Synopses & Reviews
Like so many of us, award-winning writer Katy Butler always assumed her aging parents would experience healthy, active retirements before dying peacefully at home. Then her father suffered a stroke that left him incapable of easily finishing a sentence or showering without assistance. Her mother was thrust into full-time caregiving, and Katy became one of the 24 million Americans who help care for aging parents. In an effort to correct a minor and non-life threatening heart arrhythmia, doctors outfitted her father with a pacemaker. The device kept his heart beating but did nothing to prevent his slide into dementia, incontinence, near-muteness, and misery. After several years, he asked his wife for help, telling her, "I am living too long."
Mother and daughter faced a series of wrenching moral questions: When does death cease being a curse and become a blessing? Where is the line between saving life and prolonging a dying? When is the right time to say to a doctor, "Let my loved one go"?
When doctors refused to disable the pacemaker, sentencing her father to a protracted and agonizing death, Katy set out to understand why. Her quest had barely begun when her mother faced her own illness, rebelled against her doctors, refused open-heart surgery, and instead met death head-on. Knocking on Heaven's Door, a revolutionary blend of memoir and investigative reporting, is the fruit of the Butler family's journey.
With a reporter's skill, a poet's eye, and a daughter's love, Butler explores what happens when our terror of death collides with the technological imperatives of modern medicine. Her provocative thesis is that advanced medicine, in its single-minded pursuit of maximum longevity, often creates more suffering than it prevents. Butler lays bare the tangled web of technology, medicine, and commerce that modern dying has become and chronicles the rise of Slow Medicine — a growing movement that promotes care over cure.
Knocking on Heaven's Door is a visionary map through the labyrinth of a broken and morally adrift medical system. It will inspire the necessary and difficult conversations we all need to have with loved ones as it illuminates a path to a better way of death.
"In this eloquent exegesis on taking control of the end of one's life, Butler defines a 'good death' as one that is free from unnecessary medical intervention and faced with acceptance and dignity. The book is an expansion of her groundbreaking New York Times Magazine article, published in June 2010. A journalist living in Northern California, Butler helped her aging parents, who lived in Middletown, Conn., through several serious health issues (both parents have since died). She writes affectingly of her parents' wishes to make moral decisions about their deaths in spite of the medical establishment's single-minded efforts to prolong their lives, regardless of the quality of those lives. Butler's father had a pacemaker installed in 2003 after an earlier stroke, allowing his heart to continue functioning indefinitely even as his overall health deteriorated. The brunt of his care fell on Butler's prickly, authoritarian mother to the anguish of Butler, who eventually became her father's caregiver, despite living 3,000 miles away and having two able-bodied younger brothers. Butler usefully weighs the benefits of life-prolonging medical care, and argues persuasively for helping elders face death with foresight and bravery. Agent: Amanda Urban, ICM. (Sept.)" Publishers Weekly (Starred Review) Copyright PWxyz, LLC. All rights reserved.
"Katy Butler's science background and her gift for metaphor make her a wonderfully engaging storyteller, even as she depicts one of our saddest but most common experiences: that of a slow death in an American hospital. Knocking on Heaven's Door is a terrible, beautiful book that offers the information we need to navigate the complicated world of procedure and technology-driven health care. I'm recommending it to all my friends with aging parents or partners, and holding on to a copy for myself."
Mary Pipher, author of Reviving Ophelia and Seeking Peace: Chronicles of the Worst Buddhist in the World
"Katy Butler's new book — brave, frank, poignant, and loving — will encourage the conversation we, as a society, desperately need to have about better ways of dying. From her own closely-examined personal experience, she fearlessly poses the difficult questions that sooner or later will face us all."
Adam Hochschild, author of King Leopold's Ghost and To End All Wars
"Intimate and wise, heartbreakingly compassionate, and critically helpful, this is a truly important work that I hope will be widely read. We have lost our way and Katy Butler's impeccably researched and powerful tale will help eliminate much suffering on the passage to the mystery of death."
Dr. Jack Kornfield, author of A Path with Heart
"This is the most important book you and I can read. It is not just about dying, it is about life, our political and medical system, and how to face and address the profound ethical and personal issues that we encounter as we care for those facing dying and death. You will not be able to put this book down. Its tenderness, beauty, and heart-breaking honesty matches the stunning data on dying in the West. A splendid and compassionate endeavor."
Joan Halifax, PhD, Founding Abbot, Upaya Institute/Zen Center and Director, Project on Being with Dying: Cultivating Compassion and Fearlessness in the Presence of Death
"This is a book so honest, so insightful and so achingly beautiful that its poetic essence transcends even the anguished story that it tells. Katy Butler's perceptive intellect has probed deeply, and seen into the many troubling aspects of our nation's inability to deal with the reality of dying in the 21st century: emotional, spiritual, medical, financial, social, historical and even political. And yet, though such valuable insights are presented with a journalist's clear eye, they are so skillfully woven into the narrative of her beloved parents' deaths that every sentence seems to come from the very wellspring of the human spirit that is in her. This elegiac volume is required reading for every American adult; it has about it a sense of the universal."
