As I have got older, I have instead come to realize that we have no idea whatsoever as to how physical matter gives rise to consciousness, thought and feeling. Henry Marsh

Admissions is Henry Marsh’s second memoir of his life as a British neurosurgeon. It follows upon his earlier Do No Harm. Both describe why he turned to neurosurgery, the mistakes he has made and his anxieties about each new operation.

The operations require a steady hand, a range of technical equipment, skill in avoiding areas of the brain he doesn’t want to remove, hoping the patient will not be permanently disabled. Most of his operations entail removing a cancerous tumor.

In some cases, Marsh must decide whether it is better not to operate at all. The tumor is too large, the risk of operating is great, it may be better to let the patient live as long as possible, rather than ending it in a hospital hooked up to tubes for days on end. He writes:

But surgery, I told them, was almost impossibly difficult—at least, it was very difficult to operate without, at best, inflicting lifelong disability on the patient. So, what was better? To die within the next few years or face a longer life of awful disability?

He admits he has made mistakes that take a terrible toll on his patient’s lives, as well as troubling him for months. They are not confined to the operating room. He has had affairs, is divorced from his first wife, and now married again. He writes, “We always learn more from failure than from success. Success teaches us nothing.”

Yet he admits to a terrible temper, treating patients and physicians with condescension and deceiving some of his patients, “to pretend to a greater level of competence and knowledge than we know to be the case, and try to shield our patients a little from the frightening reality they often face.”

Several of the chapters in Admissions take place in Nepal and Ukraine, where Marsh has gone to help physicians who have trained with him in Britain. In Nepal, he assists his friend Dev in his private Kathmandu hospital. The country was recently ravaged by a civil war, is continuing to recover from its recent earthquake, where most patients have only a primitive understanding of modern medicine. If the surgery is not successful, the patient’s family is often furious, mounting protests and threatening both Dev and Marsh.

In Admissions, Marsh is facing his retirement. He worries he will succumb to dementia, as his father did and dreads dying in a hospital, cared for by unknown people trying to prolong his life as long as possible. He admits to having a suicide kit, hopes he will have the courage to use it if he wants. He concludes with a discussion of euthanasia.

…my concern is simply to achieve a good death. When the time comes, I want to get it over with. I do not want it to be some prolonged and unpleasant experience presided over by terminal-care professionals, who derive their own sense of meaning and purpose from my suffering. The only meaning of death is how I live my life now and what I will have to look back upon as I lie dying. If euthanasia is legalized, this question of how we can have a good death for those of us who want it, with pointless suffering avoided, can be openly discussed, and we can make our own choice, rather than having it imposed upon us.


The Missing Shade of Blue

It was 5 years ago that I first read Jennie Erdal’s The Missing Shade of Blue. I had forgotten what a great book it is. A philosophical tour-de-force. Plus, an intriguing story, engaging characters and a set of ideas that continue to linger in my mind. From the Archives, here is what I wrote about it:

Suppose there that a person…to have become perfectly well acquainted with colours of all kind, excepting one particular shade of blue…Let all the different shades of that colour, except that single one, be placed before him…Now I ask, whether it is possible for him, from his own imagination, to supply this deficiency, and raise up to himself the idea of that particular shade, though it had never been conveyed to him by his senses.
David Hume

We are in Edinburgh. Edgar Logan, a young man from Paris, arrives to translate the essays of David Hume. “…most of my life has been spent in books, reading other people’s stories, living vicariously through characters that don’t exist.”

Early on he meets the bitter, physically crumbling, soon-to-be-dismissed-philosophy professor, Harry Sanderson and his enigmatic wife, Carrie. “Up until then I lacked the talent for friendship. Later I would sometimes wonder what it was about the Sandersons that made the difference, what it was the sucked me in…”

This is how Jennie Erdal begins her novel, The Missing Shade of Blue. It engrossed me from the first page. Several threads are interlaced throughout her tale.

On David Hume: Hume had not set out with the intention of being an unbeliever. Rather he had followed the arguments for religion and found them wanting. He was a man primarily interested in explaining our place in the world so that we might live better lives; and the art of living well, he soon discovered did not sit happily with clinging on to illusions.

On philosophy: The unexamined life is much despised. According to Socrates, it is not worth living. But actually, the examined life can get you into all sorts of trouble.

On painting: At that point the language to interpret a painting was simply not available to me. Later Carrie would tell me this was an advantage. My eyes were innocent like those of a child, though to me they were simply crude and ignorant.

On vicarious experience: Nearly all of my experience of life—the highs and lows, the hopes and disappointments, the chaotic entanglements—everything that matters in fact—all of this has been mediated through the written word. With the result that novels have given me the sense—the illusion perhaps—of a connection with others, with the texture of real lives.

On marriage: My close reading of fiction had taught me that nearly all marriages occupied strange territory. But it was more vivid and startling to see it with you own eyes.

On happiness: …happiness often reveals itself as counterpoint. It is edged about with things that are opposite to it.

On novels: …a good novel was like a small miracle…fiction allowed us to live lives of other than our own….And every so often, I said, something emerged from a novel that could only be called truth—there was no other name for it. Which has a paradoxical ring to it, since of course, fiction is made up, full of lies.

These are but a fraction of the passages I noted in The Missing Shade of Blue. Is there a story along with Erdal’s philosophical ruminations? Yes, but on my reading, it plays a minor role. There is the tragic deterioration of a once fine philosopher and an emerging relationship between the Edgar, the translator and Carrie, the painter.

