That Good Night: Life and Medicine in the Eleventh Hour - Puri, Sunita Review & Synopsis

Synopsis "A profound exploration of what it means for all of us to live-and to die-with dignity and purpose." -People "Visceral and lyrical." -The Atlantic As the American born daughter of immigrants, Dr. 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. Review Sunita Puri is an assistant professor of clinical medicine at the University of Southern California, and medical director of palliative medicine at the Keck Hospital and Norris Cancer Center. She has published essays in The New York Times, Slate, The Journal of the American Medical Association, and JAMA-Internal Medicine. She lives in Los Angeles.One SHIFT San Francisco, 2010 Donna was in her mid- sixties, with wide brown eyes and the smoky voice of a jazz singer. Her skin, sprinkled with freckles and sunspots, stretched tightly against her delicate cheekbones and jaw. It was an unusually balmy afternoon in San Francisco, and somehow the day's heat and humidity had made its way into her room on the fourteenth floor of the usually chilly university hospital. Donna grasped a handheld electronic fan, closing her eyes as it cooled her face and tousled strands of the thin gray- brown hair that brushed her shoulders. When I met her, I was a fourth- year medical student weeks away from graduation, yet increasingly uncertain that medi�cine was the right career for me. Five years earlier, Donna's kidneys began to fail from a combination of high blood pressure and diabetes. She was weak and nauseated, and missed so many days at work that she nearly lost her job as a secretary in a contrac�tor's office. In order to feel better and to survive, Donna had to begin dialy�sis, a three- hour- long treatment three times a week that would clear her blood of the waste products and toxins that her failing kidneys could no longer remove. A vascular surgeon operated on Donna's arm to create a fistula, a connection between an artery and vein that enabled the dialysis machine to remove, clean, and return all of Donna's blood to her body. For the first few years, dialysis not only staved off death but actually improved her energy and outlook. She went back to work part time. Her nausea vanished and she managed to gain back the ten pounds she'd lost when kid�ney failure claimed her appetite. But a few years later, her nausea and fatigue returned; dialysis began to cause the symptoms it had once fixed. Donna cycled in and out of the hos�pital with severe infections of the skin around her fistula and blood clots that plugged her fistula, rendering dialysis impossible. During a recent hos�pitalization, a team of physicians had placed a temporary dialysis catheter in one of the large veins in her neck while another team worked on repairing her fistula, which had clotted again. Yet she returned to the hospital several weeks later with a severe pneumonia, likely caused by powerful bacteria she'd been exposed to during her last hospital stay. When she finally left the hospital, she needed three weeks' worth of physical therapy in a nursing home before she was strong enough to care for herself at home. Though she was able to return home, she struggled to dress herself, cook, or drive to her dialysis sessions every Monday, Wednesday, and Friday. She had come to the hospital today because a blood clot once again clogged her fistula. Her doctors wanted to place another temporary dialysis catheter and consult a vascular surgeon to create a new dialysis fistula alto�gether. But Donna said no. I don't want dialysis anymore, Donna told her doctors. I've lived a good life. If Donna doesn't want dialysis, her doctors wondered, then what does she want and how should we treat her? These were questions I had rarely encountered or considered in my years as a medical student. Like the doc�tors who taught and supervised me, I was hardwired to preserve and pro�long life. On the few occasions I'd seen patients opt out of lifesaving treatments, I'd watched my supervising doctors struggle to articulate an�other plan- and the consequences and limits of any plan at all. Donna's team knew they needed help having that sort of delicate conversation with her, so they called the palliative care team to speak with Donna and help clarify what she wanted if she didn't want dialysis. As it happened, I met Donna because I had chosen to spend two weeks of elective time on the palliative care service at the University of California, San Francisco, where I was finishing my last months of medical school be�fore beginning three years of residency training in internal medicine. I'd completed all of the required rotations to graduate, having spent one to two months each learning from teams of internal medicine physicians, gyne�cologists, family physicians, surgeons, pediatricians, psychiatrists, and neu�rologists. Now, in these last months of medical school, I'd been able to choose which medical specialties I wanted to learn, and which doctors I wanted to learn from. I searched the list of electives for inspiration. Medical school had been far more technical than humanistic, its emphasis heavy on the science of medicine, light on the art of doctoring. In the first few years of medical school, I understood why this might be the case: I couldn't diagnose