Book Review: Words At The Threshold: What We Say As We’re Nearing Death

With all of the years of chaplain experience that I have, rare is the book about dying that raises my awareness of how to do my job better. The author Lisa Smartt is a linguist and the essence of the whole book is that the talk of persons who are going to die relatively soon, from a few hours to a few weeks, reflects “consistent patterns that emerge in language at the end of life.” Her data consist of 1,500 English utterances gathered over a period of four years. Some of the patterns she found include paradoxical statements such as, “I understood everything everyone said, but not a word was spoken,” metaphors such as “Yellow bus…lots of angels are driving that bus,” or visions such as seeing ancestors or spiritual figures.

After I read Smartt’s numerous categories and examples, I started to notice this special pre-death talk more often while doing my own hospice work. I then found myself responding to this special way of talking in a much more tuned-in manner than before, letting myself explore what the person was trying to convey. Just the other day a gentleman who only leaves his room in a recliner to relax in the sunroom informed me, “I have to go to a meeting.” I asked, “What is the meeting about?” (Other staff might have tried to “reorient” him by saying there was no meeting he had to attend.) He said, the meeting “is about everything.” I echoed, “Everything?” and then reflected, “That’s going to be a really really long meeting.” Chuckling, he agreed with that. I thought to myself, he might have been referring to what professionals call “life review,” i.e. the kind of run-through of our life story that some people do during the period of time before the very end as well as at other key moments of their lives.

Another characteristic this book includes is intensified language, or what I would call heightened sensitivity. I will never forget the time a patient said to me, hours before dying, that the water I gave her “was the most delicious thing I have ever tasted.”

If you find these examples engaging or touching, you will find anecdote after anecdote in Words At The Threshold, some of which are very poignant. One is about a woman who kept referring to five boxes she had to organize. Her daughter thought maybe the boxes stood for her and her four siblings, and at that her mother got agitated and exclaimed, “I need to find a place for them!”  She did not calm down when her daughter mentioned where each one of them lived.  Finally when the daughter said to her mother she could keep them in her heart, she became calm and relieved. A lesson here for all of us who may in our personal or professional lives be with someone talking near the end, is to not be too literal and instead get at deeper things such as love and other values.

Besides sensitizing me how to better connect with patients when they engage in “threshold talk”, this book also teaches me to recognize it as an indicator that patients may be nearing the end. So many times, as families struggle with uncertainty, they ask me how long their loved one has. Not even nurses always get this right, and we do not want to increase anyone’s distress by guessing wrong. Especially way wrong. But at least threshold talk can be a guide, and I can let families know that not a whole lot of time may be left. Another benefit of this book is that it  shows us how to make the most of a loved one’s end-of-life talk, for example by keeping a journal of all of the utterances to look for patterns of meaning among them, and by thinking of conversing with them as if we were learning a new language in a new land.

My only caveat is that at times, Lisa Smartt thinks that threshold talk hints at an afterlife, partly because the language is like what people who have had near-death experiences use. She thinks of these people as having died and returned, and that the similar language they use is suggestive of consciousness after death. But one could reason the reverse: that since people use such language on other occasions that do not have to do with their actual final death, that this disproves anything about threshold talk pointing to the existence of an afterlife, as comforting and moving as that would be. The author is a poet as well as a linguist, and so I take her comments about consciousness after death in that spirit.

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Book Review of GRATITUDE by Dr. Oliver Sacks


Reading  Dr. Sacks’ farewell book with its mournful black cover was like going through a typical day on the job as a hospice chaplain. Just like my patients, this famous author, well-known for his medical narratives such as The Man Who Mistook His Wife For A Hat: And Other Clinical Tales lists his regrets, his triumphs, his hopes, and his efforts to make sense of the life that he had led. In a word, this book is about how he dealt with his approaching end. Many of us can relate to his regrets, which included wasting time, being shy, and not traveling more. He also hoped to love and work as long as possible; again, much as the average person might yearn for in this circumstance. He also mentioned his regret at not having learned a second language.

