Wednesday, July 29, 2015

Ty Clever on uncertainty, contradiction, and Annie Dillard

This is What I Do: The Essay as Embodied Skepticism   

 For once, then, something.—Robert Frost

The skeptic’s or relativist’s dilemma: that they assert, with certainty, that nothing is certain, or make the absolute claim that there are no absolutes. For instance, philosopher David Hume leveled his infamous “wrecking ball” of skepticism at Reason, Belief, and even the Self, forgetting, it seems, that it was his own Self that set the ball swinging.

Yet Hume was fully aware of the contradictions in which all skeptical philosophies seem to be mired, and he comes up with a fascinating response to it: a rational argument, he claims, even one we agree with, does not necessarily have the power to derail deep habit, belief, and disposition. And, Hume argues, this is a good thing: a creature guided solely by skepticism would probably never get around to the messy, irrational business of living.

So for Hume—for all of us—the wrecking ball becomes a pendulum, transcribing an arc between extremes of world-dismantling doubt, on the one side, and life-sustaining delusion on the other. While we philosophize, we may see the truth of our abstract thought, but seconds later, or even at the same moment, we hold the unprovable belief that the sun will rise tomorrow.

While I’m persuaded by Hume’s point that even the most dogmatic skeptic (!) is incapable of living her skepticism, I’m not quite satisfied that he really captures the contradictions and paradoxes of the skeptical point of view. This may be in part because language, at least in most of its sanctioned forms, is governed by rules of non-contradiction. It’s all about agreement and consistency: subject/verb, pronoun/antecedent, tense, person.

To articulate an embodied skepticism would require a form that comfortably inhabits uncertainty and contradiction, such as the essay. As Montaigne once wrote, “If my mind could gain a firm footing, I would not make essays, I would make decisions.” More specifically, it could be argued that an articulation of the many paradoxes of skepticism calls for a brutalization of language, or at least an exploration of its limits. This is what Annie Dillard does in her stunning essay “This is the Life,” the last piece featured in the recently published anthology of essays and short fiction, Life is Short—Art is Shorter: In Praise of Brevity, edited by David Shields and Elizabeth Cooperman. Dillard examines the tension between what we know and how we live through a masterful, subtle, and shifty use of pronouns, articles, and conjunctions. While such words typically serve as the sentence’s invisible glue, for Dillard, they are the primary means by which she states, or more accurately, enacts, our slippery state of affairs. Dillard’s essay takes its readers not from ignorance to knowledge—an expectation we unconsciously bring to non-fiction—but from “ignorance to exposure,” to borrow a phrase from Stanley Cavell.

Consider the essay’s first sentence: “Any culture tells you how to live your one and only life: to wit: as everyone else does.” That opening “any” is a stay against ethnocentrism, a broad perspective that acknowledges many possibilities, but the sentence quickly sharpens down to the limited and egocentric: “your one and only life.” The “everyone” here is perfect: she means, of course, not everyone everyone, but the “everyone” of any given culture. But the potential confusion is accurate, so to speak: it represents our own confusion. Dillard’s sentence enacts the kind of amnesia that even the most “enlightened” of us suffer from, knowing that our way is one of many, but behaving as if it were the only way.

The next sentence continues in a similar pattern: “Probably most cultures prize, as ours rightly does, making a contribution by working hard at work that you love; being in the know, and intelligent. . . ” Starting with skeptical hesitation and hedging, “Probably most. . .” the sentence quickly shifts a narrow point of view: “as ours rightly does.” This dogmatic “rightly” is, in turn, affirmed by a list of values that are likely to align with the perspective of the audience of the essay when it first appeared in Image: A Journal of art and Religion: “. . . making a contribution by working hard at work that you love; being in the know, and intelligent; gathering a surplus; and loving your family above all, and your dog, your boat, bird-watching.”

The next two paragraphs swing us back to skepticism, each offering other possible ways of living a life. They open:

Another contemporary consensus might be: You wear the best shoes you can afford, you seek to know Rome's best restaurants. . . . (para 2) 
Or you take the next tribe's pigs in thrilling raids; you grill yams… (para 3) 

The third and fourth paragraphs continue to survey what various cultures see as “the life,” but Dillard begins to speed up and increase the contrasts, barely acknowledging even the most jarring shifts: “Since everyone around you agrees ever since there were people on earth that land is value, or labor is value, or learning is value, or title, necklaces, degree, murex shells, or ownership of slaves.” The universalizing “everyone” is at odds with a list of singularities, and those singularities are at odds with themselves. The anaphoric “or” serves a similar equalizing function, reducing even the shocking phrase “ownership of slaves” to just another item on a list of what people prize. The reader begins to experience (not just understand) the contingency of universalizing words we so often utter without a thought. Dillard shows that our tendency to make “a” viewpoint, the viewpoint, works on every level, from the most innocent to the most reprehensible beliefs.

