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Review by Anna Garris Goiser
One's dying is even more difficult for most of us to talk about with our family and friends than sex. Oddly enough, of the three fundamental human physical passages -- birth, sex, and death -- the first we can't remember, the second we're culturally uncomfortable with, and the third scares the daylights out of us.
Ira Byock, a medical doctor and the president of the American Academy of Hospice and Palliative Medicine, has written a book that does much to allay our worst fears about dying. In his Dying Well, he has made us a gift of experience and insight to help us not only come to grips with the realization of imminent death due to terminal illness, but as a guide for learning how to die well.
When asked how they would prefer to die, almost everyone has a pat answer, usually delivered with a snort of gallows humor -- "I want to be hit by a truck and die instantly," or "I want to die in my sleep." And they quickly amend their answer by, "I don't want to linger on as a vegetable," "I don't want to live in excruciating pain just waiting to die," or "I don't want to be lying there in a hospital bed with tubes running in and out of my body, unable to go eat or go to the bathroom by myself."
In the current climate of unease regarding health insurance and with the recurring horror stories one hears about the cost of a protracted terminal illness, nursing home abuses, unfeeling doctors and uncaring nurses and assistants, it is no surprise that most of us would like to die suddenly and get it over with when our number is up. And, unless one is one of the seemingly fortunate few whose family is totally well adjusted, many of us fear the prospect of being terminally ill within our current family dynamic, feeling our illness will overwhelm whatever fragile and tenuous connections we have with our family members and elevate an uncomfortable situation of unresolved feelings to one of unbearable sadness and emotional pain.
In Dying Well, Byock offers the reader the reader an alternative to the emotional and physical pain, physical indignity, fear, and isolation that most of us associate with dying from a terminal illness. By recounting the stories of 12 ordinary people whose dying he has witnessed in his rather ordinary community of Missoula, Montana, he demonstrates how, armed with insight and caring, people and their families can approach impending death as an opportunity to grow, transcend, and ultimately to love one another as they may never have been able to previously, so that one's dying is a triumph for everyone involved.
None of the 12 people whose stories Dr. Byock shares with the reader was expecting to die of terminal illness, although some had more time to adjust to the idea than others. They are of both sexes, range in age from eight to 86, and their conditions include pancreatic, brain, spinal, colon, and kidney cancer; ALS (amyotrophic lateral sclerosis); MS (multiple sclerosis); Huntington's chorea; AIDS; COPD (chronic obstructive pulmonary disease); senile dementia; and an unspecified convulsive brain disease. The family relationships of the dying run the gamut from highly functional to dreadfully dysfunctional.
It is remarkable that, despite the nature of the family relationships of each of the people featured in the book, none of them died in the hospital. Seven, including Dr. Byock's own father, were cared for in either their homes or those of family members; the others died in nursing homes or hospices. In each case, however, the dying person was surrounded by family and/or friends at the end.
The road from diagnosis to dying surrounded by the love of family was, in most cases, not clearly visible at the onset. The terminally ill and his or her family were guided to the path by a team of caregivers made up of hospices nurses, home health care aides, psychiatrists, social workers, and doctors with a special insight into dying comfortably and well, both mentally and physically. Their stories demonstrate how the issues of being dependent on others, fear of being a burden, shame at physical indignity, fear of unbearable pain can be handled positively, as well as how one can resolve family conflicts and disappointments in order to leave this life at peace.
Byock handles the subject of death in a honest, forthright and gentle manner -- he is never morbid, never sentimental. He includes a thorough question-and-answer section following the individual stories to address how one can begin to talk about dying with one's family; how to ease symptoms and bring relief to one's loved ones; how to deal with doctors and the medical system; how to manage dying when one is alone; how to care for a dying child; and assisted suicide. He also includes a comprehensive resource list with addresses and telephone numbers of organizations involved in the dissemination of information aiding the dying and their families.
If you love anyone on the planet -- and if a single other person loves you -- Dying Well is a book to read, think about, and discuss with those you love. Learning to die well can be a personal triumph as well as a family legacy. Dying Well is a remarkable gift, practical and loving, and an inspiring guide for all of us.
Anna Garris Goiser is a freelance writer in Washington, D.C.
©1996, ProMotion, inc.