Wednesday, August 31, 2016

Off the Leash; Dog Medicine

By chance I picked up two different dog memoirs this month - it's rather fun, how different they are.

Off the Leash: A year at the dog park.
Matthew Gilbert (2014, Thomas Dunne Books)

Dog Medicine: How my dog saved me from myself. A memoir.
Julie Barton (2015, Penguin)

    Matthew Gilbert's Off the Leash is an anthropology of his local dog park, in Brookline, Massachusetts. Amory Park is an idyllic place, where dogs can roam and romp off-leash till one p.m. every day. Of course, there are a few mosquitoes in paradise, like the dog owners who won't clean up after their dogs, or acknowledge that they have an unusually aggressive one. If either of those characters sticks around for any length of time, the human pack will exert pressure till they either shape up or move on. 

    Gilbert was not used to being a pack animal. He's the tv critic for the Boston Globe, i.e. a professional couch potato; before he got married, he had not been a dog person at all. Partly under the influence of his dog park friends, he picks up the baby-talk ventriloquism that he had formerly scorned. 

    "It was crazy, of course, and shameless. The tangle of self and dog was intimate, psychodynamic, and pleasingly neurotic. Some people developed actual voices for their dogs, just as they'd translate their dogs' actions and facial movements into human traits." Oblique, side-by-side conversations make strangers friends.

    Gilbert tunes into his Labrador's friendliness and endless appetite for play, and it does him good. "Toby had made me a more contented, freer person, someone who lives and loves despite the outcome, someone who risks play and who no longer needs to forge excuses." Gilbert knows he is likely to outlive Toby, but the joy and love make it all worthwhile.


     Julie Barton was younger, and in far worse straits, when she acquired her Golden Retriever, Bunker. She'd moved to New York after college, following a boyfriend, and it was proving to have been a bad idea. Suffering a full-on nervous breakdown, she called her mother, who drove straight from Ohio to take her home. 

    A couple of therapists and some Prozac later, she became determined to get a puppy. A good idea, and the first productive idea she'd had in months, but it came with a wave of doubt and anxiety. How to choose? "He walked over toward me, then paused, still watching me, before coming closer and sitting down at my feet. He looked up into my eyes, his own mud-brown eyes nestled under expressive little eyebrow nubs, his tiny chin hairs glowing in the light, his orange-red paws caked with mud. In that moment, of course, I knew."

    Having a fellow-creature who needs her and cheerfully loves Barton opens up possibilities. Bunker goes with her when she starts a new life in Seattle. I don't want to say as much as I usually do about what happens from there on; Barton is a gifted story-teller, and it's her story to tell. Bunker remains a real sweetheart, and their mutual devotion remains Barton's lifeline to trust, health, and joy.

Barton's Dog Medicine is the deeper, better book, but if you're not in the mood for an emotionally intense experience, pick up Off the Leash instead.

Any Good Books
September 2016 email edition

Monday, August 1, 2016

Internal Medicine


Internal Medicine: A Doctor's Stories
Terrence Holt (Liveright, 2015)

Terrence Holt conceived of his account of internship and residency not as a memoir, but as a series of parables, "seeking to capture the essence of something too complex to be understood any other way." Not only are the patients composites of his imagination, the narrator is a transformation of Dr. Holt. "He struggles differently from the way I did, but in the end he learns things that it took me much longer to figure out." This narrator is good company. He sheds light on the uncertainty of the enterprise, both from a medical point of view – the same few symptoms apply to so many conditions – and on an interpersonal level: How do you keep listening to the patient who's been labeled a whiner, or whom you just don't like?

Part of the goal of training is to teach the young doctors how to appear confident even when they' are, inevitably, uncertain. "During those years, I always felt that I knew nothing. And no matter how much you did know, there was always more you didn't. In that vast desert of ignorance always lurked that one detail waiting to kill somebody." He's in a teaching hospital, so he is often without the complete medical record, because patients are being admitted by the house staff rather than their own doctors. Much can go amiss in this process; the history may be too complicated for the patient to remember or explain; she may be confused, demented, in shock or unconscious.

Or she may be lying, concealing something she's done, like the girl who swallowed a handful of Tylenol and damaged her liver. To assume she is lying leads to a certain cynicism that may lead directly to hardness of heart. It's always a breakthrough when the young doctor looks up from his lab results and sees a human being, but if they thought about that all the time, they'd be unable to do the work. "There is so much death and suffering and grief, and in the midst of it we still need to fill out forms, subject the sick to indignities and pain, try to eat and sleep and keep all these needy people at some kind of distance."

