This slim novel focuses exclusively on Sy Baumgartner, a 70-year-old philosophy professor at Princeton. Ten years before the story opens—when BaumgartThis slim novel focuses exclusively on Sy Baumgartner, a 70-year-old philosophy professor at Princeton. Ten years before the story opens—when Baumgartner and his wife were on holiday—Anna, a strong swimmer, was drowned by a rogue wave.
The two were soulmates, and the novel mostly documents the protagonist’s bereavement and efforts to go on without his beloved. Some of Anna’s poems and autobiographical pieces, Baumgartner’s own writing projects, and the couple’s family histories are included in the book. Baumgartner also tells the story of his falling in love (over the past two years) with a younger friend of Anna’s and his hopes for a second marriage to this woman. Alas, it is not to be. As the story nears its conclusion, he looks forward to the arrival of Beatrix “Bebe” Cohen, an intelligent and sensitive Michigan University graduate student (the child he and Anna might have had, were they able to). She hopes to make Anna the subject of her doctoral work, and wants to go through the poet’s papers. Baumgartner is excited at the prospect of sharing these and seeing his wife recognized.
This is the first novel of Auster’s I’ve read. I was scared off his work for some reason, expecting it to be intimidating. Some years ago, I attempted reading something by his wife, Siri Hustvedt. I don’t even remember which book it was—possibly the one about her neurological condition. I recall finding it cerebral, chilly, and difficult, and I believed I would encounter something similar in Auster. To my surprise, Baumgartner was remarkably accessible. I enjoyed it, but didn’t find it a particularly moving, invigorating, or memorable read. There really isn’t much to it. I have no idea if it is representative of his other work. It’s possible I’ll try others . . ....more
There’s a mystery at the heart of Bergman’s skillful and intriguing work of speculative fiction. Twenty-five years before the story opens, an eight-yeThere’s a mystery at the heart of Bergman’s skillful and intriguing work of speculative fiction. Twenty-five years before the story opens, an eight-year old girl, Maeve Wilhelm, was retrieved from the bottom of a swimming pool, having spent an indeterminate period of time under water. After initial treatment in hospital, she was sent home with a dire prognosis. Defying the odds, she’s been “undead” for a very long time. Hooked up to monitors and receiving nutrition through a nasogastric tube, Maeve can breathe on her own. To all appearances, she is simply asleep. (the tale of Briar Rose is alluded to more than once.) What is most remarkable is that the child has not aged. Only her hair and nails grow.
Shortly before the accident that left Maeve in this vegetative state, her mother died. Since her twin sister, Evangeline, was too young to assist, it was left to Maeve’s oddball father, Lionel, to manage her care. Early on there was medical support, and a half-dozen researchers studied her. A cult of worshippers—the orange-robed “Congregants”— also formed around Maeve. The latter were permitted entry into the home to breathe in bedside synchrony with the child.
The story of Maeve’s mother is significant. Before being hired by Genesix, one of three biotech firms in Marks Island City, Naomi Clarke Wilhelm had been a promising paleobiologist. She’d completed a doctorate on the complex ecosystem around nearby Marks Island, an area subject to seismic activity. Years before Naomi began her studies, the remains of members of an ancient indigenous tribe had been recovered from caves there. A peculiar doll carved from red rock was also unearthed. Dr. Wilhelm had been particularly interested in the role of phosphorescent red algae in the waters around the island, and she’d hoped for a post-doc that would allow her to continue her investigations. With funding for academic work in “the ancient sciences” drying up, however, the young woman was forced into pragmatic compromise: she accepted a senior research position with Genesix. The project assigned to her was highly specialized, tightly controlled, and secretive, its purpose hidden from Dr. Wilhelm herself. Communication among the biotech’s departments was strictly forbidden. Ultimately, the company would launch Prosyntus, a procedure to arrest aging.
In addition to Evangeline, Maeve’s identical twin, Bergman has created a well-developed cast of characters, all within six (or fewer) degrees of separation from the Wilhelms. Among them is Kevin Marks, founder-curator of the Marks Museum, situated on the site of the original caves; he’s the grandson of the paleoanthropologist who discovered the ancient tribe. Monique Gray, a performance artist and indigenous refugee from an island ravaged by an addiction epidemic, is another interesting character. Finally, there are two couples who play important parts in the story. Luke and Tess are trying to cope with the latter’s terminal illness. Syl and Abe have a nine-year-old son, a classmate of Evangeline’s. Abe, a historian, is 23 years older than his wife. These characters allow Bergman to explore a number of themes. The novel includes reflections on history, impermanence, aging, loss, and memory. There are penetrating insights sprinkled throughout. Bergman has a distinctive voice—philosophical with a dash of mystical and a pinch of quirky.
Those who prefer chronological storytelling may find the author’s shifting backwards and forwards in time frustrating. In many ways, the novel compares to a jigsaw or mosaic. Each chapter provides pieces or tiles which gradually fill in the picture. Prospective readers should be forewarned that if they expect to understand the formulation of Prosyntus or its physiological mechanisms, they’ll be disappointed. Bergman addresses these things in only the vaguest of ways. This may be considered a weakness by some. Having said that, I think there’s much to appreciate overall. I really liked this novel and would certainly read more by Bergman....more
“Life doesn’t proceed in an orderly way. It frustrates people who need to control every part of their lives, who go berserk when anything changes on t“Life doesn’t proceed in an orderly way. It frustrates people who need to control every part of their lives, who go berserk when anything changes on them. Life doesn’t allow it, total control, and things will go south, and north, every which unexpected way.”
