EVERYTHING HAPPENS FOR A REASON: AND OTHER LIES I'VE LOVED, by Kate Bowler

I asked Google to find the cover of the book I'm about to praise. "Everything happens for a reason," I typed, and clicked "images." Instead of the cover, I got a pageful of annoyingly pious memes and posters--and this perfectly wonderful empathy card,

which you can order here.

I've never met Kate Bowler, but I heard Terry Gross interview her on "Fresh Air" (which is why I read her book), and I'm pretty sure she would love the card. 

Bowler, who teaches at Duke Divinity School, is the author of Blessed: A History of the American Prosperity Gospel (Oxford, 2013). The prosperity gospel is attractive: God wants you to be healthy and wealthy! And so if you trust God enough, and get rid of the sins that hold you back, and think positively, and (often) donate money to some ministry, God will make you prosper!

Except when he doesn't. Suppose, for example, that, like Bowler, you contract a mysterious neurological impairment that baffles doctors and keeps you from using your hands. Suppose you lose a much-wanted child to miscarriage. Suppose you discover at age 35 that you have stage 4 colon cancer.

Is your suffering your fault? Did you not trust enough, give enough, repent enough? Is God trying to teach you something? Is he using you to teach someone else?

No, says Bowler. These things happen because we're human.

Read this book if you've ever wondered why people suffer--or if you think you already know the reason.

Read it if you've ever wondered what to say to somebody whose has had a sobering diagnosis, or who has lost a loved one, or who is going through some other painful crisis. 

Read it, too, if you've ever wondered what not to say. The two Appendixes alone are worth the price of the book: "Absolutely never say this to people experiencing terrible times: a short list" and "Give this a go, see how it works: a short list."

Read it if you appreciate memoirs that are introspective but not self-absorbed, wise but not preachy, ironic but not unkind, often hilarious but never, ever chirpy.

And read it if you like good writing about what it means to be human that will make you laugh as well as cry.

I went back to Google and asked for "Kate Bowler, Everything Happens for a Reason." Here's what the cover looks like. I hope you read the book.

THE BRIGHT HOUR by Nina Riggs

Ancient Egyptians brought skeletons to their feasts, exhorting guests to drink and make merry while they still could. American Puritans in the 17th century kept skulls as warnings to sober up and focus on the afterlife. Memento mori, the gruesome reminders were called: remember that you must die. People died suddenly, and young. They wanted to be prepared. 

Nina Riggs did not feel prepared when she learned that a small spot in her breast was malignant. Cancer ran in her family: it had taken three grandparents and several aunts, and her mother was in treatment for multiple myeloma. But Riggs was only 37. Her sons, Freddy and Benny, were eight and five; she was not ready to leave them. Merrymaking had its place, but it didn’t address her concerns. And the afterlife, if it existed, was unknowable.

That's how my review of Riggs's The Bright Hour: A Memoir of Living and Dying begins. It's in the Fall Books issue of The Christian Century, and you can read the rest here for a few more days. After that, the magazine will likely put the review behind a firewall that can be breached only by paid subscribers.

It's a short review; you have time to click and read. Seize the day. Enjoy the now. That's what Riggs advises. In the words of her great-great-great-grandfather Ralph Waldo Emerson, she wanted to be "cheered with the moist, warm glittering, budding and melodious hour that takes down the narrow walls of my soul and extends its pulsation and life to the very horizon. That is morning; to cease for a bright hour to be a prisoner of this sickly body and to become as large as the World."

Reviewers don't always like the books they describe, but I loved this one.

Killing people is hard to do

[Moose's last photo]

Twelve years ago we took our beloved Maltese dog, Moose, to the vet and came home without him. Moose was in the late stages of congestive heart failure, and many times each day he was wheezing and crying out in pain. While my daughter held the little dog, the vet gave him a shot. It was over very quickly.

Why don't we treat death row prisoners at least as well as we treat dogs?

"Secret Drugs, Agonizing Deaths" is the headline on an article in yesterday's New York Times. Back when executioners wielded axes, they tended to wear hoods so people wouldn't recognize them. Nowadays states still conceal executioners' identities - and much more. "In the past year, Georgia, Missouri, Tennessee and other states have expanded the reach of their secrecy laws to include not just the execution drugs used, but even the pharmacies that supply them. These laws," say the authors of the article, "hide the information necessary to determine if the drugs will work as intended and cause death in a humane manner."

Too often they don't.

European drug manufacturers, opposed to capital punishment, have stopped producing the drugs that once killed American prisoners quickly and painlessly (read about it here and here). Americans have tried a number of substitutes, causing a lot of pain in the process.

The problem isn't that it's hard to kill someone without inflicting pain. Our vet could do it. 

But of course he wouldn't. And most of the world's drug manufacturers wouldn't. And of those who would - some American lawmakers, some American prison officials, some American executioners - few want the details made public.

The problem is that killing a fellow human being, even one who has incontrovertibly committed heinous crimes, is  a disgusting business. Even for people who favor capital punishment.

In his newest book, A Call to Action: Women, Religion, Violence, and Power,  President Jimmy Carter points out that "the United States is the only country in NATO or North America that still executes its citizens, and Belarus and Suriname are the only exceptions in Europe and South America."

Maybe our aversion to knowing the details about capital punishment is a first step toward joining the rest of the world with a more humane policy. Maybe instead of closing our eyes to what we are doing, we should open our eyes wide - and then stop doing it. If we are too humane to ask veterinarians to kill prisoners painlessly, let's be too humane to kill them at all.

Life in prison is punishment enough. And though it's expensive, it's not nearly as expensive as execution. As Fox News has pointed out, "Every time a killer is sentenced to die, a school closes."

KNOCKING ON HEAVEN'S DOOR by Katy Butler

On an autumn day in 2007, while I was visiting from California, my mother made a request I both dreaded and longed to fulfill. She'd just poured me a cup of tea from her Japanese teapot shaped like a little pumpkin; beyond the kitchen window, two cardinals splashed in her birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. She put a hand on my arm. "Please help me get your father's pacemaker turned off," she said. I met her eyes, and my heart knocked.

That's the first paragraph of Knocking on Heaven's Door, Katy Butler's memoir about caring for her parents in their declining years. If you have ever taken care of a demented or dying loved one, or if you know somebody who has done so, you should read this book. If your paycheck comes from the healthcare sector (now 18% of the U.S. economy), or if you find that even the reduced insurance rates under Obamacare are too high for your budget, you really should read this book. Like all good memoirs, it's about so much more than one person's experience.

Jeffrey Butler, a retired Wesleyan University professor of history, had dodged death several times--as a teenager, when he arrived seconds too late to jump into a car carrying several of his friends to a fatal crash; as a young soldier in Italy during World War II, when he nearly bled to death after a German shell blew off his left arm; and again in his late 70s, when a sudden stroke left him helpless.

His wife, née Valerie de la Harpe, was also a survivor. In her forties, she discovered a walnut-sized lump in her left breast. It turned out to be malignant, and her subsequent radical mastectomy--which removed not only the breast but also much of the chest wall and four cancerous lymph nodes--revealed the possibility of further metastasis. After enduring six months of radiation treatments, she chose to have her right breast removed as well. Her cancer did not recur.

Katy, their daughter, was no stranger to loss either. For much of her life she had an on-again-off-again relationship with her challenging parents and her semi-estranged brothers. After a divorce in her 20s, she had trouble committing to a new love. And yet, like her parents, she repeatedly picked herself up and kept going, creating a career as a memoirist and investigative journalist.

