Being Mortal: Medicine and What Matters in the End - Atul Gawande

My grandmother just turned 90 and lives on her own in the house where my mother was raised. She's lived there alone since her mother died at the age of 97, a year after my grandfather died of a massive heart attack leaving my grandmother a widow caring for her aging mother. At each step, my family has tried talk to my grandmother about her needs and moving into a facility with more activities and more people. She's very social. Up until this stupid pandemic struck, she was making crafts for the church bizarre and making tea sandwiches for the church coffee hour.

She's done amazingly well on her own, for a woman who had a heart attack ten years ago while visiting our family in Ohio. Since then she's watched her diet and makes her medical appointments through a car service for seniors. She takes trips to the grocery store or the mall. Sometimes calling a cab and sometimes taking the service. She hasn't driven since my grandfather's Chrysler needed a major repair decades ago. At each turn she's clung fiercely to her independence in a way that made little sense to us.

But now. Well now I've read this book and I feel terrible about the wasted energy of trying to convince a woman who raised two children and cared for her ailing mother and has made her limited income work for decades on her own, on the street she knows that I somehow known better what will make her life fulfilling. It would be one thing if she was complaining - or somehow making it known that her life was not satisfying to her. But she's not. She's shown, again and again, what it is she wants these years to look like for her, and the trade offs she's willing to make to have that independence in her life. So should we instead be looking at what ways in which we can make these goals of hers more achievable? Should we be aiming to help her live her best life now? Yes of course. Those are easy answers.

Being Mortal asks hard questions. The first half of the books looks at the way we treat infirmity and old age. And urges us to discuss what life looks like for our loved ones as they enter those sunset years. And really, what does life look like for ourselves? What things are essential to our being and self-actualization? It's so important to have these conversations and realize in the moment that we may be making choices based on our own preferences for our loved ones rather than what they would choose for themselves.

The second half of the book focuses on terminal illness and the limits of medicine. To what end do we continue to push our bodies past the point of diminishing returns? In the treatment of unconquerable illness, medicine will push us to choose the next thing and the next, often convincing us, against evidence, that there is always going to be a next thing. So when the final moments come, we are unprepared and the emotional toll on loved ones is enormous. Hospice services can enter the gap and make those last moments more bearable and better prepare us for their arrival. But of course no one is good at talking about these last moments. Doctors do not possess a natural ability to guide people in their end of life choices, unless they are trained and work at it.

I sometimes think awareness of an issue helps us take a step back from it and realize when we are in a situation that can sometimes be emotionally overwhelming. "Oh," we can think, "this is just like that book I read about making choices at the end of life." And maybe, hopefully, we can be better prepared to meet the next thing, even if it is the last thing. 

5/5 Stars.

Ploughshares Fall 2019 - Edited by Ladette Randolph

It's fitting that I'm trying to write this review of the Fall 2019 edition of Ploughshares when the Winter 2020 is sitting on my TBR right now and today Spring 2020 arrived in the mail. I'm way behind with no hope of catching up on my book goals this year. This global pandemic thing has made it really hard for me to concentrate on reading - which is one reason why I enjoyed the Fall 2019 edition so much. The stories were on the longer side, but they also were short enough that I didn't get away from it completely and shut down.

This collection had so many gems, but let me start by saying the nonfiction essays in this one were really really good.  First, Danielle Spencer's Drifting Out to Infinity was about math essentially. I am an English major who does well with short columns of small numbers so most of the concepts discussed were really beyond me, even the one the author claimed simplified a very complicated concept about prime numbers. But the thing I liked the most about it was the imagination it sparked in me and the desire to know more. I googled. I even insisted my husband watch a movie with me, The Man Who Knew Infinity, based on the mention in the story. So yeah, when a nonfiction piece does this, it's well done.

To that end, Tracy Daugherty's fiction story, So Much Straw, also led me down a path reading into Thomas Merton, who I'd only heard of in passing (and I'm Catholic). Pope Francis once mentioned Merton as an American approaching sainthood. So I've added Merton's memoir to my reading list.

This is really the mark of good short stories. They may be short, but the worlds they open up and the imagination they invoke are limitless.

I should also mention Kiley Reid, who's new novel, Such a Fun Age is getting rave reviews, wrote an excellent story in this collection about a teacher assigning a student a history lesson regarding George Washington's Teeth and the teacher's own history becomes through an association with the student's mother.

