That Good Night

February 1, 2019

Doctors are supposed to preserve and prolong life, writes Puri (Keck Hosp., Norris Cancer Ctr., Univ. of Southern California), but what if a patient no longer wants to continuing living in pain? In this moving memoir, the author intertwines her parents' story of emigrating from India to the United States with her own journey of being a young doctor in a young medical specialty--palliative medicine, or quality of life for those with serious, often incurable, illnesses. Inspired by her mom's career as an anesthesiologist, Puri attended medical school and unexpectedly became drawn to medicine's gray areas and the silence around mortality. As she moves from a medical residency in San Francisco to a home-based palliative care unit in Los Angeles, Puri describes the emotional toll of communicating hopeful or hopeless news, especially to women experiencing pain at all ages, and the uncertainty of what it means to "get better." Puri's writing shines when it's most personal; considering the intersection between spirituality and science, and seeing people turn to or away from faith in times of illness. VERDICT An affecting read about the limits of medicine and embracing that which is beyond one's control. The stories of Puri's patients and their families will resonate with readers.--Stephanie Sendaula, Library Journal

Copyright 2019 Library Journal, LLC Used with permission.

February 1, 2019
Doctors labor to cure disease and (recently) comfort the dying, but this moving memoir portrays a doctor practicing a new specialty that fills a gap between the two approaches.Puri (Clinical Medicine/Univ. of Southern California), the medical director of palliative medicine at the Keck Hospital of USC and the USC Norris Cancer Hospital, hits the ground running with an impressive debut. The daughter of workaholic, immigrant physician parents who assumed she would follow in their footsteps, she acquiesced and dove into the field. During training, she thrilled to see her skills cure disease and relieve suffering, but she became increasingly disturbed when they didn't. Repeatedly, she witnessed patients with devastating illnesses and little hope of cure made sicker by treatments the doctors themselves knew were futile. Patients and families usually encouraged this, in the belief that one must always "fight" disease; to do otherwise is to "give up." Using often heart-rending examples, the author emphasizes that the best treatment of advanced cancer may not be more toxic chemotherapy. A victim of end-stage lung disease grows familiar with a respirator, but ultimately the lungs will fail to recover enough to breathe without it. Many patients live years bedridden with a respirator, their family praying for a miracle. A better alternative is to discuss what is happening and plan for a future where matters might not go as everyone hopes. Doctors hate doing this, so they discuss pros and cons, allowing the patient or family to choose. Thus, hearing that a treatment for metastatic breast cancer might prolong life for several months but also cause misery and harm, people usually choose treatment under the mistaken belief that treatment means "cure" and no treatment means abandonment. Called to assist, Puri recounts many painful exchanges, which, when successful, allow patients and those who love them to embrace a deeper understanding of their mortality.A profound meditation on a problem many of us will face; worthy of being mentioned in the same breath as Atul Gawande's Being Mortal (2014).

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February 15, 2019
With a physician mom and an engineer-by-training dad who share thoughts about how all of life is like the evening sky: beautiful, but temporary, Puri comes to question how modern medicine focuses so much on preserving life at all costs. What about bringing dignity and purpose to our lives and to our deaths? At the end of her own medical school training, Puri finds her true calling in humanely treating patients living with serious and incurable illnesses. So-called palliative medicine grapples with the human suffering and mortality that Western medicine so often seeks to deny, she writes. Puri learns how terminal patients often want to leave letters for people to open on special occasions or make videos recounting their love for a spouse. And she learns the best ways to make them comfortable in their final days. This thoughtful treatise on life, death, and medicine should make readers feel more grateful for every day they have because, as Puri and her colleagues come to realize, no one knows what's coming, or when, to their loved ones or themselves.(Reprinted with permission of Booklist, copyright 2019, American Library Association.)