Tag: cancer

September Recommendations: Boyer, Doughty, Englehardt, Jamie, Patchett

For this second half of the year I chose just 15 of the new releases I was most excited about. Limiting myself in that way has been helpful for focusing the mind: I’ve already read six of my most anticipated books, I’m currently reading another, and I have several more awaiting me. Had I chosen 30 or more titles, I would likely be feeling overwhelmed by now, but as it is I have a good chance of actually getting to all these books before the end of the year. These five September releases, while very different – their topics range from cancer and dead bodies to archaeological digs and family inheritance – all lived up to my expectations:

 

The Undying: Pain, Vulnerability, Mortality, Medicine, Art, Time, Dreams, Data, Exhaustion, Cancer, and Care by Anne Boyer

(Coming from Farrar, Straus and Giroux [USA] on the 17th and Allen Lane [UK] on October 3rd)

In 2014, Boyer, then a 41-year-old poet and professor at the Kansas City Art Institute (and a single mother) was diagnosed with triple-negative breast cancer. The book’s subtitle gives you clues to the sort of practical and emotional territory that’s covered here. Although she survived this highly aggressive cancer, she was not unscathed: the chemotherapy she had is so toxic it leads to lasting nerve damage and a brain fog that hasn’t completely lifted.

All the more impressive, then, that Boyer has been able to put together this ferociously intellectual response to American cancer culture. Her frame of reference ranges from ancient Greece – Aelius Aristides, who lived in a temple, hoping the gods would reveal the cure to his wasting illness via dreams, becomes an offbeat hero for her – to recent breast cancer vloggers. She is scathing on vapid pink-ribbon cheerleading that doesn’t substantially improve breast cancer patients’ lives, and on profit-making healthcare schemes that inevitably discriminate against poor women of color and send people home from the hospital within a day or two of a double mastectomy. Through her own experience, she reflects on the pressure women are under to be brave, to be optimistic, to go to work as normal, and to look as beautiful as ever when they are in excruciating pain and beyond exhaustion.

Impossible to avoid comparisons to Susan Sontag’s Illness as Metaphor, but this book has a personal power I don’t remember finding in Sontag’s more detached, academic-level work. Boyer sees herself as one in a long lineage of women writing about their cancer – from Fanny Burney to Audre Lorde – and probes the limits of language when describing pain. I was reminded of another terrific, adjacent book from this year, Constellations by Sinéad Gleeson, especially where Boyer describes her imagined 10-part pain scale (Gleeson has a set of 20 poems based on the McGill Pain Index).

I could quote excellent passages all day, but here are a few that stood out to me:

“People with breast cancer are supposed to be ourselves as we were before, but also better and stronger and at the same time heart-wrenchingly worse. We are supposed to keep our unhappiness to ourselves but donate our courage to everyone.”

“The moral failure of breast cancer is not in the people who die: it is in the world that makes them sick, bankrupts them for a cure that also makes them sick, then blames them for their own deaths.”

“If suffering is like a poem, I want mine to be lurid, righteous, and goth.”

My thanks to FSG for the proof copy for review.

 

Will My Cat Eat My Eyeballs?: Big Questions from Tiny Mortals about Death by Caitlin Doughty

(Coming from W.W. Norton [USA] on the 10th and W&N [UK] on the 19th)

This is the third book by the millennial mortician, and I’ve taken perverse glee in reading them all. Smoke Gets in Your Eyes explains cremation and combats misconceptions about death; From Here to Eternity surveys death rituals from around the world. This new book seems to be aimed at (morbid) children, but for me it was more like one of those New Scientist books (Why Don’t Penguins’ Feet Freeze?) or Why Do Men Have Nipples?

Some of the questions are more serious than others, but with her usual punning wit and pop culture references Doughty gives biologically sound answers to them all. For instance, she explains what might happen to a corpse in space, why the hair and fingernails of a cadaver appear to keep growing, and why the quantity of ashes from a cremation is about the same no matter the dead person’s girth (all the fat burns away; what would make your ashes weigh more is being taller and thus having longer bones). I was most interested in the chapter on why conjoined twins generally die at roughly the same time.

