Archive for the ‘US medicine’ Category

Wet Afternoon by Ethel Spowers (1890-1947) — it rained heavily this week, a tornado passed out, the sky went black. Very windy tonight as I write.

Friends and readers,

Perhaps I have too strong or idealistic a notion of what a friend is. In the 18th century a friend as defined throughout the 18th century was someone on your side, not necessarily anyone intimate with you, though as Samuel Johnson used the word late in the century it meant a deep soul mate. This former definition still obtains. When Jim and I had a court case, our lawyer told us to distrust someone as he would not “be a friend of yours.” So that’s a qualification of one aspect of what this blog is about. The lone widow. A familiar trope. At this point, you could save time and skip what I have to say telling yourself what is the use of going into what most skirt acknowledging as inevitable.

Widows are not all alike; there are widows under 50, and over 50; widows with young children and widows with grown children; there are widows embedded in their families, who lived a life with their husband among varied friends; widows like me who stayed with their husband and he with them. Widows without money and widows with; sick widows and widows in good health. Sometimes the husband or partner dies suddenly; sometimes after a long agony; sometimes quickly. This makes a difference. Then different widows live in different cultures, some with a strong sense of community to which individuals belong and some where there is no such thing, and variants in-between; widows who live in frighteningly misogynistic cultures (so they are made into abased servants of family members and physically and emotionally abused), and widows in cultures where even old women are valued (rare this); widows highly educated and widows not; widows with good jobs, and widows with no place to go to do anything that’s needed except maybe make a number in a group activity (for which the leader is paid). Does she live where there is public transportation? shopping? does she drive? have a car?

So I am learning what it is to be a widow like me, age 69, children grown up, one beloved daughter living with me, solvent, in this relatively anonymous area where people are continually moving in and out of neighborhoods (the average for owned house neighborhoods is about 7 years; where I live it’s more like 5 years), has decent (good to mediocre) cultural places to attend, who drives, with a car, with my education (Ph.D.), tastes. Retired. I did know by the end of six months that most of what’s said about grief is invented to make those not grieving feel better about this presence in their midst — if they recognize a widow. It’s falsifying. Aspects of my character are changing, or different parts of my character coming out, true. My feelings changing about a few things. I’m glad to have clocks and radios I can operate; to know about my taxes and hire someone who can cope (he is honest if not helpful beyond doing it, no small thing); to feel more in control (an illusion at the best of times but still): with the help of an IT guy remotely coming into my computer I manage it. I’m lucky my older daughter put me in contact with the company and IT young man. But I’m not unusual here: I’ve met others who have IT help remotely. I can try and do drive longer distances (garmin next to me). I’m ambivalent about the teaching: I love the reading, preparation, am glad to go out, enjoy myself somewhat while leading the class and am grateful when the class members say they are enjoying it, appreciate what I bring, and to talk to a few people after class sometimes, but it is also a strain for me. A lot of work to do two in order to be out enough, to have enough places to go to where I can have some kind of meeting of minds.

I mentioned I am following a Future Learn course in Mental Health and Literature and in the week on heartbreak read this: from Dr Andrew Schuman “– about ‘Broken Heart Syndrome’ or ‘Takotsubo Cardiomyopathy’. In response to extreme emotional stress, the left ventricle of the heart can become paralysed and swell up, mimicking the symptoms of a heart attack. Only medically recognised towards the end of the 20th century, this condition reminds us that the metaphors we use to describe disappointment in love – ‘lovesickness’, ‘heartbreak’ – are rooted in bodily experience.” I first had this experience this past May, and it comes and goes less intensely since.

Gemma Jones as Mrs Dashwood in Austen’s first published novel, Sense and Sensibility: a widow thrown out of her house (1995 S&S, script Emma Thompson, dir. Ang Lee)

It has struck me now that one problem with this Mental Health course is all the terms are men’s — a male set of norms, deriving from Freud and Cognitive Behavior Therapy, is what Jonathan Bate thinks like (he has a poem that literally traces Kubler-Ross’s “five stages of grief”) and what Paula Byrne knows. There was a talk with a woman (Nancy Kelly) who has written a book on depression and runs groups might have been less pollyanna (she didn’t want to tell why she had trauma under the aegis of this program). She would not have been allowed to get away with what she said if the understanding of women’s psychology that Bonaparte uses (out of Gilligan and Lynne Brown) had drawn from that. Byrne provides no alternative to her husband’s point of view People do know that Byrne and Bate are married I assume. the experience of widowhood for a woman is quite different from that of a man (See my paper On the depiction of widows and widowers in the Austen canon.)

But now as the third year sets in I’ve learnt I must live without local companionship, be alone. Not quite since I’ve access to a very good computer and help with it, which I can operate sufficiently. So I have Net-friends, net-conversation, net news, wonderful sites I can reach, movies to watch, courses to join in on, blogs, list-servs, even face-book. Once in a long while meet a long-time friend. Two days ago I met an ex-student who is only 11 years younger than me — 58 — I had not seen him for 20 years. We caught up. He took the all three courses I used to teach at Mason in the 1990s (before most of what I taught was abolished — sophomore level literature): once he went on a trip to Europe and then came to my office with photos he had taken of the places he had gone to as a result of poems we read in class — he followed Byron’s route I recall. Now married, living in Maryland, owns a huge piece of property with small house upon it, has a cat too (!), works at a job that does come from his degree in geography. But long hours and in different shifts every three weeks. Not much time for life outside beyond what’s in his home. He had written to me. I don’t know when or if I’ll see him again. We said maybe summer.

