Motoi Yamamoto

There are multiple ways an artist may choose to deal with personal grief.  Some allow the theme of their work to capture their feelings. Artist Motoi Yamamoto has taken his grief work one step further by choosing a medium that itself is symbolic of death.

Yamamoto was in art school in 1996 when his 24 year old sister died, just two years after her diagnosis of brain cancer. Immediately he began to use art as a way to deal with his grief. His exploration led him to the medium of salt, which is a part of the death ritual in Japan. At the end of funerals, mourners are handed salt to sprinkle on themselves as a way to ward of evil spirits.

Not only is salt a funeral ritual, it is also allows his masterpieces to be impermanent. When the exhibit is finished, the piece is destroyed, and visitors are encouraged to take some salt and place it back in the sea. Symbolic, I think, of human life; a masterpiece that must come to an end, and the body returned back to the elements from which it was formed.

To create the works, Yamamoto uses a simple plastic bottle, often taking 50 hours or more to complete. The amount of salt used is expansive, in the range of 2000 pounds and up.

When you look at his installations, it is obvious that the process is tedious and time consuming. This too is intentional, as Yamamoto said in an interview with the Japan Times, “I draw with a wish that, through each line, I am led to a memory of my sister… That is always at the bottom of my work. Each cell-like part, to me, is a memory of her that I call up”

I find the work breathtaking in both the intricacy and the overall finished project.

To see a video of Yamamoto at work see below or follow this link.

Cross published at

Cancer Country Music

When you look up “Country Music” you’ll mainly find definitions about origin.  One unwritten stereotype, however, is the emotional narrative of the genre, that can at times feel as if the listener is being manipulated to tears.

There surely is a cathartic aspect to listening to songs that make you cry, as evidenced on a recent home visit of mine.  I was seeing a young cancer patient, and the TV was set on CMT, with country videos playing in the background.  What shocked me was that the patient’s young wife and friends had me pause to watch part of a video in which the theme of the song was about death.  The wife commented, “We just love these songs, and sit here and cry with them all day” (As if there wasn’t reason enough).

Well, there are plenty of country songs to cry about. In fact, there may be enough songs to actually form an unofficial sub-genre called ‘Cancer Country’ as mentioned by Ron Rosenbaum in a 2007 article published on

So, if you are a country music fan or have friends or patients who are, add these next songs to your repertoire of emotional songs about people with cancer.  The warning label on these should read “may induce tears”

The oldest on my list is Tim Mcgraw’s “Live Like You Were Dying” written by Tim Nichols and Craig Wiseman in 2004.  The song is associated with Tim Mcgraw’s father who was diagnosed with a brain tumor in 2003, living 9 months after diagnosis.  These lyrics set up the song, “I spent most of the next days, looking at the x-rays, Talking bout’ the options and talking bout’ sweet times. I asked him when it sank in, that this might really be the real end. How’s it hit ‘cha when you get that kind of news?”

In 2005 Rascal Flats released the single “Skin” written by Joe Henry and Doug Johnson. Known by fans as “Sara Beth” the song is about a girl with Leukemia going to her prom.  An example of the lyrics, “Sara Beth is scared to death, as she sits holding her mom, ’cause it would be a mistake for someone to take a girl with no hair to the prom”

Craig Morgan released his single “Tough” in 2007. This song is about a breast cancer surviver who teaches her husband a lesson about being ‘tough’.  The lyrics say it all, “She wore that wig to church, pink ribbon pinned there on her shirt, no room for fear, full of faith, hands held high singing Amazing Grace. Never once complained, refusing to give up, and I thought I was tough”

Finally, Randy Owen, former vocalist in the band Alabama, released his first solo single in 2008 entitled “Braid My Hair” written by Chris Gray and Brent Wilson. The song is about a bald headed girl going through chemotherapy and dreaming about what she will do once she’s well, as the lyrics state, “I’m gonna ride my bike, I’m gonna climb a tree. Gonna fly a kite, score running little league. I’m gonna go to school, make a friend, be able to run again. Take off my mask and just breath in the air. But most of all I’m gonna braid my hair.”

Besides being about cancer, each of these songs has another central theme- one we in Palliative Medicine talk about a lot – the theme of ‘quality of life’ living.  Each central person is dreaming about and attempting to live a full life in the midst of disease.

