Endurance: Shackleton's Incredible Voyage

Book: Endurance: Shackleton's Incredible Voyage

Basic Information : Synopsis : Characters : Expectations : Thoughts : Evaluation : Book Group : New Words : Book References : Good Quotes : References

Basic Information:

Author: Alfred Lansing

Edition: ePub on Overdrive from the Fresno County Public Library

Publisher: Carroll & Graf Publishers

ISBN: 078670621X (ISBN13: 9780786706211)

Start Date: June 14, 2019

Read Date: June 23, 2019

282 pages

Genre: History, Biography, Science

Language Warning: None

Rated Overall 5 out of 5

History: 5 out of 5

Synopsis (Caution: Spoiler Alert-Jump to Thoughts):

Lansing starts with the destruction of the ship, the Endurance. He then takes you through the chronology of the expedition. This includes who Shackleton was and his need for continued fame. Lansing talks about the fundraising and the planning. The plan was pretty good. He and a small group of men would start from Weddell Bay and travel across the continent. Another group could start from the opposite side of Antarctica, leaving food and supply caches along the way. After a couple of years and a buying spree, including purchasing the ship, the Endurance-it was renamed, the expedition begins.

They make for the Weddell Sea. Shackleton had talked with whalers about the situation they had found here. But he decided to chance it and see if he could make his way through the ice fields of the sea.

Shortly after arriving in the Weddell Sea, the sea iced up, locking the Endurance into its grip. After awhile, the pressure-when water freezes, it expands, causing ice to buckle and/or crush whatever is in its path, starts to cause problems for the ship. For close to a month, the Endurance stood against the pressure, but after a while, the pressure was too great and it was destroyed. Shackleton had his men leave the ship with as much of the supplies they could muster before the ship sank. They had enough to keep them going.

Now they survive on an ice floe in tents with their dogs. This goes on for all winter. When the Southern hemisphere’s Spring and Summer comes, they start looking for openings in the water. But then their ice floe starts to shrink and split. There are many instances where men were in danger of falling into the water when the ice cracked. Finally open water comes to them and they are able to escape.

 

But the escape to open water has its own peril. High seas, gale force winds, and air and water cold enough to give you frostbite. They have launched all three of their boats and the trick is to keep together. Somehow they are able to, even when storms drive them miles in one direction, then another one. But through their navigational abilities, and knowledge of the weather and geography they finally end up on an island.

Not sure that the island is any safer. There is a narrow beach with a glacier just above them. High winds can drive rocks air-bourne which will damage a man. Plus there is no hope of rescue here. Shackleton makes a decision-he and five others will set out for an inhabited island. If they reach it, they will send back rescue ships.

This group goes through some truly terrifying seas-90’ waves to start with. And of course the usual storms and winds. They finally make the island-but the wrong side of the island from where the towns are. So Shackleton and two others set out to cross the island-which has only been crossed once since then. They make it, but not without super-human effort and some experiences which you will have to read to believe.

They find the village and explain who they are-some of the whalers in the village know who Shackleton is. They send out rescue boats and find the parties left behind. Shackleton starts out with 28 men in his expedition. He brings back the same 28. Most are in fairly decent physical health.

Cast of Characters:

Twenty-eight people were on board the Endurance. Look at Part I, Chapter 5 for paragraphs on each person.

• Ernest Shackleton-expedition leader
• Bakewell-seaman
• Walter How
• Thomas McLeod
• Perce Blackboro-stowaway. Quiet but quick-witted
• Earnest Holmes-fireman
• Frank Wild-Second in Command
• Worsley-third in command
• Bobbie Clark-biologist. Scot, dour, hardworking
• Tom Crean-sailorman, tall, knew the sea
• Charlie Green-cook
• Hudson-navigator
• Leonard Hussey-meteorologist, practical joker
• McIllroy-surgeon
• George Marston-artist
• John Vincent-young, bully
• Orde-Lees-Storeskeeper
• Frank Hurley-photographer
• McNeish
• Greenstreet

Expectations:

• Recommendation: (Referenced) Scott Kelly in his book, Endurance
• When: May 2019
• Date Became Aware of Book: Unknown, well before Scott Kelly’s book
• How come do I want to read this book: Scott Kelly referenced this book many times in his book Endurance. He tries to draw some parallels with his own experience. He acknowledges that Shackleton’s experience was much more dangerous.
• What do I think I will get out of it? I enjoy the outdoors. There is something to be learned by looking at other’s experiences.

Thoughts:

The book is based upon diaries, articles, and interviews with expedition members. Remember, the book was written in the late 1950’s, about 40 years after the expedition.

