Tag Archives: dying
My second of three digital Hay Festival talks this year was by John Troyer, director of the interdisciplinary Centre for Death and Society at the University of Bath. Troyer is from Wisconsin (where he was speaking from, having been trapped there during a visit to his parents) and grew up with a father who owned a funeral home. This meant that he was aware of death from a young age: One of his earliest memories is of touching the hand of a dead woman when he went to visit his father at work.
That’s not the only personal experience that went into his new book, Technologies of the Human Corpse, which I’m now keen to read. In 2018 his younger sister, Julie, died of brain cancer at age 43, so her illness and death became a late addition to the preface and also fed into a series of prose poems interspersed between the narrative chapters. She lived in Italy and her doctors failed to tell her that she was dying – that job fell to Troyer. (Unfortunately, this seems to be a persistent problem in Italy. In Dottoressa, her memoir of being an American doctor in Rome, which I read for a TLS review, Susan Levenstein writes of a paternalistic attitude among medical professionals: they treat their patients as children and might not even tell them about a cancer diagnosis; they just inform their family.)
Troyer discussed key moments that changed how we treat corpses. For instance, during the American Civil War there was a huge market for the new embalming technology; it was a way of preserving the bodies of soldiers so they could be returned home for funerals. Frauds also arose, however, and those taken in might find their loved one’s body arrived in a state of advanced decay. At around the same time, early photography captured corpses looking serene and sleeping. We might still take such photos, but we don’t tend to display them any more.
In the 1970s the “happy death” movement advocated for things like “natural death” and “death with dignity.” This piggybacked on the environmental and women’s movements and envisioned death as a taboo that had to be overcome. In recent decades a “necro-economy” based on the global trafficking of body parts (not organs for regulated transplant, Troyer clarified, but other tissue types) has appeared. While whole bodies may be worth just £2,000, “disarticulated” ones divided into their parts can net more like £100,000. Donating one’s body to science is, of course, a noble decision. Many people are also happy to donate their organs, though there remains a particular wariness about donating the eyes.
One section of Troyer’s book has become “uncannily resonant” in recent days, he noted. This is Chapter 3, on the AIDS corpse, an object of stigma. The biggest changes to death in the time of COVID-19 have been that family members are not able to be with a dying person in the ICU and that funerals cannot proceed as normal. In a viral pandemic, countries are producing a huge number of corpses that they aren’t prepared to deal with. (Indeed, the Washington, D.C. area is so overwhelmed with dead bodies that ice skating rinks have been requisitioned as makeshift morgues. The suburban Maryland rink I visited as a child is one such. Grim.)
Troyer spoke of the need for an everyday-ness to the discussion of death: talking with one’s next of kin, and encountering death in the course of a traditional education – he finds that even his final-year university students, studying in a related field, are very new to talking about death. A good way in that he recommends is simply to ask your loved ones what music they want played at their funerals, and the conversation can go from there.
We may not be able to commemorate the dead as we would like to at this time, but Troyer reminded the audience that funerals are for the living, whereas “the dead are okay with it – they know we’re doing our best.” The event was sensitively chaired by Peter Florence, the co-founder and director of Hay Festival (also responsible for last year’s controversial Booker Prize tie); the fact that Troyer got emotional talking about his sister only gave it more relevance and impact.
I’ve read an abnormally large number of books about death, especially in the five years since my brother-in-law died of brain cancer (one reason why Troyer’s talk was so meaningful for me). Most recently, I read Bodies in Motion and at Rest (2000) by Thomas Lynch, a set of essays by the Irish-American undertaker and poet from Michigan. I saw him speak at Greenbelt Festival in 2012 and have read four of his books since then. His unusual dual career lends lyrical beauty to his writing about death. However, this collection was not memorable for me in comparison to his 1997 book The Undertaking, and I’d already encountered a shortened version of “Wombs” in the Wellcome Collection anthology Beneath the Skin. But this passage from “The Way We Are” stood out:
After years and years of directing funerals, I’ve come to the conclusion that seeing [the dead body] is the hardest and most helpful part. The truth, even when it hurts, has a healing in it, better than fiction or fantasy. When someone dies it is not them we fear seeing, it is them dead. It is the death. We fear that seeing will be believing. We fear not seeing too. We search the wreckage and the ruins, the battlefields and ocean floors. We must find our dead to let the loss be real.
