33 | In Order to Live: A North Korean Girl’s Journey to Freedom by Yeonmi Park

Yeonmi Park’s story is incredible. We are about the same age yet we have experienced such different life trajectories; I have a privileged, peaceful life where I don’t worry about my next meal or political violence and she happened to be born into a land ravaged by generations of dictators who had a implemented a warped socialist rule. The resiliency of Yeonmi, her mother, and sister have deeply touched me and this book is definitely one of the most important books I have ever read.

Yeonmi was born in North Korea in a tiny border town with China during the early 1990s. Her family was at a decent social ranking, enough so that the authorities weren’t on pursuit of them but not good enough to have a stable life to guarantee access to food and jobs. To make ends meet, Yeonmi’s father began to work on the black market, smuggling goods like precious medals from China into North Korea. It was risky but Yeonmi’s mother felt that there was no other choice. They had to do anything to stay alive and keep food on the table. Eventually, Yeonmi’s father was caught and sentenced to hard labor. Her mother had to begin supporting Yeonmi and her sister on her own, so she spent weeks at a time traveling around North Korea picking up her husband’s business. Before long, Yeonmi’s sister, Eunmi had heard she could help her family by escaping to China. There was a lot of demand for young Korean women but many Korean women didn’t know that they were to be effectively human trafficked and sold to families looking for brides for their sons. Because they were illegal immigrants, they had no rights and were constantly coerced by their new “families” to perform intense labor and bear sons. But many Koreans still viewed making it to China an escape and would risk it all for a chance at survival.

When Yeonmi finally made it to China at the age of 13, she was beat, watched her mother be raped, raped herself, married off, and psychologically tormented by various brokers who were looking to turn a profit on her. Her mother also suffered tremendously, experiencing pain I could not even begin to imagine. Yeonmi and her mother were motivated to survive in order to find Eunmi, who they hadn’t heard from for years. When Yeonmi and her mother caught word that there was possible escape from China to South Korea via Mongolia, they were faced with a difficult choice: to leave Eunmi behind or to save themselves. They chose to risk traveling through the frigid Gobi Desert to Mongolia where they resettled in South Korea. When help from the South Korean government, Yeonmi and her mother were able to find housing and Yeonmi was able to attain her university degree. As Yeonmi began to realize the injustices that her mother and her experienced, she began to express what had happened and realize her story could help others. She is an incredibly brave person and there is so much to admire. Her life has been hard but she is such a gift to this world and to others and I hope she knows it.

24 | Maid: Hard Work, Low Pay, and a Mother’s Will to Survive by Stephanie Land

Maid tells the story of how Stephanie Land, a single mother living in Washington, could not make ends meet despite working as a maid and receiving supplemental social services. On top of incredible financial stress, her daughter’s father is abusive and demanding, her own parents selfish and absent, leaving her without a vital support system to help her stay afloat. While I certainly do not want to discredit Stephanie Land’s experiences, as this is her book and I haven’t written one let alone experienced poverty, there were numerous points throughout the book I felt Land had gotten herself stuck where she was due to poor decision making. She stayed with an abusive man, had a baby with him despite the fact he did not want one, received several small sums of money and spent them on frivolous items, just to name a few. All of these anecdotes were characterized in such a way that did not put the blame on herself, but rather some vague institutional force she felt was suppressing her potential.

Land’s life was extremely hard. She writes about her daughter learning to walk in a homeless shelter. The fact her daughter only had one small toy figurine to play with. She often drank coffee to quell her hunger. There is no doubt how desperate her situation was to not only care for herself, but to care for her daughter. She made sacrifice after sacrifice, only buying vegetables on clearance, always making sure Mia had healthy foods to eat, and bringing Mia to the doctor’s to receive care though she could not always afford the treatments. She talks about just how little support her employer gave, not reimbursing her for gas money or time when Land drove to a client’s house, only to be met by a locked door because the client had forgotten.

Yet I didn’t always feel sympathy or pity for her. She dedicates numerous chapters to the back-breaking work she does, and buried in the details of scrubbing toilets, picking up dirty tissues presumably with men’s semen in them, and cleaning up constantly after clients, she writes about how she goes through medicine cabinets, peaks into urns sitting on the mantle, and makes all kinds of judgmental remarks on her clients’ appearances, dispositions and family politics. This aspect of her personality really put me off, for if she actually did these things, she most certainly shouldn’t have written about these voyeuristic endeavors in her book and should have kept them to herself. Secondly, she often referenced different men she had met through dating websites, bringing them around her daughter, and on a number of occasions, receiving favors from them. One man, Travis, turned out to be a downright misogynistic douche who she and Mia lived with a year who verbally degraded Land, refused to compensate her for work she’s done around his parent’s farm and ordered her to hand over the money she made doing odd-jobs. Despite all these problems, Land is reluctant to leave him because she feels Travis is a good father figure to Mia. While I’m no psychologist, Land seems to be quite easily manipulated and to be dealing with insecurities that inhibit her sense of responsibility.