and treat patients without an expert understanding of the body's physiology, the ways disease could alter it, and the proper ways to treat the dizzying myriad illnesses humans suffered. Yet during my rotations, when I actually saw patients under the guidance of a resident and attending physician, I'd been struck by how little time I spent with patients- to more than a few min�utes on rounds, and occasionally a few more minutes later in the day, when absolutely necessary. Entire days whizzed by as we ordered and waited for the results of lab tests and CT scans, typed detailed notes about patients into their electronic health records, met with social workers to figure out how to get patients home as quickly as possible, and talked with cardiologists and gastroenterologists about their recommendations for our patients. Caring for patients somehow meant spending very little time with them. One day, out of curiosity, I timed myself completing my assigned tasks. I spent twice as long in front of a computer as I did examining and talking to my patients. As graduation and the start of residency loomed, thoughts of quitting medicine arose unbidden in my mind. When I looked through the list of electives I could take, I was really searching desperately for reasons to finish my training. I'd go on to spend a month working with a psychiatrist who specialized in treating patients struggling with substance abuse. I'd spend another month working with a child abuse response team at the county hospital. A classmate recommended that I take a two- week- long rotation with the palliative care team, and I found myself signing up for an elective with them, too. Donna was the first patient I'd see with Dr. McCormick, the physician on the palliative care team during my rotation. A handsome man with gen�tle brown eyes and a warm smile, Dr. McCormick wore a blue plaid shirt and khakis and worked closely with a social worker and a chaplain named Ellen. We sat together around a rectangular table and talked about each of the twelve patients our team was seeing, including Donna, our newest re�ferral. "Sounds like the medical team wants to do what they can to help Donna continue dialysis, but she's not digging that plan," Dr. McCormick said, summarizing the dilemma that Donna's doctors needed us to address. "So let's go find out what she's got on her mind!" He was casual and person�able, professional but not distant. As we walked together down a set of hallways to Donna's room, it struck me that Dr. McCormick had never met Donna before. I wondered how he, a stranger at the eleventh hour of Don�na's life, would manage to earn her trust and ask her intimate questions that it seemed nobody had asked her before, including the many doctors who had been taking care of her since her kidneys began to fail. Sunlight poured through the window across from Donna's hospital bed. I noticed her squinting and lowered the shade slightly. Instead of hovering over her or leaning against the wall as she spoke, Dr. McCormick, Ellen, and I sat in gray folding chairs facing Donna. On the table next to her hos�pital bed, there was a brown tray with plastic rectangles of smashed peas, fluorescent orange carrots, and a small chicken breast. Someone had checked the boxes "low sodium" and "renal diet" and "diabetic" on a pink slip of paper taped to the side of the tray. "It's dialysis food," Donna said, wrinkling her nose as she noticed me looking at her lunch. "Makes me more nauseated than my kidneys do." A copy of Chicken Soup for the Soul, many of its yellowed pages dog- eared, rested next to her untouched tray. Dr. McCormick spoke to Donna in a soft tone that exuded compassion and presence. "We are from the palliative care team, and we're just here to get to know you and to support you as you think through some of the deci�sions your medical team is asking you to make," Dr. McCormick said. "I need . . . all the support . . . I can get," Donna replied, her voice fading into a whisper as she made her way through her sentences. Donna's fatigue penetrated her every word and attempted action. Lift�ing a forkful of green beans to her mouth had become an accomplishment, she told us. She scratched her arms during our conversation, and dry skin flaked onto the blue hospital blanket. I had seen patients who looked as chronically fatigued and debilitated by disease as she did, but none who re�fused the therapies we offered, even when I wondered if they were strong enough to benefit from them. Dread had consumed Donna on the ambulance ride from her dialysis center to the hospital. She told us she had felt her heart thumping against her chest as though it were warning her of impending danger. She knew her doctors would offer her another procedure or surgery to fix her fistula and allow her to continue dialysis. But a question surfaced in her mind, one she'd considered from time to time over the past several months: Would a shorter life without dialysis be better than a longer life with dialysis? "I'm not suicidal," she whispered. "I'm tired." She told us about the many ways that dialysis had enabled her to enjoy the past five years. She would miss her adopted daughter and the view of the Bay Bridge from her front porch. She would miss making her mother's rec�ipes for barbecued ribs and lemon tart. But