“Terminal Lucidity” Is “the Light Before the End of the Tunnel”

(p. D6) . . . “terminal lucidity,” [is] a term coined by the biologist Michael Nahm in 2009 to describe the brief state of clarity and energy that sometimes precedes death. Alexander Batthyány, another contemporary expert on dying, calls it “the light before the end of the tunnel.”

A 5-year-old boy in a coma for three weeks suddenly regains consciousness. He thanks his family for letting him go and tells them he’ll be dying soon. The next day, he does.

A 26-year-old woman with severe mental disabilities hasn’t spoken a word for years. Suddenly, she sings, “Where does the soul find its home, its peace? Peace, peace, heavenly peace!” The year is 1922. She sings for half an hour and then she passes away. The episode is witnessed by two prominent physicians and later recounted by them separately, at least five times, with identical descriptions.

Early reports of terminal lucidity date back to Hippocrates, Plutarch and Galen. Dr. Nahm collected 83 accounts of terminal lucidity written over 250 years, most of which were witnessed by medical professionals. Nearly 90 percent of cases happened within a week of death and almost half occurred on the final day of life.

Terminal lucidity occurred irrespective of ailment, in patients with tumors, strokes, dementia and psychiatric disorders. Dr. Nahm suggested the mechanism of terminal lucidity may differ from one disease to another. For example, severe weight loss in patients with brain tumors could cause the brain to shrink, yielding fleeting relief of pressure on the brain that might allow for clearer thinking. Yet this theory doesn’t explain terminal lucidity in people dying from dementia, kidney failure or other diseases. Like death itself, terminal lucidity retains a screen of mystery.

My grandfather talked to us for 10 minutes the day before he died. He hadn’t spoken coherently in days. His hands had become baby-like, grasping our fingers or the bed railing reflexively. The weight of his eyelids had become too heavy to lift.

Suddenly, he was back. “What’s the good word?” he asked, as if that day was the same as all the days before. He marched down the line of grandchildren at his bedside, asking for the latest news in our lives. He asked if they ever finished building the Waldorf Astoria in Jerusalem. He made a joke, one I can’t remember except for the way he smiled out of the right side of his mouth, tilted his head from side to side, and held up his hands in jest.

And then, again, he was gone.

For the full commentary see:

Sara Manning Peskin, M.D. “The Gentler Symptoms of Dying.” The New York Times (Tuesday, July 18, 2017 [sic]): D6.

(Note: ellipsis and bracketed word added.)

(Note: the online version of the commentary has the date July 11, 2017 [sic], and the same title as the print version.)

“Terminal Rage” May Be “Rage Against the Dying of the Light”

The quotation below from Dylan Thomas is his first line and title for one of my favorite, albeit sad, poems. It is the first line, but my favorite line is: “Rage, rage against the dying of the light.”

(p. D4) Terminal Agitation

“Do not go gentle into that good night” (Dylan Thomas)

My grandfather screamed two days before he died. “Open that door and let me out! Right now! It’s a travesty! Open that door!”

It was the scream of a lost child. My grandfather’s eyebrows, which had been lost over the years from the outside inward so that only a centimeter of long gray hairs near the middle remained, tilted toward each other.

Until then, we were preparing for missing and absence. Not for an agitated delirium. Not for rage.

. . .

Instead of peacefully floating off, the dying person may cry out and try to get out of bed. Their muscles might twitch or spasm. The body can appear tormented.

. . .

People who witness terminal agitation often believe it is the dying person’s existential response to death’s approach. Intense agitation may be the most visceral way that the human body can react to the shattering of inertia. We squirm and cry out coming into the world, and sometimes we do the same leaving it.

For the full commentary see:

Sara Manning Peskin, M.D. “The Symptoms of Dying.” The New York Times (Tuesday, June 20, 2017 [sic]): D4.

(Note: ellipses added. In the original, the line of Dylan Thomas’s poem, and his name, appear in italics.)

(Note: the online version of the commentary has the same date and title as the print version.)

