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How to Die Well
Ira Byock, MD was the Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire and is currently Professor of Anesthesiology and Community & Family Medicine at Dartmouth Medical School.
Dr. Byock has authored numerous articles on the ethics and practice of hospice, palliative and end-of-life care. His first book, Dying Well, (1997) has become a standard in the field. His most recent book, The Four Things That Matter Most, (2004) is used as a counseling tool widely by palliative care and hospice programs, as well as within pastoral care.
Dr. Byock has been a consistent advocate for the voice and rights of dying patients and their families. He has been the recipient of the National Hospice Organization’s Person of the Year (1995), the National Coalition of Cancer Survivorship’s Natalie Davis Spingarn Writers Award (2000), the American College of CHEST Physicians Roger Bone Memorial Lecture Award (2003) and the Outstanding Colleague Award (2008) of the National Association of Catholic Chaplains.
Question: How should we face death as a society?
Ira Byock: We have a remarkable posity [phonetic]of ability to imagine what a positive end-of-life experience would look like. We can only imagine death and suffering and its avoidance. That’s about the brightest we can get is, oh I hope I die quickly, I am hope I am hit by a truck or die in my sleep, and I don’t suffer. If I ask people what a good death looks like for them, they will often say, “I don’t want to suffer and I don’t want to be a burden to my family.”
“I don’t want to die in pain, I don’t want to die gasping for breath, Doc, I don’t want to die lying in my own filth, I don’t want to end up in a nursing home, and I don’t want to be a burden to my family.” If you think about it, it’s as if our vision of the good death was a photographic negative, there is nothing there, there is no tone or texture or color, it’s as if was a whole bordered by the things that we fear.
That is the main problem, death feels like it’s falling of a cliff, and similarly dying in death are equated, we often use the two words interchangeably. In reality as hard and as unwanted as it is, dying is a part of living. And it has its own intrinsic challenges, risks certainly, but also its potential value. For many people the reality is that this time of life we called dying is often an exceedingly important time in their lives and their families lives, but our inability to imagine is really a limiting factor.
We know, if you only know what you want to avoid, you still don’t have a direction toward which to head. And so I think it’s really important not as a – it almost sometimes seems unseemly to talk about people we know who have died well, but I submit it’s culturally critically important to explore the stories of real people who have in their own words or their own experience died well, because it provides us with some cultural orientation, a diversity of positive experience toward which we could being to imagine a path ahead that for ourselves and our families feels like something of value morally and tangibly and culturally of value despite the inherent sadness that this time entails.
Question: Who has died well?
Ira Byock: Art Buchwald recently died, well he was a hospice patient, interestingly went to hospice care thinking that he was dying in a few days to weeks, ended up living, I don’t know 15 months, graduated from hospice care, wrote a bestseller while he was a hospice patient, I think that’s pretty good, but also if you read his book talks about the importance of this time, in from my perspective they were discernable developmental tasks that he was able to accomplish revealing his life, completing relationships, telling his stories, making some inner peace with the reality that his life was coming to a close and being able to look forward into a future where he would not be physically present all of those things.
Recorded on: March 21, 2008
Dying is a part of living. Yet our inability to imagine death is a limiting factor. Confronting death allows us to complete relationships, tell our stories, and make peace with the reality that life is coming to a close.
Duke University researchers might have solved a half-century old problem.
- Duke University researchers created a hydrogel that appears to be as strong and flexible as human cartilage.
- The blend of three polymers provides enough flexibility and durability to mimic the knee.
- The next step is to test this hydrogel in sheep; human use can take at least three years.
Duke researchers have developed the first gel-based synthetic cartilage with the strength of the real thing. A quarter-sized disc of the material can withstand the weight of a 100-pound kettlebell without tearing or losing its shape.
Photo: Feichen Yang.<p>That's the word from a team in the Department of Chemistry and Department of Mechanical Engineering and Materials Science at Duke University. Their <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/adfm.202003451" target="_blank">new paper</a>, published in the journal,<em> Advanced Functional Materials</em>, details this exciting evolution of this frustrating joint.<br></p><p>Researchers have sought materials strong and versatile enough to repair a knee since at least the seventies. This new hydrogel, comprised of three polymers, might be it. When two of the polymers are stretched, a third keeps the entire structure intact. When pulled 100,000 times, the cartilage held up as well as materials used in bone implants. The team also rubbed the hydrogel against natural cartilage a million times and found it to be as wear-resistant as the real thing. </p><p>The hydrogel has the appearance of Jell-O and is comprised of 60 percent water. Co-author, Feichen Yang, <a href="https://today.duke.edu/2020/06/lab-first-cartilage-mimicking-gel-strong-enough-knees" target="_blank">says</a> this network of polymers is particularly durable: "Only this combination of all three components is both flexible and stiff and therefore strong." </p><p> As with any new material, a lot of testing must be conducted. They don't foresee this hydrogel being implanted into human bodies for at least three years. The next step is to test it out in sheep. </p><p>Still, this is an exciting step forward in the rehabilitation of one of our trickiest joints. Given the potential reward, the wait is worth it. </p><p><span></span>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
Vaccines find more success in development than any other kind of drug, but have been relatively neglected in recent decades.
Vaccines are more likely to get through clinical trials than any other type of drug — but have been given relatively little pharmaceutical industry support during the last two decades, according to a new study by MIT scholars.
What would it be like to experience the 4th dimension?
Physicists have understood at least theoretically, that there may be higher dimensions, besides our normal three. The first clue came in 1905 when Einstein developed his theory of special relativity. Of course, by dimensions we’re talking about length, width, and height. Generally speaking, when we talk about a fourth dimension, it’s considered space-time. But here, physicists mean a spatial dimension beyond the normal three, not a parallel universe, as such dimensions are mistaken for in popular sci-fi shows.
Sallie Krawcheck and Bob Kulhan will be talking money, jobs, and how the pandemic will disproportionally affect women's finances.