Weapons of Math Destruction

Weapons of Math Destruction: How Big Data increases inequality and threatens democracy.

Cathy O'Neil (Crown, 2016)

   Cathy O'Neil is a math nerd who, in 2007, left her academic career to do math for a major hedge fund. She thus had a front row seat for the financial catastrophe of 2008, which was in large part a product of the kind of mathematical processes people like her were engaged in. "The housing crisis, the collapse of major financial institutions, the rise of unemployment–all had been aided and abetted by mathematicians wielding magic formulas.What's more, thanks to the extraordinary powers that I loved so much, math was able to combine with technology to multiply the chaos and misfortune, adding efficiency and scale to systems that I now recognized as flawed."

   After leaving D. E. Shaw, O'Neil recast herself as a data scientist, working on models in the Big Data economy, and once again privy to the magic formulas that are taking over in so many areas of our lives, from college admissions to parole recommendations. She started her blog, MathBabe, "to mobilize fellow mathematicians against the use of sloppy statistics and biased models that created their own toxic feedback loops."

   In Weapons of Math Destruction, she expands that warning to general readers, including the mathematically challenged. In fact, for the kind of algorithm she describes as a WMD, the math is usually opaque, anyhow: it's proprietary to the company that is profiting from it, whether by sorting your resume by the ZIP code you come from, or selling your search clicks to on-line marketers. The black-box quality is part of what makes WMDs so dangerous: the numbers they spit out are nearly impervious to challenges, even though the numbers that went into them may be biased, false, or completely spurious.

   Another dangerous aspect of WMDs is its potential to damage people's lives. O'Neil has a case study about the Washington, D.C., school department's program of rewarding teachers whose students improve, and firing those whose students don't. Such a practice can (and did) lead to the firing of good teachers, if the previous year's teachers cheated by padding their students' scores. The school hierarchy got what it wanted, to be seen as weeding out underperforming teachers, but since they didn't do any external checking to see if that's actually what they had done, they don't know how many good teachers they lost in the process. A healthy model would have an independent way of looking at the results to see if they made sense.

   That's unlikely to happen, however, when the third destructive effect starts to work: scale. If your credit report were managed by your own bank, you could speak with them about it face to face, and presumably establish that you were not the same John Bradshaw who had defaulted on that electric bill three years ago. But scale it up to the size of the big three credit bureaus, over billions of data points, and you are unlikely to find a person who can fix mixups; but you may very well pay for the errors not only in higher interest rates, but also in difficulty getting a loan, or a job, at all.

   And that's to mention only the official credit bureaus, which are governed by requirements that let you see the data they're using, and challenge it. E-scores generated by studies of internet use, or assumption about the street you live on, are under no such constraint, and their feedback loops tend to make unfairness worse. "There's a very high chance that the e-scoring system will give the borrower from the rough section of East Oakland a low score. A lot of people default there. So the credit card offer popping up on her screen will be targeted to a riskier demographic. That means less available credit and higher interest rates for those who are already struggling."

   Most WMDs embody corporate goals such as efficiency and profit; if corporations are persons, they tend to be sociopathic ones. Human beings are much better at thinking about justice than computers are, still, and perhaps always–if we choose to, and if we know what we're up against. Weapons of Math Destruction is disturbing, and distressing, but I couldn't put it down. Cathy O'Neil is a warrior for economic justice, and we ignore her at our peril.

Bad English

Bad English: A History of Linguistic Aggravation

Ammon Shea (Perigee, 2014)

   The t-shirt that says "I'm silently correcting your grammar" has my name on it. I come by it honestly: I have linguistically sensitive forebears on all sides. My father winced at sentence adverb 'hopefully'; my maternal grandmother loathed the word 'tasty'; and I have recently felt utterly compelled to fix the number disagreement in the last sentence of the Lord's Prayer.

   But I really don't want to be a jerk about it, so I'm delighted to add Ammon Shea's Bad English to my 'language wars' shelf. Shea has taken a serious historical look at a the usage rants and grammar guides of the past century and a half. English, it turns out, changes so quickly that no guide can hope to be the last word. The peeves of the nineteenth century very often look strange to us now; the expressions that were then considered beyond the pale have either sunk out of sight or become commonplace and unobjectionable.

