Knocking on Heaven's Door: The Path to a Better Way of Death

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KATY BUTLER

KNOCKING ON HEAVEN’S DOOR

The Path to a Better Way of Death

An exquisitely written, expertly reported memoir and exposé of modern medicine that leads the way to more
humane, less invasive end-of-life care—based on the author’s acclaimed
New York Times
Magazine

piece.

his is the story of one daughter’s struggle to allow her parents the peaceful, natural deaths they wanted—and T to investigate the larger forces in medicine that stood in the way.

When doctors refused to disable the pacemaker that caused her eighty-four-year-old father’s heart to outlive his brain, Katy Butler, an award-winning science writer, embarked on a quest to understand why modern medicine was depriving him of a humane, timely death. After his lingering death, Katy’s mother, nearly broken by years of nonstop caregiving, defied her doctors, refused open-heart surgery, and insisted on facing death the old-fashioned way: bravely, lucidly, and head on.

Against this backdrop of familial love, wrenching moral choices, and redemption,
Knocking on Heaven’s
Door
celebrates the inventors of the 1950s who cobbled together lifesaving machines like the pacemaker—and it exposes the tangled marriage of technology, medicine, and commerce that gave us a modern way of death: more painful, expensive, and prolonged than ever before.

Caring for declining parents is a reality facing millions who may someday tell a doctor: “Let my parent go.” A riveting exploration of the forgotten art of dying,
Knocking on Heaven’s Door
empowers readers to create new rites of passage to the “Good Deaths” our ancestors so prized. Like Jessica Mitford’s
The American Way of Death
and
How
We Die
by Sherwin Nuland, it is sure to cause controversy and open minds.

“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. I’m recommending it to all my friends with aging parents or partners, and holding on to a copy for myself.”
—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

· National print advertising in
The New York Times
· Online advertising campaign · National television,
radio, and print publicity · 5-city author tour: Denver, New York, Portland, San Francisco, Seattle · National
radio interview campaign · Cross promotion with author’s website: KatyButler.com
KATY BUTLER
, a former finalist for a National Magazine Award, has written for
The New Yorker
,
The New York Times
Magazine
,
Vogue,
and other publications.
Her work is anthologized in
The Best American Science Writing
,
The Best
American Essays
, and
The
Best Buddhist Writing
. A winner of the “Science in Society” award from the National Association of Science Writers, she lives in northern California.

For Publicity Information and

Knocking on Heaven’s Door
September 2013

Review Copies:

Scribner Hardcover Biography & Autobiography 5 1/2 x 8 3/8, 336 pages $25.00

Lauren Lavelle

ISBN: 978-1-4516-4197-4 NONMERCH 9781476739977

212-632-4952 [phone]

212-632-4957 [fax]

Advance Praise for
Knocking on Heaven’s Door

“This is a book so honest, so perceptive, and so achingly beautiful

that its poetic essence transcends even the anguished story that it

tells. Katy Butler’s astute 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 twenty-first 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. This elegiac volume is required read-

ing for every American adult; it has about it a sense of the universal.”

—Dr. Sherwin B. Nuland, author of
How We Die:

Reflections on Life’s Final Chapter

“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. I’m recommending it to all my friends with aging parents or

partners, and holding on to a copy for myself.”

—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 criti-

cally helpful, this is a truly important work that I hope will be

widely read. We have lost our way, and Katy Butler’s impeccably

KnockingHeaven_ARC.indd 1

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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

“
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 com-

passion. 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

“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. You

will not be able to put this book down. Its tenderness, beauty, and

heartbreaking honesty match the stunning data on dying in the

West. A splendid and compassionate endeavor.”

—Joan Halifax, PhD, Founding Abbot, Upaya Zen Center, and

Director, Project on Being with Dying

“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, Katy Butler shares her saga of how a family of inde-

pendent, thoughtful, and complex souls attempts to navigate their

uncharted journey through medical institutions and specialties.

Here, the degree of individual and family suffering turns on myriad

decisions, large and small, coerced by economic and institutional

forces.
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 Caring for your Aging Loved Ones

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Selections from emails sent to author Katy Butler in

response to her
New York Times Magazine
article, “What

Broke My Father’s Heart,” on which this book is based*

“I have never been a big reader & certainly not [of] the
New York
Times,
so I am feeling a little self-conscious about writing to you. I am a registered nurse. My passion is in working with people over 80! I am

part of my clients’ lives and I watch the suffering, lack of dignity and overall poor quality of life they experience. Every day, at some point,

someone says to me, ‘I just want to die I have lived my life it’s enough.’

“I do not have the words to explain how mow much passion your

article sparked in me. Everything you explained is how I wish I could

educate my clients, their family, physicians & my own family. I have such a deep desire for encouraging my clients not to “over-treat.” This

is the first time I have heard that term used but it is going to be a part of my vocabulary now. It is so frustrating how some physicians are not

okay with death and dying and are usually too afraid to even discuss

this natural process. Instead they want to save everyone’s lives and

not provide choices.”

—R. N.

“Your article taught me how important questions are, and not [to]

allow the accepted ways of ‘modern’ medicine to be thrust upon us.

I have always felt that the medical profession has lost it way. Now I

can stand up for what is best for my parents with more confidence.

Thank you.”

—J. S.

“My mother deteriorated over about ten years. She lived with her

younger sister who just did not have the physical strength to deal with

her. I was at their house every day to make sure she had lunch. My

sister took care of dinner, and my aunt took the overnight. It was hor-

rendous. When she died of a heart attack in September 2000, I was