6 Books on Dying in Modern Times

This is a topic that has been cropping up in my life in unexpected areas. Physician-assisted suicide has been recently legalized in Canada, I taught about assisted suicide when I completed my ESL practicum last fall, and now I’ve unintentionally read three books on aging and dying that complement each other. I also remember being fascinated by this article (‘Why Doctors Die Differently’; I think it’s behind a paywall now) when it first appeared in 2012. I think the concept of how we die, or how we should die, in today’s day and age, captivates me because it’s something that affects literally everyone. Everyone goes through this eventually. Here are my thoughts on three books I’ve read and recommend, and suggestions of three more books I haven’t read yet.

Note the similar cover designs of these six books…

3 Books I’ve Read

 Smoke Gets in Your Eyes: And Other Lessons from the Crematory by Caitlin Doughty

Of the six books featured in this post, Doughty’s explores what happens at the very end of the road, after a person has died. She took on a job in a crematorium when she was 23 years old, motivated by a somewhat morbid interest in death. She describes her work and all it entails, including some gruesome details you might rather not know about. Doughty goes beyond just sharing her experiences at the crematorium, however. She explores how we have developed an unhealthy and even unnatural relationship with death. We try to avoid it. We don’t know how to behave around a body, we don’t know our options for what to do with the body, we don’t know how to accept mortality. You’ll definitely learn a thing or two from Doughty, and hopefully come away with an improved (read: more positive) opinion about death.

Being Mortal: Illness, Medicine, and What Matters in the End by Atul Gawande
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Working a step backward from Doughty, we have Gawande’s book about how we live out our final days as we age. Gawande’s work as a surgeon and relationship with his dying father qualify his writing on the topic. He highlights the problems with widely spread and accepted systems of health care (such as depressing nursing homes and futile medical procedures), and explores alternatives to these systems. A great read that had me thinking a lot about how I’ll treat my parents when they are elderly.

Good Medicine: The Art of Ethical Care in Canada by Philip Hébert
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Good Medicine caught my eye because of the Canadian perspective. Similar to Gawande, Hebert makes his case through anecdotes about his own patients, commentary on publicly known cases, and his own experience with Parkinson’s. Hebert takes a more general approach than Gawande, focusing not only death in old age but general medical practices. (He writes about a different subject in each chapters – focuses include elderly care and physician-assisted suicide). Hébert emphasizes the importance and life-changing significance of doctors asking tough questions and of patients making their explicit wishes known before finding themselves in a tragic situation. This is a valuable book I hope more people read.

How much better it would be if we knew there were certain states in which each patient would not want to be kept alive, if hospitals asked patients, especially patients facing major surgery, clear and pointed questions in advance: If you were in a non-responsive or minimally responsive state, how would you want to be treated? If you also had only the remotest prospect of even partial recovery, would you wish to be kept going by expensive and prolonged measures? And what if, on account of that care, others were deprived of truly effective care? Would you still want to be kept alive? (107)

3 Books I Want to Read

 When Breath Becomes Air by Paul Kalanithi
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At the age of thirty-six, on the verge of completing a decade’s worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. One day he was a doctor making a living treating the dying, and the next he was a patient struggling to live. Just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air […] chronicles Kalanithi’s transformation from a naïve medical student “possessed,” as he wrote, “by the question of what, given that all organisms die, makes a virtuous and meaningful life” into a young neurosurgeon at Stanford, guiding patients toward a deeper understanding of death and illness, and finally into a patient and a new father to a baby girl, confronting his own mortality. What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir.

A Good Death: Making the Most of Our Final Moments by Sandra Martin
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We can’t avoid death, but the prospect is a lot less terrifying since the Supreme Court of Canada legalized physician-assisted death. Competent adults, suffering grievously from intolerable medical conditions, will have the right to ask for a doctor’s help in ending their lives. That much is clear. The challenge now is to pass legislation that reflects this landmark decision and develop regulations that reconcile the Charter rights of both doctors and patients. If we get the balance right between compassion for the suffering and protection of the vulnerable, between individual choice and social responsibility, we can set an example for the world. A Good Death is timely, engaging and inspiring. In taking on our ultimate human right, award-winning journalist Sandra Martin charts the history of the right to die movement here and abroad through the personal stories of brave campaigners like Sue Rodriguez, Brittany Maynard and Gloria Taylor. Martin weighs the evidence from permissive jurisdictions such as the Netherlands, Oregon, California, Switzerland and Quebec and portrays her own intellectual and emotional journey through the tangled legal, medical, religious and political documentation concerning terminal sedation, slippery slopes, and the sanctity of life.