   Such a change doesn't even need centuries. Remember 'Winston tastes good, like a cigarette should'? "Here we have an extraordinarily clear line of linguistic demarcation. People either feel that using like as a conjunction marks one as essentially subliterate or they have absolutely no idea what you are talking about and fail to see why this would be a problem of any sort." There were many more of the first group around when I was little, and there are many more of the latter now. 

 

   We will always have doomsayers, and yet, says Shea, "English is not dying. It is behaving exactly as it should, which is to say that it is changing. All living languages change–it is one of the things that indicate that they are still in use by a large number of people. The problem is that, while many people accept that our language is subject to change, they want to dictate what sort of changes will take place and that is a very difficult thing to do."

   The rules and roadblocks set up by fourth-grade English teachers frequently have perverse effects, as either the teacher or the student remembers the rule but not the principle. Years of drilling students not to say 'Jimmy and me are going to the pool' has led to generations of people who say 'Between you and I.' Shea makes an amusing example of George Orwell's famous essay, "Politics and the English Language," which promulgates six reasonable-sounding rules, and breaks five of them with abandon. There must be some sort of rule about that...

   Shea is not out to stop you speaking English the way you want to. If you prefer never to split an infinitive or strand a preposition, more power to you; but don't imagine that you are defending rules handed down on stone tablets. And feel free to set a picket fence around unique and perfect, but you may also want to "accept that certain words... are used by some people in a less semantically exact manner than you would yourself employ and hope that they have some other redeeming qualities that make up for this lapse."

   Shea is being contrarian here, and a little argumentative; but I think I prefer that attitude to the certainty and superiority of the self-appointed guardians of the language. English is doing just fine; it can look out for itself.

Email edition 11/1/16

Cold Antler Farm

Any Good Books

October 2016

Cold Antler Farm: A Memoir of Growing Food and Celebrating Life on a Scrappy Six-Acre Homestead

Jenna Woginrich (Roost Books, 2014)

    "I didn't need something for a magazine shoot or a remodeled kitchen with steel appliances. I needed land, water, grass, and possibility. The little house was a blessing, a perfect fit. I didn't care about my furniture sitting level, but I did care about the pasture, barns, forest, pond, stream, and outbuilding crying for a caretaker. It became home the moment I pulled into the driveway."

    Jenna Woginrich is a writer who farms six and a half acres in the hills north of Albany, New York; or should I say, she's a farmer who blogs and writes books. Cold Antler Farm is structured around a year on the farm, from spring around to winter. That is, from seed catalogs to planting, to weeding and cultivating, to harvesting the garden. At all times there is firewood to split and stack, as heating a house in upstate New York is no small task. 

    Woginrich likes a fresh vegetable, but her first love is clearly animals. Mail-order chicks start out in the warm kitchen, but grow up to enjoy free-range lives all over the place, providing eggs and the occasional chicken dinner. A couple of pigs eat their way through the summer, eating their way from "the size of a cocker spaniel to a high school wrestler, 190 to 225 pounds." (Woginrich sells their meat on shares so she can afford their feed.) The sheep are smarter than their reputation would have it, with a weather eye out for a weak spot in the fence. After they've had their riot, in the lettuce bed or the neighbor's flower bed - oops, sorry! - they can be bribed with grain back into their proper quarters. 

    It's an isolated life, in a way, and a lot of responsibility. There are no farm-sitters, able to take on all fifty head of assorted livestock to give Woginrich a break for a weekend in the city. On the other hand, she has people she buys hay from, a guy who droves over from Vermont to shear her flock, and local butchers for her hogs and chickens. Her neighbors are generous with help and advice, and she's more and more able to reciprocate with help and hospitality of her own. 

    Cold Antler Farm carries a whiff of the excited amateur, in over her head; but on balance, you have to believe in Woginrich's dream, because she's putting in the work every day. And, with company or alone, she makes her own fun. She noodles on the fiddle, practices archery, and slips into a clear, cool pond on the hot summer days. She keeps a couple of horses, who earn their keep helping haul firewood out of the woods. Who knows what she'll try next?

Emailed 10/1/16

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

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

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

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

 

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

Primates of Park Avenue

Primates of Park Avenue: a memoir

Wednesday Martin (Simon and Schuster, 2015)

    What's it like to be a wealthy young wife and mother on the upper East Side of New York? Wednesday Martin's Primates of Park Avenue is not just a memoir, but an anthropological study of a rare and strange way of life. As a child, Martin was fascinated by pioneering anthropologists like Margaret Mead and Jane Goodall. When she grew up and moved to New York, she earned a doctorate in cultural studies and comparative literature. She was well placed to experience, and study, the contrast between the collaborative mothering practices of primitive tribes and the solitary urban mothers around her.

