Program Particulars: A Midwife to the Dying

Program Particulars

*Times indicated refer to web version of audio

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(02:01) Music Element

"Multiples of One" from Awakening, performed by Joseph Curiale

(02:26) Field of Palliative Care

Palliative care is treatment that enhances comfort and improves the quality of an individual's life during the last phase of life. The expected outcome is meant to alleviate symptoms, ease pain, and enhance the quality of life rather than effecting a cure of the underlying disease.

(02:45) Open Society Institute

The Open Society Institute, founded by businessman and philanthropist George Soros, initiated the Project on Death in America (PDIA) — a grantmaking program dedicated to "understanding and transforming the culture and experience of dying and bereavement" in America. After nine years, the program issued a three-year report describing methods of educating the public, funding and improving palliative care for the dying, and implementing strategies for Central and Eastern Europe, the former Soviet Union, and South Africa.

(03:11) Project on Being With Dying

Founded by Ms. Halifax in 1994, the Project on Being with Dying develops and offers programs for caregivers, dying people, and health care professionals to support the experience of dying, both practically and spiritually.

(05:40) Quote from Halifax's Essay

Krista cites a line from Ms. Halifax's 1995 essay, "Being with Dying":

In having been in the "field of dying" for many years, I have frequently encountered the tragic limitations of dying in America. Working with dying people in often difficult external situations and dealing with the challenges of denial, fear, and institutional resistance have made the experience of entering the "question" of dying extremely rich, if not challenging. As we all know, death in America is all too often looked on as a management problem and as a biological and moral evil.

Elisabeth Kübler studying medicine at the University of Zürich. She graduated in 1957. (Photo courtesy of Ken Ross)

Elisabeth Kübler studying medicine at the University of Zürich. She graduated in 1957. (Photo courtesy of Ken Ross)

(08:34) Origins of Hospice Movement

Hospice is specialized care for people facing death, which is aimed at comfort and quality of life and not at curing a person's illness. During the 1960s, two pioneering women established the beginnings of palliative practices many dying people benefit from today: Elisabeth Kübler-Ross and Dame Cecily Saunders.

Elisabeth Kübler-Ross, a Swiss-born physician, brought attention to the hospice movement with her 1969 publication, On Death and Dying. The book introduced the Kübler-Ross' model outlining the five progressive stages a person experiences when one learns he or she is terminally ill: denial, anger, bargaining, depression, and acceptance.

Two years earlier, Cecily Saunders opened the first modern hospice, St. Christopher's Hospice in London. For further insight into this movement, visit "The Hospice Experiment" from the documentary radio program American RadioWorks.

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(11:05) Music Element

"Gymnopedie No. 02" from After the Rain… The Soft Sounds of Erik Satie, performed by Pascal Rogé

(11:35) Views of the Afterlife

In "The Posthumous Journey of the Soul: Myth and Science" — a chapter in The Human Encounter with Death by Stanislav Grof and Joan Halifax — the authors provide an intriguing and concise overview of various approaches different cultures, ancient and modern, take to the death experience and the afterlife:

The concept of the afterlife has taken many specific forms in different cultures, but the basic underlying idea is the same—that death does not terminate human existence entirely and that in one way or another life or consciousness will continue after the body is no longer vital. Sometimes the image of the afterworld is very concrete and real, not dissimilar to earthly existence. More frequently the realms of the world beyond have special characteristics distinguishing them from anything known on earth. Whether or not the residing place of the soul is a familiar environment, the soul's journey to the afterworld is often believed to be a complex process of transitions and transformations through many different levels and realms. Comparative studies of the concepts of afterlife and of the posthumous journey of the soul reveal striking similarities between cultures and ethnic groups separated historically and geographically; the recurrence of certain motifs and themes is quite remarkable. The idea of the final home of the righteous after death—heaven or paradise—appears in many different variations.

