Author Katy Butler describes Knocking on Heaven’s Door as “part memoir, part medical history, and part investigative journalism.” She is absolutely right, and this carefully arranged braid of a book is stronger and more appealing than any single strand would be alone. Yet at bottom, it’s a deeply personal story.
Butler writes heartrendingly about the death of her father, whose health began to deteriorate when he had a mild stroke. In her view, his process of dying was unnecessarily prolonged due to a pacemaker. As her father’s health declines, Butler gets busy. She successfully lines up various kinds of support for her caregiving mother. She advocates for her father’s medical rights. And she loves him deeply, even as he changes before her eyes. Comparing her father to Tintern Abbey, the partially destroyed edifice that inspired Wordsworth, she writes, “he was sacred in his ruin, and I took from it the shards that still sustain me.”
As Butler sought to understand what was happening to her father, she explored the history of the device ticking in his chest, sending steady signals to his heart. She became absorbed by the development of emergency medicine: how it changed the deaths of many Americans, cruelly prolonged life for others and led to our culture’s worship of quick technological fixes to medical crises. She takes her father’s story as a case in point. By moving between the details of her family’s story to the larger cultural and medical context in which it takes place, Butler manages to make some astonishing arguments—arguments whose force often comes from following the money. She traces, in amazing specificity, how hospitals are encouraged to adopt a save-the-patient-at-all-costs attitude, without regard for the patient’s quality of life or quality of death. The person who really pays for this, she argues, is the patient and the often under-informed family.
In all, Butler argues persuasively for a major cultural shift in how we understand death and dying, medicine and healing. At the same time, she lays her heart bare, making this much more than ideological diatribe. Readers who are eager to get their own paperwork and wishes in order, or who are thinking about their aging loved ones with concern, or who simply care about how our culture deals with basic questions of life and death, should be sure to pick up this book. It is one we will be talking about for years to come.