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Lessons in Dying Well

Narratives that illuminate end-of-life issues

Medicine may be a science, but healing is an art. A doctor will surely poke and probe and order tests, but a healer listens as patients relate the stories of their illnesses. Healing, in other words, depends on narrative.

And physicians are not only receivers of narrative but, sometimes, storytellers themselves. Many physicians have used narrative to educate. Two of the DMS faculty members interviewed for the adjacent feature—Drs. Ira Byock and Dennis McCullough—have written very readable books about the end of life.

In both Dying Well and The Four Things That Matter Most, Byock tells patient stories that are not just about illness and death but also about the wisdom that can be received during the poignant time at the end of life. Dying Well begins with the story of how the intimacy of caring for his father during his last two months taught Byock what a rich and valuable time that period can be. Part of Byock's father's lasting legacy has been his son's interest in, commitment to, and promotion of hospice and palliative care.

The Four Things That Matter Most grew directly out of Byock's work in palliative care. One of the nation's most respected advocates for facing end-of-life issues in a forthright manner, Byock has been a member of the Dartmouth faculty for the past five years. Not content to simply provide physical comfort to the dying, he advises terminally ill patients and their survivors how to

make the most of this spiritually ripe time of life: ask forgiveness; give forgiveness; apologize; say goodbye. His book tells the stories of patients and family members who struggle to complete these four conversations, and who inevitably feel a sense of spiritual ease once they do.

Dennis McCullough, for his part, has written a book laying out an approach to elder care that he calls "slow medicine." The concept is catching on fast. My Mother, Your Mother received a glowing review in the New York Times when it was published in February 2008. A feature in the Times in May has helped McCullough's concept gain traction among caregivers; among the elderly; and among middleaged baby boomers who are, in increasing numbers, caring for their aging parents. Now, the term "slow medicine" is showing up in numerous articles and blogs.

Developed over a lifetime of practice, research, and education, slow medicine offers the promise of better—and less expensive—care for America's burgeoning geriatric population. McCullough explains in My Mother, Your Mother that elders often fare better with medicine based on face-to-face relationships that involve patients, their caregivers, and their families. He also narrates the story of his own mother's last years.

In addition to spreading the word about slow medicine through his book, McCullough is also promoting it at DHMC, where he is working with other faculty members to improve geriatric care throughout northern New England.

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Deborah Lee Luskin, the author of both this page and the preceding feature, is a regular commentator for Vermont Public Radio as well as a freelance writer. One of her recent commentaries was a narrative about caring for her own aging parents.

If you'd like to offer feedback about this article, we'd welcome getting your comments at DartMed@Dartmouth.edu.

This article may not be reproduced or reposted without permission. To inquire about permission, contact DartMed@Dartmouth.edu.

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