Search Results for: Book Review: Wise Men

I have a strange literary compulsion, and I want to share it with you, even as I have decided to give it up.

About every five years, a literate and compassionate doctor discovers that modern medicine has no rational or humane way of dealing with death. This causes many people to die expensively and without comfort, meaning or control. A few years ago, it was the late Sherwin Nuland’s best selling book “How To Die.”

This year, it’s Atul Gawande best-selling book “Being Mortal.”

Critics and readers love it. When I first wrote about it, I got hundreds of messages telling me what a wonderful book it is. I went down to Battenkill Books with Red and I bought it.

Some of my critics suggest I am arrogant and have a big and willful ego, I fear this is true, mostly, I think it is really just hubris and some conceit. I like to think in my hospice work and reading that I am somewhat superior to others, I am willing to face mortality and death when others are not.

Of course, as I get older and more and more mortal myself (death is not so abstract any more),  I come to see that I am just foolish. Sometimes, it is very smart to be oblivious.

The ostrich gets a bad rap in the time of corporatized 24 hour news.

On the way home, I asked Red, who was sitting in the back seat staring at me balefully – yes, I often talk to Red, he seems wise and is a good listener – “why am I buying this book and why am I reading it?”

Good question, I imagined him replying, if he had words.  It probably says that dying is sad, he said, painful, difficult and inevitable, and that when it is time for you to die, your suffering will be made much worse by being in a hospital and nursing home, in the care and control people whose only idea is to keep you alive and suffering and suffering by all means at any cost for many more years than is natural or healthy or than you wish to be kept alive for.

I laughed, don’t be cynical, I said, I want to face death head-on, I don’t want to hide from it, as many people do. I want to know what I need to know.

So I sat down that night with my reading light and a cup of tea and a bowl of popcorn and I plowed right into “Being Mortal,” just as I had “How To Die” some years earlier and a half-dozen books before that. I am quite up on my literary compassionate doctor death books, it is a genre all its own. Our culture doesn’t want to know anything about death, but publishers do.

Of course by the second chapter, I knew Red was right. I see that these books are not different books at all, but they are all editions of the very same book, they just put different names and covers on them to fool witless people like myself, who think they are preparing themselves for death, but who are, in fact, just preparing themselves to get depressed about it.

Dr. Gawande is a good writer, but his book didn’t prepare me for how to die well, unless you count making me think about shooting myself. The funny thing is that I hardly ever think about death or get depressed about it unless I am reading a book by a doctor about it.

By Chapter Five, “A Better Life,” I closed the book for a minute and told Red I ought to prepare him for the inevitable fact that I needed to find a cliff to jump off of when the time comes. Dr. Gawande describes in unsparing and meticulous detail – as did all of his predecessors – what occurs when the human body falls apart and disintegrates to the point that it can’t function any longer.

There are even some simple drawings to help us understand this.

One graphic shows that 100 years ago, most people died very quickly. The chart shows a horizontal line, dropping sharply straight down around age 50.  People didn’t waste as much time or money suffering then, says Dr. Gawande, they just got sick and had the good graces to die.

That was before anti-biotics, giant pharmaceuticals and corporate medicine.

In our world, we spend a lot of money keeping people alive so long we resent them for it and they resent us for doing it to them.

Today is different. People live nearly twice as long. And they rarely die at home. Corporations have taken over death, like everything else, it is a big profit center.

There is another graphic, a shorter horizontal line followed by a very curvy line that goes on a long way, this represents the new up-and-down cycle of death, which can go on for decades. Most people don’t die at home any more, the doctor points out. Regulations, technology and medicine make it too complex for most family members to care for people with so many problems – heart and blood pressure, bladder and circulation, respiratory and eye diseases, falls and tumors, wheelchairs, walkers, catheters, monitors, medications,  diapers  – so they have to go to nursing homes or hospitals.

There, they can expect to be kept alive forever without consent or consultation, on medicines and surgeries that hurt, cost a fortunate, and can’t ultimately change the outcome, only postpone it. Medicine becomes a heartless and mindless system, pressing ever onward.

You can stay alive, Dr. Gawande says, but you will most likely regret it and be depressed about it.  There is not one happy or satisfied old and dying person in this book, no matter where they are. Maybe death just sucks, no matter how  you do it.

