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.

Doctors spent a week treating a rare, flesh-eating infection in Kreiger's father's leg. When his condition did not improve, Kreiger and her family members decided to end treatment. He died four days later. 

At the Atlantic, palliative care physician Ira Byock makes the case for a shared-decision making approach to end-of-life care.