Being Mortal

Atul Gawande has written a fine book.  Almost a text book, with references a mile long.  Perhaps it should be a set text, certainly recommended reading.  Abridged, it was aired on BBC  radio 4  not as book at bed time or morning story but this year’s Reith lecture .

It deals with death and how we and medics have got it wrong: unprepared to let go, conditioned to be meddlesome, with at best an unquiet outcome, at worst an unhappy one.

He writes from a medic’s perspective and from a son’s in thoughtful gentle prose that he has the grace to say did not come easily.  He meditates on the experience of death and the fear it generates in the dying and in those closest to.

The fear stems from the unknown factors, when, how long will the suffering or indignities last?  whether the cause of death  is untimely from a mortal disease or from old age, assisted  suicide is not discussed, but life with dignity is.  Those precious moments of lucidity that give time to say the last farewell, the last I love yous, to savour what has been most cherished.

There are ways to manage this which mostly need a good deal of communication and resource to specialist care.  

For the elderly lessening the loss of autonomy, privacy, indeed maintaining any semblance f their own life is crucial. Rather than move the elderly when it is deemed safer for them to be in a home, in someone else’s home.  More often this is a recipe for unhappiness for both.

 Gawande writes of what is happening in The States as that is his experience .  He writes of the ‘criazies’. Those willing to revolutionise the care system, the institutions that dehumanise, sanitise even with the best will in the world, who worked out the human need for purpose and introduced pets. Every patient had a bird to look after as well as resident dogs and cats. The chaos that ensued shook the whole place, it came alive. Inmates’ mobility, moods and minds improved immeasurably

I have seen at first hand the revolution of the care home in our town. The dog that pads round to be petted that lights up the faces of those previously set to ‘dull’; the absolute  joy if there is a baby or children around, and as for singing! Amazing how uplifting of the spirits it is.  But, the drip feed of happy snatches has to be continuous.

Good times, even moments of happiness,  right to the end are crucial and worth striving for, and are different for each individual. Ascertaining what these are by simply asking the question, important.

To accept that medical science does not have all the answers is hard. Knowing when to let go is as much an art, as the letting go itself.

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Reinventing the self, or going your own sweet way

Whether it was the discovery that writing is less to do with words and all to do with business, or the other betrayal that caused the decline, I can not tell.

It felt, rather than fight back, fight the onslaught, I should retreat from life itself, all fire gone from the belly with no wish for anything even vaguely creative and simply put my head down and do my duty.

Surely that is the time to write? When life is oppressive or appears so? Mostly it is a matter of perspective, I have found over years. The solution is to just say no to the temptation to give up, in the words of a famous wife. No, I do not accept this thought, this apparent oppression, I refuse to kowtow.

Then, after a shower, cascading with soft, wobbling flesh, perfumed with lotion, as I fold the crisp white cotton of my pyjamas I realise something else.

The ease with which they fold, their white formal lines fitting neatly under the pillow make it seem possible to cut away the dross, clear the mind of all that and have my life in formal, stiff folds.

I am reinventing myself and will go my own sweet way.

I will be a crisp person who folds neatly, who fits her own skin perfectly, so no one would dream of betrayal or dismissal.
Now I will write only for pleasure, only to see the words on the page, the words I hear in my head and commune with.

Waiting 

I have been waiting for an email, as in days of yore people waited for signs and portents. It’s a way of procrastinating, obviously. If stuff happened simply because you wished it would, no one would do much at all.

There is a post prandial  feel to the day. The holidays are over, no guests about to arrive to necessitate a bit of bustle and elbow grease about the place, although the lack of imminent arrivals does not remove the need for a clear up. 
The weekend was spent singing in the company of singers. A festival chorus to celebrate life and the life achievements of not one hell of a musician, but two ( well three actually): John Huw Davies, a gentle, but excellent teacher, singer and conductor whose patience knows no bounds and the  somewhat overlooked Cherubini, whose Mass in C is not just a revelation, but a joy not to be missed.
So much so that the concert will be broadcast from Stockport Town Hall, on Radio three. Music , musicians, soloists and conductor irresistible 
To say nothing of JS Bach and his Magnificat which we also rehearsed and sang.
The waiting will have to wait. The day clamours, subtly, gently but loud enough to be heard