I’ve read in newspapers every once in a while a older widow’s account of herself, writing which classes her sufficiently in my sub-category: I realize a typical kind of person (cold as most are) reading it blame and despise her (indeed one article pointed out to me was by someone who used the ugly word whine) if she complains, which she usually does — why else write? self-expression? about how she’s deserted, avoided by previous friends (especially couples), has made some very bad decisions (e.g., moved from her home to be near a child or just escape — she’s told to wait a year). She tells of really mean and hurtful things said to her, some quite early on. That has happened to me. Two weeks after Jim died I was told my situation was all my fault and if I was miserable for the rest of my life it was my fault. Some widows are told they will remarry within two weeks or so of the husband or partner’s death. I’ve been laughed at. Like How I Learned to Stop Worrying and Love the Bomb, they write to break the taboos of silence, and try to get a little truth about widow’s lives out to others (maybe other widows will feel better). They teach me my case is a common one in modern societies.

I like these lines from a prose-poem as a letter to her deceased husband by Margaret Jordan. “Dear one … ” She says hours pass, and days when she does not think of him. That’s not true for me. I can pass a couple of hours and not think of Jim if I am utterly absorbed writing, reading, watching a movie, teaching, giving a paper. But otherwise he’s at the edge of consciousness. But these apply, especially the mood: I am dialoguing with her and Jim:

I stay up late most nights, and your side of the bed is piled with magazines, Half-read books, pens and paper. I sometimes eat dinner standing at the kitchen counter, or in front of the refrigerator, almost never at our old table. I eat meat …

Jim would not be surprised at my garden: that I now have three patches which just might grow daffodils, crocuses and other flowers. I tried before. I do live in the same house but differently.

I live at the foot of young mountains with deep roots. I live on rock, not along the tidal flux of bay and ocean, no longer in unstable earthquake country.

Now I pay the bills, wash the car, put on snow tires, have the oil changed, deal with a mouse in the pantry, the wasp’s nest under the eaves. I have an electric drill, a toolbox, new neighbors.

No one in my life here knew you

I don’t talk of you to students once in my class (as she does with hers), but I do with our daughters. We remember sometimes. I get the Washington Post — and even read some of it with interest.

I confess that the local library contains no book you would want to read, the paper contains no news, I no longer get the Times. Nothing happens here except small local sorrows and weather that would appall you — below zero sometimes, bitter wind blowing off the mountains.

The whirr and call of migrating geese, the shock of a star-heavy, moonless night sky, familiar scents carried by the wind. This is my life now, that I love, almost as much as I loved-and love-you, passionate, unknowable, and stil; as familiar and as present as my own breath.

What I am learning most now, though, is this: what it is to be a widow (like me in the area of the US where I live) who loved truly, deeply, been with a man closely for half a century who was taken in his mid-sixties by the spread of cancer everywhere. At long last our luck as people with no connections, not much money ran out. His brains couldn’t help him. The establishment and those living under its power do not as yet care enough, are not yet frightened enough to do anything about cancer for real. There is too much money at stake: in polluting the environment, our food and drink, and in these excruciating life-prolonging techniques and drastic surgeries.

So, there is no such thing as building another or new life. I will be alone for the rest of my life — except for the friends and true companionship through letters that happens on the Net. I am too unlike most others I meet locally. And there is no world for me to belong to: I don’t quite fit either OLLIs or academic conferences. I participate in further versions of this mis-fit now on the occasional MOOC. I had a world I made with Jim. We made one we shared together. He was my friend.

No, no second act. Carrying on with the first. Life as time gotten through and local space as having people in it whose whole ambiance I witness, experience (what’s meant by social life). Facing up to silence in my (quiet and comfortable) home, with my memories, books with their lives in them. My daughter in her part of the house. In the morning I do better, am able to cope with a life where I am absorbed by my studies, books, movies, writing; it’s late at night and in the early dawn I feel the desolation most.

Sometimes I think what hurts me worst of all is Jim is not here to see and to know how kind I’m to the cats, what a real relationship I’ve developed with them. The first years he insisted they stay out of my study after as a kitten, Ian destroyed some wires and it took Jim four hours to restore our connection to the Internet. When I retired, I did put a stop to that, but I remember when one day I came home from work and have to dart into the study, and close the door on poor Clarycat and she mewed. He reproached me on her behalf, she had been waiting in a way, she was glad to see me. After that I’ve never closed the door on her again. (Well, hardly ever.)

Clarycat, wriggling on the side of my chair (this week)

Very windy outside my window tonight. I hear the trees bending, soughing air. Sometimes I wish I could sit and cry for hours and hours until I am drained of everything and have nothing left in me. But I don’t. This is how it is with me now.

Miss Drake


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From Danger UXB (one of the great anti-war mini-series)

This is the anniversary of Jim’s dying two years ago. He has lost the ability to speak back as of October 7th and on October 8th he was beginning that terrible ordeal/agon of literally dying.

