A Time to Die

A reassuring and illuminating examination on our conflicting wishes about the end of life, how the politics and routines of the American hospital have formed our understanding and experience of death, and ultimately why what we consider a "good death" is so hard to attain. In a penetrating and revelatory study, medical anthropologist Dr. Sharon Kaufman uses two years of intensive observations and interviews with scores of patients, family members, physicians, nurses, social workers, and other staff at several community hospitals in California to explore the heart of a science-driven yet fractured and often irrational world of health care delivery, where empathetic yet frustrated, hard-working yet constrained professionals both respond to and create the anxieties and often inchoate expectations of patients and families, who must make "decisions" they are ill-prepared to make.

She sought out the critically ill, the dying and their friends and relatives. She followed patients from admission to death—days, weeks, or sometimes months later—through, what is often for them and their families, a Kafka-esque journey. She asked hospital staff what they were doing and why and stood beside doctors and nurses, observing their work, cynicism, compassion and frustration.

And she paid close attention to the most important player of allthe hospital beauracracy and how it impacts the manner and timing of patient death. Her investigative research links together the emotional experiences of patients and families, the dedicated work of hospital staff and the ramifications of institutional bureaucracy to show the invisible power of the hospital system itself—its rules, mandates and daily activity—in organizing death and individual experience of it. The book is the story of real patients and their families, an account of what drives the American hospital today, and a report on the complex sources and implications of doing something about death.