Home Sick: How to Care for Yourself and Ill Family Members During the Pandemic

“At night, all I hear are ambulances,” Andrea Wyner told me. Wyner is an American travel photographer who lives in Milan, the primary city in Lombardy, the Italian region most effected by the coronavirus. The death toll in Italy has just surpassed that of China.

Many global health experts predict that the U.S. will experience the virus much the way Italy has. Hospitals there have been unable to keep up with the influx of ICU patients and there are reports that overwhelmed medics have had to abandon patients over 80 in some areas. Data shows that the U.S. is likely one to two weeks behind Italy.

Even for the young, the coronavirus is no joke, and most of us will be among the 80 percent who experience mild symptoms, which can include a fever and cough.  But what should you do to care for yourself and others at home? And how do you know you need medical attention?

**Note: the following information is for reference only; consult your doctor by phone on how to care for yourself or a loved one with coronavirus.**

If you wake up one morning with a dry cough and a temperature, there’s a chance you’ve been exposed. Unless you have an underlying medical condition, like diabetes or heart condition, you should treat your symptoms as you would the flu. You can expect lethargy, chills, a persistent, dry cough, and a low grade fever for up to two weeks. Follow these simple guidelines and you’ll likely pull through:

Drink lots and lots of fluids. Dehydration can lead to hospitalization.

It is ok to use ibuprofen. There have been reports that patients with coronavirus should avoid ibuprofen, found in drugs like Advil. But the World Health Organization has approved its use and NPR and the Boston Globe have pronounced the caution against ibuprofen overblown.

Use dextromethorphan to reduce coughing; use guaifenesin to break up mucus. Both drugs can be found in types of Robitussin or Mucinex.

Quarantine yourself if you are sick. You may be young and healthy but others are not. By not spreading the virus you are saving lives and helping to prevent overwhelming the medical system. And by quarantine, I mean strict no-touching-things-other-people-touch.

The virus can live on surfaces for a long time. It remains “stable” on cardboard—like a coffee cup or take-out food box—for up to 24 hours; on plastic or metal surfaces—like door knobs, cell phones, and subway polls—it can last for up to three days.

Be vigilant. The Washington Post reported recently that between February 12 and March 16, 38 percent of those hospitalized with coronavirus were younger than 55. If you experience shortness of breath or a persistent fever, call a doctor.

It is important to remember that you should not just show up at a hospital; doing so could jeopardize your health and the health of others. Monitor news of the situation at your local hospital and call before visiting.

We’re at the end of a particularly difficult flu season and we’re coming into allergy season. Be calm and discerning when you analyze your symptoms or those of a loved one; consider your history with allergies and whether you received a flu shot.

If you still have questions, the USC Gehr Family Center for Health Systems Science & Innovation has created a “Coronavirus Self-Triage Guide” that will take you through a series of questions to help you understand if your experiences are consistent with the virus’s effects and whether you should seek hospital attention.

What if you have a sick family member at home? Unless you have a supply of your own medical PPE (professional protective equipment)—which is increasingly difficult to come by in this new world—keeping one sick member of your family from infecting the rest of you will not be easy.

The World Health Organization recommends that the patient be place in a well-ventilated room of the house, that their movement be limited and that their designated caregiver would wear any protective gear possible. Cleaning and disinfecting the house will help prevent spread of the virus. “Do not shake soiled laundry and avoid contaminated materials coming into contact with skin and clothes,” the WHO guide advises.

In order to prevent the overrun of U.S. hospitals there are several things we can do right now to “flatten the curve,” or spread out the rate of infection so that our medical resources can manage the severely ill. Stay at home and end your contact with others. Leave the house only for necessary items—and do so as infrequently as possible.

“Social distancing is not going to remedy this, unfortunately,” Wyner, who has family in New York and Los Angels, told me. Experts agree.  The entire Lombardy region is on lock-down, unable to leave their homes except for absolute necessities. Only grocery stores and pharmacies are open and they are deserted, Wyman told me via Skype. Italians have finally realized that risking contact means risking the death of others.

Wyner, who travels extensively for work, believes that she contracted coronavirus a few weeks ago but experienced only mild flu-like symptoms. Now she’s watching the news and marveling at crowds of spring breakers partying on Florida beaches or New Yorkers grabbing take out at their favorite local restaurant. 