Anyone know of any other “cancer country” songs that should be included?

Cross published

Grandma I’ll Miss You

Grandma I’ll Miss You is written by Kathyrn Slattery and illustrated by Renee Graef.  The book was published by Chariot Books in 1993 and is listed for ages 4-8.

The main character in this book is Katy, who is dealing with some very mixed emotions. She is aware her grandmother is dying and she is also anticipating the birth of a new sibling.  This book uniquely brings in the idea of birth being similar death.

The beginning of the book is very story like, spending most time on Grandma’s life. I suppose you could say this is the life review portion, as Grandma shares memories from her life.  As in the last two books reviewed, one of the big questions Katy has is “What will happen to Grandma when she dies? and Is there really such a place as heaven?” Unlike the other books these are just thoughts Katy has and aren’t directly addressed.

What is refreshing is that Katy actually asks her grandma, “are you afraid about dying?” This leads to a creative illustration linking death and birth together. The grandma admits her slight fear, but then tries to put herself into the unborn babies shoes, as the baby too has no concept of what it will soon experience.

The next pages are very Christian based in concepts about heaven, and about getting a new body there. Katy and her Grandma wrap up the conversation and then the very next morning the Grandma dies. I did appreciate the statement on the book’s last page, “Death, in its way, was as natural a part of life as birth”, something we in palliative care definitely understand.

The illustrations in this book are simple and realistic. There isn’t any thing that stands out in color scheme or medium used.

In terms of recommendation, this book probably has the most narrow audience of the one’s we’ve reviewed. If it is line with a family’s personal beliefs, then it would be a good conversation book, though it seems geared to older than the quoted 4-8 yr. old.  I did enjoy the normalization of death as similar to birth, and think there could be some other concepts related to that link to help grieving kids.

I hope to keep reading and familiarizing myself with what’s out there so that when families ask me what to do, I’ll be able to delve into the issue of concern, and make some more informed recommendations!

Cross published at

Tear Soup

If you look at any bibliography of childhood grief books, it is likely to be quiet extensive! Take for instance the bibliography on the Child Grief Education Association website, here.  The good news is that there is no shortage of literature available.

My question is, though, with so many choices- which ones are the best? This answer probably has much to do with the child’s age, the questions they are asking and simply the child’s personal preferences in books.  A simple title of a book won’t give any insight into the intricacies of the book, thus we must rely on word of mouth or websites such as, or the many other hundreds of grief websites that give a synopsis of the books. But even this doesn’t give a clear understanding of what the book is like.

The best option, would be to read them all ourselves. While a lofty goal that I have not yet achieved, this week I did the best I could; I went to my local library in rural America and checked out all the books I could find on childhood grief.  Hopefully the reviews of these books, with illustrations and story plot will give you a more thorough idea of some of the children’s books out there.

For this first post I have chosen a book that has great appeal for adults as well as children. I would consider it a “cross-over” book, and may in fact be more of an adult book disguised as a children’s book.

Tear Soup is written by Pat Schwiebert and Chuck Deklyen, Illustrated by Taylor Bills.  Published as a 3rd Rev. edition by Grief Watch in 2005, the age level listed for reading is age 4-8.

The main character is Grandy, who has suffered a ‘great loss’. She spends the pages working on her tear soup, which serves as a marvelous symbol of grief.  The universal statements packed into the book are so subtle, sometimes it takes a moment to recognize them.  For example, “It seems that grief is never clean… To make matters worse, grief always takes longer to cook than anyone wants it to”

She deals with adding memories to the pot and even the profound concept of the time that memories seem to run out, and the emptiness felt then. There are interactions with neighbors and friends, as Grandy says, “They filled the air with words, but none of their words took the smell of tear soup away.” Or when she comments that, “most people can tolerate only a cup of someone else’s tear soup.”

The book also approaches faith issues, as Grandy “demanded to know where God was when she was feeling so all alone.”

As one might guess, Grandy works through her grief until she realizes it’s time to eat something else instead of only tear soup.  The book ends with a nice summary of Grandy’s journey,

“I’ve learned that grief, like a pot of soup, changes the longer it simmers and the more things you put into it. I’ve learned that sometimes people say unkind things, but they really don’t mean to hurt you…and most importantly, I’ve learned that there is something down deep within all of us ready to help us survive the things we think we can’t survive.”