If there is a bright spot in the book, it is hospice, a shining light, the best hope for people who wish to die comfortably and with some control over how they leave the world.

Towards the end of the book, Dr. Gawande describes the death of his own father.  I got silly again, thinking that his father, of all people, would surely have found a good way to die. But no, he just suffered  terribly at home. I started thinking about shooting myself again.

The book is filled with many beautifully written horror stories delineating in exquisite detail just how much the body deteriorates later in life, how little can be done about it, and how long we now suffer in our system of health care.

And here’s the good news:

“Being mortal is about the struggle to cope with the constraints of our biology, with the limits set by genes and cells and flesh and bone,” says Dr. Gawande. “Medical science has given us remarkable power to push against these limits, and the potential value of this power was  a central reason I became a doctor. But again and again, I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always will be,” writes Dr. Gawande, who teaches at Harvard.

And that is the good news. I have to tell you, I have read this book before, I know it. Many times.

“The thing is,” I told Red, “is that I know all this. I think just about everybody who has ever been to a doctor’s office or had a sick grandmother knows this. Do I really need to know more about how my body and organs will deteriorate until I am nearly unrecognizable, do not know my own name,  think William McKinley is president,  am not able to pee, breathe by myself, move my bowels or even get to the bathroom, walk across the street, or dress myself?

Some years ago, a writer, a good friend of mine, decided to take her own life when she was 75, she took some pills and put a plastic bag over her head and wrote some letters to friends, including me, explaining her decision. She didn’t want to get any older in America, she wrote. She wanted to leave life behind while she was strong enough and clear enough to do it. Many of her friends were outraged at her decision.

At the time of her death, she was healthy, successful, much loved. I think I understood it. Good for her, I thought.

Dr. Gawande doesn’t really go near this topic, he kisses it off in a few paragraphs and dances around it, as doctors do, but his own book makes a perhaps unconscious and compelling case for how my friend chose to deal with death.

No discussion of death makes much sense if we are not all given the right to decide for ourselves how long we should live at the end of our natural lives. Our lives are the most precious things we shall ever own. Doctors do not own my life, neither do politicians or bureaucrats.

The issues involved in aging and death or so complex, convoluted, expensive and controversial – and so corrupted by big money and politics and big government – that there is absolutely no prospect the process will be changed significantly in my lifetime. I can read all of the death books that I want, but i know what they say now.

So it’s up to me to figure out how to die well. I don’t honestly see me shooting myself, it is far too messy and disturbing to others,  hopefully I am more creative than that. I know a poet who lived to be 94 and decided to stop eating, he just drank water and ate some oatmeal, he passed away peacefully in a few weeks at home and in bed and without pain. It was as simple as that, and he needed no permission from anyone but his wife.

Perhaps you have to think outside of the death box to do it well.

I like the eating of not eating. In a nursing home, they would never let you do it.

Maybe the point is that you can only prepare so much for death, and when it comes, just hope it comes quickly and do what you can to not prolong it. After all of this thought and reading, that’s as far as I have gotten.

I read these death books in the belief that I need to face death and understand it, but the books all remind me that there really is no simple or beautiful way to work it all out in advance, unless you put a bag over your head or get very lucky. There is too much about life – and death –  that is unpredictable and beyond our control.  I suppose that is the real lesson for me. These books are very well done, but I am not sure why people love them so much.

For sure, they are depressing.

“Being Mortal” is a very good book written by a very good and caring doctor. It is chillingly explicit and convincing. In all honesty, I can’t find much new ground in it, everybody with an older relative or parent knows this very troubling truth. I wish he had some practical ideas for fixing it.

And unless you are the Dalai Lama, you might just end up wanting to shoot yourself or put a plastic bag over your head,  and for only $26. No rational person wants to face the choices and the life Dr. Gawande describes in his  No. 1 New York Times best-selling book.

You can get depressed for free these days, just watch one of the presidential debates.

“So,” Red asks me from the back seat once more. “Does anything change after these books come out?”

“No,” I said honestly, you can’t lie to Red. “Nothing changes.”

For now, I think I’ll focus for now on living well, not dying well.  Red was right. I don’t need any more death books.  I’ll handle it when the time comes, hopefully a little sooner. In the meantime, I”ll just keep some distance from the people who want to help me die for profit. I’ll go back to Battenkill Books tomorrow and buy a new mystery.

