Before I Say Goodbye: Recollections and Observations from One Woman's Final Year

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Overview

By turns humorous and heart-rending, an unforgettable account of a young woman's spiritual triumphs over breast cancer in the last year of her life

Ruth Picardie was only thirty-three when she died, a month after her twins' second birthday and just under a year after she was first diagnosed with breast cancer. For Ruth, a journalist, it seemed natural to write about her illness. She published only five columns for Observer Life magazine before she became too sick to continue, ...

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Overview

By turns humorous and heart-rending, an unforgettable account of a young woman's spiritual triumphs over breast cancer in the last year of her life

Ruth Picardie was only thirty-three when she died, a month after her twins' second birthday and just under a year after she was first diagnosed with breast cancer. For Ruth, a journalist, it seemed natural to write about her illness. She published only five columns for Observer Life magazine before she became too sick to continue, but her moving, funny, and very human account drew a huge response from readers all over England.

Before I Say Goodbye juxtaposes these columns with correspondence from readers, e-mails to her friends, letters to her children, and reflections by her husband and her sister. The result is a courageous and moving book, entirely devoid of self-pity, that celebrates the triumph of a brave and wonderful woman's spirit. An international bestseller in England, Picardie's sobering yet ultimately life-affirming book is destined to become a classic.

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Editorial Reviews

From Barnes & Noble
Bookseller Reviews"The future will get on just fine with me. OK, so Matt never waters the garden, which means the wisteria is hardly likely to make the next century. Plus, he never gets up in the night to put blankets back on the kids, but nobody ever died of cold in a centrally heated house. Otherwise, I think life will continue you fine. it's just that I'll miss it so." When Ruth Picardie died at thirty-three she hadn't lost her battle with breast cancer; she had transcended it. The book collects the columns she wrote for Observer life magazine about her response to her malady, and letters from friends and readers throughout the world.
Publishers Weekly - Publisher's Weekly
In 1997 at the age of 32, journalist Picardie died of an aggressive cancer (originally misdiagnosed) that began in her breast and spread to her bones, liver and brain, killing her within 10 months. Her career was in full swing when she was diagnosed, and her twin children were just one year old. This collection contains her final journalistic work--columns about her illness written for London's Observer Life magazine--as well as letters to and from her friends, readers and children, plus an essay by her husband documenting the weeks before her death, when she was too ill to write. All this is as heartbreaking as it sounds, but is made bearable by Picardie's lively record of her efforts to live as long and well as possible, bravely drawing on British traditions of humor and stoicism. Her writing reveals a woman who, despite her anger and grief, remains open to life's joys and observes what is happening around her with clear eyes. Her writing is fresh and funny and displays so much pop culture savoir faire that comparisons to Bridget Jones (a character she enjoyed) are inevitable. Picardie documents the foul-weather friends who appear when they learn of her illness, her ongoing battles with her weight and the only beneficial therapy she discovers: spending wads of money on makeup and clothing. Still, without turning maudlin, she recognizes the serious nature of her condition and gently reminds her readers that life is precarious and precious. To finish this deeply personal account is to lose a friend and to celebrate her ultimately triumphant life. (Sept.) Copyright 2000 Cahners Business Information.
Library Journal
British journalist Picardie was diagnosed with Stage III breast cancer when she was 32, not long after the birth of twins, Lola and Jack. This book is comprised of columns about her illness that she wrote for Observer Life, a magazine edited by Picardie's sister Justine. Also included here are e-mail correspondence with three close friends (one a man with HIV) where no holds are barred and no subject is taboo (though British epithets still seem so much more polite than American vulgarity). The writing in the messages and the columns is frank and raw, as raw as the open wound of a mastectomy. Though Picardie avoided that surgery, she suffered the ravages of chemotherapy, radiation, and steroids, plus the optimistic complementary therapies to which she tied her hopes. The treatments ultimately failed to save her; she died less than a year after her diagnosis. This short book also includes an afterword from her husband, Matt Seaton, that puts her final days in perspective of those who loved her most. Picardie's dry humor and pointed barbs should give pause to others facing terminal illness and their friends and families. Recommended for public libraries.--Bette-Lee Fox, "Library Journal" Copyright 2000 Cahners Business Information.\
Kirkus Reviews
A sassy, brutally frank, and mercifully brief memoir of a British journalist's 1997 decline and death by breast cancer, supplemented by e-mails and recollections from her family and friends. At 32, a year after giving birth to twins, London Observer columnist Picardie discovered that a lump on her breast, previously diagnosed as a benign cyst, had become virulently malignant. Within months she learned that the cancer, which defied chemotherapy and less conventional treatments, had spread to her bones, lungs, and brain—and would soon kill her. After some soul-searching, she decided to write a column about her final days that would apply her flair for colloquial confession and shock humor ("you ram a carrot up the arse of the next person who advises you to start drinking homeopathic frogs urine") to the messy agony of dying young. Expecting to be made thin by nauseating chemotherapy treatments, she was surprised when the steroids she was prescribed made her fat. Lashing out at patronizing acquaintances, clueless physicians, quack nostrums, and New Age gurus (referring to Andrew Weill, she snarls that "books by men with facial hair are not for me"), she finds solace in binge eating and spending lavishly on expensive makeup ("My non-beard book, Shop Yourself Out of Cancer, is coming soon"). So much fire-breathing sarcasm in the five short columns she managed to complete is balanced by confessions of terror, disgust, and lingering sadness (for herself and her children both) in various e-mails she exchanged with a female cancer sufferer and a man diagnosed with AIDS. Additional essays from her sister Justine and husband Matt Seaton portray Picardie as a complicated woman ofuncommonbrilliance and strength. A slim but worthy addition to the literature of terminal illness.
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Product Details