The purpose of the expedition was to cross the Antarctic continent. To this end, he had planned out what he would need. He would take a small contingency of men and start at one place. Another group of men would lay supplies at the other end so that he would not carry everything with him. Sounds like a good plan to me. Apparently planning works only so far. Then one must work to figure out alternatives.

I am pretty confident that if I was one of Shackleton’s men that I probably would not have survived.

Today, whalers are a pariah. But to Shackleton, they were a source of information. Also they were his salvation at the end of his journey.

Was Shackleton right in risking his men’s lives when he knew of the danger which he was warned about? On the other hand, these men had signed up for this adventure, knowing that there was danger. How much risk does this allow Shackleton to make?

Shackleton made the decision at least three times that some of the dogs had to be killed. This was to preserve the scarcity of their rations. The last time was before they were going to launch their boats-the boats could barely hold the men, let alone the dogs. I do not know if I could have killed the dogs. Which probably means I was not a good candidate for being on the expedition.

Introduction

Alfred Lansing was inspired by the fictional novel, Delilah. Delilah is about a ship pre-WW I protecting the United States interests in the Philippines.

For an author, posterity is the toughest of proving grounds. Only a handful of books are so firmly connected to the timeless underpinnings of life that they survive into the future. Nathaniel Philbrick

Part I, Chapter 2

Two parts to who Shackleton was: … it was typical of Shackleton--purposeful, bold, and ___. He had not the slightest doubt that the expedition would achieve its goal. And then ..if it hadn’t been audacious, it wouldn’t have been to Shackleton’s liking. It is the confidence of the man which enables his goals to be achieved, even when the original goals fail. But it is the lack of planning for failure which almost dooms him. It is the confidence which inspires him and his men to survive. Later on Lansing said that he had one pervading characteristic: he was purposeful.

Lansing goes on and said that the basic purpose of the expedition was to further the glory of Ernest Shackleton. It is said that a man as great as Shackleton was could not do things for something greater than himself. As Patton noted, glory is fleeting. Once you die, what good is glory?

A tribute which Lansing quotes notes that Scott was better in science, Amundsen for speed, but when there seems no way out, get down on your knees and pray for Shackleton.

Part I, Chapter 3

Interesting reaction by Shackleton on finding out that he has a stowaway on board. He chews them out. Then ends the chewing out by saying Finally, if we run out of food, and anyone has to be eaten, you will be first, do you understand? The stowaway realizes at this point he has been accepted as a crew member.

Ice was the enemy. It would be the fight of life and death.

Great description of an iceberg. Until this book, I had a very fuzzy picture of an iceberg. More of a mound of hard snow. But now this is something as big and hard as a rock which floats.

Part II, Chapter 1

Shackeleton had his people well prepared and trained. When an emergency came, people knew what to do and did it.

Part II, Chapter 2

They were without hope. No ship would be sent to find them, let alone a helicopter. Yet, the men seemed to adapt well, even cheerful. They knew their situation and had adapted to living in it.

Part II, Chapter 3

They even had informal groups, whether it was signing with a banjo or readings from their limited supply of books. Some of it was because of the confidence that this situation was only temporary.

Part II, Chapter 4

It seemed like many men on that expedition had more than one skill.

Part II, Chapter 5

Lansing’s observation is that as they progressed through their hardship, they started to know themselves better. This lead to a contentment to accept what they were dealing with. Not a contentment which said we can do nothing, but one where they knew they were doing the impossible and making things, such as their survival, possible.

Some of it is that Shackleton had made sure each person had a task which lead to a sense of well-being.

Shackleton knew that of the enemies which included snow, ice, cold, the sea, and the wind, the biggest enemy was demoralization and discontentment. Seemed like Shackelton was a strong leader, but also was one which would listen to his men and change if the argument was good enough.

Part III, Chapter 1

Not all the time was Shackelton doing the right thing. Such as he thought they would be getting out of their predicament a lot sooner, so there was no need to lay in seal meat for a longer stay-it would just slow them down. Instead, they would come to want that meat later on. Lansing notes that Shackleton was not an ordinary individual. He was a man who believed completely in his own invincibility, and to whom defeat was a reflection of personal inadequacy. In other words, he thought that he could overcome any obstacle and do it in his terms. This self-image of invincibility has caused many an outdoors person to die.

The men had become attached to their dogs. So they no longer looked at them as tools. So with food running out, Shackleton had decided they needed to be killed. They had become devoted to the men. But there was also a question of survival for all. The dogs would have starved to death.

