I seem to be attracted to works by publishers who operate in, either intentionally or as a phase of their growth process, what in German is called “The Mittelstand.” Something about the core values of this amorphous, hard-to-translate economic and social blending area appeals to my sense of rightness and also provides an atmosphere of rational risk-taking that allows for interesting but not intended to be blockbuster books to be produced.
Wikipedia provides this list of core Mittelstand values:
- Family ownership or family-like corporate culture
- Generational continuity
- Long-term focus
- Emotional attachment
- Investment into the workforce
- Lean hierarchies
- Customer focus
- Social responsibility
- Strong regional ties
It seems Utopian, at least to my American predatory-capitalism trained eyes; and yet the German economy has been underpinned by firms that are well-described by most, if not all, of these qualities for many decades. It seems to me that most of the publishers whose output I most admire would agree with their inclusion in a publishing Mittelstand. My first example is a thriving operation dedicated to the from-left-field point of view.
Outpost19 is a San Francisco-based publisher of thought-provoking memoirs, essays, and works in any genre that come from a different angle than the usual bookstore offerings. Outpost19 has a lovingly curated (“emotional attachment” from the list above) selection of works from every genre imaginable. All of them have a common characteristic: They would be shuffled out of the slush pile by an intern at any “major” publishing house. Other than that, they don’t resemble each other all that much. Among the forty or so titles this press has produced in less than a decade’s existence, ADIOS, MEXICO stands at one end of the (“social responsibility” characteristic of the Mittelstand) spectrum: the real-life testimonies of two gay asylum-seekers fleeing from the horrendous, life-threatening culture of homophobia prevalent in Latin America’s rural areas; the other end (“innovativeness” in publishing this unlikely-to-be-a-bestseller topic) being held up by THE AUTOBIOGRAPHY OF DANIEL J. ISENGART by Filip Noterdaeme, a modern-day take on Gertrude Stein’s THE AUTOBIOGRAPHY OF ALICE B. TOKLAS, told by and about two German expatriate artists in New York City. This is a prime quality in companies in the Mittelstand: They see niches and fill them. They take chances that market-capitalized companies don’t want to. And they serve many, many customer who, otherwise, would never be spoken to by the book-publishing world.
I am one of those unattended readers. I want to engage in a larger conversation with society about issues surrounding health care, and while there are weighty, dry, dull factual tomes galore on the subject, there are comparatively few insider critiques. I received a review copy from Outpost19 of HOPE FOR A COOL PILLOW by Margaret Overton. I requested it because I am very much involved in the health-care machinery as the US practices it; I see first-hand the inefficiency and the indifference endemic in for-profit medicine. Margaret Overton’s memoir of her journey as a physician and a daughter through the upside-down world of end-of-life care is described by her publisher as follows:
Margaret Overton’s Hope for A Cool Pillow is a passionate argument for planning end-of-life care. As physician, daughter and student of American health care, Overton pulls from all corners, showing us the emotional, financial and physical costs of not being prepared. Her daily rounds reveal harrowing consequences, her studies at Harvard highlight the industry’s limits, and her own aging parents make her case universal. Deeply felt, frankly told, this book will challenge you — and then help you — make your own choices about end-of-life care.
I am hard-pressed to find fault with the book’s aims. I was deeply moved by the insider/outsider fault-line in Overton’s parents’ deaths from cancer and from simply wearing out, winding down from old age. Overton’s father’s death from cancer was a fairly painless, by modern American standards, affair. This was down to his insistence on preparing for his death long before it was on the horizon. This isn’t to say he suffered no pain; death hurts, and on many levels. His daughter’s M.D. helped his physical pain remain at the minimum available to (miraculously effective) drugs. Those who don’t have an M.D. in the family aren’t so lucky, as I know from attending more than one ill person’s last days. Doctors worry about lawsuits if they prescribe effective doses of pain-relieving drugs, since so many people sue for nonsensical crap like hastening a dying person’s death. Really? I myownself have never seen a case where that would not have been a merciful act. My mother’s death was not, luckily, attended by agonizing pain. Had it been, I would have made a loud and continual noise about relieving it, damn the consequences.
The other side of that story is living with pain. This is my own personal burden. I am afflicted with a genetic misery called severe tophaceous gout, which I’ve had symptoms of since 1981. It is, like all arthritic diseases, painful; and the medical establishment is scared witless to prescribe opioids except as a last resort. I am constantly called upon to remind them that total disability = last resort. Luckily I’m intelligent and stubborn and have facts at my fingertips. Many people in the assisted-living facility where I am waiting for God to remember me are not so lucky, and even more do not have champions who can or will go to bat for them. We are the throwaway people, the ones without families or support systems capable of shouldering with or for us the burden of wending our way through the labyrinthine care-delivery system. Reading Overton’s memoir made me more and more furious for that reason. She is an industry insider, she is a loving daughter, and she had battles and conflicts getting commonsensical care for her dying parents! The rest of us? Fuhgeddaboudit.
Overton’s overarching reason for writing this memoir, aside from the deeply personal ones that impel people to write memoirs, was to spark an intelligent conversation on the issues surrounding end-of-life care (an by extension all health care delivery) in a society reluctant to approach such a squicky topic. For my own part, my final wishes are, and have been, in writing and are clear: revive me if I code suddenly. If I die, donate the carcass to the local medical school wherever I happen to be; then fry the rest. I don’t care what anyone does with the ashes. That’s a lot more than most people will ever do, and the only reason I do it is the likelihood that I will die in an institution is high. Institutions are scared of death, so they do their damnedest to prolong life. As I age, my final directives will change; should my body decide to betray me in some new and unexpected way, I’ll consider how and when to change them based on that new information.
I urgently beg you all who read this to do at least as much as I have done. Do it in writing, make sure everyone around you knows where the writing is, even go so far as to have a lawyer draw up the forms and keep a copy with your will (one of which I am certain all my friends have because we’re all old enough to have significant assets to disperse, RIGHT?). Don’t put it off. I’ll leave you with the words of the wise, warm, and wonderful Margaret Overton’s hard-won wisdom on the subject for the reasons why:
I realized that what begins as a straightforward treatment or a simple hospitalization can gradually morph into a multi-week disaster with multi-organ failure not because a loved one isn’t getting good care but because a loved one is getting a lot of care. Was it when he had to go back to the operating room for bleeding? The first time, or the second time? When he couldn’t pee and had to have his prostate removed? Life gets complicated at the end. I realize that there comes a point in every person’s life when less is more. But how do you know when you’re at that point?
You don’t, and you can’t, if you’re not willing to think about it now, before it’s an emergency situation and someone you love, some stranger, someone who isn’t you, has to decide this crucial point on your behalf.
Expendable Mudge (aka Richard Derus) is a biblioholic, a tsundoku carrier, and a passionate reader. From underneath his tottering towers of unread tomes, he writes obsessively about his darlings at Expendable Mudge Muses Aloud, where many otherwise unknown books are praised, panned, or poked fun at; The Oak Wheel, where he blogs enthusiastically about short story collections; The Small Press Book Review, Shelf Inflicted (where he was a founding blogger), and wherever else he can find editors who need content, as long as it’s about books.