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二十一世紀生死課
《基因：人類最親密的歷史》辛達塔・穆克吉、《理想的告別》安・紐曼與普立茲獎得主艾倫・古德曼（Ellen Goodman）等人，口碑推薦！
死亡的原因、地點、時間及過程，都已和幾十年前截然不同。死亡的形貌幡然轉變，我們對它的了解也需從頭來過。海德・沃瑞棋醫師承繼醫界對生命與臨終的思索，本書企圖心直逼努蘭經典之作《死亡的臉》，刻劃細膩不遜葛文德《凝視死亡》，從從細胞之死到死亡的本質定義談起，內容涵蓋死亡的生理機制、死亡社會學、拒絕心肺復甦術（DNR）議題、腦死與心臟死（死亡定義）、死亡與宗教、重症照顧者的重負、代理人問題、安樂死／自殺／醫師協助自殺、死亡與社群媒體等議題。
除了自身臨床服務時的遭遇，作者還以寫論文的精神去經營各章，因此有不少相關數據的蒐集與解讀，比如全球最早安樂死入法的地方，推行的影響與原本的預期有何落差，這結果又意味著什麼？全書內容含括社會、宗教、財務、地理及醫學研究，對於現今我們人生最後一段路的樣貌，如何被各種風潮和事件改變，這本書提供了扎實豐富的回答。
各界好評
「文字優雅之中帶著一抹感傷，掩卷久久不能自已。全書醫者之心溢於言表，流露關懷之餘不失冷靜思索，文筆優美，敘事流暢，病例、數據信手捻來，巧妙地將醫學倫理、文學與科學冶於一爐。死亡議題極其複雜，沃瑞棋卻成功鋪陳出人性脈絡，並對死亡在現代社會裡的變化提出深刻洞察。」—— 辛達塔・穆克吉（Siddhartha Mukherjee），暢銷書《基因：人類最親密的歷史》和《萬病之王》的作者
「海德・沃瑞棋醫師堪稱當代維吉爾，引領我們走過複雜而混亂的現代死亡之旅。他聰慧過人，思考深刻，卻又謙虛誠懇，一步步揭開 CPR、DNR、腦死和怠速代號的奧祕。他也點出一個奇怪的現象：在大多數醫院裡，死亡都是由最年輕、最缺乏經驗的醫生處理。最重要的是，沃瑞棋醫師諄諄善誘，再次提醒我們顛簸不破的道理：在人生盡頭，與親人同在、與知交同在、與清明同在，才是最重要的事，不論現在或未來都是如此。」—— 安娜・萊斯曼（Anna Reisman）醫師，耶魯醫學院醫學人文計畫主持人
「沃瑞棋對人類死亡的歷史作了詳盡而豐富的研究，在此同時，他也完全沒忽略死亡在今天的幾個主要特點 —— 否認、不平等、過度治療和機構化。在人口逐漸老化的此刻，醫療技術的快速進展持續改變健康照顧的樣貌，而醫生就是我們最好的探路者和引路人。沃瑞棋這本書內容豐富、全面而完整，是死亡議題不可或缺的經典之作。」—— 安・紐曼（Ann Neumann），《理想的告別》作者
「面對死亡是所有人最終的學習，讓人學習謙卑和愛，然而每人只有一次機會，不能重來。沃瑞棋醫師此書以當代社會、醫療的眼光描繪死亡，給人提早學習面對的機會。」—— 楊育正教授，台灣安寧照顧基金會董事長 馬偕紀念醫院資深主治醫師
「內容相當考據，是一本有深度、認真思考死亡的好書，非常適合成為「醫學教育」，「生死教育」的參考讀物，對於從事相關工作的人，尤能擴大他們對於死亡的認識與想像。」—— 台灣在宅醫療學會理事長 余尚儒
「本書主要根據地區醫院住院醫師的臨床服務經驗，卻能橫跨演化生物學、醫學、社會學、認知心理學、歷史學、人類學…… 等學科觀點，交織學術論述、判例分析與臨床故事，還原社會情境與歷史脈絡進行詮釋，關照臨床場域的移民文化衝擊，以及醫學與宗教／靈性的藕斷絲連，是引人入勝的書寫方式，對昆蘭案的社會影響和臨終照顧議題的評論尤其發人深省。」—— 魏書娥，南華大學生死學系副教授
「海德・沃瑞棋以科學家的冷靜之眼、醫生的人道心腸，細心檢視死亡在現代社會的樣貌，歷史、解剖學和公共政策在他精湛的敘事中合而為一。對於如何好好活到人生最後一刻，這本書提供了溫暖而全面的指引。」—— 艾倫・古德曼（Ellen Goodman），普立茲獎得主，專欄作家，《我懂你的意思》和《存參》（Paper Trail）作者
「我現在的主要工作是『安寧療護與生死學』的社會教育，總覺得大眾對於臨終關懷與安寧療護的常識極度缺乏，閱讀這本書可以對照台灣民眾的社會觀念。死亡在日常生活中從四面八方包圍著我們，『死』不是『生』的反義詞，而生與死是一條連續線。」—— 許禮安，高雄市張啓華文化藝術基金會執行長，台灣安寧照顧協會理事
「一本內容充實、反省深刻的好書，巧妙融合歷史事實、統計數據及人文關懷，並展現極為傑出的敘事技巧。主題豐富精彩，我讀得津津有味，幾乎忘了它的主題是死亡。非常感謝沃瑞棋醫師送給讀者這麼好的禮物，一本深具啟發的好書！它的確是難得之作，我非常喜歡，也推薦大家閱讀。」—— 桑吉夫・邱普拉（Sanjiv Chopra），哈佛醫學院醫學教授
「沃瑞棋研究扎實，除適時補充親身經歷的故事之外，對文學、神學、統計數據、法學理論及科學知識亦信手捻來。文詞誠摯動人，佐證資料充足，全書深具說服力⋯⋯真誠而全面地檢視了這個常被忽視的課題。沃瑞棋學養豐富，言詞懇切，本書誠為認識死亡議題不可或缺之作。書中對於死亡的跨學科研究十分出色，作者對於該如何增進（而非迴避）死亡議題亦深具洞見。文字曉暢易讀，資訊新穎即時。」——《書架情報網》
「從最微觀的細胞之死，到生命與死亡的哲學大哉問，海德・沃瑞棋邀請讀者一同思索死亡與臨終的寓意與事實。沃瑞棋帶領我們穿越現代死亡的『醫療化』，重探我們似乎已經遺失的深厚人性。他的文筆、聰慧、勇氣與謙虛，造就出這本不可多得的好書。這本書內容豐富，筆觸優美，我讀得欲罷不能。」—— 艾娃・約瑟夫（Eve Joseph），《夾縫之間》（In the Slender Margin）作者
「兼具史家的好奇、醫師的透澈與詩人的靈魂，海德・沃瑞棋為今日死亡繪出一幅驚人的畫像。現代社會企圖解開痛苦之謎，但諷刺的是，這項探索撞上我們內心深處最古老的恐懼。沃瑞棋醫師冷靜爬梳，揭開科學如何改變了我們對死亡的理解，但在此同時，他也謙卑接受我們無法克服死亡的基本事實，同時坦誠接受：在死亡面前，我們只是凡人。」—— 拉斐爾・康柏（Rafael Campo）醫師，哈佛醫學院助理教授，著有《另類醫學》（Alternative Medicine）
「既冷靜剖析細胞與身體之死的已知與未知，也敏銳掌握臨終議題的文化變遷，例如病患開始在社群媒體上貼文，公開分享自己的最後一段路。沃瑞棋以深具同情的筆調記下他所見證的故事，娓娓道出現代社會裡的人如何面對死亡。」——《科學人》
「身為心臟科醫師，海德・沃瑞棋日日與死亡交手，時時見證喪親之慟，也因此能細膩觀察近年臨終照顧的變化。他的成果相當豐碩，小至細胞之死，大至死亡對社會的衝擊，都在一個個重症案例、醫學軼事和科學事實間串聯起來。」——《自然》
「醫學進展已然挪移生與死的界線，同時為醫師和病患帶來極具爭議的問題。在《二十一世紀生死課》中，沃瑞棋醫師不但精心探究這些議題，也為醫學史補充了生死邊緣的可貴記錄，這些故事縱然讓人時而不安，時而困惑，卻也發人省思，深具啟發意義。」——《今日心理學》
「沒有議題像死亡這樣人人在意 —— 卻也人人不安。想了解這個諱莫如深的課題，海德・沃瑞棋的這本書是必讀之作，他清晰地點出死亡對當前美國的意義，也勸告我們追求更合理也更溫和的結局。」—— 丹妮耶蕾・歐弗里（Danielle Ofri）醫師，藥學博士，著有《病人說的是什麼，醫生又聽見什麼》（What Patients Say, What Doctors Hear）。
「我相信每一個人都能從這本書獲益。沃瑞棋醫師兼具智慧、熱情與研究精神，為人生在世最陰暗的議題帶來光亮。這本書內容廣博如百科全書，每一頁都充滿啟發。」—— 史蒂芬・奇爾南（Stephen P. Kiernan），著有《最後的權利》（Last Rights）和《蜂鳥》（The Hummingbird）
「這本書訴說的故事無比精彩：我們向來以為生死之別清楚簡單，為什麼它現在變得這麼複雜、又這麼重要？儘管這項問題充滿挑戰，海德・沃瑞棋仍勇往直前，以清晰、幽默、知性而熱情的態度娓娓道來。我非常喜歡這本書。」—— 丹尼爾・華勒斯（Daniel Wallace），《大智若魚》（Big Fish）作者
「死亡，並不是生的反面，死亡是生命的一部分。透過認識死亡，我們更知道如何好好生活。誠摯推薦這本書。」—— 朱為民，老年醫學、安寧緩和專科醫師
「內容廣博，筆調輕快，娓娓道來死亡與現代醫學的歷史與相互影響，讀來欲罷不能。」—— 凱蒂・巴特勒（Katy Butler），暢銷書《偽善的醫療》（Knocking on Heaven’s Door）作者
死亡的原因、地點、時間及過程，都已和幾十年前截然不同。死亡的形貌幡然轉變，我們對它的了解也需從頭來過。海德・沃瑞棋醫師承繼醫界對生命與臨終的思索，本書企圖心直逼努蘭經典之作《死亡的臉》，刻劃細膩不遜葛文德《凝視死亡》，從從細胞之死到死亡的本質定義談起，內容涵蓋死亡的生理機制、死亡社會學、拒絕心肺復甦術（DNR）議題、腦死與心臟死（死亡定義）、死亡與宗教、重症照顧者的重負、代理人問題、安樂死／自殺／醫師協助自殺、死亡與社群媒體等議題。
