Margaret Overton wants to change how we think of end-of-life care

Author of “Hope for a Cool Pillow” will be at BookPeople on Thursday.


Doctors are supposed to heal people, right? It’s their jobs to fix them up and send them on their way again. So what happens when doctors continue to keep trying to heal people who can’t be fixed — the dying?

That’s what Chicago doctor Margaret Overton explores in her new book, “Hope for a Cool Pillow.” Overton will be in Austin Thursday to read from and sign her book at BookPeople.

Overton interweaves stories from her own life — watching her father die from cancer and her mother die from complications of dementia — with stories from her days making hospital rounds.

Dying isn’t funny, but Overton finds humor in it in stories like the time she arrived to a page and tried to intubate a person who had been dead for hours. Sometimes doctors are so busy trying to save patients that they miss the whole picture.

In the hospital setting, unless a patient has a clear, legally binding do-not-resuscitate order that they brought with them to the hospital and that got put into their chart, doctors have to perform lifesaving actions, whether it is best for the patient or not, she says.

Because of fear of lawsuits, “it’s been very difficult not to resuscitate absolutely everybody,” she says.

Instead of patients or their families getting to make their own choices, “end-of-life care has become the province of physicians.”

A month after her mother died, Overton attended an executive education course at Harvard that focused on the business of health care. Overton began to think about the economics of end-of-life care and “how much we could improve things if we could opt out,” she says. Again and again, she saw the system prolonging the suffering of a patient instead of providing palliative care to make the passing easier.

The course required her to do a final project, and this book is that project. “I really started thinking long and hard about how I could make this point to people in the medical profession and outside of the medical profession.”

She hopes the book will get doctors talking, but also that families will start planning out their wishes and talking to one another about end-of-life care before it is too late.

With her father, Overton was lucky because he called the shots about which cancer treatment he would do and when it was time to stop all of it and call hospice.

With her mother, it was much more of a challenge because her mother couldn’t make any decisions or understand what was happening to her. She and her sisters had to use their experiences with their father as their guide.

Overton says people who have read the book are quick to tell her their own stories of the final days of a loved one.

She wants people to know that they have choices about their own health and well-being, their own lives and their own deaths. “We have to accept that everyone has the right to deny medical care or have more medical care, whether they are being realistic or unrealistic,” she says.

One story tells of a dying woman who, by her and her husband’s choice, spent months in the hospital getting treatment for a disease that was incurable instead of living out her days at home. As hard as that was for Overton to understand that choice, it was the choice they made and had to be honored.

Overton is like many of us. She has talked to her children about her wishes but does not have a do-not-resuscitate order on paper. She’s not ready for that step yet, but she knows what she does want in hospice care. Through the experiences of her parents and some other loved ones, she has learned that not all hospice experiences are the same. You have to do your research and look at how long a hospice has been in business, how much money it spends per day on a patient, whether it is for profit or nonprofit, and whether it is accredited. She suggests going to the National Hospice Foundation for a list of questions to ask.

A small part of the book is the story of her dog, who was also aging along with her parents. She had to make end-of-life decisions for Olga, and was with her the day the vet put her to sleep.

Overton sees that public opinion about physician-assisted suicide is shifting and a growing number of states are making legal provisions for it. “When it’s available, a lot more people will sign up for it than will actually take advantage of it,” she says. “It’s almost more important to know it’s there, that it’s available, that they have control if they need it.”



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