Knowing, perhaps, that’s she’s begun to instill a true awareness of our tendency to slip into a specious universalism, Dillard leans on the word “everyone” a bit more, asking, “Who is your ‘everyone’?” She also leans on the reader. The entire essay is in second person, and, for the most part, it simply gives the essay a feel of informality. But with this question, there’s no doubt that readers are being addressed directly. We’re no longer reading a theoretical consideration of a philosophical conundrum. It’s personal now. We’re implicated.

With the implication of the reader, Dillard intensifies her questioning. Now that we know—have experienced, in our own small way, through Dillard’s essay—that no value is universal, that there are infinite ways of living a life, Dillard asks, “then what?” (she repeats this question five times over the course of the essay). The questions comes fast:

Say you scale your own weft and see the breadth and length of space. . . . What, seeing this spread multiply infinitely in every direction, would you do differently? No one could love your children more; would you love them less?. . . Would you dance any less to music you love, knowing that music to be as provisional as a bug?

Hume points out that we could question every assertion we make, every value we hold, ad infinitum; this is why he comes up with the explanation I’ve outlined above. But Dillard doesn’t merely tell us this; she makes us experience the shifts from a narrow to a broad perspective; from naive belief to enlightened (but still theoretical) skepticism, from theoretical skepticism to, finally, a personal awareness that everything we say or do can be questioned, and is “provisional as a bug.”

It’s at this point, we may say, along with Wittgenstein, “If I have exhausted the justifications, I have reached bedrock and my spade is turned. Then I am inclined to say: ‘This is simply what I do.’” And in a sense, this is what Dillard encourages: she continues to pile on the contradictory examples and pummels the reader with questions, until there is no choice but to say, “This is simply what I do.” As the reader, I must acknowledge that even though I know my preferences have no rational justification, I cannot stop myself from having them.

Later in the essay Dillard reminds us that

Our lives and our deaths count equally, or we must abandon one-man-one-vote, dismantle democracy, and assign six billion people an importance-of-life ranking from one to six billion—a ranking whose number decreases, like gravity, with the square of the distance between us and them.

The alternative offered after the “or”—that we bestow undue value on those who happen to be near us—is precisely the option most of us choose, even though when Dillard states it outright, it sounds appalling. It’s like a variation of the familiar ethical dilemma of a train heading towards a group of people. The classic version gives us two choices: either allow the train to continue, or switch the rails and send the train careening towards one person standing on another track. Most people hit the switch: one death is better than many. Some philosophers have added a twist: What if saving the group involves not merely switching tracks, but pushing a large person who happens to be standing beside you in front of the train? Here most of us hesitate. It’s the same result: one life sacrificed for many, but the nearness—which has no bearing on lives saved or lost—of the sacrificed individual causes us to pause. Call it “proximity bias.”

Which takes us back to the title and its masterful pronoun, “This is the Life.” “This” generally refers to something present or near, as contrasted with “that,” which refers to something at a further remove. So the “this” in Dillard’s title reminds us that one’s way of living is another irrational choice, made for us by mere proximity. We are compelled to acknowledge that no life or way of living it ever truly merits the “the” of exclusivity and importance; that the only honorific we deserve is the indefinite “a,” while simultaneously we live as if “this” irrational, unjustifiable life is all that matters. Dillard leaves us in the same moral quandary she found us in, still in an impossible circumstance, still skeptical but heedless, for the most part, of the truths that our skepticism reveals. We may feel we’ve seen “something”—another perfect pronoun employed by Dillard in the final paragraph—but we’re not sure what to do with that murky “something.” We conclude (or begin?) with Dillard’s parting words and the mantra of the essay: “Then what?”  

Ty Clever is the director of South Central PaARTners, an arts-in-education program at Millersville University in central Pennsylvania. He blogs about poetics, style, and art at

Monday, July 27, 2015

David Carlin (with ‘Nicole Walker’): Breaking The Rules—Part 4. OK, Nicole, thanks for asking.

OK, Nicole, thanks for asking. I see you began this series with a conversation that, appropriately, broke your own ‘Breaking the Rules’ format rules by becoming just that, a conversation, between yourself and David Le Gault. And since I’m torn irredeemably between wanting to follow and to break rules, I thought we could continue with the conversation format, which is, after all, almost the rule now, but because of distance and time constraints I propose to imagine your part of it on your behalf. Will that be OK?
Nicole: [cursor blinks – as if to say she’s (I’m?) thinking, or else as if to say, WTF?]
David: I’m not at all sure this will turn out well for us but I feel as if you are prodding me from offstage with a broomstick.
Nicole: Improvise!
David: You say.
Nicole: And by the way —
David: You also say —
Nicole: — I’m not at all happy for you to be making up my lines like this. I just want you – and everyone - to know that!
David: Yes, well you can always include those familiar meta/editorial asides in italics whenever you like since YOU HAVE THE POWER…
Nicole: [thinks…yes, I will be doing that, don’t worry!]
David: Are we an essay? Have we started to be an essay? Have we already forfeited all rights to be an essay?
Nicole: Well David, you tell me.
David: By the way, are you only going to ask people called David to contribute to this series? Is that why you asked me?

