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Book Review: Working with the Dying and Bereaved: Systemic Approaches to Therapeutic Work

in great detail the effects of AML and its treatments on their bodies. Family and friends take on newly intense roles or become more peripheral. Strangers such as nurses, doctors, and especially other patients loom large in daily life. Spirituality, as organized religion and/or personal beliefs, becomes intensely important to most but not all of the patients. However, all of them articulate concerns for the major issues of their lives, whatever the mix of the physical and non-physical. The emphasis is on the here-andnow. These are not happy stories. Four of the patients died before the book's publication. The clinical outcome for two is left unspecified, and two are identified as survivors. Six years after BMT, the luckiest of the latter underwent surgery for lens implants secondary to radiationinduced cataracts. The other remained chronically ill: "I feel worse now than when I had leukemia!" And these are not complete stories. We do not know how the patients' attitudes evolved as their disease progressed or disappeared. We are not told if these patients persisted in uncertainty or grim resistance or hopeful acceptance. But as I understand the book, the vignettes are not meant to be narratives with beginnings, middles, and ends. The accounts are recalled "after the fact" and therefore tend to be more organized and reflective, less dramatic or melodramatic, than the actual lives may have been in the living. Some readers may find the accounts less engaging than those captured in direct reporting or fiction. I do not think this is a limitation in Mcl.ean's book. She gives us a balanced, thoughtful look at eight lives (and more) under extreme stress. We are not diverted from the larger issues by the excitement of "real life" drama, which is available in abundance to caregivers. She makes us feel as if we have been coached by these patients whom we have encountered awake at night and ready to talk. Facing Death will be helpful to anyone caring for patients with life-threatening illness, whether they are new to the task or experienced in it. I think it is particularly apposite to those early in training and young enough not to have encountered some of these issues in their own lives, personal and/ or professional. This reflective book is an honest introduction to many important issues in caring adequately for those facing life-threatening illness and its losses. I recommend it strongly.