“There must be better and worse ways to die. It seems both rational and possible to minimize the likelihood of an unpleasant end.”

~William T. Vollmann, “A Good Death”

If pressed to say which books Margaret Overton’s wry, out-of-the-ordinary new memoir most reminded me of, I’d describe it as a cross between Atul Gawande’s Being Mortal and Roz Chast’s Can’t We Talk about Something More Pleasant? The Chicago-area anesthesiologist is the author of a previous memoir, Good in a Crisis (2012), about the aftermath of a divorce and a brain aneurysm. Her latest book, which released on March 1st, started off as a manifesto on the need for an overhaul of American end-of-life care, with a strong drive towards creating an advanced directive and otherwise being meticulously prepared for one’s own death.

From there, I gather, the book took on a life of its own. It’s delightfully digressive, incorporating cases Overton observed in the hospital where she worked and lessons gleaned from a Harvard Business School course on healthcare delivery but also her personal experience of guiding her parents through their last days – her father died of lung cancer in 1998 and her mother, who suffered from dementia, finally followed in 2010.

Years surrounded by infirmity and the possibility of death have convinced her of the benefits of hospice and physician-assisted suicide, still only legal in a few states. We need to know (as we already do for our pets) when suffering is too much and stop extending life at any cost, Overton insists – rather than allowing hospitals to profit from death, as currently happens, with many elderly patients undergoing expensive and ultimately ineffectual procedures in their final weeks. “The last six months of life accounted for roughly twenty-five percent of our Medicare spending.”

For as universal as suffering and death are, we sure are wont to refuse them space in our lives. Again and again Overton uses the striking metaphor of “lemon juice,” drawn from a news story about a hapless would-be bank robber who thought spraying himself with lemon juice would make him invisible to onlookers and police. In our daily lives, she opines, we keep wearing that lemon juice, denying that there is a problem with our healthcare system and our thinking about death.

My thoughts kept coming back to care at the end of life. How do we change the end game? How do we make it better for the elderly, for those of us who will some day become elderly, and how do we save our country some money in the process so that when it is our turn, there will be money left in the system to provide us with the care we want? It seemed to me that if we could just tinker with this one aspect of healthcare, a number of other issues would fall into place.

What’s so special about this book is seeing the problem from several angles and perspectives: that of a physician, that of a healthcare researcher, and that of a dutiful daughter. Overton keeps her narrative interesting by avoiding chronological rundowns; instead she intercuts, sometimes paragraph by paragraph, multiple anecdotes – alternating a hospital case with her mother’s last days, say, or jumping between her experience at the Harvard course and her father’s treatment. I can see how some might find the non-consecutive structure off-putting, but I loved every bit of this short, powerful book, from the evocative title through to the excellent final chapter. Anyone who has enjoyed the aforementioned Gawande and Chast books should not hesitate to make this their next read.

See also this Chicago Tribune article on Margaret Overton.

With thanks to publicist Beth Parker for the e-copy for review.

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