除了自身臨床服務時的遭遇，作者還以寫論文的精神去經營各章，因此有不少相關數據的蒐集與解讀，比如全球最早安樂死入法的地方，推行的影響與原本的預期有何落差，這結果又意味著什麼？全書內容含括社會、宗教、財務、地理及醫學研究，對於現今我們人生最後一段路的樣貌，如何被各種風潮和事件改變，這本書提供了扎實豐富的回答。
各界好評
「文字優雅之中帶著一抹感傷，掩卷久久不能自已。全書醫者之心溢於言表，流露關懷之餘不失冷靜思索，文筆優美，敘事流暢，病例、數據信手捻來，巧妙地將醫學倫理、文學與科學冶於一爐。死亡議題極其複雜，沃瑞棋卻成功鋪陳出人性脈絡，並對死亡在現代社會裡的變化提出深刻洞察。」—— 辛達塔・穆克吉（Siddhartha Mukherjee），暢銷書《基因：人類最親密的歷史》和《萬病之王》的作者
「海德・沃瑞棋醫師堪稱當代維吉爾，引領我們走過複雜而混亂的現代死亡之旅。他聰慧過人，思考深刻，卻又謙虛誠懇，一步步揭開 CPR、DNR、腦死和怠速代號的奧祕。他也點出一個奇怪的現象：在大多數醫院裡，死亡都是由最年輕、最缺乏經驗的醫生處理。最重要的是，沃瑞棋醫師諄諄善誘，再次提醒我們顛簸不破的道理：在人生盡頭，與親人同在、與知交同在、與清明同在，才是最重要的事，不論現在或未來都是如此。」—— 安娜・萊斯曼（Anna Reisman）醫師，耶魯醫學院醫學人文計畫主持人
「沃瑞棋對人類死亡的歷史作了詳盡而豐富的研究，在此同時，他也完全沒忽略死亡在今天的幾個主要特點 —— 否認、不平等、過度治療和機構化。在人口逐漸老化的此刻，醫療技術的快速進展持續改變健康照顧的樣貌，而醫生就是我們最好的探路者和引路人。沃瑞棋這本書內容豐富、全面而完整，是死亡議題不可或缺的經典之作。」—— 安・紐曼（Ann Neumann），《理想的告別》作者
「面對死亡是所有人最終的學習，讓人學習謙卑和愛，然而每人只有一次機會，不能重來。沃瑞棋醫師此書以當代社會、醫療的眼光描繪死亡，給人提早學習面對的機會。」—— 楊育正教授，台灣安寧照顧基金會董事長 馬偕紀念醫院資深主治醫師
「內容相當考據，是一本有深度、認真思考死亡的好書，非常適合成為「醫學教育」，「生死教育」的參考讀物，對於從事相關工作的人，尤能擴大他們對於死亡的認識與想像。」—— 台灣在宅醫療學會理事長 余尚儒
「本書主要根據地區醫院住院醫師的臨床服務經驗，卻能橫跨演化生物學、醫學、社會學、認知心理學、歷史學、人類學…… 等學科觀點，交織學術論述、判例分析與臨床故事，還原社會情境與歷史脈絡進行詮釋，關照臨床場域的移民文化衝擊，以及醫學與宗教／靈性的藕斷絲連，是引人入勝的書寫方式，對昆蘭案的社會影響和臨終照顧議題的評論尤其發人深省。」—— 魏書娥，南華大學生死學系副教授
「海德・沃瑞棋以科學家的冷靜之眼、醫生的人道心腸，細心檢視死亡在現代社會的樣貌，歷史、解剖學和公共政策在他精湛的敘事中合而為一。對於如何好好活到人生最後一刻，這本書提供了溫暖而全面的指引。」—— 艾倫・古德曼（Ellen Goodman），普立茲獎得主，專欄作家，《我懂你的意思》和《存參》（Paper Trail）作者
「我現在的主要工作是『安寧療護與生死學』的社會教育，總覺得大眾對於臨終關懷與安寧療護的常識極度缺乏，閱讀這本書可以對照台灣民眾的社會觀念。死亡在日常生活中從四面八方包圍著我們，『死』不是『生』的反義詞，而生與死是一條連續線。」—— 許禮安，高雄市張啓華文化藝術基金會執行長，台灣安寧照顧協會理事
「一本內容充實、反省深刻的好書，巧妙融合歷史事實、統計數據及人文關懷，並展現極為傑出的敘事技巧。主題豐富精彩，我讀得津津有味，幾乎忘了它的主題是死亡。非常感謝沃瑞棋醫師送給讀者這麼好的禮物，一本深具啟發的好書！它的確是難得之作，我非常喜歡，也推薦大家閱讀。」—— 桑吉夫・邱普拉（Sanjiv Chopra），哈佛醫學院醫學教授
「沃瑞棋研究扎實，除適時補充親身經歷的故事之外，對文學、神學、統計數據、法學理論及科學知識亦信手捻來。文詞誠摯動人，佐證資料充足，全書深具說服力⋯⋯真誠而全面地檢視了這個常被忽視的課題。沃瑞棋學養豐富，言詞懇切，本書誠為認識死亡議題不可或缺之作。書中對於死亡的跨學科研究十分出色，作者對於該如何增進（而非迴避）死亡議題亦深具洞見。文字曉暢易讀，資訊新穎即時。」——《書架情報網》
「從最微觀的細胞之死，到生命與死亡的哲學大哉問，海德・沃瑞棋邀請讀者一同思索死亡與臨終的寓意與事實。沃瑞棋帶領我們穿越現代死亡的『醫療化』，重探我們似乎已經遺失的深厚人性。他的文筆、聰慧、勇氣與謙虛，造就出這本不可多得的好書。這本書內容豐富，筆觸優美，我讀得欲罷不能。」—— 艾娃・約瑟夫（Eve Joseph），《夾縫之間》（In the Slender Margin）作者
「兼具史家的好奇、醫師的透澈與詩人的靈魂，海德・沃瑞棋為今日死亡繪出一幅驚人的畫像。現代社會企圖解開痛苦之謎，但諷刺的是，這項探索撞上我們內心深處最古老的恐懼。沃瑞棋醫師冷靜爬梳，揭開科學如何改變了我們對死亡的理解，但在此同時，他也謙卑接受我們無法克服死亡的基本事實，同時坦誠接受：在死亡面前，我們只是凡人。」—— 拉斐爾・康柏（Rafael Campo）醫師，哈佛醫學院助理教授，著有《另類醫學》（Alternative Medicine）
「既冷靜剖析細胞與身體之死的已知與未知，也敏銳掌握臨終議題的文化變遷，例如病患開始在社群媒體上貼文，公開分享自己的最後一段路。沃瑞棋以深具同情的筆調記下他所見證的故事，娓娓道出現代社會裡的人如何面對死亡。」——《科學人》
「身為心臟科醫師，海德・沃瑞棋日日與死亡交手，時時見證喪親之慟，也因此能細膩觀察近年臨終照顧的變化。他的成果相當豐碩，小至細胞之死，大至死亡對社會的衝擊，都在一個個重症案例、醫學軼事和科學事實間串聯起來。」——《自然》
「醫學進展已然挪移生與死的界線，同時為醫師和病患帶來極具爭議的問題。在《二十一世紀生死課》中，沃瑞棋醫師不但精心探究這些議題，也為醫學史補充了生死邊緣的可貴記錄，這些故事縱然讓人時而不安，時而困惑，卻也發人省思，深具啟發意義。」——《今日心理學》
「沒有議題像死亡這樣人人在意 —— 卻也人人不安。想了解這個諱莫如深的課題，海德・沃瑞棋的這本書是必讀之作，他清晰地點出死亡對當前美國的意義，也勸告我們追求更合理也更溫和的結局。」—— 丹妮耶蕾・歐弗里（Danielle Ofri）醫師，藥學博士，著有《病人說的是什麼，醫生又聽見什麼》（What Patients Say, What Doctors Hear）。
「我相信每一個人都能從這本書獲益。沃瑞棋醫師兼具智慧、熱情與研究精神，為人生在世最陰暗的議題帶來光亮。這本書內容廣博如百科全書，每一頁都充滿啟發。」—— 史蒂芬・奇爾南（Stephen P. Kiernan），著有《最後的權利》（Last Rights）和《蜂鳥》（The Hummingbird）
「這本書訴說的故事無比精彩：我們向來以為生死之別清楚簡單，為什麼它現在變得這麼複雜、又這麼重要？儘管這項問題充滿挑戰，海德・沃瑞棋仍勇往直前，以清晰、幽默、知性而熱情的態度娓娓道來。我非常喜歡這本書。」—— 丹尼爾・華勒斯（Daniel Wallace），《大智若魚》（Big Fish）作者
「死亡，並不是生的反面，死亡是生命的一部分。透過認識死亡，我們更知道如何好好生活。誠摯推薦這本書。」—— 朱為民，老年醫學、安寧緩和專科醫師
「內容廣博，筆調輕快，娓娓道來死亡與現代醫學的歷史與相互影響，讀來欲罷不能。」—— 凱蒂・巴特勒（Katy Butler），暢銷書《偽善的醫療》（Knocking on Heaven’s Door）作者
384 pages, Kindle Edition
First published February 1, 2017
About the author
Haider Warraich
6 books63 followersAs a physician, writer, and clinical researcher, Haider Warraich wears many hats that have come together in his new book, State of the Heart - Exploring the History, Science and Future of Cardiac Disease, launched July 2019 by St Martin's Press/Macmillan.