  • ISBN-13: 9780606204491
  • Publisher: San Val, Incorporated
  • Publication date: 1/1/2000
  • Format: Library Binding

Meet the Author

Ruth Picardie was raised and educated in London, Oxford, and Cardiff, England. She studied social anthropology at Cambridge University. After graduation, she worked as an editor and freelance writer for numerous magazines and newspapers. A happily married mother of twins, she was diagnosed with breast cancer at age thirty-two. She died in September of 1997.

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Read an Excerpt

E-mail to Carrie Turk, 20 November 1996

Dearest C,

The latest news is that I didn't have the second lot of chemo yesterday, because my white blood cell count is still crap — they went in 'all guns blazing' (direct quote from oncologist) first time round and it was obviously OTT. So I have a week off, which is brilliant — like an exam being cancelled. Next time they will lower the dose from maximum (7) to almost maximum (6). Meanwhile, my hair is falling out with amazing rapidity — I estimate total baldness will be achieved by the weekend, so the whole thing will have happened in a week. It's getting awfully expensive — had my hair cut ultra short on Monday, and reckon I will have to have it shaved on Friday. I was a bit freaked out at first — it's really alarming running your hand through your hair and handfuls coming out. Makes you look sick, feel that you are dying, etc, which I am not — it's simply a function of high dose chemotherapy. Anyway, I am now used to hoovering the bed every morning and it's easier to cope with very short hair. Meanwhile, I am asking everyone I know to buy me a hat. I hope I don't frighten the children — I imagine I'll look pretty weird. Just as long as my fucking eyelashes etc stay in place.

Anyway, at my non-chemotherapy session yesterday I learned three things.

1) My tumours are hormone receptive (quite unusual in younger women) which means Tamoxifen is an option if the chemo doesn't work, though it means I will go into the menopause 2) My primary tumour may have shrunk by a centimetre or so, though there is a huge margin of error using a tape measure (sophisticated or what) 3) I fancy one of the oncologists — pure transference, like falling in love with your therapist, since he is not at all attractive though very funny and looks a bit like Dr Green in ER. So that's mildly exciting.

Can't remember exactly what I said to you in my last fax, but the antibiotics started working within 24 hours and I now feel fine. But I definitely overdid it last month. I now realize it's hard to do anything when you're having chemo, given that you have a week of feeling really shitty and then your white blood cell count collapses and you get ill.

I can't believe Far East bureaucracy — have you sorted out a birth plan, yet? I, too, plan to spend the rest of the year having non-hair related beauty / complementary therapy treatments, going shopping, reading novels, etc. Can't believe Fred's bilingual verbal dexterity: Joe and Lola will be grunting for the rest of their lives, at this rate.