Doughty also discusses laws relating to the dead, such as “abuse of corpse” regulations and whether or not deaths at a property have to be reported to potential buyers (it depends on what state or country you live in); and what happens in countries that are literally running out of space for burials. In highly population-dense places like Singapore, but also in countries such as Germany, one is considered to ‘rent’ grave space, which is then recycled after 15 years and the previous set of remains cremated. Or graves might get stacked vertically.

This is good fun, and features lots of cartoonishly gruesome black-and-white illustrations by Dianné Ruz. If you’ve got a particularly curious niece or nephew who might appreciate a dark sense of humor, this would make a good Christmas gift for one who is an older child or young teen.

My thanks to W&N for the free copy for review.

 

Bloomland by John Englehardt

(Coming from Dzanc Books [USA only] on the 10th)

“you wonder if the scariest thing about all this is not that life can’t return to normal, but that it already has”

Especially after Gilroy and El Paso, I wasn’t sure I’d have the heart to pick up Bloomland, a novel about a mass shooting at (fictional) Ozarka University, Arkansas. But I’m very glad I did. Crucially, Englehardt’s debut doesn’t a) make easy assignments of guilt, b) resort to lurid scenes for shock value, or c) employ the cut-and-dried language of cause and effect. It’s a subtle and finely crafted piece of literary fiction. The second-person narration is an effective means of drawing the reader into the action, and inviting ‘you’ to extend sympathy to three very different characters: Rose, an Ozarka student who becomes romantically involved with one of the injured; Eddie, a professor whose wife dies in the massacre; and Eli, the shooter.

Both Rose and Eli lost their mothers when they were 11 years old. Six years before starting a poultry science course at Ozarka, Rose was caught up in a tornado that killed her grandmother and fractured her skull. The fact that her upbringing was even more traumatic than Eli’s is, I think, meant to discredit the lazy argument that dysfunctional families produce killers. In his early days at university we see Eli befriending a drug dealer named Gordon, whose hunting rifle he soups up to use in the shooting at the campus library in finals week. Englehardt also tests out another couple of predictors of violence: cruelty towards animals (au contraire, Eli can’t stand more than one day of debeaking chickens at a poultry factory and even takes one home as a pet) and violent, video-game-fueled fantasies (the story he writes for creative writing class is average for a teenage male so doesn’t raise any alarm bells).

Gradually we learn that there is an “I” behind this triple-stranded narrative: Dr. Steven Bressinger, an Ozarka creative writing professor. Although Rose, Eddie and Eli are all fully realized characters, we are also left to wonder how this Bressinger is able to access their memories and emotions. To what extent can he really put himself into their situations? And how much of the rest is made up? But then, that’s what the novelist does anyway: imagine what it’s like to be inside a character’s experience, especially when they’ve made unimaginable decisions.

So this novel within a novel thoroughly convinced me, especially as it moves into the future to examine how the campus and the wider community address issues of guilt and vengeance. Its timeliness is obvious, and Englehardt writes a gorgeous sentence, even when it’s about the homogeneity of the American suburb: e.g., “You start driving down MLK, past the mass grave of dollar stores, under the even clouds converging like one stoic slab of ice.”

My thanks to the publisher for the proof copy for review.

 

Surfacing by Kathleen Jamie

(Coming from Sort Of Books [UK] on the 19th and Penguin Books [USA] on the 24th)

I’m a big fan of Kathleen Jamie’s work, prose and poetry. Like her two previous essay collections, Sightlines and Findings, both of which I read in 2012, this fuses autobiography with nature and travel writing – two genres that are too often dominated by males. Jamie has a particular interest in birds, islands, archaeology and the oddities of the human body, all subjects that intrigue me, too.

The bulk of Surfacing is given over to three long pieces set in Alaska, Orkney and Tibet. She was drawn to Quinhagak, Alaska, a village that’s about the farthest you can go before crossing the Bering Sea into Russia, by her fascination with the whaling artifacts found along the UK’s east coast. Here she helped out on a summer archaeological dig and learned about the language and culture of the Yup’ik people. Alarmingly, the ground here should have been frozen most of the way to the surface, forcing the crew to wear thermals; instead, the ice was a half-meter down, and Jamie found that she never needed her cold-weather gear.

