That Good Night: Life and Medicine in the Eleventh Hour

Puri, medical director of palliative medicine at Keck Hospital at the University of Southern California, gives a compassionate account of her role helping patients and their families make end-of-life decisions. When Puri was a child in L.A., her anesthesiologist mother and engineer father, both Indian immigrants, taught their children about the transient nature of life, the inevitability of change, and the journey of the soul. Puri took these lessons to heart, recognizing the complementary paths of science and spirituality, and as a physician drew upon the strength, support, and wisdom of her family’s beliefs and values—honoring life and accepting death—to help her patients make “eleventh-hour” choices. The decisions that must be made—for instance, whether to administer CPR or take a relative off a ventilator—are heart-wrenching. Yet there are also moments of grace and humor (she cries with a grieving daughter; plays along with an ailing man who jokes that his swollen belly is a pregnancy). In talking with families and patients, Puri comes to realize the vital importance of discussing difficult topics before a crisis arises, and making decisions based upon what best serves the patient’s dignity and quality of life. Communication, she concludes, is the basis of the doctor-patient relationship, perhaps especially so in the final days of life. This is a powerful memoir, which Puri narrates with honesty, poise, and empathy. (Mar.)