Graceful Exit

Dr. Ferrer has written an easy to understand book that covers the many issues related to end of life care for loved ones. He has witnessed families wrestling with the care of critically ill relatives, seemingly incomprehensible medical procedures, a veritable maze of bureaucracy, and relatives at odds about the best way to proceed.Many of the drugs, procedures and medical equipment in use today were not available in previous eras, so death came at an earlier age and after less time of being infirm. Today, individuals can be kept alive with aggressive medical intervention, but quality of life, the cost of care and the impact on family caregivers must be considered. It is not unusual for a caregiver to become burned out, and for family finances to be depleted in the attempt to keep infirmed loved ones alive and comfortable. Disagreements with medical staff and other family members becomes commonplace.This book takes the reader through the various layers of decisions that those close to death and their relatives must make regarding end of life care. Hospice, palliative care, long-term life support and other options are fully explained by Dr. Ferrer through his personal experiences as an intensive care as a pulmonary specialist. His uses vivid examples of his patients that have navigated through the critical care system with varying degrees of success. His family members have not been immune from becoming patients that have had to rely on the critical care.Most chapters have valuable summaries and checklists for patients and relatives to follow in planning for end of life care. Living wills, health-care proxies, appointing a family liaison and many other important topics will allow the reader to avoid having to make hurried decisions when a loved one needs critical or long term care.Dr. Ferrer injects a human element in his narratives to help us to understand the emotions that can arise in family members when a dear one is terminally ill. He illustrates the many mistakes that patients and relatives make because of misunderstandings in dealing with the medical staff, decoding the procedures that are used, options for varying levels of care and prognosis for the future. With clear examples, he allows us the opportunity to examine the successes and failures that many families have encountered in those stressful situations.This book would have been a valuable resource for my family two months ago when my brother-in-law slipped into a coma a day after he was driven to the ER with multiple organ failures. The ICU medical staff worked around the clock to allow him to recover, but the best medical care could not prevent his condition from deteriorating. The family decisions were not always unanimous regarding his care, advanced treatments, and the future. After about 10 days in the ICU, it was jointly agreed that he would be transferred to a hospice facility. He passed away about two days later without regaining consciousness.Please take the time to read this book so that you can make wise decisions about unexpected medical situations and end of life care that will eventually affect all of us. “Graceful Exit” will allow you to start planning before being blindsided by events that can be difficult to manage under stress.

Graceful Exit is filled with compassion, kindness, wisdom and specialized knowledge about end of life issues from the perspective of a physician who helps families face the death of a loved one every day in his practice. It helps families navigate a wide range of concerns: Dr. Ferrer provides expertise in managing family dynamics at a time of heightened emotional stress; understanding the different options for rehab and assisted living facilities; and navigating the bewildering bureaucracy of Medicare.Most importantly, he helps patients and families distinguish between "best possible care" meaning the most high-tech, aggressive interventions versus what they really want - good quality of life at the end and a peaceful exit from it. The book is filled with dramatic stories illustrating how these end-of-life conversations can go well - or turn out horribly wrong.As a physician, he writes for other physicians as well. Doctors are generally not trained in how to handle emotional situations like end-of-life decisions so they revert to our healthcare system's default setting - doing as many interventions as possible to prolong life as long as possible without considering the harm to the patient physically and to the family emotionally. Dr. Ferrer gives guidance to physicians, urging them to explain the consequences of each option in simple language.Thus this book fills an urgent need, filling in a gap in Dr. Atul Gawande's Being Mortal. Gawande's book covers much of the same territory (nightmare scenarios caused by aggressive interventions on dying patients) but his suggestions for change are in the realm of public health - how to create more humane facilities for elderly patients. Dr. Ferrer brings the issue to the personal level for patients, families and physicians, creating a road map for decision-making that will lead to the desired "graceful exit."

As a sociologist who teaches undergraduate courses on End of Life Issues, I have been aware of the lack of guidance many people experience as their loved ones near death. Dr. Ferrer's book fills this gap by sharing his professional and personal experiences and knowledge in a well-organized set of chapters that address all the key topics one needs to know. What I especially appreciate about the book is its balance between information and anecdotes. Dr. Ferrer provides much specific guidance in bullet-pointed and outline fashion, such as "when to ask for a second opinion" and post-death tasks. This guidance is balanced by the stories of his patients. The book is well-written, easy to understand, and very well organized thematically, and it exudes a compassionate, caring, and nonjudgmental tone. The "Main Chapter Takeaways" presented at the end of the chapter serve as good reminders and reference points. It would certainly be on my "recommended reading" list for students, and I will also be referring to it in dealing with my aging family members.

The author addresses a very delicate subject with great dignity and sensitivity. The real life scenarios give great insight into his considerable experience and his gentle approach to guiding family and friends when faced with end of life decisions. There is equal concern for the person at the end of life as well as those providing care and support, addressing the emotional juxtapositions and reversions to typical roles in these difficult times. The practical advice is to the point and easily translated from North American situations to British. A must read for anyone seeking clarity in their own approach to a good end.