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And A Time To Die

2005 non-fiction book by Sharon R. Kaufman

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Sobering examination of the "end of life" issues that we really need to talk about.

  • Feb 5, 2010
And A Time To Die" is definitely not light summer reading.  Instead, it is a serious and revealing look at the way people die in this country.  Fifty years ago most people died at home.  For a whole host of reasons detailed in this book this is no longer the case.  The simple fact is that most folks find themselves ill-prepared when faced with life and death decisions involving themselves or close family members.  Author Sharon R. Kaufman has done us all a great service.  "And A Time To Die: How American Hospitals Shape The End of Life" brings the reader up to speed on the issues, the terminology, the technology and the players involved in various end of life scenarios Just what is meant by the term "persistant vegetative state"?  What are the advantages and drawbacks of CPR?  Is hospice care really a better alternative to a conventional hospital for many of these patients?  What happens when the patients wishes are at odds with the wishes of the family?  And just what role does religion play in the life and death decisions people are forced to make?  These issues and a great many others are presented in clear, concise and easy to understand language.

Sharon Kaufman, a professor of medical anthropology at the University of California, spent two full years observing and interviewing terminally ill patients and their families.   She also spent considerable time speaking with doctors, nurses and hospital staff who must struggle with these issues on a daily basis.  She presents the stories of 27 patients who find themselves in ICU's (intensive care units) or in other specialized hospital units. To be honest, a good many of these stories are downright disturbing.  One cannot imagine what many of these patients and their families are forced to endure.  And what is so frustrating is that the structural deficiencies of the American health care  system are largely responsible for so many of these problems.  Reading this book will surely convince you that there is so much that needs to change.

Admittedly the issues are complex and the subject matter is not particularly pleasant.  But as a practical matter, it is extremely important for people to get up to speed on many of these issues. I can only conclude that I found "And A Time To Die: How American Hospitals Shape The End of Life" to be a very worthwhile use of my time.  I would wholeheartedly recommend this book to you as well.
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August 23, 2011
This subject is particularly interesting to me because I expect to die in the not too distant future. For background, I have stage four renal cell carcinoma. One kidney was removed five years ago. Kidney cancer cells were discovered in both lungs two years ago. There is no treatment that "cures" metastasized kidney cancer. Some drugs may postpone death by several months. I decided to stop chemo treatment several months ago when the side effects, primarily intense exhaustion and nausea, got to be more than I was prepared to handle. I'm currently on an expensive and experimental drug called Avastin. To my surprise, the cancer cells in my lungs have not grown for about ten months. However, my bone marrow is now producing pre-cancerous cells which can quickly turn into bone cancer. ------I've been an atheist for as long as I can remember, so I am untroubled by concepts of sin, hell or heaven. We make our own, and that's fine with me. Death has always seemed as normal and unscary an event as birth. We are all animals and we all, no matter what we do – pray, tithe, cry, do good work, do terrible things – die. I am much more concerned with the quality of my life than the number of months or years I might have or what my death date might be. Of course, when the dying starts I might find myself joining every church I can think of accompanied by hefty donations. ------The main reason for my contentment is my two kids. I love them unconditionally and I believe they feel the same about me. ------The second major reason has to do with this book. Drifter51's review is disturbing and truthful – yet the answer to the book's issues is found in two needed actions. Learn to talk about your death with your religious counselor if you have one, your doctor, your lawyer and, most importantly, your heirs (and that means write a will.) Interview a few hospice organizations and decide which one you want. Medicare pays for hospice counseling and for hospice care. ------The second action is to write down one simple thing. Do you want resuscitation or do you want simply to be kept as free of pain as possible and to make your breathing as easy as possible while you let go of life. ------No, it isn't as simple as this, although I found it to be. But the choice is yours. You stand a good chance of not having your wishes followed by your relatives, and especially by your doctor, if you've only expressed your wishes verbally. ------Unfortunately, many, many people avoid talking about their deaths. Unless you find the idea of being in a hospital with an air tube down your throat, disgusting liquid food pumped into your stomach, your bodily wastes cleaned up with a minimum of privacy and dignity, bed sores, the likelihood of not receiving enough pain medication as you're dying, and all this possibly for weeks and months, you must make your decisions known and in writing. ------All this may seem daunting. It isn't. I wanted to make sure my wishes would be carried out and that my wishes would be enforced by my kids. I've saved them a lot of anguish by doing most of this myself. Talking to them about my cancer, my death, introducing them to my doctors, my lawyer and discussing my financial affairs and my will should make their lives easier when my life stops. ------But it still is up to you begin these discussions. And the time to start is now, not when you're ill and worried and tired. Good luck, and may you have kids as supportive and loving as mine are. ------Dying, after all, is no scarier than being run over by a wheat reaper, falling out of an airplane, being impaled by a rhinoceros or having cancer. Thank you, Drifter, for finding this book to discuss.
August 23, 2011
Thank you for your poignant and insightful comments. The reason I posted this up last night is that my 93 year old mother suffered a massive stroke yesterdayl She and my dad who are both devout Catholics had discussed these issues extensively years ago. Both have living wills and made it clear that they want no extraordinary treatment. Obviously my father is heartbroken at this turn of events but he is confident in the decisions they made. You are right. People really do need to discuss these matters and this book is an excellent way to get up to speed. Thanks again and I wish you nothing but the best.
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Paul Tognetti ()
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I guess I would qualify as a frustrated writer. My work requires very little writing and so since 1999 I have been writing reviews on non-fiction books and anthology CD's on amazon.com. I never could … more
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Most Americans, when pressed, have a vague sense of how they would like to die. They may imagine a quick and painless end or a gentle passing away during sleep. Some may wish for time to prepare and make peace with themselves, their friends, and their families. Others would prefer not to know what's coming, a swift, clean break. Yet all fear that the reality will be painful and prolonged; all fear the loss of control that could accompany dying.

That fear is justified. It is also historically unprecedented. In the past thirty years, the advent of medical technology capable of sustaining life without restoring health, the expectation that a critically ill person need not die, and the conviction that medicine should routinely thwart death have significantly changed where, when, and how Americans die and put us all in the position of doing something about death.

In a penetrating and revelatory study, medical anthropologist Sharon R. Kaufman examines the powerful center of those changes -- the hospital, where most Americans die today. In the hospital world, the deep, irresolvable tension between the urge to extend life at all costs and the desire to allow "letting go" is rarely acknowledged, yet it underlies everything that happens there among patients, families, and health professionals. Over the course of two years, Kaufman observed and interviewed critically ill patients, their families, doctors, nurses, and other hospital staff at three community hospitals. In...And a Time...

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ISBN-10: 0743264762
ISBN-13: 978-0743264761
Author: Sharon R. Kaufman
Genre: Health, Mind & Body, Hospice Care
Publisher: Scribner
Date Published: March 22, 2005
Format: Hardcover
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