Beautiful, sentimental portrait of a young woman of early-19th century Edo

I knew that the great late-Tokugawa artist Hokusai Katsushika (whose ‘Great Wave off Kanagawa” is probably the best-known Japanese graphic; it is one of his 36 Views of Mount Fuji) had a very dutiful daughter, Ôei, from having watched Shindô Kaneto’s 1981 biopic “Hokusai manga” (the title was sensationalized in English as “Edo Porn”). I think she managed the household of the obsessive artist. She also did work on his drawings and paintings (the art in effect came from an atelier Hokusai rather than from one man).


The anime based on a manga,” Sarusuberi”/“Miss Hokusai” (2015), is often quite beautiful, but it is rather puzzling in its purpose. Ôei narrates it and is the prime focus, but her character is little developed. She placates as well as assists her father, trying to make sure he delivers on commissions on time. He sometimes thinks she should do her own work, at other times derides it (in particular, representations of males).


Ôei spends time with her mother (long living separately) and her younger sister, Onao, who is sickly and  blind. (A high point is taking the younger sibling out in the snow.) Their father has an aversion to the sick, and mostly avoids seeing his younger daughter.

Though drawing erotic couplings, Ôei does not seem to have any sexual experience of her own.


There’s not much plot, the movie not attempting to image Ôei’s life after her father died (at the age of 90). I’m not sure I’d even say that the movie is “episodic,” in that nothing much happens in the “episodes.” But, as I said, the movie is often beautiful. The musical soundtrack by Fuki Harumi, is sometimes distracting, especially when the imagery gets fanciful (out of body). It is definitely not of the period portrayed (the movie begins in 1914, btw).


There is a long (1:56) making-of feature that is supposedly quite dramatic on the blu-ray, but there is only a bland quarter-hour excerpt included as a DVD bonus.. (The movie itself has a running time of 1:33).


©2018, Stephen O. Murray

A shy Heian woman’s memoir

Although I was dismayed by rereading The Pillow Book of Sei Shônagon, that did not kill of my interest in Heian Japan. I remain fascinated by the artificial, hyper-aesthetic elite culture/society of which Sei was a passionate devotee.

I went on to read what Ivan Morris translated as As I Crossed a Bridge of Dreams: Recollections of a Woman in Eleventh-Century Japan. The author’s name did not come down with the manuscript of her dream-filled memoir. She is generally referred to as Lady Sarashina. She was the daughter of a provincial governor of the Fifth Rank (the lowest of the top ranks), Takasue. Her husband (when she married at the old age of 36) and son (Michitsuna) were also officials of the Fifth Rank.


She was born in 1008, when Lady Murasaki was still working on The Tale of Genji, which the young Sarashina eagerly consumed when she could get access to any of its 51 books. She was born and lived in the capital (Kyô, modern Kytôto) until the age of nine. She then went with her father to “the eastern wilds,” where her father was an Assistant Governor. She returned to the capital at the age of twelve. Her memoir begins with the three-month westward journey back to the center of Heian civilization.

Indeed, the book is something of a travelogue, with terse accounts of many pilgrimages she took. Her elder sister died (in childbirth) in 1023, a great shock to Sarashina, even though her nurse had died two years earlier. She wrote that death, even being told about the death of strangers disturbed her greatly and for long times.

I like Morris’s characterization of her father as “a querulous, self-centered old whiner.” Takasue wanted to keep her home (she was raising her dead sister’s two children as well as pampering him).

She did not go to court, as a lady-in-waiting, like Sei Shônagon and Murasaki, but to a princess rather than an empress, returning home often (it seems that Sei did, too, but her identity was entirely tied to the court and the empress she flattered in person and in her jottings). Sarashina enjoyed the travel to temples much more than Sei says she did. Sarashina’s memoir founded the Japanese genre of travel writing, though her ignorance of Japanese geography was typical of Kyô residents. Sarashina cautioned that “anyone reading the account of visits to one temple after another might well imagine that I was forever going on pilgrimages. In fact, there were log intervals, often several years between my retreats” (at least until her husband died, when they seem to have become more frequent).

There is hardly any mention of her three children or their father, who died when Sarashina was 49. Death again devastated her and her devotion to him after his death seems much greater than any during his lifetime. She almost certainly wrote her memoir after his death. In contrast to the randomness of The Pillow Book of Sei Shônagon, it proceeds in chronological order, though scanting details. There is more about moonlight than about her marital life. And she wrote about a number of dreams, prefiguring a major obsession of later Japanese writers (e.g., Soseki Natsume).

