tag:blogger.com,1999:blog-69416919323889124732024-02-02T18:38:06.177-06:00Peete's LandingThis blog started as a photo journal of the construction progress of our" little cabin in the woods"
Contractor: Mike Kennedy, Hazel Green, Al. Construction began 12/7/2009
move in date: March 14, 2010
For many years Bob had wanted a "little cabin in the woods"..the construction of his cabin was completed just one month before he died. I deeply regret that he never got to enjoy living here.
Unknownnoreply@blogger.comBlogger167125tag:blogger.com,1999:blog-6941691932388912473.post-23353273443752200552014-10-25T11:31:00.003-05:002014-10-25T11:38:54.316-05:00We'll Let the Rest Of The World Go By
LET THE REST OF THE WORLD GO BY
A SONG FROM 1919
'With someone like you, a pal good and true,
I’d like to leave it all behind and go and find.
A place that’s known to God alone.
Just a spot we could call our own.
We’ll find perfect peace,
Where joys never cease,
Out there beneath a kindly sky.
We’ll build a sweet, little nest,
Somewhere in the west,
And let the rest of the world go by."
Well it didn't quite turn out like we intended...but we tried...
<iframe id="vp11O2BB" title="Video Player" width="432" height="243" frameborder="0" src="https://s3.amazonaws.com/embed.animoto.com/play.html?w=swf/production/vp1&e=1414254388&f=1O2BBmv7uyh0gTHLwn5UWA&d=0&m=p&r=360p+480p&volume=100&start_res=360p&i=m&asset_domain=s3-p.animoto.com&animoto_domain=animoto.com&options=" allowfullscreen></iframe>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-80538583516745393352014-08-27T10:51:00.001-05:002014-08-27T11:34:43.925-05:00How I Spend My Sleepless Nights - painting<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDTgISHn5WHr4A6PDUqfBEwu9iWdsWU8SC6a_wDe_BB6CjuKtaAeMW1EErUrL74W1F42gexOBeCif7tj-WbeR4PHkD0KBQGIdlZJWswGakMixOt1jyOo-kr_q-52Y95UBszyPrSQWElOwo/s1600/DSCN3654.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDTgISHn5WHr4A6PDUqfBEwu9iWdsWU8SC6a_wDe_BB6CjuKtaAeMW1EErUrL74W1F42gexOBeCif7tj-WbeR4PHkD0KBQGIdlZJWswGakMixOt1jyOo-kr_q-52Y95UBszyPrSQWElOwo/s400/DSCN3654.JPG" /></a></div><div class="separator" style="clear: both; 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"I have lost you -the pain is hard to bear<br />
Do I have to go through life knowing you're not there?<br />
I sit here and remember all the lovely times we shared<br />
the talks- the laughter- of every one you cared.<br />
I am told the pain will ease in time
and I will think of you without a tear<br />
but that will be impossible as I need to have you here.<br />
You were the very world to me - my ever guiding star<br />
Just kiss me softly on the cheek and tell me where you are."
Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-6941691932388912473.post-27976113732843364312014-07-01T04:46:00.000-05:002014-07-01T04:51:54.646-05:00Poetry"Give sorrow words; the grief that does not speak whispers the o'er-fraught heart and bids it break."
~William Shakespeare---
Poetry has always been able to move me to tears, moreso than any other medium of expression with the possible exception of music. My thanks to those who post these beautiful poems. They give us insight, and the realization that others feel as we often feel, even those with the remarkable gift of putting those feelings into words that rock the soul.----
Wave of sorrow,
Do not drown me now:
I see the island
Still ahead somehow.
I see the island
And its sands are fair:
Wave of sorrow,
Take me there.
-Langston HughesUnknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-22039146172921996932014-05-04T17:46:00.001-05:002014-05-04T17:52:17.561-05:00Home<a href="http://video214.com/play/ffl6rPR386J2NgU0flARoA/s/dark">Home</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-21896225179286855072014-05-02T11:43:00.000-05:002014-07-01T04:39:10.347-05:00Treasurers Of Our HeartMatthew 6:19-21
King James Version
<blockquote>19 Lay not up for yourselves treasures upon earth, where moth and rust doth corrupt, and where thieves break through and steal:
20 But lay up for yourselves treasures in heaven, where neither moth nor rust doth corrupt, and where thieves do not break through nor steal:
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Homes can be rebuilt, trees can be replanted, flowers will bloom again - someday...