I feel I’m living through these days for a third time: the first two years ago, as he lay dying; the second last year when somehow I kept the sense of it all at a distance; and now:

On October 3rd this year when Jim would have been 67 I felt how uncanny it is that he is not here, how weird is death in comparison to how we feel about someone’s existence. We have to feel deeply that the person we are attached to has deep reality, and yet they are no more than 98?% water (as I’ve read in different places). I felt haunted the way I had for a time after my father died. Then it was the irretrievably of never being able to make contact again, and I felt such a strong desire to I projected psychologically a presence hiding somewhere, invisible, silent.

It’s not like that for Jim. I have this sense of the unbelievability of existence itself. I can hardly believe I am here concretely if he’s not. I don’t know why I don’t vanish away softly in the night — like one of Lewis Carroll’s mad figures — if he could so vanish.

I’d call such feelings are one of the origins of religious belief. Tonight we would have been married 46 years, met 47 years ago.

I remember Shakespeare’s lines as Prospero: we are such things as dreams are made on, and our little life is rounded by a sleep.

And also that 90th sonnet: Do not drop in for an afterloss … in the onset come; so shall I know the very worst … which compared to loss of thee will not seem so

Jenny Diski’s latest entry as she moves into death is devastating. Her cancer is for now (what a sardonic joke in such words) in remission, for how long (ditto) the doctors can’t say (as they know nothing). Like the heroine in Wit, she is dying in immiseration because of the effect of the treatments on her, her lungs gone, she has (like Hilary Mantel) been made to look awful so that she is alienated from her body. at once feeble, unable to walk steadily and fat. Why should she care say the heartless neat doctors and nurses. She opens with talking of letters she has received; I was almost tempted to write. We learn in this one she has two grandchildren and we know the father of her daughter, once her partner-husband died a couple of years ago. So her daughter parentless.

People have asked me (well one person) what is gained by telling of Doris and me, well the same thing that is gained by her telling of these dreadful symptoms, her pain, her feebleness, how others will not help except for the Poet. Insofar as you can stop people from mouthing nonsense about triumphs, conquests, and bravery and instead tell what cancer is, you help a little in the pressure to do fundamental research. The research that is done is expensive surgery to prolong life and pills that cost huge sums — all garnering profit. What they discover fundamentally is a bye-product and not much sought. The TTP was signed yesterday: a key provision fought over was the US on behalf of the pharmaceuticals (like the fascist gov’t it is) to give them the right to charge outrageously for 5-8 years; 12 was what was wanted and the “balance” is it’s just 6-8 and uncountable thousands excluded because of the price at least until then.

I omit all the provisions which supercede workers’ rights and hand a good deal of the world over to corporations (with military backing) to exploit and immiserate everyone who is not in the elite genuinely rich and well connected.

Cancer is our great and ever spreading plague — like the engineered (in effect) famines and mass diseases of early times — India, Ireland. Settler colonialism now exterminating the Palestinians a little at a time — punctuated by the terror of lethal bombing.

Diski speaks for us all — she says don’t talk about bravery so instead I’ll say she writes what she does because she cannot help herself and thinks truth has a function in the world that helps others– if only by saying see here I am, is this the way you are? if so, we are not alone.

Diski (before cancer)

She does say it’s hard not to feel what’s happening to her is a punishment — like it’s hard not to feel the death and disappearance of someone is uncanny. But what it’s vital to remember is not to take what happens ever as a punishment. That is your psyche doubling in on itself and wanting to find some reason, some ultimate meaning for what is happening. For me not comfort, but that way madness lies.

Miss Drake

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Dear friends and readers,

Hartnett says a strange thing: in the last part of my life, ghost accumulate. Since 1989, I have lived with one quiescent, and now I live with a second as part of my heart’s blood.

A poem by David Hartnett

In the Winter Valley

At dusk in the winter valley the train went slow;
The carriage felt empty enough for apparitions,
His parents’ perhaps who died a year ago-
    Nothing happened.
On either side of the railway, ranked and stiff,
Espaliered pears paraded, frozen snow
Clotting their tiered branches. Down a far cliff
    Cascades curtained.
In the second half of life there are no ghosts,
The world is vast and tired and someone else’s.
Coldly the pear trees bloomed on their black posts.
    The train quickened.

near Sian

These flowers for the nine African-American families and friends who lost a beloved — and who are not by any means all who have been affected forevermore by social murder this week.

Reddish Table and Window (1999) — (Gloria Munoz, b. 1949)

As I traveled to and fro I listened to Simon Slater’s wonderful reading of Wolf Hall (he goes tenaciously into the mind of anyone listening for real): as with Hilary Mantel’s other novels she presents centrally a character deeply grief-stricken at the death of someone cared for: Thomas Cromwell; he loses wife, daughters, Wolsey. Again and again the experience is presented as a ghost or ghostly presence come to be with Cromwell – in his dreams, as he stands in shadows and cries, passing memories other characters arouse. In her Black Book this is very strong, but it’s equally present in Thomas Cromwell’s mind: sometimes he’s comforted, sometimes the anguish is too sharp.

