Book Reviews

"Am I dead yet?" he asked the nurse. "No," she replied.
He thought for a moment. "How will I know?"
--Patient with a serious illness^1:9

Handbook for Mortals is a "must read"--not only for all individuals and families facing serious illness but also for all clinicians. To be sure, it is a book about dying--but it is also a book about living and about managing the kind of problems faced regularly by people with serious illness. The book is a guide for people journeying through a maze of experiencing serious chronic illness and helps answer typical questions such as "What do I do now?" or "What will happen next?"

Indeed, the importance of this book will only increase along with a trend already being seen throughout our modern, scientifically advanced society: Instead of dying quickly from acute illness, more people are dying slowly from chronic disease. Moreover, the book is a guide that can help people and their families to make the often-imperceptible transition from living with a chronic condition to dying from it. In our era of high technology, clinicians typically think of few chronic conditions as fatal. We have lulled ourselves into the false belief that we will always find one more test, one more pill, or one more intervention that will make a difference and delay death.

The poignant verbal exchange between patient and nurse that introduces this review stirred my memory and reminded me of how physicians and other clinicians tend to assume too much about our patients and about the people who love them. Several years ago, I was preparing to make a return home visit to a hospice patient I had met for the first time a few weeks earlier. She was then in her mid-sixties, single, had pancreatic cancer, and was living the rest of her life with her sister and brother-in-law. When I first visited her, she was independent in her self-care but ate little and slept much of the day. A month later, I called to see if a visit would be convenient. Her brother-in-law, the daytime caregiver, answered the phone and said how grateful he was that I had called at that very moment. "I think she may be dead," he said. "Can you come right away?" I said I could.

I arrived within a few minutes and climbed the three or four steps to the front door. Through the screen door, I could see my patient lying dead in the hospice-supplied hospital bed that had been set up in the living room. Bob opened the door and anxiously restated his gratitude that I was there. He looked puzzled and frightened. As much for purposes of ritual as for clinical diagnosis, I approached the bed, felt for a pulse, and listened for a heartbeat with my stethoscope. I then turned to Bob and asked whether he had called the mortuary.

"Is she dead?" he responded anxiously.

I replied that she was, and he began to weep. I had assumed that the average layman could recognize death. I was wrong.

Handbooks and layperson guides have been written to inform the public about almost any subject imaginable in the areas of health care and healthy living: Books on diet, chronic fatigue, arthritis, diabetes, Alzheimer's disease, vitamins, headaches, and depression are only a few of these subjects. Until recently, information about death and dying was conspicuously lacking. Handbook for Mortals fills this gaping void and meets some real needs of people whose lives are likely to end in a few months or a couple of years. The book provides much practical information on the effects of serious illness and how patients and families can make the progression toward death less frightening. The book also recognizes the inner strength and common sense that so many people have, even when they are faced with something as mysterious, inexorable, and strange as dying.

Handbook for Mortals is also written using a clean, conversational style that makes the book highly readable. Short vignettes introduce topics and are used throughout each chapter to provide vivid, memorable emphasis and to give a strong sense that the authors write from their actual experience caring for patients and families who face serious illness. Quotations from Emily Dickinson, William Shakespeare, Nathaniel Hawthorne, Henry David Thoreau, Leo Tolstoy--as well as from individual patients--add both richness and timeless relevance to the subjects discussed.

Chapters cover general topics such as how to cope with the changes and losses that accompany progressive illness; how to communicate with physicians to get needed information and help; how to cope with and accommodate changes in physical appearance; and how to take control of future treatment by planning for needs and by making advance care directives. Chapters also discuss specific health problems, including pain, nausea, vomiting, shortness of breath, constipation, and diarrhea. One chapter describes specific challenges which patients and their families can expect as they confront death resulting from any of a number of causes: heart failure, liver failure, kidney failure, cancer, lung disease, HIV/AIDS, dementia, and advanced age. A chapter addresses sudden death and the particular difficulties that it presents to survivors facing this situation. The section entitled "Enduring Loss" discusses grief and bereavement in a way that is helpful not only to survivors of people who die but also to people who themselves are approaching the end of life. The book concludes with a chapter on additional resources ranging from obtaining community services and caregiver information to arranging funerals and memorials.

Handbook for Mortals is excellent reading for anyone involved with people who have progressive, serious illness. Clinicians are likely to learn about aspects of illness they have never thought about. Patients and families will obtain information that they cannot find elsewhere. The book gently provides frank answers that will calm many fears, and it is a guide for all of us: patients, their friends and family members, and practicing clinicians.

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