Treasurers on earth can easily become more than just our home, our car, our - whatever - The true treasurers of our heart can become our family, our beloved soul-mate...the one you shared with and loved day and night for your entire life ..that also can be corrupted, and WILL be taken away one day -
"For most people grief never completely goes away but recedes in the background and over time healing diminishes the pain of loss. Missing your loved one may be an ongoing part of your life but it does not interrupt your life....life goes on." ...ie, homes can be rebuilt, trees can be replanted....
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-31223841970083040592014-02-20T05:46:00.000-06:002014-02-20T05:46:46.107-06:00Jo Ann 2/02/1942 - 2/09/2014My sister - Jo Ann - I am 7 years her senior - when Bob and I married she was only 11...We remained in Covington for just one year - the balance of our life together we lived elsewhere - not close to mother and my two youngest siblings...The two years we were in San Jose, Ca. and the 13 years we lived in Chicago our visits with the family were few and far between...
I believe JoAnn was only 15 years old when she married. She and Frank Smith had 7 children...6 boys and finally, the seventh was a girl!!!! Life was certainly not easy for them...they lost two of their children - one a teenager, the other a young adult
- about 10 years ago she suffered a major heart attach that damaged over half of her heart and had lived with a disability every since.
- Frank's mother was very ill for a long time and they took her into their home and cared for her.
- JoAnn endured through many hardships - she endured with optimism and hopefulness..and I'm proud of her.
She was always so tiny - most years did not weight 100 lbs..but she was one of the strongest persons that I've known.
..I'm grateful for the time last summer that she came to Alabama and spent a week with me !!! And I'm so thankful that I was able to go to Houston and spend a few days with her at the hospital before she died.
When I think of her I will recall her "perkiness" and her forthrightness - and I will smile.
She was always completely frank, without hesitation.
I will celebrate her life with a toast and be thankful and proud that she was my sister.
To her children -I pray that their sadness and great sense of loss will pass and that happy memories of their life together will be what remains.
Her family was her life - her joy - what kept her going..now rest in peace little sister..I love you...
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Old memories have the damndest way of showing up at the most unusual time.
They can walk right through the darkest part of your mind and turn on every light-
Or take a perfect crystal day and turn it into a misty shade of blue...
I still see your dark eyes almost everywhere I turn,
I keep standing on the bridges I thought that I had burned,
I can still feel you near me in everything I try to do -
And the only thing that I can say
that makes me act and feel this way is
I never, no I never got over youUnknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-66864036487722496162014-01-12T15:10:00.001-06:002014-01-12T15:10:01.797-06:00JUST ONE MORE LOOK AT YOU<a href="http://animoto.com/play/RY7FbH40mvR9Uxsacd26Rg">JUST ONE MORE LOOK AT YOU</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-87007912538533920762013-12-23T04:18:00.000-06:002013-12-23T04:24:21.661-06:00Love Story<blockquote></blockquote>From the moment I saw you
I wanted to meet you.
From the moment I met you
I wanted to know you.
From the moment I knew you
I was in love with you.
From the moment I loved you
I wanted to spend my life with you.
And from that moment to this moment
and all the moments to come
I will love you with all my heart.<blockquote></blockquote>
Sound like a Hallmark card? That's cause it is! The last birthday card I ever gave him.
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ABSENT FROM THE BODY....PRESENT WITH THE LORD...
"I was sure by now that You would have reached down
and wiped our tears away, stepped in and saved the day.
But once again, I say, Amen and it's still raining
As the thunder rolls I barely hear Your whisper through the rain, "I'm with you".
And as Your mercy falls I raise my hands and praise the God who gives and takes away.
And I'll praise You in this storm and I will lift my hands.
For You are who You are no matter where I am.
And every tear I've cried You hold in Your hand,
You never left my side and though my heart is torn
I will praise You in this storm."
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-80671849282704438182013-10-01T00:55:00.001-05:002013-10-01T01:01:42.960-05:00Weekend in Covington, Tn<iframe allowfullscreen="" frameborder="0" height="344" src="//www.youtube.com/embed/LV0meConiVs" width="459"></iframe>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-2347453251740563992013-09-26T17:07:00.001-05:002013-09-26T17:36:59.348-05:00Kodak Moments<a href="http://animoto.com/play/h6tTphTQ0neW4L6pTLxXRw">Kodak Moments</a>
My grands and greats....Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-6879641561344088822013-09-18T15:16:00.000-05:002013-09-18T15:16:21.310-05:00Pain and Suffering - why ?
An interesting read: Why Does God Allow Pain and Suffering?
by Jen Hatmaker on September 17th,
"Suffering transcends all class, race, ethnicity, culture, privilege....
