Crossing Over presents "extended, richly detailed, multiperspectival case narratives" of 20 dying patients served by the Hospice of Lancaster County in Pennsylvania and the Palliative Care Service of Royal Victoria Hospital in Montreal. These complex narratives (each written by a single author) reveal the patient’s story from many points of view, including those of family members and professional caregivers.

The authors explain how this project differs from recent books of clinical narratives by Timothy Quill (A Midwife Through the Dying Process, 1996), Ira Byock (Dying Well: The Prospect of Growth at the End of Life, 1997), and Michael Kearney (Mortally Wounded. Stories of Soul Pain, Death and Healing, 1996 [see entry in this database]). Barnard et al. point out that Quill, Byock, and Kearney are "passionate advocates for their own styles of care . . . Yet these very characteristics--advocacy and close personal involvement--limit their books in important respects." (p. 5) Basically, these authors select cases that illustrate the efficacy of their models and present the patients’ stories from their own point of view.

Crossing Over draws on a standard qualitative methodology that includes tape-recorded interviews of patients, families, and health care professionals; chart reviews; and participant observation. After the introduction, the narratives occupy 374 pages of text (almost 19 pages per patient). Part II of the book, entitled "Working with the Narratives," includes a short chapter on research methods and 29 pages of "Authors’ Comments and Questions for Discussion." The latter is designed to be used as a teaching guide.


Crossing Over offers three advantages as a casebook of end-of-life care. First, the book includes narratives of patients who don’t seem to accept or benefit from hospice philosophy or hospice-type care. For example, Miriam Lambert, a patient with melanoma who suffered from "total pain and the despair of an unlived life." Or Costas Metrakis, an artist with stomach cancer, whose dying strayed far from the peaceful hospice ideal. Other patients died, leaving their family and/or caregivers in the lurch, their questions unanswered, their feelings unresolved. Thus, the book presents a more realistic picture of dying in North America today, even when it occurs under the best of circumstances, than do the more "ideal" collections of stories cited above.

Second, the stories are exceptionally well written. Each stands on its own as an interesting and provocative clinical tale, while also serving as part of a textured whole. Any one of them might be used as a reading assignment for a medical or nursing student class on death and dying. Finally, the authors’ comments and questions for discussion are consistently top notch, making this a good sourcebook in designing such classes.


Co-authors with David Barnard are Anna Towers, Patricia Boston, Yanna Lambrinidou. David Barnard is currently Director of Palliative Care Education, Center for Bioethics and Health Law, University of Pittsburgh.


Oxford Univ. Press

Place Published

New York



Page Count