Tuesdays With Morrie Versus Stephen Hawking Living or Dying

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					                                                                                                  Vol. 35, No. 9     629

Literatu re and the Arts in Medical Education

                                             Johanna Shapiro, PhD
                                                Feature Editor
    Editor’s Note: I’m always surprised when residents or medical students object, “But I’ve already read this
    poem [or story],” as though there could be no value in revisiting a particular piece of literature. Yet, reread-
    ing a text often provides additional insight and understanding. Last month, Jeff Ring, PhD, and Jo Marie
    Reilly, MD, described how they give Tuesdays With Morrie as a gift to their incoming resident class, then
    facilitate a group discussion that not only identifies wide-ranging themes of “love, family, and endings”
    but also touches on residents’ strong sense of the personal significance of the text as well as their apprecia-
    tion for its “parallel reading” as a bonding experience with other residents. In this issue, Robin Winter,
    MD, MMM, and Bruce Birnberg, MSW, also consider the same text, this time from a multimedia perspec-
    tive that includes Nightline interviews with Morrie and a videotape of Stephen Hawking. The focus in this
    case is a rich process that helps residents explore the meanings we attach to life and death and the choices
    we make regarding them. The book, like our patients, turns out to be worth a second look!
       In this column, teachers who are currently using literary and artistic materials as part of their curricula
    will briefly summarize specific works, delineate their purposes and goals in using these media, describe
    their audience and teaching strategies, discuss their methods of evaluation, and speculate about the impact
    of these teaching tools on learners (and teachers).
       Submissions should be three to five double-spaced pages with a minimum of references. Send
    your submissions to me at University of California, Irvine, Department of Family Medicine, 101 City
    Drive South, Building 200, Room 512, Route 81, Orange, CA 92868-3298. 949-824-3748. Fax: 714-
    456-7984. jfshapir@uci.edu.

             Tuesdays With Morrie Versus Stephen Hawking:
                       Living or Dying With ALS
                             Robin O. Winter, MD, MMM; Bruce A. Birnberg, MSW

   The las t clas s of my old             course at home to just one student,       on “Nightline,” Mitch reconnects
   professor’s life took place once a     Mitch Albom. The course began             with him and travels every week
   week, in his home, by a window         when Morrie, who was 77 years old,        from Detroit to Boston to visit
   in his study where he could watch      was diagnosed with amyotrophic            Morrie on Tuesdays. During these
   a small hibiscus plant shed its        lateral sclerosis (ALS), a fatal de-      visits, they decide to chronicle
   pink flowers. The class met on         generative neurological disease.          Morrie’s slow but progressive de-
   Tuesdays . No books were re-           Face d with a terminal illness,           terioration along with his thoughts
   quired. The subject was the mean-      Morrie decided that:                      and feelings on a wide range of top-
   ing of life. It was taught from ex-                                              ics, including family, aging, and for-
   perience. The teaching goes on. 1        He would not wither. He would           giveness. The book profoundly con-
   (p. 192)                                 make death his final project, the       veys how through Morrie’s death,
                                            center point of his days . . . Morrie   Mitch discovers what is important
   Rather than teaching his last class      would walk that final bridge be-        in life beyond his professional and
at Brandeis University where he             tween life and death and narrate        financial success.
was a professor of sociology, Mor-          the trip. 1 (p. 10)                        We ask the residents to read se-
ris Schwa rtz, PhD, taught this                                                     lected passages of Tuesdays With
                                             Tuesdays With Morrie by Mitch          Morrie (pp 1-17, 55-61, 80-89, 114-
(Fam Med 20 03;35(9):6 29-31 .)           Albom 1 shares with us the wisdom         129, 171-178, 187-192) and show
                                          of Morrie Schwartz as he faces            a biographica l video of the re-
                                          death and ultimately succumbs to          nowned physicist Stephen Hawking
From the JFK Family Practice Residency,   ALS. After seeing his former pro-         for the final portion of a three-part
UMDNJ-Robert Wood Johnson.                fessor interviewed by Ted Koppel          seminar on death and dying. This
630     October 2003                                                                                    Family Medicine

