-year-olds think they’re going to live forever,” he said. “But when I was 15, I sort of knew I wasn’t, because I spent a lot of time at the funeral home.”
Here is the title poem from his newly-published collection
I say clean your plate and say your prayers,
go out for a long walk after supper
and listen for the voice that sounds like you
talking to yourself, you know the one:
contrapuntal, measured to footfall, true
to your own metabolism. Listen –
inspiration, expiration, it’s all the same,
the sigh of creation and its ceasing -
whatever’s going to happen’s going to happen
The generation today bringing loved ones to funeral homes is the first generation, he said, that tries to get past grieving by not having a body at a funeral. He believes this carries the risk of spiritual and emotional peril.
The good death, good grief, good funerals come from keeping the vigils, from bearing our burdens honorably, from honest witness and remembrance. They come from going the distance with the ones we love. I quite enjoyed his first book about the 'dismal trade'.
Despite being declared dead, Sanders had been able to move about the country easily. Investigators know he lived in Mississippi, Louisiana, Tennessee, Georgia and Nevada. He worked as a laborer, a welder and a scrap metal collector.
According to records obtained by the AP, his arrests included possession of drug paraphernalia and a number of traffic and motor vehicle incidents, all in Tennessee. He was sentenced to two years in Georgia for simple battery. State and federal authorities have said some of the charges involved minors, but they refused to elaborate.
Court documents obtained by The Associated Press show Sanders abandoned his family in 1987 and was declared dead by a Mississippi court 1994. He lived unnoticed for years despite being arrested several times.
Sanders was wanted in the kidnapping 12-year-old Lexis Roberts, whose skeleton was found by hunters early last month. Her 31-year-old mother, Suellen Roberts, is missing. Officials say she is not a suspect in her daughters death — and they hope she has not met with foul play.
Thorne said Sanders was alone when he was arrested at the Flying J Truck Stop by FBI agents and Harrison County Sheriff’s deputies.
Father Robert Barron comments on "Hereafter", a film I haven't seen yet, but want to. We all want to know whether there is life after death and I'm interested in what Clint Eastwood has to say about it.
From the 1989 movie Glory, the splendid story of a young Bostonian Robert Gould Shaw who leads the Massachusetts 54th regiment, the first all-black volunteer army, into battle for Union in the Civil War.
Across the street from the State House in Boston is the Robert Gould Shaw Memorial, a stunning bas-relief by Augustus Saint-Gaudens.
It started a few months ago with a phone call to Sturtevant Funeral Home in Portsmouth.
A group called the Missing in America Project wanted to know about the funeral home's unclaimed cremated remains. It wanted a list of names - Social Security numbers if possible - so it could determine whether any of them ever served in the military.
So the funeral home did some research, then turned over its findings to the Department of Veterans Affairs.
The word came back: Among the unclaimed cremated remains were 10 veterans, all of whom had been honorably discharged. That was all Missing in America needed to know.
"They shouldn't be sitting there unclaimed," said Charlie Warthling, a local volunteer with the group. "This is the right thing to do."
On Thursday, the 10 will be buried with military honors at Albert G. Horton Jr. Memorial Veterans Cemetery in Suffolk. Five of them served in the Army, two each in the Navy and Marine Corps, and one in the Air Force.
"For whatever reason, their families were never able to do this for them," Warthling said. "So we'll be their family."
As recounted in the Wall Street Journal in The Lady and the Playwright, when Lady Antonia Fraser met Harold Pinter, she said
"Wonderful play, marvelous acting," she told Pinter. "Now I'm off."
"He looked at me with those amazing, extremely bright black eyes. 'Must you go?' he said. I thought of home, my lift, taking the children to school the next morning . . . my projected biography of King Charles II. 'No, it's not absolutely essential.'"
So began a 33-year marriage of true minds that ended with Pinter's death from cancer on Christmas Eve in 2008, at the age of 78.
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An inveterate journal-keeper for more than 40 years, Lady Antonia began work on "Must You Go" a month after Pinter died. "I never intended to publish it. It wasn't written for that reason," she said, drinking coffee in the lobby alcove of her midtown hotel after an early morning swim.
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"The whole thing, including the title, came into my head like that. It was an act of love and remembrance, really, a book of celebration at a time of such tremendous grief," continued Lady Antonia, 78, who has a posh, creamy voice you must sometimes bend close to hear and who has a manner that is equal parts grand and grandmotherly. "It was a very surprising thing for me to do because I'm not a very candid person, and I don't believe I would or could write it now. It was the effect of grief."
She doesn't think much of closure.
Closure? She recoils at the word and the notion. "Thank you very much. No closure," she said tartly. "I don't want closure in stopping mourning. I don't want it to stop. But it is the oddest thing when something happens and I think 'I must tell Harold.'
The new proposed anti-smoking ads proposed by the FDA go too far. They will cover half of the front of every cigarette package.
That means behind every counter where they sell cigarettes - the convenience store, the liquor store, the supermarket - we will be looking at images of dead bodies.
I'm all for momento mori, but these strike me as crass and vulgar, another overbearing regulation from those that know better than us, but less than normal people about civil society.