This is an aspect of her fiction which has been ignored in the talk about her books as well as the film adaptation; in her Black Book, in her memoir she fought to “give up her ghosts,” in her historical fiction she allows such memories to be guiding spirits of the central presence. She shows how the living left — her hero — becomes another person over time and experience as the dead intertwine inside, memories make them behave certain ways and they find solace, other people to connect to, be with all in this continuum.

Cat circa 1904-8 Gwen John 1876-1939 Purchased 1940 http://www.tate.org.uk/art/work/N05154
Gwen John (1876-1939), remembering her beloved cat-companion, Edgar Quintet

I am glad for GLBT people who can marry who they love now. See my The US Supreme Court did three good things this week!

Scotus blog: same-sex marriage

On preventing discrimination that is hard to prove: disparate impact;

On Obamacare: keeping the benefits available to millions of health care insurance (such as the system is, it’s the system we must change to a single payer like medicare)


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John Nash, Garden under Snow (1924)

Talk of all eternity?

    I think it sounds too vast
And overwhelming just for you and me,
    Two pagan lovers; we should be aghast
And shiver at its cold immensity
I’d rather be
    Back in our little past —
Transient, perhaps, but we
    Found it sweet …
     — Jan Anstruther (Mrs Miniver)

Dear friends and readers,

A new turn. I have an inexorable conflict on Mondays starting next week: I begin teaching my planned course, The Poldark Novels in Context at 1 pm. I hope also to go to the JCC for Dance Fusion at 8:30 to 9:45 am. Charlie’s one day at the Haven is Monday. So our at first weekly, then twice a month and now monthly meeting must come to an end. We exchanged email addresses a couple of months ago and will keep in contact this way, and at the end of 10 weeks the course will be over. But it’s almost a symbol. My neighbor who lives across the street and is a widow like me, her husband in his sixties a victim of this cancer plague (he died of pancreatic cancer) told me she feels like her past and future have been taken from her. Like so many people in the US she and he moved around a lot, they could make few ties except the ones she had originally as a girl and young woman in Germany, so her past was shared with him, and now he’s gone; the future they planned was for them together. He died 5 years ago. I’ve an idea like other widows she tells no one of this — but me or perhaps another sympathetic friend who can understand. Few want to acknowledge the widow’s reality (or the older divorcee).

I talked of this with Charlie. I feel my past has not been taken from me because Jim and I had such a rich intellectual life together and I carry it within me; I put out onto blogs all I remember of him; I am surrounded by the things we bought and made together. I can though see why my neighbor said what she did about her future. I have a much much diminished future. Money and troubled effort assembled a team to replace practical things Jim used to do. Mrs Thatcher was wrong: there is such a thing as society. Much I used to do is no longer fun, much I did was from his planning, his know-how, his driving. We would have gone to London for Trollope’s birthday and I would have, with him, tried to join in on Trollope Society events. He probably would have been planning this for months, and bought tickets for us to go to theater or other places too. Now none of this will occur. Ironically the activities I have available to me are the ones that kept me from him for a good deal of the time: time here on the Net with others; my reading, writing, watching movies. For me to go to LA in March is hard enough, and there’s the cost. Each day I make a small plan and follow it. I am doing things I would never have done had he lived — like teaching in these OLLIs. I need to go out and be with people, but doing this precludes say trying to write a book (not that I am keen on that any more at all) or say a series of essays for periodicals (I must be mad to go back to that); it’s more than the teaching itself is problematic for me. Charlie and I talked of how hard it is to make new friends at this age. A few friends I had thought would become closer moved off very quickly (months ago); a few (Net-friends) stayed; I now have two local friends I have met with for lunch, gone to a movie with, walk, but for the most part my life is that of a lone person with her books, films, cats and a few Net-friends.

Charlie and I will still keep in touch by email, if desired by phone, we can try to meet during the week on another day, and I can come again when the ten weeks are over.

Last week during one of the sieges of snow where everything was closed and the temperatures cause my skin to burn, not to omit black frozen ice-and-snow on roads, Charlie sent me the following sweet YouTube about a cat house, very cheering:

The cats make the house feel alive. I am become closer to my cats than ever. I feel they are there with me, and am alive to their ways of communicating with me. Ian, the boy, likes to keep two of his toys (a string toy, and a flat blue stuffed sock) in the back bathroom and will not tolerate my making the bathroom rugs neat. That is his spot to wrestle. He used to spend his morning under Jim and my bed; since Jim died he began to spend it amid Yvette’s shoes, in the back of her closet; now he lies down on the front living room couch with occasional trips to the grate. He has arrived chez lui . He is larger than Clarycat, and manifests a kangaroo-like spurt (from the back it looks so awkward) when he trots, ambles, hops, runs, skids, dances, plays with string, springs up to the heights of bookcases and tables about the house, watching and waiting for one of us to come home, sometimes jumps on poor Clarycat demanding play and wrestling with her …. she takes a bit, doesn’t mind when he licks her and will playbite back, but then growls (she’s had enough) and gets out from under. She’s doesn’t quite look kangaroo-like from behind because she’s slenderer … She spends her days near me, is right now clutched tight on my lap.


