Lynne Tillman, Mothercare: On Obligation, Love, Death, and Ambivalence, Soft Skull, 2022 (image courtesy of the publisher)

Caring for elderly parents in the last years of their life can provoke in some acute feelings of compassion and contempt. There are material burdens and existential costs — such as the creeping dread, when a parent dies, that now nothing stands between you and your own death. “Keeping her alive was done generously, but not selflessly, and also as a grueling obligation,” writes Lynne Tillman at the outset of her memoir Mothercare: On Obligation, Love, Death, and Ambivalence. The book recalls the 11 years that Tillman and her sisters administered round-the-clock health care for their mother. It serves as a rueful signpost for the rigors of chronic illness and an ambivalent, contrarian memorial to her mother.

Tillman describes her mother — “a smart, resourceful, attractive, tactless, competitive, and practical person” — as a sort of adversary, competing with her daughter for attention and affection. “From the age of six, I had disliked my mother,” Tillman recounts, though she doesn’t say what exactly sparked this formative feeling. Instead, she takes memory itself as a central subject. “This is a partial picture,” she acknowledges, “told from my vantage point, and possibly to my advantage, though I hope to write against that tendency.”

With Mothercare, Tillman returns to territory she’s explored throughout her work, most recently in her 2018 novel Men and Apparitions: family inheritance, photographic portraiture, epistemic doubt. Tillman manifests a Jamesian uncertainty about what we know and how we know it, even in the presence of documentary evidence. In this book, the author scours the field of medicalized healthcare with her skepticism, seizing on an inconclusive MRI, variously interpreted by three different doctors, who propose conflicting diagnoses and treatment plans.

Stock photograph of a birthday cake with candles in Mothercare: On Obligation, Love, Death, and Ambivalence (photo by Caterina Berger via Unsplash, courtesy Soft Skull Press)

Tillman dramatizes uncertainty by incorporating snapshots and stock images in the text. The images appear as suggestive, equivocal objects, from a sample map of the brain to a still photo of Bob Ross at his easel. These oblique visual references bring us no closer to knowing Tillman’s mother or the transformations wrought by aging and illness. “Pictures doubt,” as her fictional narrator Zeke puts it in Men and Apparitions.

But in the day-to-day tasks of elder care, one must act, even in the face of uncertainty. There are scheduled doctors’ appointments, mounting Medicare bills, the daily regime of prescribed meds. These demands give the book its narrative and ethical tensions. When their mother can no longer live alone, Tillman and her sisters hire live-in health care workers — women of color, some of them undocumented. She considers what it means to rely on the labor of marginalized people. “My privilege lived through the after-effects of colonialism and imperialism,” she writes. “The terms and effects were not abstract, they were personal, embodied in the women we were able to hire to care for Mother. I was conscious of it, but didn’t forsake my privilege.”

Of her relationship with her mother’s aides, Tillman writes with unnerving directness — and indirection. In some ways, these relationships, characterized variously by guilt, suspicion, and hostility, as well as intimacy and perhaps a kind of love, are among the most vivid in the book, including those between Tillman and her sisters. Still, the women hired to care for her mother elude the writer’s gaze: “Awful, regrettable, weird incidents and events accumulated, too many to recall. Some, many probably, are repressed.” These suppressions are not Tillman’s alone; they sustain whole systems of exploited labor.

Racial and class hierarchies perhaps undergird another distinction in the book: between the work of the caregiver and that of the artist. Here, Tillman occupies both roles, but uneasily, one straining against the other. She chafes at the “emergencies, eruptions, and thudding repetitions” of long-term mother care, which take her away from her writing. Many writers, of course, feel the drumbeat tension between family responsibilities and their art. For Tillman, this conflict is heightened by a lifetime of maternal resentment. “My possibilities and fantasies were being stolen by Mother, whom I didn’t love.”

Albrecht Dürer, “Madonna By The Tree” (1513), engraving in Mothercare: On Obligation, Love, Death, and Ambivalence (image via WikiArt, courtesy Soft Skull Press)

I find Tillman’s blunt admission refreshing. The antagonism at the heart of their relationship seems rooted in her mother’s competitiveness. “I would have been a better writer than you if I had wanted to be,” she recalls her mother telling her, not long after celebrating Tillman’s Guggenheim award. The line — “Mother’s killer sentence” — is a kind of empty threat. It reveals the woman’s thwarted ambition, her desire to undercut her daughter’s success, her casual cruelty. In a way, it suggests why, beyond more apparent reasons, Tillman might find mother care incompatible with her writing life.

Thinking of this remark, I’m tempted to compare Tillman’s account of her mother with that of Roland Barthes in his Mourning Diary. Barthes’s profound identification with his mother is sustained, perhaps, by his mother’s modesty and tact: “Maman: (all her life): space without aggression, without meanness—She never made an observation about me (my horror of that word and of the thing).” That final aside reveals so much: the writer’s recoil from being seen — or from contemplating the rift between his own self-image and his mother’s point-of-view. Or maybe he’d like to believe that the powers of observation belong to him alone.

For Tillman, a lot rides on the difference between what’s observable and what’s not — what’s revealed or concealed by an MRI or latent in a gesture, a word. She finds her mother’s life and death mostly inscrutable, though she devotes herself to learning about aging, hospice, and palliative care. “My wish, unconscious mostly, was to discover what is impossible to know. How death will be for me,” she writes, suggesting the self-regard that lurks at the heart of mother care.

Mothercare: On Obligation, Love, Death, and Ambivalence by Lynne Tillman (2022) is published by Soft Skull Press and is available online and in bookstores.

Nicole Miller is a writer, editor, and educator living in New York City. She writes fiction and criticism and teaches creative writing at NYU's School of Professional Studies.