Paying Tribute To A Doctor’s Invaluable Teacher: A Dead Body

For many doctors, the most important person on their journey from pre-med to licensed healer is dead.

“When you start medical school, you begin to learn the details of cells and tissues and development and disease,” said Jared Wortzman, president of the Tufts University School of Medicine class of 2016. “But if you ask anyone here they’ll tell you, you don’t really become a medical student until the moment you meet your cadaver.”

Edmund Chilcoate in his Coast Guard days (Courtesy)

Edmund Chilcoate in his Coast Guard days (Courtesy)

Wortzman spoke at an unusual gathering last week — a memorial service for the men and women who donated their bodies to the anatomy lab at Tufts and a reception for their families.

One of the donors was 83-year-old Edmund Chilcoate.

“This is when he was a baby. He was cute, wasn’t he cute?” said Kim Begin, one of Chilcoate’s two daughters. Begin flips the plastic-covered pages of a brown leather photo album while three of the first-year medical students who probed and dissected Chilcoate’s body lean in to look.

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End-Of-Life Conversation: From Kitchen Table To Your Doctor’s Office

Speaking to your doctor about how you want to die may be as hard as (or even harder than) talking to your family.

So, the folks who created a kit to help you start talking about death with your loved ones, while sitting around the kitchen table, are introducing the next iteration of “The Conversation:” How To Talk To Your Doctor.


A companion to the original Conversation Starter Kit, (which my blog partner Carey Goldberg used to talk to her father about death and dying) the new kit offers a detailed framework with plenty of helpful tools for the tough discussion. There are worksheets, sample scripts, a glossary of key terms, specifics about what it’s okay to say and clear, factual information on how to talk to your doctor, nurse or another provider about your end-of-life wishes, fears and concerns. (Examples: What to say if your health care provider doesn’t want to talk about it; What to do if your two doctors have conflicting opinions or if you disagree with your siblings.)

The Conversation Project was launched by a group of media and medical professionals who want to help families and loved ones begin to talk about end-of-life care far in advance.

I asked one of the founders, Jessica McCannon, M.D., of the Pulmonary and Critical Care Unit at Massachusetts General Hospital, what the biggest obstacle usually is for patients who wish to initiate these types of conversations and what might they do to overcome these barriers. Here’s her emailed response:

It’s hard to pick just one [obstacle] – and surely it’s a combination of things. The biggest obstacles are assumptions; an assumption that the health care provider will bring it up at the appropriate time. Or fear—that if they, the patient, do raise the subject, that perhaps they will be abandoned, that their health care team won’t continue to provide the care they need, or that their team will give up. Cultural beliefs also play a role; there may be cultural resistance to discussing these topics for some patients, which can be further complicated by family members who are struggling to accept their loved one’s mortality. Time is another; time often comes up in discussions about barriers for health care providers and the health care system, but I think this is also a problem for patients. If you have a limited time with your health care provider, and you have a lot of urgent questions about a new medication, or want to discuss new symptoms, it can be hard to prioritize what can be an emotional discussion over more pressing issues (this means that we all have to get creative about thinking of new formats/ways in which to share information about what matters most to patients)… Continue reading

Patrick, Citing Personal Experience, Voted Yes On Doctor-Assisted Suicide

Deval Patrick (WBUR)

For the record, Gov. Deval Patrick said his decision to vote in favor of physician assisted suicide was motivated largely by his experience with his mother near the end of her life, The Associated Press reports.

The measure was defeated by a narrow margin here in Massachusetts. But as Carey noted in a recent post, much of the passion in favor of the measure came from people who had actually witnessed a loved one die under painful conditions with much suffering; these survivors yearned for a more graceful and dignified path to death for the ones they loved.

And indeed, the AP writes:

Gov. Deval Patrick says his decision to vote for a ballot question that would have legalized physician-assisted suicide for the terminally ill was motivated largely by personal considerations.

Patrick told reporters Wednesday that he supported the question after his experience with his mother at the end of her life.

Patrick also pointed to the death of his grandmother some years earlier.

Patrick said he knew how important it was for his mother and grandmother to have some measure of control at the end of their lives, although he’s not sure they would have used the medication the question would have legalized.

Fresh Air: Existential Emptiness At The End Of Life

Listen to Fresh Air today for an insiders view of death and dying from a former critical care nurse who now counsels terminally ill people at the end of their lives. Some of those patients choose to die with an overdose of medications, which is legal in Oregon, Washington and Montana. Massachusetts voters will decide whether to legalize physician-assisted suicide in November.