Victor Frankl (Photo: Katharina Veselly)

Victor Frankl (Photo: Katharina Veselly)

(13:22) Quotes by Frankl and Allen

In Man's Search for Meaning, psychiatrist and Holocaust survivor Victor Frankl writes that there is purpose in dying:

The mental reactions of the inmates of a concentration camp must seem more to us than the mere expression of certain physical and sociological conditions. Even though conditions such as lack of sleep, insufficient food and various mental stresses may suggest that the inmates were bound to react in certain ways, in the final analysis it becomes clear that the sort of person the prisoner became was the result of an inner decision, and not the result of camp influences alone. Fundamentally, therefore, any man can, even under such circumstances, decide what shall become of him—mentally and spiritually. He may retain his human dignity even in a concentration camp. Dostoevski said once, "There is only one thing that I dread: not to be worthy of my sufferings." These words frequently came to mind after I became acquainted with those martyrs whose behavior in camp, whose suffering and death, bore witness to the fact that the last inner freedom cannot be lost. It can be said that they were worthy of their sufferings; the way they bore their suffering was a genuine inner achievement. It is the spiritual freedom—which cannot be taken away—that makes life meaningful and purposeful. An active life serves the purpose of giving man the opportunity to realize values in creative work, while a passive life of enjoyment affords him the opportunity to obtain fulfillment in experiencing beauty, art, or nature. But there is also purpose in that life which is almost barren of both creation and enjoyment and which admits of but one possibility of high moral behavior; namely, in man's attitude to his existence, an existence restricted by external forces. A creative life and a life of enjoyment are banned to him. But not only creativeness and enjoyment are meaningful. If there is a meaning in life at all, then there must be a meaning in suffering. Suffering is an ineradicable part of life, even as fate and death. Without suffering and death human life cannot be complete. The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity—even under the most difficult circumstances—to add a deeper meaning to his life. It may remain brave, dignified and unselfish. Or in the bitter fight for self-preservation he may forget his human dignity and become no more than an animal. Here lies the chance for a man either to make use of or to forgo the opportunities of attaining the moral values that a difficult situation may afford him. And this decides whether he is worthy of his sufferings or not.

On a lighter note and in stark contrast, the writer and director Woody Allen presents a more typical reaction to death in the 1976 film Without Feathers: "It's not that I'm afraid to die, I just don't want to be there when it happens."

(16:28) Reference to Kathy Foley

Dr. Kathleen Foley is a neurologist at Memorial Sloan-Kettering Cancer Center in New York and director of the Project on Death in America. She is one of the leading experts on supportive care and treating pain associated with cancer. Read her testimony (pdf; page 63) at a 2000 Senate hearing on the Pain Relief Promotion Act.

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(18:30) Music Element

"Lament and Wake" from LAGQ's Guitar Heroes, performed by Los Angeles Guitar Quartet (LAGQ)

(18:51) Reading from Whitman's "Song of Myself"

The following passage was excerpted from Walt Whitman's 1881 poem, "Song of Myself," reflecting that death, like birth, is a part of the natural order of things:

What do you think has become of the young and old men? And what do you think has become of the women and children? They are alive and well somewhere, The smallest sprout shows there is really no death, And if ever there was it led forward life, and does not wait at the    end to arrest it, And ceas'd the moment life appear'd. All goes onward and outward, nothing collapses, And to die is different from what any one supposed, and luckier. Has any one supposed it lucky to be born? I hasten to inform him or her it is just as lucky to die, and I know    it. I pass death with the dying and birth with the new-wash'd babe, and    am not contain'd between my hat and boots, And peruse manifold objects, no two alike and every one good, The earth good and the stars good, and their adjuncts all good.

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(20:00) Music Element

"Sarabande from Suite No. 3 in C major" from The Cello Suites: Inspired by Bach, performed by Yo Yo Ma

Thai monks take a photo of a mummified AIDS victim at the Life Museum at the Wat Phrabaht Nampu AIDS hospice. The body is on display for visitors to see as part of an educational exhibit for people wanting to see the reality of AIDS. (Photo by Paula Bronstein/Getty Images)

Thai monks take a photo of a mummified AIDS victim at the Life Museum at the Wat Phrabaht Nampu AIDS hospice. The body is on display for visitors to see as part of an educational exhibit for people wanting to see the reality of AIDS. (Photo by Paula Bronstein/Getty Images)

(21:13) Meeting the Dalai Lama

In October 1992, Halifax participated in the fourth Mind and Life Conference held in Dharamsala, India, where she made a presentation to the Dalai Lama and others, comparing near-death experiences across cultures. An edited selection of dialogues from this conference has been published as Sleeping, Dreaming and Dying: An Exploration of Consciousness with the Dalai Lama.

