Of course, there was no official diagnosis, or even a trip to the doctor, as of yet.

Bonus clip: I love that Ashton and Demi are so into The Real Housewives of Atlanta.

Jesse Ellison tells a moving story of her grandmother Anne, who died of lung cancer at the age of 91. Anne Ellison had expressed her desire to die "quietly, peacefully, as she went about her day, or, even better, in her sleep" — something many of us might wish for. Instead, she was moved from a hospice to an assisted living facility to an emergency room and back to a hospice, spent several minutes lying outside on a gurney in a snowstorm, and endured chemotherapy, radiation, and a colostomy before she finally died. Jesse Ellison says that all her treatments were described as "palliative," but that they brought her not more meaningful time with her family, but more suffering. She writes,

[T]here was nothing peaceful about her death. She was forced to endure exactly what she had been so afraid of. During respite care, at the assisted-living facility, and especially at the hospital, my grandmother was treated like a problem to be solved, not as an elderly woman who had had enough. Because of the way her health improved, then so quickly declined, and because the system is set up to save people, not let them die, those last few weeks became needlessly tragic. They were also-and this really would have made my grandmother irate-enormously wasteful. Tens of thousands of dollars were spent on care and treatment: the ambulance trips alone averaged $500 apiece; the first visit to hospice cost more than $10,000; and the bill for three days in Lenox Hill came to $36,772.43, not including visits from doctors. All this for a 91-year-old woman with terminal cancer and no wish to hang on.

Evan Thomas highlights this wastefulness in another Newsweek article. Most of the growth in health care spending comes from Medicare, he writes, and nearly a third of that is spent in the last two years of life. For our health care system and our economy to continue functioning, we need to reduce that amount — but not by hauling the elderly up in front of "death panels" or denying them care they need. Thomas quotes Dr. Elliott Fisher, a professor at Dartmouth Medical School, who says, "It's not about rationing care-that's always the bogeyman people use to block reform. The real problem is unnecessary and unwanted care."

Thomas offers some solutions for reducing such care, from reforming the malpractice lawsuit system to paying doctors on salary rather than by procedure. But another important aspect of reform is both very simple and very difficult: understanding and respecting the wishes of the dying. Doing this would require resources — and an attitude — that we don't currently have.

Jesse Ellison's descriptions of her grandmother's arduous shuttling between different facilities and forms of treatment were familiar to me — that's what my grandfather's last months looked like, a little over a year ago. Everyone in my family was enormously grateful to the people who took care of him, all with compassion and sensitivity. But we also didn't really know what to do as his treatments became increasingly draining for him — and as he began to express his desire to stop them. All of our feelings about his death were complicated, and at the time I wished we had someone at the hospital to help us sort through them. Thomas points out that families often have as much influence on end-of-life care as patients do, and a counseling system to help loved ones accept and respect a patient's desires would be invaluable.

Ellison's right that most of the time, a hospital's "job is to keep people alive." But at a certain point that job changes. At that point the dying, their families, and their doctors need help determining what to do next — not to satisfy some outside "panel," but to best honor the way in which patients want their lives to end. Sometimes this help is available in the form of social workers or clergy, but sometimes it's not — and all families deserve to talk to someone whose understanding of the end of life goes beyond putting it off as long as possible. I'm not sure if this would actually save us money, but it would certainly spare us pain.

The Bitter End [Newsweek]
The Case For Killing Granny [Newsweek]

[Arlington, August 4. Image via Getty]

ARLINGTON, VA - AUGUST 04: LyVonne Lightfoot (3rd R) holds a folded American flag while sitting next to her son U.S. Army Spc. Anthony M. Lightfoot's casket during his burial ceremony at Arlington National Cemetery August 4, 2009 in Arlington, Virginia. Assigned to the 4th Battalion, 25th Field Artillery, 3rd Brigade Combat Team, Spc. Lightfoot, 20, of Riverdale, Georgia, joined the Army in January 2008. Spc. Lightfoot and three other soldiers were killed when their vehicle struck a roadside bomb followed by a small arms and rocket-propelled grenade attack in Wardak Province, Afghanistan. (Photo by Chip Somodevilla/Getty Images)

Rather than separating out the simply elderly from the truly infirm, the nuns continue to live together not for financial necessity but because they feel that their deaths should not be conducted separately from their lives.

"There is a time to die and a way to do that with reverence," said Sister Mary Lou, 56, a former nurse. "Hospitals should not be meccas for dying. Dying belongs at home, in the community. We built this place with that in mind."