He writes most frequently for the New York Times but also contributes to the Guardian, the Atlantic, the LA Times and the Boston Globe amongst others. He writes about all things that fall within the purview of healthcare, from health policy to the daily interactions between patients and their physicians.
Haider Warraich completed internal medicine and cardiology training at Harvard Medical School and Duke University and will be the Associate Director of Heart Failure at the Boston Veterans Affairs Hospital, Associate Physician at Brigham and Women’s Hospital and Instructor at Harvard Medical School in the Fall of 2019.
Dr Warraich is also an avid clinical researcher and has published in the New England Journal of Medicine and Journal of the American Medical Association amongst many others.
He writes most frequently for the New York Times but also contributes to the Guardian, the Atlantic, the LA Times and the Boston Globe amongst others. He writes about all things that fall within the purview of healthcare, from health policy to the daily interactions between patients and their physicians.
Haider Warraich completed internal medicine and cardiology training at Harvard Medical School and Duke University and will be the Associate Director of Heart Failure at the Boston Veterans Affairs Hospital, Associate Physician at Brigham and Women’s Hospital and Instructor at Harvard Medical School in the Fall of 2019.
Dr Warraich is also an avid clinical researcher and has published in the New England Journal of Medicine and Journal of the American Medical Association amongst many others.
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October 9, 2022I am definitely on a death kick, mortuaries, forensic psychologists and psychiatrists discussing murder cases, hospitals and now this. I get like this sometimes, just want to read about one subject. And then.. I move on. I wonder if everyone does this at times? One of the best obsessions I had was Anthony Trollope - hhe wrote loads of books, but I'm not into fiction any more and there is a limit to how much one author can write about their speciality. Especially perhaps, death. The great unknown.
February 6, 2020
(3.5) Haider Warraich, a physician originally from Pakistan, trained at Harvard and is now a fellow in cardiovascular medicine at Duke University in North Carolina. Like Ed Yong’s I Contain Multitudes or Atul Gawande’s Being Mortal, Modern Death is a learned but engaging book that intersperses science, history, medicine and personal stories. Warraich addresses death as a biological phenomenon – perhaps more complicated than one might expect – but also as a social one that has undergone great changes in recent decades.
“The vast majority of people die in places where inert tones provide the palette, disinfectant the aroma, alarm bells the soundtrack, and open-back johnnies the wardrobe.” So Warraich describes a typical hospital or nursing home decline. Compare this to a century ago, when most births and deaths occurred in people’s homes. Although dying at home is on the rise, the author notes that patients’ wishes often have to cede to circumstances. Moreover, there’s inequality at work: affluent whites are more likely to die at home. In the United States, a disparity is seen in life expectancy as well, with just 300 miles separating the nation’s longest (Fairfax, Virginia – 82 years for men) from its shortest (McDowell, West Virginia – 64).
The very definition of death has become less straightforward as medicine has advanced, Warraich notes. Cases like that of Karen Ann Quinlan in the 1970s made the average person aware that physical life can continue even after the brain has died. Yet there is still much we don’t understand, and the idea that brain death could be reversible hasn’t been completely ruled out. The author recounts his own experience of treating a patient who collapsed of a heroin overdose but temporarily regained a pulse (known as the “Lazarus phenomenon”).
The first half of the book is about death as a medical reality, while the second focuses on particular social aspects of death: religious beliefs, the burden on families and other caregivers, the debate over euthanasia and physician-assisted suicide, and the pros and cons of using social media to share one’s journey towards death. Relatives of the ill or dying will find plenty of useful information here on designating a health-care proxy and setting up a living will and/or DNR order – just bear in mind that much of this may be specific to the United States.
If the book is reprinted it could do with more careful proofreading as there are numerous minor errors, whether typos or wrong word choices (“deference” in place of “deferral,” for instance). In some places Warraich mixes his metaphors and ends up with unintentionally awkward phrases, like “decapitation has digestible parables” and “the raison d’être of religion stems from the existential curve ball imbued so deep within us.”
Nevertheless, this is quite a fascinating book with a vital message that Warraich delivers passionately: we must bring death into the public conversation so that it holds less fear for patients and doesn’t equate to failure for doctors. After all, it’s inevitable for each of us.
“The vast majority of people die in places where inert tones provide the palette, disinfectant the aroma, alarm bells the soundtrack, and open-back johnnies the wardrobe.” So Warraich describes a typical hospital or nursing home decline. Compare this to a century ago, when most births and deaths occurred in people’s homes. Although dying at home is on the rise, the author notes that patients’ wishes often have to cede to circumstances. Moreover, there’s inequality at work: affluent whites are more likely to die at home. In the United States, a disparity is seen in life expectancy as well, with just 300 miles separating the nation’s longest (Fairfax, Virginia – 82 years for men) from its shortest (McDowell, West Virginia – 64).
The very definition of death has become less straightforward as medicine has advanced, Warraich notes. Cases like that of Karen Ann Quinlan in the 1970s made the average person aware that physical life can continue even after the brain has died. Yet there is still much we don’t understand, and the idea that brain death could be reversible hasn’t been completely ruled out. The author recounts his own experience of treating a patient who collapsed of a heroin overdose but temporarily regained a pulse (known as the “Lazarus phenomenon”).
The first half of the book is about death as a medical reality, while the second focuses on particular social aspects of death: religious beliefs, the burden on families and other caregivers, the debate over euthanasia and physician-assisted suicide, and the pros and cons of using social media to share one’s journey towards death. Relatives of the ill or dying will find plenty of useful information here on designating a health-care proxy and setting up a living will and/or DNR order – just bear in mind that much of this may be specific to the United States.
If the book is reprinted it could do with more careful proofreading as there are numerous minor errors, whether typos or wrong word choices (“deference” in place of “deferral,” for instance). In some places Warraich mixes his metaphors and ends up with unintentionally awkward phrases, like “decapitation has digestible parables” and “the raison d’être of religion stems from the existential curve ball imbued so deep within us.”
Nevertheless, this is quite a fascinating book with a vital message that Warraich delivers passionately: we must bring death into the public conversation so that it holds less fear for patients and doesn’t equate to failure for doctors. After all, it’s inevitable for each of us.
