Knocking on Heaven’s Door. Katy Butler.

Knocking on Heaven’s Door. Katy Butler. Scribner, New York. 2013. NF, 10/13

I met Katy at a book-promotional reading in San Francisco, and found her charming, sincere, and inspirational. This book is both successful and smack in line with my own healthcare philosophy. And I enjoyed it very much. The strange thing about that is my appreciation overcomes a perception of certain flaws, which only emphasizes the power of the fundamental message.

One of its strengths is unflinching personal show and tell. We really get to know Katy and feel we have been through her profound difficulties with her. A West-Coast journalist struggling with personal, professional, and financial troubles, she sees her father develop dementia and she and her mother, always at odds and uncomfortable in their relationship, awkwardly join forces to try to advocate for switching the dad’s pacemaker off. They encounter opposition from a narrowly-focused technology-centered medical profession. Eventually the father dies and then the mother dies too, she in a better way thanks to the lessons learned with difficulty through her husband’s experience.

The writing varies, but at its best, especially in the early chapters, it is spellbinding and spectacular. I had the all-too-familiar sense that I would never be able to equal her effortless natural music and quick, surprising flight of ideas.

A price one pays for the kind of truth-telling this book contains is dealing with truth not so much stranger than fiction as harder to take. Katy’s relationship with her mother is a lot like real life, including occasionally veering into the incomprehensible and often being frustrating. There is never the least hint of dissimulation, while maintaining most of the time pretty impressive literary balance.

I also found a strong emphasis on spirituality and its polarization with technology hard to identify with, my opposite to thoughtless application of equipment and algorithms tending a bit more toward what I think of as common sense. I didn’t go away convinced that the best answer to mechanization of people and their deaths is transcendental meditation or something like it.

I think the Canadian experience of healthcare stupidity engenders a little bit less specific antithesis to prolonging life by artificial means. I don’t think we would see in most contexts here this stubborn refusal to stop a simple pacemaker from sustaining a life futilely. I liked very much the detailed and well-researched characterization of the development of pacemakers from something cobbled together in a sardine can to a big-business product. I wasn’t quite sure to what extent Katy was being… not sexist exactly… but old-sex-role critical, laughing at some of the cranky haywire early garage technophiles who pioneered the system as we find it. Some of it was quite funny although I’m not sure how intentional that was.

I can’t claim to have had much of a conversation with Katy Butler, preoccupied as she was with her presentation, but I have become friends with two of her colleagues, and recognize through them that her heart is in the right place. Or at least the same place mine is. This book will certainly move the “overtreatment” movement and the one working to demedicalize death along another mile or two. I look forward to whatever she does next.

About John Sloan

John Sloan is a senior academic physician in the Department of Family Practice at the University of British Columbia, and has spent most of his 30 years' practice caring for the frail elderly in Vancouver. He is the author of "A Bitter Pill: How the Medical System is Failing the Elderly", published in 2009 by Greystone Books. His innovative primary care practice for the frail elderly has been adopted by Vancouver Coastal Health and is expanding. Dr. Sloan lectures throughout North America on care of the elderly.
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