Knocking on Heaven’s Door

“The doctors were considering giving my mother coronary artery bypass grafts plus the two valve replacement surgeries she’d rejected when she had a far better chance of surviving open-heart surgery in decent shape. My mother seems to be heading down the greased chute toward a series of ‘Hail Mary’ surgeries — risky, painful, dangerous and harrowing, each one increasing the chance that her death, when it came, would take place in intensive care.

“The cost to Medicare would probably have been in the $80,000 to $150,000 range, with higher payments if things had not gone well. More than a third of Medicare patients have surgery in their last year of life, nearly a 10th have surgery in the last month of life, and a fifth die in intensive care.”

Scott Burns reviews Knocking on Heaven’s Door by Katy Butler.

Comments (14)

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  1. Jay says:

    Why put these people, who are inevitably nearing death, through such a traumatic process as surgery?

  2. Perry says:

    Because we can. We as a society have developed the knowledge and technology to prolong life. The philosophy of the medical community seems to have gone from alleviating suffering to prolonging life, and the public in general have become used to that approach.

    At some point we as physicians and the patient population need to come to terms with reasonable end-of-life care expectations. This also applies to younger patients with terminal cancers in which there is no reason to continue the toxic doses of chemotherapy.

    Some may also be medically legally related, ie, the family expects and wants everything done despite a dire prognonsis.

    We as a society have a ways to go to accept the inevitable.

    • Kathy says:

      It is a part of one’s psychological development process. An 80 year old man shouldn’t be worried about his golf swing like a 30 year old should. Similarly, the 80 year old should not be contemplating a quadruple bypass when the risk seems to be greater than the reward. He should know that all things must come to an end.

  3. Lucas says:

    “What Butler is advocating is called “slow medicine.” The movement, which originated at Dartmouth medical school, encourages a more personal doctor-patient relationship and less aggressive care of older people at the end of life. This would be a medicine truly centered on our personal physician, not the specialist of the day whose income largely depends on procedures performed.”

    Will never happen, we are getting far too industrialized

    • Tommy says:

      Unfortunately, you are right. And now that health care costs are subsidized, why not go after the risky surgery.

  4. Layne says:

    I agree with Perry. If you can afford the care and you want to take the risk, I’m not one to stop you. Not saying it’s right though.

  5. Carter says:

    Thank God most of this nonsense will stop when obamacare kicks in and everyone will have insurance

  6. Bob Hertz says:

    I do not have the wisdom to know if these surgeries are necessary.

    I do have the perception to know that they are wildly overpriced, even by Medicare which is often the lowest payor in town.

    My solution is very simple:

    Pay for surgeries by the hour. A four hour surgery gets $4000. Let doctors and hospitals divide up the payment.

    Pay $750 per day of recovery. Pay $50 a month for medications.

    We can probably never settle the medical ethics. But we could have a radical new fee schedule tomorrow.