The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life

I loved Dr. Byock's other book, Dying Well, and wanted to read this one also. To give you some backstory, I had no interest whatsoever in these types of issues until my mother died march 11, 2013. She was 69. She was in ICU for two weeks prior and admitted into hospice on March 9, 2013. Although she had a chronic illness (COPD) she had never been hospitalized before except when she was initially diagnosed in January 2010. As an only child and constant companion to my mother (she lived next door to me), everything that occurred over this two week period was a blur. I have obsessed over every decision I made, every detail of everything that was said to me in the ICU, etc. I needed reassurance that what I did was right. My mom was one of those who felt that hospice care was "giving up." I had to convince her to even enter the hospice program. While in the ICU, the palliative care nurse came to speak to me and informed me that my mom was "very fragile and very ill." She offered the in-hospital hospice or possibly at-home hospice if my mom could make it. I stated that my goal was to get her home to see her pets and grandchildren. She despised every minute of being in ICU. Much as Dr. Byock described, the mission of the ICU physicians was to treat, treat, treat. None of those physicians indicated anything other than telling me about the various tests, the results of the tests, and the next test to be performed. I would even ask point-blank, "Does a person survive these types of issues?" to which they would respond well, yes, they can. My biggest regret is that my mom didn't seem to clearly understand the severity of her situation. The palliative care team talked only to me about the seriousness of her condition. Although I was brutally honest with my mom, and she knew what going into hospice meant, I think she would have preferred to have the doctors tell her the truth. Hospice is the best thing that could have ever happened to my mom. When we arrived home on the 9th, all of the equipment was there, the oxygen concentrator, etc. On Sunday, I helped my mom bathe and we sat on her porch. There were no words left unsaid. Sunday night she slipped basically into a coma. Prior to, she requested that I assist her in dying; she stated "I am dying". I told her I couldn't do that and live with myself but I administered the morphine that hospice provided according to their dosage. From that point forward, she no longer seemed to be in pain. The following night, she died comfortably. She had started receiving continuous care from hospice after I called them terrified becuase I didn't know what to expect. All of the issues that came up in my mind were addressed in Dr. Byock's book. I absolutely love his case histories. Of course I was deperate to find a person with my mom's exact same problems (i.e. COPD, pneumonia, pleural effusion, low oxygen saturation, AFIB, etc.) but the portrait that I gathered from all of the patient histories and their symptomology helped me to know that my mom was dying, that I didn't cause her death, that bringing her back to the ER would have only prolonged her misery in the ICU with the mask vent that she hated. I am forever grateful for these books for easing my mind. I am grateful for the services provided by the local hospice. I have now developed an interest in these issues and hope to give back in some way as a hospice volunteer. I realize this review veered off course, but if you are searching for answers about your loved one's death or stay in the ICU or trying to decide about hospice, Dr. Byock's books are wonderful. Even if you do not feel your loved one is ready for hospice, I think you would be crazy to decline hospice services (I've read that COPD patients are rarely recommended for hospice becuase the nature of their illness is very unpredictable). The services they provide are invaluable and your loved one can graduate out of hospice if they are well enough to do so.

I wrote "required reading" above because I believe this book deals with events that most people tend to ignore until it is too late. End of life issues. Unless you die in an accident or suicide, chances are you and/or your family will have to make decisions about what is to happen at the end of your life. This book explains in very easy to understand language what the issues and the options are. There are no hard and fast answers to these questions, but the author gives us a way to think about them by using many case histories and examples taken from his many years of experience. A thorough, compassionate discussion of how to prepare for the last phase of life for yourself and for those you love who may be in your care. Very worthwhile and highly recommended.

This book is not intended for everyone. Just for those of us with an ailing loved one, or a loved one who who is dying. Or those of us who may at some time have an ailing loved one, or a loved one who may die. Or those of us who may at some time ourselves be ailing or dying. Dr Byock transforms the discussion of how we live our final days from a political hot potato to a rational, personal and heartfelt fact of life. As a physician, I am keenly aware of the miraculous medical tools that we as Americans are fortunate to have available to us. I am equally aware, however how the inappropriate use of these tools can contradict our ultimate responsibility as physicians to "above all do no harm". More importantly, as the son of one of the patients whose journey through critical illness and hospice care is chronicled in The Best Care Possible, I have witnessed and experienced how an informed and caring medical team can positively effect not only the patient, but those who love her as well. Let the publication of this book awaken us all to the need for a national discussion, in a sane and rational way, of the need of advanced directives, and an assessment of how we choose to spend our final days. Sanford E Glikin, MD

Great read for medical and non medical people who is dissatisfied with current end of life care practices. The book challenges you to be a warrior to ensure good end of life care to all fellow human beings.

In our death denying society, this book (amongst some others) is a good read to have. Of course if talking about death is your cup of tea. It’s definitely mine.