Book Reviews

In his memoir ‘When Breath Becomes Air’, Paul Kalanithi writes with elegant clarity about his journey from euro-surgeon through cancer toward death. He writes with poignancy looking back at his life. First through literature, his family life, then medical training and neuro-science, he is “Seeking a deeper understanding of a life of the mind.” He struggles as a “Physiological-Spiritual Man” (Walt Whitman) to find a way, “that the language of life as experienced – of passion, of hunger, of love – bore some relationship, however convoluted, to the language of neurons, digestive tracts and heart beats.” A cancer diagnosis brings a different perspective to his life’s purpose as “the future I had imagined…evaporated.” He sees with new eyes as he experiences being the patient after years of being the doctor. He grapples to find, “What makes human life meaningful, even in the face of death and decay.” He seeks to act “as death’s ambassador,” to show us in both medical and human terms, “Here’s what lies up ahead on the road.” Kalanithi is unflinching in his portrayal of the feelings which make him afraid, frustrated and joyful. He says he “started in this career, in part, to pursue death; to grasp it, uncloak it, and see it eye-to-eye, unblinking.” This is a book about the responsibility those who care for us hold, and as a reminder for all those who will die. (If you think that’s not you, think again). He writes, “Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis I knew that someday I would die but I didn’t know when. But now I knew it acutely.”

‘A Little Life’ is an epic tale by Hanya Yanagihara. It documents the lives of a small circle of close male friends, over four decades. I began it with trepidation, wondering if I would be bored with the lives of four American students, who at first seem unremarkable. The story slowly wriggles beneath the surface of the characters to discover their emotional struggles. As their lives interweave, what unfolds is a detailed depiction of the repercussions of both physical and emotional abuse. The novel explores shame graphically. With relentless detail it describes pain and suffering. Sometimes it goes beyond the bearable as a reader, but that’s the heart of what Yanagihara is trying to show. She takes us into the landscape of survival and of disability. It is a remarkable telling, ambitious in scope, sometimes too dramatic. I wanted the protagonists to make different choices. It’s an excruciating read, but it stayed with me, and I wanted to know how it would play out. Through reading to the end, I found an empathetic understanding of the link between abuse and shame that I had known but never really ‘got’ before. It also delivers a visceral examination of self-harm in the wake of trauma. It twins inner misery with outer lives that are against type, which makes an interesting paradox. I think Yanagihara also explores the criteria to measure success – outward achievements, overcoming physical wounds, or the capacity to endure – and how best to respond and relate to those who hurt. It is not for the faint-hearted.

‘A Manual for Heartache; How to Feel Better’ by Cathy Rentzenbrink, illuminates, a process of recovery, in not too many words. After her brother’s traumatic death, Rentzenbrink felt ‘stuck’ in grief. Looking beyond the content of her story, she finds what we all share. She explains, “all loss – from the untimely death of a loved one, through to the loss of innocence, all the way to having a bag stolen – feels as though it is specific to us, but is actually universal.” What she does brilliantly is describe nebulous territories like depression, shame, grief, and gradual recovery in metaphors that resonate. “Grenades come in all shapes and sizes,” is how she describes the impact of different deaths and traumas. And of crying, “Give in to tears, think of it like bleeding a radiator.” Although a self-confessed ‘Pollyanna’, I found her willingness to expose her vulnerability comforting. “I realised how many of us look as though we’re navigating life in an apparently successful or even happy way, yet are weighed down by burdens and exhausted from the effort of hiding our sadness.” She articulates “the pursuit of distracting ourselves from our pain, so chaos and destruction often follow in the wake of the first wound.” She also reveals how touching into her pain allowed a shift to happen. “And in daring to look again on the most painful scenes from my life, I also reconnected with the warmer, sweeter memories that had been trapped in the no-go area.” Rentzenbrink’s perspective is reassuring, but not prescriptive. She sees the holes in secular society, reaches for a meaningful weaving between grief and love, and ends by offering questions for the reader to consider.

Kathryn Mannix – palliative care consultant – meets those who are referred to her ‘where they are’. With the aid of “tea-with-sympathy” she listens, she sits with them, and she puts her immense experience and wisdom at their disposal. As a reader, she guides us to “accompany dying strangers across the pages”. She lets us into the relationship between those approaching end of life and their care-givers. The stories within this book often made me shed a tear, as they poignantly describe “what a privilege, to be able to observe families as they are forged in a furnace of love and belonging, so often with its fiercest heat at the ebbing of a life.” Mannix describes working within the medical profession, yet with the shift moving from being “focused not on saving life at any cost, but on enabling goodbye.” This book is also a practical read. “Reclaiming the language of illness and dying enables us to have simple, unambiguous conversations about death.” Just as Mannix with her patients hears and has needed conversations to demystify the process of dying, and helps them to identify what is important, she encourages us to do the same. “We should all have those conversations with our dear ones, and sooner rather than later.”

In ‘Underland’ Robert Macfarlane documents a series of journeys deep underground. In the physical routes taken – often dangerous, breath taking – we accompany him down into caves, mines, catacombs, burial sites (for both humans and nuclear waste), forests and glaciers. Exploring humankind’s different calls to go down, “the same three tasks recur across cultures and epochs: to shelter what is precious, to yield what is valuable, and to dispose of what is harmful.” Beyond the actual journeys of geography, geology and history, he takes us into a beautifully written telling of what lies beneath. “The underland’s difficulty of access has long made it a means of symbolising what cannot openly be said or seen: loss, grief…physical pain.” “In the Celtic tradition ‘thin places’ are those sites where the borders between worlds or epochs feel at their most fragile.” Walking in liminal spaces alongside him, I feel this deep time connection. His encounter with pre-historic cave art in Lofoten, Norway made me tingle. “The cave is a slip-rift, an entrance to darkness where time shifts, pauses, folds.” “Force yourself to see more deeply,” he encourages. Most hopeful for me is his telling of the under storey of the ‘wood wide web’. Hearing how trees ‘en-kiss’ to share nutrients, “the fungal networks that lace woodland soil, joining individual trees into intercommunicating trees,” I cried. ‘Underland’ is a poetic map of the mystery of underground spaces.

“If there is ever to be any real peace on earth, all people need to relearn and re-establish the now diminished and hidden arts of Grief and Praise, for one without the other is not possible.” Martin Prechtel’s uncompromising and passionate message rubs off the page. His words seduce with rowdy charm. He urges us to shake off our avoidance of grief, to embrace life through praise, to recognise the consequences of the “unmetabolized war grief of past generations”. Ideas grown in hot dry New Mexico land amongst sage, marjoram and lavender, taking root in a very English garden.

This is a brilliant book about life. I gallop through the seventeen brief encounters with the fragility of the human body in Maggie O’Farrell’s ‘I Am, I Am, I Am’. It’s beautiful words capture pivotal moments in her family life. Something happens, or doesn’t happen, but each recounting of an intimate incident leaves me catching my breath, counting my own lives and lucky stars.