Notes From the Waiting Room: Managing a Loved One's End-of-Life Hospitalization by Bart Windrum

Book Review by Zinta Aistars

Paperback: 336 pages
Publisher: Axiom Action (February 1, 2008)
Price: $25.00
ISBN-10: 0980109000
ISBN-13: 978-0980109009

Perhaps no one statement that author Bart Windrum makes in his examination of how the United States health care system approaches end-of-life hospitalization is more important to understand than, simply, "death is a part of life." Yes, and he continues, in his Notes From the Waiting Room: Managing a Loved One's End-of-Life Hospitalization, that all doctors should be trained for it.

Overly simplistic? Think about it. Think about the Hippocratic oath our physicians take upon themselves as they enter their medical careers, "do no harm." If our definition in American society is of death as a state that is to be avoided at all costs, and life as a state that is to be prolonged at all costs, then doing no harm becomes a tricky proposition. Harm by whose definition?

Windrum explores how our health care system treats death and the dying, and those who care about the dying, first and foremost as an adult child of two parents whose death he has experienced in every excruciating step. These were not peaceful steps. In his Notes, Windrum shares with us how often and how, to his view, unnecessarily these final steps were made painful, confusing, alienating, and undignified. All because our typical approach to death is one of avoidance. Within a culture that is obsessed with staying young forever (i.e., never dying), to over-the-top violence in our various forms of entertainment that gives us a very false and unrealistic concept of death, to an overall cultural avoidance of facing death at all - we treat death as unnatural. We either avoid it completely or we see it as something other than what it is. Windrum consistently makes the valid point throughout his book: death is natural. It is how we treat death, how we approach it, that too often becomes unnatural.

So that others may not have to experience the indignities and sometimes black comedy of errors that the author experienced with his own family members and their hospitalization, Windrum has written this well researched and thought out book. It begins with establishing his own experience with the death of loved ones. From that, the author goes on to recommendations on how to become an effective personal representative, what essential legal documents must be in place (and often championed and reviewed) when death becomes an unavoidable reality, how to effectively manage hospitalization, the role of family involvement, the importance of "forecasting" (presenting all possible outcomes to those involved in the dying of a loved one so as to make timely and reasonable, informed decisions) and ethical support, the too often avoided descriptions of what death is really like (forget the movies), and, finally, his proposals for change. This includes PEACE, or the Patient Ethical Alternative Care Elective. Windrum also makes proposals and suggestions for the health care industry (by which time, the word "industry" in this usage seems wincingly apt) and for you and me - every day people who at one time or another will have to face death, whether that of a loved one or one's own.

In this journey of an adult son's witnessing the deaths of his mother, soon followed by that of his father, Windrum brings valuable insight. At a time when this country's health care system (to whom it is provided and how it is provided) is in such great need for reassessment and improvement, one can only hope that enough of us will make our voices heard both in the political arena as well as in our own doctors' offices, that we might accomplish and insist upon change. Change, as Windrum reminds us, occurs when continuing to do the same thing becomes more painful than change itself is perceived to be. And it is increasingly painful to see, or to be victim of, health care that is evolving in terms of medical technology, while too often ignoring the simple dignity of the human condition and the validity of one's own choices over how to live and how to die.

Our medical technology and expertise is keeping us alive longer and longer, yet is that always the best option? Even when legal documentation is in place for "do not resuscitate," Windrum shows how this may not always be enough to prevent unnecessary procedures and painful outcomes. He reminds us of the importance of every patient having his or her champion at their bedside, without which an endless stream of indignities if not medical errors might take place, in spite of legal documentation.

A better approach, beginning with the acceptance of death being a natural part of life, may be to take a closer look at how we understand hospice and palliative care. And, how we protect an individual's choice in how to die. Once a diagnosis of terminal illness has been made, Windrum argues, to make the choice to die with dignity, at a point in time when one is ready, should not be considered suicide but a choice in the manner of how one wishes to conclude a life.

If there were moments in reading this book that I felt the author may be too harsh and cynical about modern health care, that is, the health care professionals that care for us (my own career path often crosses with those in this industry, most all of whom strike me as persons who have chosen their careers driven by their caring hearts and deeply held motives to ease human suffering), then I couldn't help but think he brings to surface many very important suggestions for improvement. And improve we must. Our population is fast aging. Our medical technology is fast advancing, keeping many of us alive longer and longer by various artificial means.