This is, after all, the model for modern-day hospice care, but even within the strictures of hospice, dying in one's home is less and less of an option for some people.

There are positive effects to the surroundings and the patient-care philosophy behind the convent, which is focused on allowing patients to make empowering decisions and living the ends of their lives without a fear of death. They're cared for mostly by one geriatric specialist, Dr. Robert McCann, who is able to bill Medicare for some of their costs but goes largely unreimbursed. He says:

...through a combination of philosophy and happenstance, "they have better deaths than any I've ever seen."

Dr. McCann's long relationship with the sisters gives him the time and opportunity, impossible in the hurly-burly of an intensive-care unit, to clarify goals of care long before a crisis: Whether feeding tubes or ventilators make sense. If pain control is more important than alertness. That studies show that CPR is rarely effective and often dangerous in the elderly.

"It is much easier to guide people to better choices here than in a hospital," he said, "and you don't get a lot of pushback when you suggest that more treatment is not better treatment."

There are more tangible benefits to the philosophy behind the convent: no one can recall a resident dying in a hospital; the nuns seem to enjoya lack of anxiety about death that the doctor believes comes from their religious faith. More substantively, McCann says he need only use one-third of the narcotics he uses on his other geriatric patients to manage the nuns' pain at the end of their lives. And the nurse practioner at the convent, Barbara Cocilova, has seen other benefits, too.

Among those with Alzheimer's, Ms. Cocilova said, diagnostic tests tend to produce better-than-expected results among those who are further along in the disease process, a possible result of mental stimulation.

Dr. McCann and others say that the sisters benefit from advanced education, and new ventures in retirement that keep them active.

Geriatric medicine pracitioners often emphasize the need to stay active mentally in order to maintain mental capacity; but the setting also shows that stimulation from being part of an ongoing community is also important.

McCann, who provides end-of-life-care to laypeople as well, adds another layer of thought to the community the nuns have created.

Some days, Dr. McCann said, he arrives with his "head spinning," from hospitals and intensive-care units where death can be tortured, impersonal and wastefully expensive, only to find himself in a "different world where it's really possible to focus on what's important for people" and, he adds, "what's exportable, what we can learn from an ideal environment like this."

The story is accompanied by an oral slideshow (have your tissues ready, trust me) of the nuns, McCann and some of the staff at the convent speaking. What stands out to anyone who has watched a loved one die in an institutional setting is the amount of physical contact between the sisters and their caregivers. In a hospital, there's a lot of pulse-taking and blood-drawing and all the myriad ways of touching a person that medical care requires. But in the slide show, there's hand-holding, and face-touching, hugs and singing and smiles on not just the faces of the healthy, but on those of the ill. There are no gloves, no gowns, no bits of minute physical distance to separate the dying from the sick from the healthy at the convent, in no small part because they don't believe that those things help cushion one's death as much as they hurt the sense of still belonging to the world that the nuns think they need at the end of their lives. Let's hope McCann and the nuns he treats can find a way to make that exportable.

Sisters Face Death With Dignity and Reverence [NY Times]
A Gentle Death [NY Times]

Though previously the only deaths recorded were in Mexico, yesterday, the Centers for Disease Control reported the death of a 23-month-old child in Texas. Acting CDC Richard Besser said that although most swine flu sufferers in the US had a mild case, "we're going to find more severe cases and I expect that we'll continue to see additional deaths." Hong Kong infectious disease expert Lo Wing Lok noted that the appearance of a death — and 100 additional cases — outside Mexico was an ominous sign.

But rather than what we can do about it, let's focus on whose fault this is! Should we blame Edgar Hernandez, an adorable five-year-old who tested positive for swine flu during an outbreak in the Mexican town of La Gloria? Although he is the first recorded case in Mexico, and the governor of Veracruz visited his mother, at least one doctor told her Edgar didn't have swine flu. And there's no confirmation that the epidemic started in La Gloria.

Or does the fault lie with a woman the Daily Mail is helpfully calling Typhoid Maria, a door-to-door census taker in Oaxaca. She died of swine flu on April 13, and, according to the Mail, state health authorities were "were horrified to discover she may have come in contact with at least 300 people." The Mail winds up its article with a little history lesson on Typhoid Mary, an Irish chef who denied spreading the disease but was accused of infecting 53 people.

