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CMAJ
CMAJ - April 18, 2000JAMC - le 18 avril 2000

The Left Atrium · De l'Oreille Gauche

CMAJ 2000;162:1179-82



Taking the short view

Elegy for Iris
John Bayley
Picador, New York; 1999
275 pp. $19.99 (paper) ISBN 0-312-25382-6


In the Eugene de Mazenod Residence for aged priests in Saskatoon is a small wood-panelled chapel with a brilliant stained-glass window facing south. The Catholic Mass is celebrated there each morning before lunch. On the day I attended the service with my wife, the congregation was comprised of the two of us, a dozen white-haired old men and a handful of caregivers from the institution. Just as the Mass was about to begin, an elderly priest, the celebrant, completed a slow and careful transfer from his walker to a chair behind the altar.

Throughout the Mass I was distracted by the intricate brake cabling on two other wheely-walkers parked in front of their seated owners, the hands of a man with a fine tremor, intermittent phlegmy coughs, throaty voices straining for the hymn tune, and a thin man to my right staring straight ahead and exhaling soft incomprehensible sounds. The celebrant spoke briefly on the day's Gospel reading about the widow and her two copper coins and illustrated his point with reference to an earlier time in his life as a missionary in Brazil. I couldn't help but think about the lifetimes of pastoral work collectively hunched over in their chairs. Although the old priests' vital working days were well behind them, I felt that the celebration of life was continuing, albeit under circumstances that many young and middle-aged people like myself would at first find discouraging — if not depressing.

I mention this scene because it intensified for me the pleasure and the poignancy of reading John Bayley's story about his life with Iris Murdoch. Over her long and successful writing career, Murdoch published 26 novels (including the Booker Prize winner, The Sea, The Sea, published in 1978), works on philosophy and three plays. In his short tribute he writes of their marriage of more than four decades, and the Alzheimer's disease that claimed the novelist's final years.

We read books under a variety of circumstances, for important or trivial reasons, and in the changing company of family, friends or strangers. In the case of Bayley's book, a bibliophile friend whom I hadn't seen for a while spoke highly of it over a cup of coffee. Shortly afterward, I discovered it waiting for me on the recent acquisitions shelf at our public library, and I read it while on a week-long retreat with my spouse. It remains a bit mysterious to me why certain books appear in our lives at specific times, almost demanding to be read.

Only pages into the story I knew I was going to enjoy my time in the company of Professor Bayley and his distinguished wife. On page nine he is intrigued by the "wonderful and solitary being" who bicycles slowly by his window at St. Antony's College — or, as he puts it, "Perhaps I fell in love." Years later, going through some of Iris's papers for her publisher, he finds a note that perfectly balances his own reflective, understated affection. In an exercise book he comes upon this entry, dated June 3, 1954: "St. Antony's Dance. Fell down the steps, and seem to have fallen in love with J. We didn't dance much."

Throughout their life together one of their favourite activities was seeking out streams, ponds and oceans to swim in for refreshment and sanctuary. They also immersed themselves in the flow of language, in the reading and writing of books. In their early married life they "never possessed or wanted" a television. Their travels included more than one visit to what Aldous Huxley describes as the "greatest painting in the world," Piero della Francesca's The Resurrection, in the town hall in San-sepolcro, Tuscany. Having been encouraged to look upon this picture myself a few years ago, I felt an affinity for much of the "romantic" quality of their life together. From his first encounter with Iris while a young man at Oxford, to his days as her lover, husband and, eventually, personal caregiver during the difficult final stages of her life, when her loss of memory redefines their life together, he delights in, is fascinated by, and marvels at the woman with whom he shares his life.