Dr. Holt has a chapter about some of the neediest, the patients in a mental hospital. He works a rotation in intensive care, where matters are somewhat simplified: keep the patients alive, with oxygen and antibiotics. (Or is it, kill them slowly?) And he goes out on hospice calls, where the patients are on the far side of need. But the families need something, and a doctor actually arriving with the nurse gives them a strange sort of comfort.

Three out of three people die, it's been said. Surrounded by family or alone, dimmed by morphine or amid the turmoil by a Code Blue, "in the middle of a scene with all the dignity of a food fight in a high school cafeteria. We can't cure everybody, but I think most of us treasure as a small consolation that at least we can afford people some kind of dignity at the end, something quiet and solemn in which whatever meaning resides in all of this may be – if we watch and listen carefully – perceptible."

If we watch and listen carefully. Here's hoping we can.


Any Good Books
August 1, 2016



Friday, July 1, 2016

The Shift


The Shift: One Nurse, Twelve Hours, Four Patients' Lives
Theresa Brown, RN (Algonquin Books, 2015)

      The oncology/hematology ward in a Pittsburgh teaching hospital is a good place to learn what nurses do. The Shift is a first person account of a nurse's day there, at the minute-by-minute level of alcohol swabs and sterile saline solution; Theresa Brown drives her narrative by such details, but she also makes time to think about some larger features of the environment, and the systems that sustain it.

       The patients and staff Brown discusses are composites, for obvious reasons, but I found it easy to forget that and enjoy their stories. From the fussy patient who wipes her own room down with bleach, to the cheerful one who stocks miniature Hershey bars for the nurses, to the barely conscious old man, they stand in for their respective tribes. Brown navigates between empathy and detachment, and divides her time between providing care and keeping records of it. If it isn't recorded, it isn't done (and can't be billed for.) "We need a menu that includes the option: spent time comforting patient with life-threatening diagnosis. But nothing that empathy-intense gets included in our required paperwork."

       Of course, she's not only dealing with patients and their families. Nurses constantly interact with each other. The bureaucracy may require that they sign off on each other's calculation; prudence may dictate that they call for help to move a patient, and sometimes all the call bells go off at once. Being able to rely on one another makes a huge difference; of course, it also means more interruptions. Thirty uninterrupted minutes for lunch, which is the legal mandate, just doesn't happen most days.

      Brown's fellow nurses are probably the easy part, because they at least understand what each other is trying to do. The hierarchy of the hospital includes doctors of all levels of experience. The most senior may be the least seen, other than morning rounds, when they are surrounded by fellows, residents, and interns, all doctors at different stages of their training. And then–"These poor medical students: They worked so hard to get into med school and then in the hospital no one gives them the time of day, in part because they have no real purpose, at least on our floor. They're supposed to be learning and I'm sure they are, but as far as we nurses know they can't do anything." Officially, nurses listen to doctors and not the other way around, but many a young doctor has had his day saved by a timely word.

      Brown has answers for some things I've always wanted to know. How can nurses stand to wake up a patient who may really need the rest? Why does discharge take so long? Why do they move a dying patient out of the oncology ward? We won't necessarily like the answers, but it's helpful to see how they are embedded in the systems at work. In the end, nurses are the point of contact between systems and human beings, and we're lucky so many of them are as smart and humane as this.

      In this one twelve-hour shift, Brown learns from, teaches, and advocates with a dozen or more other professionals. "As is so often the way in the hospital, we barely nod at each other and move on. Nurses and doctors–we come and go from our patients' lives and each other's with the anonymity of mail carriers, the efficient intimacy of the guy who reads the gas meter in the basement. That initial impression is what matters. Can I work with this person? Can I trust him?" Mostly, which may be all we can really expect. People are usually doing their best. And thank heaven for them.

Any Good Books
July 2016

Wednesday, June 1, 2016

Men Explain Things to Me


Men Explain Things to Me
Rebecca Solnit (2014, Haymarket Books)

      The title essay of Rebecca Solnit's collection, Men Explain Things To Me, has been circulating on the Internet since 2008. It did not originate the term 'mansplaining', but it might well serve as the index case. The essay describes a 2003 conversation with an arrogant man who held forth to her about a book which not only had he not read, but which she had actually written. If this could happen to Solnit, who by that time was the author of several books, how much more can women be silenced who face the loss of livelihood or life if they insist on speaking up.

     Mind you, Solnit was not complaining about men explaining things when they actually know more about a subject than she does, just the ones who talk over her about things they know nothing of. She's a little leery of the broad net that 'mansplaining' seems to cast, because she knows plenty of modest men, and some patronizing women, too. But the overall pattern describes something real: a power differential that's expressed on a continuum from social awkwardness to economic injustice to rape and violence. Solnit's project in this collection of essays is to make the connections between these things clear.

