Feeds:
Posts
Comments

Posts Tagged ‘aging’

I’ve heard great things about Atul Gawande‘s books, but hadn’t read any of them. My dad sent me and my brother each a copy of Being Mortal: Medicine and What Matters in the End so we can have a conversation about how he’d like things to be if he reaches a point that he can’t care for himself and what he’s prefer the end of his life to be like. Gawande notes that many people avoid this kind of conversation.

Gawande explains why this matters by telling stories of patients and his own family members facing such decisions. He also briefly outlines the history of aging and dying, and the state of geriatric care (not great) at the time of his writing in 2014. It turns out, like so many other things about healthcare in America, this situation is mainly caused by money, and yet investing in more geriatric specialists or at least training in geriatrics for doctors and nurses would improve health outcomes and save money. As Gawande notes,

“If scientists came up with a device — call it an automatic defrailer — that wouldn’t extend your life but would slash the likelihood you’d end up in a nursing home or miserable with depression, we’d be clamoring for it. We wouldn’t care if doctors had to open up your chest and plug the thing into your heart. We’d have pink ribbon campaigns to get one for every person over seventy-five. Congress would be holding hearings demanding to know why forty-year-olds couldn’t get them installed. Medical students would be jockeying to become defrailation specialists and Wall Street would be bidding up company stock prices.”

Just after the study came out, however, the university where the doctors worked closed the geriatrics department. There is a shortage of geriatric specialists — because this is not a profitable specialty for the corporations that run hospitals and medical practices — even as we have an aging population. Gawande points out similar information about hospice care, and about supportive services that help seniors stay in their homes. These things all improve quality of life, well being, and mental health for both seniors and their family members, result in fewer invasive medical procedures, emergency room visits, hospital stays, etc.

Besides discussing these unpleasant aspects of our health care system, and the way the vision of the founder of assisted living was abandoned to economic efficiency and legal protections, Gawande also tells some very inspiring, and even sometimes funny, stories about people who have attempted to reform the way we care for the elderly. Like the Eden Alternative, which simply introduced cats, dogs, birds, and children into a nursing home with terrific results, and its offshoot, the Green House project. And NewBridge, a community in the Boston area where people live in private rooms with communal shared spaces. And Peter Sanborn Place, a housing project for disabled and senior citizens where the remarkable director created her own version of aging-in-place supportive care so that her residents could have full lives.

As Gawande learned all this, he came to change the way he talks with patients himself. He credits a palliative care professional, Susan Block, with teaching him to ask patients, “What do they understand their prognosis to be, what are their concerns about what lies ahead, what kinds of trade-offs are they willing to make, how do they want to spend their time if their health worsens, who do they want to make decisions if they can’t?” Block notes that the purpose of these conversations isn’t necessarily to learn people’s last wishes or determine which treatment options to pick, but rather “to learn what’s most important to them under the circumstances.” To help them “negotiate the overwhelming anxiety” that comes with “arriving at the acceptance of one’s mortality and a clear understanding of the limits of medicine.”

With these conversations, which Gawande acknowledges take time and skill, he envisions a cultural shift from the mindset that medicine should fix everything. He counsels courage, “. . . to seek out the truth of what is to be feared and what is to be hoped.” And, “to act on the truth we find.”

This is an excellent, if difficult read. It may make you angry at the systems we have erected in our society that prioritize profit instead of people. But it will also give you hope, that there are people within those systems working to make a difference. And it will give you tools to empower yourself and your loved ones when you find yourself facing mortality.

Read Full Post »

When I saw The Summer Book by Tove Jansson at The Green Hand bookstore in Portland in May, I was intrigued. Jansson is the Finnish-Swedish author of the Moomin books, and I didn’t realize she had also written books for adults. This book is about a young girl, Sophia, who spends summers on an island with her father and grandmother — by page nine we learn her mother has died. The book is made up of twenty-six brief chapters, each a glimpse into Sophia’s life.

Jansson herself spent most of the summers of her life on various islands in the Pellinki and Stockholm archipelagos. She describes both the wild natural beauty and the impact of people’s presence on the islands very vividly in The Summer Book (I could picture the house where Sophia’s family lived because two summers ago I read Finnish Summer Houses).

But far more than simply being evocative of a beautiful place, The Summer Book captures the strangeness of being a small motherless child growing up with a fair bit of freedom and a quirky grandmother who is a bit childlike herself. They talk and walk and play and Grandmother lets Sophia do things her father wouldn’t. They scold each other and use bad words and sing and Grandmother smokes.

Jansson tells readers what Sophia is feeling —  she gets angry with her cat for killing birds and stops speaking to him, she feels suddenly afraid of a seal skull she found on the beach, she shouts and gets frustrated and irritated with a friend who comes to the island and is afraid of the boat and the bugs. Jansson also tells readers what Grandmother is feeling. At one point she tells Sophia she couldn’t sleep and began “thinking about sad things.” She begins to describe being old: “I mean it all seems to shrink up and glide away,” Grandmother said, “and things that were a lot of fun don’t mean anything anymore. . . . ” Sophie gets upset and argues until Grandmother gives her an example: she can’t remember what it’s like to sleep in a tent, which Sophie has done.

