How do I want to die? Reflections on Atul Gawande’s “Being Mortal – Medicine and What Matters in the End”

IMG_3109Many of the case studies and personal experiences that surgeon and writer Atul Gawande depicts in his new book “Being Mortal” resonated with my own recent history of the deaths of my family members.

Gawande talks about patients with whom he worked during their struggles with ultimately incurable diseases. He carries us with him as he, despite his professional expertise, describes his sense of inadequacy when he accompanies his own father in his last years, months, weeks and days.

All the way through my reading of “Being Mortal,” my mind and heart were constantly flipping between the text on the page and the searing memories of the end-of-life for my parents, my partner Bill’s parents, my younger brother who committed suicide and Bill’s two weeks between his diagnosis with pancreatic cancer and his death.

Gawande has five themes, at least as I read his book. Firstly, we can do so much better than we are in facilitating an enriching lifestyle for aging persons so that they can retain autonomy and engagement in life-enhancing interactions with family, community and society, a key element in retaining a sense of purpose and meaning. This applies even to those with cognitive impairment as Gawande illustrates with detailed examples. Secondly, our social and health care systems need to retreat from trying to medicalize every problem utilizing extreme measures to keep people alive regardless of the quality of their living. Thirdly, families and professionals need to relinquish their fear of losing the dying person and refocus on helping them access whatever supports are necessary for spending their remaining time as they want to. Fourthly, in order to clarify for both the dying person and ourselves what their priorities are, we all need to have the courage to initiate THE CONVERSATION, asking the questions that surface what is most important to them for the amount of time that they have left. And fifthly, what we learn in helping shape options for sustaining the greatest possible meaning and engagement in life for our dying loved ones can help us prepare the ground for what we want for ourselves when our time comes.

And so, as I read through Gawande’s wonderfully thought-provoking and accessible contribution to this pressing societal issue, my mind was being cast not only backwards to my experiences with all those family members whose dying I accompanied but also forward to what I will want for myself and what I need to put in place to increase the likelihood of having as a good a quality of dying as possible.

That is not to say, obviously, that I can determine everything in advance. But as Gawande writes, “you many not control life’s circumstances, but getting to be the author of our life means getting to control what you do with them.”

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Info on Atul Gawande’s “Being Mortal” at: http://atulgawande.com/book/being-mortal/

Info on my memoir “August Farewell” and my novel “Searching for Gilead” at: http://DavidGHallman.com

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So Much Said in Silence – the new novels of Marilynne Robinson and Colm Tóibín

I was in the back row of the theatre when Marilynne Robinson and Colm Tóibín sat down with the CBC’s Eleanor Wachtel for a panel discussion at the 2014 International Festival of Authors (IFOA) in Toronto. Sitting on the aisle in the back row, to be precise, is my preferred location at many events (the exceptions being movies and musical presentations), in part for the pragmatic reason of being able to slip out quickly at the end and not be trapped by the departing crowd. But more so, it’s so that I can be alone in my thoughts, to absorb the input from the presenters without the complication of having to discuss it with a talkative person who has taken the seat next me. I seek and create the circumstances for solitude.

In the IFOA conversation between Robinson, Tóibín and Wachtel, one of the themes that emerged was the importance of solitude and loneliness. Tóibín said that one gains a great deal from loneliness, especially in circumstances of loss, that’s not possible if one is in constant chatter with others. Robinson observed that loneliness is a kind of passion for her, that she cultivates loneliness. Robinson believes that loneliness is essential for understanding and creating one’s identity so as not to be dependent on others for your own self-definition.

At that point, I had not yet read Marilynne Robinson’s newest novel “Lila” though I was anxious to having read and adored her earlier novel “Gilead.” The same was true for Colm Tóibín’s new work “Nora Webster.” I had previously read and enjoyed much of Tóibín’s writing and was looking forward to this new one.

“Lila” and “Nora Webster” did not disappoint me. Both novels thrilled me, largely because they are such quiet works—the characters not speaking of much of what goes on. So much is said in the silences.

