BOOK REVIEW: Life and Death Are Wearing Me Out by Mo Yan

Life and Death are Wearing Me OutLife and Death are Wearing Me Out by Mo Yan
My rating: 5 of 5 stars

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This strange title turns out to be a perfect summation of the book. The narrator / protagonist was a wealthy land owner named Ximen Nao who was executed when the Communists gained power in China. In heaven, Lord Yama (the judge in Chinese folklore’s version of the afterlife) sentences Ximen Nao to be sent back to Earth as a donkey, and—in subsequent lives—as an ox, a pig, a dog, and, finally and briefly, as a monkey. He’s always sent back to the family of one of his former underlings, Lan Lian, and the story follows that family over the course of several decades through the Cultural Revolution and China’s grand reforms.

The early parts (the lives of donkey, ox, and part of pig) are centered on Lan Lian’s decision to remain an independent farmer. Mao Zedong promised all farmers the right to remain independent contractors if they wished, but there was great pressure—first from the community and later from his own family—to become part of the commune. This ends up dividing the family, and ultimately Lan Lian ends up on his own. The latter part of the book (i.e. dog and monkey lives) deals with Lan Lian’s children (and eventually their children), and—particularly–with Lan Jiefang who shares a birthmark and a stubborn streak with his father. Lan Jiefang’s stubbornness is revealed as a desire to divorce his wife and to marry a younger woman. His equally stubborn wife refuses the divorce, and Jiefang and his young lover become ostracized. At the tail end of the book we see how Lan Jiefang’s son is afflicted by the same dogged determination to pursue a costly path—as a respected member of the police force he falls for a former classmate who has become a pariah.

The book mixes humor with tragedy. The animal incarnations of Ximen Nao each have its own personality, but retain some of the landlord’s character and memories. The animal stories are both part of and comedic counterpoint to the tales of woe experienced by Lan Lian’s family. Mo Yan has cameo appearances throughout the book, though in the dog’s life section he plays a more substantial role. References to Mo Yan’s character invariably come with self-deprecating humor. The author creates characters that the reader is interested in. What I call stubbornness is really a tenacious willingness to suffer for the principle of pursing one’s own happiness. In the case of Lan Jiefang and his wife, the reader is likely to be torn by the gray situation. The wife seems the more sympathetic character, but, still, one can’t help but appreciating the tenacity of Lan Jiefang and his willingness to suffer so greatly on the principle that “the heart wants what the heart wants.”

In addition to a good story with vibrant characters, this book offers a birds-eye view of China in the latter half of the 20th century. What is happening in the lives of the characters isn’t divorced from what is going on in the world, but is shaped by it. One notices this most vividly across the three generations over which the book’s story unfolds—with the middle generation (Lan Jiefang’s) serving as hinge point. When Lan Jiefang’s half-brother goes from being a Communist Party apparatchik to the wealthy CEO of a large firm, it’s a reflection of the societal undercurrents.

I enjoyed this book, and would recommend it for readers of fiction—and particularly translated literary fiction.

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BOOK REVIEW: Thirst by Andrey Gelasimov

ThirstThirst by Andrey Gelasimov
My rating: 4 of 5 stars

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This novel (novella) is translated from Russian, and is the story of a soldier, Kostya, who fought in Chechnya and was badly burned while trapped inside an Armored Personnel Carrier (APC.) Owing to his severe disfigurement, Kostya becomes a heavy-drinking homebody. This changes when one of his team members from the war, Seryoga, goes missing and a couple surviving team members come to recruit Kostya to the search party.

Kostya struggles with an internal conflict common in war stories. On the one hand, Kostya both rationally recognizes the logic of why his friend and teammate, Seryoga, didn’t pull him from the burning APC (i.e. Seryoga believed Kostya was dead) and he loves Seryoga like a brother. On the other hand, he can’t help but feel that if Seryoga had pulled him out sooner he wouldn’t be so hideously disfigured and his life—as he sees it–wouldn’t have been ruined. Kostya battles those feelings, even defending Seryoga’s decision based on the reasonable conclusion that Kostya was already dead. A flashback sequence interwoven into the contemporary timeline shows us the events of the APC attack, including—ominously—a discussion of what should happen in case grenade breaches the vehicle for the benefit of the FNG (F@#%ing New Guy.)

