Archives for posts with tag: Dying

This debut novel by the Norwegian author Kjersti A. Skomsvold was my second read on the IMPAC Dublin literary award shortlist.

An intriguing and intense book, I liked it when I read it, and it has lingered much in my thoughts ever since.

The central character is Mathea Martinsen, an elderly widow who lives alone, leading a solitary and almost agoraphobic life, “I Mathea am alone”. The details of her life are subtlely revealed, interspersed with Mathea’s own musings:

‘I never got the point of flowers, they’re just going to wither and die.’

‘I like it when I can be done with something. Like a knitted earwarmer, like winter, spring, summer, fall.’

We know that Mathea has been married to Epsilon, and that they did not have children, a loss that is not dwelt on but more obliquely alluded to:

‘I identify with bananas, for not only am I hunched over, I’ve also got a flower without sex organs and fruit without seed, and therefore I am, according to the Buddha, meaningless.’

Now widowed, childless and alone, Mathea spends much time considering her own approaching death:

‘It may take a long time before anyone realizes I’ve died.’

However, her thoughts are neither maudlin nor self-pitying as she considers, in a sometimes peculiarly detached way, her last moments:

‘It’s getting dark, I’m trying to concentrate on something useful, and the only thing that matters now is to figure out what my last words will be.’

Obituaries preoccupy, and distract:

‘LIVE LIFE. Seize the day. I’m standing next to my bed, but I don’t know how to seize my day. Finally, I decide to do what I always do: read the obituaries.’

Yet she is also philosophical, and knowing, about her own life and its inherent solitude:

‘”MATHEA MARTINSEN – deeply loved, dearly missed,” I write at the top of the page and underline it.’

‘Today I’m glad my name isn’t there. Still, an obituary would be proof of my existence…’

‘I used to read obituaries to gloat over all the people I’d outlived, but now I don’t think it matters, we all live for just a moment anyway.’

She is not afraid to consider death, and does so with much pragmatism and wry humour:

‘I need to expose myself more and more to death – without going too far, it’s a delicate balance – but then at last I’ll be able to live with the fact that I’m going to die. I figure this can be done in two ways and so I draw up a list.

1. I can visit graveyards, go to funerals, or I can plan my own funeral…

…It must be terrible to plan your own funeral. It’s probably easier to plan other people’s.

2. I can begin living dangerously. I can cross the street without first looking left, then right, then left again.’

But part of her obsession with dying also connects to her struggle with living, and her solitary existence:

‘I’m still sitting here in my apartment and I’m just as afraid of living life as I am of dying.’

Mathea appears profoundly lonely, despite her fear of others, a loneliness that she has experienced all her life:

‘Now I hear ambulance sirens in the distance again, they should be coming to get me because I’m wearing clean underwear and will be dying soon. But no, there’s someone else in the ambulance instead…’

The tragic irony is that she does want to connect with others, but does not know how:

‘I usually buy what other people buy, it’s nice to have boiled cod for dinner if the woman in front of me at the checkout is also having boiled cod.’

‘I let myself imagine that someone might notice me on the way to the store. But what would I do if that happened, probably nothing, and whoever it is might be disappointed by what they see. I’ve never heard of anyone being impressed by nothing at all, and I don’t like to disappoint people.’

‘You’re only fooling yourself if you think you can’t be lonely just because you’re busy, but the most important thing is that no one else thinks you’re lonely.’

Ultimately defeated, Mathea arrives at her own denouement:

‘I’m not afraid of dying anymore, I’m just afraid of dying alone, and I’ve already done that.’

The Faster I Walk, The Smaller I Am addresses very significant themes, around what it means to be human and to have lived, such as solitude, loneliness, the inevitability of death, the need to belong, to be visible and noticed, and to matter.

Big stuff, which lingers and makes you think…

CQ

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I listened to ‘How to Have a Good Death’ on BBC Radio 4 last night (http://www.bbc.co.uk/programmes/b01rvpq1). Hosted by Dr Kevin Foy, the programme aimed to explore how death, despite its universal certainty, is such a taboo subject, and as a result, discussions around dying tend to be avoided. The programme also specifically addressed the current controversial Liverpool Care of the Dying Pathway (LCP) and its implementation.