The reason I’m attracted to the essay is that —
         (see, I tried to straighten things up there for a moment, but is that necessary?)
   — for one thing, you don’t need to know where you are going or how you are going to get there. Which, if it works, provides the reason for the reader to keep on reading: they too want to find out where we are going to end up.
What I love, in thinking about nonfiction, and just to jostle something else in here alongside the idea of the essay, is the notion of the report or the account. But not reporting in a codified journalistic sense, with all of its associated rules (lead sentences, the inverted pyramid, ‘keep it objective’), and not accounting as in a tallying up, a tidying into neat factual columns. One of my favourite nonfiction titles is Gregoire Bouillier’s Report on Myself, because it sounds like an anti-confession, a faux-objective inquiry, like a Taskforce on Bewilderment. Let’s commission a report on heartbreak and the colour blue from Maggie Nelson! Let’s ask for a full account of the contemporary experience and phenomenon of humiliation from Wayne Koestenbaum; let it be an awkward tally of memories, observations, readings and confessions: ‘In a Buick station wagon my mother yelled at me in front of my debate partner, a girl with a perennial tan.’

What all of these investigations have in common is an explicit ethic in which the author admits to being implicated — neck-deep, as Ander Monson has saidin whatever they are reporting on or accounting for. (BTW, is it advisable to name-drop your editor, Nicole, or is it a bit sucky? Nicole:  I thought these italic brackets would be reserved for my meta/editorial ‘real-Nicole’ interventions?? David: Sorry, Nicole… and also, I suppose, what if Ander wanted to do meta-meta interventions (if he has that POWER)? There seems to be a shortage of meta-intervention conventions available to us, don’t you think??) The convention is that the essay is precisely this: a form in which the writer refuses to hide from an open account, not only of whatever it that she is addressing, but also of how she is addressed by it. Cf, of Claudia Rankine’s work: ‘she wishes to interrogate the feeling inside of a moment’; or, as Rankine says, herself: ‘I’m interested in getting at an affect – not a story.’

Because we are desiring beings, sexual and embodied, and enmeshed in cultures, dialogues and atmospheres, our human thoughts and feelings at any given moment, whether we are crossing the road, chasing after bunnies, and/or essaying an account, are more like a carnival than a card catalogue or hard-drive directory. This is what makes life interesting, bearable and complicated all at the same time. As Geoff Dyer has said, he includes so much of himself in all of his accounts, whether they are supposedly about D.H. Lawrence or Tarkovsky’s Stalker, not because he thinks he is especially notable or important, but because ‘I am available.’ His own, particular, weird (but no more weird than any of us) carnival of insights, fears, preconceptions, contradictions, fantasies, hungers, analyses, nightmares and banalities, is uniquely available to him to report upon from close quarters, as it bears upon the ambit of his chosen subject. Don’t you think? Nicole? Nicole?
Nicole: Oh, I’m still here, am I.
David: What do you mean?
Nicole: You are very needy.
David: Yes, well there is this: My job is vulnerability. (Sheila Squillante) And also this: The fundamental experience of the writer is helplessness. (Louise Gluck)
Nicole: Keep going, its Essay Daily, not Essay Until the End of Time.

