Hospice Care Gives Patient Best Possible Day

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We would like to share another excerpt from the new book “Being Mortal: Medicine and What Matters in the End” by Dr. Atul Gawande who calls for a transformation in how doctors work with patients in their final days.
In this excerpt from The New York Times, Dr. Gawande tells the story of his daughter’s piano teacher, Peg Bachelder, who had been treated in 2010 for pelvic cancer that required chemotherapy and radical surgery.

Peg had returned to teaching but two years later developed a leukemia-like malignancy caused by her treatment. “That’s when I got a call from her husband, ‘Peg’s in the hospital,’ he said.” Her leukemia treatment was not working. It had damaged her immune system and her original cancer had come back. “She didn’t know what to do,” Gawande writes.

“’What had her doctors said they could do?’ I asked Peg. ‘Not much,’ she said. She sounded hopeless. They were giving her blood transfusions, pain medications and steroids. They’d stopped giving her chemotherapy,” he writes.

“This is the moment we continue to debate in our country. What is it we think should happen now? Her condition was incurable. Should she press the doctors for anything with a remote chance of keeping her going? Or should she ‘give up?’”

After hearing Peg talk about her fears, Gawande suggested she try hospice. “It’d at least let her get home and might help her more than she knew,” he writes. “Hospice’s aim, I explained, is to give people their best possible day. It seemed as if it had been a while since she’d had a good day. ‘Yes, it has — a long while,’ Peg said. ‘That seemed worth hoping for,’ I said. ‘Just one good day.”

Peg went home 48 hours later. “A few days later, I got a surprising call from Peg. She wanted to resume teaching. She didn’t know how many more lessons she could manage, but she wanted to try,” Gawande writes.

That hospice would once again make teaching possible for Peg was more than Gawande could have imagined. “She’d had no children; her students filled that place for her. And she still had some things she wanted them to know before she went,” he writes.

Gawande believes our current healthcare system “has forgotten how vital such matters are to people as they approach life’s end. People want to share memories, pass on wisdoms and keepsakes, connect with loved ones, and to make some last contributions to the world,” he writes.

“These moments are among life’s most important, for both the dying and those left behind. And the way we in medicine deny people these moments, out of obtuseness and neglect, should be cause for our unending shame.”

In the end, Peg got to fulfill her final wish. “She lived six weeks after going on hospice. Two final concerts were played, one featured Peg’s current students, the other, her former students. Gathered in her living room, they played Brahms, Chopin and Beethoven for their adored teacher,” Gawande writes.

A short time later, Peg died peacefully in her own bed.

Gawande reflects on the experience, writing, “My final remembrance of Peg is from the end of her last recital. She’d taken each student away from the crowd to give a personal gift and say a few words. When it was Hunter’s turn, Peg gave her a book of music. Then she put her arm around her. ‘You’re special,’ she whispered to her. It was something she never wanted her students to forget.”

Read the story here.

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