She exhibited compassion for the lower orders in marked contrast to Sei’s horror at their very existence, and she knew about how rice was grown (which I am not sure Murasaki knew, and was certainly of no interest to Sei). Sashira was as timid as Sei was bold. Sashira’s other regarded her as “unfit for normal society,” let alone the hypercritical world of the imperial court.


The most self-analytic passage (#11) relates “I lived forever in a dream world. Though I made occasional pilgrimages to temples, I could never bring myself to pray sincerely for what most people want…. The height of my aspiration was that a man of noble birth, perfect in both looks and manners, someone like the Shining Genji in the Tale, would visit me just once a year in a mountain village where he would have hidden me, like Lady Ukifune [in The Tale of Genj… waiting for an occasional splendid letter.” Even this modest aspiration was delusional, however, for someone as timid as she was (literally hiding behind others when at court).

A particular interest of the book for me is that after she had read The Tale of Genji and other tales which she eagerly sought out was a girl, she came to feel that she had been too enamored of romantic fiction (in some ways prefiguring Don Quixote and Emma Bovary, though far more aware of how she had been harmed by her overeager consumption of romantic fiction). Her yearnings turned, in widowhood, to (Buddhist) merit she could have been making instead. (“If only I had not given myself over to tales and poems since my young days but had spent my time in religious devotion,” the old Sashira came to believe.)

Writing poems to answer others’ poems and appreciation of the aptness of references in the poem was central to Heian court life, as one could not miss in either The Pillow Book of Sei Shônagon or The Tale of Genji. There are many poems in all three books, though the translators say much of the beauty of Heian poems cannot be translated into English.

Morris supplied a 27-page introduction and 32 pages of endnotes. There are also 3 maps, 17 woodblocks from a 1704 printing and seven pages of 20th-century photos of places Sarashina mentioned visiting (these are quite clear in the original Oford University Press edition, not so good in the smaller Penguin one). The actual text takes up only 98 pages.


©2018, Stephen O. Murray

More revolted by than admiring of Sei Shônagon’s miscellaney

I have been on a Heian Japan tear, greatly admiring American anthropologist Lisa Dalby’s novel about the author of The Tale of Genji in The Tale of Murasaki and Columbia Japanologist Ivan Morris’s comprehensive analysis of Heian court culture and society in 1964 The World of the Shining Prince.

Morris drew on material from various extant Heian writings in addition to Genji, particularly The Pillow Book of Sei Shônagon, which he would translate a few years later (1967). I know that I read it long ago, probably in small chunks. There are 185 of these entires, covering 243 pages in Morris’s Penguin edition. He also produced 584 notes that take 110 pages, a ten-page introduction, 33 pages of appendices and a one page list of “further reading.”


Considering the high regard I have for Morris’s explication of Heian culture, the high proportion of the book that is explication rather than translation if not a problem for me. The problem is the Heian author. I cannot think of a more snobbish writer in the whole of my experience of world literature than Sei Shônagon. She does not consider just servants and peasants as subhuman, but also members of the elite who are not as refined or as knowledgeable of classic Chinese poetry as she is or who commit what she considers some fault of couture.

Juxtaposed to her dismissing of most people, including most other members of the imperial court, there is also a sycophancy that seems pathological to me. I realize that flattering is what courtiers do to rulers, but the paeans to the empress Teishi’s beauty, poise, and poetic choices is so excessive as to turn my stomach. All the more so, since the book was mostly written secretly without expectation of being read by the empress and emperor. Rather than currying favor through flattery, Sei seems to have been so dazzled by rank as to be turned into a fool, however sharp-tongued she was about those of rank equal to or less than her own.

Plus I have vastly less interest in the robes and underrobes worn by the empress, empress, chamberlain, and officials (considering ladies in waiting as official) than Sei did, find the lack of development even in the fairly extended narratives included in the book disappointing. The lack of organization, within entries as well as in the total collection of judgments and observations, particularly in the many, many lists further alienates me. I do not agree with Morris that part of the book’s “charm lies precisely in its bizarre, haphazard arrangement in which a list of ‘awkward things,’ for example is followed by an account of the Emperor’s return form a shrine, after which a totally unrelated incident about the Chancellor that occurred a year or two earlier and then a short, lyrical description of the dew on a clear autumn morning.” I am not charmed. I might appreciate the occasional lyricism if it was not cheek-to-jowl with the putdowns of the many and the sychophantic praise of Sei’s social superiors.

