What is End-of-Life Quality?

What do we want in the last days of life?  We want no pain. We want simple dignity, the physical kind where we clean ourselves, organize our medicine and command our bowels.  As important is the complex dignity of choosing where we spend our final days, make tough decisions for ourselves and, as much as possible, live as a person, not a patient.  It occurs to me that these critical building blocks are foundation for a greater quality goal.  And that, simply, is art.

In the 1920s and 30s, revolutionary psychiatrist and theorist Otto Rank taught that all art was based in the primal fear of death.  By art, he meant not only that which we mold with paint, stone and clay, but any creative activity.  Rank would argue that the architect who designs a bridge, particularly of novel design, is dealing with his fear of death.  The attorney, who develops a new argument, is driven by concerns about his mortality, even is the chef who bakes a complex and colorful pastry.  Rank believed that we cope with our coming death by trying to develop immortal creations and we pour our anxiety and confusion into creative activity and attempt to develop constructs through which we live forever.

Whatever your thoughts about Rank’s hypothesis, it is worth considering that when we think about our wishes for the final days of our lives and what we mean about “quality”, perhaps it is more than common sense goals, such as pain, control and dignity.  Perhaps a “good death” is marked by the ability to create, develop and invent.  Perhaps, a “bad” death is one that cuts us off from the chance to contribute to society and to tomorrow. If we are so isolated, so drugged, and so obsessed with basic biologic functions that we fail to find precious moments when we press figures into clay, teach our grandchildren, read and respond, or play an old melody, perhaps that is when quality truly vanishes.  When we lose the opportunity to create we lose a path to the infinite and are severed from a vital connection to the wellspring of hope.

The importance of this idea, working toward creating artful time at the end of life, gives doctors, patients and families, goals beyond physical comfort.  Certainly, through the rest of our lives, being able to contribute, make a difference, if only in the context of family and friends, is what drives us each day.  If we are healthy, none of us starts each morning by saying, “well, I wiped my bottom, took a shower and I am not to sore; that’s great, because then I have nothing else to do today.”  On the contrary, while we must never take for granted these simple actions, we feel complete only when we have moved on through the hours to interact, love, learn and, I would suggest, create art.

I like to ask my patients, if it is not self evident, “about what are you passionate?”  For many it is children or grandchildren, for others travel and exploration (which forms new experiences, new ideas and transforms us and is therefore art), some teach, others are absorbed by active or passive sport, many volunteer in their town or church and a few are what society would readily recognize as “artists.”  However, I believe that all of us need to create. All of us need to change our worlds.  All of us need to seek a more pure and wondrous tomorrow.  I believe that since the end-of-life is about living, not about being dead, if we are to find hope and comfort, we must continue to pour our souls, our minds and our hearts into every changing art.


  • Succinctly put , "If you stop, you drop." We should all leave something behind that we are proud of. It makes leaving this life a lot easier. Retirement is a great time for such efforts. Also it is the perfect time to say what needs to be said, to those who need to hear it.
  • Liz
    And I think we also want a little warning that we are approaching these final last days… I think when people say they'd rather die a quick, sudden death, the unspoken part of that statement is "but not until after I have done X, Y and Z" and an ready to die, or as ready one can be under the circumstances. I also think that in order to do the things you talk about; to make sure we are doing theses X, Y, Z things... we need to have already thought about our future death enough that we have gotten past those early days of frantic denial and panic, despair and fear; we have done enough of our *grieving for ourselves* and the future we will not have… it is only then that we can focus on the future that we can have and think about what do we want that future to be, what do we want to accomplish, leave behind…to do the things you talk about in your post. This means discussions about death need to start early - well before it is even close to the time so that we can make that mental shift of death in the abstract to coming to some sort of terms that ours will be sooner than we expected… It is only when we have worked thorough some of this that our focus can be on the things you write of. Because so many people think that talking about death is synonymous with giving up, conversations are squashed and patients are often left to deal with this on their own (and not talking about it doesn't mean people don't think about it). I really think that fairly early in the cancer process medical professionals (and if appropriate spiritual professionals) need to start the discussions both about grieving one's own death and about the things of which you write about in this (and several other of your posts). After all, in some respects isn't this part of the fundamental definition of treating the "whole" person?
  • Penny Egan
    Thank you....now I will continue to cheer Al and his needs on while not giving up on my own... All possible with love and understanding .....I'll do my best ... thank you for your thoughts , your words will be passed along. Life is worth living to its fullest till we each decide it isn't .....
