Knocking on Heaven's Door (The Book)

by Katie Butler

This is an honest, sobering look at what awaits so many elderly people and their caregivers, who are often family members.  It is the story of a Medical-Industrial Complex gone wild:  doing things to people for economic gain.  Expensive procedures that have serious unintended consequences are, unfortunately, the rule.  For a variety of reasons, many physicians perform lucrative tests and interventions that do little to improve patients’ well-being.  Death is seen as the ultimate enemy, yet we all will die.  How one dies is important, yet this is not considered often enough.  DJE (Here are my notes from KOHD - The Book.)

Katie Butler with Her Parents

From BookList: “Knocking on Heaven’s Door” is a thoroughly researched and compelling mix of personal narrative and hard-nosed reporting that captures just how flawed care at the end of life has become. My hope is that this book might goad the public into pressuring their elected representatives to further transform health care from its present crisis-driven, reimbursement-driven model to one that truly cares for the patient and the family. And since life is, after all, a fatal illness and none of us are spared, there is an urgent need for us in America to reclaim death from medicine and, whenever possible, enable the ritual of dying at home with family present (and aided by all medicine can offer) so that we are allowed to take our leave from earth with dignity.

From the NY Times Review by Abraham Verghese: “Knocking on Heaven’s Door” is a thoroughly researched and compelling mix of personal narrative and hard-nosed reporting that captures just how flawed care at the end of life has become. My hope is that this book might goad the public into pressuring their elected representatives to further transform health care from its present crisis-driven, reimbursement-driven model to one that truly cares for the patient and the family. And since life is, after all, a fatal illness and none of us are spared, there is an urgent need for us in America to reclaim death from medicine and, whenever possible, enable the ritual of dying at home with family present (and aided by all medicine can offer) so that we are allowed to take our leave from earth with dignity.

To Relieve and To Comfort

"Palliative Care it is meant to ease symptoms and pain, and focus on quality of life for severely ill patients, who may choose between continuing or halting traditional medical treatment."

It has been available for some time, but is under-recognized.  A recent New York Times article, House Calls Are Making a Comeback, is a good introduction to palliative care.  It seems to be a fertile new area for research and now prestigious institutions are vying for prominence in the field.

Read the article.

A book, God's Hotel, by Victoria Sweet, eloquently describes palliative care in action in a San Francisco alms house.  See Pathography Blog.

When I Have Fears That I May Cease To Be

by John Keats

Hear this poem read.

When I have fears that I may cease to be    
Before my pen has glean’d my teeming brain,       
Before high piled books, in charact’ry,       
Hold like rich garners the full-ripen’d grain;          
When I behold, upon the night’s starr’d face,      
Huge cloudy symbols of a high romance, 
And think that I may never live to trace     
Their shadows, with the magic hand of chance;      
And when I feel, fair creature of an hour!    
That I shall never look upon thee more,           
Never have relish in the faery power          
Of unreflecting love!—then on the shore  
  Of the wide world I stand alone, and think  
  Till Love and Fame to nothingness do sink.

Death Be Not Proud

By John Donne
Hear this poem read.

   Death, be not proud, though some have called thee
Mighty and dreadful, for thou art not so;
For those whom thou think'st thou dost overthrow
Die not, poor Death, nor yet canst thou kill me.
From rest and sleep, which but thy pictures be,
Much pleasure; then from thee much more must flow,
And soonest our best men with thee do go,
Rest of their bones, and soul's delivery.
Thou art slave to fate, chance, kings, and desperate men,
And dost with poison, war, and sickness dwell,
And poppy or charms can make us sleep as wel
And better than thy stroke; why swell'st thou then
One short sleep past, we wake eternally
And death shall be no more; Death, thou shalt die. 

The play and movie Wit is a conceit on this sonnet.

And Death Shall Have No Dominion

by Dylan Thomas

Hear Dylan Thomas Read this poem.

   And death shall have no dominion.  

