April 26, 2007


From the Heart: A Woman’s Guide to Living Well with Heart Disease. By Kathy Kastan, L.C.S.W., M.A.Ed. Da Capo. $25.

To Die Well: Your Right to Comfort, Calm, and Choice in the Last Days of Life. By Sidney Wanzer, M.D., and Joseph Glenmullen, M.D. Da Capo. $24.

      Doctors are no longer doctors: they are “health professionals” or “members of your care team.” The objective of medicine is not to treat diseases but to treat people; holistic approaches are encouraged (within insurance-company limitations). And there are no such things as “patients” anymore – there are only patients with descriptors, including “menopausal patient,” “end-of-life patient,” “patient undergoing chemotherapy,” and so on.

      Thus, medical self-help books are no longer general care manuals. Now you find your identity within the patient universe and select books in your niche accordingly. This is by no means a bad thing – the more specifically a book can address your particular concerns, the more useful you will find it – but it can be a bit disconcerting. From the Heart, for example, is not about living with heart disease but about women living, and “Living Well,” as the subtitle has it, with heart disease. The focus is understandable: author Kathy Kastan has been there, in the most personal way possible. She developed debilitating chest pan at age 42, needed emergency heart bypass surgery, discovered after the surgery that she could barely function, and found help through a group called WomenHeart. The organization not only aided her but also, some time later, nominated her as its president, and she is now spreading its message – through From the Heart, among other venues. Kastan’s message is that the heart requires emotional as well as physical recovery from heart disease, and must turn for its emotional needs somewhere other than the traditional medical establishment, which focuses on healing the body. Through her own experience and those of the many other women whom she interviewed for this book, Kastan goes beyond the typical heart-health manual (know your risk factors and the warning signs of heart problems and take steps to avert cardiac trouble or prevent its recurrence) into areas that traditional medical books cover perfunctorily if at all: effective relaxation techniques, health-insurance problems, body-image uncertainty, worries about having sex after a serious cardiac event, and how to allay concerns of family members and friends even as they look for ways to help you. There is no particular reason for Kastan’s ideas to apply only to women, and the book tries to do a few too many things in a single volume (she barely scratches the surface of employment, insurance and Social Security issues). And her final chapter, on how to advocate for change, is more institutional than personal and realistic. As a whole, though, From the Heart will be a useful resource for women who feel alone and emotionally vulnerable because of heart disease.

      As Kastan reminds readers repeatedly, heart disease is not a death sentence. But every patient – every person – confronts death eventually: medicine and one’s own body can, after a time, do no more to prolong life. End-of-life planning is no longer a socially taboo subject, partly because of well-publicized situations in which the process goes horribly wrong (the Terry Schiavo case was one) and partly because good estate planners bring up end-of-life issues as matter-of-factly as they discuss living trusts. The issue of dying as one wishes, however, is a very complicated one, with doctors trained (and, in many cases, both legally and morally obligated) to sustain life, and with patients and their families often reluctant to face end-of-life decisions even if they have been willing, in calmer circumstances, to create directives and instructions about what to do (or not do). To Die Well takes a reasonable and reassuring approach to all the uncertainties of the inevitable end, although its stands will certainly not please everyone. Sidney Wanzer is a leader of the right-to-die movement, and as such is a forceful advocate not only for making death comfortable but also for hastening it under some circumstances. Joseph Glenmullen is a psychiatrist, and his focus is on the emotional turmoil surrounding end-of-life decision-making. Together, they knock down the straw man of “prolonging life at all costs” that used to be the norm in medical practice, suggesting palliative care instead when there is no hope of recovery (although the moment at which hope disappears is not always possible to determine – and for some people, such as the highly religious, may never come). The authors then discuss hastening death in some cases, pointing out that this is not akin to suicide, since it is the disease rather than the patient’s actions that have brought the person to the brink of death and made death inevitable. Some will consider these doctors’ arguments sophistry and argue about the “slippery slope” we supposedly start down, individually and as a society, when we presume to say at what point death is 100% inevitable. In the real world, though, where patients and their families must confront unending, excruciating pain that can be almost as difficult to observe as to endure, readers are likely to find To Die Well a calming aid in what can be the most difficult time of life: its end.

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