  • Mary
    Your first paragraph sums up my next step and my main concern-which could be years away. As far as the response that a person wants to die quickly, but there's X, Y, Z. I don't think that we are working on the same rationale. Most of the time, I've been quite happy with my life, even the 3 times that I was homeless-one was as a child living with my family in the car. You get the picture about that. While I've made some really dumb choices, according to others, I'm fairly content with my choices, and know that there's a 99% chance that I'd make the same choice again. We don't all start from the same "Point A". Another way of saying it is that I've done pretty much what I wanted. I was able to grab a beloved life style. I fulfilled duty to my family and friends. My family knows that if I get caught in a car wreck or something, that I love them. That I value them. Living is more than being about money or power, but money can make it easier, lots easier. I think of Humphrey Bogart and Steve McQueen dying from cancer. While money helped, it was the care given to them by their wives, who put their own careers on hold. They were artists-actors-that knew that true art is also called love. So, Penny, as Humphrey Bogart would say to you-"Here's to you, Penny"
  • Dawn Milburn
    Thank you, Dr. Salwitz. I found this very moving- a welcome ( though scary) catalyst for allowing my family not to be afraid to talk about life's end, the life on Earth. I once heard an interesting statement. "We are all able to create- all artists, for we are made in the image of God, the Creator." Wow. My dad, Al Egan, is fighting to live, and we are joining in the fight, whether he needs us to or not- ha ha! But, all of us, sick or well, need to write our own " bucket list." I am happy to say that it appears my dad has been living his bucket list all of his life. Yes, it's really true! Now maybe we can all learn from him to live our own. I, personally, am creating things like crazy- weird things! Not afraid to die, but, yes- afraid not to fulfill what God has for me to do on Earth. Your words are artful- creative in helping us to face death. And suddenly, as I write, the Man of La Mancha stands before me, singing " The Impossible Dream." Oh, that's my dad singing... Dawn (oldest daughter)
  • John Arnold
    A toast to you, Dr. Salwitz, for such a considered post on end-of-life quality of life. You have me thinking already about further additions to my bucket list. Thank you.
  • Well put Dr. Salwitz. And raucous applause for your asking patients, "About what are you passionate?” Your mind opening question not only empowers them to reflect beyond their immediate horizons... but serves to place everyone's empathy in its next 'gear'... as the patient interacts with their friends and loved ones around such a timeless and life-defining experience as is dying. And into those defining months that accompany grieving - where most people heal in their own way and at their own speed... physically, psychologically, emotionally, spiritually and socially.
  • D Someya Reed
    Good, thought-provoking post...but personally, some things don't work for me. "We want no pain" has to be qualified (for me and probably a lot of others, too) because if "no pain" means I'm drugged to the point I don't know that I'm alive...then I want some pain. I will NEVER be organizing my medicine...I won't take enough of it to have to organize it. However, I would like to remain in command of all of my bodily functions, please. Otto Rank, I feel, is too limited in his theories and appears to believe that humanity has nothing but selfish motivations linked to perpetual notoriety. There ARE acts of selflessness. You don't hear much about them because, if you did, then an opinion is formed by the listener and the act itself is judged (intentionally or not as good or bad) and by definition then is no longer selfless. I just did something selfless yesterday that will remain selfless until I explain it to you. Here's what I did: I was writing at my computer and heard a thud at the window behind me. I jerked around to see a bird, a hawk I thought, flying away from the window. Since it flew away, I thought all was OK and returned to writing. Then, I thought, the thud was rather small; too small of a sound for that size of bird even at a glancing blow. So I went to the window. There in the bushes was a small bird clinging to a branch (white-knuckle-like were he human) with his head pointing straight down and his eyes half-closed. I went outside and grabbed a step ladder so I could see better at the back of the bushes. It was a cute little bird and not a type I'd seen around our house before. I couldn't be sure if it was injured or just stunned. I took a coiled up hose and placed it on a table in the back yard and created a little shelter around it with a section of roofing felt I had nearby. I grabbed a pair of pruning shears and snipped off the branch below where the bird was clinging and placed the branch inside the makeshift "nest." Ultimately, about an hour later and although the bird seemed to like his new found home, he recovered and flew away. I didn't expect anything from this event. Until now, I neither told anyone about it nor expect to receive any accolades from that bird (or his