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Knocking on Heaven's Door: The Path to a Better Way of Death Paperback – June 10, 2014

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Editorial Reviews

From Booklist

“Once upon a time we knew how to die. We knew how to sit at a deathbed.” In this sad yet valiant and exacting memoir, Butler, an award-winning science writer for the New Yorker and other venues, recounts the plight of her elderly father and the toll his many afflictions exacts on herself and her mother. He suffers a stroke followed by progressive dementia, speech difficulty, visual loss, and incontinence. An injury during WWII already cost him an arm. Before undergoing hernia surgery, a permanent cardiac pacemaker is implanted. As his mind and body further deteriorate, Butler and her mother plead with doctors to deactivate the device to no avail. When he finally dies from pneumonia, the pacemaker continues functioning inside the dead man’s chest, a chilling reminder of “our culture’s idolatrous, one-sided worship of maximum longevity.” About a year later, his physically and emotionally exhausted wife expires. Butler looks at the strain on caregivers, feelings of guilt and grief, the untapped utilization of palliative care, and the haziness between “saving a life and prolonging a dying.” --Tony Miksanek --This text refers to the Hardcover edition.

Review

Knocking on Heaven’s Door is a thoroughly researched and compelling mix of personal narrative and hard-nosed reporting that captures just how flawed care at the end of life has become." (Abraham Verghese New York Times Book Review)

“This is a book so honest, so insightful and so achingly beautiful that its poetic essence transcends even the anguished story that it tells. Katy Butler’s perceptive intellect has probed deeply, and seen into the many troubling aspects of our nation’s inability to deal with the reality of dying in the 21st century: emotional, spiritual, medical, financial, social, historical and even political. And yet, though such valuable insights are presented with a journalist’s clear eye, they are so skillfully woven into the narrative of her beloved parents’ deaths that every sentence seems to come from the very wellspring of the human spirit that is in her." (Dr. Sherwin B. Nuland, author of How We Die: Reflections of Life’s Final Chapter)

“This is some of the most important material I have read in years, and so beautifully written. It is riveting, and even with parents long gone, I found it very hard to put down. ... I am deeply grateful for its truth, wisdom, and gorgeous stories—some heartbreaking, some life-giving, some both at the same time. Butler is an amazing and generous writer. This book will change you, and, I hope, our society." (Anne Lamott author of Help, Thanks, Wow)

"Shimmer[s] with grace, lucid intelligence, and solace." (Lindsey Crittenden Spirituality and Health Magazine)

"[An] unflinching look at America's tendency to overtreat [that] makes a strong case for the 'slow medicine' movement, which recognizes that 'dying can be postponed, but aging cannot be cured.'" (Zaineb Mohammed Mother Jones)

"[A] deeply felt book...[Butler] is both thoughtful and passionate about the hard questions she raises — questions that most of us will at some point have to consider. Given our rapidly aging population, the timing of this tough and important book could not be better." (Laurie Hertzel Minneapolis Star Tribune)

"Butler argues persuasively for a major cultural shift in how we understand death and dying, medicine and healing. At the same time, she lays her heart bare, making this much more than ideological diatribe. Readers…should be sure to pick up this book. It is one we will be talking about for years to come.” (Kelly Blewett BookPage)

“ A pitch-perfect call for health care changes in the mechanized deaths many suffer in America.” (Roberta E. Winter New York Journal of Books)

"This braid of a book...examines the battle between death and the imperatives of modern medicine. Impeccably reported, Knocking on Heaven's Door grapples with how we need to protect our loved ones and ourselves." (More Magazine)

"A forthright memoir on illness and investigation of how to improve end-of-life scenarios. With candidness and reverence, Butler examines one of the most challenging questions a child may face: how to let a parent die with dignity and integrity. Honest and compassionate..." (Kirkus Reviews)

