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Ali Smith’s persuasive introduction highlights how controversial Simone de Beauvoir’s account was when it first appeared, a brief, but detailed account of the last few weeks of her mother’s life � or maybe better described as her long, drawn-out death. At the time, 1964, De Beauvoir was accused by some critics of cashing in on her mother’s experiences. I don’t know what ultimately drove her to publish this all I can say is that it has an incredible force. De Beauvoir adopts a direct, immediate style, beginning by recounting the phone call telling her of her mother’s fall and subsequent admission to hospital. De Beauvoir’s mother, Françoise, was then 78, a little frail and arthritic with some gastric issues but otherwise apparently healthy. And even so, de Beauvoir tells herself, almost nonchalantly, “she was of an age to die.� But the manner of the death and her mother’s treatment at the hands of a succession of arrogant, sometimes dismissive doctors proved an unexpected education both in the possible nature of death and in the reality of loss.

De Beauvoir’s relationship with her mother, famously documented in her early memoirs, was troubled, where de Beauvoir rebelled against social expectations, her mother embraced them, seeking refuge in convention. For de Beauvoir her mother seemed very much a creature of her time, brought up to be ‘dutiful.� Sometimes aloof, sometimes controlling but often someone with very little control over her own life. Here de Beauvoir almost effortlessly captures the ambivalence that can exist between mothers and daughters, the awkward mix of intimacy and distance, years of difficult visits and strained conversations disrupted by sudden flashes of unanticipated tenderness.

De Beauvoir also exposes the harsher realities of the medical treatment of women � far too much of what she reveals could still be applied to their treatment today. Although de Beauvoir’s mother has been admitted for a broken leg, her ongoing, gastric problems, considered minor by her usual doctor and mere anxiety by later ones, are actually the symptoms of a major tumour. Even though it’s rapidly obvious Françoise’s survival is highly unlikely, her doctors insist on subjecting her to a series of painful regimes including invasive surgery. For them she’s more object than person. In addition, they advise her family against telling her the diagnosis � at the time a diagnosis of terminal cancer was commonly withheld from women, considered too fragile to deal with the truth about their illness, and unlike men not in need of making advance provisions for businesses or families. Yet this was a woman, as de Beauvoir points out, who at 54 when suddenly left a penniless widow retrained and then restarted her life as a librarian, learnt new languages, even taught herself to cycle.

The attitudes of the doctors towards terminal patients documented here would be absurd if they weren’t so tragic: drugs are rationed in case of future addiction, euthanasia is not a possibility nor palliative care so following procedures, however painful, pointless, or debilitating is what must be done. De Beauvoir is clearly, acutely, aware of this absurdity yet feels unable or powerless against the weight of the system in which she and her family are now enmeshed. Her thoughts reminded me at times of reading surgeon Atul Gawande’s more recent Being Mortal on attitudes towards elderly care, partly inspired by his own father’s experiences.

De Beauvoir takes turns with her sister, and other family members, to sit with her mother in the six weeks between hospital admission and death. She records everything around her with a keen eye, from the small kindnesses of some nurses to the lack of concern for her mother’s dignity by others. The scene, every detail of the hospital room are imprinted on her, in a way I think many will recognise. Outside France is going through a period of industrial unrest and the war is raging in Vietnam but time slows down and the outer world seems either unreal or bizarre. Yet de Beauvoir’s politics still surface, she notes the distinctions between the everyday of the people dying on the public wards and her mother in her private room, the poor pay and conditions of the obviously overworked nurses. De Beauvoir’s experiences lead to a series of reflections on the nature of death in which she questions her earlier assumptions including her impressions about the death of the elderly, concluding that the value of any life is such that death is always a tragedy, and one too often accompanied by violence, drawing on Dylan Thomas it’s a cause for rage not submission. Urgent, hypnotic and devastating. Translated by Patrick O’Brian.

Thanks to Netgalley and Fitzcarraldo for an ARC