This is not to suggest that the principal characters exist in isolation from significant others or from community. Young Lila and her much older husband John Ames have an intense relationship despite the differences in age, education, socio-economic and cultural background. They are bound to each other by a mutual attraction that is as much metaphysical as it is physical. Nora Webster, struggling to redefine herself as a person and as a mother after the death of her husband, finds new life not through family or neighbours in her repressive Irish town but rather through the music that she relishes in a small musical society and with her vocal teacher, a community of people whose souls are enlivened by the arts.

Telling a compelling story through silences and through what is left unspoken takes enormous skill on the part of a writer. Robinson and Tóibín are such writers.

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The IFOA conversation between Marilynne Robinson and Colm Tóibín can be heard at Writers & Company: Marilynne Robinson & Colm Tóibín – CBC.

Information on my memoir “August Farewell” and my novel “Searching for Gilead” can be found on my website at DavidGHallman.com

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…from another Forster fan

I met South African writer Damon Galgut at the 2014 International Festival of Authors (IFOA) in Toronto where he was on several panels reading from and discussing his new novel “Arctic Spring.” Two of Galgut’s previous novels, “The Good Doctor” and “In A Strange Room,” have been Man Booker Prize finalists.

The timing couldn’t have been more propitious. I was at work at the time on a short story in which I recount English author E.M. Forster’s life leading up to and including his writing of his novel “Maurice,” his one explicitly gay novel. Galgut’s novel “Arctic Spring” is a semi-fictionalized take on the years 1912 to 1924 during which Forster was working on his novel “Passage to India.” It was during this period that he also wrote “Maurice.”

The grey area between fiction and non-fiction intrigues me. One of the most widely read contemporary excavators of this terrain is Hilary Mantel with her Oliver Cromwell novels “Wolf Hall” and “Bring Up the Bodies.” This mixed-genre seems to go by various names such as creative nonfiction, literary nonfiction, narrative nonfiction and the somewhat distinct but related historical fiction.

With my short story “Morgan and Maurice,” I was interested not only in depicting the biographical elements in Forster’s life that led up to his writing of the novel but also the dynamics behind his decision not to allow it to be published during his lifetime. I tried a number of structures and approaches before settling on a straightforward recounting of Forster’s life up to 1913 when he wrote “Maurice” and then adding an epilogue in which Forster is in an imagined conversation with the character Maurice. Or to put it more specifically, Maurice chastises Morgan for his reluctance to allow the story out into the reading public for fifty-five years and through their conversation Forster has an opportunity to present the case for his decision.

Galgut has more guts and considerably more skill than I do. His whole novel “Arctic Summer,” while based on the known historical elements of Forster’s life, is a free-flowing journey through those years 1912 to 1924 when he was working on “Passage to India” as experienced from within the skin of the great novelist himself. Having done considerable research myself in preparation for writing “Morgan and Maurice,” reading Galgut’s “Arctic Summer” has been like a protracted and uninhibited conversation with a dear friend who was prepared to share the joy and pain that went into the creation of that work of art.

My copy of “Arctic Summer” bears the inscription: “For David – with very best wishes from another Forster fan, Damon Galgut, Toronto, 26 Oct 2014” – a lovely memento of an inspiring conversation with a very gifted writer.

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Reading Thomas Pynchon’s “Bleeding Edge” – buckle your seatbelt

As someone who considers himself fairly well-read, I am simultaneously embarrassed and proud of myself – embarrassed that I had never read anything by Thomas Pynchon and proud that I have now made my way through his most recent novel. I’m also simultaneously exhilarated and exhausted. Tackling “Bleeding Edge” required enormous energy. I look forward to reading more of his work, but not for a while. I need time to recuperate.

For years, I’ve seen Pynchon’s name referenced as one of the writers most admired by other writers along with such titans as Alice Munro, George Saunders, David Mitchell, and Marilynne Robinson. How could I consider myself semi-literate if I hadn’t ever read him? So I plunged into his 2013 novel “Bleeding Edge.”

