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Demystifying Medicine One Month at a Time

Hospice for Harmon

There was an unusual sports story in the news last week.

Heroic, stoic-looking retired slugger Harmon Killebrew

Hall-of-fame slugger Harmon Killebrew announced that he’s ending his medical treatment for esophageal cancer, choosing instead to enter hospice care. As quoted in the NY Times piece, Killebrew wrote (via the Minnesota Twins’ press office), “I am very comfortable taking this next step and experiencing the compassionate care that hospice provides.” He said he had “exhausted all options with respect to controlling this awful disease.”

This is the first time I can remember a celebrity declaring publicly a choice to stop medical treatment and pursue hospice.

Certainly many other terminally ill patients choose this course. Yet most of the time this choice is made in begrudging fashion, only after death is imminent. [See a related post here.]

Killebrew’s announcement gives me hope that the public’s view of hospice can change from one of “no hope” to one of providing comfort and sustenance in one’s final days. Ironically, when you have the least control, hospice gives a sense of control over the time and place of death.

Those of us that work in hospitals too often see elders die there, when their wish is to instead die peacefully at home, in a “non-medicalized” fashion.

While Killebrew’s announcement doesn’t give us the medical details of his cancer, there are a few things that are plain: His prognosis is poor, less than six months (the main criterion for activating hospice).

A mighty swing.

We also know that the overall survival for advanced esophageal cancer is dismal, on the order of 15% at 5 years. Most of the people afflicted with it die within the first year.

The treatments for it are terrible. The esophagus is a muscular “food” tube that connects our mouths to our stomachs. It lacks a serosa, or outer layer, which is why when doctors perform surgery on it to remove a tumor, it usually heals poorly. The same is true for radiation aimed at it to shrink tumors.

And chemotherapy used against it is usually very toxic to the whole GI tract, which causes patients to become violently ill and lose weight, making the battle to stay alive a battle of nutrition.

I applaud Killebrew for his courage, openness (just the right level), and his willingness to “go to bat” for hospice.

4 Comments

  1. John- you are always right on track!!! i will miss you and Sarah-Anne so much
    thanks for being such a great person.
    hope to see you in clinic soon
    xoxox
    Mindy

  2. It seems like this actually turned out to be the same situation as Sparky Anderson. Killebrew died only a day or two after entering hospice.

    • glasshospital

      May 17, 2011 at 10:22 pm

      Well, I agree with you in principle. Not knowing the medical details beyond the broad brush strokes, it seemed rather quick. Sparky died within 24 hours of going on hospice. Killebrew was a whole four days. It does seem too late in the game. But note this paragraph embedded in the Times’ obit from today:

      In the last decade, he promoted hospice care and, as he said in his statement, he was “educating people on its benefits.” He chose to receive hospice care after ending cancer treatments.

  3. You’re probably too young to remember and didn’t live in Minnesota – but Senator Hubert Humphrey, went into hospice care at the end of his life. He and his lovely wife, Muriel, were very open about it and were forthcoming about the value of hospice. This was at the beginning of the hospice movement.

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