What puzzles me is that I don’t have negative memories from when I first read the Pillow Book long ago. In contrast, my admiration for the structure (at the level of episodes as well as that of the whole huge book) for The Tale of Genji has grown, as I have read three translations of it. In her diary, Lady Murasaki herself castigated Sei Shônagon(‘s jottings and character) “frivolous,” an adjective that I think might be applied to the aesthetes of the court in the times of both writers. Though acknowledging that Sei Shônagon was a “gifted woman,” Muraskai was also put off by “the most extraordinary air of self-satisfaction” in Sei’s writing.


©2018, Stephen O. Murray

Ivan Morris’s engaging and comprehensive analaysis of Heian culture/society


I first acquired and read Ivan Morris’s The World of the Shining Prince: Court Life in Ancient Japan (first published in 1964) after reading the Edward Seidensticker (1976) translation of The Tale of Genji (Morris deems this the first “psychological novel” rather than the first novel). In 1990 I thought Morris’s book a model of a holistic ethnography of a long-gone culture. I reread it after reading Lisa Dalby’s (2000) The Tale of Murasaki. I still think that Morris’s book readably analyzes what can be known about Heian society/culture. It certainly explicates the place of elite Japanese women of the time. All the Heian literature that has survived was written by women. Morris himself translated The Pillow Book of Sei Shonogon and As I Crossed a Bridge of Dreams. Moreover, there was a preference for daughters (rather than sons) among the elite, so that they could be married to members of the imperial family. (This is not to say that there was no male privilege, not least in lack of constraints on mobility and ready acceptance of males having multiple wives and concubines.)


(Murasaki imagined writing The Tale of Genji)

Women could inherit and hold property in Heian times, though it was difficult for them to go out and supervise their holdings. Indeed, a reluctance to leave the capital (now Kyoto) also hamstrung males of the court. Eventually, regional landowners toppled the aesthetes of the Heian.

Morris says that women lived in semi-darkness, isolated by screens from male interlocutors. While their male contemporaries were writing in Chinese, some women created Japanese literature (still enamored of Chinese models) in cursive (“grass script”).

Morris’s separation of Heian beliefs into “religions” and “superstitions” feels old-fashioned, but he made a clear rationale for distinguishing what Robert Redfield called “the great [written] traditions” and “small [unwritten] traditions.”

Not much is recorded about the lives of the masses. Morris relates what can be known, while recurrently emphasizing that the culture/society that is knowable from the literature of elite Heian women had little to do with the lifeways of Heian peasants. Even provincial governors, appointed by the Emperor, were looked down upon for being away from court. And warriors had no prestige in Heian Japan (samurais were far in the future!).

“Artistic sensibility was more highly valued than ethical goodness. Despite the influence of Buddhism Heian society was on the whole governed by style rather than any moral principles and good looks tended to take the place of virtue. The word yoki (‘good’) referred primarily to birth, but it also applied to a person’s beauty or his aesthetic sensibility’ the one implication it lacked was that of moral rectitude” (207).

“As in almost any polygamous society, the possession of numerous attractive concubines and mistresses, in addition to a well-born principal wife, far from labeling the man a lecher, was an enviable status symbol—an indication of his wealth, skill, charm, and health” (248)

The evanescence of beauty was already keenly noted even back then (the sadness of mono no aware).

Morris concludes with an appreciation of The Tale of Genji as literature (not only as a source of information about the Heian court society and culture) and of the woman who became known as Murasaki, a character in it, as the author.

For anyone interested in Heian Japan and/or those wanting to understand the sociocultural context of Genji and other Heian literature, Morris’s book cannot be recommended too highly. Morris produced other interesting work (The Nobility of Failure, Nationalism and the Right Wing in Japan), outstanding translation of Mishima’s The Temple of the Golden Pavilion and Shôhei Ôoka’s Fires on the Plain. Alas, he died in 1976 at the age of 50, and the 1962 collection Modern Japanese Stories.