Self-consciousness is the pivot of the essay. A good essay is self-aware and self-implicating, maybe even self-lacerating or self-dismantling, since its author tries to give a full and frank account, which realizes all too well that it can never be a full and frank account, of what it is to address, and be addressed by, the thing at hand (the putative subject of the essay). The clear and present dangers of the essay form, on the other hand, include self-pity, self-regard, self-protection and special pleading. Am I sounding like a wanker?
Nicole: There is always that possibility.
David: Or perhaps like an Australian.
Nicole: Breaking the rules…?
David: Everybody knows you are not really saying these things. I think the playing field of the essay is very wide, in fact it runs right down into the creek, the borders only seem to be defined by the organizing voice of the essayist, wouldn’t you say?
Nicole: Hmm, you mean, so long as we know it is all a game in the essayist’s mind then anything is possible?
David: Yes, the essayist is Godlike, but also, importantly, a clown and an idiot. Doomed to fail, but artfully, somehow. If it works.
Nicole: So the only rule is it has to work?
David: The rule, perhaps, if we are going to make one, is that the reader is able to be complicit with the game. Also, another rule will be that the essayist allows the essay to suggest its own structure, and then seeks to honor that suggestion. These are sounding like two excellent rules, if I say so myself. Part of the game is to listen to the essay as it develops and to tend it as it grows, like a child, in its own particular and unpredictable way. So in this sense the essayist is far from Godlike; rather more humble, like a parent has to be.
Nicole: Perhaps we should sing a song now?
David: What?
Nicole: I just thought, why not? Why not a song?
David: Phew, you are really getting into this! A song! Lets just say, anyone can sing a song at any time, OK? Another thing I thought to mention, if not sing about, was to return to this business of card catalogues and hard-drive directories. This, in fact, could be another rule: the rule of irony. (There are now three rules, which is good, because a well-known meta-rule of design is that things should always come in threes...) Essays are inherently ironic because they purport to be offering knowledge about something (e.g. the handy Of Cannibals, by Montaigne), and yet they must also be disquisitions on not-knowing, on the limitations of what the essayist knows  (or else they are fibbing, which is against the rules).  And because an essay is a theater of the brain (David Shields), and what it feels like to live with a human brain is more like a carnival than etcetera…well, this could explain why essayists have frequently turned to bureaucratically utopian structures such as card catalogues and wedding contracts — to work against them, to harvest their ironic energy and thereby to produce dramatic (or perhaps rhetorical?) tension.
And always, once one is started, one is thinking, how are we going to finish this?
Nicole: And how are we?
David: Well, we still don’t know, in fact. We are trying to watch and listen for the shape, and for the turn. Near the start, I said that we don’t need to know where we are going in an essay, but that’s quite wrong, actually. Of course we need to know where we are going, even if it turns out to be a mirage when we get there. We need to have an idea of what it is we believe we are heading towards – and what we should be thrillingly surprised about is everything we discover along the way. Otherwise, why should the reader follow us, if we don’t even maintain the delusion that we are worthy guides? I always repeat to my students, and anybody who is interested, the advice the novelist Rodney Hall gave me a few years ago, a propos of any creative writing.  He said you only need two things. First, you need to have some idea of what it is you are trying to reach, in a piece of writing, even if that is only the feeling inside of a moment. Imagine that this thing that you are trying to reach is like a flag in the distance, poking up from within a high-walled maze. Your job — the second thing is to know this — is to step into the maze, heading sideways, forwards, sideways again, up and down col de sacs, stumbling on blindly but always keeping the flag there in your peripheral vision, as you gradually approach it.

Nicole: Is that it — ?
David: What do you mean: is that it? Do you mean, is that the answer or is that the end?
Nicole: Hmm, language is always ambiguous, isn’t it...
David: You know what? I wish you had been the real Nicole. And things had turned out just like this, broken and unruly, essayed.
Nicole: Or maybe better to say it like this: the essay is an offering in the gap between us, where we can be broken and unruly.
David: Not us in particular.
Nicole: No, you know, more broadly.
David: Yes.

Bouiller, Gregoire Report on Myself. Mariner Books, 2009.
Dyer, Geoff. Out of Sheer Rage: In the Shadow of DH Lawrence. Canongate Books, 2012.
Dyer, Geoff. Zona: A Book about a Film about a Journey to a Room. Text Publishing, 2012.
Gluck, Louise. Proofs and theories. Harper Collins, 1995.
Koestenbaum, Wayne. Humiliation. Macmillan, 2011.
Le Gault, David & Nicole Walker.A Kindness of Rules, Essay Daily, 2015.
Monson, Ander. Neck Deep And Other Predicaments. Graywolf Press, 2007.
Montaigne, Michel de. ‘Of cannibals.’ The complete essays 152 (1958).
Nelson, Maggie. Bluets. Wave Books, 2009.
Rankine, Claudia. Citizen: An American Lyric. Macmillan, 2014.
Shields, David. Reality Hunger: A Manifesto. New York, NY: Alfred A, 2010.
Squillante, Sheila. ‘On using asterisks like bread crumbs’, Essay Daily, 2015.
Walker, Nicole. ‘Breaking the Rules--Part 3. What You Don't Know’, Essay Daily, 2015.

DAVID CARLIN’s new book is The Abyssinian Contortionist (UWAP, 2015). His other books include the memoir Our Father Who Wasn’t There (Scribe, 2010), and Performing Digital (edited with Laurene Vaughan, Ashgate, 2015). Apart from books and essays, he has also written and directed plays and documentaries, and in 2014 curated, with Paper Giant, the digital media exhibition Vault: the Nonstop Performing History of Circus Oz (Melbourne Festival). He lives in Melbourne, where he directs, with Francesca Rendle-Short, RMIT University’s nonfictionLab research group. David co-chairs the 2015 NonfictioNOW Conference, with Robin Hemley and (the real) Nicole Walker.

