 I'm delighted to introduce the first speaker of the afternoon, Dr. David Sheetemire. David and I have known each other a long time. He was in not the first but the second fellowship class, the great class of 1987. How many were in that class, David? Four. David is a palliative care physician at the Theta Clark Medical Center and a community associate of the medical humanities program at the Medical College of Wisconsin. David has an interest in the medical care of the underserved and part of his medical training occurred in Liberia at the Elwa Hospital. He completed a sabbatical during training at Tuber City Hospital on the Western Navajo Reservation in Arizona. David's clinical interest is in the long-term management of diabetes and hypertension and in teaching ambulatory medicine and clinical ethics. Among David's many books I'll just mention a few. He and John Lapuma wrote a book in 1994 called Ethics Consultation, A Practical Guide, which was a landmark book at its time. Another book that David is co-authored with Carl Jungkomin and with Art Dursi, I think art is in the audience there art, is called Practical Ethics for Medical Students, Interns and Residents, now in its third edition and I understand that a fourth edition is being planned. Another poetry casebook that David wrote is called House Calls, House Calls, Rounds and Healing. So it's a great pleasure of mine to bring David Sheedemire back to the center to speak about going home again. David. Well thanks so much Mark and thanks for giving me a chance as a young man all those years ago. You know people ask me if I ever play my accordion for dying patients and I say that would just be mean. I mean they're too sick to get away. So I've just been waiting for someone to ask me and so far no one has. Actually I was asked once to play at the wedding of a dying man's son at our hospice and in the rehearsal just a few minutes before the service the minister asked if I could play here comes the bride and I don't know the last time that you've heard that song but I hadn't heard it since cartoons as a kid but this was my big chance so I said I'll do it and wouldn't you know the first part of that song is just made for the old button box. You just toggle a few buttons here and there. Really the chapel's really tiny and that's the only part I had to play that's the easy first part. Before you knew it the handsome groom and his bride were up front so no I don't usually play the accordion out loud at the hospice but on that day a family member of another patient in a nearby room said I heard that accordion. It reminded me of my uncle playing years ago and I said that's why I play it. It reminds me of home too. So yes in a way I'm always somehow playing the accordion for my patients. It reminds me to help them get back home to the shire. Here's another story an 80 year old farmer with 200 acres of barley is dying of COPD and CHF and renal failure and you know how they all circle around again and despite the morphine drip he's quite lucid. He says it's harvest time and the winter is coming and his son is out on the tractor and he wants to be out there too but he's just too sick. So I get up to leave and I tell him I'll see him in the morning but he says no you won't. I'll see you upstairs doc. He dies that night. There's another patient with lung cancer and he's been in terminal delirium and that's what we call it medically but it really is just kind of a middle space and three times he's called out to that middle space in front of him he said I'm ready I'm going but today when I see him he's yelling I changed my mind. His family's troubled by this apparent change of heart but I tell him it's okay it's it's natural. I'm reminded though of another patient who earnestly pulls on my sleeve asking me doc I'm dead now aren't I am I am I dead now I'm somehow reminded of the shared elements in all of these cases as different as they may seem the patient is really thinking doc give me the truth am I dying I'm close am I home yet you know home is a place of familiar sounds and sights and smells home is a place you wish for a place like Evelyn's kitchen in this Tom Waits song. Walked from Natchez to Hushbakina I built a fire by the side of the road I lived on nothing but dreams and train smoke somehow my watch and chain got lost I wish I was home in Evelyn's kitchen with old gif curled around my feet and I hope my pony I hope my pony I hope my pony knows the way back home you know some people just aren't willing to trust their ponies to know the way back home one of my patients is a meticulous highly organized successful woman who wants to prepare accordingly for the afterlife but she's dying with spiritual distress our chaplain visits her daily because she has so many questions and concerns about near-death experiences lights at the ends of tunnels her own faith traditions view of the afterlife but like me our chaplain can only listen like me he has no real answers to these questions like me he has seen too many people die the good and the bad with or without the peaceful look on their faces with or without their eyes open with or without religion with or without family members at their sides with or without and like me he can't answer the one question she's really asking us what do I do early in the morning on the day the next day after I die well that next day you know she'll be up working early in the morning and the first thing on the agenda is a good cup of coffee as thick and black as bilge water one of the many troubles with dying is that no one can tell you from personal experience what to bring what to leave behind no one can pack for you on this trip perhaps it's because home is not just a familiar place of peace and safety and contentment place like Avalon's kitchen it's also a place of longing it's a place where we've never been but we always want to go for me this place is is hard to describe without music I listen to my words but they fall far below I let my music take me where my heart wants to go I sat upon the setting sun I never wanted water once speaking of water it's another rainy night at the hospice I'm at the bedside of a man dying of prostate cancer he has that kind of hormone unresponsive prostate cancer that just riddled with metastases even his skull is riddled with the tumor his son is a burly bearded Harley type and he tells me he went out to the crossroads at the cemetery the night before he went and stood over his mother's grave and he said mom time come and get dad come and get him he thinks his dad's taking too long to die he wants him to have more medicine but I'm like the old bar tender down at the crossroads bar I know the man's had enough to drink already he has several of the physical signs of dying he's got no pulse although I can hear his heartbeat with my stethoscope he has no urine output remarkably although he's moving his jaw while breathing and ordinarily should be gurgling and gasping for breath he's breathing quite slowly and peacefully that's because I've given him the equivalent of a couple that drinks for the road so I tell the son he's already on his way he's going now to be with your mom just stay with him no need to speed this up I think to myself he's okay he's going home tonight when a man loves a woman he'd sleep out in the rain if she says that's the way it ought to be now in terms of taking things with you when you die you could really do worse than my uncle Jarvie like me he played the harmonica in the accordion and when he died