Ars Moriendi, Part Two: Hippocrates and Hypocrites*

Part One considered the “before” of end-of-life care (and once again, Bill Keller’s piece is recommended reading: check it here), and this excerpt (from Keller, then me) deals with the “during”, and the unanticipated, if revealing way many doctors handle things when they are the ones getting the grim diagnosis.

Terminal illness –and how best to process it– is not remotely an easy to discuss, describe or resolve dilemma. The primary issue, it seems to me, boils down to awareness (which, come to think of it, applies to virtually every situation): it might be easy to blame the doctors or the system, or even the families, but we are currently ill-equipped to have open, honest discussions about treatment options vs. realistic scenarios, and in America especially, our one-two punch of denial and deference to authority leads to many well-intended instances where pain and suffering is prolonged in the name of hope. Keller’s article indicates we can learn a lot from our brethren across the pond, where humane and mature solutions are not met with hysterical screams of ‘death panels’ and the like…

But the hospital that treated him offers a protocol called the Liverpool Care Pathway for the Dying Patient, which was conceived in the 90s at a Liverpool cancer facility as a more humane alternative to the frantic end-of-life assault of desperate measures. “The Hippocratic oath just drives clinicians toward constantly treating the patient, right until the moment they die,” said Sir Thomas Hughes-Hallett, who was until recently the chief executive of the center where the protocol was designed. English doctors, he said, tell a joke about this imperative: “Why in Ireland do they put screws in coffins? To keep the doctors out.”

The Liverpool Pathway brings many of the practices of hospice care into a hospital setting, where it can reach many more patients approaching death. “It’s not about hastening death,” Sir Thomas told me. “It’s about recognizing that someone is dying, and giving them choices. Do you want an oxygen mask over your face? Or would you like to kiss your wife?”

Anthony Gilbey’s doctors concluded that it was pointless to prolong a life that was very near the end, and that had been increasingly consumed by pain, immobility, incontinence, depression and creeping dementia. The patient and his family concurred.

And so the hospital unplugged his insulin and antibiotics, disconnected his intravenous nourishment and hydration, leaving only a drip to keep pain and nausea at bay. The earlier bustle of oxygen masks and thermometers and blood-pressure sleeves and pulse-taking ceased. Nurses wheeled him away from the wheezing, beeping machinery of intensive care to a quiet room to await his move to “the other side.”


Doctors talking about death are not unlike priests describing the horrors of hell: there is the air of presumptive jurisdiction, but also an aloof conviction, almost pitying, that affirms it’s not a place (death, hell) they’ll ever find themselves. We cannot despise them for this: without these affectations that eventually become ingrained, they could not conceivably perform their functions. Their comportment suggests that they have seen many of the things we pray to avoid, and have become intimate with horrors we can hardly imagine. In order to acclimate, they must first fortify themselves.

Physician, heal thyself?

It is understandable that so many of us assume doctors, who have more of everything—knowledge, money, connections—are able to take care of each other in ways their patients cannot conceive. If this were indeed the case it would be comforting in a way. At least we would have irrefutable evidence that solutions do exist and we might look forward to one day employing them ourselves.

But the reality, if less polemical, is nevertheless enlightening. According to a growing field of first-hand testimonials, doctors do in fact tend to die differently, but not as a result of special or preferential treatment. The ultimate, paradoxical disparity lies in an intentional demurral of treatment. Less last-ditch cycles of chemotherapy or illusions of a few extra months—itself a proposition that begs the complicated question: does more time with more adversity (physical if not mental) seem in any way appealing?

This phenomenon, which could simply and accurately be described as acceptance, illustrates several things. The most revealing might be the consequence that doctors see enough avoidable anguish they are disinclined to die in denial when their own diagnoses stare back at them in black and white. Aware of how little can be done, and able to measure the difference between best intentions and bottom lines, some prepare accordingly. In the process, perhaps they are able to provide a measure of peace—and not the opposite—for themselves and their families.

*excerpted from a memoir entitled Please Talk About Me When I’m Gone.


It Was 335 Years Ago Today: A Brief History of Jethro Tull (Both of Them)

Most people knew Jethro Tull had been around forever, but more than three centuries??

Oh. You mean the actual British dude, Mr. Tull, whom the progressive band was named after? (Wait, so that isn’t the singer’s name?) Quite an arbitrary choice, though certainly more cerebral than many of its era (Strawberry Alarm Clock, anyone?); and considering one of the early choices was Candy Coloured Rain, I think we can all appreciate that less acid-addled minds prevailed.

So who was this Jethro Tull and why is he important, aside from being on the cover of this album? Well, do the words seed drill mean anything to you?

Eventually, as agricultural improvement became fashionable, more interest began to be taken in Tull’s ideas.  While several other mechanical seed drills had also been invented, Tull’s complete system was a major influence on the agricultural revolution and its impact can still be seen in today’s methods and machinery.

Suffice it to say, this was the iPod of its day. Arguably, the Agricultural Revolution would have taken longer to reach its full…flowering without Mr. Tull, and for that we can be grateful. No Agricultural Revolution, no Industrial Revolution. No Industrial Revolution, no electricity. No Electricity, no phonograph. No Phonograph…well, you get the picture. Without Jethro Tull…no Jethro Tull!

