Tuesday, 30 August 2016

Being Mortal

Four times a year I go into one of the Southern Medical Laboratories offices and have a sample of blood taken. Someone in a lab somewhere then measures my levels of cholesterol, blood sugar and uric acid. And they look for the one I am really interested in: my levels of Prostate Specific Antigen. PSA is produced only by the prostate gland, and seeing as I have had mine removed, if there is any PSA in my bloodstream it can have come from only one source: prostate cancer cells that have drifted off through my lymph system and are now lodged and growing in some unknown part of my body. About three years ago my PSA levels, while still comparatively low, were increasing alarmingly, doubling every four months or so in a pattern which, if not  dealt with would have proven imminently fatal. My urologist started me on a course of hormone injections which reduced the levels immediately to zero, where they have stayed since.

While the hormones deal to the overwhelming majority of cancer cells, a few are impervious, and they will be there, slowly and microscopically increasing until they are detectable. My PSA reading will stay at zero for "some time", but no-one can tell me how long "some time" might be. The average seems to be about three years, which is about now, but who knows? Ten is possible, even  longer, But one day the blood test will reveal a number greater than zero, and that will mean I am already embarked on a process whereby the hormone proof cancer cellswill grow exponentially until they kill me - not immediately but over a shortish span of years.

So I go into the little room, sit in the overstuffed armchair, watch as the friendly woman inserts her needle and I play my three monthly game of Russian Roulette. I can use Google, so I have a pretty fair idea of what death from prostate cancer looks like. It will be like most modern deaths, OTAA, that is, One Thing After Another. My body will fail, and the doctors will fix it, only to have it fail somewhere else. There will be an escalating game of punch and counter punch until the end, as it inevitably must, arrives. It's an odd thing to have a reasonable idea of how I will die, although, if you think about it, this knowledge is not unique to me. In the West, in the 21st Century, almost everybody will have a OTAA death.

A few months ago I visited the cemetery in Hamilton South, a now defunct town in the Maniototo. I noted that in the first 23 years of the cemetery's existence there was no-one buried who was older than 60. In the last 50 years of internments there were only 2 who were younger than 60. Patterns of life and death have changed. Only a couple of generations ago, death was usually unheralded and swift in its arrival. Now it is, typically, a prolonged affair as drugs and surgery are used to prolong life with interventions which are increasingly expensive and decreasingly effective. We'll all have the pills, and the oxygen bottles and the various appointments with a very sharp knife. We'll all have things happen to us which are painful, and which will win us a longer life, though often only slightly. We will become part of systems which seem hell bent on keeping us alive at all costs, even if that life is... hell. We'll all ask whether or not it is worth it.

Dr. Atul Gawande is a general surgeon who seems to have had a lot of experience dealing with very elderly people. His book Being Mortal presents the issues surrounding our own mortality and our seeming inability to admit to it. The book is anecdotal, filled with case studies and character sketches, but it is nevertheless unflinching in presenting us the reality of death, and the futility of our obsessive efforts to defeat it. He spends a lot of his time discussing the issue of elder care, and the fact that safety, comfort and convenience, which seem to be the defining aims of many elder care facilities, do not necessarily provide the residents of such facilities with a life that is worth living. He presents some moving cases of younger people afflicted with incurable, debilitating disease, where the same issues are apparent.

Many of us are not good at facing our own mortality, and this book is a helpful way of allowing us to do so. For myself, I am afraid neither of death nor the cancer which is likely to be its cause. We'll take it as it comes.  I don't want anyone to go administering a suicide pill, but neither do I want any expensive and painful procedures that will keep me alive technically, but in no other meaningful sense. Sitting in the dark as we drove South on Sunday, prompted by Atul Gawande's clear, wise words on the subject, we talked about what is to come and made some provisional plans against that (I hope very  far distant) future event. This is what this book is good at provoking. For anybody who is facing death, either their own or someone else's (and of course, that is, ultimately, everybody) this book is a must read.

Monday, 29 August 2016

The Inner Voice of Love

I was pointed to this remarkable book by someone who knows the geography of my soul pretty well. This, the last of Henri Nouwen's many books is a series of excerpts from a journal he kept during a painful and difficult time in his life. After a career as a world renowned scholar and spiritual writer, in 1987 Nouwen became the pastor of L'Arche, a community for people with intellectual impairment in Toronto. Soon after moving there, an important relationship led him to a place of profound spiritual growth, but also  through a period in which he lost his sense of self worth, his sense of  being loved and even his faith in God. This period of deep growth and anguish gave rise to one of his most highly regarded books, The Return of The Prodigal Son, but he regarded his journal as too raw, too personal for public consumption. Near the end of his life he was persuaded to allow the wisdom from this period to be shared, and I am glad he was courageous enough to do so.

The Inner Voice of Love is a series of very short chapters, each less than 2 pages in length. I have found I can't read more than one or two at a time, because they are so rich and full, so the book is slow going. Each chapter stands alone, as do, say, the small chapters in a book by Anthony De Mello, but reading it from cover to cover reveals a progression in thought and a sort of narrative structure. There are many works of spiritual sustenance out there, but what gives this depth for me is the knowledge that it is borne out of real struggles: a real human being is faced with his own limits and seeks to find there the eternal truths he has given his life to.

Here is the dark night of the soul. Here is the cloud of unknowing, as one man lived through it. The result is a depth of insight which has helped me in the task of making sense of my own life, and the love with which I am surrounded. This is a book I imagine I will recommend often.

