Author: Sebastian Sepulveda, MD and Gini Graham Scott; c.2017, Rowman & Littlefield; $37.98; 271 pages
The end is near.
It might not happen today, or tomorrow. It might not happen for decades, but you truly never know. Even so, you want to prepare for it as much as possible, to protect yourself and your loved ones. “At Death’s Door” by Dr. Sebastian Sepulveda and Gini Graham Scott may clear things up.
The inevitable has arrived.
You or a loved one has been in an accident, gotten a diagnosis, had a sudden onset of illness, or has been fighting disease for awhile. The end is near and you’ve no idea what to expect.
“To fully understand what happens…” says Sepulveda about those first minutes, “it is also important to understand the hospital system…”
Your regular doctor, for starters, may not be the one to care for you at this point. He or she may defer to someone like Sepulveda, who deals specifically with end-of-life issues. You’ll also be seen by one or more specialist “teams” to assist you and your family, if you’re in a hospital; help will differ if you prefer end-of-life care at home or at any other type of facility.
Generally speaking, the patient decides when and where help is sought, which treatment to receive, and when to stop treatment. As Sepulveda writes, however, people are messy and complications arise, especially if neither patient nor family fully understands what’s happening or if they “are influenced by popular TV shows…”
That’s when end-of-life professionals can help.
Emotions run high when the end is near, so it’s important for patients and families to know that medical technology is a work-in-progress. Most people don’t return from cardiac arrest. Obesity comes with panoply of complications. Smoking can kill in many ways; dementia adds complexity. Doctors have various legal parameters they absolutely must heed. ICU nurses are rock stars. And death can be peaceful, especially if the patient has in place a DNR/DNI.
Says Sepulveda, “I wish all patients would consider putting this kind of decision in place as soon as possible.”
After reading “At Death’s Door” for awhile, it may seem that author Sebastian Sepulveda (with Gini Graham Scott) has written this book specifically to encourage readers to consider Do Not Resuscitate / Do Not Intubate orders. That’s a curious notion, at first – but then its urgency becomes crystal clear.
Through several chapters of gripping anecdotal evidence, Sepulveda and Scott show how different diseases affect physical systems and the ways in which they cause loss of life; how a DNR/DNI alters a care plan; and how it might save pain on both sides of the bed. The end is near in each of Sepulveda’s tales; whether the DNR/DNI is in place or not, the outcome is the same. The difference: one offers less pain and more peace, he says. What would you want for yourself? What would you want for your loved one?
Valid questions, all, from a book that forces readers to think, hard. Yes, you may be a patient someday, and you’ll be glad you’ve read “At Death’s Door,” in the end.