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Two articles in our Fall issue—one featuring excerpts from a diary kept by one of our former freelance writers while she was dying of cancer and one a profile of the founder of what is now the March of Dimes—sparked quite a few letters. And some older articles piqued readers' interest, too.

Hurt makes us human

Thank you for publishing Mary Daubenspeck's journal ["One More Byline," Fall 2004]. As one of her caregivers during the final months of her life, I found the piece very painful to read, for it brought back difficult memories, but I loved her beautiful writing and loved the opportunity to remember her.

Her brother Andy was absolutely right in his remark at the end of the article that Mary never accepted her death—but my hope for her is that she made peace with it in the end. She just loved life too much to let go; as much as it hurt for those who cared about her to see her struggle at the end, I respected her for her beliefs.

That respect, and her memory, still inspire me as I care for my patients. Palliative care has shaped me, and continues to do so, both personally and professionally. There are a handful of special patients in the careers of all caregivers whom we keep close long after they die because they change us forever—and Mary was one of those for me. Part of the challenge of getting through these difficult deaths is finding some meaning in the midst of all of the hurt.

Again, thank you very much for sharing this piece—for the reminder that it is the ability to feel hurt that makes us human.

Karen Skalla, M.S.N., A.R.N.P.
Brownsville, Vt.

Required reading

I want to thank you for sharing Mary Daubenspeck's diary with your readers. It should be required reading for all oncologists and physicians dealing with lifelimiting illnesses. Most important would be her January 22, 2001, entry describing her feeling of liberation after she decided to stop aggressive treatment of her cancer: "My new life is heaven on earth."

After 30 years in medical oncology, I have spent the last five years doing hospice and palliative medicine. Over and over in my practice, I hear patients say the same thing and then go on to die before they can receive the full benefit of


We're always glad to hear from readers—whether it's someone weighing in with an opinion about an article in a past issue or someone wanting to be added to our mailing list to get future issues. We are happy to send Dartmouth Medicine—on a complimentary basis, to addresses within the United States—to anyone who is interested in the subjects that we cover. Both subscription requests and letters to the editor may be sent to: Editor, Dartmouth Medicine, One Medical Center Drive (HB 7070), Lebanon, NH 03756 or DartMed@Dartmouth.edu. Letters for publication may be edited for clarity, length, or appropriateness of the subject matter.

hospice care.

Although in many instances aggressive high-tech therapy to the very end is patients' choice, I feel physicians need to be more realistic about the possible benefits of these treatments, so perhaps more quality time, without the toxicities of therapy, is available to patients. The comment of Daubenspeck's physician on January 19—"if I were a member of his family he'd refuse to give me more chemotherapy" —was well put but perhaps could have been said months earlier.

Hopefully the presence of Dr. Ira Byock at Dartmouth will further promote the cause of palliative medicine, both locally and nationally.

Allen D. Ward, M.D.
Dartmouth College '61
Hyannis, Mass.

A feature in this issue, beginning on page 43, highlights Byock's work.

Helpful and moving

As an interfaith chaplain at Central Vermont Medical Center, I would appreciate being added to your mailing list. On several occasions, our hospital president, Daria Mason, has shared her copy of Dartmouth Medicine with me. I have found useful, helpful, and moving information in each issue I've had the opportunity to read.

The Fall issue contained several helpful items, as well as two very emotionally moving pieces: "One More Byline" by Mary Daubenspeck and "Broken Bodies, Broken Souls" by Emily Transue. I intend to share both articles with the members of our palliative-care committee, the staff in our psychiatry unit, and our physicians at a CME luncheon I am responsible for.

Thank you very much for the opportunity to receive my own copy of the magazine.

Linda F. Piotrowski
Barre, Vt.

Relevant experience

I happened to see your Fall issue at our local library, and I found Mary Daubenspeck's diary of her experience with cancer very relevant. I am a psychiatric nurse practitioner at the VA Medical Center in Manchester and have worked in hospice and palliative care. I have read Dartmouth Medicine in various waiting rooms for years, but this article prompts me to ask to be put on your mailing list. Thank you.

Sherry Kahn
Hudson, N.H.

Game plan

Mary Daubenspeck, the author of one of the features in your Fall issue, was my sister-in-law (her oldest brother, Joe, is my husband). I found reading her words poignant, gut-wrenching, uplifting, sad, memorable . . .

Mary has been in my life since the day I was born. We played together as children; back then, who ever imagined that we would "cancer" together as adults? We

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