By Julie Grimstad
That Good Night allows the reader to peer into palliative care medicine through the window of a fervent practitioner’s eyes. Dr. Puri’s experiences in her professional life—including moving stories about some of her patients—are interwoven with threads of her personal life as the child of immigrants from India. The book reads like a good novel.
My review begins at the end, not to give away the tender closing chapter, but simply to say that I wanted to keep turning pages when there were no more to turn. This is a great compliment to the author. Nevertheless, a thorny question kept intruding on my enjoyment of this book: Is Dr. Puri totally unaware that hospice and palliative medicine is riddled with fraud, abuse, and even intentionally caused deaths? She mentions a few shortcomings of hospice, such as not paying trained caregivers to help dying patients remain comfortable at home, but generally presents an idealistic picture of hospice and palliative care without a hint that not all palliative care is good.
That said, Dr. Puri’s descriptions of her intensely difficult conversations with patients and families reveal a physician who is both sensitive and kindhearted. She strives to use language ordinary people can understand to communicate the medical information they need in order to make sound and informed healthcare decisions. She is attentive to patients’ emotional and spiritual needs. She does not offer easy solutions, but instead asks questions to discover each patient’s hopes and wishes so that she might help fulfill them when possible. This is the kind of doctor I would want for myself or a loved one with a serious illness, even though, as a Christian, I can’t agree with her perspective on some essential issues.
There is not a single case in the book where Dr. Puri withheld or withdrew treatment against a patient’s expressed wishes. Unfortunately, her viewpoint regarding withdrawal or withholding of ordinary treatment and care based on quality of life or patient preferences is not pro-life. For example, the caregiver of an elderly patient with dementia was distraught that her patient, and longtime friend, had refused a feeding tube in her medical advance directive. Dr. Puri assured the caregiver, “You wouldn’t be starving her, Anna. You would only be honoring her wishes.” That is not logical because, if a person dies from denial of food and water, she dies of starvation. Her wishes don’t alter that fact. Deliberately starving someone to death is immoral and barbaric.
Overall, this is a good book, but one that has some shortcomings we must not ignore.
Julie Grimstad serves as president of the Healthcare Advocacy and Leadership Organization. A nationally known speaker and writer, she addresses many aspects of medical decision-making and patient advocacy. She has served as a volunteer patient advocate since 1985.
This article, and others like it, can be found at clmagazine.org.