Knocking on Heaven’s Door: The Path to a Better Way of Death by Katy Butler
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Katy Butler was living thousands of miles from her vigorous and self-reliant parents when the call came: a crippling stroke had left her proud seventy-nine-year-old father unable to fasten a belt or complete a sentence. Tragedy at first drew the family closer: her mother devoted herself to caregiving, and Butler joined the twenty-four million Americans helping shepherd parents through their final declines. Then doctors outfitted her father with a pacemaker, keeping his heart going but doing nothing to prevent his six-year slide into dementia, near-blindness, and misery. When he told his exhausted wife, “I’m living too long,” mother and daughter were forced to confront a series of wrenching moral questions. When does death stop being a curse and become a blessing? […] When doctors refused to disable the pacemaker, condemning her father to a prolonged and agonizing death, Butler set out to understand why. Her quest had barely begun when her mother took another path. Faced with her own grave illness, she rebelled against her doctors, refused open-heart surgery, and met death head-on. With a reporter’s skill and a daughter’s love, Butler explores what happens when our terror of death collides with the technological imperatives of medicine. Her provocative thesis is that modern medicine, in its pursuit of maximum longevity, often creates more suffering than it prevents.

Have you read any of these books? Is this a morbid topic or does it interest you?

Review: Solving the Procastination Puzzle by Timothy A. Pychyl

Title: Solving the Procrastination Puzzle
Author: Timothy A. Pychyl
Format/Source: Paperback/Library
Published: December 2013
Publisher: Jeremy P. Tarcher
Length: 107 pages
Genre: Non-fiction
Why I Read: Solid recommendation from Lifehacker on a practical book for tackling a bad habit
Read If You: Procrastinate!
Rating★★★★
Links: GoodReads IndieBound Chapters | Amazon 

Solving the Procrastination Puzzle is a book written by an author who really knows what he’s talking about. Timothy A. Pychyl is a Canadian academic known in psychology for his research on procrastination. He founded the Procrastination Research Group in 1995 and has published numerous academic articles about procrastination. He put together this book to organize the ideas published on his blog and podcasts (xvi), and to “communicate ideas outside of formal scholarly journal articles” (ix). I appreciated that Pychyl wrote this book to make accessible the results of his research that would otherwise be locked up in academia, unable to benefit the population at large who could really use help with their bad habits. This book will help you understand, at a deeper level than you may have considered previously, why you procrastinate and how to get past those problems.

Pychyl knows his audience. He answers the question, “Why is the book so short?”, in his introduction. He doesn’t want to contribute to procrastination habits by writing a dense book that might motivate us to instead procrastinate and never finish reading. He also believes “less is more”. He writes, “[W]hen it comes to learning strategies for change, a few key ideas are what is required” (xvii). Extensive background research and technical descriptions are not what those of us who are looking to make real change need. I definitely appreciate this sentiment! I felt motivated to complete this book, and take notes for future reference, because its length made it feel very manageable.

The most finite, limited resource in our lives is time. (13)

Pychyl doesn’t fill his book with wishy-washy feel good advice. Nearly every page includes practical and useful information. Each chapter opens with a nugget of good advice – “a key phrase that may become your mantra for change” (xviii). One phrase that particularly stuck with me is “I need to be more aware of my rationalizations” (36). This comes from Chapter 5, which then lists and explains a number of rationalizations we use when we procrastinate. For example, we manufacture our happiness conflict by ‘rationalizing’ our procrastination through reactions such as trivialization, denial of responsibility, saying ‘it could have been worse’, etc. (42-44). This is a big thing for me! Some of this stuff might seem obvious when you read it, but to see it logically explained and set out as a problem many people have was really a kick in the pants for me. Pychyl provides clear and concrete explanations of procrastination habits and proposes actionable solutions to overcome them. For me, just being aware of those habits is already helping me work past them. I also especially appreciated the ‘implementation intentions’ (self-regulatory statements) that he suggests. Here are a couple:

 IF I feel negative emotions when I face the task at hand, THEN I will stay put and not stop, put off the task, or run away. (24)

IF I say “I’ll feel more like doing this later”, THEN I will just get started on some aspect of the task. (55)

My one negative criticism is that the comic strips scattered throughout don’t add anything to the book. Though, they aren’t integrated with the text so they’re easily skippable.

