Book Review
Handbook for mortals: Guidance for people facing serious illness
Joanne Lynn and Joan Harrold
ISBN: 0-195146-01-8; 2001; 256 pages; Oxford University Press;
Susan Bardy
Hospice Nurse Clinician, Mary Potter Hospice, North Adelaide SA
This book, written by two medical doctors, is intended to be used by sufferers of terminal illness and their significant others. It aims to give helpful, commonsense advice at various stages of terminal disease progression.
Not specifically designed as a textbook, the language is easy to understand and largely free of medical and academic jargon. The presentation however is rather untidy, pages contain 'information boxes', anecdotes and poems, that while in itself is interesting, tend to interrupt free flow of the text. Writing style is confrontational, lacking gentleness that is so often needed when addressing most terminally ill people. Admittedly there will always be some who may prefer information to be more 'up front', however there is simply too much of this style contained in this book to be of universal benefit. For example, terminally ill readers could find chapters 10, 11 and 13 both traumatic and confusing. These chapters deal with planning ahead, foregoing medical treatment and events occurring near death. While these mainly emotional issues are important, they should be dealt with more sensitively. I wondered if upon reading a book like this in this style could only further exacerbate the psychological pain and add to individual and family anxiety - a factor always present in terminal illness.
The book is crammed with a range of major clinical issues and these include: Practical management of pressure area care, breathlessness, diet, hydration and continence. Unfortunately these points are scattered throughout the various chapters and are difficult to locate.
Chapter seven concentrates specifically on pain management and contains several clinically relevant and useful points. Yet when discussing change of opioid dosages there is hardly a mention of the doctor's role in providing expert guidance. More space should be given over to issues of over or under medication.
Chapter twelve's open discussion on 'hastening death' is talking about physician assisted suicide a subject hotly debated and to my mind a question without a firm answer. Elsewhere, sudden death and dying of children (chapters 14 and 15) are specialised areas that need a more in depth approach in management, one that a handbook of this kind has found difficult to address.
By far the strongest chapter (chapter 16) deals with grief. It begins with an initial approach of 'Grieving your own death' while confronting, then moves quickly to aspects of grief concentrating on strategies for those left behind after death. Overall this book should be considered with care by nurses, evaluating the text in terms of what it has to offer given their likely experience and practice context. For those nurses looking for a resource for patients, consideration must be given to the confronting nature in which it is written. The bottom line is that Handbook for Mortals is a volume I would be reluctant to recommend to any of my patients, especially those who find end of life issues difficult to cope with.
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