third segment focuses on the dis-        keep an open heart even in the face        vide o doc ume nta ry ba se d on
tinction betwee n prese rving a          of illness and to be involved, com-        Stephen Hawking’s book A Brief
meaningful life versus prolonging        passionate, and kind to others and         History of Time.3 The video seg-
life in the face of inevitable death.    oneself. To illustrate how he feels        ments give a biography of Hawk-
   We explore this distinction by        about his impending death, Morrie          ing and show him in his wheelchair,
first concentrating on the death of      tells Ted Koppel the following story       on a ventilator, completely para-
Morrie Schwartz, asking residents        that also appears in the book:             lyzed, speaking with a speech syn-
to react to his thoughts on life and                                                thesizer in a computerized voice.
death, as well as to his end-of-life       The story is about a little wave,        Hawking appears as the complete
decisions. Selected quotes from the        bobbing along in the ocean, hav-         opposite of what Morrie wanted,
readings are presented at the semi-        ing a grand old time. He’s enjoy-        according to Mitch Albom:
nar for discussion. The first quote        ing the wind and the fresh air—
involves a dramatic event organized        until he notices the other waves           There were other people who suf-
by Morrie: his “living funeral.” The       in front of him, crashing against          fered from ALS, Morrie knew,
idea ca me to him following a              the shore. ‘My God, this is ter-           some of them famous, such as
friend’s sudden death, when Morrie         rible,’ the wave says. ‘Look what’s        Stephen Hawking, the brilliant
was struck by the fact that his friend     going to happen to me!’ Then               physicist . . . He lived with a hole
never had the opportunity to hear          along comes another wave. It sees          in his throat . . . This was admi-
any of the nice things people said         the first wave, looking grim, and          rable, but it was not the way
about him.                                 it says to him, ‘Why do you look           Morrie wanted to live.” (p. 161)
                                           so sad?’ The first wave says, ‘You
  Morrie had a better idea . . . on a      don’t understand! We’re all going           Howeve r, this life-sustaining
  cold Sunday afternoon, he was            to crash! All of us waves are go-        technology enabled Hawking to
  joined in his home by a small            ing to be nothing! Isn’t it terrible?’   continue his research, write books,
  group of friends and family for a        The second wave says, ‘No, you           and maintain his family relation-
  ‘living funeral.’ Each of them           don’t understand. You’re not a           ships.
  spoke and paid tribute to my old         wave, you’re part of the ocean.’”           We challe nge the residents to
  professor . . . And all the heart-       (pp. 179-80)                             think about what choices they
  felt things one never gets to say                                                 would make if fac ed with ALS.
  to those we love, Morrie said that        In the second “Nightline” inter-        Most of the residents felt that their
  day. His ‘living funeral’ was a        view, Morrie expresses the emo-            decision would depend on their age.
  rousing success.” (pp 12-13)           tional distress he still feels about the   If they were older and accom-
                                         death of his mother when he was            plished, they said they would allow
   Some residents felt the living fu-    only 8 years old. Ted Koppel is            themselves to die like Morrie. If
neral was very egocentric or “too        taken aback by how fresh the sense         they were young with ALS, they
real” and could easily have turned       of loss is for Morrie. We point out        thought they would choose to live
into a “roast.” We point out that it     to the residents that Morrie is not        like Stephen Hawking. We point out
helped Morrie bring closure to his       unique in continuing to feel the loss      that feeling accomplished and sat-
important relationships and avoid        of a loved one for many years after        isfied with life is not necessarily age
the social isolation so common to        the person’s death. In the book,           dependent. One can be young with
those with a fatal illness. This sym-    Morrie says, “Death ends a life, not       a sense of accomplishment, con-
bolic living funeral let Morrie’s        a relationship.” (p. 174)                  nected to loved ones, and accept-
close friends and family know that          In the third interview, Morrie is       ing of an impending death or old,
he was willing to talk about his ill-    so weak that just talking has become       isolated, unfulfilled, and not ready
ness and death and that they did not     difficult. He makes it clear that life     to die. While Morrie Schwartz and
have to be afraid to visit him.          will have no meaning for him once          Stephen Hawking provide a stark
   To give residents a more poig-        he loses the capacity to respond to        contrast in their choices, there are
nant and captivating illustration of     and intera ct with others. When            obviously many different points
Morrie, we intersperse our discus-       Morrie reaches that point, he says         along the continuum that influence
sion with video clips from the three     he would prefer to die. He summa-          people’s choices concerning life
interviews that Ted Koppel did with      rizes his feelings with the saying         and impending death. This discus-
him on “Nightline.”2 In the first in-    “Don’t let go too soon, but don’t          sion helps residents appreciate how
terview, Morrie is still relatively      hang on too long; find the balance.”       important these issues are not only
strong and talks openly about his           We contrast Morrie’s acceptance         for patients making end-of-life de-
disease and the importance of ac-        of death and refusal of life-sustain-      cisions but for themselves as well.
cepting it. He advises people to         ing technology with clips from a
Literature and the Arts in Medical Education                                                                  Vol. 35, No. 9           631

   In the last portion of the semi-      must be taken into account when                    Corresponding Author: Address correspondence
                                                                                            to Dr Winter, Family Practice Center, 65 James
nar, we talk about palliative care for   providing either supportive or pal-                Street, Edison, NJ 088 18.732-321-7493. Fax:
terminally ill patients such as          liative care. It also challenges resi-             732-906-4986. RWinter@SolarisHS.org.
Morrie and withdrawing life-sus-         dents to think about their own val-
taining treatment from patients like     ues and the choice s they would                                       REFERENCES
Stephen Hawking. We present              make if they developed a similar                   1.   Albom M. Tuesdays with Morrie: an old
medical protocols on withdrawing         life-threatening disease. Finally, the                  man, a young man, and life’s greatest les-
ventilators, dialysis, and artificial    seminar enables residents to distin-                    son. New York: Broadway Books, 1997.
                                                                                            2.   Nightline. Co nv ers ations with M orrie
nutrition in order to incorporate        guish between their own personal                        Schwartz: Lessons on Living. ABC News:
these clinical practicalities into the   values and needs and those of their                     Reference #S961101, November 1, 1996.
discussion.4                             patients, sensitizing them to fully                3.   ABrief History of Time. Director: Errol Mor-
                                                                                                 ris. Paramount Studio, 1992.
   Juxtaposing Morrie Schwartz           respect and implement their pa-                    4.   Brody H, Campbell ML, Faber-Langendoen
with Stephen Hawking serves to           tients’ wishes.                                         K, et al. Withdrawing intensive life-sustain-
highlight many of the issues and         Acknowledgments: We would like to acknowl-              ing treatment—recommendations for com-
                                         edge the work of Nanette Soffen, Nancy Violette,        passionate clinical management. N Engl J
decisions that patients have to make     and Rebecca Aguas in the preparation of this            Med 1997;336(9):652-7.
when facing a terminal illness that      paper.