The story is short and sparse, and that complements the somber tone of the book. One reason for dragging Kostya into the search is that his father is a Lieutenant Colonel with the pull to access records. This forces Kostya to open up the estranged relationship with his father and his father’s new wife. One gets the feeling that Kostya blames his father more for his plight than he does Seryoga, adding to any pre-war problems in the relationship. There are several factors that combine to move Kostya toward a better place over the course of the story. One is the thaw in relations with his father, and–perhaps even more so—the burgeoning relationship with his step-mom, Marian, who he discovers to be a genuinely good person. A second factor is reconnecting with his military buddies. Finally, his art (Kostya has a talent for drawing) becomes more therapeutic as his friends and family begin to see it.

This is a classic brothers-in-arms story. The universality of that bond comes through in translation. With tweaks in details (and choice of liquor) this story could be about American soldiers in Vietnam or Iraq. What makes the book a worthwhile read, if nothing else, is its display of that commonality of human experience. The ways of soldiers who have a stake in each other, even if they feel little personal stake in the grand strategy that has put them where they are.

I found this story to be moving and thought-provoking. I’d recommend the book—particularly for readers of literary fiction—and it’s definitely literary fiction. The story is character driven, and not plot or action driven. The tension derives from the interaction of characters and not (except for the APC fire) outside events. Many will find the ending abrupt and anti-climactic, but it’s the story of Kostya’s journey and not of any particular destination.

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BOOK REVIEW: The World’s Best Street Food by Lonely Planet

The World's Best Street Food: Where to find it and how to make it (General Pictorial)The World’s Best Street Food: Where to find it and how to make it by Lonely Planet
My rating: 4 of 5 stars

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This is a combination guide to street food and cookbook. Each of the 100 entries consists of two pages. The first describes the food, how it’s eaten [that’s not always as self-evident to outsiders as one might think], its origins, where one can find a quintessential or famous example of the food, and whether there are any variants on the recipe. The second page is the cookbook entry, which lists the ingredients and describes the process by which they are combined to create the dish in question.

The foods are divided into broad categories of savory and sweet. The savory category is the larger by far, comprising 80 of the dishes—leaving 20 sweets. The dishes represent about 50 different countries of origin. A lot of these countries are well-known street food cultures such as Thailand, Vietnam, India, Mexico, and the US, but there are also a number of locales with which readers may be less familiar– such as Ghana, Malta, and French Polynesia. The dishes include a number of my favorites, such as Vietnamese Banh Mi, US Breakfast Burrito, Indian Masala Dosa, Thai Pad Thai, Hungarian Langos, and Singaporean Hainanese Chicken Rice. However, I also learned of new dishes that I’m eager to try, such as Croatian Cevapcici, Burmese Mohinga, and Chilean Sopaipilla.

WARNING: While I didn’t deduct stars for it, I will warn readers that this isn’t a good book to get as an e-book—at least unless you have a high-end tablet. It was a bit of a pain to read on my Kindle Touch, and the graphics (which I assume are beautiful in the print edition) were largely useless on my device. One could blow up the text easily enough (within limits, at least,) but the pages got grainy if one blew them up too much—and some of the text remained small when expanded.

There are photos. As I mentioned, on my device they were largely useless (grainy black-and-white) but your results may vary.

I found this book to be interesting and informative. While I wish the e-book had been easier to read, it was well-organized and offered a broad selection of dishes from a large number of countries.

I’d recommend this book for street food lovers and foodies.

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BOOK REVIEW: 100 Movies to See Before You Die by Anupama Chopra

100 Films to See before You Die100 Films to See before You Die by Anupama Chopra
My rating: 4 of 5 stars

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Full Disclosure: I’m not much of a movie-goer, and have seen a mere 16 of the titles on Chopra’s list—if memory serves, but it often doesn’t. My point being that I may not be the best judge of what films should be included in such a list.

Be that as it may, I liked this book and its list. First, I found it to be a richly diverse set of films. Given that Chopra works for Indian media, one might expect that the book would be completely dominated by Indian films (fyi–I don’t know much, but I have learned not to lump all of Indian cinema under the term “Bollywood.”) Alternatively, one might expect the list to be ruled by Hollywood because the US has been the 800-pound gorilla of moviemaking since the early days of the industry. It’s true that the US and India are well represented on the list (the US with 34 movies and India with 26,) but Hong Kong, Italy, Japan, France, Mexico, and others are suitably represented (not to mention films produced by / in multiple countries.) (Nigerians and other Africans from countries with filmmaking industries may not agree because Africa isn’t represented, but the fact that the most recent film is 2007 makes me assume the book may not be up to the latest breakthroughs. [My edition is listed as 2013, but I think that’s just the e-publishing date. I’d guess the book came out around the time of the last film on the list, but could be wrong.])

