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Sexuality at the End of Life


By Anne Katz RN, PhD

In the terminal stages of the cancer trajectory, sexuality is often regarded as not important by health care providers. The need or ability to participate in sexual activity may wane in the terminal stages of illness, but the need for touch, intimacy, and how one views oneself don’t necessarily wane in tandem. Individuals may in fact suffer from the absence of loving and intimate touch in the final months, weeks, or days of life.head:heart

It is often assumed that when life nears its end, individuals and couples are not concerned about sexual issues and so this is not talked about. This attitude is borne out by the paucity of information about this topic.

Communicating About Sexuality with the Terminally Ill

Attitudes of health care professionals may act as a barrier to the discussion and assessment of sexuality at the end of life.

  • We bring to our practice a set of attitudes, beliefs and knowledge that we assume applies equally to our patients.
  • We may also be uncomfortable with talking about sexuality with patients or with the idea that very ill patients and/or their partners may have sexual needs at this time.
  • Our experience during our training and practice may lead us to believe that patients at the end of life are not interested in what we commonly perceive as sexual. How often do we see a patient and their partner in bed together or in an intimate embrace?
  • We may never have seen this because the circumstances of hospitals and even hospice may be such that privacy for the couple can never be assured and so couples do not attempt to lie together.

intimacy-320x320For the patient who remains at home during the final stages of illness the scenario is not that different. Often the patient is moved to a central location, such as a family or living room in the house and no longer has privacy.

  • While this may be more convenient for providing care, it precludes the expression of sexuality, as the patient is always in view.
  • Professional and volunteer helpers are frequently in the house and there may never be a time when the patient is alone or alone with his/her partner, and so is not afforded an opportunity for sexual expression.

Health care providers may not ever talk about sexual functioning at the end of life, assuming that this does not matter at this stage of the illness trajectory.

  • This sends a very clear message to the patient and his/her partner that this is something that is either taboo or of no importance. This in turn makes it more difficult for the patient and/or partner to ask questions or bring up the topic if they think that the subject is not to be talked about.

Sexual Functioning At The End Of Life

Factors affecting sexual functioning at the end of life are essentially the same as those affecting the individual with cancer at any stage of the disease trajectory. These include:go deeper

  • Psychosocial issues such as change in roles, changes in body- and self-image, depression, anxiety, and poor communication.
  • Side effects of treatment may also alter sexual functioning; fatigue, nausea, pain, edema and scarring all play a role in how the patient feels and sees him/herself and how the partner views the patient.
  • Fear of pain may be a major factor in the cessation of sexual activity; the partner may be equally fearful of hurting the patient.

The needs of the couple

Couples may find that in the final stages of illness, emotional connection to the loved one becomes an important part of sexual expression. Verbal communication and physical touching that is non-genital may take the place of previous sexual activity.

  • Many people note that the cessation of sexual activity is one of the many losses that result from the illness, and this has a negative impact on quality of life.
  • Some partners may find it difficult to be sexual when they have taken on much of the day-to-day care of the patient and see their role as caregiver rather than lover.
  • The physical and emotional toll of providing care may be exhausting and may impact on the desire for sexual contact.
  • In addition, some partners find that as the end nears for the ill partner, they need to begin to distance themselves. Part of this may be to avoid intimate touch. This is not wrong but can make the partner feel guilty and more liable to avoid physical interactions.

Addressing sexual needs

senior intimacyCouples may need to be given permission to touch each other at this stage of the illness and health care providers may need to consciously address the physical and attitudinal barriers that prevent this from happening.

  • Privacy issues need to be dealt with. This includes encouraging patients to close their door when private time is desired and having all levels of staff respect this. A sign on the door indicating that the patient is not to be disturbed should be enough to prevent staff from walking in and all staff and visitors should abide by this.
  • Partners should be given explicit permission to lie with the patient in the bed. In an ideal world, double beds could be provided but there are obvious challenges to this in terms of moving beds into and out of rooms, and challenges also for staff who may need to move or turn patients. Kissing, stroking, massaging, and holding the patient is unlikely to cause physical harm and may actually facilitate relaxation and decrease pain.
  • The partner may also be encouraged to participate in the routine care of the patient. Assisting in bathing and applying body lotion may be a non-threatening way of encouraging touch when there is fear of hurting the patient.

