But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.

    This new edition includes an all-embracing and incisive afterword that examines the current state of health care and our relationship with life as it approaches its terminus. It also discusses how we can take control of our own final days and those of our loved ones.Shewin Nuland's masterful How We Die is even more relevant than when it was first published.

    Informed by her many years working as a nurse, with more than a decade in palliative care, Tisdale provides a frank and compassionate meditation on the inevitable.From the sublime (the faint sound of Mozart as you take your last breath) to the ridiculous (lessons on how to close the sagging jaw of a corpse), Tisdale leads readers through the peaks and troughs of death with a wise and humorous hand. This is more than a how-to manual or a spiritual bible: it is a graceful compilation of honest and intimate anecdotes based on the deaths Tisdale has witnessed in her work and life, as well as stories from cultures, traditions, and literature around the world.

    Kathryn Mannix has studied and practiced palliative care for thirty years. In With the End in Mind , she shares beautifully crafted stories from a lifetime of caring for the dying, and makes a case for the therapeutic power of approaching death not with trepidation, but with openness, clarity, and understanding. Weaving the details of her own experiences as a caregiver through stories of her patients, their families, and their distinctive lives, Dr. Mannix discusses the universal, but deeply personal, process of dying. With meditations on life, death, and the space between them, With the End in Mind describes the possibility of meeting death gently, with forethought and preparation, and shows the unexpected beauty, dignity, and profound humanity of life coming to an end.

    It will inspire the necessary and difficult conversations we all need to have with loved ones as it illuminates a path to a better way of death.Like so many of us, award-winning writer Katy Butler always assumed her aging parents would experience healthy, active retire­ments before dying peacefully at home. Then her father suffered a stroke that left him incapable of easily finishing a sentence or showering without assistance. Her mother was thrust into full-time caregiving, and Katy became one of the 24 mil­lion Americans who help care for aging parents. In an effort to correct a minor and non–life threatening heart arrhythmia, doctors outfitted her father with a pacemaker. The device kept his heart beating but did nothing to prevent his slide into dementia, incontinence, near-muteness, and misery. After several years, he asked his wife for help, telling her, "I am living too long." Mother and daughter faced a series of wrench­ing moral questions: When does death cease being a curse and become a blessing? Where is the line between saving life and prolonging a dying? When is the right time to say to a doctor, "Let my loved one go"? When doctors refused to disable the pace­maker, sentencing her father to a protracted and agonizing death, Katy set out to understand why. Her quest had barely begun when her mother faced her own illness, rebelled against her doctors, refused open-heart surgery, and instead met death head-on. Knocking on Heaven's Door, a revolution­ary blend of memoir and investigative reporting, is the fruit of the Butler family's journey. With a reporter's skill, a poet's eye, and a daughter's love, Butler explores what happens when our terror of death collides with the tech­nological imperatives of modern medicine. Her provocative thesis is that advanced medicine, in its single-minded pursuit of maximum longevity, often creates more suffering than it prevents. Butler lays bare the tangled web of technology, medicine, and commerce that modern dying has become and chronicles the rise of Slow Medicine - a growing movement that promotes care over cure. Knocking on Heaven's Door is a visionary map through the labyrinth of a broken and morally adrift medical system. It will inspire the necessary and difficult conversations we all need to have with loved ones as it illuminates a path to a better way of death.

    “There is nothing wrong with you for dying,” hospice physician B.J. Miller and journalist and caregiver Shoshana Berger write in A Beginner’s Guide to the End. “Our ultimate purpose here isn’t so much to help you die as it is to free up as much life as possible until you do.” Theirs is a clear-eyed and big-hearted action plan for approaching the end of life, written to help readers feel more in control of an experience that so often seems anything but controllable. Their book offers everything from step-by-step instructions for how to do your paperwork and navigate the healthcare system to answers to questions you might be afraid to ask your doctor, like whether or not sex is still okay when you’re sick. Get advice for how to break the news to your employer, whether to share old secrets with your family, how to face friends who might not be as empathetic as you’d hoped, and how to talk to your children about your will. (Don’t worry: if anyone gets snippy, it’ll likely be their spouses, not them.) There are also lessons for survivors, like how to shut down a loved one’s social media accounts, clean out the house, and write a great eulogy. An honest, surprising, and detail-oriented guide to the most universal of all experiences, A Beginner’s Guide to the End is “a book that every family should have, the equivalent of Dr. Spock but for this other phase of life” (New York Times bestselling author Dr. Abraham Verghese).

