Pembirdie

Category: reading

  • Book review: Being Mortal

    Being Mortal: Medicine and What Matters in the End by Atul Gawande

    Mr. Gawande is an excellent writer. He’s the kind of writer who writes stories, and then weaves them into the point he’s trying to make. (Morgan Housel does that, too). This helps make Being Mortal a fast read, but it has spots worth slowing down for. In short, this is a thoughtful book and I think most people would benefit from reading it and then discussing it with loved ones.

    Being Mortal is concerned with what happens to us at the end of our lives: specially, what happens to us in the medical system. Modern medicine allows us to keep people with serious illnesses alive far longer than at any other time in human history. Unfortunately, this can lead to hard decisions and high costs, and it’s not clear that our medical interventions make people’s final years better.

    I witnessed this with an older relative. She fell at home, and later the doctor found a large deep tissue injury that was infected and required surgery. With the hope it would heal, she had another surgery, experiencing delirium in the hospital. She then had a stay in a nursing facility, where she received (at times) substandard care and had a wound management system applied incorrectly, ultimately leading to another infection that required re-hospitalization, another surgery and more delirium. By this point my husband’s parents had enough and took her home, but the surgeon still held out hope she would heal, even as she wasn’t eating. She had an expensive and resource-intensive wound vac in place for weeks before transitioning to hospice.

    While the book doesn’t offer any easy answers, it does suggest some questions that should be considered when someone has a serious illness.

    1. What do they understand about their illness and their prognosis?
    2. What are their concerns about what lies ahead?
    3. What kind of trade-offs are they willing to make? What trade-offs are they not willing to make?
    4. How do they want to spend their time if their health worsens and time is short? What are their goals?
    5. Who do they want to make decisions if they can’t?

    One of the physicians in the book phrases it another way: “How much are you willing to go through to have a shot at being alive and what level of being alive is tolerable to you?”

    Honestly, these are not bad questions to ask before someone becomes seriously ill. They are not bad questions to ask yourself and discuss answers with trusted loved ones. Catastrophic things can and do happen to healthy, active people at unexpected times and with little warning – I see it regularly in the hospital. Having a healthcare provider assist in this discussion would probably be helpful (especially to make sure #1 is accurate), but I don’t think it’s essential. If you have a firm grasp on the answers to these questions, even if you don’t have the answers to nitty gritty medical questions, your healthcare team should be able to help apply them if you make goals/hopes/wishes clear.

    One thing that felt prescient was Mr. Gawande’s discussion of medically-assisted suicide. He doesn’t outright condemn the practice, but worries that it essentially provides a way for people to ignore caring for the dying – you don’t need to, because if things are too bothersome they can just end things immediately. He notes that “the fact that, by 2012, one in thirty-five Dutch people sought assisted suicide at their death is not a measure of success [but] failure,” and links it to inadequate hospice programs. If people have access to resources that will help reduce suffering and improve their lives in their final days, he argues, they won’t choose to cut them short.

    Unfortunately, this is what is happening in Canada. Canada legalized medically-assisted suicide, or “MAID” (medical assistance in dying) in 2016, two years after Being Mortal was published. It is also known to have inadequate social supports and hospice resources. Today, one in twenty Canadians dies from medically-assisted suicide. Despite this evidence of failure, people instead seem to be interpreting it as evidence of its success. Proponents are moving forward with the goal of expanding MAID eligibility to people who have chronic mental illness. Cynically, I wonder if more people choosing to die saves the healthcare system dollars.

    One thing this book lacks is a Christian perspective. Mr. Gawande is areligious. While I still think this book provides a lot of wisdom and things to think about, faith plays a role in our final days that we must acknowledge and can also make a big difference in our perspective of things.

    SDG

  • Book review: The Children Money Can Buy

    The Children Money Can Buy: Stories from the frontlines of foster care and adoption by Anne Moody.

    Ms. Moody is a social worker who got her first job working as a case worker for foster children in Michigan. The job eventually become to mentally and emotionally taxing and when her family moved to Seattle, she began working for an adoption agency. She writes about her experiences with foster care and adoption, mostly focusing on adoption. Ms. Moody writes with a clearly positive slant toward adoption while at the same acknowledging its problems and advocating for best practices with realism that comes from experience.

    Her view on foster care is bleak. She acknowledges her experience dates from decades ago, but I suspect things haven’t gotten much better. Ms. Moody believes there is too much emphasis on reuniting the family, particularly when it seems clear that the parents are not making good faith efforts to correct their deficiencies and their children bear the burdens of the dysfunctional foster care system.