All love R xxxx

E-mail to Carrie, 2 December 1996

Dearest, dearest Carrie,

Chemo was vile. I don't fancy Mr Miles any more, since he flirts with all the sad old ladies and I am obviously one of many. Imagine four days of the worst hangover combined with the worst flu, where you can hardly move, feel poisoned, and are half-asleep but not pleasantly out of it all the time. Felt too wretched even to listen to the radio, and didn't want any cheering up from hovering mother and husband. Managed to get up in the morning with the kids for a bit, ditto post-nursery, and that was it. Self Pity Inc. I was only sick once (different anti-emetics), had a smaller dose, but it felt worse (cumulative effect). Uugh. Thank god you can't remember pain (otherwise you wouldn't be having another baby). Four more to go (at least) and I don't even know if it's working. Not sure why some people respond to it and others don't. Must ask if there's a relationship between devastated white blood cells and devastated cancer cells.

Meanwhile, the Ghost press sale begins on Thursday. Do you want some fripperies sent by Fed Ex? E-mail me immediately.

All love, R xxx

E-mail to Carrie, 17 December 1996

Dearest Carrie,

Thank you for the divine stockings and JOE and LOLA stamps which they will love and, no doubt, decorate the walls with. Lola is currently an obsessive doodler and cutting a molar. Poor Joe on antibiotics again, for ear infection and terrible cough. Both permanently ill (must buy vitamin drops) and talking gibberish.

Matt has perked up, after seeing the breast unit therapeutic nurse. (He'll be seeing her fortnightly from now on.) Also he had a day off the work / childcare grind on Saturday, going cycling in the morning, and to Porchester Baths with Garry and his brother Mark, David and Charlie, to compare willy sizes in the afternoon. But he is being amazingly unsupportive and egocentric — he left for work this morning without saying good luck (chemo this pm). I guess he doesn't have anything left over at the moment. Mum thinks he's in denial, which he probably is, too.

I have been to see a complementary medicine guru recommended by a journalist friend of Justine's who recovered from skin cancer and has been extremely helpful. He is suggesting a whole programme of treatment, ranging from vitamins to low level oxygen administration. In general, what he said made sense ie not 'I'm going to give you shiatsu to make you feel better' but 'You've got a 50:50 chance of survival; Guys don't know why some people survive and others don't; we're going to make sure you are one of the 50 per cent who do.' The downside is he is a money grabbing wanker, who is charging 2,500 pounds for the first six months' treatment. Matt thinks it's a waste of money and would rather we went on. holiday to South Africa and redecorated the house. Ho hum.

Dad is over and all is well because (a) Anne is here to jolly, him along and (b) they are not staying with us. The other exciting news is I went to Justine's Chinese doctor (not a poncy Hale Clinic type place but funny old men mixing herbs in Camden High Street) to get Joe's eczema looked at, and who should be seeing Dr Lily before me but Princess Diana. She is stunningly beautiful in the flesh. Went to see Evita the movie, starring Madonna. Quite stirring, once you stopped being embarrassed by the fact that it's a musical. Eva Peron died of breast cancer and guess what: the c-word isn't mentioned once. The great unmentionable.

All love R xxx

E-mail to Jamie, 3 February 1997

Dear Jamie,

Apologies for snail mail paced response: I get so little e-mail that I forget to check it. How are you? I have chucked in the chemo after four cycles (supposed to have six) because it's not having much (if any) effect and I've been reacting really badly to it eg puked during last session, despite intravenous anti-emetics. I have now become allergic to Guy's — last time I went in to see the, oncologist I felt really ill for the rest of the day, even though I didn't have any treatment. Am supposed to be starting radiotherapy in the next week or two (every day for six weeks) and I' m hoping I get to have it at St Thomas's. Hey, bet you don't get fun e-mails like this every day.

Fun things about breast cancer:

1. You get your hair cut really short because it's falling out, and it really suits you. You decide to keep it that way forever. 2. You can be really horrible to people and not feel guilty.

Blah blah blah. How's work? Garden? Etc.