Part V, Chapter 2

Sometimes survival does not depend on you. It depends on forces outside of you. Such as in the expedition’s case, they needed open water to launch their boats. They could see it, but not get to it. Their job was to be prepared for that chance. But in the end, once prepared they could only wait.

Part V, Chapter 3

When they got to open water, they now needed to make towards land. After four nights, Shackleton could only read in the men’s faces how much more of the cold, the water, these men could take. In the end, their fate was left to God, the controller of the forces of wind, cold and storm.

Part V, Chapter 5

Over time, there was a sense that each was equal. They had suffered equally and felt they could argue their cases the same as anybody else. The sense of unity did depend somewhat on the weather. On beautiful days, this might be the best place in the world to be stranded. On the days when the wind blue cold and a storm roared through, their sense of community suffered.

Part V, Chapter 6

Optimism it is, and if not overdone, it is a fine thing. Wrote by Orde-Lees

When would rescue occur? The person who was left in charge tried to make the date as far away as possible so that the men would not get dispirited.

Part V, Chapter 6

There is a section in this chapter which has got to be a classic. I hope I do not get into trouble, but I would like to quote two paragraphs of this chapter:

The truth was that he [Shackleton] felt rather out of his element. He had proved himself on land. He had demonstrated there beyond all doubt his ability to pit his matchless tenacity against the elements--and win. But the sea is a different sort of enemy. Unlike land, where courage and the simple will to endure can often see a man through, the struggle against the sea is an act of physical combat, and there is no escape. It is a battle against a tireless enemy in which man never actually wins; the most that he can hope for is not to be defeated.

It gave Shackleton a feeling of uneasiness. He now faced an adversary so formidable that his own strength was nothing in comparison., and he did not enjoy being in a position where boldness and determination count for almost nothing, and in which victory is measured only in survival.

Part VI, Chapter 2

Lansing describes a mountain of water rising above them and then somehow not having the water crash on them. And then this happened not once more, but every 90 seconds or so, thousands of times each day. How could men live with this happening? Lansings says that after a while, it was just in the background, it lost all elements of awesomeness and they found it routine and commonplace instead. Sort of like beauty which we become accustomed to so we discount it.

Life was reckoned in periods of a few hours, or possibly only a few minutes-an endless succession of trials leading to deliverance from the particular hell of the moment. Very potent statement.

Part VII, Chapter 2

Amazing the mountaineering they did on the final leg of their journey to reach a place where rescue was possible. The sound of their return to civilization? A factory whistle!! A peculiar thing to stir a man--the sound of a factory whistle heard on a mountainside.

Evaluation:

Wow! Written in 1959 from diaries and accounts in 1915/1916, Alfred Lansing makes the Shackleton expedition’s Antarctic adventure come alive! From the self-confidence of Shackleton setting forth on crossing the seventh continent, to being trapped by an ice pack and eventually having it crush his ship, to surviving on an ice flow, to being in three small boats heading towards a small island, and then setting out to find an inhabited island.

This is a book to read even if you are not an outdoors person. You understand what people can do when heroic situations are called for. Also why having a group who will live and cooperate is so important to survival.

As I reread my review, I realize that occasionally my review is better than the book. This is not one of those times. The book far exceeds my words.

 
Notes from my book group:

Would you have survived the situations these mean found? Why did they survive them? What influence does the unity which they felt versus the type of people they were?

Today whalers are looked upon a destroyers of ocean life. But in the time this book portrayed, there was not that stigma. How can we tell today what occupation will be viewed as evil?

How does hardship mold the people of this expedition? How does it mold a person?

Was Shackleton right in risking his men’s lives when he knew of the danger which he was warned about? On the other hand, these men had signed up for this adventure, knowing that there was danger. How much risk does this allow Shackleton to make?

Shackleton ordered that the dogs be killed. Why? Did he have alternatives? Would you have killed the dogs? If not how would you have survived? If you would release them, how would these dogs have lived?

Adventure has a connotation of increased risk. Should a person place themselves, and probably others, into more danger without necessity? When there is a need to rescue a person, at what cost? Should those who place themselves in danger be rescued?

The people of this expedition survived through their own skill and fortitude. What outside forces could have overcome these qualities? To what degree are we all reliant on what is called “good fortune”? What is required of a person to receive good fortune?

Many of these questions are either from or adapted from LitLovers.

