Adieu

“Ruthie’s gone. Ruthie’s gone. Ruthie’s gone.”

-Evangeline Finlay, her caregiver

They took mom’s body and left a rose on her bed.

She just stopped breathing, after eleven days without food or water, eleven days with her family waiting for the end, she just stopped breathing. Her heart continued beating for a few more minutes then slowed and stopped. It was over. Just like that. It was over.

Ninety-seven years. A long life. Eleven days. A long death. And then she just stopped breathing. I expected more. I expected a poetic moment. I’d read accounts of a profound change when the living spirit departed its container. Nothing. Perhaps it takes a soul more poetic than mine to see what I couldn’t. Or maybe a spirit more evolved than mine. Or maybe all those accounts were truly poetry.

Now we’re held captive by ritual. We cannot bury her during Passover, so we must wait until Sunday. She was a cultural Jew, not much on religion, but as a Jew she’ll be buried – after Passover.

They took mom’s body and left a rose on her bed.

I liked the men who took her body away. They were extremely respectful, wore ill-fitting black suits and white plastic gloves and their papers said they were from a removal service. They wrapped her in the sheet from her bed, covered it with a red velvet cloth and wheeled the gurney to the elevator and a waiting van. There were no witnesses. None of the residents, waiting their turn, were in the hall when she passed by. I thought the management might have closed the corridor but surely everyone would have known why.

They took mom’s body and left a rose on her bed.

Adieu mom.

 

Lord of the Flies

I watched Zorba the Greek the other night. I know, I know, I called this piece Lord of the Flies. Just bear with me. There’s a scene near the end where the old woman is dying and the village crones come into the house to wait for her end so they can ransack the house.
Now we’re doing the same. We sit and wait for her to die, but mom is not cooperating. When she’s gone, we’ll store her body and get rid of her things.

It feels like we’re the subjects of a sadistic social experiment: confine five members of a family and two strangers in a small space, subject them to a massive amount of stress and sorrow and see how they react. How long will it take for social norms to break down? Who gets drunk? Who flees in terror? What will distract them, make them cry, make them laugh? How do they cope? Lord of the Flies.

It’s been a week now, no end in sight. No one can say how long.

And what about mom? Breathing seems to take more effort today but her blood pressure is an enviable 120/60. She hasn’t taken food or water for eight days. The doctor who didn’t think she’d last this long has increased her morphine so she gets it every two hours now. She wakes when the nurse administers the drug and begins to moan. There’s a sign of recognition when a family member comes to comfort her and she’s able to lift her arms for a sort of hug. Her moaning increases because she cannot talk but the recognition of family seems to indicate some sense of awareness of her condition. She knows, but is as powerless as we are to change anything. She is trapped in a useless body. In any real sense, she is already dead.

Why do we allow this? When death is inevitable, when life holds nothing more, why do we persist in maintaining breath? Even people with faith in an afterlife, in God’s blessing, who believe in some reward for good behavior, do not agree to end life when it is no longer viable. Even when they believe they’re going to a better place. Suicide is a dirty word and to hasten my mother’s death would be murder. We’ve got it all wrong.

Waiting – Watching

All we can do is watch. She sleeps with her mouth open, a gaping void with three teeth, the two in front and one more after a gap. Her breathing is labored and noisy, currently about nine breaths per minute, but subject to change. One bulging eye is part open but blind, we think. Her skin, mostly purple now is so thin it barely covers the bones that protrude at the joints. Her legs, once her great pride now just pale sticks. My eyes trace the purple veins in her hands and watch the pulse still beating in her neck. She looks as if her still-working organs would be visible beneath the nightgown.

When she wakes she seems agitated, tries to speak but can no longer form words. She moans and stretches out her arms as if seeking a human touch and my embrace – hesitant from fear of hurting her or a lifetime of awkward affection – does seem to comfort her, or so I choose to think. We talk to her, not knowing if she can hear. We tell her we’re here, we love her and we’ll be all right when she leaves. Nothing that has gone before matters now. It’s OK for her to go now, we say, but she can’t agree. We give her permission but she has no more control of this than we do. Or does she? Is she fighting to stay alive, raging “against the dying of the light” Who can say?