Monday, July 20, 2015

Andrew Bomback - Hope is not a Plan: On Being Mortal, Doctors, and Death

My friend spent two weeks at a writer’s retreat in Vermont, where he met a former physician who was now working on a memoir about why she left medicine. The former physician told my friend that her memoir was not a doctor memoir, “because all doctor memoirs suck.” My friend, who’s not a physician, asked me, because I am, if I agreed with that assessment. Like many modern conversations, ours was over email. I wrote back: I sort of agree with your new friend that doctor memoirs suck, but I am a very biased reader. I always feel that the doctor is trying to make himself or herself sound like a much better person than he or she really is. It's quite possible that I am the outlier among doctors in being an on-again-off-again asshole, but I doubt it, because all my doctor friends have equally asshole-ish tendencies. And that stuff almost never comes out in those memoirs. And I think the narrative arcs in those memoirs tend to be artificial, too. Nothing in medicine is linear. Again, I'm really biased. 

Upon the recommendation of my wife, a fellow physician who specializes in hospital medicine, I read Atul Gawande’s latest book, Being Mortal. The book moved her to start a hospital-wide book club in the hope of spurring conversations about how healthcare workers deal with aging and dying. Nothing speaks to how poorly physicians, nurses, social workers, patients, and families handle mortality than the fact that my wife has been trying to plan this book club for four months, as of this writing, and still has not been able to get full buy-in from her hospital.

Throughout Being Mortal, Gawande uses Tolstoy’s The Death of Ivan Ilyich as a teaching tool on how doctors can manage or mismanage their patients’ death experiences. He himself first read the book as a medical student in a seminar series called “Patient-Doctor” that emphasized the humanistic parts of doctoring (many medical schools have such courses – mine offered “Clinical Practice” every Friday afternoon, and we read William Carlos Williams’s The Doctor Stories). The key part of the Tolstoy novella, for Gawande, is that Ivan Ilyich’s greatest suffering stems not from his fatal illness but rather from his doctors and his family refusing to acknowledge that he is dying. Instead of comforting him, they bring in new experts and try new treatments, well-intentioned efforts that do nothing to stop the impending advance of death. I wrote this last sentence about Ivan Ilyich but it could apply to any patient today in any intensive care unit in any American city.

Death, Gawande writes, is not what the very old fear. “It is what happens short of death – losing their hearing, their memory, their best friends, their way of life.” He quotes Philip Roth – “Old age is not a battle. Old age is a massacre.” – before lambasting doctors for having too narrow a focus. “Medical professionals concentrate on repair of health, not sustenance of soul.” These professionals, trained to “fix” more than “manage” problems, should not “be the ones who largely define how we live in our waning days.”

If I were teaching “Patient-Doctor” or “Clinical Practice,” I’d assign the medical students “Errand,” the Raymond Carver short story that relays the last moments of Anton Chekhov’s life. In the story, Chekhov is receiving hospice care in a luxury hotel in southern Germany, and his physician is summoned late in the night by Chekhov's wife, who reports that her husband is becoming short of breath and coughing up blood. When the physician arrives, he sees that Chekhov is nearing his end; oxygen might help, but that will take hours to retrieve, and by then Chekhov will be gone. The physician picks up the phone and dials the hotel's kitchen, ordering up a bottle of champagne with three glasses. Chekhov drains his glass, compliments the champagne, and then passes away. When discussing the physician's decision to order champagne instead of oxygen for the dying Chekhov, Carver writes, “It was one of those rare moments of inspiration that can easily enough be overlooked later on, because the action is so entirely appropriate it seems inevitable.” When I am confronted with a dying patient, I think of the doctor ordering champagne, and I hope that my own actions will someday be viewed by the patient’s survivors as “so entirely appropriate.”

My least favorite parts of Being Mortal are when Gawande recounts patient stories. I concede that non-physicians might find such tales interesting. To a doctor, though, these examples feel too precious, too convenient, too memoir-y. I don’t need to know what Gawande learned from each patient’s death. I want to know how he approaches a dying patient who won’t acknowledge death. Even more, I want to know how he approaches a fellow physician whose recommendations for a dying patient are not “so entirely appropriate.”