• Why the title of Endurance?
• Does this story work as an adventure story?
• Did the ending seem fitting? Satisfying? Predictable?
• Character:
  • Which character did you identify with?
  • Which one did you dislike?
• Every story has a world view. Were you able to identify this story’s world view? What was it? How did it affect the story?
• In what context was religion talked about in this book?
• Was there anybody you would consider religious?
  • How did they show it?
  • Was the book overtly religious?
  • How did it affect the books story?
• Why do you think the author wrote this book?
• What would you ask the author if you had a chance?
• What “take aways” did you have from this book?
• What central ideas does the author present?
  • Are they personal, sociological, global, political, economic, spiritual, medical, or scientific
• Describe the culture talked about in the book.
  • How is the culture described in this book different than where we live?
• How did this book affect your view of the world?
  • Of how God is viewed?
  • What questions did you ask yourself after reading this book?
• Talk about specific passages that struck you as significant—or interesting, profound, amusing, illuminating, disturbing, sad...?
  • What was memorable?

New Words:

• Percheron (I, 2): a breed of draft horse that originated in the Huisne river valley in western France, part of the former Perche province from which the breed takes its name. They were originally bred for use as war horses. Over time, they began to be used for pulling stagecoaches and later for agriculture and hauling heavy goods.
• Barkentine (I,2): a sailing ship similar to a bark but square-rigged only on the foremast
• Forecastle (I,3): the upper deck of a sailing ship forward of the foremast, or the forward part of a ship with the sailors' living quarters.
• Hummocky (I,4):a small knoll or mound above ground. They are typically less than 15 meters in height and tend to appear in groups or fields. It is difficult to make generalizations about hummocks because of the diversity in their morphology and sedimentology. An extremely irregular surface may be called hummocky
• Timorously (III,2): showing or suffering from nervousness, fear, or a lack of confidence
• Amenomania (III, 2): a disused psychiatric diagnosis that originally designated patients with delusional disorders which do not paralyse them, but who may have fixed bizarre delusions. [Lansing says that it means windmadness].
• Bergschrund (VI,2): a crevasse that forms where moving glacier ice separates from the stagnant ice or firn above. It is often a serious obstacle for mountaineers, who sometimes abbreviate "bergschrund" to "schrund". Lansing says that it is cut by wind.

Book References:

• Delilah by Marcus Goodrich
• South by Earnest Shackleton
• The Perfect Storm by Sebastin Junger
• Into Thin Air by Jon Krakauer
• Shackleton’s Way: Leadership Lessons from the Great Antarctic Explorer by Margot Morrel
• Science from an Easy Chair by Edwin Ray Lankester
• Marmion by Sir Walter Scott
• Sailing Directions for Antarctica by the US Navy
• Morte d’Arthur by Alfred Tennyson
• Penny Cookbook by Prudence Penny
• The Nautical Almanac
• David Copperfield by Charles Dickens

Good Quotes:

• First Line: The story that follows is true.
• Last Line: I could still see my Burberry [jacket] flapping in the breeze on the hillside--no doubt it will flap there to the wonderment of gulls and penguins till one of our familiar [gales] blows it all to ribbons.
• For an author, posterity is the toughest of proving grounds. Only a handful of books are so firmly connected to the timeless underpinnings of life that they survive into the future. Introduction by Nataniel Philbrick
• Optimism it is, and if not overdone, it is a fine thing. Wrote by Orde-Lees. Part V, Chapter 6

References:

• Publisher's Web Site for Book
• Author's Web Site
• Wikipedia-Book
• Wikipedia-Author
• Amazon-Book
• Amazon-Author
• Barnes and Noble
• GoodReads-Book
• GoodReads-Author
• NOVA on the Shackleton expedition
• Cool Antarctica site
• Mashable
• Kirkus Review
  

APNews - New book on finding the Endurance:  Review: The hunt for Shackleton’s ’Ship Beneath the Ice’

The Art of Dying Well

Book: The Art of Dying Well: A Practical Guide to a Good End of Life
Basic Information : Synopsis : Expectations : Thoughts : Evaluation :  New Words : Book References : Good Quotes : Table of Contents : References

Basic Information:

Author: Katy Butler

Edition: epub on Overdrive from the San Francisco Public Library

Publisher: Scribner

ISBN: 1501135317 (ISBN13: 9781501135316)

Start Date: May 29, 2019

Read Date: June 20, 2019

288 pages

Genre: Essay, Personal Growth, Death

Language Warning: None

Rated Overall: 5 out of 5

Synopsis (Caution: Spoiler Alert-Jump to Thoughts):

Katy Butler takes the reader through options in the dying process. She emphasises that it is better to die in peace and comfort than trying to prolong a life which may or may not be livable after treatment. She labels this as The Lost Art of Dying. She talks about how we are geared to prolonging life rather than evaluating the results of prolonging the life. Is the life remaining going to be better by living it fuller rather than treating a progressive illness?