February 5, 2020
I wanted to write a comprehensive review but I don't think any review does justice to this excellent and well researched book. Consider this lousy review the exact opposite of this wonderful (and sobering) book.
April 11, 2021
Думаю, для России книга совсем не подходит - у нас совсем другой подход к лечению и смерти - но очень интересно узнать, как работают и относятся к уходу из жизни американские врачи. Хайдер Варрайч родом из Пакистана, и видимо обладает прирождённым талантом рассказчика, потому что за всю книгу он касается ряда важных тем и не ходит кругами.
Почему клетки умирают? А почему не живут? Что вообще такое смерть? Когда останавливается сердце? Или когда мёртв мозг? Зачем проводить реанимацию? Надо ли вытаскивать людей с того света? Почему эвтаназия до сих пор не получила распространения? Вопросов много, на все будут даны ответы. Несмотря на мрачную тематику, Варрайч умудряется сохранять спокойствие и проявляет эмпатию как к пациентам, так и к героям своих историй.
Стала ли я меньше бояться смерти после этой книги? Да нет, конечно. Такое невозможно. Но было очень интересно.
Почему клетки умирают? А почему не живут? Что вообще такое смерть? Когда останавливается сердце? Или когда мёртв мозг? Зачем проводить реанимацию? Надо ли вытаскивать людей с того света? Почему эвтаназия до сих пор не получила распространения? Вопросов много, на все будут даны ответы. Несмотря на мрачную тематику, Варрайч умудряется сохранять спокойствие и проявляет эмпатию как к пациентам, так и к героям своих историй.
Стала ли я меньше бояться смерти после этой книги? Да нет, конечно. Такое невозможно. Но было очень интересно.
April 3, 2017
Dad flushed dead turtles and goldfish down the toilet. From water pets we graduated to land mammals, such as cats and dogs. Then the day arrived when each of them died. Then a classmate of hers died, making my sister inconsolable. Uncle Wes died and I remember attending his wake as a little boy in a dark oaky Chicago living room parlor.
Death is part of life, as early lessons teach us. We also learn that life is for the living by remembering those who went before us and helping those behind us. It’s an endless parade of humanity.
Modern death means different things to different people, writes Haider Warraich. The current issue comes down to questions of extending life or prolonging death. This book explores the history and evolving thought on end-of-life care decision-making.
About two hundred years ago, life expectancy began to rise, with a reduction in child mortality accounting for most of the increase. This period also witnessed better public sanitation, hygiene and nutrition. Today, most Americans die of chronic diseases that sap the mind and body before the end arrives.
I found myself astonished at the story told here, especially the last fifty years, a period of medical advances that we take for granted today. Warraich consolidates these recent events to crystallize where we are today.
Cardiopulmonary resuscitation came together in the sixties. Also in the sixties, an emergency response system developed with trained paramedics staffing ambulances. With CPR, cardiac monitors and ventilation devices, the modern intensive-care unit came into prime time. Medicine, an art for thousands of years, became a science, writes Warraich.
Around this time, just fifty years ago, new discoveries altered our conception of life and end of life. But no one anticipated the long-term outcomes of these advances. Technology changed the patient-doctor relationship. Before the forties, we interacted at home or in clinics. Most of the action now takes place in hospitals.
Living wills of fifty years ago preceded today’s advanced care planning. Congress endorsed living wills in the Patient Self-Determination Act. The patient-autonomy revolution came at the right time to save patients rights. Now we can define our treatment preferences. Warraich’s research found that patients who wanted less aggressive treatment held to that preference. But those who wanted aggressive treatment kept changing their minds, which made them poorer and more depressed.
After all the tears, agonizing and hand-wringing, what does modern medicine do? Does it prolong death, or does it extend life?
Uncle Frank kept my aunt on life support way too long. Money was not an issue for him, but he was not going to let his wife go, even though members of the family quietly urged him to face the inevitable. Although there was life, the quality of life was long gone.
Me? I plan to take the least invasive path out of here. When my time comes, I just want to spend my final days and minutes laughing with familiar faces and voices with music, because hearing is the last sense to go.
Interesting book. Thirty-three pages of notes.
This topic came on my radar four years ago when The Best American Essays 2012 published How Doctors Die, by Ken Murray, http://www.zocalopublicsquare.org/201...
Fresh Air, Oct 2012, http://www.npr.org/2012/10/09/1625700... Fresh Air, July 2010, http://www.npr.org/2010/07/29/1288286...
Related. “When the evidence says no but the doctor says yes,” from ProPublica and The Atlantic. https://www.propublica.org/article/wh...
Death is part of life, as early lessons teach us. We also learn that life is for the living by remembering those who went before us and helping those behind us. It’s an endless parade of humanity.
Modern death means different things to different people, writes Haider Warraich. The current issue comes down to questions of extending life or prolonging death. This book explores the history and evolving thought on end-of-life care decision-making.
About two hundred years ago, life expectancy began to rise, with a reduction in child mortality accounting for most of the increase. This period also witnessed better public sanitation, hygiene and nutrition. Today, most Americans die of chronic diseases that sap the mind and body before the end arrives.
I found myself astonished at the story told here, especially the last fifty years, a period of medical advances that we take for granted today. Warraich consolidates these recent events to crystallize where we are today.
Cardiopulmonary resuscitation came together in the sixties. Also in the sixties, an emergency response system developed with trained paramedics staffing ambulances. With CPR, cardiac monitors and ventilation devices, the modern intensive-care unit came into prime time. Medicine, an art for thousands of years, became a science, writes Warraich.
Around this time, just fifty years ago, new discoveries altered our conception of life and end of life. But no one anticipated the long-term outcomes of these advances. Technology changed the patient-doctor relationship. Before the forties, we interacted at home or in clinics. Most of the action now takes place in hospitals.
Living wills of fifty years ago preceded today’s advanced care planning. Congress endorsed living wills in the Patient Self-Determination Act. The patient-autonomy revolution came at the right time to save patients rights. Now we can define our treatment preferences. Warraich’s research found that patients who wanted less aggressive treatment held to that preference. But those who wanted aggressive treatment kept changing their minds, which made them poorer and more depressed.
After all the tears, agonizing and hand-wringing, what does modern medicine do? Does it prolong death, or does it extend life?
Uncle Frank kept my aunt on life support way too long. Money was not an issue for him, but he was not going to let his wife go, even though members of the family quietly urged him to face the inevitable. Although there was life, the quality of life was long gone.
Me? I plan to take the least invasive path out of here. When my time comes, I just want to spend my final days and minutes laughing with familiar faces and voices with music, because hearing is the last sense to go.
Interesting book. Thirty-three pages of notes.
This topic came on my radar four years ago when The Best American Essays 2012 published How Doctors Die, by Ken Murray, http://www.zocalopublicsquare.org/201...
Fresh Air, Oct 2012, http://www.npr.org/2012/10/09/1625700... Fresh Air, July 2010, http://www.npr.org/2010/07/29/1288286...
Related. “When the evidence says no but the doctor says yes,” from ProPublica and The Atlantic. https://www.propublica.org/article/wh...
February 15, 2017
This is really a 4.5 star review. Let's start with a few background facts that color this review. My family and in particular my mother has been very open in its discussion of death. I know my parents wishes when the end comes and they know mine. We're of the perspective that less is more at the end. I have also read "How We Die" (many years ago) and part of "Being Mortal." I was afraid this book was going to feel like a retread of those popular titles but it was anything but.
First of all, this is a well-written book. It is a nice read. I read it in 4 days. As for the content, it takes a wholistic approach to death and dying. It covers a lot of territory including a historical look at some issues. I often find the history chapters in nonfiction kind of boring but not this one. It gave nice context without bogging it down.
Overall this gave me a lot to think about on a subject I felt like I had already given a lot of thought to. I highly recommend, especially if you are uncomfortable about the subject matter.
First of all, this is a well-written book. It is a nice read. I read it in 4 days. As for the content, it takes a wholistic approach to death and dying. It covers a lot of territory including a historical look at some issues. I often find the history chapters in nonfiction kind of boring but not this one. It gave nice context without bogging it down.
Overall this gave me a lot to think about on a subject I felt like I had already given a lot of thought to. I highly recommend, especially if you are uncomfortable about the subject matter.
March 24, 2017
Amazing to read from the perspective of a nurse who increasingly feels like she commits medical battery on the elderly every day in the course of her work because their families refuse to let them go. Stop asking "what else can be done for her medically?" when your mother is 95 and has dementia and a slew of comorbidities. It is awful to watch and even worse to be forced to participate in these torturous procedures, tests, and invasions thrust upon the dying. Get those advance directives done now...don't wait until it's too late.
March 4, 2017
Really 4.5 stars. I have not read this in a discussion group, but it's an important topic to talk about. Because it also touches on the role of religion and spirituality, on the definition of death, and on assisted suicide, it might spur some different viewpoints. Besides which, as the author and others have pointed out, death has been removed from a natural part of life to the technological world of medicine, and it needs to become normalized again so that we can talk about our preferences.