She’s got a point. To Italians, taught the lesson of this virus with each pass of the ambulance, our slowly dawning awareness of the dangers of coronavirus is perplexing. But those reacting are often doing so in panic. “Why do they think they will run out of food?” Wyner asked me.

Because no one has told us otherwise. And that’s the real point of these past few weeks. The absence of clear and concise information—either from the president or our state and local leaders—has made dealing with the virus so much harder. Our die was cast by decades of federal services starvation, health care inequality, and the sickness of nationalism.

As the New York governor and the New York mayor tussle over whether to issue “shelter in place” orders for the state, it looks like we’re still on our own to figure out how to survive the plague this time.

 

¹ see notes and transcript from convo, 3.19.2020, 10:30 am EST

² https://abcnews.go.com/Health/coronavirus-live-updates-china-reports-domestic-cases-1st/story?id=69679965&cid=social_fb_wnt&fbclid=IwAR2yeRGSiyV_nwfPhFPlB4uKt5ByHL-RE5dRiIvRWMvNAGjkBKld59eebms

³ https://www.usatoday.com/in-depth/news/2020/03/18/u-s-coronavirus-growth-rates-show-many-states-could-close-behind-new-york/5072663002/

⁴ https://www.snopes.com/fact-check/italy-elderly-coronavirus/ and https://www.telegraph.co.uk/news/2020/03/14/italians-80-will-left-die-country-overwhelmed-coronavirus/

⁵ https://www.usatoday.com/in-depth/news/world/2020/03/19/coronavirus-curve-us-may-its-most-dangerous-point/2863553001/

⁶ https://www.businessinsider.com/what-coronavirus-mild-symptoms-are-fever-2020-3

⁷ https://www.usatoday.com/story/news/health/2020/03/19/coronavirus-illnesses-can-serious-young-adults-cdc-report/2874271001/

⁸ https://www.bostonherald.com/2020/03/19/coronavirus-who-does-not-recommend-against-using-ibuprofen/ and

⁹ https://www.npr.org/sections/health-shots/2020/03/18/818026613/advice-from-france-to-avoid-ibuprofen-for-covid-19-leaves-experts-baffled

¹0 https://www.healthline.com/health/cough/robitussin-vs-mucinex and https://www.youtube.com/watch?v=w8dUyUF5T2g&feature=youtu.be&fbclid=IwAR1JYYuhCIzQ42QEzyGoqNHtP43_phoP0_NFCqY3BLfJNFn9mMbKi7QunnY

¹1 https://www.nejm.org/doi/10.1056/NEJMc2004973

¹2 https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces

¹3 https://www.washingtonpost.com/health/2020/03/19/younger-adults-are-large-percentage-coronavirus-hospitalizations-united-states-according-new-cdc-data/

¹4 https://www.statnews.com/2020/03/18/ppe-shortages-health-workers-afraid-scouring/

¹5 https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts

¹6 https://arstechnica.com/science/2020/03/test-test-test-who-says-as-us-flounders-with-covid-19-response/

¹7 https://www.businessinsider.com/who-social-distancing-isnt-enough-countries-must-test-2020-3

¹8 https://www.nbcnews.com/news/us-news/coronavirus-comes-spring-break-locals-close-florida-beaches-after-governor-n1163741

¹9 https://nypost.com/2020/03/16/takeout-business-is-just-too-small-to-help-struggling-new-york-restaurants/

End of Life Planning in a Pandemic

Rapid developments and the unprecedented nature of this pandemic make understanding and preparing for it dizzying. What has become clear over the past two months is that the death toll is incredibly high and that a majority of those killed by the virus are over the age of 60.

“The grim reality is that for the elderly, COVID-19 is almost a perfect killing machine,” American Health Care Association CEO Mark Parkinson recently told Alex Spanko at Skilled Nursing News. Even as our elders are targeted by this virus, so too are younger individuals, some who knowingly or not have preexisting conditions like diabetes, heart disease, and lung disease.

Mortality is hard for us to get our heads around—which makes planning for any eventuality difficult. I typically advise families to complete their end of life planning long before a crisis requires it, but this pandemic has run out our collective clock. The crisis is now and COVID-19 has made death our daily conversation. 

Even if you remain uninfected, there is a great chance that every one of us will lose someone we know. Talking to your closest loved ones about your end of life decisions will help you get the care you want—and importantly, it will help your loved ones to know how to make decisions on your behalf, a huge comfort in times of uncertainty, grief, and crisis.