Love love love Ruth xxx

E-mail from Jamie, 7 February 1997

Darling Ruth,

The chemo is a big decision. But I suppose it would have had an effect after 4 months? It seems to work well for some but not others. Luck(!) of the draw I suppose. My mate in NYC who has AIDS and developed bone marrow cancer has had a miracle recovery and thinks it may be his chemo. He had to take a week off each month to have his because it made him feel so shitty. But he knows someone else younger and fitter who did the same treatment who's just kopped it.

I started drugs in November after a low T-cell count (for me, nothing serious compared to lots of others, it was over 200). On the one hand I don't hold much store by such narrow definitions and anyone's T-cell count can vary by hundreds depending on whether they've got a cold or whatever. But for a year I'd been feeling out of sorts which my doctors kept putting down to HIV. They would. If I went in to casualty having been run down by a truck they'd say it was HIV-related. Anyway after only three weeks on basic treatment (AZT and DdI) they did a test to see how much virus was in my body (a viral load) and were surprised to discover I had less virus than their tests can detect. A good sign.

I've now upped the ante. I asked to go on a protease inhibitor (saquinavir) along with old AZT and a drug called 3TC. From everything I can read on the internet etc this is a good combination. Luckily no side effects as yet. The AZT depletes white blood cells supposedly and does make you a little more susceptible to colds (he sniffs, having one right now). But after lots of research I'm sticking with it. The recommended doses are much less than people used to be on hence fewer side effects. AZT is one of the few drugs that gets through the 'blood-brain' barrier (so they tell me) and can help reduce any chances of dementia. Rather late in the day some might say. . .

My T-cell count has gone up by 100 in four months. If after a year of drugs treatment my viral load is still undetectable and if I can boost my, T-cell count up further then I may come off them.

If nothing else it makes me feel I'm in control. There's always the chance that I might be poisoning myself but I couldn't just let the little bastard virus sit and multiply. My attitude is if I'm going to go down I'm going to take a few of the little HIV buggers with me.

Wouldn't it be great if they discovered that all either of us needs is sunshine, holidays, good food, getting away from it all and S.L.E.E.P. I sometimes feel that if I went to a Greek island and spent four months just sleeping, sunbathing and swimming I'd cure anything. Fuck it, even if it don't work I'd feel better.

BY THE WAY, X doesn't know about my situation ... (only about a dozen people do).

Lots and lots of love. Write sooner and I will too.

Jamie

E-mail to Jamie, 10 February 1997

Dearest Jamie,

Thanks for your brilliant, long e-mail (I also, cheekily, read the short one to Matt). It feels good to have a friend who is sick too. God knows, I wish you weren't, but there's a level of connection that even the most supportive friends can't achieve. And I do not want, to talk about it with the sad, bald fucks you meet in hospital the whole time.

Re: treatment: there seems to be very little consensus among my docs. Every one you talk to says something slightly, but significantly, different about treatment. But have established that the chemotherapy would have had an effect by now if it was going to work — they take a more proactive approach at the Marsden, and routinely review treatment after four cycles, whereas Guy's seem to let you suffer for the full whack, regardless of efficacy, unless you take control. Am supposed to be starting radiotherapy tomorrow (every day for six weeks, no washing, no deodorant, eek) but I have a pain in my breast bone which I fear could be secondary bone cancer, so am going to see the docs tomorrow to review situation. (Only because my sister forced an appointment out of them.) If it has spread, I'd 'like' to try another chemotherapy regime, using taxanes (yew tree extract — 'natural' but very toxic, causing total body — alopecia!). Oh gawd ...

You queers are amazing at dealing with HIV. Do you go to counselling or what? Like you say, the fact that you have done so much research and are making treatment decisions must make you feel good. Have yet to get a web browser and find breast cancer site. Part of me is so exhausted by all the appointments and X-rays and tears that I want to switch off from the subject completely. Re: alternative stuff The number of treatments therapists is (a) overwhelming and (b) expensive but I'm dabbling a bit. Can't be any less effective than the fucking chemotherapy, and doesn't make me feel shitty. But if second chemo and radiotherapy fail, then I will be on every mad diet and consulting every bearded healer in the business.

Glad that your drug combo is going well, with no side effects. (Crass aside: do you watch ER? Jeannie has HIV and is feeling -Sick cos of drugs.) Re: blood brain barrier. I think Id rather go nuts than die in agony. Or maybe you can do both.