friends). But, honestly, I felt really good for having done it. And, I created some "art" in the form of a recovery nest from everyday material. If this had been the final act of my life...say, I had a fatal heart attack while putting the ladder away...I would have thought I'm going out on a good note. Now, both my wife and I have always been detail oriented. Besides attention to detail, my wife was very literal...she took your meaning from exactly what you said. Exactly! To both of us, end-of-life is just that...the moment your life ends. It's not the hours, days, weeks, months or years leading up to that moment. I won't even get into theological immortality, rebirth, ascension, or even string theory of theoretical physics and the 11 dimensions. We both had always agreed that “life is for living” and end-of-life is the “moment” of death. Since medical prognostication is such an inexact science, the duration of end-of-life may never be the same for any two people. There are even those who say that you start dying (end-of-life) from the moment of your birth. Kind of true in a way so isn't your entire life “for living” up until the moment of your death? What is it then that we truly mean by end-of-life? There's another expression about "art" that I wanted to use in a piece that I was writing. The expression of "Life imitates art." I'd grown up thinking that it meant we copy what we see done in movies or on TV. Actually, it has more of a philosophy behind it with the position that: What we perceive to be in life and nature is not what's actually there but what we've been taught to find there by artists through their art. As Dr. Salwitz suggests there are many forms of "art." Who constructed “end-of-life” and what should it mean to each of us? Shouldn’t we be living our lives every day as best we can, in sickness and in health (that sounds familiar from somewhere, doesn’t it?) for both ourselves and others, and not waiting for someone to construct an "end-of-life period" for us to live in until that moment when we are no longer? On a lighter note, would we want to become what Bill Cosby used to say in his routine about his aging (and now kinder) parents that they are just two old people trying to get into heaven? Something to think about?
    • Mary
      Talking about pain is theoretical, because there are so many different types of pain, and each person has different tolerances of pain. My first baby was a breech baby. That is called by many to be the worst pain in the world, and back in my day, the mother and baby usually died. This type of pain is worse than having a bone snapped off and walking 9-10 miles in 110+ heat, wearing, spurs, chaps, etc. Fortunately the stud didn't fight me, as I led him up and down steep arroyos. I have RSD-nerve damage in my right breast. My fingers turned black-I begged for their amputation. I could hardly sleep for more than 4 hours. I dreamed that I was running cows into a holding pen, my horse spooked. I was caught on my breast by a railroad spike. I couldn't kick or lift myself off, and cows kept coming in and hitting body. I also dreamed that I was in a truck wreck, and a steel beam impaled my breast, and the truck was vibrating from the rescue crew trying to get me. My neighbors came over and braided my hair, helped clean the house, etc. That was worse then when a young horse slipped, while I was roping, He rolled over me, and the rope was caught in the back of my knee. My jeans weren't torn, but I had a pressure cut down to the bone and tendons. Everybody saw them. I was put on massive antibiotics. Believe me that did not hurt as bad as the breech birth or the RSD. With the baby and the RSD I wanted to crawl out of my skin. I wanted to die. With the RSD, I told the doctors they had 3 weeks to find something or I would blow my brains out. They had already tried the strongest opiates and opiate combinations that the AF had. They treated me like a battlefield casualty and gave me doses that would make a civilian run for safety. I asked when should I have relief-24 -48 hours, but nothing helped. I threw the almost full bottles at one colonel with my left hand. This works for cancer patients. Nothing worked. I was sent to a pain clinic and stellate ganglions worked. I claimed use of my right side. I watched my father try to control the spasms of pain, I watched him writhe in pain. He said that it was worse than being burnt with hot tar and in a burn unit, and he showed me the burn scars. He was a strong man-a fit man- we ran every morning at 0'Dark Thirty-he was a boxer. I'm told that my cancer is one of the most painful ones. For my family's sake, I want to be doped out of my mind. I know from my personal experience that the dope might not even work. I know from watching my father that if it works, it sometimes stops working, and the pain takes over the body. I don't want my family anguished, feeling helpless, as they watch me writhe, trying to crawl out of my body, trying to escape my pain, until the pain is so bad that I can't move anymore.. I know from experience that time doesn't have any meaning when this happens-if it happens. My family would be more satisfied that I'm escaping pain if possible. Meanwhile this discussion is theoretical, as it hasn't happened yet, and it might not happen. Only time will tell..