Really so many stories were good in this collection on a humorous track, including Ian Stansel's The Calleri, which is more complicated than can be briefly explained but was darkly humorous. And Nancy Mays, The Pfeffermans about a middle class family concerned for their mother who through a close call medically develops an imaginary friend. And finally, Takbum Gyel's, Notes on the Pekingese about an office dog with a strong sense of ambition. Yep, you read that right.

Where else can such a collection exist? No where. That's why Ploughshares remains such a valued investment for me.

4/5 Stars.

The Last Romantics - Tara Conklin

I really enjoyed portions of The Last Romantics. In the end, it felt a little bit too long, but I really did enjoy this story of four siblings making their way through a world in which their father dies young and their mother, unable to handle the strain of living as a widow responsible for the lives of four children, who shuts down and puts a "pause" on their mothering. I love sibling stories. Sibling relationships contain so many multitudes of depth and understanding.

I only have one sister. And our relationship has lasted through rivalry, separation, and now a close bond of friendship, mutual admiration and respect, and shared lifestyles. It's sometimes hard for me to imagine having similar experiences with two additional people.

Renee, Caroline, Joe, and Fiona are each individually shaped by their experiences during "the pause" and it carries them into adulthood in varied ways. Never able to fully unload their baggage, they go through periods of self denial. Joe perhaps the worst, because he has been coddled and protected from his choices until he also dies an early death, which leaves each of the sisters grieving in their own destructive ways.

The story is told in flashbacks with Fiona giving an author talk at some point over the age of 100. I didn't quite understand the need for this narrative voice as I found it a distraction that teetered on the edge of unbelievability. Will modern medicine improve our lives and outcomes, extending out life spans to well past 100? Perhaps, but the contemplation of this question added nothing to the story except a hint at the secret hiding in the middle.

On the whole, this was a well crafted novel about the complicated relationships between siblings, needlessly complicated by a contemplated future in which we experience extended lifespans and unnamed security crises.

3/5 Stars. 

The Namesake - Jhumpa Lahiri

When I read the Lowland a couple years ago, I was aware that I wasn't "beginning at the beginning" so to speak when it came to Lahiri's fiction. The Lowland was a moving story of two brothers that suffered only in comparison to the fact that I had read Cutting For Stone earlier that year and I found it the superior of the "brothers" books. (You can read my review of The Lowland here).

In The Namesake, Lahiri takes on the first generation conundrum of not connecting to our parent's culture and forging ahead our own lives in the only country we know. (I say this tongue in cheek because I'm a first generation American born to Canadian parents, aside from knowing the British name for things, there have not been many challenges for me in making my own identity as an American). But for Gogol Ganguli, this transition is harsh and beautifully rendered by Lahiri through the very specific fact of Gogol's name.

Gogol is named for his father's favorite author. A stand-in name until the formal letter arrives from his great-grandmother, Gogol becomes his formal name when said letter is lost somewhere in transit from India to Massachusetts. Gogol grows up resenting his name and resenting his parents' lifestyle. When he leaves for Yale, it gives him an opportunity at crafting a new identity. He changes his name to Nikhil, a name chosen by  his parents but abandoned by Gogol in his first days of kindergarten.

He gets his first real girlfriend and tries to craft an identity through their shared interests. He studies architecture and breaks up with his college girlfriend. He moves to New York and meets another woman, wealthy and WASPish with a family home in New Hampshire and a Brownstone in the City. He loses himself in their identity. Drinking their wine, keeping their schedule. But a family tragedy makes him take stock of his choices. He thinks long and hard about how much searching for his own identity has made him unfairly reject the humanity of his own parents.

In agreeing to a date with a childhood friend, he hopes to recapture some of the legacy of his parents he has let slip away. But because Gogol's motivations are never quite his own or well crafted enough to come from an honest place, the eventual marriage is stifling and uncomfortable.

I love how well made Gogol is in the story. At some point it appears that Lahiri drifts into contemplation of Moushumi and I wonder if Lahiri wasn't a bit more taken with her than with Gogol. In the brief chapters in which she appears, Moushumi is both fuller and more vibrant than even Ashoke or Ashima, Gogol's parents.

I really do enjoy Lahiri's writing, and it's interesting coming back to her early work after reading The Lowland because her writing was so much tighter in her later novel. But as an exploration of the conflicting loyalties of a first generation child, The Namesake is both moving and clinical.

4/5 Stars.