There is no corner untouched by grief, no demographic, no alliance. If you haven’t suffered, just live longer.
To this end, the church has a history of formulizing suffering, giving it tidy origins and endings and whitewashing the horrid, debilitating middle. We’ve assessed the complicated nuances of universal sorrow and assigned it categories, roots, principles. Or in the face of uncertain causes, we recite some of the coldest, inhumane theology:
"God is sovereign. Deal with it."
In an attempt to understand the ordinary grief of human life, I fear we’ve reduced a complicated reality to an unmanageable burden; we’ve put a yoke of despair on people who mourn, assigning accolades to those who “suffer well” and, in ways overt and subtle, urging our brokenhearted to buck up. Then adding insult to injury, we fall into the trap of explaining suffering, as if any one of us could possibly understand its eternal scope.,,,,"
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-90048610110141109542013-09-16T04:03:00.000-05:002013-09-16T04:03:29.620-05:00"Love Is Patient and Kind..."1 Corinthians 13:<blockquote><b>We're conditioned to think that our lives revolve around great moments,
but great moments often catch us unaware, beautifully wrapped in what others may consider insignificant.
PEOPLE MAY NOT REMEMBER EXACTLY WHAT YOU DID, OR WHAT YOU SAID,
BUT THEY WILL ALWAYS REMEMBER HOW YOU MADE THEM FEEL!<b></b></b>
</blockquote>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-6941691932388912473.post-16579137401533440262013-09-15T18:16:00.001-05:002013-09-15T18:20:48.048-05:00Travels with Bob and Charlene....what a wonderful world...<a href="http://animoto.com/play/qYxcbVTCSprZDdt1JHGiGg">What A Wonderful World - What A Wonderful Life</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-80727253801565057312013-09-09T12:22:00.000-05:002013-09-09T12:22:30.768-05:00<br />
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<span style="background-color: white; color: #333333; font-size: 14px; line-height: 17px; text-align: left;"><b><span style="font-family: Georgia, Times New Roman, serif;">"To fall in love is easy, even to remain in it is not difficult; </span></b></span></div>
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<span style="background-color: white; color: #333333; font-size: 14px; line-height: 17px; text-align: left;"><b><span style="font-family: Georgia, Times New Roman, serif;">our human loneliness is cause enough.</span></b></span></div>
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<span style="background-color: white; color: #333333; font-size: 14px; line-height: 17px; text-align: left;"><b><span style="font-family: Georgia, Times New Roman, serif;"> But it is a hard quest worth making </span></b></span></div>
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<span style="background-color: white; color: #333333; font-size: 14px; line-height: 17px; text-align: left;"><b><span style="font-family: Georgia, Times New Roman, serif;">to find a comrade through whose steady presence</span></b></span></div>
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<span style="background-color: white; color: #333333; font-size: 14px; line-height: 17px; text-align: left;"><b><span style="font-family: Georgia, Times New Roman, serif;"> one becomes steadily the person one desires to be."</span></b></span></div>
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<span style="background-color: white; color: #333333; line-height: 17px; text-align: left;"><div style="font-size: 14px; text-align: center;">
<b><span style="font-family: Georgia, Times New Roman, serif;">Anna Louise Strong </span></b></div>
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<b>Sometimes I feel as though I've lost myself....</b></div>
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</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-23562112051313463042013-08-22T13:25:00.001-05:002013-08-22T13:25:52.940-05:00Covington, Tn.<span style="background-color: white; color: #37404e; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 14px; line-height: 18px; text-align: left;">Most of the buildings around the square of my hometown, Covington, Tn., have been converted into antique, gift shops, etc. Earlier this year when Barb and I were there we stopped by the drug store where I worked while in high school...Rop</span><span class="text_exposed_show" style="background-color: white; color: #37404e; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 14px; line-height: 18px; text-align: left;">er Drug (now an antique store). One of her purchases was an old window...I've printed pictures of Covington and "framed" them in the window...The Courthouse on the square...Bob in front of the courthouse with Roper Drug Store in the right background, the church were we were married, the Ritz Theater where mother worked, Old Trinity (the church Bob's ancestors founded) and the angel statue at the gravesite of his great-grandparents, Edwin Robert Peete and Jane Eleanor Taylor Peete..</span><br />
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<span style="font-size: large;"><i><b>To think that the affairs of this life always remain in the same state is a vain presumption; indeed they all seem to be perpetually changing and moving in a circular course. Spring is followed by summer, summer by autumn, and autumn by winter, which is again followed by spring, and so time continues its everlasting round. But the life of man is ever racing to its end, swifter than time itself, without hope of renewal, unless in the next life that is limitless and infinite.” <br />
</b><span style="text-decoration: underline;"><b>― Miguel de Cervantes Saavedra, Don Quixote</b></span></i></span></div>
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<span style="font-size: large;"><i>Interesting dialogue from the movie "The Next Three Days<br />