  • I do not know that I agree with this. I am a formally trained visual 'artist'. The Art's discipline's are as studied as all other disciplines. Just because one engages in creative thoughts and exercises does not necessarily make them an artist or the 'product' of their production art. Art can be subjective...depends. The formal criteria for exceptional artists and art is complex. When one feels pain..sometimes that is a good sign. The social criteria attached to the definition of 'dignity' probably varies from individual to individual as well as culture. One's definition of 'love' ,'family', neediness etc. kind of goes with personal agendas. What I find really funny is that artists on the whole are not accorded the respect or attention that members of the science communities receive. I find it ridiculous that I have to take my own blood pressure, weigh myself, temperature as well as my child's because the person in the drs. office will not do it accurately at times. Anyway..living and dying seems to happen regardless of what our plans are.
    • D Someya Reed
      I agree with what you're saying in general and some specifics but our language is what makes these concepts difficult. We allow too much laxness and variation in definition. Does the Art of Medicine or the more specific Art of Surgery make all doctors and surgeons "artists?" When no one can define dignity or even agree on some of the parameters, how can anyone say that they can give or even assist you in having a "dignified death?" Your idea of "quality of life" is undoubtedly vastly different than my own even though our interpretations likely share many common elements. My belief is that we are "living" every day of our lives. We shouldn't decide to alter the way we live because someone has told us that we are now in a linguistically made-up period called "end-of-life." And you are absolutely correct that living and dying happen no matter what but the living part is more up to us, decisively, than the dying part (and who actually decides when dying begins?). As to respect for those who practice the visual arts, we not only have problems with definitions and interpretations but also prejudice and stereotyping. Personally, I am in awe of someone who can create an artistic presentation from raw materials. A oil painter who can create on canvas a scene so lifelike that if you place it in a window frame you would believe that you are actually looking outside. An Impressionist who can convey emotion without uttering a word. Even some of the beautiful things drawn on or done to a paper napkin. There's is definitely talent but not everyone agrees unless you succeed financially and even then some people don't really "get it" they just agree. Here's a quote you might like from Sir Arthur C. Clarke (author of 2001: A Space Odyssey and much more): “The creation of wealth is certainly not to be despised, but in the long run the only human activities really worthwhile are the search for knowledge, and the creation of beauty. This is beyond argument, the only point of debate is which comes first."
      • I enjoyed your reply. One of the very great men I studied with, was a man named Leon Golub. His work you should see. His huge paintings are raw...he painted monsters, giants, soldiers...He was small in stature..delicate of structure somehow...but one of the kindest men I have known in my brief interactions with him .He did not always paint 'realistically..but his work was very real. I struggled with paint...still do...put it aside for a long time...but he knew how to help me connect with what I was doing instinctively but without conscientiously knowing it. I had several instructors like this..outstanding teachers and thinkers. As far as the 'art' of good surgery..my left collarbone is at my neckline...perhaps there was damage to my thoracic nerve. My husbands surgery..now that might be art....technical expertise is essential in surgery...not necessarily for 'art'. Creative approaches in surgery I would think would be outside of the box in standard approach but have to be sanctioned.
      • I would reference art critics such as Susan Sontag..to help present concepts to you about art. Odilon Redon is one of my favorite artists...some of the women surrealists are incredible..Laurie Anderson performance artist..O Superman, 1981..I just loved the surrealists...Philip Glass music..etc. My son loves electronic music, lessons for years on violin..he may apply electronics to that. Basically the sensual aspect of things....hearing, seeing, feeling, touch and movement...very elementary aspects of psychology and brain development....
      • Leonora Carrington...
      • Here is some imagery for you..my friend in Baltimore..lived upstairs from us (my first husband and myself) went to Maryland Institute of Fine Arts. So did my 1st husband. She was the daughter of an eastern shore minister....carved ducks and duck painting society...She had ceramic, red ones, male appendages on her walls as coat hangers. She had a red ceramic sculpture of a woman on a bed screaming in a gyno exam posture...she would freak me out all the time. Her issues were obvious to me....These were sculptures she made in class. She actually entered the red woman in an art show at an eastern shore contest..ducks and stuff...and they rejected her submission and broke it. She was a school teacher eventually..Art..Junior High..... Last I heard of her she was married and purchasing a hounds tooth check sofa....
  • Mary
    Since we can't define art- let's all hope that we are blessed with competent, good, and caring doctors and staff. That our lives will progress in a decent and dignified way. That we are with loved ones that respect us. That when the end comes, however a person defines it, that our desires on how it ends will be respected and medically possible. I wish the best for all of you. I've enjoyed the discussion and POVs, but I'm opting out of this one
    • Art can be recognized by educated in the field....sometimes good instincts....