    On the other hand, she has a very positive view of adoption, and certainly comes at it more from the perspective of the parents. It was interesting to read this book in conjunction with “You Should Be Grateful” by Angela Tucker. They both discuss the fact that a percentage of adoptions “fail.” Ms. Moody emphasizes this is a small number, while Ms. Tucker feels the number is too large to be acceptable.

    Both are advocates for open adoptions. Ms. Moody believes this benefits everyone, birth parents, adoptive parents, and adoptees. She also feels very strongly that birth mothers must receive counseling on all the available options for them, including parenting. She acknowledges and strongly condemns coercive tactics by adoption agencies and consultants that pressure and guilt people into relinquishing their babies, and also discusses the ethical dilemma of couples essentially paying a woman for her baby. (Apparently in some states, like Washington, laws make the blatant exchange of money for baby less likely.)

    While Ms. Moody has worked with birth mothers (and fathers) at her adoption agency, her insight into their perspectives is limited. Her book also lacks the adoptee perspective. She and her husband adopted a daughter named Jocelyn from Korea, and while she talks about her and even includes one of her other daughter’s perspectives, we don’t hear directly from Jocelyn, or other adoptees. While acknowledging unique challenges that adoptees may face, Ms. Moody feels that overall problems are exaggerated, and it’s hard for me to know what to think about that.

    Overall, I felt this was a helpful book to read. I read it after “You Should Be Grateful“ and initially it came off as perhaps a bit too optimistic about adoption, but as I continued through it it felt more balanced.

    Of note, Ms. Moody has a positive view toward adoptions by gay couples, although I can’t say much about it as I skipped that chapter.

    SGD

  • Book review: “You Should Be Grateful”

    “You Should Be Grateful”: Stories of race, identify, and transracial adoption, by Angela Tucker.

    I came across Angela Tucker while googling adoption. I listened to one of her podcasts. She comes across as a gracious, well-spoken, intelligent and empathetic woman.

    You Should Be Grateful tells part of her adoptee story and her perspective from working at an adoption agency and mentoring adoptees, as well as incorporating research and philosophies related to adoption and transracial adoption in particular. (Transracial adoption referring to people adopting a child of a different race/ethnicity/skin color.) Ms. Tucker is a Black woman who was adopted as a young child by parents who also adopted multiple other children of various ethnicities and raised her in a loving, supportive environment. Despite having a closed adoption, Ms. Tucker was eventually able to track down and reconnect with her birth parents, relatives and half-siblings.

    Although I think it’s becoming more common now, historically there are more narratives from adoptive parents than adopted children, and while no doubt every adopted child’s story is different, reading about an adoptee’s experience is valuable. Ms. Tucker writes generously and honestly, both about the excellent upbringing her adopted parents provided her and her irrepressible longing to know her birth mother, as well as the complicated emotions that were part and parcel of finding and connecting with her birth family.

    In the book, Ms. Tucker introduces three words/concepts that were new to me:

    1. Hiraeth (here-eyeth): A deep yearning for a home that never was. Angela makes the case that all adoptees have some degree of hiraeth.
    2. Exulansis: The tendency to give up trying to talk about an experience because people are unable to relate to it. (A neologism coined by John Koenig in The Dictionary of Obscure Sorrows.)
    3. Sondersphere: A realm where every person in an adoptee’s life has a place–where birth parents and adoptive parents and biological aunties and foster parents and adoptive cousins all exist together. (Coined by Ms. Tucker, based on a word coined by John Koenig.)

    Another concept she discussed was that of a “ghost kingdom,” essentially what someone imagines their life would have been like if an event (such as adoption) had not happened.

    Ms. Tucker is not anti-adoption, and she is not anti-transracial adoption although she raises a lot of concerns. However, as the word “sondersphere” suggests, she is strongly in favor of adoptions being widely open. While she understands that adoptive parents have a responsibility to care for their child’s wellbeing and that birth parents may very well not have the capacity to be a healthy presence at times, she argues that honest information sharing is the best policy. In her own experience, she found that connecting with her birth family actually strengthened the (already strong) bonds she had with her adopted family. I could see adoptive families having concerns that if their bond with their adopted child is not very strong, bringing in the birth family could weaken them further. At the same time, those concerns are centered on the adoptive parents, rather than on the child.

