Wherever They Are to Be Found

 

“We’re always buying books,” the Artist used to tell people who wondered what we did all winter. We felt it as a big loss when all three bookstores in Benson closed (one because of death, one due to retirement, and one when the owner moved out of the area). The only independent bookstore I know of in Cochise County now is down in Bisbee, and getting to Bisbee always seemed to take a lot of planning, so much so that we hadn’t been there since spring of 2021. And why would I go without my husband, who loved to read the New York Times at the library in Bisbee (only library in the county to carry it) and to enjoy a generous bowl of pho at the little hole-in-the-wall Vietnamese restaurant? 

at Bisbee library

Awaiting lunch in Bisbee

As for where to find used books, there are still thrift shops and little shops run by various Friends of the Library groups in Cochise County. The Friendly Bookstore in Willcox even has an outdoor 10-cent book table, which the Artist and I have perused for years on a regular basis. (That reminds me of someone who came in my bookstore in Northport to ask where my 10-cent books were. Nowhere, sorry! I am working for a living, not on salary or pension!) Books on the table remain outdoors night and day, in all kinds of weather, enduring baking sun and punishing dust, and in the event of rain (a rare occurrence), soaked volumes are hauled off to the waste transfer station down the road and the table refilled with a “new” lot of used books. But on my own in recent weeks, I haven’t been doing much book shopping. It isn’t the same by myself, we have plenty already in the cabin, and I can borrow books from the library. 

 

The other day, however, a shady parking spot was available across the street (shade for puppy), so I stopped, and a glance through the 10-cent books turned up a little paperback I figured had to be worth gambling a thin dime. Author Stephen Levine’s book, Meetings at the Edge, had a subtitle that began Dialogues with the Grieving and the Dying…. Now, I do not think (or feel that) “the Universe” put that book out there for me to find. On the other hand, the subtitle did speak to my situation. 

 

Each chapter begins with someone calling “the Dying Project,” a free telephone consultation service provided by Stephen and his wife Ondrea (1979-82) for the “terminally ill and those working closely with a death.” Some callers had cancer, while others had family members who had received a terminal diagnosis or were already near death. One woman’s daughter had been murdered. There were occasional professionals who worked with dying patients and had a crisis of their own at the same time.

 

A family member wrote to me recently that “when we open ourselves to love, we open ourselves to pain,” and reading that it occurred to me that the briefest way I can describe the lessons in Meetings at the Edge is that the author gradually brings his callers to see that they – and that is, we, all human beings-- must be open to pain and loss and even to death in order to be fully open to love and to be truly alive, because if we fight against what is, we cannot be fully alive in the world as it is.

 

Disclosure: I am not a Buddhist. (In fact, I am so not-Zen!) And this book is saturated with Zen metaphysics. But just as I find the way people treat other people much more important than anything they say they believe, so as I read this book I set the metaphysics to one side and focus on the practice, which is not a turning away from or attempting to cover over grief but a sitting with it, acknowledging it, with all its pain, in order to get beyond pain to a core of – Levine calls it “undifferentiated,” “eternal,” or “universal,” -- I’ll call it undying love.

 

In my last post, I quoted myself as follows: “There is no shortcut to a long relationship.” Similarly, there is no shortcut through grief. There is no spiritual pain pill, no bromide, no set of magic words to clear away the clouds of bereavement once and for all. 

 

I have written about the deep gratitude I feel for my years with the Artist, for our rich life together, along with gratitude I have for the support and love of family and friends, attentive neighbors, and even a very demanding puppy that gets me out of bed one morning after another. And all that is true and real, and the sun is shining here in Arizona (even as it snows again in Michigan), and I realize I am a very fortunate woman in many, many ways . But if anyone thinks my heart is not often heavy, that my throat does not ache and that my eyes don’t fill with tears as I drive down the highway, then I have painted a very, very misleading picture. 