In her essay, "Lovingkindness: The First Abode," Halifax writes about a personal experience she had when first meeting His Holiness:

Years ago I participated in a small meeting with His Holiness the Dalai Lama. Several weeks before, I had undergone eye surgery to remove some growths on my sclera. Following surgery my eyes were subjected to radiation therapy. Unfortunately the radiologist did not fractionate the dose of radiation enough and my eyeballs were burned. I was forced to wear bandages for several months as my raw eyes were healing. Since I was virtually blind, I considered not attending the meeting. Then I realized that I felt well enough to participate in some minimal way. His Holiness was very kind to me during the meeting, and after it was over, he asked if we could spend some time together. I knew that he was busy, so busy that he had given no private audiences to anyone during his six weeks in the United States, and I almost refused his invitation because I didn't want to bother him. In truth, I didn't feel worthy of his attention. But his assistant called and insisted that I come. When I arrived in the private home in which His Holiness was staying, he threw his arms around me in a big embrace. He then led me to a chair and asked me what had happened. After I briefly told him the story, he said that he hoped I had not suffered too much and that he was happy that my mind was clear and strong even though my eyes had been injured. He was kind without pity, loving without neediness. He then put his hands over the bandages and prayed. At the moment when His Holiness touched the bandages, my fear disappeared, and I was truly happy. I had been touched by the essence of lovingkindness and compassion. It reminded me of something he had said in a talk: "My religion is kindness."
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(26:06) Music Element

"Americana" from Rarum, Volume 1: Selected Recordings, performed by Keith Jarrett

(26:33) Reading from Poem by Marie Howe

Following is an excerpt from the poem "The Last Time" by Marie Howe from her collection What the Living Do, chronicling her brother’s death from AIDS at the age of 28:

The last time we had dinner together in a restaurant with white tablecloths, he leaned forward and took my hands in his hands and said, I'm going to die soon. I want you to know that. And I said, I think I do know. And he said, What surprises me is that you don't. And I said, I do. And he said, What? And I said, Know that you're going to die. And he said, No, I mean know that you are.

Maria Callas performing as Maddalena in La Mamma Morta at the Teatro Alla Scala.

Maria Callas performing as Maddalena in La Mamma Morta at the Teatro Alla Scala.

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(27:00) Music Element

"La Momma Morta" from Philadelphia [Original Soundtrack], performed by Maria Callas

Maddalena's Aria from La Mamma Morta from Andrea Chénier

Translation: Carlos Bardera

La mamma morta m'hanno alla porta della stanza mia; Moriva e mi salvava! poi a notte alta io con Bersi errava, quando ad un tratto un livido bagliore guizza e rischiara innanzi a' passi miei la cupa via! Guardo! Bruciava il loco di mia culla! Così fui sola! E intorno il nulla! Fame e miseria! Il bisogno, il periglio! Caddi malata, e Bersi, buona e pura, di sua bellezza ha fatto un mercato, un contratto per me! Porto sventura a chi bene mi vuole! Fu in quel dolore che a me venne l'amor! Voce piena d'armonia e dice: "Vivi ancora! Io son la vita! Ne' miei occhi è il tuo cielo! Tu non sei sola! Le lacrime tue io le raccolgo! Io sto sul tuo cammino e ti sorreggo! Sorridi e spera! Io son l'amore! Tutto intorno è sangue e fango? Io son divino! Io son l'oblio! Io sono il dio che sovra il mondo scendo da l'empireo, fa della terra un ciel! Ah! Io son l'amore, io son l'amor, l'amor" E l'angelo si accosta, bacia, e vi bacia la morte! Corpo di moribonda è il corpo mio. Prendilo dunque. Io son già morta cosa!
They killed my mother in the doorway of my room; She died saving me! Later, at dead of night, I wandered about with Bersi, when suddenly a livid glow flickers and lights ahead of me the dark street! I looked at it! My childhood home was ablaze! I was alone, and surrounded by nothingness! Hunger and poverty, deprivation and danger. I became ill, and Bersi, so good and pure traded her beauty for my sake! I bring misfortune to all who love me. It was then, in my misery, that love came to me! And murmured in a sweet, melodius voice: "You must live ! I am life itself!" Heaven is in my eyes! You are not alone! Let your tears fall on my breast! I will walk with you and be your support! Smile and hope! I am love! Is all around you blood and mire? I am divine! I can make you forget! I am the god who descends to earth from the empyrean and makes this world A paradise! Ah! I am love, love, love" And the angel approaches, kisses me, and in that kiss is death! The moribund body is my body. Take it then! I am already dead like it!
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(30:37) Music Element