Saturday, 27 August 2016

Sydney

 
The sun is rising on our last morning in Sydney. Outside are the calls of tree frogs and unfamiliar birds. Inside there are some few soft, brief whimpers from Zoe as she moves in her sleep and soon there will be the padding of Naomi's feet on the stairs. My son Nick lives in Five Dock, in the part of the city known as the Inner West where he and Charmayne have a four bedroom two bathroom house about 30 minutes by car or bike or train from Nick's office in the Quay area. 

We have been here almost a week, meeting our newest grandchild and celebrating Naomi's 5th birthday. There has been a picnic and a few brief trips in the car, but mostly we've been pretty domestic. There have been many contented hours when I've been left holding the baby, and many more being cast in one of Naomi's games. Clemency's roles in these dramatic productions involve the two women, separated in age by a mere 59 years, sitting side by side, placing small plastic dolls into modestly sized plastic houses and voicing conversations. My role is usually as a villainous beast of some sort or other, ravenous for whatever creature Naomi is currently pretending to be, and involves much chasing, dodging, catching, squealing and escaping. My character can always, but always, be defeated by magic. There were also books to be read, hands to be held, walks to be taken, prams to be pushed. Nick's house has no garden as such, but it does have a leafy little deck, and yesterday we helped to reorder it. Today I believe we will be organising storage in the underground garage. Happy, happy, happy. 

I'm reading two significant books at the moment, Henri Nouwen's The Inner Voice of Love and Atul Gawande's Being Mortal and both have been a providential commentary on our trip here. Time passes. There are events which are eagerly awaited future happenings; they arrive, are experienced and then move into memory. Our August trip to Australia. Zoe's birth and before her, Naomi's. Nick's wedding in Hawaii. Nick's birth. Our wedding. Life. It is all so full and rich and beautiful. It is all so inexorable, and timeless. It is all so brief. I am daily more aware of the things which really matter to me, and by things I mean people. He aha te mea nui o te Ao? He tangata, he tangata, he tangata. I am surrounded by those who love me, and who therefore mediate to me that greater love in which all this is held.

Through a wall, Zoe is crying. It's probably been another unsettled night for Nick and Charms, so in a few minutes I will make tea and read my book and hold my tiny granddaughter to my chest while her parents sleep a little longer. I am so grateful to be alive and to be here. 

Monday, 8 August 2016

Zoe


I woke at 4 this morning and lay thinking about the day ahead, the day when my grand daughter Zoe would be born. Across the Tasman, in Sydney, my daughter in law would still be sleeping, I hoped, ready for the huge day ahead. I had Skyped with her and Nick and Naomi last night and she looked so tired and so uncomfortable in the last hours of her great task. Nick was calm and focused. Naomi was transferring her energies into a game she had devised; "the opposite game" where she made statements which were the opposite of what she wanted to say. Hi Grandma (meaning Grandpa), I'm very sad to see you. Things are bad here in Sydney, I'm very unexcited.... 

Charmayne's parents arrived while we were talking, in order to collect Naomi for the night. We greeted and made small talk (what do you say at such a poignant moment?) made our farewells, then waited for this latest one of us to arrive. Which she did, at about 9:30 this morning, our time. Zoe Yin-Mei. It is such a beautiful name, and so alive with meaning . She peers blearily out of the  photographs I have of her, her little face blotchy from her arduous journey and her tiny fingers curled in a tight blue fist. Her name means life and is a statement of hope and determination and intent, for her and for me. How can I love her so much, whom I have never yet seen? How can I wish her so well?

In a fortnight we will make the trip across the ditch to meet her properly and to celebrate Naomi's 5th birthday.  But this morning I woke, drank tea in the frozen darkness, and sat in the silence of my study, thinking of Zoe as she journeyed earthward.

Travel well, little one, this day and all your days, may your name define you and reflect what you bring to all around you.

Friday, 5 August 2016

Endings and Beginnings


A few weeks ago, Noah started kindy. He's an open, friendly little guy and has no trouble socialising. He's adventurous, curious and intelligent and is always up for some new and interesting experience, so getting him along to a place with a sandpit full of diggers, scheduled morning tea and lots of other kids was no big problem. A week or so later though, a penny dropped for him that kindy wasn't so much a welcome break in his usual routine as a whole new routine in itself and that's where he balked. Poor wee guy. He was having his first immersion in  this pattern which we all repeat time and time and time again. Life is a constant series of endings and new beginnings. We start something or we join something or we learn something and the something suits us well. We get adept at it and comfortable in it and, if we are lucky, enjoy it. Then it ends and we leave it and pick up in its place something unfamiliar in which we are, once again, a neophyte. Kindy. Junior school. Intermediate. High School. University. Job. Job. Job. Job. Yet another job. Yet another one still.

Every ending is a little death. The way we relate to the world ends along with our comfortable pattern and we flounder around for a while in a context which is incrementally bigger, more complex and more challenging than the last one and is therefore simultaneously freeing, exciting and frightening.

A plethora of endings sit on my horizon, so as I look at closing off a long series of life chapters I have a particular sympathy for Noah as he closes off his first. For him, his world is expanding.

For me too.

It's an odd thing, that as all that once shaped my life sputters to a gradual halt, the universe has never seemed more miraculous, more welcoming, more beautiful, more full of purpose and meaning, more gobsmackingly huge and powerful. I find myself filled with a new, indefinable yearning which makes itself conscious as an attraction to those experiences and relationships which draw me closer to the heart of all things. And a correspondingly growing sense of ennui with those which are, instead, just part of the obfusticating cloud. Much of what made up the last few stages of my life has lost a lot of its gloss. And as it ends I find myself confronted by, bundled up by, transported off by a will which is so much bigger and more compassionate and kinder than mine

I appear to be enrolled in some kind of kindy, also.