Abraham Varghese in The New York Times:
In 1968, a letter to The British Medical Journal titled “Not Allowed to Die” described the ordeal of a retired 68-year-old doctor admitted to “an overseas hospital” (almost certainly in America) with metastatic stomach cancer. After much of his stomach was surgically removed and a blood clot cleared from his lung, he asked that “no further steps be taken to prolong his life, for the pain of his cancer was now more than he would needlessly continue to endure.” Two weeks later the unfortunate doctor had a heart attack in the hospital. His heart was shocked and restarted five times in a single night; morning found him in a persistent vegetative state. His body remained alive for another three weeks. That hellish situation, rare in the rest of the world, is all too common in this country. Although most of us claim no desire to die with a tube down our throat and on a ventilator, the fact is, as Katy Butler reminds us in “Knocking on Heaven’s Door,” a fifth of American deaths now take place in intensive care, where 10 days of futile flailing can cost as much as $323,000, as it did for one California man.
Butler’s introduction to the surreal world of health “care” at the end of life was precipitated by the sudden illness of her father, a native of South Africa. Jeffrey Butler lost his arm while serving in World War II. He married, earned a Ph.D. from Oxford and settled into academic life in the United States. He was a charismatic father, the sort who would “stand in our bedroom doorways and say good night to my two brothers and me quoting Horatio’s farewell to the dying Hamlet: ‘May flights of angels sing thee to thy rest!’ ” At 79 he was active and enjoying retirement when he suffered a stroke. Soon after hospitalization a “discharge planner” told the family that Jeffrey had to be immediately transferred to a neurological rehabilitation facility. “Only later would I understand the rush,” Butler writes. “The hospital was losing money on him with every passing day. Out of $20,228 in services performed and billed, Medicare would reimburse Middlesex Memorial only $6,559, a lump sum based on the severity of my father’s stroke diagnosis.” A year later, her father was outfitted with a pacemaker. The device would keep his heart functioning even as he descended into dementia and almost total physical helplessness over the next five years.