Tag: Death Meditation

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How To Fight For Yourself At The Hospital — And Avoid Readmission

By Judith Graham

Hands of an older woman in the hospital

Everything initially went well with Barbara Charnes’ surgery to fix a troublesome ankle. But after leaving the hospital, the 83-year-old soon found herself in a bad way.

Dazed by a bad response to anesthesia, the Denver resident stopped eating and drinking. Within days, she was dangerously weak, almost entirely immobile and alarmingly apathetic.

“I didn’t see a way forward; I thought I was going to die, and I was OK with that,” Charnes remembered, thinking back to that awful time in the spring of 2015.

Her distraught husband didn’t know what to do until a longtime friend — a neurologist — insisted that Charnes return to the hospital.

That’s the kind of situation medical centers are trying hard to prevent. When hospitals readmit aging patients more often than average, they can face stiff government penalties.

But too often institutions don’t take the reality of seniors’ lives adequately into account, making it imperative that patients figure out how to advocate for themselves.

“People tell us over and over ‘I wasn’t at all prepared for what happened’ and ‘My needs weren’t anticipated,’” said Mary Naylor, director of the New Courtland Center for Transitions and Health at the University of Pennsylvania.

It’s a mistake to rely on hospital staff to ensure that things go smoothly; medical centers’ interests (efficiency, opening up needed beds, maximizing payments, avoiding penalties) are not necessarily your interests (recovering as well as possible, remaining independent and easing the burden on caregivers).

Instead, you and a family member, friend or caregiver need to be prepared to ask plenty of questions and push for answers.

Here’s what doctors, health policy experts, geriatric care managers, older adults and caregivers recommend:

Start Planning Now

Planning for a transition home should begin as soon as you’re admitted to the hospital, advised Connie McKenzie, who runs Firstat RN Care Management Services in Fort Lauderdale, Fla. You may be too ill to do this, so have someone you trust ask your physician how long you’re likely to be hospitalized and whether you’ll be sent home or to rehabilitation afterward.

Ask if a physical therapist can evaluate you or your loved one at the hospital. Can you get out of bed by yourself? Walk across the room? Then discuss what difficulties might arise back home. Will you be able to handle your own bathroom needs? Get dressed? Climb stairs? What kind of assistance will you require?

Request a consultation with a nutritionist. What kinds of foods will and won’t you be able to eat? Does your diet need to change over the short term, or longer term?

Consider where you’ll go next. If you or your loved one is going to need rehabilitation, now is the time to start researching facilities. Ask a hospital social worker for advice or, if you can afford it, hire a geriatric care manager (now called aging life care professionals) to walk you through your options.

Before Being Discharged

Don’t wait to learn about the kind of care that will be required at home. Will a wound need to be dressed? A catheter need tending to? What’s the best way to do this? Have a nurse show you, step by step, and then let you practice in front of her — several times, if that’s what it takes.

Ann Williams watched a nurse give her 77-year-old mother a shot of Warfarin two years ago after being hospitalized for a dangerous blood clot. But when it was Williams’ turn to give the injection on her own, she panicked.

“I’m not a medical professional: I’ve only given allergy shots to my cats,” she said. Fortunately, Williams found a good instructional video on the Internet and watched it over and over.

Make sure you ask your doctor to sit down and walk you through what will happen next. How soon might you or your loved one recover? What should you expect if things are going well? What should you do if things are going poorly? How will you know if a trip back to the hospital is necessary?

If the doctor or a nurse rushes you, don’t be afraid to say, “Please slow down and repeat that” or “Can you be more specific?” or “Can you explain that using simple language?” said Dr. Suzanne Mitchell, an assistant professor of family medicine at Boston University’s School of Medicine.

Getting Ready To Leave

Being discharged from a hospital can be overwhelming. Make sure you have someone with you to ask questions, take good notes and stand up for your interests — especially if you feel unprepared to leave the hospital in your current state, said Jullie Gray, a care manager with Aging Wisdom in Seattle.

This is the time to go over all the medications you’ll be taking at home, if you haven’t done so already. Bring in a complete list of all the prescriptions and over-the-counter medications you’ve been taking. You’ll want to have your physician or a pharmacist go over the entire list to make sure there aren’t duplicates or possibly dangerous interactions. Some hospitals are filling new prescriptions before patients go home; take advantage of this service if you can. Or get a list of nearby pharmacies that can fill medication orders.

