Unabashedly Bookish

[#1]

Last night I saw a powerful play out about the health care debate, Anna Deveare Smith's Let Me Down Easy.  Smith writes in a unique way: She writes one-woman plays by recording interviews with real people, cutting them to size, and committing them to memory.  She becomes each of her interviewees on stage, to present the sort of powerful discussion that would never happen, by chance, around a dinner table.

The focus here is health care, for which Smith brings about twenty diverse voices to the table, from ABC commentator Joel Siegel to bicyclist Lance Armstrong.  One grand idea that emerges is that in order to reform health care, we need to deal with the strange way we Americans think of death.

The story opens with portraits of strength.  Onto the stage walk a series of people to give their monologues (what they said in their interviews with Smith).  We meet Armstrong, who won seven consecutive Tour de France's; Brent Williams, a professional bull rider; Michael Bentt, a Heavyweight Champion Boxer; and Lauren Hutton, the first model to sign a million-dollar contract.  Each owns the stage with his or her graceful body and talks about how working hard on that body (in biking, riding, fighting, or dieting) was a testament to will.  "You know, when, when you're riding a bull"--like when you're in great shape, and very alive--says Brent Williams, "you're feeling like...there ain't nothing in the world that could...beat you up or nothing like that, 'cause there's just so much power."  In turn, Armstrong stands wide-legged at his breakfast table, grabs a whole-grain muffin, one side in each palm, and eats in fistfuls as he says he lives to express the potential of his body.  After he got testicular cancer, he says, he raced harder than he ever had.  After all, "I certainly, I didn't, I just didn't want to face this, this, this demon called failure."  We see why Armstrong became a champion: He does not separate losing and death.  Each is a type of failure.

The problem is--the play suggests--that we too often think of death as failure.  We flash to a chat with Sally Jenkins, a sportswriter for The Washington Post.  She says, with manic energy about her lifetime spent chronicling our modern heroes, that athletes are our heroes because they symbolize strength that doesn't fade to old age.  We want our athletes to retire before they start losing, so that we can hold onto that ideal image.  Jenkins goes on to say that athletes die twice.  One death is retirement, and the second is the one they share with the rest of us.  The first death is often a worse blow to a top athlete, because it means an end of the identity he (and his fan base) likes best.

Soon, we sit in a quieter spot with Phil Pizzo, a Dean at Stanford Medical School.  To deal with our health care crisis, he says, we're going to have to stop being so scared of death.  About 27 percent of Medicare dollars are spent on people in the last stage of life.  That's because we are in denial about death and use elaborate technologies to extend the heart beat and the breath and the vital signs even after the quality of life is gone.

Doctors use machinery to extend the days that a heart beats, because death marks their own professional limitations, says Reverend Peter Gomes, a Minister at Memorial Church at Harvard University.   And when death comes, doctors tend to leave the room, turning the patient over to the clergy, as if the stages of dying were radically distant from life.  "When it [is] clear that [a patient isn't] going to recover," Gomes said, "the doctors [say], 'Well, we'll leave him to you now.  To the clergy.'  ...I thought, 'Cowards. Why don't you stick around?'  ...Their job was to keep the person here with all the science and the technology that we produce.  [When death comes,] the doctors resent the fact that they're leaving in defeat, because death is a defeat for them.  So they have to go off and save somebody else.  They don't want to be around for the moment of expiration.  One of the most important things that you can do is to be with someone when they die. And the doctors don't like it, so off they go."

Gomes lets us know that sitting with someone at his death is a way of accepting that person.  So we see Trudy Howell, the director of Chance Orphanage in South Africa, which houses children dying of AIDS.  Howell helps these children die by helping them feel safe.  One of these children remembers her mother, who died some years before, and Howell buries this child next to her mother when the time comes.  That act of kindness reverberates against the monologue of Susan Youens, a teacher who is in love with Franz Schubert and tells some of that composer's life story.  At age 20, Schubert put to the poem "Death and the Maiden" to music.  In the poem, death sings, "Give me your hand.../I am not cruel,/You will sleep softly in my arms."  When Schubert learned he had syphilis and would die young, he worked madly at "Death and The Maiden" and composed almost 1000 works before dying at age 31.  Youens loves what Schubert made of life: His work was partly so rich because it came from his meditation on dying.

One of the best parts of the play comes from Eduardo Bruera, a doctor at the Anderson Cancer Center.  He says that death is a loss that we want to ignore, but really isn't so different from other losses that shape our lives.  Death is not categorically different than other moments in our lives; and we will likely handle our moment of death in the way that we've confronted our other big losses, like heartbreak or being fired or getting injured, he says.  If we've confronted those things with stoicism, we'll probably meet death with stoicism.  If we get angry over loss, we'll probably get angry about death.  If loss depresses us, so will death.  Death, he means, is another factor in our lives as we know it, and we can actually work on our relationship to death by working on our reactions to events we're currently experiencing.

In this play of voices, Smith does something that great literature always does: She lets new ideas rise from a dialogue that no one viewpoint controls.  She means to say that we need a new, wide dialogue about death in order to figure out modern problems about health care, insurance, and our sense of safety.