On Westray, Orkney (hey, I’ve been there!), there was also evidence of environmental degradation in the form of rapid erosion. This Neolithic site, comparable to the better-known Skara Brae, leads Jamie to think about deep time and whether we’re actually much better off than people in the Bronze Age were. Prehistory fits the zeitgeist, as seen in two entries from the recent Wainwright Prize shortlist: Time Song by Julia Blackburn and Underland by Robert Macfarlane. It’s a necessary corrective to the kind of short-term thinking that has gotten us into environmental crisis.

A cancer biopsy coincides with a dream memory of being bitten by a Tibetan dog, prompting Jamie to get out her notebook from a trip to China/Tibet some 30 years ago. Xiahe was technically in China but ethnically and culturally Tibetan, and so the best they could manage at that time since Tibet was closed to foreigners. There’s an amazing amount of detail in this essay given how much time has passed, but her photos as well as her notebook must have helped with the reconstruction.

The depth and engagement of the long essays are admirable, yet I often connected more with the few-page pieces on experiencing a cave, spotting an eagle or getting lost in a forest. Jamie has made the interesting choice of delivering a lot of the memoir fragments in the second person. My favorite piece of all is “Elders,” which in just five pages charts her father’s decline and death and marks her own passage into unknown territory: grown children and no parents; what might her life look like now?

There is beautiful nature writing to be found in this volume, as you might expect, but also relatable words on the human condition:

What are you doing here anyway, in the woods? … You wanted to think about all the horror. The everyday news … No, not to think about it exactly but consider what to do with the weight of it all, the knowing … You are not lost, just melodramatic. The path is at your feet, see? Now carry on.

My thanks to Sort Of Books for the free copy for review.

 

The Dutch House by Ann Patchett

(Coming from Bloomsbury [UK] and Harper [USA] on the 24th)

Maeve and Danny Conroy are an inseparable brother-and-sister pair. Their mother left when Danny was little, so his older sister played a maternal role, too. And when their father dies, they become like Hansel and Gretel (or Cinderella and her little brother): cast out into the wilds by an evil stepmother who takes possession of the only home they’ve ever known, a suburban Philadelphia mansion built on the proceeds of the VanHoebeeks’ cigarette empire.

It’s interesting to see Patchett take on a male perspective in this novel; she does it utterly convincingly. I also loved the medical threads running through: Maeve is diagnosed with diabetes as a teenager, and Danny spends many years in medical training even though his only ambition is to follow in his father’s footsteps as a property developer. There was a stretch in the middle of the book – something like 46% to 58% – when I was really bored with Danny’s dithering (‘but I don’t want to be a doctor … but I don’t want to marry Celeste’), and the chronology is unnecessarily complicated by flashbacks, though this is, I think, meant to convey Danny’s desultory composition of his memoirs.

In the end I didn’t like this quite as much as Commonwealth, but it’s a memorable exploration of family secrets and memories. As the decades pass you see how what happened to Maeve and Danny has been turned into myth: a story they repeat to themselves about how they were usurped, until this narrative has more power than the reality. Readers, meanwhile, are invited to question the people and places we base our security on, and to imagine what it would mean to forgive and forget and start living in a different way.

Patchett is always so good on the psychology of complicated families, and her sharp prose never fails to hit the nail on the head. The Goldfinch comes to mind as a readalike – not least because of the significance of a piece of art: the cover depicts a painting made of Maeve when she was 10 – as well as Nick Hornby’s How to Be Good.

I read an electronic proof copy via Edelweiss.

 

Have you read any September releases that you would recommend? Which of these tempt you?

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Best Nonfiction Books of 2018

Below I’ve chosen my 12 favorite nonfiction books published in 2018. You’ll be unsurprised to learn that half of them have a medical theme. Many have already featured on my blog in some way over the course of the year. To keep things simple, as I’ve done in previous years, I’m limiting myself to two sentences per title: a potted summary plus why you should read it. Let the countdown begin!

 

12. The Line Becomes a River by Francisco Cantú: Francisco Cantú was a U.S. Border Patrol agent for four years in Arizona and Texas. Impressionistic rather than journalistic, his book is a loosely thematic scrapbook that, in giving faces to an abstract struggle, argues passionately that people should not be divided by walls but united in common humanity.

