The Last Lecture

by Randy Pausch

Pausch delivered his "Last Lecture", titled "Really Achieving Your Childhood Dreams", at Carnegie Mellon University on September 18, 2007. He gave an abridged version of his speech on The Oprah Winfrey Show in October 2007. The talk was modeled after an ongoing series of lectures where top academics are asked to think deeply about what matters to them, and then give a hypothetical "final talk", with a topic such as "what wisdom would you try to impart to the world if you knew it was your last chance?" Before speaking, Pausch received a long standing ovation from a large crowd of over 400 colleagues and students. When he motioned them to sit down, saying, "Make me earn it", someone in the audience shouted back, "You did!"

Link to Original Talk 1 hr 16 min

Link to Abbreviated 10 Minute Oprah Talk

These are worth listening to; maybe somewhat tangential to what we will cover, but classic and inspirational.

Deborah Alecson Poetry Reading

Deborah Alecson's recent Poetry Reading in Great Barrington.

On December 20, 2014, Deborah Golden Alecson read from her recently published collection of poems entitled Complicated Grief  (Finishing Line Press, 2014).  These poems were generated out of her bereavement following her mother's suicide.  

The term "complicated grief" is used to describe a grieving process that goes outside the boundaries of normal grief.  This can be the result of the psychological state of the bereaved and/or the nature of the relationship with the deceased when he or she was alive and/or a death from suicide.  

What makes the grief complicated are the plethora of emotions that are not just errupting because of a single loss, but include a cascade of frightening feelings that come from a lack of resolution or comprehension.  

In Alecson's case, the complication came not only from the shock of the suicide, but from a history of abuse from her mother.  A manifestation of complicated grief can be an inability to concentrate that can then result in an inability to work.  In her experience, she had to take a few months leave of absence from teaching.  This time was necessary for her to integrate her loss; and one of her ways she did so, was to write these poems.

Gawande's Reith Lectures

 The Reith Lectures were inaugurated in 1948 by the BBC to mark the historic contribution made to public service broadcasting by Sir John (later Lord) Reith, the corporation's first director-general.  Bertram Russell gave the first talk

This year, there are four talks by Atul Gawande.  They were presented in Boston, London, Edinburgh, and New Delhi.  All can be accessed and listened to or read.  In addition they can be downloaded for free to iTunes and transferred to an iPod for easy listening.  O! Brave New World!

You can gain access to Gawande’s four lectures at the BBC site.  They are:

Why Do Doctors Fail? Dr Atul Gawande: The Future of Medicine

1/4 Surgeon and writer Dr Atul Gawande explores the nature of fallibility in medicine.

The Century of the System Dr Atul Gawande: The Future of Medicine

2/4 Atul Gawande calls for a radical rethink of medical systems to transform healthcare.

The Problem of Hubris Dr Atul Gawande: The Future of Medicine

3/4 Atul Gawande calls for a new approach to the 'great unfixables' - ageing and death.

The Idea of Wellbeing Dr Atul Gawande: The Future of Medicine

4/4 Atul Gawande calls for a new focus on systems to ensure doctors work more effectively.

Even if you have read “Being Mortal” you will enjoy these orations.

George Bascom - Death Poems

George Bascom (1927 - 1993) was a surgeon/poet from Manhattan, Kansas.  As he was dying of prostate cancer, he penned a few poems about death which are prescient and moving.

Here's one:
Incurable

Like a weathered barn in fading fog

death out there grows steadily more clear.

The dogged feet go on to

an inexorable détente.

Hope is a little fire

that flickers with uncertain light

beneath a boundless sky.

And I beside it drift

through night and day between

the peace of stone-deep rest

and aching wakefulness.

You can more find of Bascom's death poems on Docs-Google.

A Poem for Leo

Early Thursday morning May first

I closed the circle with my father 

Of whom I am from

Honored to help

Leo’s spirit Free

From his well worn body

92 frail skin and bone

Yet still strong and courageous

Bedridden for two months

He remained a stand up guy

Offering grace and humor

Ethan visited with Leo

Understanding accepting

Sharing open hearts

Leo barely able to speak 

Offered Ethan advise

Grandfather to grandson

About the son:

“Don’t listen to him”

Leo enjoyed life long luck

He transitioned at home

His wish and my promise

We together the seven days

Of leaving his body behind

Hospice provided help

Amazing nurses aiding insight 

Meds and visits as needed

Combined with compassionate care

From Leo’s wonderful home health aides

Mark and GiGi who gave generously

Of their Warm Haitian Creole hearts

Leo walked through the only door open

Clearly and consciously seeking he stopped eating

We were together throughout this seven day journey

To his well deserved long sought release

Leaving one's body is no small task

We dressed Leo casual for comfort

Who could he still possibly need to impress?