Specific strategies for couples who want to continue their usual sexual activities can be suggested depending on what physical or emotional barriers exist. Giving a patient permission to think about their self as sexual in the face of terminal illness is the first step. Offering the patient/couple the opportunity to discuss sexual concerns or needs validates their feelings and may normalize their experience, which in itself may bring comfort.

More specific strategies for symptoms include the following suggestions. senior lesbians

  • Timing of analgesia may need to altered to maximize pain relief and avoid sedation when the couple wants to be sexual. Narcotics, however, can interfere with arousal which may be counterproductive.
  • Fatigue is a common experience in the end stages of cancer and couples/individuals can be encouraged to set realistic goals for what is possible, and to try to use the time of day when they are most rested to be sexual either alone or with their partner.
  • Using a bronchodilator or inhaler before sexual activity may be helpful for patients who are short of breath. Using additional pillows or wedges will allow the patient to be more upright and make breathing easier.
  • Couples may find information about alternative positions for sexual activity very useful.
  • Incontinence or the presence of an indwelling catheter may represent a loss of control and dignity and may be seen as an insurmountable barrier to genital touching.

footprints-leftIt is important to emphasize that there is no right or wrong way of being sexual in the face of terminal illness; whatever the couple or individual chooses to do is appropriate and right for them. It is also not uncommon for couples to find that impending death draws them much closer and they are able to express themselves in ways that they had not for many years.

Complete Article HERE!

Some of the Most Incredible Facts About the Human Body


That’s right; most of you isn’t even really you. In fact, between 2 and 6 pounds of your weight is actually just bacteria. Feel free to factor that in next time you’re on a diet.

Scientists have discovered that there are small deposits of magnetite in human brains. While they’re not 100% sure why, a leading theory is that the magnetic crystals aid our sense of direction by drawing upon Earth’s natural magnetic fields. Similar deposits can be found in the brains of homing pigeons, dolphins and bats, who all use magnetic fields to navigate.

The muscle that moves your jaw up and down (called the masseter) exerts more pressure than any other muscle in your body — up to 200 psi on your molars! However, we still wouldn’t recommend trying to chomp through a jawbreaker.

You might not be able to run faster, but you can run farther! Human bodies are perfectly engineered for running long distances, and it’s believed we evolved this way in order to hunt more efficiently. In fact, this type of hunting — called Persistence Hunting — is still practiced by hunter-gatherers in Southern Africa. You can see a video of the process here.

There are a few other primates who can toss objects, but humans are the only animals who excel at accurate, high-momentum throwing. Some scientists argue that our ability to throw is very much responsible for our success as a species, as it gave us a way to kill strong animals from a distance. Today it comes in handy as a way to play fetch with your dog.

That’s right, GOLD! However, it’s only 0.2 milligrams of gold, which by today’s standards will net you…less than a cent. But still. It’s real gold. In fact, there are a lot of valuable chemical elements floating around your body, including Rubidium, Boron and Scandium (all valued at thousands of dollars per kilogram). All together, the chemical elements of an average human body are worth about $160.

Of course you know that your fingerprints are unique but, as it turns out, the shape of your ears is, too! Biometrics developers are working on ways of implementing this knowledge in order to easily identify individual people in crowds from CCTV footage or to take attendance in a classroom. If you’re looking for a way to evade this new technology, we recommend wearing a hat, or maybe investing in some Spock ears.

Both the shape and the pattern of bumps on your tongue are entirely unique to each individual. In fact, both your teeth and the bacteria in your mouth are also unique between people — even identical twins! So the next time someone calls you unoriginal, just stick your tongue out at them and show ’em how special you are!

A baby has over 300 bones at birth, but adults have only 206. So what gives? Did you just lose some bones and not realize it? Nope! Actually, many of the bones in a baby’s body fuse together to create bigger, mega-bones (not a medical term), and that’s how you end up with only 206 in adulthood.

Babies are born exhibiting a number of fascinating reflexes, including the ability to walk on a flat surface (as long as the baby’s body and head are supported). Another baby superpower is called the Palmar Grasp, which allows the baby to grab onto an object with surprising strength. In fact, some babies can even support their own weight (although we don’t advise trying to recreate the picture above).

And speaking of superpowers, here’s a shout out to your liver, which is basically the superhero organ of the human body. Your liver performs over 500 functions, including producing bile and cholesterol, removing bacteria from the bloodstream and — of course — clearing the blood of toxins from drugs and alcohol. Keep that in mind next time you complain about working overtime.