Just for a bit of morbid fun, I decided to draw up my top 10 nonfiction books about death, dying and the dead. Many of these are personal accounts of facing death or losing a loved one. In contrast to the bereavement and cancer memoirs, the books by Doughty and Gawande are more like cultural studies, and Montross’s is about working with corpses. If you need a laugh, the Bechdel (a graphic memoir) and Doughty are best for black comedy.
- The Light of the World by Elizabeth Alexander
- Fun Home: A Family Tragicomic by Alison Bechdel (her father, too, was a funeral home director)
- Dear Life: A Doctor’s Story of Love and Loss by Rachel Clarke
- The Iceberg by Marion Coutts
- From Here to Eternity: Traveling the World to Find the Good Death by Caitlin Doughty
- Being Mortal: Medicine and What Matters in the End by Atul Gawande
- When Breath Becomes Air by Paul Kalanithi
- Body of Work: Meditations on Mortality from the Human Anatomy Lab by Christine Montross
- The Bright Hour: A Memoir of Living and Dying by Nina Riggs
- To Travel Hopefully: Journal of a Death Not Foretold by Christopher Rush
Tomorrow morning we will announce our Wellcome Book Prize 2018 shadow panel winner. Beforehand I wanted to do a quick recap of my reviews, especially for the two books that I read before the shortlist announcement. My full reviews are here:
Stay with Me by Ayobami Adebayo
To Be a Machine by Mark O’Connell
Mayhem by Sigrid Rausing
The Vaccine Race by Meredith Wadman
I give some extra thoughts on and favorite quotes from the other two below:
The Butchering Art by Lindsey Fitzharris
This is a great blend of medical history and popular science that should draw in readers who wouldn’t normally gravitate to either topic – provided they aren’t too squeamish. Fitzharris has recently returned to Oxford as a visiting academic, and this has also been nominated for the Wolfson History Prize. Follow her on Instagram (@drlindseyfitzharris) for a steady stream of gruesomely fascinating photos (I wish The Butchering Art had been illustrated!). Her next book will be much of a muchness, it seems, documenting the early years of plastic surgery after World War I through the story of pioneering surgeon Harold Gillies.
In the days before Joseph Lister…
“Operating theaters were gateways to death. It was safer to have an operation at home than in a hospital, where mortality rates were three to five times higher than they were in domestic settings.”
“The surgeon was very much viewed as a manual labourer who used his hands to make his living, much like a key cutter or plumber today.”
See what the rest of the shadow panel has to say about this book:
Annabel’s review: “[A]n extremely readable account of a ground-breaking career which led to real advances in hospital medicine. I enjoyed the whole, but particularly the grisly bits!”
Laura’s review: “It’s easy for me to feel a bit impatient with popular histories of periods or subjects that I know well, but Fitzharris strikes exactly the right note, writing clearly and accessibly with no dumbing down.”
Paul’s review: “It is one of the better books that I have read on medical history[;] Fitzharris writes in an engaging way on a subject that is not going to appeal to everyone, but in amongst all the blood is the fascinating story of Joseph Lister.”
With the End in Mind by Kathryn Mannix
“It’s time to talk about dying. This is my way of promoting the conversation,” Mannix writes in her introduction to this accessible and reassuring book about death. She believes we are afraid of death because of our misconception that it is inevitably painful and undignified. In her decades of working in hospice care, this has rarely been the case. (Thank goodness that, compared to the earlier nineteenth-century situation Fitzharris surveys, we have reliable pain control options.) Mannix sees the role of the hospice worker as being like a midwife for the dying, a helpful idea I first encountered in Henry Fersko-Weiss’s Caring for the Dying: The Doula Approach to a Meaningful Death.
Many of the stories in this book are of peaceful deaths the patient and family had time to prepare for. Others are sad stories of denial. One, though, is quite gruesome, yet magnificently described. Alex, a young man with testicular teratoma, has a massive GI bleed:
“Alex’s head is thrown back, almost as though it is a voluntary movement. A huge, dark-red python slithers rapidly out of his mouth, pushing his head backwards as it coils itself onto the pillow beside him; the python is wet and gleaming and begins to stain the pillowcase and sheets with its red essence as Alex takes one snoring breath, and then stops breathing. His mother screams as he realises that the python is Alex’s blood. Probably all of his blood.”
See what the rest of the shadow panel has to say about this book:
Annabel’s review: “[I]t is helping patients, and their families and loved ones, to understand the process of dying, and dispelling the taboos around it that make this book such a valuable and compelling read. I wish I’d read something like this book before my mum died.”
Clare’s review: “For me, this enlightening book is a strong potential winner for the Wellcome Book Prize and I hope it brings comfort and guidance for those who need it.”