Julianne Moore won an Oscar for Best Actress for Still Alice, a movie which puts before the viewer a woman left alone whose illness takes from her her future, and her past. One of the friends I mentioned went with me to see it. She lives alone, aged nearly 60, and fears what will happen to her. She cried intensely twice as she watched. Unexpectedly I didn’t cry but I certainly saw this movie and the novel it’s based are about more than Alzheimer’s.

Julianne Moore as a woman with early on-set Alzheimer’s

It is an unusually close and truthful depiction of deterioration. Yes she’s upper middle class, privileged, and has great doctors, but the film shows us that families are not this loving panacea. We see how Alice’s deterioration brings out real conflicts, and towards the end her husband goes off to another city because he’s still young and wants to further his career, and she gets in the way. He doesn’t exactly leave her, as one of her daughters comes to live with her. The curtain is brought down before the harrowing end which is pictured half-way through when Alice, still well enough, goes to visit a nursing home where elderly people who have lost their ability to take care of themselves are put. Julianne Moore’s performance was utterly believable.

It appears to be leaving the movie-houses soon (on hardly any screens, only twice a day, small auditoriums, small audiences in them), so this is a recommendation to hurry out. It is directed and written by the same two people — a good sign for the screenplay and independently produced — or you’d not have the ending it has. In comparison, The Theory of Everything was about Hawking’s wife’s romance and skidded along a distanced untenuous upbeat surface (some improbabilities stared you in the face). That The Imitation Game and Birdman won for screenplays show just how little any certain criteria are used for films.

I am following a Future Learn course on film-making (from Exeter this one), and the weeks are wildly disparate in quality. Two have been superb, and two awful — it seems the people making movies, have no idea how to judge the material they present; they take this supposed practical approach. It is pretended the people following are going to make movies, the way many many books on screenplays are based on the idea the reader is going to try to write a screenplay. I now see why: many of these people don’t have an intellectual understanding of what they are doing; they can understand how a camera works and what angles they could to produce certain effects. Often the actors understand more of their art as an art and its value than anyone else — I see this during interviews. Film studies scholars have little respect outside of their own circles; these movie-making people accept popular critics as a form of advertisement; when the critics are intelligent their work crosses over and is used by film scholars.

As to the Oscars ceremony, the whole thing now that I have paid some attention to it for the last two years (when Jim was alive he never did nor did I), most of it is absurd, from the attention paid to what the actresses wear, to gossip about the show. This year the talk about it included talk about the politics of some of the movies and speeches. These appeared to do no good if you look at who won the prizes for the most part (an exception to this is CitizenFour for best documentary, not that it was anywhere near as good as Laura Poitras’s first film). I gather at the core of all admiration this is envy — especially for the “after Oscars party.” People want to be included and inside exclusive coteries.


Joan Rivers (undated)

I was surprised that I didn’t cry at Still Alice because I’ve been crying more easily. Indeed I worry a little about this as if I’m in public people will become uncomfortable if suddenly tears run down my face. Jim’s permanent absence, his non-existence are more real to me than ever — even if I have him in memories, artefacts, my daughters, the very way of quiet comfortable enough life his years of work with mine make possible to me. I should not be surprised at the denial of the reality of widows and widowers’ feelings by most people who have not experienced this loss, and how many who have are afraid to speak of it lest they offend or lose whatever connections or friends they have. It is not even that surprising to me anymore that books about widowhood end with an upbeat idea of the building a new life that genuinely replaces the old so the person no longer misses the old. I have experienced myself how very hard it is to get anyone to publish life-writing which does not end with an upbeat moral, an exemplary typology that the reader can gain (false often) hope from. It may be that were I to read the more academic writing on grief I would find that Kubler-Ross’s cant was recognized as such; through the thicket of jargon and distanced intimidating writing there might be a genuine engagement with human emotion at the loss of a beloved life partner. Here and there over this past two years I have seen poems acknowledge it, a couple of novels, a couple of memoirs. I’ve recorded these in this blog.

When Joan Rivers was widowed from the most painful kind of death, a spouse’s suicide, she quipped: “she scattered his ashes at Neiman Marcus, so she could visit 5 times a week …. ” There’s an insightful informative essay on her in this week’s New Yorker by Emily Nussbaum. Nussbaum sees Rivers as surviving by consciously buying into all the most outrageous norms of our society, the anti-feminist ones too. So at the Oscars she went around saying “Who are you wearing tonight?” Nussbaum sees her act as reinforcing what hurts many women badly; myself I never heard some of the attacks on other women Nussbaum cites or alludes to. I found her jokes genuinely funny: when a man wants anal intercourse, this gives you the chance to read or do some paper work, so don’t knock it. And you won’t get pregnant this way either. My blog-review of Rivers’s movie, A Piece of Work has been most of the most read (reblogged) and popular pieces I’ve ever written; there I see her as “activating her anger, sublimating it and reaching others where they live. And the way she confronts our cultural hypocrisies defies them and through her act, she mocks our false norms.:

Note on the table in the photo beside her all those pills. She is very young and vulnerable — this looks like her face before surgery. She lasted until 82 when she died at the hands of doctors in a hospital during an operation that should not have killed her. She was probably not expecting this, given all the operations she had voluntarily undergone.