“I thought I knew my limits, I thought I should have limits, but limits and boundaries are erased and erected and erased again. There is nothing stable when dealing with a parent or friend whose condition is essentially unstable.”
Lynne Tillman initially presents her mother, Sophie—whose final years are the subject of this book—as she imagines her when young: talented and ambitious, a girl who dreamt of painting and writing. Marriage had apparently changed everything for her. This attractive, smart, and resourceful woman had tried to contort herself into the ideal 1950s American wife and mother: she stayed home and raised three daughters in the suburbs. It made her very angry. When her husband retired, the couple moved to Florida. After his death in 1984, her eldest daughter found her an ideal Manhattan apartment. Nearly 79 years old, Sophie was finally back in the lively city of her birth, the place where she belonged.
She spent seven-and-a-half years strolling the streets she loved and enjoying all that New York had to offer. But that’s not what this book is about. Its focus is the eleven years that Tillman and her two older sisters cared for Sophie when she became ill. “Keeping her alive was done generously,” writes the author, “but not selflessly.” Since childhood, Lynne had disliked her mother, so being involved in her care for such a long period was “a gruelling obligation.” Life felt “narrower”, “disturbed by emergencies, eruptions, and thudding repetitions.” Time was being “stolen” by her parent. A paragon of rationality, practicality, and organizational ability Sophie may have been, but she was also blunt, rude, arrogant, competitive, narcissistic, and envious of her daughters—the youngest in particular. It is the tension between ego and superego—the author’s actual feelings towards her parent and the sense of obligation to her—that makes this memoir so compelling.
Tillman makes it clear that she’s not speaking for her sisters here; the reflections in the book are hers alone. Late in the memoir, she explains why her reactions to the circumstances were unlike those of Sophie’s older daughters:
Each of us sisters had a different mother and father. It’s remarkable and true that siblings experience their parents differently, and each can say, “That wasn’t how he was with me,” or “She liked you better,” and “We had different parents,” the main source of disorder among them. It is confounding to comprehend just how different parental differences can be. Winnicott’s good-enough mother might be good enough for one, not the other.
The author also notes that the terminal illness of a mother or father places unique strains on adult children. Differences in siblings’ sense of duty and their understanding of how a parent’s care should be handled can permanently break and divide families. Although not explicitly discussed, their awareness of the potential for estrangement, as well as “a decided practicality,” informed the Tillman sisters’ interactions with each other and “encouraged getting along.”
Sophie’s health problems were first apparent to Tillman in 1994 when she returned to New York after four months abroad. Her mother’s behaviour had become strange: she was unkempt and distant, she stared vacantly in front of her, and she seemed depressed. Dementia, you might think—everyone does, including doctors, when an elderly person presents as cognitively impaired. However, when you hear hoofbeats, it’s not always horses; sometimes there really can be zebras.
Sophie had normal pressure hydrocephalus (NPH), a little-known and often missed condition, mainly affecting the elderly. Cerebral spinal fluid (CSF) accumulates in the ventricles (fluid-filled chambers) of the brain, which then press on tissues and structures. While the cause of NPH can’t always be determined, it’s often due to a head injury, hemorrhage, infection, inflammation, or a tumour, which impedes CSF flow. When the condition was first named, the pressure of the fluid was thought to be normal, but it can, in fact, run quite high. Memory loss, urinary frequency/poor bladder control, and problems walking are the main signs.
The Tillmans were both lucky and unlucky. A good internist made this “subtle” diagnosis based on symptoms and an MRI, but the arrogant neurologist to whom he referred the family for confirmation of the diagnosis did not agree with it. The specialist believed the patient’s adult daughters were simply refusing to face the truth: Sophie had Alzheimer’s. He ridiculed them, dismissing their point that her cognitive decline had been precipitous, not an insidious process, as is the case with Alzheimer’s disease. The differing opinions of two other physicians further muddied the waters.
Ultimately, the condition was treated as NPH. A neurosurgeon operated, placing a shunt in Sophie’s brain. This would allow CSF to drain through tubing from the brain’s ventricles, down the neck, and into the abdomen. Unfortunately, the surgery failed. Within days of being released from hospital, Sophie began to have seizures. The tubing was too long and had twisted, and the CSF was unable to drain. A “revision” surgery was performed to adjust the tube’s length, but the patient still didn’t progress: she was immobile, even semi-comatose. For the neurologist, this confirmed his view that the patient did not have hydrocephalus at all. A new neurologist provided assistance and a fresh perspective on care of the elderly. Sophie underwent further revision to address a tube-clogging issue (a common problem), and though the surgical delay had caused permanent brain damage, she did begin to recover some of her faculties. Over the years, a total of six revisions would be performed. According to Tillman, when the shunt was functional, Sophie was lucid. Towards the end, however, its malfunction caused significant seizure activity.