Doing a bit of work - in fact off to interview Joanna Briscoe (novelist) this pm. Keep in touch.

Luurve Ruth xxx

Copyright © 2000 Ruth Picardie

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Reading Group Guide

Before I Say Goodbye
Recollections and Observations from One Woman's Final Year
Ruth Picardie

An Owl Book
Reading Group ISBN: 0-8050-6647-0

As a freelance journalist and columnist for the Observer (London), Ruth Picardie wrote spirited articles on everything from movie stars to motherhood. Language was her element and she possessed special talents any writer might envy--an uncommon stylistic flair and a wicked sense of humor. When she was diagnosed with Stage IV breast cancer in October 1996 at the age of thirty-two, these gifts did not fail her. Her wry style and mordant humor animate even the columns she wrote about her illness for the Observer's magazine, Life. Before her death in September 1997, she managed to publish seven hilarious, sad columns that generated an enormous response throughout England. Collecting Ruth's columns, e-mails she exchanged with three close friends, and letters from readers, Before I Say Goodbye offers a kind of consolation and insight. Bitter and hilarious, despondent and uplifting, cynical and optimistic, the book is a paradox the straight-on confrontation of a reality that has nothing reasonable about it.

Disappointed that cancer had not transformed her into a luminous waif with fantastic cheekbones, she rails: "Why am I so fat? Before anyone mentions the term 'comfort eating' can I just say that cancer isn't just about getting round to reading Middlemarch before its too late: it's a full-time job keeping up with eating opportunities." Her flippancy underscores what made her columns so compelling to readers. One writes that Ruth's columns remind her that "this is happening to a real flesh and blood human being and not one who has been mysteriously transformed into some serene apprentice angel with a foot in two worlds."

Finding personal indulgence, especially "retail therapy," to be the best treatment, she praises a London "skin care god" as "the most important retail oncologist in the country." Bemoaning her "chances of leaving this world in anything smaller than a size 16 urn," Ruth bequeaths the fancy lingerie she has splurged on to her friend India, who responds graciously: "I would love to have your underwear after you've copped it, but I fear you seriously underestimate my stupendous girth. Perhaps I could wear your knickers as remembrance bracelets around my outsized wrists." The effect is of life being lived, in its flawed, often funny, sometimes nearly unbearably rough texture.

Before I Say Goodbye is a compassionate improvisation, a clear-eyed record of what Ruth's husband, Matt Seaton, calls "a desperately haphazard process." In a moving postscript to the book, Matt recounts the difficult final months of Ruth's illness. The book offers no neat conclusions, no portraits of superhuman resolve or unshakable faith. Remarkably, however, the book provides far more comfort, than one might expect from a book that proposes no answers. Any reader will find in it a sharp reminder to live well and fully.

Questions for Discussion

1. Several of the early e-mails in Before I Say Goodbye are between Ruth and her friend Jamie, who has been diagnosed with AIDS. Whether or not to come out in the open with the news of their diagnoses is a frequent topic, and one on which they disagree. Ruth says, "I don't know how you have survived without telling the whole world" (p.15). Although Jamie's and Ruth's choices are of course partly based on their individual personalities, what issues do you think might have influenced their decisions? What do you think each might hope to find--or avoid? Jamie admits that "I've grown so used to not talking about the 'condition' or diagnosis that it comes as a relief to me to be able to chat away about it" (p.10). Do you think that "chatting" is somehow less frightening to Jamie than more serious forms of discussion?

2. The decision whether, and how, to talk about a terminal diagnosis seems to extend even to the means of discussing it. In the book's introduction, Ruth's husband, Matt, says that for Ruth e-mail was "a way of expressing thoughts and feelings more spontaneously than in a letter, yet more reflectively than in a telephone conversation. It had a quality of being simultaneously intimate and serious, yet transient and disposable, and this meshed with something in her writer's psyche" (pp.viii-ix). Ruth herself says, "I like cyber-cancer better than phone-cancer" (p.17). How might e-mail make talking easier?