    Those mothers are not merely solitary (armies of nannies notwithstanding), but competitive, verging on cutthroat. The perfect children they are raising require the perfect nannies, tutors, play groups, and schools; the mothers themselves maintain fiendish exercise and makeup routines, and dress to the nines to go out for milk. They also maintain a social hierarchy Martin has to crack, by means that would make a sixth-grader blush: at her son's new school, the other mothers overtly ignore her, and exclude her child from play dates. "It was clear that on the Upper East Side, moms and toddlers had their pecking order worked out and their places set and their dance cards full long before the wee ones were out of their Robeez."

    Why are these women like that? They have everything they could possibly need. (In anthropology-speak, they live in a state of 'extreme ecological release.') They're the richest and least vulnerable people on earth, by most measures. But there is one scarce resource: men. Women of child-bearing age outnumber eligible men by two to one in these precincts, so a woman who lets herself lose status, or look weak, risks getting pushed out of the tree by a younger, more aggressive female. Martin comes close to making us feel sorry for them, or at least see the pathos behind the glossy facade. Keeping up with the neighbors, in a state of self-imposed semi-starvation, is extremely stressful. It's no wonder some women take pills, or become a little too devoted to their afternoon glass of wine.

    Still, the extremity of the circumstances makes the book funny. Witness the observation that very high heels are a declaration that one has a driver at the ready, or the back-of-the-envelope calculation of what it takes to look that good, ("Something like $95,000, on the low end, just to be beautiful enough...") She's not naming names, exactly; the discretion extends to which nursery school she maneuvered her way into, and what her own wealthy, older husband does. But the machinations about acquiring the Birkin bag by Hermes, and worrying about which playgroup can get you into the right kindergarten - if it weren't funny, it would be terrifying.

    Cultural observation often involves the risk of going native, and that's what happened here. It doesn't sound like Martin really minds. "Yes, I found myself wanting smooth blond blond blonder hair, and a Birkin, and a Barbour jacket, and whimsical emerald-green velvet Charlotte Olympia flats with kitten faces on them. And I surrendered." More power to her, say I.

Any Good Books emailed

April, 2016

Moonlight Sonata at the Mayo Clinic

Moonlight Sonata at the Mayo Clinic

Nora Gallagher (Alfred A. Knopf, 2013; paperback, Vintage, 2014)

   Before that day in the fall of 2009, when she was lighting a fire and her vision blurred, Nora Gallagher's map was her Daytimer. She led a stressful life, coping with the deadlines at her day job (editing copy for Patagonia, the outdoor clothing company); keeping up with family obligations; and jetting around the country giving talks about her books. Driven by 'things not yet happened,' she had no time for prayer or relaxation. "I traveled like this to talk about my spiritual life, but the irony was lost on me."

   But she went to the doctor to see what this new blurring was; you really don't want a doctor looking at your eye to say, "Darn." And with that, Gallagher's crowded schedule was yesterday's news. "It was like falling into Oz. I walked right over the border without knowing I was crossing it. It had no border patrol. I did no planning. I had no map." This book is the map she makes as she goes along, as a coastal mariner might, of shoals and lighthouses.

   The first thing that was hard is that no one could say what was wrong with her. She had an eye doctor for a case of uveitis that she'd had for years, but the extreme fatigue and weight loss pointed to something more complex. On general principles, the doctors started her on steroids, and the tests started to multiply; she was treated like "a thing to test, not a person to heal." The nurses who didn't look at her, the residents who scoffed at her questions, and the world famous specialists who didn't accept follow-up appointments, appear in the book by only their initials.

   The other kind, the doctors who listened, are named. They obviously saw her as a person, and cared about her, but no one knew what her trouble was, so she won the golden ticket to the Mayo Clinic, in Rochester, Minnesota, where the whole place might as well be Oz. The Mayo Clinic has figured out some best practices: the local hotels connect to the clinics by tunnels to avoid the winter weather, there are strange and beautiful things to see everywhere you look, and the staff always tells you what to expect. Eventually, they even figured out what was wrong with her.

   She didn't do all this alone. Her husband, Vincent, was right alongside, though on the other side of the glass wall that separates the healthy from the sick. The priest at her Episcopal church, I'm pleased to say, was another good companion, a veteran of waiting rooms. His advice to stop and consider 'what is real now' resonates: "If you stayed in the present, if you paid attention thoroughly to the now, what it had in it might come to you. And if you did not pay attention to the present, you might miss essential information that might be exactly what you needed."

