Demystifying Medicine One Month at a Time

Tag: baseball heroes

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.

Rapid Demise

Why Sparky Anderson’s death occurred so soon after he went to hospice.

George "Sparky" Anderson (1934-2010)

Hall of Fame baseball manager Sparky Anderson’s death was announced less than 24 hours after a previous news item revealed that his family had moved him to hospice.

Baseball fans across the U.S. are saddened by the loss of the first manager to win World Series championships in both leagues (Tony LaRussa is the other); many are likely puzzled as to why his death came so closely on the heels of his family’s announcement about hospice.

Among patients, hospice in the U.S. has mixed connotations; some view it as the desirable way to make a final exit, others perceive the very word pejoratively as coded language for ‘giving up all hope.’

The modern hospice movement can be traced back to Dame Cicely Saunders, who founded St. Christopher’s Hospice in London in the mid-1960s. With her nursing background, Dame Saunders’ experiences led her to formulate the principles of palliative care: alleviating pain and suffering to the the maximal extent possible, with the ultimate promise of bringing dignity to the dying.

The difficult part for a patient like Anderson, his family, and his doctors is deciding when to initiate the referral to hospice. Making the decision is a gradual process, the key part of which is reaching acceptance of imminent death. Obviously, many patients and their families never reach this stage.

In order to qualify for hospice, a patient must have a terminal diagnosis, defined as six months or fewer of remaining life. This is fairly straightforward with cancer diagnoses, which are staged precisely and tend to move along predictable trajectories. Prognosis is much more challenging for patients in the end stages of chronic diseases like congestive heart failure, emphysema, and dementia, which is the condition that Anderson was reported to have.

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