During the last decade of her life. Sophie was also on a whole host of ever-changing medications. Over a dozen were administered at breakfast alone. The impression the author gives is that her mother, though wheelchair-bound, was active and engaged with life. She took lessons to relearn how to knit and paint, she enjoyed being taken to the park and the theatre by her caregiver, and she derived pleasure from the birthday parties her daughters threw for her.
I admit that I was skeptical about an elderly person (in her 80s, then 90s) going through multiple surgeries and setbacks. Was the payoff worth the cost for this mother and her daughters? It’s hard to say. The second neurologist was free of the ageist bias of the first. An optimist with high expectations, he told Sophie’s daughters that if this were his mother, he would choose as they did. Tillman stresses how fit, vigorous, and generally together her mother had been prior to the onset of the NPH symptoms and how determined and resilient she was after.
Much of the book concerns the challenges around finding reliable, competent, full-time caregivers for Sophie. She had not wanted to be placed in a home, and the sisters did their utmost to respect her wishes. However, there were financial constraints and ethical dilemmas, not the least of which was hiring women of colour at minimum wage to do the demanding work. Some of the carers were incompetent, thieving, or downright loopy, and had to be let go. Frances, the caregiver who stayed the longest, treating Sophie like her own mother, stole from the family and regularly rang up huge phone bills. Tillman turned a blind eye to it all. If this was the price that had to be paid for care—and to save Tillman from spending more time in the apartment than she had to—then so be it.
A short, absorbing memoir, Mothercareacknowledges some hard truths. Children do not always love their parents. Even when they do, caring for them is demanding and life-altering. “I learned what I never wanted to know,” writes Tillman, who was clearly transformed by the experience. The fifteen years between Sophie’s death in 2007 and the writing of this book appear to have provided time for reflection and understanding. This is a thoughtful, honest, and mature work that comes not from the wound but the scar. Tillman concludes with some thoughts on mortality, but it’s her remarks about the aged among us that most struck me:
In New York City, these people are not hidden from sight, they are in plain sight, if you notice them. The healthy and capable elderly take buses, go shopping, go to movies, take walks, slowly, go to restaurants alone or with friends, they live among and with us. They live. That’s the point.
The turning away interests me, the ignoring, ways to ignore inevitability. Now that I have seen the inevitable, against my will, which I didn’t want to see or know, I can rarely pretend it won’t happen to me, and pay more attention. Let’s say, I have become aware....more
This was interesting enough to complete, but it didn’t offer any startling insights into what old age is like. The reader gets the typical sorts of deThis was interesting enough to complete, but it didn’t offer any startling insights into what old age is like. The reader gets the typical sorts of details: how one’s memory, especially for names, fails; how time passes differently—more rapidly—than it does when one is young; how the body gives out, and so on. Interspersed with interesting details about the author’s life are bits of (sometimes comparative) anthropological information about the San bushmen of the Kalahari, with whom Marshall Thomas spent considerable time and whom she wrote about, as well as information about old age/retirement homes and communities, which she researched both for a future self who might need to move into one and for her readers, who might be interested in knowing what’s available. The text is fairly lively, but occasionally rambling and disorganized. I don’t regret reading the book, but I can’t say it’s a memorable piece of writing....more
er·rat·ic /əˈradik/ adjective not even or regular in pattern or movement; unpredictable. "her breathing was erratic" GEOLOGY a rock or boulder that differs er·rat·ic /əˈradik/ adjective not even or regular in pattern or movement; unpredictable. "her breathing was erratic" GEOLOGY a rock or boulder that differs from the surrounding rock and is believed to have been brought from a distance by glacial action.
Vicki Laveau-Harvie was born in Canada but put continents between herself and her deranged parents in order to safeguard her sanity. For years she has lived and passed as a typical ratepayer in Sydney, Australia. Her sister didn’t get quite as far away. She lives with her partner in British Columbia, the next province over from Alberta. Over many years, Vicki and her sister dutifully, even heroically, kept tabs on the aging parents who had legally disowned and disinherited them.
Laveau-Harvie’s is a crisp, compelling, and sometimes sardonic memoir, leavened by the occasional dose of gallows humour. It opens at the time that their delusional, vindictive 90-something mother breaks her hip and requires hospitalization. The two sisters fly in to stay with their father in their parents’ sprawling, bizarrely opulent ranch home in Okotoks, a small town just south of Calgary. That place, once frequented by the Blackfoot First Nation, is known and named for the massive boulder now crumbling and caving in on itself—an “erratic”, brought there thousands of years ago by glacial ice. The sisters wonder if they might finally rescue their dad, a frail Stockholm syndrome victim, from the captor whose influence has infiltrated his every synapse. They want to seize the opportunity offered by an osteoporotic fracture, have medical professionals assess their “mad as a meat-axe” mother, and finally see her declared incompetent. It’s a tough prospect: hospitals are in the habit of discharging difficult patients back home to the family, and this patient’s delusional displays are performed with such conviction that members of the medical team are convinced—and, in some cases, actually charmed—by her stories.
