No Harm

Field Guide to Falling Ill is a book of essays by Jonathan Gleason that won the inaugural Yale Nonfiction Book Prize in 2024, an award that recognizes “book-length works of nonfiction by first-time writers of the genre that are formally ambitious, intellectually rigorous, and deeply attentive to lived experience.” “No Harm” is an excerpts of the final chapter, which grapples with the question of whether or not it’s possible to have a good death in the US medical system.

Dr. William Husel was often one of the only physicians on the floor of the intensive care unit of Mount Carmel West, a hospital on the southwest side of Columbus, Ohio. He worked the night shift, and he specialized in the treatment of end-of-life patients, a difficult and frequently thankless job. One could view his night work as a sign of altruism—a willingness to take on shifts that others did not want. At night, cortisol levels surge and patients are wakeful, putting them at risk of secondary complications. There is a “60 percent rise in death rate beginning at 2 a.m. and reaching a peak at 8 a.m.,” as a 1987 article in The American Journal of Medicine put it. In other words, many patients die at night. In the sharp, unnatural light of the ER at 3:00 a.m., families are weary, and the idea of a good death holds least sway. But volunteering for the night shift could also be a sign of something else. There is less oversight in hospitals at night, as fewer doctors and pharmacists are working, and most administrative staff is away. In the hushed corridors and darkened rooms, what might it be possible to do?