ORANGE COUNTY VOICES : For Terminally Ill, Hospices Offer Palliative Alternative

James Wilson (not his real name) is a 54-year-old man with terminal cancer. Eight months ago he consulted his doctor about some vague pains and now he is dying.

The diagnosis of cancer was made quite rapidly, but the tumor was incurable at the time of diagnosis. He consulted another physician and yet another. No surgery, no radiation, no chemotherapy would help him.

Desperate, he went to Mexico, where he was treated until his money was exhausted. He returned to his home in Orange County, terminally ill, uninsured and bankrupt. Soon after arriving home, he developed abdominal pain, nausea and vomiting.

If he had followed the path of most residents of Orange County in similar dire straits, Wilson would have gone to a local emergency room and been admitted to the hospital. His pain and other symptoms would have been controlled at a cost approaching about $1,000 a day and he would have died an expensive and lonely death in that hospital.

But Wilson had one bit of good luck. A friend referred him to a hospice that accepted him into its program for the care of the terminally ill.

The hospice team, which included nurses with particular expertise in the care of the terminally ill, social workers, and a chaplain, worked with Wilson’s doctor to develop a care plan that provided him with palliative care.

Palliative care is the term used to describe treatment designed specifically to relieve pain and suffering. This is a relatively new medical specialty and has recently been recognized as such in the United Kingdom. It is represented in the medical community by a growing corps of physicians and nurses who are focused on the relief of pain and the other problems associated with terminal illnesses.

Although there are some specialized devices used for certain problems, most of the benefits of hospice care accrue with the application of everyday drugs and devices well known to physicians with an interest in palliative care.

By far, the most important benefit of hospices from the perspective of patients and their families is the hospice philosophy of making every day valuable--focusing treatment on the relief of whatever is diminishing the quality of life for the patient.

In this time of intense concern about health care costs, hospices are just what the economist ordered. In Wilson’s case, the hospice is able to provide the care that he needs for about one-fifth of what it would cost in a hospital. This modest cost (as medical costs go) is covered by Medi-Cal and a real testimonial to the efficiency of hospice care.

This is clearly a win-win situation; Wilson gets care focused on his real needs in the far more comfortable and appropriate setting of his own home and society pays far less than it would in a hospital.

The hospice movement in this country began as a community service provided by voluntary, nonprofit entities, like the Visiting Nurse Assn. here in Orange County. Although the care was initially provided on a pro-bono basis, Medicare and Medi-Cal and most insurance plans in this country now pay for hospice care.

Interestingly, this highly successful, cost-effective program, whose early development was so vigorously supported in Great Britain, is only minimally supported by that nation’s National Health Service. I recently had the privilege of visiting several hospices in England and Scotland and exchanging ideas with the doctors and nurses that run them. I was surprised to learn that the majority of their support came from community charities--the government provided far less than half their operating costs (typically less than 25%). A prominent physician there told me that the government had decreed that no new hospices would be supported, a chilling thought in a country where the government controls most medical care.

In this country, hospice care is becoming available to more and more patients as our capacity to provide that care grows. We live in a time and country where more and more people are being cured of what was incurable in the not-very-distant past. But for those for whom a cure is not possible, hospices offer humane and effective palliative care to virtually everyone who needs it.

Wilson is home now. His pain is relieved by a plastic patch on his chest that supplies a synthetic narcotic through his skin. The visiting nurse comes by and changes the patch every three days. And Wilson’s son and daughter-in-law are coming over for Thanksgiving dinner.

Those of us who enjoy good health would not think Wilson has much to be thankful for. But the physicians, nurses and families of patients who have walked the cold and lonely halls of the cancer ward on the fourth Thursday in November in the days before hospices came to town know better.