“Well I’ll tell you what it’s like,” Sophia said. “You can hear everything much clearer, and the tent is very small.”

As Sophia goes on talking, Grandmother remembers better. And in exchanges like these, Jansson manages to portray what it’s like to be young and misunderstood and old and misunderstood. This is a lovely, quiet book, a series of sketches more than a story, an unfolding of life rather than a plot. If you want to be transported by your reading, this is the kind of book to do that. If you want a story with a beginning, middle and end, it might not be to your taste. I enjoyed it very much — I like to read books in translation, to experience a taste of some other place’s literature. I’m not going to any remote islands this summer, but The Summer Book took me to Tove Jansson’s and it was a wonderful place to visit.

Read Full Post »

I was a little skeptical of the praise Trick received (it’s on at least one list of best translated books of 2018) because I wondered if the star power of Jhumpa Lahiri as the translator turned reviewers’ heads. I was wrong: this is just a good book, deserving of praise. It’s the story of an artist in his seventies, recovering from poor health, a widower. He is called to his daughter’s house — the house he grew up in — in Naples, to care for his four year old grandson while she and her husband, both mathematicians and professors, go to a conference. He quickly ascertains that they are fighting, and that the boy, Mario, is both ” well behaved and out of control.”

I have to say Starnone does a terrific job of writing Mario — he is precocious in his family’s eyes, as all children are, and yet ordinary, well spoken as children of the well educated often are, and yet fully a four year old. He also writes Daniele Mallarico, the elderly artist, very well. He has recently been commissioned to illustrate a deluxe edition of Henry James’ story, “The Jolly Corner.” Which I plan to read.  He is struggling to send off a few plates to his editor before he goes to Naples when the book opens.

As he cares for the child, he reflects on his own childhood and especially, his adolescence in Naples, and on what he became, and whether he is who he wanted to be. He also reflects on his body of work and as is so often the case with creative people, doubts himself. It’s an incredibly poignant, but also incredibly realistic, examination of identity, creativity, and growing up — and old. Mario represents what childhood is but also what childhood means at the end of life; his actions and his contrary, slightly crazed little self bring out both love and doubt in Daniele, and create both a tension and a source of introspection and examination. Is Daniele a talented, important artist or did he simply believe those who saw talent in him, regardless of what he was actually capable of? It’s a good question and this novel really drills down on what is talent and what is human nature, and it desire for influence and importance?

There’s also an amazing appendix of “notes and sketches” for the illustration project. A good read.

Read Full Post »

Full disclosure: I’m one of those nuts who got up before dawn to enjoy uninterrupted hours of BBC America coverage of both the royal wedding and The Queen’s Jubilee.  So perhaps I’m the target demographic for Mrs. Queen Takes the Train, a debut novel from established historian and biographer William Kuhn.  I read it to write a brief review for the Concord Public Library.*

Sometimes it’s just nice to read a book you can tackle in one or two sittings, one that is witty and smart but not overbearing. Kuhn works in a variety of “issues” but I never felt like the book was messagey, even when it touches on mental health or other serious topics. Mostly I got a kick out of the clever but respectful portrayal of The Queen; we see her making marginal notes in biographies of herself, struggling with her computer and vowing not to call the IT woman again, annoyed with rogue tweets (“it’s gin o’clock!) by someone impersonating her.

There are a number of other characters, some of whom I warmed to more than others, but none of whom felt extraneous to the story. I enjoyed the train scenes very much; Kuhn’s portrayal of The Queen’s fellow passengers was terrific and reminded me of people I heard and saw on our recent trip to England. All in all, a nice little comedy of manners, which is something I always appreciate.

Here’s my review, a version of which will come out in January’s “Beyond the Bestsellers” and various other places.

Historian William Kuhn’s debut novel is reminiscent of Alan Bennett’s The Uncommon Reader. Queen Elizabeth II is feeling low. She decides a visit to the decommissioned royal yacht Britannia, which is moored near Edinburgh, might be just the thing to set her right again. The Queen boards an ordinary train at King’s Cross Station with a string of staff on the trail, trying to keep her safe and to keep her adventure private. Downton Abbey or Upstairs Downstairs fans will enjoy the stories of her majesty’s dresser, lady-in-waiting, equerry, stable girl, and butler, as well as a clerk in a posh cheese shop. Kuhn weaves their stories — touching on everything from the Iraq War to class and racial stereotypes, yoga, sexual orientation, aging, environmental politics, royal and family dramas, and Twitter – into the tale of the AWOL Queen, to humorous effect. A light-hearted, entertaining read packed with interesting tidbits about contemporary British life and the royal household.

* Since I mention my job here and quote from a review I wrote for it at work, it’s a good time to remind readers that my blogs represent my views and not those of my employer, and I am writing here as a private citizen.

Read Full Post »