   This kind of openness to the present posed a challenge to her faith. The triumphalism of the Nicene Creed, the Almighty Father, the Mighty Fortress, came to seem ludicrously at odds with the Jesus who made mud with his spit to heal a poor man's sight. "The man Jesus had had quite a lot to say about losing. He was -- now I understand -- preoccupied with loss: lost sheep, lost coins, lost sons. His own lost life." She can still identify with that Jesus, because now she can hear, and tell, the everyday stories of loss, and of having nothing left to lose. "It is a kind of desecration that we made of this man, a crown, a king, a Lord. Jesus is about as far away from a king as a person can be."

   But he's willing to go where people are lost, hurting, and scared. Jesus is a voluntary citizen of Oz. When the losses mount up, as they inevitably will, that's information I want to hold onto. 

 

Email edition, March 1, 2016

When Breath Becomes Air

When Breath Becomes Air

Paul Kalanithi (Random House, 2016)

    Paul Kalanithi was a brilliant young neurosurgeon near the end of his training at Stanford when he learned he had Stage Four lung cancer. His report of crossing the boundary from doctor to patient is the fulfillment of his youthful ambition to become a writer; his death in the spring of 2015 represents not just a loss to his legion of family and friends, but to medical writing, as well.

    It may not be surprising that someone facing death in his thirties should think deeply about the meaning of life, but Dr. Kalanithi seems to have done so from a very young age. The son of first-generation Americans from India, Paul moved with his family into the Arizona desert at the age of ten, where his father established a cardiology practice. His mother, dismayed by the difference in the educational opportunities out West, set out a course of reading, into which young Paul dove avidly. He read Robinson Crusoe and Billy Budd, Brave New World and Hamlet, his wide-ranging curiosity forming his moral imagination.

    At Stanford, he studied biology and neuroscience alongside literature and philosophy, eventually deciding on medical school, which "would allow me a chance to find answers that are not in books, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay." He found that it did so, but also put up some barriers: to dissect a cadaver, you may have to suppress your awareness of its history as a human being. "Seeing the body as matter and mechanism is the flip side to easing the most profound human suffering. By the same token, the most profound human suffering becomes a mere pedagogical tool."

    Becoming a neurosurgeon, studying neuroscience on the side, was the natural outgrowth of his interests, and of his drive to excel. "While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact." He was only a year and half from finishing his residency when backaches, fatigue, and weight loss announced the abrupt shortening of his brilliant career. 

 

    The question of meaning now arose in a more demanding form. He would not have the luxury of spending twenty years in research and teaching, then twenty more as a writer. Should he and his wife try to have a child he would not live to see grow up? His oncologist refused to predict how long he had to live, beyond assuring him that he could complete his residency. Not only was the span of his life unknowable, as he knew very well from the doctor's side of the desk, it depended on what he valued. 'The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out.... Death may be a one-time event, but living with terminal illness is a process."

    Though he must have had a harder and harder time concentrating, Paul Kalanithi kept writing through his first rounds of cancer treatment. He writes about the last day he performed surgery, and the way his life is already described in the past perfect tense: "Most ambitions are either achieved or abandoned; either way, they belong to the past." Early on, he tried to participate in his own care, suggesting lines of testing and arguing about treatment. He shows us the loss, and the relief, of letting that go.

    His wife, Lucy, had to finish the book, describing the family gathering around. As his energy fades, his baby daughter learns to coo and to sit up. They passed each other on earth for only eight months, of which he must have treasured every second. Lucy writes, "He let himself be open and vulnerable, let himself be comforted. Even while terminally ill, Paul was fully alive; despite physical collapse, he remained vigorous, open, full of hope not for an unlikely cure but for days that were full of purpose and meaning." 

 

    In that he succeeded resoundingly, and I am grateful.

Any Good Books – February 2016

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The Faraway Nearby

The Faraway Nearby

Rebecca Solnit (2013, Penguin Books)

   A friend recently described me a nonfiction snob. My inner ten-year-old lawyer rises to object. On the one hand, of course, it's true that I don't like novels as well as essays, history, biography, or memoirs of travel, illness, and grief; but I don't think I regard that taste as anything to feel superior about, any more than liking choral music better than symphonies, or football better than soccer. My excessively literal turn of mind seems like just one of the coves and inlets that make up the coastline of my personality. So I trust that you take all these musings with due allowances.

