How do you know when you start to become a sick person?
That question and the difficult quest for an answer hang over Nina Riggs’ beautiful and haunting new book, The Bright Hour: A Memoir of Living and Dying (Simon & Schuster, 320 pp., **** out of four stars).
At age 38, Riggs, a poet and direct descendant of Ralph Waldo Emerson, discovers that treatments for her breast cancer are no longer working and that the disease has become metastatic and incurable.
The devoted wife and mother of two young boys begins her story by attempting to put her new reality in perspective. “There are so many things worse than death,” she tells us on page one, “old grudges, a lack of self-awareness, severe constipation, no sense of humor, the grimace on your husband's face as he empties your surgical drain into the measuring cup.”
What follows is a thoughtful and heartbreaking exploration of what makes life meaningful in a person's remaining days. We’re with the author as she relives the mastectomy and chemotherapy, which result in an “obliterated sense of femininity,” as well as her attempts to explain what is happening to her sons.
Buried within this agonizing tale are moments of levity — I laughed out loud many, many times — and flashes of poetry: “The 's' in please is the sweetest sound,” she writes, “like steam rising after a summer shower, like a baby whispering in his bed.” I imagined Riggs hold her children as this thought came to her.
As the disease progresses, we learn more about the people closest to her, including her mother, Janet, who is dying of multiple myeloma, and her husband, John, who emerges a loving and steadying presence. While other couples are dreaming of growing old together, she and John must tend to funeral arrangements and estate planning.
To cope, Riggs invokes an Emersonian aphorism, “always do what you're afraid to do” (which, she tells us, was actually said by Emerson’s aunt), while being unflinchingly honest about her experiences.
Looking back at her abbreviated life, our narrator confesses that she once let her 9-month-old suck on the power cord to her laptop — “he giggled and whined simultaneously each time it zapped his tongue” — so she could search the Internet to determine if her otherwise healthy child might be developing autism.
We also learn that during her first pregnancy, doctors told Nina that her unborn son had a clubfoot. “Not the world ending,” she writes, “but the ground shifting. Everything stranger than before.” It's the same perspective she takes with her own cancer diagnosis. The author is not looking for our sympathy; rather, she’s offering a window into her fragile, ever-changing world.
Riggs references Plato’s belief that doctors should ideally experience all of the illnesses they seek to cure. I have often struggled to understand what my patients are going through as they fail one round of chemotherapy after another and try desperately to qualify for a clinical trial involving an experimental new drug. This book provides a stunning look at that experience and has forever changed my understanding of the illness narrative. It’s a book every doctor and patient should read.
It's hard not to compare The Bright Hour to When Breath Becomes Air, Paul Kalanithi's best-selling memoir about his battle with lung cancer. Both were in their late 30s when they discovered they were dying, and both write spare prose with a poignancy that is uncommon. However, Rigg' book is markedly different in tone and content. It's more humorous and less philosophical — but equally moving.
Nina Riggs passed away in February, leaving behind a young family and a final, harrowing thought. “I am not done becoming me,” she wrote as death approached. “I am still in the works.”