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Ann Mandelstamm, chair of the St. Louis chapter of Final Exit Network

Those of us who espouse death with dignity usually concern ourselves with older adults who have no hope of recovery: those with terminal cancer, ALS, Alzheimer’s or other diseases for which no cure is known. We tend to forget that young people also face these terrible and tragic conditions. In her book PINKY~SWEAR, Persis Oberreither has written beautifully and poignantly of 18 year old Amy’s automobile accident on the night of September 24, 2001. This book explores the heartbreaking medical and ethical challenges faced by Amy, her doctor, and her parents during the three weeks which followed the accident.

Amazingly enough, lovely young Amy Oberreither had a living will in place, largely because of her experience with a much beloved grandmother who had steadily declined, mentally and physically, from Parkinson’s. After seeing her once vibrant grandmother reduced to helplessness, Amy urged her mother, “Promise me you’ll never make me live like that.” The title of this book comes from their ritual linking of little fingers to make the promise official.

Oberreither recalls events in Amy’s life, from childhood to age 18, which make her real to the reader. Although the focus of the book is on the accident and its aftermath, Amy never once seems to be just a patient in a coma. Through her mother’s retelling, she is funny, athletic, devoted to her dog Fudge, both affectionate and at times sarcastic, in every way a living presence in the book. The photographs are stunning. I couldn’t help loving her.

No parent can read PINKY~SWEAR without a pounding heart. Even though the outcome is known from the subtitle, I couldn’t put down this gripping account. But what I liked best is Oberreither’s courageous honesty about each major happening in Amy’s care. For example, a wound care specialist visits Amy, and in an awkward attempt to be sympathetic to her mother, the specialist remarks that she always tells her own daughters to wear their seat belts. Oberreither recalls, My eyes narrowed. Gee I never thought of that. I guess they always listen to you. I guess that makes you mother of the year. It is exactly this kind of emotional candor that takes the reader right into Amy’s hospital room to endure the long days and nights with her parents.

The journey that they take, each decision and event in sequence, leads to the eventual awareness that Amy will probably never be off life support. While no doctor can predict exactly what will happen and while her mother hopes that every grimace or twitch means she is waking up, Amy’s coma remains deep and persistent. Her brain injury is “as bad as it gets.”

Even in the midst of such tragedy, protocols must be followed. Amy’s neurosurgeon, other specialists, the head of intensive care, and a Jesuit trained in bioethics (this is a Catholic hospital) talk to Amy’s parents. Most people in the hospital are kind and sensitive, but not all. The committee and the Oberreithers unanimously agree that it is in Amy’s best interest to have her life support removed.

This book illustrates a love ferocious in its intensity and a courage that never falters. But at its core is respect, respect for a daughter’s deepest wishes and for her integrity. Written by a mother devastated by grief, about a talented and delightful daughter, and dedicated to the grandmother who inspired the initial discussion about quality of life, PINKY~SWEAR is an unforgettable and influential book.

Reviewed by Ann Mandelstamm

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