It seems so unlikely, it was never a happy life, why fight to continue it? Because her lack of faith leads to fear of the unknown? Maybe.

There is a nurse from hospice and a full time aide. They watch “Ellen” with the sound off. They chart every event, record imperceptible changes. They will not leave her alone and they won’t leave us alone with the morphine. They will keep her comfortable but they won’t speed her journey. They say if we have private thoughts to express they will leave the room for a moment. I can’t think of anything I need to say.

They tell us to talk to her, reassure her, tell her it’s OK but I don’t think she can hear, or could understand if she had somehow regained the hearing she lost years ago. I think this advice is meant for us, to let us feel we are doing what we can, to comfort us. They tell us there may be moments of clarity, or not.

Her breath is shallow now and has fallen to seven per minute. “American Idol” with sound, kept respectfully low. A swab with water for dry lips causes her to close her mouth tight. She wants no more. She sleeps. Does she dream? Sometimes there is eye movement beneath the lids but does it signify a dream?

And she wakes and begins to moan. It’s too high pitched and scratchy to be a moan but it’s not a whine. It sounds like an old 78 recording of a soprano past her prime. It is the sound of anguish, of reaching, of need. The nurse administers morphine, Atavan, and Seroquel by syringe without needle in her mouth, then massages her throat to make her swallow. She sleeps again.

So we watch – and look for signs of change. Has her breathing slowed? Or is it faster? Have her feet turned purple? Blood pressure down but sometimes it rises before death. Pulse? There is no pattern, our deaths, like our lives are unique. And this is the one body process we cannot know from the experience of others.

The Today Show. No change.

Meredith

Divorce Court

Weight Loss Program Advertising and Bankruptcy Lawyers

One Life to Live

Local News

No change.

We are seven waiting for mom to die.

Her hospice nurse and aide

The three children

The two grandchildren

Waiting

No change

Her breath is a little slower now, maybe six per minute and the time between is longer.

Watching her breathe, ten or fifteen seconds between breaths is a lifetime. It seems too long. I think she’s gone but no, her chest slowly rises and falls again accompanied by a raspy moan.

It will be 83 degrees and sunny tomorrow.

©2015 Ron Scherl

Gateway to Understanding

Is emotion the gateway to reason or is it an obstacle to understanding?

I had always believed in the power of the intellect, that an educated intelligence should be sufficient to decode the clues and understand the opportunities and conflicts we all face. Now I’m not so sure. In fact, I’m pretty sure the opposite is true; it is only through emotional engagement that we can truly understand anything at all. How we respond to art offers a window.

Angle of Reflection contains a scene in a museum where Ben and Emma are discussing a Picasso exhibit. Ben is able to admire the technique and appreciate the results from an intellectual distance but maintains that Picasso never moves him. (Let’s assume he’s never seen Guernica.) Emma tells him it may yet happen and to beware of sealing his emotions in today’s opinion.

Later he reflects on a painting that moved him more than most: Vermeer’s, A Maid Asleep. “I couldn’t turn away. I was immediately and profoundly drawn into that world, I could walk into that woman’s dreams and imagine stories that explained all the elements Vermeer chose to include.” We can’t know whether the artist had the same stories in mind but it doesn’t matter, what is significant is that the emotional reaction to the image made the content knowable.

Here’s where we get back to the question of antidepressant medication: it is my contention that one of the severe effects of many years on SSRIs was a stifling of emotion, which led to a failure to understand what was happening to me. I couldn’t get to it because I couldn’t feel it.

I’m not the first to report this. “SSRIs also cause a multitude of troubling side effects. These include sexual dysfunction, suppression of REM sleep, muscle tics, fatigue, emotional blunting, and apathy. In addition, investigators have reported that long-term use is associated with memory impairment, problem-solving difficulties, loss of creativity, and learning deficiencies.” Robert Whitaker: Anatomy of an Epidemic, Broadway Books, Random House, 2010.