Find out if equipment that’s been promised has been delivered. Will there be a hospital bed, a commode or a shower chair at home when you get there? How will you obtain other supplies that might be needed such as disposable gloves or adult diapers? A useful checklist can be found at Next Step in Care, a program of the United Hospital Fund.

Will home health care nurses be coming to offer a helping hand? If so, has that been scheduled — and when? How often will the nurses come, and for what period of time? What, exactly, will home health caregivers do and what other kinds of assistance will you need to arrange on your own? What will your insurance pay for?

Be sure to get contact information (phone numbers, cell phone numbers, email addresses) for the doctor who took care of you at the hospital, the person who arranged your discharge, a hospital social worker, the medical supply company and the home health agency. If something goes wrong, you’ll want to know who to contact.

Don’t leave without securing a copy of your medical records and asking the hospital to send those records to your primary care doctor.

Back At Home

Seeing your primary care doctor within two weeks should be a priority. “Even if a patient seems to be doing really well, having their doctor lay eyes on them is really important,” said Dr. Kerry Hildreth, an assistant professor of geriatrics at the University of Colorado School of Medicine.

When you call for an appointment, make sure you explain that you’ve just been in the hospital.

Adjust your expectations. Up to one-third of people over 70 and half of those over 80 leave the hospital with more disabilities than when they arrived. Sometimes, seniors suffer from anxiety and depression after a traumatic illness; sometimes, they’ll experience problems with memory and attention. Returning to normal may take time or a new normal may need to be established. A physical or occupational therapist can help, but you may have to ask the hospital or a home health agency to help arrange these visits. Often, they won’t offer.

It took a year for Barbara Charnes to stand up and begin walking after her ankle operation, which was followed by two unexpected hospitalizations and stints in rehabilitation. For all the physical difficulties, the anguish of feeling like she’d never recover her sense of herself as an independent person was most difficult.

“I felt that my life, as I had known it, had ended,” she said, “but gradually I found my way forward.”

Complete Article HERE!

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Never Too Old to Feel Orphaned

Mourning Parents in Middle Age

By Jo McGowan

Mourning Parents in Middle Age

I was nine years old when my father’s mother died. I still remember hearing the phone ring and knowing—instantly—that Grandma was gone. I was already in bed for the night but I ran down to the kitchen where my mother was on the phone with my father, who had been with my grandmother in the Rose Hawthorne Hospice. My older sister had also come running into the kitchen, and we held each other tightly in that tidal wave of grief and disbelief. It was the biggest and the worst thing that had ever happened to us.

In the middle of it all, sitting on the couch with Mom, waiting for Daddy to come home, I suddenly realized that my father was now an orphan. He was forty-five (touchingly young to me now). I remember meeting him at the door when he came home and thinking how brave he was, how strong. Years later, in my twenties, I understood that being “orphaned” at forty-five was not what I thought it was when I was nine. Now that I am fifty-eight and an orphan myself, I realize that it was worse. But also better.

My mother died eight years ago, my father a little less than a year ago. I’m still emerging from those twin losses. I don’t think I will ever be the same. I still wake sometimes, panicky, in the middle of the night wondering where they are. I still think of things I want to tell them. I still wonder what they would make of my life, my dreams, my stories. I still have questions that only they could answer. I miss them. Dreadfully and physically. There is a void in the center of my heart. I ignore it most of the time and carry on, because that’s what we do. But something has been torn out of me. Yet, strangely, I think I’m a better person now.

Does anything ever prepare us for the loss of our parents? When I was a young adult, I believed that when you reached your forties and fifties, you were beyond needing your parents. I was closer to the truth when I was nine. By the time my own parents died, everything had shifted. They were no longer the center of my life, and their new dependence meant that, whenever I was with them, I took on the role of parent myself, guiding them, making their decisions, steering them through life as I saw fit. That fact somehow made me feel I would be ready to let go when the time came.

But something funny happened when the time came. Time sped up or telescoped or folded in on itself—I don’t understand it and I don’t know how to describe it—and I found to my surprise that the immediate past had merged with the distant past to make a coherent present that was whole and entire of itself. Mom and Dad were young when I first met them—in their early thirties. As I grew up, I listened to their stories of times before I was even born, when they were younger still. I lived with them through their middle years and absorbed their lives without even being aware that I was doing so. I got married when they were the age I am now and I remember thinking in my youthful self-absorption that their lives were ending as mine was taking off.

