Last Rights: Rescuing the End of Life from the Medical System

Last Rights: Rescuing the End of Life from the Medical System

by Stephen P. Kiernan

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"Gripping…A superb resource for boomers dealing with their parents' final days…as well as for health-care professionals who need to hear this story from the other side."

Kirkus Reviews

With advances in medicine, technology, and daily diet and exercise practices, Americans are living longer than ever before. We have an unprecedented opportunity for meaningful closure – free of pain, among loved ones, with our affairs in order and spiritual calm attained. Instead, most of us discover that our doctor has minimal training in providing end-of-life care, and will seek to extend life no matter how painful, expensive and futile that effort might be.

In Last Rights, award-winning journalist Stephen P. Kiernan shows how patients and families can regain control of the dying process, creating familial intimacy like never before. Bolstered by both scientific research and intimate portraits of people from all walks of life, Last Rights offers a hopeful, profound vision for patients, doctors, and families: a way to honor people during their greatest vulnerability, a chance for families to reconnect, an opportunity for the medical system to treat patients with ultimate respect, a time to give comfort and compassion to those we most love.

Product Details

ISBN-13: 9780312374648
Publisher: St. Martin's Press
Publication date: 12/10/2007
Edition description: First Edition
Pages: 320
Sales rank: 339,948
Product dimensions: 5.50(w) x 8.50(h) x 0.72(d)

About the Author

Stephen P. Kiernan is a writer and journalist for the Burlington Free Press. He is the author of The Curiosity, Last Rights and Authentic Patriotism. His numerous awards include the Gerald Loeb Award for Financial Journalism, the Associated Press Managing Editors' Freedom of Information Award, and the George Polk Award. He lives in Charlotte, Vermont.

Read an Excerpt

Last Rights

Rescuing the End of Life from the Medical System Chapter One 
Last Hours
On the final night of his life, Jack happened to glance out the window just before eleven and notice that it was snowing: fat flakes cascading past the porch light, changing direction in a puff of wind like a school of fish veering from a predator.
Had Jack known what lay ahead, the seven hours left to him, he might have done something other than turn back to the television. He might have reached for the phone and called his daughter, a college freshman, to send her his love and let her tap him for spending money one last time. He might have climbed the stairs to his son’s room, interrupting that bookish boy’s latest fascination for a discussion of how to help his mother weather widowhood. Jack might have gone to his wife, already in bed, to plan for life without him or remind her where his will was stored or revisit their fondest memories like jewelers scrutinizing rubies. He might simply have decided to go to the window, to watch the snow and contemplate the infinite.
Instead, Jack plunged his hand into a bag of potato chips, washed a mouthful down with the warm dregs of a beer, and watched the Celtics lose in overtime. He lit a cigarette, an unfiltered Camel—he reasoned thatif you’re going to smoke, you might as well taste it. Though he’d never seen the Celtics play in person, in the morning his loyalty would cost him both five bucks and a razzing from Bo, a coworker buddy who favored the Lakers.
It was December 1, 1976, a Monday, and too early for snow. Jack switched off the TV, crushed out his smoke. With a beefy forearm he gathered the empties against his stomach and shuffled into the kitchen.
After shoving everything into the trash, Jack went back through the house dousing lights. He moved slowly, aware that lately the furniture crowded him because he’d put on so much weight. Always a hefty guy, Jack now had a bona fide belly, a smoker’s cough he hacked through some mornings, a general sluggishness in his blood. He would have gone to a doctor, but why bother when you already know what the problem is? You’re getting older, fifty-six in April, and the beer and the sweet tooth and the butts and the lack of exercise have a bigger effect now than when you were twenty-six. Jack put a hand on his lower back as he bent down to turn off a table lamp. Yes, he should cut down. And exercise. Definitely quit the Camels, God forbid. But a man cannot be disciplined about everything. A man who has worked hard all his life also deserves some pleasures, doesn’t he?
This line of thinking was so familiar that it was nearly furniture, too. Room by room, Jack flicked switches and left darkness behind him. At the top of the stairs he paused, dimly aware of his heart laboring but also hesitant. Was he forgetting something?
Of course he was. Jack was experiencing many of his life’s last sensations and emotions. Yet he did not know. He did not pause to savor, to think: this is the taste of warm beer, bitter yet pleasant; this is the holy hush of snow falling; this is the unique sibilance of an empty potato chip bag being crushed into the trash.
Instead, there would be no last words, no consummate gesture, no muttered prayer. Jack did not know that this was his one opportunity to say good-bye.
He glanced into his son’s room, but the boy was reading and Jack did not interrupt. He passed his daughter’s room, missed her a moment, then went into the bathroom to brush his teeth.
“It’s snowing,” Jack called through the open door to his wife. “Really coming down.”
But when he entered the bedroom Jack saw that she was already asleep. A novel lay open on her lap. He placed the book on the bedside table facedown but still open, so as not to lose her place. It was a little gesture, miniscule really. But she would notice it when she moved the novel again the following night, putting it away on a shelf—she would set aside all reading for many months. At that moment twenty-four hours later, her world having changed utterly, Jack’s care over so small a thing would touch her in a deep and previously unknown place. For now, though, she dozed.
Jack climbed into bed and shut off the light. Six hours left. Did his mind, then, turn over the lessons of his life? Did Jack’s soul ache at all he was about to lose, so that he reached for his wife and sought the comfort of one last embrace? Did he fear what might come after death—a reckoning perhaps, or bliss, or nothing at all?
No, Jack remembered that the mortgage was due on the third, Wednesday, and he would have to drop off the check on the way to work to avoid paying the late fee.
He shifted his pillow. Lately he’d been folding it over to raise his head while he slept. It helped him breathe, and his wife said he snored less. Jack felt a mild indigestion, that December Monday nearing midnight, but he ignored it and the sensation soon passed.
Then there was only the dark, the quiet house, and in time, dreams. Even on the cusp of ceasing to exist, there are dreams.
The alarm buzzed in darkness and Jack slapped it off: 5:45 a.m. Forty minutes left. Out the window he saw six inches of fresh snow.
Jack was born on April 8. He and his wife celebrated their August 1 anniversary twenty-nine times. He observed holidays and remembered Mother’s Days and kids’ birthdays and anniversaries of starting jobs. Jack oriented the compass of time with meaningful dates throughout the year. Yet never had he given a moment’s thought to his life’s fifty-five unremarkable December 2s. Jack’s family will remember, though. His son will note the date solemnly every year, honoring his father while in turn ignoring the May 25 that waits with cold patience for him.
Down in the kitchen Jack lit a cigarette, squinting against its smoke as he dug through the hall closet for his boots and parka. A slug of coffee, and out he shuffled into the gray morning. Grabbing a snow shovel, Jack started at the garage and worked his way back. The first few pulls tightened his shoulders. The stuff was heavy. Upstairs the bathroom light went on, meaning his wife was awake, and he began to hurry.
Jack was halfway home when he felt one of his smoking coughs coming on. He straightened, trying to deep-breathe it away. But the air felt as though it went somewhere other than into his lungs, down into his left arm somehow. And when he exhaled, in the place where the breath had been there was a powerful ache. Jack frowned at his arm as if it belonged to someone else. The pain intensified. He leaned the shovel against himself and rubbed his shoulder. How could so small an exertion hurt so much?
A sledgehammer of pain struck Jack in the chest. His body seemed to fold around it. He clutched the shovel for balance, as if staying upright were the most important thing imaginable. Then Jack’s knees buckled, slamming his face down on the shovel’s handle and giving him an instant nosebleed. He leaned to the right, curling around the massive stab in his core. The snow, with an arc of red from his nose, cushioned his fall.
Whatever was happening, Jack thought, it was going to take over the day. The mortgage payment would definitely be late. Already the world was developing a vagueness. The cold against his cheek, the tightness in his lungs—they grew distant. The early daylight in some kind of ebb. Even the pain became strangely remote.
Jack’s eyes roved, and he thought to ask: “Anyone?”
Minutes later his wife, humming along with the radio, glanced out the bathroom window. She saw Jack’s form, prone amid a spray of red. She screamed and screamed.
What is the imprint a body makes when it falls? Later that morning, when Jack was lifted from where he lay, with all the care that experts in that grim line of work can provide while nearby a stricken wife and son watch, the outline he left was no snow angel. No, if you take a man in a loose parka and tip him sideways with a shovel in his hand, the shape that remains is strange but familiar: a human form, hooded and cloaked, and in his merciless grip the tool that spares no one, the scythe.
Copyright 2006 by Stephen P. Kiernan. All rights reserved.


