Modern Death: How Medicine Changed the End of Life by Haider Warraich

This interdisciplinary study of death and how we can improve–not avoid–it is highly readable and timely.

modern-death

In Modern Death: How Medicine Changed the End of Life, Haider Warraich explores how human death has evolved over the course of history and offers recommendations for its future. A medical doctor, Warraich supplements his research with anecdotes from his personal experience, and draws on literature, theology, statistics and legal theory as well as the hard sciences. The resulting expert opinion is heartfelt, convincing and well informed.

Warraich begins with the mechanics of how cells die and the opportunities for analogy they offer: cells choose to die to promote the good of the organism; not dying on time is as bad as dying too soon. He recounts the medical advances that have increased human life spans astronomically in the last two centuries. Chiefly, people now die far less frequently from infection and simple injuries, instead living long enough to die of cancer and heart disease. Because of both medical and cultural shifts, more people die in hospitals or nursing homes than at home.

This is the story of how medicine learned to save and expand lives–especially through procedures like cardiopulmonary resuscitation–and then how medicine learned not to resuscitate. Warraich shows what modern death looks like, how it works, its achievements and shortcomings–and then investigates what a good death could look like, and how we can do better. Science has lengthened lives so successfully, delayed death so thoroughly, that our new problem often is not staying alive, but letting go.

In what comes to feel like the real heart of Modern Death, Warraich then studies the nuances of euthanasia, assisted suicides and the withdrawal of life support systems, and their legal histories in the United States and worldwide. He finds that these three categories of death are far less distinct than generally believed. Finally, he advocates strongly for patients’ control over their own ends of life and exhorts his readers–patients and physicians alike–to discuss death openly.

These conclusions form the book’s central purpose. Along the way, Warraich explores different cultures’ and religions’ approaches to death. He also discusses the philosophical and legal difficulties in defining death and life. Warraich’s chief goal is a better end-of-life experience for everyone.

If Modern Death occasionally uses a few more words than necessary, the inclusion of Warraich’s anecdotal experiences enliven what could have been a dry academic text. For readers interested in its thesis–that death is an important part of life, and medicine and society could do a better job of delivering this experience–it is a sincere and thorough examination of an often overlooked subject. Well served by Warraich’s professional expertise and earnest emphasis, this is an indispensable entry into the conversation about death.


This review originally ran in the January 6, 2017 issue of Shelf Awareness for the Book Trade. To subscribe, click here.


Rating: 7 cells.

book beginnings on Friday: Modern Death: How Medicine Changed the End of Life by Haider Warraich

Thanks to Rose City Reader for hosting this meme. To participate, share the first line or two of the book you are currently reading and, if you feel so moved, let us know what your first impressions were based on that first line.

I do enjoy learning more about end-of-life issues, medical and legal and ethical. This one seems to be for me.

modern-death

The opening chapter, “How Cells Die,” begins:

It had been the longest of months–in both the best and the worst possible ways. Brockton is a small town about a half-hour drive south of Boston, but in many ways it seems a world apart.

A little out of context, it seems, but we are just beginning. I like that it’s not a dry, thesis-sentence sort of beginning. Reading on, Haider Warraich does seem to grasp the idea of narrative writing, making his storytelling immediate and personal; and he does have a personal story to tell, being an MD. I am optimistic.

Modern Death is forthcoming in February. Stick around!


This quotation comes from an uncorrected advance proof and is subject to change.

Playing Dead: A Journey Through the World of Death Fraud by Elizabeth Greenwood

This engrossing inquiry into faked deaths introduces curious characters and a litany of questions about life.

playing dead

Elizabeth Greenwood had recently quit teaching public school in New York City to return to school herself, and her student loan debt had hit six figures. She was feeling desperate, trapped and bored with her day-to-day existence. When a friend made a joke about faking her death to get away from it all, she was intrigued.

The idea became the research project that consumed her time and imagination for years, and resulted in Playing Dead: A Journey Through the World of Death Fraud. Greenwood explores the world of pseudocide from several angles. She speaks with several subjects of infamous botched cases, but fails to identify any successful fraudsters (by definition, they are hard to find). She visits with the investigators who pursue these attempted frauds on behalf of the insurance companies frequently scammed (“His workplace, in a way, is the DMV of death”), as well as with professionals in the field of helping people disappear. She also cozies up to a passionate “Believer” in Michael Jackson’s epic prank: that the singer is not dead at all, but in hiding, sending coded messages to his fans. When Greenwood sits down with family members who have been left behind, she finds the most damage inflicted. Finally, in the Philippines, she sets out to purchase her own death certificate.

Initially Playing Dead asks: Is this deception possible in a modern era of closed-circuit cameras, digital signatures and the inerasable Internet? Is it better to fake death, or simply to disappear? Are those who get caught really “morons and idiots,” as one specialist asserts? By the end of her journey, though, Greenwood asks different questions. Why are pseudocides overwhelmingly male? Is this an act of sacrifice or ego? “Is transformation without annihilation possible?” By the epilogue, she has reconsidered, for herself at least, which is preferable: a difficult life or a false death.

