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The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life, Ira Byock, MD, Avery Publishing, 2012.

If you or someone you love appears to be coming to the last days (weeks or months) of life, Ira Byock is the kind of physician you hope will be there as guide and comforter for the end of the journey. He was working in hospice in Montana when he wrote the commendable Dying Well where he argued that the end of life could be time of special growth and meaning. Now he is Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in New Hampshire and he has more to say about providing "the best care possible" to patients and families facing the end of life both from a clinician's perspective and from a much broader societal, political and cultural perspective. While such topics could feel oppressive or overwhelming for the reader, Byock is a skilled storyteller and he illustrates is points with compelling patient narratives of patients both young and old. His stories give examples of excellent care and communication offered and times where care and communication left much to be desired. Integrated in these stories are helpful tools for the toolbox of end of life conversations and care including both words to say (or not say) along with ways of thinking about and approaching delicate situations. Throughout it all is Byock's deeply humanistic values brought to bear in the care of the dying and the living up to the dying. His goal for his practice and for our culture is to embrace the concept of providing the "best care possible" for the vulnerable last chapters of our lives.

Byock comes across as a skilled clinician, a gifted storyteller, an inspiring teacher and a relentless advocate for patients and families. He takes the "big picture" perspective in each case so that it's not just a person's health but the person's well-being which is our concern. It's not just the individual but the individual in context of family and community that needs to be considered. It's also the goal of living fully with suffering minimized as much as humanly possible until dying gently. In order to have the important conversations that are needed both in the hospital room and in the public square, Byock respectfully challenges us to face the reality of our mortality in a grown-up way because the consequences of doing otherwise lead to too much unnecessary suffering. And unnecessary suffering is counter to the ideals of medicine and palliative care and ultimately to the values of our broader culture.

This book is engaging and accessible for both the lay person and the clinician, and it presents both practical wisdom and big ideas effectively. It is a unique source of guidance and inspiration for patients, potential patients, family members and healthcare professionals.

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