Book Reviews

The Outermost House by Henry Beston (Henry Holt 1928)

I listened to this account of the year Beston spent living on the dunes at Cape Cod while I was on a long road journey. The book is so lyrical it is made for reading aloud, but I had to buy a print copy when I got home so I could read it for myself to pause over wonderful descriptions of landscape and wildlife, as well as the tragedies of stormy weather and shipwrecks. This is the best of American nature writing, more evocative even than John Muir, and with none of the economics bombast of that other temporary hermit in Massachusetts, Henry David Thoreau. I sensed the author had weighed every word, like a poet. How could I have missed this gem for so long?

The splendor of color in this world of sea and dune ebbed from it like a tide; it shallowed first without seeming to lose ground, and presently vanished all at once, almost, so it seemed, in one grey week (Chapter MidWinter).

Learn to reverence night and put away the vulgar fear of it, for, with the banishment of night from the experience of man, there vanishes as well a religious emotion, a poetic mood, which gives depth to the adventure of humanity (Chapter Night on the Great Beach).

Not so many people know the name of Henry Beston or this pinnacle of his oeuvre, even in his home country. Perhaps that is because he never made scientific contributions as a naturalist and never became politically active as a conservationist like Muir, Leopold or Rachel Carson who said this book inspired her. The Outermost House is a treasure, and although written nearly eighty years ago from a cabin later washed away by a huge storm on the Cape that is no longer a quiet corner of the state, its sensitive and gripping descriptions of land, sea and sky and reverence for nature should be enjoyed perennially.  A philosophy is expressed in the closing passage.

Touch the earth, love the earth, honour the earth, her plains, her valleys, her hills, and her seas; rest your spirit in her solitary places. For the gifts of life are the earth’s and they are given to all, and they are the songs of the birds at daybreak, Orion and the Bear, and dawn seen over ocean from the beach.

Active Hope by Joanna Macy & Chris Johnstone (New World Library 2012)

It’s a myth that ostriches bury their heads in sand to blot out approaching danger (they’d suffocate), although that’s what most of us do (metaphorically) when we start to think about the state of our planet. It’s easy to feel hopeless, and hard to act as responsible stewards for posterity’s sake. The challenges seem overwhelming—climate change, environmental destruction, species extinction, food insecurity, fossil fuel extraction and fishery depletion, population growth, vast differentials in wealth, corruption in high places, and distrust of government, to name those at the top of my list. If I ask myself what I can do, I’m tempted to bury my head. That’s a shameful reaction, although understandable for a powerless individual.

This book was therefore designed for me, and for everyone who feels likewise. It goes a fair distance towards its goal of encouraging hope, drowning despair, and stirring activism to counterweight headlong consumerism.

Joanna Macy is a veteran environmental activist and a scholar of Buddhism, while her coauthor is a physician and psychologist. Macy and another author, David Korten of Harvard Business School and economics advisor to developing countries, have popularized the concept of A Great Turning, by which they mean turning away from the industrial-economic model of the past couple of centuries, for while it has brought vast benefits to the quality and quantity of our lives the price has been high for the environment and for communities, and now we are charged with crises. Macy and Johnstone call this new state of precipitating calamities, The Great Unravelling. Yet, governments, companies, and institutions still merrily plow the profits of Business as Usual as if growth can continue indefinitely and ecological threats can be faced without any change of heart. The standard the authors raise for sustainable human flourishing is based on interconnectedness, care of the community, and love of nature; they find encouraging green shoots around the world.

The book tells a story that is familiar to people who are awake to environmental issues, but it frames them in a psychological, philosophical, and almost quasi-religious way. In the section, Going Forth, the authors strive to avoid making us feel guilty (and closing the book) by suggesting how we can contribute to the Great Turning. They give examples and exercises challenging our customary values and behavior, some of them familiar and others refreshingly new. The style has something in common with some self-help books. It is stimulating and thought-provoking, if leaving my appetite not completely sated because inspiration to act as a better steward generally springs from more than a diet of information and instruction. It often takes inspirational literature, poetry, music, or the visual arts to play on our sensibilities, and yet Active Hope points to these more transcendent mental vehicles too. While devoid of poetry, it reminded me of T.S. Eliot, who embraced hope for the world through the words of the Christian mystic, Julian of Norwich, and it also prompted a memory of the Tibetan Bodhicitta prayer for the welfare of community. Active Hope succeeded as good books do, by leaving the reader more thoughtful and challenged.

Active hope prayer

Gray Mountain by John Grisham (Doubleday 2014)

Considering John Grisham’s reputation and productivity, it’s taken a long time for me to pick up one of his thrillers. Gray Mountain is set in the coal fields of Appalachia, not far from where I read it in West Virginia. The story opens in New York City in the first days of the Great Recession where Samantha is a junior lawyer laid off by a Big Law firm. She takes an opportunity for pro bono work to gain professional experience in a legal aid firm in south-west Virginia with the aim of returning home as soon as the economy improves. It is a journey to another world, where a few lawyers struggle to help poor people in the mining community suffering from black lung and other cancers caused by polluted air and groundwater. The lawyers are pitted against a coal industry that manipulates the law and hires goons to evade moral and legal responsibilities for compensating sick workers and clearing up tailings from mountaintop removal which they dump in pristine valleys and streams. The story arc moves Samantha from familiar and comfortable territory into danger and frustration. In the end she is changed by the experience, and my first experience of a Grisham novel won’t be my last.

