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Critics' Opinion:
Readers' Opinion:
First Published:
Sep 2013, 336 pages
Paperback:
Jun 2014, 352 pages
Book Reviewed by:
Stacey Brownlie
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Knocking on Heaven's Door is a visionary map through the labyrinth of a broken and morally adrift medical system. It will inspire the necessary and difficult conversations we all need to have with loved ones as it illuminates a path to a better way of death.
Like so many of us, award-winning writer Katy Butler always assumed her aging parents would experience healthy, active retirements before dying peacefully at home. Then her father suffered a stroke that left him incapable of easily finishing a sentence or showering without assistance. Her mother was thrust into full-time caregiving, and Katy became one of the 24 million Americans who help care for aging parents. In an effort to correct a minor and non–life threatening heart arrhythmia, doctors outfitted her father with a pacemaker. The device kept his heart beating but did nothing to prevent his slide into dementia, incontinence, near-muteness, and misery. After several years, he asked his wife for help, telling her, "I am living too long."
Mother and daughter faced a series of wrenching moral questions: When does death cease being a curse and become a blessing? Where is the line between saving life and prolonging a dying? When is the right time to say to a doctor, "Let my loved one go"?
When doctors refused to disable the pacemaker, sentencing her father to a protracted and agonizing death, Katy set out to understand why. Her quest had barely begun when her mother faced her own illness, rebelled against her doctors, refused open-heart surgery, and instead met death head-on. Knocking on Heaven's Door, a revolutionary blend of memoir and investigative reporting, is the fruit of the Butler family's journey.
With a reporter's skill, a poet's eye, and a daughter's love, Butler explores what happens when our terror of death collides with the technological imperatives of modern medicine. Her provocative thesis is that advanced medicine, in its single-minded pursuit of maximum longevity, often creates more suffering than it prevents. Butler lays bare the tangled web of technology, medicine, and commerce that modern dying has become and chronicles the rise of Slow Medicine - a growing movement that promotes care over cure.
Knocking on Heaven's Door is a visionary map through the labyrinth of a broken and morally adrift medical system. It will inspire the necessary and difficult conversations we all need to have with loved ones as it illuminates a path to a better way of death.
Prologue
On an autumn day in 2007, while I was visiting from California, my mother made a request I both dreaded and longed to fulfill. She'd just poured me a cup of tea from her Japanese teapot shaped like a little pumpkin; beyond the kitchen window, two cardinals splashed in her birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. She put a hand on my arm. "Please help me get your father's pacemaker turned off," she said. I met her eyes, and my heart knocked.
Directly above us, in what was once my parents' shared bedroom, my eighty-five-year-old father, Jeffrey—a retired Wesleyan University professor, stroke-shattered, going blind, and suffering from dementia—lay sleeping. Sewn into a hump of skin and muscle below his right collarbone was the pacemaker that had helped his heart outlive his brain. As small and shiny as a pocket watch, it had kept his heart beating rhythmically for five years...
If you are moved by the drama of the everyday, if you appreciate a sustained narrative willing to follow its characters to their best and worst places, or if you have ever watched someone who suffers from a fatal illness, or the inevitabilities of aging, lose all quality of life due to the marvels of medicine - and then wondered if medicine always is so marvelous, you will want to give this book a chance...continued
Full Review
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(Reviewed by Stacey Brownlie).
Adam Hochschild, author of King Leopold's Ghost and To End All Wars
Katy Butler's new book - brave, frank, poignant, and loving - will encourage the conversation we, as a society, desperately need to have about better ways of dying. From her own closely-examined personal experience, she fearlessly poses the difficult questions that sooner or later will face us all. Dr. Jack Kornfield, author of A Path with Heart
Intimate and wise, heartbreakingly compassionate, and critically helpful, this is a truly important work that I hope will be widely read. We have lost our way and Katy Butler's impeccably researched and powerful tale will help eliminate much suffering on the passage to the mystery of death. Mary Pipher, author of Reviving Ophelia and Seeking Peace: Chronicles of the Worst Buddhist in the World
Katy Butler's science background and her gift for metaphor make her a wonderfully engaging storyteller, even as she depicts one of our saddest but most common experiences: that of a slow death in an American hospital. Knocking on Heaven's Door is a terrible, beautiful book that offers the information we need to navigate the complicated world of procedure and technology-driven health care. I'm recommending it to all my friends with aging parents or partners, and holding on to a copy for myself.In Knocking on Heaven's Door, Katy Butler describes a relatively new movement in modern healthcare termed "slow medicine," and advocates urgently for its principles to be applied in hospitals and specialists' offices across the United States. The slow medicine ethos mimics that of the slow food movement; taking time and applying restraint in care is favored over rushing into multiple and/or extreme medical measures. Slow medicine also favors a holistic, patient-centered approach versus the sometimes piecemeal, symptom-fixing focus of today's medical culture.
The principles of slow medicine are particularly applicable to geriatric care. Butler references Dennis McCullough's book, My Mother, Your Mother as an excellent source for those ...
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