Use your time in self-isolation to organize your primary documents and information. You can use a file box or prominently-marked cabinet drawer in your home to store the following items:

Collect your financial information, including: 

* bank account numbers, both checking and savings

* check books

* insurance policies

* investment account details 

* safe deposit box keys

* Social security card and other identification like birth certificates and passports

* Utility and other monthly billing information 

* mortgage, deed, or lease for your home or residence

* vehicle title

* Internet account numbers and passwords, including subscriptions and email accounts

Include a list of important contacts with this collection, including phone numbers for family members, your lawyer, doctor, and financial planner, pastor or priest, and preferred funeral home.

Also include the following documents:

• Estate Plan 
• Advance Directive
• Funeral or Memorial Directions

Estate planning is the term for a set of documents generally referred to as a Will. The documents vary by state (links to state documents can be found here). 

In New York, for instance, an estate plan includes a series of documents that perform several tasks: the designation of a person who will make medical decisions on your behalf, the medical proxy; the designation of a person who will make financial decisions on your behalf, the Power of Attorney; a list of your assets; a list of your beneficiaries; and your last will and testament, a narrative of your wishes. (You can access the New York State forms here.)

An Advance Directive is a document (sometimes called a living will) that will help you to think through and record your medical wishes. Like Estate Planning documents, these forms vary by state (and in some cases also allow you to designate a medical proxy). The National Hospice and Palliative Care Organization also provides state-specific forms here, which I recommend using.

Electronic notarization tools like docusign.com and notarize.com will allow you to notarize these documents remotely.

Don’t let notarization deter you: A majority of states allow electronic notarization (find out here if you live in a state that does) but even if your state does not, don’t let that deter you from filling out the forms and discussing them with your family members. These conversations—and in a time of crisis, these forms—will go a long way toward alleviating alarm and anxiety.

If you spend time in more than one state, fill out the advance directive for both; some states do not recognize forms from other states.

Should you die, what are your wishes for your body? Use one side of a blank piece of paper—have a loved one assist you if writing is difficult—to record what you would like done with your body. Include this document in the drawer or box where you keep your will and other information. The National Funeral Directors Association website lists options to consider. Would you prefer burial (and if so where and in what type of casket) or cremation (and if so, what type of urn or box would you prefer; how would you like your ashes to be disposed)? 

On the other side of this paper, write down how you would like your friends and family to honor your memory? Are there songs or poems that have meaning to you? Who would you like to sing or speak? Your memorial need only adhere to traditional ceremonies as much as you’d like it to. 

The NFDA provides a helpful checklist that will guide you and your family through the process of making arrangements, including requesting a death certificate from your state’s Department of Health (or its equivalent; you can find a list here) and writing an obituary (resources on how to do so are here and here). 

Consider, for the sake of the environment, green or natural burial options. (You can access the Green Burial Council website here.)

Talk about your wishes with your loved ones. Often, the surest way to have your medical and end of life plans followed is to have your family agree to honor them. It will save them uncertainty about your wishes, it will give them more space to grieve, and it will prevent any disagreement among your family members.

***

Caring for an ill loved one at home is difficult but may be necessary during this pandemic. It is anticipated that hospitals may be too crowded to treat all patients. The WHO has provided guidelines for those who have an ill family member in their place of residence. Their guidelines include details on how to seclude the infected person, how to prevent caregivers from being infected, and what medical supplies will be necessary, although access to all medical supplies seems increasingly unlikely. (Click here and scroll to “Home care for patients.…”)

Advocating for a loved one in a hospital or institution will be complicated by pandemic-specific limitations placed on family member visits, made either by the facility or the state. In some cases, exceptions are being made for those residents who are on hospice care… but we have no reason to believe that this will remain the case.

Stay in touch with your loved one with video chats and calls. Or if your loved one can no longer communicate, connect with a staff member, hospice nurse, or fellow resident for regular updates.

If a palliative care team exists in the facility, seek them out. As Jennifer Moore Ballentine, executive director of the California State University Shiley Institute for Palliative Care, recently noted, during this time of crisis, palliative care can provide “quality of life, discernment of patient goals, advance care planning, pain and symptom management, and support for caregivers over protracted trajectories.”

Aid in Dying—the highly regulated procedure that allows terminal patients to receive lethal doses of medication in order to hasten their death—is currently legal in nine states. Compassion & Choices, the largest aid in dying advocacy organization in the U.S. has information on each state here. 