This book has wonderful illustrations and while I am not sure a preschool child would understand the significance of all the metaphors, it would certainly provide a starting point for topic discussions. It may also serve as a great recommendation for a family with an adult who has been resistant to dealing with their own grief… by innocently entering into the realm of a kid’s book, they may be surprised to have issues raised within themselves.

Stay tuned over the next weeks for more reviews of children’s literature and feel free to leave your own favorite children’s books about grief in the comment section below.

Cross published at

Photographer Jack Radcliffe

Jack Radcliffe is a photographer based in Baltimore, Maryland.  Known for his documentary style, black and white photographs, he has excelled at photo series of family members and friends over a span of time.  His images display intimacy allowing the viewer an empathetic connection at once.

It is no surprise, then, that Jack was asked in 1996 to become a part of an exhibition and book supported by the Corcoran Gallery of Art , entitled “Hospice: A Photographic Inquiry” (Bulfinch Press, 1996).

The book incorporates the works of 5 photographers; Jack Radcliffe, Jim Goldberg, Nan Goldin, Sally Mann and Kathy Vargas.

Jack acknowledges his fear when first asked to be a part of the project saying, “When I began I wasn’t really sure what hospice was. I only knew that it had to do with death.”  He got in contact with a hospice in York, PA called York House AIDS Hospice and the director Joy Efema granted him permission to come photograph.

The York House was a three bed inpatient facility that no longer exists.  Primarily taking care of AIDS patients, Jack writes how fortuitous it was to start this project after the death of his own mother, “My mother had just died, and my father was dying. I wasn’t dealing at all with my loss. Being with Joy and the nurses at York House – seeing their devotion to patients, both physically and spiritually- helped me to view death as a part of life. It was a cathartic transformation for me, and eventually I was able to grieve for my parents as well as the patients I came to know.”

When you look through the photographs on Jack’s website, you’ll find a narrative below the pictures from Barbara Ellen Wood, who was assigned as an intern to keep a journal during the project.  I found the little vignettes and descriptions added to the visual story presented.

The project took 4 years to complete, and artistically, using just 3 rooms over and over again proved a different challenge for the photographer.  Attempting to reveal the relationship with the subject’s environment, without causing the viewer to notice the repetitive background caused Jack to move in closer and change perspective, which ultimately changed his long term photographic style.

While his images, which were taken over a decade ago, should be overly familiar to us in palliative care, I found myself touched and moved more than expected. Perhaps these photo’s actually allow me to step back and feel the emotion captured more than my typical myopic view in the midst of daily work.

All images copyrighted to Jack Radcliffe. Quotes from the blog Camera Obscura (2009)

Cross published at

Death on a Pale Horse

One of the things I enjoy about the arts, is the ability to continually stimulate more art. Art imitates life, life imitates art, and art even imitates art.

The theme of this post centers on a piece I saw recently at the Art Institute of Chicago. Delving in to find out some background I found a convoluted web of paintings, poems, and etchings inspired from one another.

The story starts not at the beginning as in the Bible’s first words, “In the Beginning…” but actually in the final book of the Bible: Revelations. This symbolic and often macabre portrayal of the apocalypse has a chapter in which some seals are opened and four horsemen ride out.

One of the four is Death riding a Pale horse being followed by Hell. The specific verse reads, “I looked, and there before me was a pale horse! It’s rider was named Death, and Hades was following close behind him.” (Rev. 6:8 NIV)

While the images of Revelation had been depicted in distilled illustrations as seen in the upper right(taken from a manuscript done in the 11th century) it was Albrecht Durer’s “Four Horseman of the Apocalypse” (1497-98) to the left, that first put some macabre drama into the idea. With sudden motion and danger, Death, Famine, War, and Plague come riding across the page.

It is widely believed that it is from Durer’s image that artist John Hamilton Mortimer got his inspiration for his drawing “Death on a Pale Horse”(1775). He embellished the image further, pulling the horseman away from the group and adding an even more frightening tone.