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After three impressive albums, Tull signalled that they were around to stay with the release of Aqualung in 1971, an ambitious quasi-concept album that dealt with organized religion and man’s inhumanity to man. The title track (which features one of the great rock guitar solos of all time courtesy of Martin Barre) and “Locomotive Breath” became, and remain, FM radio staples. It is (as is often the case with “classic” albums) the somewhat lesser-known tunes that retain their true staying power. The one-two acoustic punch of “Cheap Day Return” and “Mother Goose” are archetypes of a sort; the kind of whimsical British folk that Tull perfected: the songs seem straightforward and pleasant enough (and they are) but are cut by their topical, and occasionally unsettling, lyrical import. This is Anderson’s calling card, and nowhere is it in better effect than the one minute and twenty-four seconds of perfection entitled “Cheap Day Return”. In astonishingly succinct and effective fashion Anderson deals with his own alienation, offers a sardonic appraisal of his own budding super-stardom (What a laugh!), and his father’s imminent death, all in a song that sounds innocuous as a nursery rhyme.

They were on top of the world (and the charts) in ’72 when Thick As A Brick became the first pop album comprised of one continuous song to reach a widespread audience. The concept may have been audacious, but the music is miraculous: this is one of the handful of holy grails for prog-rock fanatics: the ones who bought this album on vinyl, then, and the brave souls who have no shame in their game, now. Simply put, many beautiful babies were thrown out with the bath water by hidebound critics (then, now) who were content to dismiss the more ambitious (pretentious!) works that certain bands were putting out as a matter of course in the early-to-mid ’70s. And by works I don’t mean this but I do mean this (at least side one). And for every one of these there was one of these. And before he (rightly) became a more mainstream iconoclast, Peter Gabriel was the driving force behind albums like this and this and especially this. As could correctly be said of any artistic era, it was the best of times and it was the worst of times.

Inevitably, Jethro Tull lost some of that same audience (more than a handful forever) with their next opus, the more challenging (and, upon initial listens, less rewarding) A Passion Play. It was a shame, then, and remains regrettable, now that folks don’t have the ears or hearts for this material, as it represents much of Anderson’s finest work. His voice would never sound better, and he was possibly at the height of his instrumental prowess: the obligatory flute, the always-impressive acoustic guitar chops and, for this album, the cheeky employment of a soprano saxophone: it is a gamble (and/or a conceit, depending upon one’s perspective) that pays off in spades. All of the above is amply demonstrated in the opening section, embedded below. Not for nothing is this considered the masterpiece of the Tull oeuvre amongst die-hard fans (an encomium that only adds fuel to the fire for the legion of Tull haters, snot running down their noses).

Tull plowed ahead, making music their own way, and cranked out an album per year through the entire decade. In another nice bit of art imitating history, Anderson recorded the second album of his “pastoral trilogy” (including the majestic Songs From The Wood and the fin de siecle-inspired Stormwatch), ’78’s Heavy Horses.


In 1731 he published his book, ‘The New Horse Hoeing Husbandry’, detailing his system and its machinery. It caused great controversy at the time, and arguments continued for another century before his eventual vindication.

We can hope that the scales of artistic justice will have a similar fate in store for Anderson, and that his tour de force (the title track) is fully vindicated in the eyes of critics and casual music fans everywhere (though it’s difficult to protest too much for an artist who has sold many millions of albums). Nevertheless, it’s an embarrassing commentary on how close-minded so many folks are that they probably have never even heard this song. Of course,  the professionals who write most often about rock music in the ’70s are not known for their fondness of multisyllabic words and material that obliges a modest understanding of world history.

The early ’80s were not particularly kind to Tull (or, put another way, the Tull of the early ’80s was not particularly kind to fans), and after the synth-heavy Under Wraps, it seemed like the time might be right for Anderson to turn more of his attention to salmon farming. But the (sweet) dream was not yet over: toward the end of the decade Tull unleashed back-to-back albums that recalled some of the better work of the past while being (mostly) entrenched in the here-and-now. The best moments on Crest of a Knave (’87) and Rock Island (’89) stand (mostly) alongside the best work the band did in its prime.

Farm on the Freeway:

Strange Avenues:

The ’90s were a time when bands who made double-albums in the ’70s replayed that material, live, to the retro crowd, working that nostalgia circuit in very profitable fasion. To Tull’s credit, they still toured regularly, and also made new albums from time to time. To say the results were mixed indicates a generosity that only the most unfaltering fan would deny. Still, Anderson had a few tricks left in his codpiece (figuratively speaking), like the surprisingly satisfactory Divinities: Twelve Dances With God. As the title suggests, it is a musical meditation on faith (all different types). The topic alone is cause for critics who wrote for Creem and Rolling Stone in the ’70s to suffer a fresh outbreak of the Herpes they contracted while covering The Sex Pistols, but the material holds up.

As some may be surprised to know, Jethro Tull still roams the earth, and while new albums aren’t being produced at the former pace (based on their post-’95 output, this is a good thing for all involved), they are still playing to crowds who happily pay to see them. If Pete Townshend decided he did not, in fact, want to die before he got old, it seems fair play for Jethro Tull and their fans to keep living in the past.