we put a harmonica in his coffin I do think this is the proper burial practice for harmonica and accordion players and I think it could even apply to bagpipers you know if you're Scottish and you die outside of Scotland after your underground the sprites come and they transport you through the secret passages right back home to Scotland so that's how in this old song the dead man's able to get back home again his living companion takes the high road but he takes that low underground road Bayon Bonnie banks and Bayon Bonnie breads where the sun shines bright unlocked they are me and my true love spent many happy days on the bunny bunny banks you know that is a little bit like a bagpipe isn't it I mean wouldn't it be a better world if we put all the harmonicas and the accordions and the bagpipes right in the coffins and the urns of those who played them in this life it would take them completely out of circulation it's really quite risky allowing them to go to a state sales or antique shops someone might restore them did you realize that the fragile reeds inside here are only held on by bees wax they are just waiting to go out of tune I'd say don't let sick accordions even make it to the box but all I'd say make them DNR do not repair aren't but that's not my worry that's a problem for the next generation and speaking of the next generation let's get back to the things that we leave behind and the things that we carry we leave memoirs and memories we leave songs we leave home and family and most of all we leave behind the next generations to do as they will what do we take with us well I'm not telling you what to pack but I know the things that I'm gonna carry I'm with my uncle Jarvie I'm gonna take my harmonica I'm gonna take my accordion you know these bellows are just made out of cardboard the casings on both sides which hold the reeds are just thin wood the reeds are miller millimeters thick strips of metal buttons are just plastic the whole thing should cremate nicely I mean who among us is to say that they're not button boxes there when I go home again and I'll be sitting around the kitchen table playing in the accordion while the family talks and although they're too kind to say anything I can tell that I'm bothering them in a way that only harmonicas and accordions and bagpipes can bother people even people who love you so I'll go to the back bedroom and only my old beagle Shiloh will go with me there curled up in his bed with his feet under his chin and his eyes half open just waiting for me to play the next song just like home thank you it's time for questions time for questions about accordions or harmonicas or going going home again and while we're waiting for those don't forget that tonight guitar man John Lantos will be there leading a sing along along with our lead singer Mark the legend seaguller singing I shall be released by Bob Dylan so any any questions at all I this one is about almost a hundred years old and this is about 70 they can be repaired yes that better hey so my name is Una Bernhardt I'm a master student at the Harris School here there's been a lot of research recently about music at the end of life working for Alzheimer's patients and patients with other severe cognitive disabilities at the end of life how has your experience had have you had any experience with that and could you share a little bit yeah well I don't remember the old movie the doctor with William Hertz the key thing is to play the music the patient one so I mean that is no small point the memory should be the patients John whom is it gonna give a talk on comfort food and and we're music is like comfort you know those songs that you knew when you were 15 are kind of imprinted on you so it so I think people I always encourage people to if someone has their made music and during their life sometimes they even have their own CD they at least bring the CD that the patients made so he can hear she can hear their own music and it's amazing sometimes I come in and say mom was a great panel player she even played you know for the choir or something and I go well does she have any tapes of her music and they go yeah we have him somewhere so so let's bring him in very individual what do you think do you think we should be playing music at the bedside more I know that it worked for my family so yeah from time to time I think it can work I think it can work too we don't want to crowd them I wasn't kidding about you know I don't walk in with the accordion and say how would you like to hear when the moon hits your eye like a big pizza pie you know some people like harp music in the little higher-class music then then and that they deserve that classical music if that's their thing everyone has different music you know but it's a great question I mean the question is what what what music to play it's like a prescription for the patient when we all get to nursing homes you'll want to be you'll hear Van Morrison in the dining room instead of good night Irene that was so beautiful thank you thank you I don't think I'll ever forget that you know one of what I thought you did so beautifully was bring dignity and actually a sense of possibility on the subject of dying which I think is just very very unique and one of the concerns I have there's just tremendous unfairness in the differences in the way people have the opportunity to die or the dignity with which people die across strata especially socioeconomic and I think racial lines in our country and I'm just interested in your thoughts on that it's a great question and I appreciated your work in the community it well I mean I don't know my thoughts on that yeah you know I don't that's a great question I mean everybody dies kind of one at a time I do know there's people dying now that have never died before but to dignify there's such a great question it's so hard because I think that dying services should be on your list of they're on community list and and let me just say you know people that people without financial means surely are not without spiritual means so I don't know that we dying is no respect for the pocketbook how's that persons everyone goes so I think a lot of but I think it could be on the resource list how's that dying services hospice services we don't you know I take it that so it's a deeper question than just dying in pain I mean I think we're doing a pretty good job of not having people die in pain anymore physical pain but the spiritual pain is really tough question because our Chapman will say at our meetings will say well what's the what's the patient spirituality he'll say they go to such and such and then we'll say well have they been has such and such been there to visit and oh yeah they came one time so he's going like every day some of these some of these patients I mean she really wanted to know what to get ready she always gets ready for stuff so it's not enough to just say to her you're good you're good it'll be fine she really wanted to know so he was there every day so those those are kind of resources that again people without means are not without those resources either and those we may not be able to monitor those that's what I'm trying to say very good question well yes yeah absolutely thank you for that comment that so I think everyone heard that the musical voice of your loved one that's probably the best music you could hope that you'd have that when you go when you go home again so I'm it still says yellow so that's good right come on up let's gotta get this