Though the book is no masterpiece, it is admirable how far Land has come from working as a cleaner to published a book that has been widely circulated and reviewed. I would most certain not compare it to Evicted by Matthew Desmond, in it’s own right it does communicate exactly what Land wants it to. That people don’t expect to find themselves in that type of desperate situation ever, but when they do, they realize just how difficult it is to get out.

15 | The Lost City of Z: A Tale of Deadly Obsession in the Amazon by David Grann

I became interested in reading The Lost City of Z after reading David Grann’s Killers of the Flower Moon; I really enjoyed his journalistic style: investigative but also critical of how justice played out in the case of the Osage. This book was published eight years prior to Killers and I would have to say it’s quite different. It is a blend of biography, self-reflection and clear speculation as Grann chronicles the story of Percy Fawcett, a British man with an insatiable appetite for exploration and an obsession with finding the lost city of Z, an El Dorado-like untouched paradise, deep in the Amazon rainforest. There is also much more meandering throughout the book, as Grann discusses the stories of various other explorers including Fawcett’s main competitors, Fawcett’s companions and the drama on certain expeditions (every expedition has a Judas, apparently) and parts of Fawcett’s life that are a bit too tangential for my liking including his early days in Sri Lanka where as a young officer he met his wife and heard folklore about a treasure trove in a cave (he did not find it). But Grann does go to considerable lengths to piece Fawcett’s story together: traveling to England’s Royal Geographical Society where Fawcett was trained and his expeditions funded and to the Amazon itself, retracing Fawcett’s last known location. He also conducted extensive archival research, interviewed Fawcett’s surviving relatives who provided him with access to Fawcett’s journals, papers and private correspondences with his wife and sought help from anthropologists who studied both ancient and contemporary Amazon tribes. Grann paints a grim picture of what an obsession with the Amazon did to one man and his party.

Incredibly, Fawcett didn’t just explore the Amazon once, he went multiple times, each time exploring a different route. He, along with his eldest son Jack and his son’s best friend Raleigh, disappeared in 1925 on what would be his fifth Amazon expedition. No one has found their remains or knows what happened although many con-men have claimed to know what happened. Attacked by a violent tribe? Contraction of disease? Infection? Jaguar attack? Poison dart frog? Piranha? Starvation? The list goes on and on of the terrible things that could have happened to Fawcett and his party, all of which are plausible, but none confirmed. In the end, Grann doesn’t find out what happened to the missing group or if Z was real. Instead, the reader gets a glimpse into what kind of a culture facilitated this mission and infatuation with a mystical civilization.

When thinking about what I learned from this book, one word kept repeating itself in my mind, over and over again. Ego. Ego drives people to do the most extreme things, to the most extreme places, to submit oneself to the most extreme of circumstances. For name, recognition, reward, who knows what exactly what was going through Fawcett’s mind, but this explorer’s ego wasn’t uncommon in 20th century England, or 19th, or 18th or 17th. The idea of discovering, conquering and subjugating the foreign is rife in European (and American) history. Domesticate the savage, excavate his riches and profitting, was surely the mantra of colonizers who not only sought to exploit people and their labor, but also the land for agriculture and resources. Not only was the Royal Geographical Society, mostly focused on drawing accurate maps and developing the tools to do so, in on the idea of discovery, so were institutions like the Royal Botanic Gardens and the Crown. All these ideas of superiority in race, language and cultural values were used to justify European conquests of parts unknown and to educate and Christianize savages they encountered. It was violent: disease decimated those with no immunity, many were enslaved or murdered by rubber barons and miners, not to mention those who lost ancestral lands to burning, logging and damming. I think Grann should have highlighted this more, just how embedded this mindset of superiority, stemming from European cultural institutions was in explorers of Fawcett’s day.

While Grann is no anthropologist or scholar, there were some fascinating tidbits about the Amazon’s cultures and ecology. While there are hundreds of tribes all throughout the Amazon, many are insulated by the jungle and do not have any contact with government authorities. Some are violent and will kill any trespasser on site. On the other hand, there are many other tribes who do have councils of their own and lobby on the national scale for various Indian rights. There are Indians who have integrated into Brazilian and Bolivian societies (though Grann does not write about the challenges they face). There is amazing diversity in cultural practice, language and custom in the region, the landscape acting as an impermeable barrier to keep egoistic white men out and natives safe. I would be open to reading more literature on South America both fiction and non-fiction as there is just so much to learn.