Caroline gave her cat, Mitzi, a necessary operation, to remove cysts from one of her paws. Both her legs were shaved, the one with the cysts and one for an IV. The poor creature did not understand what was being done to her, was terrified probably, felt pain, and at first looked exhausted and in need of much affection and reassurance. After a couple of days, she perked up, and managed to get her neck cone off. After it was put back, she looks longing out the window (where it’s still freezing cold) because she is a cat who likes to go outdoors — basically to a small fenced-in garden at the back of Caroline’s house. The latest photo suggests recovery on the way. Her life is saved again (she is 14 and was in effect a rescue cat) and she can carry on too. What else is there?

Call this Mitzi gets all better:

Mitzi when well — Empress before the operation

Mitzi convalescing at home (Jim denied cancer patients were allowed to convalesce at Kaiser)

Mitzi perking up; observing the snow and freezing rain?

Mitzi recovering


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From Frederick Wiseman’s Near Death

Dear friends and readers,

In a NYRB review (Jan 8, 2015, 72:1), A Better Way Out, Marcia Angell with a few important qualifications heaps praise on Atul Gawande’s latest book on how medicine treats aging and dying, how people sickness, aging, death because of modern medicine’ goals, training, politics: Being Mortal: Medicine and What Matters. I’ve discussed Gawande before (see Realities of Medicine: how misunderstood), and Marcia Angell’s writing several times (see her on privatizing all aspects of medicine) and this review seems to be publicly on-line, available to the public. So let me just call attention just to a central section of the book and one of its silences.

In the book’s “most powerful chapter,” “Letting Go,” Angell reviews the book so as to bring out Gawande’s theme about the deeply inhumane and dishonest way cancer is treated by modern physicians and hospital staffs (and I’d add hospices too). Knowing how bleak an outlook, doctors lie and offer painful maiming operations and immiserating chemotherapies and radiations whose outcome they cannot predict. They make the last months or year of a person’s life an experience of toxic suffering, giving them (as I know too well) no opportunity to decide to enjoy what they can of their last months. She does not mention that if you refuse the doctor’s treatments, they tell you to go away; they will not provide half-way or palliative care to enable you to carry on in your own way. It’s all or nothing. It’s also highly exploitative. A multi-million edifice for its practitioners and drug companies. A friend told me recently about The Confessions of a Surgeon by Paul Ruggieri where he exposes the pressure put on doctors to recommend operations in order to make huge sums for hospitals (a brief inadequate review). Statistics quoted include physicians on average telling terminally ill patients they will live 5 times longer than they do; those who can find a palliative specialist and stop chemotherapy very early, having no operation, live about 25 per cent longer than those who submit to these treatments.

Do read Angell’s essay. Everything she writes is worth reading and thinking about.

She faults him in two areas: the first is money. He hardly ever discusses money in his writing: yes there are a couple of essays where he discusses money and the way medicine is delivered generally, and advocates moving gradually to a single-payer system, but since what drives each and every encounter between patient and medical person is a fee (and often hefty) this kind of general discussion doesn’t begin to get near the problems (see Money-Driven Medicine). Worse he gives a superficial and prejudiced account of physician-assisted dying: he is against it — he is strongly for high-tech solutions when he thinks they provide a “good outcome;” she points out there is no evidence in any of the US or European states where such practices have begun that assisted dying is resorted to unless the patient decides for it. That Gawande calls this resort a measure of failure shows how somewhere deep in himself he has not accepted the inferences of his own arguments; he may know enough not to use the metaphors of bravery and courage, and heroism (which should have no place in discussions of killing and therefore painful diseases) but he thinks of the decision to die rather than live through a hideous self-destruction unacceptable. Why? when he himself has said it’s not a question of life once it’s most cancers: life’s not on offer, occasionally it is a question of prolonging life (and this is where patients get sucked in, especially when young); for most it quickly enough becomes how and when and where the person dies.

That latter was Jim’s phrase when at first he wanted to do nothing. I couldn’t face his death, and I should have and proposed we go on a trip, and he try to have the best last few months he could. And then he couldn’t face it either.

Endings matter, for animals too.

A sick kitten being cared for


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Dear friends and readers,

I regret to report that the cancer epidemic has reached Jenny Diski. In a determinedly comic column Diski announced she had been diagnosed as having a form of inoperable cancer which features cancer traveling into your lypmph nodes and (“very bad” she writes) into the esophagus. Statistically she is told she has 2-3 years before she dies: in the case of cancer you ignore statistics at your peril: I ignored the 40% of all people diagnosed with esophageal cancer dead within a year, and we went ahead with a horribly mutilating operation (if in doubt remove it) for him, which when the cancer metastasized only made him die quicker and suffer much more. I hoped he’d be in the 60%.

She writes:

One thing I state as soon as we’re out of the door: ‘Under no circumstances is anyone to say that I lost a battle with cancer. Or that I bore it bravely. I am not fighting, losing, winning or bearing.’ I will not personify the cancer cells inside me in any form. I reject all metaphors of attack or enmity in the midst, and will have nothing whatever to do with any notion of desert, punishment, fairness or unfairness, or any kind of moral causality. But I sense that I can’t avoid the cancer clichés simply by rejecting them.