Much to appreciate life’s life lessons

Fortunate to be born a son of Leo

Generous non-judging supportive father

Ever happy he set himself free

Japanese Death Poems

In the death poem, or jisei, the essential idea was that at one's final moment of life, one's reflection on death (one's own usually but also death in general) could be especially lucid and meaningful and therefore also constituted an important observation about life. The poem was considered a gift to one's loved ones, students, and friends. The tradition began with Zen monks, but was also popular with poets, whose poems were often just as solemn as those of monks, or entirely flippant and humorous. The poems are often full of symbols of death, such as the full moon, the western sky, the song of the cuckoo, and images of the season in which the writer died.  See also, Japanese Death Haiku.

The death poem of Basho, one of the greatest haiku poets of all time:

    On a journey, ill;

    my dream goes wandering

    over withered fields.

About the above graphic: During his last moments (September 9, 1769), 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. most important symbols of Zen Buddhism.

Kobayashi Issa captures mortality well in this haiku:
 

In this world 

we walk on the roof of hell,         

gazing at flowers.

  

The "R" Word

What would happen if there was "a pill that would extend your life by one day, but it cost a billion dollars, it’s unlikely that many people would argue that health insurance should pay for it. We all understand that while the benefit might be real and quantifiable, it’s not worth the expense. But what if the pill cost a million dollars? And what if it extended your life by 10 years?"

This is a fine post on a Forbidden Topic in Health Policy Debate: Cost Effectiveness.

Rationing is definitely the “R” word.

Read full blog post.

The Green House Effect

Homes for the Elderly to Thrive

by Jane Brody

NY Times, December 16, 2014

In his book, Being Mortal, Atul Gawande describes Green Houses (resident friendly nursing homes) that are the brain child of Bill and Jude Thomas.

Jame Brody devotes her weekly column on Dec. 16^th to a discussion of these innovative nursing homes that are doing no less than reinventing elder care. Their program advocates for changes that can transform the medically dominated culture of care for the elderly. Their homes for the elderly are called Green Houses.

Read Jane Brody’s essay for more information.

See Chapter 5 in Notes from Being Mortal.

How Medicare Stacks Up

U.S. Health Care Lags Worldwide for Those Over 65.

A survey of older people in 11 countries finds that U.S. adults are sicker than their counterparts abroad, as well as the most likely to have problems paying their medical bills and getting needed healthcare. U.S. adults also reported difficulty getting care in a timely fashion and using emergency departments for issues that a primary care physician could treat. Among the bright spots for the United States: having a care plan for chronic illness, and planning for end-­of-­life care.

A Conversation with Deborah Alecson

On December 11, 2014, our professor, Deborah Alecson was interviewed on NPR-WAMC by Alan Chartock.  You can listen to this fascinating discussion at: In Conversation with Deborah Golden Alecson.

You will be interested in hearing her thoughts and insights about death and dying.

Chronic Diseases Are Killing More People in Poor Countries

Chronic diseases like cancer and heart disease are rising fast in low- and middle-income countries, striking far younger populations than in rich countries and causing much worse outcomes, according to a new report.

Deaths from chronic diseases have risen by more than 50 percent in low- and middle-income countries over the past two decades, according to the report, by the Council on Foreign Relations. The increase is part of a shift in global mortality patterns in which infectious diseases, such as malaria and tuberculosis, have declined substantially and are no longer the leading cause of death in the developing world.

This article, by Sabrina Tavernise, appeared in the December 4, 2014 New York Times.  Read full article.

Hoping for a Good Death

Author and Father

by Elizabeth Reis

New York Time, December 1, 2014 

Hoping for a Good Death is an essay about the hospital death of a 78 year-old man by his daughter who teaches medical ethics at the University of Oregon.  It’s a good introduction to a discussion of advanced directives.  Dr. Reis tells us that chaotic dances of death surround even the death-beds of those who are informed.

One of the commenters recommended “the Institute of Medicine report on Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. It has plenty of data and support for making advance care planning a normal part of being an adult, no matter one's state of health.”

Dr. Reis writes: "The biggest lesson I have learned is that every family should not only discuss end-of-life wishes but should act on them by filling out an advance directive. If my father had completed one, his end might have played out differently. By the time we told the medical staff that he didn’t want to be hooked up to machines, he already was, and we acquiesced in letting things take their course, with the hope that he might improve." 

See also: KOHD post on IOM Report.