All the Light We Cannot See by Anthony Doerr (Scribner 2015)

This is a bumper year for books about WWII. Unbroken by Laura Hillenbrand was hailed by Time magazine as number one for nonfiction, The Narrow Road to the Deep North by Richard Flanagan won the Man Booker Prize, and All the Light We Cannot See by Anthony Doerr won the Pulitzer Prize. Although war reveals the best and worst in humanity, I rarely read its stories, either fiction or nonfiction. But this trio is not to be missed. It would be hard if forced to choose between them, but I might take the Doerr novel for its craft and sheer cleverness. The power of his writing is the passionate suspense and creation of vivid images and metaphors. “The last days of May 1944 in Saint-Malo felt to Marie-Laure like the last days of May 1940 in Paris: huge and swollen and redolent. As if every living thing rushes to establish a foothold before some cataclysm arrives.” The story flickers back and forth in time and between two players and places. Marie-Laure is a blind teenager from Paris who is unknowingly harboring something that Hitler seeks, and Werner Pfennig is a German boy recruited by the Nazis for his genius in radio communication. Their lives become entangled from the start, not that they know it until the story climax.

Being Mortal by Atal Gawande (Henry Holt 2014)

A friend urged me to read this book: “It’s about end-of-life matters by a Harvard surgeon and best-selling author. It’s important.”

At one time, my research focused on the biology of aging and I published Cheating Time. It’s a subject that always fascinated me, and as I climb in the mid decades of life it takes on new meaning. Dr. Gawande’s book is a revelation, not that it is about the causes of aging and not really about medical advances: it describes the hard choices for the closing years and months of life, and their impact in society and on our loved ones and ourselves. For all its triumphs, modern medicine often fails at these times, and sometimes aggravates and prolongs suffering.

In the first half of the book, he asks about the options for seniors who are so frail they can no longer care for themselves at home, and don’t have a family home to parachute into. None of them are rosy. He pulls no punches in describing how nursing homes, although providing essential food and shelter, , supervised medication and a safe environment, struggle to preserve autonomy, privacy and dignity which are still dearly held by residents.

“Prosperity has enabled even the poor to expect nursing homes with square meals, professional health services, and bingo. They’ve eased debility and old age for millions and made proper care and safety the norm to an extent that the inmates of poorhouses could not imagine. Yet still, most consider modern old age homes frightening, desolate, even odious places to spend the last phase of one’s life. We need and desire something more.”

The worst nursing homes warehouse our seniors out of sight and beyond the fringe of society. Gawande describes how people like the widow Alice, who was victimized by scammers, and Felix, the widower doctor struggling against the toll of aging, eventually had to surrender their independence to a nursing home. Most of us can tell stories of folk we knew in the same straits, which may one day be our own. One of our neighbors spent her last months in a poor example of a nursing home. The kindly and welcoming staff looked overworked; the place was clean, but grim and grey like the bowels of a naval ship where sunlight can’t penetrate. There was no soul in it, and one of the depressed residents shot himself.

Yet, the author throws a light on some remarkable pioneers who have succeeded in transforming nursing homes to something more like real “homes” in communities.  Others have launched a revolution in “assisted living” as an intermediate stage between hospital and nursing home. Like most changes, the novelties were resisted before they gained momentum, although some of the original and inspiring ideas were never incorporated into business models as the movement took off nationally. Demography is making insatiable demands for assisted living, and we see units springing up across our county.

The second half of the book is about choices for people facing terminal illnesses, and the medical care offered. Gawande tells more stories of people and patients he knew, and most movingly of his father’s struggle with spinal cord cancer.  These are not easy chapters for readers who have their own struggles or are caring for someone else, but despite it all he finds cause for optimism.

Medical care reaches the point of diminishing returns with terminal illnesses. We pour money into the fight to put off the evil day. Twenty-five per cent of the Medicare budget is spent on surgeries, medication and hospitalization for patients in their final year of life, not necessarily to reduce suffering but to gain a little more time, often not very much. Would the investment be better spent elsewhere? Do these efforts really improve the net quality of life, he asks? We fail to accept the finitude of our lives and, because survival times vary for a given disease, we cling to the hope that we will be among the lucky one percentile. “Hope is the thing with feathers/ That perches in the soul …And sore must be the storm/ That could abash the little bird …”

Stories of patients making hard decisions about their care were the most memorable passages in this book. The medical options were limited or experimental, often a trade-off between more suffering now and the chance of more life later. These are agonizing choices, because gambling generally doesn’t pay off.

One group grasped every straw offered by doctors. It is understandable with a younger patient encouraged by family, friends and medics hoping to be their heroes. The other group included Dr. Gawande’s father (also a doctor) who chose to be taken on hospice for palliative care rather than accept aggressive treatment. The striking observation was that this group found much pleasure in their remaining time (in his case several years) to enjoy priorities of life—family, travel, hobbies, etc. It helped if they had already discussed before falling into unconsciousness whether strenuous efforts should be made to revive them. These are tough discussions, but they made crisis decisions easier later on, and eased the minds of those making them. Gawande admitted that the word hospice sounded at first like defeat, and it was a revelation when he saw joy and rewarding activity embraced amid grim facts and bleak prospects. Perhaps this book achieves its highest purpose when he admits, “It struck me that, for the first time I can remember, I did not fear reaching this phase of life.”

His arguments strike home when he comes down firmly in favor of hospice care. My mother made that choice for herself and discussed her wishes with us when she faced her final illness. It conflicted with our irrational hope that she could still make a miraculous recovery if only the doctors tried the right cocktail of drugs, but her decision was unwavering and it enabled us to enjoy quality time together before she passed away peacefully. This is a book of authority and compassion that should be widely read and encourage public discussion about end of life care.