But experienced as the Butlers were in suffering and loss, they were not prepared for the technologically enhanced torments of old age.

Knocking on Heaven's Door tells what can happen when a person's mind and body endure a series of shocks that would naturally lead to decline and death--except that, through various technological interventions, the body is not allowed to decline along with the mind.

In Professor Butler's case, a major stroke wiped out most of his ability to function independently and set him on the road to dementia. At the same time, his heart was slowing down. A year after his stroke, over the opposition of his primary care physician, Butler was fitted with a pacemaker. His cardiologist strongly recommended it. He needed hernia surgery, the doctor said, and his heart was not likely strong enough to survive the operation. So he had the pacemaker installed, he had the surgery, and he was rewarded with another six years of increasingly hellish existence--not only for himself, but also for his wife and his daughter. His mind was shot. His body would not do what he wanted it to do. But his artificially assisted heart kept relentlessly ticking away.

Not long after her husband finally died, Valerie Butler, then 84, learned that her own heart was giving out. She would need a double-valve surgery plus a bypass operation, her doctor told her. Without surgery, she had a 50/50 chance of dying within two years. With surgery, she could live another six. There was, however, a risk of stroke ...

Valerie Butler said no. She died within months.

She died of old age, sickness, and death [Katy writes]. She died of a heart calcified and broken by six years of nonstop caregiving. She died of being eighty-four. She was continent and lucid to her end. She took back her body from her doctors. She died the death she chose, not the death they had in mind. She reclaimed her moral authority from the broken medical system that had held her husband hostage. She died like a warrior. Her dying was painful, messy, and imperfect, but that is the uncontrollable nature of dying. She faced it head-on. My brother Jonathan called it a triumph.

This is not a book about assisted suicide or euthanasia. Do not read it to find ammunition for or against whatever you believe about those ethical issues, because that is not why Katy Butler wrote it. It is partly a very personal memoir about an already troubled family who found caregiving much, much harder than they ever expected. It is partly a love letter to the father Katy alternately fled and adored, and to the mother she admired but could not get along with. It is also a look at what the contemporary American approach to healthcare is doing to elderly people and to those who care for them.

And it is a clear-eyed recognition of a truth so many of us try to avoid: that it is our nature to die, that there is nothing we can do to escape death. Thanks to technology, we may be able to postpone it. We may be able to make the dying process take a lot longer (and be a lot more miserable). We can choose to add weeks to our lives and hundreds of thousands of dollars to our hospital bills by dying in an ICU rather than in hospice or at home. But we can't stave off the grim reaper forever.

If we refuse to accept our mortality, if we are willing to pay any price and bear any burden to make our lives longer (though not better), if we continue to pass healthcare laws that refuse to subsidize doctors for discussing end-of-life issues but that give carte blanche to businesses that value corporate profits over compassionate care--then death will continue to be not only an enemy, but an increasingly ferocious one.

Is the West's reckless lifestyle killing our poorer neighbors?

[Africa, with Tanzania highlighted]

I spent all day Monday in an outpatient clinic (I'm fine; thanks for asking). I met a lot of nurses, and every one of them was excellent.

When Velda came to take away the remains of my lunch, I offered her my untouched can of ginger ale.

"I don't drink soft drinks," she replied. Since I rarely do either, we started chatting.

Velda grew up in Tanzania, moved to Belgium, spent several years in London, and finally came to the United States. She returns to Tanzania regularly, and she is not happy with what she sees.

"I grew up eating lots of vegetables," she told me. "We might have had ice cream once every three years. But now people are eating American-style junk food. They don't know it's not good for them."

Tanzania's cigarette industry is big. In spite of national bans on most forms of advertising, Velda vividly recalls a huge billboard for Sportsman - one of Tanzania's most popular cigarette brands - right across from a school entrance where children can't help seeing it every day. And the children are smoking - she's seen them.

Supposedly regulated drugs are easy to buy without a prescription. Velda's 18-year-old nephew, once an honor student, is now a prescription-drug addict and a drop-out.

"The thing is," Velda said, "there's no way to get treatment for most diseases. It's not like here. If people want to be healthy, they have to take care of themselves. When they get sick because of junk food or smoking or drugs, they just die."

I checked the statistics. Tanzania's per capita income is $1700 in U.S. dollars. There is one physician for every 125,000 people (compare America's ratio of one physician for every 375 people; or Cuba's of one for every 156). Tanzanians live, on average, to age 53. Velda's twin sister died at age 23.

Velda, who is a kind and gentle nurse, gets angry when she thinks about what's happening to her people. "Why?" she kept saying. Why are international companies so aggressively promoting foods and cigarettes and drugs that will shorten people's lives and even kill them? Why is nobody stopping them? Why?

Violence : It isn't just about the guns

This is not a blog post about gun control. Everything that can possibly be said about that subject, pro or con, has already been said millions of times since Friday. We are talking too much, too soon. In the words of my rabbi, “Judaism teaches that when there is nothing to say we should say nothing….Sometimes only silence gives voice to what has happened."

We Americans should all be sitting shiva.

But when, next week, we rise from our knees and begin working – together, I hope – to reduce the terrible problem of violence in our country, we must realize that our disorder goes much deeper than simply owning too many guns, and that any effective solution will have to go much deeper too.

When they are distressed, some people clean house or do push-ups  I collect data. All week I have been amassing numbers and arranging them in rows and columns, trying to shed light on the question: Why are some nations violent while others are not?

To answer that question would take a lifetime of research and more wisdom than Solomon’s. The best I could do was to look at the homicide rates of the 34 OECD nations, which are the countries that most resemble the United States in culture and economics, and to compare them with rates in other categories. The best I can offer are correlations, not causes.* Here is what I have learned in the last four days.

1. Despite what liberals like myself would like to believe, the homicide rate does not correlate, either negatively or positively, with the gun-ownership rate per se.** South Korea, for example, has a very low gun-ownership rate but a high homicide rate. Austria, Norway, and Switzerland, on the other hand, have relatively high gun-ownership rates but low homicide rates. Japan has low rates all around – very few guns, very few homicides – while the United States has high rates of both gun ownership and homicide.

2. Despite what some preachers (and atheists) have claimed, the homicide rate does not correlate, either negatively or positively, with religiosity. The United States is highly religious and highly homicidal. Japan is barely religious and has almost no homicides. Most nations, though, are an unpredictable mixture of spirituality and savagery.

3. There appears to be some correlation between high homicide rates and a high degree of economic inequality. This seems particularly evident in Mexico, Estonia, the United States, and Chile, who all have lots of homicides and a great gap between rich and poor.

4. The homicide rate correlates most strikingly with three other rates:

• The higher a nation’s homicide rate, the more likely it is to have a high rate of military expenditures.
• The higher a nation’s homicide rate, the less likely it is to have an effective healthcare system.
• The higher a nation’s homicide rate, the less likely its students are to earn high scores in mathematics.

In other words, if you want to identify homicidal OECD nations, look for the ones with the strongest militaries and the weakest social services. 

In case you’re wondering, of the 34 OECD nations, the United States has the third-highest homicide rate. We also have the highest number of guns per 100 residents and the fourth-highest rate of military expenditures (for what is by far the most expensive military in the world). At the same time we have the third highest income-inequality rate. In healthcare outcomes we are in 24th place, and in mathematical achievement we are tied with Portugal and Ireland for 25th place.