Of course, that wasn’t true: their lives remained as full and as busy as mine is today, and I can see this now. But it took their deaths for me to understand fully the complete human beings they were—to realize that they had once been children, teenagers, college students, young adults, and that all of those selves were contained in the selves I knew as a child and took care of as an adult. They had friends, ambitions, secret fears. They had regrets. They had love. I, who loved them unconditionally my whole life, feel as if I am getting to know them at last. Now that they are gone, the complexity and richness of their lives is so much clearer to me. I wish I could talk with them again. I would ask for their thoughts on some of the things that I am thinking about now. I would go with them for long walks. I would introduce them to podcasts. We would discuss politics.

I find myself constantly calculating their ages in relation to my own, as if they are contained within me, living through me and I through them. They are a part of me now in ways they never were when they were alive and my love for them feels deeper and more complete. St. John Chrysostom is supposed to have said: “Those whom we love and lose are no longer where they were. They are now wherever we are.” It’s a pretty thought, and a comfort. Now I see it is also the plain truth.

Complete Article HERE!

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Mario Fonovic on accepting death and smiling in the face of terminal cancer

By Brett Williamson

Mario Fonovic seated in the palliative care ward of the Queen Elizabeth Hospital.
Mario Fonovic seated in the palliative care ward of the Queen Elizabeth Hospital.

At 55 years of age Mario Fonovic is in the final stages of terminal lung cancer. He doesn’t expect to see the end of 2016, but he is refusing to go without a smile on his face.

“I’m a doer,” Mr Fonovic told 891 ABC Adelaide‘s Mornings program.

Mr Fonovic joined the program to discuss a topic most people dread — death.

“I’ve arranged my funeral right down to my flowers — but don’t bring tissues, bring a tambourine,” he said.

Mr Fonovic said he was neither sad nor scared of his approaching death, and had decided to share his journey on Facebook.

“I can see what is happening to my body,” he said.

“I feel it, I can see it and eventually I will end up in a coma.

“If I can help one person accept death or dying or cancer [I will].

“Just accept what is happening in your life and get on with it, because life is short.”

Looking back on his life, Mr Fonovic said he wished he had only done one thing differently.

“My one and only regret is that as a gay man I never fought to have a child,” he said.

Mr Fonovic said he was lucky to have legally married his partner Sid in a ceremony in California before legislation there changed.

The two plan to move into a newly purchased home together this week and Mr Fonovic is determined he will not die in a hospital.

Too many hospital visits

Mr Fonovic has spent his fair share of time in and out of hospital since being diagnosed with asthma eight years ago.

Being a long-time smoker only made his condition worse.

“Four years ago I coughed … after having one of my last cigarettes and blew a hole in my left lung,” Mr Fonovic said.

His left lung had deflated and he struggled to breathe.

After a week in hospital being treated he was sent home, but within six hours he was back in the emergency department — his left lung had deflated once more.

After another round of treatment Mr Fonovic’s life began to return to normal.

Eighteen months later Mr Fonovic was back in hospital — this time his right lung had collapsed.

“I ended up looking like the Michelin Man as air was leaking into my body,” he said.

He was placed in intensive care and surgeons removed a third of his right lung.

In December 2015 Mr Fonovic visited a respiratory physician to check whether he would be suitable for a lung transplant.

Mario Fonovic having his chest scanned
Mario Fonovic having his chest scanned

During a routine scan the doctor discovered cancer.

“I was so happy the day that I went on the transplant list … because I wanted my life back,” he said.

“In one breath I went, ‘yes’ — and then it was cancer.”

Getting on with it

A burst of stereotactic intense radiotherapy saw Mr Fonovic end up with an infection and he was once more admitted to hospital.

“On the second of May [my doctor] shook my hands and said, ‘you are in remission’,” Mr Fonovic said.

“In the following week I went downhill to the point where I couldn’t walk down my hallway.

“I felt like a semi-trailer had parked on my chest.”

Three weeks later Mr Fonovic admitted himself into hospital for a follow-up scan and found out the cancer had returned.

“The PET scan actually showed how bad it is,” he said.

“Not only had I got the cancer back, but it had taken over the whole lung.”

