Sunita Puri, That Good Night: Life and Medicine in the Eleventh

(Random House 2019)

Thanks to the Ballengers for introducing to us Sunita Puri, who wrote the book during her fourth year of medical school. Puri tells about herself at age five sitting with her physician farther in their living room, watching the beauty and fading sunset which she'd wanted to remain forever. At that teaching moment her father told her that nothing in life is permanent, and that we ourselves and those we love will all die someday. Decades later this truth of life's destiny was buried in Puri's psyche.

Like many physicians who focus only on curing their patients' disease, Puri also believed that she has failed when her patients die, despite the many procedures of biotechnologies that modern medicine offered to prolong life. Once she actually calculated the time she spent with patients mostly looking not at their bodies, but at reports of their blood, lab tests, and other diagnostic methods. She concludes that she spent more time on her computer writing about her patients' medical condition than spending time with them. This realization caused her to question medicine as her vocation.

She finally chose Palliative Medicine as an elective at the beginning of her residency which soon convinced her that medicine is just as much art as it is science. Her mentor, Dr. McCormick, was quite different from those MDs who would spend a few minutes looking at their patients' lab reports while ignoring their bodies except a few hasty minutes of examination and listening to their hearts and lungs with their stethoscopes.

Instead of talking around the subject of dying euphemistically, Dr. McCormick spoke the truth to his patients. He helped patient such as Donna to choose the quality of life for her final days. Earlier when she suffered from kidney failure, she was helped by dialysis to continue working for another five years. Dr. McCormick assured her that stopping dialysis is a merciful way to die-first there is coma, then difficult breathing which medicine can relieve.

Chaplain Ellen told about "legacy work" explaining that the dying wanted to leave messages expressing their love for those left behind. Palliative Medicine is a relatively new specialty which focuses on treating the pain and suffering of patients living with terminal illness. Although people have suffered and died from incurable illness, the American Board of Medical Specialties did not recognize hospice and palliative medical subspecialty until 2006. Puri concludes that now "I would come to a different and new understanding of medicine's role in our lives." Elisabeth Kubler-Ross, in her pioneer writing about Death and Dying (1969), has finally paid off in half a century later in the person of Dr. Sunita Puri.

-Franklin Woo