Sixty years ago President Eisenhower warned us about the path we were taking:

Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. ... Is there no other way the world may live?

Today President Obama announced that Vice-President Biden will "lead an exploration of options" regarding "the renewal of an assault weapons ban, limits on high-capacity ammunition magazines and an end to loopholes allowing gun purchases with no background checks."

Such options, if legislated and enforced, might well decrease our appalling homicide rate. They will not, however, reduce our huge military outlay. They will not make our healthcare and educational systems competitive with those of other nations. And until we prioritize people over power, we are likely to continue down our violent path.

--------------------------------------------------
* This research is about correlation, not causation. Two facts - we'll call them A and B - coexist. A may cause B. On the other hand, B may cause A. Some other fact may cause both A and B. Or A and B may have nothing to do with one another. For example, eating chocolate may cause migraine headaches. On the other hand, an incipient migraine headache may cause a person to crave chocolate. Or possibly some alteration in brain chemistry may cause a person both to crave chocolate and to get a migraine. Or maybe chocolate and migraines are totally unrelated. It takes wisdom, common sense, and often hindsight to sort out how, and if, coexisting facts are causally related.

** I have not studied OECD gun laws, so I do not know what kinds of guns are involved in these countries, who can legally purchase them, or what background checks or training are required before purchase. Nor do I know how laws may have changed over the last couple of decades, or how homicide and gun-ownership rates may have changed in response to changed legislation. Any of those factors could affect their homicide rates.

Death with Dignity

Seneca the Younger committing
suicide with the help of his friends,
A.D. 65 (Luca Giordano, 1684)

Next month Massachusetts voters will decide whether to allow "Death with Dignity," aka physician-assisted suicide. If a majority vote yes, Massachusetts will become the fourth state (after Oregon, Washington, and Montana) to allow a licensed physician "to prescribe medication, at the request of a terminally-ill patient meeting certain conditions, to end that person’s life."

Father Tadeusz Pacholczyk, a Catholic priest and fierce right-to-lifer who weighed in on the issue in yesterday's Wall Street Journal, plans to vote no.

In "Please Step Back from the Assisted Suicide Ledge," Pacholczyk argues that physicians who provided lethal medications would destroy public trust as surely as policemen who provided guns or lifeguards who provided millstones (millstones?) to despondent people. He then offers two anecdotes: one about a woman who felt betrayed by her grandparents' joint suicide (they did not have a terminal illness, and their deaths were not physician assisted, so her story does not apply), and the other about a friend with multiple sclerosis who is glad he's still alive to enjoy his grandchildren (nobody is suggesting that PAS be mandatory, for Pete's sake, so this story doesn't apply either).

Father Pacholczyk makes me embarrassed to admit that I too would vote No.

I'm not going to make an argument here. I'll just point out that, when it comes to dying, there are more than two or three choices. Some people believe dying people should be kept alive for as long as medically possible, no matter how they or their families feel about it, no matter how much suffering is involved. Other people believe that, in extreme cases, doctors should have the right to administer lethal drugs to dying patients (euthanasia). Physician-assisted suicide lies between these two positions. So do hospice care, palliative care, and other dignified alternatives to either prolonging suffering, on the one hand, or causing death, on the other.

I believe that a lot of people support physician-assisted suicide or euthanasia because they fear they have only one alternative--to be kept alive for days, weeks, months, or even years of misery through painful interventions. Extremism breeds extremism. There are other approaches to terminal illness, however, as Bill Keller's excellent article in Sunday's New York Times points out. Last month Keller's father-in-law, Anthony Gilbey, died in a U.K. hospital of inoperable cancer. In "How to Die," Keller describes the older man's six-day dying process and the decisions--personal, medical, and political--that made his death dignified, loving, and peaceful. "We should all die so well," Keller concludes.

The approach used with Mr Gilbey, the Liverpool Care Pathway, doesn't appeal to extremists on either side, says Keller. "'Pro-life' lobbyists ... portray it as a back-door form of euthanasia.... Euthanasia advocates ... say it isn’t euthanasia-like enough." It is, however, realistic, compassionate, family oriented, spiritually sensitive, and sensible. It allowed Mr Gilbey to die at peace with God and his family, knowing he was loved.

The Liverpool Care Pathway is the standard approach "in most British hospitals and in several other countries [where, by the way, assisted suicide is illegal] — but not ours," writes Keller. "When I asked one American end-of-life specialist what chance he saw that something of the kind could be replicated here, the answer was immediate: 'Zero.'"

Learn more about how we Americans could choose to die with dignity, if only we were willing to give up our politically exacerbated extremism. Read Bill Keller's moving (and short) article. Click here.

THE CASUAL VACANCY by J.K. Rowling

J.K. Rowling's first novel for adults was released a week ago, and a lot of reviewers have weighed in since then (Google them, if you care: some of the best are from U.K. newspapers). The professional reviews mostly range from "OK" to "Oh dear," and Amazon customer reviews stand (right now) at 2.7/5.0 in the U.S., 2.9/5.0 in the U.K. Maybe the higher U.K. score is because more U.K. readers know what Ms. Rowling means when she says things like "the rubber soared right across the room."

In my review for Books and Culture (online edition) I look at an aspect of The Casual Vacancy that other reviewers didn't mention, to my knowledge--its fairly obvious theological underpinnings. (Quite a few other underpinnings are fairly obvious in the book as well, but I decided not to mention them in the review.) It would make me and B&C editor John Wilson very happy if you'd click the link and read my review on the B&C website.

In the review, I argue that Rowling's village of Pagford is post-Christian. Indeed, it is post-moral: love of neighbor is sorely lacking. Instead, we see status seeking. Middle-class chauvinism. Decreasing funds for social services. Increasing poverty. Love of money. Selfishness. Bullying. Disdain for outsiders (gays, people of color, people on welfare, mentally ill people, ugly people). Abuse. Fractured relationships. Polarization. And on, and on. If you've been paying attention to U.S. or U.K. politics recently, the picture will look depressingly familiar.

In Pagford there's a shabby little street called Hope. Three of the book's characters have lived there. One moved out long ago and became one of the town's biggest (literally) hypocrites. One died. And by book's end, one is getting ready to leave. There are still plenty of people in Church Row, though. You just might not want to spend time with them.

A lot of readers have found A Casual Vacancy dull. I understand: it didn't grab me until I was past page 200 (I stuck with it because I had a review to write). Then I read it a second time, and found it interesting right from the beginning. I think that's because by then I knew all the characters and could just read the story without trying to sort out Colin and Gavin and Simon (why do Brits have so many five-letter names that end in "n"?). To make your reading more enjoyable right from the start, here's a list of the book's major characters. Print it out and use it as a bookmark:

• Barry and Mary Fairbrother and four children including the twins, Niamh and Siobhan. Barry, who was born in the Fields but became a banker, dies. The family lives in Church Row.
• Miles and Samantha Mollison and two daughters, Lexie and Libby. Miles practices law and Samantha owns a bra shop. They also live in Church Row.
• Howard and Shirley Mollison, parents of Miles and Patricia (who now lives in London). Howard owns the village deli and is president of the Parish Council (sort of like being mayor); Shirley is a hospital volunteer. They live around the corner from Church Row in Evertree Crescent.
• Colin and Tessa Wall and their son, Stuart ("Fats"). Colin is deputy headmaster at the comprehensive school (=high school vice principal); Tessa is a guidance counselor. Fats is in high school. They live in Church Row.
• Simon and Ruth Price and two sons, Andrew ("Arf") and Paul. Simon works at the printworks; Ruth is a nurse. Arf is in high school.
• Vikram and Parminder Jawanda and three children including Sukhvinder, the youngest, a high school student. Both parents are doctors. They live in the Old Vicarage.
• Gavin Hughes, divorced, a junior partner in the law firm where Miles Mollison is senior partner. He lives outside town at the Smithy.
• Kay Bawden and her daughter, Gaia. Kay is a social worker; Gaia is in high school. They  live in Hope Street. Kay and Gavin have a rocky relationship.
• Terri Weedon and her children Krystal and Robbie. Terrie is a junkie and a prostitute who lives in the Fields (a subsidized housing project). Krystal is a classmate of Fats, Arf, Sukhvinder, and Gaia. Robbie is three years old.
• Nana Cath, Terri's grandmother. At various times she has taken care of Terri and Krystal. She lives in Hope Street.