In a response of Biblical proportions, the Egyptian government will slaughter all pigs. But perhaps more disturbing than this porcine genocide or the media blame game is the cause La Gloria's residents identify for their outbreak. They blame toxins from pig waste, which enter the air and water from nearby farms. But "Typhoid Toxins From Nearby Farms" is less fun to say than "Typhoid Maria," so let's just keep pointing fingers.

U.S. has its first swine flu death [Reuters]
Typhoid Maria: How the first swine flu fatality was a Mexican census taker who went door-to-door... and may have caused a pandemic [Daily Mail]
Patient zero? Mom of first confirmed case talks [MSNBC]
Egyptian government slaughtering all pigs in the country as a precaution against swine flu [AP]

Given the youth of most of its user-demographic, death probably isn't something Facebook has really had to deal with. But as the Times' Michelle Slatalla discovers, it can haunt those left behind. Someone might be dead and mourned,

...but on Facebook, people live on — indefinitely — because the profiles of dead users are not routinely deleted. The company confers “memorial” status on deceased users’ accounts, having learned after the Virginia Tech shootings that many survivors want to grieve online by, say, posting goodbye messages on the walls of deceased Facebook users.

Slatalla's friend Steve, never much of a Facebook user, inserts himself into her life through birthday notifications and his smiling picture long after his death from cancer. Because, unless you take special steps, requesting that Facebook delete an account (probably not any bereaved person's highest priority) there's no "death" status that suddenly goes into effect. Says an FB rep, "'Many people who have somebody they’re still mourning find it very comforting and feel it keeps them connected to a loved one.'”

In a way, it makes a certain kind of sense. To a large degree, Facebook acts as a sort of second memory, keeping you vaguely aware of people from your dim past and abreast of far-away friends. It certainly aids in remembering quotidian things - birthdays, spouse names, current jobs - and, for good or ill, keeps you uniquely connected to the past. While, undeniably, there's something a little macabre about an abandoned Facebook page - and something very lonely about an unvisited one - a well-visited, tended profile with regular pokes and messages could become a sort of cut-rate 21st century mausoleum, and there are worse things.

Friends To The End And Beyond [NY Times]

Included are clips from Monty Python's "dead parrot" sketch, several Fawlty Towers episodes, and Smith's brother's comedy routine. Performing under the name "Doc Brown," her brother delivers a bizarre rap on "equestrian dressage." Smith says their late father would have liked Doc's act because it uses no bad language. She also says that comedy is one of the few places where people feel comfortable talking about death and despair, and that she envies comedians for the "pure enjoyment" they give people. [The New Yorker]

"Well, has mom agreed to this?"

"That's not a suicide pact, Dad. It's a murder-suicide."

Not to get all 'Lives' on everyone, but a piece in today's "Science Times" made me think of me, me, me! Or, at any rate, my family.

It's the account of a woman who's promised her mother in vague terms that she'll "help her out" should she ever fall ill, knowing full well what this means to a woman who's a member of the Hemlock Society. And it brings up those cases which are less black and white, even for those who find the issue a straightforward one: when the politics of "assisted suicide" don't have a whole lot to do with the misanthrope in question. Take my grandpa!

I've mentioned Grandpa Moe before, a known eccentric who hoarded clocks by the thousands, buried gold bars under the house and kept a deep-freeze full of beef sides in preparation for a vague apocalyptic happening known as "The Bad Times." To call him a pessimist is an understatement: he believed every year was his last, that he'd never live to see a grandchild, that ill-health and dementia were stalking him. He was also a eugenicist (he thought "stupid people" should be fixed), and so wildly "pro-choice" (not that I think anyone of that movement would have been particularly eager to claim him) that he regularly scandalized local pro-life protesters with his arguments for mandatory abortions based on IQ. Needless to say, he had no moral qualms about the issue of euthanasia. When I was pretty young, he took me aside, much as the mother in the Times article does, and asked me to shoot him if he ever "lost it."

In the article, the dutiful daughter agrees. In the end, she is spared a terrible choice when her mother has a swift natural death. In my grandfather's case, things were not so simple. After my grandmother died, he lost all will to live — but then, how much had he ever had? At 87, there was nothing physically wrong with him, but he sunk into a deep depression that quickly led to a general physical deterioration. He grew cadaverous and never left the bed. Then he started the suicide attempts: in his weakened state, he was rather easily disarmed when he went for his guns and swords (yes, an arsenal was necessary for The Bad Times) and tried to hang himself, but when he went on hunger strike, there was not much to do.