Contributors included Dr Kate Granger, who I have spoken about previously (https://sufferingandthearts.wordpress.com/2013/04/01/terminally-ill-doctor-to-tweet-from-her-deathbed/). Dr Granger is a junior doctor who has incurable cancer. She has broken with convention and chosen to openly and publicly (including on twitter) speak about her experience living, and dying, with terminal disease.

Recent years have seen a dramatic improvement in the care of the dying. As discussed on air, death is ‘complicated’ and requires its own specialty, Palliative Medicine. I have my own views on this, which I will come back to another time, but I do wonder whether we have over medicalised dying as a result of such specialisation…

Contributors also included the originators of the LCP. Whatever one’s views on the pathway, at the very least it serves as a platform from which issues around death and dying can be openly addressed and discussed, which potentially facilitates those affected having a say in their own dying process.

The prospect of death and the certainty of our mortality fills most people with fear. We tend to speak less about what we fear most, which epitomises how we deal with the subject of death and dying.

Which is why I welcome programmes such as ‘How to Have a Good Death’. I may not fully understand the concept of a ‘Good Death’, but I embrace opportunities that expose us to the taboo subject of mortality, and which challenge us to stop and consider our own dying, and even perhaps ultimately accepting it…

CQ

… not a title, or description, that I usually subscribe to (I have some idea of what a ‘bad death’ might mean, but a good one feels much more difficult to qualify, although it seems to appears frequently, and often glibly, in both the lay and medical press), but this is an interesting piece that I recently came across in The New York Times:

http://www.nytimes.com/2013/04/14/opinion/sunday/a-good-death.html

The New York Times photographer Joshua Bright visited and photographed a dying man, John R. Hawkins, for more than a year. He seems to have decided on his topic first, and then sourced his subject through the New York Zen Center for Contemplative Care.

Hawkins was ‘being ushered’ from this life by his long-term friend, Robert Chodo Campbell, who is a Zen priest and co-founder of the Zen center.

At the outset, Bright states that he ‘went in search of both a photo project and a profound experience.’

He appears to have found both: ‘ We could use news of a good death. Not a tragic death or a famous death, just a good one, the kind that might happen to any of us if we are lucky.’ http://www.nytimes.com/slideshow/2013/03/30/opinion/sunday/20130330_EXPOSURES-SS.html?ref=sunday#1

Check out the slide show particularly. I remain unsure as to what constitutes a ‘good death’, but I was moved by the images and the intimacy shared.
I defer to Kafka: ‘The meaning of life is that it stops.’ We surround ourselves with living, often ignoring the fact that dying is an intrinsic and inevitable part of it all.
Thus I welcome a redress of the imbalance with portrayals of death and dying as delivered by Bright, but even more so, I applaud John R. Hawkins’ generosity and sharing.
CQ

I am currently re-reading Sarah Bakewell’s Montaigne: How To Live (subtitled A Life of Montaigne in one question and twenty attempts at an answer), which has reminded me just what an accessible and enjoyable book this is.

For now, I am going to focus on one of the questions posed:

1. Q. How to live? A. Don’t worry about death

Early on in his life, Montaigne was obsessed by death, in fact he was so obsessed by the thought of losing his life that he was unable to enjoy life itself.

In his 30s, Montaigne experienced the loss of many of those close to him, including the deaths of his best friend, his father, his younger brother, and his first born child. All of these losses served to re-inforce the undeniable reality, but more so the fear, of death.

Montaigne had an epiphany when he was 36, following a riding accident. He recovered, but was utterly changed by the ‘near-dying’ experience. Thereafter, he lived his life differently:

‘If you don’t know how to die, don’t worry; Nature will tell you what to do on the spot, fully and adequately. She will do this job perfectly for you; don’t bother your head about it.’

This maxim – ‘Don’t worry about death’ – became Montaigne’s means of living, a rebirth of sorts where he could experience life without the constant shadow, and fear, of death.