What a ride.

Within the first half-dozen pages, my jaw was dropping at the velocity of the robust narration and I was guffawing at the hilarious images, tweeting out gems of lines such as “Dizzy’s learning curve is permanently flat-lined.” And so many countless more along the way: “I have always depended on the kindness of stranglers” and “Maxine could conduct workshops in Conquering Eyeroll” and “‘I’m an adulteress!’ Vyrva wails quietly. ‘Ah, come on. Adolescentress, maybe’” and on and on and on.

But being delighted by the scrumptiousness of such snippets is like licking the peaks of whipped frosting not recognizing that they are perched on an enormous confectionary creation that defies thorough digestion by us ordinary mortals and whose recipe includes far more arsenic than sugar. Which is not to say that “Bleeding Edge” is indigestible but rather that you need to observe mother’s ordinance to chew each mouthful twenty times before attempting to swallow and that you should relinquish any hope of being able to fully clean your plate in one lifespan.

What is it about “Bleeding Edge” that makes reading it such a satisfying and draining endeavour? The vibrant characters whose innermost workings of brain, heart, and libido we think we grasp only to have them yanked out of our hands; the complex plot that reads like an amalgam of front page news, secretive espionage files, nineteenth century murder mysteries, and nearly impenetrable science fiction; the illusions running from quantum physics to pop culture icons; the ceaseless gyrations from identifiable New York City streetscapes to imaginative worlds of deep treacherous cyberspace.

I will read more Thomas Pynchon, once I catch my breath.

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For information on my most recent books, the memoir “August Farewell” and the novel “Searching for Gilead,” see my website at http://DavidGHallman.com

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In Praise of Tough Reads

I read Zadie Smith’s “NW” immediately after finishing Jonas Jonasson’s “The 100-Year-Old Man Who Climbed out of the Window and Disappeared.” The juxtaposition taught me something about my reading proclivities: I prefer books and authors that make me work.

Zadie Smith made me work. It was sometimes difficult to sort out the connection amongst the constellation of characters in “NW.” Standard formatting devices such as quotation marks around speech were often eschewed blurring the line between what was spoken out loud and what was internal monologue. The four parts of the novel were each structured differently: the first, “visitation,” had a typical format of numbered chapters; the second, “guest,” used borough designations to set off the chapters; the third and longest part, “host,” numbered not the chapters but each individual paragraph; and finally the fourth, reprised the title “visitation” and was essentially one relatively short chapter. But more challenging than these structural variations were the difficulties that I experienced in following the characters’ evolutions with the at-times convoluted plot. I had to be constantly attentive. I needed to reread sections or flip back to previous chapters. I did a great deal of highlighting of passages that I thought would help me follow the storyline.

And, bottom line, I was totally engaged. “NW” was not a fun, easy read. It was, by contrast, difficult. And I loved it. Like a great workout at the gym, Zadie Smith had the adrenalin pumping through my brain. And that left me satisfied in the same way that a rush of endorphins does.

As for “The 100-Year-Old Man…,” it’s probably sacrilege to say that I was bored. I know that the book has been immensely popular, as are others by Jonasson. And, truth be told, I wasn’t exactly bored. It was a fun story told by Jonasson with such an entertaining narrative style that the book carried me along effortlessly. Which is not to say that Jonasson’s writing is effortless. As a struggling fiction writer myself, I know how hard it is to write a text that has the fluidity of Jonasson’s work. But as for visceral satisfaction? For me, “The 100-Year-Old Man…” doesn’t come close to “NW.”

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Making Art from the Pain in One’s Personal Life

If Miriam Toews can write fiction about suicide in her own family, can I?

By coincidence, I finished reading Canadian prize-winning writer Miriam Toews’ newest novel “All My Puny Sorrows” on World Suicide Prevention Day.

As a “survivor of suicide” (a term used to refer to people who have lost a family member or close friend to suicide), I suppose I should have been aware of WSP Day, especially after all the publicity surrounding actor Robin Williams’ recent suicide. But I wasn’t. One tends to block out some things.