And if that’s not impressive enough for you, it’s recently been discovered that your nose can smell at least 1 trillion scents, making it the most sensitive organ in the body by a large margin. However, I think we can all agree that there are some scents you might be better off forgetting.

It’s called the Mammalian Diving Reflex, and it is seriously one of the coolest things your body is capable of. When you splash cold water on your face, your body thinks it’s going for a swim, and prepares accordingly. First, your heart rate slows down 10-25%. Then the blood vessels in your extremities constrict and send more blood to your lungs. As a result, you use up less oxygen and — if you were swimming — would be able to stay underwater longer.

Maybe the Mammalian Diving Reflex is what the people in face wash commercials are actually demonstrating…

Ounce for ounce, human bones can withstand a lot more pressure than steel. In fact, a cubic inch of human bone could bear a load of 19,000 pounds! Bones are also a lot lighter, less dense and more flexible than steel, which makes them a great material for, you know, supporting your entire body. Steel wins when it comes to building materials, though, because using bones would be a little too spooky.

Like, a lot of saliva. In fact, throughout the course of your lifetime, the amount of saliva you produce could fill the Olympic-size swimming pool pictured above…twice. Maybe even more if you spend a lot of time thinking about Warhead candies.

A single strand of hair can support about 100g (which is equal to about two candy bars). But twisted together, one person’s entire head of hair (consisting of about 150,000 individual strands) could support 12 tons of weight — that’s the weight of 2 elephants!

Not only is hair very strong, it’s also virtually indestructible. Aside from being flammable, hair won’t break due to extreme temperatures, and it’s also resistant to a lot of acids and other corrosive chemicals.

Although hair doesn’t easily break, you still lose between 60 and 100 strands of it every day. Think of how many elephants you could be lifting if you didn’t!

This reflex, known as the Photic Sneeze Reflex, is present in 18-35% of the population, and it causes people to sneeze when exposed to a change in light intensity (such as leaving a dimly lit building on a sunny day). Sneezing can also occur in some people after eating spicy foods, or even when they’re full after eating. This phenomenon is not completely understood, but we’re pretty sure it’s the lamest superpower ever.

While your eyes remain the same size throughout your entire life, your ears and nose will continue growing as you get older. This is partially due to the fact that they are made out of cartilage (rather than bone), but is mostly as a result of gravity. So they’re not actually growing as much as sagging. Regardless, you’ll be able to tell your grandkids “all the better to hear you with,” so that’s pretty cool.

Since fat is essentially an endocrine organ, it needs a supply of blood to function. So, as fat is added to your body, your body in turn constructs blood vessels and capillaries to provide blood to the fat cells. For each pound of fat, your body creates 7 miles of blood vessels, and that means your heart has to work harder to pump blood throughout your body. This is part of the reason why obesity is often linked to heart disease, and is also part of the reason why we’re having a salad for lunch.

Complete Article HERE!

20 Interesting Facts You Never Knew

Everyone took a sexual education course in middle or high school to learn about the “birds and the bees.” However, there are a lot of facts that sex ed teachers leave out. These facts are sometimes the most interesting and the most useful in real-life situations. Here are 20 little known facts about “doing it.”

Patterns In Sexual Desire

Most women have an increase in sexual desire around the time that they ovulate each month. This is nature’s way of making sure the Earth stays well-populated.

It Sounds Gross But…

Semen can be great for the facial pores and can even help with acne. The male-produced “facial cream” can also prevent wrinkles.


A Headache Is A Bad Excuse

We’ve all heard the cliche “my head hurts” excuse for turning down sex. However, sex often helps with pain, especially with headaches.

We’re Not Judging

Many straight men enjoy having their anal areas stimulated, and that is totally okay! Sexual experts say that the anal areas are packed full of nerves and can make a male orgasm so much better.

1, 2, 3…And They Keep Coming!

Women can orgasm an unlimited amount of times. Men generally need a period of time after orgasming to recover. However, women need barely any time and are ready to go as many times as they please.

Men Are Erect…A Lot

It is said that many men experience about 11 erections every single day. While they may not be raging every single time, it does happen pretty often.

Celery Can Arouse

Yes, celery. The pheromones in celery can cause arousal in men. In addition to the arousal, the vegetable also makes men who eat it more attractive to women.

The Left Side Is The Best Side

A group of scientists found the upper left quadrant of the clitoral head is the most pleasurable spot to touch. So, it’s okay to tell him to go “a little to the left.” It’ll be sure to make the sex even more enjoyable.

