I first stumbled on this book one sunny day when I was walking around Lake Union with my friends Abi and Kristal. Abi stopped by a curbside "library" (a little kiosk where neighbors could leave books for other neighbors to borrow) and found this one. Kristal is a breast cancer survivor, so we had in fact been talking about cancer and death on our walk, and we were all struck by the weird synchronicity of this find. Kristal took a picture of Abi with the book, I posted it to Facebook, and my sister saw the photo and went to Powell's to look for the book. Once she'd read it, she gave it to me.

The subject-matter of the book is very similar to Atul Gawande's Being Mortal. However, Morris is a journalist, so her approach is much different from Gawande, who is a practicing surgeon as well as a writer. I have to admit that I found Morris' book a little over-written at times, and I preferred Gawande's focus on history, sociology, and science. Morris is more personal and more emotional. It's more populist, and less intellectual. However, she has a similar concern about how advances in medicine have paradoxically left us at a disadvantage in understanding and accepting our mortality. She doesn't cover the broad range of topics of how we handle the elderly and the dying that Gawande does, but instead she focuses on the ways in which even when we try to make sure our end-of-life experience isn't a nightmare of painful attempts to prolong life no matter what, we can get sucked into desperate measures anyway.

If there is a basic thesis here it's that a living will and explicit DNR instructions aren't necessarily going to save you from procedures you would prefer not to undergo. She is very compelling in exploring all the ambiguities and uncertain feelings that can lead family members, medical personnel, and even the dying person themselves to make bad decisions when push comes to shove. If your instruction is that "I don't want desperate measures unless there's a high probability that I'll be highly functional if I survive," how do you judge what is "high probability" or "highly functional"? One of Morris' strongest points is that a lot of times there's no right answer, so it's easy to let inertia carry you in the direction of "more life," for better or worse. While she tends to focus on stories where "more life" means "more suffering," she does acknowledge that sometimes "more life," even when it means "more suffering," can also mean "more time with family and loved ones." Is that time worth it? Who can possibly measure such a thing?

Although she does talk about practical things such as living wills, medical directives, and "value history forms" (in which you attempt to describe your priorities and what's important to you), or how to talk about death with loved ones who are dying or with children, the book is really less a how-to than an invitation to contemplate your mortality and what it means for you and those close to you. Like Gawande, she feels we are too insulated from death now, so we don't really deal with it until it's happening. A lot of times that's too late. Also like Gawande, she stresses how the process of dying can be a very clarifying thing and can bring people closer together. Gawande opened my eyes to the fact that fear of death can be allayed by a sense of connection to family and community, and I'd say Morris comes to that same point from a somewhat different direction. What matters in the end is our connection to other people, and the process of dying has a way of driving that home. If we can grasp this fact while we're still in the prime of life, then our lives and relationships will be richer for it. That's why she wants us to start talking about death sooner rather than later.