She goes through the steps of dying, starting with just growing old and what one should be doing at each step. As we age, we slow down. We lose balance. We become aware of our mortality and how frail our bodies are becoming.

Then there is the active preparations for death to actually dying.

Expectations:

• Recommendation: Mel
• When: March 6, 2019
• Date Became Aware of Book: March 6, 2019-From a column Katy Butler wrote
• How come do I want to read this book: There are several things which I have been thinking about after my parents deaths over the past few years.
• What do I think I will get out of it? I am hoping that the book will help me to think through what I want in my own death.

Thoughts:

Introduction: The Lost Art of Dying

• Our health system rewards cure rather than care. This leads the system in making us a cog than a person.
• Contemplating our own vulnerability and mortality as we age leads us to be better prepared as the time draws closer and to be better satisfied with our care.
• Death cafe meetups
• Interesting distinction. She says that perfection is not a goal of art; it is an ambition of technology and science. She goes on and talks about how art is formed-through the use of imperfect materials which are found. In many ways, this is true of the book. Make use of the resources you have if you are dying.

Chapter 1: Resilience

Stage: This stage is when you still have physical capabilities. Usually in your 50's and 60's and early 70's. Being active can help extended this time. You still have the capabilities to reverse health problems.

Actions: Inventory your condition, build up reserves and make a determination of weaknesses.

Death during this stage is usually long and painful. But the best thing you can do is to walk energetically every day. Be active physically in whatever way you enjoy. As you get physically weakened, adapt.

While medical innovation can offer benefits, there are risks. You must weigh these risks, including what is not known.

High priority-guard your brain. It is here which you will be able to continue to function independently.

Use a mutual support system-neighbors helping and checking in on other neighbors.

Elders worthy of emulation know they will soon lose life-amd so they generously give it away to those around them. Doug von Koss

Fill out the Advanced Health Care Directive. Nothing is more profound than contemplating your feelings about how you want to be treated when you are dying... Butler goes on and says that it is an act of kindness to provide clear guidance of your wishes to those around you concerning what you want to happen to your body. Also it is an act of personal power to provide this specificity.

Cruzan decision (lookup what this is) gave four things a lay person has concerning patient autonomy:

• the right to determine medical treatment
• treat patients justly
• benefit the patient
• do not harm the patient

Two documents which enable a person to express their will are:

• Durable Power of Attorney for Health Care-allows a proxy to make the decisions in cases where you are not able to
• Living Will or Advance Directive. A POLST is a stricter version of this
  

Where to get theses?

• Health Plan (Kaiser)
• Mydirectives.com
• Also see aging with diginity.org – pamphlet called Five Wishes. Will cost $5

All will help you imaging “a good death”. Some questions/statements would include:

• My wish for how comfortable I want to be...
• My wish for how I want people to treat me....
• My wish for what I want my loved ones to know...
  
  

Butler states that the forms and all are stimuli for conversations a person should have with their loved ones. The idea is that there should be consensus about what the person who is dying wants and what is acceptable for those who need to make voice heard about what I want.

The first two thirds of life deals with what do I want to be, building and achieving status. The last third of life deals with what meaning does/did my life have-giving back both materially and in what has been learned. Reflection is part of this.

Ways to prepare:

• Build physical, social and spiritual reserves. Plan for a good death.
• Get at least half an hour of exercise a day-Make it pleasurable
• Get support for any issues you have-diabetes, …
• Find health care that emphasizes prevention and is accessible as mobility is less.
• Get to know neighbors, cultivate friendships with younger people, help those less able than yourself, mentor
• Pick a medical advocate. Talk openly about what I want done.
  
• Sign advance heath care directives
• Prepare for disability. Authorize access to medical records.
• Get family on same page as myself
• Have a quiet time for at least half an hour each day.
  
  

Chapter 2: Slowing Down

More felt than seen. The emphasis is to continue with the changes from the previous chapter. It will higher your plateau for living.

Simplify your routines. Understand the limits of medicine and the medical profession. Come up with a coordination of medical profession-I may already have that with Kaiser.

The key thing is to do things which will help you maintain independence:

• reduce financial accounts
• bill pay on autopay
• declutter
• smaller house and yard
• Keep tasks manageable
• Conserve your personal energy as that will start running out.
• Maintain mental clarity as this will start decreasing
• Simplify medical
  

Slow medicine-not a single silver bullet, but tackle multiple issues.

Butler recommends that Kaiser has a good set of senior advantage offerings.

