Dry Ice Factory

This book was a gift from ron_drummond, who thought it might be useful to me in thinking about treatment options for my cancer. It turned out to be much more than that, and indeed it really opened my eyes regarding mortality in ways that I'd been vaguely hoping my whole life I'd eventually come to see. Much of the book is not about terminal illness in the sense of cancer but rather what happens as we get older and our bodies start to fail. It's a difficult book to read, because it forces us to confront what that physical failure looks and feels like. Gawande, who is a practicing surgeon, is an impressive writer, and he spends a lot of time on the social history of care for the elderly over the centuries and how it has changed in the face of modern medical advances. One central thesis is that as we've gotten better at prolonging life, we've gotten worse at accepting our mortality and at making good decisions about how we want to die. The most depressing chapter was probably the one about the practice of geriatric medicine in this country and how it is so badly rewarded that we don't have nearly enough physicians practicing geriatrics to serve our aging population.

The thing that Gawande really helped me understand is how our perspective and priorities change when we are confronted with mortality, and it felt as though he was talking to me in real time as my own perspective shifted in the face of the diagnosis that I have a very aggressive and, statistically speaking, probably fatal form of brain cancer. The thing that has blown me away is the tide of love and support that has flowed my way in response to this news, and how calming it has been. I was completely shocked and freaked out by the initial discovery of the tumor and the speed with which I was assigned to have major brain surgery and my life was totally upended, but as my family and friends formed a circle around me, the fear and panic rapidly abated. I didn't understand why, but Gawande spells it out in plain language: 'The only way death is not meaningless is to see yourself as part of something greater: a family, a community, a society. If you don't, mortality is only a horror. But if you do, it is not.' The thing I've been realizing is that in my family and in the science fiction community I'm part of something larger than myself, and that something larger will survive after I'm gone. I find it enormously comforting right at the moment. Not that I'm not ever going to be afraid again, and even now I'm worried about the upcoming radiation/chemo treatment and what that might do to my health and whether it will actually do anything to help me survive.

One of the other hard parts about reading the book is that Gawande's father eventually developed an astrocytoma tumor like mine, and he reacted very badly to the radiation and chemo treatment I'm about to undergo. Of course, he'd already been suffering from a spinal tumor, and everybody handles these things differently. I've been told over and over that my cancer is unique -- pretty much literally so, since it's based on my own genetic material -- and thus my experience is also going to be unique to me. When Gawande does get to the terminal illness chapters of the book, he has some very helpful things to say about how to make choices to preserve what's important to you rather than just to try to prolong life. He emphasizes the advantages of figuring out what's important to you in the first place and then deciding what trade-offs you're willing to make to preserve it. He also has some interesting things to say about studies showing that hospice can be very useful not only in helping you make these final decision, but also even, in some cases, helping you live longer without further potentially damaging medical treatment. These are hard things to think about, but he illustrates with vivid examples the ways that facing up to the realities can pay off in quality of life and love at the end of it all.

Over all I thought this was a brilliant, very well-written and -researched book, and I think it would be useful to anyone who is dealing with a dying relative or friend or is interested in thinking about their own mortality. I will say, however, that it reduced me to tears any number of times just from the compassionate descriptions of the suffering and loss that some people suffer as their lives or the lives of their loved ones go south. It's not an easy read, but I highly recommend it. It taught me things I needed to know.