The
two literary gems I am about to plug, both recent publications, explore the
subject of mortality, but in a vastly different vocabulary – one in the very
learned but warm and ingratiating language of a healer, the other in the light
satirical banter and reflection of a comic master.
Gawande,
an accomplished, experienced surgeon, sets a terrific example for health
practitioners the world over. He is
self-effacing and honest about the medical profession’s failures at the task of
preparing terminal patients for their ultimate departure from the flesh. It is a fact we have all heard underscored
many times among the most educated of modern minds. But it is so rewarding to me as a lay person
to have a member of the profession itself fully own this failing and devote a
sizeable book to examining the whys and wherefores of it and, more importantly,
pointing the way toward a more sensitive and humane approach to preparation for
aging and death.
He
admits that his medical school training did not prepare him to deal with
it. “The way we saw it, and the way our
professors saw it, the purpose of medical schooling was to teach how to save
lives, not how to tend to their demise.”
The most startling assertion in the entire book on the part of a fellow
surgeon, one the author highlights, is the admission that in his way of
thinking “death is the enemy,” and all the doctor does must be devoted to
defeating it. If in doubt about the
advisability of a certain regimen of treatment for someone struggling to stay
alive, ignore the doubts and go with it, even if it results in adding to the
needless suffering of the body and soul in travail and robs the patient of
dignity and relative peace.
Nursing
homes come in for a huge drubbing. He
recounts the history, and it is not pleasant reading to hear how the aged and
infirm in former days were treated. In
1912 an Illinois state official described a home for the aged he had examined,
called back then a poorhouse, as “unfit to decently house animals.” One went to such a place to die, not to
live. If there is a topical sentence in
the book, it is this, in his chapter on Dependence: “How did we wind up in a world where the very
choices for the very old seem to be either going down with the volcano or
yielding all control of our lives?”
Perhaps
I knew, but had forgotten, that the concept of assisted living is quite a
recent invention, even though I have worked closely with two of them in
Columbia leading drama clubs. They are
devoted to the creation of a living and active environment for people who are
on the downgrade but have a long way down to go. All that is possible is done to preserve
their sense of autonomy. These places do
work, even though, as Gawande points out, the concept has been exploited and
corrupted a bit in some areas of the country.
Gawande
does not deal in generalities or paint in broad strokes. He gives a lot of detail, citing the
progressions of many individual patients with which he has been involved. He opens up his files and his memory to take
us down numerous paths trod by terminally ill individuals and the part that he
and other physicians played in leading them through possible treatments. And he is always putting things in what I
call a humanistic context, perhaps even a spiritual one. He frequently backs away from minute
recounting and inspection to remind us of what life’s essentials are, not just
for survival but for joy and contentment.
This man is an observer of the human heart and a reader of people, though
he confesses that that could not always have been said about him. He was a slow learner.
There
are essentially two kinds of doctors who serve the elderly, according to the
book. There are those it calls the
Informational type. The medic gives the
patient all the facts and details about their condition and plans treatment for
them based solely upon that doctor’s professional opinion. This is what you must do or else! If you choose not to, let it be on your head
(my words, not those of the author).
There it is, take it or leave it, no room for discussion, though
presented in very courteous terms usually, not a bossy one.
But
Gawande tells of how he came to adopt what he calls the Inspirational
approach. It begins by asking the
patient what his or her goals are. He
gets them talking about themselves and what they value most for what life they
have left. From there on the discussion
works its way into examining options and chosen priorities and “matching
treatments to them.” The patient has the
sense of planning with the doctor, and Gawande admits that it is a challenge,
much harder than the direct, aggressive approach practiced by the Informational
physician. He tells us that a worldwide
revolution in the treatment of the mortally ill is going on, though we are yet
in transition. So much more educating
and training will be required to establish what he calls “a new norm.”
At
times it felt, as I read, as if I was reading a novel or at least a series of
short stories. The detail is so sharp
and well honed that it seems very close to fiction. There are many characters to whom we as
readers are introduced, of varying ages and varying degrees of helplessness and
infirmity. When I was finished, it felt
as though I had actually lived through many of those crises and struggles with
them on a first name basis. Nothing is
abbreviated, there is no sketchiness whatsoever. At moments it was saddening, at other moments
heartening, at still other moments a gripping narrative of push and pull, of
individual human destinies being shaped and completed. He even includes his own father in the
accounting. It is a brilliant balance
between the sharing of intricate data and the portraying of human drama,
informative and deeply touching. I
get the feeling that I have read one of the most important books that I ever
have or ever will read. I cannot
recommend it too highly, all of us being, whatever our age or in whatever state
of health, among the mortal.
The
publisher of “Being Mortal,” copyrighted 2014, is Metropolitan Books, Henry
Holt and Company, New York
When
I read autobiographies, I approach them with a certain caution. Most I have read tell stories out of school
that I never really wanted to hear, even if they did go on to share the details
of vital interest that I was seeking and expecting. A kind of confessional one moment, an awkward
attempt at self-justification the next!
But all caution was swept out the window, when I was no more than a few
paragraphs into Billy Crystal’s “Still Foolin’ ’Em.” It is his sixty-fifth birthday and he begins
as I would expect him to open a gag presentation on stage.
