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"Death was a longtime fascination," novelist Lynne Tillman writes in "Mothercare," her powerful new memoir. At age 5, decades before the contours of a heartbreaking family illness became visible, she asked her father to bury her in a coffin. She wanted her blanket with her, "so I wouldn't be cold if I woke up dead."

More than 40 years later, in 1994, those contours became more pronounced. Tillman "learned what I never wanted to know" when her elderly mother, Sophie, showed signs of serious decline. The 11 years Tillman and her two older sisters devoted to caring for her are the focus of this book.

When Tillman returned to Manhattan after a semester of teaching in England, she met her 86-year-old mother in a coffee shop and was surprised by the sight: "hair disheveled, she appeared out of sorts, even depressed." She "behaved strangely." Her handwriting, once perfect, was now "faint and spidery."

Neurologists disagreed on a diagnosis until one doctor identified the correct cause: normal pressure hydrocephalus (NPH), a rare condition that places too much fluid on the patient's brain. Until Sophie's 2006 death, Tillman and her sisters helped Sophie through various medical procedures described in unstinting detail, from shunts that sometimes clogged to medical staffers who forgot Sophie and left her alone on a gurney in a hospital corridor.

Tillman unleashes a lot of anger in this book, much of it directed at medical professionals. She doesn't mince words. Although she acknowledges that doctors have a tough job, she castigates people like the "arrogant" head of neurology whose misdiagnosis adversely affected Sophie's condition, the "useless" geriatric consultant, or the "incompetent and indifferent" staff at a hospital's luxury wing.

Tillman also has choice comments about Sophie. From age 6, "I had disliked my mother" and admits she "never felt guilty" about her conflicted feelings during Sophie's illness — obliged to care for her mother yet wanting time to write. Tillman often portrays her mother in an unflattering light, as when she writes that, three months before Sophie's death at age 98, she tells her daughter, "If I had wanted to be, I would have been a better writer than you."

Photos that appear throughout the book add little and sometimes come across as insensitive. The passage in which Tillman writes that her mother took up painting includes a photo of 1980s TV personality Bob Ross with one of his cookie-cutter oils. For the most part, however, this is a well written, memorably unsentimental account of one family's medical struggles and the ill feelings they released. Tillman's goal was to tell a "cautionary tale" that "may be helpful, informative, consoling, or upsetting." She was right on all counts.

Michael Magras is a freelance book critic. His work has appeared in the Washington Post, Times Literary Supplement, Pittsburgh Post-Gazette, Kirkus Reviews and BookPage.


By: Lynne Tillman.

Publisher: Soft Skull Press, 176 pages, $23.