<span style="text-decoration: underline;"><b>John Brennan:</b></span> So, "The Life and Times of Don Quixote," what is it about?<br />
<span style="text-decoration: underline;"><b>Julie:</b></span> That someone's belief in virtue is more important than virtue itself.<br />
<span style="text-decoration: underline;"><b>John Brennan:</b></span> Yeah, that's in there. What else is it about? ...Could it be about how rational thought destroys the soul? The triumph of irrationality, and the power that is in it...Now we spend a lot of time trying to organize the world. We build clocks and calendars and we try to predict the weather, but what part of our life is truly under our control? What if we choose to exist in a reality of our own making, does that render us insane; and if so - isn't that better than a life of despair?</i></span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-72461763878042144802013-08-22T12:55:00.000-05:002013-08-22T13:00:36.750-05:00Life After Delivery<div style="text-align: center;">
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<span style="letter-spacing: 0px;"><b><i><span style="font-family: Verdana, sans-serif;">In a mother's womb were two babies. One asked the other: "Do you </span></i></b></span></div>
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<span style="letter-spacing: 0px;"><b><i><span style="font-family: Verdana, sans-serif;">believe in life after delivery?" The other replies, "why, of course. There </span></i></b></span></div>
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<span style="letter-spacing: 0px;"><b><i><span style="font-family: Verdana, sans-serif;">has to be something after delivery. Maybe we are here to prepare</span></i></b></span></div>
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<span style="letter-spacing: 0px;"><b><i><span style="font-family: Verdana, sans-serif;">ourselves for what we will be later.</span></i></b></span></div>
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<span style="letter-spacing: 0px;"><b><i><span style="font-family: Verdana, sans-serif;"> "Nonsense," says the other. "There is </span></i></b></span><b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;">no life after delivery. What would that life be?"</span></i></b></div>
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<b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;"> "I don't know, but there </span></i></b><b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;">will be more light than here. Maybe we will walk with our legs and eat </span></i></b><b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;">from our mouths."</span></i></b></div>
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<b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;"> The other says "This is absurd! Walking is impossible.</span></i></b></div>
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<span style="letter-spacing: 0px;"><b><i><span style="font-family: Verdana, sans-serif;">And eat with our mouths? Ridiculous. The umbilical cord supplies</span></i></b></span></div>
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<span style="letter-spacing: 0px;"><b><i><span style="font-family: Verdana, sans-serif;">nutrition. Life after delivery is to be excluded. The umbilical cord is too</span></i></b></span></div>
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<span style="letter-spacing: 0px;"><b><i><span style="font-family: Verdana, sans-serif;">short." </span></i></b></span></div>
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<span style="letter-spacing: 0px;"><b><i><span style="font-family: Verdana, sans-serif;">"I think there is something and maybe it's different than it is</span></i></b></span></div>
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<span style="letter-spacing: 0px;"><b><i><span style="font-family: Verdana, sans-serif;">here." the other replies,</span></i></b></span></div>
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<span style="letter-spacing: 0px;"><b><i><span style="font-family: Verdana, sans-serif;"> "No one has ever come back from there. </span></i></b></span><b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;">Delivery is the end of life, and in the after-delivery it is nothing but </span></i></b><b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;">darkness and anxiety and it takes us nowhere."</span></i></b></div>
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<b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;"> "Well, I don't know,"</span></i></b><b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;">says the other, "but certainly we will see mother and she will take care of </span></i></b><b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;">us."</span></i></b></div>
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<b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;"> "Mother??" You believe in mother? Where is she now? </span></i></b></div>
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<b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;">"She is all </span></i></b><b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;">around us. It is in her that we live. Without her there would not be this </span></i></b><b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;">world."</span></i></b></div>
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<b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;"> "I don't see her, so it's only logical that she doesn't exist." </span></i></b></div>
