Crossing Over is the perfect complement to the wide range of technical medical textbooks available today as it presents an often-overlooked perspective of the dying process.
What is the role of palliative care in today's society? What can-and can't-it do to alleviate the physical and emotional suffering experienced by those who are terminally ill?
The answers to these questions-and many more-can be found in a remarkable and compelling new book, Crossing Over: Narratives of Palliative Care. As seen through the case studies of nineteen terminally ill patients, the authors present a unique and honest view of the personal and professional challenges that dying patients, their families, and their caregivers must face to achieve the goal of having "a good death."
Written by David Barnard, Anna Towers, Patricia Boston, and Yanna Lambrinidou, Crossing Over emphasizes the human element that is intrinsic in end-of-life care and beautifully documents the physical, psychological, spiritual, and social dimensions involved in terminal illness. Even more telling, the authors are not afraid to show how, in some cases, the goal of providing compassionate care cannot be achieved, often because of personal, institutional, or social care complications.
Based on work conducted at the Hospice of Lancaster County in Lancaster, PA, (see the Sept./Oct. Exchange for more on this program) and the Palliative Care Service at the Royal Victoria Hospital in Montreal, Canada, the authors introduce readers to people from a range of ethnic and social groups, including the elderly, young women, minorities, and children.
"Our objective in each narrative has been to tell the story of the patient's experience of illness and care with particular emphases on the patient's inner life, or subjective experience, and on the caregivers' experience of giving care," write the authors. "Our narratives include the voices and points of view of patients, families, doctors, nurses, social workers, chaplains, volunteers, friends, and neighbors as they interact with each other and form their own conflicting judgments over the course of the patient's illness and up to one year after the patient's death."
Each narrative begins with the patient's life history leading up to the time of final illness and documents how the palliative care team responds to each person's crisis. Take the case of 34-year-old cancer patient Shamira Cook, who says, "What they should know is that you never get ready to hear that you're going to die...I just don't know what to think, what to do. I feel like a piece of glass. I feel like if I move the wrong way that I am going to go to pieces." The authors show, through descriptive and sensitive prose, how the palliative care team is able to pick up those pieces and glue them together so that Ms. Cook faces her final days with dignity and compassion.
To complete the full perspective of the experiences faced during a terminal illness-and to put a more human face on the medical professionals in attendance-the authors also present the emotions, frustration, and fears of the members of the medical team-doctors, nurses, and volunteers-involved in the case. In so doing, the reader is reminded of the tremendous toll that caring for the terminally ill places on all caregivers, lay and professional. In addition, the book includes current and topical issues, such as pain management, terminal sedation, and the role of spirituality as an adjunct to care.
Crossing Over is the perfect complement to the wide range of technical medical textbooks available today as it presents an often-overlooked perspective of the dying process. The book works both as a collection of stories or, for health care professionals, as a workbook, complete with author commentaries, questions to encourage further discussion, an index of themes, and a comprehensive bibliography.
Crossing Over: Narrative of Palliative Care, by David Barnard, Anna Towers, Patricia Boston, and Yanna Lambrinidou, is published by Oxford University Press, Inc.
Laura Schmidt, ABCD member and volunteer, is an award-winning health care writer. Contact her at: LSch340283@aol.com.
Values on Paper is a new book from Barry K. Baines, M.D., medical director of Ucare (MN) and is the associate medical director of Hospice of the Twin Cities. Patients and families can use ethical wills to describe values, and the intangibles they’d like to pass on to others. An ethical will helps leave a legacy that says: "This is who I am. This is what our family stands for. This is what I wish for you." Visit www.perseuspublishing.com to order
Facing Death, Facing Grief: Teens Healing at Camp Brave Heart is the fifth in a series of videos produced by Family Experiences Productions, Inc. The program addresses topics of special importance to teens, such as going back to school, dealing with friends and gossip, grieving with the body. Program filmed at Hospice Austin’s Camp Brave Heart. Program includes discussion guides for viewers and leaders; a special version with information about 9-11 is also available. Visit www.fepi.com/html/facing_death.html for details.
Hospital-Hospice Partnerships in Palliative Care: Creating a Continuum of Service, a new report from the Center to Advance Palliative Care (CAPC), profiles nine programs nationwide. Information targets senior managers and clinical leaders of hospitals and hospices, and features case studies, along with legal and financial analyses. Read it online at www.capcmssm.org or order a copy by calling 212-201-2671.
From the producers of & Thou Shalt Honor, a PBS program scheduled to air this fall, comes this interesting point: "In 1946, there weren't enough diapers, schools, colleges, jobs and housing to take care of an exploding peacetime population of American children. Soon, there may not be enough caregivers to provide for this rapidly aging population. The 21st century will be marked by an unprecedented, dramatic increase in the size of the older population as the Baby Boomer generation ages." Visit www.pbscaregiving.org for details on getting involved in community-related projects based on the program.