3. "Cancer is all about fear, secrecy, and euphemism," Ruth says (p.17). Throughout the book Ruth mentions cancer euphemisms that annoy her, such as "involvement" and "oncologist." Euphemisms are designed to soften what is too real, too harsh, brutal, or even tasteless. Ruth seeks them out and unmasks them, perhaps as a kind of therapy. One of her readers offers an insight into how this helps Ruth: "What you write seems to capture the utter unreality of your situation" (p.47). Ruth's situation is of course all too real. How do you think her unmasking of euphemisms helps her to deal with the "unreality" of her real situation?

4. One of the book's great strengths is the counterpoint of Ruth's own voice to those of her friends, particularly Carrie and India. Together they create a kind of ensemble. Compare the more emotional letters from Carrie to those of India. Carrie's grief is more open: "The image of the kiddies going to bereavement counseling breaks my heart" (p.64). India's obsession with her own weight and other problems often dominates her letters. When Ruth splurges on expensive lingerie, India replies: "I'm writhing with jealousy in my mammoth grey bra and huge granny knickers" (p.24). Yet both Carrie and India help Ruth enormously. Talk about the "counterpoint" effect of these letters on Ruth.

5. The role of humor in dealing with serious illness is well known. One of Ruth's readers writes "all the research shows that snotty patients do best" (p.55). Ruth seems to agree. She debunks a myth of terminal illness--that it is "supposed to make you extremely wise and evolved" (p.57). She minimizes it comically: "I was hoping for a little pay-back: something--a couple of cheekbones, say--in return for the aching veins, the headaches, the disastrously thinning eyebrows" (p.58). Ruth's brand of humor can be described as sarcastic, which might be the most suitable form of humor for the occasion. Do you agree, and why do you think so?

6. Ruth's husband adds an afterward to Before I Say Goodbye. Mat's account is in some ways a more conventional survivor's narrative--more elegiac, philosophical, reasoned, and analytical--but it also raises some serious issues, both practical and emotional, that surround the terminal illness of a loved one. Discuss your response to Matt's somber reflections as compared to Ruth's scrappy, humorous attitude.

7. Ruth's columns elicited an overwhelming response from her readers, prompting many of them to share intimate details of their lives and experiences. Were these letters written to comfort Ruth, or did they function more as a catharsis for the readers? If you were writing to Ruth after reading one of her columns, what would you say to her?

8. One issue that has come up at various points in the book is the loss of self-control, first the feeling that one has lost control over one's self by "allowing" the onset of serious illness and, later, the actual loss of physical and mental self-control. Ruth struggled to maintain control, and its diminution in one who valued it so highly is particularly distressing to read about. Matt details the decline of Ruth's self-control both from her point of view and in terms of its effect on him and on their relationship. Do you think the idea of "control," as both Ruth and Matt use it, is an illusion in the first place? If it is an illusion, is it a sustaining one that you think could help in the physical or psychological treatment of cancer?

9. Matt confesses that cancer altered his relationship with Ruth in irreparable ways. "Cancer changed everything: it put us on different tracks, stretching our grasp of one another to the limit and eventually forcing us apart" (p.117). He describes his own self-pity and frustration, and relates some advice he received from a friend: "She had the courage to tell me what I already knew, but could not quite bring myself to frame in words: that I had probably had as much love now from Ruth as I was going to have" (p.128). Discuss Matt's remark that "The dying person has to break her bonds with the world, to separate herself off: it is the process of alienation I still bitterly regret, but it is also a necessary part of letting go" (pp. 128-129).

10. Matt decides to take the two-year-old twins to visit their mother's body in the hospice room. "It seemed an obvious step, to take the children to see their mother one more time. Perhaps it wasn't quite the done thing, but since death is a fairly impossible concept for two-year-olds, I felt that they were only going to begin to grasp what had happened if they saw Ruth cold and inanimate. Children, Ruth was fond of saying, are concrete little thinkers and don't need euphemisms. Circumlocution is for grown-ups; children just need the truth" (p.130). Do you think the visit was a fitting tribute to Ruth? Do you think she would have approved?

Ruth Picardie studied social anthropology at Cambridge University. A former editor at the Guardian and Independent newspapers, she worked as a freelance writer for numerous magazines and newspapers. She died in September 1997.
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