Thanks to reader Art, https://www.goodreads.com/user/show/1...
who included the following links in his review. I copy them below in case Art’s review doesn’t come up when you search. He also included Terry Gross’s interview with author Haider Warraich on Fresh Air, which led me to this book.
“How Doctors Die: It’s Not Like the Rest of Us, But It Should Be,” by Ken Murray
http://www.zocalopublicsquare.org/201...
“When Evidence Says No, But Doctors Say Yes,” by David Epstein
https://www.propublica.org/article/wh...
The articles discuss ineffective or futile treatment, which relates to Modern Death: How Medicine Changed the End of Life. The author's conclusion is, not for the better in most cases.
In earlier times in more developed countries, and in the developing countries today, before medicine had advanced to its current state, most people died suddenly or after a brief illness. Their last days were spent in the homes of family members who cared for them. Now, most people die in hospitals, hooked up to machines, often in opposition to their expressed wishes. The end of life has been transformed into a limbo of prolonged dying.
Why does this happen? Insurance pays for it. Patients and their families, from hope or religious beliefs or lack of knowledge about the successes and risks of treatments, often want to try anything and everything. Physicians comply, from fear of being sued or from unwillingness to talk with patients and their families about what treatment can realistically accomplish and the side effects it will cause.
For another thing, the increasing sophistication of our tools has made it more difficult to say exactly when death has occurred. Machines can keep bodies breathing and their hearts beating when their brains will never function again; when life support is removed, death usually soon follows. Warraich talks about the cases of Karen Ann Quinlan, Nancy Cruzan, and others. Jahi McMath, a 13-year-old, experienced brain death after elective surgery. Though a court has declared her dead and her body continues to degrade, she was transferred to a nursing facility and her body receives “life support” (quotation marks by the author).
Critical by Tom Daschle, about our health care system, touches on the subject from a different perspective. If the U.S. had a body to set standards for what care is effective and what is wasted, would so much useless treatment be administered at the end of life? Warraich gives statistics for “an acute escalation of medical interventions” (of doubtful utility) near the end of life. (p. 264)
A byproduct of our system of prolonged dying is the toll it takes on caregivers. Warraich discusses the shortcomings of living wills and the strain on caregivers to make constant, countless decisions about care or, when the patient’s preferences are not known, to figure out what the person would have wanted. When there is more than one family member, there is the prospect of disagreement about what to do.
Warraich’s book covers similar territory to Being Mortal, though concentrating on the very end of life and not the declining years. Though not as elegant a writer as Gawande, he does speak affectingly and from the heart. These and other writings over the past few years urge us to demystify death and to talk with our families or potential surrogates about our preferences, should they be called upon to make decisions for us about our care.
Thanks to reader Art, https://www.goodreads.com/user/show/1...
who included the following links in his review. I copy them below in case Art’s review doesn’t come up when you search. He also included Terry Gross’s interview with author Haider Warraich on Fresh Air, which led me to this book.
“How Doctors Die: It’s Not Like the Rest of Us, But It Should Be,” by Ken Murray
http://www.zocalopublicsquare.org/201...
“When Evidence Says No, But Doctors Say Yes,” by David Epstein
https://www.propublica.org/article/wh...
The articles discuss ineffective or futile treatment, which relates to Modern Death: How Medicine Changed the End of Life. The author's conclusion is, not for the better in most cases.
In earlier times in more developed countries, and in the developing countries today, before medicine had advanced to its current state, most people died suddenly or after a brief illness. Their last days were spent in the homes of family members who cared for them. Now, most people die in hospitals, hooked up to machines, often in opposition to their expressed wishes. The end of life has been transformed into a limbo of prolonged dying.
Why does this happen? Insurance pays for it. Patients and their families, from hope or religious beliefs or lack of knowledge about the successes and risks of treatments, often want to try anything and everything. Physicians comply, from fear of being sued or from unwillingness to talk with patients and their families about what treatment can realistically accomplish and the side effects it will cause.
For another thing, the increasing sophistication of our tools has made it more difficult to say exactly when death has occurred. Machines can keep bodies breathing and their hearts beating when their brains will never function again; when life support is removed, death usually soon follows. Warraich talks about the cases of Karen Ann Quinlan, Nancy Cruzan, and others. Jahi McMath, a 13-year-old, experienced brain death after elective surgery. Though a court has declared her dead and her body continues to degrade, she was transferred to a nursing facility and her body receives “life support” (quotation marks by the author).
Critical by Tom Daschle, about our health care system, touches on the subject from a different perspective. If the U.S. had a body to set standards for what care is effective and what is wasted, would so much useless treatment be administered at the end of life? Warraich gives statistics for “an acute escalation of medical interventions” (of doubtful utility) near the end of life. (p. 264)
A byproduct of our system of prolonged dying is the toll it takes on caregivers. Warraich discusses the shortcomings of living wills and the strain on caregivers to make constant, countless decisions about care or, when the patient’s preferences are not known, to figure out what the person would have wanted. When there is more than one family member, there is the prospect of disagreement about what to do.
Warraich’s book covers similar territory to Being Mortal, though concentrating on the very end of life and not the declining years. Though not as elegant a writer as Gawande, he does speak affectingly and from the heart. These and other writings over the past few years urge us to demystify death and to talk with our families or potential surrogates about our preferences, should they be called upon to make decisions for us about our care.
March 28, 2019
I was surprised and pleased by this book. The author is a physician who appears to be in training in cardiology at Duke. The book is a collections of memoir and essay on the subject of how death is viewed in the context of modern medicine. The motivation is that death is perhaps the central topic of human existence in one way or another and yet it is an event that everyone undergoes but nobody knows anything about. Moreover, most of the common conceptions about death that are widely held are anecdotal and often flat out wrong and even if not wrong are often hopelessly out of date when looked at in terms of medical science and practice. The idea is that to get people talking about death and its related issues more openly will help patients and their relatives deal with end of life issues and will help physicians and health care professionals better serve patients.
In the interests of transparency, I am currently dealing with multiple situations these days in which parents, peers, and children are dealing with extended medical situations - increasingly common with an aging population - and I have spent far too much time in hospitals on various peoples behalf to not realize the importance of what Dr. Warraich is writing about.
The book seems like an odd collection of topics but it holds together well and the number of “aha” moments (I did not know that!) is large both in total and per page. There are lots of notes for those who wish to read more. The writing is superb. Some of the earlier chapters cover the micro level biology of how cells die, which sounds strange but which is crucial for understanding some of the later issues that get covered - “brain death” and DNR orders for example. Warraich also discusses the geography of death and how people are increasingly dying in hospitals and nursing homes rather than in their own homes. The discussion of resuscitation was an eye opener to me and I thought I was relatively well informed as a lay person.
All of this is fascinating, but the book gets even better as it progresses, when Dr. Warraich talks about the bordens of end of life medical processes on family and family representatives/proxies. Many are taking on these responsibilities just at the time that their own children have grown and it is important to clearly discuss what they are getting into. Related to this is the nature of family conflicts - and conflicts more generally involving the patient, family, and treatment team. Topics like assisted suicide and euthanasia round out the second half of the book.
...but then Warraich provided a last chapter about the increasing importance of social media in the lives of patients in these extended hospitalizations and institutional stays. The argument is not only that making use of social networks helps connect people to patients in beneficial ways to fight loneliness and isolation. There is also the possibility that having patients and family write/blog about their experiences can be helpful on its own and ease some of the concerns of those facing an inevitable death. This is one of the better uses for social media that one hears about these days.
This is a fine book and I hope Dr. Warraich continues to publish, and not just in his medical journals.
In the interests of transparency, I am currently dealing with multiple situations these days in which parents, peers, and children are dealing with extended medical situations - increasingly common with an aging population - and I have spent far too much time in hospitals on various peoples behalf to not realize the importance of what Dr. Warraich is writing about.
The book seems like an odd collection of topics but it holds together well and the number of “aha” moments (I did not know that!) is large both in total and per page. There are lots of notes for those who wish to read more. The writing is superb. Some of the earlier chapters cover the micro level biology of how cells die, which sounds strange but which is crucial for understanding some of the later issues that get covered - “brain death” and DNR orders for example. Warraich also discusses the geography of death and how people are increasingly dying in hospitals and nursing homes rather than in their own homes. The discussion of resuscitation was an eye opener to me and I thought I was relatively well informed as a lay person.
All of this is fascinating, but the book gets even better as it progresses, when Dr. Warraich talks about the bordens of end of life medical processes on family and family representatives/proxies. Many are taking on these responsibilities just at the time that their own children have grown and it is important to clearly discuss what they are getting into. Related to this is the nature of family conflicts - and conflicts more generally involving the patient, family, and treatment team. Topics like assisted suicide and euthanasia round out the second half of the book.
