Joe’s Career Blog
Career development observations and advice for medical professionals from Dr. Joseph V. Simone.
Friday, May 27, 2016
I am at an advanced age (80) and, though there are disadvantages (I can no longer throw a good forward pass to my grandsons), one of the things I enjoy about my age is that young and old physicians often ask me for advice on career issues. I enjoy that opportunity, which brings me back to my own questions and challenges.
When I was in medical school and for a couple of decades afterward, I and many other physicians before and during their formal medical training, were avid readers of non-technical books about medicine in various formats like biography, essays, and fiction. I wrote about this in a very early column and came across it by accident recently. Although some students and physicians still read about the best values of being a doctor, that practice does not seem commonplace. So here is my small effort to help revive such reading.
A few of these books had a profound and lasting impact on my thinking and values so that even today, decades later, I have vivid memories of the issues, triumphs, and difficulties they addressed. My top three such books: Microbe Hunters by Paul de Kruif (initially published in 1926); Arrowsmith by Sinclair Lewis (1925); and Aequanimitas by Sir William Osler (1904). Don't let the age of these books spook you…truth and passion about our profession never dies.
Of course, the impact of books depends not only on the topic and skill of the author, but also the frame of mind of the reader at that specific time. All three fed my burning idealism, an unformed mixture of saving mankind, practicing medicine with utmost skill, and satisfying my scientific curiosity. These and other books helped move me gradually from seeing medicine as the fantasy depicted by Hollywood in the Dr. Kildare movies to seeing medicine as a vocation, a noble calling.
Microbe Hunters describes the work and the environment of scientists and physicians who explored, opened, and illuminated the world of microbiology. Written for the general public with flair and suspense, a bit like the Western paperbacks of its day, it also has scientific heft and accuracy. I first read it as a teenager when my favorite sections were those describing the work of Louis Pasteur, Robert Koch, and Paul Ehrlich; they still are my favorites. I was and am inspired by the struggles and perseverance of Pasteur and Koch, who laid the foundations of microbiology and its application to curing human disease. Ehrlich strikes a special cord in me for his pioneering search for antibiotics and for essentially establishing the field of chemotherapy. This was dramatized effectively in the 1940 movie, Dr. Ehrlich's Magic Bullet, starring Edward G. Robinson.
Sinclair Lewis's Arrowsmith was dedicated thus: "To Dr. Paul H. De Kruif I am indebted not only for most of the bacteriological and medical material in this tale but equally for his help in planning the tale itself…" I first read this novel during my pre-med years. It traces the career and struggles of Martin Arrowsmith, a physician-scientist in the fast moving, fermenting world of microbiology in the early 20th century. The academic locale is based at the Rockefeller Institute (now Rockefeller University) in New York City, then a world leader in the study of microorganisms and their diseases. I wanted to be Arrowsmith, preventing and curing horrible diseases like plague, fighting the ignorance of peers and the wiles of academic politicians, risking my life to save lives, and tragically and heroically losing my devoted wife to the diseases we fought together in the tropics (the latter no longer seems attractive). It was an inspiring and, yes, heroic way of life.
I was in medical school when I first read Aequinimitas by Sir William Osler and I was immediately captivated. Here was a renowned physician, the first professor of medicine of the Johns Hopkins School of Medicine and one of the founders of the modern era of medicine, speaking directly to me about being a physician, a good physician. The book consists of a collection of Osler's addresses given over the years, many to incoming or graduating medical classes. They were inspiring and made me proud to be a budding member of the profession. But they also were practical, providing advice about how one should behave and what one should value. And most of all, his words rang true, refreshing and clarifying feelings and beliefs that were deeply, if vaguely, held.
The book was an immediate international hit. A section of Osler's preface to the 2nd edition describes the book's reception and intent, as well as his bedrock view of medicine as a calling akin to a religious vocation.
"I have to thank my friends, lay and medical, for their kind criticisms of the volume; but above all, I have been deeply touched that many young men on both sides of the Atlantic should have written stating that the addresses have been helpful in forming their ideals. Loyalty to the best interests of the noblest of callings, and a profound belief in the gospel of the day's work are the texts…from which I have preached. I have enduring faith in the men who do the routine work of our profession. Hard though the conditions may be, approached in the right spirit—the spirit which has animated us from the days of Hippocrates—the practice of medicine affords scope for the exercise of the best faculties of mind and heart."