     This is inevitably a historical project, at least to some degree, but the treatment is deft and light-handed (or as much so as it can be, when the material is so outrageous.) The mothers of disappeared Argentines who protested in the Plaza de Mayo; the hotel maid who accused Dominique Strauss-Kahn of sexual assault; and Anita Hill, who told the Senate Judiciary Committee about Clarence Thomas's behavior as her boss, all made important and consequential statements in the world, against great odds. They all faced the near certainty of being told that they were delusional. Imagine how many women before them never even had a chance to speak or be heard, let alone to be believed.

     The internet, in addition to recirculating Solnit's original TomDispatch piece, has continued to be the venue for women's struggles to be heard and believed. Google 'academic mansplaining', and you'll come to a Tumblr archive with a thousand such stories. Feminist bloggers are routinely threatened with violence, sometimes to the point of deciding to cancel public appearances. After the 2014 mass shooting in Isla Vista, California, the Twitter hashtag #YesAllWomen appeared half a million times in two days. Five hundred thousand people said things like this: "Sure #NotAllMen are misogynists and rapists. That's not the point. The point is that #YesAllWomen live in fear of the ones that are." Innocent men feeling wrongly accused may not be the very first thing we should be concerned about.

     Solnit's essay on Virginia Woolf is in a different vein, a little meditation on epistemology. To plan, or to remember, we rely on things we can't possibly know, and it's well to be aware of it. "To me, the grounds for hope are simply that we don't know what will happen next, and that the unlikely and the unimaginable transpire quite regularly. And that the unofficial history of the world shows that dedicated individuals and popular movements can shape history and have, though how and when we might win and how long it takes is not predictable."

    I think she's right about that; if pressed to predict, I'd say that Solnit's writing moves things in the right direction.




Any Good Books, emailed
June 2016
 

Monday, May 2, 2016

Learning to Walk in the Dark


Learning to Walk in the Dark
Barbara Brown Taylor (2014, HarperOne)

    We don't give darkness much time or space in our lives these days. Electric lighting first appeared fourteen decades ago, television and computers and smart phones within living memory; light follows us everywhere we go, in a way that is historically new. Like quiet, darkness is now something we have to go to some trouble to experience.

    In Learning to Walk in the Dark, Barbara Brown Taylor explores the consequences of this shift for the natural world, and for our spiritual lives within it. After she'd left her job as rector of an Episcopal Church in 1998, she and her husband moved to a farm in the hills of rural Georgia, where the Milky Way is actually visible, and it makes sense to notice the seasons of the moon. That the flood-lit neighbors down the road deny themselves this part of country life is a minor irritation, but not much of a surprise. They very likely have never lived with real nighttime darkness.

    Nor, if they happen to be churchgoers, have they heard anything positive about it. The usual servings of holy writings tend to lead to what Taylor calls the 'full-solar version of Christianity.' (We heard just such a reading in today's lectionary. The twenty-second chapter of Revelation told of a vision that "there will be no more night; they need no light of lamp or sun.") In the fundamentalist youth group where Taylor first experienced Christianity, darkness was regarded as a thing to be avoided at all costs, and the precursor to eternal damnation.

    Yet, she says, "even in the Bible, that is not the whole story about darkness." Abraham met God by starlight, and his grandson Jacob wrestled all night with the angel, in a way that changed the whole story of the world. And when Moses made his covenant with God, in the presence of the people of Israel, a cloud obscured the mountain-top. "While this darkness is dangerous, it is as sure a sign of God's presence as brightness is, which makes the fear of it different from the fear of snakes and robbers."

    Darkness can be mystical, then, and even holy. There are truths to be found there that are unavailable to the bright light of day, like the stars that shine unseen overhead, at noon. Taylor goes into one of the great caves of West Virginia with a guide; they stop several times to sit in the dark. "There is no way to tell time, which means there is no rush. There is no light, which means that I do not have to worry about how I look. There is no one beside me, which means that I do not have to come up with something to say. Above all, there is no threat."

     And what of the darkness that is a threat, when loss, pain, or sorrow makes it seem like God has departed for good? We can pray to be able to pray; we can read Job and the Psalms, with more resonance than before; we can look for trusted guides. "For good or ill, no one can do your work for you while you are in this dark place. It has your name all over it, and the only way out is through."

     Such times come to all of us who live long enough, I think, and they are the crucible of wisdom. Taylor, now in her sixties, is wise about life, in a way I'm grateful for: "To be human is to live by sunlight and moonlight, with anxiety and delight, admitting limits and transcending them, falling down and rising up. To want a life with only half of these things in it is to want half a life."

    May we have grace to want a whole life.



Email, May 1, 2016

My reviews of some earlier books by Taylor: http://anygoodbooks-mixedreviews.blogspot.com/search/label/Barbara%20Brown%20Taylor