Orgasms Are Different

A man’s orgasm lasts about 22 seconds while a woman’s lasts about 18. It is also very common for it to be uncomfortable to pee after having sex because of an antidiuretic hormone that prevents urine from freely flowing.

Sex Can IMPROVE With Age

Sexual attraction is a life-long drive. The reason most older people don’t have sex very often is that there is a lack of opportunity to have sexual encounters.

Get Your Heart Going

Sex is a great way of getting in your daily cardio exercise. During an orgasm, heart rates can reach between 140 and 180 bpm.


Lube Can Make A Difference

While lube is considered a sex tool for older people, many sexual experts say that a little lubricate can make the difference between pain and pleasure during sex. This doesn’t mean the woman is not turned on. Natural “lube” can come and go without any warning.

Penetration Is NOT The Secret

Most women do not orgasm from penetration alone. The majority of women need some type of clitoral stimulation to reach their climax. It has nothing to do with size or penetration.

Everything Expands

The penis is not the only thing that grows during a sexual encounter. In fact, the testes grow by 50% and the vagina can double in size when aroused.

More Sex Makes You More Appealing

After having sex, a woman’s estrogen levels double. When estrogen levels are higher, a woman’s hair can look shinier and her skin can even feel softer.

Not Only People Can Be Arousing

Some people have sexual attraction to objects instead of specific people. There is a woman known to be sexually aroused by the Eiffel Tower.

Have Sex, Live Longer

Scientists have found that orgasms can actually prolong your life. That’s right, the more sex you have, the longer you can live.

Humans & Dolphins Alike

As far as sex is considered, dolphins and humans have one key fact in common. The two mammals are the only animals in the world that have sex for pleasure.

Sex Everyday Keeps The Doctor Away

Sex can actually help you stay healthy. Many doctors believe this is because sex can lower blood pressure and greatly decrease stress levels.

It’s Like Two Puzzle Pieces

Not every penis, or vagina, is the same. If a guy is too large, women can control penetration by changing positions. If he is too small, there are many toys, etc that couples can invest in.


Chlamydia at 50… Could it be you?

by Jenny Pogson

senior intimacy

If you think only young people are at risk of sexually transmitted infections, think again – rates could be on the rise in older adults.

With more of us living longer and healthier lives, and divorce a reality of life, many of us are finding new sexual partners later in life.

While an active sex life comes with a myriad of health benefits, experts are warning those of us in mid-life and beyond not to forget the risk of contracting a sexually transmitted infection from a new partner.

Figures suggest rates of infections have been on the increase among older people in the US and UK in recent years and there is a suggestion the same could be happening in Australia.

Chlamydia, a common bacterial STI, is on the up among all age groups in Australia, and has more than doubled in those over 50 since 2005; going from 620 cases to 1446 in 2010.

Gonorrhoea, another bacterial infection, has seen a slight increase in the over 50s, rising from 383 infections in 2005 to 562 in 2010.

While these increases could partly be attributable to more people being tested, the trend has caused concern in some parts of the medical community here and overseas.

Cultural shift

Older people are increasingly likely to be single or experiencing relationship changes these days, according to the UK’s Family Planning Association, which last year ran its first sexual health campaign aimed at over 50s.

It’s much easier to meet new partners, with the advent of internet dating and the ease of international travel. Plus, thanks to advances in healthcare, symptoms of the menopause and erectile dysfunction no longer spell the end of an active sex life.

But despite this, education campaigns about safe sex are generally aimed at younger people; not a great help when it’s often suggested that older people are more likely to feel embarrassed about seeking information about STIs and may lack the knowledge to protect themselves.

And, as noted by Julie Bentley, CEO of the UK’s Family Planning Association, “STIs don’t care about greying hair and a few wrinkles”.

Risky sexual practices

Dr Deborah Bateson, medical director at Family Planning NSW, started researching older women’s views and experience of safe sex after noticing a rise in the number of older women asking for STI tests and being diagnosed with STIs, particularly chlamydia.

The organisation surveyed a sample of women who used internet dating sites and found, compared with younger women, those aged between 40 and 70 were more likely to say they would agree to sex without a condom with a new partner.

Similarly, a telephone survey commissioned by Andrology Australia found that around 40 per cent of men over 40 who have casual sex do not use condoms.