Another aspect of the book’s diversity is the age range; the films are from 1922 to 2007. They don’t seem to be heavily weighted toward the modern day—as is a common defect of such lists. Yet another dimension is diversity of the class and genre of film. By that I mean that the list includes unambiguous classics of cinema like “Citizen Kane,” but it also includes what might be considered less cerebral movies such as “Enter the Dragon” and “Kungfu Hustle.” It also includes comedies and sci-fi movies, which are often under-appreciated by critics. Still, Chopra doesn’t resort to using to box office earnings as a criterion either. Many huge money makers aren’t on the list (e.g. “Titanic.”)

The entries for each film are just a couple of pages, but, in addition to a summary, they include the awards won by the film and a piece of intriguing trivia for each entry. There are some graphics in the form of movie posters and set photos. There isn’t a photo for every entry, but they aren’t that important and, in the case of my little Kindle, the pictures couldn’t be seen well anyway.

I’d recommend this book for anyone who wants a tight list of films to be seen that prominently features international cinema.

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BOOK REVIEW: Narrow Road to the Interior: And Other Writings by Matsuo Bashō

Narrow Road to the Interior: And Other WritingsNarrow Road to the Interior: And Other Writings by Bashō Matsuo
My rating: 5 of 5 stars

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Bashō was a traveler, and much of his poetry came from what he witnessed and experienced on the road. This volume contains four travelogues (each containing interspersed haiku); the most famous of these being the title piece, but also including: “Travelogue of Weather-Beaten Bones,” “The Knapsack Notebook,” and “Sarashima Travelogue.” In addition to the travel writings, there is a section of select Bashō poems. The word “travelogue” may create a misapprehension. These weren’t diaries of the minutiae of his travels. They offer a poet’s eye view of highlights and insights, and—of course—interspersed poems. [There is a term for this genre of prose mixed with poetry, haibun.]

Matsuo Bashō was born in Iga-Ueno (famously a center of ninja warriors during the Warring States Period), and traveled extensively within Japan. He lived from 1644 to 1694, during the time between the end of the Warring States Period and the Meiji Restoration that brought Japan into modernity. It was a period of relative peace ruled by a military dictatorship, lying in the long shadow of war. Zen touches are prevalent throughout Bashō’s writings, but so are references to Chinese philosophy and history, Shinto, not to mention the Japanese poets who preceded him.

In addition to the aforementioned content, the book includes some nice ancillary features. First, there is a Translator’s Introduction that helps provide necessary context about Bashō’s life and times, as well as offering insight into what was valued in Japanese poetry of this time–including influences of systems like Zen, Taoism, and Confucianism. There is an Afterword describing the last years of Bashō’s life, as well as end-notes and a bibliography. Notes are useful for this type of book because most readers face both cultural and historical barriers to understanding (myself included.) As for graphics, there is a map to help readers grasp the extent of the poet’s travels. There is also a chronology to help keep the events of Bashō’s life—most notably the timeline of his travels—straight.

I’m not sure how the translator’s (Sam Hamill) version compares to an ideal, but I enjoyed it. For example, Bashō refers to an innkeeper called Hotoke Gozaemon, which Hamill translates as “Joe Buddha.” I suspect that is an example of veering away from literal translation to communicate an essence in a way that is readily grasped by the English-language reader. Some of the haiku translations seem clunky, but it’s extremely hard to put haiku into English, so I can’t say it could be avoided. English syllables and words can be chunky and our grammar doesn’t lend itself to being sparse. I will say that a nice feature of the “Selected Haiku” section is that it includes the Romanized Japanese poem under the translation. This isn’t done throughout the haibun “travelogues,” but it’s done in that last section. The main benefit of this is allowing the reader to hear the sound of the poem, but it can also allow one to compare different translations of the same poem.

There are several translations of these same writings available (often gathered together into a single volume like this because it makes for an acceptable length book–rather than the pamphlets that the individual haibun would be.) This is the only version that I’ve read to date, and so I can’t compare it to others. However, I was quite pleased with this version and found it to be both readable and evocative.

I’d recommend this book for haiku lovers, travelers, and those who want to see what awesome travel writing can look like.