I’m beginning to feel that I’m nearing the finish line for Angle. Could be wrong, of course, I’ve thought this before, then I sent it to my editor. I began to wonder how you know when you’re done with a novel. There is no requirement for length, no facts that have to be explained, no rules to follow. Thinking won’t get you there. I suppose you can say that it’s finished when someone decides to publish it, but Fitzgerald was still trying to rewrite Gatsby as it was on the press. I asked a friend who is a wonderful painter how she knew when a painting was finished. She said: “I don’t know, I just feel it.”

Feels right to me.

©2015 Ron Scherl

Work

I’m beginning to understand how Donna Tartt could spend ten years writing a novel. I used to think it would be impossible to maintain interest in the same book over that long a time. I used to think you could rewrite and polish only so many times before it was perfect. But that was before I tried to write a novel, and before I hired an editor to help.

A few weeks ago I sent my latest draft to my efficient and perceptive editor, a draft that I had polished through the technique of reading it aloud, recording it, and making changes as I listened to the playback.

I was really pleased with it. I thought reading aloud had helped to make the dialogue flow better and cleaned up some awkward sentence structure. I had noticed that when reading I stumbled over inaccurate punctuation and fuzzy thinking. Any text that I wasn’t fully committed to didn’t read smoothly. I had discovered a way to get to the truth of the book.

I was also weaning myself from antidepressant medication and was sure I was seeing the effects of clarified thinking and emotional access in my writing. I was right about that, especially in the passages dealing with relationships, but I was missing the bigger picture. In the process of stripping down some characters trying to get to the truth I wanted to convey, I lost some objectivity and allowed reality to overwhelm the fictional narrative resulting in a loss of pace, tension, and structure.

In other words, in finding some truth about myself, I managed to lose my reader. My editor had no trouble pinpointing the problems: “I think what’s missing in this chapter is an emotional hook that will compel the reader to care…As a reader, I feel unsure of what the book is about and therefore unsure of what I should care about, and why.”

Ouch!

I was surprised and disappointed.

When we talked she was quick to apologize for being so blunt, then added: “but isn’t that what you’re paying me for?”

She’s right, her comments and suggestions are enormously helpful, and I’ve gone back to work with enthusiasm, understanding the task is to fictionalize the narrative while retaining the emotional truth.

Not a problem, this is only year three of this book.

©2015 Ron Scherl

Mom

Mom is 97 years old, suffering from severe dementia; her mind is no longer connected to reality, yet the burden of her body continues. One dark, unseeing eye bulges out of her head; the other struggles to focus through a cataract. She cannot hear much. Her arms are covered with purple bruises, her legs bandaged to cover skin too thin to protect her. She is tiny, except for a severely bloated stomach that houses the tumor that refuses to kill her.

Her thoughts are trapped somewhere between disappointment and fantasy, in a world that never existed. It was never a happy life and that it continues in this painful demented manner is a terribly cruel punishment. She lost her parents at the age of twelve: her mother died, her father sent her away. She never recovered. Such an unhappy life that refuses to end.

Yet there is nothing we can do. We cannot end her life. That decision is not for us to make. She is in pain, partially controlled by morphine. She is agitated: perhaps frustrated by growing mental incapacity, perhaps fearing death. Xanax helps a little. She is depressed, always has been, and there is Zoloft for that. This is maintenance, not life. We give her all these meds because she is demented and we fear she will succumb to the pain and despair and kill herself. What is rational behavior in this circumstance? Is it reasonable to preserve a worn out body by controlling a dysfunctional brain with drugs that render her senseless?

She can no longer make her wishes known to us, but this is consistent with a life-long pattern. In our family, no one ever makes clear what she really needs; we all persist in equivocating and deferring until we get what we want because some decision had to be made, or, more frequently, just move on, unsatisfied and slightly resentful. So mom wouldn’t tell us what she wanted when she was able, now she cannot.

She was frightened when we first arrived, not knowing my sister and I, perhaps thinking we were the ones who would take her away. I sat with her a while, holding her hand, offering what comfort I had to give. She became calmer. I wanted to will her to die. I told her to let go. She would fall asleep, I’d watch her breathe, wanting to make it stop. Then she’d wake with a small spasm, turn to me unable to see, not knowing who I was. Once she said she wanted to go home and I thought she really wanted to die, but it may be that she was still looking for a place for herself that she had never been able to find.