My favorite part of Being Mortal is how Gawande handles “The Median Isn’t the Message,” the essay by Stephen Jay Gould in which the paleontologist rejects the survival data he’s been given for his own cancer diagnosis in favor of the slim chances that his fight with cancer will be an outlier. Gawande says he thinks of Gould’s essay “every time I have a patient with a terminal illness…[W]e’ve built our medical system and culture around the long tail. We’ve created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets – and have only the rudiments of a system to prepare patients for the near certainty that those tickets will not win. Hope is not a plan, but hope is our plan.” Here, Being Mortal sheds itself of memoir and announces itself as a book-length essay on why hope is the wrong plan for dying patients. Here, Atul Gawande gives his readers a flash of his own asshole-ish tendencies.


My daughter, Juno, was at a playdate with one of her friends, whose name happened to be June. Her parents also happened to be doctors – the mother a pediatrician, the father a cardiologist. The symmetry was amusing. While the children dressed up as Elsa and Anna from Frozen, we adults tried at first to talk about our town and our children. Soon enough, though, we were talking about medicine. My wife told the cardiologist that the new advances in heart failure management – ventricular assist devices, transcatheter aortic valve replacement surgeries, home infusions of milrinone – have made it harder for patients to accept that it’s natural to die of heart failure. The cardiologist said that one of his favorite headlines from The Onion was “World Death Rate Holding Steady at 100%.”

The truest line in Being Mortal, from a physician’s standpoint, is when a critical care doctor tells Gawande, “I'm running a warehouse for the dying.” Gawande writes that the critical care doctor said this line “bleakly.” This is a good example of why writing students are instructed to avoid adverbs, because Gawande compromises the line by saying it was delivered “bleakly.” The doctors I know would have said those exact same words but would have done so with a smile and a laugh. The line would have been delivered as a joke.

Malcolm Gladwell, discussing why people tell jokes about themselves (his specific reference was engineers making engineering jokes), calls such jokes “grievances.” Jokes are a way for a group of people to complain: This is the way we think! Why doesn’t everyone else think like us? If you want to learn about how doctors process the deaths of their patients, don’t read their published memoirs. Instead, listen to the jokes they tell each other.

A doctor tells his patient that she has terminal cancer. “Terminal?” she asks. “As in, there’s nothing you can do about it?” “Nothing,” the doctor says, “nothing at all.” “Well, with all due respect,” the patient counters, “I want a second opinion.” “Okay,” the doctor says, “you’re ugly, too.” Interpretation: Doctors are frustrated by patients’ inability to accept their own mortality. This denial can put us in the uncomfortable position of having to convince patients and their families that death is inevitable. Doctors – at least the ones I know and respect – laughed at the “death panel” fears stirred up by opponents of Obamacare. The laughter stems from our near total impotence regarding death in the hospital. The patients and, more commonly, the families (because the patients are too ill and only rarely have clearly defined advanced directives) decide which life-sustaining interventions they want, regardless of medical advice. We can use leading language, we can make heartfelt recommendations, we can outright say that an intervention is futile, but the patient and the patient’s family ultimately make the decision on what to do and what not to do.

An oncologist goes to the morgue to find his patient. “He’s scheduled for chemotherapy,” the oncologist tells the mortician. “Sorry,” the mortician says, “but you’re too late. The nephrologist just took him off for dialysis.” Interpretation: Doctors over-treat patients, but this over-treatment isn’t about making more money. The over-treatment – the “flogging,” as we say in the hospital – is rooted in our collective inability to admit defeat, which in turn is driven by fears of our own deaths. If I, as a doctor, give up on this patient, someday another doctor will give up on me. Older doctors flog more than younger doctors (I have no data to back up this claim, because no such data would ever be collected, but I assure you it’s true).

The doctor takes his patient into a room and says, “I have some good news and some bad news.” “Give me the good news,” the patient says. The doctor replies, “They're going to name a disease after you!” Interpretation: Doctors need to create emotional distance from their patients’ deaths. We teach our medical students how to deliver bad news to patients. They practice, first on each other, then on actors pretending to be patients, and then, eventually, on their own patients during clinical clerkships. In the title essay of The Empathy Exams, Leslie Jamison relays her experiences as a medical actor and describes the process by which she tried to evaluate a medical student’s empathy. She correctly points out that she was not grading the students on their empathy as much as their projections of such empathy. We don’t teach our trainees apathy, but this is a learned behavior, too. We must have some separation from the bad news we’re delivering, some ability to send home the patient who’s just cried in the office and move on to the next patient. We must have the capacity to leave the office and be with our own families and not think about our patients’ suffering.

On my first night on-call as an intern, I admitted a hemophiliac on a Friday night who died by Sunday of an intracerebral hemorrhage. He’d presented to the emergency room that Friday night complaining of a headache and severe constipation. He was given an enema and sent for a head CT. The next morning, presenting his case to my team, I explained my working theory that the intracerebral bleeding was caused, at least in part, by excessive straining to move his bowels. He’d burst a blood vessel trying to defecate. My first patient death may have been prevented by a stool softener, by laxatives, by prunes. Within a week, I was telling this story as a joke to my co-interns. None of us was more than a month removed from our medical school graduations, but we all laughed. We were doctors now.

