Summary:

This is a comprehensive social history of European (or "Western") attitudes toward death and dying over the last thousand years. Ariès organizes his history into five sequential cultural constructs, each of which conveys the meaning of death to the individual and community, as well as the social institutions around death and dying, during a different period of Western history, beginning in the Middle Ages.

Cultural responses to death must begin by acknowledging that death is mysterious and overwhelming; a wild beast; a meaningless monster. Death lurks at the edge of our consciousness, ready to destroy us and demolish whatever meaning we attribute to our lives. In medieval Europe Christianity had domesticated this monster by establishing a comprehensive set of beliefs and practices that Ariès calls the "tame death." Death was merely a transition to eternal life. The individual was understood as an integral part of the community and not as autonomous and isolated. Therefore, death and dying were communal events, supported by specific prayers and practices (i.e. ars moriendi) that "tamed" the unknown.

In the centuries that followed, Ariès's "tame death" evolved through five stages into the radically different cultural conception of death that characterizes Western society--especially in its American form--today. These changes result largely from the gradual replacement of community-oriented personal identity with today's radical individualism; and the gradual sequestration of death to a position behind the scenes, so that dying and death become remote from ordinary experience.

In today's world we encounter "invisible death," a somewhat paradoxical name because its invisibility allows the savage beast free rein. Death is no longer "tame" because we deny its existence so effectively we no longer develop personal and communal resources to give it meaning. Death's invisibility enhances its terror; our culture's loss of spirituality enhances death's meaninglessness.

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When their young son dies from kidney failure, Stewart and Sharon Mackaney funnel their grief into a business--transporting donated organs for transplant patients. Sharon has put on weight and not cut her long hair since the death of her child, Matthew. The fortyish woman likes to read about vertebrate organs in a worn copy of Gray's Anatomy. She totes a red cooler on her trips crisscrossing the country. Inside of it is a precious organ--a kidney, liver, or pancreas.

Sharon spends lots of time in airplanes, hotels, and bars. Although they continue to share a house, she and her husband have been estranged since Matthew's death three years earlier. Stew suffers from irritable bowel syndrome and chronic flatulence that began at his son's funeral and has not improved a bit despite psychiatric treatment.

Stew and Sharon receive an award for their work as organ transporters. During a speech at the fundraising event, Sharon criticizes the audience for hoarding their kidneys. On returning home, she spends time in Matthew's bedroom and later has a variation of the recurrent nightmare that has plagued her since her son's death. Sharon dreams that her hair is gone, and she rises, unencumbered, until reaching the ozone layer where she is incinerated.

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In 1918, the lives of ordinary Americans are disrupted by two cataclysmic events--an epidemic of influenza and World War I. Lydia Kilkenny is a young woman who works in a Boston department store. She falls in love with Henry Wickett, a sensitive and sickly man who is enrolled in medical school but has little enthusiasm for becoming a doctor. After marriage, Henry drops out of medical school. He tries to enlist in the army but is rejected.

Henry turns his attention to "Wickett’s Remedy"--a tonic accompanied by a handwritten letter emphasizing hope and encouraging recovery. Lydia designs the product’s label and concocts the placebo (based on ingredients revealed to her in a dream). The Remedy is an unsuccessful business venture for the couple.

A businessman named Quentin Driscoll likes the taste, however, and sells the Remedy as a beverage (QD soda). Although Driscoll promises to share future profits from the sale of the soda pop with Henry and Lydia, he fails to honor the agreement. QD soda eventually becomes quite popular, but Lydia never reaps any of the financial gain.

Influenza claims the lives of the two most important men in Lydia’s life--her brother, Michael, and her husband, Henry. She feels helpless and decides to volunteer at the local hospital where she cares for patients with the flu. Lydia realizes that she wants to become a nurse and signs up for a Public Health research project investigating how influenza is transmitted. Unfortunately, none of the test subjects (Navy deserters) contract the flu during the study, but a promising young doctor dies of influenza and pneumonia. Lydia later marries one of the men she meets during the research project.

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A chronicle of the author's perceptions, thoughts, memories, and personal relationships during the months after he was diagnosed as having AIDS. Brodkey's mind and prose are as sharp as a knife's edge. Beginning with the desperate struggle for breath that signaled pneumonia and, retrospectively, "how my life ended. And my dying began," continuing with the reactions and decisions of himself and his wife, the first half of the essay spins out an observant, introspective, cerebral, even amusing account of his particular experience.

