This book, subtitled Reflections for Life’s Final Journey, is, in short, a book about death. And while it wasn’t necessarily the most uplifting book to read, Howard approaches this subject with hope and encouragement.
Deborah Howard has worked as a hospice nurse for many years, and eventually felt compelled to write this book as an aid to guide people through the process of having a loved one die, or even knowing that the reader is facing death himself. Howard is a Christian, and this book is unapologetically so. While there is a great deal of emphasis on God, eternal life, and the perspective towards death that that mindset brings, Howard also provides much information about hospice that is useful even if you are not in agreement with the tenents of Christian faith.
I actually only had a vague notion of what hospice does before I read this book, so I found those parts of the book extremely interesting and informative. Howard talks about how hospice was founded with the idea that people who are dying deserve to do so with dignity, with as little pain as possible, in their own homes, and surrounded by those they love. She says that the founder of hospice was horrified by the way that those who were dying in hospitals were more or less considered failures of the medical profession. (Granted, this was decades ago when hospitals were quite a bit different from what they are now.)
Having recently watched a loved one suffer through the final stages of cancer, I sincerely wish that I had been more familiar with hospice and the alternative that they offered. While we were comfortable and cared for in hospital, there will always be something impersonal and vaguely routine about the care there. Looking forward, with another relative diagnosed with terminal cancer, it was encouraging to understand that for someone like him, who hates hospitals and strangers, there is another option for him, and that he can spend his final weeks in his own home.
Howard emphasizes hospice as an alternative to the growing movement of assisted suicide. Because patients who are enrolled in hospice have a terminal illness and a prognosis of less than six months to live, and all potentially life-saving options have been exhausted, the goal of hospice is not to help the patient “get better.” Instead, their goal is stated as helping the patient “remain comfortable and free of suffering for the rest of his/her life.” This is done, not by putting the person to sleep as though they are worth no more than a dog, but by providing them with equipment and medication that they need to make their final days as comfortable as possible. Enabling someone to be in their own home, surrounded by their own family and loved ones, creates a situation where the focus can be on the joy of the patient’s life.
Throughout the book, Howard opens each chapter with the next part of a story of a hospice patient and his family. She uses this story to illustrate the various stages of dying, from diagnosis onward. Howard is realistic in her portrayal of human response to dying: we don’t want to! But as she discusses the different stages and puts them into an eternal perspective, the reader is shown how death is inevitable but does not have to be viewed with terror.
She reminds the reader that preparation for death can (and should!) take place at any time in one’s life, not just when a life-threatening prognosis is given. We do not know when our last moment will be – it can happen at any time. I greatly liked the line she quoted from Dr. Charles Hodge: “It is important that when we come to die we have nothing to do but die.” In another place she tells a story of St. Francis –
It has been said that someone found St. Francis working his garden and asked him, “What would you do if you knew that you would die in ten minutes?” St. Francis replied, “I’d try to finish this row.”
Howard discusses what happens after death, as well. She believes in the Biblical definition of eternity, obviously, so although she examines other beliefs, she mostly does so to show how she does not believe that they logically fit into the real world. I can see where a non-Christian may be greatly offended by much of this book, but I also think that it is a book that can put forth a challenge to that non-Christian’s beliefs. If nothing else, it gives the reader much to consider, as so often we prefer to pretend that we will never die, when in fact we all will.
As I said at the beginning of my review, Sunsets wasn’t a super cheerful read. But I still came away from it encouraged and informed. I feel like I have a lot more information about hospice, and some clarified thoughts about death and the afterlife. Howard’s book is written in a gentle and loving way. It is never harsh or disparaging, even when she is discussing beliefs that she does not believe are true. I would strongly recommend her book to anyway who is facing the challenge of becoming a caregiver for a loved one who is terminally ill. This book is full of practical and helpful information to guide people through this most difficult of times.