While the reasons behind this willingness to engage in unsafe sex are uncertain, Bateson says older people may have missed out on the safe sex message, which really started to be heavily promoted in the 1980s with the advent of HIV/AIDS.

In addition, older women may no longer be concerned about becoming pregnant and have less of an incentive to use a condom compared with younger women.

“There is a lot of the information around chlamydia that relates to infertility in the future, so again for older women there may be a sense that it’s not relevant for them,” she says.

However, the Family Planning survey did find that older women were just as comfortable as younger women with buying condoms and carry them around.

“There’s obviously something happening when it comes to negotiating their use. Most people know about condoms but it’s just having the skills around being able to raise the subject and being able to negotiate their use at the actual time,” Bateson says.

As with most things in life, prevention is better than cure – something to remember when broaching the topic of safe sex and STIs with a new partner.

“If you’re meeting a new partner, they are probably thinking the same thing as you [about safe sex],” says Bateson.

“So being able to break the ice [about safe sex] can often be a relief for both people.”

Stay safe

Anyone who has had unprotected sex, particularly with several people, is potentially at risk of STIs, says Professor Adrian Mindel, director of the Sexually Transmitted Infections Research Centre based at Westmead Hospital, Sydney.

“People who are changing partners or having new partners, they and their partner should think about being tested,” he says.

“Also think about condom use at least until [you] know [the] relationship is longer lasting and that neither of [you] are going having sex with anyone outside the relationship.”

The UK’s Family Planning Association also stresses that STIs can be passed on through oral sex and when using sex toys – not just through intercourse.

It also notes that the signs and symptoms of some STIs can be mistaken as a normal part of aging, such as vaginal soreness or irregular bleeding.

And remember that often infections don’t result in symptoms, so you may not be aware you have an STI. However, you can still pass an infection on to a sexual partner.

So if you are starting a new sexual relationship or changing partners, here is some expert advice to consider:

  • If you have had unprotected sex, visit your GP to get tested for STIs. This may involve giving a urine sample to test for chlamydia, examination of the genital area for signs of genital warts, or a swab of your genitals to test for STIs such as herpes or gonorrhoea. A blood test may also be required to test for syphilis, HIV and hepatitis B.
  • If you are starting a new relationship, suggest your partner also gets tested.
  • Use a condom with a new partner until you both have been tested for STIs and are certain neither of you is having unprotected sex outside the relationship.
  • If you have symptoms you are concerned about, such as a urethral discharge in men or vaginal discharge, sores or lumps on the genitals, pain when passing urine or abdominal pains in women, see your GP.

Complete Article HERE!

A Farewell to a great man

Dear sex fans,

I realize this is a bit off topic for this blog, but I want to acknowledge the death of famed British neurologist and author, Oliver Sacks.

1993: Portrait of British-born neurologist and author Dr Oliver Sacks standing in the admittance driveway of Beth Abraham Hospital with his arms crossed over his chest, New York City. (Photo by Nancy R. Schiff/Hulton Archive/Getty Images)

1993: Portrait of British-born neurologist and author Dr Oliver Sacks standing in the admittance driveway of Beth Abraham Hospital with his arms crossed over his chest, New York City.

In February, he wrote an op-ed in The New York Times revealing that he was in the late stages of terminal cancer, after earlier melanoma in his eye spread to his liver.

“It is up to me now to choose how to live out the months that remain to me,” he wrote. “I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and thought and written. I have had an intercourse with the world, the special intercourse of writers and readers.”

Earlier this summer I read Dr Sacks’s memoir, On the Move.  I love it.  It’s an interesting memoir by a fascinating personality.  And while reading I discovered that we had a dear friend in common, Thom Gunn.  What a small world!  So I decided to send him a note.

Dear Dr Sacks,

I just finished reading your memoir, On The Move.  What an amazing life you’ve lived.on-the-move-by-oliver-sacks

Of all the marvelous things you’ve done and all the fascinating people you mentioned in your book nothing surprised me more than your close friendship with Thom Gunn.  I was a friend of Thom too and I lived directly across Cole Street from him.  I moved to the flat at 1207 Cole Street in 1979.  At the time I was working on my doctorate in clinical sexology at the Institute For The Advanced Study of Human Sexuality in San Francisco.

I didn’t know Thom well at first.  However, I would regularly see him walking both in our neighborhood and elsewhere in town.  He was always in his leathers, rain or shine, and used to think to myself, “What a mensch!”