“I
looked in the [bathroom] mirror. . .My scream brought Janice, my wife of
forty-two years, running in. I kept
yelling, ‘Holy S---! What the f---
happened to me?’ Somehow, overnight it
seemed, I had turned from a hip, cool baby boomer into a Diane Arbus
photograph. I looked at Janice for an
encouraging word, for a hug, for an ‘It’s okay, Billy, you look great. It’s an old mirror.’ All she did was glance down at my robe, which
had opened up, and ask: ‘When did your pubic hair turn gray?’ ” At once I was,
so to speak, in the floor laughing to beat the band. That is how he launches
this wacky ship, and he is forthwith off and running and making us run with him
without ever getting winded.
Yes,
he covers the many highlights of his career and how he came to be one of the
most sought after comedians this nation of ours has ever known. But woven all through those highlights are
his many reflections on the aging process.
Of course, as you can probably tell from this opening of the book, he is
not averse to putting us on, but who cares.
He exudes a quality of loving embrace that gets extended to a host of
individuals he has worked with and associated with, and when I say a host, I
mean a super abundance, an armada; this guy has made more friends than most of
us have ever had the opportunity even to meet, with heads of state, fellow show
people and sports celebrities into the bargain.
They swarm through his life, coming from every direction.
Consider
some of his chapter titles. “I
Worry.” He comes forth with a long list of worries, mostly having to do with his
alleged inability to sleep. “I don’t
worry about dying in my sleep, because I never sleep. When the angel of death comes to my bedside
and puts his hand out for me, I’m going to look him right in the eye and say,
‘Get the f--- out of here.’ Then Janice
will tell him, ‘Don’t listen to Billy – he’s overtired and a bit cranky.’ ” Unless you are especially prudish, you will
roar when you read through his chapter on “Sex.” And in “Count to Ten” he shares his mind on
how religion comes to bear upon life beyond 65: “People say it is a given that.
. .you turn to religion. Personally, the
aging friends I know turn to the Holy Trinity: Advil, bourbon, and
Prosac.” (He earlier in the book takes
on the subject of his Bar Mitzvah and even satirizes that. But do not misinterpret him, being Jewish
gives him a pride that is pleasantly disguised beneath many of his asides about
it.) He has a very short chapter called
“Take Care of Your Teeth,” in which he remonstrates about going to have his
teeth cleaned after turning 65 as a birthday celebration and being passed among
no less than six dental specialists and bemoaning the fact that so many people
have been in his mouth.
He
has one entitled “Conservative,” which is misleading. In it he talks about his gripes, and some of
them are quite serious and point-well-taken, but he gets through hardly a one
without making us at least snicker. He has
an ironic twist on the most common of them that any of us might share. One I especially found delightful was about
being patted down at the airport. Once
at LAX a woman screener who recognized him said, “Billy, you are the best. I love you.
Can I see your picture ID.” And
that is just the start of what goes on for a full page and a half. Outrageously funny!
Billy
seems to have no hesitation or embarrassment about being human in every sense
of the term. Eroticism seeps through
much of his writing, whatever the subject matter at hand. In his chapter “Kiss Me Twice” he confesses
to having had a blazing affair with Sophia Loren. “It started when I was 13” and lasted for many
years. One super moment for him is when
on a certain public occasion he finally gets to meet this Italian woman who has
fueled his fantasies as a kid.
I
feel compelled to quote a passage from his chapter “Grandpa.”
It
blesses me no end, an aging man talking.
“There are more and more people telling me I’m not as important as I
once was. The inevitable becomes clearer
every day. Sometimes, like a sudden
rainstorm, I get that scared, sad feeling that time is getting shorter. . .I
can’t stop conjuring the saddest images my mind can muster, and I’m lost – and
then I hear the footsteps running toward me and I hear the giggles, and they
yell ‘Grandpa!’ and suddenly they’re in my arms and I squeeze them and hold on
to them for dear life. . .I am important [after all]; I am their star; I am
their grandpa.”
His
last two chapters – “Can’t Take It With You” and “Buying the Plot” are luminous
in their detail about late life choices and plans for dying and settling
accounts with the present world. They
are, to use the much heard lingo of the theater, worth the price of admission, and
many times more. No Shakespearian sonnet
could be more inspired and profound than what he shares about the place of his
family (including the wife) in his thinking and late life living; he walks us
right into his heart of hearts. But all
he so quirkily says is overlaid with a quietly joyful embracing of the
process. He shares in great detail his
experience of losing loved ones – fellow performers, celebrities, and members
of his own extended family.
This
is one comedian who exudes no contempt for the human race. He speaks to us like a brother who shares all
our dilemmas. He does not spin any
fantastic webs or tell any tall tales. He
faces into one hard knuckle issue after another and deals out salvos. But he does it all with a gusto and a lust for
living that is infectious. Anyone above
50 should give reading it high priority.
“Still
Foolin’ ’Em,” copyrighted 2013, is also published by Henry Holt and Co., New
York
To
read other entries in my blog, please consult its website: enspiritus.blogspot.com. To learn about me consult on the website the
blog entry for August 9, 2013.