Jim too thought this kind of language ridiculous but eventually was driven to say the physicians had intended to battle the cancer in his body. All they did was ruin his body.

She jokes:

So – we’d better get cooking the meth,’ I said to the Poet, sitting to one side and slightly behind me. The Poet with an effort got his face to work and responded properly. ‘This time we quit while the going’s good.’ The doctor and nurse were blank. When we got home the Poet said he supposed they didn’t watch much US TV drama.

I hope she does keep a cancer diary in public; from my reading of so many of her essays (whenever I come across one, I read it, pronta), she will be perceptive and wise. Her book might tell of the hurt, the pain and lies, will be another voice calling attention to the crying need for fundamental research.

People in the world writing, reportage, and in colleges need to know that this epidemic is killing out of all proportion old, middle-aged and now young, rare cancers no longer rare.

Just now I’m reading Diski’s Skating to Antartica, which is lending me courage to go on the trips I’ve planned this fall. I realize I should read her Stranger on a Train. As a regular essayist she’s in a league with Hilary Mantel, Lorna Sage, Margaret Atwood, Diane Johnson, Anita Brookner; among men, Richard Holmes, Richard Davenport-Hines.

Poor woman. Cooking did distract Walter White and that “lost waif,” Jesse Pinkman.


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The piano a couple of weeks ago

Dear friends and readers,

I took that photo of my spinet piano a couple of weeks ago when Yvette had left a composition book on it. She had devised a song, sung it and somehow took a photo and recorded herself so as to put a video of herself singing on her blog. I wrote of this more than two weeks ago and how I was planning to begin piano lessons for myself. I finally did this week, one hour with a woman named Julie. We wrote out clefts, notes, begin playing on her Steinway grand piano. The sounds coming from the teacher’s piano were lovely — harmonious, bright like a bell. Full with an echo when you left your finger on a key. I like calm rhythms. As I said on facebook when I began to play I cried because I wished I could be happy while playing these. I felt I ought to be. I remember I wrote shortly after Jim’s death I felt I was living in a house which had lost one of its four walls. Now I understand the meaning of Haushofen’s Wall better: she said it was about how this transparent wall was between her and the rest of the world: Lessing said of the book it could have been written only by a woman. Maybe it’s good then that my spinet has a much tinnier, thinner sound. I don’t have to feel I’m can’t reach something I was surprised to feel I wanted.

I want the lessons for myself too: when I was 12 I asked for piano lessons, but my parents would not buy me a piano. My father insisted I learn guitar; he had some vicarious dream of me playing guitar to others at parties. How little he had to have imagined me for real to dream such a thing. But it was an old guitar; one he had picked up somewhere so I was ashamed of it. Nonetheless I took weekly lessons for three years. Looking back I realize that I was discouraged from the start, told I had no ear, or would not be very good at it by the teacher. Why I persisted I don’t know. I know why I quit but that belongs to a rape story. Suffice to say here I quit so as not to have to take a long walk past a big park by myself. Not that the teacher regretted my absence, though once I remember him worrying about me one day when I looked in some distress, and offering to phone my parents. Well now I’ve no one to tell me I will never play well. Not that I expect much more than simply learning to play songs and make music.

I looked diligently to see if I could find a photo of Jim playing, but I never seem to have taken one of him doing this. There’s only one of me one Christmas (2005) sitting next to the piano as it used to look with his books piled on the top for when he wanted to play anything. Why would I have taken such a photo? He didn’t play to show off to others; I didn’t expect I would have to remember him playing.

Julie’s a cancer widow too; she’s about 76 — 4 years ago her husband died age 72 of a horrible lung cancer metastasized: it had taken 2 years. The first time I met her (last week for an introductory brief time) she said by the end his death was a relief. She said she was “fine” now; this time she said as how when she used to look at a kind of flower he liked and they would drive by, she would cry but now when she drives by, she rejoices to remember he loved it. Her smile when she said this was slightly frozen; such a statement is of course a sign of madness.

This is a very sad weekend for me. Last year after several days of feeling bad (and going to one of several godawful oncologists at Kaiser who pronounced him as looking “really great,’ like all of them hardly paying any attention for real), and then telling me he could not drive to Caroline’s wedding, on August 3rd he awoke early and said in a kind of deep panicked voice, “something is very wrong.” A strange very bad pain; we rushed to the 24/7 Tysons Corner medical facility and by 12 the tests were done. It was some time after that a much better doctor sat down in that cubbyspace with us and pronounced two words quickly and softly, “liver mets.”

I had no idea what she meant. I felt bewildered. Later that afternoon when we were home and I looked about metastasis and then liver, did I realize the gravity of what had been said. Jim was not up to going to Caroline’s wedding that day; the reform rabbi who was performing the ceremony brought a computer person with her and they set up something which permitted Jim to watch the ceremony from home with Clarycat on his lap and to be seen by everyone at the wedding doing so. I think he heard it too. Still I did not understand this was a death sentence at first nor how soon death would come. I kept using the word probably for a week or so. Maybe it was when the doctor dismissed us to a hospice — how Jim hated them when he still had some strength, tried to throw them out, showed what scorn he could for the first woman’s phony spiel. He looked upon me as deluded by them; if I was at first (as I am a little slow this way), within 2 weeks I saw what most of them were.