We must have a new and better understanding about how we approach death and dying. If Windrum accomplishes nothing more than to encourage us to get our own legal documentation in place(and there are five such documents that we should have completed) to ensure our personal choices are taken into consideration when that inevitable moment arrives, this book is worth its price.

No Shortcuts to the Top by Ed Viesturs with David Roberts

Book Review by Zinta Aistars

Paperback: 384 pages
Publisher: Broadway, 2007
Price: $14.00
ISBN-10: 0767924711
ISBN-13: 978-0767924719

I was handed this book by a colleague, saying, "Hey, you're Latvian, too, aren't you?" Indeed, I am, and if perhaps my first spark of interest in this book came from that - Ed Viesturs' father, Elmars Viesturs, came to the U.S. very much by the same route as my own parents, refugees from the Soviet occupation of Latvia - then it soon enough veered far more to his achievements in mountainclimbing. I'd heard of Viesturs before. I'd seen a few film clips of his remarkable feat in summiting the world's 14 highest mountains over a span of 18 years. If his Latvian name caught my attention (my own father's name is Viestarts, a variation of the same, and the name is, in fact, rooted fittingly in folklore based on a Latvian warrior), it was his life and how he lived it that sustained my attention.

Yes, his life and how he lived it, because the story of Ed Viesturs is not just about climbing mountains. It is very much about HOW he climbs those mountains, and not only how he climbs them, but also how he descends. Viesturs continually reminds his readers that his secret to his mountainclimbing success - "Reaching the summit is optional. Getting down is mandatory." - is to never allow ego to get in the way of reaching the summit, to keep passion for one's pursuit aligned equally with sound sense, and that even the most desired outcome for a personal dream must sometimes be put on hold, perhaps numerous times, when the wisdom of experience-honed instinct dictates: this is not your time.

Viesturs tells his story (with the help of writer, David Roberts) from its logical beginning. The boy reads a book. It is a book about a mountainclimber who is doing battle with one of the most difficult, if not quite the highest, mountains: Annapurna. Although his childhood unfolds in the flattest parts of the Midwest, his imagination soars with his reading. (Do books still so inspire our youth? one has to wonder ... ) To climb all of the fourteen 8,000-meter peaks in the world (8,000 meters above sea level) becomes his life's pursuit.

Dreams are often not practical. Viesturs realizes he must pursue also some more practical career, and so he earns a degree in veterinary science. Alongside the practical, however, he never stops pushing the dream. He eventually ends up abandoning the "sensible" career, subsists on a meager salary as a climbing guide, takes on odd jobs to allow for the needed time off to travel across the world and climb. We can already see the needed fiber and hardy character of the man in these early climbing days, in how he approaches his goal with just the right mix of sensible and dream-crazy. He has the discipline to train, he has the persistance to continue when others fall away, he has the character to not give in to numerous rejections or obstacles that would close the door on so many others. He has what it takes to be a winner in whatever arena.

This is a gripping adventure story. It even has its element of mature romance, as Viesturs eventually meets his wife, Paula, who is his source of support and encouragment, his best friend, his companion dreamer. There is also history alongside his accomplishments to give the reader perspective. Many die. Very many. What Viesturs accomplishes only five others can claim to have done. And while Mount Everest is the mountain most know, it is not at all the most dangerous. Viesturs' story nears grand conclusion as he ends where he begins, with his last climb, the same mountain that inspired him as a boy: Annapurna. As the circle closes, the reader, too, feels a deep satisfaction.

If we ever wonder, as Viesturs does at one point, if living such a life makes sense, he ties it up nicely as he talks about how he was able to become a professional mountainclimber, financed by sponsors. He has a debate with a reporter about the statistics he faces, life or death. While the reporter uses the metaphor of Russian roullette, Viesturs argues that his odds actually improve with each summit, even as his experience accumulates. What he does, he says in his speaking tours, can be an approach well transposed to any pursuit in life. Know when and how to chase your dream; know when to turn back; know what should be sacrificed along the way and what should never be left behind; know when to trust your instincts; know how to celebrate an accomplishment without letting it get overmuch to your head; know how not to give up on what truly matters; know how to go home again and appreciate the source of your strength.