    Ms. Tucker also touches on the microaggressions that transracial adoptees may face, and helpful or unhelpful ways their adoptive parents interact with their race. She believes it is imperative for transracial adoptees to interact with children and adults who share their birth culture so adoptees can connect with that aspect of themselves, rather than ignoring it’s existence. Interestingly, she includes a discussion of how assigning food-labels to a racial characteristic (“chocolate” skin, “almond-shaped” eyes, “oreo”) carries the connotation of being able to eat, and therefore dominate, the person with this trait. I’m still on the fence on what I think about this one. This afternoon I called my cat, “honey.” My dad and mom called each other this all the time. Were they subconsciously trying to dominate each other? I think not.

    Of course, reading a book like this, I can’t help but relate it to my own experience, not as an adoptee but as a member of a household that included two transracial adoptees, my African American youngest brother and Chinese youngest sister. Their adoptions were closed. We grew up in a small town in southwest Nebraska, where there were two other (also adopted) Black kids, one other (also adopted) Asian kid, and one (also adopted) Indian kid. There were a decent amount of Hispanics who mostly stayed together and everyone else was White. We had an (also adopted) Korean aunt, a Black uncle, and an (also adopted)Korean cousin, but they lived far away. I’m not aware that my siblings had meaningful, sustained relationships with any Black or Asian adults during their childhoods. We did not participate in an adoption-related activities or camps, that I am aware of. As a kid, I truly did not believe racism was still a problem.

    I know now that I was wrong.

    My brother experienced things growing up that I didn’t know about until much later in life. I don’t know about my sister, but she’s shared events from the past few years that demonstrate she deals with microaggressions on a regular basis. (Recent example: her boss said she was a standout member of the ESL program at work.)

    My siblings have never seemed interested in talking with me about being adopted, or about the emotional struggles they may or may not be going through. I wonder if they have experienced “exulansis.” I’m sure I haven’t presented as a great listener. While I don’t think I’ve ever felt that they “should be grateful,” growing up I never considered they would feel different at all. I wish I’d known better.

    Cautions regarding this book: it is certainly not from a Christian perspective. It trends toward “wokeness” but I don’t believe to the point of being unhelpful. When describing group discussions with adoptees, Ms. Tucker is always careful to describe that she introduces her pronouns when starting the discussion, which is something that goes along with LGBTQ+ affirming practices.

    SDG

  • Book review: Wicked Marigold

    (Spoilers to follow.)

    I am just outside the demographic for Wicked Marigold, by Caroline Carlson. This is an elementary or middle school-aged novel, and sometimes that is just fine but for this book I felt my age.

    It tells the story of Princess Marigold. Before she was born, her older sister was kidnapped by an evil wizard, but she unexpectedly returns one day and immediately sucks up her parents’ and the kingdom’s attention. Marigold finds it all very annoying, throws a tantrum that creates a giant mess and inadvertently gives her the idea she is wicked, and runs away to stay with the evil wizard to prove it. Hijinks ensure.

    One of the book blurbs said it was reminiscent of Howl’s Moving Castle, which is a book I adore. In retrospect, this comparison my have set my standards too high and let me to draw unflattering comparisons. There are definitely similarities, but Wicked Marigold loses every time. The evil Wizard Torville? He likes to sulk and makes messes and is very particular about certain things, but he’s no match for Howl, who steals every scene he’s in. The demon Pettifog, who has a magical contract to help the wizard with his magic? I prefer Calcifer. Marigold has nothing on Sophie Hatter (not to mention she is at least seventy years younger).

    Other parts of the book seem a bit precious or twee, in ways that Howl’s Moving Castle and The Ordinary Princess do not. Maybe it is trying too hard. Six guards resign on the spot when three year old Princess Marigold throws a gigantic tantrum. The kingdom has a famously irritable dragon. Marigold learns how to greet a stranger seventeen polite ways. Why do these things bother me? I don’t know, they just do. I felt a similar dislike for stylistic choices in The Girl Who Circumnavigated Fairyland in a Ship of Her Own Making, but eventually got past it and cried when September had to kill the fish. Nothing in Wicked Marigold tempted my tear ducts to flow.

    All the negative comments aside, I enjoyed the book. It didn’t go along with my expectations, but that isn’t always a bad thing. I kept waiting for Marigold’s angelic sister to reveal that she had a bad side… but she didn’t. She’s a completely good, beautiful, nice person and that’s it. Kind of refreshing. The evil “bad” guy is not as evil as he first appeared… but on the spectrum of “good” vs “bad,” he still chooses to identify with the “bad” side and I’m not convinced he doesn’t belong there. It was rather a relief that the book wasn’t populated with any “diverse” LGBTQ+ characters who use they/them pronouns. The book was stuffed with worldbuilding, and if it had more time to explore things (like Gentleman Northwinds and his relationship with Torville, for instance) I think I would have enjoyed it more. That’s the tradeoff with junior fiction, I guess.