Ways to prepare:

• Simplify your life,
• manage your energy levels
• do what matters to you.
• Enroll in an HMO or Medical Advantage plan
• Medication review with doctor once a year
• Guard your brain. Stay away from anticholinergics (dementia risk)
  • Also things which will increase the likelihood of falling
  • See American Geriatrics Society's “Beers List”
• Question and eliminate unnecessary screenings-see Choose Wisely website
• Improvise rites of passage-peace with loss
  

Chapter 3: Adaptation

You know you are not getting better, you need aids to do things, assistance for normal life stuff.

Butler favors not as much drugs and invasive procedures, but more on friendship with others and alternative care such as social workers and therapists.

Also the questions are slightly, but significantly different: What matters to you? Rather han What’s the matter with you? Emphasis on keeping meaning for you rather than repairing you.

FINDING ALLIES IN OCCUPATIONAL AND PHYSICAL THERAPY

Stay active and well socialized to keep functional, both physically and mentally.

Keep from falling:

• Get cataract surgery if needed.
• Give up progressive lenses as you age.
• Asses home for things which will cause you to fall
• Make sure your shoes are in good shape

People deny themselves pleasure when they become disabled. Adjust instead.

Joy and gratitude is essential for well-being. Be passionate about something outside of yourself.

Be able to look back at your life and not regret it.

Ways to prepare:

• Plan financially for possible disabilities
• Do not just rely on family. Use hired help or community resources
• Use a physical, speech and/or occupational therapist.
• Prevent falls
• Review medications

Chapter 4: Awareness of Mortality

Addressed to those who:

• If you are serious or terminally ill.
• A vital organ is slowly failing
• Early stages of an incurable disease.
• Doctors do not give a good prognosis-or even none.
• Terms such as chronic, progressive, serious, advanced, late or end stage is used
• Doctors ask about your goals of care-what matters to you.
• Gut feeling that the next medical appointment will divide your life into before and after.

Length of life is not the only metric of quality of care.

Accepting death, while continuing to live as much as you can.

Have your doctor sketch out how they think your life will progress. Common ones include:

• Niagara Falls
• Looping Decline
• Stair Step
• Dwindles

Palliative care is not hospice. But emphasis relieving suffering and improving function. See web site: getpalliativecare.org

Address your fears, ask your doctor:

• What is it like to die from my condition?
• Will you still be my doctor if I decide to opt for strictly palliative care?
• When do patients with my condition benefit most from enrolling into hospice care?

Think through how your treatment matches your objectives. Your doctor has five traditional duties. You need to understand how the treatment you want and are receiving fit in:

• To prevent disease
• To restore functioning
• To prolong life
• To relieve suffering
• To attend the dying

When you have a short time to live, energy is the most precious commodity. How do you want to spend it?

Don’t postpone joy

Ways to Prepare:

• Pause before making major medical decisions
• Join a support group
• Find a palliative care doctor/nurse

Ask your doctor questions:

• Can you sketch the usual trajectory of my illness
• What do you hope this treatment will do for me?
• How will I feel day to day?
• What alternatives and what are the pro's and con’s?
• What is it like to die with my condition? How will medicines affect this?
• Will you still be my doctor if I opt for palliative care?
• When do patients with my condition benefit the most from hospice care?

Ask Yourself:

• What activities or capacities make my life worth living?
• What are my fears and regrets?
• Given that time is short, how do I want to spend it?

Chapter 5: House of Cards

Addressed to those who:

• Includes caregivers, not only those who are experiencing this decline
• No longer have a zest for living-the dwindles. Loss of:
  • Appetite
  • Energy
  • Investment in relationships
• Takes more than 20 seconds to get up out of a chair, walk 10’ and back and sit down.
• Lost 10 lbs or 10% of body weight in past year
• Troubles walking half a mile, unscrew jar lid, pick up a chair.
• To get up, you push with both hands
• You fall easily or use a walker or need help balancing
• 10 hours or more a day of sleep
• You have caregivers or require an assisted living situation
• Gone to ER at least once this year and come back worse, rather than better
• No longer forgetting names, but also forgetting way home

More likely to suffer complications from hospital stays. Each day an older person lies in bed, you lose about 5% of your muscle mass.

Good medical care at this stage includes:

• Physician house call service
• Focus on comfort
• Upgrading advanced health care directives
• Considering what a peaceful death will look like
• Working on reducing hospital visits, including ER.
• Considering what medicines are appropriate for this stage of life.