The lymph nodes on the side of his lungs had stimulated the nerves on his spinal cord and were causing him immense pain.

With the firm belief he would not see his next birthday, Mr Fonovic said he decided all he could do was face death.

“You just put your feet on the side of the bed, pull your trousers on and get on with it,” he said.

The cancer may have wreaked havoc on Mr Fonovic’s body, but mentally he is nowhere near finished with life.

Complete Article HERE!

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Leonard Cohen managed that rare thing: to talk with clarity about death

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‘Cohen’s economy of words, the syntax of love, his ability to go straight to the only matter that matters – her death, his mortality, their love – is a thing of beauty and wisdom.’
‘Cohen’s economy of words, the syntax of love, his ability to go straight to the only matter that matters – her death, his mortality, their love – is a thing of beauty and wisdom.’

The songwriter’s letter to Marianne Ihlen in her last hours was beautiful, poetic and to the point. Yet so often we deal with death in an inane, mawkish way

A short goodbye. A few sentences. But words of such clarity, simplicity and beauty. Many of us have by now read Leonard Cohen’s letter to a woman he once loved, Marianne Ihlen, on her deathbed – and those who didn’t know it already have seen that Cohen is a class act, a man you don’t meet every day.

He heard that she was dying and two hours later he wrote to her that he too was old and his body failing. He had, of course, written for her before, with the lyrics of So Long, Marianne and Bird on the Wire. This time he told her: “Know that I am so close behind you that if you stretch out your hand, I think you can reach mine.”

Slipping into unconsciousness, her friend said that Marianne did reach out her hand. Cohen’s letter also stated that he didn’t need to talk about her beauty and her wisdom, “because you know all about that”. The 10 years they were together on and off, their intimacies, their passions, their endings, those – despite the songs – are all a part of their own personal story. Now he wishes her endless love on her journey – to death. It is everyone’s journey, but few speak so directly of it, not even while whispering in the waiting rooms.

Was Marianne his greatest muse? What does it matter? He loved her for a while. He loved his four bottles of wine a day before he took himself off to the Buddhist monastery where he was given the Dharma name of Jikan which means “silence”. But he knows about silence as he also knows about the tower of song.

Death is so often met with silence or with sentiments that are an inane babble to fill a void. The mawkish inscriptions and epitaphs seek to cauterise the grief, to fix it for a while. For how to write of loss? How do you write to a person you will never see again? I have done it, clumsily, inelegantly, with false jauntiness and then a wish for them to rest. Whatever that means.

So Cohen’s economy of words, the syntax of love, his ability to go straight to the only matter that matters – her death, his mortality, their love – is a thing of beauty and wisdom in itself. His ever deepening voice, the self-mockery, to see him now deadpan and dapper is still quite something. But once she held him like a crucifix and he let her go: “I’m cold as a new razor blade,” he sang.

Some think of him as a doom-monger but he is deadly funny and the faith was always there. “I think I was touched as a child by the music and the kind of charged speech I heard in the synagogue, where everything is important,” he said in his eighth decade, adding ironically that he was singing “a lot of Jew-sounding songs in different keys”.

Yet it is the fact that his words are so charged that is the reason they touch us. In my local park, there is an inscription on a bench for a friend who died and the words are taken from So Long, Marianne: “It’s time that we began to laugh and cry and cry and laugh about it all again.”

Cohen once said: “Poetry is just the evidence of your life. If your life is burning well, poetry is just the ash.” What ash though? Warm, sacred, dancing us to the end of love; young passions, old bodies, a rare and gracious farewell. So long, Marianne. Thank you, Mr Cohen.

Complete Article HERE!

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27 heartwarming pics of a man taking his dog on a farewell trip

By Alicia Barrón

Robert is making sure Bella lives out the rest of her days as a happy dog.

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When Robert Kugler found out his beloved chocolate lab, Bella, had cancer — he knew what he had to do.

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Robert adopted Bella as a puppy. She’s now 9 years old, or about 63 if you’re counting in human years.

In May, a veterinarian told Robert that what he initially thought was a shoulder injury was actually cancer and that it had spread to Bella’s lungs. The doctor had to amputate one of Bella’s legs and told Robert she had three to six months to live.

That was 14 months ago.

Determined to show Bella the same kind of unconditional love she had shown him throughout her life, Robert hit the road to give her the farewell tour of her doggie dreams.