I admire the writing of Ta-Nehisi Coates. He has been writing essays and blog posts on race and other issues for the Atlantic for several years now.

I have a soft spot for people who write unpopular, unconventional, sometimes harrowing truth. Who are not afraid to think and make me think.

Coates, the author of Between The World And Me,  manages to be provocative without being arrogant, defiant without being angry. More than any journalist, he has been helpful to me as I struggle again to understand the racial trauma that seems so deeply embedded in American life, and recurs and recurs, our national nightmare.

I sometimes think I understand it,  but Ta-Nehisi Coates reminds me in a very powerful way that I cannot and do not.

There is very little I can add to the raging discussion about race and America, and I don’t propose to do that here on my blog. I’m not a pundit or activist or sociologist.  I’m writing this review to talk about my personal reaction to this book and perhaps to help you if you wish to read it.

I have lived around black people for most my whole life, in one way or another –  schools where I grew up in Providence and Atlantic City, work and life in Philadelphia, Boston, Washington, the integrated community of Montclair, N.J., as a journalist in many different places covering riots,  violent crime, gang warfare,  politics, and the police. They were always a part of my landscape. They are not now.

Since 2003, I have lived in upstate New York writing books and this blog about animals and rural life,  there are only a handful of people  here of any color, and so I watch the wrenching racial divide from a distance.

I feel sometimes I have lost touch with it, how could I not? Assuming I ever really grasped it in the first place, I think I did not. If you wish to get in touch with it, this book is a good way to start.

This is not really a book for people like me to agree or disagree with, that seems somewhat presumptuous, given where I am and what I do. But I couldn’t stop reading it, I could not put it down, and that doesn’t happen often. For the first time in my memory, I feel I had some sense of what it is like to be an African-American father or son in this country right now. What it means to live in dread and fury at the world around you. I understood intellectually what the rage is about, after reading Between The World And Me,  I felt it viscerally and emotionally, in the gut. For all the millions of words written and argued about race, Coates made me feel it.

I am so sick of the screaming jackasses that pass for commentators on cable TV, and the raging blockheads online,  it is a gift to know people like Coates are still writing.

I will be honest and say that I do not believe I have the tools to fully comprehend what it is like to be black in America today.  Between The World And Me is on every list there is of the best books of the year, usually in the number one spot. I started reading it at midnight last night and finished it at 4 a.m. I was not able to put it down. It is a short book, 152 pages. Toni Morrison blurbed it on the cover, she said “this is required reading.” I agree with her, I hope everyone who is interested in American life, past, present and future will have the opportunity to read it.

Coates was inspired to write this book after reading James Baldwin’s The Fire Next Time, one of the first classic explorations of black rage and pain. Baldwin’s book was written to his nephew,  Coate’s book was written to his 15-year-old. He sets the tone near the beginning when his son watches in tears while he learns that the officer who killed Michael Brown in Ferguson, Missouri will not be prosecuted for the shooting. “I have to go,” the son says simply, and goes to his room.

Coates has a very different perspective than Baldwin, who published The Fire Next Time in 1963. Both books offer blunt advice about how to survive in an often dangerous and hostile world with black skin.

Baldwin pleaded with his nephew to awaken to his own dignity and power, and help America live up to it’s potential and claim to be a just and free nation.

Coates son is struggling to understand what he sees as extreme recurring racial murder and injustice – one shooting of unarmed black people after another.  “I write you in your 15th year,” Coates writes, “And you know now, if you did not before, that the police departments of your country have been endowed with the authority to destroy your body…I tell you now that the question of how one should live within a black body, within a country lost in the [American] Dream, is the question of my life, and the pursuit of this question, I have found, ultimately answers itself.”  This book does not pretend to be either balanced or hopeful.  It is dangerous, Coates tells his son, to believe in the American Dream, to fall for it. “Historians conjured the dream,” he writes, “Hollywood fortified the dream. The Dream was gilded by novels and adventure stories.”

Coates tells his son: “Here is what I would like for you to know: In America, it is traditional to destroy the black body – it is heritage.” That is not an idea anyone ever taught me in history class.

