My rating: 3 of 5 stars
Disclosure: I choose to read this book for review because I have an healthy fascination with death rituals which stems from studying anthropology. I also have several friends that are going into the medical field or are already there. While reading this book I was looking a relaxed, informational way of portraying the information and cultural attitudes about death, while also looking at any “how they did it” sort of information.
Knocking on Heaven’s Door is a memoir of what Butler and her family went through after her father’s stroke, and details the tribulations of dealing with the corrupt medical system. I applaud Butler for having the guts to write this book. Anyone would find the subject matter personal and extremely difficult to write. However, Butler uses that to infuse the writing with eloquence and passion. Several times I caught myself wishing I could help her and her family during their crisis as any human being would want to help another that is suffering.
During this impassioned writing, Butler does a fairly good job at explaining the medical system, and how the system is set up for allowing a good deal of corruption and pressure from the biomedical industry. During which, she specifically explains Medicare, the pace-maker industry, and how doctors are monetarily rewarded by the industries for putting mechanical parts in people, rather than spending a little extra compassionate time with the patient. Despite having been so affected by this sort of drama, Butler shows heroic constraint when detailing the set up and how it affected her family. You can tell it’s biased, but it is far from inflammatory. The descriptions are simply matter of fact with a personal anecdote.
Butler also recounts the difficulties inherent with getting a life saving medical treatment, such as a pacemaker, turned off when the patient is suffering and miserable, but unable to communicate these thoughts. This is quite possibly the most tragic and interesting parts to me from an anthropological point of view. Butler notes all the people she talked to on the ethics committees, and all the steps they take to ensure that it’s not a murder to turn off the medical equipment. She also notes the limitations of a hospice and a “do not resuscitate” bracelet may affect the various medical decisions along the way. These little notes of wisdom of what the Butler family faced may help others facing similar situations, as well as offer compassion and understanding.
Butler also repeatedly mentions another aspect that I found quite interesting from an anthropological point of view: She notes that her parents grew up in an age where medical advancements were really just starting, and the whole of their generation was enamoured by science, but there wasn’t the healthy dose of skepticism yet. Butler notes the changes coming to such an attitude as information and experiences are had and shared.
There was one part of the book that I thought completely irrelevant, and that was when Butler spent a whole chapter explaining how she and her mother found Zen Buddhism. Not that being a Buddhist is irrelevant, since that aspect shows how she and her mother approached things from a pacifist way. We all know that we are influenced by our beliefs, so that part is relevant. But to spend an entire chapter on the finding of Buddhism shuffled into the middle of the book struck me as not relevant. After this point, my interest in the book dwindled.
Alas, despite the one chapter that threw my attention off, it was a pretty decent book. It was good all the way to the last 2 chapter, which then diverted from the memoir to more of a commentary on “slow medicine” and “good deaths”. In Butler’s opinion, as well as my own, slow medicine for those nearing death and a good death are more important than expensive last ditch efforts to extend life by a day, even if that life is miserable.
As a final note, Butler mentioned in the book that her age was in the early 50s as she went through this ordeal. This information is definitely in a past tense, and there may be advancements in ethics committees and the regulations that Butler didn’t mention. I do hope that a lot of people read this book, and when they do, they have the courage to ask their doctors for more information, then really evaluate their options to live out life the way they want to live through their twilight years.
This was a truly good book, but due to the chapter on how the Butler women came to Buddhism making my attention flag in the middle of the book and the ending chapters being less passionately written than the others, I did not give it 4 or 5 stars. I’d give it 3.5 if Goodreads had allowed it. It’s an enlightening and academic book as much as it is a heart warming and, at times, a heart wrenching memoir.