...but then Warraich provided a last chapter about the increasing importance of social media in the lives of patients in these extended hospitalizations and institutional stays. The argument is not only that making use of social networks helps connect people to patients in beneficial ways to fight loneliness and isolation. There is also the possibility that having patients and family write/blog about their experiences can be helpful on its own and ease some of the concerns of those facing an inevitable death. This is one of the better uses for social media that one hears about these days.
This is a fine book and I hope Dr. Warraich continues to publish, and not just in his medical journals.
March 23, 2017
Modern Death
I picked up a copy of Haider Warraich’s book Modern Death as soon as I saw it advertised. This is a topic that I find fascinating and Mr. Warraich’s book was billed as the “follow-up” to Atul Gawande’s Being Mortal, so I didn’t think twice about the impulse purchase. While reading the first few chapters, I was a little disappointed. Mr. Warraich wasn’t presenting anything that I hadn’t already read or taught about as a professor of health law and ethics. I didn’t make my first earmark until page 91, but shortly after had to be careful not to earmark every other page. I quickly decided that Mr. Warraich had written a text that should be read by everyone – not just people fascinated with the legal and ethical issues surrounding end of life.
Modern Death begins with an overview of issues surrounding death, including the legal definition of “death” and methods of sustaining life. Landmark cases are explained and a detailed history of the development of CPR is included. After building a firm foundation, Mr. Warraich delves into the issues he sees most often as a physician. That first earmark on page 91? It was for this quote: “The reason people increasingly don’t want CPR is not that they are afraid it will fail but that they are afraid it will only partially work. Patients are afraid that if CPR makes their heart start beating again their brain will have to pay a huge cost.” In a society that values independence and self-reliance, this is so very true. Most people would rather not continuing living if they have to live in a vegetative or severally impaired condition. What is life in today’s world if you cannot continue to do the daily activities that you love?
After an excellent ethical analysis of death and resuscitation efforts, Mr. Warraich considers deeply the role of religion in the dying process. He states: “Physicians very frequently find themselves in difficult situations with patients who have a strong faith, but rarely do they talk about religion and spirituality.” One study estimates that only 10% of physicians broach this difficult but important subject. This number is extremely low considering a study of cancer patients showing that patients provided with “spiritual care had a better quality of life prior to their deaths, were more likely to pass in hospice, and were less likely to receive aggressive and unnecessary care close to death” when compared to patients not provided spiritual intervention.
Modern Death also examines the role of physicians assisting care-givers and surrogate decision makers. He proffers that physicians are usually at the center of the decision-making process and they are often required to buffer the various opinions of family members and caregivers. In addition, he states that the burden placed on surrogate decision makers (aka health care proxies) is seriously overlooked.
The topics of euthanasia and physician assisted suicide are also touched on in Modern Death. Mr. Warraich offers his own personal perspective and thoughts regarding this controversial topic. He provides a unique perspective regarding the shift in opinion over centuries, not just decades.
I have added this book to my list of texts that every healthcare professional should consider reading. Additionally, I will be giving it to my parents. Per Mr. Warraich’s suggestion, I will instigate the talk that everyone avoids, but everyone should have before it is too late and we simply have to guess.
I picked up a copy of Haider Warraich’s book Modern Death as soon as I saw it advertised. This is a topic that I find fascinating and Mr. Warraich’s book was billed as the “follow-up” to Atul Gawande’s Being Mortal, so I didn’t think twice about the impulse purchase. While reading the first few chapters, I was a little disappointed. Mr. Warraich wasn’t presenting anything that I hadn’t already read or taught about as a professor of health law and ethics. I didn’t make my first earmark until page 91, but shortly after had to be careful not to earmark every other page. I quickly decided that Mr. Warraich had written a text that should be read by everyone – not just people fascinated with the legal and ethical issues surrounding end of life.
Modern Death begins with an overview of issues surrounding death, including the legal definition of “death” and methods of sustaining life. Landmark cases are explained and a detailed history of the development of CPR is included. After building a firm foundation, Mr. Warraich delves into the issues he sees most often as a physician. That first earmark on page 91? It was for this quote: “The reason people increasingly don’t want CPR is not that they are afraid it will fail but that they are afraid it will only partially work. Patients are afraid that if CPR makes their heart start beating again their brain will have to pay a huge cost.” In a society that values independence and self-reliance, this is so very true. Most people would rather not continuing living if they have to live in a vegetative or severally impaired condition. What is life in today’s world if you cannot continue to do the daily activities that you love?
After an excellent ethical analysis of death and resuscitation efforts, Mr. Warraich considers deeply the role of religion in the dying process. He states: “Physicians very frequently find themselves in difficult situations with patients who have a strong faith, but rarely do they talk about religion and spirituality.” One study estimates that only 10% of physicians broach this difficult but important subject. This number is extremely low considering a study of cancer patients showing that patients provided with “spiritual care had a better quality of life prior to their deaths, were more likely to pass in hospice, and were less likely to receive aggressive and unnecessary care close to death” when compared to patients not provided spiritual intervention.
Modern Death also examines the role of physicians assisting care-givers and surrogate decision makers. He proffers that physicians are usually at the center of the decision-making process and they are often required to buffer the various opinions of family members and caregivers. In addition, he states that the burden placed on surrogate decision makers (aka health care proxies) is seriously overlooked.
The topics of euthanasia and physician assisted suicide are also touched on in Modern Death. Mr. Warraich offers his own personal perspective and thoughts regarding this controversial topic. He provides a unique perspective regarding the shift in opinion over centuries, not just decades.
I have added this book to my list of texts that every healthcare professional should consider reading. Additionally, I will be giving it to my parents. Per Mr. Warraich’s suggestion, I will instigate the talk that everyone avoids, but everyone should have before it is too late and we simply have to guess.
May 14, 2017
Two end-of-life emerged on my lengthy library reserve list at the same time. Not pleasant reading, but important.
While MODERN DEATH is a sort of text book about death through the ages, with discussions of cell death, etc., EXTREME MEASURES is more of a handbook about what happens when one gets into the clutches of an ICU. And it isn't pretty.
I thought it was especially telling that healthcare workers -- nurses, doctors, and others -- don't die the way members of the general public often do. That's because healthcare workers avoid ventilators and extreme measures. The author of E.M. even cites a nurse who had DO NOT INTUBATE tattooed on her chest. More than a DNR is required to escape the extreme measures taken to preserve -- well, not to preserve life, but to preserve breathing and a beating heart even if useful brain function is gone forever.
In addition to a DNR/DNI, (these often do not survive a patient's transfer from one facility to another) people should have a POLST (physician order for life-sustaining treatment) which has the force of law. E.M. has many painful anecdotes and several pages of online resources such as polst.org and her own website jessicazitter.com which are useful for more information.
MODERN DEATH is more scholarly with many pages of bibliography. Clearly the author did a ton of research but I found Zitter's book to be much more practical and useful. Except I hope I never need to read it again and that I and everyone I care about (and for) just fall asleep one night and never wake again.
That's how it was with my mother. She fell and ended up in an ICU with big mitts on her hands to prevent her from pulling out tubes, etc. I invoked hospice and got her out of there in a hurry and back to her own bed where she died five days later with my husband and me with her. It was sad, but it was peaceful.
While MODERN DEATH is a sort of text book about death through the ages, with discussions of cell death, etc., EXTREME MEASURES is more of a handbook about what happens when one gets into the clutches of an ICU. And it isn't pretty.
I thought it was especially telling that healthcare workers -- nurses, doctors, and others -- don't die the way members of the general public often do. That's because healthcare workers avoid ventilators and extreme measures. The author of E.M. even cites a nurse who had DO NOT INTUBATE tattooed on her chest. More than a DNR is required to escape the extreme measures taken to preserve -- well, not to preserve life, but to preserve breathing and a beating heart even if useful brain function is gone forever.
In addition to a DNR/DNI, (these often do not survive a patient's transfer from one facility to another) people should have a POLST (physician order for life-sustaining treatment) which has the force of law. E.M. has many painful anecdotes and several pages of online resources such as polst.org and her own website jessicazitter.com which are useful for more information.
MODERN DEATH is more scholarly with many pages of bibliography. Clearly the author did a ton of research but I found Zitter's book to be much more practical and useful. Except I hope I never need to read it again and that I and everyone I care about (and for) just fall asleep one night and never wake again.
That's how it was with my mother. She fell and ended up in an ICU with big mitts on her hands to prevent her from pulling out tubes, etc. I invoked hospice and got her out of there in a hurry and back to her own bed where she died five days later with my husband and me with her. It was sad, but it was peaceful.