 

How to wrap up this post? Perhaps I won’t even try. It is early yet in my journey….

 

Summer morning light, northern Michigan

Book Review: BEING MORTAL

Being Mortal:

Medicine and What Matters in the End

by Atul Gawande

NY: Henry Holt/Metropolitan, 2014

Hardcover, $24

I learned about a lot of things in medical school, but mortality wasn’t one of them. ... Our textbooks had almost nothing on aging or frailty or dying. How the process unfolds, how people experience the end of their lives, and how it affects those around them seemed beside the point. The way we saw it, and the way our professors saw it, the purpose of medical schooling was to teach how to save lives, not how to tend to their demise.

So begins Gawande’s latest book, important and well worth reading, as his writing always is, and particularly relevant to individuals in what the French call the “third age” of life (think of the riddle of the sphinx) and those who are or soon will be caring more and more for that generation as time brings about the inevitable.

Every doctor, every nurse, sooner or later must confront death, but Gawande notes that until recently few in modern medicine were given tools to deal with the situation. Instead, American medical training has focuses on testing, recording, gathering facts, prescribing drugs, and offering patients an increasing number of choices among an array of procedures with hoped-for but unclear outcomes. Death was the elephant in the living room, the one everyone knew was there but no one wanted to mention.

Medical costs in the final year of life are astronomical, as everyone knows but equally unfortunate (perhaps worse), Gawande believes, is the harm inflicted when people are “denied ... the basic comforts they most need.” And “basic comforts,” it turns out, are more than food and shelter and safety.

The most frequent complaint Gawande hears from nursing home patients is, “It just isn’t home.” However homelike in appearance (appearances often geared to appeal to residents’ adult children rather than residents themselves), in most facilities designed for care of the frail elderly, residents lack the privacy and autonomy most of us take for granted all our lives.

Gawande traces the history of the “assisted living” movement from its origin in the vision of a West Virginia coal miner’s daughter. When Keren Brown Wilson’s mother, Jessie, needed help with the basic tasks of living, there was nowhere for her to go but a nursing home. The daughter, a college student at the time, never got over her mother’s frequent plea, “Take me home,” and because of those pleas, Keren Wilson developed an interest in issues related to aging and eventually earned a doctorate in gerontology. What her mother had in mind for “home” was not a place designed for her health and safety (placement considerations important to most children of the elderly) but a place where she could be herself again, not a patient, but Jessie the person. Dr. Wilson wrote a paper to outline what such a place might look like.

The key word in her mind was home. Home is the one place where your own priorities hold sway. At home, you decide how you spend your time, how you share your space, and how you manage your possessions. Away from home, you don’t.

For a variety of reasons, Wilson’s original idea became diluted beyond recognition as “assisted living” facilities popped up all over the country, but Gawande visits and describes a few places where privacy and autonomy, key to Wilson’s original vision (rather than regimentation) are the rule.

Paramount at every stage of aging, whether or not it involves terminal illness, is “how to make life worth living when we’re weak and frail and can’t fend for ourselves....” What makes life worth living will vary from one individual to another, and the point of the “hard conversations” with family members and medical staff is to determine, in each case, what makes life worth living to this particular individual. For one man, being able to eat chocolate ice cream and watch sports on television was enough. “My dad,” Gawande tells us, in one of the passages focusing on his own experience with his frail, aging surgeon father, “didn’t think that would be good enough for him at all.”

Not surprisingly, there is a lot in Being Mortal about hospice and palliative care. The idea of offering “concurrent care” actually came from an insurance company. Instead of having to choose between hospice and other treatments, policyholders with less than a one-year life expectancy could continue their regular treatment and receive hospice care. Since they did not have to give up anything, enrollment in hospice jumped from 26 to 70 percent. More surprising were some of the other results:

They visited the emergency room half as often as the control patients did. Their use of hospitals and ICUs dropped by more than two-thirds. Overall costs fell by almost a quarter.