13 | Hillbilly Elegy: A Memoir of a Family and Culture in Crisis by J.D. Vance

Hillbilly Elegy seemed to have garnered a lot of attention after it’s 2016 release as many people sought to find some explanation of how Trump had so much political support stemming from the Appalachian region. However, I think it is important to recognize that this isn’t some great sociological investigation or commentary; Vance is writing a memoir of his childhood and young adult years. He’s writing about his life and the people who both contributed and inhibited his growth, the opportunities and setbacks he encountered and what he believes to the reasons he has been able to make a life for himself.

Vance was essentially raised by his Mamaw (he writes it’s pronounced ma’am-maw) and Papaw in Middletown, Ohio in the 1980s, a place where troves of Kentucky Appalachian transplants relocated in the wake of massive recruitment by manufacturing companies seeking blue-collar workers. Mamaw and Papaw Vance, in Vance’s words were true Jackson County, Kentucky “hillbillies”– they abide by a set of societal norms of which defending the family’s honor is the singular most important rule. Vance’s memoir is filled with stories, some more legend than truth, of his Mamaw’s no bullshit attitude: when she caught some theives stealing her family’s cow, she took a shotgun and managed to hit one guy in the leg. She would’ve shot the downed thief again to kill him if not for her brother holding her back. Mamaw cussed, called people out on their mistakes and encouraged J.D. to beat up a school bully who would repeatedly beat up a scrawny classmate. J.D. clearly worshipped his grandmother. Vance’s mother, Mamaw’s second child, was largely absent in his life, moving from boyfriend to boyfriend, eventually falling into drug addiction. Vance’s father broke up with his mother a few months after he was born and started a new family of his own, living a conservative religious lifestyle after joining the Pentecostal Church. Vance’s grandparents and family from Kentucky believed in God but didn’t attend church (Vance comments that people from Appalachia think they go to church more than they do; apparently, the actual rate of church going is very close to the rate of church attendance in liberal San Fransisco). Vance’s older sister Lindsay was one of the only constants in his life, protecting him from their abusive mother and taking care of him when no one else did. He writes about ACEs or Adverse Childhood Experiences, a metric used by psychologists and social services to understand childhood trauma and the likely problems adults who experienced ACEs as children, will have. For example, if a child experiences parental separation or divorce, has a family member who abuses drugs or alcohol, has depression or is suicidal, all these different ACEs affect the child in profound ways, even altering brain chemistry for life. Adults who experienced ACEs, especially multiple ones, have higher rates of obesity, heart disease, psychological problems, substance abuse and even have problems maintaining normal relationships and holding down a job.

While Vance experienced multiple ACEs, he writes that he was able to “make it” because of people in his life: his Mamaw, who instilled in him importance of doing well in school and took him under her wing after Vance’s mother proved time and time again she was unable to provide for her son, his sister Lindsay who protected him during his childhood, his mentor (Amy Chua) in graduate school, various friends and his future wife, Usha. He also had the opportunity to enlist in the Marine Corps after high school and later enroll in college at Ohio State University with minimal debt thanks to need-based financial aid, Pell Grants and the GI Bill. Yale, where he attended Law School, also gave him essentially a free-ride; the irony being that it was cheaper to attend a private, out of state school than a public, in-state university. It is clear that Vance is grateful for the people in his life and the opportunities he had, but he feels that in addition to things happening to align for him, he also worked incredibly hard and sacrificed his fair share. He worked two jobs to support himself through college, sleeping less than four hours a night in order to graduate with minimal debt and a double major in just under two years. He worked for a remodeling company after college, lifting tiles in order to save up money for law school. His work ethic was what contributed to his success: while his peers from Middletown and Jackson County got caught up in adolescent parenthood, drugs and unemployment, Vance did the opposite, focusing in energies to excel in school and provide for himself. A obvious conservative, Vance believes that what set him apart from his peers and others in his community was not only having a few saving graces along the way like supportive relatives, but the fact he also worked to get where he wanted to go, instead of wallowing in excuses and self-pity.

This is where things get dicey. Many readers thought this attitude of “I worked hard, so should they” was pompous and completely neglected the systemic pressures Appalachians and other poor working whites face, including disappearing manufacturing jobs due to processes like globalization, trade wars and unchecked capitalism, the incredibly extractive coal and mining industries (which have also wreaked substantial environmental havoc), the overprescription of of opioids, contributing to the ensuing epidemic, the increasing political isolation, brain-drain, and a whole host of other issues Vance largely fails to address. Vance writes off these experiences as it’s just what happens when people make poor life decisions. Until young women stop having children with multiple men, people decide to work hard at their job, stop taking drugs, start working hard in school, things will continue to deteriorate, all at the expense of the next generation of children. Vance writes of many neighbors who were those stereotypical “welfare queens”: each of her children have a different father, she’s addicted to drugs, has a new boyfriend every month, she uses her food stamps to get food, then sells it for cash to fund her drug habits. He writes of his co-worker with a pregnant girlfriend coming in perpetually late to work, taking extensive bathroom breaks, who slacks. After multiple warnings, his boss fires the guy who later complains that it isn’t his fault he got fired and that it was unfair as he has a child on the way. Vance writes that there are so many people who completely neglect the opportunities right in front of them. You can’t help people until they help themselves. It’s not a policy problem, Vance argues, but a mindset problem. Poor working whites have created a construct in which they are the victims.