And I, the reader, quickly fell under the spell of his conversational yet eloquent prose. I was transfixed by his poetic rendering of their 40-year love affair. I felt compelled to read passages aloud to my wife. "Here, listen, just listen to this ... ," I would say, as Bayley remembers their early relationship in terms of the myth of Proteus and Hercules. Later he recalls Pierre and Natasha in War and Peace, who "understand each other and grasp each other's viewpoint without having to make sense or needing to be coherent." Eventually they become like Ovid's Baucis and Philemon, to "whom the gods gave the gift of growing old together as trees." Bayley provides just enough context for such references to make them clear to those of us whose reading of the classics is less than complete. His erudition glows gently in a way that informs and engages the reader, especially when his allusions take on an ironic overtone in the context of Murdoch's eventual dementia. It's not hard to imagine oneself attending one of his lectures on Shakespeare or Tolstoy.

Elegy for Iris is a book of wisdom skilfully crafted and modestly shared near the end of two writers' lives. An example of this wisdom shines through in Bayley's observation about Romantic writers, who discovered that "To remember and to write was to create their lives and their sense of living things." For many writers, (like Wordsworth recalling his visit to Tintern Abbey or Proust in his recherche du temps perdu), life recreated from memory appears to take on a status superior to quotidian living itself. While Bayley succeeds admirably in his written act of creation, he reminds us of the crucial difference between living and remembering life. He maintains no illusions about the relative value of day-to-day living versus writing about life lived. During their final Christmas together, he writes: "No need to remember, as this ritual that has replaced memory goes on."

Twice in the book he quotes the Reverend Sydney Smith, a clergyman of Jane Austen's time who used to advise his parishioners, "Take short views of human life — never further than dinner or tea." In promoting the short view, Bayley ironically surveys the richest expanses and effectively plumbs the greatest depths of human experience. And he kindly encourages us to do likewise.

Vincent Hanlon
Emergency physician
Lethbridge, Alta.

[Contents]


Illness and metaphor
Memory loss

Constance, two years older than Diana, had all her own teeth, could hear birds sing, and only needed glasses for reading, which she had pretty well given up, and for intimate weeding of the garden which she could still do, hunkered down for minutes at a time and able to rise as swiftly and agilely as a young girl. Yet Constance often could not move from their bedroom without Diana's aid. Particularly in winter, she might forget that it was morning and be putting herself to bed again by the time Diana had finished in the bathroom.

This morning Constance had left their bed, taken off her pyjamas and was standing irresolutely beside clothes put out for her the previous night.

"Have I had my shower?"

"No," Diana said, smiling.

While Constance showered, Diana took up a small slate, lifted the cellophane to clear it of the crossed off items of yesterday, and began to write the list for today, the first item intended to amuse Constance:

Put on your clothes
Breakfast
The morning show
Lift bulbs in the bed by the garage
Lunch
Rest
Errands on the avenue
Walk on the beach
Dinner with David

The last three items had been scribbled impatiently and had to be erased and redone. Even taking care, Diana formed letters only Constance and druggists could read. Reinforcing any cliché about her profession irritated Diana, but even now she couldn't slow down her mind to make her hand its adequate servant.

. . .

Constance arrived at the breakfast table, dressed, with the slate in her hand, the first item crossed off.

"David who?" she asked.

"My brother."

Constance stared away from Diana at the blank slate of her memory.

"My twin brother."

"Is it your birthday?" Constance asked in sudden agitation.

"No, no, of course not."

. . .

"... I can't even remember what's the matter with me most of the time."

"There's nothing the matter with you, except that."

Excerpted from Jane Rule, Memory Board (1987), ch. 2, with kind permission of Naiad Press, Tallahassee, Fla.

[Contents]


Room for a view
The shadow

Some years ago, when I was visiting New Zealand, I looked toward the equator in the middle of the afternoon and noticed that my shadow fell to the right. This was quite disorienting: in Canada, when you look toward the equator at that time of day your shadow is on the left. I began to reflect how our shadows are part of our identity. I suspect we take our shadows for granted. Maybe we shouldn't.

In my practice I often hear patients refer to their shadow side. Yet a shadow varies so much in size and shape, depending on the angle of the light. It's hard to see your shadow behind you; you can only really know the shadow in front, which means keeping your back to the light. At noon in the tropics you stand on your shadow. In the evening, your shadow can be huge and frightening as you walk away from the setting sun. Cast against a distant wall, it almost disappears because of the immensity of the sun. If you walk toward a bright, glaring light, your shadow can only be seen by others. The same is true when you walk toward a bright, glaring truth.

