I’m finding it impossible to write on sex and intimacy this week. Finn is in Deutschland and not in my face, and I’ve eaten all the refined sugar within reach as a substitute. I’m more miserable than I anticipated I would be. We Facetimed last night for a half hour and it was like eating cold oatmeal. He was tired, I was distracted. I think I might have alarmed him; I said I wanted to switch gears on the project because it was starting to feel irrelevant. “Am I fired?” he asked. Nope. I’m just much more interested in the story for the seaside book. We can always pick it up again. Sleep well, sweetheart, and hurry back.
Since joining Substack I’ve read at least one unique essay per day about the writer’s relationship with their mother, some were treacly, some were interesting, some were better than good. I actually have 35K words of memoir about Mum, and have considered serializing it here on Substack, so I won’t be writing about her anytime soon.
I can write around her though. She was a reader of books, especially medical topics. So in order to try to please her, I read the books she read and tried to get her to love me for that. I wonder how people like Oliver Sacks managed to be so successful in the publishing world while being so busy with their medical careers. I’ve been writing as long as I’ve been in medicine, often about medicine, and at the end of the day I hardly have any cojones to even approach the edges of publishing anything much. Still, Mum made me a reader of books, especially medical topics.
Therefore, I was so excited when Finn’s daughter and I hit it off. She is a pre-med student. She is a sparkling, wild young woman with a curious, incisive mind. I just love her. She has the requisite nose for the absurd that is so helpful to providers of healthcare. She says she is glad I don’t have fake boobs like her classmates' mums, (“Ohmigod, you have real G cups?”) she keeps snails for pets, and she taught me that “cunty” is the word du jour. I’ve been using it for everything. (I welled up Sunday morning when I realized I wouldn’t be seeing her for about three weeks as she goes back to uni.) We’ve been trading titles. Of course I told her to read Sacks and gave her the highlights of what I’ve read in the last five years. She recommended When Breath Becomes Air, by the late Dr. Paul Kalanithi and I told her my top pick was Being Mortal by Dr. Atul Gawande.
While cleaning later that day, I found Mum’s copy of Being Mortal. I reread one of the chapters, squatting near the closet, and it all came back. What a sumptuous feast of prose that book is. Death is mysterious, even after being privy to the process for work many, many times. Anything that explores that mystery is endlessly fascinating to me.
I’d almost like to write about it, but reading is a simple pleasure. "Important" books were never my thing. Analysis is a tertiary pastime to the languid, indulgent act of picking up a book (or magazine, or tablet) during the days of a busy life. We must read, lest we forget why. A gradual, unfolding reflection on the reading is also a luxury. Phrases return at odd times of the morning, ideas are turned over and grasped again while driving, a conversation cues a memory within the text. Non-effort is my favorite way to enjoy a book.
Being Mortal addresses quality of life and a good death, which I’ve always been especially interested in, even before Mum passed away. I'm not scared of it or shy about it. Nobody gets out alive. I know Mum knew it, too. In the years before her retirement she got her affairs in order, and it wasn't until her apartment was empty did I realize how thorough and precise she'd been about it. That is not the behavior of a fearful person. All of us in medicine who are seekers have notions from experience about what constitutes good medicine and a meaningful death. This book crystallizes those notions. I am glad she read it.
Traveling back, 8 years, now– back to the hospital, (perhaps it was day three or five, I don't remember) I sat with her as she came to terms with the pointlessness of treating her cancers. Aggressive treatment would kill her in a more gruesome way than if she were allowed to fade out at home in hospice. She related cases that she'd treated as nurse: families who were unwilling to let go and how horrible it had been for the patient. Heroic measures, aggressive radiation, just one more gamble with experimental chemo-- please don't put me through that, she asked. I was grateful we could talk openly about it, and I felt privileged that she would entrust this wish to me.
The oncology patients at her clinic wore wigs and inappropriately cheerful hats. I studied their grey skin and hopeless expressions while waiting with her. I didn't want her to go that treatment route. I didn’t think I could be that supportive indefinitely. Also, Mum’s intellectual sophistication put her above “cancer treatment culture” and she didn’t give two figs about staying positive. Cancer fights you, not the other way around, and she knew it. I knew it was self-centered of me to want to make treatment decisions for her, but I did not want cancer treatment to define her life or death. She was more complex than that. As conflicted as I was about Mum, I hoped she would not be in pain and that her last days would be defined by peace, dignity, and mercy– so that maybe by proximity, our relationship could hold those virtues too.
As the decades of her auto-immune diseases passed, I often secretly criticized the conservative treatment she chose. However, treating Lupus, RA, and Scleroderma conservatively prolonged her life. She was willing to suffer some pain so that she got more time in the long run. Only she had any idea how sick she was. She never let on, except through her perpetual anger. When she had skin cancer removed two years before she died, I wonder if she knew then how little time she had. She was seventy, medically complicated, and exhausted from years of chronic pain and medication side effects. It’s almost as though she made a bad bet with the proverbial devil at the crossroads.
My boss and I talked about it when I told her that Mum chose hospice and I was going to need time away. "She's a nurse. I bet she's known for a while that the disease was this advanced." I did not believe her at the time, but now I'll admit that maybe she was right.
The clinical and the spiritual aspects of life's end can meet in the middle. It is wonderful that I can be a resource for a bright young student like Finn’s daughter, and that I can turn Mum’s bitterness into sweetness. I’m listening to When Breath Becomes Air now so I’ll be ready to discuss when I see her again. What a sin, and a shame, it would be to piss on her spirit like Mum so often did to me. I carry peace, dignity, and mercy instead.
Thanks for the restack. The dark humour we rely on professionally pervades EVERYTHING. It makes death quite anti-climactic!
"The clinical and the spiritual aspects of life's end can meet in the middle."
I knew we were connected. Mom and I also always talked about death and dying the same way we talked about anything else. It was never taboo or scary. Probably because I grew up playing in emergency rooms and ICUs and hospitals and nursing homes as we visited her aunts, uncles and mom. They all died young and mostly of cancer. It was always just a part of life...