Fifteen years ago, Gilah Silber became a geriatric physician because she wanted to offer comfort and even joy to people as they made their last passage in life. Dr. Silber trained with a strong purpose to care for the aging and dying individual-in body, yes-but also in mind and spirit. To her dismay, she went on to practice medicine in a place she never expected to go, namely, a wonderland of nursing home facilities, where up was down, and down was up. As her adventures in long-term "careland" have taught her, it is the institutions that are at the center of the universe, not the people they...

As she makes her daily rounds to visit her nursing home patients, a geriatrician tells us what life and death are like in long-term care, given the insights of a decade of practice. Gilah Silber, M.D., offers up candid portraits of patients, the families who surround or neglect them, and the varied personalities of facilities themselves, where treatment and care are colored by the administrative outlook and the attitudes of staff. Alongside her stories, which are by turns fascinating, funny, exasperating, and moving, Dr. Silber points up the problems and predicaments of old age and chronic...

"The Gaping Peaks - The Triumph of Dogma in Health Care" presents anecdotal examples, as well as ethical, financial, and logistical concerns, that highlight the inconsistences and faults that exist in health care today. Dr. Silber analyzes the commonly proposed solutions to this dilemma, with the crux being that health coverage isn't interchangeable with health care. Insurance for the unforeseen has morphed into entitlements and has bred indifference, unaffordability, and inaccessibility. Illustrations of care depict a variety of physician and patient types. Despite adherence to protocol,...