Americans are treated, and overtreated, to death

The doctors finally let Rosaria Vandenberg go home.

For the first time in months, she was able to touch her 2-year-old daughter who had been afraid of the tubes and machines in the hospital. The little girl climbed up onto her mother’s bed, surrounded by family photos, toys and the comfort of home. They shared one last tender moment together before Vandenberg slipped back into unconsciousness.

Vandenberg, 32, died the next day.

That precious time at home could have come sooner if the family had known how to talk about alternatives to aggressive treatment, said Vandenberg’s sister-in-law, Alexandra Drane.

Instead, Vandenberg, a pharmacist in Franklin, Mass., had endured two surgeries, chemotherapy and radiation for an incurable brain tumor before she died in July 2004.

“We would have had a very different discussion about that second surgery and chemotherapy. We might have just taken her home and stuck her in a beautiful chair outside under the sun and let her gorgeous little daughter play around her — not just torture her” in the hospital, Drane said.

Americans increasingly are treated to death, spending more time in hospitals in their final days, trying last-ditch treatments that often buy only weeks of time, and racking up bills that have made medical care a leading cause of bankruptcies.

I have discussed this problem many times on this blog.  Our problem (and both doctors and patients have this problem) stems from seeking to fix medical problems rather than to treat patients.

But we have a real problem in medicine, balancing hope and reality.  If you were 30 would you accept palliation or would you try anything.  What would you expect from my as your physician?

I wonder if a non-aggressive option was ever offered to this patient.  My experience tells me that many patients accept reality and opt for better quality-of-life in their dying days or weeks.

This discussion reminds me of one of my first medical ICU patients in 1978 (my senior residency year).  The patient had aplastic anemia and had failed all chemotherapeutic attempts at restoring his bone marrow function.  In the ICU hospital epidemiology required reverse isolation so that he would not develop an overwhelming infection.

Explaining the situation to the patient, he begged to be taken off reverse isolation.  He told me that he knew he would die, but until he died he wanted to see faces and kiss loved ones.  I had a great attending physician and together we overruled hospital epidemiology.  The patient died soon thereafter, but had a couple of very enjoyable days saying goodbye to loved ones.  I wish I had a video of our conversation to show to all medical students and residents.

Palliative care programs can help residents understand.  But perhaps we need more patient education programs.  We need patients and families demanding palliative care also.

Please read the entire article, it is well written and important.