PERT Program

Tip of the Month: October 2004


FILM AND BOOK RESOURCES ABOUT THE THE END OF LIFE

People form their views about death and dying in many ways. A significant influence for nurses and nursing assistants is their personal experience with the residents and families for whom they provide care. Entertainment and news media, personal family dynamics, and cultural and religious experiences also impact our perspectives on death. This month's tip focuses on media examples that carry themes of death, dying, loss, and grief.

You may have opportunities to share the PERT educational curriculum in both formal and informal educational settings. Segments from books and movies are excellent resources for use as discussion starters. They can also help to reinforce points about dying and end-of-life experiences. Mark Bonnema illustrated this when he prefaced his PERT module on Spirituality by showing a portion of Darth Vader's death scene from Star Wars: Return of the Jedi. Who would have thought of Darth Vader and Luke Skywalker as poignant role models for life reminiscence, closure, grief, and saying goodbye?

Numerous movies depict death, often violently. Yet other end-of-life themes found in films include spiritual distress, transcendence, forgiveness, the intricacies of family relationships, and the potential for emotional growth.

In addition, books are powerful tools for communicating about these subjects. Many contain metaphors, vivid descriptions, and in some cases actual examples of death, loss, and grief. Both fiction and non-fiction can provide us with imagery that challenges our ideas on life and death and help to expand our beliefs.

Take a moment to think about the books and movies that have made an impact on your views of death and loss. Perhaps you remember reading a book as a child that made you think deeply about death. What types of media have more recently influenced your perspective? We would love to hear from you! Please send the titles of your favorites to us via the PERT Program contact page. Let us know if you've referenced them when giving a training or in-service, and if so, how. We'll post the information on the website.

Staff and team members suggested the following books and films as titles that made an impact on them personally and professionally. These are only a few examples of the myriad resources available:


Films: Popular Culture
Wit
(2001, Directed by Mike Nichols; HBO Films)
A famous professor of English (Emma Thompson) is diagnosed with terminal ovarian cancer. The film portrays the complexities of diagnosis, treatment, and decision making. It gives a realistic portrayal of the mixed communication skills of medical and nursing staff.

Ponette
(1996, Directed by Jaques Doillon)
This film shows the confusion of death and grief through the eyes and words of a 4-year-old. Ponette's mother dies in a car accident, after which Ponette tries to understand all that has changed. Input from her father, aunt, cousin, and peers both enlighten and confound her. A well acted and genuinely engaging film about loss and transcendence. (French, subtitled)

It’s a Wonderful Life
(1946, Directed by Frank Capra; Liberty Films)
A despairing businessman (James Stewart) is shown by an angel what life would have been like had he never existed; the resultant view transforms his life. An American classic and a holiday favorite.

Cinema Paradiso
(1989, Directed by Giuseppe Tornatore; Cristaldifilm)
After 30 years, a famous film director returns to the community where he grew up. He reflects on his friendship with the elderly projectionist of the local theater, now deceased, from whom he learned to love movies. (Italian, subtitled)

My Dog Skip
(2000, Directed by Jay Russell; Alcon Entertainment)
A very shy boy finds his way into his community with the help of a four-legged friend named Skip. A tearjerker for sure. The death of a pet often is the first significant loss a person experiences; this film opens the door for discussion of death from the perspective of a child.


Films: Educational
Walking Us Home...The Hospice Experience
(2000, Rites of Passage; www.wisdompeople.org)
This video provides hospice care education and information for health care professionals, patients, family members, and the lay community. A documentary both lighthearted and serious, it includes interviews with patients, families, and care providers.

Harriett's People
(2000, VideoPress, School of Medicine, Univ of Maryland; www.videopress.org)
A documentary shot on location at the Levindale Hebrew Geriatric Center and Hospital. A team of nurses, nursing assistants, and a physician strive to provide the best EOL care possible for the nursing home residents in their care. The film (and many others) is available for rent or purchase.

The Forgetting: A Portrait of Alzheimer's
(2004, PBS; www.pbs.org/theforgetting/index.html)
Based on David Shenk's book of the same name, this documentary aims to help people better understand and cope with the devastation of Alzheimer's disease. Excellent resource on this specific illness; also pertinent to caring for residents with any type of dementia.

On Our Own Terms: Moyers on Dying
(2000, PBS; available through Films for Humanities and Sciences at www.films.com)
This acclaimed 4-part PBS series reports on the growing movement in America to improve care of the dying. Through research, interviews, and commentary, this documentary provides information on EOL tools, care options, the experience of dying, and coping with grief.


Books: Fiction (Children's Literature)
Bridge to Terabithia
(Paterson, K. New York: HarperTrophy, 1987)
A boy and girl become best friends through the creation of imaginary Terabithia, the land where they rule supreme. It is in Terabithia that they develop the courage to face life's challenges both big and small. The knowledge they gain and the support they find in each other, allows one of them to face the biggest test of all.