Patients Know Their Condition and Should Be Listened to by Physicians

The article quoted below gives evidence that on average the patients of female physicians have slightly better health outcomes than the patients of male physicians, and speculates that the reason is that on average, female physicians are somewhat better at listening than are male physicians. The article does not highlight an important implication of this speculation: that what the patient is saying is worth listening to, i.e., it has merit, often providing true and useful knowledge about their own condition. Patients actually know something. If so, this goes against the popular views that physicians should be paternalistic, and that the only actionable source of health knowledge is a randomized double-blind clinical trial.

(p. D4) Whether your doctor is male or female could be a matter of life or death, a new study suggests. The study, of more than 580,000 heart patients admitted over two decades to emergency rooms in Florida, found that mortality rates for both women and men were lower when the treating physician was female. And women who were treated by male doctors were the least likely to survive.

Earlier research supports the findings. In 2016, a Harvard study of more than 1.5 million hospitalized Medicare patients found that when patients were treated by female physicians, they were less likely to die or be readmitted to the hospital over a 30-day period than those cared for by male doctors. The difference in mortality was slight — about half a percentage point — but when applied to the entire Medicare population, it translates to 32,000 fewer deaths.

Other studies have also found meaningful differences in how women and men practice medicine. Researchers at Johns Hopkins Bloomberg School of Public Health analyzed a number of studies that focused on how doctors communicate. They found that female primary care doctors simply spent more time listening to patients than did their male colleagues. But listening comes with a cost. Doctors who were women spent, on average, two extra minutes, or about 10 percent more time per visit, creating scheduling delays and putting them an hour or more behind their male colleagues by the end of the day.

Dr. Nieca Goldberg, a cardiologist whose book “Women Are Not Small Men” helped start a national conversation about heart disease in women, said the research should not be used to disparage male doctors, but should instead empower patients to find doctors who listen.

. . .

Edna Haber, a retired mortgage company owner who lives in Westchester County in New York, said she has had wonderful male and female doctors, but her worst experiences have all involved male doctors.  . . .

Recently she decided to see Dr. Goldberg to discuss heart palpitations and feeling lightheaded. But a series of medical tests during the office visit found that her heart was normal. “I do believe that had I been with a male doctor, I think he just would have put his arm around me and said, ‘Listen, go home, relax, meditate, maybe take a tranquilizer,’ and that would have been the end of it.”

But Dr. Goldberg knew the patient had been concerned enough to see a doctor, so she suggested that she wear a heart monitor for a few days. Several days later, the technicians monitoring the feed noticed a pattern that ultimately showed Ms. Haber needed a pacemaker.

“She paid attention and treated me as if I was credible,” said Ms. Haber. “I wish all the women I know could understand how important it is to have a doctor who pays attention to them, whatever part of the body they are looking at. I think a lot of women are getting short shrift.”

For the full story see:

Tara Parker-Pope. “Should You Choose a Female Doctor?” The New York Times (Tuesday, August 21, 2018 [sic]): D4.

(Note: ellipses added.)

(Note: the online version of the story has the date Aug. 14, 2018 [sic], and has the same title as the print version.)

The “new” study mentioned above is:

Greenwood, Brad N., Seth Carnahanb, and Laura Huang. “Patient–Physician Gender Concordance and Increased Mortality among Female Heart Attack Patients.” PNAS 115, no. 34 (Aug. 21, 2018): 8569–74.

Crowdsourced Data on Elephants’ Response to Death

(p. D2) It was 2013 when Sanjeeta Pokharel first witnessed Asian elephants responding to death. An older female elephant in an Indian park had died of an infection. A younger female was walking in circles around the carcass.

. . .

For a paper published Wednesday [May 18, 2022 [sic]] in the journal Royal Society Open Science, the scientists used YouTube to crowdsource videos of Asian elephants responding to death. They found reactions that included touching and standing guard as well as nudging, kicking and shaking. In a few cases, females had even used their trunks to carry calves, or baby elephants, that had died.

. . .

Combing through YouTube, the researchers found 24 cases for study.

For the full story see:

Elizabeth Preston. “Gray Mourning: All for One, and One for All: Crowdsourcing Grieving Elephants.” The New York Times (Tuesday, May 24, 2022 [sic]): D2.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the story has the date May 17, 2022 [sic], and has the title “Elephants in Mourning Spotted on YouTube by Scientists.” Where the wording differs slightly between versions, the passages quoted above follow the online version.)

