Being Mortal, by Atul Gawande

Subtitled Medicine and What Matters in the End, Being Mortal is a clear-eyed examination, illustrated with cases from surgeon-author Gawande's practice and family, of the disservices our culture--particularly our medical culture--does to the elderly and the terminally ill. The first part of the book deals with aging and how we can best care for people who have become unable to care for themselves. Gawande provides an overview of the history of elder care and discusses innovations of the past several decades, including the original concept of assisted living and the move to create small communities of frail people living on their own schedule rather than being regimented to meet the needs of a large elder-care facility. Gawande stresses that the goals of family and physicians--to keep the frail elders safe--are not necessarily aligned with the desires of the people themselves, which may be to maintain some control over their own lives or to feel that their lives still matter. This distinction is important, but (speaking as someone with a parent in assisted living) not always easy to be responsive to.

A similar distinction is at the heart of the second section of the book, in which Gawande examines how doctors react to terminal illness. Trained to fight death to the bitter end, doctors may cause unnecessary suffering and undoubtedly drive up medical costs by putting patients in intensive care rather than letting them live out their last days at home or by recommending additional rounds of chemotherapy that are almost certain to be ineffectual. Gawande suggests that doctors need to move beyond the two models of physician behavior in which they were trained--the doctor as all-knowing "godlike" expert who tells patients what to do or the doctor as informer who gives the patient the options available and then instructs the patient to decide what course to follow. Instead, he recommends that doctors ask patients what their goals are and then, with the patients, determine a course of action that will help them meet those goals. Although he started as something of a skeptic, after spending time with hospice staff, Gawande also advocates for hospice care as an option that can alleviate suffering and help patients live and die as they wish.

At the end of the book, Gawande briefly discusses euthanasia.

Being Mortal presents a variety of ideas that should be of particular interest to physicians, those advancing in age (such as myself), and those with elderly parents or terminally ill relatives. I noted that the reviewer in the New York Times expressed skepticism about some of Gawande's claims and citations, but I didn't read the book as a scientific study but as one doctor's journey to a new way of thinking about end-of-life decisions. As such, I thought it was effective and well-written with case studies that touched the heart.

I should note that I listened to the audio version of the book, ably read by Robert Petkoff. Since I have had trouble getting through a couple of print books on similar topics, I am developing a hypothesis that listening to this emotionally challenging material may be easier than actually reading it.

Favorite passage
In the end, people don't view their life as merely the average of all its moments--which, after all, is mostly nothing much plus some sleep. For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments, the ones where something happens. Measurements of people's minute-by-minute levels of pleasure and pain miss this fundamental aspect of human existence. A seemingly happy life may be empty. A seemingly difficult life may be devoted to a great cause. We have purposes larger than ourselves.

Dear Committee Members, by Julie Schumacher

The protagonist of Dear Committee Members--or, since this is an epistolary novel, the epistolarian--is Jason "Jay" Fitger, writer and English professor at a "second-tier" Midwestern university whose support for the liberal arts is dwindling. A graduate of a prestigious writing workshop known as the Seminar, Jay has published several novels to ever-decreasing critical and public acceptance. Working in the midst of a building under renovation (but only on the floors housing the Econ Dept.), Jay cranks out a plethora of letters of recommendation (LORs), which make up the text of the book. He recommends faculty colleagues for awards and appointments and students for jobs, graduate school, and psychological counseling. The through threads in the novel are (1) Jay's effort to find support for one particular graduate student, Darren Browles, who is working on a novel based on Melville's Bartleby the Scrivener, but set in a Nevada whorehouse, and (2) his attempts to improve relationships with his ex-wife and former lover, both of whom work on the same campus in positions to make decisions affecting Jay's students.

Jay's letters of recommendation are unusual. First, he does not hesitate to write honestly of mediocre students: "Mr. Trent received a C- in my expository writing class last spring, which--given my newly streamlined and increasingly generous grading criteria--is quite the accomplishment. His final project consisted of a ten-page autobiographical essay on the topic of his own rageful impulses and his (often futile) attempts to control them. He cited his dentist and his roommate as primary sources." And another: "If Selebritta Online is in need of an editor/copywriter who refuses to allow the demands of honesty or originality to delay her output, it will have found one in the unflappable Ms. Tara Tappani." Second, Jay simply cannot resist the urge to comment disparagingly on the state of the academy, halfheartedly promote his own novels, and ruminate wistfully on his days at the Seminar.