I can see why this rubs people the wrong way, but I think it’s important to understand this is a memoir of Vance’s life. Take his work for what it is, rather than critique his take on social policy. Vance is not a sociologist trying to understand why people are they why they are. I think he is very brave in writing about his family history and putting it out there for strangers to read. There are too few narratives of what upward mobility and the accompanying challenges are like for everyday Americans and his story should be read with empathy and compassion though admittedly he veers into dangerous territory when he writes about Appalachians as a whole, rather than his own experience. Vance was in his early 30s when the book was released; it would be interesting to see if he writes another part to his memoir some decades later and if his attitudes and beliefs change at all in the future.

10 | A Higher Loyalty: Truth, Lies, and Leadership by James Comey

James Comey is a figure familiar to those who have followed any American political news since 2017, the former FBI Director famously and abruptly fired by Trump. Turns out, Comey was speaking at a diversity event, aimed to recruit Black and Latino Special Agents to serve in the FBI when he saw headlines on the news: “Comey Fired.” He learned his fate from television. How disrespectful and humiliating.

I didn’t know much about Comey prior to reading his political memoir, but Comey has been active, off and on, in public service since the 80s, serving as, among other positions, as part of the U.S. Attorney’s Office in the Southern District of New York, as Assistant U.S. Attorney during the Clinton Administration and as both U.S. Attorney and Deputy Attorney General during the Bush Administration. During his early years, he helped prosecute members of Italian crime families, discussing how he came to realize how being a leader of a mob family is critically different from being an leader of a public institution. While in crime families personal and familial loyalty are the ultimate vow, one which violence, coercion, and even murder are used to test said loyalty in, the type of loyalty which Comey claims to espouse is loyalty not to a person or entity, but to the justice system and institutional values of the United States. I would agree with him, yet his seemingly wavering devotion to this ethical leadership irked me, as throughout the book, he painted himself as a paragon of righteousness. Every decision he made, regardless of how controversial, was right, was ethical and was just. Comey never admits of making a mistake or even admits to the possibility that he may have made one. He writes that no one wants a leader who isn’t sure about something. People want a strong leader who, at the least, has unquestioned confidence in his own ability to make tough decisions during stressful moments. Yes, I agree, I don’t want someone is a position of power to regret making a decision that affected people’s real lives in a negative way, yet I find the chasm between me and Comey to have widened as he never suggests a shortcoming. The paradox was obvious to me; Comey writes we’re all humans and make mistakes. What’s more is that we should be allowed to. Yet in his memoir, he assures readers he’s always done the right thing. Okay, so is Comey human like me?

Comey’s memoir is an important read during this chaotic political time. I appreciate that he did write his book after his firing because it’s important for people to understand who he is and what he stands for, in his own words. The writing is compelling for the most part, especially towards the end of the book when he share intimate details about his meetings with Trump. Throughout his prior dealings with Obama, he reiterates several times how important it is for the President and the FBI Director to never have a buddy-buddy relationship, for there to always be professional distance to ensure there is no influence and that if the President or his associates are to be investigated, the FBI remains a apolitical institution where justice always prevails. For Comey, this meant he would never have lunch with Obama or even play pick-up basketball with him. This was just plain inappropriate. However, just days within Trump’s swearing in, Trump asked Comey to have dinner with him, during which Trump says: “I need your loyalty.” Comey immediately draws parallels to what an Italian crime mob boss would say. Spoiler, pretty much the same thing. Comey describes a numbing horror that dawns upon him. Not only was this dinner unconventional, the President was asking for something completely immoral and unjust. Loyalty? You mean, to lie on his behalf or stymie investigations to render them ineffective or inconclusive? It’s very believable Trump did indeed say those words, probably not just to Comey. And when Comey didn’t do what Trump asked, which was to essentially bury the investigation of Michael Flynn, Comey was fired.