While Mortimer’s original image is lost, his apprentice John Haynes did an exact etching from the drawing of the same name, which was published in 1784 by Mortimer’s widow, and is housed at the Art Institute of Chicago. (Image to right)

From here the path splits. First is artist William Blake(1757-1827) an ardent admirer of Mortimer, whose version “Death on a Pale Horse” (1800) is felt to share similar composition styles with Haynes/Mortimer, though undoubtedly less grim. (Image to left)

Haynes etching on Mortimer’s drawing also inspired the poet Charles Baudelaire who wrote “Une Gravure Fantastique” (A Fantastic Engraving) (1861) specifically about the art work. It is translated below by Jacques LeClercq and printed in Baudelaire’s Flowers of Evil:

This eerie specter wears no clothes at all./A dreadful crown, reeking of carnival,/sits weirdly on his naked skull. Without/Or spurs or whip, he wears his charger out/ (A ghostly and apocalyptic nag,/ Nose foaming like an epileptic hag)./ The hideous pair plunge ruthlessly through space,/ Trampling infinity at breakneck pace./ The horseman’s flaming sword, as on they rush,/ Fells victims that his steed has failed to crush,/ And, like a prince inspecting his domain,/ He scans the graveyard’s limitless chill plain/ Where, in a dull white suns’s exhausted light,/ Lies every race since man emerged from night.

The other famous poet, seemingly inspired by the Haynes/Mortimer image is Percy Bysshe Shelley. One of the most famous of Shelley’s works is “The Masque of Anarchy” written in 1819 following the Peterloo Massacre, and claimed by some to be one of the greatest political poems ever written in English. In the midst of the poem we find the reference to the etching:

…Last came Anarchy: he rode/On a white horse, splashed with blood;/He was pale even to the lips,/Like Death in the Apocalypse.

And he wore a kingly crown;/And in his grasp a scepter shone;/On his brow this mark I saw-/’I AM GOD, AND KING, AND LAW!’

With a pace stately and fast,/Over English land he passed,/Trampling to a mire of blood/ The adoring multitude….

There are certainly other artists inspired by the original Revelation verse, such as Benjamin West’s “Death on a Pale Horse” (1796) and J.M.W. Turner’s “Death on a Pale Horse” (1825-1830). However, I found it more interesting to trace the inspiration from one landmark piece of work that in turn inspired so many others.

I suppose the lesson learned is that you just never know what things in your life will wind up inspiring generations that follow!

Cross published at

Bedrich Smetana ‘Piano Trio in G minor’

I must admit that Bedrich Smetana (1824-1884) is not one of those composers I go around mentioning or hear brought up in conversation much. In fact, the name didn’t even sound familiar when I first started researching this piece. However, his ‘Piano Trio in G minor” is familiar, and the story of it’s inception is worthy of a post for this blog.

Smetana was a Czech composer who lived in the 1800s. A pianist foremost, he gave his first public performance at the age of 6. He began writing orchestral work in his early 30’s and continued to compose until a year before his death at age of 60. Outside of his homeland he is best known for the opera The Bartered Bride and the Moldau from the song cycle Ma Vlast.

Smetana married his childhood friend Katerina Kolarova in 1849. They then had 4 daughters between 1851-1855. Tragedy struck in 1854 when his 2nd daughter died of TB, then in 1855 his favored eldest daughter Bedriska died of scarlet fever. It was in the midst of this grief that he wrote the Piano Trio in G minor in memory of Bedriska. The piece took 2 months to write and premiered Dec. 3, 1855 with Smetana himself as the pianist.

The piece is written in three movements with three voices of piano, cello, and violin. The first movement, ‘Moderato assai’ communicates Smetana’s emotional anguish, opening with a violin solo that I find truly haunting. This motif continues throughout the first movement echoed by both cello and piano. It is often not subtle, and if you listen it feels as if the grief is angry or about to burst. The cello attempts a 2nd motif, as a solo around minute 2 of the video below. Though still sorrowful, it seems more controlled, an outsider perhaps speaking reason to the unabashed 1st motif.

The second movement ‘Allegro ma non agitato’ strays from the usual style of having the second movement slow like an adagio. It is in fact more of a polka-like allegro, and is said to be written more as a dedication to his daughter, absent the emotional grief. You’ll hear the first motif from the 1st movement played at the beginning in staccato fashion. It certainly looses some of the sadness when played in this fashion.

