Deborah Alecson Podcast

Deborah Golden Alecson, a faculty member in the Schools of Health Science and Nursing, discusses a September 2014 report issued by the Institute of Medicine called “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.”

Alecson is faculty member in the Schools of Health Science and Nursing, an author, and one of Excelsior’s resident experts on death, dying and bereavement.

Deborah's Podcast.
Check out other links KOHD-WC to Institute of Medicine.

This is How I Want to Die

by Rabbi Jack Mpline

This essay was published on October 22, 2014 in The Jewish Forward.

Deborah Alecson writes: "This is lovely and spot-on request made by a rabbi re: his dying."

This is an edited version of the 2011 Yom Kippur sermon by Rabbi Jack Moline where he explores the condition he wants to be in at the end of his life and how best to assure that outcome.  He describes his father's series of illnesses and surgeries that enabled him to live until the age of 65, only to die of brain cancer. When reflecting on his father's suffering he is aware that ages ago we died of incurable diseases, natural events, starvation, as prey to animals, etc. Modern medical technology and advances have brought us what is too often a long drawn out dying and years of chronic illness leading up to our death. Rabbi Moline does not want to die this way. He urges each of us to talk with our loved ones about what we want at the end of our life and not to soley rely on the advanced directives that we hopefully have also put into place.  Debra Alecson

Ending Live - PBS

"Barbara Mancini was arrested and charged with helping her dying father kill himself. Anderson Cooper has her story and more on the end-of-life debate."

This is a well-done. thought-provoking report on assisted suicide.

Ending Life - PBS.

My Girl (1991)

(from IMDb) The movie is set in Madison, Pennsylvania, in the summer of 1972. Vada Sultenfuss (Anna Chlumsky) is a 11-year-old tomboy and a hypochondriac. Vada's father, Harry Sultenfuss (Dan Aykroyd), is an awkward widower who does not seem to understand his daughter, and as a result, constantly ignores her. His profession as a funeral director, in which the Sultenfuss' residence is also a funeral parlor, has led Vada to develop an obsession with death as well as disease. Vada also thinks that she killed her own mother, since her mother died giving birth to her. She regularly tends to her invalid grandmother (Ann Nelson), who suffers from Alzheimer's disease. Harry's brother Phil (Richard Masur), who lives nearby, also stops by frequently to help out the family.

Vada is teased by other girls because her best friend, Thomas J. Sennett (Macaulay Culkin), is unpopular and a boy. Their summer adventuresfrom first kiss to last farewellintroduce Vada to the world of adolescence.

Vada's summer begins well. She befriends Shelley Devoto (Jamie Lee Curtis), the new make-up artist at her father's funeral parlor, who provides her with some much needed guidance. She is also infatuated with her teacher, Mr. Bixler (Griffin Dunne), and steals some money from Shelley's trailer to attend a summer writing class that he is teaching.

But before long, things start to fall apart. Her father and Shelley start dating and get engaged, she cannot bring herself to tell her father that she has experienced her first menstrual cycle, Thomas J. dies from an allergic reaction to bee stings while looking for Vada's mood ring in the woods, and she finds out that Mr. Bixler is engaged to someone else.

Vada's grief, however, manages to mend the rift between her and her father, she learns that she didn't kill her mom during childbirth (since her father tells her that things like mothers dying in childbirth just happen), and by the end of the movie, Vada has not only managed to deal with her pain and grief, but has also overcome some of her previous issues as well.  1991, 102 munutes

Note:  This is a sweet movie about death and dying and grief.  It's light entertainment with some moving moments.  DJE

Caitlin Dougherty: Funeral Director

"Talking about death isn't easy, but mortician Caitlin Doughty is trying to reform how we think about the deaths of loved ones — and prepare for our own.

'My philosophy is honesty,' Doughty tells Fresh Air's Terry Gross. "I think that we've been so hidden from death in this culture for such a long time that it's very refreshing and liberating to talk about death in an open, honest manner."

Doughty is the founder of The Order of the Good Death, a group of funeral industry professionals, academics and artists who focus on the rituals families perform with their dead and how the industry disposes of dead bodies. She is also starting her own funeral service in Los Angeles, called Undertaking L.A., that will help families with planning after they lose a family member.

