The culture of death

Editor's note: This column originally ran Dec. 3, 2011.

On the night my father would die, a young physician from Walter Reed Hospital called to ask if I wanted them to use heroic measures to resuscitate him as he slipped the exhausting weights of this world.

He felt they could keep him alive and breathing on machines for up to another week if I gave the word. I told him to let Dad go when his flight departed.

The next morning, the doctor called to say he had flown away in the night just as he'd forecast.

I've never regretted that decision. Dad's quality of life had ended months earlier. His once-active life had dwindled into one monotonous bedridden day of weakened existence after another. He would never get better or relive the life he had known for over six decades.

Dr. D. Bruce Foster for 25 years has been the chief of emergency services at a hospital in Pennsylvania. He's also the author of the novel Kiss Tomorrow Goodbye. During his career, the doctor has saved the lives of many folks, and he's also seen many patients surrender their lives after suffering for weeks, sometimes months, connected to machines.

Foster recently penned an op-ed for Newsday advocating a change in our national view that hearkens to a kinder, gentler era when our efforts to supposedly cheat death had not become a national obsession. He was emphatic that he wasn't speaking of euthanasia--not at all. Instead, he suggests a return to plain ol' common sense and allowing nature to take its course when it is obvious a person's quality of life has ended and cannot possibly be restored.

He said something is amiss when we put loved ones and relatives through "several months of ignominy that often exceeds the entire net worth of many citizens at their retirement."

"It is in this fashion that we manage to spend over 80 cents of every health-care dollar on the last year of life and consume 14 percent of the gross domestic product."

I believe he makes a logical argument for how our culture needs to at least reflect upon how it chooses to face the inevitable end in the most respectful, reverent and rational way.

He told me that he's watched many people pass away over the years, most often in a clinical setting.

"Mostly, of course, it has been the elderly at the end of life," he said. "Often they are no longer able to recognize family members, are essentially bedridden, and have multiple serious health issues. As their worn-out bodies fail, they typically stop eating and drinking."

Foster said this is predictably followed by kidney failure and the onset of coma. "Two or three days later they breathe their last breath. It's a very peaceful and painless way to go. Forty or 50 years ago, this was how most folks left the world, surrounded by loved ones in their own bed, each bidding their final farewells."

That form of serene passing has been largely replaced by an entirely different, much less peaceful and far more costly approach often fostered by guilt. I believe some relatives of a dying person salve their emotional reactions by voting to use all means possible just to keep a loved one breathing, even when all hope for quality of life is passed. Such concern may sound caring, but is it really if you are the one dying?

Foster explained the routine medical process of sustaining one's existence at the end: "We must start IVs to rehydrate you and insert a tube through an incision in your abdominal wall into your stomach to provide nutrition. We place you in an ICU where there is no night and day, where the constant clanging of alarms prohibits sleep and where needle sticks every couple of hours constitute a form of slow torture.

"If you're unlucky, you have a tube placed through your mouth and into your lungs and are placed on a mechanical ventilator. This means you can't talk or even close your dry mouth and ensures that no final words of love or respect will be whispered in the ear of a beloved."

Foster said that after a week or more costing $10,000 a day, the patient is transferred to a nursing home, "where we continue to water and feed you like a plant. You are surrounded by strangers, as opposed to family, but they are nurturers, so your diapers are changed on a regular basis. After a month of so you develop pneumonia and are transferred back to the hospital where the cycle is repeated. With a little luck, within the next several months, you will die, despite the best efforts of modern science and the torture will be over."

First do no harm--remember that traditional admonition in medicine? I do.

I like Foster. He pulls no punches. He also offers a lot of relevant food for thought. His remarks were powerful enough to convince me to enlist as a volunteer at a hospice in Fayetteville. It is a warm place that seems to me to express those same long-departed, common-sense values and reverence for our inevitable departures that Dr. Foster is pleading for.

If an ailing person with a terminal diagnosis can be kept relatively happy, free from pain and surrounded by physical and spiritual caring to compliment the affection, what else really matters as the end approaches, my friends?

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Mike Masterson's column appears regularly in the Arkansas Democrat-Gazette. Email him at [email protected]. Read his blog at mikemastersonsmessenger.com.

Editorial on 08/26/2014

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