Indeed, there are no shortcuts to the top. And that, perhaps, in this time of instant gratification, of superficial and short-lived pleasures, of quick and easy fixes that somehow never last, of climbing on the backs of others to reach a higher level, is the best part of this grand adventure story. Viesturs never forgets his values. He never loses a solid sense of personal integrity. He never loses sight of his motivation. He does what he does because he wishes to know what his personal best can be. And yet, when he summits, he never quite forgets he is not alone. Family at home, fellow climbers, the ghosts of climbers that didn't make it ... the reader realizes by end of this story that mountain peaks were not his only, or even his greatest accomplishments. This is much more about the journey than the destination, and it is a journey taken with a rare kind of wisdom and integrity.

To learn more about Ed Viesturs and his summits and current journeys to explore the effects of global warming at the earth's poles, I encourage a long visit to his stunning Web site at http://www.edviesturs.com/

And Baby Makes Five by Gail Gaymer Martin

Book Review by Zinta Aistars

Mass Market Paperback: 176 pages
Publisher: Barbour Publishing, Inc, 2007
Price: $4.95
ISBN: 978-1-59789-638-2

And Baby Makes Five was the second of two Christian romances sent to me by the author, Gail Gaymer Martin, for review. I had already read Garlic and Roses, so came to this book with a certain expectation in place. As stated in my review for Garlic and Roses, I am by no measure a "romance" reader.

And yet, I do try to keep an open mind whenever opening the cover of a yet unread book, doing my best not to judge by cover or even by genre. That said, certain stereotypical assumptions for the genre of romance held. The main characters were attractive, young people, pitted against seemingly insurmountable odds, but driven by their growing passion one for the other. What differentiates this book, however, from the usual expectation for a romance paperback, is that the passion is more one of faith than heaving bosom. Indeed, this is what saved the book for me. Are we not all weary of cliche by now? Perhaps not. Perhaps there are those readers who like their literary diet predictable, like to know exactly what they are getting, like the comfort and reassurance of routine. I am not one of them. I enjoy a surprise. A sudden twist. An a-ha moment. Looking for that? I would suggest passing up this genre entirely.

Still here? Okay. If you are still interested, this little paperback isn't bad. While I have extremely slim pickings for comparison, I found the opening scene intriguing. Felisa Carrilo is doubled over with pain while working in the fields in the hot southern sun. Chad, young and wealthy owner of these fields, happens by and notices. The young woman seems to be hiding something ... and then he realizes it is her belly. The pretty young Mexican woman is pregnant, and he is horrified at her predicament, convinces her to let him help her (no easy feat, but as a migrant worker, she has grown to distrust her employers if not men in general) and takes her to the hospital.

What follows is, let's face it, something of a Cinderella story. Prince Charming saves the poor, downtrodden woman. He brings her and her baby to live in his mansion, exposes her to the life of the wealthy, the two fall in love and, yes, there is that happily ever after part coming. This is, I would suspect, the general outline of most romance novels. What makes this one different is that, as mentioned earlier, it is based more on passion of faith than passion of flesh. There are prejudices to overcome, not the least of which is the slow pace of their cautious courtship in a society that has all but forgotten the art of courtship. There are also racial and ethnic prejudices, class prejudices, and not only from the upper class looking down. The lower class looking up has its own set of stereotypes and expectations to overcome. All of this does add an element of interest to the storyline.

For all its lack of surprise or plot twist, I have to say I enjoyed the quick and easy read. Much as one does a quick, sweet snack between gourmet meals. While I was eager to return to my usual more literary choices in reading material, a bite of chocolate now and then isn't all bad. I was reminded, in reading both of Martin's books, of what a tragedy it is that modern society has indeed forgotten the art of courtship. The glance from afar. The shy first conversation. The touch of fingertips. The longing and wondering. The waiting. With our modern life pressures to skip the wait and go immediately to instant gratification ... the sad truth is that the gratification is made empty. Passion of the flesh when separated from passion of the heart is cotton candy. It melts in a moment, leaving nothing behind but empty calories and an unsatisfied hunger.

For this reason, I commend the author for the two books I've read, and the many others she has written that I have not read. Light reading, yes, but it serves a need, it is a valuable reminder that romance is often the last thing secular "romance" novels address. If at all.