Valerie Lovelace at Maine Death with Dignity, writes, “If you’re a patient, it’s important when having a conversation with your physician that you ask directly, ‘Will you fully support my decision to qualify for medication under the Maine Death with Dignity Act when I am ready for that? Will you write my prescription if/when I do qualify?’

And you should receive a direct answer in response.” If the doctor will not comply, you should ask for a referral to a doctor who will. 

Because COVID-19 moves so quickly, it’s difficult to imagine a scenario in which many patients in states like Maine, where aid in dying is legal, will be able to complete the steps required to receive it. 

Compassion & Choices also provides robust tools and instructions on how to plan your end of life care and organize your estate.

Rationing is common practice in health care—in the U.S. we ration care according to patient income or class—but we will increasingly see new factors like age, underlying illnesses, and location factor into medical treatment decisions as the pandemic ramps up. 

In this pandemic scenario, some nations are experiencing the inability to provide respirators and other critical care to all patients. Italy has, according to some reports, decided to not use precious resources to treat those over 80. An Italian economist has been accused of suggesting that the elder population be “culled” to save money. Medical ethics dictates that our social obligation is to protect the individual wishes of the patient—but triage scenarios, like the one we’re in, often establish other priorities. 

Based on the experiences of other countries, we can assume that most of those who die from COVID-19 will do so in facilities, but it is also predicted that hospitals in the U.S. will become so crowded that they are unable to admit all of our ill patients. As well, rural communities across the U.S. are underserved by hospital care, often living long distances from a hospital. It is reasonable to expect and plan for the deaths of some at home.

A home death has already been recorded in Italy; local officials were confused about how to collect the body of the deceased, the sister of Luca Franzese, and so he remained in their home with her body for an extended period of time. He posted his experience on Facebook.

The National Hospice and Palliative Care Organization has asked for a disaster waiver that would initiate coverage of hospice and palliative care during the emergency. As of this writing, it has not been approved. But it is conceivable that some hospice access will exist in areas of the country, either at home or in facilities, if the program is adept at managing infectious diseases. Should your loved one die at home with hospice care, the staff will guide you and your family through the process. 

Should your loved one die at home without hospice care, you will need to protect yourself while making some simple efforts to preserve the body until it can be collected.

Amy Cunningham, funeral director at Fitting Tribute Funeral Services in Brooklyn, New York, suggests that you and your family “make ceremony on your own,” by spending time with the body until it is taken away. Other countries have postponed funerals until after the pandemic has subsided; at this time, the U.S. has not.

Cunningham’s advice for caring for the body includes, immediately after death, placing a rolled towel under the jaw of the deceased to close their mouth (once the jaw sets it can be removed). Place a mask over your deceased loved one’s mouth to prevent the spread of infection and wear gloves and protective clothing when in contact with the body. It is believed that the greatest risk of infection from a COVID-19 patient is immediately before death.

Gently bathe the body, without moving it excessively or making it too wet. Swaddle it first in plastic and then in a bedsheet, turning it as little as possible. 

The virus dies when the body dies, but because little is yet known about the effects of COVID-19, the National Funeral Directors Association recommends using every precaution when preparing or touching a body. It has also advised that regular funerary practices are acceptable: embalming, cremation, viewings and all types of services, so long as efforts to prevent infection are taken.

If for any reason—fear of contamination, overwhelmed municipal services—the removal of your loved one’s body is delayed, Cunningham suggests opening a window to keep the body cool and applying ice (in order of effectiveness: dry, block or cubed; use whatever is available) to the neck and torso of the body.

Contact your local funeral director or medical examiner. (You can find your local medical examiner by searching the internet for the name of your municipality/town/city and “medical examiner.”)

If necessary, a memorial service can be held online to accommodate quarantined or distant family and friends. Tribucast, for instance, is an online service that will help you memorialize your loved one. 

***

For most of human history, we have cared for our dying loved ones at home; it is only in the past century that death has been professionalized, undomesticated. Death care is a skill we have collectively lost. COVID-19 will almost definitely change our familiarity with death’s ancient ways.

We’re about to face very challenging times. Without government direction, we’re on our own, so stay informed, stay aware, and be thoughtful about your actions and reactions. Reach out to those around you, to your family and community for support. 

 

Ann Neumann is author of The Good Death: An Exploration of Dying in America and a contributing nonfiction editor at Guernica magazine. Neumann writes the column “Drug Money” on pharmaceutical greed for The Baffler. She has written for The Guardian, Harper’s magazine, The New York Times, The Washington Post and other publications.