"Interlude 1" from Gurdjieff, Tsabropoulos: Chants, Hymns and Dances, performed by Anja Lechner

(32:00) Living Wills

A recent survey conducted by FindLaw, a legal resource organization, revealed that one-third of all Americans have a living will. A living will, often referred to as an advance medical directive, is a written document that states the kind of care and degree of medical intervention — including the use of life-prolonging procedures — a person wants in the case of a life-threatening medical condition. Advance medical directives vary from state to state according to laws and regulations.

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(32:16) Music Element

"(Ask the) Sphinx" from Air and Ground, performed by Los Angeles Guitar Quartet (LAGQ)

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(39:37) Music Element

"Gymnopedie No. 02" from After the Rain… The Soft Sounds of Erik Satie, performed by Pascal Rogé

(39:51) Reading from Poem by Mary Oliver

The following poem, "When Death Comes," appears in New and Selected Poems by Mary Oliver:

     When death comes like the hungry bear in autumn; when death comes and takes all the bright coins from his purse to buy me, and snaps the purse shut; when death comes like the measles-pox; when death comes like an iceberg between the shoulder blades, I want to step through the door full of curiosity, wondering: what is it going to be like, that cottage of darkness? And therefore I look upon everything as a brotherhood and a sisterhood, and I look upon time as no more than an idea, and I consider eternity as another possibility, and I think of each life as a flower, as common as a field daisy, and as singular, and each name a comfortable music in the mouth tending as all music does, toward silence, and each body a lion of courage, and something precious to the earth. When it's over, I want to say: all my life I was a bride married to amazement. I was the bridegroom, taking the world into my arms. When it is over, I don't want to wonder if I have made of my life something particular, and real. I don't want to find myself sighing and frightened, or full of argument. I don't want to end up simply having visited this world.

(49:29) Music Element

"Swing Low" from Night Night Songs, performed by Shannon Moore

(47:06) The Terri Schiavo Case

At the age of 26, Theresa Marie Schiavo suffered severe brain damage after going into cardiac arrest from a lack of oxygen being delivered to the cerebral cortex. Schiavo spent the following two-and-a-half months in a coma, and then lived the next 15 years in a condition diagnosed as an irreversible persistent vegetative state (PVS).

During this time, Terri Schiavo was unable to speak for herself and had no written living will. Her husband, who was also Schiavo's legal guardian, advocated the removal of all life support, including a feeding tube, arguing that his wife had verbally informed him before her heart attack that she would not be want to be kept alive by artificial means. Terri Schiavo's parents disputed the PVS diagnosis and believed she would recover.

Court battles ensued for nearly seven years, with a final appeal making its way to the United States Supreme Court. Even Florida governor Jeb Bush, the U.S. Congress, and President George W. Bush became involved on behalf of the parents. In the end, the courts upheld her husband's decision and Terri Schiavo's feeding tube was disconnected; she died on March 31, 2005. An autopsy was performed, but the results have not yet been released.

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(49:52) Music Element

"12/12" from Nuevo, performed by Kronos Quartet

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is a medical anthropologist, Buddhist teacher, and founder of the Project on Being with Dying.