Miriam Toews is a gifted writer. Among her many accolades is the Governor General’s Award for Fiction that she won for her novel “A Complicated Kindness.” Toews brings those artistic skills to “All My Puny Sorrows.” But she also brings much more – her own family history.

Early in the story line of the novel, the father of Yolanda, the narrator, kills himself by jumping into the path of a speeding train. The focus of the plot is Yoli trying to prevent her sister Elfrieda from committing suicide. Elf, an internationally-acclaimed pianist, is as fragile as she is talented. Because of her internal demons, she has come to the conclusion that life is too painful to continue. Despite Yoli’s best efforts, Elf eventually succeeds. In Toews’ assured writing, “All My Puny Sorrows” melds excruciating sadness with subversive humour. The novel is a poignant, masterful, engaging read.

This is art imitating life. Miriam Toews’ father committed suicide. And so did her sister.

Was it scary for Toews to write about her sister’s death? She says that, once she got through the total immobilization that grief over her sister’s death caused, it was scarier not to write about it. She felt that she needed to address it head on. And she is a writer of fiction, so she wrote a piece of fiction.

I am a survivor of suicide. Rick, my younger brother, was only thirteen months younger than me and we grew up almost as if we had been twins. After retiring, he went into a deep depression and committed suicide. He killed himself a short six months before Bill my long-term gay lover died suddenly after being diagnosed with pancreatic cancer.

I have written explicitly and in detail about Bill’s death in the memoir “August Farewell.” I mentioned Rick’s suicide briefly in “August Farewell.” In my novel “Searching for Gilead” which was published a year after the memoir, the brother of one of the main characters commits suicide. That was a conscious, albeit tangential, way for me to write about my brother’s suicide. At least it feels tangential, and totally inadequate. Increasingly, I experience the compelling need to write a piece of fiction that more explicitly addresses my brother’s death.

Why?

I suppose it would be cathartic. I guess that I hope it would help me “process” (god, I hate that word) the feelings of regret and guilt that I, like many survivors of suicide, experience. Perhaps, it could play some role in helping other people understand the devastating impacts of depression and grapple with the precursors and consequences of suicide for all concerned. Certainly my memoir “August Farewell” about my lover’s cancer death gave me some measure of relief having recorded our sacred end-of-life journey and many readers have expressed profound appreciation for it as an aid in helping them deal with their own issues of love and loss.

But my sense of compulsion to write fictionally about my brother’s suicide is more than just for these personal and public reasons. I have a strong sense that the creation of art in fiction can go to places that non-fiction narrative cannot, that living in the realm of the imagination unlocks chambers that otherwise wouldn’t be, that universals are liberated from the specifics.

At this point, I know not when and how and in what fictional genre I may attempt to tread some of the same territory that Miriam Toews has. But I feel the need to. Stay tuned.

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For information on Miriam Toews’ “All My Puny Sorrows”, see: http://amzn.to/1tNou01

For information on my writing, including my memoir “August Farewell” and my novel “Searching for Gilead”, see my author’s website at: http://DavidGHallman.com

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“Living a Vibrant Life” – Convocation Address

Living a Vibrant Life

David G. Hallman

Convocation Address on Reception of an Honorary Doctor of Divinity Degree

from Victoria University in the University of Toronto

at the Victoria University Convocation/Emmanuel College Graduation

May 15, 2014

 

I deeply appreciate this recognition from Victoria University and I thank those responsible for it.

Jesus said, “I come that you might have life in all its abundance.”

If I had been an editor working with the writer of John’s Gospel, I might have suggested a few options for this line, such as, “I come that you might live life vibrantly, or exuberantly, or passionately.” In any case, that’s how I interpret John 10:10 – we’re being offered the opportunity, the gift, to live vibrantly.

For me, living a vibrant life has five dimensions:

Firstly, the vibrant life is expressed through engagement with community:

I had the great privilege to work for over thirty years within The United Church of Canada and the World Council of Churches—communities of faith that care about justice, about human rights, about the Earth.