Along the way, she acquires a few tips: keep your first name when you take on a new identity. Stay in disguise. Don’t bother with a surrogate body. Quit driving altogether. Disappear on a hike, not into the ocean. And whatever you do, don’t assume you can return home to family and friends after just a few years dead. The exercise of seeking pseudocide for Greenwood, “acts as a gentle reminder that our realities are far from fixed.”

This energetic exploration of a world many readers may not have ever considered is perhaps slightly macabre, but ultimately very human; it is a questioning of how we seek satisfaction in life, and when we cut and run. Greenwood’s narrative voice is humble and approachable, but as an investigator she is tenacious, going the distance–to death and back–to bring this oddly fascinating story to her readers. Playing Dead will please those attracted to the eccentric, as well as anyone who has ever fantasized about leaving it all behind.


This review originally ran in the July 12, 2016 issue of Shelf Awareness for the Book Trade. To subscribe, click here.


Rating: 7 cars.

Grief Is the Thing with Feathers by Max Porter

A minimalist meditation on loss takes an unusual slim and poetic form.

grief is the thing

Max Porter’s Grief Is the Thing with Feathers handles bereavement and the novel format in inventive ways. Scraps of poetry, dialogue and ramblings, with lots of white space, fill just over 100 pages, but this sparse little volume takes on no less than love, loss and art.

Three parts, “A Lick of Night,” “Defence of the Nest” and “Permission to Leave,” roundly sum up the grieving process. Brief segments are narrated from three characters’ perspectives: Dad, Boys and Crow. Mom has recently died, and Dad and two young sons struggle to cope until a special Crow comes along to care for them–in a manner of speaking.

The Crow’s voice tends toward the stream-of-consciousness, as a bird’s might, but there’s no questioning its agency and intelligence. Dad is an eccentric Ted Hughes scholar, struggling to write a book on deadline. Under these influences, Grief Is the Thing with Feathers resembles free verse. The Boys generally speak as “we”; despite the occasional singular, the two brothers are interchangeable. In Porter’s poetic bent and unusual usages, “They were in brother with each other.” They are nonetheless realistic and childlike; they wonder, when their mother dies, “Where are the fire engines…? Where are the strangers… screaming, flinging bits of emergency glow-in-the-dark equipment at us to try and settle us and save us?”

This is not a novel for children, with its moments of gore and sex, but it is a whimsical and ultimately pleasing perspective on grief, and utterly original.


This review originally ran in the June 3, 2016 issue of Shelf Awareness for Readers. To subscribe, click here, and you’ll receive two issues per week of book reviews and other bookish news.


Rating: 7 flecks of toothpaste.

The Heart by Maylis de Kerangal, trans. by Sam Taylor

The story of a heart transplant, from life to death to final outcome, is viewed through the varied perspectives of some of the people involved.

heart

Maylis de Kerangal’s The Heart, translated from the French by Sam Taylor, spans just 24 hours but covers some of the most profound material imaginable. Simon and his two friends leave the beach after a pre-dawn surfing session and crash off the road. In the hours that follow, Simon’s parents are asked to make decisions about the removal of his organs. A woman with three sons waits for the heart transplant that will, hopefully, prolong her life. De Kerangal follows these and other players–doctors, nurses, family and friends–as the drama unfolds: of Simon’s heart, life and death and definitions, the meaning of generosity and what we love.

The Heart delves deeply into its subjects: the transplant operations are described in precise detail. The anguish of parents losing a child is explored at some length in its various incarnations–aggression, confusion–and compared to that of shipwreck survivors, or of a man who has just been in a fight with “some guy who was asking for it.” Characters are complex–the nurse who met with a lover last night, “sober and ravishing”; the soccer-obsessed surgeon with the violent girlfriend; the man from the Coordinating Committee for Organ and Tissue Removal, whose job it is to convince the parents to approve the transplant and who is passionate about music and his Algerian goldfinch. Through these and other points of view, an extraordinary and shocking story is revealed. Taylor’s expressive translation renders a sensitive, stark and entirely engrossing novel.


This review originally ran in the January 19, 2016 issue of Shelf Awareness for Readers. To subscribe, click here, and you’ll receive two issues per week of book reviews and other bookish news.


Rating: 7 minutes.

The Iceberg by Marion Coutts

An artist reflects in a variety of ways on the end of her writer husband’s life.

iceberg

Tom Lubbock was an art critic for the Independent and the father of an 18-month-old boy, when he was diagnosed with brain cancer in 2008. In The Iceberg, his wife, Marion Coutts, a versatile and prolific artist and writer, recalls his final years. The resulting memoir is musing, lyrical, ambling and sometimes digressive. The range of emotions she expresses is startling and real.

Coutts begins with “a diagnosis that has the status of an event” as she introduces her husband and their son, Ev. Tom works with words and concepts, meticulously and thoughtfully constructing the writings that are his livelihood and passion. When he has a seizure, a tumor is discovered in the speech and language part of his brain: Tom and Marion must reinvent communication. They practice and make lists: of names of friends, of ideas for outings, of opposing word pairs (big/small, light/heavy). They play a game of yes/no questions when Tom has something to discuss: Is it about your work? Is it about us? Is it food or clothing? These coping mechanisms are an interesting intellectual exercise, but are also central to this family’s experiences. Coutts writes: “I have lost the second consciousness that powers mine. Lost my sounding board, my echo, my check, my stop and finisher. I am down to one.”

