Handbook for Mortals: Guidance for People Facing Serious Illness
By Joanne Lynn, M.D. and Joan Harrold M.D.
Oxford University Press
242 pp. $25

Most of us know about death, in theory, if only as a witness to someone else's. But our own? We can imagine it, but little more. Perhaps those that come closest are caregivers to the dying: more than chance witnesses to death, they're often on the scene long before a loved one reaches the terminal stages of illness and long after life is eclipsed. Yet on this unfamiliar journey, the trusted travelogue is missing.

Handbook for Mortals bridges this gap, and it is useful that the book's reliable information-givers are Joanne Lynn, director of the Center to Improve Care of the Dying at the George Washington University Medical School, and Joan Harrold, a fellow at the National Cancer Institute. As physicians who have cared for thousands of terminally ill people, they are practiced and practical. What they offer in these pages of readable and often graceful prose is grounded in their "quiet conviction that people, even very sick people or very burdened people, have remarkable spirits, inspiring creativity, the capacity to cope with illness and mortality, and the wonderfully human drive to find one's own life's meaning."

The authors' goal in Handbook for Mortals is empowerment -- the offering of ideas, strategies, and facts that patients need to possess when seeking professional help from the health care system. It isn't really a system, Lynn and Harrold write, "but a mix of disconnected, and sometimes dysfunctional, groups, plans, services, and professionals." Offering a way out of this maze, the 15 chapters range from the motivational to the informational. The authors detail the ways doctors treat pain and terminal illness, then move on to how one might handle a decision to forgo treatment. Even in the valley of death, the authors note, it is still possible to have an informed imagination, one that broadens options during the time leading to life's exit.

Often, as in the chapter about dealing with the death of children, readers are exhorted to weigh the value of life, not just the extension of it. "Children aren't supposed to die -- they are meant to outlive their parents. They are so innocent, and the world can be so cruel. Many parents wish they could take their child's place. Many wonder what they did wrong. Some question their belief in God. Most would do anything to keep their child alive. ... If there is a chance for cure, you and your child will want to pursue it. But your child should live, not exist as long as possible. Your child's life should be comfortable, and it should be a life that both your child and your family value."

Many of the chapters combine sample questions and conversations you might have with a doctor about the more clinical aspects of medications and diseases. On bedsores -- a common complaint of the dying -- the authors offer specific caregiving advice such as changing your charge's position every two hours and massaging sore limbs with lotion and creams. On finding the right physician for the dying: "Ask your doctor, 'How many patients like me have you followed through to death?' Don't accept: 'There's no one quite like you!' If your doctor doesn't really have any experience, find someone (another doctor, a home health nurse, a nursing home nurse, a hospice professional, or a support group leader) who has 'been there' before." This counsel is well-advised.

Despite the long sections on handling the death of loved ones, the authors seem at a loss about how to best eulogize the passage of life. A weak section of Handbook for Mortals is the sparse two paragraphs that Lynn and Harrold devote to those who have the last word on death: newspaper obituary writers. It might have interested the book's readers to know that the dozen or so large-circulation major dailies have staffs of four, five, or perhaps more writers on the death beat. Many are the most competent reporters in the newsroom, pros who know how to get the facts and get them fast. The better-known a person is, whether nationally or locally, the longer the obituary. For the globally famous, press agencies have on file advance obituaries, ready to run instantly. Saturday is usually a slow news day, so competition for space in the news hole is slight and an obituary writer is likely to add on a few more paragraphs. In addition, the Sunday circulation of the newspaper is almost always larger than on weekdays, which means more readers.

Taking the authors to task for glossing over obituaries may seem off-the-wallish, I will admit. But having toiled in a newsroom for three decades, I know that many survivors want the finest obituary possible for their loved one, and for themselves too. Some people even deliver to the hometown newspaper a draft of their own obituary. A few papers will run it; others, fittingly, bury it.

When it comes to the words that might soothe the dying before their end, the authors are more attentive. The book quotes from masters of literature and other observers. The greats are here: Shakespeare, Auden, Dickinson, Tolstoy. So also are some lesser-knowns. The actor Tony Perkins writes about his work with AIDS patients: "There are many who believe that this disease is God's vengeance, but I believe it was sent to teach people how to love and understand and have compassion for each other. I have learned more about love, selflessness and human understanding from the people I have met in this great adventure in the world of AIDS than I ever did in the cutthroat, competitive world in which I spent my life."

Much praise is due the authors. As physicians, they could have rejected the hard labor of writing. Instead, they answered a nobler call: caring and comforting through the word.

-- Colman McCarthy, a columnist for the Washington Post from 1969 to 1977, directs the Center for Teaching Peace in Washington, D.C. He is the winner of a 2001 Excellence in Journalism award for an opinion series from the Northern California Chapter of the Society of Professional Journalists.

First published June 25, 2001
Last updated December 5, 2007
Copyright © 2001 Consumer Health Interactive