  • As communities of faith, we spearheaded the Nestle Boycott to protest the unethical marketing practices of multinational companies that were promoting their infant formula in developing countries in ways that threatened the health and lives of babies;
  • As communities of faith, we fought for human rights and equality for all persons in church and society through initiatives that were at times controversial but ultimately transformative;
  • As communities of faith, we sounded the alarm on human-induced climate change seeing it as an ecological justice issue internationally and inter-generationally. We worked from local to global levels to reduce the causes and to support those most vulnerable to the impacts.

I invite you graduates and all of us to give thanks for the vibrant communities through which we can contribute to making our world a better place.

Secondly, vibrancy challenges us to live openly:

From early in life, I self-identified as gay and decided that I would try to live openly and honestly as a gay man.

In August 1976, I met my partner Bill. We fell in love and lived together for thirty-three years. Two weeks after we had first met, I took Bill as my date to a summer barbecue for United Church staff and their spouses. Our initial trepidation was quickly dispelled by the warm welcome from my colleagues.

And in 1993 after struggling to come to terms with a positive diagnosis from my doctor, I ultimately concluded that it was best for me to be open and honest about being a person-living-with-HIV.

I invite you graduates and all of us to reflect on the challenges and the opportunities for living openly and honestly as our authentic selves.

Thirdly, I’ve come to realize that living vibrantly requires confronting death:

Over a few short years, I accompanied in their final days of life my mother and father, Bill’s parents, Rick my younger brother who committed suicide, and Bill who died two weeks after being diagnosed with stage four pancreatic cancer.

I struggle with this cavalcade of losses and I’m grateful for communities of support. These experiences of death are affecting how I view issues of life such as the continuum of sociability and solitude, the role of memory, the Möbius strip of joy and despair, and the complexity of end-of-life options.

We all lose loved ones. I invite you graduates and all of us to ask ourselves how our experiences of death are impacting our perceptions of life.

Fourthly, the vibrant life is one of artistic expression:

The primary tool for me has been writing—books on ecological theology, the memoir “August Farewell” about Bill’s death and our life together, a novel “Searching for Gilead,” and my current writing project, a collection of short stories. The process of transforming ideas and images into words invigorates my mind and my spirit.

Music in many forms has also been a source of enrichment – be it through the lyric songs of Gordon Lightfoot, the riveting concerts of the Toronto Symphony Orchestra, or the iconic vocals of Judy, Barbra, and Cher.

I invite you graduates and all of us to celebrate how the arts feed our souls.

Fifthly, and finally, I understand the vibrant life as living as a fully embodied spirit:

For me, this means trying to live life to the fullest—emotionally, intellectually, physically, sexually, and spiritually. It means pushing the limits; challenging ourselves, our institutions, our world; falling down and getting back up; crying and laughing; praying and singing.

I invite you graduates and all of us to rejoice in this creation that so vibrantly fuses body and spirit.

In our communities, in our openness, in our grief and pain, in our artistic expressions, in our embodied spirits, let us remember this assurance, that however vibrant or fractured our lives may be, we are not alone, we live in God’s world. Thanks be to God.

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Citation for David Grant Hallman for a Doctor of Divinity Degree

Victoria University, May 15, 2014

Delivered by Rev. Joan Wyatt

Chancellor Cecil, Chancellor Wilson, Principal Toulouse, Chairman Huyer
Members of the graduating class, Honoured guests, David Grant Hallman.

David Hallman grew up in Waterloo, Ontario and studied community psychology at Wilfrid Laurier University where he received an M.A. He also studied arts and culture at L’Université Paris-Sorbonne. David is the author of five works of non-fiction, all in the field of ethics and more recently, a memoir and a novel. He is recognized for his scholarly work as an environmental ethicist both through his work in the United Church of Canada (UCC) and the World Council of Churches (WCC). It is my privilege to name some of the many accomplishments that resulted from David’s passionate commitment to issues of justice over an almost forty year career.

