Ars Moriendi, Part One: The Conversation*

Writing in the New York Times on October 7, Bill Keller’s touching essay “How To Die” confirms a regrettably consistent reality regarding end-of-life care (the before, during and after of how we die): opinions about it, indeed cognizance of it, is often limited to those who have had direct experience with a loved one’s struggle.

As many friends and readers of this blog know, I have direct experience with such a struggle: my mother’s ultimately losing battle with colon cancer, a disease that took her life just over ten years ago.

As many friends and readers of this blog know, I’ve spent the last couple of years working on a memoir entitled Please Talk About Me When I’m Gone. While this project is an attempt to commemorate –and celebrate– my mother’s life, it also concerns itself with the often uneasy interstices that comprise the before, during and after of how we die. More, it is a (hopefully, sufficiently subtle) call to arms, a (hopefully, sufficiently humble) petition to combine insight and compassion for collectively waging a more effective assault on this –and by extension any– disease. More still, it might function as a (hopefully, sufficiently altruistic) j’accuse documenting all the things my family and I struggled against: ignorance, apathy, lack of understanding, etc. The essence of the story –the essence of any good story, the imperative of art– is to share perception and accrue knowledge, admit what you did not know to help someone else recognize what they should learn, and communicate awareness through empathy.

I strongly recommend reading Keller’s piece, because it is short, not-so-sweet, yet appropriately matter-of-fact. Here is the crux of this tale’s “before”, the dilemma (how, when?) that patients and, just as often, their desperate families confront:

When they told my father-in-law the hospital had done all it could, that was not, in the strictest sense, true. There was nothing the doctors could do about the large, inoperable tumor colonizing his insides. But they could have maintained his failing kidneys by putting him on dialysis. They could have continued pumping insulin to control his diabetes. He wore a pacemaker that kept his heart beating regardless of what else was happening to him, so with aggressive treatment they could — and many hospitals would — have sustained a kind of life for a while.

In my family’s case, we never had the proverbial moment of truth, a benevolent intervention by the professionals who are paid to tell us how and how long. From a chapter entitled “Fairy Tales and Feeding Tubes” (recently posted in full on the site), this awkward confrontation with reality –a situation that arrived when alternatives ceased to exist– is depicted:

She could not have known her life would now be measured in weeks instead of months. None of us knew.

Here’s the thing about acceptance: we all had time to prepare and adapt. My mother, finally, after opening every door and stumbling down every last alley, had no other choice but to accept. Sometimes the choice makes itself when there is nothing left but a choice that will make itself. She finally accepted where we were and what was coming.

Even with the best of intentions we waited too long to bring in hospice. We did not understand that at a certain point even a single day is too long. In shockingly short order, her body had deteriorated to the point of its final betrayal: she could no longer digest food.

“Your body can no longer digest food,” my father said as we all stood around the bed, confronting the moment that, after all denials, medical interventions, and best wishes otherwise have failed, arrives at last. The only comfort is that at least it’s not a doctor telling her; at least she is in her own home.

There is an extended section of the memoir, covering several chapters, that honestly, if unflinchingly describes how we gained the knowledge we now have, and how hard-won it was to acquire. These brief chapters are a bit more didactic, albeit infused with (hopefully, sufficient) artistic import. In some regards, although the impetus throughout is on recounting and exploring the story of one woman’s life (focusing, inevitably, on how it ended), the so-called takeaway –at least in its author’s eyes– is that anyone who encounters this material might be a bit better informed and therefore equipped to do what they can, with kindness and charity, to ease the transition with a minimum of needless suffering.

***

Eventually, we asked: What should we expect?

Well, we can’t know for certain, they said. But at this stage you should probably begin to consider end-of-life options.

And can you point us in the right direction?

Certainly, they said. After all, we literally deal with this every day…

This is a conversation that never occurred, and it’s one entirely too many families won’t get the opportunity to have. Having not had the pleasure, I feel I’m in a safe position to suggest that, tempting though it may be, this predicament cannot necessarily be placed on doctors or even the system. Certainly, some surgeons and oncologists are better equipped than others (on human as well as professional levels) to conduct helpful—or at least honest—discussions regarding options, percentages, and prognoses.

How much time have I got? That is the big one, the most crucial, if feared question each patient eventually, inevitably asks. And if they can’t—or won’t—bring themselves to give voice to the concern that rips like a current through every part of their consciousness, it is up to the family to make the inquiry on their behalf. We didn’t want to know, but we needed to know. We had the right to know, we felt. Questions: Were we prepared to process it, whatever the verdict happened to be? Wouldn’t the doctors tell us, finally, when it was time to confront the final stage? Isn’t it our obligation to provide care and distraction, and let the professionals do what they are taught to do? And so on.

