Dancing with Broken Bones: Portraits of Death and Dying among Inner-city Poor (review)

Dancing with Broken Bonesis a bare bones evaluation of the dismal reality of health care for people with terminal conditions living in poverty in the United States and the existing disease treatment model that dominates end of life care. The author, David Wendell Moller, is director of Human Values in Medicine at Saint Luke’s Hospital of Kansas City. He received his MA in sociology from the New School for Social Research in New York City and earned both an MA in Philosophy and a PhD in Sociomedical Sciences from Columbia University.

This engrossing book, which is the result of three research initiatives funded by the Open Society Institute and Indiana University Research Venture Fund, describes the interaction between impoverished or “invisible” Americans (p. 53) and our nation’s “broken” health care system. Moller’s insightful analyses and accompanying dialogues with each of these patients, their families, and medical staff helps “penetrate this invisibility” (p. 10) by honoring the lives of those who have historically been “cast aside, disregarded” (p. 12) by our “death-avoiding culture” (p. 55). The book follows the trials of terminally-ill inner-city patients during the last months of their lives, offering lucid insight into the difficulties of “dying while living within the confines of urban poverty” (p. xi). Given the fact that poverty in America “ferociously attacks the bodies and souls of individuals, families, and communities” (p. 20), the author takes issue with “our strong cultural preoccupation with social and economic status” (p. 21) which unfairly burdens an already burdened element of our society. Our collective fascination with wealth leads to an “unintended bias toward chronicling the experience of those who are empowered” (p. xii) in a society where “monetary success is a cherished value” (p. 20). The struggles of many of the poor and “invisible” Americans to obtain adequate health care in this country is, in the author’s estimation, of minimal importance to the average American.

Moller’s attempts at “conscious listening” (p. 157) allow his readers to appreciate the role race and class play in making many poor patients feel “intellectually and personally alienated” (p. 16) while receiving “inferior care” at public hospitals in the inner city (p. 17). By cinematically zooming in and out of the lives of various “indigent patients” (p. x), Moller allows his readers to witness the “dignity and courage” (p. 66) many poor patients embody as their “bodies are dismantled by disease and dying” (p. 25). As the experiences of these patients illustrate, American physicians—many of whom come from very different backgrounds than the patients in this book—find it increasingly difficult to empathize with patients who are confronted with economic and racial barriers. The lamentable suspicion between patient and physician that arises from such a situation leads, as is apparent in the profiles Moller highlights, to deepening mistrust and a prevailing feeling amongst poor patients that they received “inferior care because they were poor” (p. 16).

In sum, Dancing with Broken Bonesweaves a tapestry portraying the sadness of lives needlessly made futile by the pangs of “social isolation” (p. xiv) and disease. Moller takes his own personal experiences and knowledge to bring compassion and insight into the topic of end of life care in inner city America with individual profiles that are at once raw and heartfelt. Although many terminally-ill elderly Americans in the inner city view the health care industry through a lens smeared by futility, Moller’s ability to combine the highly personal with the pragmatic places the daily struggles of these individuals on “center stage” (p. 52) and, thus, “honors their lives” (p. 52). Overall, the profiles of resilience contained in the pages of this fine book are a painful reminder that the unnecessary suffering of poor Americans can be avoided only when the poor are recognized in their full humanity.