Atul Gawande Posts

On “Dying” and “In Gratitude”

jenni-diski51hmou4betl-_sx311_bo1204203200_I’m writing a memoir, a form that in my mind plays hide-and-seek with the truth. It contains what I imagine and what I remember being told. Absolute veracity is what I am after. 

Jenni Diski In Gratitude 

Two women writers, Jenni Diski and Cory Taylor, are diagnosed with cancer and its inoperable. Trying to come to terms with the doctor’s grim prognosis is not easy. Suddenly time takes on a different meaning. Jenni Diski began a column for the London Review of Books once her cancer was diagnosed. It was a series a essays that were published reflecting on her life, her birth family, her writing, her school and most significantly her complicated relationship with the Nobel Prize winner, Doris Lessing, who took fifteen-year-old Jennifer Simmonds under her wing. The Australian writer Cory Taylor too spends a while in her memoir, Dying, remembering her mother and the choices she made. In both the memoirs what comes across clearly is that the two dying writers are reflecting upon their past but are also hugely influenced by and acknowledge the presence of the women who made the writers what they are. Jenni Diski had always nursed a desire to be a writer but had not been very focused about it till she met Doris Lessing and was introduced to her world of writers and other creative minds who always made interesting conversation and had ideas to offer. Cory Taylor discovered that her mother had had a dream to be a writer but never achieved it. She writes in Dying : “Writing, even if most of the time you are only doing it in your head, shapes the world, and makes it bearable. …I’m never happier than when I’m writing, or thinking about writing, or watching the world as a writer, and it has been this way from the start.” Three Australian writers including Benjamin Law wrote a beautiful obituary for Cory Taylor in the Guardian terming Dying as a “remarkable gift” for providing a vocabulary and invitation to speak about that “unmentionable thing”, a “monstrous silence” — death. ( 6 July 2016, http://bit.ly/2dPq0Mx ) These sentiments on writing and the gift of the memoir can probably be extended to Jenni Diski and In Gratitude too.

Apart from Jenni Diski’s and Cory Taylor’s preoccupation with writing and their evolution as writers what comes 41vdphgesjlthrough strongly in both memoirs is the tussle between secular and religious modes of coping with death and its rituals. Also how ill-prepared a secular upbringing makes an individual in understanding burial rites or managing one’s grief once a loved one departs. How does one mourn? The structures of religious rituals seem to take care of the moments of sorrow. There is much to do. Yet the challenge of speaking of death and the process of dying is not easy. Cory Taylor had even contemplated euthanasia and ultimately passed away in hospice care.

In Gratitude and Dying: A memoir put the spotlight on the magnificent leaps medicine and technology have made, in many cases it has prolonged life but with it is the baggage of ethics — whether it is possible to go through the agony of pain while dying a slow death or to end it all swiftly by assisted suicide or euthanasia. These are critical issues not necessarily the focus areas of both books although Cory Taylor confesses in having contemplated euthanasia. While reading the memoirs innumerable questions inevitably arise in a reader’s mind.

Some of the literature  published recently has been seminal in contributing to the growing awareness and need to discuss death increasingly in modern times when advancement in medical technology seems to prolong human suffering. Also in an increasingly polarised world between the secular and religious domains bring to the fore the disturbed confusion that reigns in every individual on how to deal with the dying, the finality of death, disposal of the mortal remains and the despair it leaves the distraught survivors in. Some links are:

  1. “Daughters of Australian scientists who took their own lives reflect on their parents’ plan” http://bit.ly/2dDfvc8 ( Jan 2016)
  2. Amitava Kumar’s essay “Pyre” published in Granta ( https://granta.com/pyre/ ) and recently republished in Best American Essays 2016, edited by Jonathan Franzen.
  3. Atul Gawande’s Being Mortal ( 2015)
  4. Paul Kalanithi’s When Breath Becomes Air ( 2016)
  5. Aleksander Hemon’s moving essay on his infant daughter’s brain cancer ( “The Aquarium: A Child’s Isolating Illness” JUNE 13 & 20, 2011 ISSUE http://www.newyorker.com/magazine/2011/06/13/the-aquarium )
  6. Randy Pausch’s The Last Lecture  ( 2008, https://www.youtube.com/watch?v=ji5_MqicxSo )
  7. Andrew Solomon’s essay on his mother’s decision to opt for euthanasia ( “A  Death of One’s Own” 22 May 1995 http://www.newyorker.com/magazine/1995/05/22/a-death-of-ones-own )

In Gratitude and Dying are strangely comforting while being thought provoking in raising uncomfortable questions about mortality, importance of time, maintenance of familial ties and doing that which pleases or gives the individual peace. Both the memoirs have a confident writing style as if by capturing memories in words the writers are involved a therapeutic process of facing their mortality while the urgency to their writing has an unmistakable strength to its tenor as if no one will have the time to dispute their published words.

