In any “there’s good news and there’s bad news” situation, most people want the bad news first, so that the good news becomes dessert – something sweet to offset the bitter that came before. So first I will tell you the bad news about That Good Night: Life and Medicine in the Eleventh Hour by Sunita Puri.
If someone you loved has died in the recent past, or if someone you love is so ill that her or his life is hanging by an IV tube, this book is going to hurt. Because it is a book about dying and death. It brings mortality front and centre. It talks about things we don’t want to even think about, leave alone experience.
Now here’s the good news. This book shows us how to accept mortality. It gives us the options available to us when the people we love are just too worn or tired or hurt to sustain life anymore. It shows what we can do for ourselves too, in preparation for our own possible time on that IV line. It allows us to be scared, worried, guilty, angry, and it gives us permission to be free of all that as long as our motives are right. It is, in other words, 300-odd pages of massive relief.
Sunita Puri, the author of That Good Night, is a doctor in the US, the daughter of Indians who moved to America after years of Partition-created poverty in Mumbai and Delhi. Puri’s mother is an anesthesiologist, and Sunita and her younger brother grew up in a household steeped in medicine. But towards the end of her years as a medical student, Sunita wasn’t sure if she was interested in her subject anymore. She felt she was stagnating. No particular specialty made sense to her. Until, that is, she did a two-week rotation at the teaching hospital’s palliative care unit, where she found her vocation.
Palliative care is a growing medical specialty that can be an option for people for whom medical support in the form of feeding tubes, ventilators, dialysis and so on no longer does any good. If the patient or the person who can make decisions on behalf of the patient decides to stop all such support, the palliative care team works out how best to manage the patient’s pain, how to help the patient achieve what she or he wants to do (for instance, be strong enough to attend a daughter’s wedding), and basically give the patient what medical support cannot give her or him: dignity and quality of life for as long as the patient lives.
Few people want to die during surgery, or while hooked to machines in an ICU. Many of us have parents who’ve made us swear we will never take them to hospital however sick they may be. Those of us who have considered our own mortality have sworn that when our time comes to die, we will not be attached to tubes. But at the crunch, at the eleventh hour, at the time we have to make this decision once and for all, we may find ourselves changing our minds. After all, when the technology of medicine seems able to produce miracles, doesn’t it make sense to try and keep our parents and grandparents and ourselves alive for as long as we can? To quote the poet Dylan Thomas, should we not “rage, rage against the dying of the light”?
Puri discusses this and many other questions in her book and she makes whole possibly hurtful, potentially depressing concept of dying something that is almost magical. Or perhaps it’s the acceptance she feels at the end of the book that is magical. Because her acceptance is your acceptance too. That Good Night is far from being academic, or scientific, or emotionless. Puri is not trying to convince her readers of what she believes. Instead, this book is about her own path to accepting the concept of medically-eased death, with all the doubts, fears, guilt, frustration and anger it entails, and the revelations, epiphanies and peace she finds on her journey.
That’s because though she found her vocation during that two-week rotation at the teaching hospital, Puri had to struggle to understand why exactly she was drawn to palliative care, and then how to make doctors and patients alike aware of its value as an end of life option.
As her struggles play out over the pages of this book, you learn about Puri’s family, some of her many patients, the many people she learned from and the things she learned from them that had little to do with medicine as a subject and lots to do with being a person, her understanding of God, faith and service to humanity, and the way she was brought up by her parents, all of which contributed to and strengthened her belief in palliative care.
You see her come of age both as a person and as a doctor. You see her deal with relatives of patients who accuse her of wanting their relative to die, and people who believe that removing a painful and potentially infection-causing feeding tube from a relative’s stomach means the patient will starve to death. You see her grow to understand her responsibility and grapple with the notion that she’s been taught in medical school to keep people alive, not ease them into death, but look at what she’s doing.
And as you read all this, you feel her occasional anguish, her sometimes confusion, her exhaustion, her doubts and fears, and ultimately her acceptance. Which, as I said earlier, becomes your acceptance. Because Puri writes beautifully. Her words make her journey your journey. And tough as it is, her passage —and yours — to acceptance is beautiful. You have to read this book. It will save your life when you need to learn to accept death.
Kushalrani Gulab is a freelance editor and writer who dreams of being a sanyasi by the sea