Comey ends his book with saying he chooses to be optimistic, saying that this forest fire will do significant damage in the short term, but will inevitably spurt growth down in the line. Now, I don’t this this metaphor is necessarily helpful- calling Trump a forest fire is to suggest this forest fire was a spontaneous event of sorts. Trump becoming president was spontaneous. People voted for him. There’s nothing about spontaneous about that. Furthermore, forest fires are natural occurrences, part of an ecological cycle that will ensure balance in the land. Trump is not balancing anything. He’s constantly pointing fingers, at the press, at Democrats, at other people. Every week there’s a terrible headline about something Trump or his associates have done clandestinely before or during his presidency. Look at how many Trump associates have been sentenced to prison or are currently under federal investigation. Look how much turnover there is his administration. There’s been no conclusion with his good buddy Shel’s paper buying and suppressing of damning stories about his encounters with adult stars. That story broke years ago yet there’s no resolution. So for me, his positivity doesn’t ring true yet. It’s just gets worse as people become apathetic and think “oh, that’s no big deal” because there’s so much that’s happened it has given the public amnesia.

While I admire and think Comey’s commitment to justice and serving the nation is honorable, I certainly think there are just too few people like him in elected office. At least, that’s how he made me feel. He writes about he was often alone in standing up and making the right decisions as awry political biases and allegiance marred politicians on both sides ability to make other “right” decisions. I understand “right” is relative but I’m sure most of us can agree that when something is wrong, like lying under oath, using a non-secure web domain to communicate classified information, asking to stop an investigation because you know someone is a “good guy.” Wrongdoings should be investigated and punishment should be deftly delivered. Sometimes it feels like a young child knows the difference between right and wrong better than grown-ass adults do.

9 | Death’s Acre: Inside the Legendary Forensic Lab the Body Farm Where the Dead Do Tell Tales by Dr. Bill Bass and Jon Jefferson

“Anthropologists and insects can reveal the truth about a crime, but they can’t force the wheels of bureaucracy to turn, and they can’t guarantee that justice will be done. All they can do is serve as a voice for victims, and hope that voice is heard.”

This book is a fascinating read– a much more informative read than Mary H. Manheim’s The Bone Lady and one that reads more seriously and with more gravity than Mary Roach’s Stiff. Mostly because Manheim writes about her career in before the 1990s, before the advent of DNA technologies while Bass is writing about his career which spanned the 1940s until the 2000s. Intertwined with case reviews of some of the biggest cases he has ever worked on and accomplishments as the department head of Anthropology at the University of Tennessee (UT) at Knoxville, Bass writes about his personal life, the deaths of his first and second wives to cancers and how he threw himself into his work to seek solace.

I’ve always wondered why people pursue such professions– homicide investigators, coroners, forensic entomologists/anthropologists/etc. It’s because they believe in a greater mission and are able to look past the literal-ness of their work. By solving crimes, they are keeping their communities safer, pioneering the use of new scientific methods and testing and cataloguing information to help solve other cases. There’s no shortage of colorful description about how Bass’ colleague, a leading fingerprint expert, asks Bass to cut off a hand of a murdered prostitute’s corpse, or how Bass himself reviews hundreds of crime scene photos of three dead and bloated bodies of a man, his wife, and their four year old daughter, left to rot in a mountain cabin for a month, as he looks for maggot pupae in order to determine the time of death. The reality of the job is sickening yet incredible- it is because of the diligence and dedication that people like Bass have to their jobs that crimes are solved, criminals are successfully prosecuted and victims receive some justice.

One of the most remarkable parts of Bass’ legacy is the creation of the Body Farm, an anthropological research facility at UT literally borne out of genuine curiosity with how to answer questions like: how long does a body take to decay outside, in the dead of winter? In the heat of the summer? What about in water? What kinds of residue is left in the soil? How can you tell if a body has been moved after the death? However macabre these questions are, there’s no doubt how critically forensic evidence needs to be investigated in order to shed light on the scene, without the murderer or the victim saying what happened. The level of scientific expertise developed due to the research efforts at the Body Farm is amazing, so much so that federal, state and local law enforcement agencies have consulted with Bass and his proteges on hundreds of cases. Bass really exemplifies what it means to bridge his academic work as a professor of anthropology to the “real world,” frequently going to crime scenes to collect and examine evidence. He doesn’t skimp on the explaining the science (in layman terms) of what happens when bodies are burned– as the body looses water, muscles and tendons clamp up and the body begins to curl. By examining the structure, color and density of the bone, one can tell how hot the fire was, the position of the body as it burned, but it can also reveal, though burned, if there were peri or post mortem wounds to the bone– perhaps a gunshot entry/exit wound or blade mark.

To me, crime fiction in books and television seems perverse in a way– many times what happens in fiction is inspired by something happening in real life. “Good” crime show producers and writers consult real world experts- forensics scientists, FBI agents, police, in order to make something as “real” and “believable” as possible. I personally don’t read or watch anything to do with crime fiction for the reason I don’t think someone’s lived and post-mortem experience should be fictionalized to create a sensational story, with fake blood and the like. But reading Bass’ book and learning about the very “down to earth” research conducted at the Body Farm seems less and almost not at all disturbing as the research is only necessitated because of real crime.

