Stuff I'm reading
Well, actually I'm not doing a huge amount of reading at the moment (too busy mucking round on the computer, going for walks and having enjoyable talks with visitors) but three subjects have interested me recently: self-discovery, illness and death. Hmmm, you might say, think I'll pass on this one...
But wait, don't go! These are really good books, even if you haven't got cancer. Stick around and see what you think.
With every breath, by Mike Riddell
Why is Mike Riddell one of the most original people I know? Let’s see. None of my other friends, to my knowledge has: stripped naked in front of an Auckland City Council meeting (well, almost - I think he kept his undies on); shimmied up a power pole to cut telephone wires during the 1981 Springbok tour; spent six weeks in a filthy Moroccan jail; married a woman who has become a family court judge; written a book and then screenplay for a film called “The Insatiable Moon” (starring Rawiri Paratene of “Whale Rider” fame); spent most of the seventies stoned (hmm, there might be a few other of my friends who did this, but they haven’t admitted it yet …); got a Masters degree from a Swiss theological school; written a Ph. D. thesis on New Zealand poet James K Baxter; written and performed a drama on Baxter for the Edinburgh Fringe Festival; allowed his parishioners to interrupt and contradict his sermons (hooray!); and coped with appalling family trauma which would have sunk someone with any less courage and inner strength.
Alongside those highly unusual outer experiences, Mike has slowly been cultivating a rich and deep inner life. With every breath is a short book packed with insight about the biggest journey any of us will ever make - the journey within.
With his usual disarming honesty, Mike begins by writing about the gap he was painfully aware of as a younger man: between the seemingly motivated and successful person he appeared, and the trainwreck which was his personal and inner life at the time.
He fashions a rough prayer stool for himself, and determines that he will blunder his way slowly into a voyage of discovery. Who am I? What do I find in the silence when I go deep into myself? He begins to learn how to put aside the falseness of the ego, and to make out the outlines of the real Self; and he finds that deep within himself, he encounters another Presence - he doesn’t mind what you want to call it - a Presence which embraces him and accepts him.
For thirty years he keeps up this simple regular practice of contemplation and silence. With every breath he finds himself rowing forward: the image of the small craft afloat on the water is maintained right through to the final chapters on death and beyond.
The writing is seasoned with quotes from some of the great voyagers: Jung, Thomas Merton, Julian of Norwich (but for light relief you can also find Oprah Winfrey, Bob Dylan and Winnie the Pooh in there as well).
I’ve been using this book for the last while to help me with my own journey, just a chapter a day. There are seventeen of them, each one a few pages long; they can be read and re-read. I’ll be sticking with this little gem and pondering it for a good few months yet.
http://www.lulu.com/content/paperback-book/with-every-breath/17031431
Kindle edition: https://www.amazon.com/Every-Breath-Mike-Riddell-ebook/dp/B012PUOASK
Mortality, by Christopher Hitchens
In 2011, public intellectual and bad-boy atheist Christopher Hitchens received a dreadful
diagnosis: cancer of the oesophagus. Eighteen months later, after an awful journey through the most unpleasant parts of the health care system, he was dead. During those months he chronicled something of what he was going through; it’s a relatively short book, jam-packed with beautifully written prose from his “great turbine of a mind” (a particularly apt phrase from the publisher’s preface).
Hitchens keeps you at arm’s length: we don’t hear about his tears, his deepest anxieties, his fury. What we do get is a series of searing descriptions about what it’s like to swallow after your whole throat has been scorched by radiotherapy, or how it feels to watch your body being pumped full of toxic matter. He doesn’t do self-pity, but he doesn’t spare his readers any pain.
You also get some uproariously funny descriptions of his encounters with would-be well-wishers; a fascinating catalogue of responses to his illness from his religious enemies and friends; and some impressively erudite reflection on subjects such as Nietzsche’s famous dictum that “That which does not kill me makes me stronger” (Hitchens convincingly proves that Nietzsche was wrong, using incidents from the philosopher’s own life).
It’s not a book you “enjoy”; but you come away with a sense of admiration for the man’s mind and his willingness to step back and objectify his situation. The eye through which he observes himself is dispassionate.
Without wanting to diminish his achievement, I have to say that what I owe him most is his reference to John Diamond’s book, which is next on this review list. Without Hitchens, I would not have discovered it. Thanks, Christopher. Rest in peace, you great turbine.
C, because cowards get cancer too, by John Diamond
Before Nigella became a famous cook, she was an M.A. graduate from Oxford in modern and
mediaeval languages; and she was married to, and had her two children with, a journalist called John Diamond. What a tragedy that he died of cancer, and that she ended up with that despicable Saatchi. If you want to get a picture of who seems to be the real Nigella, as painted by her loving first husband, now deceased, then read this book, and you will discover a highly intelligent, deeply caring and compassionate woman, not the slightly simpering and seductive vamp-cook image she seems to have cultivated since then.
