The "Mozart Effect"

I still love to study at night. I discovered this during my undergraduate years at the University of Toronto. It is peaceful and quiet, no extraneous noise to interfere with concentration or compete for attention. The overnight CBC radio announcer used to keep me company with gentle dialogue and lots of classical music. I didn't know much about orchestral music then and nothing about time epochs like the Renaissance, Baroque or Romantic periods.  What I did know was that every now and then, I would feel calmer or more focused when a particular piece was played. I kept a small notebook on the desk and each time I became aware that the music was touching me in some way, I would write out the name of the piece or the composer. The list grew over the years and when it was time to leave Toronto for my first job, I took that list to the city's only classical music store, located in Yorkville, handed it to the salesman and said "more of this please". I walked out with a double record set entitled, The Golden Age of Baroque and went on to wear grooves in the vinyl. I have expanded my repertoire since then, embracing Mozart and Haydn & earlier works as well. All this to say, I attended an all Mozart concert at the NAC recently. Breathless & shivering with joy at times, the music filled every crevice of my being and I left the concert hall believing that music is the greatest of the healing arts.

Symphony #29 in A major K201 - Allegro con spirito (Prague Chamber Orchestra/Sir Charles Mackerras)

Violin concerto #5 in A major K219 - Allegro aperto (James Ehnes/Mozart Anniversary Orchestra) 

Clarinet concerto in A  major K622 - Adagio (Sabine Meyer) 

Andante from Piano concerto #21 in C major K467 played by violinist Joshua Bell/ASMF

Why healing? because on the day that marked the concert, two of my patients were imminently dying: I knew when I returned from weekend call at the sister hospital, their beds would be occupied by someone else and the family units I had come to know would have been forever changed.   

Celebrated Teacher ~ Ageless Voice

"By three methods we may learn wisdom: first, by reflection, which is noblest; second, by imitation, which is easiest; and third, by experience, which is the most bitter." 

~ Confucius

Puddle Jumping

Palliative fellows & residents from across Canada "meet" via teleconference every two months to hear presentations on topics of shared interest. In yesterday's session on Grief and Bereavement, we learned that kids grieve in chunks. The speaker likened this to puddle-jumping. "For adults grief is like wading through this enormous river, whereas for children it's puddle jumping, but when they're in that puddle, it's no different to the river". There were two messages in this statement:

1. In between the puddles, it is play as usual. Kids experience grief differently from adults, not consistently and not all the time.
2. Children re-grieve the same loss as they age but not in the same way because the ability to think and process 'looks' different at age 4yr when compared to age 6 or 8 or 10yr.

Rather than protecting children, preparing them in an age-appropriate way to deal with loss & sad feelings empowers them. It is a legacy in the form of a "set of coping skills".

Children want to know:

1. Did I cause it?
2. Can I catch it?
3. Who is going to take care of me?

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Just Listen

an excerpt
Rachel Naomi Remen

"I suspect that the most basic and powerful way to connect to another person is to listen.  Just listen.  Perhaps the most important thing we ever give each other is our attention.  And especially if it's given from the heart.  When people are talking, there's no need to do anything but receive them.  Just take them in.  Listen to what they're saying.  Care about it.  Most times caring about it is even more important than understanding it."

In the Moment ~ A Place for Living

THANKSGIVING EVE
(written by Bob Franke, sung here by Issac Guillory)
It`s so easy to dream of the days gone by
So hard to think of the times to come
And the grace to accept every moment as a gift
Is a gift that is given to some
What can you do with your days
But work and hope
Let your dreams bind your work to your play
What can you do with each moment of your life
But love `till you`ve loved it away
Love `till you`ve loved it away
There are sorrows enough for the whole world`s end
There are no guarantees but the grave
But the lives we have lived and the times we have spent
Are a treasure too precious to say

Benefits of Mindfulness

1. Ability to experience the present moment 
2. Clear awareness of thoughts & emotions 
3. Ability to relate to one's experience with compassion/understanding 
4. Ability to experience/transform emotional distress 
5. Space where creative solutions can arise

Dr. Steven Hick MBSR video presentation, "Mindfulness and being in the moment...  the key to positive mental health." Presented in Winnipeg, 2008.
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Essence of Mindfulness

I went into the woods because I wished to live deliberately, to confront only the essential facts of life, and see if I could learn what it had to teach, and not, when I came to die, discover that I had not lived.