He tells Upworthy it’s not everyday you get to just pack up, get behind the wheel, and go, but after losing two siblings in nine years, he began to look at time as being much more valuable than money.

As for Bella, he says, “She teaches me lessons every day, and I am so blessed to spend my time with her.”

Here are 27 of the most heartwarming photos from Bella’s farewell tour:

You can’t put a price tag on the type of love, loyalty, and companionship a pet provides, and these incredibly moving photographs prove it.

The bond between Robert and his “Bella girl” is truly special. In spite of Bella having cancer and only three legs, Robert says, she begs to be in the car nearly every time she’s awake.

You can follow this dynamic duo’s road trip adventures on Robert’s Instagram, and he says they’ve got no plans of slowing down anytime soon because “right now … sharing the love of this dog with the world has become my new purpose.”

Complete Article HERE!

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What I should have told my dying friend

By Shannon Molloy

Clare Atkinson
Clare Atkinson passed away on June 22 from a rare form of cancer. Her friend, journalist Shannon Molloy, had so much he wanted to tell her.

The last time I saw my friend Clare was two weeks ago in a hospice in Melbourne.

For a place where people come to die, it was an unnecessarily sad old building with no warmth, no comfort. Just beige walls and dull furnishings.

Terms like “palliative care” weren’t hidden away here — but instead, displayed on signs with arrows pointing the way to the sick and dying. There, among the mostly elderly patients, lay my 31-year-old dear mate.

Physically, she was a shell of her former self. Cancer had ravaged her body in 18 short months and left behind a confronting sight where vibrancy and a constantly burning energy once resided. Her stomach and legs were horrifically swollen, overrun with fluid as her organs slowly shut down.

But inside, her old spirit still glimmered.

“How are you?” I clumsily asked as I walked in. The moment the words left my mouth, I regretted them. How did I think she was?

“Well, I’ve been better,” she laughed gently. “Not sure if you can tell.”

I sat and held her hand, gently patting the bony and frail limb that once gripped a pen that wrote stunningly insightful words, and held a microphone that powerfully conveyed compelling pieces, here and abroad, for radio and television. Her remarkable but brief career in journalism seemed a million years ago in that moment, as she slipped in and out of consciousness and struggled to speak.

Like so many of the times I’d spent with her after her diagnosis, words failed me. I said nothing of the consequences at this meeting — the final one I would have with her, as it turned out. Just words to fill the silence, a forced smile painted on my face.

What was there to say anyhow?

Clare Atkinson, with the writer Shannon Molloy, had an inspiring love of life.
Clare Atkinson, with the writer Shannon Molloy, had an inspiring love of life.

I know now. I should’ve said that she’d been a wonderful friend for the past 11 years, from the moment we were introduced at uni and set about reviving our student association together — a task from which a cherished and close friendship was born.

I should’ve said that I’d always admire her and, truth be told, that I envied her; that I was proud of all she’d achieved — more in a third of life than most of us could dream in a whole lifetime.

Perhaps I could’ve told her that she’s one of the kindest people I’ve ever met, with not an ounce of malice in her bones.

I might’ve asked if she was frightened. She didn’t seem it, but I would be. I’d be angry too — furious at how unfair the situation was, that she was just getting started. Why was now the time she had to face this awful, daunting thing?

I should’ve told her that I’d rather selfishly become determined to live a better life than I had before, for her, I suppose. To be more adventurous, to take risks, to love, to be a good person, to be less concerned with the small and trivial things, to stop stuffing around… all of the things she had been, even before her own mortality presented itself at 29.

I should’ve shared all the many fond, happy memories I have of our antics — most of which flooded my mind the moment I stepped away from that small, depressing hospice room.

There was the night of drunken deep and meaningful chat about our futures at an end-of-year uni social.

There was the early morning SOS call after a fight with an ex-boyfriend, when I collected her from a darkened street and took her to McDonald’s for sundaes and a long whinge about stupid boys.

There were emails back and forth after she moved to Germany for work. There were excited Facebook chats when she later came home and met the charming man who’d become her husband.

There was a night — now quite funny — when we danced wildly inside a club while our unlucky friend was hit by a taxi outside. She was fine, just a bit bruised. And now, whenever we hear an ambulance siren, we announce that her cab home has arrived. Well, we did.