The Iceberg neatly captures the events of diagnosis and death, with a stark attention to what comes in between, and little reference to the rest of life. Tom’s medical conditions are described with varying levels of detail, as Coutts often has only a vague understanding of them. Her encounters with the British National Health Service are frequently frustrating. These physical realities are less than central, however. The Iceberg is a forthright emotional account, often celebratory, even exultant: Tom especially often finds joy late in his life. Of course, Coutts is also destitute, bereft, undone. Such feelings alternate with a cerebral, even detached perspective. These jarring intersections are at the center of her story. She writes unflinchingly of her short temper with Ev, and occasionally with Tom; she relates both anguish and resolve, resignation and anger, often with a striking sense of remove. “There is going to be destruction: the obliteration of a person, his intellect, his experience and his agency. I am to watch it. This is my part.” Or of sitting at his deathbed: “I love being in position here. It is perfectly correct.”

Coutts’s prose is layered, textured, dense with meaning and interjected with brief e-mails to loved ones about Tom’s status along the way. As a consideration of art, life, death and love, the full impact of The Iceberg is deeply moving and intelligent, a worthy elegy.


This review originally ran in the January 22, 2016 issue of Shelf Awareness for the Book Trade. To subscribe, click here.


Rating: 7 words.

The Year of Magical Thinking by Joan Didion (audio)

I said I was laying off the audiobooks, because my present life & schedule don’t allow for enough listening time. But then I picked up another, and another. Among other things, I’ve hurt my knee again and am back in the gym. But you’re not here to hear about my knee.

year of magical thinkingI’m so glad I tuned into The Year of Magical Thinking. It’s not a feel-good story: it tracks the year in Joan Didion’s life following her husband’s death, and maps her experience with grief. It’s almost New Year’s, and Joan and husband John have been visiting their daughter in the hospital, where she is unconscious with a life-threatening case of pneumonia and septic shock. On December 30, 2003, he collapses at the dinner table, is rushed to the hospital and pronounced dead that night. John is John Gregory Dunne, also an accomplished writer, and their lifestyle has always kept them very close: working from home, together, consulting on every aspect of their lives, from work, food, family and world events to the most insignificant details. Didion is of course, obviously, shocked and unmoored. During the year that follows she experiences different types of grief, shock and bafflement. This book is a little like a diary of that time, which it charts chronologically, ending one year and one day after John’s death.

Along the way, she nimbly weaves in the research she performs on related subjects within psychology, medicine and anthropology: research on grief, on cultural relationships with death and dying, and on medical issues, as she tries to understand when, how and why John died. This last is a surprisingly opaque question, covering the time between his collapse and the doctor’s pronouncement about an hour and a half later. What had been done in the interim? What could have been done? She examines the reports of the ambulance team, the nurses and the ER doctor.

And to compound the complicated and tragic story, daughter Quintana spends most of this year in and out of hospitals, near death on multiple occasions. What we know, although Didion at the time of writing does not, is that Quintana died within the year after the book’s timeline closes. Her later memoir, Blue Nights, covers that personal loss. I haven’t read that one – yet.

The difficulty of this book, then, is obvious: it is filled with sad stuff. Didion is a deft and clever writer, though. We see more than a little joy, although much of it is remembered. We see a strong family, and we see good times. The entwining of personal experience (past and present) and research is beautifully done. Didion uses repeated phrases to draw her reader along the book’s line, to tie everything together. It’s a lovely piece of work, although I did have to turn away when I had a particularly bad day. The subject matter is what it is.

My one criticism is that Didion fails to recognize and acknowledge a certain privilege: that her life is set against the Ritz, the Royal Hawaiian Hotel in Honolulu, the fancy home in Malibu, Chanel, Brooks Brothers, an endless parade of the food, clothing, and scenery of her choice and at her command. This privilege, compounded by her failure to acknowledge it (is it possible she is unaware?), distanced me from her. She is both a fine writer and a complex and sympathetic person; it is my instinct to identify with her, and that is where this memoir shines; but that effect is lessened by her experience of the world to which she is apparently blind. Near the end, she describes a difficulty early in her marriage, when she and John had made a $50,000 down payment on a house in an L.A. suburb but hadn’t yet sold their home in Malibu: where would the money come from? They go to a luxury resort in Hawaii to think it out, then find that the Malibu home has an acceptable offer. She does speak briefly to the irony of the Hawaiian brainstorming session. We could call this a partial exception to my complaint. The episode still comes off a little tone-deaf, though.

This is a fairly small criticism. Because of this privileged position, Didion lost a few degrees of identification with her reader. On the whole, though, she is a sympathetic and fully realized character. Her story is shocking but true; it is beautifully structured and well written, and I will definitely read more Didion.

Barbara Caruso’s narration felt spot-on to me.


Rating: 7 leis.
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