The author resists the temptations of the misery memoir and spends little time describing what it was like to be raised by such parents. Laveau-Harvie says that her way of coping with the dysfunction (besides moving across the globe) was to forget it. I’m not sure I completely believe her. In any case, we only get scanty dribs and drabs about the girls’ growing-up years. The family was wealthy: their father made millions in the oil industry, enough for his grasping multilingual wife to purchase and hoard antiques, furs, and valuable paintings by the Group of Seven, iconic Canadian visual artists. At some point, when their mother no longer got a charge out of buying mink stoles and coats, she turned to get-rich-quick schemes, sending out cheque after cheque to scam artists on almost every continent, blithely bleeding away her husband’s bank account. There are closets full of shoeboxes packed with cancelled cheques to prove it.
As the book’s title suggests, The Erratics is a surprising, unpredictable memoir, initially focusing on a destructive and unstable mother and switching to a story about the rescue and reclamation of a father. It raises thought-provoking ethical questions about negotiating one’s way with mentally ill and elderly parents, and it exposes the fractures and divergent reactions to dysfunction within a family. It’s a quick read and a worthwhile one.
Many thanks to the publisher and to Net Galley for providing me with an advance reading copy....more
Nicci Gerrard’s book about Alzheimer’s Disease is a combination of memoir and journalism. She tells about the last years of her father’s life, beautifNicci Gerrard’s book about Alzheimer’s Disease is a combination of memoir and journalism. She tells about the last years of her father’s life, beautifully capturing him as a person both before and after Alzheimer’s struck. Gerrard manages to do what psychiatrist Arthur Kleinman tried (unsuccessfully) to accomplish in his recent book The Soul of Care: provide a sense of the personhood of a loved one stricken with a condition that seeks to erase the self. (In Kleinman’s case, it was his wife, Joan.)
Gerrard has also done considerable research, speaking with experts in the field (both academic and frontline clinicians), Alzheimer’s patients, and care givers. Her findings are rich and informative. She discusses the biological aspects of the disease, noting that while imaging and post-mortem studies of brain tissue often reveal obvious abnormalities in the appearance of cells and structures, these do not always correspond with the way patients may have presented clinically. A dissected brain may look very abnormal, yet in life the patient may have shown no signs of cognitive impairment. Conversely, brain slices from a patient who had been diagnosed with the disease may show no visible markers of dementia. What appears to be true, however, is that the characteristic amyloid plaques that are considered the hallmark of Alzheimer’s Disease may be the “ashes” after the damaging “fire”, rather than the cause of the impairment.
Gerrard notes that while we generally think of dementia as a disease that impairs memory, there are actually multiple indicators—a “bewildering number of cognitive impairments” that, according to one book, may number as high as 256. There are also multiple varieties of the disease itself. While Alzheimer’s, the most common form (accounting for one half of all dementia cases), typically presents with the loss of episodic memory (long-term memory of personal experience), there is a form of Alzheimer’s in which memory is preserved but visual processing is damaged: colours can extend beyond boundaries, objects can appear upside down or on a tilt, and the sufferer may have difficulty locating a door.
According to Gerrard, if we now seem to be in an Alzheimer’s epidemic, this is because the disease has come out of hiding. The statistics she cites give one pause. In 2015, an estimated 850,000 people in the UK were living with dementia, but it is believed that an equal number were undiagnosed. The number (in the UK) is expected to rise to over one million by 2021. According to the World Health Organization, an estimated 47 million worldwide have the disease; 5.5 million of them are in the US. Familiar with these numbers as Gerrard is, it is no wonder that she feels a sense of urgency about the need for society to address the many issues around humane and respectful care of the afflicted. (She and a friend began a campaign, named after her father, to push for this.) Our awareness, she says, brings social, political, and moral responsibility.
Gerrard doesn’t just write about dementia; she also illuminates a number of other related subjects: aging, including a sense of the normal cognitive changes experienced as we get older; advance directives; assisted dying; care giving; old age “homes” which almost never feel like “home”—because they are not physical extensions of the self in the way a real home is; death; grief; and the ways in which we later take our departed loved ones into our own psyches. I found one of her remarks about aging particularly striking: “We identify ourselves as young, because in one sense we still are. The older, current self is a newcomer, still something of a stranger, who we have to live with but who we don’t feel entirely comfortable with and may sometimes be distressed by.”
Like consultant neurologist Jules Montague, author of Lost and Found: Why Losing Our Memories Doesn’t Mean Losing Ourselves, Gerrard is interested in the question of personal identity in individuals who lose the narrative of their lives, the sense of the continuity of themselves and their stories over time: “I used to say that we are made of our memories, but what happens when our memories are lost? Who are we then? If we are out of our mind, where have we gone? If we have lost the plot, what happens to the story we are in?”
Gerrard’s book echoes a point that Dr. Montague makes about how alterations in moral capacity in patients with neurological disease can affect the way those patients are perceived by family members. If they remain kind and cooperative, patients are likely to be viewed as “essentially themselves” by those close to them. When Gerrard asked neurologist Dr. Martin Rossor, the National Director for Dementia Research at the National Institute for Health Research, if he believed that a self is ever wholly lost to the disease, his judgement was similar to that of Jules Montague. Perhaps a self is lost, he said, “when all empathy goes”.