“Katy Butler’s science background and her gift for metaphor make her a wonderfully engaging storyteller, even as she depicts one of our saddest but most common experiences: that of a slow death in an American hospital. Knocking on Heaven’s Door is a terrible, beautiful book that offers the information we need to navigate the complicated world of procedure and technology-driven health care.” (Mary Pipher author of Reviving Ophelia and Seeking Peace: Chronicles of the Worst Buddhist in the World)

"Katy Butler's new book—brave, frank, poignant, and loving—will encourage the conversation we, as a society, desperately need to have about better ways of dying. From her own closely-examined personal experience, she fearlessly poses the difficult questions that sooner or later will face us all.” (Adam Hochschild author of King Leopold’s Ghost and To End All Wars)

“Intimate and wise, heartbreakingly compassionate, and critically helpful, this is a truly important work that I hope will be widely read. We have lost our way and Katy Butler’s impeccably researched and powerful tale will help eliminate much suffering on the passage to the mystery of death.” (Dr. Jack Kornfield author of A Path with Heart)

"This is the most important book you and I can read. It is not just about dying, it is about life, our political and medical system, and how to face and address the profound ethical and personal issues that we encounter as we care for those facing dying and death. [This book's] tenderness, beauty, and heart-breaking honesty matches the stunning data on dying in the West. A splendid and compassionate endeavor." (Joan Halifax, PhD, Founding Abbot, Upaya Institute/Zen Center and Director, Project on Being with Dying: Cultivating Compassion and Fearlessness in the Presence of Death)

"This beautifully written and well researched book will take you deep into the unexplored heart of aging and medical care in America today. With courage, unrelenting honesty, and deepest compassion, ... Knocking on Heaven’s Door makes it clear that until care of the soul, families, and communities become central to our medical approaches, true quality of care for elders will not be achieved." (Dennis McCullough author of My Mother, Your Mother: Embracing "Slow Medicine,'" the Compassionate Approach to Cari)

“This book stands as an act of profound courage. It is brutally honest about the nature of relationships, searingly insightful in the potential of healing, and shines and intense light on our ignorance…For that alone, it is an important one to read.” (108ZenBooks.com)

Knocking On Heaven’s Door is a disquieting book, and an urgent one. Against a confounding bioethical landscape, Katy Butler traces the odyssey of her parents’ final years with honesty and compassion. She does a great service here, skillfully illuminating issues most of us are destined to face sooner or later. I cannot imagine a finer way to honor the memory of one’s parents than in such a beautifully rendered account.” (Alexandra Styron author of Reading my Father)

"Compassionate and compelling." (Shelf Awareness)

"Butler’s advice is neither formulaic nor derived from pamphlets...[it] is useful, and her challenge of our culture of denial about death necessary...Knocking on Heaven’s Door [is] a book those caring for dying parents will want to read and reread. [It] will help those many of us who have tended or will tend dying parents to accept the beauty of our imperfect caregiving." (Suzanne Koven Boston Globe)

"Knocking on Heaven's Door is more than just a guide to dying, or a personal story of a difficult death: It is a lyrical meditation on death written with extraordinary beauty and sensitivity." (San Francisco Chronicle)

"[Knocking on Heaven's Door is] a triumph, distinguished by the beauty of Ms. Butler's prose and her saber-sharp indictment of certain medical habits. [Butler offers an] articulate challenge to the medical profession: to reconsider its reflexive postponement of death long after lifesaving acts cease to be anything but pure brutality." (Abigail Zuger, MD New York Times)

"A stunning book, truthful and its dignified, and it could be a conversation-starter. If there's a need for that in your family -- or if you only want to know what could await you -- then read Knocking on Heaven's Door. You won't regret it." (Appeal Democrat)

“Astonishingly beautiful. [Butler’s] honest and challenging book is an invitation to all people—Christians included—to reconsider the meaning of drawn out deaths and extreme measures in a historic—and eternal—perspective.” (Rachel Marie Stone Christianity Today)
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Product Details

