The San Jose Mercury News’ Lisa M. Kreiger recounts how $323,000 was spent on her father— a man with “do not resuscitate” and “desire for a natural death” orders — during his last 10 days of life:
On a lovely Saturday, under a cobalt blue sky, we shared a happy day of gardening. He couldn’t remember how to rake, but helped by picking up each leaf by hand. I showed him how to wind a garden hose. He became drowsy after lunch, so I drove him back to his assisted care facility.
By Tuesday he was shaking, dehydrated and speaking gibberish. Fear was in his eyes. I raced him to Stanford’s emergency room. The diagnosis: septicemia. Bacteria were rushing into his bloodstream, causing shock. At 88, his immune system was weak. His veins were leaking, causing his blood pressure to crash. He needed fluids, antibiotics and a tube to help failing lungs. It was the last time I saw him conscious, the last time I saw his open eyes.
Doctors and nurses in the emergency room jumped into action. The final bill attests to their effort: ER charges ($18,589), catheter to monitor oxygen ($2,125), other catheters ($5,400), chest X-ray ($1,076), and much more.
Should we have quit then? Suddenly, that “do not resuscitate” order seemed unclear; its black-and-white legal language didn’t really apply. He needed a ventilator to help him breathe long enough for antibiotics to work. Dad’s acute infection seemed treatable. Doctors said there was a decent chance we could turn it around. We’d likely know within a day, they said.
At the Atlantic, palliative care physician Ira Byock makes the case for a shared-decision making approach to end-of-life care.