NZF Writers & Readers: Ready to Die? with Charlie Corke

Sarah Forster reviews Ready to Die? with Charlie Corke, at the NZ Festival Writers & Readers Festival on Saturday, 11 March. 

Dr Charlie Corke’s book Letting Go is a powerful book about how we handle these final moments of our life. Dr Corke is a career-long intensive care specialist, and he wrote the book to fill a gap for those sitting with their dying loved ones in their final moment. He notes later ‘I got into it for the machines when I was young, and as I got older I became more thoughtful.’

This session was chaired by the reliably excellent Jo Randerson, who began with the question ‘What does a good death look like?’ Dr Corke says, ‘Death is always bad, but we can make it worse. In general, deaths that are anticipated and planned for and gentle, where the family and loved ones are there – with few tubes, and little intervention are what most of us aspire to. And then there is the opposite of that.’

Part of his aim while writing the book was to express how far we’ve come in intensive care. When he began practising medicine, intensive care and kidney dialysis wasn’t even considered for anybody over 65. This discussion is now happening for older people, which means it is more ‘real’ – the person involved is not able to contribute usually. And you need family to decide what to do.

One of the things Dr Corke campaigns for is for people to have end-of-life care plans, which Letting Go includes suggestions of at the back. An end-of-life care plan is something between a patient and their doctor, based on a conversation. This means there has been a discussion about limits of what is acceptable and not acceptable. The problem with these ideal plans is, he says, ‘Doctors wait for patients to say, and patients wait for doctors to ask.’

Why do we resist? The vast majority of us think that when the time comes, our family and our doctor will know what to do . But that’s not quite true. Dr Corke reminds us that when we are confronted with this crisis, there is always something to do now – the question is whether this something is acceptable to the individual whose decisions we are making.  ‘You don’t want to treat somebody who doesn’t want to be treated, or not treat somebody who does.’

At the point of being housebound with a chronic illness, 95% of patients are beyond planning. If you begin a plan now, before you are unwell, it is much easier to tweak it as you go. Dr Corke wants everybody to consider it.

In past years, a care plan has included technical details – what tubes are okay, and which ones aren’t – but now we are moving to answering the question ‘What situation is unacceptable to you as a person.’ A bit of poetry is best. The worst deaths are where nobody agrees on what a person who is unable to make their own decision wants – when they have a plan, or do agree, Dr Corke likens this to a perfect dive.

Both Jo and Dr Corke gave personal examples of situations throughout this session, which drove home just how important this work is.

Part of having a care plan can be to select a ‘substitute’ in your care plan that you would trust to make your decision for you. Dr Corke notes that family often  aren’t that respectful of decisions made by elder relatives. You need somebody who will listen to everybody respectfully, and make a decision on the information at hand. He has appointed his eldest daughter as his agent. He is concerned that his wife likes him and would keep him going longer than he wants. He has told his other daughters and they have agreed that she is the right one – they reckon she’s ‘hard.’

Dr Corke has set up ‘my values .org’ as a space to talk about what we want at the end of our lives. The values in this area are about independence, on the other end being prepared to be looked after. Within those values we can get a perspective on where people are at.

We then discussed dysthanasia. Dr Corke says, ‘Dysthanasia is something we can all agree we don’t want – this means, literally, ‘bad death’. ‘ This is the name for screwing up death with too much medical treatment. He is looking forward to people understanding this, that they don’t want too much medical intervention making a mess of things.

Dr Corke notes, ‘If there is no plan or discussion, then the system will just carry on and do everything to prevent death. You now have ambulances who will come to your house and resuscitate everything – then the patient moves to the intensive care department, where everything has to be done within seconds – xrays, blood … In first world countries, our systems are geared to do it, and to not do it is becoming increasingly hard to do.’

This session was full of shocking facts – perhaps the most shocking for me is that 70% of treatments in ICU work are provided where they can’t and won’t save lives. Dr Corke wants people to know this because he can’t see the medical system changing on its own – it needs a grassroots movement from patients to make it re-think its philosophies. ‘We need to say medicine is a good thing, but it can go bad.’

Jo brought up the concept of Christianity and how it impacts end-of-life treatment. Dr Corke said he doesn’t know what happens when we die. ‘Personally, I just don’t want to leave a mess.’ They agreed though, that funerals are important as that is where we often have the hard discussions about what people mean to us.

The discussion turned a little to the past, when death was witnessed more frequently, and Jo noted that there are no longer as many frameworks around death now that we all live so far apart, and there is so much intervention. We have a tendency to put it in a box. Dr Corke said, ‘Noone wants  to talk about it, but when people are being frank about it you will find that families will discuss it together. You need to listen to each other.’

The questions in this session were worthwhile and thoughtful, and I’ll give the final word to Dr Corke: ‘You don’t resent having fire insurance for the house. Likewise, you don’t resent having an advanced care plan.’

Reviewed by Sarah Forster

Letting Go: How to Plan for a Good Death
by Dr Charlie Corke
Published by Scribe Publications
ISBN 9781925322705

NZF Writers & Readers: Looking Back – Elspeth Sandys and Renée

Sarah Forster reviews Looking Back – Elspeth Sandys and Renée. 

I decided to come to this because I saw Renée at Litcrawl last year and thought what a woman. And I came out with the same opinion, and a much better knowledge of Elspeth Sandys than I had going in.

