For the past couple of years, Vailia Dennis, 87, has wondered if there existed, on the face of the Earth, even one other human being who thought as she did about death. Then she read about Art Buchwald, the newspaper columnist who died at age 81 on Jan. 18, 2007, nearly a year after he opted out of further mdical treatment, preferring to put himself in the hands of fate.
At last, Dennis thought...a soul mate. "I read about Art Buchwald and I discovered that we were like blood-related creatures." she says. Buchwald refused kidney dialysis. He went on to outlive doctors' predictions by almost a year, time he spent holding court with the fabulous, the famous and the powerful, and by all accounts, having great time!
Dennis refused open-heart surgery, enrolled in care at the San Diego Hospice & Palliative Care and, within the familiarity of her San Diego home, has so far outlived predictions of her demise by two years. "This has been the most comfortable, the most interesting time of my life," she says.
Dennis doesn't run into a lot of people who understand her decision to say "No, thank you," to medical intervention, but those who do are out there...more of them, it seems each year. About 1.2 million patients, 80% of them older than 65, received hospice services in 2005, an increase of 150,000 from the year before and up from 210,000 in 1990, according to the National Hospice and Palliative Care Organization.
Certainly, not all are rejecting further treatment. Many people have simply exhausted all that medicine has to offer. But end-of-the-life experts say there are hints in the numbers that point to a trend toward more people being willing to call a halt to aggressive treatment. The average length of service to a hospice patient has increased from 48 days in 2000 to 59 days in 2004, suggesting that people are coming to the services soomer in the courses of their diseases.
"The decision that Art Bushwald made is actually not so unusual," says Dr. David Casarett, professor and geriatrics researcher at the University of Pennsylvania and chairman of the American Geriatrics Society's ethics committee. "A lot of people decide that the burdens of continued treatment outweigh the benefits. They don't want to go through another hospitalization or another surgery."
They prefer a graceful exit on their own terms. "Art Buchwald is a perfect example. He lived for months with a good quality of life," says Diane Meier, director of the Center to Advance Palliative Care at Mount Sinai School of Medicine in New York. "He said, 'I'm not going to play,' and lo and behold, nothing bad happened. He didn't get caught up in grasping at all the straws, and he didn't spend his last days tethered to a machine."
It's a decision that can be difficult for loved ones to accept. Maybe a parent is ready to let nature take its course but children resist, or siblings disagree, or a spouse cannot let go. Sometimes it's the medical establishment that won't give up the fight. "In our culture, we have a unique, almost religious, faith in medical technology," Meier says.
But watching a relative suffer through the final, ultimately futile, throes of medical heroics can diminish that faith in technology. Dennis' was her brother's caretaker after his second of two open-heart surgeries. She watched him deteriorate bed-bound and mentally unaware during his final months. She's seen enough to say "no" when doctors told her she needed open-heart surgery for her bypertrophic cardiomyopathy, a condition that causes a thickend wall inside the heart.
"I flatly didn't want to go through that," she says. "I know the stresses you go through just trying to recover enough to walk. I didn't know if I would come out of it being who I am now, with the same independence, the same determination, the same ability to laugh. I thought it could take away a part of me that I didn't want to give up."
She and Art Buchwald both outlived medicine's predictions for them, but that is not uncommon. Patients in hospice care live longer than patients with similar conditions who are not in hospice care, according to a September, 2004 study in the Journal of Pain and Symptom Management. Researchers studied 8,700 Medicare patients with 16 different terminal conditions and compared those who went to hospice care with those who did not. Researchers compared with patients longevity and found that for all conditions, patients in hospice lived longer by days to months.
Reduced costs: And, for most conditions, the study found, the cost of care was lower for patients in hospice. Those with congestive heart failure, one of Dennis' health problems, lived nearly two months longer in hospice care, and the cost of their care was less by almost $9,000. That kind of cost savings will be increasingly important as the baby boom generation gets older and sicker. Though health care costs overall average $7,356 a year for Americans, the costs during the last spending in the December 2002 issue of the journal Health Services Research. The cost of the last year of life for all Americans, the study found, accounts for 22% of the nation's annual health care bill.
Getting a little more time for a little less money was not what drove Dennis' decision. And through she wanted no more agressive medical intervention, she did want care...psychological, spiritual and medical for such things as pain and medical for such things as pain symptom management.
"I'm living in my own home, by myself and I could not be doing this without hospice." she says. "My fears are minimal, but when I'm not doing well, there's someone I can call. A nurse visits me weekly, more if I need it. The chaplain comes once a week because we enjoy talking to each other. A woman comes three times a week to help me shower. And, a social worker is available for anything I need."
She has used her bonus years to spend time with her children and grandchildren and to paint, read and write. As an octogenarian, she has fearlessly plunged into learning what computers can do, setting up a Web site and blog. "I'm free," she says. "I eat when I want to eat. I'm adept at the Internet, so I can look up whatever I want to learn."