OK, now you're ready to read. Or to resume reading, if you gave up early. The Casual Vacancy, as everyone points out, is not Harry Potter. All the same, it's worth getting into if you want to think about what the Muggle world might look like without Hogwarts, without Dumbledore, and without Harry.

MORTALITY by Christopher Hitchens

Before yesterday, I had read no books by Christopher Hitchens. I had read about him, to be sure. His name kept popping up everywhere.

 "I wouldn't walk around the block to hear Christopher Hitchens take cheap shots at Christians," writes Stephen Prothero in God Is Not One. Prothero, a professor of religion at Boston University, calls Hitchens one of the "'Four Horsemen' of the angry atheist apocalypse" (along with Sam Harris, Richard Dawkins, and Daniel Dennett)--fundamentalists all, but by another name.

And yet Hitchens's books are extremely popular, as are books by the other Horsemen. "If you want to know why the 'new atheists' ... sell so many books," says theologian and former bishop N.T. Wright in Simply Jesus, "the answer is that they're offering the modernist version of the good old-fashioned theological term 'assurance.' They are assuring anxious ex-believers that the nightmare of small-minded and stultifying 'religion' is gone forever." In other words, they offer to save us from fundamentalism.

Writing Hitchens's obituary in Christianity Today, an evangelical (though not fundamentalist) magazine, Douglas Wilson takes no offense:

This [propensity to attack sacred cows] was all part of Christopher's very public rhetorical strategy, not a function of an inability to domesticate a surly temperament. He was actually an affable and pleasant dinner companion, and fully capable of being the perfect gentleman.

Angry fundamentalist, savior from fundamentalism, nice guy... who was Christopher Hitchens really? In a New York Times review of Mortality, Hitchens's just-published posthumous book about his slow death from cancer, Christopher Buckley muses: "What discrepant parts were in him: the fierce tongue, the tender heart."

It was Buckley's review that prompted me to put Mortality on hold (now there's a great idea...). I won't sum up the book here; you'll do better to click this link and read Buckley's heartfelt appreciation. I'll just say that Mortality, like life, is short. It consists of a Foreword by Graydon Carter,who worked with Hitchens at Vanity Fair; seven essays that Hitchens wrote for that magazine; an eighth chapter of "fragmentary jottings" in the manner of Pascal's Pensées; and an Afterword by Hitchens's wife, Carol Blue. You can read the whole thing in an evening; if you're a fast reader, you can read it twice.

But why read a book about dying at all? Maybe because you're a Hitchens fan (I'm not), or because you love the way he writes (I do), or because you hope to gain wisdom (you may).  I guess I read it because mortality has been much on my mind of late. Stage four cancers, fatal strokes, hospital infections, dementia have attacked family members and friends, some in their 90s, some--like Hitchens, like me--in their 60s. I looked at mortality myself last year (and blogged about it here). I wanted to hear what Hitchens, the gentlemanly curmudgeon, had to say. I wanted to know how he felt, knowing his time was nearly up.

In chapter one, Hitchens reacts to learning he has stage four cancer (as he later notes, "the thing about Stage Four is that there is no such thing as Stage Five"):

I can't see myself smiting my brow with shock or hear myself whining about how it's all so unfair: I have been taunting the Reaper into taking a free scythe in my direction and have now succumbed to something so predictable and banal that it bores even me.

Hitchens never allows his dying, however predictable and banal, to bore his readers.

A GOOD MAN by Mark K. Shriver

In June my husband, who gets lots of review copies unbidden, asked me if I wanted to read Mark Shriver's memoir about his father, Sargent Shriver, who passed away in 2011 at age 95. "Since you're a fan of all things Kennedy," he said, "I thought you might want to see it." I didn't.

True, a high point in my adolescent life was standing in back of St. Matthew's Cathedral one December morning in 1963 waiting for mass to begin when suddenly a very tall, very disheveled, very pregnant Eunice Kennedy Shriver pushed past me, wearing smudged red lipstick and a full-length fur coat. But sons are not necessarily good biographers, and anyway, I had a stack of mysteries awaiting my attention.

But then in July a Facebook friend pointed me to Reeve Lindbergh's review of A Good Man in the Washington Post, suggesting that this was a book I might want to read. Lindbergh--herself the daughter of two famous parents, Charles and Anne Morrow Lindbergh--called it "a moving and thoughtful book." Maybe I'll read this after all, I said to myself. And then a week or two later, my friend Estelle sent me a copy of the book as an early birthday present, telling me she thought I'd connect with it on many levels. I must be supposed to read this one, I thought.

Estelle was right. This is a delightful book for lovers of Camelot--those of us who lived through the suddenly shattered dream of the Kennedy administration. Mark Shriver never saw his uncle Jack--as it happens, Mark was the baby bump under Mrs. Shriver's fur coat at that mass nearly 50 years ago, exactly one month after President Kennedy's assassination--and he was only four when his uncle Bobby was shot. But he grew up with a father who founded the Peace Corps and ran for vice-president, a mother who founded the Special Olympics, four rambunctious siblings, and twenty-some cousins, most of whom were unusually energetic and competitive. Mark's childhood home often hosted the rich and the famous, and he recognizes the privilege of growing up well connected. At the same time, he is refreshingly candid about the self-doubts such an environment fostered.

The book, though, isn't about Mark. It's about Sarge, the good man of the title, the father he adored. And Mark's portrayal of Sarge's goodness is what I liked best about the book (and what Estelle knew I'd most appreciate). See, my father was a good man too. Shriver was an extroverted, energetic, Catholic politician while my dad was an introverted, often tired, Protestant professor; but at core the two men were surprisingly similar. Both were quietly but unalterably faithful Christians. Both adored their wives and children. Both, though they worked hard and accomplished much, put their families ahead of their jobs. Neither one tooted his own horn, and neither one was bothered when others moved past him into the limelight or up the career ladder. Both men were brilliant, and, sadly, both spent their final years moving into the oblivion of Alzheimer's Disease.

Mark tells a story about his father that made me gasp in recognition. The two men were in the car together. Sarge "was having one of those lucid moments that make you ... forget for a minute or two that this is all really happening." Mark seized the moment to ask his father a blunt question.

"Dad," I said, "you are losing your mind. You know that. How does that make you feel? How are you doing with that?"

"I'm doing the best I can with what God has given me," he said.

Sixteen years ago I wrote an article for U.S. Catholic magazine about my father's decline and death from Alzheimer's. Here are some lines from that article:

"Are you afraid of dying?" I asked my father several months before he died.