she wouldn't miss the crushing fatigue of kidney failure that had slowly deprived her of one independence after another: The ability to use the toilet in her Spanish- tiled bathroom. The pleasure of taking a shower alone, scrubbing herself with lavender body wash, standing rather than sitting in a plastic shower chair. The full sensory immersion in her garden, hands deep in the fragrant earth as she tended her marigolds and daisies, leaving behind imprints of her knees in the soft dirt. "I am sorry this has been so tough for you," Dr. McCormick said to Donna, handing her a box of tissues. "I hear you saying that dialysis has really helped you to live well and to enjoy your life, but I also hear that over the past year it's really been making you tired and sometimes it's even made you sick." "Yes, it has," Donna said, pausing to catch her breath. Even crying wore her out. "Have your other doctors talked with you about what stopping dialysis would mean?" I held my breath, unsure exactly what Dr. McCormick was asking. Did he want Donna to say out loud that she knew she would die without dialysis? "Honestly . . . they didn't really . . . say too much," she said, wrapping thin shreds of tissue paper around her right index finger. "What would . . . happen to me?" "Well, the first thing you need to know is that it is okay for you to want to stop dialysis if it is not helping you to live well," Dr. McCormick began. "But it is also very important for you to understand what would happen without dialysis. The toxins that dialysis usually removes from your blood would build up." "And then . . . I would . . . die?" Donna whispered. "Yes, you would die from your kidneys failing," Dr. McCormick replied. I had never seen a doctor tell a patient so directly that they would soon die. I'd seen well- intentioned doctors try to soften the blow of hard facts by cluttering their sentences with rambling apologies or canned reassurances, talking around the truth. Their worry that a patient might be unable to handle plainly stated facts, that they must require unnecessary words and sentiments as a sort of shock absorber, struck me as a form of paternalism. Dr. McCormick's sentences, concise and compassionate, almost felt transgressive. I had never seen a doctor disclose a wrenching truth with acceptance rather than avoid�ance. His voice was steady and clear, free of euphemisms like "passing on" or "being at peace." I waited for Donna to stop the conversation, to say that dis�cussing death so openly overwhelmed her. But all she did was nod. It was as though Dr. McCormick had validated what she already knew, as if she found this statement of truth comforting. "But our focus would be making sure that you are comfortable and free of any suffering during that time." He looked Donna in the eyes, placing his hand respectfully on her shoulder and nodding his head deeply to emphasize the last part of his sentence. "How would . . . I suffer?" Donna asked, suddenly looking at me. Even though after years of studying I could tell Donna everything about how her kidneys work and what happens to her body when they fail, I hadn't the slightest idea how she would experience dying from kidney failure, or what medications could ease her suffering. My silence stunned me. I struggled to understand how I could be on the cusp of becoming a physician and lack the words to answer her question, to guide her through the one certain transi�tion every patient of mine, every human being including myself, would ex�perience. "When you stop dialysis, one of the most common things that happens is that the fluid that dialysis usually takes out of the body can build up in the lungs, and you can have some difficulty breathing," Dr. McCormick began, and Donna nodded. "So I would give you medicines to help prevent any gasping or difficulty breathing you might have." "Good," Donna whispered, adding, "I don't . . . want . . . to suffocate." "There are two medicines I will make sure we give you so that you don't experience that awful feeling," Dr. McCormick said. "The other thing that can happen is that the toxins that build up when you stop dialysis can make you confused and eventually sleepy. Usually this isn't painful, but it can worry those around you." "I don't . . . want pain," Donna responded, and Dr. McCormick quickly reassured her that kidney failure generally doesn't cause pain, and death would arrive only after loss of consciousness. Kidney failure, he told her gently, could be a very merciful way to die. I had never seen this type of doctoring before. As the conversation unfolded, I felt a knot in my stomach harden, real�izing the enormous implications of Donna's statements. Intellectually, I knew that patients could choose not to start a treatment or discontinue a treatment that wasn't helping them, but I had never witnessed a patient say that their quality of life was actually worsened by a treatment intended to help them live. "I'm ready," Donna whispered. "I know . . . God is . . . waiting for me," she whispered. Chaplain Ellen took Donna's hand and asked her if she found solace in religion or spirituality. Donna nodded, whispering that she was a Christian, asking Ellen to pray with her. As Ellen read from the book of Psalms, Donna's shallow breathing slowed, her face relaxing. "When the righteous cry for help," Ellen read, "the Lord hears and delivers them out of all their troubles. The Lord is near to the brokenhearted and saves the crushed in spirit." "Thank you, sister," Donna whispered. The dying I had encountered prior to meeting Donna had been either sud�den and unexpected (the result of a terrible car accident) or a failure of t... That Good Night “A profound exploration of what it means for all of us to live—and to die—with dignity and purpose.” —People “Visceral and lyrical.” —The Atlantic As the American born daughter of immigrants, Dr. 