Another of the author’s interests is the way in which the arts may be used to aid those with dementia. Since she is a patron of the Creative Dementia Arts Network, it is not surprising that Gerrard should devote some of the pages of her book to visual-arts and music programs that seem to be helping patients stay connected to the external world. She also highlights the work of painter William Utermohlen, whose self-portraits, completed as his disease claimed him, provide viewers with a window into the interior experience of the condition. Some of these paintings can be seen online. I am providing one link here that highlights the progression of his illness through his art. Utermohlen’s work shows us that not only is memory erased in Alzheimer’s, but a person’s spatial sense and perceptual capacities can be eroded as well: https://www.boredpanda.com/alzheimers...
The Last Ocean is a valuable work, which addresses some matters I haven’t seen discussed elsewhere. It is an honest and affecting piece. I do have a couple of relatively minor reservations about the book, however. At one point, Gerrard comments that animals “perish”, while humans “die”. I’m not sure I understand her distinction. If anything, our mortality links us with the other animals on earth. It seems to me Gerrard is insinuating that the death of nonhuman animals is a lesser thing than the death of humans—perhaps because animals lack the mental faculties, self awareness, consciousness, and sophisticated culture of humans. Having been with my own companion animals as their lives drew to a close, I believe that animals can certainly be aware that they are dying, and sometimes humans would be wise to take instruction from them. My second reservation about the book relates to some of Gerrard’s writing, especially towards the end: it is occasionally too self-consciously literary. Overly lyrical phrasing sometimes draws too much attention to itself and distracts from the content....more
I preferred this second volume of linked short stories about elderly former math teacher Olive Kitteridge over Strout’s first book about her and some I preferred this second volume of linked short stories about elderly former math teacher Olive Kitteridge over Strout’s first book about her and some of the other residents of Crosby, a small (fictional) coastal town in Maine. As with the first book, Strout explores ageing, regret, loneliness, the distances between people and their occasional fragile connections. I don’t recall the first book about Olive as well as I’d like, but it seems to me (with her now older protagonist) Strout’s concern with the body’s betrayal and certain decline is more in the forefront, and reading OLIVE, AGAIN can be somewhat grim.
Towards the end of the book, Strout attempts to lighten the work with a pretty over-the-top story about a long-married elderly couple who haven’t properly spoken to each other in 35 years and who more or less live on opposite sides of yellow tape that divides some of the rooms of the house into “his” and “hers” halves. Their 40-something daughter, Lisa, purposefully returns for a visit. She carries a DVD documentary that has been made about her and her very unconventional “career” choice. (Lisa quotes her junior-high math teacher’s words about the importance of being oneself as a sort of weird justification for her job—something I really couldn’t buy.) This and another story about a teen-aged girl housecleaner who regularly touches her breasts for a voyeuristic elderly man in cognitive decline (who then provides her with envelopes containing large sums of money) just did not convince. Neither did the 73-year-Old Olive’s unfamiliarity with baby shower “protocols”. Living in a small, interconnected town and never having been to a baby or wedding shower before? Not knowing you’re supposed to bring a gift or about the practice of sticking bows on a paper plate which is then fashioned into a hat? (I’m not Olive’s age, but even I know about these things.)
Having said this, I found two of Strout’s stories quite powerful. In one, LIGHT, Olive visits and consoles a former student dying of breast cancer. In another, HELPED, a successful middle-aged woman returns to Crosby when her reclusive father dies in a fire that has also destroyed the family home. Her father’s solicitor, who knows something of the Larkin family secrets, listens to the woman with attentiveness and compassion. Strout movingly captures the gift of one person being entirely emotionally present for another who is suffering.
I found OLIVE, AGAIN an absorbing read overall, but there is something in Strout’s work that feels just slightly off to me. It holds me back from giving this book (and others of hers I’ve read) a full five stars.
At over 450 pages, ELDERHOOD, by San Francisco geriatrician Louise Aronson, is a big book. It’s an ambitious one, too. In the opening pages, the authoAt over 450 pages, ELDERHOOD, by San Francisco geriatrician Louise Aronson, is a big book. It’s an ambitious one, too. In the opening pages, the author states her intention to highlight relevant information from many disciplines about the last of the three acts in a human life: old age. (Childhood and adulthood are acts one and two respectively.) As the pages turn, several key themes emerge. One is that geriatrics (as a medical specialty) lags behind most others. Caring for the elderly has low status, it is not prioritized by the health-care system, and geriatricians are poorly remunerated relative to other specialties.
Like childhood, old age consists of a number of stages, but people only seem to realize this when they live them. What is generally true, however, is that the medical care of elders needs to be different from that of adults. The heroics, technical fixes, and dedication to saving lives for which modern medicine prides itself are of more benefit to people in the first and second acts of their lives than to those in the third. Insurance companies are another part of the problem. They will reimburse for chemotherapy and dialysis (which can be punishing treatments for the old), but not for basic services that would improve the health and daily functioning of elders with chronic diseases or debilitating conditions. Palliative care and hospice are also grossly underfunded. Clearly, a revolution—a complete system overhaul—is in order. Unfortunately, Dr. Aronson doesn’t offer many ideas as to how this might be achieved..