Naturally, there are no definitive answers to any of these questions. Or worse, the answer to each one is—or can be—yes and no. Depending on the patient’s age, or situation, or the doctor’s preference, or competence, or conscience, there is probably never an adequate formula for combining truth with commiseration. Speaking only from personal experience, the worst news you can receive is not the bad news you abhor, but a deferral disguised as an alternative.

When they were unable to successfully operate, in July 2002, we knew it was no longer a matter of if but when. How long have we got, we asked in direct—and especially indirect—ways. It was apparent, then, and even more obvious, now, that the issue was not how much they knew but how much they didn’t know. For all they knew, it could be a year or it could be six months; there could be a miracle, my mother might make medical history. And so, they declined and demurred and filled my parents’ heads with words like “quality of life” and, unbelievably, chemotherapy. My mother, not knowing the truth and my father, not yet wanting to confront it, began to embrace this potential course of action as one last bulwark against the unimaginable. As long as we are in motion, we are still in control: this is what I heard every time I looked at my father’s face. None of us, including the doctors, could know that in little less than a month the most important question would answer itself.

It would be too easy to insist that our doctors were negligent or, at least, woefully indifferent. The reality, I suspect, is even worse than that. Obviously doctors do not want to give false hope or obliterate any remaining optimism, but the rationale for their institutional code of silence may in fact have more to do with us than them. Our country’s capacity for denial is well documented; it is more likely our ever-increasing penchant for litigation that gives them pause. When the going gets tough (and the going is always tough in cancer wards) we pray doctors can perform tasks far beyond their human abilities. Even after the surgery (successful or not) has occurred, we expect these people to become priests, social workers and saints.

Still: you want answers. Aside from comfort and serenity, those are the hardest things to come by when you’re dealing with terminal cancer. No one knows anything and you get the sense that even if they did know—especially if they do know—they are not going to tell you.

*excerpted from a memoir entitled Please Talk About Me When I’m Gone.

Share

The Verdict Is In: Top 10 of 2009

elvo

Let’s do this.

1o. Mastodon: Crack The Skye

mastodon 

Some men let their freak flags fly. Some men get tatted up and sport full arm sleeves. Other men get tattoos on their fucking foreheads. You only do shit like that if you are in this for the duration, which means that half-stepping is simply not an option. Either that or you’ve done a lot of drugs. Looking at the cats in this band, you know it is all of the above. And then you listen to them. These guys somehow balance a full-on testosterone assault with brilliant writing and playing (and singing, as most of the members share the vocals at times), and deliver a product that is both thoughtful and bruising. Like many bands that eventually become excellent, Mastodon has spent some time working on their sound and style and 2009 is the mainstream coming-out party. It’s been fantastic to see these guys on several best-of lists this year. Unlike too many of their compatriots, they actually deserve it.

 

9. Hope Sandoval & The Warm Inventions: Through The Devil Softly

hopesan 

To quote myself from a few months back: I’d love to take credit for prompting the return of Hope Sandoval after an eight year absence — a circumstance I lamented earlier this year. Little did heartsick homeboys like me know she was already wrapping up work on her second album, the recently-released (and highly recommended) Through The Devil Softly. She is touring now, so catch her if you can. I was delighted to discover that she was appearing in D.C. at the historic 6th and I Synagogue: I finally had the opportunity to see Hope Sandoval sing (!) in an intimate venue (!!) performing new music (!!!). She did not disappoint. And, as has been well documented over the years, her shyness is not an act. Or, it’s a very successful act: the only words she uttered for the entirety of her performance were “Thank you” once the concert ended. No encore, no fanfare, no problem. We weren’t there to hear her speak; we were there to hear her sing. And just see her, in person. And, for the record, she is as beautiful as ever. So…this album would get sentimental points toward Top 10 inclusion just by virtue of being made, but as it turns out, it’s a pretty fantastic record. So there.