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<b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;">To</span></i></b><b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;"> which the other replied, "sometimes when you're in silence you can hear</span></i></b><b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;"> her, you can perceive her." I believe there is a reality after delivery and </span></i></b><b style="letter-spacing: 0px;"><i><span style="font-family: Verdana, sans-serif;">we are here to prepare ourselves for that reality....</span></i></b></div>
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<i><span style="font-family: Verdana, sans-serif;"><span style="letter-spacing: 0.0px;"><b></b></span><br /></span></i></div>
<span style="letter-spacing: 0.0px; text-decoration: underline;"><b><i><span style="font-family: Verdana, sans-serif;">Psalm 46:10 “Be still and know that I am God.... </span></i></b></span><br />
<i><span style="font-family: Verdana, sans-serif;"><span style="letter-spacing: 0px;"> </span><span style="letter-spacing: 0.0px;">I will be exalted among the nations,<br />
</span><span style="letter-spacing: 0px;"> </span><span style="letter-spacing: 0.0px;">I will be exalted in the earth.”</span></span></i><br />
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-73194286878195139022013-08-22T04:16:00.000-05:002013-08-22T04:19:00.959-05:00Answer - Sarah McLachian<b style="font-family: Georgia, 'Times New Roman', serif;">I will be the answer -</b><b style="font-family: Georgia, 'Times New Roman', serif;"> at the end of the line</b><br />
<span style="font-family: Georgia, Times New Roman, serif;"><b>I will be there for you - </b></span><b style="font-family: Georgia, 'Times New Roman', serif;"> while you take the time</b><br />
<span style="font-family: Georgia, Times New Roman, serif;"><b>In the burning of uncertainty - </b></span><b style="font-family: Georgia, 'Times New Roman', serif;"> I will be your solid ground</b><br />
<span style="font-family: Georgia, Times New Roman, serif;"><b>I will hold the balance - if you can't look down</b></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><b><br /></b></span>
<span style="font-family: Georgia, Times New Roman, serif;"><b>If it takes my whole life - </b></span><b style="font-family: Georgia, 'Times New Roman', serif;"> I won't break, I won't bend</b><br />
<span style="font-family: Georgia, Times New Roman, serif;"><b>It will all be worth it - </b></span><b style="font-family: Georgia, 'Times New Roman', serif;"> worth it in the end.</b><br />
<span style="font-family: Georgia, Times New Roman, serif;"><b>Cause I can only tell you what I know - </b></span><b style="font-family: Georgia, 'Times New Roman', serif;"> that I need you in my life</b><br />
<span style="font-family: Georgia, Times New Roman, serif;"><b>When the stars have all gone out - </b></span><b style="font-family: Georgia, 'Times New Roman', serif;"> you'll still be burning so bright.</b><br />
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<span style="font-family: Georgia, Times New Roman, serif;"><b>Cast me gently into morning -</b></span><b style="font-family: Georgia, 'Times New Roman', serif;"> for the night has been unkind.</b><br />
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<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6941691932388912473.post-52336782293203043462013-07-30T13:26:00.000-05:002013-07-30T13:26:26.924-05:00How Doctors Die...<span style="background-color: white; color: #37404e; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 14px; line-height: 18px; text-align: left;">Not a popular subject but...very interesting...expresses my sentiments exactly.....no un-necessary end-of-life, futile, over-treatment..no radiation, no chemo,...no CPR...of course, circumstance are not the same for everyone...age is a fact</span><span class="text_exposed_show" style="background-color: white; color: #37404e; display: inline; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 14px; line-height: 18px; text-align: left;">or...Like most everyone else<br />I wish to die at home with my family....I understand family wanting to do everything possible to care for and prolong the life of their loved one...I went through that very thing 3 years ago with Bob...I'm so sorry that he had to endure his last year being drug from doctor to doctor...enduring the treatments that caused so much damage and eventually took his life....he was 80 years old for God's sake !!! I should have know better!!! His Cardiologist should have advised us instead of encouraging treatment....he was in a much better position to know the outcome than we were.</span><br />
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<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">How Doctors Die</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">By KEN MURRAY, MD</span></span><br />
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<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">————————————————————————-</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">Health 2.0 EDU offers online classes with the world’s top experts in health care and information technology. Tuesday, July 30th at 3pm/6pm ET join Merck’s Aman Bandhari and Thomas Tsang as they explain How HITECH and the ACA Are Changing the Data Landscape. Sign up here.</span></span><br />
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<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).</span></span><br />
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<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.</span></span><br />
<span style="color: #37404e; font-family: lucida grande, tahoma, verdana, arial, sans-serif;"><span style="font-size: 14px; line-height: 18px;">Ken Murray, MD, is Clinical Assistant Professor of Family Medicine at USC. This post was originally published at Zócalo Public Square, a non-profit ideas exchange that blends live events and humanities journalism.</span></span><br />
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Unknownnoreply@blogger.com0