And of course, there was that day in early December 2014 when she dropped a bomb. She had cancer, it was terminal and it was very rare and very aggressive.

“I’m so sorry,” I said. I couldn’t think of anything else, and so I left it at that and let her speak.

On reflection, I said nothing of real consequence at any stage. I couldn’t. My role was to remain the funny one, I reasoned, to be her brief light of relief from the heavy burden of the rest of her new existence.

I told jokes, brought her old photos, suggested podcasts and books, shared funny stories about diva celebrities I’d encountered through work and generally tried to keep the mood up. In reality, I was scared to confront this thing that was stealing my friend away from me, from her family, from her adoring partner, from the rest of her mates.

I was terrified that if I was to drop my guard that I might cry, and I might never stop. And that would be selfish in light of her struggle. And so I kept the cancer chat light, treating it like a deadly elephant in the corner of the room, and tried to make her smile instead.

There was a day a few months ago though, when I went to see her and she was in a reflective mood. We spoke for several hours about the old days, about the years since, about life, and she said something that still rings in my head.

“If I could go back to the beginning of my life and choose not to have the cancer, but to miss out on everything I’ve done, in exchange for something far duller, I wouldn’t do it,” she told me.

“Because as shit as this is, I’ve had an amazing life. It’ll be over too soon but I’m pretty happy with it.”

In a rare and unfiltered moment, I was as candid as I could be without losing it.

“You did real good,” I said. And she had.

She lived how we all should live — fiercely, bravely, enthusiastically and like her life depended on it — long before it actually did.

And when it’s all said and done, isn’t that a place we all hope to be when our time’s up?

Clare Atkinson died late in the night on Wednesday June 22, peacefully and surrounded by her loved ones.

It was just days after she was able to return home from the hospice to her lovely, bright bedroom, with views out over the city.

Clare Atkinson on her wedding day with husband Lewis Rowland-Coman.
Clare Atkinson on her wedding day with husband Lewis Rowland-Coman.

You can donate to the Clare Atkinson Memorial Fund, supporting the Peter MacCallum Cancer Centre’s research into cancer of the unknown primary (CUP).

Complete Article HERE!

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The Violet Hour: Great Writers at the End by Katie Roiphe review – how to cope with death

This study of Susan Sontag, Sigmund Freud, John Updike, and how they coped with the mystery of extinction, is also a memoir about brushes with mortality

By 

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Katie Roiphe: ‘I think if I can capture death on the page, I’ll repair or heal something. I’ll feel better.’

Katie Roiphe begins her study of writers in their last hours with the story of a near-death experience: her own. At the age of 12 she began coughing up blood, but decided not to tell anyone – not her parents, or sisters, or doctor. She had in fact developed acute pneumonia, and after an operation that removed half of a lung she came out of hospital weighing 60lb, “too weak to open a door”. Ever since that narrow escape, death became her obsession, but one that continued to defy understanding or articulation. Who could make sense of such a thing? Her answer: great writers, specifically great writers as they approached death’s door. “I think if I can capture death on the page, I’ll repair or heal something. I’ll feel better. It comes down to that.” This mini-memoir, and a coda, are the most compelling parts of The Violet Hour. They bookend a sequence of five case studies of writers whose thoughts on mortality are often arresting, sometimes moving, yet never add up to a coherent vision of what Henry James called “the distinguished thing”.

Roiphe (above), an essayist, teacher and contrarian, is a woman up for a challenge. Her most recent books – a study of literary unions, Uncommon Arrangements, andIn Praise of Messy Lives, a scattershot broadside against the way we live now – reveal her tough, unbiddable, non-ingratiating character. Fittingly, her first subject is Susan Sontag, a writer whose personal and intellectual fierceness could be Roiphe’s model. Sontag’s determination to outface death became part of her legend. She had already survived cancer, twice, when she was diagnosed with leukaemia in 2004. Believing herself to be “exceptional”, she rejected the evidence, adopting a get-well-or-die-trying attitude that caused intense anguish among the people who cared for her – her son David, friends, nurses, hired hands. She took up cudgels once again, enduring chemo and the dangerous procedure of a bone marrow transplant. The treatment caused her shocking physical agony. At this point I couldn’t help thinking of Woody Allen’s line: “I don’t want to achieve immortality through my work. I want to achieve it through not dying.”