    They are promises. They are the only way to walk from one night to the other."Nina Riggs was just thirty-seven years old when initially diagnosed with breast cancer--one small spot. Within a year, the mother of two sons, ages seven and nine, and married sixteen years to her best friend, received the devastating news that her cancer was terminal.How does one live each day, "unattached to outcome"? How does one approach the moments, big and small, with both love and honesty?Exploring motherhood, marriage, friendship, and memory, even as she wrestles with the legacy of her great-great-great grandfather, Ralph Waldo Emerson, Nina Riggs's breathtaking memoir continues the urgent conversation that Paul Kalanithi began in his gorgeous When Breath Becomes Air. She asks, what makes a meaningful life when one has limited time?Brilliantly written, disarmingly funny, and deeply moving, The Bright Hour is about how to love all the days, even the bad ones, and it's about the way literature, especially Emerson, and Nina's other muse, Montaigne, can be a balm and a form of prayer. It's a book about looking death squarely in the face and saying "this is what will be."Especially poignant in these uncertain times, The Bright Hour urges us to live well and not lose sight of what makes us human: love, art, music, words.

    What began as the chronicle of an imminent and early death became something much more--a powerful exhortation to the living.That Julie Yip-Williams survived infancy was a miracle. Born blind in Vietnam, she narrowly escaped euthanasia at the hands of her grandmother, only to flee with her family the political upheaval of her country in the late 1970s. Loaded into a rickety boat with three hundred other refugees, Julie made it to Hong Kong and, ultimately, America, where a surgeon at UCLA gave her partial sight. She would go on to become a Harvard-educated lawyer, with a husband, a family, and a life she had once assumed would be impossible. Then, at age thirty-seven, with two little girls at home, Julie was diagnosed with terminal metastatic colon cancer, and a different journey began.The Unwinding of the Miracle is the story of a vigorous life refracted through the prism of imminent death. When she was first diagnosed, Julie Yip-Williams sought clarity and guidance through the experience and, finding none, began to write her way through it--a chronicle that grew beyond her imagining. Motherhood, marriage, the immigrant experience, ambition, love, wanderlust, tennis, fortune-tellers, grief, reincarnation, jealousy, comfort, pain, the marvel of the body in full rebellion--this book is as sprawling and majestic as the life it records. It is inspiring and instructive, delightful and shattering. It is a book of indelible moments, seared deep--an incomparable guide to living vividly by facing hard truths consciously.With humor, bracing honesty, and the cleansing power of well-deployed anger, Julie Yip-Williams set the stage for her lasting legacy and one final miracle: the story of her life.

    One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air chronicles Kalanithi's transformation from a naïve medical student "possessed," as he wrote, "by the question of what, given that all organisms die, makes a virtuous and meaningful life" into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality. What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir. Paul Kalanithi died in March 2015, while working on this book, yet his words live on as a guide and a gift to us all. "I began to realize that coming face to face with my own mortality, in a sense, had changed nothing and everything," he wrote. "Seven words from Samuel Beckett began to repeat in my head: 'I can't go on. I'll go on.'" When Breath Becomes Air is an unforgettable, life-affirming reflection on the challenge of facing death and on the relationship between doctor and patient, from a brilliant writer who became both.

    In addition to the practical and compassionate guidance that have made The 36-Hour Day invaluable to caregivers, the fourth edition is the only edition currently available that includes new information on medical research and the delivery of care.The new edition includes:-new information on diagnostic evaluation-resources for families and adult children who care for people with dementia-updated legal and financial information-the latest information on nursing homes and other communal living arrangements-new information on research, medications, and the biological causes and effects of dementiaAlso available in a large print editionPraise for The 36-Hour Day:

    Sunita Puri knew from a young age that the gulf between her parents' experiences and her own was impossible to bridge, save for two elements: medicine and spirituality. Between days spent waiting for her mother, an anesthesiologist, to exit the OR, and evenings spent in conversation with her parents about their faith, Puri witnessed the tension between medicine's impulse to preserve life at all costs and a spiritual embrace of life's temporality. And it was that tension that eventually drew Puri, a passionate but unsatisfied medical student, to palliative medicine--a new specialty attempting to translate the border between medical intervention and quality-of-life care.Interweaving evocative stories of Puri's family and the patients she cares for, That Good Night is a stunning meditation on impermanence and the role of medicine in helping us to live and die well, arming readers with information that will transform how we communicate with our doctors about what matters most to us.