Henry David Thoreau

MBSR begins on Tuesday. Eight weeks, one group session per week, daily practices, one full Saturday retreat. I am so looking forward to this experience. What is Mindfulness? According to Kabat-Zinn, it is paying attention in a particular way, on purpose.... It is a practice that uses motivation & intention to cultivate, sustain and integrate awareness into the present moment with non-judgmental acceptance.

Apparatgeist

There is an interesting article about mobile phones in this week's Economist entitled "The Apparatgeist calls".  It explores social & cultural factors that affect the way mobile phones are used in different countries and goes on to comment that busy lives and emerging technologies (aka "smart phones") are subjugating phone behavior and erasing some of these differences. A sardonic commentary can be found on this blog, Some Observers. The term itself &  apparatgeist theory (which I had not heard of before) were coined by Katz & Aakhus in their 2002 book (Perpetual Contact: mobile technology, private talk, public performance) to draw attention to both the meanings people construct for mobile technologies and their social consequences. Reading The Economist article caused me to think about styles of communication and ultimately, to reflect on two encounters that occurred on the same day this week at the hospital. Although there was an exchange of information in both, their impact on me was noticeably different.

Picture this: Two people, each with their eyes downcast and fixated on respective iPhone screens, automatically sidestep, pass each other and traverse, one on & the other off the elevator through the open door. Without ever looking up to acknowledge each others presence, each one simultaneously seems to appreciate what has happened and chuckles to themselves.

Picture this: Our palliative team was asked to help with symptom management for a patient whose heart was weak and kidneys were failing. I began by sitting in a chair, taking my place amongst the family members encircling the bed, devotedly watching & knowing. Very quickly, it was apparent that moving to the bed and taking the patient's hand was a gesture that fit the gravity of the situation. Focused, sensitive, intimate conversation, the realization that going home was unlikely. "Breaking bad news" and the river of tears that followed.

Dying Intestate

We were asked to attend a patient in the Emergency Department on New Years Day. She had become unexpectedly & suddenly very, very ill with a life-threatening complication of cancer and was not expected to survive. Her cancer had been diagnosed several months prior and was growing despite surgery, chemotherapy and radiation treatments. It became clear from reading the medical record, discussions about end-of-life issues were often postponed at the patient's request. When pressed (gently & respectfully) she gave us permission to call her good friend whom she had thought of asking to assume the role of executor. Her friend arrived discombobulated, breathless and holding back tears, rising to the task of collecting details & hastily preparing a Will with the help of a social worker. I would not want to spend my last moments on earth in this way. 

Sudden, fatal illness will take some people much sooner than anyone could have predicted. If one dies without a Will in Canada, they are considered to have died ‘intestate’: This means the provincial government decides how your assets will be divided - not you. Intentions you may have had for distributing your assets (estate) are not taken into account. There could be many repercussions, for instance a common-law spouse left out of the process entirely or additional legal costs for beneficiaries, not to mention the possibility of quarrelsome litigation for “would be” heirs.  Whereas when you die with a valid will, the person you appointed as your executor pays your taxes, settles debt, then distributes the remaining assets according to your expressed wishes. Everyone with assets of value (home, investments, pension, RRSPs) needs a will. There are some resources listed on the right panel of this blog and many more to be found on the Internet. Your lawyer can help and for very little money, there is a National Will Kit to guide self-preparation of a will. Some tasks that will spare family & friends unnecessary grief:

• Appoint an executor (spouse, reliable family member, friend) and an alternate.
• Appoint a Power of Attorney for property (this allows someone to handle your affairs should you become incapable, for example, a coma) and for personal care.  If you appoint two or more persons to have your Power of Attorney for Personal Care, appoint them jointly.
• Make your wishes regarding organ donation known.
• Make your wishes for burial or cremation known.
• Appoint a guardian for children. Specify the age of inheritance. Prepare a list of information about your child/ren, such as medical details, medication, education, daily routine, and preferences.  Update as needed.
• Outline how assets are to be divided amongst the chosen heirs (spouse, children, relatives, friends), including charities and/or churches. Decide on specific bequests, either of property (such as a painting) or money to certain children, relatives, or friends. Create a simple list identifying personal items, describing each item and stating to whom it is to be left.

This patient had a superstitious fear of preparing her will and appointing a power of attorney.  She was an educated woman who wanted to minimize suffering and anguish for her friends and family. Making a will is a useful, practical chore, the larger issue here is that people who are dying are still living and for some, facing death while you are living is very difficult.