Gawande cites a 2010 study from Massachusetts General in which patients with stage IV lung cancer were randomly assigned to two different groups.

Half received usual oncology care. The other half received usual oncology care plus parallel visits with a palliative care specialist ... The result: those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives—and they lived 25 percent longer.

In other words, not only was it cheaper to add hospice care to other treatments, but terminally ill patients lived longer, had fewer emergency incidents, and their quality of life was higher. Gawande attributes much of the difference to the open conversations that hospice encourages and the focus of its staff on the person and his or her individual values and goals rather than on hope for recovery.

Conversations about end-of-life choices, he admits, are not easy. They take time and may “unleash difficult emotions” for all involved. In the end, however, they can make all the difference. The battle analogy he uses to make his point comes from the 19th century and pulls no punches:

Death is the enemy. But death has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender when it can’t, someone who understands that the damage is greatest of all if all you do is battle to the bitter end.

The author of Being Mortal shares with readers not only his medical experience and the fruits of his research into how society deals with aging and dying, but also his own personal story, that of a loving son distressed to see his father losing ground.

My only wish – I will not call it a complaint – is that an index would have been helpful. I highly recommend this book.

Warning: Another Burst of Enthusiasm Coming Your Way

Cricket and Sarah--Together Again

There’s one thing you’ll never hear me say, and that’s “Oh, you have to read [whatever]!” No, there is nothing you “have to read,” as far as I’m concerned. My recommendations are for books I found worth reading, and you can take them or leave them without offending me.

Recently I fell upon a used hardcover copy of a book that I could hardly put down until I’d read through to the end, and immediately I sat down to make out a book order including several copies of the paperback edition. My Grandfather’s Blessings: Stories of Strength, Refuge, and Belonging, by Naomi Rachel Remen, is a collection of stories from a medical doctor who counsels patients and families dealing with chronical and terminal illness. Much of her wisdom she received early in life from the grandfather who died when she was seven years old. How lucky Rachel was to have such a grandfather! How lucky the rest of us are that she has shared him with us! But that is only the beginning. She also learned from her own chronic illness and from the illnesses and losses and grief of many people she met over the years in her practice, and all of this feels very important to me right now.

You see, my bookstore is in a small village, and in a place like this, with a large population of retirees, there are always familiar names on the community prayer list. Often the obituaries in the county newspaper are for, if not friends, family or friends of friends. Another timely coincidence came when Kathy Drue over at Lake Superior Spirit posted some thoughts on grief that I read when halfway through Remen’s book. My only problem is—where to begin? I want to quote the entire book! Every short chapter (some only two pages), every page, every paragraph, every story and observation is a gem.

Early in her first few chapters, the author makes the observation that we are given many more blessings than we receive. What? I had to read the sentence several times over before continuing. Family, friends, strangers, nature—all offer us blessings on a daily basis that we may be too distracted to notice, let alone open our hearts to receive. Sometimes we realize and acknowledge and are grateful in retrospect, and it is then that we have truly received the blessing. So it may seem paradoxical that Remen believes blessings are not something “given” by one person to another, but as she sees them, they are not “help,” nor do they “fix” problems. Being blessed has more to do with being seen in one’s most essential goodness and wholeness.

Does all this sound vague and uncomfortably touchy-feely? Are you put off by it? Many of Remen’s medical colleagues over the years have been resistant, but those who opened broke through their resistance found the rewards priceless. Where to begin?

Well, there’s only one way I can think to resolve the what-to-quote question, and that is to quote nothing. My decision is very deliberate. I opened this book and read through it never knowing what the next page would bring. I had the joy of discovery, sentence after sentence. Why would I deny that joy to other readers? It would be a different kind of joy to talk about the book’s stories with people after they’ve read it, and our own stories would quickly come into the conversation. Already I imagine very meaningful discussions.

Have I piqued your interest? And how do you relate the two dogs to a discussion of blessings?