4 | Being Mortal: Medicine and What Matters in the End by Atul Gawande

“The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet– and this is the painful paradox– we have decided that they should be the ones who largely define how we live in our waning days.”

Being Mortal

I first came across the idea of “quality of life” when watching the French movie The Intouchables (2011), a story of a wealthy quadriplegic man named Philippe, who instead of hiring a live-in caregiver who is medically trained and qualified, hires a young black man, Driss, from the projects who has zero experience or interest in the job. Philippe’s friends become concerned about this decision and confront him saying “…these street guys have no pity…”, to which Philippe replies: “That’s what I want.” Philippe and Driss strike a friendship that allows Philippe to feel like he’s living; the two take joyrides through the streets of Paris in Philippe’s Maserati, go paragliding in the Alps and Driss even throws snowballs at Philippe and jokes: “Don’t be so lazy. You have to throw some back” as Philippe laughs with joy. Later, when Driss leaves the job due to familial duties, Philippe becomes deeply depressed and withdrawn as his new caregivers treat him like a retarded child, incapable of any mental capacities. There is a happy ending though, when Driss returns, allowing Philippe to live a life without constant pity from those closest to him.

There have been many highly publicized debates about a subject related to this idea of “quality of life” and what happens when it is subject to imminent compromise. For example, there are a number of states including Oregon and Washington that have passed laws legalizing assisted suicide or assisted death for those with terminal illnesses which cause significant pain and loss of quality of life. I remember the case of Brittany Maynard, a 29 year old California woman who was suddenly diagnosed with a terminal brain cancer. Because California did not have any laws to allow her to make that decision, she and her family had to move to Oregon in order to take advantage of the “Death with Dignity” law. She became the figurehead of the national debate; at the time of her death, only three states in the U.S. legalized assisted death laws, but to date, seven states have passed the legislation. Maynard describes why she made the choice to pass away this way. In this way, she is in control. When she feels the time is right and before the pain becomes too great to bear, she will be able to decide when to pass. In an interview after her passing in 2014, Maynard’s husband talks about of Maynard’s fear of suddenly (and inevitably) losing her mental capacity during a seizure or stroke (which results in the loss of speech), to which point she cannot self-administer the medication. That that point, she loses complete control over her own body, her mind engulfed in fear and the loss of the ability to communicate her desires. Death with Dignity allows her to pass on her own terms in an environment she chooses, with the people she chooses to be around her.

The word “dignity” has been thrown around– some feel that the loss of bodily functions such as eating or relieving oneself, such that they need 24/7 oversight might cause them to live a life without dignity. Other feel the life with pain or life constrained to a bed or wheelchair is the limit. Whatever the case, the inevitable fact Gawande argues many people do not wish to accept though they know is that we are mortal. We live for a finite period of time, then we will die. While for a few, death will come quickly and unexpectedly, perhaps in a tragic accident, for most, there is a gradual decline of loss of physical and/or mental capacities. This is a frightening thought, I know for me that is. Older people tend to have trouble with hearing, seeing, walking, sleeping, bending down… the list goes on and on. Not to mention loss of appetite, memory loss, motor function, and secondary effects which lead to loss of independence. Many elderly gradually lose the ability to drive (apparently 3x more likely to cause an accident than a newly licensed teenager), grocery shop, cook, do housework and take care of oneself. I cannot imagine myself going through this process, it must be terrifying to be cognitively sound yet feel as if your body is giving out. Thus, Gawande says, we have turned to medical interventions to prolong the period in which we can delay the process of aging or mitigate the effects. If you have hearing loss, you get hearing aids. If you have this issue, you get that medicine. If the side effects are too much, you get another medication to help with that. With major illnesses and diseases, it’s similar. You take blood thinners to reduce the chance of blood clots, you remove tumors as physicians recommend, you take all the preventative and proactive measures you can.

Gawande shares the story of many who do not realize their diagnosis is a death sentence. A young woman who is diagnosed with a terminal metastatic cancer just days before her due date and her family, continue to push to her doctor to “do his job” and come up with possible avenues of treatment, completely neglecting the reality of her situation. Not because she and her family aren’t listening, but more so due to the fact her doctor is not telling her ‘you will die from this, in a matter of months.’ Gawande writes that the majority of doctors significantly overestimate the time their terminally ill patients have. Doctors aren’t trained social workers, there are social workers that work with terminally ill patients for a reason, but the delivery of “the news” is not always clear. Doctors aren’t at fault though, because who wants to let the young 36 week pregnant lady know she will die in the next few weeks and that any surgery will be pointless as the cancer has already spread to vital organs? Patients and their families aren’t always receptive to the full array of possibilities, many putting blind faith in science which is not as advanced as they believe it to be. This is the paradox outlined in the quote at the beginning of this post, that patients feel they have no choice but to resign and leave the fate of their life in the hands of their physicians who want no blood on their hands. So patients try everything: surgery, chemotherapy, experimental therapies and treatments. Gawande argues that this is a form of abuse, as some patients’ bodies will actually decline due to the applications of these procedures, the opposite of what they believe it might do.