There is much pain in Between The World And Me. No hope, really, no suggestions or ideas for resolution.  I was disappointed by that, it made me sad. I was weaned and fed on The Dream.

Coates is a wonderful writer, he is profoundly thoughtful and insightful. And although the book was clearly written for black people, not for whites – many whites are reading it. It helped me to stand in the shoes of a black father terrified that his son might go out to buy a soda and be gunned down for no reason. And that the people who did it – police or private citizens – are not likely to ever be punished. That feeling would certainly and radically shape my view of my country and my life there.

Like most white people, I do not see myself as a racist,  I think other people are racist, even though I have seen firsthand that few racists would describe themselves that way.  No one I have ever met admits to being racist, it is a hateful label. Yet Coates and so many others tell us racism is epidemic and nearly universal. You can do the math yourself.

I think that racism is quite often an unconscious affliction, a learned behavior, an acceptance of awful realities. And I was somewhat deaf and blind to this widening African-American vision of America as an oppressive and murderous place. That would mean that I am a racist. I guess I have long understood that racism is deep and embedded, not just a string of  hateful comments and brutal incidents captured on videos and TV.  Racism permeates all of life – school, politics, government, real estate, business, law enforcement.

But I never quite accepted that, I suppose I didn’t really want do. I still don’t really want to.

America has been good to my ancestors, good to me. I have never been afraid of the police, I have always seen them as saviors, someone to call when I need help. The police officers I covered and know have been good people, not mindless murderers. My grandmother didn’t see them that way, she thought they were frightful and dangerous agents of the state, never to be trusted.

I hate to see them the way Coates and so many others now see them. But I also want to handle the truth. My ancestors know what it is like to be terrified of the police, and after reading Coates book, I am reminded that this is the reality for black people.

In my years as a police reporter, I saw how ugly and difficult and frightening the work of the police can be. It is easy to judge them, but like racism, not so easy to really understand them or the true and dehumanizing nature of their work. Still, the images and videos I have seen this year have shaken my somewhat removed and complacent view of the world. I think I do understand where Coates is coming from. He is not seeking my approval or blessing, one reason he can write so authentically. Empathy is all about being able to stand in the shoes of another, and if you read Coates book, I can almost guarantee that you will be able to do that to some degree. That is an amazing achievement for any writer.

There is a lot of powerful writing and reading in Coates journey from the dangerous ghettos of Baltimore (white parents don’t have to tell their sons to be “twice as good” to survive, he tells his son) to the top of the media and publishing pile in New York City. Coates has a big soapbox now, he is a favored of tv talk shows, and he is committed to using his soapbox in an authentic and thoughtful way. He believes the very structure of the American Dream was built on slavery and racism, he sees no evidence that anyone in the business or political community – or many American citizens – are committed to stopping the killings, mass incarceration, educational and social crises of the African-American community and its  young men.

There is no greater evidence of systemic racism, he argues, than the fact that nobody seems to care about the violence, poverty and brutality of these lives. Is he wrong? I have yet to see the crisis engulfing black youth mentioned by even one candidate in all of the debates.

Coates sees racism as a strong of government policies, police brutality, the indifference and arrogance of the white establishment. The white world, he writes, has turned his back on the horrific life of so many black men, trapped in violent ghettos with no way out, locked up in jails, ignored or rejected by the educational system, unable to find work or live away from danger. This, he suggests, is not an accident, but a system that dates back well before the birth of the United States.

For me, the most powerful passage had to do with a polite, generous, much-loved Howard University student named Prince Jones, a friend of Coates, who went to the same college. Jones came from an upwardly mobile African-American family. His mother was a radiologist who raised herself out of poverty in rural Louisiana. She gave her son a Jeep to take to school. Jones could have gone to almost any school in the country, he chose Howard, a black college.

One day Coates got a telephone call – it shocked him to his very soul – telling him that Prince Jones had been shot and killed by a police officer in Virginia. The plainclothes and undercover officer – he was working on a drug case – claimed Jones tried to run him over with his Jeep. There was no evidence of any kind that Jones had drugs in his possession or had used or sold them, he had never committed a crime or been arrested for one.

A jury awarded the Jones family $3.7 million in a wrongful death trial and verdict. The official police version of the shooting describe it as a surveillance operation “gone bad.”