But Osler's head was not in the clouds. He continues, "That the yoke of the general practitioner is often galling cannot be denied, but he has not a monopoly of the worries and trials in the meeting and conquering of which he fights his life battle; and it is a source of inexpressible gratification to me to feel that I may perhaps have helped to make his yoke easier and his burden lighter."
The title address, Aequanimitas, was given to the medical graduates of the University of Pennsylvania on May 1, 1889, his last day at Penn before leaving for Johns Hopkins.
"…my tender mercy constrains me to consider but two of the score of elements which may make or mar your lives—which may contribute to your success or help you in the days of failure. In the first place, in the physician and surgeon no quality takes rank with imperturbability… [meaning] coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of great peril…It is the quality which is most appreciated by the laity though often misunderstood by them; and the physician who has the misfortune to be without it, who betrays indecision and worry, and who shows that he is flustered and flurried in ordinary emergencies, loses rapidly the confidence of his patients." He describes this quality in more detail and expresses regret that "some among you…may never be able to acquire it. Education, however, will do much; and with practice and experience the majority of you may expect to attain to a fair measure."
He goes on to describe the second and similar desirable element. "…the mental equivalent to this bodily endowment [imperturbability is] a calm equanimity. How difficult to obtain, yet how necessary, in success and failure! One of the first essentials in securing a good-natured equanimity is not to expect too much from the people amongst whom you dwell." He continues that colleagues and patients are full of fads and eccentricities, whims and fancies and weaknesses, "which are not unlike our own."
Another passage also demonstrates the timelessness of his words despite the passing of a century. "I would warn you against the trials of the day soon to come to some of you—the day of large and successful practice. Engrossed late and soon in professional cares, getting and spending, you may so lay waste your powers that you may find, too late, with hearts given away, that there is no place in your habit-stricken souls for those gentler influences which make life worth living."
Among the 22 addresses are these titles, "Doctor and Nurse," "Teaching and Thinking," "Internal Medicine as a Vocation," "Nurse and Patient," "The Hospital as a College," and "Chauvinism in Medicine." In the latter, he lists the four great features of the profession of medicine—its noble ancestry, remarkable solidarity, progressive character, and singular beneficence.
I will end this quick survey of Osler with several of his well-known quotes and biographical information. "One of the first duties of a physician is to educate the masses not to take medicine." "Look wise, say nothing, and grunt. Speech was given to conceal thought." "Live neither in the past nor in the future, but let each day's work absorb your entire energies, and satisfy your wildest ambitions."
A brief, but excellent biography of Osler can be found at www.whonamedit.com/doctor.cfm/1627.html. The site also has quotes, a list of his writings, and a bibliography of literature written about him. The best major biography of Osler is the Pulitzer Prize-winning, A Life of Sir William Osler, by Harvey Cushing, MD.\
I believe there is no better inspiration and influence for medical students, residents and fellows than reading Aequinimitas. But reading Osler—and de Kruif and Lewis—still excites and inspires an old duffer like me as well.
A modern day equivalent of these authors is Atul Gawande, MD, MPH, who has written some wonderful articles on being a better physician: "Cowboys and Pit Crews" was published in the May 2011 The New Yorker, which publishes many of his articles. Several excellent books are "Being Mortal," one of my favorites, and "The Checklist Manifesto," Complications," and "Better."
Friday, May 27, 2016
I attended the 21st annual meeting of the National Comprehensive Cancer Network (NCCN), which met in Hollywood, Fla. this spring. I had not attended since I formally retired from academic medicine in 2001. Because I was one of the founding members and the first chairman of its Board of Directors, Robert W. Carlson, MD, the current CEO, invited me to attend. I was curious for two reasons: 1) I wanted to know how had NCCN had fared in the past 15 years, and 2) its development is a good story in which I played a role. More important, NCCN has become a vital organization because it develops, and updates regularly, cancer therapy guidelines that are widely available in the U.S. and around the world. It has expert panels for each cancer type that meets regularly and describes the degree of certainty and solidity for each recommended guideline based on available data and experience.
A bit of background history will be useful to understand the foundation of NCCN. In the 1980s, Medicare changed its hospital reimbursement system from a cost plus basis to one based on Diagnosis Related Groups (DRGs), later called the Prospective Payment System (PPS), which attempted to control inpatient costs by using the average regional cost for a disease or procedure and the length of stay as a payer benchmarks; this rule was applied broadly. However, specialty hospitals, such as children's hospitals and some freestanding cancer hospitals, were later exempted from PPS because there were too few such hospitals in any region to set a valid average cost and because these centers had more patients with advanced disease.