A Philosophical Adventure is the subtitle of The Missing Shade of Blue. That it is, the kind of book I am forever searching for. I found it one of those “small miracles.” For a philosopher, it will be a fictional treat. For a translator or painter, it is an endless debate. For any reader, it is a rich dialogue on Hume, happiness, friendship, language, and should you be the least bit interested, fly-fishing.


C. P. Cavafy

They change their sky, not their soul, who rush across the sea. Horace

When I was younger, I used to yearn for a warmer place to live. But I’m too old now to move anywhere and my lifelong spouse has no interest in taking leave of the city where we have lived for the past 50 years.

Still, when the days are dark and the rain is pouring down, I begin to yearn for that elusive place once again. However, in his poem The City C. P. Cavafy reminds me that no matter where I might find a warmer place to live, I will never be able to escape myself.

The City

You said: “I’ll go to another country, go to another shore,
find another city better than this one.
Whatever I try to do is fated to turn out wrong
and my heart lies buried as though it were something dead.
How long can I let my mind moulder in this place?
Wherever I turn, wherever I happen to look,
I see the black ruins of my life, here,
where I’ve spent so many years, wasted them, destroyed them totally.”

You won’t find a new country, won’t find another shore.
This city will always pursue you. You will walk
the same streets, grow old in the same neighborhoods,
will turn gray in these same houses.
You will always end up in this city. Don’t hope for things elsewhere:
there is no ship for you, there is no road.
As you’ve wasted your life here, in this small corner,
you’ve destroyed it everywhere else in the world.

Cavafy was born in Alexandria in 1863 to a Greek family of some wealth and at various times in his life he lived in England and Istanbul. He returned in Alexandria after the collapse of the family business where he died in 1933 at the age of 70.

In a comment about Cavafy’s poem The City, Orhan Pamuk wrote: I have read [it] again and again in Turkish and in English translation. There is no other city to go to: The city that makes us is the one within us. Reading Cavafy’s The City has changed the way I look at my own Istanbul.

Every now and then I read one of Cavafy’s poems that have been translated and published on the Web or in one of the volumes of his poems. He wrote only 154 that can be found here

From the Archives this is one I especially like for reasons that are not at all obscure:

An Old Man

At the noisy end of the café, head bent
over the table, an old man sits alone,
a newspaper in front of him.

And in the miserable banality of old age
he thinks how little he enjoyed the years
when he had strength, eloquence, and looks.

He knows he’s aged a lot: he sees it, feels it.
Yet it seems he was young just yesterday.
So brief an interval, so very brief.

And he thinks of Prudence, how it fooled him,
how he always believed—what madness—
that cheat who said: “Tomorrow. You have plenty of time.”

He remembers impulses bridled, the joy
he sacrificed. Every chance he lost
now mocks his senseless caution.

But so much thinking, so much remembering
makes the old man dizzy. He falls asleep,
his head resting on the café table.


Starting Small

Community-Supported Models A C.S.A refers to a community-supported agricultural group that encourages its members to upfront funds to a farm that be drawn upon to pay for a portion of its future harvest. It also permits the farm to cover its costs during the slow growing months.

The Times recently reported an extension of the model for a bookstore—a C.S.B. It describes a bookstore in a coastal city in Maine that has a small population of residents during the winter, but much larger number during the summer months.

Like the C.S.A. model, C.S.B. members can “invest” various amounts of money to draw upon to buy books throughout the year. At the same time, the bookstore is able to sustain itself during the slow months.

In a way, it’s like owning a portion of the farm or bookstore or whatever other type of organization adopts the concept and thereby establishes a closer relationship between members and the business than otherwise be possible.

Tax the Rich Late last year in an attempt, albeit modest, to confront the growing economic inequalities in this country, the Portland City Council adopted a plan that imposes a surtax on companies whose chief executives earn more that 100 times the average pay of their workers.

Said to be the first of its kind in the nation, the companies are required to pay an additional 10% of their regular business tax, if their executive salaries are 100 times the median pay of their employees, or a surcharge of 25%, if they are paid more that 250 times the median employee pay.

At the time the city of Portland, was the first to impose such a tax. Thomas Piketty, the author of Capital in the Twenty-First Century, said he was in favor of the tax as a “first step.” The Portland mayor at the time echoed Piketty’s view, acknowledging that while it is a small attempt to address the nation’s income inequalities, “…it is a start.”

(And not long after, Seattle became the second city to require a tax on the wealthy. The new measure requires individual city residents to pay a 2.25% tax on any income beyond $250,000 annually; couples who file jointly will pay the same rate on earnings beyond $500,000. The Seattle Times reports the tax is designed to support the city’s affordable housing, climate change, education and transit efforts.)

Offshore Wind Farms In the quest for renewable sources of energy, offshore wind farms hold considerable promise. The wind never stops blowing off the coastal states of this country. Harnessing it could provide an almost inexhaustible source of energy that might eventually make a significant contribution to reducing the nation’s pollution.

The first commercial offshore wind farm in the US is located 3.8 miles off the coast of Rhode Island. Known as the Block Island Wind Farm, it was launched last December and consists of five turbines capable of powering about 17,000 homes.

About 50,000 wind turbines have been installed in this country that provide roughly 5 percent of the nation’s electric power and even more in particularly windy states such as Kansas and Iowa. The turbines are much less costly to install on land than at sea, but the wind is also much weaker on land.

Like the two other projects I’ve mentioned, the Block Island Wind Farm is a relatively small project. At the same time, it could mark the start of much larger projects off the coastal waters of this country. The chairman of the company that built the turbines, said, “I do believe that starting small has made sense.”