The letters are very funny, in part because of such details as the names of companies to which English majors are applying for jobs (Avengers Paintball, Flanders Nuthouse, Catfish Catering), the topics of papers written by students (one student receives an advance for a novoir or memel--a combination novel and memoir--about her childhood as half girl/half cheetah), and Jay's complimentary closes ("Hoping to maintain a distance of at least one hundred yards," "Yours in digestive health," "With candor, regret, and a whiff of vengeance"). The satire of academic life, while broad, is also effective. Surprisingly, however, the ending is sad, reminding us that the young people for whom Jay writes LORs are, while perhaps not scholarly geniuses, human beings.

Definitely recommended--especially for anyone in academia or publishing.

Favorite passage
What, after all, is a writer's life without a dose of despair? The point is that literary endeavor has always been riddled with frustration but in recent years has become increasingly formidable; ergo my revulsion for programs like yours that, under the false pretense of support, function as succubi draining the bank accounts and lifeblood of unsuspecting students . . .  [Remember, this is a letter of recommendation!]

Fall will arrive soon enough, with requests from students trickling in via email, and the trees that shade Willard Hall flushing red at the hem. There is nothing more promising or hopeful than the start of the academic cycle: another chance for self-improvement, for putting into practice what one learned--or failed to learn--during the previous year.    [From a more serious letter at the end of the book]

Hush, Hush, by Laura Lippman

In recent years, Laura Lippman has focused primarily on stand-alone mysteries rather than her Tess Monaghan series--but Tess is back in Hush, Hush. Now the mother of a three-year-old, she has a partner--Sandy Sanchez, the cold case investigator from After I'm Gone, whom I predicted might become a recurring character ( see http://novelconversations.blogspot.com/2014/02/after-im-gone-by-laura-lippman.html for proof of my foresight!).

Hush, Hush revolves around Melisandre Dawes, a woman found not guilty by reason of insanity for killing her infant daughter. After more than a decade, she has returned to Baltimore to reunite with her daughters and make a film about the insanity defense, which she feels is misunderstood. She has engaged a down-on-her-luck documentarian, Harmony Burns, to help her, and transcripts of Harmony's interviews for the documentary are interspersed throughout the text. Tess and Sandy have become involved because Melisandre is worried about her security and has asked her old boyfriend (and Tess' uncle) Tyner Gray to help. Tyner arranges for Melisandre to hire Tess and Sandy to make a security assessment for Melisandre. Soon enough, however, they are investigating another death in the Dawes family.

Hush, Hush is almost overcrowded with characters vying for the reader's attention--Tess, Crow, and daughter Carla Scout; Sandy; Tyner and his wife Kitty, who is not happy with Melisandre's intrusion in their lives; Melisandre and Harmony; Melisandre's surviving daughters Alanna and Ruby, both of whom have troubles of their own--and their stepmother Felicia. Sandy, for example, plays such a small part that you wonder why Lippman introduced him to the mix (other than to keep him alive in our imaginations for a later book in which he'll have a bigger role?). Lippman also may have included one too many subplots. Still, Hush, Hush is better than most series mysteries at an advanced point in their development. An entertaining diversion.

Favorite passage:
Baltimore had always had a scruffy side, but it had felt vibrant, a lovable mutt of a city ready to play or brawl.

[Hush, Hush follows on A Spool of Blue Thread--both set in Baltimore by authors who love the city. I'm also in the midst of watching The Wire, so Baltimore is definitely on my mind at the moment.]