The original eight cancer hospital exemptions went to Memorial Sloan Kettering, MD Anderson, Roswell Park, Fox Chase, City of Hope, USC-Norris Cancer Hospital, Dana-Farber, and Fred Hutchinson. These institutions were allowed to charge on a negotiated cost plus basis; this gave them a huge financial advantage. Others were added later. Representatives of this initial group of PPS exempt cancer centers met regularly, especially after the general election of 1992.
In 1993, the new Clinton administration attempted to radically change how hospitals were paid. This caused uproar among academic centers of all kinds because one of the provisions in the draft proposal was to redirect patients to community hospitals that were less expensive than academic hospitals. I had been at Memorial for only a year and became deeply involved in trying to deal with the potential changes.
Meetings with representatives of the all the PPS-exempt cancer hospitals were intense as we struggled to focus on a plan. This was not easy. Some felt the goal should be to protect market share. We met with politicians, medical directors of large corporations, and insurers trying to make a case for sending patients preferentially to these well-known cancer centers. We did not get very far. We learned that insurers were made up of regional branches that operated under different laws. A few of us came to believe the attraction of higher quality of care should be promoted. We tried that with medical directors, insurers, etc., but we had a big problem: there was no objective evidence that the marquee cancer centers gave better care or cured more patients than community hospitals.
Nonetheless, I was asked to lead a subgroup to develop a plan around the idea of higher quality and, incidentally, to serve as the first head of the project. Some colleagues and I pitched the idea of the developing cancer care guidelines to the PPS-exempt centers and received mainly a cool reception. This was partly due to the fact that we needed money from each participating center to fund the development of the guidelines. With the invaluable help of Cathy Harvey, DrPH, and Bruce Ross, we managed to get funding commitments from each center via annual dues (I think it was over $100,000 per year) and we drafted a strategic plan.
We later realized we could not pull this off with volunteers only and needed a full-time leader and staff. NCCN then hired Bill McGivney, PhD, and, after a slow start, the program began to take off. McGivney started the annual NCCN meetings in Florida, which were highly successful and provided some income. He also promoted disease-specific committees of volunteers from the participating cancer centers. Becoming a member of these committees became a coveted post. After I left Memorial in 1996, NCCN continued to do well and became a reliable national and international source for cancer care guidelines, which were offered free of charge and, eventually, were published in many languages. The NCCN became the primary trusted source of treatment guidelines globally.
Fast forward to 2016. NCCN had its largest ever turnout of attendees this year. More than 1,200 registrants filled the Diplomat Hotel. In fact, the NCCN cannot return to that venue after many years of going to the same place because the attendance had grown so much that the expected attendance was too large for the Diplomat and the meeting would be moved to Orlando in 2017. One of the more interesting things I observed by schmoozing and chatting round the coffee pot and posters is that this annual meeting seems to attract a larger proportion of oncology nurses and other non-MD cancer caregivers than ASCO and other large meetings. That is a very good sign since nurses provide most of the care
This year's agenda looked rather familiar with the specifics differing because of advances in the science and the evolution of caregiving. As usual, the speakers of the presentations were experts in their field and presented clear data and opinions, with the usual precautions against stretching the results too far.
I wish to describe two sessions that were unique for me compared to past NCCN meetings, and a very welcome change. The first presentation on the first day was on palliative care, a topic absent from the meetings I attended years ago. The presentation was followed by a panel discussion on the matter. I heard many compliments from those who attended that session. It is a topic that has too long been ignored because many doctors do not want to give bad news to patients and their families that stopping cancer therapy (no effective drugs available) and switching to treatment of the patients symptoms, physical, spiritual, and mental.
My only disappointment was that it did not go far enough. Care of cancer survivors is often neglected and the oncologists too often do not follow the patient after therapy has stopped to offer help for a variety of common problems, such as psychosocial, mental, family disruption, etc. I also believe NCCN should consider having guidelines for managing the care of cancer survivors.