But AIDS is often a disease associated with more emotional baggage than other fatal illnesses, and in Brodkey's case we learn that he traces both his dying and his homosexual experiences to "the major drama of [his] adolescence", daily sexual abuse by his adoptive father, with the implied knowledge and acquiescence of his mother. Writes Brodkey, "I experimented with homosexuality to break my pride, to open myself to the story." "Now I will die disfigured and in pain."

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This slim volume dips into "quotable quotes" drawn from literature and historical writings dating back several centuries. The quotes are put forth by physicians, patients, observers of medical issues, and writers of fiction as well as essayists. Each quote is but a few lines. The author, the source, and the date (when known) are provided for each quotation.

Many of these quotations will be familiar to persons who are widely read or who study the literature by and about medicine. Some of the quotes are scatological in the sense that they address issues of bodily parts and functions; others are simply amusing, while many are profound observations. The range is wide and the selections eclectic.

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The story begins as a young woman enters the hospital for cancer treatment. She struggles to maintain her identity despite the institutionalized depersonalization typical of the hospital environment. Later, loss of hair from her cancer treatment also threatens her identity, for her appearance is a large part of who she is. Although she is rather proud of the fact that she refuses to buy a wig, preferring scarves instead, she covers all the mirrors in her home. Finally, she learns that even her naked skull can be beautiful, and dares to walk outside bareheaded for the first time after her treatment.

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A woman who has had extensive bowel surgery and a colostomy now must deal with her changed appearance. She feels unattractive, and the strong odors and liquid stool that come from her colostomy are repulsive to her and to her husband. She is angry about her loss of identity, and takes the anger out on her husband. He feels guilty about her illness and surgery, and tries to overcompensate by trying extra hard to please his wife. He finally begins reading "Moby Dick" to his wife as a way to say that he will stay with her through the long haul.

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This very short story is told from the point of view of an adult child who has just learned that his (or her) father has been taken to the hospital for angina pectoris. The narrator recounts in a telegraphic form what it is like finding his (her) way through the hospital to the doctor and finding out the verdict about the father's condition.

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Paul Monette wrote about his partner's life and death with AIDS in both prose (Borrowed Time: An AIDS Memoir, see this database) and poetry. This poem, a lyric elegy to Roger Horwitz, concerns Roger's loss of sight despite treatments for cytomegalovirus infection. It is a love poem; Monette's devotion to Roger is unbounded. If Roger cannot see, then the poet wishes not to see--this is empathy to the fullest degree.

When, in the up and down course of the visual problems, Roger can suddenly, temporarily see, then Monette gleefully cries, "I toss my blinders and drink the world like water." The poem contains numerous references to sight, light, and eyes, such as "blacked out windows / like an air raid," "peer impish intent as a hawk," and "I'm shut tight Oedipus-old."

This constant stream of images and the unpunctuated, no-place-to- relax-and-catch-your-breath rhythm of the poem leads the reader through the suffering and uncertainties and into the final lines--the mourning for Roger. Grief is loneliness; it is the desperate ache of MISSING someone. Monette feels isolated from "the sighted fools"--he yearns for Roger, who, through it all and despite feeling like Job, could "hoot on the phone / and wrestle the dog so the summer was still / the summer."

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This memoir of Bayley's life with novelist Iris Murdoch who, in 1994, began exhibiting signs of Alzheimer's disease, is divided into "Then" and "Now," with emphasis on the "Then." Bayley admits that their independent lifestyles, which had both bound them and allowed them freedom, kept him from knowing the "real" Murdoch; sadly, the novelist is almost as much an unknown to him as to us. He speaks of Murdoch's lack of any sense of superiority and her disinterest in social or artistic success; she simply did her work.

In the brief section titled "Now," Bayley presents seven episodes of their life together between January and December 1997. These pictures of Murdoch lost and at sea, following him around, uttering "mouse cries," collecting pebbles, moss, sticks, dead worms, and asking over and over "When are we going?"--these will be familiar to Alzheimer's families, as will his sometimes rage and his constant sense of frustration and loss.

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