Finally, as an afterthought, I wonder how people with depression would feel about this book. I’m not sure it would be the best resource for them. When I experienced culture shock (which can include a period of depression), I had a very hard time getting anything done outside of work. I think this was a different experience than when I’m simply procrastinating, and I could recognize that difference. I’m not sure what my point is here, exactly, but I feel like giving this book to a person with depression who appears to be ‘procrastinating’ might not be beneficial. 

The Bottom Line: An invaluable resource for anyone who finds themselves procrastinating. Solving the Procrastination Puzzle is an easily digestible book by an author who knows his stuff. This book will help you understand why you procrastinate (really why, not just ‘because you don’t want to do the thing’) and how to overcome it (really how, not just ‘by doing the thing’).

Further Reading: 

Review: 438 Days by Jonathan Franklin

Format/Source: Hardcover/Library
Published: November 2015
Publisher: Atria Books
Length: 269 pages
Genre: Non-fiction
Why I Read: Intriguing subject matter
Read If You: Like stories about people who overcome the impossible
Rating★★★★
Links: GoodReads IndieBound Chapters | Amazon 

Since reading In the Heart of the Sea, I’ve been interested in reading more stories about 19th century sea exploration and survival tales. 438 Days describes one man’s survival lost at sea for over a year. This story, however, differs from the historical stories in which I might find interest. The lost seaman is an El Salvadorian living in Mexico. Salvador Alvarenga became lost after a storm in November 2013. I’m astonished that, in spite of all our technological advances, the world remains so vast that we can still lose entire planes (let alone one man in a little boat) and never find them.

My heart broke for Ezequiel Córdoba, a young man who accompanies Alvarenga at the last minute. He has little experience on the expansive ocean, which causes him a great more suffering than Alvarenga initially experiences. An anecdote from their third week at sea demonstrates the relationship between the two:

Day 23: Córdoba was in worse shape. He pleaded with Alvarenga, “Oranges, bring me oranges.” Alvarenga stood above the prone man and assured him food was close. “Okay, I am going to the store, I will see if it is open, to bring you some food,” he said with conviction as he pointed to the horizon. “I will get tamales, oranges and shrimp.” Alvarenga strode with confidence for the few seconds it took to cross the boat. After waiting for five minutes in silence, he strode back with bad news. “The store is closed, but don’t worry, they open in an hour and they have fresh tortillas.” To his surprise, the scheme worked. Córdoba stopped moaning and fell asleep. The game of visiting the store bought Alvarenga a few hours of respite from t he cloud of fear that had seize Córdoba’s mind and rarely loosened its grip on the despairing young fisherman. (92-93)

This anecdote also illustrates an aspect of the book I appreciated. Franklin interviewed experts on various subjects related to Alvarenga’s journey. After relaying the story shared above, Franklin quotes Dr. John Leach, a “senior research fellow in survival psychology”. Leach explains why the shop exercise was beneficial to both Córdoba and Alvarenga’s mental health. Córdoba has something to look forward to and Alvarenga has “an automatic task […] a job that gives meaning to your existence” (94) to complete. There are numerous places where Alvarenga’s journey is explained and supplemented by experts in relevant fields, or by those who interact with Alvarenga.

Alvarenga’s survival techniques impressed me. Likely few other men would have been able to survive in his position, without his knowledge. What most surprised me was how he could survive on raw foods, eating creatures like fish and birds whole and drinking turtle blood. I got really stressed on those rare occasions when he would spot a boat. Like, it’s only day 126, you know he’s not going to be rescued (131)!

Because of In the Heart of the Sea, my mind did wander a bit towards the concept of cannibalism, but it was not something I really wanted to dwell, especially given the modern context of this story. The word is mentioned once in the book (about the media frenzy as Alvarenga’s story emerges). Alvarenga makes peace with Córdoba’s mother, but Córdoba’s brothers are unimpressed with Alvarenga’s explanation (253). I can’t imagine what it would be like to be in their position. I discovered while looking for news updates that Córdoba’s family filed legal action against Alvarenga, suing for $1 million, shortly after the book was published.