I did eventually get a decent nurse (an ex-doctor from the Philippines who answered my questions instead of telling me what a good question that is and avoiding any answer lest they compromise their position with anyone, risk anything) twice a week, and it was due to him that the last four days we did have a round-the-clock second decent nurse. Once near the end they exasperated him to the point he removed a rubber sheet they had forced on him and he laughed to find this kind of emotion could still stir him.

It was a terrible two weeks last August, filled with pain for him: he was also pretending to be more delusional than he was to avoid talking to me. I just keened on and off. August 3rd is in some ways far worse for me than October 9th (the night he actually died). All hope died. Hope gone. It was the end of the life we had lived. He had used the metaphor of a wall too. When we still hoped he was going to recover for a while, live yet for a couple of or even few years, he’d say he was on the other side of a wall where cancer patients dwelt. That no one who had not had cancer could know what it was to experience it. No matter how I empathized I was on the other side — I felt that was not quite so, since the world had gone grey for me. I’d see as in a distance farmer’s markets with people buying food and crafts cheerfully. The brightness on the other side of a wall.

Polser’s film of The Wall

A musical weekend: Yvette plays and sings weekend mornings and I began practicing twice a day for 15 minutes. I bought a metronome. Furniture polish to make the instrument look better. We also ventured forth for the first time in two years to Wolf Trap: to hear a favorite folk-rock singer, Mary Chapin Carpenter, sing with the National Symphony Orchestra (and her own band intermingled with them). What a journey — and a hugely crowded set of parking lots. It’s not a trivial trip, and without Vivian it would have been much harder to get there and taken much longer getting home. The National Symphony Orchestra made such beautiful sounds — especially the exquisite opener, Yvette and I considered getting a subscription. Vivian said the first piece of music was the best. Yvette called it a wonderful night of music, only the orchestra out-performed her. We will keep an eye out for concerts we might like and go to the Kennedy Center on the occasional Sunday. Carpenter’s voice in real physical life is a deep harmonious melancholy mezzo soprano too — she was singing a new kind of song for her, more emotional, “Songs for a Movie” a new album. I did miss her rousing, raucous ones but they wouldn’t go with that orchestra. The evening was cool, the sky pretty — until it began to rain after we were driving home.

I like music. Thus far the class I genuinely enjoy at the JCCNV is the dance fusion workshop. This week I went once to waterarobics and the instructor had a tape of disco music. There is one jolly woman who doesn’t bother follow the instructor and she was water-dancing the whole hour.

A friend told me about Stephen Grosz’s Examined Lives, a book partly about grief. He writes about popular beliefs, saying that death and grief are quite distinct. (So Kubler-Ross is a codification of the social lies I outlined the other day. I remember when Jim was still thinking he might recover him ironically going over the stages, telling me where we were in this scheme of things.) She wrote: “With death there is closure – the person dies. Grief is different – there is no such closure, only a gradual lessening of the pain over time.” Perhaps accurate words wanted are bereft and gradual numbing. But I am not numb.


The man I hired to see my lawn mowed each week has obligingly grassed over both little plots I made for Jim and I to have flowers in for our retirement years together. All that is left is the circle around the maple tree. It’s so small even I can weed it, but if there are no daffodils after this year, that will be fine.

I thought of Emily Bronte’s Remembrance with its opener, “Cold in the earth,” and read it and it helped to reconcile myself to Jim’s having been cremated (though never fully) — at least I don’t have to dream of him cold in the earth. But Marina Tsvetaeva’s stanzas as translated by Elaine Feinstein are more appropriate to a world where missiles drop bombs on sleeping people who had the temerity to want to eat more:


Tonight — I am alone in the night,
a homeless and sleepless nun!
Tonight I hold all the keys to this
the only capital city
and lack of sleep guides me on my path.
You are so lovely, my dusky Kremlin!
Tonight I put my lips to the breast
of the whole round and warring earth.
Now I feel hair — like fur — standing on end:
the stifling wind blows straight into my soul.
Tonight I feel compassion for everyone,
those who are pitied, along with those who
    are kissed.


Who sleeps at night? no one is sleeping
In the cradle a child is screaming
An old man sits over his death, and anyone
young enough talks to his love, breathes
into her lips, looks into her eyes

Once asleep — who knows if we’ll wake again?
We have time, we have time, we have time
    to sleep!
From house to house the sharp-eyed
watchman goes with his pink lantern
and over the pillow scatters the rattle
of his loud clapper, rumbling.

Don’t sleep! Be firm! Listen, the alternative
is — everlasting sleep, Your — everlasting house!

Here’s another window
with more sleepless people!
Perhaps — drinking wine or
Perhaps only sitting,
or maybe two lovers are
unable to part hands,
Every house has
a window like this _
A window at night: cries
Who sleeps at night? No one is sleeping.
In the cradle a child is screaming.
An old man sits over his death, and anyone
of meeting or leaving.
Perhaps — there are many lights,
perhaps — only three candles.
But there is no peace in
my mind anywhere, for
in my house also, these
things are beginning:

Pray for the wakeful house,
friend, and the lit window.


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