Sooner or Later: Restoring Sanity to Your End-of-Life Care

Damiano de Sano Iocovozzi had the following post at the AMA Facebook page a few days ago:

At present, the USA is still spending 25% of the health care dollar on medical futility for those insured and uninsured patients who can no longer benefit from critical care anything in the nation's ICUs. What normally happens is this: as a patient's disease progresses or is deteriorating due to old age, an ambulance is summoned. Without an advance directive, the patient may get intubated, placed on life support, maybe he is coded, transferred to intensive care where an expensive but futile fool's errand begins and costs about $10,000 per day. A steady stream of specialists marches in and out of the room 24/7 ordering a la carte a list of medically futile diagnostics, therapies, respiratory care orders, advanced pharmaceuticals, maybe a trip to surgery or to the cath lab, critical care nursing and more specialists. As time goes on and the patient's disease continues to deteriorate his status, a hospital-acquired infection sets in, kidneys shut down, dialysis begins, more blood draws to measure levels of heavy antibiotics that will not cure, help usher a remission or a reprieve from old age. A new rush of drips is started to keep the blood pressure stable as the bacteria proliferate. Usually death is preceded by another code blue where the poor unfortunate is literally shocked on the thorax, given CPR and the worst part, cannot even get to say good bye due to a large tube from mouth to lungs. So, Mr. Klein, while you columnists diddle on about nothing, you have missed a stampede of elephants telling you that enormous waste is still happening, at billions of dollars on futile medicine that deprives many of dignity and saying good bye. The better alternative is to grant immediate medicare or medicaid to pay for visiting hospice nurses at about $100 per day for the uninsured terminally ill. For the insured terminally ill, wouldn't it also be enormously beneficial if they too got the hospice option early on, saving them the indignity of the ICU?

Mr. de Sano Iocovozzi is promoting his new book, Sooner or Later: Restoring Sanity to Your End-of-Life Care. The book site's synopsis states:

It offers the reader a safe place to help process the turbulent emotions during the diagnosis phase and remain sane, rational and in control. In large print for easy reading, the book includes pertinent questions to ask specialists. It is written in a way reader and provider understand, empower patients and their families to seek the appropriate level of care. To date, no other book offers the information and tools to take control and make good decisions to maintain the best quality.