Friday, March 1, 2019

Counting Backwards

Counting Backwards: A Doctor's Notes on Anesthesia
Henry Jay Przybylo, M.D. (W.W. Norton, 2018)

     Anesthesia is a mystery, even to its practitioners. Dr. Przybylo (who goes by Dr. Jay around the hospital) has administered anesthesia over thirty thousand times over his career, and he doesn't exactly know how the gas he uses does what it does. "Despite decades of research, its mechanism of action remains a mystery. I must have faith in my anesthesia gas." He has faith, as well, in his experience; and in his preparation, which is invariably meticulous. A mistake he made in his first year of practice, when he picked up the wrong syringe, led him to work out a standard approach to setting up his operating area. "The basic needs must be within an arm's reach and not concealed in clutter. The anticipated is one step away; the potential, another step beyond."

     From this cockpit, Dr. Jay manages the drugs, both gaseous and intravenous, that render the patient insensible and pain free, to make surgery possible. He has drugs to dispel anxiety, prevent the formation of memory, stop pain, and prevent movement. At the same time, he has to keep tabs on the vital signs of the patient: he doesn't want to suppress the heart rate, blood pressure, and breathing of the patient too much. Depending on what the surgeon is doing, the body may respond with lulls or surges, and the maintenance of stability may require anticipation–verging on art–from the anesthesiologist.

     Because Dr. Jay specializes in the care of children, he has need of a few other arts. While an adult may understand that she needs a shot to begin the process of anesthesia, a child will probably see that as unacceptable. "Since every step taken toward a procedure room increases the anxiety of my patient, my goal is to shorten or disguise the time from that first step until my anesthesia coma is induced. Distraction is a major tool, and maintaining an ability to distract keeps me young, or at least requires that I stay current and informed."

     Indeed, he seems to be a lifelong learner on many fronts. He studies what the other people in the operating theater are doing, learning the rhythms and habits of the surgeons he works with. He understands cardiology, cancer, and diseases of the lungs. He has learned more and more about preventing post-operative pain, and has improved the way he speaks to people he isn't sure can understand him.

    Dr. Jay has a deft touch with the history of his field, from recreational ether to sonar-assisted lidocaine shots. He's also very good with simple explanations of how things work, and what kinds of things can go wrong. But what really makes me recommend Counting Backwards are the lessons that all of us could use. Setting up his space the same way every time, for example, is critically important to working as efficiently as possible; at the same time, it's an exercise in mindfulness, a way of preparing himself from the inside out.

   Thus prepared, he makes the machinery an extension of himself, and, seemingly, vice versa. But he doesn't fall into the machinery completely. No matter how long the procedure goes on, he prefers to stand up and watch over the drapes, rather than sitting down. "Far too often, when the readings waver, all eyes home in on the monitor screen. I've resorted to placing a towel over the screen to stop residents from watching it instead of the patient." As long as the patient is a human being, the doctors have to be, too.

Any Good Books published by email,
March 1, 2019

Friday, February 1, 2019

Why Religion? A Personal Story

Why Religion? A Personal Story

Elaine Pagels (2018, HarperCollins)

       When fifteen-year-old Elaine Hiesey went to hear Billy Graham preaching at San Francisco's Cow Palace, she was transported by his promises, to a degree that horrified her sedate suburban parents. Her father was at odds with religion, her mother a nominal Methodist, but she took up with a crowd of Bible-thumping Jesus enthusiasts near her home in Palo Alto. Fortunately, by my lights, she also had a crowd of arts-minded friends from the local community theater. When one of them, a gifted artist, was killed in a car accident, her Christian friends declared that he was going to hell, because he was Jewish. "That made no sense. Wasn't Jesus Jewish? When that didn't seem to matter, I realized that what they had said had nothing to do with what had drawn me to that church, and to the faith we'd claimed to share." 
        Though she left that church, she retained a sense that religion had answers to questions that she had never been encouraged to think about in her childhood home. She wasn't encouraged to think about them at Stanford, where she studied history; the study of religion wasn't even available there. But since the question wouldn't leave her alone, she pursued graduate study at Harvard's Divinity School. They put her off for a year, on the grounds that women take up space in graduate school better used by men; nevertheless, she persisted. 
       Harvard happened to be one of two places in the U.S. that had copies of the ancient books that had been discovered at Nag Hammadi, in Egypt, twenty-five years earlier. With names like the Gospel of Truth and the Gospel of Mary Magdalene, the 'gnostic' gospels purported to record the lost teachings of Jesus. The second-century bishop Irenaeus considered them heretical. By the fourth century, they had been translated from Greek into Coptic; they were hidden from the proscriptions of the Alexandrian bishop Athanasius, and only returned to light in the 1940's. These discoveries have been the basis of Elaine Pagels's professional life, which has included teaching, and the writing of both scholarly and popular books.