This is a recent cultural shift, Gawande writes, as just a few decades ago, the majority of deaths occurred at one’s home. Now, most deaths occur at the hospital, surrounded by beeping machinery and unfamiliar faces in a clinical, sterilized setting. What is so great about this prospect? He writes: “At root, the debate is about what mistakes we fear most– the mistake of prolonging suffering or the mistake of shortening value life.” There is a middle ground though, which is completely subjective, yet unrecognized by federal law. Brittany Maynard found it, but that required intensive research, reflection and resources for her to be able to move to another state and have the support of medical teams to respect her decision. She passed before the suffering became too great for her to bear yet at a point she felt her life was well lived. I have great respect for her, her husband and family for pioneering the national debate around this topic.

Not only does aging place a burden on the individual experiencing the process, but it also deeply affects that individual’s children and their families. Though a common familial structure and living arrangement in other countries, multi-generational living is not common in the U.S. as specific industries and educational opportunities are concentrated in particular areas, requiring people in the workforce to become geographically mobile. Moreover, the expanded housing market, ideals of individualism and “coming of age” and other socio-cultural factors have encouraged young people to live independently. So until older people experience issues to the point they cannot care for themselves, they do live on their own, but then they are faced with the choice between (a) continue living on one’s own and risk serious injury (falling, heart attack) and no one being around to help them seek emergency medical attention, (b) moving in with children (if that is an option), (c) nursing home, (d) assisted living… these choices of course vary depending on one’s finances, familial structure and geography. Gawande considers a multiplicity of cases. His wife’s grandmother Alice Hobson who until has a serious fall, lives independently as an 80+ year old. Alice’s son and daughter-in-law becoming increasingly concerned, eventually convincing her to move into assisted-living. She becomes withdrawn and depressed like Philippe does after Driss leaves, as she is subject to the facilities’ strict regiment: when to eat, what to eat, when to wake/sleep and what activities are available. She eventually dies. Another man named Lou lives independently as a 94 year old. Due to his daughter’s concerns regarding Lou’s safety, he unwillingly moves into her home where tensions arise as Shelley is burdened with caring for her own children and her father, who has many medical appointments, therapists visits, health issues, and idiosyncrasies she finds difficult to deal with. She reaches a breaking point, confessing to her father who hard it has been on her. He moves into a type of assisted living that values patients’ sense of independence. For example, though he is prone to falling and isn’t able to balance well, he feels undignified confined to a wheelchair. Thus, under a aide’s watch, he allowed to walk using a walker when and where he pleases. He decides when he wants to wake up and go to bed, how he wants to spend his time and how he wants to decorate his room. Lou’s life does end, but he is happy, having never lost his sense of dignity. A life well lived. Gawande says that we do not realize how one’s state of mind feeds into one’s body: a happy person lives a longer life. And it doesn’t take much for Lou to feel happy.

The irony is that even if you know what’s going to happen, it doesn’t make it any easier to accept. However, Gawande argues that the earlier on people confront the difficult questions around the terms in which they wish to live and die, the smoother it will be and the less anguish and pain will be felt. In the case of La Crosse, Wisconsin, elderly residents have unusually low end-of-life hospital costs, during the last six months they spend half as any days in the hospital as the national average, there’s no sign that doctors and/or patients are halting care prematurely, and their life expectancy outpaces the national mean by a year. How? Gawande writes that in 1991 local medical leaders instituted a campaign to get both medical professionals and patients to discuss end-of-life wishes. Some questions include: Do you want to be resuscitated if your heart stops? Do you want aggressive treatments such as intubation and mechanical ventilation? Do you want tube or intravenous feeding if you can’t eat on your own? Though uncomfortable to think about let alone discuss with tohers, the advanced directive written allowed patients, their families, and caregivers to find a certain peace, as the patients’ wishes were clearly spelled out.

