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Monday, May 5, 2008

A "do it now" kind of guy: Slow medicine at the end of life

Edie Gieg, 85, strides ahead of people half her age and plays a fast-paced game of tennis. But when it comes to health care, she is a champion of "slow medicine," an approach that encourages less aggressive – and less costly – care at the end of life.

At the end of her husband's life, she was spared extreme options because she lives at Kendal at Hanover, a retirement community affiliated with Dartmouth Medical School where it is possible – even routine – for residents to say "No" to hospitalization, tests, surgery, medication or nutrition.

Her husband, Charley Gieg, was 86 at the time, and was suffering from a heart problem, an intestinal disorder, and the early stages of Alzheimer's Disease when doctors suspected he also had throat cancer. A specialist outlined what he was facing: biopsies, anesthesia, surgery, radiation or chemotherapy. His wife doubted he had the resiliency to bounce back. She worried, instead, that the treatments would usher in a prolonged period of decline and dependence. This is what the Giegs feared even more than dying, what some call "death by intensive care."

During her husband's out-of-town consultation with a doctor, Edie stayed in touch by email with a nurse practitioner (NP) at Kendal.

"It is imperative that none of this be rushed! Think about all the what-ifs," wrote the NP. The doctors the Giegs had chosen, she wrote, “tends to be a 'do-it-now' kind of guy." The NP asked whether Charley would want treatment if he was found to have cancer. If not, why go through a biopsy, which might further weaken his voice? Or risk anesthesia, which could accelerate his dementia?

"Those are the very questions in my mind too," Edie replied. The Giegs took their time, opted for no further tests or treatment, and Charley came back to the retirement community to die.

Outside of Kendal, it is rare for patients and their families to make these vital decisions. As the chief medical officer for UCLA Medical Center explained, the culture at an acute care hospital "has a built-in bias that everything that can be done will be done." The pace of care at the hospital, he added, discourages "real heart-to-heart discussions." Once a patient is drawn into that system, "it's really hard to pull back from it."

Advice: Decide how you want to live your life – even at the end.

Read another end of life story.

Thanks to Jane Gross for the source article in today's NY Times.

1 comment:

Anonymous said...

I like this short story. People should determine how they want to live and how they want to die. The fact is no one knows when they are going to die, but we do have the option to live and die with diginty. Good for you Eddie.