  • Paperback: 352 pages
  • Publisher: Scribner; Reprint edition (June 10, 2014)
  • Language: English
  • ISBN-10: 1451641982
  • ISBN-13: 978-1451641981
  • Product Dimensions: 5.5 x 1 x 8.4 inches
  • Shipping Weight: 11.4 ounces (View shipping rates and policies)
  • Average Customer Review: 4.7 out of 5 stars  See all reviews (453 customer reviews)
  • Amazon Best Sellers Rank: #25,257 in Books (See Top 100 in Books)

More About the Author

My first book, "Knocking on Heaven's Door," drew on 30 years in journalism and 8 years as my parents' part-time caregiver and full-time medical advocate. I wrote it to save others some of the hardship they experienced in the labyrinth of the American medical non-system. (They lived good lives, and hoped to die good deaths. One succeeded, one failed. ) Named one of the ten best memoirs of the year by Publishers Weekly, it was a bestseller and was chosen as a New York Times Notable Book of 2013. Overnight success at 64!
Prior to that, my writing appeared in The Wall Street Journal, The New Yorker, The New York Times, Vogue, Best American Essays, Best Buddhist Writing, and Best American Science Writing.
Since the book's publication, I've spoken widely to doctors and fellow family caregivers about how to create more humane approaches to life's final passage and to give those we love "Good Deaths." It can be done. The positive response within medicine -- at Kaiser Permanente, Harvard Medical School, and Grand Rounds across the country --has been surprising and healing.
I was born in South Africa's Great Karoo desert but don't remember it. I was a baby when we moved to England, and after graduating from Wesleyan University in Connecticut, I drove to San Francisco with $300 in my pocket. The Bay Area has been my home ever since. In my 20s and 30s, I got up at 4:30 every morning to practice at SF Zen Center and then changed out of my robes and covered riots, cult scandals, the right-to-die movement, AIDS, and other news from the edge for the SF Bay Guardian and SF Chronicle. A double life.
Among my favorite experiences as a journalist were writing about: a female impersonator turned Zen street saint, a disappointing Valentine's Day, Mickey Hart of the Grateful Dead, the Gyuto monks, and Jeff Bridges's Buddhist practice. I wrote a few pieces about neuroscience and human behavior for the science section of the New York Times, covered downward mobility among baby-boomers for Mother Jones, and described the implosion of the Howard Dean campaign for Salon.com.
In my late 50s, I joined the "roll aboard generation" of baby-boomers who are helping out aging and ailing parents. A New York Times magazine article dissecting how technological medicine prolonged my father's last miserable years ("What Broke my Father's Heart,") exploded on the Internet and led to a contract to write "Knocking on Heaven's Door: The Path to a Better Way of Death." An instant New York Times bestseller for Scribner in the fall of 2013, it won the 2014 "Books for a Better Life" award for Best First Book and was shortlisted for a major national literary prize.
Earlier on, I was a finalist for a National Magazine Award and winner of awards from the National Association of Science Writers, Mental Health America, and the Association of Health Care Journalists.
Earlier in life, I worked as a crossing guard; lived on an abandoned avocado plantation in the Venezuelan rainforest; served pizza; cleaned cabins in a zen monastery-cum-resort; and sang "Row Row Row Your Boat" with my darling Brian and inmates of a locked dementia ward. I teach memoir writing at Esalen Institute and live just across the Golden Gate Bridge from San Francisco. My local independent bookstore is Book Passage in Corte Madera, Ca., which carries autographed copies of "Knocking on Heaven's Door."
I've also written for JAMA-Internal Medicine, MORE, Tricycle: the Buddhist Quarterly, Yoga Journal, Psychotherapy Networker, Vogue, Byliner, The Whole Earth Review and Catalog, and others. I don't know what is next.