September 7, 2017
I am quitting after page 33. I cannot take seriously a book with this paragraph: "Stories of men and women who defied death abound in the history books. Perhaps the most famous of these figures is Methuselah, Noah's grandfather, who recently made an appearance in pop culture, played by Anthony Hopkins in Darren Aronofsky's film Noah. Methuselah, whose legacy remains as a synonym for longevity, is said to have lived for 969 years, and his death prompted God to unleash the great Flood (citation to Genesis)." There was also an earlier reference where the author gave examples of medical census taking like the one the Lord asked Moses to do, as a precursor to Thomas Cromwell's. I learned a few interesting things, particularly about cell death, but I can't read a supposedly scientific book about death that counts the Bible as a history book.
August 1, 2021
*will try to do a proper review later.
Recommended for: fans of body horror, anyone entering the medical profession, EMTs, people with terminal illness, civilization critics, anyone who is going to die.
Recommended for: fans of body horror, anyone entering the medical profession, EMTs, people with terminal illness, civilization critics, anyone who is going to die.
April 7, 2017
Dr. Warraich is currently working Duke and I went to his hometown reading/discussion at the Regulator. This is a compelling, interesting read about, as the title says, modern death. I appreciate some of the historical and social background he brings in along with personal stories. He writes about legal battles related to withdrawal of life-sustaining treatment, right-to-die issues and perspectives from the ICU, none of which I ever see in an NC hospice. That said, I wish he would have explored a bit more about what a non-acute or critical death looks like to show people how it can be. He touches on it, but you can tell he really doesn't have experience in that arena. I would also argue with the idea, which Warraich repeats throughout, that death is a universally feared and fought concept. I'm not at all sure that is true, and sounds like a manifestation of our cultural death phobia rather than core part of human nature.
April 5, 2017
This is such a well-intentioned and earnest book, and it could be really important but the writing leaves a lot to be desired. Sentences like "Cancer, perhaps the most storied disease of our times, has also benefited immensely from advances in both prevention and treatment." or "Through much of time, writers and poets and philosophers have found parallels between life and death, and between birth and dying. The mirroring of life and death does not just provide lyrical flourishes, it is reflected in history. Back when human beings gave birth to their young'uns in caves, they also passed away in caves." -- just left me shaking my head. So I skimmed, focusing on the personal stories of how different people--doctors, patients, families-- handle death and dying.
April 12, 2017
There were a few times when I found this book a little annoying (such as when he says that he has never talked to his mother about what sort of life-sustaining interventions she would want, but he knows that she would always want more time; despite the fact that he says in another part of the book that surrogates tend to be more aggressive about treatment than patients would be, and the conclusion of the book saying that we all need to talk about end-of-life issues more in our everyday lives (i.e. not when you're in the ICU!)). But overall, I liked the book, and I appreciated that he recognized that over-aggressive care can count as "doing harm" (and thus going against the "first, do no harm" that guides most doctors), which seems to be a pretty rare insight for doctors.
May 8, 2017
I won this as a Goodreads Giveaway.
Wow, I was blown away by this book. It was not what I'd expected, in the best way possible. Dr. Warraich writes with such humanity and compassion that it makes tackling a dark and frightening subject almost a pleasure.
The reader is guided through all the aspects of death in the modern age, from the difficulty in defining death in the face of medical advances over the past one-hundred years, to the legal and ethical challenges posed by modern death, to the spiritual and religious considerations one must take into account when dealing with death.
This book is a must read for anyone who wishes to prepare themselves for the inevitability that awaits us all. Five stars.
Wow, I was blown away by this book. It was not what I'd expected, in the best way possible. Dr. Warraich writes with such humanity and compassion that it makes tackling a dark and frightening subject almost a pleasure.
The reader is guided through all the aspects of death in the modern age, from the difficulty in defining death in the face of medical advances over the past one-hundred years, to the legal and ethical challenges posed by modern death, to the spiritual and religious considerations one must take into account when dealing with death.
This book is a must read for anyone who wishes to prepare themselves for the inevitability that awaits us all. Five stars.
March 13, 2017
A valuable history of how medical advances have impacted the way people view death as well as how they die. I found the first chapter on death at the cellular level somewhat challenging to read, but it is worth continuing as there are excellent chapters on many other aspects of the dying experience including the use (or not) of CPR, the burden carried by health care proxies and the debates around the concept of death with dignity. The book shines when Dr. Warraich shares personal stories and experiences, but as a whole it is very readable and illuminating on a subject that many people find hard to discuss.
March 3, 2017
When I learned of this book I was curious...when I finished it, really a long essay on the art and science of death from a medical, philosophical and artistic perspective by obviously a very humane physician I was stunned at its beauty and depth. Who should read it? Well, anyone who will eventually face death, the families of anyone facing serious illness, caregivers, everyone in the medical profession - that I suspect means everyone should read it.
Did Not Finish
July 11, 2021Found this on a shelf in the public library and thought it looked so interesting. I wanted to have an audiobook copy as well, and sadly, I paid for one because there was no library copy available. It is way over my head. Three chapters too complicated for me... The author doesn’t make it easy to understand for me like Mary Roach does. I learned my lesson to Read a few chapters of the print before paying for a copy whether it be in print or audiobook. I will not be finishing this.
March 8, 2017
The way we die has changed a great deal in the last century. Modern medicine can now prolong our dying which is something few people want. We want to live a long time but not spend a long time dying. Dr. Warraich does a good job of exploring questions around death. Lots to think about here.
March 22, 2017
Excellent book though admittedly a tricky subject matter. If it is a subject that interest you at all, and/or if you read and appreciated Being Mortal, I highly recommend this book. Well researched, well documented and eye-opening.
August 19, 2017
Well written and inciteful about the state of death in modern times. He explains cell death, the history of death, ethics, landmark cases, and more. A must read for everyone - especially every Doctor and Nurse.
February 25, 2017
GET YOURSELF A HEALTH CARE PROXY. NOW. AND TALK ABOUT YOUR WISHES RE: CATASTROPHIC ILLNESS AND WHAT YOU WANT DONE WITH YOUR REMAINS. THIS IS NOT A DRILL.
September 29, 2017
Do not resuscitate me, please.
December 18, 2018
I thought this was a very well written and interesting book. The anecdotal stories were effective , and the history of death and its progression in medicine was well illustrated. I also really liked how other countries and Cultures were discussed. I would have liked a little more development into quality of life and factors helping to decide measures to prolong, but overall great book.
May 31, 2017
Along with Atul Gawande's Being Mortal this book has opened my eyes to the immediate, likely future looming before my grandmother and for me as her caregiver. After 4 years of caregiving with its ups and downs, there are days I feel like I have a form of PTSD. There are days I feel like I'm losing my baseline (sanity) as surely as she's losing hers (health). But this book gave me perspective and hope and a dose of the reality I suspected but was ultimately too ignorant to nail down. It also showed me that we have choices not typically, or ever, presented and we may have to fight to enact those choices. I'm ready for the fight. I'm better equipped for this marathon.
"...the de facto mode of modern death looks something like this: Person falls sick, gets better, but never gets back to baseline, accumulating diagnoses and procedures until it becomes clear (usually quite belatedly) that more will not necessarily do any good. This makes sense for the vast majority of people, and perhaps with good reason, but a select few patients don't want to go down this trodden path."
The author talks a lot about fear of death itself (and all the attending suffering) and the fear of discussing death in families; that people don't broach the subject with their loved ones out of fear or respect, awkwardness or an unreadiness in themselves to face the thoughts. I don't know if we're a weird family in that way, but thankfully, none of my family members have any trouble talking about death, what they want for themselves at the end, and what our role will be as survivors (assuming the young outlive the old). There's no awkwardness, no stress, no fear. It's like talking about the weather. I didn't realize there was so much tension around this subject with most other families.
"Awareness of our mortality does more than remove the shroud of fear from death--it makes us kinder. One study showed that people who thought more about death were more likely to participate in selfless activities such as blood donation. Other research has shown that people who reflect about dying are more likely to donate to charities and have enhanced gratitude. And lastly, thinking of death, almost counterintuitively, reduces stress, and reducing stress is known to lead to a longer and healthier life."
"...the de facto mode of modern death looks something like this: Person falls sick, gets better, but never gets back to baseline, accumulating diagnoses and procedures until it becomes clear (usually quite belatedly) that more will not necessarily do any good. This makes sense for the vast majority of people, and perhaps with good reason, but a select few patients don't want to go down this trodden path."
The author talks a lot about fear of death itself (and all the attending suffering) and the fear of discussing death in families; that people don't broach the subject with their loved ones out of fear or respect, awkwardness or an unreadiness in themselves to face the thoughts. I don't know if we're a weird family in that way, but thankfully, none of my family members have any trouble talking about death, what they want for themselves at the end, and what our role will be as survivors (assuming the young outlive the old). There's no awkwardness, no stress, no fear. It's like talking about the weather. I didn't realize there was so much tension around this subject with most other families.