It finally dawned on me that he lived across the street from me.

Once he saw me in my roman collar.  (I was ordained a catholic priest in 1975 at the age of 25 in Oakland, CA.  I had come out to my local superiors; I was a member of the Oblates of Mary Immaculate, before I was ordained.  Like I said, I was working on my doctorate to become a sex therapist and prepare for an upfront gay ministry.)  Thom smiled at me when he saw me; I blushed and told him what I just told you.  He was fascinated, but I also believe he thought I was a twit.  He probably was right.

I knew nothing about Thom other than he was my neighbor.  Then one day I was in a bookstore on Haight Street and there was a photo of Thom in the window advertising a reading.  That’s when I started asking around about him.  Despite his cult status within the gay community, he was the most unassuming person.  I was honored to have a personal connection with him.small_front

I finished my doctorate in 1981.  My dissertation, Gay Catholic Priests; A Study of Cognitive and Affective Dissonance was directed by Wardell Pomeroy.  A firestorm of media attention followed.  The media branded me as THE gay priest, as if.  I think Thom read about me in the New York Times because next time he saw me he clapped me on the back and said, “Well done.”

No sooner did I complete my doctorate, and because of the media attention my public coming out caused, the leadership of my religious community in Rome began a process of dismissal against me.  I was devastated and lost.  I was even getting death threats.  Thom was always so supportive and encouraging.

I fought the church for the next thirteen years in an effort to save my priesthood and ministry.  Alas, the writing was on the wall back in 1981 and it was only a matter of time till they had their way with me.  I wrote about the travail in a book that was published in 2011, Secrecy, Sophistry and Gay Sex In The Catholic Church: The Systematic Destruction of an Oblate Priest.

Thom was always so solicitous about my wellbeing.  He knew how difficult life had become for me.  And both of us found ourselves on the forefront of caring for friends who were dying of AIDS.  One of my landlords died in 1986.

Thom introduced my housemate and I to Augie Kleinzahler and his girlfriend, Caroline Lander, who lived only a few blocks from us in Cole Valley.  We all became great friends and copious amounts of strong drink were consumed.  I wonder, do you know Augie?

When Thom turned sixty I surprised him with a homemade German chocolate cake.  I told him he was the oldest person I knew.  This made him laugh and he called me a whippersnapper.

In 1992 the surviving landlord sold the Cole Street duplex and I and my housemate moved to Oak and Ashbury.  Sadly, I didn’t get to see Thom as much as before.  I move up here to Seattle in 1999 because I could no longer afford to live in SF.  I was deeply saddened to learn of Thom’s death in 2004.  He was such a great guy, what a marvelous soul.

Again, thank you for your memoir; it was grand getting to know you on a personal level.  I read The Man Who Mistook His Wife for a Hat when it came out in the mid-eighties and loved it.  But I never guessed you and Thom knew each other or that you actually visited him when I lived across the street from him.  What a small world.  I wish I had known you back then.

Anyhow, thank you for the bringing me this unexpected flood of memories of Thom.  I wonder what he would have made of yesterday’s Supreme Court decision (Obergefell v. Hodges).  I contend that we got marriage equality only because we walked through AIDS first.  I think Thom would have agreed with me.

All the best,

Richard Wagner, M.Div., Ph.D., ACS

To my astonishment, Oliver wrote back; I mean that literally, a handwritten note.  Apparently, he never used a computer.

Dear Dr. Wagner (can I say Richard?),                                                          6/60/15

I am greatly interested and greatly moved, by your letter — your courage in being honest and forthright, at a time and on a subject bound, sooner or later, to cause your ejection from the priesthood. In another few years perhaps, with Pope Francis at the helm, these last bastions of Catholic bigotry may have fallen.

I like to think of you as living across the street when I visited Thom, and glad to know that he appreciated you and your works. I still miss him deeply — there were not too many people with whim I could be entirely open — and I like to think that his ghost is pleased that my title came from his poem. (I find it a huge relief being open now to all and sundry {Oliver came out earlier this year} — I am so glad I completed my book before I became ill).

And what a liberation, an affirmation for us all that the Supreme Court voted as it did. I suspect that Ruth Bader Ginsberg, quite ill now, stayed on to ensure the 5/4 decision.

Thanks for your letter and my very best wishes,


Oliver Sacks01     Oliver Sacks02

Click on this link to see a copy of Oliver Sacks’s note.

Thank you Dr Sacks and farewell!

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