"Dying?" he said, considering. "No, not of dying. I live an abbreviated life."

I asked him what he meant. "A little taken away here. A little taken away there," he explained patiently, as if to a student needing help. "I do the best I can with what's left."

Sargent Shriver was born in 1915; my father, in 1910. Their age cohort is sometimes called the Greatest Generation. Both men were great. Both were exceptionally good. And I believe both had found the secret of happiness.
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A Good Man is also available as a CD audiobook (unabridged) and as an audible.com download (abridged). To listen to a five-minute excerpt read by Mark Shriver, click here.

THE BEGINNER'S GOODBYE by Anne Tyler

Dorothy keeps popping up unexpectedly. Aaron, her husband, first sees her at the house the oak tree fell on. She then starts joining him at random times and places: in the grocery store check-out line, in the street near his office, in Belvedere Square. One day she appears just outside his office window, by the trash cans.

The odd thing is, Dorothy has been dead for nearly a year.

Aaron is neither romantic nor religious. He's the dutiful, unimaginative editor at the family-owned vanity press, publishers of a Beginner's series--"something on the order of the Dummies books, but without the cheerleader tone of voice," thin books to get you started:

Anything is manageable if it's divided into small enough increments, was the theory; even life's most complicated lessons. Not The Beginner's Cookbook but The Beginner's Soups.... Not The Beginner's Child Care but The Beginner's Colicky Baby.

But how can Aaron apply this wisdom to grieving? How can he begin to say goodbye to Dorothy, his wife of ten years?

The Beginner's Goodbye includes everything you'd expect in an Anne Tyler novel (it's her 19th): Lovable, socially awkward characters. Family ties that sometimes bind. Writing that is at once accessible and literary, comic and profound. Baltimore.

It's not as rich as Tyler's magnificent Dinner at the Homesick Restaurant, but then a Beginner's guide is just meant to get you started. This one could start a lot of conversations, not only about grief but also about communication in marriage, and how we sabotage our own happiness, and whether marriage partners can ever really know one another.

THE ART OF RACING IN THE RAIN by Garth Stein

Book publisher's marketing department's hypothetical dream plot, 2012 version:
Jacqueline Kennedy's toy poodle, having been transformed by a vision of heaven, moves to a decrepit Provençal farmhouse, falls in love with a shih tzu, and gives birth (without anesthetics) to a litter of pleasantly diverse puppies, who, being both French and Chinese, are perfectly housebroken by age six weeks.

Occasionally while reading The Art of Racing in the Rain I wondered if author  Garth Stein ever worked in that marketing department (short answer: probably not). He sure knows how to load a book with crowd-pleasing elements:

The dog. Like Chet, the narrator of Spencer Quinn's wonderful comic detective stories, narrator Enzo is an articulate canine of indeterminate ancestry. Chet, however, is much doggier. Enzo, by contrast, is literary, culturally sophisticated, and psychologically astute--practically an Edwardian English butler. The book does not reveal whether he ever scoots his bottom on the rug.

The dad. Like Robert Pirsig's Zen and the Art of Motorcycle Maintenance, Stein's Art has to do with values, machines, and fathers, but it is blessedly shorter and simpler than Pirsig's tome--none of those lengthy digressions about ancient philosophy that gave Zen weight but also made it harder to read.

The dying woman. Like far too many popular books, films, and songs, Racing in the Rain centers on a dying young woman--in this case, with brain cancer. When was the last time you wept for a fictional dying man? Just wondering.

The dysfunction. Like just about everything by Jodi Picoult, Racing features people in dysfunctional families fighting with, against, and for one another.

The driver. Families, love, death, parenting--would a guy read this book? Hey, let's throw in a whole lot about auto racing! Cars! Technique! Competitions! And let's make Dad a driver! Should work.

The dharma.  Add a few grains of motivational spirituality--the cryptic mantra, "That which you manifest is before you" (huh?); the expectation of reincarnation; the belief that the mind, or the will, controls events; the valuing of the soul above the body--why, it almost sounds philosophical, yet you don't have to think very hard.

The dénouement.  May I tell you that the ending is reasonably happy? And that it takes place in Italy? What's not to like?

Well, it worked. I--and a million or so other people--liked The Art of Racing in the Rain. It's not a great book, but it's well plotted and cleverly written. Sometimes you laugh; sometimes you cry. Sometimes you laugh at yourself for being manipulated into crying. But it's a pleasant read. And it does make me wonder what my dogs are thinking.

NEVER SAY DIE by Susan Jacoby

"Susan Jacoby has long made it her project to uncover ill-formed, cynical 'junk thought' and administer a cold dose of reason and logic against it," wrote Ted C. Fishman in the New York Times ("It Gets Worse," 2/25/11). "But Jacoby is no Mr. Spock. Her rationalism is delivered in an angry barrage peppered with enthusiastically snide asides."

"In her book, Ms. Jacoby serves as a reality instructor. Bad news flows from her as profanity from a rap group," wrote Joseph Epstein in the Wall Street Journal ("Nobody Gets Out of Here Alive," 1/29/11). "Imagine a modern-day Cassandra but one ticked to the max."

OK, Never Say Die isn't for everybody. Sheeesh, if neither the NYT nor the WSJ liked it, perhaps it isn't for anybody. But don't quit reading yet (I promise to keep this short). Though I agree with Messrs Fishman (aged 52 at time of writing) and Epstein (aged 74) about Ms. Jacoby's style (she is now 66), I still think she offers some insights that we neglect at our great peril (I'm 63):

1. When AARP magazine and self-help books dispense relentlessly upbeat advice and unfailingly inspirational stories, they focus almost entirely on the "young old" - people in good health in their 60s and 70s. Rarely do they look at the "old old" - people in failing health and/or over age 85, when fully 50% have Alzheimer's disease. Boomers who believe that the optimistic sources are giving an accurate picture of old age are in for a big shock.

2. To the extent that we live in a dream world in which old folks are happy and healthy until they suddenly, painlessly drop dead (while parachuting out of an airplane, perhaps, or in the midst of wild sex), we will not as a society provide for the real-life needs of real-life old people and their exhausted caregivers.

3. If we want to continue providing adequate health care for seniors, we're going to have to provide adequate health care for everyone else too. People will not vote to pay Grandma's medical bills if they can't pay their own.

Check out Susan Jacoby's short Newsweek column, "The Myth of Aging Gracefully" (1/30/11), for a preview of her position. Here's a sample paragraph from chapter 7 in Never Say Die, "Greedy Geezers and Other Half-truths":

The myth of young old age, which simultaneously overestimates the earning potential and underestimates the needs of the dependent old old, also poses a major impediment to any serious, reality-based discussion of social justice for both old and young. Healthy old old age is costly, and unhealthy old old age is even costlier. If, as a society, we see longevity as a good thing, then we're going to have to pay for it. But all we are hearing from public officials, now that the brief period when conservatives could use the health care debate to prey on the fears of the elderly has passed, is how to pay less to support longer lives. If there really were such a thing as a radically new brand of old age in which everyone can take care of himself or herself, there would be no reason to worry. Society would be off the hook. The boomers - healthy beneficiaries of this wonderful new old age - would surely be able to tote that barge and lift that bale until the very end.