©2018, Stephen O. Murray

The diary of the author of The Tale of Genji

There are not a lot of thousand-plus year-old diaries. (Prior to the Norman conquest of the Anglo-Saxons, the English language did not even exist.) There are, however, some Japanese ones, even if one excludes the “Pillowbook” of Sei Shônagon. The Diary of Lady Murasaki (ca. 973 ca. 1020) is predominately the view of a lady-in-waiting of the Northern Fujiwara empress Shôshi.” Murasaki” is the name of the major female character among the hundreds of paramours of Genji, the resplendent and sensitive-to-women’s feelings son of an emperor in Genji monogatori (The Tale of Genji), the very long (1200+ pages in printed English) and episodic novel written by a lady-in-waiting whose name is unknown.


The “Diary” is less of a diary in the modern sense than ones kept by some male courtiers, who dated their entries. The first half recounts the birth of a prince (Aysuhira) to Shôshi in the tenth year of her marriage (some of the delay undoubtedly was that her marriage preceded menarche) in 1008. This consolidated the position of Shôshi and her court, including her courtier, the widowed “Murasaki.” Jockeying for position was the primary dynamic of life among rival courts, in the profusion of wives, young emperors, and abdicated emperors who were free of ritual obligations and in many cases did more in the way of ruling after they stopped reigning. Michinaga, Shôshi’s father, besides having been emperor himself was brother-in-law to two other emperors, uncle and father-in-law to another, and grandfather to two more.

Knowing how important producing a male heir was is crucial to understanding the fuss made about the birth to Murasaki’s patroness of a male baby. She did not explain the series of rites (translator Richard Bowring’s footnotes and substantial introduction do that) following that birth. The diarist records considerable detail about who was wearing what. Bowring notes that the detail is “almost suffocating,” and I’d drop the “almost.”

To understand Heian Japan, Ivan Morris’s The World of the Shining Prince is far more informative and readable than Murasaki’s diary (the “shining prince” is Genji, whose father, an emperor, made him a commoner, thus not a prince…). Having slogged through the latest (Royall  Tyler’s) translation into English of Genji monogatori (I prefer Edward Seidensticker’s), I read the slim volume out of curiosity about the author… about whom I learned very little. Many characters in her novel become nuns, but their creator realized she was still attached to the world, however annoyed she was by the vanity, jockeying for attention and position, and censoriousness of her social peers.

The most interesting part of the volume is in the form of a letter, and in that, after short descriptions of various other women, what surely is a reminder to herself as much as a communication to an unknown correspondent: “It is very easy to criticize others, but far more difficult to put one’s own principles into practice, and it is when one forgets the truth, lauds oneself to the skies, treats everyone else as worthless, and generally despises others that one’s own character is clearly revealed.” Since this is in the midst of a criticism of another courtier whose letter has fallen into her hands, one cannot exonerate “Murasaki” of not practicing what she preached. In the same “entry” she calls the other great Heian writer, Sei Shônagon, who had retired from court before Murasaki became a courtier of being “dreadfully conceited.” (There is a whole paragraph of criticism of her.)

Not that there are no women whom she praised, especially her patroness empress, but the wife of the governor of Tanba in the particular section from which I’ve quoted.


(Empress, baby, Murasaki, with Michinaga below)

And “Lady Murasaki” is modest about the poems she produces—in an elite in which extemporaneous concoction of poems was a skill recurrently tested and severely judged (as any reader of Genji knows very, very well). Being very stylized thirteen-syllable poems (usually rendered into English as couplets, but written in one vertical line in Japanese), Bowring warns against making inferences about the views, values, or personalities of the poets. Many are allusions to T’ang Dynasty Chinese poems, and though I am sure Bowring is right that the poems are not windows to the souls of the Heian poetasters, there has to be something in what someone remembered and was able to use, though je ne sais quoi!

The date of Aysuhira is established in multiple sources, and various rites occurred x days after that, but it is not certain that the descriptions were written on those days, and the other parts of the diary are not only undatable but even their order is uncertain.

I can’t imagine the book of being of interest to anyone who has not read Tales of Genji and the Pillowbook of Sei Shônagon, and, probably Gossamer Days, and is desperate for more Heian writing.

The original (Princeton University Press, 1982) edition of Bowring’s translation also included the 120 poems attributed to Lady Murasaki. Dropping them is a decision difficult to understand.


