Very frank, very well written, and actually? Kind of hopeful.

Being MortalI give this book five stars not because I loved it but because it is what I would call a necessary read, and I mean necessary for everyone, young, old, medical professional and laity alike. It’s about That Conversation, what Gawande calls in one chapter “Hard Conversations.” The subject is how we want to live out the end of our life.

Gawande is a surgeon and one of the best parts of this book is that he is learning how to have this conversation himself. He’s learning how to do it as a medical professional with his patients, and he’s not shy about telling us where and how he has screwed up. He is also learning how to do it as a son to his father, also a surgeon, who has been diagnosed with a rare spinal tumor.

The difficulty, he writes, is that in the last fifty years we have learned how to prolong life.

As recently as 1945, most deaths occurred in the home. By the 1980s, just 17 percent did…Across not just the United States but also the entire industrialized world, the experience of advanced aging and death has shifted to hospitals and nursing homes…You don’t have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help…Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need.

Later he writes

You’d think people would have rebelled. You’d think we would have burned the nursing homes to the ground.

But we haven’t, and new discoveries and better medical practice mean that citizens of industrialized nations are living longer, healthier lives. “A life,” Gawande writes, “designed to be safe but empty of anything they care about.” The trick now is to make sure our aging populations are not just safe, or even–heresy! sacrilege!–not safe at all, but living a life that achieves quality of life, not just quantity.

The good news is, things are changing. (He doesn’t say so but you know it has everything to do with the Boomers, a generation now making decisions for their parents, and who will soon be making those decisions–or not–for themselves.) Keren Brown Wilson built the first assisted living facility in Oregon in 1980, and when that concept became bastardized people like Dr. Tom Wilson revolutionized an assisted living facility with two dogs, four cats, 100 parakeets and child care for employees that brought children back into the lives of the inmates (using that word deliberately, as Gawande does himself).

Researchers studied the effects of this program over two years, comparing a variety of measures for Chase’s residents with those of residents at another nursing home nearby. Their study found that the number of prescriptions required per resident fell to half that of the control nursing home. Psychotropic drugs for agitation, like Haldol, decreased in particular. The total drug costs fell to just 38 percent of the comparison facility. Deaths fell 15 percent.

From inmates locked away from life, warehoused until they died, Dr. Wilson’s patients became once again members of a community. And as Gawande goes on to say, this experiment and others like it are beginning all across the nation.

There is also Hospice, which organization Gawande’s father chooses to help him through the end of his life with palliative care. For Hospice, it’s all about making the end of each individual story as valuable to them as is physically possible for them. It’s impossible to say enough good things about Hospice and Gawande doesn’t stint them here. (Full disclosure: I already support Hospice and this book is making me double that support this year.)

I know it sounds a little macabre, but this is the one book you really should read. Make a teenager read it and they will understand that much more about what Grandma is going through. Make a Millennial read it and he’ll understand in spades how important that retirement plan is and how they should start one now. Make your doctor read it and she’ll see how important first asking those essential questions is, “What do you want? What is most important to you?” instead of automatically reaching for the scalpel or the drugs.

“Death,” writes Gawande

is normal. Death may be the enemy, but it is also the natural order of things. I knew these truths abstractly, but I didn’t know them concretely–that they could be truths not just for everyone but also for this person right in front of me, for this person I was responsible for.

Me, either. Now I feel like I do. Read this book, and recommend it to everyone you know. It is very frank, very well written, and actually? Kind of hopeful.

****
See also on Vox, “2015 is the year America started having a sane conversation about death,” http://www.vox.com/2015/12/16/1011744….

Year in Space

Follow Commander Scott Kelly on Twitter for some amazing views of glorious Planet Earth. My favorite so far?

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Well, of course.

Always from the top of the page on down.

“And how is your writing going, Michael?”
“Still from the top of the page on down, Mrs. Raglan.”

–Frederick Raphael, After the War

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Wow. John Sandford just picked Though Not Dead for his Facebook book club.

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[Click on either image above for a link straight to John’s FB Book Club page.]