The paper in the Royal Society Open Science journal mentioned above is:

Pokharel, Sanjeeta Sharma, Nachiketha Sharma, and Raman Sukumar. “Viewing the Rare through Public Lenses: Insights into Dead Calf Carrying and Other Thanatological Responses in Asian Elephants Using Youtube Videos.” Royal Society Open Science 9, no. 5 (May 2022): 211740.

Among Hoofed Mammals Outsiders Are More Likely to Innovate

(p. D2) Fair or not, goats have not earned a reputation for their problem-solving abilities.  . . .  But if you hide food in a strange cup and put a lid on it, a goat may find a way, a new study finds. And not just any goat, a team of researchers says. Animals that functioned like outsiders in their social group were best at tackling and solving a problem.

. . .

Mr. Caicoya and his colleagues looked at 13 species of hoofed mammals, with their study totaling 111 individuals living in zoos in Spain and Germany.

In a study published on Wednesday [April 12, 2023] in the Proceedings of the Royal Society B, Mr. Caicoya and his colleagues reported that around 38 percent of the animals avoided the cups entirely.

. . .

They found that animals that were outcasts or low in the pecking order had less fear of new objects, more willingness to explore them and a greater chance of getting the prize.

. . .

“The ones that are on the margins of the groups are the ones that are eating less and have more problems surviving in nature,” Mr. Caicoya said speculatively, “so those are the ones that normally take more risks to get food.”

Necessity, perhaps, is the mother of innovation.

For the full story see:

Veronique Greenwood. “Mammalian MacGyvers; Revenge of the Outsiders: Shunned Goats Solve Problems.” The New York Times (Tuesday, April 11, 2023 [sic]): D2.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the story has the date April 4, 2023 [sic], and has the title “Outsiders Solve Problems. Just Ask Goats.” The passages quoted above follow the wording in the lengthier online version.)

The study co-authored by Caicoya and mentioned above is:

Caicoya, Alvaro L., Alina Schaffer, Ruben Holland, Lorenzo von Fersen, Montserrat Colell, and Federica Amici. “Innovation across 13 Ungulate Species: Problem Solvers Are Less Integrated in the Social Group and Less Neophobic.” Proceedings of the Royal Society B: Biological Sciences 290, no. 1996 (2023): 20222384.

Dogs Can Alert Owners to Epileptic or Diabetic Emergencies

(p. B1) Rosebud is a service dog trained at a nonprofit called Canine Partners for Life in Cochraneville, Pa. The dog can detect when Ms. Vible will have a seizure about 15 minutes before it happens. She lets Ms. Vible know with a whine or a bark and then lies down with her owner until the seizure is over.

Seizure-alert dogs are part of a growing class of service animals that can detect warning signs of epileptic seizures and diabetic emergencies and identify other medical conditions. Demand has surged, according to trainers and training centers—some of which now have long wait lists—as recent scientific studies have started to confirm the dogs’ efficacy in helping their owners.

. . .

Their acute sense of smell helps the dogs detect low and high blood-sugar levels and epileptic seizures before they happen. Researchers haven’t yet identified the specific compounds that the dogs are smelling. But once the dogs recognize the smell, they are trained to respond with a specific action such as barking or pawing at their owners. Depending on the owner’s state and the animal’s training, some dogs also might alert another adult, bring a juice box or press a button that sends a phone text to a caregiver.

The University of Bristol in England this year produced a study of dogs’ ability to detect hypoglycemia, which occurs when a diabetic’s blood sugar drops dangerously. If left untreated, this can lead to unconsciousness or death. In assessing the effectiveness of 27 glycemia-alert dogs, the Bristol study found that the dogs alerted their owners to 83% of hypoglycemic episodes in more than 4,000 hypo- and hyperglycemic episodes.

The findings of another study released this year showed promise for people suffering from epilepsy. Researchers from the University of Rennes in Normandy, France, presented dogs with samples of breath and sweat odors obtained from epileptic patients having seizures, not having seizures and exercising (to determine whether the dogs were just detecting sweat). All of the dogs succeeded in identifying the epileptic-seizure-odor sample, and the dogs spent about 23 seconds investigating the seizure smell, compared with about five seconds spent on the other samples.