Susan Sontag with her son. David, in 1967.
Susan Sontag with her son. David, in 1967.

Sontag is an extreme case – and the only woman – in this book. Her example is unlikely to make Roiphe, or anyone, “feel better” about death. Sigmund Freud, on the other hand, adopted the opposite approach. Even as a young man he disliked the idea of “prolonging life at all costs”. Stricken by an inoperable cancer of the jaw, he refused any painkillers other than aspirin. “I prefer to think in torment than not to be able to think clearly,” he said. Was his stoicism a better, braver way to face the end? As Larkin wrote in “Aubade”, “Death is no different whined at than withstood”. His disciples believed that Freud had no terror of the end, but Roiphe wonders if he protested his indifference too much: he may have been trying to persuade himself that he didn’t care.

Shadowing Roiphe’s book is a tentative desire to find something consolatory – a truth, a meaning – in death. Can writers teach us how to die? The uncertain, provisional nature of her project is evident. Instead of a continuous narrative, she writes in discrete floating paragraphs, as if conducting a philosophical investigation. Either that, or she doesn’t quite know how to structure her argument. Maurice Sendak, a writer and illustrator she has revered from childhood, described death “as if it is a friend who is waiting for him”. He suffered a heart attack at 39, but lived on till his 80s. He owned Keats’s original death mask and would take it out “to stroke the smooth white forehead”. When his lover died, Sendak drew his corpse, obeying the creative instinct “to turn something terrible into art”. Here Roiphe does get at something useful, which is the consolation of work: “For the time it takes to draw what is in front of you, you are not helpless or a bystander or bereft: You are doing your job.” (I would take “or bereft” out of that sentence.)

John Updike, characteristically, worked unto the last, writing some of his most poignant poems (in Endpoint) from his hospital bed. Like Freud, he cleaved to stoicism in considering death, but unlike him had sought comfort in religious faith and sexual adventure, the latter his way – or at least his characters’ way – of cheating mortality: “If you have a secret, submerged, second life, you have somehow transcended or outwitted the confines of a single life.” In an almost too-perfect illustration of his twin drives we learn that Updike plotted Couples, his great novel of adultery, while in church – “little shivers and urgencies I would jot down on the program”. The oddness of this chapter, however, concerns what happened between Updike’s family during his last illness. His first wife Mary and their four grown-up children seem to have come a cropper under the Cerberus-like vigilance of his second wife Martha. The children felt that Martha, perhaps with her husband’s tacit agreement, restricted their “alone-time” with Updike. This is interesting as gossip, but I can’t see how it enlarges our understanding of the writer or his work.

Dylan Thomas in 1946.
Dylan Thomas in 1946.

Even less illuminating is the record of Dylan Thomas’s bibulous last days in New York, swaggering – or staggering – from hotel to pub to hospital and thence into a coma. Roiphe notes that myths have clustered around his death, and the causes of it. Some still argue that he “wasn’t an alcoholic”. Seriously? Put it this way: if Dylan Thomas was not an alcoholic then his was an even more horrifying personality than at first appears. Addiction would at least explain, if not excuse, his lechery, his flakiness, his self-pity, his self-loathing, his tendency to steal from his friends, and the fact that he had written only six poems in his last six years. At 39, Thomas is the youngest to go of this small assembly and the one whose death I felt least inclined to lament.

The Violet Hour does, however, rally at the end. For reasons the author doesn’t entirely understand she seeks an interview with James Salter, then 89 years old, and nearly the last Great American Novelist. To her surprise he agrees to talk. Perhaps it is her contact with a living subject, perhaps it is Salter’s wry, Delphic way with words, or the fact that he came close to death as a fighter pilot in Korea, but something is unlocked by their encounter and Roiphe at last identifies what her quest has been about – not death but the fear of death: “The knowing you are about to die. The panic of its approach … That’s what I’ve been trying to write my way through.” It returns her to another formative moment in her life, the sudden collapse of her father – a heart attack in the lobby of his building – and her belated realisation that he must have felt pain in the minutes before he died. She is excruciated by the idea of his pain, and that he may have panicked. “The idea that he didn’t have time to be afraid had consoled me.”

This book is Roiphe’s haunting but muddled attempt to come to terms with the mystery of extinction. Her father died, and she will never know what he was going through. Salter, who died last year, knew best: “Don’t dwell on it.”

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