November 2020 – MarshaReads.com

Unquiet: A Novel

By Linn Ullmann

Translated from Norwegian: Thilo Reinhard

Published 2018

Read Oct 2020

This reader listened to an audio version of the book which allowed her to be unaware that Linn Ullmann is the daughter of Liv Ullmann and Ingmar Bergman. This reader has since learned that the book, while called a novel, does, at least in part, reflect actual events. Frankly if the book had been called a memoir and/or the true parental situation of the author was part of the marketing of the audiobook, this reader likely would have not chosen to read it. But absent that distraction, this reader did choose to read the book and greatly enjoyed it. Although this reader is generally aware of the celebrated works of the authors’ parents, this reader is just young enough and just uncool enough to have none of their films. So this reader won’t discuss the real parents any further.

The narrator tells us fairly early in the book that she and her father, a famous Swedish filmmaker, had planned to write a book about him. They had spent two years discussing the project and planned that they would take a jeep tour when they were done (her father loved driving his jeep). Unfortunately by the time the tape recorder was purchased and the recordings began, the father’s health had failed substantially and only a few recordings were made. So the narrator instead provides us with her thoughts about her life—focusing only on her childhood, the time during which the recordings were made, and after his death.

The narrator was the “love child” of a famous Swedish filmmaker and a Norwegian actress. She never names them, which suited this reader, and refers to them by “the father” or “papa” etc. She was the youngest of his nine children born of 5 mothers. The filmmaker was married to four of these women but he and her mother never married. So there was never “the three of them” that she remembered but rather only she and her mother and she and her father.

She tells of the summers spent with her father and his last wife on his property on an island off the coast of Sweden. The property had a number of buildings including the narrow house he progressively expanded over the years and a barn that was converted to a movie theater. She tells of times with her mother including when they were in the United States in a rented yellow house outside of New York City chosen because it had trees and children should be raised with trees.

She tells of the sessions she records on a small recorder but never listened to until after her father’s death so she didn’t realize how poor the sound quality was despite being told this was the best device for the job. The dialog between father and daughter is quite sad as it shows the rapid decline of his mental and physical capabilities which contrasts with his robustness when she was a child.

Absent the knowledge of the true identity of the characters of the book, this book told a story of a girl born of a father 48 years her senior and a younger (by 20 years) mother. This reader developed a sense that the narrator generally felt distant from both of her parents. She desperately wanted more connection with her father, a desire that lasted throughout her life. It seems she had more connection with her father than any of his other children but this connection was still very much on his terms and didn’t seem to take into consideration any needs of hers, perhaps due to expectations of fathers in the timeframe of the story (1960’s), his age, and his focus on his own interests and career . The mother/daughter relationship seems somewhat universal in many ways: daughter is annoyed by mother; mother has distinct ideas about what children need (in this case trees and milk); mother is inconsistent in dealing with her daughter; and likely neither ever understands nor connects fully with the other. The author moves seemingly randomly through time with her various memories which suited this reader well. It felt like our own memories which pick varying times when we choose to start remembering.

The writing was quite engaging. Descriptions of the wind-swept island, her father driving his jeep fast to make the ferry to buy his papers on the mainland, the drying house where she hid when a young girl—all are quite vivid.

Forget that the characters are real people and enjoy the beauty of the writing, the way the author reels out memories of a childhood, and the approach she takes to show the realities adult children face when parents’ lives are coming to a close.

When Breath Becomes Air

By Paul Kalanithi

Published 2016

Read Oct 2020

This book was published posthumously after the author succumbed to cancer a mere twenty-two months after diagnosis with Stage IV Lung Cancer. It has received several awards and spent over a year on the best seller lists. The author had been struck down quickly and completely just as he was finishing his neurosurgery residency and just before he had originally hoped to launch a scientist/surgeon career and have a “normal” life with his wife, also a medical doctor. The author wrote this book during the time between diagnosis and death.

These aspects this reader knew when she started reading the book.

This reader posed some questions: Was the hype surrounding this book associated mainly with the tragedy of the loss of a young medical superstar long before his time? Did the book itself have elements that could drive it to endure as a book of great substance after the early hype had faded?