We were going to take her away, we came to move her to a home for people with dementia, but there’s not enough left to move. She is beyond the attention they would give her, more dead than alive.

There is nothing to be done. She has an aide who bathes her, feeds her, changes her diapers, and laughs at her plight in the kindest way. “That’s what they do when they get old,” she says, and then cleans up the mess. She makes her comfortable and mom kisses her hand in appreciation.

We don’t handle death very well in our culture, partly because we have huge industries manufacturing drugs and services whose sole purpose is the preservation of life, regardless of the quality of that life. We crucified Kevorkian and only a few states allow a person to choose the time and manner of death. We consider suicide to be insane. We need to rethink our priorities and reimagine our death. There comes a time, as in mom’s case, when preserving a useless body is the truly irrational act.

 

ANGER

From Angle of Reflection:

“Ben wanted to see Michel’s organic vineyards and chemical neighbors again. It wasn’t far. He couldn’t look at these two plots of land without believing the absence of intrusive chemicals just had to be better for everyone, for the entire ecosystem of the vineyard, including the people and animals who worked there. So why was he introducing foreign substances into his own body to alter the natural balance? Anti-depressant medications were unnatural and they worked in subtle and insidious ways: reinforcing harmful behavior by making you comfortable with it, reinforcing passivity by making it seem acceptable behavior. Depression is difficult, but rounding off the edges doesn’t help. It just makes it worse. He had made his decision.”

Ben decided to change because he didn’t like the way he felt, or didn’t feel, and because he had come to believe in the need for man to live with, and work from what nature gives.

Now I’ve begun to look into the research on anti-depressant medication – something I should have done long ago – and what I’m reading is making me angry. Whether I would have had this reaction while still taking the meds is an open question, but I feel healthier just being able to feel the anger.

The first stop was the first of a series of NY Times opinion articles by a writer named Diana Spechler called “Breaking Up With My Meds.”

http://opinionator.blogs.nytimes.com/2015/02/12/breaking-up-with-my-meds/?_r=0

Her condition would seem to be more severe than mine, but her description of some of the side-effects of the medication was similar.

Here’s the paragraph that hit home:

My thinking is slowed, my creativity stymied. When I work, I feel as though boulders are strapped to my brain. I’m constantly thirsty. I’ve lost my taste for exercise, a mood-enhancer I’ve long relied on, and become more sedentary than I’ve ever been. Perhaps most disruptive of all, depression still lies, dead weight, on top of me — a few hours here, a few hours there — and medicated, I feel less motivation to wriggle out from under it.

Embedded in the article was a link to a piece from 2011 in The New York Review of Books titled: “The Epidemic of Mental Illness: Why?” By Marcia Angell, Senior Lecturer in Social Medicine 
at Harvard Medical School and former Editor in Chief of The New England Journal of Medicine. She discusses three books on psychiatry and the use of anti-depressant drugs

http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/

Here are the three books she discusses:

The Emperor’s New Drugs: Exploding the Antidepressant Myth by Irving Kirsch

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker

Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations About a Profession in Crisis  by Daniel Carlat

I don’t intend to summarize or criticize any of these works, read Angell’s article, but as always with this blog I want to explore my personal reactions to what is significant in my world and, specifically, how it affects creativity.

I feel so strongly that trashing the meds has enabled me to reach an emotional awareness that has, in turn, allowed me to write with a greater precision, clarity, and depth than ever before. That’s only my belief, but at this stage, it’s the only one that counts.

Kirsch has two major theses, both strongly supported by the data he presents. One: anti-depressant medications are no more effective than the placebos used to control clinical trials, and this fact is well known to the pharmaceutical companies, the FDA, and doctors who have taken the time to read the literature. It is easy to understand why nothing is done about it: the drug companies make a lot of money selling these meds, the FDA receives half its funding from the drug companies, and the doctors don’t have anything else to offer their patients.

Two: The marketing and prescribing of these meds is based on the theory that depression is caused by a chemical balance resulting in a deficiency of neurotransmitters in the brain. There is no evidence that this is true. None.