 

11. Bookworm by Lucy Mangan: Mangan takes us along on a nostalgic chronological tour through the books she loved most as a child and adolescent. No matter how much or how little of your early reading overlaps with hers, you’ll appreciate her picture of the intensity of children’s relationship with books – they can completely shut out the world and devour their favorite stories over and over, almost living inside them, they love and believe in them so much – and her tongue-in-cheek responses to them upon rereading them decades later.

 

10. Everything Happens for a Reason: And Other Lies I’ve Loved by Kate Bowler: An assistant professor at Duke Divinity School, Bowler was fascinated by the idea that you can claim God’s blessings, financial and otherwise, as a reward for righteous behavior and generosity to the church (“the prosperity gospel”), but if she’d been tempted to set store by this notion, that certainty was permanently fractured when she was diagnosed with stage IV colon cancer in her mid-thirties. Bowler writes tenderly about suffering and surrender, about living in the moment with her husband and son while being uncertain of the future.

 

9. Gross Anatomy by Mara Altman: Through a snappy blend of personal anecdotes and intensive research, Altman exposes the cultural expectations that make us dislike our bodies, suggesting that a better knowledge of anatomy might help us feel normal. It’s funny, it’s feminist, and it’s a cracking good read.

 

8. The Unmapped Mind by Christian Donlan: Donlan, a Brighton-area video games journalist, was diagnosed with (relapsing, remitting) multiple sclerosis in 2014; he approaches his disease with good humor and curiosity, using metaphors of maps to depict himself as an explorer into uncharted territory. This is some of the best medical writing from a layman’s perspective I’ve ever read.

 

7. Skybound by Rebecca Loncraine: For Rebecca Loncraine, after treatment for breast cancer in her early thirties, taking flying lessons in an unpowered glider (everywhere from Wales to Nepal) was a way of rediscovering joy and experiencing freedom by facing her fears in the sky. Each year seems to bring one exquisite posthumous memoir about facing death with dignity; this is a worthwhile successor to When Breath Becomes Air et al.

 

6. Face to Face by Jim McCaul: Eighty percent of a facial surgeon’s work is the removal of face, mouth and neck tumors in surgeries lasting eight hours or more; McCaul also restores patients’ appearance as much as possible after disfiguring accidents. This is a book that inspires wonder at all that modern medicine can achieve.

 

5. That Was When People Started to Worry by Nancy Tucker: Tucker interviewed 70 women aged 16 to 25 for a total of more than 100 hours and chose to anonymize their stories by creating seven composite characters who represent various mental illnesses: depression, bipolar disorder, self-harm, anxiety, eating disorders, PTSD and borderline personality disorder. Reading this has helped me to understand friends’ and acquaintances’ behavior; I’ll keep it on the shelf as an invaluable reference book in the years to come.

 

4. Free Woman by Lara Feigel: A familiarity with the works of Doris Lessing is not a prerequisite to enjoying this richly satisfying hybrid of biography, literary criticism and memoir. Lessing’s The Golden Notebook is about the ways in which women compartmentalize their lives and the struggle to bring various strands into harmony; that’s what Free Woman is all about as well.

 

3. Implosion by Elizabeth W. Garber: The author endured sexual and psychological abuse while growing up in a glass house designed by her father, Modernist architect Woodie Garber – a fascinating, flawed figure – outside Cincinnati in the 1960s to 1970s. This is definitely not a boring tome just for architecture buffs; it’s a masterful memoir for everyone.

 

2. Educated by Tara Westover: Westover writes with calm authority, channeling the style of the scriptures and history books that were formative in her upbringing and education as she tells of a young woman’s off-grid upbringing in Idaho and the hard work that took her from almost complete ignorance to a Cambridge PhD. This is one of the most powerful and well-written memoirs I’ve ever read.

 

 

It was a real toss-up between Westover and this one, but since Educated has already gotten a ton of attention this year, I’ve awarded the title of nonfiction book of the year to:

 

1. Under the Rock by Benjamin Myers: A spell-bindingly lyrical book that ranges from literature and geology to true crime but has an underlying autobiographical vein. Its every sentence is well-crafted and memorable; this isn’t old-style nature writing in search of unspoiled places, but part of a growing interest in the ‘edgelands’ where human impact is undeniable but nature is creeping back in.