I have found in psychotherapy that people who are most insistent on knowing the harsh truths about themselves, their family or their culture benefit most from their personal inquiry. The most useful history is always the most painful. And the most painful is the most deeply buried, whether in the recesses of the mind or in the archives of a nation. I sometimes ask my patients to do a role-play in which they persistently insist, "I must know," while I counter with all the usual rationalizations: "It's too painful." "What's the point in digging up the past?" "You'll upset everybody." "You can't remember it clearly anyhow." They come to understand that these resistances have been handed down for generations. The more they push through their resistance, the better they are able to face the harsh light of personal truth, and the better they are able to see their shadows.

Most people claim that they want to know the truth about themselves. And yet most are afraid of knowing "too much": whether they have a genetic predisposition to cancer, for example, or the sex of an aborted baby, or what their father really did in the war. People are remarkably ambivalent about knowing the truth, especially about themselves. This ambivalence applies to physicians as much as to anyone.

Therein lies a problem: you can't see in others what you refuse to see in yourself. The axiom to follow is not "Physician, heal thyself" so much as "Physician, know thyself."

Much is written about patterns of practice, but physicians could learn more by analysing their "patterns of patients." In professional as in social relationships, we subtly select people who will help us re-enact our unresolved conflicts. Then we coach each other toward a dramatic demonstration of that conflict, hopeful to learn how and why it happened in the first place, more often to further confuse ourselves and deepen the wounds. Such situations can be tragic or comic, but invariably they are a source of frustration. From referred patients and their physicians, I often hear the same story from different points of view. It isn't a question of who is right, but of understanding the roots of this apparently futile restaging of unrecognized problems. It isn't enough to be a conscientious, well informed, likeable or agreeable physician. Problems with patients often arise from the physician's deep unawareness of self. Changing roles, specialization, place of work, office or staff can compound these problems. Sticking with it, though painful, can be an opportunity to face painful truths about ourselves. Regardless of rank, reputation or income we are all fallible beings of equal intrinsic worth. Unless we learn from painful truths, we will re-enact unresolved conflicts, possibly in ways that are harmful to our patients.

Examining our shadows can help us to know ourselves. When we are determined to face the harsh light of truth about ourselves, our shadows are very distinct. The size, shape and location of our shadow may indicate how well we are facing the light.

Philip G. Ney
Child, adolescent and family psychiatrist
Victoria, BC

[Contents]


Lifeworks
I have been a family doctor for 28 years. My hobby is painting, and over the years I have managed to take many small courses at night or on weekends at our city art gallery and in high schools. However, I was always too short of time to do any work on my own. Last year, when my father died, my lifelong desire to paint suddenly became more urgent. I turned an empty bedroom into a studio, and every Sunday afternoon I work there, determined to express some moments of life through this medium. My main interest is acrylic and watercolour portraits and scenes with people, which I suppose is not surprising for a middle-aged doctor reflecting on her life so far. This painting, First Breath, measures 18 × 24 inches and was done in acrylic on a canvas panel. It was inspired by a photograph taken by the father of the newborn in the days when I was still delivering babies, and is intended as a tribute to the family doctors and nurses who attend the miracle of birth. — Lianne Lacroix, Kelowna, BC

[Contents]



The warranty is running out

For middle age
I lack at times
enthusiasm.

Those in charge,
the politic, the parent
authoritarian, omnipotent
well of knowledge and support,
have crumbled into human remains.

The DNA which never failed
to mount repair of my immortal frame
is giving up.

My friends —
playing tag
just yesterday,
are dying piece by piece.

This was not part of the bargain.

Robert C. Dickson
Family physician
Hamilton, Ont.

[Contents]


One thousand words

Monthly clinic for the children of shipyard workers in Vancouver, BC, July 1943
[Photo courtesy of National Film Board Collection / National Archives of Canada / PA-116149]

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