BLUE NIGHTS by Joan Didion

In certain latitudes there comes a span of time approaching and following the summer solstice, some weeks in all, when the twilights turn long and blue.... You notice it first as April ends and May begins, a change in the season, not exactly a warming ... yet suddenly summer seems near, a possibility, even a promise....During the blue nights you think the end of day will never come. As the blue nights draw to a close (and they will, and they do) you experience an actual chill, an apprehension of illness, at the moment you first notice: the blue light is going, the days are already shortening, the summer is gone.... Blue nights are the opposite of the dying of the brightness, but they are also its warning.

Only a "connoisseur of catastrophe," as John Banville describes Joan Didion in his New York Times review of her latest book, would see long, lazy midsummer evenings as a harbinger of doom. Life is good, Didion might have thought in 2003. She loved her work, her marriage was great, she knew lots of famous people, she was a famous person, she traveled the world and stayed in the best hotels, she wore designer labels, she had interesting friends, her daughter was now married to the love of her life ...

So of course a pessimist like Didion would expect it all to crash around her ears, maybe all at once, probably without any warning except the inevitability of loss. "Did I believe the blue nights could last forever?" she asks.

And indeed, as readers of her 2005 memoir, The Year of Magical Thinking, will recall, Didion's charmed life screeched to a halt one week late in 2003. The first words of that book are the first words she wrote after her husband, John Gregory Dunne, died suddenly of a massive coronary event:

Life changes fast.
Life changes in the instant.
You sit down to dinner and life as you know it ends.

The evening her husband died, December 30, John and Joan had just returned from the hospital where their only child, Quintana, had been lying unconscious since Christmas day. The flu had turned into pneumonia, which had brought on septic shock. She would not come out of her coma for two more weeks; she would never regain her health.

Dunne's funeral was delayed until late March so Quintana could attend. Two days afterward, she collapsed from a massive hematoma in her brain and was rushed into surgery. In June of the next year, 2005, she was hospitalized with acute pancreatitis. In late August, shortly before Magical Thinking was published, Quintana died. Didion was now childless and a widow.

Blue Nights is about Quintana as Magical Thinking was about John. Didion wrote the earlier memoir in 88 days, finishing it about a year after her husband's death. Blue Nights comes six years after Quintana's death: Didion needed the time to grieve and to heal. Yet of the two books, Blue Nights feels more immediate, more agonizing, more raw.

Still, as The Economist's reviewer noted, "even when she writes about the hard drama of her own life, such as the sudden death of her husband followed by the death of her only daughter, her stories manage to be larger than her own grief." Blue Nights is not only about Quintana. It is about the losses of old age; the radical contingency of human life; parental guilt; adoption; fear; time; illness. It is about missed occasions for gratitude.

If I owned my copy of Blue Nights, I would underline these words:

We wished them happiness, we wished them, health, we wished them love and luck and beautiful children. On that wedding day, July 26, 2003, we could see no reason to think that such ordinary blessings would not come their way.

Do notice:

We still counted happiness and health and love and luck and beautiful children as "ordinary blessings."

Blue Nights is a poem about appreciating the moment.

"Ms Didion has translated the sad hum of her thoughts into a profound meditation on mortality," wrote The Economist's reviewer. "The result aches with a wisdom that feels dreadfully earned."

Steve Forbes's Prostate vs Mehmet Oz's Heart

Last week two articles highlighted America's split over health-care policy. One likened the U.S. Preventive Services Task Force* to a "death panel" and argued that we need more free enterprise in our health-care system. The other lamented the tens of millions of Americans who do not have adequate health care and argued that our inability to come up with "a health care reform law that we can all live with" is "a failure of basic morality."

The first article, "The Department of Health and Human Services' Death Panel" (Forbes magazine, 21 November 2011), is by Steve Forbes, a publisher and businessman whose net worth is estimated at $430 million.

The second article, "Enough Is Enough" (Time Ideas, 31 October 2011) is by Mehmet Oz, a cardiothoracic surgeon and media personality whose net worth is estimated at $7 million.

I'm pretty sure both writers are part of the 1%. Both were graduated from Ivy League universities: Mr Forbes with a history major from Princeton, Dr Oz with an undergraduate degree from Harvard, an MD from the University of Pennsylvania Medical School, and an MBA from the Wharton School of Business. Both are Boomers: Mr Forbes was born in 1947, Dr Oz in 1960. But despite the similarities, their views on health care couldn't be further apart.

Steve Forbes is irate with what he calls a "committee of 'experts' [scare quotes in original] appointed by the Department of Health & Human Services," because "this group recently declared that men should not be routinely screened for prostate cancer." See, Mr Forbes recently had a routine exam which led to removal of his prostate, and he is convinced - medical research be damned - that routine prostate exams save lots of lives. What is more, he is sure that the HHS research is all about "rationing and saving money," and that "what we need in health care is more free enterprise, not Soviet-style controls." He does not explain why he is opposed to the government's saving money, or why he thinks free enterprise would be less interested than the government in doing so.

Let's say Mr Forbes is right, the researchers are mistaken, and all men should get regular prostate exams. I am wondering how free enterprise will encourage that, given the ever-increasing number of uninsured Americans. Mr Forbes has endorsed Rick Perry for president; both men believe that health care is best handled by the private sector. It's not working so well in Governor Perry's Texas, however, according to a September 8, 2011, article in the L.A. Times. Insurance premiums are up - "when compared with incomes, insurance in Texas is less affordable than in every state but Mississippi" - as is infant mortality. "More than a quarter of Texans lack health insurance, the highest rate in the nation." Texas has some of the best hospitals in America for the rich and the well-insured, but "nearly a third of the state's children did not receive an annual physical and a teeth cleaning in 2007, placing Texas 40th in a state ranking by [the nonprofit Commonwealth Fund]." I don't imagine Texas, despite its governor's faith in private enterprise, will be offering free prostate exams any time soon.

Looked at another way, how would a federally managed health-care system prevent men from getting regular prostate exams if they really want them? A PSA test can cost as little as $45. If insurance companies, those pillars of private enterprise, stop subsidizing such tests on the grounds that the federal government says they have no proven value, will it be such a hardship for men to pay for their own tests? The poor might not be able to afford them, of course, but they're mostly uninsured and aren't getting them anyway - unless they are enrolled in some government program like Medicare or Medicaid. Yet Mr Forbes doesn't seem worried that those very programs may be cut back by politicians who favor a free-enterprise-based health-care system. His logical contradictions make the head spin.

Mehmet Oz, by contrast, doesn't serve up any ideology in his article. If he cares whether our health-care system is based on free enterprise, a single-payer system, or some combination of government and private business, he doesn't say. His article was sparked, not by a personal health crisis, but by what he saw when he volunteered at the "CareNow Free Clinic in the Los Angeles Sports Arena, where more than 700 doctors, nurses and health professionals had turned out to serve the local community."

During this four-day event, according to the CareNow website, "1,000 patients per day [were provided] with medical, dental and vision care they would not otherwise have received. A total of 7,200 procedures were performed, from dental fillings and root canals to medical exams and podiatry; from eye exams and prescription glasses to mammograms, Pap smears, immunizations and other services. Everything was offered at no cost to the patient."

Dr Oz, who has also volunteered at free clinics in Arkansas, North Carolina, and Texas, saw a "tide of disease and despair" in Los Angeles. A young mother whose children were insured by the state but who had no insurance herself. A young man with untreated, out-of-control diabetes who had no idea how to treat it. A woman who had lost her job and her insurance two years before, and was "too ashamed to seek help for a mass she felt in her right breast. Now the tumor had replaced her entire breast and blasted through the skin." Dr Oz writes:

At what point, I wondered that day and still wonder now, will we finally say enough? ...  I don’t underestimate the complexities of implementing a health care reform law that we can all live with. As with most entitlement programs since the Great Depression, we will have to perfect health care reform over time, just as Social Security, Medicare, veterans’ benefits and others were.

