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Being Mortal and EOL

Posted 6/29/2015

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  Today feels like the end of an important era. A very beloved, very long-term patient died early yesterday morning. She had first been diagnosed with breast cancer in 2002, developed brain mets and received whole brain radiation in 2004 and then lived for another eleven years. There was a high price for this amazingly long survival; she was damaged by the radiation, and the consequences worsened with time. She had increasing troubles with balance/mobility and, eventually, cognitive losses, especially her short term memory.

  However, a few things never changed. To the very end of her days, she was delighted by life, never complained, took her limitations with grace, and loved her family. In return, her two sons loved and tended to her beyond anything I have ever witnessed. 

  Because she had rallied so many times, had responded to one or another last ditch treatment plan, it seemed almost impossible that she would eventually die. Her sons found it inconceivable and believed, always, that she would awaken again, smile her wonderful smile, and go on. Their determined optimism did make it very difficult to consider EOL (end of life) decisions, to talk about DNR and feeding tubes and all the other painful decisions that must be considered and balanced and decided. In the end, all the right choices were made, and she died, truly surrounded by her family, in peace.

  These experiences over the past few weeks have made me especially appreciative of this column from Susan Gubar. She talks about Gawande's wonderful book, Being Mortal, and applies it to her own situation. Here is the beginning and a link to her column and then a link to a review of his book. If you have not read it, please do so.

Living With Cancer: Being Mortal
By Susan Gubar

Like many people with advanced-stage cancer, I wonder when I will decide about treatment, “Enough is
enough.” In helping me formulate an answer to this question, Atul Gawande’s latest book, “Being Mortal,” will
now play an indispensable part.
A bestselling doctor-writer, Dr. Gawande has received praise from reviewers better able than I am to
assess his judgments on the shortage of geriatric physicians; the damages done by nursing homes that don’t
feel like homes; the benefits of experiments in assisted living to alleviate boredom, loneliness and helplessness; and the positive effects of palliative care with respect to the quality and also the quantity of life.
But too few cancer patients know how useful his book can be for those dealing with the difficult decisions
presented by incurable disease. Dr. Gawande has faced this situation with patients and with someone he loved.
From the start of “Being Mortal” to its close, Dr. Gawande highlights the problem of terminal cancer care
through poignant case studies that encourage people like me to formulate priorities. He is astute about the
financial costs of that care: “25 percent of all Medicare spending is for the 5 percent of patients who are in their final year of life, and most of that money goes for care in their last couple of months that is of little apparent benefit.” And about how the cost pertains to individuals: metastatic breast cancer treatment amounts to “an average of $94,000 during the last year of life.”

http://well.blogs.nytimes.com/2015/06/25/living-with-cancer-being-mortal/

And a link to the book review: 

http://www.nytimes.com/2014/10/17/arts/being-mortal-by-atul-gawande.html

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