©2010, Stephen O. Murray


I think that Lisa Dalby put both the poems and diaries to great use in her novel, The Tale of Murasaki.

Tony Richardson’s “Mademoiselle”

The success as a stage director of Tony Richardson (1928-91) seemed to flow seamlessly to film. Richardson directed John Osborne’s plays “Look Back in Anger” and “The Entertainer” first on stage then on screen for a company (Woodfall) he and Osborne founded. I’d like to see the adaptation of William Faulkner’s sordid Sanctuary (1961), which starred Lee Remick as Temple Drake, but have never had an opportunity.

Before winning an Oscar as best director for the winner of best picture of 1963, Tom Jones, Richardson directed Rita Tushingham in an adaptation of Shelagh Delaney’s “A Taste of Honey” (1961). Tom Courtenay and Ralph Richardson in an adaptation of Alan Sillitoe’s story “The Loneliness of the Long Distance Runner.” And he followed up “Tom Jones” with an adaptation of the black comedy about the funeral business in LA by Evelyn Waugh, “The Loved One” (1965) with a very mannered performance by Rod Steiger.

Though he also had male lovers, Richardson seems to have had a passionate marriage to Vanessa Redgrave (1962-67) until he was drawn, like a moth to a flame, to Jeanne Moreau (also born in 1928 and still going strong) that ended his marriage and his string of film successes. At her behest he directed “Mademoiselle,” from a screenplay by Marguerite Duras of a screen treatment a decade earlier by Jean Genet that was booed at Cannes in 1966, followed by the hideous 1967” The Sailor from Gibraltar” in which Redgrave played the wife who lost her husband to Moreau. Then Moreau found other romantic interests. Richardson’s career was not done, but he made unsatisfying movies including “The Charge of the Light Brigade” (1968), an adaptation of Vladimir Nabokov’s Laughter in the Dark (1969), a bizarre movie about the Australian outlaw Ned Kelly with Mick Jagger playing Kelly, a creditable adaptation of Edward Albee’s “A Delicate Balance” (1973, reuniting him with Lee Remick in a cast headed by Katharine Hepburn and Paul Scofield), a disappointing return to Henry Fielding (author of Tom Jones) in “Joseph Andrews” (1977 with Ann-Margaret and Peter Firth) and only four more movies: the underrated “The Border” (1962 with Jack Nicholson) and “Blue Sky” (not released until 1994 with Tommy Lee Jones and Jessica Lange in a performance that won an Oscar), the overrated “The Hotel New Hampshire” (1984), and a two-part tv movie of “The Phantom of the Opera” (1990) from Arthur Kopit’s book for his then-unproduced smash-hit stage musical “Phantom” (with Charles Dance and Burt Lancaster).

It is a puzzling filmography, the main continuities of which are obtaining the services of talented actors and actresses and a penchant for literary adaptations (I guess I include the two Osborne plays from the start…).


Having finally seen “Mademoiselle,” I’m not sure why it was booed at Cannes, where the similar but worse “The White Ribbon” was the highest prize, the Palme d’Or, in 2009. Both movies were shot in black-and-white and are set in villages in which malignity rules. (The village where Richardson filmed was, I kid you not, named Le Rat, in the Corrèze département of central France.)“Mademoiselle” opens with Moreau opening a sluice gate and shows the flooding of a farm that follows. This has been preceded and will be followed by arson of barns. Moreau’s character is revealed to be the teacher of a one-room local school and the municipal secretary. Unmarried, she is perhaps a frustrated virgin (repression kills). For sure, she is a menace to the community in general and to an Italian woodcutter (Manou, played in Italian by Ettore Manni), who is servicing various frustrated wives and none too popular with the cuckolded husbands.

Mademoiselle bullies Manou’s son, Bruno (Keith Skinner) in class and eventually has her night of amour (out in the countryside during a rainstorm) with Manou, sealing his fate. Mademoiselle is more calculating than a noir femme fatale, and not only fatal but toxic.

With an English boy playing the son of the itinerant Italian in a French village, there is not a lot of dialogue. There are long takes (many of them long shots in distance as well as duration) of the underlit house where Manou and Bruno stay and of small human figures in the landscape. Cinematographer David Watkin was nominated for a BAFTA for his work, which for me was the best aspect of the movie (just as the cinematography in the 2011 Palme d’Or-winning “The Tree of Life” seemed to me superior to the very minimal storytelling). (Watkin had already begun working with Richard Lester, starting with “The Knack …and How to Get It (1965) which won the Palme d’Or at Cannes in 1965 and “Help!” and went on to win an Oscar for his cinematography in “Out of Africa” in 1985). Steven Soderberg has said that “Mademoiselle was the most beautiful black-and-white film I have ever, ever seen.”


