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Summary and book reviews of Knocking on Heaven's Door by Katy Butler

Knocking on Heaven's Door

The Path to a Better Way of Death

by Katy Butler

Knocking on Heaven's Door
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  • First Published:
    Sep 2013, 336 pages
    Paperback:
    Jun 2014, 352 pages

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Book Reviewed by:
Stacey Brownlie

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About this Book

Book Summary

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...

Please be aware that this discussion guide may contain spoilers!
  1. Where do you draw the line between saving a life and prolonging a dying? Has your family included a member who "lived too long"? Do you think it is okay to "let nature take its course"? How do you distinguish that from suicide?
  2. How did you feel about Valerie Butler's choice? Was it brave, or not? Do you think it caused her children more or less suffering than her husband's death? What were the blessings and drawbacks of her unexpectedly rapid death? What were the advantages and disadvantages of her husband's protracted death, from the point of view of his survivors?
  3. Butler writes, "I don't like describing what the thousand shocks of late old age were doing to my father—and indirectly to my mother—without ...
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Reviews

BookBrowse Review

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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.   (Reviewed by Stacey Brownlie).

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Media Reviews

Kirkus Reviews

With candidness and reverence, Butler examines one of the most challenging questions a child may face: how to let a parent die with dignity and integrity. Honest and compassionate thoughts on helping the elderly through the process of dying.

Publisher's Weekly

Starred Review. In this eloquent exegesis on taking control of the end of one's life, Butler defines a 'good death' as one that is free from unnecessary medical intervention and faced with acceptance and dignity.

Author Blurb 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.

Author Blurb 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.

Author Blurb 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.

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Beyond the Book

Slow Medicine

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.

Rocking Chair by artist Suzanne DeJohnThe 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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