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BOOK REVIEW: On Love and Barley by Matsuo Bashō

On Love and Barley: Haiku of BashoOn Love and Barley: Haiku of Basho by Bashō Matsuo
My rating: 5 of 5 stars

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This is a short collection of English translations of the haiku poetry of Matsuo Bashō. Bashō is one of the seminal figures in Japanese literature, and was a fascinating person. Living in 17th century Japan, his hometown was Iga-Ueno (a city whose other claim to fame was being one of two centers of medieval black-ops warriors known as ninja,) but he was also an ardent traveler and Zen Buddhist. One will note that many of his poems are about traveling.

The name of the collection is drawn from one of the poems (labeled “152” in this collection) that reads: “girl cat, so thin on love and barley”

Translating poetry is one of the hardest language tasks imaginable—and translating haiku to English is the hardest of the hard. This is because Japanese is grammatically sparse and the number of beats per syllable is limited, while English… not so much. Therefore, if one literally translates, not only would one likely get circa-2000 Babel Fish gibberish, the Zen simplicity vanishes. One has to appreciate any haiku to English translation that gets some of the feel of haiku right while still conveying meaning. This collection does a nice job in many cases, and maybe does it as well as can be expected.

The original poems [i.e. the Japanese] aren’t included. This may not seem like an issue to a reader who doesn’t know Japanese, but it can be nice to read the original poem phonetically (Japanese is a very phonetic language—unlike English.) The sound of a poem can be as evocative as its meaning. Some haiku translations offer three versions of the poem (i.e. the Japanese characters [useful only for Japanese readers], a Romanized spelling of the Japanese poem, and the translated poem), but—except for some of the poems referenced in the introduction—this one only gives the translation.

There is a substantial introduction that both gives one insight into Bashō as a person and poet, and puts his haiku into a broader context. There are also some end-notes for many of the poems to make sense of words and phrases that may not make sense to a contemporary English reader. There are some drawings that aren’t necessary, but they don’t hurt either, making a nice way to break up the collection. The book consists of about 50 pages of poems (with 5 haiku / page, or 250+ poems), and is less than 100 pages in total.

I would recommend this collection for poetry lovers. While poetry translations can be perilous, they can also offer new insight–even if one has read multiple translations of the same poem in the past.

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BOOK REVIEW: Fanny Hill by John Cleland

Fanny Hill, or Memoirs of a Woman of PleasureFanny Hill, or Memoirs of a Woman of Pleasure by John Cleland
My rating: 3 of 5 stars

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Many people know this as the first English-language pornographic novel. It remains one of the most widely banned books in English (thus, my need to read it), though by today’s standards its 1740’s style isn’t exactly explicit in language—avoiding vulgar terms in favor of neutral terms used in double entendre. It is graphic, however, and sex is central throughout. (Fun Fact: As with many of the works of the Marquis de Sade, this book was written while the author was in prison–though in Cleland’s case it was debtor’s prison.) It’s the story of a young woman of “loose morals”—both professionally and as an amateur, if you will. The story is told through letters to another woman in which Frances Hill explains how she ended up leading the life she did.

As with de Sade’s “Justine,” the inciting incident is that Hill becomes an orphan—though in this case her parents succumb to small-pox. Also, like Justine, Hill starts out naïve, and is taken advantage of by unsavory characters. This shouldn’t suggest that the character and story are completely the same. [Note: this book was written several decades before de Sade’s.] Hill is neither as relentlessly virtuous nor as relentlessly victimized as is Justine. At various points, she has agency in her decisions, while agency is at best an illusion for Justine. Hill even develops a love interest in the book in the form of a young lawyer named Charles who is soon separated from her (providing an engine for the continuation of the story.) Furthermore, she ultimately finds herself in the hands of a man who does her a fair turn, rather than twisting her misfortune to his desires (as all the men and many of the women do in Justine’s life.)

As one might expect of a novel written in the middle of the 18th century, the prose is purple. Also, as mentioned, it’s not for those with delicate sensibilities as sex is a fixture throughout. It’s interesting to read what the state of erotic literature was in the 18th century. If you’re curious about what that first porn novel was like, I’d recommend this book—as long as you are neither a prude nor incapable of deciphering the purple prose of that era.

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BOOK REVIEW: Justine by Marquis de Sade

Justine (Harper Perennial Forbidden Classics)Justine by Marquis de Sade
My rating: 3 of 5 stars

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This is the story of a virtuous, and pretty, young woman who repeatedly falls prey to lecherous libertines. Over the course of the story, she is victimized by aristocrats, monks, and outlaws. The lead goes by the name Therese, though her given name was Justine. She is one of two sisters orphaned after their father ran afoul of a man by having an affair with said man’s wife. The story is set in France immediately before the Revolution, as it was written while de Sade was imprisoned in the Bastille in 1787.