Some things in life cannot be fixed. They can only be carried. Meghan Devine

About 25% of people in their 70’s are considered frail; 40% in their 80’s.

Upgrade the Advanced care Directive to a POLST

Understanding your situation will lead to uncertainty and issues with established protocols. Uncertainty is not a temporary nuisance which can be chased away through learning the rules, or surrendering to expert advice, or just doing what others do. Instead it is a permanent condition of life… To be responsible does not mean to follow the rules. It may often require us to disregard the rules or to act in ways the rules do not warrant. Zygmunt Bauman

Her belief in God is a loving God who does not inflict suffering, at least as far as technology. (Later it looks more like a New Age type of belief, not Christian).

At times caregivers need to be an advocate, a warrior for the person who is dying to have their wishes honored.

When the prognosis looks closer to terminal, ask for comfort care. This is saying yes to making the patient feel comfortable, eliminating or reducing pain or distress. Make sure only essential doctor appoints are made.

Ways to Prepare:

• Recognize frailty and protect against the ramifications, such as falling
• Avoid hospitalization. Do home-based care
• Get a POLST signed with a DNR.
• Halt dialysis
• Relax dietary and other restrictions. Enjoy the remaining time.

Chapter 6: Preparing for a Good Death

In death, you die alone, but you can and should have others with you till the end. It is easier with others. This does require the acceptance of a coming death.

Look for hospices between 9-15 patients/nurse-the lower the better. Go to Medicare’s hospice compare page Do site visits to better understand the facility and how they operate.

There are three things people want know/express before they die:

• Regrets to express and want forgiveness
• Fear of being forgotten-they want to be remembered.
• Lives had meaning.

Ask yourself:

• What stands in the way of dying in peace?
• What do you regret?
• What does a good death mean to me?
• How do people with my illness die?
• What can be done to ease the symptoms?
• Are there certain people whom you do not want to see?
• How might your survivors feel better once you are gone?

A “to do” list from who gets what to what do you want to talk about is helpful. They generally fall into three categories:

• Telling your story
• Arranging practicalities
• Interpersonal work at life’s end

People die as they’ve lived. Judith Redwing Keyssar

Many people do five emotional tasks at the end of life:

• Please forgive me
• I forgive you
• Thank you
• I love you
• Goodbye

Ways to Prepare:

• Call a hospice for an informal meeting
• Consider the five emotional tasks
• Enlarge your support

Chapter 7: Active Dying

Useful if:

• Stop eating
• Thoughts of packing up and going home, or moving to a higher floor
• See, dreams or speaks of the dead
• Talks of wanting to join dead loved ones
• Spirit guides
• Cannot get out of bed, needs help to go to the bathroom or uses a diaper
• I am dying or there is not much time
• Brief spurt of energy, joy, or exuberance. May last hours or even days
• Withdrawls, naps, does not speak much, and/or keeps keyes closed.

If in a hospital or a medical facility, look for the following signs, as medical stuff may disguise impending death:

• ICU with stage four cancer or infection shutting down whole body. Also prior ICU visits
• ICU doctors argue about treatment or multiple organ systems failure
• Doctor suggests meeting with palliative care or hospice people.

Modern death involves three things:

• Physical comfort
• Human connection
• Pain control

Modern times, death is more hidden, so we are not exposed to it and do not recognize it. The goal is not a “perfect” death, but one where the passage is kept comfortable and human. Dying is not an emergency, but a time to recognize the human being and who they are. Express your care for the person.

Being able to help care for a person relieves some of the guilt of the thought, did I do enough?

There needs to be a team of people helping you. But it also takes a strong person to coordinate and be there.

Hospice at home may not be for everyone. There are difficult situations. Or times when you cannot have adequate care. She does think that if you have the resources, dying at home is the better way to die.

Plan for some basic needs if you are doing in home hospice:

• Food and comfort for those who are at the home
  • Takeout menus or food from friends
• Medical care which supports the dying (hospice care n home service or palliative care)
• Prescriptions for pain/anxiety management
• Calmness
• Reading material or puzzles, games, music
• Whiteboard/notepad for messages
• Documents detailing medical wishes and conditions

Equipment might be:

• Hospital bed
• Wheelchair
• Bedside commode
• Paper towels
• Dark cotton towels
• Adult diapers
• Garbage bags
• Lavender or eucalyptus spritzer-there are smells with the dying
• Charcoal briquettes under the bed to absorb odors

No right way to die. The dying will feel different emotions. They may want to talk about deep, personal stuff, or watch a TV show or sports. Sometimes a person will “hold on” as long as people are in the room. Step out occasionally.