But that’s not the main reason for reading “C”. Before picking up the Hitchens book, I was unaware that a person called John Diamond existed. If I had been in London in the 90s, it would surely have been otherwise, because he was making a big name for himself there in journalism and radio. Well, he was … until he discovered an annoying lump on his neck, which turned out to contain cancerous cells, which turned out to be secondaries from a primary source in his tongue. Over the next few months, he took the unusual step of turning his regular weekly column in the Times into a sort of diary of his cancer. This book “C” is not in fact a collection of these pieces, although it does include a number of them. It is rather a more organised account of his dizzying descent into the world of cancer and its treatment. He takes us into the radiotherapy and its side effects: loss of taste (because his taste buds were irradiated - and the doctor didn’t actually mention this first time round); teeth falling out; pain and more pain. He invites us into the wards and surgeries and laboratories and waiting rooms full of damaged people, the whole alternative universe of the cancer-stricken; and then we experience with him a tracheotomy and the full removal of his tongue. And, alas, the sickening return of the cancer into his larynx.
Boy, what a journey this is. Like Hitchens, Diamond doesn’t do self-pity - he just narrates what happened. He does this with refreshing honesty and humour, and liberal doses of wry self-deprecation. There are plenty of laugh-out-loud moments in this book, and the writing is consistently sharp and engaging. But, unlike Hitchens, Diamond bares his soul. We are allowed into his shock, his panic, his terror, his despair, his grieving. We share his agony losing his temper with his small children when it all gets too much for him. He reveals as much of his own humanity as he can, and the book is all the richer for it.
I got it through Amazon UK, and I thoroughly recommend it as a story of human courage and candour from a witty, intelligent and self-aware writer. You don’t need to have cancer to gain a huge amount from Diamond’s writing; anyone can be enriched by an encounter with this exceptional person.
As I come to terms with a slow-growing liposarcoma in my abdomen, unresponsive to chemo and radiotherapy, not causing me much pain, symptoms manageable, I read this book and was reminded of the old saying “I complained because I had no shoes until I met a man who had no feet”. There are different ways to die, and the road Diamond found himself on turned into a process that left his body terribly mutilated, debilitated and pain-wracked. Both his illness and the treatments he received were continual vicious assaults on his person. That he kept on churning out these honest and wonderfully crafted words throughout it all is a great tribute to him. I stand in awe.
Being Mortal: Illness, Medicine and What Matters in the End, by Atul Gawande
Listen to an interview between Gawande and Kim Hill on Radio New Zealand
http://www.radionz.co.nz/audio/player/2469454 (The red button on your screen switches it on or off.)
Not long ago, my surgeon quoted one of his mentors to me: “A good surgeon knows when to
operate; a great surgeon knows when not to.” As I read this book, it became clear that Atul Gawande, a US surgeon and writer whose family comes from the Indian subcontinent, would totally agree with this dictum. And he would go further and apply it to other procedures as well (and I’m sure my doc and his mentor are right with him): a great oncologist knows when to stop the chemo, stop the radiotherapy, stop anything if it is going too far.
This is a wonderfully warm and honest book from a man who is clearly both a skilled surgeon and a thoroughly decent human being. He tackles head-on the problem of medical overkill: when do you stop treating someone? The patient has been through two gruelling courses of chemo; she is worn out, and they haven’t worked. There’s a third product on the market; some of the family are desperately hoping it might just do the trick. The doctor is certain it won’t, but how does he tell the patient and the anxious family? He can't find the words to do it; so away they go again. Halfway through the treatment the patient might break down with the misery, or even die. And no one is happy.
Gawande is totally honest about his failures in this area, and reveals how difficult and sensitive it is to talk to the patient and the family about death, and when to stop treatment. He believes we have developed all sorts of techniques and resources to cure cancer, but we have not yet worked out when to admit that we have come to the end of the road. He talks about the “difficult conversation” that so few doctors know how to manage, in an environment where everyone hopes and believes that medical science has triumphed, so that failure and death become unthinkable and unsayable.
He becomes increasingly convinced that at some point in a person’s illness, the relentless “cure-at-all-costs” mentality, with its driving need to squeeze out ever more survival time, needs to be replaced with a quest for what really matters: quality. Perhaps it is better to come to terms with death, put the painful medical and surgical techniques away, and enjoy the last few weeks or months of life in one’s home or in a hospice.
Some of the richest parts of this book are in the long and detailed case studies; the most moving is the story of his own father, who used as much medical and surgical help as he could get to combat his illness, but then accepted his son’s encouragement to stop fighting, and came to a peaceful end.
My only gripe with the book is that the first half deals with the question of how we treat the elderly; there is plenty of fascinating and important material here, but it would have perhaps been better to make two books out of one. Otherwise, this is a great read, and raises all sorts of important questions, both for doctors and for anyone brushed by serious illness.
From the Epilogue:
We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being.
Whatever we can offer is justified only if it serves the larger aims of a person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it, the good we do can be breathtaking.
I never expected that among the most meaningful experiences I’d have as a doctor - and, really, as a human being - would come from helping others deal with what medicine cannot do as well as what it can. But it’s proved true.
And as well ...
I've discovered Alec Guinness reading T.S Eliot's Four Quartets on Youtube. Eliot is notoriously opaque, but Guinness brings him alive, with rhythms of great beauty and enigmatic spiritual force. I'm listening over and over to the Guinness version, and have sent away for a commentary to try to understand these poems. Written twenty years after Eliot's masterpiece The Waste Land (considered by many critics to be the greatest English poem of the twentieth century), and ten years after he joined the Anglican church, Four Quartets provide a spiritual counterpoint to the earlier work, and invite the reader to travel through darkness and back out to hope.
In case this all sounds a bit serious and po-faced, an excellent friend has given me the DVD of Blackadder Goes Forth, and my next cunning plan is to work my way systematically through this important work. That should bring me back down to earth.
Cheers.