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. 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 ..." The Grief Handbook The Grief Handbook will take you by the hand and offer empathy and compassion, helping you through what can feel like the worst days of your life. Bridget McNulty lost her mum suddenly. She couldn't find the support that she needed in the rawness of her immediate grief, and the loneliness felt profoundly shocking. The Grief Handbook weaves her personal experience with expert psychological insights and practical advice, to enable you to navigate your grief in your own way. There is no one-size-fits-all recovery process for bereavement. Understanding that each experience of grief is unique, you can stop worrying about how you should be feeling. This interactive journal offers you room to explore your feelings at your own pace, helping you not to shy away from the enormity of your heartbreak. To be able to move through grief we need to understand our emotions, tune into our needs and know that what we are feeling is normal. Grief isn’t something to “get over”, but a loss to honour and live with. This gentle book shows us how A guide through the worst days of your life Bridget McNulty ... Burnout: The Secret to Unlocking the Stress Cycle (New York: Random House, 2019) Puri , Sunita , That Good Night : Life and Medicine in the Eleventh Hour (New York: Viking ..." Every Deep-Drawn Breath Winner of a Christopher Award—now with a discussion guide “Perhaps one lesson to draw from the pandemic, with help from books like this one, is that the ICU experience can be changed for the better” (The Washington Post) for both patients and their families. You will learn how in this timely, urgent, and compassionate work by a world-renowned critical care doctor. In this rich blend of science, medical history, profoundly humane patient stories, and personal reflection, Dr. Wes Ely describes his mission to prevent ICU patients from being harmed by the technology that is keeping them alive. Readers will experience the world of critical care through the eyes of a physician who drastically changed his clinical practice to offer person-centered health care and through cutting-edge research convinced others to do the same. Dr. Ely’s groundbreaking investigations advanced the understanding of post– intensive care struggles and introduced crucial changes that reshaped treatment: minimizing sedation, maximizing mobility, and providing supportive aftercare. Dr. Ely shows that there are ways to bring humanity into the ICU and that “technology plus touch” is a proven path toward returning ICU patients to the lives they had before their hospital stays. An essential resource for anyone who will be affected by illness—which is all of us. A Critical Care Doctor on Healing, Recovery , and Transforming Medicine in the ICU Wes Ely ... — Rana Awdish , MD, author of In Shock : My Journey from Death to Recovery and the Redemptive Power of Hope “Every Deep-Drawn ..." Living Well with a Serious Illness A practical guide for understanding how palliative care can improve quality of life for patients and their caregivers. Robin Bennett Kanarek was a registered nurse working with patients suffering from chronic medical conditions when her ten-year-old son was diagnosed with leukemia. As her son endured grueling treatments, Robin realized how often medical professionals overlook critical psychological, emotional, and spiritual support for people with life-threatening illnesses. Living Well with a Serious Illness is the culmination of decades of Robin's work to advance the field of palliative care. Although palliative care is often associated with hospice and end-of-life planning, Kanarek argues for a more expanded definition that incorporates palliative care earlier in patients' journeys. Living Well with a Serious Illness helps patients and their caregivers understand • what palliative care entails • how to access the support they need when going through a serious illness • what questions to ask medical professionals • how to navigate advanced care planning • definitions of common terminology used with end-of-life planning • the importance of spiritual care, coping strategies, and emotional support • how to become an advocate for palliative care This book illuminates the importance of seeing patients as individuals who can benefit from care for their body, mind, and spirit—the core tenet of palliative care. Atul Gawande, Being Mortal: Medicine and What Matters in the End (New York: Metropolitan Books, 2014), 187. 2. ... Sunita Puri , That Good Night : Life and Medicine in the Eleventh Hour (New York: Viking, 2019), 10. 