Doughty's new memoir, Smoke Gets in Your Eyes and Other Lessons from the Crematory, serves as, among other things, a way for her to cope with working with dead bodies."  This book is also available in audio format (read by the author). 

Caitlin Dougherty's Web Site.

Why We Write About Grief

Image from NY Times article

The authors Joyce Carol Oates and Meghan O'Rorque opine in the NY Times about why they, and others, write about grief.

In this insightful e-mail conversation, "Ms. Oates and Ms. O’Rourke discussed how they wrote about their own grief and why the literature of loss resonates with readers today. The dialog, which has been edited for length and clarity, began by asking them what led them to write about their experiences."

Brittany Maynard is a 29 year-old woman with an inoperable glioblastoma multiforme.  She has chosen to die Nov. 1, 2014 in her bedroom in Portland, Ore., surrounded by family — her mother and stepfather, her husband and her best friend, who is a physician. She said she wanted to wait until after her husband’s birthday, which is Oct. 26.

Deborah Alecson found this post.  It should stimulate some discussion.

Also see The Brittany Maynard Fund To expand the death-with-dignity options to all.

The PBS News Hour featured Ms. Maynard's case on October 14, 2014. The discussion between Ira Byock (key Hospice and Palliative Care physician) and Barbara Coombs Lee (Compssionate Choices)

Brittany Maynard did end her live in accordance with the laws of Oregon on November 1.  Here is her last video (Huffington Post).

Being Mortal (2014)

Book review by Abby Zugar, NY Times, October 7, 2014

In this book, “Gawande has turned his attention to mortality, otherwise known as the one big thing in medicine that cannot be fixed. In fact, the better doctors perform, the older, more enfeebled and more convincingly mortal our patients become. And someone should figure out how to take better care of all of them soon, because their friends, neighbors and children are at their wits’ end.

"It is one thing to understand this helplessness, as most young doctors do, by watching the trials of patients and their families; as an observer Dr. Gawande has visited this territory before.

Abby Zugar’s engaging review of Being Mortal is a good introduction to this book.

See also, Gawande's essay in the NY Times:  The Best Possible Day.

Also see Paula Span's review for A Caregiver's Bookshelf A Doctor Discovers Dying.

DJE's notes from Being Mortal.

Atul Gawande delivered four talks based on this book for the BBC.  They are well-worth accessing.

The Best Possible Day

Atul Gawande, a cancer surgeon and author, was concerned that his colleagues and he were not handling end of life matters well with their patients.  He researched a book, Being Mortal (October 2014) on what has gone wrong with the way we manage mortality and how we could do better.  He writes:

“I spoke with more than 200 people about their experiences with aging or serious illness, or dealing with a family member’s.  Among the many things I learned, here are the two most fundamental.

First, in medicine and society, we have failed to recognize that people have priorities that they need us to serve besides just living longer. Second, the best way to learn those priorities is to ask about them.

I also discovered that the discussions most successful clinicians had with patients involved just a few important questions that often unlocked transformative possibilities:

(1) What is their understanding of their health or condition?

(2) What are their goals if their health worsens?

(3) What are their fears? and

(4) What are the trade-offs they are willing to make and not willing to make?

These discussions must be repeated over time, because people’s answers change. But people can and should insist that others know and respect their priorities."

Full NY Times essay: The Best Possible Day.

Letters to the Editor.

Dying Without Morphine

An African Cancer Patient Dying in Unnecessary Pain

"Imagine watching a loved one moaning in pain, curled into a fetal ball, pleading for relief. Then imagine that his or her pain could be relieved by an inexpensive drug, but the drug was unavailable.

Each day, about six million terminal cancer patients around the world suffer that fate because they do not have access to morphine, the gold standard of cancer pain control. The World Health Organization has stated that access to pain treatment, including morphine, is an essential human right.

Untreated cancer pain is a human disaster not unlike famine; its victims are starving for relief. But as the Ugandan experience shows, there are easy-to-implement, cost-effective health care models that could rapidly deploy morphine to cancer patients around the world."

Dying Without Morphine is an important Op-Ed piece from the NY Times (October 1, 2014)

Over 100 years ago, Osler called morphine "God's Own Medicine."  It is cheap and effective, but it has been demonized and is not available around the world to the people who need it most.