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Emily Rodriguez
James Knippling
Honors English 102
11 March 2012
Pride at the End of Life: A New Outlook on Hospice
How do you want to spend the end of your life? In a hospital, hooked up to ventilators
and other life support machines, barely able to comprehend what is going on around you? Or
would you rather spend that precious time interacting with loved ones in the comfort of your own
home? Given the choice, most people would choose the latter. This idea coincides with the
philosophy of hospice care. The goal of hospice is to help dying people feel alert and pain free
while providing compassionate and individualized care. One difference between hospice and
other forms of care for terminally ill patients is that hospice accepts that death is near and does
not try to postpone it. If used correctly, hospice can be very advantageous. Hospice should be a
more widely used treatment because its benefits greatly outweigh those of regular hospital
treatment and it has been proven to be more effective for everyone involved.
A brief history is necessary to show that modern hospice is a rather new practice. A
British woman named Dame Cicely Saunders founded it in the late 1940s. While working at a
London hospital, she began spending a lot of time with a dying man. She said she felt that it was
her religious duty to see him daily and make sure he had someone to talk to. From observations
of this man and other patients as well, she noticed that pain control and care for the dying was a
huge problem. She used the term total pain to describe a patients physical, spiritual,
psychological, and social pain and realized that all of these must be considered when treating a

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patient (Smith). The first change she administered was putting patients on regular pain control
schedules. Although this seems like a relatively obvious solution, it was a new idea at the time. It
has carried over into the hospice care of today and patients continue to receive pain control
twenty-four hours a day, seven days a week. Saunders compassion is illustrated in this quote,
"You matter because of who you are. You matter to the last moment of your life, and we will do
all we can, not only to help you die peacefully, but also to live until you die (American Cancer
Society). Dame Cicely Saunders was an intelligent woman who has unknowingly touched the
lives of thousands of people by implementing a practice of care that encompasses all of a
patients needs and makes him or her feel comfortable and important.
Death is not a pleasant subject for most people to discuss. Even doctors, who are trained
to handle difficult matters, often tip toe around speaking about death with patients. One such
example involves eighty-five year old Dorothy Glas. During the last two months of her life, she
received care from twenty-five different doctors but not one of them asked her how she wanted
to die (CBS News). Hospice has acquired a somewhat negative connotation throughout the years
and most of the time doctors would rather not discuss it. A common misconception is that
patients in hospice stop taking medication altogether. The truth is that they receive medication
that is meant to relieve their pain instead of being given treatment that hopes to cure an incurable
condition. Often when doctors bring up the option of hospice care to patients and their families,
it is immediately brushed aside because people do not want to seem as if they are giving up. In
reality, if a person is terminally ill, hospital machines will not always extend their quantity of life
or improve their quality of life, and it will cost them dearly.

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Hospice is significantly more cost efficient than alternate options of care. Nurses and
doctors make visits to many hospice patients houses, which, of course, eliminate the need to pay
for a hospital stay. Spending several days or months in the hospital can easily bankrupt people,
especially those hooked up to machines that are keeping them alive. According to a statement
given to CBS News by Dr. Ira Byock from the Dartmouth-Hitchcock Medical Center in New
Hampshire, it can cost up to ten thousand dollars a day to stay in the intensive care unit.
Medicare and Medicaid Services reported in 2009 that thirty percent of all its spending goes to
care given to patients in the last year of their life. It adds up to one hundred billion dollars each
year (McCue). In 2010 they reported that fifty billion dollars are spent on doctor and hospital
bills in the last two years of patients life (CBS News). Research discovered that a patient with
incurable breast cancer spends, on average, sixty-three thousand dollars on medical care during
the last six months of their life (Gawande 2) These outrageous numbers shine a light on modern
societys pursuit of medical miracles.
Modern medicine has made unbelievable advances and saved countless peoples lives that
would not have stood a chance fifty years ago. Most of these medical miracles are the
exception, not the rule, yet people continue spending money on drugs and treatments hoping to
magically cure their terminal illness. At a certain point people need to discuss what is more
important to them, the quantity or quality of their life. In an article written by Mike McCue, he
cites a study that found direct hospital costs to be lowered by three hundred and seventy-four
dollars a day for patients who had been taken off the usual hospital pathway and put into some
sort of hospice care. Another study done by Duke University stated that hospice patients saved
Medicare an average of two thousand, three hundred and nine dollars per person (Hospice Care

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Research). Imagine how much money and anguish could be saved if this practice became the
norm for hospitals.
Patient satisfaction can be significantly improved when put into hospice. Family
members of people in hospice are at an advantage as well. Since family is the primary caregiver
for this type of care, their well-being must be considered as well. Caregivers of patients who died
while receiving normal hospital care were three times more likely to suffer from depression six
months after the death than caregivers of hospice patients (Gawande 2). Several surveys have
consistently found that people with a terminal illness list their top priorities as things like
avoiding suffering, being with family and in touch with others, and having mental awareness
(Gawande 2). By reading stories comparing hospice and non-hospice patients it is clear to see
how at peace they became during the end of their life.
An article titled Letting Go published in The New Yorker by surgeon Atul Gawande
describes several terminally ill peoples stories and illustrates hospices effectiveness. One such
person, Dave Galloway, was a forty-two year old firefighter with pancreatic cancer. His wife and
three year old daughter would spend their days in and out of the hospital with him. Eventually
his pain was became unbearable, so his physician offered him a choice; move to the intensive
care unit or be put in at home hospice care. Dave chose hospice and it turned out to be a great
decision. The hospice staff taught his wife how to clean him and care for him when they were not
around. He was given an electrical bed that would allow his upper body to be propped up.
Comfort packs containing morphine for sudden pain and several other painkillers were shipped
to his house in case there was an emergency. Higher doses of narcotics were given to him so he
would feel well enough to be with his wife and daughter. He was even able to visit his favorite

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restaurant. It was soon discovered that the intravenous feedings he was receiving were not being
absorbed by his system and were causing symptoms like skin swelling and difficulty breathing.
Following in the hospice custom of alleviating pain, the nurses suggested Dave stop the feedings.
His wife was a little apprehensive because she did not want to feel as if she was starving her
husband, but the nurses convinced her that it would eliminate much of his suffering. After the
feedings were stopped, his swelling reduced and he could move without feeling out of breath. A
couple of days later Dave Galloway passed away peacefully surrounded by the people he loved
(Gawande 5).
Sara Monopolis story began in a similar way to Daves, but ended up taking the opposite
approach to medicine. Sara was a healthy young woman in her twenties. She was married and
pregnant with her first child when she was diagnosed with lung cancer. Quickly after the
discovery, she was induced into labor and started on chemotherapy after the healthy baby girl
was born. Her lung cancer was in too late of a stage to be curable but she and her family
remained optimistic about recovery. A short time later it was discovered that her body was not
responding to the chemotherapy so the doctors decided to give her a different drug. Saras body
was deteriorating and most of the time she was too sick to even hold her baby. None of the drugs
were doing anything except making her weaker and sicker. Sara had mentioned at one point that
she wished to die in the comfort of her own home. Her family refused to consider switching into
hospice care when the physicians brought up the idea. They were not ready to accept the fact that
Sara was not going to beat her cancer and they let their love and hope for her overcome their
understanding of what was best for her health. One morning Sara woke up terribly frightened and
unable to breathe. She was immediately rushed to the hospital where it was discovered that she

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had developed pneumonia. The outlook was not good and Sara would probably not make it out
this time. Her family finally agreed to let a hospice care team visit her. The morphine she was
given greatly reduced her difficulty breathing although she continued to flutter in and out of
consciousness. The next day the doctors tried to put a catheter in her and put her through tests but
Saras mother refused. It seemed as though she had an epiphany and finally realized what all of
the unsuccessful treatments had done to her child. Even though Sara died the next day in the
hospital, at least she was freed from all of the machines at the very end of her life (Gawande 1).
It is a shame that people like Sara did not have the opportunity of receiving the benefits
of hospice sooner. Clearly, patients like Dave were able to have a better quality of life before
their death. The average length of stay for patients in hospice is only about sixty-seven days and
more than one - third of people die within one week of entering hospice (McCue). Amberly
Molosky, the director of Hospice for Banner Health, was quoted saying, There is a real problem
with patients being referred to hospice services too late and, thus, missing out on benefits of
these services (McCue). Patients and their families cannot be put at total fault for not choosing
hospice services. The doctors and nurses need to be the guiding hand for these people who might
have never dealt with death before. It is their job to prepare the patients and let them know about
every possible type of care that is offered.
Studies have revealed that doctors try to avoid giving patients a specific diagnosis but
they have no trouble letting them know when a disease in incurable (Gawande 6). If doctors were
not so worried about disappointing patients, their relationships with them could be much more
honest. Dr. Susan Block is an expert at managing end of life issues with patients and their
families. She points out that a family meeting requires just as much skill as performing an

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operation. Through experience she has learned that it is more effective to help calm patients and
families anxiety first, then figure out what is most important to them under various
circumstances. Instead of simply laying the facts and options on the table and forcing a decision
(Gawande 10). Listening is a key element in this process along with using euphemisms like If
time becomes short, what is most important to you? rather than, What do you want when you
are dying? These simple tricks help calm patients worries.
Dr. Block has found her techniques to be very effective with not only her patients but
with her own family too. Years ago, her seventy-five year old father was found to have a mass
growing on his spinal cord. The mass was going to leave him a quadriplegic and even with
surgery, there was still a chance of him becoming debilitated. As hard as it was to have such an
emotional conversation with someone she loved, Block knew she needed to find out what her
father was willing to give up to stay alive. He told her that as long as he could watch football and
eat chocolate ice cream, he wanted to live. This short conversation proved useful when it came
time for her to make a quick decision regarding a second surgery. Her father was able to lead a
fairly productive life for ten more years before his condition worsened again. This time he would
need a feeding tube, but Block knew that was not how he wanted to live and so she started him
on hospice care and he died a short time after. By asking a few simple questions, Jack Block was
able to enjoy the end of his life in the best way possible (Gawande 10-11).
So how can hospitals and physicians help give people the end of life care that they
deserve? A few hospitals and companies have done experiments showing the benefits of hospice.
These have gone unnoticed. The insurance company, Aetna, observed that not enough terminally
ill patients were using hospice and if they were, it was only for a short time. For patients with a

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life expectancy of one year or less, Aetna decided to give them hospice care along with their
usual treatments. After two years of the program, big changes were taking place. Seventy percent
of patients were more likely to use hospice compared to the twenty-six percent before the
program (Gawande 9). Overall costs of patients in the program greatly declined and patients
visited the hospital much less often. By simply figuring out patients individual needs, they were
able to give them more effective care. Programs like this are helpful because they allow hesitant
people to experience hospice without giving up the routine of their usual care.
Gradually, hospice has gained popularity among terminally ill individuals. In two
thousand and eight, utilization of hospice care reached an all time high of nine hundred and thirty
thousand individuals enrolled (McCue). Hospice has been proven to be an effective means of
treatment and it is slowly being respected and recognized nationally. Through hospice, patients
have been able to gain a sense of integrity and peace at the end of their life. With the assistance
of doctors, nurses, and other specialists, patients are able to recognize their wishes when their
time becomes short. By implementing hospice care before a patients health reaches a critical
decision, patients and families are able to make an informed decision. Hospice is a worthwhile
option of care that should be commonly considered.