CQ

This article appeared in today’s Telegraph (http://www.telegraph.co.uk/health/healthnews/9965450/Terminally-ill-doctor-to-tweet-from-her-deathbed.html). I came across it via my Med Hum Twitter feed.

Dr Kate Granger, a 31 year old elderly care specialist, was diagnosed with a rare and aggressive form of cancer in 2011, and was given a prognosis of less that 5 years.

She has already published a book, The Other Side (http://theothersidestory.co.uk/), and has a blog drkategranger, in which she shares her illness experience thus far.

In the Telegraph interview, Dr Granger speaks of humour, and how it has helped both her and her husband to cope. She hopes to continue this sense of humour to the end, culminating in ‘live tweets’ from her deathbed.

This public sharing of her experience is not just about helping herself and her husband cope with what life has thrown at them. Dr Granger also hopes that her experience may help others in a similar situation, and facilitate a sharing of what they are going through with their loved ones.

I was struck by many things when I read about Dr Granger. Most particularly, I am in awe of her courage in dealing with something so huge with such a positive and constructive attitude. Anything that facilitates discussion on death and dying, and challenges the silence that too often surrounds this most absolute of truths, is to be embraced. Even more so when the discussant is brave and generous enough to put an ‘I’ into the argument.

CQ

In 2011, Susan Spencer-Wendel, a journalist and mother of three young children, was diagnosed with motor neurone disease and given a prognosis of 3 to 5 years (http://www.guardian.co.uk/lifeandstyle/2013/mar/16/motor-neurone-disease-goodbye-dying). As her disease progressed, she has chosen to spend her time making the most of every moment. She made a list of things she wanted to do, including trips with each of the people she loves. She has now written a book, Until I Say Good-bye, which procured an advance of $2m, plus film rights for a further $2m, and which has facilitated achieving most of her goals thus far, as well as allowing her husband to give up his job and look after her.

Even now, as she becomes increasingly incapacitated and dependent, she continues to ‘do’, and to live.

People deal very differently with the fact that death is going to happen much sooner that they had anticipated. We are all going to die, but mostly we live our lives denying this. Faced with a life-threatening illness and no hope of cure, there seems to be a spectrum of coping strategies. At one end of the continuum are those who ‘make the most’ of what time is left. At the other end are those who socially die at diagnosis. Perhaps the majority lie somewhere in between.

There is no right or wrong as to how we deal with our dying, although how we ‘manage’ it does have an impact on those left behind. Susan Spence-Wendel’s husband made an interesting observation:

“It may sound strange, but living with joy isn’t easy. It’s hard. You make your decisions about how you approach things. Susan works at being happy.’

On the flip side, it is also very difficult to witness the unsharable suffering of those who socially die well before physical death.

I believe that how we have lived our lives reflects how we live our dying. and pretty much determines how we deal with the knowledge that death is at once undeniable and soon.

CQ

This piece, from Tim Lott’s regular Guardian weekend column, is profoundly moving and sad, but also uplifting (http://www.guardian.co.uk/lifeandstyle/2013/feb/23/tim-lott-fathers-final-moments).

Lott tells of time spent (‘sad, but also tender and positive and beautiful’) with his imminently dying 87-year-old father.

Lott’s father was intermittently aware that his family was present, as they shared the experience amongst themselves, ‘laughter, reminiscence, and unexpected joy’, alongside their sadness.

Lott’s take on sadness and loss and mourning following death leaves much to reflect on, in terms of what we mourn…

‘I wept, but not for his death. He was fulfilled.’

‘I will miss him, but I will never mourn him. His death was, like the man himself, profoundly average yet utterly exceptional.’

Lott mentions something, which I have often personally considered:

‘Death is so intimate – more intimate than first love.’

This intimacy troubles me, and the extent to which we are truly ‘invited’ to be present at the time of dying. Intuitively and instinctively, it feels ‘wrong’ to allow someone you love (or indeed anyone) to die alone. Yet I also wonder whether, without explicit consent, it is one of the most intrusive and invasive things we, inadvertently, do.

