Death with indignity: how Medicare and other federal subsidies rope the elderly into painful, futile, and costly end-of-life care.

• Author: Brownlee, Shannon
• Position: On political books - The Conversation: A Revolutionary Plan for End-of-Life Care; Curing Medicare: One Doctor's View of How Our Health Care System Is Failing the Elderly and How to Fix It - Book review

The Conversation: A Revolutionary Plan for End-of-Life Care

by Angelo E. Volandes

Bloomsbury USA, 240 pp.

Curing Medicare: One Doctor's View of How Our Health Care System Is Failing the Elderly and How to Fix It

by Andy Lazris

CreateSpace Independent Publishing Platform, 290 pp.

How is it that the one place my father swore he never wanted to set foot in again was the very place he spent ten of the last twenty days of his life? At eighty-four, desiccated and frail, his life had narrowed to reading in short bouts between naps. He could no longer sculpt or carve jade, or had the will to paint. The high point of his days was now focused on going out to lunch with my brother or stepmother. He was deaf in one ear and so hard of hearing in the other that conversations could never proceed in a linear way, but constantly looped back upon themselves because he needed things to be repeated. To the end he retained his sense of humor.

A series of medical emergencies, small and large, had landed him in the hospital multiple times over the previous decade. A side effect from a cholesterol drug led to kidney failure and three weeks in the hospital on dialysis. There was a small stroke, and then another. He was hospitalized for constipation that over-the-counter remedies could not resolve.

Many of these ailments meant a trip over the Coast Range to the big hospital in Portland, Oregon, where the doctors and nurses are caring, but the indignity and pain left Mick loathing every second he spent there. During his previous stay, he fumed that the nurses insisted on accompanying him to the toilet to prevent him from falling. "I can't even take a piss on my own!" He outsmarted them by perching on the edge of the bed and using a urine bottle, a trick that was probably more likely to lead to a fall than if he shuffled the ten steps to the bathroom on his own. Once he returned home, he told me, my brothers, my stepmother, and anybody else who would listen that he never, ever wanted to be in that hospital again.

In November 2013, however, he developed a volvulus, a loop in the gut that at first shows up as constipation and vomiting but if left untreated often leads to a section of the bowel dying and the patient developing a fatal infection. My brother took him up the coast to the community hospital, where the loop in his bowel was straightened out with a simple procedure. They could have kept him there overnight to see if the volvulus developed again, but the emergency room doctor said Mick might be having a small heart attack and he didn't "feel comfortable" keeping him there. He wanted him to go to the hated big hospital in Portland. Keep Mick away from Portland, I urged my brother on the phone from my home 3,000 miles away. No chance. Into an ambulance Mick was bundled for the bumpy ride across the mountains. So much for respecting the wishes of the dying.

Once in Portland, my father's new set of doctors began "working him up." Blood was drawn, vital signs taken. He was assigned a young hospitalist, a primary care doctor employed by the hospital to interact with the family and coordinate the various specialists involved in my father's case. Shortly after arriving, Mick suffered another volvulus, which was again resolved with a quick procedure. But now it was apparent that this was probably going to keep happening. The only treatment for recurrent volvuluses is abdominal surgery.

There was almost no possibility that Mick would emerge from major surgery in any shape to leave the hospital, much less resume his old, already much diminished life at home. On the phone...