As Therese is telling her tale of woe on the eve of her trial for murder and arson, one might question whether she is an unreliable narrator. In other words, was she as morally upright and steadfastly pious as she portrays, and were her sufferings truly through no fault of her own [beyond naïveté.] That level of complexity is beyond de Sade’s simple formulation. The lesson of his amorality tale is that Therese ends up in such a mess precisely because (by being so virtuous and pious) she fails to comply with what de Sade saw as the law of nature. His version of the law of nature is defined by the strong lording over the weak, and the ideal of “do unto others, before they can do unto you.”

What is the evidence for de Sade’s twisted amoral moral to the story? First, he includes a sister, Juliette, who follows the path of least resistance (accepting a life of vice) and ends up much better off. Second, all of the “villains” (though de Sade didn’t see them that way, I’m certain) are prone to Bond Villainesque exposition on this philosophy as justification for the vile acts they are perpetrating. This ham-handed approach can make for an annoying read. [However, if one is interested in the minutiae of the philosophy of libertinage, one may find some of the arguments interesting. While de Sade’s philosophy is rank and vile, it may have just been a wild pendulum swing from what was going on in the mainstream world at the time.]

While I certainly wouldn’t recommend the book as a treatise on ethics, morality, or philosophy, it’s an interesting story. I’ve only read one other book by this author (i.e. “120 Days of Sodom”) and can say that “Justine” is vastly better than that one.

I’d recommend it for those intrigued by the occasional amorality tale. It can’t be said to lack tension. Needless to say, it’s graphic in places, and not for readers of delicate sensibilities.

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BOOK REVIEW: Sleeping, Dreaming, and Dying ed. by Francisco J. Varela

Sleeping, Dreaming, and Dying: An Exploration of ConsciousnessSleeping, Dreaming, and Dying: An Exploration of Consciousness by Dalai Lama XIV
My rating: 4 of 5 stars

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This book is a product of the 4th Mind & Life Institute Conference that took place over five days in October of 1992 in Dharamsala, India. It reads as a narrated description / transcription of the event. The Mind & Life Institute was established as a dialogue between science and Tibetan Buddhism, and is actively supported by His Holiness the Dalai Lama—who is an important figure in the book, both asking questions of the presenters and offering clarification on Tibetan Buddhist thinking on various points. The exact subject of each conference is different, but the mind is a recurring theme. Which makes sense as Tibetan Buddhist practices of the mind are as advanced as any, and it would be of great benefit to understand them better from a scientific perspective.

As the title suggests, this conference (and the book) deal with three topics: sleeping, dreaming, and dying. This may seem like a case of “one of these things doesn’t belong,” but from the Buddhist perspective on consciousness it’s a sensible enough grouping. One can think of it this way, sleeping and dying are points at which consciousness goes bye-bye. [Although, lucid dreamers retain consciousness in REM sleep, and there are unsubstantiated claims of the ability to maintain consciousness in sleep by extremely advanced practitioners.]

There is some front matter (a forward by the Dalai Lama and an editor’s Introduction) and then eight chapters. The first chapter discusses both the Western and Tibetan perspectives on “the self,” what it is, and whether it is [real or illusory.] This topic seems unrelated to the book’s theme, but it’s a way to develop a common understanding for the rest of the discussion. If participants have different views on what a person is, mentally speaking, and what consciousness is, then it’s easy to talk past each other without even realizing it. The second chapter is an overview of what was known about sleep, principally from the perspective of neuroscience (it should be noted that neuroscience was a fairly fledgling term at that time.) The next three chapters (ch. 3, 4, and 5) are about dreaming. The third chapter is a bit unique. The general approach throughout the book is to give the understanding of science and then to compare and contrast that with Buddhist thinking. However, chapter three’s discussion is led by a proponent of psychoanalysis (i.e. the Freudian approach,) which isn’t so scientific, but is a Western philosophical approach. [Chapter one is also heavily philosophical.]

Chapters four and five delve into the subject of lucid dreaming, which is referred to as dream yoga in the Tibetan Buddhist tradition. For me this was the meat of the subject, and it was the reason that I bought the book. Tibetan practices on lucid dreaming are incomparable, and at this point science’s understanding was beginning to blossoming as well.