The final movement, ‘Finale: presto’ starts off with restless energy with themes borrowed from earlier works that Smetana wrote. As this movement is to give closure to his daughter’s death, I find it interesting that 3/4 of the way in (around min. 6:35 below) one of the secondary themes evolves itself into a funeral march (7:10 especially) and then just as suddenly we’re back to the impassioned quick paced melody from the beginning of the movement with the biggest surprise, ending gustily in the major key of G (less gloomy, perhaps grief resolved).

The listener may have the distinct impression that this piece is the story of his grief, rather than being in the midst of his grief. This may be because we know historically that he re-worked the Piano Trio 2 years later. I wonder how different that original piece was, played just months after his daughter’s death than the version heard today.

Below are the three separate movements in order from YouTube. If you have little time, I’d encourage you to at least hear the first 30 sec’s of each, to sense the difference.

Cross published at

Justin Roberts ‘Sand Castle’ (2006)

I’m sure you’ve had those ah-ha moments when listening to songs and finally really “hearing” the lyrics. This happened to me this week as I had the children’s music writer/singer Justin Roberts on. On one of the slower songs on his album “Meltdown” (2006) I suddenly heard words that I realized were talking about dying.

Justin Roberts is known as a Children’s Indie Rock singer/songwriter. While trying to make it in the Indie Rock Adult world with a group called ‘Pimentos for Gus’ in the 1990’s, he took a day job in a preschool. Taking his guitar to entertain the kids, he began writing songs for them and produced his first album “Great Big Sun” (1997). Still unsure of his path, he headed to the University of Chicago to pursue a Ph.D. in religious studies. The music writing continued and was getting more attention than his studies, soon turning Roberts into a full fledged rocker with 7 albums released to date.

Many interviewers denote that Justin’s music is often adored by adults as well as kids. Themes range from milestones such as getting glasses and picture day at school, to family dynamics of moving and sibling relationships with the song my kids love, ‘My brother did it’.

Robert’s isn’t afraid to tackle the tough subjects either, as in ‘Sand Castle’ the song I was listening to with my kids. He wrote this song for a friend who lost his Mom. The music is mellow and slow and has a sorrow about the melody. In fact, I think it was this sense of sadness that made me stop to hear what the words were saying. The imagery is subtle, telling about this child and father out at the beach remembering and saying goodbye to the child’s mom. The last lines “She slipped through our hands/Just like a balloon returns to the sky/So Dad and I/Knew you’d be somewhere out in the sea/In a million sandcastles to be”

I think kids are a unique population when it comes to dealing with death and loss, so to have stumbled across another possible resource was a delight. I’d be interested if anyone knows of other children’s music that deals with death?

I’ve posted the song below to listen to with the lyrics here. For email/rss subscribers you may need to head to the original post site to hear the song (Scroll to the bottom of the page)

Sand Castle (2006)

Dad and me went out to the sea

Just to build it, just to build it

We dug our hands down in the sand

Then we filled it, then we filled it

Till you were just a sandcastle

When we watched you in front of those waves

That was like a real hassle

But you were beautiful and brave

You stood like a sandcastle

And I’ll never forget that day

I’ll never forget that day

We sang ba ba ba…

Dad and I heard planes in the sky

Engines roaring, engines roaring

We built a bridge and castles so high

They were soaring, they were soaring

Till you were just a sandcastle

When we watched you in front of those waves

That was like a real hassle

But you were beautiful and brave

You stood like a sandcastle

And I’ll never forget that day

I’ll never forget that day

We sang ba ba ba…

We didn’t want you to go

We just thought you should know

She slipped through our hands

Just like a balloon returns to the sky

So Dad and I

Knew you’d be somewhere out in the sea

In a million sandcastles to be

We sang ba ba ba…

Justin Roberts –web– –Facebook– –Twitter @MusicianJustin– –YouTube

Pablo Picasso: Self Portrait Facing Death (1972)

Does anyone not know the name Picasso? Based on sales of his works at auctions, he holds the title of top ranked artist according to the Art Market Trends report. He was also a prolific artist with estimates of 50,000 works of art produced in his lifetime. (This includes paintings, drawings, sculptures, etc).