I have no answer, apart from making my own wishes explicit to those I love.

CQ

Just been, and it was magic. Mega Magic.

The current performance, which includes just a short few days at The Tricycle, centres around the death of Hughes’s father (Sean Hughes senior) from cancer.

The show is a tribute to Hughes’s dad, and as such has many moving moments, but it is also an honest and brave depiction of their at times troubled relationship.

Hughes does not dwell on pathos, and while this is a script with death and dying as its focus, it is by no means leaden or depressing. On the contrary, it is hilarious, at times uproariously so, a fact that in no way diminishes (in fact it enhances) the very real and poignant central theme.

Hughes cleverly skips around – his childhood, moving back to Dublin in 1970 aged 5 with a cockney accent at the height of ‘The Trouble’, the Irish, Catholicism, drinking, his own health and relationships – but always within sight of his father, so that returning repeatedly to his hospital bed feels natural. The show is very much about the death of ‘someone you love’ (a phrase Hughes repeats several times, and also questions what it means in relation to our parents), and about what grief means and how we make sense of it, but within the context of both the lived life of the person who has died, and the lives of those left in death’s wake.

I loved the finale. I had wondered on what note it would conclude, and I think Hughes got it just right. It served to beautifully and movingly emphasise what the entire show had attempted to portray  –  that we can indeed talk about death and dying and loss and grief, that we can also laugh about it, and we can combine it all, publicly, to create something tangible and meaningful, while at the same time entertaining and real.

I felt uplifted as I walked home.

Genius. I was mesmerised, moved and seduced by Hughes’s mind and brilliance.

CQ

Another gem of a Christmas present was a subscription to The New Yorker. The first issue arrived last week, and there is so much of interest that several days later I am still reading it, and this week’s issue is due tomorrow…

For now, I want to mention an article by James Wood on Becoming Them: Our parents, our selves (http://www.newyorker.com/reporting/2013/01/21/130121fa_fact_wood).

Woods reminisces, movingly, of Sundays when growing up, mostly the rituals and the boredom, but also memories of classical music, which his father was passionate about, but perhaps his children suffered from composer overload at an early age…

However, years later Woods discovered himself a passion for classical music, which persists in his forties. Perhaps this, just like the gesticulations, the little phrases that creep in as we age, not to mention the physical reminders, are part of the ‘plagiarism of inheritance.’

Seeing my parents in myself traumatised me around 10 years ago. Now, I am much more accepting of it. When I first noticed it, they were both alive. Within recent years, both died in relatively quick succession.

Woods suggests that we ‘mourn them [our parents] only haplessly, accidentally, by surviving them.’ A friend of Wood’s challenges this view and believes that the real point is that we become our parents, taking on their gestures and habits once they have died.

A preservation of past generations, but not as in ‘they live on in our memories’, more in terms of those before us continuing within us in an unavoidable physical (and social) sense. Utterly rational when you consider science and DNA, not to mind ‘nuture’, but…

Thus, you potentially mourn your parents by becoming them. This feels more than a little weird to me (but may also merely reflect my own mourning processes, or lack of).

But Woods moves onto another interesting point. if you can mourn your parents by becoming then, then surely you can also mourn them before they die. This I get. As I child, I (shamefully and secretly) wished that my parents died together in a car accident. The thought that one would be left alone, forever grieving and sad for the other, felt unbearable to me.

As I grew up, and left, I dwelt less on the fact that my parents would inevitably die. Old age arrived, and with it a world for them that became increasingly smaller, and exclusive. In latter years, I never seemed to find a way into this terrain.

Woods challenges Larkin’s line about life being first a thing of boredom, then later replaced by fear, suggesting that fear comes first.

I am not convinced. Boredom seems to me the prerogative of children, and, from what I have witnessed, fear, if and when it appears, and this is of course by no means universal, can escalate as both time and worlds shrink.

CQ

I had been meaning to read this book for some time, and only just got round to it this week. Timely, as a BBC documentary on the author’s life will be screened over the Christmas period.

Jansson was already famous for her Moonintroll cartoon strips and children’s books before The Summer Book appeared in 1972.