 

My 2018 nonfiction books of the year (the ones I own in print, anyway).

What were some of your top nonfiction reads of the year?

 

Upcoming posts:

27th: Best fiction of the year

28th: Runners-up

29th: Best backlist reads

30th: Other superlatives and some early 2019 recommendations

31st: Library Checkout & Final statistics on my 2018 reading

Natural Causes by Barbara Ehrenreich & Human Errors by Nathan Lents

 

Two recent books about our flawed bodies and the ultimate pointlessness of trying to control them…

 

Natural Causes: Life, Death and the Illusion of Control by Barbara Ehrenreich

A decade ago, Barbara Ehrenreich discovered a startling paradox through a Scientific American article: the immune system assists the growth and spread of tumors, including in breast cancer, which she had in 2000. It was an epiphany for her, confirming that no matter how hard we try with diet, exercise and early diagnosis, there’s only so much we can do to preserve our health; “not everything is potentially within our control, not even our own bodies and minds.” I love Ehrenreich’s Smile or Die (alternate title: Bright-Sided), which is what I call an anti-self-help book refuting the supposed health benefits of positive thinking. In that book I felt like her skeptical approach was fully warranted, and I could sympathize with her frustration – nay, outrage – when people tried to suggest she’d attracted her cancer and limited her chances of survival through her pessimism.

However, Natural Causes is so relentlessly negative and so selective in the evidence it provides that, even though it’s sure to be considered for next year’s Wellcome Book Prize longlist, I would be unlikely to recommend it. In the first chapter, “Midlife Revolt,” which has been excerpted at Literary Hub and is worth reading, Ehrenreich writes of her decision to give up routine medical screening after a false positive mammogram caused undue stress. She decided once she passed 70 she was old enough to die without accepting a “medicalized life.” Moreover, she believes there’s an epidemic of “overdiagnosis,” especially in the USA, where there can be a profit motive behind testing. (This is certainly not the case in the UK, where the NHS doesn’t pester me about getting cervical smear tests to line any pockets; no, it’s about saving taxpayers money by catching cancer early and thus minimizing treatment costs.)

I love the U.S. cover. (Note the different subtitle.)

Ehrenreich goes on to argue that many medical procedures are simply rituals to establish patient trust, that cancer screening is invasive and ineffective, that there is little evidence that meditation does any good, and that fitness has become a collective obsession that probably doesn’t help us live any longer. It’s uncomfortable to hear her dismiss early detection techniques as worthless; no one whose doctor found cancer in the early stages would agree. The author also seems unwilling to confront her own personal prejudices (e.g. against yoga).

Although she uses plenty of statistics to back up her points, these usually come from newspapers and websites rather than peer-reviewed journals; only in two chapters about how macrophages ‘betray’ the body by abetting cancer does she consult the scientific literature, in keeping with her PhD in cellular immunology. Her most bizarre example of how our bodies aren’t evolutionarily fit for purpose is copious menstruation. Overall, the book is a strange mixture of hard science, social science, and, in later chapters, philosophy, as Ehrenreich asks about the nature of the self and the soul and what survives of us after death. As usual, her work is very readable, but this doesn’t match up to many other mind/body books I’ve read.

Favorite lines:

“The only cure for bad science is more science, which has to include both statistical analysis and some recognition that the patient is not ‘just a statistic,’ but a conscious, intelligent agent, just as the doctor is.”

“The objection raised over and over to any proposed expansion of health insurance was, in so many words: Why should I contribute to the care of those degenerates who choose to smoke and eat cheeseburgers? … we persist in subjecting anyone who dies at a seemingly untimely age to a kind of bio-moral autopsy: Did she smoke? Drink excessively? Eat too much fat and not enough fiber? Can she, in other words, be blamed for her own death?”

My rating:


Natural Causes was published in the UK by Granta on April 12th. My thanks to the publisher for the free copy for review.