Excerpted from Last Rights by Kiernan, Stephen P. Copyright © 2006 by Kiernan, Stephen P.. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents

Introduction     xi
The Imprint a Body Makes
Last Hours     6
This Is the News     7
A Baby and a Basketball Game     18
A Dog Is Better Than a Pill     23
So Much Potential     47
Not an Emergency
What Is a Crisis?     51
Possible Paths     55
Still Alive     65
Mysteries of Life     70
Two Visions     72
Heal Thyself
Doctors' Beginnings     77
"Take Five Years"     82
A Piece of Cake     88
"This Was Medicine     95
"Maybe I Can Make You Laugh"     103
Barriers to Change     109
Medicine and Love are Not the Same Thing
One Experience     127
Families as "Problems"     130
No One in Charge     138
The Economics of Dying     152
The Most Important Time     159
Smelling the Roses
"Her Wishes Were Totally Ignored"     179
The Desire for Control     183
Dreams Coming True     191
The Final Caress     207
"We Can Celebrate"     216
A Gift of Silver
Lobster Newburg     223
A Bowl of Applesauce     233
Illness As Opportunity     240
The Lesson of the Leaves
The Endless Cycle     245
An Agenda for Improvement     247
Four Final Lessons     270
Sources and Resources     277
Acknowledgments     289
Index     291

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Last Rights: Rescuing the End of Life from the Medical System 5 out of 5 based on 0 ratings. 5 reviews.
Anonymous More than 1 year ago
This book is very enlightening, informative, and thorough!! It discusses end-of-life decisions that we will all face either for a parent, spouse/partner, and ourselves! It is an ABSOLUTE MUST-READ!!
Anonymous More than 1 year ago
Guest More than 1 year ago
This book says everything I have tried so diligently to explain to my adult children. This is a must read for any person contemplating how their own end of life or terminal illness is to be, how it is handled, and demand how it will be. It is about control, your control, over your end of life decisions. Stephen Kiernan has my utmost appreciation for his enormous labor intensive research and his desire to see this important information put in the limelight for more and more patients, physicians and the health care industry to begin to comprehend. He has written how the ending is now a new beginning.
Guest More than 1 year ago
Read this book it's that simple. Why? Because with a mixture of thorough investigation and thoughtful story-telling, Kiernan makes his topic, how the modern day medical machine approaches the end of life, not only a compelling read, but a kind of hopeful prescription for both the medical community and individuals about how to make the end of life a positive journey instead of a medical nightmare.
Guest More than 1 year ago
I just finished my copy of Last Rights by Stephen Kiernan and it's a must read! In this book Kiernan talks about the process of dying by highlighting stories of people's real life experiences and interspersing those with today's medical data. He is a great storyteller and I found the book uplifting, motivating and interesting. I highly recommend this book.