In Part 1: In Perfect Health, the author gives us a sense of his journey leading to becoming a neurosurgery resident. His father and uncles are doctors and he knew before graduating from high school that he didn’t want to become a doctor, especially as he saw little of his father while growing up He had decided “if that [little time with family] was the price of medicine, it was simply too high”. He takes a BS in English and Biology at Stanford and then continues at Stanford for a MA in English. After spending so much time with literature and words and his continuing interest in the biological aspect of identity, he decides to go to medical school. He spends a year taking all the classes needed as prerequisites and during the year that his medical school applications are being considered, he completes a yearlong program at Cambridge in the History and Philosophy of Science. That program confirms to him that words aren’t enough. “I found myself increasingly often arguing that direct experience of life and death questions was essential [to him] to generalizing substantial moral opinions about them.” “Moral speculation was puny compared to moral action.”

So the author is off to Yale Medical School where he soon meets Lucy who will eventually become his wife (whom he discusses very little in the book). When it is time to choose a path for residency, he chooses away from “lifestyle” specialties—those with more humane hours, higher salaries, and lower pressures. So after choosing away from medicine before he entered college, he chooses neurosurgery because it “works in the crucible of identity” and it was the most demanding path. Could he become a member of the ranks of the “polymaths”. He now sought a career path that would be all consuming.

While in his sixth year of residency, after he became chief resident, he begins experiencing a lot of pain in his back. About six months later he finally submits to appropriate tests and scans and his feared diagnosis of lung cancer is made.

In Part II: Cease Not Until Death, the author charts his progression through various treatments and through his evolution of the patient-doctor relationship. Initially he is a clear partner with his oncologist in choosing his treatment course. Although Paul initially doesn’t see the possibility of returning to surgery, his oncologist picks a treatment course that will be least damaging to his hands. He does eventually return to residency, initially focused only on the surgery piece and later on the whole experiences of patient care as well after he learns his program may not find him worthy of graduation from residency if he doesn’t. If ever there was a person motivated to be the best, Paul was certainly one, although he never actually says this. He loses out on a Stanford surgeon/scientist position for which he was contending prior to his diagnosis but is later offered a similar position in Wisconsin which he decides he cannot accept. His runway is no longer twenty years and the position required that in his view. Through this period he understands that his oncologist has provided him the space to determine what’s most important to him so that the treatment course can be directed to support that.

The patient-doctor relationship takes another turn just as he is about to graduate from residency abd just weeks before Lucy’s due date. His disease begins to overpower him, preventing him from attending the graduation ceremony and shortly thereafter he releases himself from needing to be a doctor on his case. He then fully devotes himself to writing this book.

By considering the topics he spends significant time discussing, it’s possible to follow the author’s evolution on several paths: what questions are important to him; what path should be pursued to answer those questions; what career path in medicine should be followed to allow driving as close to the asymptote of excellence he expects from himself. A fundamental question he pursues throughout his life is what enables the essence of the identity? Words can describe identity. Biology must somehow define identity. Neurosurgery can enable reclaiming the identity when the body is diseased. But science is imperfect in answering some of these fundamental questions. He comes to a wonderful conclusion: Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and it is never complete. And Truth comes somewhere above all of them…”

Lucy Kalanithi, Paul’s wife, provides a thirty page Epilogue that gives pictures from the last eight months of his Paul’s life: his determination to write this book despite increasing pain including his fingers; the warm times they spend together with family and friends; the final days and hours of his life; the memorial service. She attests she was a witness to his ability to face death with integrity.

While the initial hype about this book was likely in part due to the tragedy of such a promising doctor being struck down at an early age, the book should remain recognized as a book of substance. The author notes that dying of this type of cancer at such an early age is unlikely but dying at some point isn’t. We all have to face death at some point. His chosen vocation was to not only technically help his patients but also guide them in deciding paths of treatment—which might include no treatment. He lived this situation from both sides of the patient/doctor relationship and it made him a stronger doctor. In sharing his story the author the reader might choose to consider asking themselves a question he poised for himself—what gives a life meaning—which he learns is different than what gives a life purpose.