The last three chapters are on death, and each offers a different character. The first two emphasize Western views, but in different ways. Chapter six outlines the Christian position on death—a theological rather than scientific understanding. Chapter seven explains the medical community’s view of death. This sounds straight forward, but it’s a much more technical subject than one might imagine. What organ has to stop functioning and for how long before one is actually dead. Besides all the coma patient stories, one may be aware of cases historically in which people were discovered to have been buried alive accidentally due to bad calls by doctors. The last chapter is about near-death experiences. This is an area in which there is a great potential for differing views. While science doesn’t deny that people have all sorts of fascinating experiences such as seeing bright lights at the end of “tunnels” and out-of-body experiences, scientists tend to attribute such events to material causes. [Neuroscientists can now induce out-of-body experiences by zapping a specific part of the brain.]

There are graphics in the form of diagrams and tables in the chapters that are most technical (e.g. chapter two and chapter seven,) but they are used sparingly. There’s an appendix that describes the Mind & Life Institute, as well as a glossary that explains both Tibetan and scientific terms. There are also a few pages of end notes that will help one find related material.

The weakness of this book is clearly its age. The Buddhism probably hasn’t changed much, but the science has changed a lot. Since 1992 there has been a revolution in understanding of the brain due to advances in functional Magnetic Resonance Imaging (fMRI) and other technologies.

However, despite the book’s age, there’s a lot of thought-provoking discussion, which offers plenty of room for both scientists and Buddhists to gain a better understanding of the mind and consciousness. I’d recommend this book for anyone interested in dream yoga / lucid dreaming, or—for that matter—death.

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BOOK REVIEW: Being Mortal by Atul Gawande

Being Mortal: Medicine and What Matters in the EndBeing Mortal: Medicine and What Matters in the End by Atul Gawande
My rating: 5 of 5 stars

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This may be the scariest, saddest, and most necessary book that I’ve read in some time. In it, Dr. Gawande discusses how medicine has proven increasingly effective at extending life, but—at the same time–we are less able to care for the elderly. The traditional approach, in which the elderly move back in with their families (or live independently near them,) often proves untenable. And it’s not necessarily because people are too busy, lazy, or indifferent to put up with granny, but rather that granny is likely to end up with needs that require a professional caregiver—in some cases for virtually every aspect of her daily life. In short, we’ve done a great job of extending life, but often with a sharp dip in the quality of life at the end.

The nursing home was the solution that the health care community came up with when this problem first became apparent. While the nursing home is both necessary and effective for many, for those of sound mind and sound-ish body, the move can be highly demoralizing. People revert from being independent and autonomous adults into a child-like status in which they have little freedom or privacy. Again, if grandpa has dementia or needs to be tube-fed, there’s no way around this, but if he’s just at risk for a fall that might break his hip, then it can be humiliating.

When it comes down to the end, fear of death has led to an unwillingness to ask important questions or even consider what might be just around the corner. This has led patients to keep asking for that one treatment that just might extend their lives—and doctors have been more than willing to allow this. This may be fine in the early days of a terminal illness, but once one has gone through—say–a couple of courses of chemotherapy, the treatment one is likely to get is some trial phase experiment that is as likely to kill one cruelly as extend one’s life—and to the degree that it does extend one’s life one may suffer a set of complications far more miserably than one would in letting the disease kill one. One of the most intriguing study results cited showed that people who took up hospice palliative care (making one comfortable) were found on average to live a little longer than those who kept seeking whatever treatment they could find.

This all sounds like bad news, but the author devotes much of the book to exploring the options that have been put forth in the face of these problems. One of these is the assisted living facility as an alternative to a traditional nursing home. These facilities work for people who are of sound mind and who aren’t too bad off physically. They allow the individuals to live as they might in a condo or apartment, but there are on-sight caregivers and assistance with all the tasks around the house that might prove too challenging for an older person. The other major solution is hospice care. Not that palliative care is new, but it’s increasingly being show to be a preferable option for all concerned. Another important outcome resulted from a major insurance provider’s decision to allow individuals to pursue palliative care while they were still being treated. [Historically, one only had the option of hospice once one had given up on treatment.] At any rate, the intriguing finding was that the insurance company actually ended up paying less because more people signed up for palliative care and those individuals used expensive health care elements like emergency rooms and intensive care units (ICU) less.

While I can’t say that I enjoyed reading this book, I would recommend it for everyone. It’s very readable. The approach is case-based. Dr. Gawande talks not only about his own patients and the patients and caregivers that he interviewed (his practice is not geriatric in nature, so he spoke with several experts), but also about the end of his own father’s life. It’s a short book of about 300 pages arranged into eight chapters. There are no graphics, and endnotes are the only ancillary matter, but nothing else is necessary for this book.

Read it.

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