 

8. James Blackshaw: The Glass Bead Game

jamesb

It is lamentable (if typical) that a young musician this good is still flying under the radar. With the release of The Glass Bead Game, it seems somewhat safer to predict that more people will begin to hear what they’ve been missing. Blackshaw is making music that is necessarily “out of time” (unless solo acoustic workouts suddenly become all the rage) but the upside here –and it’s crucial to stress that this is quite clearly not a commercially-driven calculation– is that this type of music is intrinsically timeless, in its way. Blackshaw’s compositions certainly articulate a contemporary vision, but (like John Fahey, with whom his work inevitably draws favorable comparison) one imagines something deeper and more distant; not the past per se but the way we think when we are prompted to think about the past.

Although he is quite capable, when playing solo, of arresting and beautiful work, his recent inclusion of other instruments (on this effort the violin and cello accompaniment is augmented by Blackshaw’s own, not unimpressive, piano playing) is a shrewd move: the sound is, obviously, bigger, but it’s also deeper and reaches closer to the clear profundity his earlier work attained in more stark (but never austere) terms. While his initial releases (again, inexorably) drew comparisons to everyone from the aforementioned John Fahey to Robbie Basho and Leo Kottke, Blackshaw has already developed a discernible style and he brings a rustic, British sensibility to his compositions. This guy should be around for a very long time.

 

7. Sunn O))): Monoliths & Dimensions

sunno

Scary. Serious. Sludge. Sadistic. Slow. Silly. Sonic boom. Soul. Sick. Sunn O))).

6. Grizzly Bear: Veckatimest

gbear

There’s not much I can say here that several dozen critics won’t be saying (albeit more breathlessly and unanimously) in the days ahead. The bottom line is –and there is no getting around it– this is one of the best albums of the year, and these young men are almost offensively talented. You don’t just write songs like this and sing like that. Unless…you write songs like this and sing like that. There are more than a handful of flavors-of-the-year topping all the cool lists this year that everyone knows will be stale next year and forgotten the year after. This one, it seems quite easy to predict, will be around for the long haul, for all the right reasons.

5. Neko Case: Middle Cyclone

neko

There was no way she could top Fox Confessor Brings The Flood and no one was asking her to. I wasn’t anyway. She is getting to Ella Fitzgerald territory (to invoke the cliche that I believe was first used in Ella’s honor: she could sing names out of the phonebook with a broken jaw and it would still sound sweeter than anyone else), and there is little she can do at this point to disappoint. Long may she sound her siren song(s). I remain smitten and unashamed to celebrate it.

4. Vieux Farka Touré: Fondo

fondo

About half-way through the year I wrote about Fondo, Vieux Farka Touré’s follow-up to his remarkable self-titled debut. Half a year later, it has not lost even a little of its luster; indeed, it has accrued additional value, and this is one to cherish –now and for the future. Here is a quick summation of what I said in June:

Word to the wise: get on board the Vieux Farka Touré bandwagon now. Not so you can be hip or prepared to drop his name at a cocktail party (for one thing, no one would listen to this music at a cocktail party, and more importantly, who goes to cocktail parties?) or for any reason that would behoove Starbucks to put this disc in their stores. No, the best reason to acquaint yourself with Vieux Farka Touré is because he is a surpassingly brilliant young musician who, if we are fortunate, has a long and productive career ahead of him. Nobody seems to agree on what “world music” actually means, which is probably not such a bad thing. It might suffice to suggest that “world music” is the sort made outside the States, likely sung in a different language and unlikely to yield traditional hit singles. In other words, music that involves actual instruments played with some degree of proficiency by sentient beings. Anyone with a moderately open mind might find Fondo, the followup to Touré’s eponymous (and astounding) debut, a very welcome antidote for the myriad of overproduced and underwhelming product being pumped out for mass consumption.

3. Living Colour: The Chair In The Doorway

lc

I’m going to take the liberty of quoting my recent PopMatters review, because I can (and should):

The rumors of Living Colour’s demise have been greatly exaggerated. They are back, but perhaps more to the point, they were never really gone. The good news is that The Chair in the Doorway is exquisite enough to make casual fans lament the ostensibly lost time. Something about contemporary cataclysms seem to serve as a call to action for this band: Collideoscope (2003) was very much a post-9/11 statement, and many of the songs on The Chair in the Doorway sound like a wrathful response to last year’s Wall Street fiasco. It is immediately apparent (and reinforced after subsequent listens) that the band put considerable thought into this album. Everything from the order of the songs to the production sounds like the result of a shared vision and a near-perfect plan. The finished product is fresh and clean, but retains an abrasiveness that gives it a most welcome edge. As ever, Living Colour’s cauldron bubbles over with rock, soul, hip-hop, metal, blues and their own idiosyncratic expression, a heart full of soul. It is right, then, to celebrate the return of a beloved band. It is also appropriate to acknowledge that, five albums in, Living Colour has solidified their standing as one of the most consistent, original and important bands America has produced. There’s little left to say: kick the chair out of the doorway and get this essential album into your life, immediately.