 

 

Human Errors: A Panorama of Our Glitches, from Pointless Bones to Broken Genes by Nathan H. Lents

Lents is a biology professor at John Jay College, City University of New York, and in this, his second book, he explores the ways in which the human body is flawed. These errors come in three categories: adaptations to the way the world was for early humans (to take advantage of once-scarce nutrients, we gain weight quickly – but lose it only with difficulty); incomplete adaptations (our knees are still not fit for upright walking); and the basic limitations of our evolution (inefficient systems such as the throat handling both breath and food, and the recurrent laryngeal nerve being three times longer than necessary because it loops around the aorta). Consider that myopia rates are 30% or higher, the retina faces backward, sinuses drain upwards, there are 100+ autoimmune diseases, we have redundant bones in our wrist and ankle, and we can’t produce most of the vitamins we need. Put simply, we’re not a designer’s ideal. And yet this all makes a lot of sense for an evolved species.

My favorite chapter was on the inefficiencies of human reproduction compared to that of other mammals. Infertility and miscarriage rates are notably high, and gestation is shorter than it really needs to be: because otherwise their heads would get too big to pass through the birth canal, all babies are effectively born premature, so are helpless for much longer than other newborn mammals. I also especially liked the short section on cancer, which would eventually get us all if we only lived long enough. As it is, “evolution has struck an uneasy balance with cancer. Mutations cause cancer, which kills individuals, but it also brings diversity and innovation, which is good for the population.”

Lents writes in a good conversational style and usually avoids oversimplifying the science. In places his book reminded me of Kathryn Schulz’s Being Wrong and Mark O’Connell’s To Be a Machine. It’s a wry and gentle treatment of human weakness; the content never turns depressing or bitter. Recommended for all curious readers of popular science.

Favorite lines:

“While lithopedions [“stone babies”] and abdominal pregnancies are quite rare, they are also 100 percent the result of poor design. Any reasonable plumber would have attached the fallopian tube to the ovary, thereby preventing tragic and often fatal mishaps like these.”

“to call our immune system perfectly designed would be equally inaccurate. There are millions of people who once happily walked this planet only to meet their demise because their bodies simply self-sabotaged. When bodies fight themselves, there can be no winner.”

 My rating:


Human Errors was published in the UK by Weidenfeld & Nicolson on May 3rd. My thanks to the publisher for the free copy for review.

Wellcome Book Prize Shadow Panel & Two Longlist Reviews

I’m delighted to announce the other book bloggers on my Wellcome Book Prize 2018 shadow panel: Paul Cheney of Halfman, Halfbook, Annabel Gaskell of Annabookbel, Clare Rowland of A Little Blog of Books, and Dr. Laura Tisdall. Once the shortlist is announced on Tuesday the 20th, we’ll be reading through the six nominees and sharing our thoughts. Before the official winner is announced at the end of April we will choose our own shadow winner.

I’ve been working my way through some of the longlisted titles I was able to access via the public library and NetGalley. Here’s my latest two (both ):

Plot 29: A Memoir by Allan Jenkins

This is an unusual hybrid memoir: it’s a meditative tour through the gardening year, on a plot in London and at his second home in his wife’s native Denmark. But it’s also the story of how Jenkins, editor of the Observer Food Monthly, investigated his early life. Handed over to a Barnardo’s home at a few months of age, he was passed between various family members and a stepfather (with some degree of neglect: his notes show scabies, rickets and TB) and then raised by strict foster parents in Devon with his beloved older half-brother, Christopher. It’s interesting to read that initially Jenkins intended to write a simple gardening diary, with a bit of personal stuff thrown in. But as he got further into the project, it started to morph.

This cover image is so sweet. It’s a photograph from Summer 1959 of Christopher and Allan (on the right, aged five), just after they were taken in by their foster parents in Devon.

The book has a complicated chronology: though arranged by month, within chapters its fragments jump around in time, a year or a date at the start helping the reader to orient herself between flashbacks and the contemporary story line. Sections are often just a paragraph long; sometimes up to a page or two. I suspect some will find the structure difficult and distancing. It certainly made me read the book slowly, which I think was the right way. You take your time adjusting to the gradual personal unveiling just as you do to the slow turn of the seasons. When major things do happen – meeting his mother in his 30s; learning who his father was in his 60s – they’re almost anticlimactic, perhaps because of the rather flat style. It’s the process that has mattered, and gardening has granted solace along the way.