Since the life span of most in the developed world has essentially doubled over the last century (largely due to advances in public health/sanitation), a lot of us would benefit (when the time comes) from being cared for by a geriatrician, a physician who understands the critical social and psychological dimensions of aging, the changes in physiology that accompany old age, and the ways in which care (including pharmacological treatment) needs to be tailored for safety. An appropriate dose of a drug (for hypertension, depression, or arthritis) for a fifty-year-old can be dangerous, even deadly, for an eighty-year-old.
For me, the power of Dr. Aronson’s book is in the stories of her interactions with patients at various stages of elderhood. The author uses case studies well to illustrate key points and dilemmas.
In the end, I feel the author attempted a bit too much here. As well as dozens of stories, there are elements of memoir and long sections on the challenges of practising modern medicine—particularly burn-out, from which the author herself suffered. Furthermore, the book is rather meandering overall; the headings and subheadings often seem quite unrelated to the content; and the author addresses some topics multiple times. Organization is not a strength. While I did learn a great deal from the book, I believe the audience and topic would have been better served with a briefer, more focused discussion....more
Fifty-six-year-old Wendy Mitchell was out for her usual jog when she fell, badly banging and bloodying herself. After seeking medical attenRating: 3.5
Fifty-six-year-old Wendy Mitchell was out for her usual jog when she fell, badly banging and bloodying herself. After seeking medical attention, she returned to the place she’d stumbled, expecting to see a pothole or uneven ground. There was neither. A few days later while out on another run, she fell yet again. Aware that she’d been excessively fatigued and had been experiencing a persistent “sensation of a head half-full of cotton wool”, Mitchell visited her GP. A few weeks later (perhaps)—after she’d been slurring her words at work one day—she checked herself into the local hospital to undergo diagnostics. There was vague talk of a stroke, but test results were basically normal. A neurologist sent her to a clinical psychologist for cognitive testing, who suspected incipient dementia, and, some months later, confirmed it.
For some time Mitchell was off work. At the National Health Service, she had been known for the encyclopedic memory and superior organizational skills she brought to the job of scheduling nursing staff at a large hospital in Leeds. When she did finally return to work, she was stymied by her deficits: the computer programs that were the crux and core tools of her work seemed utterly foreign to her. The phone calls from other NHS staff and administrators—a regular part of her work, easily and automatically managed in the past—were completely discombobulating. Often callers did not identify themselves; they spoke too fast, and rarely supplied context details, assuming that Mitchell already had them at her fingertips. Eventually, of course, she told her supervisors and then her colleagues about her diagnosis. Her team attempted to make work accommodations for a time, but these were insufficient to compensate for the cognitive losses. Mitchell was forced by her disease into early retirement.
Written mostly in the first-person present tense, apparently to underscore Mitchell’s living day by day with the disease, the main text of SOMEBODY I USED TO KNOW is occasionally broken up by italicized letters written to her former self. These elegiac letters are addressed to “you”—another person, not herself— someone she was once intimately acquainted with, now gone. “I know life wasn’t easy for you,” she begins one of these messages; “I know life was lonely. I know you worked hard to hide these things from the girls [Mitchell’s daughters], painting a smile on your face and being determined not to let it slip.I remember that even if you did a good job of hiding it from others by making a joke, too proud to let it slip, and never in front of the girls, life was difficult.” While I understand the author and co-writer Anna Wharton’s desire to communicate Mitchell’s sense of the loss of her former self as well as some of her backstory, I found this authorial device contrived and tedious. People don’t address themselves in this artificial way. I also dislike present-tense tellings, which I understand are intended to bring immediacy to a narrative, but which often end up sounding forced and unnatural. Extraneous details are inevitably included, apparently to bring a novelistic quality to the text or to help readers better visualize scenes. More often than not, though, the details turn into text filler and padding. For example, on page 67, we read: “my eyes fall on . . . a Post-it note: Book dentist appointment. I sigh and roll my eyes” and on page 68: “something inside goes cold, a worry starts to whittle away. I feel my eyebrows knit together into a question mark . . .” Really? I don’t think many people notice the movements of their eyes and the “knitting” of their eyebrows. Imagining the latter as a punctuation mark was a bit too fanciful for me. Unfortunately, these unnecessary bodily play-by-plays populate the book. They are silly and detract from an important narrative that would be better served by a simple, plain telling.
Mitchell’s memoir is valuable in that it gives readers a good sense of the feel of Alzheimer’s as it encroaches. I was not surprised to read of Mitchell’s sense, before the diagnosis, of there being something “not quite right”, a general, inexplicable cognitive clouding. What was surprising and alarming to read about were the times in which she would completely blank out. At work one day, for instance, she was, for a short period of time, completely engulfed in a fog. Panicked “by a brain gone AWOL”, she moved through a corridor to the bathroom and sat on a toilet seat “Waiting for the world to clear. Waiting for time to pass.” Until I read this book, I was also unaware of the clumsiness and incoordination associated with the disease and the visual hallucinations that can occur.
