Face the reality that death is a part of life

By Pam Tapper
December 7th, 2009
Section: Opinions

If a person is in a hospital or a nursing home, the last two months of life are the most expensive. Medicare paid $50 billion last year for the last two months of patients’ lives, more than the government spent on education or the Department of Homeland Security. It is also estimated that 20 to 30 percent of these expenditures had no significant impact on the patient.

Dr. Ira Byock of Dartmouth-Hitchcock Medical Center in Lebanon, N.H. said that modern medicine has become so good at keeping the terminally ill alive by treating the complications of underlying disease that the inevitable process of dying has become much harder and is often prolonged unnecessarily.

Are we saving lives or avoiding death? At what point are we saving a vibrant and worthwhile life, and at what point are we extending an illness? Death is a part of life.

We are so caught up in the youth culture, particularly in Southern California, that the subject of dying is almost taboo. It just isn’t discussed, but it happens. It is a time that comes to all of us. We all hope that it comes later rather than sooner, but it comes. Most of us hope that it comes to our parents later rather than sooner, as well, but it arrives inevitably.

When our loved ones are sick, we want to relieve them and help them, but sometimes, modern medicine takes on a life of its own.

Patients are admitted to a hospital to discover why they are ill, only to be referred to several specialists, each with a battery of tests and medications, sometimes counteracting each other. Sometimes the tests are uncomfortable and are eventually determined to be unnecessary. Sometimes we put our loved ones through painful tests just to find out why they are in pain.

The government or private insurers pay 85 percent of the health care bills. Most patients don’t even have a chance to look at the bills. Since the patient has little financial input into the health care bills, he also has little input into what type of health care he wants.

Some patients and their families want to cling to life, often making it easier to hope for a miracle than to discuss how they want to die. Many studies have shown that most patients and their families are not even aware of certain end-of-life options like home health, living wills, home hospice and even pain management.

“Often the best care is saying ‘Let’s see how you do on this particular treatment for a couple of days. And see if you respond.’  Not necessarily doing a lot of tests,” said Dr. Elliot Fisher, a researcher at Dartmouth Institute for Health Policy. “The best care may well be staying home with a trial of a new medication, rather than being admitted to a hospital.”

Dr. Fisher is convinced that there is so much waste with end-of-life treatment that if it were eliminated there would be no need to ration beneficial care to anyone.

“Collectively, as a culture, we really have to acknowledge that we’re mortal,” said Dr. Byock. “Get over it, and start looking at what a healthy, morally robust way for people to die looks like.”

A friend of mine was recently diagnosed with pancreatic cancer. When he went to see his family doctor regarding which treatment to follow, the family doctor recommended that he take a cruise. This may have been an unorthodox recommendation, but why not enjoy your last months of life? Cancer treatment may have prolonged his life a few months, but it would have been painful and probably in a hospital. Why not go to sea and see the wonders of life? As the body starts to deteriorate, the patient could come home and have pain management administered at home.

Americans are sometimes called control freaks. We control everything from cradle to grave. Why not face the reality that death is a part of life? When the time comes, let’s spend it as comfortably as possible with our loved ones, not clinging to life with a tube in every orifice, sedated out of our senses.

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  • David Bailey

    re: Pam Tapper says: I read your article carefully and I am sure you really are a caring person. But my point is still valid. Once you decide that a certain group, for whatever reason, can be denied care; where do you draw the line. There is a science fiction movie called Logan’s Run that you should rent.

  • David Bailey

    Pam Tapper: You are arguing passionately to take away someones choice about the end of their life. Where is your compassion? I couldn’t live in a society that could decide my life didn’t have enough quality.

    My brother lives in a wheelchair. Since his bicycle accident, he has suffered every indignity you described in your article. He can talk normally and turn his head and move a few fingers on one hand. He’s also the most creative, articulate and at times wickedly funny people I know. Why would I want a government run health system that says his life has no merit?

    • Pam Tapper

      Dear David,

      My heart goes out to you and your brother. I know this is a very sad thing for a family and for a patient. I think we are talking about two different age groups. I was talking about people in their 80′s and 90′s at the end of their life spans. I’m sure your brother is not in that category. It is even sadder when this happens to someone in the prime of their life. I’m talking about people that are no longer creative, articulate or even wickedly funny.

