Book review: The Living Sea of Waking Dreams. The challenges in withdrawing futile treatments

David Jeffrey is an Honorary lecturer in palliative medicine. University of Edinburgh

Richard Flanagan, a Man Booker prize-winner, sensitively explores loss and suffering in his latest novel, The Living Sea of Waking Dreams. This book can be read at many levels; a story of individual suffering, global loss from climate change and a fantasy of magic realism and extinction. This review will focus on the author’s examination of suffering.

Francie, aged 86, suffers a cerebral haemorrhage followed by a series of strokes, chest infections and eventually renal failure. Her three children; Anna an architect, Terzo a hedge-fund manager and Tommy, her carer, come to her bedside. Her doctors advise them that to intervene medically would only prolong the agony of her dying. Initially, the family agree, but a few hours later they urge her doctors to do everything possible to keep Francie alive. Anna reflects that the reason for their change of mind was to regain a sense of control.

What follows is a sad spectacle of Francie being subjected to a sequence of futile interventions, including an operation, admissions to intensive care and eventually receiving dialysis. When Frances is reduced to speaking only in a hoarse whisper she asks Anna, “ I want. The rites read. Best. Call for the. Priest.” Terzo responds, “She doesn’t want to die. We don’t want her to die”.

Tommy is more accepting of death, but is made to feel weak by Terzo’s confident assertion that his mother is living not dying. As Francie deteriorates with each new catastrophe Terzo’s resolve that their mother should live only strengthens.

After a series of strokes, Francie using an alphabet board spells out, letter by letter, L-E-T-M-E-D-I-E, only to be met by Anna’s reassurance, “But you’ll get better Mum”.

The lie was that postponing death was life.

The paradox in this terrifying picture of the “solitude of suffering” is the kindness of the health care professionals whose actions only seem to increase Francie’s suffering. This arises because of a lie with which the nurses, doctors and family collude, “The lie was that postponing death was life”.

The book explores the reasons behind each of the children’s attitudes to death and dying revealing the complexity of family dynamics. It brilliantly conveys the difficulties which can arise in withdrawing futile treatments. Oncologists are sometimes blamed for being too aggressive in their treatment of patients with advanced cancer, but occasionally it may be the family who drive them to pursue futile treatments whilst ignoring the wishes of the patient.


Featured book
The Living Sea of Waking Dreams by Richard Flanagan. Chatto & Windus, London, 2021. ISBN978-1-784-74418-2  Pp285, Price£16.99

Featured photo by Daria Shevtsova on Unsplash

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