Knocking on Heaven's Door
The Path to a Better Way of Death
By Katy Butler
(Scribner, Hardcover, 9781451641974, 336pp.)
Publication Date: September 10, 2013
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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.
Katy Butler, a former finalist for a National Magazine Award, has written for The New Yorker, The New York Times Magazine, Vogue, and other publications. Her work is anthologized in The Best American Science Writing, The Best American Essays, and The Best Buddhist Writing. A winner of the “Science in Society” award from the National Association of Science Writers, she lives in northern California.
?eoeKaty Butler?e(TM)s science background and her gift for metaphor make her a wonderfully engaging storyteller, even as she depicts one of our saddest but most common experiences: that of a slow death in an American hospital. Knocking on Heaven?e(TM)s Door is a terrible, beautiful book that offers the information we need to navigate the complicated world of procedure and technology-driven health care. I?e(TM)m recommending it to all my friends with aging parents or partners, and holding on to a copy for myself.?e
"Katy Butler's new book?e"brave, frank, poignant, and loving?e"will encourage the conversation we, as a society, desperately need to have about better ways of dying. From her own closely-examined personal experience, she fearlessly poses the difficult questions that sooner or later will face us all.?e
?eoeIntimate and wise, heartbreakingly compassionate, and critically helpful, this is a truly important work that I hope will be widely read. We have lost our way and Katy Butler?e(TM)s impeccably researched and powerful tale will help eliminate much suffering on the passage to the mystery of death.?e
-Dr. Jack Kornfield
"This is the most important book you and I can read. It is not just about dying, it is about life, our political and medical system, and how to face and address the profound ethical and personal issues that we encounter as we care for those facing dying and death. You will not be able to put this book down. Its tenderness, beauty, and heart-breaking honesty matches the stunning data on dying in the West. A splendid and compassionate endeavor."
-Joan Halifax, PhD, Founding Abbot, Upaya Institute/Zen Center and Director, Project on Being with Dying: Cultivating Compassion and Fearlessness in the Presence of Death
?eoeThis is a book so honest, so?insightful?and so achingly beautiful that its poetic essence transcends even the anguished story that it tells. Katy Butler?e(TM)s perceptive intellect has probed deeply, and seen into the many troubling aspects of our nation?e(TM)s inability to deal with the reality of dying in the 21st century: emotional, spiritual, medical, financial, social, historical and even political. And yet, though such valuable insights are presented with a journalist?e(TM)s clear eye, they are so skillfully woven into the narrative of her beloved parents?e(TM) deaths that every sentence seems to come from the very wellspring of the human spirit that is in her. This elegiac volume is required reading for every American adult; it has about it a sense of the universal.?e
-Dr. Sherwin B. Nuland, author of How We Die: Reflections of Life?e(TM)s Final Chapter?
?eoeKnocking On Heaven?e(TM)s Door is a disquieting book, and an urgent one. Against a confounding bioethical landscape, Katy Butler traces the odyssey of her parents?e(TM) final years with honesty and compassion. She does a great service here, skillfully illuminating issues most of us are destined to face sooner or later. I cannot imagine a finer way to honor the memory of one?e(TM)s parents than in such a beautifully rendered account.?e
"This beautifully written and well researched book will take you deep into the unexplored heart of aging and medical care in America today. With courage, unrelenting honesty, and deepest compassion, Katy Butler shares her saga of how a family of independent, thoughtful, and complex souls attempt to navigate their uncharted journey through medical institutions and specialties. Here, the degree of individual and family suffering turns on myriad decisions, large and small, coerced by economic and institutional forces. Knocking on Heaven?e(TM)s Door makes it clear that until care of the soul, families, and communities become central to our medical approaches, true quality of care for elders will not be achieved."
?eoeThis is some of the most important material I have read in years, and so beautifully written. It is riveting, and even with parents long gone, I found it very hard to put down. Katy Butler's book will challenge and nourish you. I am deeply grateful for its truth, wisdom, and gorgeous stories?e"some heartbreaking, some life-giving, some both at the same time. Butler is an amazing and generous writer. This book will change you, and, I hope, our society."
"A forthright memoir on illness and investigation of how to improve end-of-life scenarios. With candidness and reverence, Butler examines one of the most challenging questions a child may face: how to let a parent die with dignity and integrity. Honest and compassionate thoughts on helping the elderly through the process of dying."