Summary:

Two hospice nurses describe their work with dying patients, especially with the special forms of communication typical of dying patients. The authors define "Nearing Death Awareness" as patients' knowledge and expression about their own dying. What doctors and family members may assume is the patient "losing it" or "hallucinating" actually is often a kind of symbolic communication dying patients typically use, either to describe their dying experiences or to request something they need for a peaceful death (such as seeing a loved one). By dismissing the patient as "confused," caregivers miss the opportunity to help the patient and may also alienate and frustrate both patient and family. By being aware of what is going on, caregivers can be more responsive and comforting to the patient and the family.

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Summary:

Howard Carter very skillfully weaves together the various meanings that the heart holds for us--biological, medical, psychological, cultural, and spiritual. He does so through four patients that he interviewed when he was appointed to a distinguished professorship in medical humanities in a joint program of St. Patrick Hospital and the University of Montana, in Missoula.

Each of the sections of the book focuses on one of the patients who suffers, respectively, from a prototypical heart problem: a young man with congenital defects who undergoes successful surgery; a middle-aged woman with a viral illness who learns how to live with her chronic heart condition; a middle-aged man whose blocked coronary arteries are cleared, as is the stress in his life; and an old man who turns to spiritual matters as he faces heart failure.

What contribute significantly to the uniqueness of this book are the essays that Carter provides at the end of each Patient Section. They are the vehicles for the synthesis of the patient stories, the scholarly look at how "we have largely lost the anchoring image of the heart" in American society, and his very poignant personal reflections about life in (or at least near) the wilderness of Montana. (See Solid Footing, Higher Ground -Third Essay as an excellent example of his skillful and moving writing.)

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