    • I would find no dignity in dying being led around by the nose by individuals who presume power and control over my rights as a human being...I will die alone...if I choose....with people who I know love me around..if there are any...etc. What a load of BS to put everybody else in charge and think you are..with their permission of course.
      • Mary
        Hey, I was told that I couldn't fill out my directive the way I did. I took my medical proxy up, and we filled it out the way I wanted to. One of the issues was counseling for my family after I pass. I told them my family are all adults, they are mature enough to decide how they wanted to handle grief, and it's not my place to dictate to adults. They wanted me to order my family to gather and go through a stupid forgiveness rite. I told them that I've never been a Drama Queen, and this insistence and attitude by the cancer support staff does not show respect to me or my family. We are not their emotional puppets nor their cash cow. I did fill it out that I did not want anybody to read to me. That they had to announce their presence before they touch me-I was stabbed in the back at a gang school, and I became more jumpy. I also worked with horses, and you don't let them shove you around, nip you in the back, etc. I do not care to be tubed for more than 3 days- which had the social support howling mad. I asked them why is this an option, if you won't do it? you say this is a legal document-it has choices listed. You told me that I could choose what ever options I wanted. Why don't you grow up and get over it? I was told to go to Houston and have half of my face cut off, including the bone, etc. I haven't been anywhere near Houston or a surgeon. I did what I thought and still think is my best option-radiation. I now have a different oncologist that is not a jerk. I spent weeks calling and Emailing here-Houston, going up and trying to be polite, but I ended up cursing like a chief bosun mate, kicking the wall and pounding the desk. I do not have any person's permission to do anything. They didn't want me to fill out a DNR-I told them that I would complain to social security for breaking rules. I told them that I was perfectly capable of committing suicide without their permission, so get the DNR. My family isn't being told by them to do anything. They have managed to enrage my family. I have already given the emotional support team the finger, and survived. Part of this is that they refused to answer questions, and I have been repeatedly told that I shouldn't worry. They sound like gang members that are setting a con. I seem to have a pleasant relationship with my oncologists-the manipulators can go stay with other fascists and dictators for eternity. Don't get on me about being a sheeple. I just hope that others here get what they hope for. They deserve that. My brother and I thought that we'd drown while scuba diving, get shot or knifed in a fight or feud, bit by a rattler a few hundred miles from anywhere. Driving way too fast,. My personal one, is to have a horse roll over on the side of a mountain or in a rodeo-that didn't work- I got up and walked out of that- I was on crutches for a few months for the worst horse wreck-everybody had a clear view of my bones. My brother thought that it would be repacking biological weapons that were leaking. He just bled out of every pore for a few weeks-with IVs and whole blood stuck in his arms, legs etc. Just because I want to be left alone by social workers, etc, it doesn't mean that others do, and I wish them well kindly. What is wrong with hoping that others can live and die in their standards of dignity? Who are we to dictate to others, and despise their dreams and hopes.
        • I make no reference to horses or any other specific animal. Too many cooks.....if you know what I mean. Too many inroads for criminal activity. My experiences were just walking to work, getting married, going into a doctors office..so called safe venues.....a neighbor, a fellow student.....
          • Mary
            I broke wild horses, did contract ranch work, been on my husband's ships USN ships. How in the world is that being a criminal? I have a national security clearance. My brother was a career Marine. I have something that's hanging on walls in other people's homes. They call it art. . A person doesn't have to be educated to recognize art. Art calls to the soul. I am a person of the Rocky Mountains, a member of Phi Kappa Phi. I learned to rope and shoot, and I taught my children how to sew, arrange flowers, ride broncs, shoot shotguns, revolvers, and rifles. They went to the opera and ballet. My children were also in the stringed instrument section of the regional youth sympathy orchestra. My son qualified as a maritime machine gunner within an hour-it usually takes 3-4 days. I don't put anybody down because of how they grew up or their environment. You have had experiences that I haven't had-we are people from different environments.
          • You misinterpreted me..I am referring to the 'organized' medical community. Not you. I lived in various environments..my ex-husband s family were farmers and livestock owners. I lived in a middle class white industrial neighborhood, but..there was a chicken farm across the street. I lived in downtown Baltimore, on the edge of the city of Trenton, edge of city of New Brunswick...my Dad taught English horseback riding...my Mom a great swimmer grew up on a lake..musicians....etc. I have worked in retail, credit and collections, business and finance, data processing for the auto industry...involved at various levels with the hotel industry...and studied visual arts from kindergarten...