The narrative focuses on the relationship between 6 year old Sophia and her grandmother, who live on a remote island in the Gulf of Finland. The child’s father is also there, but is very much a silent presence in the background. To some extent the book was a response to the death of Janssen’s beloved mother in 1971, and is based on ‘real’ people from the author’s life, her own mother represented by the grandmother, and Sophia the author’s niece. The location also reflects Jansson’s personal history, with the setting based on a house that she and her brother built on a remote island off Finland in 1947.

Although the (short) book predominantly follows the companions as they spend time together, exploring, talking, swimming and foraging, there are also other threads running through the narrative, particularly the grandmother’s musings on ageing and death. Deceptively straightforward sounding chapters such as ‘The Morning Swim’, ‘Moonlight’ and ‘The Magic Forest’ contain much more than is apparent at first glance. In the latter chapter, for example, the forest itself becomes a metaphor for living and dying:

‘This forest was called “the magic forest”. It had shaped itself with slow and laborious care, and the balance between survival and extinction was so delicate that even the smallest change was unthinkable.” (p.27)

The notion of death is introduced early, when Sophia asks her grandmother directly, with an endearing frankness and openness that only the very young can engender:

‘When are you going to die?’ (p.22)

Shortly afterwards, we learn that Sophia’s mother has died:

‘Sophia woke and remembered that they had come back to the island and that she had a bed to herself because her mother was dead.’ (p.25)

The book is about imagination, in both the old and in the young, and it is also about wisdom that similarly transcends generations. What is particularly impressive, is Jansson’s ability to portray a dual perspective, the simultaneously believable voices of both a child and an elderly woman.

It is thus not only 6 year old Sophia who bubbles with imagination, but her grandmother also displays impressive imaginative ingenuity. When Sophia’s friend Berenice comes to stay, and is bored and tiresome, the grandmother suggests that she draws something:

‘”Draw a picture,” she said.

“I don’t know anything to draw,” the child said.

“Draw something awful,” Grandmother said, for she was really tired now. “Draw the awfullest thing you can think of, and take as much time as you possibly can.”‘ (p.45)

Death features again in Sophia’s questions about heaven, and in the grandmother’s internal reflections on the euphemisms for death:

‘It was too bad that you could never have an intelligent discussion on the subject. People were either too young or too old, or else they didn’t have time.’ (p.135)

The grandmother struggles with the process of ageing, as she becomes aware that her memory for recent events is slipping (p.56), and how much she hates the chamberpot under her bed, a ‘symbol of helplessness’ (p.170). At times, she seems weighed down by sadness, and by an almost palpable sense of loss:

‘A very long time ago, Grandmother had wanted to tell about all the things they did, but no one had bothered to ask. And now she had lost the urge.’ (p.90).

She also feels that she cannot describe things anymore, the words have somehow been lost to her, and so, it will all die with her death:

‘And unless I tell it because I want to, it’s as if it never happened; it gets closed off and then it’s lost.’ (p.90)

But, just as she is there for Sophia, listening and reassuring during her many tantrums, so too is the little girl there for her grandmother. She attends to the older woman’s outburst:

‘But now I have the feeling everything’s gliding away from me, and I don’t remember, and I don’t care, and yet now is right when I need it!’ (p.93)

And so, on a night when she was unable to sleep due to ‘thinking about sad things, the grandmother shared her anxieties with the attentive child, thereafter sleeping soundly…

The relationship between the older and the younger companion is very moving. Even when they quarrel, it is with love:

‘One evening, Sophia wrote a letter and stuck it under the door. It said, “I hate you. With warm personal wishes, Sophia.”‘

The prose is just delightful, for example the tree trunks ‘formed a tangled mass of stubborn resignation’ (p.27), and when the pair quarrelled, they ‘quarrelled the wrong way.’ (p.111).

The Summer Book has never been out of print in Scandinavia. I am not surprised. It is a truly magical work, which can tell us much about humanness, but perhaps especially about relationships, and how being there for the other can enhance, and even make sense of, the whole business of being.

CQ