Pablo Picasso worked up until the day he died at age 91; literally painting till 3 am on Sunday, April 8th, which was just hours before his death.

His last well known self-portrait was done a little less than a year before his death, entitled Self Portrait Facing Death (June 30, 1972).


The piece is done with crayon on paper, and took several months to complete. A friend, Pierre Daix, tells of his memory of the piece on a visit to Picasso, “[Picasso] held the drawing beside his face to show that the expression of fear was a contrivance.” Then on another visit 3 months later, Pierre recalled that the harsh colored lines were even deeper, and Pierre writes, “He did not blink. I had the sudden impression that he was staring his own death in the face, like a good Spaniard”

There is much commentary about this piece. People talk about the fear of death Picasso had and how terrified his eyes look. They comment on the deep lines of age, and the work symbolizing Picasso’s confrontation of death.

Self Portrait (June 28, 1972)
Interestingly, as I researched this post I found a complete catologue of Picasso’s works, in sequential order. It appears that just days prior and days after the piece above, he did several other self portraits.

I’m placing them in order, and wonder if there is a comment in the progression, I certainly feel there is a change with each. (Copyright Estate of Pablo Picasso/Artists Rights Society (ARS), New York)

Self Portrait (July 2, 1972)


In all his works through the next months before his death, I saw no further self portraits, these above were done in a burst, as if when done with these, he was done contemplating self and death.

Picasso’s death itself was sudden, waking on the morning of

Self Portrait (July 3, 1972)

the 8th with an inability to get out of bed, calling for his wife, and dying 10 mins later. His cause of death was likely a heart attack with complications from heart failure.

I am happy to have stumbled upon the other portraits, giving us different glimpses of the idea of himself. Having such different works done in such a short time, gives testament to the complexity of all of our own self concepts. Just as I see the feelings of chaos, fear and acceptance in the works above, my own patients contemplating death can bounce from chaos, fear and acceptance sometimes in the span of a few hours.


References and more reading on the title piece:

*And special thanks to Karen Faught for alerting me to this piece

Cross published at

Scott Joplin “Bethena”

Thanks to Phyllis Lee for alerting me to this!

Scott Joplin is known as “The King of Ragtime”, with such famous pieces as Maple Leaf Rag and The Entertainer. Born near Texarkana, Texas in 1867/68, Scott Joplin began playing the piano at age 7, at the homes where his mother cleaned and did laundry.

Ragtime was popular between 1897 and 1918, ironically paralleling Joplin’s career. In fact it was the publication of Maple Leaf Rag in 1899 spurred the popular spread of ragtime.

Early in his career, Joplin lived in Sedalia, Missouri. He married Belle Hayden in 1899, the marriage lasting only a few years. Although they had one daughter, she died only a few months after birth.

It was on a trip back to Sedalia, traveling through Arkansas, that he met Freddie Alexander, falling instantly in love. He wrote the piece “The Chrysanthemum”(1904) for her, which many regard as one of his most beautiful pieces. Listen to a bit of this upbeat ragtime song, since we’ll contrast it with another piece at the end.

The two were married in June 1904 in Little Rock, Arkansas and took a train back to Sedalia, stopping a few days at a time to play concerts. It took a whole month to travel home and upon reaching Sedalia, Freddie was feverish. What seemed to be the flu, slowly turned to pneumonia and in September 1904, Freddie died. Only married 10 short weeks, Joplin was devastated. He left Sedalia for good after her funeral.

In his grief, Joplin wrote “Bethena”(1905). Experts believe that this was in honor of Freddie, and quite the contrast from “The Chrysanthemum” written when he fell in love. On the original publication there is a picture of a woman, which some have even speculated is a picture of Freddie.

I think if you listen to this, you’ll hear the grief but also a type of endearment. Ragtime in its nature is not sad or depressing. The ability for Joplin to take such an upbeat genre and still convey sorrow is truly remarkable. I’d heard this piece before, not knowing the background; Context, once again, is everything.

Scott Joplin developed complications from tertiary syphilis in 1916, and required admission to Manhattan State Hospital in January 1917 due to a “decent into madness”. He died there April 1, 1917.

Cross published