2. Dan Auerbach: Keep It Hid

dan ae

2009 had barely begun when I signed up to review this release, and expectations were, shall we say, somewhat stratospheric, considering that the album Dan dropped (along with the tag-team partner in his “day job” as The Black Keys), Attack & Release, was arguably the best of 2008. This was followed by a top-notch DVD documenting the subsequent A&R tour (which killed). So when word spread that the indefatigable Auerbach had already recorded a solo album, well, it was difficult to expect too much. Incredibly, it turns out that Keep It Hid was pretty close to an out-and-out masterpiece. Go figure. Here is what I had to say about the matter about ten months ago. If you’re not trying to read the whole rapturous review, here are some highlights:

What’s the story behind all this superhuman productivity? Auerbach has stated that, quite simply, he never stops working. Equal parts driven and inspired, it made all the sense in the world for him to build his own studio. Akron Analog, named after his hometown and preferred method of recording, is where he began assembling the rough cuts, mostly written during recent tours, into the songs that came together as Keep It Hid. This is not a retreat from the sonic explorations Auerbach undertook on Attack and Release, it is an expansion of them. The songs stretch out with that familiar multi-tracked guitar base, augmented throughout with the often subtle employment of organ, banjo and bass. This work unquestionably signals a step forward in Auerbach’s rapidly evolving style. Auerbach never seems to be straining himself or merely appropriating other, signature sounds just for the sake of doing so. The music he has so obviously, and voraciously, absorbed makes him who he is, pure and simple. In sum, Dan Auerbach was responsible for helping make one of the better albums of 2008, and Keep It Hid is already a contender in 2009. Should we go ahead and call him the current King of the Hill? Based on all available evidence, he’s that guy, and the competition for his crown is not particularly close at this time.

Anyone in need of further convincing needs to check out the album (or check their head) and is definitely advised to peruse this revealing interview wherein Auerbach talks about his process, his influences and his ambitions.

1. Rashanim: The Gathering

rashanim

Picking a jazz album for best of the year might seem like a stretch. Picking a jazz album that few people have heard of may seem pretentious bordering on recalcitrant. Except for one thing: Rashanim’s The Gathering remains the most convincing and exceptional album I’ve heard—in any genre—all year long. And to be perfectly frank, it’s not even really that close: this is not only the best album of 2009, it is without a doubt (at least in my mind) going to rank as one of the great albums of the decade, and for the ages. So, to paraphrase Don Vincenzo Coccotti (Christopher Walken) in True Romance before he whacks Dennis Hopper: “Hopefully that will clear up the how-full-of-shit-am-I question you’ve been asking yourself.”

I wrote at length about the band, and their latest release, back in August and even then I had a fairly solid idea that this one would be at or near the top of my list once the dust settled. The title of the post (and featured blog for PopMatters) was Rashanim: Healing Music For Unrighteous Times. That seemed accurate, then, and it seems even more appropriate, now.

So…who are Rashanim? They are a jazz trio operating out of New York City who record for John Zorn’s label Tzadik and are categorized in its “Radical Jewish Culture” series. (Being neither Jewish nor radical, I still find this concept rather rad, and to be certain, some of the very best music in the world is being created on Zorn’s middle-finger-to-the-industry label.) So…what does Rashanim sound like? The music is impossible to isolate or explain simply, in part because it incorporates so many disparate influences, using them all as a point of departure. Rashanim invokes other places and times yet remain very rooted in a modern sensibility. Klezmer? Ancient Jewish music? Jam-band? Surf guitar? All of the above: it’s definitely jazz and it is certainly imbued with a distinctively Jewish sensibility. Above all, it rocks. Like Zorn’s Masada albums, many of the songs have biblical or Hebrew titles (sometimes both), and for the most devout or scholarly (particularly the scholarly devout) these songs may accrue added levels of significance; but like much of Zorn’s catalog, the individual tunes can–and should–be appreciated simply for their superior craftsmanship and the almost inexpressible joy they provide. Like Zorn, and like many of the best composers, the melodies are effusive: instantly identifiable after only a few listens yet strikingly distinctive. This music challenges but rewards abundantly.

Let’s cut to the chase: call me Santa Claus and consider this recommendation the best holiday gift I could give you.

Share