The lead researcher of the study, Amelie Catala, a Ph.D. candidate at the University of Rennes, says the research could help in the development of electronic noses, devices that can detect and analyze odors and flavors.

“If there is an organic compound related to these diseases that we can detect and identify, it could help develop electronic noses,” she says.

Medical-alert dogs are being trained by for-profit and nonprofit centers, by individual trainers and at times by individual pet owners themselves. In addition to those skills already mentioned, some have been trained to warn patients about abnormal heart rhythms, and to detect allergens. Dogs also have been trained to help identify certain cancers in laboratory settings.

For the full story, see:

Aili McConnon. “Dogs That Can Read Warning Signs Progress Before Explosion.” The Wall Street Journal (Monday, Sept. 16, 2019 [sic]): R9.

(Note: ellipsis added.)

(Note: the online version of the story has the date Sept. 12, 2019 [sic], and has the title “A Growing Role for Medical-Alert Dogs.” The last four paragraphs quoted above appear in the online, but not in the print, version of the article.)

The University of Bristol academic paper mentioned above is:

Rooney, Nicola J., Claire M. Guest, Lydia C. M. Swanson, and Steve V. Morant. “How Effective Are Trained Dogs at Alerting Their Owners to Changes in Blood Glycaemic Levels?: Variations in Performance of Glycaemia Alert Dogs.” PLOS ONE 14, no. 1 (2019): e0210092.

The University of Rennes academic paper mentioned above is:

Catala, Amélie, Marine Grandgeorge, Jean-Luc Schaff, Hugo Cousillas, Martine Hausberger, and Jennifer Cattet. “Dogs Demonstrate the Existence of an Epileptic Seizure Odour in Humans.” Scientific Reports 9, no. 1 (2019): article #4103.

9,000 Years Ago 10,000 Humans Lived in the City of Catalhoyuk

The Catalhoyuk section of Four Cities appears germane to the question: how long have humans more or less like us existed on earth? Apparently at least 9,000 years. But only in the last few hundred years have some humans flourished. The bigger question is: what novel economic system has allowed the the flourishers to leapfrog previous humans?

(p. 16) Nine thousand years ago, the people of Catalhoyuk, maybe 10,000 of them, lived in cuboid clay houses packed against one another above the Konya Plain of south-central Turkey. Their dwellings were uniform, suggesting a highly regulated society: one or two rooms, painted in white or with red ocher designs. You exited not via a front door but by climbing a ladder to the roof. Much of life was lived up there: cooking, socializing, ambling along sidewalks that ran across the top of the city.

Let me say that again in case you missed it: This was 9,000 years ago. In terms of human society, that is just an imponderable span of time. The oldest of the books of the Hebrew Bible date to roughly 3,000 years ago; the pyramids of Egypt go back about 5,000 years. These were not prehumans or near relatives. They were like us: complex, organized, alive to meaning and living at a time beyond reckoning.

. . .

At Catalhoyuk, Newitz hangs out with Ruth Tringham of the University of California, Berkeley, who has devoted years to humanizing the remnants of this city of the dim past by focusing on one skeleton, of a woman she has dubbed Dido. Dido replastered her walls regularly, kept her home swept clean, covered the floor in reed mats and decorated the place with art: clay figures of animals and stylized human females. In other words: much like us.

Catalhoyuk was founded by pioneers of urban living. “When the earliest construction began,” Newitz writes, “many people coming to live at Catalhoyuk were only a generation or two removed from nomadism.” It was brand-new, this fixed settlement thing, but it proved remarkably successful. By the time Dido was born, the city was about 600 years old. I’m tempted to repeat a number yet again. Think of the settled, structured history Dido could look back on. As evidence of her awareness of the past, Dido, like everyone else in town, buried her ancestors in her home, beneath her bed. Some were given a special honor: Their skulls sat in niches in the walls. Dido could enjoy the comfort of her forebears’ empty eye sockets following her as she went about her daily chores. In other words: not so much like us.

. . .