A Spool of Blue Thread, by Anne Tyler

Eccentric Baltimore families populate every book of Anne Tyler's I've ever read, including A Spool of Blue Thread. In this case, it is the Whitshank family--Red, Abby, and their four children, as well as Red's parents Linnie and Junior, who built the family home that is essentially another character in the story. Because the novel's first focus is Red and Abby's most troublesome child, Denny, the reader gets the faulty idea that he will be the protagonist (and, in those early pages, I was disappointed because I felt Tyler was repeating herself). In fact, however, his story is just Tyler's first example of the book's intriguing themes--that we shape the stories we tell others and ourselves about our lives to approximate what we want them to be and every member of a family tells a different story about the same events. Abby's story about Denny is that he sucked up a disproportionate share of his parents' attention, leaving the other three children somewhat neglected, while Denny's story is that his parents cared more about his younger brother Stem than about him, pushing him aside when the perfect Stem joined the family.

Sibling rivalry comes to the fore as Red and Abby start to deteriorate--Red has a mild heart attack and Abby begins having memory problems that resemble the aftereffects of a stroke. Stem, his wife Nora, and their three boys decide to move in with Red and Abby so Nora can keep an eye on Abby and take over the housework and cooking. Then Denny shows up to help, carrying little physical baggage but a huge psychological load comprised largely of resentment toward his parents and his brother. Tension increases until a climactic event  occurs--but there's still a third of the book remaining, so where will Tyler go next?

Surprisingly (to me at least), she goes back in time to recount various versions of the staples of family history--how Red and Abby fell in love and how Junior and Linnie became a couple. The two perspectives on  Junior and Linnie's story are especially surprising, giving readers new insight into Junior's obsession with the family home and deepening awareness of the theme. The final section of the book returns to the present, revealing that--despite conflict and trauma--no one is significantly changed. We are, in essence, who we are.

One of Tyler's great strengths is capturing the craziness of family conversations, people talking over one another, subjects suddenly veering in unexpected directions, the hard-of-hearing parent illustrating all too literally that what is said is not always what is heard. Her description of a funeral is both hilarious and heartbreaking. As someone who has experienced divergent memories of shared history, I also enjoyed the opportunity to think about the themes Tyler explicates. The longer I stuck with the book, the more I relinquished by irritation and enjoyed Tyler's work.

Favorite passage:
But it has occurred to me, on occasion, that our memories of our loved ones might not be the point. Maybe the point is their memories--all that they take away with them.

But it was easier, somehow, to reflect on them all [Abby's children] from a distance than to be struggling for room in their midst.  [I think my mother may have occasionally felt this way about her children!]

One thing that parents of problem children never said aloud: it was a relief when the children turned out okay, but then what were the parents supposed to do with the anger they'd felt all those years?

The Train of Small Mercies, by David Rowell

It is the day of Robert Kennedy's funeral, and people along the mid-Atlantic are preparing to view the train carrying his body from New York to Washington, DC. The Train of Small Mercies provides glimpses of what is happening to some of those people, using the device of telling a story from each state along the route. In New York, college student Lionel is preparing for the first day of his summer job working on the train--by coincidence the very train carrying Kennedy's body. Lionel's mind is occupied with his girlfriend, who has just told him she is pregnant, and he can barely focus on the instructions provided by the older black men who have worked the trains for decades. At the other end of the line, in Washington,  Irish immigrant nanny Maeve's job interview with the Kennedy family has been postponed, and she relies on the concierge at her hotel--the first African American man to hold the job--to advise her what to do. Between the two ends of the journey, a woman sneaks away from her husband, who disliked RFK, to see the train, but her daughter is injured, casting an even greater pall over the day. A boy just returned from being kidnapped by his father reenacts the shooting with his friends. A Vietnam vet who lost a leg in combat is interviewed by an old classmate, now an intern at the paper, about his experiences, as his family hovers protectively nearby. And a suburban man who has just gotten an above-ground pool is disappointed that his first pool party does not go as planned. Each story is visited numerous times, though equal attention is not directed to the six.

Rowell's book was inspired by a collection of photographs of the funeral train and it has the feel of a series of snapshots--quick glimpses into lives touched by the historic event. Rowell also does a good job of capturing the turmoil of the time--Washington, DC, is a scary and violent city; race relations are troubled, as are gender relations; Vietnam divides the nation; the nation is in a state of shocked grief following the assassinations of Dr. King and Senator Kennedy. The snapshot quality of the book also accounts for its less satisfying aspects, as none of the stories are resolved in any way. While I understand that resolving them would not have been in keeping with the novel's structure, I still found the lack of resolution frustrating.