The second example was the keynote session on the second day of the meeting. Its title was "Cancer Care in an Election Year." There were six experts in politics and political policies, two were also practicing physicians and one was a member of Congress. It was a lively, erudite discussion from a panel equally divided politically. They knew and respected one another and did a wonderful job of describing the difficulties of improving health care and controlling its cost. I have never heard a better discussion of the topic. These were smart, deeply engaged experts who really cared a lot about things like out-of-pocket costs of care, which many cannot afford; the risks and potential rewards of bundled payments (doctors and hospitals must negotiate on who gets what); and many other important issues.
My snapshot view of NCCN in 2016 instilled in me the confidence that it had evolved favorably in the recent years and seemed to be on the right track.
Thursday, April 7, 2016
After many of my lectures, especially to those who are still in medical training or in early or mid-career, I mention the integrity and sanctity of work. I am passionate about this issue, which is why I wrote this column about 10 years ago.
In a short play, titled The Stonemason, author Cormac McCarthy has encapsulated the irreplaceable gist of a profession practiced correctly and with honor. This applies to every profession, whether medical or the "dirty hands" type. I think the lesson it teaches is even more relevant today in our ever-changing medical environment and is especially appropriate for a medical and nursing audience; we deal with lives and the stonemason deals in buildings.
The play is set in Louisville, Kentucky, in the 1970s and is narrated by Ben Telfair, a stonemason whose father, Big Ben, and his grandfather, Papaw, are also stonemasons (papaw is a common name for a grandfather in the South.) It is a masterfully written story of a family faced with the acute problem of Ben's wayward nephew, Soldier, who is in trouble with the law.
The play has a number of important layers, but the soul of the work, and the reason I read it over and over, is Papaw, the 100-year-old stonemason. His passion intimately weaves the sanctity of work and craftsmanship into a single fabric with spiritual wisdom about what really matters in life. He reminds me of the craftsmen who built medieval cathedrals with pride of craftsmanship and with an acute sense of the nobility and sanctity of their work.
Ben recognizes the knowledge and wisdom Papaw offers and he avidly tries to soak it up before Papaw is gone. When he realizes what a remarkable and unique resource his grandfather is, he says, "Oh I could hardly believe my good fortune. I swore then I would cleave to that old man like a bride." Neither Big Ben nor Soldier places a high value on Papaw's views of stonemasonry and his exacting standards.
During the course of the play, Papaw relates through Ben's narration what he knows and how he feels about stonemasonry, and not coincidentally, about life. He also is speaking to us about how one loves and respects his work: the truth of it, the wholeness of it, the essence of it. For Papaw, how he approaches his work is inextricably linked to how he views the world, how he treats others, and how this is all intertwined with his basic faith.
Here are excerpts from the play. While Ben and Papaw are working on a farmhouse, Ben the narrator speaks about stonemasonry:
"For true masonry is not held together by cement but by gravity. By the stuff of creation itself. The keystone that locks the arch is pressed in place by the thumb of God. When the weather is good we gather the stone ourselves out of the fields. What he likes best is what I like. To take the stone out of the ground and dress it and put it in place. We split the stone out along their seams. The chisels clink. The black earth smells good. He [Papaw] talks about stone in a different way from my father [Big Ben]: always as a thing of consequence. As if the mason were a custodian of sorts. He speaks of sap in the stone. And fire. Of course he's right. You can smell it in the broken rock. He always watched my eyes to see if I understood. Or if I cared. I cared very much. I do now. According to the gospel of the true mason God has laid the stones in the earth for men to use and he has laid them in their bedding planes to show the mason how his work must go. A wall is made the same way the world is made."
There are physicians who have the same respect, almost reverence, for their patients and how to put them back together. Perhaps for them it is because the mystery of their lives is held together "by the stuff of creation itself" and deserves—no, demands—professional and personal respect.
Ben continues, describing the essence of the work. "So. It's not the mortar that holds the work together. What holds the stone trues the wall as well and I've seen him check his fourfoot wooden level with a plumb bob and then break the level over the wall and call for a new one. Not in anger, but only to safeguard the true. To safeguard it everywhere…I see him standing there over his plumb bob, which never lies and never lies and the plumb bob is pointing motionless to the unimaginable center of the earth four thousand miles beneath his feet. Pointing to a blackness unknown and unknowable both in truth and in principle where God and matter are locked in a collaboration that is silent nowhere in the universe and it is this that guides him as he places one stone over two and two over one as did his fathers before him and his sons to follow and let the rain carve them if it can."