          • I like this , it calls to me,..does not fine art make. Regardless of educational level if one does not have specific education..just as in medicine or teaching etc.....
          • On a lighter note..my husband does a performance piece where he wears a giant gun mask and calls himself Mr. Gunhead and walks around giving the guns specifications..funny as hell but provocative.
  • Mary
    Many fine artists learned from each other and by experimentation. Some cave art is phenomenal by any standards. Nobody needs an education to enjoy true art by the masters. A person either likes something or does not. I do not like Pollock or Warhol, others do.
    • Education regardless. Subjective taste..not the issue..I appreciate Warhol..not one of my favorites either. My husband likes him. I would take a painting by Mel Leipzig over a Warhol any day. Being an educated critic..visual arts, music, dance etc. One needs to know the language as well as the discipline. Bringing work into a studio class can be a real education. If one is studying formally. Do you think that there are different approaches to horse training etc?
  • D Someya Reed
    Jill...You have described in two sentences (especially the second one)... "I would find no dignity in dying being led around by the nose by individuals who presume power and control over my rights as a human being…" "What a load of BS to put everybody else in charge and think you are..with their permission of course." ...what I have been unable to convey in thousands of words I've written and presented on the potential for "bad" care and poor quality of life (remaining) in hospice. Thank you! I think we all know, deep down, what we want the end of our life to be like. The difficult part is getting what you want when all those around you are using their own wants, needs, standards, etc. to tell you what yours should be. In fact, how is this "end-of-life" any different than any other period in your lifetime?
    • Excellent! Depends on who is in power does it not? Politics dictate....money fuels politics...
    • Only issue is....I changed..my attitudes changed and therefore my responses and desires changed..just not interested ..
    • Don't you think that every woman should be given a D&C procedure with no anesthesia in front of her young son? This way they would never want sex or exams or children...
  • Mary
    Jill, would you do me a favor and look up Phi Kappa Phi in Baton Rouge, Louisiana? My culumative GPA at a university was 3.99. I am a member of Phi Kappa Phi. One time they were taking the census-a trapper gave us his data in case a census taker made it up to us. A census taker made it to us. She asked if we knew how she could get the trapper. We gave her a note from him, so she proceeded to ask us questions. When it came to the educational level, she said, "Do you have any idea if he passed the 8th grade, or even got to it?" We replied that he had a Masters degree from U of Oklahoma, and his bachelors at Princeton. She asked why in the world would he trade that in for a trap line, a pack of hounds, and mountain lion hunting. Not everybody is made to stay in doors. My father went through the same thing, he labeled it as the students and faculty meetings are driving me crazy-his school was UCLA. He took off, and we went hunting. I learned to love and value each type of life. The artists that I'm talking about are Michaelangelo of the Sistine Chapel fame. Peter Paul Rubens of Flanders, Albrecht Durer of Germany with his exquisite cross hatching in his etchings, Turner of England with his experiments of time and motion, Monet, Cezanne, even Van Gogh. If they did not experiment, our art would be far different. Somebody had to do it first. There wasn't any Wikipedia for reference. This is how death is artistic, we can each choose the style that suits us, The medium or mediums-the layers of oil, the Cadillac smoothness of acrylics, Sumi ink, chalk, watercolour, and findings for textures. How we use our brushes, our tools, Some people will make frescos, other Japanese woodblock prints. The list goes on and on. I don't like to think of death as a living art-it takes too much thinking. As far as horse training methods, it depends on the horse/breed temperament, the trainer's culture, and what you want to train it for. It also depends on how long you want to spend training the horse. Nothing has an easy answer.
    • Do not care..I think you are mistaken..our options are dictated by the medical community etc....
      • Mary
        • Qualifier..
          • scorn..3.2 no Mason Gross Graduates have sigma, magna deans list etc. Entry is by portfolio admission etc.
  • Thank you. Pinned this on my Aging Is Not For Sissies board. http://www.pinterest.com/pin/147141112799166035/ I am on that down hill slope. (76) My brain is slowly drifting in its own direction and making my passion to write and share information more difficult. Despite the difficulties, however, it is this push to create that forms three quarters of the current quality of my life. Family and friends form the rest. Your post needs a wider audience. So I will do what I can.

Leave a Reply