Admittedly I am fearful of death. I am afraid of the gradual decline of my capacities, the pain and the heartache it will cause my loved ones. However, when you realize the fear around death is a cultural mindset, it feels somewhat more liberating. Several years ago, I watched a TED Talk by an artist, proposing the idea of pledging one’s body after death back to the environment. After one passes, the body will be placed in a mushroom-spore infused suit, eventually helping the body to decompose and feed the soil. She isn’t proposing to eliminate ritual, rather she wishes to reimagine the links between life and death. It is natural for living organisms to die, their bodies feeding others as the cycle of life is sustained. To participate of course, while alive, one must make this pledge, but it’s a fascinating way to conceptualize death and what happens after. Since I watched her speak, I am committed to mushroom suit idea. Are you?


2 | The Bone Lady: Life as a Forensic Anthropologist by Mary H. Manheim

 

A quick 100+ page read constituting short 3-6 page case studies and anecdotal experiences, I found this read to have served its declared purpose. In the Introduction, Manheim writes the idea for the book was borne out of “notic[ing] and appreciat[ing] the widespread interest the general pubic has in forensic anthropology and bioarchaeology” and her stated purpose for this book is to “share [her] passion” and the “human stories behind the cases.”

While I agree with many who have reviewed her book, in that Manheim is offers exceedingly little in terms of detail or methodology used in evaluating cases, I also note that this autobiographical look some of her life experiences does not necessitate gruesome descriptions or technical details. In the age of the inundation of television crime drama, including the nature of media’s macabre reporting on everyday crime, I do not think Manheim misses the mark (especially given this book was published almost 20 years ago) on sharing how much coordination it takes between law enforcement, forensic anthropologists, dental experts, entomologists, to name a few, before the advent of advanced genetic technologies.

What drew me to this work is my interest in learning about applied anthropology beyond academia. Manheim explains that as a forensic anthropologist, she belongs to a branch of anthropology sometimes referred to as “the fifth”; the accepted four branches are physical anthropology, cultural anthropology, linguistic anthropology and archaeology. As her work is outside of the realms of academia for the most part, as her cases are brought to her by law enforcement, cemetery directors and even insurance agents, she explains how her work necessitates working together with forensic entomologists (the study of insects on a postmortem body), textile experts (who yields insight on when certain fabrics were used/worn/in fashion and by who/what social status/gender, the stages of decomposition of the fabric, etc.) and facial reconstruction experts/scientific sculptors (who reconstruct facial features such as skin, hair, the nose, eyeballs using forensic racial/ethnic/cultrual markers to determine what someone might have looked like based only on skeletal remains).

Manheim ties in stories her aunts and mother told her throughout her childhood with some of the cases she visits. She recalls a particular instance while retrieving horse bones in the Louisianan woods in the 1980s when storm clouds began rolling in. Manheim transports the reader back nearly thirty years to when similar storm clouds began rolling in and her Aunt Penny rushed the family into a hide beneath a massive sycamore tree. Aunt Penny grabs her Bible and an axe, opens the Bible up and places it on the ground facing the storm clouds. She then brings the axe down into the ground and turns around to face the family peering out of the storm hide as the clouds begin to part. Manheim quickly interrupts the digestion of the story as lighting, thunder, wind and rain set in as she and her colleagues trek the rest of the way through the woods back to their cars with plastic bags of bones slung over their shoulders. I appreciate the reflective and sporadic nature of the book, as yes, many reviewers point out she is not “a writer”– I agree, as in the professional sense she is not a trained writer who uses flowery language to bring a reader into the story, but I don’t think that should disqualify anyone from writing about who they are and what they know.

My paternal grandfather’s side of the family is from Louisiana– and while ancestral records are complicated by divorce, adoption, remarriage and a certain ambiguity that comes with record keeping from generations past, I can’t help but feel some kind of pull towards these stories. As Manheim’s entire life and career was based in Louisiana, she touches on the history of the Civil War and the Confederate roots, racial/ethnic migrations, industries and spirit of Louisianans throughout the book. There is a certain mystique to the Louisiana– nothing that diminishes or eliminations the lived experiences of the people there; perhaps it is the everchanging landscape of swamps, bogs and bayous, or the patchwork of cultural heritage that remains manifest in the names of places and things that people left. Either way, I appreciate any chance I get to learn about Louisiana.

There are cases of Native Americans who protest at the exhumation of ancient graves for anthropologists’ desire simply learn at the expense of their cultural and spiritual beliefs, the discovery of the skull of a young Asian male only dead for 2-3 weeks but no missing persons report in the area’s Asian community, and the case of the 70 year old man’s body found underneath the house 20 years later after he disappeared, a self-inflicted gunshot to his head. Though disturbing, this is the nature of death– there is so much more than the remains which Manheim is responsible for analyzing. She acknowledges that her work is only piece of the puzzle in figuring out what happened and the circumstances which death prevailed over life. As an anthropologist however, I wish there was a deeper examination of death, the role ritual plays in our society and how important not just empathy for victims and their families is, but how socio-cultural understandings of death and the afterlife inform her work.