Swimming in a sea of Death: A Son’s Memoir by David Rieff, (Simon & Schuster) 2008, £12.99

Unfortunately I have had recent experience of my father and his brush with his mortality. A serious blood clot carried him off into hospital where, thankfully, at the age of 70, the doctors were able to correct this life-threatening problem.  It was a significant experience for me, as a pastor and as a son.

As a pastor I have spent much of the last two decades living in the shadow of death and doing my best to support those people who experience death in all kinds of different situations.  For some death is expected, slow and painful; for others it is a sudden, untimely and utterly tragic.  However, as a son my awareness of my parents’ mortality has been to date partial and even denied.  Of course, I have seen them both get old. Landmarks such  as a  40^th Wedding Anniversary; the marriage of daughters and  the arrival of grandchildren; the arrival of the bus pass offering free transport were reached but perhaps celebrated not reflected upon. However I do not think I had ever quite taken into my own consciousness the reality of how close to the end of their lives they might be.  This is a reminder and challenge for all of us who are professionally engaged with death and dying. The physical, emotional and spiritual reality of dying is very different for those who have a more intimate, and perhaps, more complex relationship to it through those they love very deeply. Distance is a key element in the geography of death. Those who work closely with the dying may well protect themselves by ensuring that there is plenty of detachment!

David Rieff, the son of Susan Sontag, offers in this short book an intelligent, if slightly chaotic, but always challenging and disturbing, account of his mother’s final illness.  We are taken thought the details of the process with feeling and real passion.  It is unapologetically personal.  The narrative is rich and can be read from so many different perspectives.  For Rieff the high priests of the body (the medical profession) disappoint.  In the end, neither science nor medicine, reason nor raw intellect could undo her death.  From this perspective and persuasively for this reviewer, this book is a superb argument against the concept of ‘a good death’.  Susan Sontag “died as she had lived: un-reconciled to mortality”.  Perhaps that’s the most honest starting point for those of us who work in this area and indeed for those whose lives are shaped by personal experience of loss and change.  So within this struggle there is pain and regret and a rather beautiful unresolved humanity.  It is our humanity that makes us mortal, not our creeds, whether they be theological, scientific or psychotherapeutic.

So all of us swim in the one sea of our lives, trying to stay afloat as best we can, clinging to such life-lines and preservers as we might draw about us: reason and science, faith and religious practice, art and music and imagination.  But in the end the wall go down, we all sink, we all die.  This messes up Elisabeth Kübler-Ross’ tidy and too hopeful five stages of death.  Life is much more interesting, much more uncontrollable much more anger-filled than that.

This is why this book needs some attention from those of us who are professionally engaged in the area of end-of-life care, but particularly the medical profession. I would make this book required reading for all medical and nursing students! Rieff’s medical critique about how his mother was treated needs some attention and reflection.  Rieff argues that just as prisoners become experts in legal briefs, patients and their families learn the arcane of medicine and pharmacy.  But in the end, a death in the family is more than a medical or religious or scientific or intellectual event.  It is for humans a signature question about being and ceasing to be.  So let’s get rid of this absurd concept of a good death and inspired by Rieff engage in a more honest debate and dialogue and listening around the human complexities of our mortality.  Rieff is as hard on himself as a person as he is on the professionals.  He laments his tendency to be inhibited, witholden, morose, clumsy cold.  Who is to teach a boy to be impulsive, generous, cheerful and warm if not his mother?  What makes this books so convincing – it breaks open and lays before the reader the questions and refuses to take refuge in easy or controlling answers.

From what distance do you view end of life? How does the personal relate to the professional? Can we recover and nurture the chaos of an imagination fired by feeling?