Dead men naked they shall be one

With the man in the wind and the west moon;

When their bones are picked clean and the clean bones gone,  

They shall have stars at elbow and foot;  

Though they go mad they shall be sane,  

Though they sink through the sea they shall rise again;  

Though lovers be lost love shall not;  

And death shall have no dominion.

And death shall have no dominion.
Under the windings of the sea

They lying long shall not die windily;  

Twisting on racks when sinews give way,  

Strapped to a wheel, yet they shall not break;

Faith in their hands shall snap in two,  

And the unicorn evils run them through;  

Split all ends up they shan’t crack;  

And death shall have no dominion.

And death shall have no dominion. 
No more may gulls cry at their ears  

Or waves break loud on the seashores;  

Where blew a flower may a flower no more  

Lift its head to the blows of the rain;  

Though they be mad and dead as nails,

Heads of the characters hammer through daisies;

Break in the sun till the sun breaks down,  

And death shall have no dominion.

A Refusal to Mourn the Death by Fire of a Child in London

by Dylan Thomas

Hear Dylan Thomas reading this poem

Never until the mankind making
Bird beast and flower
Fathering and all humbling darkness
Tells with silence the last light breaking
And the still hour
Is come of the sea tumbling in harness

And I must enter again the round
Zion of the water bead
And the synagogue of the ear of corn
Shall I let pray the shadow of a sound
Or sow my salt seed
In the least valley of sackcloth to mourn

The majesty and burning of the child's death.
I shall not murder
The mankind of her going with a grave truth
Nor blaspheme down the stations of the breath
With any further
Elegy of innocence and youth.

Deep with the first dead lies London's daughter,
Robed in the long friends,
The grains beyond age, the dark veins of her mother,
Secret by the unmourning water
Of the riding Thames.
After the first death, there is no other.

Japanese Death Haiku

Matsuo Basho (1644 – 1694)

On a journey, ill;
my dream goes wandering
over withered fields.

Yosa Buson (1716 – 1783)
winter warbler -
long ago in Wang Wei's
hedge also

Shinsui

Shinsui, died September 9, 1769, at 49.  During his last moment, Shisui's disciples requested that he write a death poem. He grasped his brush, painted a circle, cast the brush aside, and died. The circle— indicating the void, the essence of everything, enlightenment— is one of the most important symbols of Zen Buddhism.

Kobyashi Issa  (1763 - 1827)

This world of dew
is only a world of dew -
and yet
           *written after the death of one of his children

A bath when you’re born,
a bath when you die,
how stupid.

Suicide: Talking About Attempts

The nation’s oldest suicide prevention organization, the American Association of Suicidology, decided in a vote by its board last week to recognize a vast but historically invisible portion of its membership: people, who tried to kill themselves but survived. About a million American adults a year make a failed attempt at suicide, surveys suggest, far outnumbering the 38,000 who succeed, and in the past few years, scores of them have come together on social media and in other forums to demand a bigger voice in prevention efforts.

See NY Times Article, April 14, 2014:  "Suicide Prevention Sheds a Longstanding Taboo: Talking About Attempts"

This is a helpful and informative article which discusses attempts to give voice to the many suicide-attempt survivors.

My Mother's Keepers

Photo from NY Times article

My Mother's Keepers is a touching essay written by Janet Steen about the care given her mother by a Caribbean family living in the Boston area.
It could be a template that would help elderly patients while also assisting poor families.  Instead of paying exorbitant fees to a nursing home care can be provided in the community.

ICU Doc Calls for Good Death

A 'Code Death' for Dying Patients

By Jessica Nutik Zitter, M.D.

New York Times, April 10, 2014

see: A ‘Code Death’ for Dying Patients

“…physicians need to relearn the ancient art of dying. When planned for, death can be a peaceful, even transcendent experience. Just as a midwife devises a birth plan with her patient, one that prepares for the best and accommodates the worst, so we doctors must learn at least something about midwifing death."

This essay is a keeper.

Simulated ICU at Beth Israel, Boston