But we’re not perfecting the law; we’re fighting over it. Politicians dither and people die. Lawyers argue the merits of this or that technical point, and more blameless Americans grow sick and slip away.

Which is the real "death panel" - a government agency concluding that routine PSA screenings save few lives, or a health-care system that, favoring industry profits over human needs, leaves 50.7 million Americans uninsured?
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*The USPSTF, according to their website, is

an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists). [It] conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications) and develops recommendations for primary care clinicians and health systems. These recommendations are published in the form of "Recommendation Statements."

REFUGE: AN UNNATURAL HISTORY OF FAMILY AND PLACE by Terry Tempest Williams

Twenty years ago, a woman in her mid-thirties wrote a book that would become an environmental classic. I finally read it last week.

Still in print and still selling briskly, Refuge defies classification. Check out the reviews posted on Terry Tempest Williams's website: Wallace Stegner evokes her poetic style; Barry Lopez mentions the story's emotional depth; the Kansas City Star calls the book an environmental essay, and Kirkus highlights its political implications.

Williams interweaves two stories: the rise of Utah's Great Salt Lake, and her mother's slow dying from cancer. "Most of the women in my family are dead," she writes in the Prologue. "Cancer. At thirty-four, I became the matriarch of my family. The losses I encountered at the Bear River Migratory Bird Refuge as Great Salt Lake was rising helped me to face the losses within my family."

I read more memoir than nature writing, and I found Williams's account both moving and satisfying. It is good to read about a strong family with supportive grandparents, aunts, cousins, siblings, and friends. The Tempest tribe has been Mormon for many generations, and their faith, shared history, and rituals clearly strengthen them. At the same time, Williams does not skirt difficult issues. Her father's grief sometimes turns into rage. Her grandmother and mother push well beyond Mormon boundaries to find beliefs that will sustain their difficult journeys. Williams grows weary of caregiving, even briefly considering giving her mother enough morphine to send her on her way.

I have cared for dying loved ones, and I have faced serious illness. I recognize the emotions she describes, both her own and her mother's.

I suspect that readers of nature writing find the book equally satisfying. Williams does not just use the natural world to illustrate her own emotions. "Currently the Annie Clark Tanner Scholar in Environmental Humanities at the University of Utah" (see her bio here), she writes as a scientist and a keen observer of nature. Her descriptions of birds, their habitat, and their interactions with their human neighbors stand on their own (she even includes a six-page appendix listing all the birds associated with the Great Salt Lake).

And although the book is by no means a political essay, she ends it with a stunning chapter, "The Clan of One-Breasted Women," that is simultaneously political, environmental, poetic, feminist, and urgent.

Thanks to my friend Molly H. for giving me this book. Twenty years ago I might not have understood it as well as I do today. Now I pass it on to you.

Fear, death, and being human: thoughts before surgery

Heart and blood vessels
(Leonardo da Vinci)

I am scheduled to have open-heart surgery next week.

They will open my chest, slicing right down the sternum, and they'll hook me up to a machine to pump my blood and keep me oxygenated while they mend my innards. I am told this will take from three to six hours.

Fortunately, I will be sound asleep the whole time. And to prevent any operating-room chatter from possibly invading my dormant brain cells, large noise-cancelling headphones will fill my ears with reassuring music.

I've known this was coming since 2003. In May 2008 I wrote a brief note about it here. Last March my cardiologist and I agreed that it's time to go ahead. A defective valve needs replacing. An aneurysm needs repairing. Some faulty electrical circuits need rewiring. Bring on the plumbers and electricians.

As Samuel Johnson said to his friend Boswell, "Depend upon it, sir, when a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully."

In my case, the mental concentration is another word for fear. I felt fear when my cardiologist announced, "Mrs. Neff, you are not normal." (I also burst out laughing, which puzzled him.) I've felt fear every time  I've had echocardiograms, CT scans, MRIs, Holter monitor readings, and other tests - and I've had a lot of them. When the doctors decided I needed a catheter ablation, I could not stop shaking. My thoughts turned dark and morbid during three days in the hospital while they started me on a potent medication.

Most of the time, thank goodness, I can deal with fear. Denial works remarkably well. Failing that, joking can be effective. But when surgery became a date on my calendar, not just a remote possibility, I knew I had to pay attention. So I asked myself the obvious question, What are you afraid of? And I gave myself the obvious answers: Pain. Serious side-effects of surgery, such as stroke. Undesirable brain changes, such as compulsive alliteration.

Death.

Not much chance of that, they tell me. The numbers are excellent: the survival rate is at least 97 percent. I'm otherwise healthy, and my surgeon is one of the best. Not much chance of stroke, either. It happens, but not to the vast majority of patients.

When I strode up to the Grim Reaper to fling these statistics in his face, he was not impressed. Life, he pointed out, is a sexually transmitted condition that is 100 percent fatal. At age 63, if I am average, I can expect to live another 26 years (check out your own life expectancy here). That no longer seems very long. What's more, my healthy life expectancy is only another 8 years, according to the World Health Organization's database. I'm guessing I might have more time than that because I've never smoked, have had excellent medical care, have eaten good food, have exercised. My parents did all of those things too, and their health was good up to about age 79. But that's still only 16 years away.

If I survive this surgery - and I believe I will - I will probably have another 10 to 20 years before the artificial valve has to be replaced, or Alzheimer's infiltrates my brain, or I am attacked by cancer or strokes or some other disease. It's going to happen because I am dust, and to dust I shall return.

This is where I might go theological, or at least pietistic, and start talking about heaven, resurrection, immortality. I'm not going to do that. Undeniably many people find comfort in their faith. Morris West, author of The Shoes of the Fisherman and many other novels, faced open-heart surgery with strong faith: "Alive or dead, I was resting in the hand of Omnipotence. I knew with absolute conviction that I could not fall out of it" (A View from the Ridge, p. 145). Before he reached that conclusion, though, he had to face his own mortality. When he went into surgery, he knew he might never wake up.

As it turned out, West lived another 11 years: he died at his desk at age 83 while working on his 28th novel. He did, however, eventually die. So did all my ancestors. So did several of my friends. So will you. So will I.

This can be hard for us Americans to accept. When doctors want to talk with us about our end-of-life plans, some of us worry about death panels. When someone dies, we want to know who's to blame (the doctor? the hospital? the deceased's habits? ourselves, for not intervening in some way?). The idea that death is a normal part of being human - from the Latin humus, earth, soil, dust - is hard for us to understand - and what we do not understand, we fear.

Voldemort, remember, means "flight of death." His followers were Death Eaters - people who feared death so much that they were willing to kill to avoid it. By contrast, Dumbledore and Harry Potter accepted death willingly, and thereby saved the wizarding world. I don't expect to save any worlds, but I am guessing that if I can accept - really accept, believe at a gut level - that I am dust, I will save myself a lot of unnecessary anxiety over the next few days.

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Oh, by the way, I may not be posting much for a while. Or - who knows - I may feel the urge to comment on every passing headline (someone please stop me! No one should blog while medicated!). If you want to keep up with Lively Dust but you don't want to keep checking back unnecessarily, sign up to "Follow by Email" - right-hand column, second box from the top.