The meds are designed to increase the amount of neurotransmitters in the brain, thereby acting on a condition that is not proven to exist.

Here, from Angell’s work is the nut of the problem:

“…because certain antidepressants increase levels of the neurotransmitter serotonin in the brain, it was postulated that depression is caused by too little serotonin. (These antidepressants, like Prozac or Celexa, are called selective serotonin reuptake inhibitors (SSRIs) because they prevent the reabsorption of serotonin by the neurons that release it, so that more remains in the synapses to activate other neurons.) Thus, instead of developing a drug to treat an abnormality, an abnormality was postulated to fit a drug.

That was a great leap in logic, as all three authors point out. It was entirely possible that drugs that affected neurotransmitter levels could relieve symptoms even if neurotransmitters had nothing to do with the illness in the first place (and even possible that they relieved symptoms through some other mode of action entirely). As Carlat puts it, “By this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain.” Or similarly, one could argue that fevers are caused by too little aspirin.

That’s interesting and amusing, but here’s the real problem for me: once a person is put on a psychiatric medication, which, in one manner or another, throws a wrench into the usual mechanics of a neuronal pathway, his or her brain begins to function…abnormally.

So here’s the deal: these drugs (SSRIs) increase the level of serotonin in the brain, but there is absolutely no scientific evidence that my depression or anyone else’s resulted from a deficiency of serotonin. In my case, the result was an enormous dulling of emotions, loss of mental acuity and creativity, and an increase in passivity that kept me from trying to overcome the effects of depression. I believe it worsened over time but can’t say for sure; it may be that changed circumstances finally forced me to recognize what was happening all along.

For me, the only way past this was to quit taking the meds. I feel very strongly that this has resulted in reversing these debilitating conditions and that has, in turn, freed me to write the insight and clarity I was seeking. We’ll see.

©2015 Ron Scherl

Reading Aloud

The hardest part of the transition from photographer to writer is mastering the difference in the creative process.

In many types of photography the creative act is instantaneous. To reduce it to its most basic Cartier-Bresson decisive moment: see it, shoot it. Of course, there’s a lot that must happen before that moment in order to be in position to capture it, but the act of creativity really does take place in an instant. This is true of almost any journalistic type of photography but also holds for portraiture, fashion, even landscapes; any time the subject is alive, or changing light is an element.

Even when there’s a great deal of pre-production preparation and post-production processing and elements of creativity are spread throughout the process, even then, the critical creative act is the instant of releasing the shutter.

Only still life photography is exempt from this and only when the lighting is fully controlled. Maybe that’s why the French call it nature morte.

The act of writing a novel is a very different process.

Larry Walker sent me a quote from William Faulkner on the subject:

“It begins with a character, usually, and once he stands up on his feet and begins to move, all I can do is trot along behind him with paper and pencil trying to keep up long enough to put down what he says and does.”

That was certainly true of my first novel – but then the work began and hasn’t yet been completed. The creative process evolves from writing to editing and the number of revisions mounts at an alarming rate. It amazed me how often I could revise the same text and still find absolute clunkers that had to go. I would repeat the process until I hated every word then take a break and ask a friend to read it, after which I could admit that not every word was worthless and revise yet again.

Now, I’ve revised my revision process. I found that when I had trouble with a passage, reading it aloud would often point to the problem. When I stumbled over the reading, it was because either the thought or the language was unclear. In dialogue, it showed mostly in the placement of the “he said, she said” attributions. But in expository passages, reading aloud revealed awkward structures or fuzzy thinking. Enough time and consideration would eventually lead me to an improvement, often after several iterations, and I learned that when the words flowed easily from my mouth they were just better written.

I mentioned this to my friend Jess, who said she’d love to hear my reading, so I recorded the first chapter and sent it to her. In doing so, I discovered a new process: record, then listen while reading the text, stop to revise where needed and record again. Repeat until the words sound right.

Not exactly ready for “This American Life,” but Jess now has a podcast for one, and I’ve discovered an editing tool that works well for me.

I don’t know if other writers work this way. I’d love to hear from anyone who does.

Charting Progress

It’s been a month without medication. I’ve been keeping a journal, a daily emotional temperature chart, and a few trends have emerged.