      Why Religion also recalls her personal life: her marriage to the distinguished physicist Heinz Pagels; the illness and death of their six-year-old child, Mark, of pulmonary hypertension; their adoption of two more children; and her husband's shocking death in a hiking accident. "No longer married, suddenly I was widowed. From Latin, the name means 'emptied.' Far worse; it felt like being torn in half, ripped apart from the single functioning organism that had been our family, our lives." She describes the numbness of the ensuing months, as she figured out how to keep her family going, and tried to understand how rage might coexist with grief. It was a propitious time to study the book of Job, and the development of early Christian conceptions of Satan. 
     So, really, why religion? Heinz Pagels actually asked her this at the beginning of their courtship. "After an intense discussion, contentious and hilarious, we came to see that each of us was hoping to understand something fundamental." Today, she is not a believer, nor an unbeliever - her understanding comes from a time before creeds gave those words meaning. She sees religion both in a larger context, as part of the knotted net that binds all humans to each other and with the world; and as a personal, interior experience, all but incommunicable; in that sense, she is a gnostic. "Even now, writing about what's so deeply personal, I'm aware that anything I say can speak to you only as it resonates through what you have experienced yourself; yet even within those limits, we may experience mutual recognition."

     I hope that's not heresy, because it feels like salvation.

Email edition February 1 2019

Tuesday, January 1, 2019

Every Word is a Bird We Teach to Sing

Every Word is a Bird We Teach to Sing: Encounters with the Mysteries and Meanings of Language
Daniel Tammet (2017, Little Brown Spark)

       Most of us could see, given the right squint, the roundness of three or the pointiness of K, or even the dog shape of the word 'dog', facing to the left; that's the kindergarten level of synesthesia. Daniel Tammet's native synesthesia is somewhere around Ph.D. level by comparison. In addition to instant calculation of squares, cubes, and calendars, "...I kept a list of words according to their shape and texture: words as round as a three (gobble, cupboard, cabbage); pointy as a four (jacket, wife, quick); shimmering as a five (kingdom, shoemaker, surrounded)." And imagine the thrill of 'lollipop', with its embedded '1011', a nice round multiple of three!

       This savant-wizardry came along with epilepsy and Asperger's syndrome. The mental landscape of Tammet's childhood was so full of sensation that he had a very poor grasp of spoken language--it just didn't register with him. Mercifully, his high school German teacher invited him for a weekly conversation, throwing him a lifeline that gave him a better grasp of ordinary social intercourse. Still, he says, "I learned my mother tongue self-consciously, quite often confusedly, as if my mother were a foreigner to me, and her sole language my second."

       The first essay in this collection reprises parts of Tammet's 2007 memoir, Born on a Blue Day, which was a world-wide best seller. But what would he do for an encore? Was that book a singularity, as some English-language reviewers suggested, or did he have more to say? Well, one thing that happens when your memoir succeeds is that people begin to write to you as though they know you; one such correspondent was a young Frenchman whom Tammet would fall in love with and go on to marry; they now live in Paris. He also summoned the nerve to send off his book to Les Murray, an Australian poet whose poetic language stems from a strain of autistic-savant creativity that Tammet found profoundly resonant. Tammet went on to become his French translator.

       Translation turns out to be a part of his natural vocation. Because of the way his mind works, Tammet is conversant in something like ten languages, including Icelandic and Esperanto. Iceland, it turns out, has authorities charged with making official judgments about what children can be named; he gives us an essay on what 'purely Icelandic' means, and how that changes through time. He goes to meet Esperanto speakers, who live in the paradox that they have to sell their universalist vision in their other native tongue. 
      His experience of being treated as a linguistic curiosity (not to say freak show) gives him a sympathetic bond with the Esperantists, as well as those who devote their passion to reviving or preserving the native tongues of Mexico or the Isle of Man, perhaps the ultimate quixotic pursuit. "Fifty years ago, many new words needed coining to match modern island life: the elders of the recordings had never ridden in a car or airplane, owned a computer, or gone to university."

      Tammet has other wonderfully informative conversations with deaf people who joined the Deaf community by learning ASL as adults; people who make the Bible the first written book in obscure languages; and socio-linguists who record and study phone conversations. He also makes a larger point about translation's relationship to literature, which came to him while reading Anna Karenina in English. "Something had worked itself in my head. All literature, I finally realized with a jolt, amounted to an act of translation: a condensing, a sifting, a realignment of the author's thought-world into words." Yes, he can do this. Yes, he's a writer. And his thought-world is a fascinating place.

January, 2019

Saturday, December 1, 2018

A Girl Walks Into a Book

A Girl Walks Into a Book: What the Brontës Taught Me About Life, Love, and Women's Work
Miranda K. Pennington (Seal Press, 2017)

     Even though my own acquaintance with the works of the Brontë sisters is slight, and unlikely to get better, reading about Miranda Pennington reading them is delightful. A Girl Walks Into a Book is a fine example of a genre I love: it combines historical insights about the lives of the authors with plot summaries and critiques of the books, and a memoir of Pennington's life as she encounters and rereads them. Jane Eyre (Charlotte Brontë) and Wuthering Heights (Emily) do not lose their strangeness and individuality under Pennington's scrutiny, yet she can take some lessons from them for twenty-first century life. 
     Not that the lessons come easily: "I do wish I could have filed away the most urgent lesson of Wuthering Heights: be honest with yourself if the person you want to marry is still obviously entangled with someone else." The romantic adventures Pennington shares call up in me a certain horrified fascination–how can so many bad choices come to a good end? But really, it's all about growth. When her father gave Jane Eyre to the absurdly bookish grade-schooler, he threw her a lifeline that would support her for decades. "At school,...I felt like a freak, awkward, dorky, and out of place, always spoiling for a fight. But inside, in the pages of Jane Eyre, I found sanctuary. And even when something unpleasant happened, I consoled myself that it gave me something else in common with Jane."