Because understanding of this pandemic and virus is constantly shifting, the information here may quickly become outdated. Check with primary sources for current protocols. I will endeavor to update this document as things develop—and I welcome suggested edits and inclusions from readers!

National Catholic Reporter Review

Bill Tammeus reviewed The Good Death at the National Catholic Reporter this month. You can read the entire review here. Tammeus writes:

In the end, Neumann decides, “there is no good death. … But there is a good enough death.”

Beyond that, she writes, “there is really one kind of bad death, characterized by the same bad facts: pain, denial, prolongation, loneliness.”

And that is what people of faith should be working hard to help people avoid.

I love libraries.

Thank you, Choice, a publication of the Association of College and Research Libraries, for this great review of The Good Death!

 

A regular contributor to a number of periodic publications, Neumann (visiting scholar, Center for Religion and Media, New York Univ.) brings a journalist’s eye to her journey through the personalities and politics that shape discussions of end-of-life issues in the US.  She does not present the debates over these issues; she offers stories of people who are involved in these circumstances, on a personal level and/or political level.  She recounts her own father’s death at home and how that experience shaped her work; she also talks about her work as a hospice volunteer, giving readers a taste of that growing part of end-of-life care.  She speaks to those in states that have legalized assisted suicide and examines the feelings and personalities that animate the respect life movement.  She writes of her friendship with the leader of a group calling itself Not Dead Yet, a disabilities rights organization that believes that laws that permit assisted suicide threaten the disabled.  In sum, this is a moving portrait of the ethical issues around end-of-life care, a portrait told through stories that give the subject a poignancy often lacking in such discussions.  Readers will be informed by this sensitive and at times moving book.

–A. W. Klink, Duke University

Summing Up: Highly recommended. All readers.

The New Physician Review

Thanks The New Physician (and Abhinav Seetharaman) for this fantastic review of The Good Death in your spring issue! Here’s a clip:

“In all, The Good Death not only depicts how Neumann provides care for her close ones, but also serves as an example on how we an treat our loved ones during the twilight of their lives to ensure their happiness and a peaceful closure. Upon conclusion of this book, students and physicians will be able to reflect on how they can better maneuver around the prongs of death, and alleviate the mental pain and challenges it brings upon them.”

All the News.

Looking for more on The Good Death? Here are some links and updates from the last few amazing months.

6.1.2016 – A conversation with Alison Biggar for Aging Today, a publication of the American Society on Aging.

5.28.2016 – Best tweet ever!

Alizah Salario @Alirosa 24h24 hours ago
My honeymoon reading list is set: @emmastraub “Modern Lovers” @otherspoon’s “The Good Death” & @paula_span’s Kindle single on @JohnJpshanley

5.24.2016 – I gave a talk for the Westchester End of Life Coalition at Concordia College in Bronxville. The audience of about 50 people was primarily nursing students and teachers, fulling engaged and whip smart.

5.3.2016 – I wrote an op-ed for The Guardian on Prince’s death and opioid use.

5.1.2016 – Conscience Magazine, a publication of Catholics for Choice, noted The Good Death in their May issue.

5.2.2016 – My monthly column, “The Patient Body,” for The Revealer, a publication of The Center for Religion and Media, was on calls for religious sensitivity training for doctors.

4.27.2016 – I was in Boston to give a talk on The Good Death at Novartis pharmaceutical company (like being in the lion’s den!) and then another that evening at Harvard Book Store, with incredible Katherine Stewart as co-respondent.

4.23.2016 – Marian Ronan, a research professor of Catholic Studies at New York Theological Seminary, reviewed The Good Death for Marginalia at the Los Angeles Review of Books…and confirmed once and for all that, no, I’m not anti-Catholic.

4.1.2016 – Charming Midwest Book Review covered The Good Death for their April issue.

4.22.2016 – While in Los Angeles, I reported out this story about burial of mass murderers for the Washington Post which appeared on the cover of the Outlook section.

4.15.2016 – I wrote an op ed for The Guardian on Canada’s move to legalize aid in dying.

4.10.2016 – Audible made The Good Death an audio book!

4.14.2016 – My interview with journalist Doug Henwood on The Good Death for Left Business Observer.

4.7.2016 – My essay for the Well section of The New York Times on the plight of widowers.

4.6.2016 – Buzzfeed’s Jina Moore schooled Gay Talese by naming 68 women writers that he should read–including me!