Judith Schwartz, east coast regional coordinator for the nonprofit Compassion and Choices, tells Terry Gross that the top reason terminally ill patients say they want help dying is not because they’re in excruciating pain. She said people want to die when they can no longer do any of the large and small things they love. For some people that doesn’t matter, she said, but for the people it matters to, it matters a lot, and those patients stare straight into the “existential meaningless” of life. Continue reading

In Memoriam: Eloquent Writer Who Chronicled Own Dying

dudley clendenin

Dudley Clendinen and his daughter Whitney in 2007

I shouldn’t have been surprised but I still gasped with sadness this morning when I saw the May 30 obituary on Maryland Morning’s Website:

The writer and journalist Dudley Clendinen died today in Baltimore after a year and a half long battle with amyotrophic lateral sclerosis, or ALS. Dudley worked as a reporter and editorial writer for The New York Times, and was the author of several books, including Out for Good: The Struggle to Build a Gay Rights Movement in America, on the evolution of the gay rights movement, and A Place Called Canterbury: Tales of the New Old Age in America. He remained in his home until he was moved to hospice care at the Joseph Richey House earlier today. He was 67 years old.

Dudley was open about his experience with terminal illness, both in the op-ed pages of The Times, and on Maryland Morning, where he spoke about the disease in a series of interviews with Tom Hall called “Living with Lou: Dudley Clendinen on a Good, Short Life.

Maryland Morning will post audio of a remembrance of Dudley later today. Its series was extraordinary, as was Dudley’s courage and style as he did it. We posted praise and excerpts of it here, here and here. One of my favorite quotes: “Life gets so quirky and interesting when you’re dying.” Dudley was writing a book about the end of his life; I hope he got close enough to finishing it, and though I don’t know of any official post-mortem instructions, plan to buy many copies of it when it comes out, in lieu of flowers…

How Thinking About Death Can Improve Life

(Bête à Bon-Dieu/flickr)

My father called yesterday to tell me he’s got spinal stenosis, yet another complication atop a long list of medical problems he faces at age 77. I don’t want to think about what’s next.

But maybe I should.

A new paper suggests that thinking about death and mortality may be a good thing: It can improve our physical health and offer perspective on life. Researchers report that even “non-conscious” thoughts of death, for instance, walking past a cemetery “could promote positive changes and promote helping others.”

From the news release:

Past research suggests that thinking about death is destructive and dangerous, fueling everything from prejudice and greed to violence. Such studies related to terror management theory (TMT), which posits that we uphold certain cultural beliefs to manage our feelings of mortality, have rarely explored the potential benefits of death awareness.

“This tendency for TMT research to primarily deal with negative attitudes and harmful behaviors has become so deeply entrenched in our field that some have recently suggested that death awareness is simply a bleak force of social destruction,” says Kenneth Vail of the University of Missouri, lead author of the new study in the online edition of Personality and Social Psychology Review this month. “There has been very little integrative understanding of how subtle, day-to-day, death awareness might be capable of motivating attitudes and behaviors that can minimize harm to oneself and others, and can promote well-being.” Continue reading

Scientific American: How Thinking Of Death Affects What We Do

You’re going to die. I’m going to die. We don’t talk about it much. Even though if you ask me, it’s incredible that we talk about anything else, given the existential enormity of that impending black hole.

So it gladdened my heart to find a fascinating Scientific American article on research about the effects of at least thinking about mortality, and how it affects us. The gist: Distant, abstract thoughts of death just make us want to hunker down as we are; more personal, imagined encounters with death can shake us up toward becoming better people.

One of our systems of existential thinking responds to the abstract concept of dying, so that even subtle everyday reminders of death, such as driving past a cemetery, prime the mind to ward off existential terror. This system tends to bolster our already existing beliefs, both religious and cultural, as a way of affirming life. For instance, studies have shown that after people reflect on what will happen when they die, they become more nationalistic and defensive about their political beliefs.

The second existential system is vivid, concrete and highly personal; it is triggered not by subtle and abstract thoughts but by actually coming face to face with death. When this system is primed into action—as the above apartment fire scenario is meant to do—our very personal sense of mortality can lead us to reexamine our priorities in life, to become more grateful and to grow spiritually. Soldiers who have seen combat and people who have lived through life-threatening illnesses often report these shifts in attitude.

