Stars and Stripes

For the first time in 18 years, the press has taken an officially sanctioned photo of a fallen U.S. soldier returning to American soil in a flag-draped casket. 

This is thanks to a change in policy instigated by Defense Secretary Robert Gates and backed up by President Obama. 

Photo from The New York Times. 

Palliative Care Grand Rounds, Volume 1, Issue 3

Welcome to volume one, issue 3 of Palliative Care Grand Rounds!

Here you will find an overview of what's been happening in the cyberworld regarding palliative care, death, dying, end-of-life care, and all sorts of related topics for the past month. 

Entries in this series are rotating throughout palliative-care-oriented blogs and are hosted on the first Wednesday of each month. Next month's series will be hosted by Thaddeus Pope at Medical Futility on May 6th. 

There is a lot here, so if you want to read a bit at a time and come back later to read some more, that might be a good way to approach it. I do realize it looks overwhelming :)

That said, let's jump right in ... 

This month, a study was released in JAMA telling us that terminal cancer patients who are self-defined as religious are nearly three times as likely to seek life-sustaining measures near the end, and are also less likely to prepare for death—in terms of advance directives, living wills, healthcare advocates.

Also this month, Washington's Initiative 1000 went into law, legalizing physician assisted suicide. One stipulation of the law is that hospitals and individual practitioners can choose to opt out of the legislation. The has the potential to cause massive confusion. As a Washington-based nurse practitioner, risaden of Risa's Pieces, has an excellent post on his thoughts on this law, what he has encountered related to it, and how it compares to Oregon's law.  

Taking a harder look at the risks of skiing without a helmet, and the signs of serious head trauma in the wake of Natasha Richardson's death—a sad reminder that death by falling is the third most common cause of accidental death. 

60-Second Psych in Scientific American takes a look at whether the suicide of Nicholas Hughes, the son of Sylvia Plath and Ted Hughes, was due to hereditary causes. Children of mother's who kill themselves are more likely to commit suicide ... but is that correlation or genetics?

If the Rapture occurred, what would happen to your bank account? That's right, the Christian Rapture. Well, Mark Head thinks that in the event of the Rapture, in the midst of God's eternal glory, you will still be worrying about what is happening to your financials down on earth, So, for a $40 fee, he has a service that sets up an email that can be sent to your relatives with your bank account information. (And you can totally trust Mr. Head with your financial information.) "Christians on call" for the site log on to it to keep it going. If no one logs on for three days, it is assumed Rapture has taken place, and the emails are sent out. I guess you'd want to pick your most heathen-y relatives, just to ensure they're left behind to receive the email. How do you start that conversation?

This piece is a real doozy. How you go from normal life and a simple spinout in snowy conditions to freezing to death, or nearly freezing to death. And what it's like to freeze to death. Fascinating. Well-written. From Outside magazine online. 

A story about taking care of Sean, a former Fortune 500 company worker with early onset Alzheimer's, from the blog Confessions of a Young Looking Social Worker. 

A geropsychiatrist writes about two old goats—one figurative and one literal—both using the same meds to good purpose. Funny!

A touching piece that comes very close to my interests. A medical librarian writes about her mother-in-law's good death from cancer—thanks largely to the help of good hospice care—and the bittersweet satisfaction that brought the family. 

The blog Palliative Care Success discusses a NEJM article that shows high-spending regions of the country are more likely to recommend hospitalization for an 85-year-old patient with an exacerbation of end-stage congestive heart failure. They were also three times as likely to admit this patient to intensive care, and 30% less likely to discuss palliative care with the patient and family. The post suggests Advanced Palliative Care Organizations (APCOs) can help reduce the number of people dying in hospitals and reduce the number of days patients spend at the hospital near the end, but APCOs are limited in how many physicians and other professionals they are drawing. 

The relationship between palliative care and the church, the spiritual role of palliative care ... but also the palliative care needed by a dying church (in this particular community) are all addressed in this beautiful blog entry written by a former pastor and Tampa-based hospice worker. 

Losing a laptop becomes an opportunity to explore advance directives as a metaphor for being prepared for the death of technology with backup and storage. 

Fran Johns, one of my favorite bloggers, has a beautiful piece on the therapeutic and restorative qualities of pulling Oxalis. Fran is part of the slow-blogging movement and does not update often, but when she does, it is always something amazing. Be sure to bookmark her site. 