David began his career in the United Church in 1976 in a social justice portfolio with a focus on the needs and rights of disabled persons. This position quickly expanded to include the rights of children, criminal justice, French-English relations, and the AIDS crisis. In the spring of 1976, at the request of the United Church Department of Church in Society, he produced a submission to the Ontario Human Rights Commission arguing that the Human Rights Code should include protection against discrimination on the basis of sexual orientation — in accommodation, employment and services. David’s own courage to be “out of the closet” about his experiences as a gay man contributed to the dialogue in the Church about sexual orientation and the development of further policy and advocacy on human rights issues including equal marriage as well as empowering others to draw on his pastoral skills as they struggled with their own issues of sexual identity.

In the 1980s David’s responsibilities shifted to preparing resources and coordinating advocacy on environmental issues for the UCC. In 1988 he was seconded to the Climate Change Program of the World Council of Churches in Geneva to co-ordinate advocacy on global environmental issues with the United Nations. During this time his commitment and passion for the health, wellbeing and future viability of creation, coupled with his gifts for writing, research, public speaking and advocacy, helped to raise awareness in religious communities around the globe about the critical issues affecting environmental degradation. David published and offered leadership on many such issues, including climate change, acid rain, uranium mining, nuclear energy, toxic waste and the depletion of the ozone layer.

Since retirement and the death of his beloved partner William Conklin in 2009, David has turned his attention to the arts and to writing. Fearing that he might forget “the excruciating, intimate, heart-wrenching, spiritual, god-awful 16 days between diagnosis and death that were, at times, punctured by Bill’s uproarious sense of humour,” David wrote nonstop for six weeks. Originally intended only for his own reflection, August Farewell, a memoir of passion, love and loss was published to critical acclaim in 2011. In the fall of 2011 David’s first novel, Searching for Gilead, was released. When asked what gave inspiration for the novel David said:

Though writing August Farewell was cathartic, I still had — still do have — issues with which I’m struggling in my head and in my heart. So I decided to try and grapple with them through a work of fiction. That’s where the title comes from. I made a list of those issues, and they spelled out GILEAD: God and religion in general, injustice in the world, love and relationships, environmental crises, the arts, and death.

Like August Farewell, Searching for Gilead tells a love story that addresses significant human issues, including same-sex relationships.

When asked “what it is like now to experience unabated climate change when so much of your life was devoted to help avoid it?” David said, “I am suspended in a kind of existential grief, a grief that I have chosen to explore through differing layers of loss, through the arts.”

Continuing this exploration, David is currently working on a collection of interrelated short stories and, consistent with a life time of research, he is currently “slaking his thirst” on “the good writing of others.” An avid social media aficionado, you can check out David’s reading experiences on his blog, follow him on Twitter, enjoy his “this day in history” entries on Facebook, and explore his website at http://DavidGHallman.com. Consistent with a lifelong commitment to action, not just words, David currently co-chairs the Maestro’s Club Ambassadors, a team of volunteers that work to build long-term donor relationships for the Toronto Symphony Orchestra. He also continues his role as a lay leader at Saint Luke’s United Church, Toronto, a vibrant, intercultural family of faith.

David Grant Hallman has exercised a ministry that integrates his personhood, his considerable intellect, his passion for justice, and his questions of what it means to be human. He not only has contributed significant ministry leadership in Canada and in our world, but also has modelled how to continue the journey in new ways, still pursuing significant questions and passions, still contributing and publishing and inviting others into the search for Gilead.

With great delight, Chancellor Cecil, I now present to you, David Grant Hallman and I request that you confer upon him the degree of Doctor of Divinity.

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Honorary Doctor of Sacred Letters degrees were bestowed at this same Convocation on respected English literature scholar Dr. Alexandra Ferguson Johnston and Canadian folksinging legend Gordon M. Lightfoot.

The three of us are pictured below from left to right: myself, Alexandra Johnston and Gordon Lightfoot.

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