Tuck Everlasting
(Babbitt, N. New York: Farrar, Straus and Giroux, 1985)
Given the opportunity, would you drink from the fountain of youth? Natalie Babbitt's novel explores the consequences of freezing time — where one never grows old, never changes, and never dies. Superbly written, this book looks at the process of dying through the eyes of the few people who never will.

Charlotte’s Web
(White, E.B. New York: HarperTrophy, 1986)
A wonderful early memory is that of sitting on the floor in Mrs. Cowan's first grade room listening to her read Charlotte's Web out loud. (If you were lucky, you got to sit in her lap.) There is no better early way to learn the joy of friendship and love, or the sadness of death and saying goodbye, than through the experiences of Charlotte the spider and Wilbur the pig. A book for everyone.

The Fall of Freddie the Leaf
(Buscaglia, L. Thorofare, NJ: Slack Incorporated, 1982)
Supposedly a children's fable, the lessons learned by Freddie the leaf and his companion leaves are powerful for young and old alike. Explore life and death in the changes of the passing seasons.


Books: Fiction (Adult Literature)
I Heard the Owl Call My Name
(Craven, M. Laurel Press, 1993)
Written when she was 69 years old, first-time author Margaret Craven adeptly portrays the challenges and gifts of melding two cultures. A young vicar, unaware of his terminal prognosis, is sent to a remote NW Indian village to live and work among the indigenous people. There he learns that change and death are inevitable, but both can be met with planning, grace, and joy.

A Lesson Before Dying
(Gaines, E. New York: Albert Knopf, 1993)
This simple but intense story explores the characters' search for value and meaning in life, even when some lives seem to count for nothing. Set in 1940s Louisiana, a young black man is wrongly accused of murder and sentenced to die. His grandmother wants nothing more than for her grandson to die recognizing that his life is valued. The town schoolteacher is sent to the prison to teach the young man lessons of love, salvation, and dignity — "lessons before dying" that impact all involved.

Talk Before Sleep
(Berg, E. New York: Dell, 1994)
Two friends evolve a deeper level of caring and commitment when one journeys with the other through her death from breast cancer. This is a powerful portrayal of the strength in human bonds and friendships.

The Secret Life of Bees
(Kidd, S.M. New York: Penguin, 2002)
This is a compelling novel of an adolescent girl coming to terms with the long-ago death of her mother. Through the fierce commitment of her black nanny, involving an escape into a distant town, Lily is welcomed into a world of the female divine during which her healing begins.


Books: Nonfiction
Dying Well: Prospects for Growth at the End of Life
(Byock, I. New York: Riverhead Books, 1997)
Accented by 12 case studies, Ira Byock's work on "dying well" is regarded as a practical guide through the physical and emotional labor faced at the EOL. Byock describes landmarks in communication that assist the dying process as well as imperative medical symptom management. A practicing hospice physician, his views support and explain hospice philosophy.

Kitchen Table Wisdom: Stories That Heal
(Remen, R.N. New York: Riverhead Books, 1996)
Currently used in a number of medical school curriculums, this book brings together the best in story telling and lessons learned in the world of medicine. Remen is both a physician and patient (herself living with a chronic, life-threatening illness) with a strong belief in the potential for medical staff to provide compassion and empathy in all aspects of patient care. This wonderful book contains over 100 stories, each only a few pages long, making it easy to pick up and read again and again.

Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying
(Callanan, M., Kelly, P. New York: Simon and Schuster, 1992)
"Nearing-death awareness" is the unique communication of dying patients as described by the authors, two experienced hospice nurses. Callanan and Kelly offer practical advice for family members and professional caregivers on how to recognize, understand, and respond to a dying person's messages. Another book filled with poignant and enriching life stories.

The Spirit Catches You and You Fall Down
(Fadiman, A. New York: Farrar, Straus and Giroux, 1997)
The Spirit Catches You is an exquisite portrayal of the collision between Western medicine and the cultural/spiritual beliefs of a Hmong immigrant family from Laos. A true story chronicled by a journalist it includes a wealth of information on Hmong culture, history, and the resettlement movement of the Hmong people into the US after the Vietnam war.


Books: Memoirs
Death Be Not Proud
(Gunther, J. Perennial Classics Edition. New York: HarperCollins, 1998)
Johnny Gunther died of a brain tumor at age 17. Told through the recollections of his father, this memoir celebrates Johnny's life while recognizing and acknowledging the deep pain of a parent who faces the death of his only child.

A Grief Observed
(Lewis, C.S. New York: Harper Collins, 1996)
CS Lewis married the poet Joy Davidman Gresham late in his life. Three years later Joy died of cancer and Lewis spiraled into a crisis of faith provoked by his grief. In A Grief Observed, Lewis unapologetically voices his despair and doubts while ultimately emerging with a richer understanding of himself and his relationship to God.

Tuesdays with Morrie: An Old Man, A Young Man, and Life's Greatest Lesson
(Ablom, M. New York: Doubleday, 1997)
Morrie Schwartz, a college professor and mentor, knew he was dying. When previous student Mitch Ablom contacts him after a 20-year absence, the two men resume a long-ago tradition of Tuesday visits in Morrie's study. Their rekindled friendship turns into a final "class" on both living and dying.