Book Review: "Last Acts of Kindness"

Judith Redwing Keysarr is the Director of Palliative and End of Life Care of Jewish Family and Children’s Services of the San Fransisco Bay Area. Her book, “Last Acts of Kindness: Lessons for the Living From the Bedsides of the Dying” was recognized as the American Journal of Nursing Book of the Year in 2011. Ms. Keysarr will appear as our guest onRN.FM Radio on Monday, November 26th, 2012. (As always, I received no compensation for this book review.) 

In the 21st century, the notions of hospice and palliative care have gained greater support among the general public and the healthcare establishment, to a large extent because of the courageous individuals who have selflessly championed the cause of death with dignity.

Judith Redwing Keysarr is one of those individuals who has shed light on the beauty and power of the end of life, and her book, "Last Acts of Kindness: Lessons for the Living From the Bedsides of the Dying" provides brilliant, well-written and poignant illustrations of the ways in which death and dying can inform the very nature of our living.

Keysarr writes: 

“In most nursing and medical school programs, very little is taught about how to deal with dying patients. The messiness of birth and death are not highlighted, either. I remember one morning, as a student nurse, walking into the room of a man who was actively dying. I was stunned by the chaos in the room, the secretions coming from his wide-open mouth, and the sickening smell in the air. I was not prepared for some of the physical realities of the last moments of life, nor was I prepared emotionally for the helplessness and lack of control that I experienced. After the patient died, my nursing instructor told me to shave him and clean him up for his family. I followed these orders, and then in my charting of the day, I wrote a poetic comment as my way of dealing with the emotions. I was reprimanded and reminded that a chart is a legal document and not a term paper. Fortunately, this did not dissuade me from my nursing career or from my goal of becoming a midwife to the dying.”

In the course of this lovingly written and poetic book, Ms. Keysarr shares stories of people who died in the hospital, in residential facilities, and those who died at home, and she shares important and timely information for those who themselves wish to prepare for the inevitable. And while some who write about hospice seem to focus on death in the comfort of the home, Keysarr points out that the dying person needs specialized care no matter where they happen to be. 

“Just because a person is dying in a hospital does not mean that death is less sacred than if they were dying at home in a more natural environment. Hospital chaplains are allies when it comes to working with the nursing and medical staff to ensure that people have needed time with loved ones for emotions, for rituals, for clergy, before or after the death occurs, or both. They can often direct family to a quiet space in which to discuss the spiritual needs of the patient or conduct a simple ceremony. I believe that it should be protocol to ensure that the patient’s and family’s wishes are honored throughout the process of dying and death. More importantly, those who are experienced and skilled in the 'art' of medicine need to help empower patients and their loved ones to ask for what they need in order to create a safe and sacred environment.”

Speaking of her work with the dying and their families, the author shares directly from her experience:

“I continue to learn from each person I attend and from each family member and friend who stands beside a person they love. I have watched people change drastically and open to life in new and unexpected ways, after being at the bedside of a loved one. The simplest and most profound lesson that I have learned over and over again is that love is truly all that matters, and in the end, a force much greater than our small human lives connects us all.”

And when it comes to efforts to prolong life, Keysarr is unequivocal in her observations of how we deny death:

 “And why do we do these things? Because we can. We live in a society that will not look directly in to the mirror of mortality without squirming or quickly turning away. The media want us to believe that people can and should live forever--or at least longer than their bodies are willing or able to. Commercials and advertisements flood us with images and information about how to stay young, look young, and avoid the aging process—insinuating that if we don’t age, perhaps we won’t have to die.”

The patient stories that Keysarr weaves throughout this book are both moving and illustrative of the various ways in which we humans confront our ultimate demise. From the challenges of pain control to homelessness to the power of love in the face of death, Keysarr allows us a glimpse into the intimacy, quiet, and occasional chaos of the dying process. She also infuses our reading with ruminations on the ways in which the healthcare system in the United States fails the ill and the dying--and what we can do to change it. 

"New models of holistic and affordable care must be created and replicated quickly in order to serve the millions of aging people in this country. A few models already exist, such as the Eden Alternative in New York State and the Green Hospice projects around the country. In addition, many individual residential hospices and care facilities have made it their mission to create environments of care and compassion. It will take the voices and demands of healthcare providers and consumers to create a major culture change in long-term care facilities."

 And when it comes to life-saving technologies, the author acknowledges their importance, but also the ways in which such technologies can separate us from the person in the bed. 

“If you have never witnessed life support in the ER or ICU, it would be an educational experience to see someone in this condition and to imagine yourself as the person in the bed. Patients appear to be untouchable because of all the tubes and wires and machines. However, what people in this state need the most is the touch and sounds of someone they love, and it is important for healthcare professionals to facilitate this as much as they can.”

The stories in Keysarr's book are, as one reviewer stated, like a quilt that challenges us to not only view death as a medical event--but also as a spiritual experience. The author is truly a midwife to the dying, and in delivering this well-written and thoughtful book, she has given us all a gift that can be reopened time and again. 

"Last Acts of Kindness: Lessons For the Living From the Bedsides of the Dying" offers healthcare providers an opportunity to examine death and dying from multiple viewpoints--clinical, human, and spiritual--and offers the layperson a rich fabric of stories that illustrate the varieties and similarities of the death experience. 

Keysarr offers convincing arguments for the embracing of death and dying as sacred processes that are part and parcel of the human experience, and this deftly written book should be part of any comprehensive library on this most tender and crucial subject.