I'd like to know any of your thoughts on the above.

[#2]

Wow, what a great blog.  I too recently saw this show, and your words have brought me right back to the extraordinary emotion that Smith evokes.  For anyone who lives in NYC or is visiting in the next couple of weeks (the show closes on December 6), please skip Wicked and Mamma Mia and see this instead!

http://www.2st.com/component/option,com_plays/task,viewPlay/id,129

[#3]

You're right, "....no one view point controls". Points of view:  Age, occupations, religions, heritage; views of death as a child, as middle aged, and ageing.  Security, or lack of, in the healthcare system, support systems...all play out.  I know what I felt as a child, when I lost someone;  I know what I felt in middle age, and I now know what I feel, this moment.

I can't speak for a doctor who is losing a patient.  I only surmise.  Their job as a physician is to help that patient.  If helping means curing, or if it means helping in the process of dying.  The ones that may step aside, to allow family or clergy to do their job, then that's what they do.  Is it reneging their responsibility, to step aside?  I don't think so.  There are many doctors and nurses who cry for their patients, just as a family member would.  We just don't see it.  It's hard to let go; it's as though watching a friend, or family member, die, I'm sure. It doesn't mean they, the caregivers, haven't done their best, and walking away, doesn't mean that that life didn't have value and worth:  It's hard to witness that loss.

As I age, I do think about death.  How would I want to be seen in those last days?  I think about my own loss, not to be able to see my children grow further in their life, not being there to help them, if needed; or my grandkids to grow into adulthood, loving them more each day...I miss that, just thinking about death.  If it's selfish, then I guess that's how I feel.  I want to be graceful in death, I want to be strong, not whining about my own loss, but I grieve for my children's, and grandchildren's, feelings of loss.  I cry, right now,  just thinking of what they, themselves, will feel when I'm gone.  Staying strong, and beautiful, and productive, and real, that's what I want for them, or anyone, who faces loss.

[#4]

Last night, and this morning, this subject weighed heavily on my mind.  Tears wouldn't stop.  It's one subject I really don't like to think about, much less talk about.  But, my words are there in black and white, never-the-less. 

That loss is an horrendous feeling for me,  It links itself with the word love.  lately, I've wondered more about that word, love, and how it fits into my life at this moment.  I fight it.  It feels like a death sentence for some reason.  To love is to feel loss.  I know, that sounds strange.

After I wrote those words in my last post, I felt like a liar, a fake, a fraud.  I feel like I'm always sitting in judement of another's situation, or circumstance.  I presume too much.  It's more a reflection, I think, of my own feelings, as I would like to see myself in those ideal positions.  The real truth of the matter is, I ran away from those truths.  I turned my heart off, and froze when it was required of me to take action, and love.  These were my parents.  I walked away and couldn't face what love was, or should be, when their deaths faced me.  How do you understand those moments of grief, when you won't allow it to touch you?  Again, more forgiveness is needed.  I struggle, it seems, on a daily bases, to forgive myself.  As old as I am, you'd think that would have been resolved by now.  But, I don't know what I could have done differently.  It was who I was, and probably still am.

[#5]

Hi Kathy,

I think I understand your feeling there--that in restrospect, we wish we could have loved more, or been more present.  I've felt that.

[#6]

Right.

[#7]

Well, again, not wanting to think about death, and here it is once again, slapping me in the face!  Da*n mail!  Plowing through a weeks worth of mail, the usual advertisements from cable companies, credit card companies, companies wanting money, again, because I gave to them, once....compaines wanting me to change insurance companies, and the mail that slaps me in the face...the cremation company.  Here is what I read, that takes me back to seeing just how old these companies think I am.  And just how old I start to feel!  If you're fifty-five or older, there is no way you can avoid this thought of dying!  It's a given.  It's thrown at you every chance these companies want to throw it.  Do I have a choice, to NOT think about death?  H-no!  This is what I read this morning - talk about feelings of guilt!  I'm sorry I have to die one of these days!  Geeze!:

Dear Ms. S----

Nobody enjoys thinking about death, but the best time to plan for it is ahead of time-----when good decisions can be made in a thoughtful manner.

It's your responsibility.

How do we acknowledge the people we love?  How do we see to it that we leave this world a better place for others after us?  We can take responsibility for those things we have the abilitiy to control.  Don't leave these difficult decisions to family on the worst day of their lives.  It's your responsibility.

Plan for the inevitable.

S---- Cremation provides simple, earth-friendly, and affordable cremation services.  We help people plan ahead---not only for the benefit of their loved ones, but to ensure we leave the planet in good shape when we depart.

We offer these services because our clients are caring enough not to burden their loved ones with an awkward duty at a time when they are most emotionally vulnerable; wise enough to consider the many environmentally sound advantages of cremation; and smart enough to know value when they see it.

Gain peace of mind.

If you agree, and would like to learn more, we offer our assistance.  Please complete the enclosed reply card and mail it back to us.

We are not a traditional funeral home or mortuary.  We simply porvide complete cremation services specifically tailored to meet your needs and wishes---for the most resonalbe prices and the lightest impact on the environment.