All the physicians involved in Karen’s care agreed that her prognosis was extremely poor. They also agreed that the chances of her coming out of her coma were next to nil. Many physicians at that point might have gone with the Quinlans’ wishes, yet the doctors in this case did not. In retrospect, it is still difficult for me to imagine what I would have done in their position. On the one hand, Karen was in a state where her quality of life was almost subhuman. She was dependent on a machine to help her breathe. She needed artificial nutrition, in spite of which she was seriously underweight. And it was clear that there was no available technology or intervention that would help her regain any of her normal functions. Subjecting her to these interventions was not making her feel better in any conceivable way, and keeping them going was not going to make her feel different either.
And yet, at that time, all this was happening in a complete ethical and legal vacuum. Physicians are trained to think autonomously and to manage the patient in front of them. Several times a day, physicians face ethical decisions. Most of the time, they do what is congruent with their own moral compass. At that time, they rarely looked over their shoulder and second-guessed a decision. Frequently they would go ahead and write their own rules. Variability in medical practice increases as one moves into a data-free zone, and ethical decisions at the end of life were about as data- and legislation-free as it got.
This is a story of a dish everyone loved, then everyone hated but hardly anyone stopped eating. It’s a story about love and fashion, of private devotion and public shame. It’s a story of a thing with an unclear past and an evolving present, though it never really changes. It’s about millennial excess to some—a hashtag on more than 400,000 Instagrams.
To others it shows the cynicism of restaurants eager to make bank on a dish with the easiest of odds: a vegetal-tasting fruit of supermarket ubiquity, spread onto the world’s most common comfort food.
Yes, this is a story about avocado toast. Simple as that. Or, rather, “basic”—trendy in a bland, unquestioning way, without imagination or style—that’s what avocado toast has become. But that doesn't mean we’ve stopped paying $9 for it.
Rooney has said that she wrote the bulk of “Conversations with Friends” in three months—there’s that flow for you—and her book has the virtues of that speed with surprisingly few of its faults. Perhaps as a result of such swift execution, the novel gave me the curious feeling that Rooney wasn’t always sure where she was going but that she trusted herself to find out. She writes with a rare, thrilling confidence, in a lucid and exacting style uncluttered with the sort of steroidal imagery and strobe flashes of figurative language that so many dutifully literary novelists employ. This isn’t to say that the novel lacks beauty. Its richness blooms quietly, as when Frances, about to have sex with Nick for the first time, says, with moving clarity, that her insides feel “hot like oil,” or when she recalls a terrifying episode during her childhood when her alcoholic father, stumbling into the house drunk, tripped over one of her shoes and threw it into the fire: “I watched it smouldering like it was my own face smouldering. I learned not to display fear, it only provoked him. I was cold like a fish. Afterward my mother said: why don’t you lift it out of the fire? Can’t you at least make an effort? I shrugged. I would have let my real face burn in the fire too.”
“Lights On, Rats Out” is told up-close and in the writerly equivalent of slow motion, as though the narrator is still trying to figure out what everything means and how to fit it altogether. LeFavour’s tale is a gritty one, and requires a certain corresponding grit in the reader. It is, among other things, a love story about a dedicated and gifted analyst and his difficult but equally gifted patient. For those who have wondered what actually takes place in therapy, this book provides a sense of the granular way in which change can take place. We are so used these days to instant diagnoses, even for complex, many-tiered problems, that it comes as something of a shock to read an account of nearly gothic suffering that does not provide easy answers or assign ready blame, preferring instead to circle its own mysteries. (Even Dr. Kohl is stymied, wondering if his patient was a victim of early sexual abuse that she can’t call up.) This is a courageous and unsettling memoir, infused with humor as well as pain, and marked throughout by a survivor’s wry insight.