Skip to main content

Knocking on Heaven’s Door: A Book Review



Knocking on Heaven’s Door” by Katie Butler is a book that will resonate with most of our GeriPal readership. In it she writes about a medical system that is all too enamored with expensive high-tech interventions while high-touch, low-cost interventions are rarely reimbursed yet desperately sought after by family caregivers. It is a theme that we have written about before on this blog, but her story sheds a light on the dysfunction of our health care system when it comes to someone dealing with a chronic, progressive illness like dementia.

Butler leads us through the story of caring for her father Jeffrey, a World War II veteran, professor, and father of three who suffered a stroke in his late 70s. With the honesty that I can only imagine comes from Butler’s time as a reporter, she opens up a world where caregiving duties fall on the shoulders of wives and daughters, of which the medical system and others rely heavily on but provide far too little support.

Butler’s father becomes more frail and more dependent on others as he develops a progressive dementia. The one thing that Butler family would for him to be less dependent on, his pacemaker, is one thing that the family found impossible to discontinue, with doctors stating that deactivation of this device would “be like putting a pillow over your father’s head.”

This past week we have written about putting pacemakers in and turing them off. If any of what we talked about interested you then “Knocking on Heaven’s Door” is a must read. The mix of reporting, personal journal, and instruction manual also makes it an important read for caregivers of older adults with chronic illness. Lastly, this is a perfect gift for those physicians who refuse to deactivate devices like pacemakers because they feel like it is somehow more special than any other life sustaining treatments.

by: Eric Widera (@ewidera)

Comments

Jonathan Langer said…
Thank you Eric for bringing this book to our attention. As a chaplain in a community hospital, we can help the team provide support and care for families facing end of life issues. Your blog is important to us all. Jonathan Langer
Helen Chen, MD said…
Thank you so much, Eric, for helping Katy Butler to bring this important topic out into the light. I haven't read the book yet, so my comments fall into the category of bullcrit ie commentary re: a book not yet read. Reflecting on the quote about 'putting a pillow' I am reminded of how powerful and how dangerous our words can be during clinical encounters especially during such fraught times. We teach our trainees how to account for declines in creatinine clearance when dosing drugs, perhaps we should also teach them (and ourselves) to be judicious in dosing out our words during times when there may be limited emotional reserve.

Popular posts from this blog

Geroscience and it's Impact on the Human Healthspan: A podcast with John Newman

Ok, I'll admit it. When I hear the phrase "the biology of aging" I'm mentally preparing myself to only understand about 5% of what the presenter is going to talk about (that's on a good day).  While I have words like telomeres, sirtuins, or senolytics memorized for the boards, I've never been able to see how this applies to my clinical practice as it always feels so theoretical.  Well, today that changed for me thanks to our podcast interview with John Newman, a "geroscientist" and geriatrician here at UCSF and at the Buck Institute for Research on Aging.

In this podcast, John breaks down what geroscience is and how it impacts how we think about many age-related conditions and diseases. For example, rather than thinking about multimorbidity as the random collection of multiple different clinical problems, we can see it as an expression of the fundamental mechanisms of aging. This means, that rather than treating individuals diseases, targeting …

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Becoming an Advocate for Older Adults: A Podcast with Joanne Lynn

Geriatricians in the 2030s may be able to prescribe very costly medications for older Medicare beneficiaries who cannot get supper. Most older Americans who live with disabilities will not be able to pay for adequate housing, food, medicine, and personal care. All who serve older adults must shoulder the responsibility to help avert this oncoming suffering and social disruption. The window of opportunity for effective change is already narrow; procrastinating for a decade will be too late.
These are the words of Joanne Lynn, a geriatrician and palliative care physician, who leads Altarum’s work on eldercare. She wrote a recent JAGS editorial titled The “Fierce Urgency of Now”: Geriatrics Professionals Speaking up for Older Adult Care in the United States” which is very much a call to action for those who care for older adults.  We talk with Joanne about this article and some meaningful things clinicians in both geriatrics and palliative care can do to be advocates for a growing popu…