4.4.2016 – Ann Mandelstamm reviewed The Good Death for The Humanist. She wrote:

“The subject of this extraordinary book is heavy, but Neumann sprinkles it with delightful and touching stories of real people facing death (names changed, of course). She understands that this final stage of life can be acceptable, even empowering, if a person is lucky enough to experience “kindness, attention, and friendship of the human heart.” What renders dying terrible is unbearable pain, confusion, and a sense of being abandoned. She advocates strongly for everyone to have the right to say how much suffering he or she is willing to endure.”

4.1.2016 – My super fun piece on cults and capitalism, “Taking Liberties,” appeared in Issue 30 of The Baffler. You can read it here.

3.10.2016 – C-SPAN’s Book TV recorded an event that included other Killing the Buddha contributors (Scott Korb, Peter Manseau, Gordon Haber) and took place as Morbid Anatomy Museum in Brooklyn on March 10. You can watch the video here.

3.30.2016 – Kathleen Stephenson of KBOO’s Radiozone had me on the show to discuss The Good Death.

3.28.2016 – I was on Airtalk with Larry Mantle on KPCC, talking about The Good Death. You can listen here.

3.28.2016 – My talk with Point of Inquiry’s fabulous Lindsay Beyerstein is here.

3.24.2016 – Powell’s Books and Death with Dignity’s Peg Sandeen hosted an energetic and packed reading of The Good Death.

 

San Francisco Chronicle Op-Ed

I have an op-ed in the San Francisco Chronicle today titled, “The Conversation is Not Enough.” You can read it here, and then, if you’re in San Francisco, come by Booksmith tonight to hear me read from The Good Death and converse with the amazing Katy Butler, author of Knocking on Heaven’s Door. More even details can be found here.

A Q&A with Ellie Faustino, Religion Dispatches

I had a wonderful conversation with Ellie Faustino about The Good Death. You can read the whole piece here. Here’s a clip:

“There are many who argue that being a financial, emotional or physical burden to our families and friends is an illegitimate fear. They argue that our families benefit from giving us such care, that we are better people by accepting and being a “burden.” Many of those in the disability community throw their hands up and say, wait a minute, “What about me? I have no choice but to rely on others and that’s what a compassionate society must do, care for those who need it.”

They’re absolutely right. And yet, we often use the rewards of caretaking as a blind to mask the emotional and other challenges that caretaking demands. Much as we extoll the glories of parenting to cover the trials of, say, a single working mother of two children. So one’s burden can be a very legitimate reason to fear incapacitation for some but not for others.”

Slate’s Libby Copeland Reviews The Good Death

I love this review because Copeland gets the current moment in death culture. She astutely writes:

“Our increasing willingness to talk about death in recent years could be considered progress—but it’s also something of a posture, which makes it easy to forget that we’re often broaching the subject of mortality in the most superficial of ways.

Specifically, there’s one kind of death talk that’s still much less accessible: end-of-life care. This topic is complicated and emotionally grueling and won’t succumb to metaphor. It’s also where the most compelling philosophical and moral questions about mortality reside.”

Read the entire review here.

Review of “The Good Death” at PalliMed!

If you follow my writing at all (or my posts at Facebook or Twitter) you already know that I’m a big fan of the PalliMed blog, where I spent hours reading the archives and current posts when starting to work on The Good Death. Which makes this review, by Anna Dauer, so exciting. Here’s a clip, below. You can read the whole thing here.

While not prescriptive about how to provide care, at times even noting hospice philosophy as patronizing, Neumann provides a descriptive, moving base of knowledge for beginning to acknowledge the work to be done to improve the quality of dying in America. Her chapters’ titles pay tribute to a meaningful situation or story, but belie the impactful prose that illustrates the experiences she recounts:

• Terminal Restlessness
• Mortality Parade
• Priceless Days
• Double Effect
• Hunger and Thirst
• A Small but Significant Minority
• The Most Vulnerable
• Dying Inside
• A Good Death

Spoiler Alert: Neumann does not define a good death. Her work won’t let us off so easily as that. But her writing will enlighten, inspire, and potentially enrage readers who are interested in the topic so often swept aside in our culture, despite its gravity and pervasiveness.

A must-read for physicians and those passionate about care for the dying in this country, The Good Death provides additional context outside the specific realm of health care, or rather reminds us how we might impact the daily living and dying for all Americans, no matter socioeconomic circumstance or credo.