Steve Jobs: How To Live Before You Die

Here’s Jobs giving the commencement speech at Stanford in June 2005, shortly after his first surgery for pancreatic cancer, when he thought, or at least he said, that everything was fine.

The address is funny, wise and exceedingly sobering (how many graduation speakers tell 20-year-olds: “Your time is limited”).

Here’s Jobs on death as a motivating force:

“Remembering that I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life, because almost everything — all external expectations, all pride, all fear of embarrassment or failure — these things just fall away in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking that you have something to lose. You are already naked — there is no reason not to follow your heart.”

(Hat tip to Tina Barseghian at MindShift, with a great tribute to Jobs today.)

Traffic, Labor Day And A Death Far Away

Last year there were more than 1.2 million traffic deaths worldwide, according to the WHO

As folks make the mad Labor Day dash to their cars to get — now! — to the Cape, the Vineyard, the in-laws in Connecticut, it’s worth noting two things:

1. Slow down, be safe and embrace an attitude of we’ll-get-there-when-we-get-there (the grill will still be hot when you arrive).

2. Things are far worse elsewhere. For example, here’s a public health professor living in Bangladesh, Tracey Koehlmoos, who’s been blogging for BMJ about the massive number of road traffic deaths where she lives and in poor countries around the world. After writing about the terrible things that happen to others on the treacherous, pothole-laden roads around her, something terrible happened to Koehlmoos: her husband, a U.S. Army colonel, died in a traffic accident last month.

On 27 August 2011, my husband, Colonel Randall L. Koehlmoos, US Army, died in a road traffic accident in Jakarta, Indonesia. The irony of a soldier who has served in every major war and peace action for the past three decades meeting his demise on the streets of Jakarta is not wasted on me, even now in the depths of my grief. It highlights that we are all at risk and that this issue must be addressed before more lives are lost and more families suffer. Continue reading

How We Die Now: Five New Stages, Family Included

Co-author Barbara Okun

In 1969, Dr. Elisabeth Kubler-Ross revolutionized popular thinking about how we die. Her bestselling book, “On Death and Dying,” proposed a five-step set of stages that a dying person tends to go through: Denial, anger, bargaining, depression and acceptance.

Now, a new book, “Saying Goodbye,” argues that it’s time for a new paradigm. With medical advances, dying now tends to be a much longer process than it was when the old five stages came out. And that presents new challenges for everyone involved.

CommonHealth spoke with co-author Barbara Okun, a professor of counseling psychology at Northeastern and a clinical instructor at Harvard Medical School.

So it’s time for a new five stages of dying to replace the now-classic Kubler-Ross stages?

First of all, she deserves a lot of credit for bringing the topic of death and dying out of the closet. And in those days, people diagnosed with cancer had weeks or at most a couple of months to live. So she was talking mostly about patients’ reactions. But it’s changed.

‘Death is more a process than an event, and illness and death are a family process.’

Of course there’s still sudden death, but we’re addressing death after the diagnosis of a fatal illness, when people can live years because of medical advances. Death is more a process than an event, and illness and death are a family process.

So given that, let’s look at your proposed five stages…

1. Crisis — Crisis is when you think there’s something wrong, and it can last a long time because you have to get several different opinions, and you go for tests and then you wait for the results. It can be a very anxiety-producing period because you don’t know whether you’re imagining things or there’s really something wrong. If it’s an adult, the person has to decide who they want to share the process with. If it’s a spouse or family member, everybody’s feeling that anxiety, and trying to find out what this might mean.

2. Unity — Unity is when you know. Some patients find it a relief: Even if it’s not a good diagnosis, at least they know what it is. And unity is when everybody pitches together to figure out what’s the best course of action in terms of establishing a medical team, a legal team, getting your affairs in order just in case, finding out what social services or options and entitlements are available. Family members typically put their differences aside and everybody comes together to be supportive. And it’s a time for people to organize and decide who’s going to be the point person for the doctors, who’s going to deal with the insurance company, who’s going to research different treatment options, who’ll help with estate planning and who’ll do the actual caretaking.

And then it starts getting long….that brings us to….

3. Upheaval — It’s like when people start thinking, ‘This has gone on so long, I can’t keep taking time off from work or asking my friends to take my kids to all their activities.’ Nerves start fraying and old resentments and conflicts re-emerge, and then people feel guilty because they feel ambivalent. In a way, they want it to be over with, and they feel guilty and ashamed but those are normal feelings. Continue reading