Andrew Bomback is a physician and writer in New York. His essays have recently appeared in Human Parts, Hobart, The Harlequin, Full Grown People, and BULL.

Wednesday, July 15, 2015

Thomas Mira y Lopez: On Valeria Luiselli, Owing Everything and Nothing, and Saladin's Strange Encounter with Orlando Bloom

Over a spate of recent weddings, I’ve had plenty of occasion to realize how out of touch I am. “Is this Taylor Swift? Kanye? The Backstreet Boys?” I ask an increasingly frustrated dance partner. “And who sings this?” I shout while stomping along to a Bruno Mars song that approaches a billion views on YouTube. In spite of my relatively young age, I still pride myself, however foolishly, on being behind the times. It carries some definite advantages: true, my excitement is often tempered by being the last to know, but so too is my agitation. I carry much less hankering to react imprudently. That, and I’ve pretty much avoided all 90s pop.

So it was only on a recent evening that I stumbled upon the latest debate concerning writing and the writer’s life, some weeks after its internet star had brightened and burnt. The argument stemmed from an online article that questioned a) whether there was a surplus of creative writing programs in the country and b) whether these did a service to their students or only sustained their illusions about an unsustainable career. Are there too many of us calling ourselves writers and not enough readers to treat us with the proper care? What does it mean to call oneself a writer, much less to call oneself anything at all?

As is the internet’s nature, backlash sprang up against the original post, soon followed by backlash to the backlash, and so on and so forth. In the spiraling in (or out) of the debate, the original argument proved itself true: there was simply too much to read, especially when it came to posts ruing the overpopulation of writers. It seemed the only conclusion to be made was that the busy reader, given how easy it is to alt-tab or hyperlink away, owed the writer nothing.

Like most arguments, the one arguing a surplus of writers has been made before. It’s a condition I myself celebrate and bemoan several times a day, depending on my mood. As a reader, I take heart in knowing there’s so much to dive into; at the same time I realize there’s so much I won’t read. As a writer, I cheer myself thinking that so many of us sit in the same boat; then again, what if the boat looks like this?

Whatever the case, I was a little down in the dumps that evening when I returned home to find Valeria Luiselli’s Sidewalks waiting in the mail. I had drunk an ill-advised espresso and so I opened it directly before bed. My eye had been directed to the first essay in the collection, “Joseph Brodsky’s Room and a Half,” about Luiselli’s search for the poet’s grave at the San Michele cemetery in Venice, but given the late hour I figured I’d stick just to Cees Nootebom’s introduction. (A quick side-poll: do you, dear readers, given that there’s so much to read, hew to the introduction before all else? Or do you avoid all possible spoiler alerts, not only to the book’s subject matter but to the author’s style and strategy of thought? Do you fear the introduction will prescribe too much the way you are supposed to read, but do you, like me, read it nonetheless?)

A few pages in and I ran across this (the text is Nootebom’s, the quoted material Luiselli’s):

A romantic element still remains in this city of millions: the moment of the creative void, of the “relingos,” which Luiselli defines in the same breath as “absences in the heart of the city” and “everything we haven’t read.” That should be easy enough to resolve. But the twist is a different one: if there is no writing, there can be no reading. So this is about writing as the creation of emptiness: “A writer is a person who distributes silences and empty spaces.”

A little out of context, but here was something. In Luiselli’s geography, Nootebom argued, writing serves a different purpose. A relingo—“everything we haven’t read”— and thus the written word become “absences in the heart of a city,” the small patches we have overlooked or left off the map. The writer’s job is to create that emptiness, to distribute silence and empty space. If writing exists so as to be discovered, then it must also exist to remain anonymous and unknown. Too many writers and too much to read? That’s the point. We’re here to be unread as much as read.

I take heart in this. Here was a synchronous response to the worries of my day, late-night serendipity practically airdropped into my lap—evidence that, whatever we happen to read or write, we do so waiting for those reminders that we are always in conversation and that these lines of conversation might be aligned together until they form a radiance of streets capable of piercing a clogged and congested city center.

Luiselli had changed the terms of the debate I was mulling over—now I would go to bed in a state of uncertainty, all the more preferable to falling asleep a cynic. And I hadn’t even begun the book.


One of my favorite moments in an otherwise dismissible film occurs near the end of Kingdom of Heaven. This is Ridley Scott’s take on the Crusades, a long boring bloated movie whose battle scenes are inexplicably overlaid with shredding heavy metal guitars, a soundtrack so anachronistic it woke my friend up who had fallen asleep halfway through. The viewer owes it nothing. There is one relingo, however, a discovery awaiting relish: the scene where Orlando Bloom, the heroic and gentle crusader (I forget the name of his character, though it hardly matters since Orlando Bloom really only ever plays Orlando Bloom), meets Saladin, the Muslim sultan and military commander, to negotiate the fate of Jerusalem.