I’m grateful to the longlist for making me aware of a book I otherwise might never have heard about. I don’t think the book’s mental health theme is strong enough for it to make the shortlist, but I enjoyed reading it and I’ll also take a look at Jenkins’s upcoming book, Morning, about the joys of being an early riser. (Ironic after my recent revelations about my own sleep patterns!)

 

Favorite lines:

“Solitude plus community, the constant I search for, the same as the allotment”

“The last element to be released from Pandora’s box, they say, was hope. So I will mourn the children we once were and I will sow chicory for bitterness. I will plant spring beans and alliums. I’ll look after them.”

“As a journalist, I have learned the five Ws – who, what, where, when, why. They are all needed to tell a story, we are taught, but too many are missing in my tale.”

 


With the End in Mind: Dying, Death and Wisdom in an Age of Denial by Kathryn Mannix

This is an excellent all-round guide to preparation for death. It’s based around relatable stories of the patients Mannix met in her decades working in the fields of cancer treatment and hospice care. She has a particular interest in combining CBT with palliative care to help the dying approach their remaining time with realism rather than pessimism. In many cases this involves talking patients and their loved ones through the steps of dying and explaining the patterns – decreased energy, increased time spent asleep, a change in breathing just before the end – as well as being clear about how suffering can be eased.

I read the first 20% on my Kindle and then skimmed the rest in a library copy. This was not because I wasn’t enjoying it, but because it was a two-week loan and I was conscious of needing to move on to other longlist books. It may also be because I have read quite a number of books with similar themes and scope – including Caitlin Doughty’s two books on death, Caring for the Dying by Henry Fersko-Weiss, Being Mortal by Atul Gawande, and Waiting for the Last Bus by Richard Holloway. Really this is the kind of book I would like to own a copy of and read steadily, just a chapter a week. Mannix’s introductions to each section and chapter, and the Pause for Thought pages at the end of each chapter, mean the book lends itself to being read as a handbook, perhaps in tandem with an ill relative.

The book is unique in giving a doctor’s perspective but telling the stories of patients and their families, so we see a whole range of emotions and attitudes: denial, anger, regret, fear and so on. Tears were never far from my eyes as I read about a head teacher with motor neurone disease; a pair of women with metastatic breast cancer who broke their hips and ended up as hospice roommates; a beautiful young woman who didn’t want to stop wearing her skinny jeans even though they were exacerbating her nerve pain, as then she’d feel like she’d given up; and a husband and wife who each thought the other didn’t know she was dying of cancer.

Mannix believes there’s something special about people who are approaching the end of their life. There’s wisdom, dignity, even holiness surrounding them. It’s clear she feels she’s been honored to work with the dying, and she’s helped to propagate a healthy approach to death. As her children told her when they visited her dying godmother, “you and Dad [a pathologist] have spent a lifetime preparing us for this. No one else at school ever talked about death. It was just a Thing in our house. And now look – it’s OK. We know what to expect. We don’t feel frightened. We can do it. This is what you wanted for us, not to be afraid.”

I would be happy to see this advance to the shortlist.

 

Favorite lines:

“‘So, how long has she got?’ I hate this question. It’s almost impossible to answer, yet people ask as though it’s a calculation of change from a pound. It’s not a number – it’s a direction of travel, a movement over time, a tiptoe journey towards a tipping point. I give my most honest, most direct answer: I don’t know exactly. But I can tell you how I estimate, and then we can guesstimate together.”

“we are privileged to accompany people through moments of enormous meaning and power; moments to be remembered and retold as family legends and, if we get the care right, to reassure and encourage future generations as they face these great events themselves.”

 


Longlist strategy:

Currently reading: The Butchering Art by Lindsey Fitzharris: a history of early surgery and the fight against hospital infection, with a focus on the life and work of Joseph Lister.

Up next: I’ve requested review copies of The White Book by Han Kang and Mayhem by Sigrid Rausing, but if they don’t make it to the shortlist they’ll slip down the list of priorities.