Read these books.

Jenni Diski In Gratitude Bloomsbury, London, 2016. Pb. pp. 250 £12.99 

Cory Taylor Dying: A Memoir Canongate, London, 2016. Pb. pp. £12.99 

24 Oct 2016 

 

 

Siddhartha Mukherjee, “The Laws of Medicine”

The-Laws-of-Medicine-216x300

Siddhartha Mukherjee is a thinking medical practitioner who is constantly researching, evaluating, placing within historical context and evolving his engagement with medicine. Every time you listen to him deliver a public lecture ( http://www.jayabhattacharjirose.com/siddharth-mukherjee-27-april-2014/ ) or read his books  ( The Emperor of All Maladies: The biography of Cancer), he makes his discipline accessible.   It is not confined to some hallow portals of obscure terms. Siddhartha Mukherjee like Atul Gawande, Abraham Varghese and Preeti Rebecca John are a minority in their fraternity. They work every day in their hospitals but they are also able to look at their discipline in an objective manner and comment upon it.  More importantly they are bringing the discourse about health into the very middle of society.

Siddhartha Mukherjee’s latest book The Laws of Medicine is part of the TED Talks imprint published by Simon & Schuster. The concept is very simple. TED Talk books take off from where the public lecture concluded. So The Laws of Medicine is a continuation of the TED Talk Siddhartha Mukherjee delivered in March 2015. “Soon we’ll cure diseases with a cell, not a pill” TED Talks, March 2015 and here is the link to the interactive transcript http://bit.ly/1O0AcPn

Listen to it. Also read the book if you can. As the author says, “This book is about information, imperfection, uncertainty, and the future of medicine.” But it is also much more. It is about the human being forever being on alert, looking for information and details everywhere and not becoming complacent, letting machines, technology and others do the thinking for you. The brain continues to be important. Apply it to any discipline.

Siddhartha Mukherjee The Laws of Medicine: Field Notes from an Uncertain Science Simon & Schuster, London, 2015. Hb. pp.80 Rs 299

25 Oct 2015 

Being MortalIf we shift as we age towards appreciating everyday pleasures and relationships rather than towards achieving, having, and getting, and if we find this more fulfilling, then why do we take so long to do it? Why do we wait until we’re told? The common view was that these lessons are hard to learn. Living is a kind of skill. The calm and wisdom of old age are achieved over time.  ( p.95)

…Three Plagues of nursing home existence: boredom, loneliness, and helplessness. (p.116)

Reading award-winning writer and practicing general surgeon Atul Gawande’s Being Mortal was such a cherished reading experience. His basic premise is that the conversation with people who are severely ill, with slim chances of recovery is one of the most difficult tasks a medical practitioner has. His insights into caregiving, an analysis of the US healthcare system, assisted living and an understanding of the Indian family social structure offering support similar to hospice care abroad are sharp. For instance something that is often noticed in practice, but rarely uttered is how many daughters look after their ageing parents. Yet the mantra in society, at least in India is, a son is important to have since he will care for you in your old age. Whereas Atul Gawande points out quite rightly too, “your chances of avoiding the nursing homes are directly related to the number of children you have, and, …having at least one daughter seems to be crucial to the amount of help you will receive.” I marked the book extensively and scribbled comments since it resonated with me. Having been a caregiver for my ailing grandfather, familiar with the excruciating conversations about enemas, maintained a funeral notebook where he had detailed the arrangements and been responsible for telling my surviving grandparents that their spouse had died, Being Mortal is a godsend. Atul Gawande’s perceptive observations about caregiving, mortality, longevity, quality of life as opposed to honouring the Hippocratic oath echo conversations heard often amongst caregivers. There is much, much more to read and discover in this book. Read it. Buy it.

Atul Gawande Being Mortal: Medicine and What Matters in the End Hamish Hamilton, an imprint of Penguin Books, New Delhi, 2014. Hb. pp. 282. Rs. 599 

12 Nov 2014 

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