"Awareness of our mortality does more than remove the shroud of fear from death--it makes us kinder. One study showed that people who thought more about death were more likely to participate in selfless activities such as blood donation. Other research has shown that people who reflect about dying are more likely to donate to charities and have enhanced gratitude. And lastly, thinking of death, almost counterintuitively, reduces stress, and reducing stress is known to lead to a longer and healthier life."
August 28, 2018
"EEG and ECG's don't give us any information about the life of the organism. A blip on ECG may mean that there are some cells in the heart that stubbornly continue to contract despite the annihilation of most of their brothers and sisters
This book is brilliant.
Ada begitu banyak hal yang bisa dipelajari dari buku ini, sang Author, Haider Warraich menuliskannya dalam bentuk yang sangat baik -disertai begitu banyak jurnal dan pengalaman yang ia alami di rumah sakit. Sebagai tenaga medis, ada begitu banyak yang bisa di refleksikan dari buku ini. Perkembangan dunia kesehatan yang begitu pesat mulai membuat kabur batas antara hidup dan mati. Pesan utama dari kesehatan (jika kita hanya memandang dari sisi logika) adalah melawan kematian. Death is enemy, they said. Namun sampai batas apa kita akan melawan kematian. Kematian adalah fakta yang tidak bisa terelakkan, semua yang bernafas akan merasakan kematian. Jika kita berbicara tentang 'kematian' dalam sebuah obrolan ringan maka semua aura ceria berubah menjadi gelap, dingin, menyedihkan seakan Dementor datang menghampiri.
Kengerian dari istilah kematian ini membuat ilmu kesehatan terus meningkat dari waktu ke waktu. Sampai akhirnya setiap negara memiliki kriteria kematian yang berbeda. Buku ini menceritakan sejarah bagaimana kematian itu di definisikan, lalu timbul istilah baru seperti brain death, teknik CPR, istilah DNR/DNI sampai akhirnya membahas kontroversi dari euthanasia. Author menggambarkan bagaimana kompleksnya masalah di ICU, mengamati pasien-pasien yang mengalami koma dengan vital sign yang masih baik namun sama sekali tidak menunjukkan adanya tanda-tanda perbaikan, hanya bergantung pada sebuah mesin -ventilator- sampai akhirnya kriteria kematian yang telah ada sesuai undang-undang tiba. Aku rasa buku ini banyak membuatku dalam merenungkan hal-hal yang akan kutemui di masa depan nantinya.
When it comes to themselves, doctor certainly don't consider death the worst possible outcome. In fact, the vast majority of physicians value the quality of their life far more than the length or their life. This is reflected in the fact that physicians rarely want to have CPR performed on them if the need arises.
This book is brilliant.
Ada begitu banyak hal yang bisa dipelajari dari buku ini, sang Author, Haider Warraich menuliskannya dalam bentuk yang sangat baik -disertai begitu banyak jurnal dan pengalaman yang ia alami di rumah sakit. Sebagai tenaga medis, ada begitu banyak yang bisa di refleksikan dari buku ini. Perkembangan dunia kesehatan yang begitu pesat mulai membuat kabur batas antara hidup dan mati. Pesan utama dari kesehatan (jika kita hanya memandang dari sisi logika) adalah melawan kematian. Death is enemy, they said. Namun sampai batas apa kita akan melawan kematian. Kematian adalah fakta yang tidak bisa terelakkan, semua yang bernafas akan merasakan kematian. Jika kita berbicara tentang 'kematian' dalam sebuah obrolan ringan maka semua aura ceria berubah menjadi gelap, dingin, menyedihkan seakan Dementor datang menghampiri.
Kengerian dari istilah kematian ini membuat ilmu kesehatan terus meningkat dari waktu ke waktu. Sampai akhirnya setiap negara memiliki kriteria kematian yang berbeda. Buku ini menceritakan sejarah bagaimana kematian itu di definisikan, lalu timbul istilah baru seperti brain death, teknik CPR, istilah DNR/DNI sampai akhirnya membahas kontroversi dari euthanasia. Author menggambarkan bagaimana kompleksnya masalah di ICU, mengamati pasien-pasien yang mengalami koma dengan vital sign yang masih baik namun sama sekali tidak menunjukkan adanya tanda-tanda perbaikan, hanya bergantung pada sebuah mesin -ventilator- sampai akhirnya kriteria kematian yang telah ada sesuai undang-undang tiba. Aku rasa buku ini banyak membuatku dalam merenungkan hal-hal yang akan kutemui di masa depan nantinya.
When it comes to themselves, doctor certainly don't consider death the worst possible outcome. In fact, the vast majority of physicians value the quality of their life far more than the length or their life. This is reflected in the fact that physicians rarely want to have CPR performed on them if the need arises.
April 22, 2017
An excellent book about the way modern medicine has increased our ability to keep the Grim Reaper at bay (for a time), but at what cost? Medical interventions might keep a heart beating and might keep a person fed, hydrated, and breathing, but medical interventions cannot always prevent pain and suffering. The difference between life and quality of life can be hard to define.
The book's register is quite elevated, making it a challenging read at times. For this reason, I won't assign this to my undergraduate students taking my Death, Dying and Bereavement class. Nevertheless, I found this far-ranging book highly engaging. That being said, my students would probably benefit from reading a late chapter on the way people use social media not just for well wishes for the dying or memorials for the dead, but how the dying use social media to document their dying process.
Warraich looks at end-of-life care through historical, legal, ethical, and medical lenses, allowing the reader to consider the realities and implications of a number of trajectories through the end of life.
While Warraich does draw on a lot on statistics and evidence-based research, he balances his approach with anecdotes. The most challenging section was at the beginning where he describes death on a cellular level. I wish he had placed that deeper in the book. It almost scared me off. Having read about 30 books on death and dying, I do see Warraich as making a valuable contribution to the dialogue. Thoughtful and well informed.
The book's register is quite elevated, making it a challenging read at times. For this reason, I won't assign this to my undergraduate students taking my Death, Dying and Bereavement class. Nevertheless, I found this far-ranging book highly engaging. That being said, my students would probably benefit from reading a late chapter on the way people use social media not just for well wishes for the dying or memorials for the dead, but how the dying use social media to document their dying process.
Warraich looks at end-of-life care through historical, legal, ethical, and medical lenses, allowing the reader to consider the realities and implications of a number of trajectories through the end of life.
While Warraich does draw on a lot on statistics and evidence-based research, he balances his approach with anecdotes. The most challenging section was at the beginning where he describes death on a cellular level. I wish he had placed that deeper in the book. It almost scared me off. Having read about 30 books on death and dying, I do see Warraich as making a valuable contribution to the dialogue. Thoughtful and well informed.
April 27, 2017
Rating: 3.5/5.0
This is an interesting book that talks about a topic most people tend to avoid and that is death. The book discusses death from medical perspective. It also tapped on different other perspectives like the spiritual, religious psychological and some cultural. The good thing that it also discusses some of the most important medical cases related to death and terminal diseases. The good thing that it does not support or highlight a single point of view but represents all the different ideas from different people. The author also focuses on euthanasia (Physician assisted suicide) with some real life cases. Ofcourse you have to make the decison whether you find this acceptable or not. Then there is the issue of whether a patient has a heartbeat but a dead brain and what is needed to be done.
The book also talks about how CPR has changed life and death, how it was invented and how it advanced and was adopted eventually.
There are lots of useful information here, lots of real life cases and lots of statistics that make an interesting reading. I would have loved it if the author would have also tapped on NDEs (Near Death Experiences) and the medical views on those cases, because the book had nothing to say at all about that. There are many people who face death and make it alive, many people went in comma then woke up. Perhaps some talk about this subject would have made the book more interesting. Overall this was an interesting read.
Note: I have won a free copy of this book by participating in a giveaway.
This is an interesting book that talks about a topic most people tend to avoid and that is death. The book discusses death from medical perspective. It also tapped on different other perspectives like the spiritual, religious psychological and some cultural. The good thing that it also discusses some of the most important medical cases related to death and terminal diseases. The good thing that it does not support or highlight a single point of view but represents all the different ideas from different people. The author also focuses on euthanasia (Physician assisted suicide) with some real life cases. Ofcourse you have to make the decison whether you find this acceptable or not. Then there is the issue of whether a patient has a heartbeat but a dead brain and what is needed to be done.
The book also talks about how CPR has changed life and death, how it was invented and how it advanced and was adopted eventually.
There are lots of useful information here, lots of real life cases and lots of statistics that make an interesting reading. I would have loved it if the author would have also tapped on NDEs (Near Death Experiences) and the medical views on those cases, because the book had nothing to say at all about that. There are many people who face death and make it alive, many people went in comma then woke up. Perhaps some talk about this subject would have made the book more interesting. Overall this was an interesting read.
Note: I have won a free copy of this book by participating in a giveaway.
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