PATHS OF GLORY (DVD)

CNN reports that Claude Choules, 110, has died in Perth, Australia. Mr Choules was "the last known survivor of the 70 million combatants from World War I, a British sailor who witnessed the surrender of the German fleet in 1918."

That was the war known at the time as "the war to end all wars. As we know all too well, it didn't. Approximately 16 million people died in that war, and then 21 years later war broke out again. Estimates of World War II deaths range from 50 to 78 million.

Choules's son, Adrian, told reporters that

his father refused to glorify war.... In later life Choules refused to be interviewed about the wars in which he served. "He always said that the old men make the decisions that send the young men into war," Adrian said. "He used to say, if it was the other way around, and the old pollies were off fighting, then there would never be any wars."

I read about Choules's death right after watching Stanley Kubrick's 1957 film, Paths of Glory, about French officers, troops, and an impossible assignment in 1916. If ever a film illustrated Claude Choules's words, this is it. Self-deception, pride, cynicism, arrogance, injustice, hypocrisy, mendacity - Kubrick explores all these themes in a mere 88 minutes in a film that will incite you to shake your fist and roar at your TV screen.

There are plenty of decent human beings in the film, and some of them are officers. Colonel Dax (Kirk Douglas), for example, who defends the three hapless scapegoats, is appealingly earnest. The villains range from the oily Général  Broulard (Adolphe Menjou) to the miserable Lieutenant Roget (Wayne Morris), all managing to be despicable without turning into caricatures. Best performance in my book was Ralph Meeker's portrayal of Corporal Philippe Paris, a dutiful soldier who suffers for other men's sins. Nobody won any Academy Awards, however, and the film was so controversial that it was banned in France and Switzerland for nearly 20 years.

OK, it's probably not a date night film, but it's gripping, provocative, and brilliant - will that do? Preview it here, or read this excellent review and summary, or read the book it was based on ("a chilling portrait of injustice, this novel offers insight into the tragedies of war in any age"), or ask Netflix to send you the DVD.

In case you're wondering about the title: It comes from Thomas Gray's poem "Elegy Written in a Country Churchyard," line 36:

The paths of glory lead but to the grave.

The Medicaid card: a useless piece of plastic?

Quotation of the Day from "Today's Headlines," an e-newsletter from the New York Times:

"My Medicaid card is useless for me right now. It's a useless piece of plastic. I can't find an orthopedic surgeon or a pain management doctor who will accept Medicaid."

--NICOLE R. DARDEAU, a nurse in Opelousas, La.,

who needs surgery for herniated discs in her neck.

I found this especially interesting since just yesterday I learned that the highest-salaried doctors in the United States are orthopedic surgeons who specialize in the spine.

The problem is not limited to orthopods, of course. As the linked article by Robert Pear, "Cuts Leave Patients with Medicaid Cards, but No Specialists to See," points out, physicians across the board are turning away patients enrolled in the Medicaid program, which is supposed to assure health care to our poorest citizens.

To compound the problem, as states cut Medicaid payment rates for doctors - 20 states did so last year, 16 more states propose doing so in 2011 - people are swarming onto the Medicaid rolls. "Medicaid will soon be the nation’s largest insurer," Pear writes. "It accounts for almost half of the increase in coverage expected under Mr. Obama’s health law."

It's easy to throw blame around for our country's health-care problems: we've been doing it for years, to no appreciable effect. Democrats blame Republicans for doing nothing, and Republicans blame Democrats for doing the wrong thing. Consumers blame greedy doctors, hospitals, insurance companies, and pharmaceutical companies. Doctors blame greedy lawyers, the high cost of medical education, and inadequate reimbursement.

Hold your blame, folks, no matter how certain you are of your opinions. Blame could justifiably be attached to any or all of the above. The underlying problem, though, is neither greed nor bad law nor a broken system.

The underlying problem is that the United States, unlike all other developed nations, has no system at all. Nor do we have the non-system of a genuinely free market with open pricing, vigorous competition, and informed consumers. And until we get some sort of unified approach to health care, prices will continue to rise, accessibility will continue to fall, and Americans will continue to die younger than we need to.

At last count, people of 27 other nations live longer than we do. All 27 pay considerably less per capita for health care.

CIRCLING MY MOTHER by Mary Gordon

When my father died in 1995, he immediately strode back into my imagination as the healthy, middle-aged man of my childhood, adolescence, and young-adult years. When my mother died four months later, my imaginary clock refused to turn back. For a long time I had a hard time seeing her any way except the way she was during her painful last years - unable to speak, unable to walk, profoundly depressed.

I've spent a lot of time going through old photos since then, and I can now - at least part of the time - see both my parents as the intelligent, attractive, well-respected people I knew throughout most of my life. I also enjoy imagining their life during their 17 years together before I was born (hint to mothers: if you have kept the shoebox full of letters you wrote your husband during your engagement, you might want to consider the merriment they will someday provide your children). I came to understand that my parents were not supporting actors in my personal drama, but leading actors in their own. I now realize that, though my mother and I were close in many ways, I never really knew her.

That realization was one reason I particularly enjoyed Ruth Reichl's Not Becoming My Mother, happily renamed in the paperback edition For You, Mom, Finally. And that was also why, when a friend recommended Circling My Mother by novelist Mary Gordon, I expected an equally satisfying read.

I immediately identified with Gordon's story. Her mother was born in 1908, mine in 1910. I was born in 1948, she in 1949. Both mothers suffered from dementia; both spent their last years in nursing homes. My mother died at age 85; hers lived to be 94. Gordon, like me, was trying to get her mother back. Explaining the book's title, she writes:

I came to realize that I couldn't see my mother properly by standing in one place, by standing still. For the last eleven years of her life, the years marked by dementia, she was much more a problem to me than a joy. I wanted to move from the spot where I thought of my mother as a problem. To do this, I had to walk around her life, to view it from many points - only one of which was her career as my mother.

Gordon does this through ten essays, three of which were previously published. Many of the essays' titles begin "My Mother and ...", as in "My Mother and Her Bosses," "... Her Sisters," "... Her Friends," " ... My Father." In them, Gordon gives us a composite view of Anna Gagliano Gordon, daughter of a Sicilian immigrant father and an Irish immigrant mother, first of five daughters (there were also brothers), crippled by polio at age 3, a hard worker from age 17, married at 39, a mother at 41, widowed at 49, extremely devout Catholic, eventual alcoholic, and wearer of Arpège.

In the end, though, we learn a lot more about Mary than about Anna.

This is Mary's memoir, not Anna's. It is the story of a relationship as perceived by the daughter, not a portrait of the mother. It's the kind of book that all of us who have lost our mothers should write for our personal catharsis, but that few of us should publish.

Fortunately, Anna's daughter is a fine writer who entertains us with tales about mid-century Catholic immigrant life, moves us with stories of injustice and dysfunction and missed opportunities, and lets us share her pride as she pays tribute to a flawed but decent, imaginative, and self-giving woman.

Still, Mary Gordon knows she has not yet found her mother:

I will try to keep my mother from vanishing. I will try to understand distance, but to understand that I will also have to understand closeness. I must enter a world of undulations. A world where everything is moving, nothing is forever still....

I am trying to see my mother. I must begin now to learn how to look.

Memoir aficionadas will find Circling My Mother a treat. Women looking for ways to understand their own aging or dead mothers may also enjoy it, though it offers no advice beyond Gordon's own approach: To understand our mothers, we must circle them repeatedly. We must learn how to look.