Handbook for Mortals (Review)
By Colman McCarthy
Handbook for Mortals:
Guidance for People Facing Serious Illness by Joanne Lynn, M.D. and Joan Harrold M.D. Oxford University Press 242 pp. $25
All of us know death, if only in theory, if only as we witness or hear of someone else’s. Our own? We can imagine it, but little more. Yet it is still possible to have an informed imagination, one that broadens the options during the time leading to life’s exit.
Among the reliable information givers are Joanne Lynn, director of the Center to Improve Care of the Dying at the George Washington University Medical School and Joan Harrold, a Fellow at the National Cancer Institute. As physicians who have cared for thousands of terminally ill people, they are practiced and practical. What they offer in these pages of readable and often graceful prose is grounded in their “quiet conviction that people, even very sick people or very burdened people, have remarkable spirits, inspiring creativity, the capacity to cope with illness and mortality, and the wonderfully human drive to find one’s own life’s meaning.”
The author’s goal is empowerment—the offering of ideas, strategies and facts that patients need to possess when seeking professional help from the health care system It isn’t really a system, Lynn and Harrold write, “but a mix of disconnected, and sometimes dysfunctional, groups, plans, services, and professionals.”
Seventeen chapters are here, ranging from the specific-rich to the motivational. With only about 10 percent of current deaths falling into the sudden or unexpected category--a reversal from two generations ago before modern medical technology took hold—everyone has a choice: take action or take your time. The latter attitude is a roll of the dice, a chancy hope that family members or doctors and nurses will not only be there
at the moment of need but will be up to the challenge of deciding wisely. Lotsa luck.
Those who take action prefer to go with a relatively sure shot, not a long-shot. The leading cause of death in the United States is heart or circulatory disease. For this population, the authors write, “the death will seem sudden, even if the person has been ill for some time. Most people with serious heart and blood vessel disease have episodes of serious illness—heart attacks or heart failure, for example—and then long periods of ‘nothing changing’….You will think that you will get a decent warning of when your time is at hand, just like your Aunt Bertha with breast cancer or cousin Harry with kidney failure. Not so. You may become too short of breath to walk stairs, or you may stay relatively well. Either way, you are likely to end up dying within a few days of being quite stable in your ‘ordinary’ health.”
A weak section of “Handbook for Mortals” is the sparse two paragraphs that Lynn and Harrold devote to those who have the last word: newspaper obituary writers. The dozen or so large circulation major dailies have staffs of four, five or perhaps more writers on the death beat. Many are the most competent reporters in the newsroom, pros who know how to get the facts and get them fast. The better known a person is, whether nationally or locally, the longer the obituary. The globally famous—popes, presidents, Hollywood stars over 90—have advanced obituaries, ready to run instantly. The ideal time to die is on a Saturday morning. Saturday is a usually a slow news day, so competition for space in the news hole is slight. An obituary writer is likely to add on a few more paragraphs. In addition, Sunday circulation of the newspaper is almost always larger than on weekdays, which means more readers.
Some of that may seem off-the-wallish. But having toiled in a newsroom for three decades, I know that many survivors want the finest obituary possible for their loved one. And for themselves too—as when they deliver to the hometown newspaper a draft of their own obituary. Some papers will run it, others, fittingly, bury it.
Throughout the text, the authors set aside space for boxes of quotes from literature’s masters. The greats are here: Shakespeare, Auden, Dickinson, Tolstoy. So also some lesser knowns. The actor Tony Perkins writes about his work with AIDS patients: “There are many who believe that this disease is God’s vengeance, but I believe it was sent to teach people how to love and understand and have compassion for each other. I have learned more about love, selflessness and human understanding from the people I have met in this great adventure in the world of AIDS than I ever did in the cuttthroat, competitive world in which I spent my life.”
Much praise is due the authors. As physicians, they could have rejected the hard labor of writing. Instead, they answered a nobler call: caring and comforting through the word.
Colman McCarthy, a columnist for The Washington from 1969 to 1977, directs the Center for Teaching Peace in Washington DC.