Knocking on Heaven's Door: The Path to a Better Way of Death Read Free Page B

old man’s friend”
    for its promise of an easy death, a doctor might well feel duty-
    bound to prescribe antibiotics. If he collapsed and my mother
    called 911, paramedics would do everything they could to revive
    him as they rushed his gurney toward the emergency room.
    With just a little more bad luck, my father might be wheeled
    into an intensive care unit, where my mother and I—and even my
    dying father—could become bystanders in a battle, fought over the
    territory of his body, between the ancient reality of death and the
    technological imperatives of modern medicine. It was not how we
    wanted him to die, but our wishes might not mean much. Three-
    quarters of Americans want to die at home, as their ancestors did,
    but only a quarter of the elderly currently do. Two fifths of deaths
    now take place in a hospital, an institution where only the desti-
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    knocking on heaven’s door
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    tute and the homeless died before the dawn of the twentieth cen-
    tury. Most of us say we don’t want to die “plugged into machines,”
    but a fifth of American deaths now take place in intensive care,
    where ten days of futile flailing can cost as much as $323,000. If
    my mother and I did not veer from the pathway my father was trav-
    eling, he might well draw his last breath in a room stripped of any
    reminder of home or of the sacred, among doctors and nurses who
    knew his blood counts and oxygen levels but barely knew his name.
    Then again, the hospital might save his life and return him
    home to suffer yet another final illness. And that I feared almost
    as much.
    I loved my father—even as he was, miserable, damaged, and
    nearly incommunicado. I loved my mother and wanted her to
    have at least a chance at a happy widowhood. I felt like my
    father’s executioner, and that I had no choice.
    I met my mother’s eyes and said yes.
    I did not know the road we would travel, only that I’d made
    a vow. In the six months that followed, I would learn much
    about the implications of that vow and about the workings of
    pacemakers and of human hearts, about law and medicine and
    guilt, about money and morality. I would take on roles I never
    imagined could be played by a loving daughter. I would watch
    my father die laboriously with his pacemaker still ticking. After
    his death, I would not rest until I understood better why the
    most advanced medical care on earth, which saved my father’s
    life at least once when he was a young man, succeeded at the
    end mainly in prolonging his suffering.
    Researching a magazine article and then this book, I would
    discover something about the perverse economic incentives
    within medicine—and the ignorance, fear, and hope within
    our own family—that promoted maximum treatment. I would
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    katy butler
    contemplate the unintended consequences of medical technol-
    ogy’s frighteningly successful war on natural death and its ban-
    ishment of the “Good Death” our ancestors so prized. Armed
    with that bitter wisdom, I would support my mother when she
    reclaimed her moral authority, defied her doctors, refused a
    potentially life-extending surgery, and faced her own death the
    old-fashioned way: head on.
    My mother and I often felt like outliers, but I know now that we
    were not alone. Thanks to a cavalcade of relatively recent medi-
    cal advances ranging from antibiotics and vaccines to dialysis,
    911 systems, and airport defibrillators, elderly people now sur-
    vive repeated health crises that once killed them. The “oldest
    old” are the nation’s most rapidly growing age group. But death
    is wily. Barred from bursting in like an armed man, it wages a
    war of attrition. Eyesight dims, joints stiffen, heartbeats slow,
    veins clog, lungs and bowels give out, muscles wither, kidneys
    weaken, brains shrink. Half of Americans eighty-five or over
    need help with at least one practical, life-sustaining