    Every day she tries to bring care and comfort to those reaching the end of their lives and to help make dying more bearable. Rachel's training was put to the test in 2017 when her beloved GP father was diagnosed with terminal cancer. She learned that nothing - even the best palliative care - can sugar-coat the pain of losing someone you love. And yet, she argues, in a hospice there is more of what matters in life - more love, more strength, more kindness, more joy, more tenderness, more grace, more compassion - than you could ever imagine. For if there is a difference between people who know they are dying and the rest of us, it is simply this: that the terminally ill know their time is running out, while we live as though we have all the time in the world. Dear Life is a book about the vital importance of human connection, by the doctor we would all want by our sides at a time of crisis. It is a love letter - to a father, to a profession, to life itself.

    She was forty-four years old, with a devoted husband and three young children, and she had only one year of health remaining.Susan decided to live that year with joy.She quit her job as a journalist and spent time with her family. She built an outdoor meeting space for friends in her backyard. And she took seven trips with the seven most important people in her life. As her health declined, Susan journeyed to the Yukon, Hungary, the Bahamas, and Cyprus. She took her sons to swim with dolphins, and her teenage daughter, Marina, to Kleinfeld's bridal shop in New York City to see her for the first and last time in a wedding dress.She also wrote this book. No longer able to walk or even to lift her arms, she tapped it out letter by letter on her iPhone using only her right thumb, the last finger still working.However, Until I Say Good-Bye is not angry or bitter. It is sad in parts--how could it not be?--but it is filled with Susan's optimism, joie de vivre, and sense of humor. It is a book about life, not death. One that, like Susan, will make everyone smile.From the Burger King parking lot where she cried after her diagnosis to a snowy hot spring near the Arctic Circle, from a hilarious family Christmas disaster to the decrepit monastery in eastern Cyprus where she rediscovered her heritage, Until I Say Good-Bye is not only Susan Spencer-Wendel's unforgettable gift to her loved ones--a heartfelt record of their final experiences together--but an offering to all of us: a reminder that "every day is better when it is lived with joy."

    Rana Awdish never imagined that an emergency trip to the hospital would result in hemorrhaging nearly all of her blood volume and losing her unborn first child. But after her first visit, Dr. Awdish spent months fighting for her life, enduring consecutive major surgeries and experiencing multiple overlapping organ failures. At each step of the recovery process, Awdish was faced with something even more unexpected: repeated cavalier behavior from her fellow physicians—indifference following human loss, disregard for anguish and suffering, and an exacting emotional distance.Hauntingly perceptive and beautifully written, In Shock allows the reader to transform alongside Awidsh and watch what she discovers in our carefully-cultivated, yet often misguided, standard of care. Awdish comes to understand the fatal flaws in her profession and in her own past actions as a physician while achieving, through unflinching presence, a crystalline vision of a new and better possibility for us all.As Dr. Awdish finds herself up against the same self-protective partitions she was trained to construct as a medical student and physician, she artfully illuminates the dysfunction of disconnection. Shatteringly personal, and yet wholly universal, she offers a brave road map for anyone navigating illness while presenting physicians with a new paradigm and rationale for embracing the emotional bond between doctor and patient.

    Ballet dancers and rock musicians, professors and thieves-"anyone who had fallen, or, often, leapt, onto hard times" and needed extended medical care-ended up here. So did Victoria Sweet, who came for two months and stayed for twenty years. Laguna Honda, lower tech but human paced, gave Sweet the opportunity to practice a kind of attentive medicine that has almost vanished. Gradually, the place transformed the way she understood her work. Alongside the modern view of the body as a machine to be fixed, her extraordinary patients evoked an older idea, of the body as a garden to be tended. God's Hotel tells their story and the story of the hospital itself, which, as efficiency experts, politicians, and architects descended, determined to turn it into a modern "health care facility," revealed its own surprising truths about the essence, cost, and value of caring for body and soul.