    SDG

  • Book review: Don Quixote, Part 1

    Mostly, I read this book because I’m not above being a sycophant, and to a less degree because it seems like one of the books a person should read at some point. A work colleague, my “buddy” during the onboarding process, is coming over for dinner next week. Don Quixote by Miguel de Cervantes is his favorite novel. I thought it’d be something we could talk about.

    I’ve learned that Don Quixote actually consists of two parts that were written and published years apart. I’ve just finished Part 1, which seems like enough of an achievement to write about. I don’t know if I can discuss it in an intelligent manner, but I do have some thoughts.

    1. This book is LONG. The first part clocks in around 500 pages. (Admittedly, the version I’m reading is one of those small paperbacks.) The second part is just as long.
    2. I saw on the Internet that Don Quixote is considered by some to be the first modern novel. It was quite readable. (Not sure what role the translation played in this.) In fact, it’s hard for me to comprehend how this book was written more than 400 years ago, as parts of it seem so fresh. (Again, unsure what role the translation played in this.) On the other hand, novels are not written this way anymore. Don Quixote involves a lot of people sitting around and telling each other their stories. To be sure, there is action as well, but the latter half of Part 1 in particular seemed to consist mostly of people telling their life stories, along with a novella thrown in. Similarly, there’s a lot more unadorned dialogue than I’m used to, whole chapters of two individuals going back and forth each making their arguments with long paragraphs of text. Today’s authors, I think, try to use more “show, don’t tell,” in their approaches, whereas Cervantes heavily uses dialogue to explain what characters are thinking, planning and doing.
    3. On a similar theme, there isn’t much of a point in the plot of Don Quixote. It doesn’t have the classic three part structure that I associate with novels. Sure, things happen and wrap up by the end, but it’s mostly episodic.
    4. The famous windmill scene happens in Chapter Eight. For context, this is essentially the very beginning of Don Quixote’s adventures. Total chapter count is fifty-two. Don Quixote has a short escapade before Chapter Eight but it’s preliminary – his “squire,” Sancho Panza, isn’t with him until right before the windmills. And the windmill “adventure” lasts no more than three pages. Given that the windmill scene is essentially all I knew about Don Quixote prior to reading it, the fact that it came so early into the novel and that it played such an insignificant role in the story was astonishing. True, it’s a great visual and you can read all sorts of symbolism into it. The cynical part of me wonders if it is so famous because it’s early enough into the novel that almost everyone gets that far before abandoning the effort.
    5. Don Quixote is funny. And not (just?) in an erudite way. It has a lot of slapstick humor and even scatological humor. It’s almost like a Looney Toons cartoon. Don Quixote and Sancho Panza are constantly getting beat up, but never seriously slowed down. At one point, they vomit into each other’s faces. A long paragraph is devoted to Sancho Panza attempting to secretly defecate while he is standing right next to Don Quixote. Unfortunately for him, the smell rises up to Don Quixote’s nose. “Sancho,” he says, “I think you’re more frightened than you had let on.” And then asks him to stand farther away.
    6. It’s clear than Don Quixote has gone mad and truly believes he’s a knight errant, but it’s not clear to me if he uses being a knight as an excuse to avoid things he doesn’t want to do, or if he’s always acting in good faith. For instance, at one point Sancho Panza is “blanketed,” tossed up and down on a blanket by some guys at a inn as a joke when he tries to leave without paying the fee. Don Quixote has already left the inn, and returns when he hears Sancho’s cries; but when he gets to the wall of the inn and actually sees Sancho being tossed into the air, he can’t move and doesn’t do anything to stop it. He later attributes this to being enchanted, as he believes everything in the inn (a castle, in his mind) is enchanted. I still can’t decide what really happened.
    7. While it’s a comic story, Don Quixote (and to a lesser degree, Sancho Panza) is a tragic figure. He’s mad. His attempted heroic deeds cause only confusion, disaster or loss of property to the unsuspecting people around him or physical damage to himself and Sancho. He brings some people laughter, but it’s the laughing-at-you-not-with-you kind. This is not a guy you would want to meet, because he would somehow mess up your life all while believing he was doing something noble. At the same time, there is something noble about his steadfast dedication to living out his life as a knight errant. He ends up in a cage. That’s hard to laugh at, especially when I take care of people lacking capacity in the hospital.

    Overall, I’m happy I read it, but I haven’t decided if I’m reading Part 2 yet.

    SDG