Mademoiselle’s motivation remains opaque, even for a character from Duras or Genet. (She is somewhat similar to the character Moreau played for Buñuel in “Diary of a Chambermaid,” but more extreme and more respected by the citizens who ruthlessly scapegoat the alien and don’t suspect the native “bad seed.”) And her viciousness is recognized only by Bruno, who says nothing to anyone though his father is being blamed for the fires she sets.

I don’t think it is a good movie, though less annoying than either “The White Ribbon” or “The Tree of Life,” both of which are even murkier. “Mademoiselle,” is better than the mind-numbing “Lady from Gibraltar,” but then most anything is. For sure, there is none of the frenetic pacing of “Tom Jones,” Joseph Andrews,” or the Richard Lester movies David Watkin shot! I do have to mention the long snake that Manou has wrapped around his waist and then thrusts at Mademoiselle.

The only bonus feature on the MGM DVD is a trailer. Had I seen it first, I’d have avoided the movie. It certainly shows that Richardson was very famous at the time…


©2012, Stephen O. Murray


An absorbing fictional memoir of the author of “The Tale of Genji”

Reading Lisa Dalby’s imagined life of the author of what some call “the first novel,” The Tale of Genji,  in the hospital, I read many paragraphs more than once, and at least one sentence four times. That and the constant interruptions that caused me to lose my exact place did not lessen my esteem for Dalby’s feat of historical empathy for the Heian-era writer (whose world is explored by Ivan Morris’s The World of the Shining Prince, which I intend to reread.)



Dalby provides a plausible portrait of the author of The Tale of Genji, pressed into imperial service after her tales had started to circulate and interested the regent, Michinaga. He wanted her around to influence her portrayal of the shining prince to be like himself. He did less to act to like Genji, except in multiplying sexual conquests, than he hoped to see himself in what his courtier wrote. He forced her to write reports of the ceremonies after the birth of a boy child to his daughter, Shôshi.

Dalby used the surviving poetic output of “Murasaki” as well as surviving diary fragments. I think the makes an interesting, unpretentious character who would rather observe than be observed hates being talked about, as she was by other female courtiers),] has a low sexual drive, but two passionate relationships, the first with a female peer, Kerria Rose, the second with the son of a Chinese diplomat whose father was negotiating with her own father, a self-styled expert on Chinese poetry, though he was quite ignorant of the culture. Ming-Gwok explains much to the enraptured but discreet young Japanese woman. And she tells him about Japanese culture, though not yet having her own experience of the court in Miyako (Kyoto).

Before accompanying her father to the frontier province of Echizan (a posting that was based on his knowledge of written Chinese), she had been pledged to the promiscuous, rich Nobutaka, a marriage she evaded as long as she can. She genuinely missed him after he dies and does not take up with any other men. (She admits she enjoyed thwarting Genji’s seductions, though she first conceived him as an imagined ideal lover.)


(Hioshige illustration of the usual screen barrier between male and female interlocutors)

She does meet and is intrigued by the former courtier whose Pillow Book is another Heian era classic, Sei Shônagon. The novel’s heroine feels pity for Shônagon’s fall from the palace and finds offputting her Pillow Book stories that all seem to end in self-celebration. Murasaki is more self-annulling Buddhist, as unconcerned as a woman in her position can be about the esteem of others (which her book, nonetheless, draws).


“I had exhausted myself trying to capture the nature of the twisted relationships into which men and women fall… I had been concerned lest Genji succumb to flights of magical fantasy. I wanted him to be wonderful but at the same time believable, and my readers, judging from their responses, found him so. I amazement for over twenty years I watched Genji grow until eventually it seemed I myself was merely a tool for his shining persona. Was I writing Genji? Or was Genji just using me…. Finally, I came to the realization that fiction ultimately creates its own truths.”

A tale of eight, or nine, or ten lumbar punctures

(Warning: Following this narrative requires paying close attention to the dates involved!)

