THAT GOOD NIGHT

Doctors labor to cure disease and (recently) comfort the dying, but this moving memoir portrays a doctor practicing a new specialty that fills a gap between the two approaches.

Puri (Clinical Medicine/Univ. of Southern California), the medical director of palliative medicine at the Keck Hospital of USC and the USC Norris Cancer Hospital, hits the ground running with an impressive debut. The daughter of workaholic, immigrant physician parents who assumed she would follow in their footsteps, she acquiesced and dove into the field. During training, she thrilled to see her skills cure disease and relieve suffering, but she became increasingly disturbed when they didn’t. Repeatedly, she witnessed patients with devastating illnesses and little hope of cure made sicker by treatments the doctors themselves knew were futile. Patients and families usually encouraged this, in the belief that one must always “fight” disease; to do otherwise is to “give up.” Using often heart-rending examples, the author emphasizes that the best treatment of advanced cancer may not be more toxic chemotherapy. A victim of end-stage lung disease grows familiar with a respirator, but ultimately the lungs will fail to recover enough to breathe without it. Many patients live years bedridden with a respirator, their family praying for a miracle. A better alternative is to discuss what is happening and plan for a future where matters might not go as everyone hopes. Doctors hate doing this, so they discuss pros and cons, allowing the patient or family to choose. Thus, hearing that a treatment for metastatic breast cancer might prolong life for several months but also cause misery and harm, people usually choose treatment under the mistaken belief that treatment means “cure” and no treatment means abandonment. Called to assist, Puri recounts many painful exchanges, which, when successful, allow patients and those who love them to embrace a deeper understanding of their mortality.

A profound meditation on a problem many of us will face; worthy of being mentioned in the same breath as Atul Gawande’s Being Mortal (2014).