http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande?printable=true
If you have some time, it is worth reading. I was particularly interested in his discussion about the use of hospice care along with standard medical care for those with serious illnesses. In fact an article just came out in the New England Journal of Medicine this week showing that early palliative care along with standard oncologic care for metastatic cancer resulted in less depression, better quality of life and better mood scores than standard care alone. Also the hospice group had less aggressive care at the end of life but had on average a significantly longer survival than the standard care (about 3 months longer). Now 3 months doesn't seem like a lot, but it is the amount of benefit received from many types of chemotherapy. And, believe me, even a few months of good quality life is worthwhile, particularly for the surviving family--and I think for the patient as well who has a little extra good-quality time with loved ones. It may be that in the future, the paradigm of calling in hospice at the last minute may change to have hospice involved early even if the patient may have a remission.
Some of the stories in this article mirrored my mom's story. We were never given any information on how long she was likely to live, the doctors were always optimistic and there was always another drug or procedure to try. I do wish we had had the option of bringing in hospice, and still trying the medical options. Luckily we had some idea what my mom's wishes were, thank goodness we had some brief conversations before she passed, but it was very hard to talk about these things without sounding like we were giving up. Had we known we were close to the end we could have done a couple things differently. We could have made a video of her, or at least a voice recording. She could have left each of us a short recording of her hopes for us and her advice. That would have been such a precious gift.
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