The dying will probably be able to hear you. So it is OK to speak to them.

Ways to Prepare:

• Prepare for the needs of the dying
• Bring in hospice care if you can
• Make pain management a priority
• Alternative to 911 calls in a crisis
• Get a DNR and POLST
• Keep focused on what matters
• Hospitals
  • Have unnecessary medical equipment, beepers, monitors, … removed
  • Ask for comfort care only-no blood draws, diagnostic tests or vital signs.
    • Pan management only
  • Claim the space by what the person wants.
  • Recite poems or prayers, whatever will comfort the person and yourself.
    • Anglican Prayer for the Time of Death

Conclusion: Toward a New Art of Dying

Dying can be ugly, and families and friends thirst for beauty. A good death is judged not only by the peace and comfort of the dying person, but by the memories that inhabit, or later haunt, those who survive it.

Evaluation:

 Let me start by saying, I am not dying, at least not any more than anybody else is. So why am I interested in this book. First, my parents died in the past five years, so death has been on my mind. Also my wife’s cousin recommended an article by the author, Katy Butler.

Is this book good? Yes. It is practical with lots of bullet point recommendations, along with many stories of those who faced death in various circumstances. Having said that, who is this book good for? It is aimed at those who are pondering what kind of death they would like to have. Those in their 60’s is the preferable target audience. Does Butler have any special leanings? Yes. She thinks that as we get older, medical procedures are too invasive and not particularly effective in improving a person’s quality of life; medicine can cause its own problems with confusion and balance; home hospice is the best place to die.

This is a book which is a good guide to ponder how you want to die and how to prepare for death. Butler’s goal is to prolong your ability to enjoy your life, even as you age. As part of this, she gives you an understanding of how to increase your time of health. This is a theme of the book. Eventually you will have a choice-lengthen your life by medical means or learn to enjoy your life as your body declines. Her preference is to continue to enjoy life rather than be inflected with medical procedures.

Either way you choose, this is a book which will cause you to think about your mortality. It gives you the tools to take charge of your life and death.

New Words:

• joie de vivre (French): joy of living

Book References:

• The Art of Dying by an anonymous Catholic monk
• The Way of Dying Well by an Angleican
• Piety Promoted: In Brief Memorials and Dying Expressions of Some of the Society of Friends, Commonly Called Quakers
• Being Mortal by Atul Gawande
• Natural Causes by Barbara Ehrenreich
• When Breath Becomes Air by Paul Kalanthi
• History of Palliative Care by Michael Stolberg
• My mother, Your Mother: Embracing “Slow Medicine,” The Compassionate Approach to Caring for Your Aging Loved Ones by Dennis McCullough, MD
• How to Protect Your Family Assets from Devastating Nursing Home Costs: Medicaid Secrets by Gavriel Heiser.
• This Chair Rocks by Ashton Applewhite
• The Emperor of All Maladies by Siddhartha Mukherjee
• Hard Choices for Loving People by Hank Dunn
• Choosing to Die by Phyllis Shacter
• Final Exit by Derek Humphry
• The Story of Babar: The Little Elephant by Jean de Brunhoff
• Share the Care
• Sacred Dying by Megory Anderson
• Last Acts of Kindness by Judith Redwing Keyssar

Good Quotes:

• First Line: To our ancestors, death was no secret.
• Last Line: And then I urge you to take your voice out into the wider world, and keep telling your stories.
• Elders worthy of emulation know they will soon lose life-and so they generously give it away to those around them. Doug von Koss as quoted in chapter one.
• Nothing is more profound than contemplating your feelings about how you want to be treated when you are dying… Chapter One
• Don’t postpone joy. Chp 4
• Some things in life cannot be fixed. They can only be carried. Meghan Devine, in It's OK That You're Not OK: Meeting Grief and Loss in a Culture That Doesn't Understand
• People die as they’ve lived. Judith Redwing Keyssar in Last Acts of Kindness

Table of Contents:

• Introduction: The Lost Art of Dying
• Chapter 1: Resilence
• Chapter 2: Slowing Down
• Chapter 3: Adaption
• Chapter 4: Awareness of Mortality
• Chapter 5: House of Cards
• Chapter 6: Preparing for a Good Death
• Chapter 7: Active Dying
• Conclusion: Toward a New Art of Dying

References:

• Publisher's Web Site for Book
• Author's Web Site And Facebook
• Wikipedia-Author
• Amazon-Book
• Amazon-Author
• Barnes and Noble
• GoodReads-Book
• GoodReads-Author
• Washington Post review
• California Health Care Foundation Interview
• Publisher’s Weekly