ForeWord Reviews

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Twelve Breaths a Minute

End-of-Life Essays

Foreword Review — July / Aug 2011

As a book reviewer I am usually at once attending to both the words on the page and what should be said about them. With Twelve Breaths a Minute, however, I could not think beyond these essays. I could only read, unblinkingly, imagining nothing but the scenes the writers were putting before me, hypnotized by their messages and their honesty.

These writers risk telling the truth: A doctor admits, “What alarms me is how ill-prepared physicians are—and, as a result, patients and families are—to navigate the ambiguity surrounding reasonable expectations of medical technology.” A daughter states, “If I had one more conversation with my father, I’d say, ‘I’m sorry I didn’t know more, sooner, Daddy.’” A mother can say, “For my twelve-year-old daughter, death was a welcome friend.” The words of this book were no doubt difficult to write. They are difficult to read—not because of any stylistic coarseness, but because these are harrowing accounts of lives struggled for and lost, and how the world continues on afterward: “The rain fell on her without knowing she was dead,” one contributor writes, “it fell on her as it fell on earth.”

In twenty-three personal narratives, one gains the perspectives of daughters, mothers, grandsons, caregivers, nurses, a nursing home worker, nonprofit workers, a lawyer, an EMT dispatcher, physicians, religious leaders, and hospice workers, all people who are forced to make life-and-death decisions. Frankly and assiduously, they tell of the ambivalence, confusion, and questioning that surrounds such decisions. After all, “It’s a complicated thing to be employed to help people die,” as Eve Joseph, a hospice worker, writes in “Yellow Taxi.”

Part of a medical humanities series, Twelve Breaths a Minute is tasked with providing an education about end-of-life circumstances. But it does not have a single agenda to advance. As Jewish Healthcare Foundation President Karen Wolk Feinstein writes in her introduction to the collection, this book aims “not to produce an academic thesis” but rather “to extend the community conversation by allowing providers, patients, family members, and others to express themselves and tell their stories.”

The book is certainly a community effort. Three organizations—SMU Press, the Creative Nonfiction Foundation, and the Jewish Healthcare Foundation—and twenty-six writers came together to produce this conversation-provoking collection. Some of the writers have numerous writing credits; for others, Twelve Breaths a Minute represents their first publication. Regardless, each essay is thoughtfully composed. In fact, several of the chapters were nominated for the Best Essay Award granted by Creative Nonfiction, a literary journal that Lee Gutkind edits. A winner of this award—Diana Flescher’s “Mr. Stone”—is also included in the book.

The well-written narratives of Twelve Breaths a Minute depict events that should be memorialized. Physician Anne Jacobson witnesses a man wordlessly slipping away from a woman he loved since he was a teen. Howard Mansfield recounts “the Godot-like absurdities of the nursing home.” Laurie Foos’s essay begins with the simple sentence, “My father called me the day he was going home to die.” With such unadorned statements, the collection’s contributors alert readers to the utter intimacy of what they relate.

The collection can be read for many reasons—to bear witness, to appreciate the striking figurative language that arises in times of pain and illness (“an inoperable mass twisted like a sheet around a clothesline;” the many words for pain: “ghostlike,” “gnawing,” “coiling”), or to learn from others’ experiences. Not only fine in a literary sense, the essays provide specific and practical information. Phyllis Galley Westover, for instance, writes that she would “arrange hospice care sooner.” The essayists’ hindsight provides advice for the reader. And the well-researched essays relate the kind of facts that can help one make better end-of-life decisions for a loved one. One learns, for example, that “more than half of the people who die each year die in a hospital or health care facility,” and “71 percent of men admitted to nursing homes don’t last three months.”

Twelve Breaths a Minute’s subject is what we all must face—the end of life. One startling page after another, these essays will bring readers to a renewed sense of what it means to survive. And to die. And readers will find that, like many things in life, this book is difficult to let go.

Janelle Adsit