Dying Badly Is Expensive

The most important personal health care is at end-of-life. Half of all medical expenditures are made during the last two weeks of life. Most are futile and expensive gestures intended to show that we care for the victim of the procedures. Yes, I mean *victim*; Few people want to die among noises, bright lights, and strangers. Fewer still want to die with a crash cart team breaking their ribs, their loved ones pushed out of the room. Home hospice care costs a small fraction of what aggressive in-patient care does, and a death at home surrounded by family and loved ones is much more humane and transformative for all involved.

My doctor wife and I discuss the stereotypical "New York daughter". She's the one that went off to the big city to be a hard-driving success. Well and good, but without balance and too busy to stay in contact with her parents. Mom is dying. No time to stay with her, until very near the end, when this business minded daughter shows up demanding every procedure. No expense is too good for Mom (especially if someone else is paying for it). Arguments erupt with the siblings that stayed with Mom through the course of her decline. Medical advanced directives are interpreted in the most interventional way. Mom dies anyway, perhaps in the ICU after a risky operation or two, separated from family.

Sorry. New York daughter may be able to throw her weight around, and instigate huge expenditures paid by insurance and government, but it is no substitute for taking the time to be with Mom, to work out the issues that all the frantic activity is done instead of. New York daughter should read Virginia Morris's book "Talking About Death", and spend the time with Mom while both are cognitively able. Yes, it is expensive in time (perhaps months away from work), but if we weren't spending so much money on futile efforts to ignore death, we wouldn't have to work such long hours to pay for it.