  • Sam

    A relative of mine that recently passed away was of old age and accepted it was “his time to go.”

    I like your article because it is important that people recognized and talk about death. Death is often so ignored that people seem to forget that it is a reality. I think if people acknowledged we had a finite amount of time on this earth, more of them would live their life to the fullest!

    That said, it doesn’t mean we can’t do everything possible to try to prolong our life! My cousin was in a coma for a few months after a car crash. “Pulling the plug” was an option considered. Luckily, they didn’t because recovered and is alive and well!

    • Pam Tapper

      Dear Sam,

      I’m sorry for the loss of your Grandfather, and I’m happy for your cousin’s recovery. As I said to David, I was talking about another age group, those in their 80′s or 90′s at the end of their life spans. I’m sure your cousin was not in that age group. This is a subject that requires a great deal of discussion. Would we pull the plug on a vibrant 90 year old, just because he was 90? Along with modern medicine people are younger at 90 than they used to be. AARP says 60 is the new 40, 70 is the new 50. We need to review each case, but if a person is beyond recovery, it seems almost inhumane to keep them alive on machines, that only help them to deteriorate faster.
      Have a blessed season.

    • Pam Tapper

      Dear Sam,

      I’m sorry for the loss of your older relative. I’m also happy about the recovery of your cousin. I was talking about a different age group, people in their 80′s and 90′s, people at the end of their lifespans. We need to review each case by case.
      Some people are very young at 90. It’s just that if their is no hope for recovery, it seems inhumane to just keep them alive with machines.

  • http://www.balescollege.co.uk London school teacher

    A brave subject to touch, let alone one to have a very strong opinion about!

    The difficulty comes in choosing who not to help – if 20-30% don’t get life extended, what about the other 70-80%?

    This is surely an issue that will become more pronounced as society ages as a whole from the baby boomers in the next 20 years..

  • David Bailey

    Your article is well written and totally heartless.

    • Pam Tapper

      It is heartless to let your parent’s skin breakdown into decubitus, open bleeding sores down to the bone and have pain every time they are turned, and to develop a hospital acquired infection, because they have been in there too long. That is what is heartless.

  • David Bailey

    The government shouldn’t be allowed to dictate your options. If you or your loved ones want to “cling to life’ it should be your choice. Not some cold hearted bean counter.

    • Pam Tapper

      Do you have any idea what clinging to life means? It means putting your loved one on a ventilator, because they cannot breathe on their own, which then means they have to be put on a nasal gastric tube, because they can’t eat around the ventilator. To eat on a nasal gastric tube, one has to have a liquid diet like Ensure or Glucerna. With the liquid diet one also has uncontrolled liquid stools which can come anytime day or night. One might just be cleaned up and suddenly there is another liquid stool. The liquid stools attack the skin, because the patient can’t move and have to be turned every two hours and if the stool came just after the last turn, then the patient has to lay in the liquid stool for two hours, until the next turn. As a result, the skin breaks down and bedsores form which become open sores and become infected and have to be treated with antibiotic ointments that don’t always work immediately. Probably at this point the kidneys would give out and the patient would be on dialysis, so the patient would have his kidneys drained every other day by a machine through a tube in his arm. Also if his heart goes out, a pacemaker or a automatic internal cardiac defibrilator can be inserted to keep his heart going. A patient couldn’t die even if he wanted to. This is clinging to life. Would you choose to have your loved one cling to life for months at a time, because modern medicine can keep one in this state for months at a time, until the heart finally gives out. Bean counters or not, I would not want to be in this state, nor would I want my loved ones to be in this state. So many times, I hear families say, “Oh please doctor, you must do anything to keep my father alive.” Why would you want to keep your father in this state? Do you have a guilty conscious that you didn’t do enough while they were alive, so you want to keep them alive as long as you can? Are you thinking about the patient or yourself? Do you want to ease your guilt or do you want to ease the patient’s pain? As I said in my piece, death is a part of life. Every day, live life to the fullest and when your time comes, let go.