Beginning the End-of-Life Discussion

Hope for a Cool Pillow
by Margaret Overton

Physician Margaret Overton experiences two sides of the same coin in Hope for a Cool Pillow, her new memoir, which tackles disparate views of healthcare.

Overton, a Chicagoan whose first memoir, Good in a Crisis, was one of Chicago Book Review’s Best Books of 2014, examines the deaths of her parents, which she experiences both as a daughter and as a physician, one eye on the experience as a loved one, one eye on the experience as a medical professional. This dual view is at the heart of Hope for a Cool Pillow, which looks at the emotional, medical, financial, physical, legal, and logistical aspects of the end-of-life journey.

The book opens with a reminiscence of Overton’s early healthcare career as she shares a story from her first clinical rotation during her third year of medical school. Working with a 102-year-old patient named Esther, Overton admires her “quiet aplomb” and approves of the do-not-resuscitate order that would keep doctors from undertaking any emergency rescue measures to keep her alive. This, Overton thinks, “is the way to go”—death without extraordinary intervention to extend someone’s life. “A quiet death without fuss or muss.”

It is through this lens that we follow Overton on her dual journey, one of a healthcare professional, one of a daughter watching her parents come to the end of their lives.

Her father was the first of her parents to go. An orderly man, Carl “had an obsessive interest in end-of-life planning.” Here was a man who, every day for forty-five years, “timed his four-and-a-half-mile drive to and from work.” In 1997, Carl’s health went into decline. Over the next several months, Carl would be in and out of the hospital for various check-ups, surgeries, treatments, and chemotherapy. By Autumn 1998, he had died.

Twelve years later, Overton’s mother passed away, also after a period of declining health. Dementia set in, and during her last year of life, she succumbed quickly, a difficult death wherein pain “just gripped her and then let her go.”

During the twelve years that intervened between the passing of her father and her mother, healthcare had evolved such that hospice had become big business. While her father lay dying, Overton’s family dealt with one hospice nurse who took care of Carl for nearly three weeks. For her mother, seven different nurses cared for her over the course of nearly a month. It was an unwelcome change in Overton’s eyes, a transformation to a less personal, more clinical process that extended life without necessarily making end of life any better or any easier.

Margaret Overton

While we watch Overton deal with the deaths of her parents, we also see her grow in her career as a physician. We see her treat various patients, some of whom make it, some of whom don’t. We see her attend a program called “Managing Healthcare Delivery” at Harvard University, a course in which she quickly loses interest as she ponders the gulf between healthcare providers and patients, between for-profit and not-for-profit care, between easing death and extending life.

There is much to ponder in these pages. End-of-life planning—how we want our wills and finances to be structured, how we want our lives to end, how much medical intervention we wish to endure—is a tricky, personal issue. It’s one most of us don’t want to think about, not for ourselves, not for our parents. And, yet, with the rising cost of healthcare and with the expansion of life-saving measures, it’s something we must think about.

Overton’s story is interesting, if not perhaps somewhat fragmented. Told in a non-linear fashion, Hope for a Cool Pillow jumps around from topic to topic. It’s a little messy and convoluted. It feels a little foggy, as though Overton was struggling to come to grips with the various issues that she confronted during the decade or so covered in the book.

That might be a turn-off for some readers, but it’s not necessarily a flaw. In fact, one could argue that the wandering, choppy approach is just about as real as real can be: It mimics life.

Few of us have the luxury of dealing with the death of a parent in a bubble or a vacuum. The rest of life doesn’t stop while a parent is struggling with cancer or Alzheimer’s or heart disease. The world doesn’t stop turning while we endure the hefty tolls exacted by the process of dying and the aftermath of death.

Death is, for most of us, an uncomfortable topic. In Hope for a Cool Pillow, Overton has shared an intimate insider’s view of different sides of the healthcare equation. As such, it is a thought-provoking read. Perhaps not a comfortable read, but one that provides an opportunity to think about the unthinkable, opening the door for those discussions we know we ought to be having with the people we love.

March 2016, Outpost 19
Memoir
$16, paperback, 181 pages
ISBN: 978-1-937402-90-7

—Reviewed by Kelli Christiansen

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Mornings and Mindfulness

The Morning Hour
by Richard Quinney

Born in 1934 in Elkhorn, Wisconsin, Richard Quinney has been a Sociology professor, photographer, Delegate of Crime Prevention for the Eisenhower Foundation, husband, father, Buddhist meditation practitioner, and author of more than a dozen books about Sociology, nature, and photography. Perhaps it is no wonder, then, that his latest work, The Morning Hour, which comprises a series of reflections on his personal life, covers such a wide range of topics.

In the preface to his book, Quinney reveals the origin of its title. Every day for decades, the morning hours have been his time “for contemplation and of the writing a few words to the day.” He fills his journals with thoughts about things he finds most interesting and dear: family, work, the beauty of the natural world, what it means to die. Now in his eighties, Quinney has completed more than fifty years’ worth of journal entries. The Morning Hour contains a selection of these writings, organized thematically, each one no more than a couple pages long. Despite their brevity, the reflections are impressively erudite, evidence of a curious mind that has devoured a lifetime’s worth of literature, from Homer’s epics to The Great Gatsby to the Tibetan Book of the Dead. From these books he’s derived questions—and a few answers—about what it means to live mindfully and with intention.

His reflections are perhaps most insightful when he connects his existential musings to smaller, more personal moments. In one particularly moving passage, Quinney describes his experience of standing in front of Georges-Pierre Seurat’s painting Sunday Afternoon on the Island of La Grande Jatte at the Art Institute of Chicago, squinting so “the dots of paint make new colors.” His mind drifts to thoughts of his daughter, who lives in Paris, and what it means to be her father and a grandfather to her children. The passage is both touching and provocative, a lovely reminder that great art is more than the sum of its formal aesthetics: When considered thoughtfully, it can evoke some of life’s most important insights.

Author Richard Quinney

The book also shares the author’s insights into death. When he was a child, writes Quinney, his religious mother made him recite the Lord’s Prayer every evening before bed, the last two lines, he reminds us, centered on dying: “If I should die before I wake/I pray the Lord my soul to take.” For most of his adult life, Quinney did not recite the prayer. But now in old age, he finds himself thinking of it often. As depressing as this preoccupation with dying may sound, Quinney’s view of death, we learn, is informed by The Diamond Sutra and other Buddhist writings, which describe the process of dying not as an end to life but as the ongoing, natural state of all living things. Here he illustrates the Buddhist concept of death by comparing it to the act of looking at photographs:

There is a difference between the portrait of the ancestor living at the instant of the photograph and my viewing of the portrait after the ancestor has passed away. […] And there is the realization that there is a fine line, and only a fine line, between those who once lived and those of us who live today. The separation between the living and the dead vanishes readily with time. The vastness of our time of being unborn makes our living, our existing, but a drop of dew, a flash of lightning, and a dream. Unborn is our primary natural state.

The book’s frequent focus on death does not detract from its uplifting messages about living well. When considering life beyond family, the book brims with images of blooming gardens, birds in flight, and majestic mammals, which together form a vital and animated view of the natural world. The juxtaposition of bountiful life with death is striking but important, it seems, to Quinney’s overarching philosophy. By insisting that life and death are worth pondering in equal measure, Quinney creates a vision of existence that enlightens and comforts—impermanence, he seems to say, is a part of being human, and in our impermanence, we become both precious and beautiful.

April 2016, Borderland Books/University of Wisconsin Press
Nonfiction/Mindfulness & Meditation
$24, hardcover, 176 pages
ISBN: 978-0-9965052-1-5

—Reviewed by Amy Brady

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A Life Lived Thoroughly

Black Dove:
Mama, Mi’jo and Me
by Ana Castillo

Best known for her fiction and poetry, Ana Castillo takes a retrospective look at her life in Black Dove: Mama, Mi’jo and Me, a collection of essays. While some of essays were previously published throughout the years, most were written specifically for this collection. All of them weave together to tell Castillo’s life story and that of the two people who have changed her life the most: her mother and her son.

Unsurprisingly to readers familiar with Castillo’s work, she devotes much of this collection to the strong women in her family. Readers get a glimpse of Castillo’s migratory origins, starting with her mother, who was born in Nebraska but forced to move back to Mexico in poverty. Castillo’s own Chicago upbringing goes back to a time of youth protest (e.g., the Vietnam War), Martin Luther King’s murder, and Iceberg Slim novels. We learn of Castillo’s humble, working-class roots, her early will to explore worlds outside of herself, and parents who, despite wanting the best for their children, remained distant after their long days as factory workers.

A few essays later, following Castillo’s turbulent entrance into young womanhood, she discusses her struggles as a single, feminist mother raising a son. The journey to nurture a child in a world hostile to black and brown children proves to be a rocky one. Moments of pride mingle with moments of fear and anguish, the culmination of which is revealed when her son, whom she affectionately calls Mi’jo, is sentenced to jail time. Castillo ends the book by coming full circle with the end of her mother’s life and the end of her role as a daughter.

Black Dove is equal parts memoir and family portrait. Castillo narrates her full life with humor and a touch of self-deprecation. Describing a near-death experience in “When I Died in Oaxaca,” Castillo writes, “I may have just suffered the humiliation as a Mexican American not knowing who the Mexican president was at the hour of my death but that didn’t mean my lover had to start treating me like a total gringa.”

If Castillo can’t make sense of life’s events, she can at least make some light of them. Her essays describe injustice in its many forms (e.g., the immigrant’s exploited labor, police surveillance, the prison industrial complex). Castillo also navigates her many identities, each one with its own triumphs and heartbreaks. As a daughter, Castillo reflects on her yearning to know and be close to her mother. As a mother, Castillo reflects on her yearning to prepare and protect her son—now grown with a family—as she knows how, and whether that is enough. As a Chicana, Castillo reflects on her own breed of American. Those identities merely scratch the surface of a complex, dynamic individual.

Given the largely chronological order of the essays, a few of them seem a touch out of place, such as the piece about Castillo’s near-death experience and a piece toward the end of the book in which she reflects on religion. A few essays may take readers out of the natural flow of Black Dove, though they probably read well on their own.

Even while Castillo writes to us as a woman of many identities, the one she emphasizes most is that of a singular person with a story—a story not necessarily worth more or less than anyone else’s, but one that hopefully stays with people similar and different from her. In the book’s introduction, Castillo addresses other Americans and insists that, in spite of differences in origins or politics, as countrypeople we have more in common than we like to believe.

It’s hard to pinpoint just one thing that makes Black Dove worth while, but the sincerity in these pages makes Black Dove an accessible read, both for those familiar and those unfamiliar with Castillo’s work.

May 2016, The Feminist Press at CUNY
Essays/Memoir
$16.95, paperback, 350 pages
ISBN: 978-1-55861-923-4

—Reviewed by Ola Faleti

Read more about local poet, novelist, and essayist Ana Castillo.