Laura’s review: “[The book is] written from her own experiences as a specialist in palliative care, and this proved, for me, both its strength and its downfall. … Mannix writes particularly well on the characteristic patterns of somebody who is entering a gradual decline.”
Paul’s review: “Can highly recommend this moving book and I think it should be essential reading for anyone who has any concerns about death.”
I wouldn’t be at all surprised to see either of these win the Wellcome Book Prize on Monday. Stay tuned for tomorrow’s shadow panel winner announcement, and Sunday’s write-up of a shortlist event I’m attending in London.
I don’t believe that you can learn how to die, or gain wisdom, or prepare, and the work I have done on this book has, if anything, confirmed that suspicion, but I do think you can look at a death and be less afraid.
The subtitle – “Great Writers at the End” – gives you a hint of what to expect from this erudite, elegiac work of literary biography. In a larger sense, it is about coming to terms with the fear of death, one of the last enduring Western phobias.
Roiphe was a sickly, morbid child. After a serious, extended case of something like pneumonia, she had half a lung removed, and her chosen reading was books about Armenian genocide. Although she was convinced she was going to die at 12, it was only a blip; her next significant encounter with death was her father’s cardiac arrest at age 82. Once again, she was utterly unprepared. In investigating six great authors’ deaths, Roiphe is not so much looking for sage tour guides to the underworld as asking how one faces and narrates death.
To start with I was skeptical about Roiphe’s set of chosen writers. Between Susan Sontag, Sigmund Freud, John Updike, Dylan Thomas, Maurice Sendak and James Salter there’s no class or racial diversity, and the gender balance is poor. Yet as I read on I set these quibbles aside. There are literally hundreds, maybe thousands of subjects Roiphe could have chosen, so in a sense the particular authors discussed here are arbitrary. She’s eschewed more obvious candidates like Christopher Hitchens, probably because he wrote enough about his own impending mortality himself. The criteria were probably as plain as this: an author who meant something to Roiphe, left a lot of documentary evidence, preferably had some living descendants and colleagues to interview, and whose death was drawn out enough that s/he had time to wrestle with the thought of it in writing.
Starting each chapter with the vigil at an author’s deathbed in a hospital room or at home, Roiphe skips back and forth in time to pinpoint where illness and death cropped up in that author’s life and work. For Susan Sontag, dying at New York’s Sloan Kettering in 2004, it was her third bout with cancer. A final extreme intervention, a bone marrow transplant at Seattle, had recently failed. Still Sontag shirked the notion of death, refusing even to talk about it. Work was how she had always transcended the specter of death – by writing books like Illness as Metaphor and inserting scenes of false death into her fiction – and now it was all that kept her going. Perhaps, Roiphe theorizes, there was a kind of solipsism at the heart of Sontag’s denial of death: she just could not believe that anything would continue existing without her. Well before her first experience of cancer in the 1970s, she wrote in a notebook: “Too abstract: death. Too concrete: me.”
One might expect Freud to have been more disciplined about the business of dying, what with his theory of Thanatos (the death drive) and his frequently professed acceptance. However, as Roiphe emphasizes, it is one thing to say you accept death, and quite another thing to actually accept it. In Freud’s case, his refusal to give up cigars despite painful throat cancer and 33 oral surgeries flew in the face of his otherwise rational methods. Cigars were his only vice, he shrugged. Is a cigar just a cigar, or are there overt sexual connotations? For Updike, sex was like Freud’s cigars: sensual evidence that life goes on. Adultery, a frequent theme in his fiction, was perhaps an unconscious strategy for ‘cheating’ death. It was only after his diagnosis with lung cancer that death replaced sex as the central obsession of his work. His last book, like his first, would be poetry: Endpoint, one last valiant effort before death.I found the Updike chapter the most absorbing, even though I’ve never read any of his work. (Like Joyce Carol Oates, he was so darn prolific I have no idea where to start.) Prior familiarity with the author in question is neither here nor there, though: you learn everything you need to know from Roiphe’s biographical treatment, and thematic threads are strong enough to lead from one to another. Self-destructive behavior, compartmentalizing life, turning to work or sex to ward off depression, ignoring signs of mortality like serious illness and others’ deaths – we all employ hypocritical strategies, and these authors are no different. Even Thomas’s “Rage, rage against the dying of the light,” resistant as it might sound, was actually delivered in a lulling tone of resignation when he read it aloud, Roiphe reveals.