Towards the end of the book, I began to feel a little seasick myself. I wasn’t feeling so great and reading this book just made my head spin more! It’s a bit like trying to fathom the size of the universe – trying to imagine how Alvarenga survived 438 days lost in a tiny boat, 320 of those days alone. I don’t suppose I would survive a week. Franklin does a good job of illustrating how Alvarenga managed his time and what kind of headspace he strove for (and sometimes lost).

A cynic might say otherwise, but I’m impressed that Alvarenga chose to tell his story with a journalist who could share that story with the world. I did ponder the connection was between Alvarenga and Franklin (who is the sole author credited for the book). In the author’s afterword, Franklin asks the question I wondered all along – “What else [aside from financial benefits] motivated him to spend hour after hour with me, telling all the details of his story?” Franklin quotes Alvarenga’s answer at length, but here is the gist of it:

I suffered so much and for so long. Maybe if people read this they will realize that if I can make it, they can make it. Many people suffer only because of what happens in their head; I was also physically being tortured. I had no food. No water. If I can make it so can you. If one depressed person avoids committing suicide then the book is a success. (261) 

The Bottom Line: A fascinating tale of survival and resilience, unlike any other. Recommended for fans of narrative non-fiction.

Further Reading:

Brief Thoughts: The Education of Augie Merasty by Joseph Auguste Merasty and David Carpenter

This memoir offers a courageous and intimate chronicle of life in a residential school. Now a retired fisherman and trapper, the author was one of an estimated 150,000 First Nations, Inuit, and Metis children who were taken from their families and sent to government- funded, church-run schools, where they were subjected to a policy of “aggressive assimilation.” As Augie Merasty recounts, these schools did more than attempt to mold children in the ways of white society. They were taught to be ashamed of their native heritage and, as he experienced, often suffered physical and sexual abuse. But, even as he looks back on this painful part of his childhood, Merasty’s sense of humour and warm voice shine through.

★★★★ | GoodReads | IndieBound | Chapters | Amazon

  • Over 1/3 of this slim volume consists of modern-day explaining and exploring by David Carpenter, an author Merasty was eventually put in contact with after writing to the “dean of the University of Saskatchewan”, inquiring about a co-writer to help him with his memoir. Carpenter’s writings allow Merasty’s story to become a fuller story by showing the long-term impact of residential schools. The afterword is perhaps the most heartbreaking part of the book, to learn that Merasty did not have the support to pull out of his downward spiral even after he worked so hard on creating his own life and recording his story. 
  • Merasty narrates in first person. Although Carpenter has tidied up and smoothed out Merasty’s words, his distinct voice remains. I felt as though I could be reading a transcript of a friend telling me his experiences. Merasty originally started writing as part of his testimony for the Truth and Reconciliation Commission. His work is more a primary document than a literary memoir. Merasty’s real and raw perspective provides a valuable contribution to body of residential school memoirs. 
  • Merasty understands that he doesn’t need to write a detailed tell all in order to have his readers understand the horrors experienced by residential school attendees. His memoir never strays toward the graphic. There are times when reading a vivid account of a person’s experiences can be valuable, and all people have a right to share their experiences as they wish. There are times, however, when an account like Merasty’s – that explores and condemns the horrors but doesn’t require you to imagine them too closely – can be beneficial. You don’t necessarily need to have a clear full account to be moved someone’s story. Merasty’s memoir, therefore, is suitable for the faint-hearted or those new to the topic.
  • I found it somewhat comforting (not sure if that’s the right word given the subject) to read about the good people in the schools he remembers. In the first chapter, he describes all the people “who showed kindness and genuine care for us kids”, briefly mentioning ominous figures but dismissing them for the time being. Merasty encounters nasty beings, but his first chapter reminds you that there are some decent people in the world. 
  • The Education of Augie Merasty is a residential school memoir suitable for those new to the topic or those looking to read a first-hand account.