   The Faraway Nearby, Rebecca Solnit's book of essays, hits all the high spots of the reasons I like non-fiction. It's storytelling based in the real world, seen in lives beginning and ending; in connections across time and space, from Burmese monks to South American lepers to Arctic explorers; in actions as mundane as preserving fruit and as challenging as rafting down the Grand Canyon. They are stories that haven't necessarily ended, yet we can make sense out of how far they have come.

   Some years ago, Solnit had one of those ghastly years: as she watched over the unravelling of her mother's mind in senile dementia, she had her own breast cancer scare, and her boyfriend ended their relationship. By way of recovery and escape, she accepted an opportunity to spend a summer in Iceland, near the Arctic Circle, where she read and contemplated older stories of the frozen North. The environment reminds her of Mary Shelley, who set the framing story of Frankenstein on an ice-bound exploration vessel. In fact, her mother, Mary Wollstonecraft, had also written a book about traveling in Scandinavia – the best stories extend into the past as well as the future.

   Solnit spins tales out of abiding and evolving metaphors. One of these is spinning itself, taking short strands of fiber and turning them, by hand, into a long, continuous strand. Is that not what writing is, and indeed reading? Think of all the myths and fairy tales about spinning: it is a task of perseverance, usually under some compulsion. "Scheherazade forestalls her death by telling a story that is like a thread that cannot be cut; she keeps spinning and spinning, incorporating new fragments, characters, incidents, into her unbroken, unbreakable narrative thread." The strand may serve healing, as did the sutures after Solnit's breast biopsy. It may connect, literally, as in the cognate 'sutra', the word for the thread that bound Buddhist wisdom into books of palm leaves; as well as metaphorically, as in the transmission of Buddhist wisdom itself.

   Having spun a thread, you may take it into a labyrinth, which is not a maze; you can't truly get lost, but you can journey into the unknown, and come back to where you started, changed by the journey. Solnit seeks relief from all the light in Iceland by visiting a labyrinth, a piece of art experienced in the dark like a high-concept fun-house. "It was easy to believe that what was dark was solid, what was light was spaciousness into which you could move, but reality as you bumped into it was often the other way around, with open blackness and hard pale surfaces." This recalls what she said of her mother, even before Alzheimers: "It was as though she travelled by a map of the wrong place, hitting walls, driving into ditches, missing her destination, but never stopping or throwing out the map."

   Like light and dark, heat and cold are more complex than we sometimes imagine. In the far North, "Nothing decays, and so time stops for the dead, if not the living. Cold is stability and warmth can be treacherous." This is a thread that connects the ancient Europeans found intact in glaciers to cryogenically preserved people, and to Snow White. On her retreat in Iceland, Solnit looked into the books of a Danish explorer called Peter Freuchen. He told a story from 1905 about a lethally sudden thaw. A party of Inuit travelers had their sleds, which were made of frozen meat and hide, eaten by their dogs when the temperature rose; they made shelters and ate the dogs, and one woman eventually survived by eating the bodies of her companions as well, including her husband. 

 

   Freuchen recorded the story three times, with varying details; did his memory get better or worse? The survivor, Atagutaluk, went on to marry again, and become a matriarch of her village. Surely her telling of it was altered over time, and different people heard it differently. Solnit says, "Freuchen saw only a corner of the picture. The picture always gets bigger; there is always more to tell; one thread is tangled up with all the others; even when it stops, other threads carry the story onward, beyond the horizon."

   The Faraway Nearby gives us story on story, image on image, laid out in a beautifully labyrinthine structure. Solnit's mother doesn't get better, but she does become happier. "She forgot the stories that fueled her wrath, and when they were gone, everything was different. ...She had achieved something of the state people strive for through spiritual practice: a lack of attachment to the past and future and a wholehearted participation in the present. It had come as part of a catastrophic terminal illness, not a devotional pursuit, but it came."

   What saved Solnit in the darkest times was to face outward, to seek the perspective of oceans, and of centuries. This is advice most grief memoirs could use more of: "To dig deeper into the self, to go underground, is sometimes necessary, but so is the other route of getting out of yourself, into the larger world, into the openness in which you need not clutch your story and your troubles so tightly to your chest."

New Years blessings on all your stories - may they go on and on.

Any Good Books – January 2016