Who believes that anyone will stop smoking because of these ads?
Yes, I think people should stop smoking. But I don't think it's the role of the federal government to force such graphic images on cigarette makers and all the rest of us.
She dealt with the disease courageously, quietly and privately, Rabe said, and conducted herself with enormous grace "and made it into an opportunity for her children to grow and be human."
In the most famous scene in Jill Clayburgh’s most influential movie, her character reacted to the news that her husband wanted to leave her. Ms. Clayburgh’s Erica responded with such naturalness, confusion and wounded pride that she captured the imagination of a generation.
Enlarge This Image
“As Miss Clayburgh plays this scene,” Vincent Canby wrote about “An Unmarried Woman” in 1978, “one has a vision of all the immutable things that can be destroyed in less than a minute, from landscapes and ships and reputations to perfect marriages.” But she proved that a reputation could be made in less than a minute too.
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She remained elegant, lovely and so recognizable that she became accustomed to being treated as an avatar. “My God, you’ve defined my entire life for me,” one weeping “Unmarried Woman” fan told her in 2002, and that experience was apparently not unusual for her. When she and Lily, an actress, roomed together in Manhattan in 2005 as both of them prepared for stage appearances, a writer for The New York Times visited the 61-year-old eternal heroine and still saw her unforgettable movie persona.
“Jill Clayburgh appears to be living in an updated Jill Clayburgh vehicle,” Nancy Hass wrote. “Fluttery-yet-determined mom flees comfortable exurban married life to share tiny Manhattan apartment of headstrong, aspiring-actress daughter. Conflict, hilarity and, of course, self-actualization ensue.” For Jill Clayburgh, in both her life and work, that’s just what happened.
Paul Mazursky said
“Jill was a beautiful person and an extraordinary actress. I loved her and miss her. She was deep, funny, surprising, sexy, a great mother and a great wife. … What more can I tell you?”
Other girls in other schools all over the world have stood out from their classmates and fascinated them as Jill fascinated us. But there was something else, something more enduring about Jill that set her apart: her immense talent. That, combined with her powerful discipline.
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While the majority of her classmates were in the chorus, Jill memorized vast swathes of Euripides, Shakespeare, and Gilbert & Sullivan. If most of us forgot our lines, who would have noticed? But Jill, from an early age, carried the plays entirely from memory. Of all her starring roles at school, the most memorable to me was the tragic heroine Hecuba in The Trojan Women of Euripides. This was when she was 11 years old. The character she played was a mother and a grandmother, as well as a queen....It was a performance — a tour de force — that more than half a century later is still vivid.
In Southwestern France, at a seaside resort , 28-year-old Adrien Monnoyeur ignored the weather forecasts of high winds and went kite-surfing on surfboard, towed by a large kite when a particularly strong gust of wind lifted him high in the air.
A local resident told Sud Ouest newspaper: 'I was on the phone to a friend looking out the window. I was telling him to watch the sea when I saw the kite surfer go past me at breakneck speed.'
The woman did not know what was happening at first, adding: 'It all happened in the space of a second. I even thought I had a hallucination.'
She could see every details of the kite-surfer's face, saying: 'He was a very good looking young man. It was so strange.
'I couldn't even see fear in his face. It was instead an expression of astonishment, but this is just my feeling.'
Bodies will be stockpiled for cremation under new rules to cut costs and
carbon emissions.
Rather than being cremated straight after a funeral, corpses will be stored for days in coffins or body bags in local authority buildings so they can be incinerated in one go.
Council bosses claim the decision to use cremators during one period rather than after every service will cut down on energy bills and reduce their carbon footprint.
But critics described the scheme as ‘obscene’ and ‘undignified’.
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The policy will leave families having to return up to a week later to the crematorium to collect the ashes, causing unnecessary additional stress.
Crematoriums in Warwickshire are already operating the system and Redditch Council in Worcestershire is piloting the scheme before deciding whether to make it permanent.
Conservative MP Philip Davies said: ‘This is absolutely ludicrous.
‘There should be some dignity for these people being cremated and their family.
‘This will have no effect whatsoever on climate change and is just another way for local authorities to save money.
‘Councils have lost sight of what they were set up to do in the first place – serve the people and not obsess about climate change.’
Via Brits at their Best, comes this poem by Edward Thomas, born in 1878 who was killed in action at the Battle of Arras in 1917.
I have come to the borders of sleep,
The unfathomable deep
Forest where all must lose
Their way, however straight,
Or winding, soon or late;
They cannot choose.
Many a road and track
That, since the dawn's first crack,
Up to the forest brink,
Deceived the travellers,
Suddenly now blurs,
And in they sink.
Here love ends,
Despair, ambition ends;
All pleasure and all trouble,
Although most sweet or bitter,
Here ends in sleep that is sweeter
Than tasks most noble.
There is not any book
Or face of dearest look
That I would not turn from now
To go into the unknown
I must enter, and leave, alone,
I know not how.
The tall forest towers;
Its cloudy foliage lowers
Ahead, shelf above shelf;
Its silence I hear and obey
That I may lose my way
And myself.
Legacy Matters