One: I’ve been able to stabilize sleep patterns and that’s a big relief. I sleep through the night now and wake feeling rested, most of the time. Occasional glitches, but that’s always been true.

Two: the Hallmark emotional moments continue, but there was also genuine bad news this week and my response was real, nakedly emotional, and appropriate. My emotional range has expanded and I’m grateful for that. The medication was designed to flatten the roller coaster, but I don’t think I need that anymore. I need to feel it all.

Three: My internal censors are breaking down. I’m much more inclined to say what I’m feeling and I tend to think that for the most part, this is a positive thing, as long as it doesn’t become a burden to others, and as long as I don’t use it in a constant search for positive reinforcement.

It is definitely a good thing for the development of Angle of Reflection, allowing the exploration of Ben’s character to deepen and to provide the opportunity for change and growth. In early chapters, while searching for intimacy, Ben tends to deflect challenges to his defenses with humor.

“So making the photo becomes a way of making the connection?” Emma asked.

“It does, usually the object is nothing more than a good portrait, one that reveals some truth about the subject. By the way, I’ve always wondered about the method, I mean seeking to make a connection with a camera hiding your face? Anyway, it worked for us and the connection was profound, and I have the pho­to too. Someday that might be all I have.”

“Do you worry about that?”

“I think about it. I try not to. I try to just enjoy what is happening now, but some­times I can’t help it.”

“You need a bit of the yogi in you. Live in the moment.”

“The only Yogi I know used to be a catcher for the Yankees.”

 

This will change.

©2015 Ron Scherl

Creativity is Risk

The decision to de-medicate really began last year with a simple question from a very good friend: I was thinking last night that I’ve never seen you be aggressive. Have you always been like that? 

I was surprised by the question and it has haunted me ever since. To some extent I’ve always been more passive than was good for me, but I also think it’s become worse over the years. There are really two indivisible issues: passivity and timidity. They start with hesitation and develop into a rigid shell; together they create a kind of death of the soul.

Depression can be the precursor of both conditions; the usual medications can make them worse because the effects put a limit on your presence in the world. They allow you to accept what should be an unbearable way of life. The shell forms and within it there is never enough air or water to allow anything to grow. You begin to die inside: old relationships wither, new ones never have a chance.

The timid and passive don’t take risks and there is no creativity without risk.

It is an act of courage to walk out on a stage and play a sonata before an audience. Or sing an aria, or paint, write, or photograph. It’s not just the risk of failure and humiliation, although that can be a powerful stop sign, the bigger risk is in opening yourself and finding out what’s inside. And you do have to dig because anything of value emerges from the core of your being. Call it soul, or heart. It doesn’t matter. It’s the only thing you have to give and if you can’t open enough to tap into it, you can’t produce anything of value. I’m talking about works of art, but also about what you give in a relationship, the love you give to a friend, a lover, or a child. It’s all risky, but essential.

Here’s a bit from Angle of Reflection in which Ben acts against type and takes a risk because he just had to photograph that woman, in that place, at that time.

“They came out of the gallery into a small stone courtyard with indirect sunlight bouncing off the walls and up from the ground, creating a lovely portrait light. He asked Emma to pose for a moment and started shooting before she could say no. He was keenly aware of the crowd around them in a city full of photographers, but he had to do this. He shot and moved, asking her to turn to him sometimes, look away at others. He wanted to juxtapose her youthful skin against the ancient stone walls, but more than that he wanted to capture the light that made her glow with a beauty that made his heart ache. He had her bring one hand up to her face for a few frames but it didn’t work. Then he had her turn her back to him and made a few images of her hands and hair as she did that twirly chignon thing. After a few minutes, she became self-conscious, turned around and made a funny face at him, and he stopped. It was too late, he was in love and frightened by the intensity of the moment and his feel­ings for her. His hands were shaking and his heart was beating much too fast. She looked at him and seemed to understand. Very quietly she said “thank you,” and quickly squeezed his hand before they walked in silence to the next venue.”

Ben had to take the risk, the opportunity would never have come again. I missed too many moments. No more.

©2015 Ron Scherl