At Death's Door is an attempt to provide scenarios that can occur when a patient is approaching the end of life. Sepulveda, a doctor with 30-plus years of experience, and Scott, a well-known writer, describe a variety of situations that involve decision making for end-of-life care, coping mechanisms that can hinder the decision-making process, and cultural issues that are often misunderstood or ignored. Each situation is an attempt to provide a realistic view for the reader. However, the recalled dialogue would be better replaced with a summary—an interpretation would provide far more insight than the choppiness of the report. Medical terms are defined throughout, which is beneficial for non-medical readers…. Thus, the book will be best suited for laypeople seeking knowledge of the pitfalls that can occur along the end-of-life road…. This book is rich in personal experiences, which afford a level of authenticity to the work—this is difficult to find. It will prove invaluable to many who are seeking information on how to navigate the uncharted waters of end-of-life care.

Summing Up: Recommended. Lower-division undergraduates and general readers.

Choice Reviews

[R]eading this book would allow you to reflect on how you try to assist patients and families with end-of-life issues.

International Association for Hospice & Palliative Care

While this book could easily serve as a classroom text for medical students, families who want to avoid stressful scrambling in a crisis situation at life’s end are well-advised to invest in a copy of At Death’s Door to review and keep at home. Digesting the pages will help families prepare, which will then bring them peace of mind. It may also inspire living better.

The Caregiver's Voice Review

Through several chapters of gripping anecdotal evidence, Sepulveda and Scott show how different diseases affect physical systems and the ways in which they cause loss of life; how a DNR/DNI alters a care plan; and how it might save pain on both sides of the bed. The end is near in each of Sepulveda’s tales; whether the DNR/DNI is in place or not, the outcome is the same. The difference: one offers less pain and more peace, he says. What would you want for yourself? What would you want for your loved one? Valid questions, all, from a book that forces readers to think, hard. Yes, you may be a patient someday, and you’ll be glad you’ve read At Death’s Door, in the end.

Pantagraph

From the vantage point of a highly experienced and thoughtful physician at the bedside, Dr. Sepulveda brings clarity to the decisions confronting patients, doctors and the 21st century health care system at the end of life. Using compelling case vignettes, Dr. Sepulveda writes with clarity about the pathophysiologic processes of the common fatal diseases of our time – COPD, heart disease, dementia, obesity and cancer – and how patients, their families and physicians face the dilemmas and decisions to be made at life’s end. Dr. Sepulveda brings to life how a compassionate and honest physician can help guide patients and their families in the hard decisions faced at life’s end.

Matthew S. Ellman, MD, Associate Professor of Medicine, Yale School of Medicine

Dr. Sepulveda provides an excellent overview of what we are likely to encounter in hospitals as we near death--whether our own or a loved one's death. This book is a worthwhile read for anyone preparing an advance directive or who is appointed to make end-of-life decisions for another. It also provides a useful introduction to end-of-life concepts and topics commonly encountered in U.S. hospitals.

Anita J. Tarzian, PhD, RN, Program Coordinator, Maryland Health Care Ethics Committee Network (MHECN); Law & Health Care Program, Maryland Carey Law; Associate Professor, University of Maryland School of Nursing