After completing the first course of chemo infusions, the only major procedure for the sixth day in the hospital was a lumbar puncture for intrhathecal chemotherapy (taking a sample of cerebrospinal fluid ten pumping a prophylactic dose of chemicals to the brain). My chief physician said that it should be less painful than bone marrow biopsy—the only pain from which I felt was the local anesthetic before it.

The position, bent over my bedside tray and the side of the bed was very uncomfortable for me. My back was sore before I was hospitalized and this position seemed devised to put strain where it was least tolerable.

I could accept that, but was put off that I was put into the position long (to me) before the nurses (or whatever their official rank) were ready to start. And then one realized she had not brought alcohol along and had to go out in search of it.

They stuck me and stuck me and stuck me again. Only after half an hour did one rearrange the room so that my feet had support (two chairs) instead of dangling that hurt my back—and that I had said several times was bothering me more than the punctures.


After eight failures they attributed to my spine not being straight, they gave up referred me on to a CT-guided one. (The one who has done many, many said I had been a “trouper.”) They said that it might not be able to be scheduled since the facility closed at 16:30. I was thrilled to be told (at 15:45 that I would be picked up at 16:00. At 17:00 the procedure went perfectly, clearing the major obstacle to discharge, but then I had to wait for transport, get through a traffic jam of gurneys etc., and get an elevator.

Back in my room, I was guided through instructions including three pages of prescriptions. I am definitely not complaining about that, being so often asked to sign documents I have not had any time to review, including the consent for the previous treatment.

Then, the catheter was removed. I quickly proved that I could still pee (which was not surprise to me: not peeing was the problem before.) Then the peripherally inserted central catheter (PICC) was removed and I had to lie on my back for another hour, special torture since my whole day had been focused on getting out! But finally (20:11) I did

Seems like a fairly happy ending to an uncomfortable and painful story, but this is where institutional ineptness kicked in.

Friday I had an outpatient appointment, which went well. The hospital had ordered a computer-guided lumbar puncture for Monday.   There was no one around with the authority to countermand the order, and the medical staff was long gone before 4:30PM Friday. Knowing that repeating the procedure so quickly, without even having seen any results of the first test was not normal, but did not cancel the appointment in case (a very bad case it would have been!) that Dr. Kaplan wanted more chemicals dispatched to my brain.

The hospital had not reported my Thursday discharge to OP. Eventually, it turned out that they had reported me discharged on Wed, scheduling the test that was necessary before discharging me for Monday.

I had thought that the lateness in the day in which it was done in Thursday was the source of confusion, but was staggered to learn I had been reported discharged Wed. Monday afternoon OP still had no communication from across the street that the procedure had been done, and this complicated scheduling follow-ups far beyond the capacity of the clerk who only had to make two “provider visit” followups for the next week. We were in the otherwise empty office nearly two hours after the end of the OP visit. (One clerk also denied that I had an appointment Monday, although I as sitting in front of her after the appointment…).

For the moment my white blood-cell count was above normal and the calcium level (that had been blamed for my earlier passings out) had fallen from more than double normal to less than normal.

Hardly “no harm, no foul,” though I learned that Paranassus Avenue seems to be unbridgeable chasm between hospital and OP and will watch out for other such breakdowns. And I should not have had the pain of the series of failed punctures, even presuming my spine has curvature. But I nearly had another one with no one wanting it to be repeated. And the unnecessary assumption of the uncomfortable position for the visual attempts with no amelioration for the first half hour disturbs me.

Plus, considering that a needle was being put up my spine, even if below where paralysis was a strong possibility of botching the procedure, but I was uneasy about the nurses getting and discussing text messages while I was not just present, but suffering (in silence, but visibly, I’m sure).

OK, the procedure seems to be routine for them, but this one was not, and I think should have commanded fuller attention.
Despite all that, I have to recognize that they then exerted themselves to get the computer-guided one done so that I could be discharged. Along with my day nurse, Kimberly, moving as much of heaven and earth as she could to realize my goal of being discharged.

And I learned that abnormal curvature of the spine is called Scoliosis and affects about one in a hundred male (white) Americans and two female ones. I never knew it existed or that I had it. From now on, I will articulate that I have the problem if anyone wants to try to puncture my span by visual clues! (BTW, the puncture wounds still hurt five days later, though the initial back pain has retreated.)


©2018, Stephen O. Murray