At The Mom and Me Journals dot Net, Gail Rae writes about donating some of her mother's items to a garage sale. The need to de-clutter leads her to rid the place of her deceased mother's items as if they are just things, but one special piece, a tiara, needs an important home. 

Dethmama finds welcome relief from her work as a hospice nurse in the form of a new puppy named Olive. She has also posted a long-awaited sequel to a great story, Hospice Hitwoman and the C.Y.A., about a family who is anxious to see their loved on pass away, before the right time even. 

At the Pallimed blog, Dr. Drew Rosielle discusses a study that shows most people do not understand the actual details of resuscitation, and many would choose to not have chest compressions, shocks IVs through the groin, even though those are sometimes regular parts of resuscitation. Dr. Rosielle also has an excellent post on JAMA's series on palliative care of latinos. 

Pride and Prejudice and Zombies: Seth Grahame-Smith has reworked Jane Austen's Pride and Prejudice to include zombie battles. You can find a fantastic (in every sense of the word) excerpt here. 

If you want some death at the movies, check out Sunshine Cleaning, an irreverent and touching comedy about two sisters who open an industrial cleaning business—specifically cleaning up after dead people. The film stars Emily Blunt, Amy Adams, and Alan Arkin. 

Is it ethical for a wife to use a deceased spouse's sperm for artificial insemination? The Health Monitor at Radiography Schools takes up this issue and contrasts it with other sperm-donor controversies of late.

Is there such a thing as a style for your illness? Dana Jennings writes about getting a buzz cut to develop a tough, "Prison Break"-esque style for his prostate cancer treatent. For him, the haircut is a "visible bulwark against the tide of emasculating side effects caused by the treatment of prostate cancer."

Thanks to all who sent in suggestions! I'm sure there is even more out there I couldn't get to. And if you're interested, here's where you can find issues 1 and 2. 

Security Helmets

I don't want to write too much about this because I think this is a time during which this family deserves privacy ... but I want to point out how good the human brain is at finding ways to create the myth of our own safety.

Actress Natasha Richardson is in critical condition due to a tragic ski accident on a beginner, bunny hill. Just one of those freak accidents, a terrible, terrible event, and unfortunately, something that happens in life every once in a while.

News reports coming out about this immediately pointed to the fact that she was skiing without a helmet.

I think writers included this fact so readers could feel a false sense of security. You read that and think, "Oh, but I would wear a helmet and therefore, this would never happen to me." But my goodness. I am far from an avid skier, but I do live in the Pacific Northwest where people ski a lot, and nobody skis with a helmet.

Reporters have just thrown in this made up, miscellaneous safety precaution that Ms. Richardson was supposedly ignoring in order to give readers a phony safety blanket.

Washington State's First Execution in Eight years

For most of the past six months, my home state has been on the verge of its first execution since 2001.

Two separate executions have been cycling through the legal system. One is the possible execution of Darold Stenson, who was convicted of killing his wife and business partner in 1993. A judge ordered a stay on that execution in early December (for at least 90 days). I'm not sure where it stands right now.  

And now, it appears, barring any further appeals, that Cal Coburn Brown will be executed at 12:01 am on Friday—in other words, late tonight, early tomorrow morning.  

The immediate prospect of an execution always raises the issue of whether the legal system should be killing people, especially in an area like Washington where it doesn't happen very often. 

Here, from the Seattle Times is a pro–death penalty piece and a con–death penalty piece. Anyone else care to add their voice? 

Palliative Care Grand Rounds, Volume One, Issue Three ...

... will be hosted right here, on Wednesday April 1.

If you have tips or ideas for things for me to add—stories, radio programs, articles, blog entries, whatever—on death, dying, end-of-life care, palliative care, anything like that, please forward them along.

You can email them to me at jessica.knapp@gmail.com. Or just drop them into the comments section of any blog entry for this month, and I'll probably get the message that way, too.

And don't forget to check out Palliative Care Grand Rounds, Volume One, Issue Two, currently up at dethmama's blog!

Q&A with an obituary writer

A fascinating Q&A with Bruce Weber, an obituary writer at The New York Times. He addresses issues like handling controversy in obits, writing advance obituaries, what questions are hardest to ask surviving family members, and who gets "the verb." (In The New York Times, only one obit per page receives a verb in the headline. That obit is considered the most important. It's another way to rank people by class and stature even after their lives are over. The Times loves systems of power and influence, especially when they're in charge.) Well worth at least a quick skim.