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Thank you for sharing “A long good-bye” (January Viewpoint). It was a privilege to read your story. Sharing these stories extends an invitation to wrestle with the conundrum of technology keeping us alive – perhaps longer than desired or warranted. I empathize with you. My story is different but complementary: “A good good-bye.”
It was after Thanksgiving in 2005 when my dad, then 84 years old (the same age as your dad), learned that his lung cancer had recurred. Given his age and overall health status, he was not a good candidate for further lung surgery. Radiation or chemotherapy were options for him. My dad said no.
You see, my dad was a physician. He knew that submitting to more medical care might buy him more weeks of life, but at the cost of his enjoyment of whatever weeks of life he had left. And he understood that the side effects of more clinical intervention could land him back in the hospital. He knew from years of experience in caring for his patients that dying a lingering death in a hospital slowly drains away a person’s personhood. More than any pain he might experience – more than death itself – my dad dreaded the prospect of silently slipping away tethered to technology in a hospital and dependent on others to make decisions for him. He was determined to let go of his life as he had lived it: his way, taking responsibility, making his own decisions.
Home hospice care was arranged, with dad involved in the planning. Our entire family was fortunate in that my older brother is a physician who specializes in pulmonary medicine and critical care. And my sister-in-law is a nurse. They watched over my dad; most importantly monitoring his medications, those prescribed by his physicians and those he prescribed for himself.
The big decision was about Florida. My dad and stepmom escaped winter in Buffalo, N.Y., every year, spending four to six weeks in Florida. My dad was determined to get away from the grey cold and savor the warm sun one more time. My brothers, my sister and I urged him not to delay and to head south in February. No way. My dad insisted that he had never enjoyed Florida in February. He and my stepmom would go, as they always did, when the pages of the calendar turned to March.
Putting home hospice care in place for my dad in Florida was no problem. My older brother and his wife helped my dad and stepmom get down to Florida and settled in.
My dad succeeded. I will always remember our last conversation. Despite his shallow, labored breathing, there was lightness and peacefulness in his raspy voice. I asked how he was feeling. “Son, I’m in paradise,” he replied.
My dad spent his last days visiting with family and friends out on the condo’s sunny balcony overlooking the ocean. Many of his friends from Buffalo are snowbirds, and they came by to see him. His best friend, his “gumba” for some 70 years, lives most of the year in Florida, just 10 minutes away from the condo my dad and stepmom enjoyed. It was a blessing, for both men, to have time to talk, reminisce and reassure each other. My dad got to go out to eat at a favorite waterside restaurant. Then the next (and last) morning, he tried to take a shower with the help of the home care aide but he could not get comfortable. So he washed up and shaved himself and was helped into a clean change of clothes. He went back to bed. The bright sun was shining through the windows. He passed over peacefully in a warm, comfortable, sun-filled room with the sounds of the surf in the distance and family at his side.
To be blunt, my dad saved Medicare a lot of money. But who got the best end of the deal?
The 5 percent of Medicare patients who die annually account for 25 to 30 percent of total Medicare costs, with as much as 78 percent of last-year-of-life expenses in the month before death. Do we really need to spend billions of dollars to hold off the ultimate bad outcome: death? This is the definitive case in point of medical-care spending that does nothing to improve health. It is up to each of us to choose, while we have the capacity to make the choice: a long good-bye or a good good-bye. Let’s choose wisely.
–David Aquilina


I just finished the column that appeared in this month’s digital edition of Health Management Technology. It definitely touched a chord because my parents were both quite elderly when they passed away. In a way, they were lucky, though. Neither spent any real time being supported by machines in the way that your father was and I think they preferred it that way. I just wanted to say that the column struck me as a real tribute to your father.
– Rita Shoor


A real tribute
I just finished the column that appeared in this month’s digital edition of Health Management Technology. It definitely touched a chord because my parents were both quite elderly when they passed away. In a way, they were lucky, though. Neither spent any real time being supported by machines in the way that your father was and I think they preferred it that way. I just wanted to say that the column struck me as a real tribute to your father.
– Rita Shoor

Touching editorial
Just received HMT’s January issue, was very touched by your editorial on your dad.
– Stephanie Fraser
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