Finding out what he had to say about his own medical narrative may interest those who almost never hear about or think about what it means to review one’s life as death nears, but for me I initially found that very predictable. Nevertheless, because he expresses it so eloquently,  even as a jaded clinician, I became more and more captivated by his life review. More than that, reading this little book became a ritual means for me to say goodbye to this spectacular and compassionate doctor. For example he explains, “[As I get older] I begin to feel not a shrinking but an enlargement of mental life and perspective…One has seen triumphs and tragedies, booms and busts…One is more conscience of transience, and perhaps, of beauty….One can take a long view and have a vivid, lived sense of history not possible at an earlier age.”

The book was engrossing in so many other respects as well. Like his other works, he offers a distinctive view that makes it a privilege to saunter among his words. Who else would link the number assigned to each element in the periodic table with one’s age? He opens his essay entitled “Gratitude” by saying, “Mercury is element number 80….on Tuesday I will be 80 myself.”  He goes on to say that  when he was eleven years old that instead of referring to his age, he explained, “I could say ‘I am sodium.’”  (Sodium is the eleventh element). Such an association alone should be enough to entice the scientifically minded and the intellectually curious to get this book.

It is poignant to read that his defense mechanism for dealing with loss was to “turn to the nonhuman.” It saddened me to learn that when he was sent away to a boarding school, “numbers became my friends.”And that “the elements and the periodic table became my companions.”

The last chapter is entitled “Sabbath.” Here he mentions his Orthodox upbringing, and his growing indifference to the practice of Judaism and finally his rupture with it when his mother utterly rejected him when she found out he was gay. Much later in life, he was introduced to positive experiences of the Sabbath and found he could enjoy its peace not only on the seventh day of each week, but on the “seventh” day of his life as well.
The act itself of perusing the book is a sort of Sabbath. It causes the reader to reflect, to pause, and to savor existence. “I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.”

This article was first printed in pallimed.org on March 20, 2017 and is reprinted here with their kind permission. the link is:
http://www.pallimed.org/2017/03/book-review-gratitude-by-dr-oliver-sacks.html

Book Review: The Impossible Lives of Greta Wells

Early on in this romantic time-travel novel, author Andrew Sean Greer (HarperCollins, 2012) clues me in that he is not going to follow some predictable formula. One of his characters is a gay man dying from AIDS who is both gentle and provocative. He says to a woman who had made a petty complaint  about his dog coming close to her flowers “When you were a little girl, madam…was this the woman you dreamed of becoming?”  I, and I suppose just about any of Greer’s readers, immediately pondered this question for myself. What are my own regrets and embarrassments, what my sources of pride and fulfillment?  If nothing else it is a fantastic comeback for any stranger who acts surly about a trifle and who is taking being alive for granted.

Another profound observation comes about for Greta, the main character,  (and for us) when she travels back to 1941. Then, unlike in 1985 when her twin brother, the gay man’s partner, had died of AIDS as well, he is alive. Greta thinks about some irritating behavior of this “restored” brother, and muses, “It was infuriating, and so like my brother, but not in any of the ways I had hoped….And yet of course when the dead come back to life they come back with all the things we didn’t miss.” (emphasis mine.) How astute of the author to refer to an earlier stage of grieving which typically does not include the negative memories that might occur in a later stage.

I am very glad that I read on. Greta gets more insights about love and loss, which we could always benefit from. But while the plot is intriguing on one level, it is confusing on another: Greta cycles between three times, 1918, 1941 and 1985, which is clear. The confusing part is that while she is in one time period, “another” Greta is getting things done and affecting other relationships in the other two periods while she is “away.” Moreover, the reaction of some of the other people in the older time periods to her revelation to them about her traveling to the other two is far-fetched, but the pleasure of the fantasy, the romance and the insights, are well worth the trips.

 

I borrowed this book from the local library. I was not required to write a positive review. The opinions I have expressed are my own. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”