I met John once in Chicago years ago when we passed each other on book tour. He’s a really fun and interesting guy to talk to, so if he’s ever in your area you should definitely go see him. And then of course there are the books. (My favorite is Winter’s Prey.)

Though Not Dead is the eighteenth Kate Shugak novel, and my favorite. An elder has died and left a puzzle for Kate to solve which sends her on what is essentially a scavenger hunt through the last seventy years of Alaskan history.

I was able to do something in Though Not Dead I’ve always wanted to do: tell the modern history of the state of Alaska through the life of a single character. Everything’s in here, the Klondike Gold Rush, the salmon rush, the defense rush of World War II, the Great Alaskan Earthquake of 1964, the oil rush. I had a blast.

Further, Though Not Dead contains my most favorite line from all my books:

“So, does he look like he might taste familiar?”

Though Not Dead

He was the first white naturalist ever to observe and sample the flora and fauna and Native life of Alaska.

Where the Sea Breaks Its Back: The Epic Story - Georg Steller & the Russian Exploration of AKWhere the Sea Breaks Its Back: The Epic Story – Georg Steller & the Russian Exploration of AK by Corey Ford

The Steller’s jay, common to the western American coast from southcentral Alaska to Central America, is a relation of the eastern blue jay, common to central and east coastal America. The Steller’s jay is gorgeous, a graduated blue with an aggressive crest that stands straight up and makes it look like Mr. T in a really bad mood. I’ve grown up around the Steller’s jay, they’re the default blue jay for me, and so it was with a delightful shock of recognition that I read this passage in Corey Ford’s Where the Sea Breaks Its Back

He sent Lepekhin to shoot some of the strange and unknown birds he had noticed…He “placed in my hands a single specimen, of which I remember have seen a likeness painted in lively colors and described in the newest account of the birds of the Carolinas.” Steller’s fantastic memory had recalled a hand-colored plate of the eastern American bluejay in Mark Catesby’s Natural History of Carolina, Florida, etc., which he had seen years before in the library of the St. Petersburg Academy; and he identified Lepekhin’s find as its west coast cousin, known today as Cyanocitta stelleri, or Steller’s Jay. Now his last doubts about the land they had discovered were resolved. “This bird proved to me that we were really in America.”

steller's jay

The words are Georg Steller’s, a German naturalist in the employ of Russia. It was July 20, 1741, and after six weeks of wandering all over what today is known as the Gulf of Alaska with no maps, too few provisions, a to put it politely fractious multinational crew, having lost sight of the second ship in their expedition, Steller stepped ashore on what is today known as Kayak Island in what today is known as Prince William Sound. He was the first white naturalist ever to observe and sample the flora and fauna and Native life of Alaska.

He was a capable scientist and a terrific writer. He was also a difficult personality frustrated by what he perceived to be the idiots he sailed with.

“Just at the time when it was most necessary to apply reason in order to attain the wished-for object,” he wrote in his journal, “the erratic behavior of the naval officers began. They commenced to ridicule sneeringly and to leave unheeded every opinion offered by anybody not a seaman, as if, with the rules of navigation, and they had also acquired all the other science and logic. And at a time when a single day–so many of which were afterwards spent in vain–might have been decisive for the whole enterprise, the course was suddenly changed to north.”

He was generally right about the crew, especially the execrable sailing master Khitrov, who knew everything about sailing except how to navigate. It didn’t make Steller any more beloved on board. He wanted to winter in Alaska but the captain, the Dane Vitus Bering, decides to make for Kamchatka instead. The Mother of Storms loses her temper with them and it amazes me how well the St. Peter stands up under all the horrific storms she throws at them, but eventually they wreck on what is today known as Bering Island and spend the winter there. To which wreck we owe our knowledge of Steller’s sea cow, a northern relative of the manatee which went extinct shortly thereafter.

The following spring, after the death of fully a third of the crew from scurvy and exposure, including Bering, after a winter of being literally nibbled to death by the blue foxes that overran the Aleutians at that time, they cannibalize the wreck of the St. Peter into a longboat and set off again for home, reaching it in less than six weeks. All of Steller’s carefully preserved specimens had to be left behind.

