Knocking on Heaven's Door: The Path to a Better Way of Death

Knocking on Heaven's Door

If you are taking care of a very sick parent or other close relative, this is the book for you. Katy Butler, a journalist, tells the end-stories of both her parents. She lived on the left coast; they, in Connecticut when one day her father, Jeffrey, suffered a severe stroke.  Shortly after the stroke, his cardiologist recommended a pacemaker, and her mother and Katy agreed. This was without talking about any of the ramifications while he was well and could understand the consequences. His GP was against it; he had seen too many patients with hearts “outliving” the rest of their bodies.

Jeffrey recovered somewhat but by this time his type A wife has made him surrender both his belt and his wallet.  The former Wesleyan history professor was bored silly. During a week visit, Katy arranged for her dad to be picked up by a special van and brought to the pool where he used to swim.  Katy made the journey with him two days to show him the ropes, and bought him a new watch that thrilled him. His wife had also hidden his nice silver watch.  Katy’s dad loved the cheap watch and the sense of independence it gave him. After Katy left, he continued the van/swimming trips for a long time.

The book also covers Katy’s extremely difficult relationship with her mother. Did you guess that there were issues?  Katy’s two brothers took little part in caretaking their Dad because they did not get along with their mother either.  She was very controlling about their diet as adults, their haircuts, their clothes, and especially their failures in life.

Only one of the brothers ever returned to Connecticut and that was only after Katy had pressured him repeatedly to help, and basically gave him an ultimatum.

One interesting fact revealed in the book was that both mother and daughter were Buddhists. Katy had become one in California and when her mother visited, Katy took her on a meditation retreat. This served as a strong bond between them.

This book is very honest, both about Katy’s impatience with caregiving and her mother’s occasional meanness.  For one long period, neither spoke to each other.  Katy also chronicled how much operations cost Social Security, then she rated their effectiveness.   According to Katy, many expensive operations were covered that helped little in improving her dad’s everyday life. At the same time, speech therapy and other services that made a huge difference in his daily progress were capped at very low amounts.

Another interesting facet that this science journalist covers is the history of the pacemaker and of other medical procedures. She also talks about the birth of the hospice movement, and how vital that group has been to helping people--families and patients--to have much better end-of-life experiences.

The book is not all doom and gloom. There are some beautiful letters Katy’s father wrote to her after his stroke, some remarkably well-written and perceptive notes. As dementia set in, others were still perceptive, but bizarre: with repeated words, lack of sentences, and odd use of words. Katy had to piece together their meaning.

This is the story of how medical care of the elderly affected one family. It also documents how adult children often must parent their parents.  What a difficult transition that is.

Another book that emphasizes communication and humane care for the elderly is Dennis McCullough’s My Mother, Your Mother:  Embracing Slow Medicine—the  compassionate approach to caring for your aging loved ones.