Mitchell describes how she tries to find meaning after her devastating diagnosis. (She bakes cakes for a homeless shelter—until she can no longer follow recipes; she writes a blog; she rides a bright pink bike along a special route that includes none of the right turns that appear to hijack her brain.) A great deal of meaning is found in advocacy work and participating in research, which “means I’m contributing to changing the future for my daughters . . . so that one day a diagnosis won’t be filled with emptiness, but with hope of a cure and better understanding and conditions in care homes.” Life is oddly “busier now, more varied and challenging than it ever was when I was at work”, she observes at one point. To Mitchell’s surprise, she quite suddenly overcomes a lifelong fear of animals (cats and dogs), recognizing that her life has become more like theirs: lived in the present moment. She also finds that positive transformation, even personal growth, can occur in those diagnosed with dementia. For example, for most of her life, she had been “an intensely private person”: retiring, shy, a listener. However, as she begins to attend support groups and involve herself in Alzheimer’s organizations, she discovers a new, more open, and social self. About her meeting Julianne Moore, star of the film STILL ALICE, Mitchell writes: “for a moment, I have that strange feeling again, as if Alzheimer’s is a gift, as if we could all learn something from the harsh lessons it teaches.” I admit that I was sometimes skeptical of this kind of gratitude. Maybe, though, as Mitchell herself notes, there is “nothing wrong in making a list of the advantages of having Alzheimer’s. Perhaps it might even help.”
Other topics addressed in the memoir include the medical profession and the media’s negative and limiting language about dementia and the effect this kind of language has on patients; the care-givers’ burden, including resentment and guilt; the impact of dementia on friendships; medications; challenges the cognitively impaired experience in the home (mirrors, TV screens, cupboard and closet doors are particularly problematic); how modern technology (i-pads and cell phones) can assist; and finally, the awkward but important discussions with family about what the future will inevitably bring. Mitchell emphasizes throughout that her daughters are her great loves and that she never wants them to become her caregivers. In some respects, however, they already are—though at the time of the book’s writing, at a distance.
The only other memoir I’ve read from the point of view of a person living with dementia is Gerda Saunders’s MEMORY’S LAST BREATH—a very different book from Mitchell’s, and one in which the author attempted to address the nature of memory itself, how recollections are transformed, remade, each time we retrieve them. Really, when you think of it, it’s a pretty amazing thing that a memoir of any kind can be cobbled together when an author’s brain is failing. As people live longer, more and more of us are likely to face a diagnosis of dementia—a terrible, sobering thought. Personal accounts like those of Mitchell and Saunders put a human face on a devastating disease. Although I do have some reservations about the writing in SOMEBODY I USED TO KNOW, I still found this memoir an illuminating and worthwhile read....more
Acclaimed Canadian novelist, Elizabeth Hay has produced a beautifully written and affecting memoir about her“acts of love are never uncomplicated”
Acclaimed Canadian novelist, Elizabeth Hay has produced a beautifully written and affecting memoir about her parents’ last years. In 2008 when Hay’s narrative opens, the frail couple are in their late eighties and living in London, Ontario, a mid-sized city in the southwest of the province, some seven hours’ drive from the author’s Ottawa home. Gordon, Elizabeth’s father, had been an ambitious secondary school teacher of history and then a high-school principal. He had worked hard to advance his career, ultimately becoming a professor of education at the local university. A frightening, gloomy figure, volcanic in temperament, he would erupt with fury when disobeyed, once throwing his young son hard enough across the dining room for the boy to require stitches. (He would later feel deeply ashamed by his loss of control, but sadly incapable of apology.) Jean Stevenson Hay, Elizabeth’s mother, was born in the Ottawa Valley in 1919 (the same year as her husband), and had apparently trained as a nurse before marrying and bearing four children—Elizabeth being the third. Jean ultimately turned to art, making adventurous journeys (in her sixties) to Canada’s far north in order to explore and sketch the terrain of Ellesmere Island alongside scientists. (This was a time when grants were available for artists to travel to the Canadian Arctic.) Throughout her married life, Jean worked steadily to counterbalance her husband’s dark energy, attempting to bring light into the home. Having a painter’s studio built just off the side of their house when she was 65 no doubt allowed her the physical space for her creativity to flourish and her psychological health to be preserved.
By the end of January 2009, after her mother had undergone two knee surgeries due to a streptococcal lung infection that had spread through the blood, Hay had arranged for Gordon and Jean to live at a retirement home in Ottawa, just a short walk from her house. The move would allow Elizabeth to visit them daily and tend to their needs. Hay documents the physical and cognitive decline of both parents as well as many painful memories from the past. (A particularly sad anecdote concerns Hay’s father’s failure to acknowledge his daughter’s literary achievements. When it came time to winnow down his personal library before vacating the London house, Gordon left behind his daughter’s seven novels, personally inscribed to her parents.) Growing up (and even in adulthood), Hay’s relationship with both parents was fraught. All three of them were touchy, defensive, easily set off. Hay feared and even hated her disapproving and fury-prone father, and she harboured anger towards her mother, who had been so committed to keeping the peace that she did not defend or protect her daughter. Hay is frank about her motivation for taking on the care of her parents as they neared their end: it was due to a kind of competitiveness, a desire to be loved the best of the four children.