Ben then talks about seeing samples of Papaw's work, some of it 80 years old, while driving in the region. "…in a thousand structures I've never seen a misplaced stone… . The beauty of those structures would appear to be just a sort of a by-product, something fortuitous, but of course it is not. The aim of the mason was to make the wall stand up and that was his purpose in its entirety. The beauty of the stonework is simply a reflection of the purity of the mason's intention."
Papaw and Ben feel a passionate responsibility to their profession and for its integrity. They believe what they do matters not only for the quality of the wall they build, which can be seen by all, but also for what cannot be seen, what almost no one will know or understand or value. They do things right out of respect for their profession, their craft and, most of all, out of respect for themselves. The characters who disdain such values, Big Ben and Soldier, are chronically unhappy and unfulfilled and find it hard to love unconditionally. They make excuses for their unhappiness, their impatience and the short cuts taken in their work and in their lives. For them, too, their jaded and cynical views of work are of one piece with their views of life.
The message is clear: Integrity in one's work and a passion for doing the right thing and doing things right are an inseparable part of what we love and value, of what brings happiness. Medicine is the same. Doing the work that we love is a privilege and a blessing; doing it with the same integrity and passion for truth as Papaw is the way we respect our patients, our profession, and ourselves.
I recommend that you read The Stonemason, because I cannot do it full justice.
Friday, January 9, 2015
As physicians and other health care providers age they often become wiser, but not always. I like to think I am one of those who is self confident enough to take an honest look at my experience objectively as it developed and evolved over the years. Like many colleagues I am often asked for advice by those who are in the medical profession or considering joining it about the current status of their careers and/or what steps one might take to advance a career.
Because I have a consulting business, I receive calls from physicians or nurses asking if they could hire me to consult with them on their careers. My answer always is negative; I do not charge any individual for providing career advice or for putting one in contact with an institution or medical group that might be a better fit for his or her career. Providing this advice is a way of paying back the kindness of the many people who offered free advice to me. I believe that helping others navigate a career in such a complex profession is part and parcel of our professional responsibility.
Most professionals who have been active for many years in the field are asked for career advice. Unfortunately, some of us should not give career advice because we have serious handicaps—for example:
· People who have been in the same institution for their entire career including residency and fellowship. Their advice may be OK, but their personal experience is very narrow and they may reflexively recommend that the advisee remain in the same institution, which may not be the best fit for the advisee.
· People who cannot keep a counseling session in confidence. Too often a professor has a session with the advisee and casually drops bits of information in the cafeteria or elsewhere--“Hey, did you know John Smith is looking for a job at the University of Norwich?” This is a breach of trust, unless the advisee gives permission to spread the word, which is unlikely because it may tee off his immediate superior.
· People who have strong biases in favor of one career direction. A common example: the advisor is an academic and the advisee is talented and it is likely that he/she could make it in academia, so the advisor leans heavily in that direction. But what if the advisee has a family to support and is deep in debt for his/her education? What if the advisee has a handicapped child who needs special schools? The correct approach is to learn as much as possible about his/her needs, family situation and what type of career the advisee prefers before narrowing the choices.
A potential advisor should consider himself or herself as a confidential counselor, like a good lawyer, whose role it is to help the advisee arrive at the best solution for that particular person. The counselor asks questions to understand the advisee’s circumstances, desires, and talents, and to raise red flags that the advisee had not considered. Here is where the advisor draws on a long experience and knowledge of institutions and their leaders. There are institutions that are considered “career killers” due to poor leadership, a lack of resources, rapid turnover of staff, or a lack of any extraordinary medical or nursing programs.
An advisor’s approach is determined in large part by where the advisee is in career development. For example, the advisor may be asked to advise a professor in the later part of his/her career; a mid-career faculty member who believes it is time to advance where she is or move on to another institution; a junior faculty member seeking an opportunity to become more independent in his professional progress; a trainee who needs help learning the basics of assessing and getting a faculty or partnership position--or, lastly, the advisee may still be in college or medical school, a scenario I was asked about recently:
A good friend of mine who lives nearby has a daughter who is in college on track for a bachelor’s degree in nursing. She is bright and has done very well in school, so some of her teachers are urging her to apply for medical school. She doesn’t have enough experience to know what that means and whether that track would be satisfying. Her father asked me if I would meet with her; I agreed, but suggested that we invite my daughter, who is a physician (she is a big shot at the CDC and my buttons are popping!), to join us to balance our viewpoints.