In such fraught circumstances is born an astonishingly thorough and thoughtful examination of this new land. Steller is the first to describe the life cycles and to name the five species of Pacific salmon. He is the first white man to discover the salmonberry. He is the only naturalist ever to have observed the Steller’s sea monkey. Alas, while they’ve been gone there has been a regime change in St. Petersburg and the old spirit of exploration is gone. Steller’s report is filed and forgotten in the archives of the Russian Academy of Science, where it can still be seen today, and he himself died in penury and ignominy.

This book was first published in 1966 but there is nothing dry or dated about either the subject matter or style. This is a riveting, rip-snorting survival tale along the lines of Alfred Lansing’s Endurance. The last chapter, in which Ford describes what happened after the Bering expedition brought back news of the abundance of sea otters and fur seals in Alaska, stimulating a horde of promyshlenniki and the subsequent slaughter of Alaskan wildlife and rape of Alaska Natives is a cautionary tale that carries a grim warning into the present day. Highly, highly recommended.

View all my reviews

Dana Peak and Mount Dana. But of course.

A long while back my friend Donna Freedman asked me to write a list of the ten best Alaska place names for a City Smart Anchorage guidebook, which led to one of the most fun afternoons I ever spent in the Alaska Room of the Loussac Library in Anchorage. The City Smart Guides are, alas, no more, but here is the list of names I came up with.


turnagain1. Turnagain Arm. In yet another flop at finding the Northwest Passage, Captain Cook had to “turn again” here.
denali
2. Denali. The tallest mountain in North America. Not McKinley, not Big Mac — Denali. De-NAH-lee. It’s a Tanaina word for “home of the sun” or “the high one.”
aleutians
3. Alyeska. An Aleut word distinguishing the Aleutian Islands from the mainland, or “the great land.” ‘Nuff said.

4. Picnic Harbor. So named because during an October blow, the harbor is a picnic compared to beating through Chugach Passage.

5. Farewell Burn. Between Rainy Pass and Rohn on the Iditarod Trail, it is farewell to sanity as mushers suffering from dehydration and sleep deprivation begin hallucinating about white lights, crying friends, dead relatives and Hawaiian beaches.
Dana and silver salmon
6. Salmon. There are two Salmon Bays, one Salmon Bay Lake, two Salmon Berry Lakes, thirteen Salmon Creeks, one Salmon Creek Divide, one Salmon Creek Reservoir, one Salmon Flats, one Salmon Fork, one Salmon Fork Black River, one Salmon Island, one Salmon Lagoon, four Salmon Lakes, one Salmon Mountain, one Salmon Pass, one Salmon Point, one Salmon Ridge, seven Salmon Rivers, one Salmon Run, one Salmon Slough, one Salmon Trout River, and two villages named Salmon. And these are only the places in English.

7. Egegik. A village on Bristol Bay. The name is possibly derived from the Yupik word iguugek, meaning “his testicles.” I don’t know the story here, but there is bound to be one.
killisnoo
8. Killisnoo: A village south of Angoon. Corrupted from the Tlingit word kootsnahoo, meaning “bear’s rectum.” A close second for Number 8 was Anaktuvuk Pass, which means either “caribou shit” or “where the caribou shit.”

9. Taiga. The name of my father’s hunting and fishing lodge on the Kichatna River and the setting of the ninth Kate Shugak novel, Hunter’s Moon. Taigataiga means “bear shit” in some obscure Athabaskan dialect.

10. Dana Peak (north of Petersburg) and Mount Dana (northeast of Pavlov Bay). But of course.


Donna now writes the Frugal Cool blog over on MSN.
Here is her personal blog, where she can show you how to get free stuff. She’s famous for that.
Every other Tuesday she writes for Get Rich Slowly.

I’d chosen Valladolid.

I’d chosen Valladolid, not because I knew anything about it, but because I liked the sound of its syllables.

–Laurie Lee, As I Walked Out One Midsummer Morning

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