Dr. Sherwin B. Nuland, author of How We Die: Reflections of Life's Final Chapter
"Knocking On Heaven's Door is a disquieting book, and an urgent one. Against a confounding bioethical landscape, Katy Butler traces the odyssey of her parents' final years with honesty and compassion. She does a great service here, skillfully illuminating issues most of us are destined to face sooner or later. I cannot imagine a finer way to honor the memory of one's parents than in such a beautifully rendered account."
Alexandra Styron, author of Reading my Father
"This beautifully written and well researched book will take you deep into the unexplored heart of aging and medical care in America today. With courage, unrelenting honesty, and deepest compassion, Katy Butler shares her saga of how a family of independent, thoughtful, and complex souls attempt to navigate their uncharted journey through medical institutions and specialties. Here, the degree of individual and family suffering turns on myriad decisions, large and small, coerced by economic and institutional forces. Knocking on Heaven's Door makes it clear that until care of the soul, families, and communities become central to our medical approaches, true quality of care for elders will not be achieved."
Dennis McCullough, author of My Mother, Your Mother: Embracing 'Slow Medicine,' the Compassionate Approach to Caring for Your Aging Loved Ones
"This is some of the most important material I have read in years, and so beautifully written. It is riveting, and even with parents long gone, I found it very hard to put down. Katy Butler's book will challenge and nourish you. I am deeply grateful for its truth, wisdom, and gorgeous stories — some heartbreaking, some life-giving, some both at the same time. Butler is an amazing and generous writer. This book will change you, and, I hope, our society."
Anne Lamott, author of Help, Thanks, Wow
"A forthright memoir on illness and investigation of how to improve end-of-life scenarios. With candidness and reverence, Butler examines one of the most challenging questions a child may face: how to let a parent die with dignity and integrity. Honest and compassionate thoughts on helping the elderly through the process of dying."
An exquisitely written, expertly reported memoir and exposé of modern medicine that leads the way to more humane, less invasive end-of-life care — based on the author's acclaimed New York Times Magazine
This is the story of one daughter's struggle to allow her parents the peaceful, natural deaths they wanted — and to investigate the larger forces in medicine that stood in the way.
When doctors refused to disable the pacemaker that caused her eighty-four-year-old father's heart to outlive his brain, Katy Butler, an award-winning science writer, embarked on a quest to understand why modern medicine was depriving him of a humane, timely death. After his lingering death, Katy's mother, nearly broken by years of nonstop caregiving, defied her doctors, refused open-heart surgery, and insisted on facing death the old-fashioned way: bravely, lucidly, and head on.
In this visionary memoir, based on a groundbreaking New York Times Magazine
story, award-winning journalist Katy Butler ponders her parents' desires for "Good Deaths" and the forces within medicine that stood in the way.
Katy Butler was living thousands of miles from her vigorous and self-reliant parents when the call came: a crippling stroke had left her proud seventy-nine-year-old father unable to fasten a belt or complete a sentence. Tragedy at first drew the family closer: her mother devoted herself to caregiving, and Butler joined the twenty-four million Americans helping shepherd parents through their final declines.
Then doctors outfitted her father with a pacemaker, keeping his heart going but doing nothing to prevent his six-year slide into dementia, near-blindness, and misery. When he told his exhausted wife, "I'm living too long," mother and daughter were forced to confront a series of wrenching moral questions. When does death stop being a curse and become a blessing? Where is the line between saving a life and prolonging a dying? When do you say to a doctor, "Let my loved one go?"
When doctors refused to disable the pacemaker, condemning her father to a prolonged and agonizing death, Butler set out to understand why. Her quest had barely begun when her mother took another path. Faced with her own grave illness, she rebelled against her doctors, refused open-heart surgery, and met death head-on.
With a reporter's skill and a daughter's love, Butler explores what happens when our terror of death collides with the technological imperatives of medicine. Her provocative thesis is that modern medicine, in its pursuit of maximum longevity, often creates more suffering than it prevents.
This revolutionary blend of memoir and investigative reporting lays bare the tangled web of technology, medicine, and commerce that dying has become. And it chronicles the rise of Slow Medicine, a new movement trying to reclaim the "Good Deaths" our ancestors prized.
Knocking on Heaven's Door is a map through the labyrinth of a broken medical system. It will inspire the difficult conversations we need to have with loved ones as it illuminates the path to a better way of death.
About the Author
Katy Butler, a former finalist for a National Magazine Award, has written for The New Yorker, The New York Times Magazine, Vogue, and other publications. Her work is anthologized in The Best American Science Writing, The Best American Essays, and The Best Buddhist Writing. A winner of the "Science in Society" award from the National Association of Science Writers, she lives in northern California.