How Depressing

One of the issues that dominated my thinking as I was writing the book proposal* for Conversations On Dying was how to prevent it sounding completely depressing. Would it even be possible?

I was keenly aware of publishers’ aversion to depressing topics. Lisa Genova had to self publish her debut novel, Still Alice, because publishers told her nobody wants to read about a depressing topic like Alzheimer’s.

She proved them spectacularly wrong, but still. My book is about dying. If Alzheimer’s disease is too depressing, what chance would a book on dying stand?

There wasn’t much I could do about the subject matter. I decided I had to trust my subject, Larry Librach, to reel people in. Larry was a passionate, funny man, and he preserved his sense of humour to the last. It would not be true to say that he continued positive to the last, because he had his down days, and his setbacks. But his character was not eclipsed by them. It shone through.

In the event (and rather surprisingly, at least to me) nobody raised the issue of the subject matter when Trena White, my agent, began the process of pitching the book to publishers. But it was no surprise to me that the person who eventually decided to acquire the book for Dundurn Press, Margaret Bryant, had recent personal experience of deaths in the family. It’s how I snagged Trena too – her grandmother had died without palliative care, and after that she’d become passionate about the subject of end of life care.

So the book was sold, and I didn’t have to think about it any more. Until now.

The book is written. Now we’re turning our thoughts to marketing it, pre-release, and that “how depressing is that” question is popping up again.

So I was delighted when very first of my beta-readers for Conversations On Dying, my friend Sue Reynolds, said the found the book “uplifting”. It’s what I wanted to achieve. I knew parts of the book were visceral and direct. I didn’t want to gloss over the more grisly aspects of dying. But I was hoping too, to show that it is possible to die calmly, to preserve our integrity, to stay true to ourselves, even as we die. Here’s what Sue wrote to me after she finished the book: “It was a wonderful, satisfying read.  Even though the sad ending was a foregone conclusion right from the title, and even though I cried when lovely Larry finally left us, I found the book quite uplifting.”

I’d asked another friend, Kristen den Hartog (author of And Me Among Them and The Occupied Garden) if she’d provide a blurb for the back cover, and she too found something positive to say: “It seems strange to call this book rejuvenating, since it peers so intently at mortality. But Conversations on Dying is just that.”

Not that I’m so very surprised by this. When, several years ago, I worked with Larry to produce some patient materials for the Temmy Latner Centre’s website, I’d spoken with most of the centre’s physicians about their job, and I’d asked a lot of them if they found it challenging or depressing.

I was surprised by their answers. All of them acknowledged that the job is immensely challenging. They want to give their patients more time than they have, and there are a lot of barriers in the way of them doing the best job they can (funding barriers, resource barriers, sometimes even physical barriers as they drive from home to home). But not a single one of them said the job was depressing. On the contrary, they all said it’s the most satisfying job they’ve ever had in their careers (and some of the older physicians had long careers behind them).

Many of them talked about the privilege of being welcomed into patients home and helping them and their families navigate this most critical journey. Some talked of the intensity and intimacy of the relationships they are able to build with their patients and their families. One, who had come to palliative care from family medicine, said she felt her work now made a real difference in her patients’ lives. In family medicine, she said, the work is often routine: wiping runny noses, writing prescriptions, referrals to specialists. In palliative care every patient is special.

Sue, in her recent blog post, mentioned her friend Janet’s husband’s reaction to Janet’s dying. “For Sufis,” he said, “this is the greatest privilege. To be with someone as they are dying. To serve them.”

It requires some intense mental gymnastics for those of us who were raised in a culture that tends to ignore dying and to deny death to come to see participation in dying as a privilege. But if I learnt anything from the palliative care doctors I interviewed half a decade ago it was that the culture needs a reset.

Death is challenging. It’s difficult. It can be agonizing and it will inevitably break our hearts when someone we love dies. But we can also be uplifted and rejuvenated by it. If that seems strange to you, don’t worry. I’m still trying to cope with it myself.

• Before non-fiction writers start writing their books they produce a proposal, which is supposed to demonstrate to publishers that there’s a market for the book, to give them some idea of how big that market might be, and how to address it. The proposal is a business plan for the book.