    “I have many more stories about all that transpired […]. But I sincerely hope that what I have related here will have some impact, so all that has happened in our school, and other schools in all parts of Canada – the abuse and terror in the lives of Indian children – does not occur ever again.” (86%)

      Brief Thoughts: The Karluk’s Last Voyage by Robert A. Bartlett

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      ★★★½

      Call it love of adventure if you will; it seems to me the life that ought to appeal to any man with red blood in his veins, for as long as there is a square mile of the old earth’s surface that is unexplored, man will want to seek out that spot and find out all about ti and bring back word of what he finds. Some people call the search for the North Pole a sporting event; to me it represents the unconquerable aspiration of mankind to attain an ideal. Our Karluk drift and its possibilities interested me keenly, for we were on the way to a vast region where man had never been; we were learning things about ocean currents and the influence of the winds and almost daily were bringing up strange specimens from the bottom of the sea. And I felt sure that come what might we would get back in safety to civilization. (50)

      • One of the earliest chapter books I remember reading, perhaps in grade three, is Traped in Ice by Eric Walters. The main character is Helen, a 13 year-old who boards the Karluk with her seamstress mother and younger brother. I remember being disappointed, at that age, when I  eventually found out she wasn’t real (There was a Helen aboard the Karluk – an 8 year old Inuit girl, on board with her mother, father, and baby sister).
      • One scene that stood out for me from Trapped In Ice was Captain Bartlett playing Chopin’s “Funeral March” as the ship goes down, and jumping from the ship to the ice at the last moment. Of all the bits of the tale I expected to be fictionalized…this one wasn’t! I didn’t know what happened to the Captain after he left the island to get help (other than that they were eventually rescued), so there was still a good chunk of the story left (about 50%) for me to learn about.
      • I enjoyed reading the tale in the Captain’s own words. I have a budding interest in seafaring exploration. This is the first book I’ve read that was written by someone who lived it. The tone is naturally a bit more formal and old-fashioned so while it wasn’t a dull read for me it felt much slower going as the two books I’d read immediately prior I had completed in a day each. I did get the sense that quite a lot of sugar-coating happens in this narration, if only by omission…This is not a tell-all where Bartlett disparages those who might rightly deserve to be. I have a couple other books on my TBR about the Karluk, so I’ll have to compare. Bartlett remains very factual at times, but his personality does come through. I especially felt for him as he wrote of his angst while he waited weeks for a ship to be finally sent to pick up the remainder of the Karluk crew, knowing that they had no idea if he had succeeded. 
      • How well off they were, for so long after the Karluk was trapped and sunk, surprised me. They had good stores of food and no health troubles. Of course, how they fared after Bartlett departed isn’t really dealt with (and see my comment on sugar-coating above…). Still, I’m always amazed at how much can be packed into a ship!
      • Bartlett has a largely decent attitude towards the Inuit. Though he at times uses the term savages, he seems to respect them and their abilities. He writes, “Then he [an Inuit he’s trying to trade with] voice the age-old cry of the savage against the civilized; the pity of it is that the savage is right. ‘White man steal from other man,’ he said. ‘White man promise bring things for fox skins and bear skins. White man no bring ’em. White man go ‘way, forget come back.'” (251)
      • I liked the bits where Bartlett explains about the practicalities of travelling in the Arctic. I even liked his lists of supplies! I was reminded of Chris Hadfield’s book, which really put into perspective the astonishing amount of knowledge of an astronaut must have in order to be able to survive many scenarios. Bartlett demonstrates his knowledge of Arctic ice travel, of rationing and keeping moral and navigating dangerous ice, which saved those who followed his lead.

      Pemmican has been the staple article of food for polar expeditions for many years and contains, in small compass, the essentials adequate to support life. It is put up by various packing-houses, expressly for such needs as ours. I have lived for a hundred and twenty days on pemmican, biscuit and tea and found it amply sufficient. We had two kinds of pemmican; one, for ourselves, consisting of beef, raisins, sugar and suet, all cooked together and pressed, was packed in blue tins; the other, for the dogs, without the raisins and sugar, in red tins. I remember once, after a talk which I was giving on the North Pole trip, a lady came up to me and inquired what pemmican was, which I had mentioned several times. I explained what it was made of and what it was used for. She thought for a moment and then said, “Well, what I don’t understand is how you shoot them.” (117-8)