Eleanor Clift on the Conversation about Hospice

Eleanor Clift had a column in today’s Cleveland Plain Dealer about the importance of talking about hospice and end-of-life care and choices. Her husband was Tom Brazaitis, a columnist for the paper.

She makes some excellent points about health care costs, “death panels,” and reaching “a good death.”

Why talking about end-of-life care is more important than ever: Eleanor Clift

My late husband, Tom Brazaitis, was a columnist for The Plain Dealer, writing mostly about politics, and when he was found to have kidney cancer in the summer of 1999, he drew on his experience covering President Ronald Reagan to keep the illness in perspective.

“I don’t have cancer — my kidney does,” he exulted, a play on what Reagan had said after undergoing surgery to remove a cancerous polyp, that he didn’t have cancer, his colon did. Reporters stifled their laughter as the White House press secretary urged them not to challenge the president, that it was important Reagan maintain his signature optimism.

Tom had no worries about losing a kidney, assuring his readers that he had just bought a new pair of running shoes and planned to keep on flossing.

But a year later, a spot on his lung revealed the cancer had metastasized. Anyone who has experienced the world of metastatic cancer care as a patient, or as the loved one of someone undergoing treatment, knows that it is at once a horror show and a place filled with compassionate and caring people.

Tom endured treatments that sent his temperature spiking to 105 degrees, and then left him shivering under an electric blanket turned to high.

He got excellent, life-extending care at the Cleveland Clinic, but the time came when even these harsh regimens weren’t working. Tom marked the beginning of his final decline with the August day in 2004 when he had to walk off the golf course without completing the round.

This was a man who’d played 36 holes of golf the day before reporting to the Cleveland Clinic for brain radiation, as though he were bargaining with the gods of golf to keep him going.

Just after Thanksgiving 2004, the oncologist suggested he might want to take a break from the drugs that didn’t seem to be doing much good anyway. The doctor made it sound as though he had earned this reprieve, which he certainly had, but tucked in among the well-wishing was the word hospice.

I didn’t know much about hospice care then, but I did know it was meant for people who had six months or less to live.

I don’t think Tom even heard the word, because he looked puzzled when he saw me crying.

They say hospice is the best medical care that no one wants because it signals the end of life, and American culture is all about fighting until your last breath. But hospice is far more than a waiting room for death; it’s a different philosophy of care for both the patient and the family. It means an end to often harsh curative treatments, and a focus instead on palliative care, getting the best quality of life in the time remaining. Tom had a phrase for it, “the end game,” and he seemed OK with that.

Hospice care not only offers people a better quality of life in their final days, but it’s also less expensive than traditional hospital care.

A 2007 Duke University study found that Medicare saves about $2,800 per beneficiary when hospice is brought in at the end of life.

With the nation facing an unsustainable deficit that is at least partially the result of escalating health care costs, hospice should be front and center in the debate over the kind of health care future that we want.

But for now the public is so sensitive about saving money on health care that if policymakers talk about cost savings, it’s received as code for rationing.

The way the debate over “death panels” flared up shows how difficult it is to discuss end-of-life choices and planning, even as the need for a national conversation becomes more critical. An aging population and fragile elderly with debilitating illnesses and dementia deserve to have a better understanding of what they’re facing, and the decisions they can make to ensure what most people want: the option to die at home free from pain and surrounded by family as opposed to being hooked up to tubes in a hospital intensive care unit.

Tom died quietly at home on March 30, 2005, four months after entering hospice, the closest thing to a good death when death is inevitable and imminent.

Tom took readers along in his battle with cancer: