Archive for January, 2011

Hospice Has a Marketing Problem

Wednesday, January 5th, 2011

In early December GAP’s grandmother fell and broke her hip.  And in the past month she has been through reconstructive surgery, left the town where she lived for more than 90 years, and been moved into a nursing home in a city far from her home.  She’s been frail for a number of years, but all of these recent events have really taken a toll.  She’s tired.  She’s scared of further injury.  And she’s stressed and overwhelmed by the whirlwind that her life has become during the past month.  She misses her beloved husband who passed away several years ago.  And she’ll tell you she’s ready to die.  But when the subject of hospice care is raised she is adamantly against it.

Most people (not quite everyone, but close) believe that hospice is where you go to die; where you will be surrounded by other dying people; where you go when nothing can save you; where you go when prayers and painkillers are all that are left; doom incarnate.

But most people are wrong.  Hospice is not those things.  Hospice has a completely different problem.  The issue is not that hospice isn’t a worthwhile path to choose.  The issue is that hospice care has a marketing problem.

Unfortunately for patients and their families all of those beliefs are incorrect.  Further still, they are predicated on two incorrect assumptions.  The first is that hospice is, by definition, an actual place.  The second is that heroic life-saving measures are always in the best interest of the patient.

If you’ve never read the writing of Atul Gawande then you’re missing out.  Not “missing out” in the way that people usually mean it, like if you’d never read The Da Vinci Code or never seen Braveheart (I’m guilty of that second one…).  But missing out in a way that will enrich your mind and challenge your preconceptions.  Gawande is a surgeon at Brigham and Women’s Hospital in Boston, a professor at the Harvard schools of Public Health and Medicine, an author, and an occasional columnist for The New Yorker.  While I’m sure he is quite accomplished in each of his many roles, it is that last item on his résumé that got me into his fan club.

Much like Michael Lewis did for the financial crisis, Gawande diagrams the moving parts of the health care system in a way that makes them resonant and compelling, not to mention accessible to the lay reader.  His 2009 article on waste and abuse in the healthcare system garnered national attention, particularly given the then-current debate on health care reform in Washington.  And his 2010 article on hospice care left me in tears from its poignant truths and heart-wrenching anecdotes.

What Gawande spells out in his article is the truth about hospice.  He explains that hospice isn’t just another name for giving up.  It is about living with an illness, rather than curing it.  As the article explains:

“The difference between standard medical care and hospice is not the difference between treating and doing nothing… The difference [is] in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focusing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.”

Hospice is about keeping patients comfortable and happy and free from pain without delivering intervention care.  Patients can receive hospice care from nurses and social workers in their own homes.  They can be under hospice care for long periods of time before passing.  They can be removed from hospice care if their condition improves.  And some patients actually fare better under hospice care because they are free from the stress of surgical procedures and hospitalizations.

Gawande also points out in his article that we Americans are lousy at dying.  And we are lousy at letting people die.  Even as a doctor Gawande couldn’t bring himself to tell the family members of a patient whose organs had nearly all shut down that she was dying.  Because we’ve gotten so good at cheating death, we’ve become unwilling to submit to it, even when that is the right thing to do.

The problem with hospice is not hospice.  The problem with hospice is its reputation.  No one wants to choose hospice because they assume it means a sad and demoralizing end to a life that was once happy and vibrant.  But the truth of the matter is that few deaths are as demoralizing as those in an ICU.  Death while under hospice care can mean that your last days were spent happily.  It can mean that your last breaths were taken in your own home.  It can mean that you die as a person, instead of as a patient.

Gawande’s article on hospice is long and difficult to read at times.  But it is also one of the most important and valuable things I’ve read in the last year.  If you’ve made it this far in this post, I suspect you may agree with me.  You can read the article here.  I promise you that it’s worth it.

Resolved – Part 2

Monday, January 3rd, 2011

One year ago I launched this blog with a set of resolutions for 2010.  But I did so with a fair amount of equivocation.  Amidst other objections I pointed out that I found New Year’s resolutions off-putting because they ask us to define ourselves as a set of faults, and I stand by that.  But I moved forward with my resolutions nonetheless.  And today, one year later, I’m so glad that I did.

By some stroke of either genius or dumb luck last year’s resolutions were not binary.  I asked quite a bit of myself, but none of my goals was set in a way that facilitated pure success or failure.  Rather, they were phrased in shades of grey.  They were a framework for changes I wanted to make in myself, but they were not rigid or binding.  And it was that freedom to allow smaller measures of success that enabled me to fare better with my resolutions than I ever would have expected.

2010 was not a year of major milestones for me.  In 2004 I got married.  In 2005 we bought our first house.  In 2007 I finished my MBA.  In 2008 I had my first child.  In 2009 I started a new job.  But last year was not a year of significant events.  Yet I think I accomplished more in 2010 than I have in years.  I changed a lot last year.  Some of those changes were carefully cultivated.  Others were wholly unexpected but yet no less important.  And although it strikes me as strange, I attribute these changes and accomplishments to those resolutions and to this blog.  There is something compelling about making your goals public.  There is something compelling about eschewing your fear of failure.  There is something compelling about this particular brand of accountability wherein merely by posting my aspirations in this forum I felt, throughout the year, more committed to them than any other goal I’ve pursued in the past.

In fact, I started a running list of potential 2011 resolutions several months ago, adding new entries as they dawned on me.  Even amidst the satisfaction of 2010′s successes, I found myself eager to cross the threshold into 2011 and a new set of challenges.  In 2010 I took control of my life in completely new ways and it was, quite simply, empowering.  So it is not surprising to me that I am finding exhilleration in my goals for 2011.  I do not know if it is realistic to hope for comparable success in the coming year as I achieved in the past year.  But I know that taking such risks served me well in 2010.  So I find no reason to change my tack now.  With that, my goals for 2011 are:

  1. Read literary classics that I’ve never read before (there will be a dedicated post on this one at some point).
  2. Regularly carry and use reusable grocery bags.
  3. Don’t waste food.
  4. Choose at least one initiative from The Happiness Project for implementation in my own life.
  5. Brush my dogs more often.
  6. Deepen existing friendships.
  7. Send actual birthday cards in the actual mail and do it on time.
  8. Get our family photo albums properly archived and up to date and keep current with them.
  9. Grow an herb garden.

As I read back over my list, what I love most about it is that I can’t foretell the ways in which the pursuit and realization of these goals will enrich my life.  Last year I had a goal of meeting people who would challenge my perceptions of the world.  I had no idea that some of those people would weigh less than five pounds.  I had a goal of traveling to new places, and those new places turned out to be completely different than the ones I expected to visit.  I had a goal of reading more nonfiction and I had no idea that the entire year would become a dedicated literary project.

My resolutions were stated at the beginning of 2010.  But they evolved organically throughout the year and came to mean more to me by year’s end than I ever intended at the outset.  I can only hope that my new set of resolutions will come to mean as much.  But I do hope.  I hope that through my care and feeding of them, I will find that they feed and care for me in kind.

Here’s to 2011 and all the goodness that it may bring each of us this year!

Happy Birthday, Ten Dollar Thoughts!

Saturday, January 1st, 2011