      Just as much to the point, as the book progresses, she has something in common with Charlotte Brontë. Both face the problem of supporting themselves in a world that is not exactly panting for what they have to say. Charlotte's early biographers contributed to myth-making that emphasized how far from the centers of culture she lived, and depicted an overnight success. As usual, that just means that all the work that led up to it fades into the shadows. The Brontë children wrote stories and created worlds among themselves; when Charlotte sent her publishers detailed instructions about the design of her books, she was not entirely new to the issues at hand, having made her own small books of her family's stories as a teenager.

     After Charlotte, Pennington admires the under-sung Anne Brontë. Her Agnes Grey includes little of the wildness of her sisters' better known work; its plot, about a governess who eventually marries a clergyman, is downright conventional. But the voice of Agnes, and her sharp views of her sometimes feckless employers, shows how much Anne was learning in her own situations, where she must have felt like the proverbial fly on the wall. Pennington says, "Truth in fiction never makes it weaker, but anchors it, unlike lying in non-fiction, which is like robbing a tree of its roots."

     Wuthering Heights, Emily Brontë's entry in the three-headed publishing sensation that Charlotte had begun, brings out Pennington's witty side. Of the second generation produced by Cathy and Heathcliff, she says, "They live as happily ever after as a pair of borderline inbred teenagers with seriously dysfunctional parents and an alarmingly small social circle could be expected to." And this lovely bit: "Retelling it all is Nelly Dean, a maidservant with an impeccable memory and the rare ability to survive for the duration of the book."

     The same might be said of the Brontës themselves, who originally numbered six. Their mother died when they were small, and her sister moved in to help raise them. The oldest sisters, Maria and Elizabeth, were mortally sickened by unhealthy conditions at the school they attended, dying a few months apart. The sole brother, Branwell, was perhaps an even greater tragedy: he was crushed by the pressure of not finding his way in the world, with three unmarried sisters sure to fall to his care. When he came home after losing a tutoring job, he went downhill by way of alcohol and opium to his death. Charlotte is the only one who survives to marry, a Mr. Nicholls, whose main attraction may have been that he was a clerical associate of her father's. Indeed, he remained in residence with Mr. Brontë after Charlotte died in turn. 
     But she certainly made a mark in the world, both in her own work and in supporting and promoting her sisters'. Though Pennington is, in a way, a tugboat alongside the Queen Mary, the smaller vessel has an important function. I have a much better idea of what I might like to sample of the various film and television adaptations, the biographical material, and, conceivably, the novels themselves. You never know.

Thursday, November 1, 2018

Almost Everything

Almost Everything: Notes on Hope
Anne Lamott (Riverhead Books, 2018)

As she neared the age of 61, Anne Lamott determined to write down some things she knows about hope and despair, for the benefit of the children in her life, and anybody else who may be "both exuberant and worried." That is, by turns, any of us may feel the pull of the edge of the cliff; we think the unthinkable, or at least the unspeakable, all the time. Lamott's gift is to speak what's unspeakable, in a matter-of-fact style that, to some of us, comes as a great relief.

She's also more willing than most people to talk plainly about the miraculous side of life, that things don't always get worse; that in the blackest, bleakest night, love has been a penlight. She's talking about the kind of big truth whose opposite is also true: "Every day we're in the grip of the impossible conundrum: the truth that it's over in a blink, and we may be near the end, and that we have to live as if it's going to be okay, no matter what."

We also get, as you expect if you know Lamott, a bunch of stories in which her own demons come to the fore, especially her tendency to think she can fix the people around her. "The harm is in the unwanted help or helping them when they need to figure things out for themselves. Help is the sunny side of control." It can't be easy to be her relative, or her friend.

How like life, though - it's not always easy to be anyone's relative, or friend. Relationships are always going to affect who we turn out to be, for better and for worse. "Families are hard partly because of expectations, that the people in them are supposed to mesh, and expectations are resentments under construction." The roles we take on in families offer us both constraint and comfort; they keep us safe while they make us crazy.

If you don't already know and like Anne Lamott, this is not the book to start with. Go back to her novel Crooked Little Heart, or Bird by Bird, her delightful book on writing. She's also been mining this current territory of thoughts on faith for a while now, and may be running out of new things to say.

And yet – and yet – the old things are still worth saying, and hearing. Anything that gives us the courage to face how tough things are can plant a seed of hope, which skimming through life in denial is never going to do. "There is the absolute hopelessness we face that everyone we love will die, even our newborn granddaughter, even as we trust and know that love will give rise to growth, miracles, and resurrection."