Perhaps looking back 9,000 years can yield practical guidance on how to move forward from where we are. For me, the effect of reading “Four Lost Cities” was more meditative. This is a long, long, long ride we are on. Much is beyond our control. Humanity trundles on.

For the full review, see:

Russell Shorto. “In Ruins.” The New York Times Book Review (Sunday, March 14, 2021 [sic]): 14.

(Note: ellipses added.)

(Note: the online version of the review has the date Feb. 25, 2021 [sic], and has the title “Searching for Our Urban Future in the Ruins of the Past.”)

The book under review is:

Newitz, Annalee. Four Lost Cities: A Secret History of the Urban Age. New York: W. W. Norton & Company, 2021.

Apple’s Bold “1984” Super Bowl Ad, Had Failed Marketing Test

(p. C4) Conceived by the Chiat/Day ad agency and directed by Ridley Scott, then fresh off making the seminal science-fiction noir “Blade Runner,” the Apple commercial “1984,” which was intended to introduce the new Macintosh computer, would become one of the most acclaimed commercials ever made. It also helped to kick off — pun partially intended — the Super Bowl tradition of the big game serving as an annual showcase for gilt-edged ads from Fortune 500 companies.

. . .

FRED GOLDBERG The original idea was actually done in 1982. We presented an ad [with] a headline, which was “Why 1984 Won’t Be Like ‘1984,’” to Steve Jobs, and he didn’t think the Apple III was worthy of that claim.

. . .

HAYDEN Steve Jobs was excited but frightened by it. Steve Wozniak offered to pay to run the commercial himself.

SCULLEY Before the commercial ran, we had to take it to the board of directors. The board sees the commercial, and then there’s just dead silence in the boardroom. They turn and look at me, and [a board member] says, “You’re not really going to run that thing, are you?”

HAYDEN As the closing credits scrolled up, the chairman, Mike Markkula, put his head in his hands and kind of folded over the conference table, and then slowly straightened up and [proposed hiring a different ad agency].

SCOTT I made it. I thought it was pretty good. But I was thinking, “Really? They’re going to run this on the Super Bowl? And we don’t know what it’s for?”

GOLDBERG I had them do a theater test. We get back the results, and it’s the worst business commercial that they’ve ever tested, in terms of persuasiveness.

SCULLEY The board said, “We don’t think you should run it. Try to sell the time.”

GOLDBERG And it was Jay Chiat who told us to drag our feet, basically, when we were told to sell off the time on the Super Bowl.

HAYDEN At long last, it came down that we would run the “1984” commercial once.

For the full story, see:

Saul Austerlitz. “The Super Bowl’s Big Ad Touchdown.” The New York Times (Saturday, February 10, 2024): C4.

(Note: ellipses, and bracketed year, added. The bracketed words in comments from Goldberg, Sculley, and Hayden were in the original.)

(Note: the online version of the story was updated Feb. 5, 2024, and has the title “40 Years Ago, This Ad Changed the Super Bowl Forever.” In the print and online versions, the names of panelists were in capitalized and bold fonts.)

Apple’s bold and famous “1984” Super Bowl ad could only be understood by those who were familiar with:

Orwell, George. Nineteen Eighty-Four. New York: The New American Library, 1961 [1st published in 1949].

In Final Message, Navalny Quoted “Hope, My Earthly Compass”

(p. 26) Aleksei A. Navalny, an anticorruption activist who for more than a decade led the political opposition in President Vladimir V. Putin’s Russia while enduring arrests, assaults and a near-fatal poisoning, died on Friday [Feb. 15, 2024] in a Russian prison. He was 47.

. . .

Mr. Navalny dedicated his final post on social media to his wife on Valentine’s Day.

. . .

The song he quoted, “Hope, My Earthly Compass,” is one of the best-known hits in Russia. Its refrain is “Hope is my compass, and success is a reward for courage.”

For the full obituary, see:

Valerie Hopkins and Andrew E. Kramer. “Aleksei A. Navalny, Russian Opposition Leader, Dies at 47.” The New York Times, First Section (Sunday, February 18, 2024): 26.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the obituary was updated Feb. 18, 2024, and has the title “Aleksei Navalny, Russian Opposition Leader, Dies in Prison at 47.”)

