Fourth Estate £14.99

Blue Nights, By Joan Didion

The nights are getting longer – and lonelier

Blue nights are luminous evenings that herald summer's approach. Joan Didion no longer takes pleasure from them: she feels only sorrow at their impending end; the approach of darkness.

She has known darkness. In 2003, her husband died, then her daughter Quintana was admitted to intensive care. She died 20 months later.

This memoir of Quintana is not a chronological account: Didion is still too engulfed in grief to think about her daughter for long. Instead, she evokes haunting clips from Quintana's life: fragile, viscerally emotive fragments that echo Didion's shattered heart. Her pain is raw: she berates herself for not having detected Quintana's anxiety earlier. At five, Quintana called a psychiatric unit about herself. Her thoughts were disturbed. As an adult, her psychiatric diagnosis "kept changing". Didion's distrust of medicine is harsh: depression and anxiety occur in many conditions.

Her criticism recurs in a harrowing scene: visiting Quintana in the intensive care unit, she finds a doctor hand-ventilating her due to lung problems. Didion is angry that no one summoned her despite Quintana's brain "being damaged" by insufficient oxygen, but as a former consultant anaesthetist trained in ICU, I know that emergency treatment is endangered by distressed relatives distracting attention.

Didion's self-blame is devastating. No parent could be expected to diagnose their own child, and early diagnosis might have made little difference. Although Didion's parenting was relaxed (she took the five-year-old Quintana to a traumatic movie; allowed her to accumulate splinters and cuts on her feet) most psychiatric disorders have genetic as well as environmental component causes.

Didion's depression – she has symptoms such as anhedonia, loss of interest, anxiety, poor appetite – is rooted in unresolved bereavement. Much of the book is concerned with her own failing health, her vulnerability, but her sadness stems from her losses.

Blue Nights is beseeching, brittle, heart-breaking: the result of events too much for a person to take. Some may be frustrated by the lack of concrete information. (There is more in Didion's memoir about her husband, The Year of Magical Thinking.) But this is not so much an account of Quintana's life as a text on grief, illustrated by her death; a dissection of loss and the cruelty of mortality. The only comfort is that we all die and the most we can hope is to die loved. Quintana did.

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