This memoir makes clear that old age can be terrifying, gruelling, and heartbreaking—not just for those who endure the ravages directly, the elderly themselves, but for the family members who are there for the duration. In their final years and months, Hay’s parents often expressed the wish that it could all just end quickly—with the help of a pill. In spite of all that is so difficult as loved ones’ lives wind down, there can be moments of beauty and love. There can be opportunities to better understand family members and to appreciate the essential vulnerability of all—even those who have frightened us. Hay writes about some of these moments and about how she came to understand just how deeply her parents’ lives had been woven together.
Hay’s father died in 2011; her mother in 2012. A small photograph of the two together provides a touching and humble conclusion to an interesting and moving narrative....more
This is the first in a series of diaries prolific British playwright and screenwriter Simon Gray began keeping when he turned 65. A smoker since earlyThis is the first in a series of diaries prolific British playwright and screenwriter Simon Gray began keeping when he turned 65. A smoker since early childhood, a cigarette was no doubt usually burning in his left hand as he transcribed, with his right hand on a canary yellow pad, his often rambling and sometimes rather unruly thoughts. This first diary begins with Gray’s learning of his friend Harold Pinter’s esophageal cancer. Not surprisingly, then, the book focuses on the indignities of aging, along with memories of early childhood, and personal and professional missteps along the way. (Gray had been an adulterer, an alcoholic, and profligate with his money.) I was most entertained by the early sections of the book in which Gray is on holiday in Barbadoes with his second wife, Victoria, and imagines all sorts of backstories for guests staying at the same hotel. There are some laugh-out-loud moments about the poetry of W.H. Auden—which Gray loathed for its sloppy language—and the need for a comprehensive book on piles (hemorrhoids) in history.
Gray’s musings are often unrestrained. Sentences can go on a half a page or more, joined by seemingly endless dashes. It is often difficult to follow the thread, and I found the play-by-plays of soccer and cricket matches (in particular) very tedious. This is a very “male” piece of writing—that is, many of Gray’s preoccupations, and certainly his perceptions of women, are likely to be more sympathetically received by a male audience. In general this book is one in which parts are better than the sum.
I enjoyed the playful and often lovely language and the poignant relationship between Elisabeth, a young girl (and, later, young woman) and Daniel GluI enjoyed the playful and often lovely language and the poignant relationship between Elisabeth, a young girl (and, later, young woman) and Daniel Gluck, an elderly man, but I thought that a lot of this novel was simply a mess. There are too many unanswered questions: why had Daniel grown up in England, and his sister in Germany? We know that his sister died at 21–was it in the Holocaust? Daniel’s seemingly slight acquaintance with pop artist Pauline Boty, about whose work he speaks indirectly to the child Elisabeth and whom she later “discovers” as a graduate student in art history is apparently reason enough for Ali to include pages and pages about the life and works of Boty (and her sometimes subject, Christine Keeler—“star” of the Parfumo Affair.) How all of this relates to the immediate post-Brexit-vote period is unclear to me. Even Elisabeth’s mother is a problematic piece of the jumble. Early on, she seems almost homophobic, referring to Daniel as an “old queen” and refusing to let the girl interview him for a school project on neighbours. Yet, she ends up leaving her daughter with the man (when she barely knows him) so that she can “go shopping”. In fact, she stays out a lot longer than the short while she says she’ll be gone, and her daughter knows she has liaisons at a local hotel. Do these constitute her “employment”? (Is she supposed to be some sort of echo of Keeler—as Elisabeth is an echo of Daniel’s dead sister? Who knows?) Later, this same mother will be liberal and welcoming to her grown daughter and will find herself attracted to a same-sex friend. We have no idea how or why the change has come about. Nothing makes much sense.
Ali Smith's reflections on aging, decline, and the winding down of time are moving, but, on the whole, this book feels, if not quite a still birth, at least a premature one. I don’t think it is a particularly coherent or successful piece of art.
Schine's novel is about a worthy topic: the decline of aging parents when an adult child lives across the country. Molly, an archeologist, lives in LoSchine's novel is about a worthy topic: the decline of aging parents when an adult child lives across the country. Molly, an archeologist, lives in Los Angeles with her partner, Freddie. Her parents, Joy and Aaron, live in New York. Aaron has dementia, and, because of this, he is confused by his colostomy bag and has taken to regularly disassembling it. He has also begun making night-time forays, minimally dressed, out of the apartment and down the elevator. Luckily the doorman has caught him. Even while caring for Aaron, 86-year-old Joy, Molly's mother, continues to work part time as a conservator (they need the money) at a smallish Jewish museum, reassuring herself that Aaron sleeps most of the day anyway and does not go near the stove.
Close to American Thanksgiving, Molly flies from L.A. to New York in an effort to sort the problem out. Though Molly's married brother, Daniel, lives in New York, he is (after all) a son. Molly's understanding is that only a daughter can really attend to things.
As far as I got (page 52), Schine's writing was competent but bland. To give Schine her due, it's not easy to make a domestic novel that focuses on aging lively and compelling. While the author's approach is generally light, the characters were uninteresting to me; they appeared to lack much of an inner life. Having read a good chunk of the book without feeling much engagement, I decided to abandon the novel. ...more
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