“’The Bear’ Soars” With “The Chemistry of a Frantic Workplace” and the “Camaraderie” of “A Common Goal”

We are about halfway through the second season of “The Bear.” A lot of current shows are cliché-laden, woke, clones of each other. This one is not perfect (constant f-bombs are jarring), but the show is funny and intense and different. I like its sincere intensity. Carmy is intense about getting a job done well. He has flaws, as do the other characters, as do all classical heroes (see The Odyssey). But they keep trying, they keep showing up. In the end, the food matters. The sous chef comes to work for Carmy because she knows he is great at what he does, and can drive her toward greatness. When the sous chef at random times and places has an idea for a new dish, she pulls out her pad and writes notes. Deirdre McCloskey says we all should do that. Robert Loring Allen in Opening Doors says Schumpeter used to stop in the middle of a walk and jot notes before moving on–and his students would laugh at him. Let them laugh.

(p. C3) It’s jarring to watch the aggressive workaholism of “The Bear” amid the current reconsideration of work and work-life balance that’s been happening since the pandemic. Not a day passes without a new account of employees re-evaluating priorities; frustrated bosses urging staffers back to their offices; or social media phenomena like “quiet quitting” and “lazy girl jobs,” which really are rejections of wanton careerism.

. . .

At the same time, everyone’s in. No one’s “quiet quitting.” “The Bear” soars when it depicts the chemistry of a frantic workplace with camaraderie and a common goal. There is no place these characters would rather be, no people they’d rather be with. (One of the most poignant moments is when Sydney stops what she’s doing to make a harried co-worker an omelet.) They have found purpose—even Cousin Richie, who, in the season’s best episode, apprentices at a sleek Michelin three-star restaurant and discovers a talent for customer service, not to mention an upgraded taste in clothing.

“I wear suits now,” Richie says upon his return. Casual Fridays be damned!

Even a non-chef can appreciate this vibe. “The Bear” made me nostalgic for a time, before the (delightful!) arrival of family and children, when I lived alone, kept a refrigerator barren but for a jar of mustard, existed in my own self-absorbed, work-crazed head, socializing only with other self-absorbed work crazies.

For the full review, see:

Jason Gay. “What ‘The Bear’ Says About The Work-Life Revolution.” The Wall Street Journal (Saturday, July 29, 2023): C3.

(Note: ellipsis added.)

(Note: the online version of the review has the date July 28, 2023, and has the title “‘I’m a Psycho’—What ‘The Bear’ Says About the Work-Life Revolution.”)

“If You Burn Out, Relight the Fire”

(p. A11) Dr. Gladys McGarey, 103, continues to consult, give talks and podcast interviews after nearly eight decades in the medical field. She started an Instagram account that has nearly 47,000 followers.

“If you burn out, relight the fire,” says McGarey. She ran a clinic while raising six children and had to start a new one when her husband and clinic partner left her when she was 69 and married one of their colleagues.

. . .

Not everyone wants to work in their later years, says Dr. Robert Waldinger, a professor of psychiatry at Harvard Medical School.

“It’s not burnout. It’s just ‘I don’t want to do this anymore,’ ” says Waldinger, director of the Harvard Study of Adult Development, a longitudinal study on how people thrive.

As people get older, they are better at discerning what really matters, he says, and what they can let go of. The goal isn’t necessarily an 80-year career, but finding purpose in whatever we chose to do in our 80s and beyond, whether that is taking care of a grandchild, playing the piano, or joining a community theater.

For many, there is passion, purpose and love in the work.

. . .

Like others who have remained engaged in their careers in their later years, she says the secret is to find things that make life important and our “hearts sing.”

For the full commentary, see:

Clare Ansberry. “At 103, Work Still Makes Heart Sing.” The Wall Street Journal (Wednesday, Jan. 3, 2024): A11.

(Note: ellipses added.)

(Note: the online version of the commentary has the date December 29, 2023, and has the title “TURNING POINTS; How to Work—and Love It—Into Your 80s and Beyond.”)

The memoir by McGarey mentioned above is:

McGarey, Gladys. The Well-Lived Life: A 102-Year-Old Doctor’s Six Secrets to Health and Happiness at Every Age. New York: Atria Books, 2023.