On a side note, I had my own experience with the RFK funeral. My family arrived in Washington, DC, on the day of the funeral, and our hotel room had been given away to press (I guess reservations didn't mean too much then). We found a motel in Arlington. The next day we went over to Arlington National Cemetery and saw some members of the Kennedy family visiting the grave. Days later at a White House ceremony, there was no acknowledgment of the recent tragedy (at least that I remember, although the event has a surreal quality in my memory, so I'm not sure I really remember much).

The Hand That First Held Mine, by Maggie O'Farrell

The Hand that First Held Mine is my second Maggie O'Farrell novel and I seem to see a pattern emerging. There's a mysterious element to the story--not in the whodunit sense, but in the missing pieces of a puzzle sense. When the mystery is resolved/the puzzle completed, the theme that emerges is the toxic effect of family secrets. And everything is presented in rather elegant prose that captures place  particularly well.

Here part of the mystery is what links to two halves of the novel together. One half, set following World War II, is the story of Lexie Sinclair, a young woman who has been expelled from college right before her graduation because she walked out of a building through the men's only exit. Fleeing her family's quiet country life, she moves to London and becomes a journalist under the wing of Ennis Kent, who becomes both lover and mentor. The second half focuses on Ted and Elina, an unmarried couple who have just gone through the traumatic birth of their first child, during which Elina almost died. Elina is incredibly weak and has completely forgotten the birth. For Ted, fatherhood loosens fragmentary memories that seem to threaten his sanity. What those memories mean is the second and related part of the novel's mystery.

One description called the mystery's resolution a "tremendous revelation." Unfortunately, I cannot agree--by the time the revelation came, I had known what it was going to be for some time. That doesn't mean I didn't admire parts of the book. The story of how Lexie evolved from a naive country girl to an accomplished journalist in a time when that was not an easy path for women was inspiring. I also found O'Farrell's description of the brain fog that envelops Elina after her traumatic birth experience compelling. In essence, I enjoyed parts of The Hand That First Held Mine almost as short stories. As a novel, however, the book was not as rewarding.

Favorite passage:
There on the landing sits the typewriter. It is clogged with dust, the ribbon dried and flimsy. Looking at it gives Felix a feeling close to vertigo. He realises he can replicate in his head the exact sound it used to make. The clac-clac-a-clac of the metal letter hitting the paper, the ribbon raising itself each time to make the impression. The machine-gun fire of it, when the work was going well. The stops and pauses when it wasn't, to allow for a sign, a draw on a cigarette. The ding every time the carriage reached its limit. The whirr as the page was snatched out, then the rolling ratcheting as a new one was wound in.

One Day, by David Nicholls

I'm not sure why I downloaded another David Nicholls book to listen to when I wasn't too keen on Us, which I had "read" just a few weeks ago, but when you're checking out audio books on line, you don't always have a great selection, so . . .

One Day is the story of Emma and Dex, who find themselves in bed together (though not having sex) the night of their college graduation in 1988. Emma is a serious girl--perhaps too serious--and Dex is a golden boy. However, as Nicholls checks in on their lives and friendship once a year, on the anniversary of that first night spent together, Emma gradually fights through a series of bad jobs and a few bad boyfriends to find success, while Dex, who has some early success as a television presenter, spirals downward into alcoholism and drug abuse.

When the book reaches what seems to be its climax, Nicholls doesn't wrap it up, instead returning to the days following Dex and Emma's first meeting, as well as extending forward a few years in anticlimactic fashion.

While Emma is a fairly likable character, one has to wonder at her loyalty to Dex, who is thoroughly disagreeable. Despite some humor, it's a relationship that offers little reward to the reader (or at least this one). Hmm...a disagreeable main character, humor that fails to redeem--sounds a lot like Us.  I think this will be my last David Nicholls.