They stand on the desert battlefield between their two armies. The Crusaders dot the rubble behind Bloom; the besieging Muslims line the horizon, their banners flapping in the wind, lances straight and still, their mass menacing the background scenery. The two men have finally reached a compromise (the Crusaders will abandon the city in return for safe passage out of it) and Saladin, satisfied, walks away.

Orlando Bloom, hand on the helm of his sword, squints after him. “What is Jerusalem worth?” he calls out. Saladin turns around. He is played by the Syrian actor Ghassan Massoud (this is before Ridley Scott footmouthed his views on hiring Middle Eastern actors) and he is the best thing in the movie. “Nothing,” Saladin replies, helmet and chainmail perfectly still. Orlando Bloom flexes his jaw and squints harder. Saladin walks a few paces further only to spin around again. A surprise! The music swells. His cloak rustles ever so gently in the desert breeze as he raises both hands to his chest and balls them into fists. He breaks his face into a mischievous grin. “Everything,” he says, every syllable pure and discrete, as if this is his body’s most natural and yet most articulate form of expression.


I recognize that grin in Luiselli’s work.

I went on to read “Joseph Brodsky’s Room and a Half” the next morning and found an essay that cherishes whimsy and contradiction, an act of writing seemingly so unconcerned with whether you read it or not that it stands as the most persuasive reason to read it in the first place.

Luiselli visits San Michele to find Brodsky’s headstone, but her trip is fueled as much by its lack of direction as its original aim. Brodsky’s headstone proves difficult to find (it has no official directions to it, only the poet’s name written in whiteout as an addendum on the sign pointing towards Ezra Pound’s neighboring grave), yet its very absence fits the essay’s concerns—the absences caused by the Russian’s exile, the absence of information surrounding the majority of anonymous names in the cemetery, the absence of those persons themselves.

These parallels might seem convenient, but Luiselli’s navigates a tricky path through the essay. A cemetery’s graves, like an unread book, contains what we do not know; a less adept essayist could very well lose clarity and precision when presented with that great expanse of information. But Luiselli relishes the unknowns that San Michele contains. She outlines the elegant, eloquent anonymity of a place. “There’s no necessity to be polite to the dead,” she points out while traipsing around the grounds and it’s this acceptance of her own limitations that allows her to see so much. She seems as likely to rub out the name on a grave as to assiduously record every one.

This affinity for the unknown seeps its way into the essay’s structure. Section headers are organized by names of San Michele’s inhabitants, some of them famous (Brodsky, Stravinsky, Luchino Visconti) and others anonymous (Enea Gandolfini, Lidia Tempesta). As an organizational strategy, these headers direct attention to death’s egalitarian nature: the unknown and the well-known rest side by side. But more than that, they serve as relingos to be discovered, in celebration of the names themselves, asking us to pause on what would normally be overlooked. Luiselli’s simple record keeping establishes a momentary connection. We busy readers, for however long we’d like, stand there squinty-eyed and square-jawed, puzzling over a faraway name.

I’d argue it’s these simple acts of connection that Luiselli is most after. If this is an essay and a writer concerned with absence, it’s only so that creative ways might be found to fill that void. Luiselli opens with the remark that “Searching for a grave is, to some extent, like arranging to meet a stranger in a café” and the promise here is that reader and writer, just like the living and dead, will start off strangers but end up friends. We have only to catapult ourselves over paradox and realize we must look for something in a place we can’t find and look for nothing in a place we can.


I’d like to imagine that had coincidence extended a bit further on that recent evening and I had run into Luiselli outside the coffee shop (scene of my insomniac espresso), I’d have asked her what she thought about this latest referendum on the vain endeavors of writing. “Is it all hopeless?” I’d ask, of course in a tone of utmost hope. And perhaps she’d respond, as she responds to Bergson’s theory that people are only moved to laughter when the subject of their laughter appears human in some way, with a simple “Could be” and then flick ash from her cigarette and continue on her nightly walk.

“What does the reader owe the writer?” I call after her, as puzzled and puppy-dogged as Orlando Bloom. She turns around. “Nothing,” she says with a wave of her hand. Then a pause and a beat. Her hands ball into fists. She grins. “Everything.”


Thomas Mira y Lopez has an MFA in creative nonfiction from the University of Arizona. He'll be the Olive B. O'Connor Fellow in creative nonfiction at Colgate University in 2015-2016 and is at work on an essay collection about cemeteries and other resting places.