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.

Washington Black - Esi Edugyan

I'm just going to say it now. This is the best book I will read in 2019. The moment I woke up after reading all night, I sent a note to my mom and sister - "Just finished this last night. It's exquisite."

Exquisite. I'm not sure I can think of a better word than that to describe Esi Edugyan's Washington Black. First, the writing is exquisite. This is about as tight as a novel can be written but still say so much. Words aren't wasted. Ordinary words line up in a sentence and become transformative. Here's some examples:

"You were children," his father said. "You knew nothing of beauty."
"Children know everything about beauty," Titch countered softly. "It is adults who have forgotten."

"In any case, it was then I recognized that my own values - the tenets I hold dear as an Englishman - they are not the only, nor the best, values in existence. I understood there were many ways of being in the world, that to privilege one rigid set of beliefs over another was to lose something." 

Goff gave a flustered grunt, shoving some boiled potatoes into his mouth, but I could see he was interested. "Such a thing is not possible." 
I peered quietly at him. "Nothing is possible, sir, until it is made so."

Point number two: The nuance is exquisite. These characters, they're complex without being unnecessarily so. There are strong positions on slavery and race, but it's not surface stuff. There is so much nuance - so much examination of the subtle violence of slavery and racism that accompany the obvious violence. 

Point number three: The timelessness of the story is exquisite. Yes, clearly this novel is set in the 1830s. It boldly displays that at the start of each section. And yet. And yet. I would sometimes completely forget that this was happening in a setting close on 200 years ago. All of a sudden a carriage would make its way through a city and I would be shocked to remember that this was all happening a long time ago. This shouldn't be possible when one of the characters is a former slave, and slavery is still a very much real part of the plot, but it just somehow was. George Washington Black, "Wash", was timeless in his character. Somehow. And that is just a very real mark of the artistry put in by Edugyan. 

So I could say many things about the plot. How 11 year old Wash is selected by Christopher Wilde to become his assistant while he toils around his brother's plantation. How Christopher, "Titch", is repulsed but also complacent in his brother's mistreatment of slaves on the land. How the brutality of slavery seeps into every page of the first part of the novel and beyond. How Wash has an opportunity to escape that life without truly understanding what this meant to be forever one part out and one part in. How a daring escape led to a discovery of what it fully means to be your own person. 

But this is really not a novel that can be described but has to be experienced. Because my heart still feels full of it and that's a rare gift.

5/5 Stars.