That Good Night: Memoir

A doctor's meditation on how we go, gently or otherwise

On May 21, 2022, The New York Times published a guest essay, “My Patient Didn’t Die From Covid. He Died Because Of It.” I read it twice. Then I ordered the essayist’s book and read that, too. I’ve been thinking about it since.

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The call came without warning, as such calls tend to do. My father, who lived in a nursing home because he could no longer live on his own, had yet again contracted pneumonia, and this time it had devolved into sepsis. A doctor I’d never met was on the other end of the line, saying my father’s organs were failing rapidly. She wanted to know: Would I authorize a Do Not Resuscitate order?

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Sunita Puri had nearly decided to leave medicine when she discovered palliative care. She couldn’t, at first, explain the attraction. Her mother, though herself a doctor — an anesthesiologist who guided patients through the twilight of surgery — didn’t understand either, or initially approve. In Puri’s memoir, “That Good Night: Life and Medicine in the Eleventh Hour” (Penguin Books), published in 2019 but feeling hyper-topical in 2022 amid a pandemic that’s killed 6.2 million people and counting, she eloquently describes how she, and the patients and families she worked with, fumbled toward a better understanding of how we do or do not go gentle into that good night. But where poet Dylan Thomas urges us to rage against the dying of the light, Puri writes from the side of acceptance: preparing ourselves to acknowledge and face what we cannot escape, and striving for the best quality of life possible until then.

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My father had never signed any paperwork specifying his end-of-life preferences. But I remembered something he had once told me: He wouldn’t want to live insensate, wholly dependent on machinery. Another comment that had stuck in my memory: He thought 80 years was an ideal lifespan. When that anonymous doctor called, my father was 79, unhappily widowed, with a checkered medical history: dementia, head trauma that had required surgery, diabetes, hypertension, multiple episodes of pneumonia that had sent him to the hospital. He relied on a wheelchair, a breathing tube, a personal aide and the nursing home’s staff to get through each day. He spoke only to berate others, including me the last time I’d seen him. He’d struck me then as someone who was no longer living, but waiting to die.

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The power of Puri’s book lies in her gift for seeing and describing her patients not as case studies in terminal care but as relatable humans facing heartwrenching decisions with a varying assortment of foibles and philosophies. She arrives in their lives amid frustration and vulnerability, representing an area of medicine that is unfamiliar and off-putting even to some doctors. One patient, stumbling over the word “palliative,” asks if she is a paleontologist; a family member, realizing the implications of Puri’s involvement, declines to address her as “doctor,” as a healer. She watches as some families find their way to peace with the fate they have been dealt and as others rip themselves apart arguing about what a loved one really wants. She endures tongue-lashings from a couple who cannot bring themselves to think their son will never walk out of the hospital and who blame his condition entirely on her and her colleagues. She runs into red tape with a man who is deemed ineligible for the home visits she wants to order for him because the only living quarters he can afford are in a warehouse. She steeps in others’ grief, anger, despair and fear.

***

The doctor promised not to give up on my father right away. But she wanted me to understand that she could do only so much, that rapidly diminishing returns were involved; she said something about a cutoff of thirty minutes. As she talked, I looked up at the sparkling white lights strung outside a cineplex where my husband and I had just taken the kids to see “Peanuts.” I’d left the three of them back in the lobby, milling happily with the crowd ogling the posters for coming attractions. It was Thanksgiving night, a time for family. I gave the doctor my consent for a DNR. By Sunday I was on a plane, crossing an ocean to bury my father in the spot he’d long ago reserved next to my mother. He and I had failed each other many times; this time, it felt as if I’d done the right thing.

***

“That Good Night” is an heartfelt call to place dignity at the forefront of how we think about and cope with death and dying. Puri, who grew up in an Indian American household, touches several times on a Hindu scripture that translates approximately as “the soul wears the body like a cloth”; her father likes to quote it as a reminder of the temporal nature of our physical existence.

After being called in on the case of Alice, whose lymphoma has been complicated by a relentless fungal infection that has put her on a ventilator, Puri assures Alice’s fiancé that she won’t be made to suffer in her final moments, then discusses the removal of Alice’s breathing tube with a junior colleague.

“This sucks,” he said, and I nodded in agreement. But was it worse than anchoring Alice’s body to a world it was trying to leave?"

Giving “That Good Night” extra poignancy is Puri’s recognition that all her doctorly expertise doesn’t make it any easier to talk with her parents about their end-of-life wishes, and her admission that she, too, personally struggles with that inevitability.

I thought back to the many times I feared death as an outcome for my patients, convinced that it was my job to forestall it, to control and manipulate nature. Giving death this much power distorted my view on life — my own, and that of my loved ones and patients. … What if I regarded my own death with reverence instead of fear? … Or, even more radically, what if I had some sort of gratitude for the transience of my life?

“Gratitude” is probably not the first word that comes to mind when thinking about death and dying, but it is the one that emerges from a reading of “That Good Night” — gratitude to Puri for writing this important and thoughtful memoir, and for devoting her life to such important and thoughtful work.

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