2." Gastroparesis Gastroparesis: Pathophysiology, Clinical Presentation, Diagnosis and Treatment is a reference book providing a centralized source of data on gastroparesis collected over the last decade. Contents include the pathophysiology, clinical presentation, diagnostic recommendations and treatment options for gastroparesis. The reference is split into broad subsections, with the strategy of first focusing on the key features of the disease and then turning to controversies, recent developments, patient support resources, the spectrum of treatment – including medical and surgical - and future directions. Chapters will include coverage of important topics like autonomic neuropathy, the brain-gut axis, potential pathophysiological advances at the cellular level, diagnostic and therapeutic options specifically targeted at the pylorus, and the evaluation of the female predominance in gastroparesis. This is a must-have resource for scientists looking to find the next step in their research as well as healthcare professionals ranging from Gastroenterologists to Internists, Surgeons, Nutritionists, Psychiatrists, and Psychologists, Residents and Medical Students who struggle with how to optimally take care of their gastroparetic patients. Provides a comprehensive overview of what is known regarding the pathophysiology, clinical presentation, diagnostic considerations and treatment options for gastroparesis Includes key updates made in the last decade, including the progress made by the NIH Gastroparesis Consortium Presents both sides of key controversies in the field, including the debate between classification of gastroparesis versus functional dyspepsia Fully reviews the major advances in pharmacologic agents for therapy, both anti-emetics and prokinetics Extensive update on the "Pyloric Revolution" and our understanding of the pathophysiology of gastroparesis and how the focus on the pylorus has literally transformed our treatment strategy with an emphasis on both surgical and endoscopic advances in addressing pyloric dysfunction That Good Night : Life and Medicine in the Eleventh Hour by Sunita Puri Responders elaborated on the benefit of books over websites as being the ease of flipping open to important pages that have been marked for reference." Dear Doctor In the form of an open letter from patients to their doctors, spiritual writer and professor of medical humanities Marilyn McEntyre brings to light the hidden fears, desperate needs, deepest hopes, and heartfelt truths that many feel doctors overlook in their approach to health care. It's a clarion call for doctors to attend to the whole person and listen deeply, rather than rush to assess a set of symptoms. And it's a letter that informs doctors of the many things that patients already know about themselves and their health. Engaging and candid, Dear Doctor covers the basics of how patients view their time with doctors, how they want doctors to collaborate on health issues, and even how patients bring their faith and spirituality to their view of their health and their bodies. Ultimately, this book is an important first step to begin a dialogue between two communities that often have a very large disconnect. On medical reticence about dying, Sunita Puri in That Good Night : Life and Medicine in the Eleventh Hour , points out sharply, “Lacking the language to discuss mortality is the ultimate way of erasing it.” I don't know if anyone has ever ..." The Dark Between Stars “So inspiring . . . if you have a flair for the fantastical, this poet is certainly for you.” —TEEN VOGUE “In the simplest way, Atticus captures those little things that make life magic.” —KARLIE KLOSS “The entire read is the feeling of a soft summer love song—full of lust and longing.” —CBC NEWS “So inspiring . . . if you have a flair for the fantastical, this poet is certainly for you.” —TEEN VOGUE “In the simplest way, Atticus captures those little things that make life magic.” —KARLIE KLOSS “The entire read is the ..." Telepon Pertama dari Surga (The First Phone Call from Heaven) “Bagaimana seandainya akhir bukanlah akhir?” Suatu pagi di Coldwater, Michigan, telepon-telepon mulai berdering. Para peneleponnya berkata mereka menelepon dari surga. Mukjizatkah ini? Atau olok-olok kejam? Ketika berita ini menyebar, banyak orang mulai berdatangan ke Coldwater untuk ikut membuktikan. Pada saat yang sama, Sully Hardings, pilot yang telah kehilangan nama baiknya, baru bebas dari penjara dan mendapati kota tempat tinggalnya sedang mengalami “demam mukjizat.” Bahkan anaknya yang masih kecil membawa-bawa ponsel mainan karena berharap ditelepon ibunya dari surga. Ketika telepon-telepon ini makin sering terjadi, dan bukti adanya kehidupan di alam baka mulai terkuak, kota itu––dan dunia––mulai berubah. Hanya Sully yang tidak percaya. Baginya, tidak ada apa-apa lagi setelah dunia yang penuh kesedihan ini. Dan dia bertekad untuk membuktikannya, bagi anaknya dan bagi dirinya sendiri. Dalam Th e First Phone Call from Heaven, Mitch Albom bertutur dengan fasih tentang kisah cinta, sejarah, dan keyakinan; suatu misteri mendebarkan dan perenungan tentang kekuatan hubungan antarmanusia. Dalam Th e First Phone Call from Heaven, Mitch Albom bertutur dengan fasih tentang kisah cinta, sejarah, dan keyakinan; suatu misteri mendebarkan dan perenungan tentang kekuatan hubungan antarmanusia."