The officer was never reprimanded or arrested or removed from the police force for shooting Prince Jones. Like so many other people this year, I watched in disbelief as a police officer shot a fleeing black man in the back eight times. I watched the video of a Chicago police officer shooting a young black man 16 times as he lay in the street. It took the authorities a year to figure out the shooting was a crime.  I read about the young girl who moved to Texas to work, was pulled over for a minor traffic violation and killed herself  in a dingy jail cell three days later. These are not arguments, these are powerful messages from a kind of Hell I didn’t really think all that much about. I am thinking about it now.

Towards the end of the book, Coates travels to a Philadelphia suburb to talk to his friend’s mother, a dignified and respected physician.  “He had means, he had a family. He was living like a human being. And one racist act took him back. One racist act. That’s all it takes.” In this book, the racist acts add up, they are as wrenching as they are damning.

I can only imagine how I might have responded to the death of Prince Jones if he were my son or friend. I am not where Coates is in all of this – really, how could I be?  We come from different places.  We are a rich and powerful country, we can a lot of things, if we have the will.

But I can’t dismiss or criticize him either. If I were black, I can well imagine saying the very same things to my son.

When I first read Baldwin’s book back in the 60’s, I was inspired by it, I was eager to support any movement that supported human dignity and power, I thought I might actually be a part of it.  Baldwin was challenging people like me to be a part of it. But I see that things have moved past that, we are in a different reality. Coates does not offer me or people like me any role,  really,  that might help or support his son or other sons.  He is not asking for help, he doesn’t seen to think anything will really help.

That is disappointing. I never articulated it, but I thought things were getting better. Some things are better. Many awful things are not.

But it should be remembered that Coates is not writing from the fringes, but the mainstream. His publisher for this book is Spiegel & Grau, an imprint of  the largest commercial publisher on the earth – Random House.  He works for the influential and mainstream Atlantic Magazine. He does not seem to have left the Dream completely behind him. Coates writes like a genius, you will be hearing a lot from him down the road.

For me, the bottom line is this:  I came away with a powerful feeling of truth as I sat up most of the night reading this book. His writing made me think and it made me feel, the two things all great  writing should do.

Talking about race is hard, and so is writing about it. Everybody says we need a dialogue, but everyone is either screaming or hiding when the subject comes up. Political correctness is, in fact, a noxious thing, as is racism. It is a killer of free speech and thought. Whatever we are feeling about it, we need to say it out loud, and that is triumph of Between The World And Me. Coates is speaking his very powerful truth.

I was profoundly shocked by some of the videos and images and stories I have seen last year, I am sorry for the death and suffering, but I am grateful that there is now a robust national debate and understanding of things that need to be changed. If Coates is right, the system is so heavily invested in racism it will never change.

I can and will support people who will advance the chance to change and acknowledge the need for it. I have learned in my own life about the power of photography over words sometimes, and new technologies have made it possible to awaken those who wish to wake up. It is time. Blacks were slaves – for 250 years – a lot longer than they have been free.

If life for Coates son and for the sons and daughters of other black mothers and fathers changes because of all this, then there will have been some purpose to all of the pain and suffering. If it doesn’t change, then there is good reason to fear for the country that saved my grandmother and so much of my family and gave them lives of peace, opportunity and freedom. That is, after all, the Dream, and if it doesn’t work for everyone, then it doesn’t ultimately work for anyone.

The immigrant experience is very different from the slave experience. It is not the same thing. The racial divide is very deep and very real, for so many people, and also for me. Coates describes in compelling detail the horrors that face so many young African-American men in America. I am not going to join any mob and shout my confessions of racism to the rafters, yet I think it starts there, much as it begins for alcoholics in AA. I think it lives in all of us, in the culture in which we were raised, in the country we claim to love.

Race matters. I live here too, I care about my country, if I understand nothing else, I understand the horror of living in fear and hatred. I don’t ever want to look away from it.

Like, Between The World And Me, ($24.00, Kindle $11.99) I don’t have any powerful epiphanies to share about race in America, I have no great solutions to offer. I am wiser, though, and smarter for reading this book. I felt it quite deeply. I agree with Toni Morrison. Between The World And Me ought to be required reading.

_

This book can be ordered through Battenkill Books, my local bookstore, a great independent bookstore. You can call 518 677-2515. Ask for Connie.