Each chapter is its own microcosm. The author herself only appears in the prologue and epilogue; in between, although she obviously interviewed survivors (and Salter, who died before he could read the finished book), she edits herself out so we can be right there with the subject. There’s no distance at all. That sense of intimacy is clearest in the chapter-heading photographs of the authors’ (posthumously?) empty studies. These are haunting images. Look at Sendak’s desk covered in paints and drawings, slippers carefully waiting underneath; a cardigan on the back of the chair – there’s such a sense of life. The life continues in the work.
None of these authors got death perfectly right. Several of them fought it right to the end; several of them veered towards faith despite a lifelong antipathy to religion; several of them were ultimately taken aback by the simple realization that they, too, were mortal. Roiphe discovers no magic formula for how a writer should do death. Despite their contradictory approaches, though, all her subjects had the same destination:
here’s what I learned from the deaths in this book: You work. You don’t work. You resist. You don’t resist. You exert the consummate control. You surrender. You deny. You accept. You pray. You don’t pray. You read. You work. You take as many painkillers as you can. You refuse painkillers. You rage against death. You run headlong toward it.
In the end the deaths are the same. They all die. The world releases them.
This would be an ideal book for fans of Olivia Laing (see my review of The Lonely City) or Julian Barnes’s Nothing to Be Frightened of. What Roiphe observes of Sendak’s habit of drawing the dead and dying could equally be applied to The Violet Hour: it’s about seeing the beauty in what terrifies you. One of my top few nonfiction reads of 2016 so far.
With thanks to Grace Vincent of Virago for sending a review copy. The Violet Hour releases today in the UK; it was published on March 8th in the States by The Dial Press.
“There must be better and worse ways to die. It seems both rational and possible to minimize the likelihood of an unpleasant end.”
~William T. Vollmann, “A Good Death”
If pressed to say which books Margaret Overton’s wry, out-of-the-ordinary new memoir most reminded me of, I’d describe it as a cross between Atul Gawande’s Being Mortal and Roz Chast’s Can’t We Talk about Something More Pleasant? The Chicago-area anesthesiologist is the author of a previous memoir, Good in a Crisis (2012), about the aftermath of a divorce and a brain aneurysm. Her latest book, which released on March 1st, started off as a manifesto on the need for an overhaul of American end-of-life care, with a strong drive towards creating an advanced directive and otherwise being meticulously prepared for one’s own death.
From there, I gather, the book took on a life of its own. It’s delightfully digressive, incorporating cases Overton observed in the hospital where she worked and lessons gleaned from a Harvard Business School course on healthcare delivery but also her personal experience of guiding her parents through their last days – her father died of lung cancer in 1998 and her mother, who suffered from dementia, finally followed in 2010.
Years surrounded by infirmity and the possibility of death have convinced her of the benefits of hospice and physician-assisted suicide, still only legal in a few states. We need to know (as we already do for our pets) when suffering is too much and stop extending life at any cost, Overton insists – rather than allowing hospitals to profit from death, as currently happens, with many elderly patients undergoing expensive and ultimately ineffectual procedures in their final weeks. “The last six months of life accounted for roughly twenty-five percent of our Medicare spending.”
For as universal as suffering and death are, we sure are wont to refuse them space in our lives. Again and again Overton uses the striking metaphor of “lemon juice,” drawn from a news story about a hapless would-be bank robber who thought spraying himself with lemon juice would make him invisible to onlookers and police. In our daily lives, she opines, we keep wearing that lemon juice, denying that there is a problem with our healthcare system and our thinking about death.
My thoughts kept coming back to care at the end of life. How do we change the end game? How do we make it better for the elderly, for those of us who will some day become elderly, and how do we save our country some money in the process so that when it is our turn, there will be money left in the system to provide us with the care we want? It seemed to me that if we could just tinker with this one aspect of healthcare, a number of other issues would fall into place.
What’s so special about this book is seeing the problem from several angles and perspectives: that of a physician, that of a healthcare researcher, and that of a dutiful daughter. Overton keeps her narrative interesting by avoiding chronological rundowns; instead she intercuts, sometimes paragraph by paragraph, multiple anecdotes – alternating a hospital case with her mother’s last days, say, or jumping between her experience at the Harvard course and her father’s treatment. I can see how some might find the non-consecutive structure off-putting, but I loved every bit of this short, powerful book, from the evocative title through to the excellent final chapter. Anyone who has enjoyed the aforementioned Gawande and Chast books should not hesitate to make this their next read.
See also this Chicago Tribune article on Margaret Overton.
With thanks to publicist Beth Parker for the e-copy for review.