Customer Reviews

Most Helpful Customer Reviews

172 of 173 people found the following review helpful By Sinohey TOP 1000 REVIEWER on September 13, 2013
Format: Hardcover
Once in a while a book comes along that makes a significant impression on our way of life. Katy Butler has written such a book, based on and expanded from her original 2010 article (What Broke My Father's Heart) in the New York Times. In "Knocking at Heaven's Door", Ms. Butler exposes the often tragic end-of-life circumstances, caused by society's unrealistic expectations and/or religious beliefs as to the sanctity of life; prolong it at any cost (usually to the patient's & family's)! This is supported, and frequently encouraged, by the medical establishment out of incompetence, greed or fear of litigation. Other reviewers have given a good synopsis of the book from laymen's point of view; I shall add a perspective from someone who has been in the trenches.

The inexorable advance in medical skills, nutrition, antibiotics, chemotherapeutics and overall technology has resulted in a significant boost to the overall health of society and its longevity; at the beginning of the 20th century life expectancy, on average, was 45 years compared to 78 years today. But a longer life is not necessarily a quality life. And that is where we fail as a society. We have become very adept at prolonging life no matter what, but what we are often really doing is protracting death. Over twenty percent of deaths in the USA happen in the critical/intensive care units "where 10 days of futile flailing can cost as much as $323,000", or to put it differently about 80% of medical expenses occur in the last 2 years of life in patients with debilitating chronic intractable conditions or incurable diseases. The USA is one of the few 'first world' countries where this extravagant waste continues to happen.
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Format: Kindle Edition
Ostensibly, I was eager to read Katy Butler's Knocking on Heaven's Door because I wanted to find a book for my students. I advise students entering the medical professions from a major university. My stated mission is to help them find careers where they will be happy, but lurking behind my mission is a human being who has been hurt and healed by physicians. I want my students to be passionate about medicine, but for me, and the aging members of my generation, I ache with the hope they will be compassionate. Passion can be saving a patient at all costs--costs to comfort, costs to their wishes to die at home among family, costs to their family's need for freedom, and rest and closure. To ensure their passion, I encourage my students to volunteer in the emergency department of hospitals; to ensure their compassion, I ask them to take a deep breath and volunteer with hospice care.

Katy Butler's book is personal--for her and for me. She traces the steps many of us will follow as our parents, and in my case, a spouse, move from vigor to failing health, to death. I started reading for my students, but I soon was reading for me, staying up until dawn, crying and laughing as I recognized the universality of our common plight.

I have already seen many beautiful and accurate reviews of Knocking on Heaven's Door, so I will leave the particulars to those authors I have come to respect and love in the scientific, yet spiritual, field of medicine.
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85 of 87 people found the following review helpful By Rachel S. Houseman on September 10, 2013
Format: Hardcover Verified Purchase
Spoiler alert: Medicare is imperfect and so is your physician. Those are just two of the takeaways from Katy Butler's "Knocking on Heaven's Door: The Path to a Better Way of Death." Butler whipstitches together a personal story of family, life and loss, with a troubling but informative assessment of current medical practices and American cultural norms that surround end-of-life issues.

I first encountered Butler's writing on the subject in a New York Times article in 2010 called "What Broke My Father's Heart." She laid out the multitude of personal and medical issues as her parents entered their 80s - a sudden health crisis of her father's that ultimately laid the groundwork for his years-long decline - stroke, heart disease, dementia, blood clots, brain hemorrhage. She explained how our current system more often than not intentionally draws out the process of dying. Medication, surgical interventions, technology - all of these things led to the shell of the man she knew as her father, simultaneously saving and dooming him. She also lovingly describes the impact his years-long dying had on her mother, who became a round-the-clock caregiver, bather, cook, cleaner and diaper changer.

What stood out most to me, what I took away from that article, is explained more fully in "Knocking on Heaven's Door." That for many, many of us, being forced to make a split second decision in a medical emergency will likely lead to a much longer path of disease, decline, and pain. Your mother has a heart attack? "If you don't agree to a breathing tube/feeding tube/CPR/pacemaker RIGHT NOW, she will die, and it will be because you LET her.
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