People have heard that and asked, "why didn't anyone call 911? They could have put him on an IV, maybe given him antidepressants." Maybe. But no one did. Oddly enough, it had little to do with his "right to die" — if you'd asked many people involved about the politics of it, you'd have found their views far more complex than the story might suggest. We saw it as his wish more than his right, perhaps, but also an act of monumental hopelessness that, at the end of the day, was of apiece with the way he had lived his life. It was certainly what he wanted, but it had less to do with dignity than with the affirmation of a philosophy which, as the days drew on, rapidly ceased to seem an amusing eccentricity and more something deeply sad and rooted in fear. To call it political is silly; my grandfather, much as I loved him, was unwell and his views had no business being imposed on anyone.

In this regard, I thought the Times piece was right: to the extent the personal is political, of course there are ramifications, but the stories are personal and unique. As the piece's author puts it, "my mother had been ready to die for years. Not that she was suicidal, but she had always been one of those people who found the cloud in every silver lining. For my mother, life’s positives outweighed its negatives, but just barely." For my own grandfather, anything less than an ending of despair and doom would surely have nullified the cloudy outlook that had guided his every adult action. What he found in his kind of death was, in a sense, a grim sort of self-fulfilling satisfaction. Why weren't five children, six loving grandchildren, years of health an enticement? Well, that was not what he had planned on. And there is comfort in the expected.

Keeping A Promise When A Life Is Near Its End [New York Times]

• The Center for Adolescents of San Miguel de Allende is the only school in Mexico that offers a professional midwifery degree and may be the model for future schools to teach midwifery all over the world. • The British woman who was given the first successful ovarian transplant last year is expected to give birth this week. • A new law in Australia requires Family Courts to consider ordering mothers to repay child support to the men they claimed were the fathers of their children if paternity is successfully challenged. So far, 18 men have been cleared of paternity. • New research suggests that women with a history of serious mental illness are much more likely to have babies who are stillborn or die within the first month of life. • After attacking Kenyan police earlier today, six gunmen kidnapped two elderly Italian Roman Catholic nuns from their homes and drove them into Somalia. • Is it better to get married earlier or later in life? • Researchers say that a new technique for screening embryos during IVF will double the chances that the embryo will implant in the mother's womb. • A girl in North Carolina who studied teenage highway deaths for her senior project was killed in a head-on collision on Saturday. • Stu Rasmussen has been elected the mayor of a small town in Oregon, making him the country's first openly transgender mayor. • Kombucha may be the hot drink right now, but home brew versions can be potentially dangerous. • In perhaps the first case of its kind, an Italian couple face prosecution for causing their child "psychological suffering" after they allegedly argued in front of him during their divorce. •

Elizabeth Barry of the University of Warwick finds that widely-read obituaries were one of the first ways regular people attained celebrity — albeit posthumously. People's life stories were run as cautionary tales in the 17th century — showing the consequences of wicked or virtuous living — but quickly became a popular human interest read. Initially, the obits featured royalty and other public figures, but the genre grew to include all kinds of people who'd led interesting lives. Says Barry, "Different kinds of deaths came to be commemorated and you didn’t have to be something like a military hero or be a political player or be some sort of high person in society to get public commemoration on your death."

Eventually, the obit-mongers were criticized for catering to low-brow tastes hungry for scandal. But Barry feels the universality of death acted as an equalizer and created the sense of identification that characterizes the modern celeb-public relationship. Of course, by any standard this is a conveniently reductive definition of celebrity - weren't the "military heroes and political players" already kind of celebrities? - but the notion of a fleeting, arbitrary celebrity, manufactured for public entertainment and then discarded, is certainly a unique phenomenon. If Barry's theory holds any water, there's a pleasing neatness to the notion of a life, reduced to a few paragraphs for strangers' delectation, with the veneer of beneficence. Wholly public, yet completely selfish. When Rupert the Baby Deer died last month - only a day after we'd learned about his existence - our shared grief was overwhelming. A friend mused that in a sense this mini emotional roller-coaster was really our celebrity-obsessed age to scale: the emotion is no less real for its lack of depth, but as the stories end, so too does our interest. The tragedy is somehow a neat cap to the narrative. From death cars to autopsies, we feel a right to know how and why things ended - to know if the end was just or tragic. Maybe Barry's onto something.

Dead People In 1700s Were The First Celebrities[Live Science]