Mary McCallum was chairing, and had them both read their opening chapters of their memoirs (in Elspeth’s case, her second one). Both dealt with their love of reading. Renée states, ‘Reading was a drug, a spell under which I fell willingly.’

Elspeth’s memoir is about her teenage years into her years in the UK: ‘I’m the bad news my parents never wanted to hear.’ She read Trollope, Dickens, The Cruel Sea, For Whom the Bell Tolls, Moby Dick, Georgette Heyer. Shakespeare. She notes, ‘Is it any wonder I’ve become an expert at pretending I know what I’m talking about?’

Both women were missing parents – Renée’s dad died when she was only two. Renée’s mum had to marry because Renée was born, which saw her seen as inconvenient, while her younger siblings were loved dearly and given opportunities galore. Renée says, ‘She taught me to work, and she taught me to read. And how to manage personal disasters.’ She regrets not having the chance to know her as an adult, as her mum died at 42.

Elspeth’s adoptive mum turned up to her first wedding on tranquilisers – dressed entirely in black, with bold lipstick. She stood out, with her big lot of lipstick. Elspeth learned much later she was extremely intelligent – had topped nursing school and ought to have been running a hospital, rather than a home.

Mary then brought up a story Renée tells in her book – there was a man on her bus who noticed she was a reader, and began giving her his old John o London’s Weekly’s, which opened her mind up to the idea that there were people who wrote books, plays, performed in theatre. At this stage she was 12, and starting paid work, but now she had a possibility.

Elspeth’s source of books was more straightforward – her father was in publishing, and they had all the great writers available to her. However, in her teens she was with three different foster families in the space of three years, so they became more important to her.

We moved, then, from reading to writing. Elspeth married an actor and moved to the UK and wrote on scripts for radio and TV. They moved to the Cotswalds, where anyone who had moved there since the 1640s were seen as interlopers. Their presence there attracted many others – John Hurt, Sam Neill, among others. Hurt bought one of the manor houses and came with his partner. They bought horses, but neither could ride. His partner died after being thrown from a horse during a storm.

Elspeth notes that they entertained every weekend, and it was exhausting – being a mother, writer, wife. Mary asked more about who she learned from – she said Ben Kingsley taught her the most, despite being one of the most difficult people she’d ever known: ‘he was enormously imaginative.’ Meanwhile John Hurt was a ‘devil-angel’.

Living in the village, as the kids make friends  at school, they slowly become part of it all – and all goes well until Mrs Whittaker – the upper class – labels them ‘communists’. The upper class counts as Mrs Whittaker. The longhouse they live in is painted as a communist cell.

Back to Renée – a proud lefty. Renée’s explosion of creativity happened when she was 50. She left her husband, became a lesbian, and an activist. She started writing, revues and plays centred on women. Prior to this she had worked doing everything in Napier’s theatres, directing, down to the jobs nobody else wanted. She says, on moving to Auckland, ‘It was like releasing something that had been damped down all those years.’

She had a lot of luck – sent a script to Mercury Theatre on spec, only to be asked for something else – she wrote her play ‘Setting the Table’ in four days. From there on, she was asked to do revues, commissioned for plays, and more. Her play ‘Born To Clean’ was a musical play. She says of the period, ‘I was very very stroppy. I hadn’t had an adolescence. I regret nothing.’

‘Born to Clean’ is about three young women who meet at school, drift apart, then reconnect. It includes a tampon scene – the characters read the wording on a pack of tampons – which Renée was concerned was too far out for people to accept. People laughed so hard, there was a queue for the box office for the rest of the run. It did well all over New Zealand – then filled the theatre every night for a month in Sydney, despite a negative review from a male in the SMH. In Renée’s words: ‘so tough shit’.

Mary then asked Renée whether she thought she would effect change. Renée noted on her two plays where she presented the female POV, that she’d read maybe two things about how women survived in the 1930s: she could see what they did, they went hungry. This is who she wrote about in ‘Wednesday to Come’. And she wrote ‘Pass it On’ about the Waterfront Lockout. She noted this was a tough one to research – the stories were hard to find.

Mary noted for Elspeth and Renée that the nexus of real life and fiction was ‘slippery and fertile.’ She then prompted Elspeth to agree that yes, her novel Obsession is based on she and Maurice Shadbolt’s relationship – Shadbolt enticed her back to NZ to live in the bush. She then said ‘I don’t see much of a difference between memoirs and fiction writing. All fiction is autobiographical.’ For those of you waiting – there will be no third memoir.

The two women held different opinions on whether you ask permission to write about others in your family. Elspeth hasn’t written about her children or her first husband, at her childrens’ request; while Renée doesn’t ask permission.

One last word of wisdom for the genuinely fascinating and wonderful Renée: ‘As soon as you give mothers a name, they become people’. She refers to her mother by her first name throughout – and her sons began doing the same for her once she explained her logic.

I would 100% go to any event featuring Renée in any festival this year. Don’t miss her!

Reviewed by Sarah Forster

 

NZF Writers & Readers: Francis Spufford: Electric Eclecticism

Tara Black reviews Francis Spufford: Electric Eclecticism. 

Francis Spufford has written about science, history, politics, theology and technology. His most recent book is True Stories & Other Essays, and he won Best First Novel at the Costa Book Awards last year with Golden Hill.

You can see Francis Spufford on Saturday, 10 March at 11.30am at Francis Spufford and Elizabeth Knox talk about God.