The four of us, she and her father and my daughter and I, sat around a table and started to chat. She told us about her current course in college and wanted some advice on nursing versus medical school. My daughter and I both described our views of the experience of medical school and the training that comes afterward. She asked a number of questions. The next step was to ask her what drew her to nursing and what part of nursing she liked best. At first she said public health was attractive because one can influence the health of a large number of people. My daughter then described what type of work nurses do when recruited to the CDC.
Then we asked what I believe is the most important question--whether her ultimate goal is to work directly with patients or was it something else, such as an administrative role. She said she leaned toward working directly with patients. Then my daughter explained that nursing opportunities include nurse practitioners and physician assistants, some of whom specialize in one aspect of medicine and nursing and advanced training was available in all. The downside of medical school is that she would need to take extra classes to qualify for applying and the number of years required after medical school to then become a specialist in medicine.
The discussion lasted over an hour, and neither she nor we arrived at a decision. That was not the purpose of our meeting, which was to provide her with ideas, information, and vignettes from our own careers, and to offer a place to go (us) to discuss any of the issues that may come up in the future She is clear-headed, smart, and realistic without the fanciful pie-in-the-sky ideas that we sometimes hear from people her age.
She left us feeling that she would make her own decision based on what she learns at school and from people like us, and most of all, based on what she believes is likely to make her happy in her career. And that is the way these advisory chats should end.
Tuesday, December 23, 2014
Dear friends and colleagues
I am writing to let you know that I am dying.
I just finished reading Atul Gawande’s book
Being Mortal and realized that I have many of
the symptoms of the patients in his book--therefore, I too must be dying.
I am a little sad about this, but to be honest
I knew this was coming and so was not totally surprised.
I learned when I was quite young that all people die,
though like most adolescents I believed deep down
that it wouldn’t happen until I was 110 or so.
But that attitude gradually died soon after I began
going to funerals.
Funerals were a big deal in the
Italian-American culture in which I grew up.
Our entire family went to the funeral home (no baby-sitters)
and walked up to the open casket to pay our respects.
The female relatives of the deceased all dressed in black
would be sitting in the front row of the visitor seats
mentally recording who showed up and who didn’t.
The women in black resumed weeping when friends visited
the casket and turned to embrace them, now both crying.
The casket was surrounded with a forest of flowers
that gave off a strong sickly sweet scent that often made me feel sick,
so I learned the trick of stealthily leaving the room to get a
few breaths of fresh air in the entrance corridor.
On one occasion of escaping into the corridor I noticed a
small room at the back with the door cracked open.
Being nosey I stuck my head in to find a dozen or more
people (mostly men, none of whom had a formal funereal role)
eating from a large buffet of food, smoking and drinking wine or spirits,
but it was the Italian cannoli that caught my eye when I was invited in.
Food and drink were (and are) common at Italian or Irish wakes.
Wakes were also an important occasion of reconnecting with distant
relatives and friends that we saw rarely. That and the food and drink
lightened the atmosphere, with eventual laughter in the background
recalling shared funny experiences long before. It also got us up to date
about who else had died or moved in the interim. It was a positive
social event at a time when many rarely travelled far and phone usage
was relatively expensive and used infrequently.
My mother would talk at home for days afterward about the news and gossip;
she loved that part of it. It was more effective than Facebook because
one got the information directly from a reliable source with all the gory details,
and everyone hugged and kissed to cement our relationships and love
for one another (my sisters and I aggressively wiped our faces of the juicy kisses from aunts and uncles as soon as possible).
In those days, wakes were held for three days (to some, shorter would
have been a sign of disrespect for the deceased).
That was a significant burden for the decedent’s family because after the wake
they still had to go to the funeral Mass on the fourth or fifth day
and then lead a parade of cars to the cemetery.
My father and I usually managed to avoid the multiple days
and the Mass. Enough is enough.
I don’t know when the tradition of long wakes died out along with
the shift to a closed casket with a photo of the deceased on a table.
Cremation was unheard of in those days due to some quasi-religious
taboos. My mother nearly fainted when my wife and I said we would
be cremated. Of course, when she died we had a traditional wake
for her as she wished.
So that is the story. I hope you don’t mind that I made this announcement
in such an informal way, but times have changed.
And since I have no date certain for my demise, I thought I would
take care of this bit of business while I was still able instead of burdening
my family with trying to contact all my friends and colleagues.
I’ve had a good, productive and overwhelmingly happy life with a loving family.
What more could one ask of life?