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talking about death.jpgI first stumbled on this book one sunny day when I was walking around Lake Union with my friends Abi and Kristal. Abi stopped by a curbside "library" (a little kiosk where neighbors could leave books for other neighbors to borrow) and found this one. Kristal is a breast cancer survivor, so we had in fact been talking about cancer and death on our walk, and we were all struck by the weird synchronicity of this find. Kristal took a picture of Abi with the book, I posted it to Facebook, and my sister saw the photo and went to Powell's to look for the book. Once she'd read it, she gave it to me.

The subject-matter of the book is very similar to Atul Gawande's Being Mortal. However, Morris is a journalist, so her approach is much different from Gawande, who is a practicing surgeon as well as a writer. I have to admit that I found Morris' book a little over-written at times, and I preferred Gawande's focus on history, sociology, and science. Morris is more personal and more emotional. It's more populist, and less intellectual. However, she has a similar concern about how advances in medicine have paradoxically left us at a disadvantage in understanding and accepting our mortality. She doesn't cover the broad range of topics of how we handle the elderly and the dying that Gawande does, but instead she focuses on the ways in which even when we try to make sure our end-of-life experience isn't a nightmare of painful attempts to prolong life no matter what, we can get sucked into desperate measures anyway.

If there is a basic thesis here it's that a living will and explicit DNR instructions aren't necessarily going to save you from procedures you would prefer not to undergo. She is very compelling in exploring all the ambiguities and uncertain feelings that can lead family members, medical personnel, and even the dying person themselves to make bad decisions when push comes to shove. If your instruction is that "I don't want desperate measures unless there's a high probability that I'll be highly functional if I survive," how do you judge what is "high probability" or "highly functional"? One of Morris' strongest points is that a lot of times there's no right answer, so it's easy to let inertia carry you in the direction of "more life," for better or worse. While she tends to focus on stories where "more life" means "more suffering," she does acknowledge that sometimes "more life," even when it means "more suffering," can also mean "more time with family and loved ones." Is that time worth it? Who can possibly measure such a thing?

Although she does talk about practical things such as living wills, medical directives, and "value history forms" (in which you attempt to describe your priorities and what's important to you), or how to talk about death with loved ones who are dying or with children, the book is really less a how-to than an invitation to contemplate your mortality and what it means for you and those close to you. Like Gawande, she feels we are too insulated from death now, so we don't really deal with it until it's happening. A lot of times that's too late. Also like Gawande, she stresses how the process of dying can be a very clarifying thing and can bring people closer together. Gawande opened my eyes to the fact that fear of death can be allayed by a sense of connection to family and community, and I'd say Morris comes to that same point from a somewhat different direction. What matters in the end is our connection to other people, and the process of dying has a way of driving that home. If we can grasp this fact while we're still in the prime of life, then our lives and relationships will be richer for it. That's why she wants us to start talking about death sooner rather than later.


( 3 comments — Leave a comment )
Apr. 16th, 2016 05:48 pm (UTC)
I just finished Morris' book this morning and agree with the points you make about it. There were several places where she described changes needed in the hospital system -- such as paying closer attention to patients' pain levels and managing pain better -- that I've seen happening in multiple hospital settings between 2006 and now. That left me thinking there's clearly been at least some good progress in the 15 years since the book was published.

My biggest takeaway is the recognition that we really don't know what decisions we'll make until faced with them, and the two-edged sword of specificity. Morris makes the point over and over that simple statements like "no extreme measures" need additional definition and clarification, yet also reminds readers to not hobble their health care proxies with too many specifics, to leave room for them to make judgment calls based on their understanding of your wishes.
Apr. 16th, 2016 06:04 pm (UTC)
Great points. I don't know about pain care, but I've certainly noticed that my doctors talk about quality of life, so it does seem as though the medical system may be trying to evolve on this issue. You are also right on in pointing out the two-edged sword of specificity. We can't escape judgement calls, no matter how specific the directions, or so Morris argues.

Edited at 2016-04-16 06:04 pm (UTC)
Apr. 18th, 2016 10:18 am (UTC)
That's why she wants us to start talking about death sooner rather than later.

Remarkably sensible, though in some of our circles I wonder if it's possible to talk about it too much? That is, we're still pretty far from talking about it enough.
( 3 comments — Leave a comment )

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