Today, the world of baseball received some extremely sad news. Harmon Killebrew, one of the all-time great players and great men of the sport, is entering hospice care as doctors have informed him that they no longer believe they can cure his esophageal cancer. The 74-year-old Killebrew played for 21 seasons, including 20 with the Washington Senators/ Minnesota Twins franchise. He was inducted into the Hall of Fame in 1984, hit 573 career home runs and made 13 All-Star teams. He was the AL MVP in 1969, and hit the longest home run in Twins history on June 3, 1967, a towering 520 foot moonshot commemorated today at the Twins’ new home, Target Field, by a statue of a Gold Glove outside the stadium exactly 520 feet from home plate.
To learn more about how Killebrew will live out his remaining days, I interviewed an expert, Amy Markowitz. Ms. Markowitz was the managing editor of the Journal of the American Medical Association’s case-based series on palliative care, titled “Perspectives on Care at the Close of Life.” The series was recently compiled into the textbook “Care at the Close of Life: Evidence and Experience.” She has spent years writing about hospice and other forms of palliative care and interviewing patients and their families before, during, and after they enter the final stage of their lives. Quite conveniently, she also happens to be my mother. For more on what Killebrew and his loved ones are going through and how they likely made the somber decision to turn to hospice care, I’ll turn it over to her.
Doug Wachter: How is hospice care defined? How does it differ from normal medical procedures? What might typical hospice care consist of?
Amy Markowitz: Unlike what most people understand, hospice is a form of health care service, not a place. Hospice is about providing compassionate care, and is aimed at ensuring comfort and relief of pain and other symptoms for patients who are nearing the end of their lives. It focuses not only on the biomedical and physical symptoms but also the psychological and spiritual needs of patients and their loved ones. Hospice care centers around ensuring the patient is allowed to live out their life with dignity and respect. A person can receive hospice care at home, at a hospital, or in a dedicated hospice facility.
DW: How do the goals of Killebrew’s doctors change now that he has entered hospice care?
AM: Their objectives shift to finding out from Killebrew and his family what they would define as his “goals of care,” are and making sure that the care he receives is aligned with those goals. Some patients would rather tolerate more pain in order to be more alert and enjoy their last days or weeks with their families, whereas others opt to avoid pain as completely as possible, even though they may feel more sedated. This is a very personal choice, and one that is made independently by each patient along with their loved ones. Hospice care is multidisciplinary, and the hospice or palliative care team will try to address the patient’s spiritual and emotional needs in addition to their biomedical needs. His medical team will keep close track of and work tirelessly to alleviate his pain, but he may have other physical symptoms. With Killebrew’s esophageal cancer, these could include dryness of the throat or excess salivation, difficulty or inability to swallow, anxiety, or difficulty breathing. His care staff will ensure that the he is maximally comfortable. Often hospice nurses attend to the patient in their home, but when hospice care is performed in a hospital, often the patient can be in a room that is made to look much more homey than a normal hospital room, with the minimum of equipment. Unlike regular medical care, hospice care that is delivered in hospitals does not have defined visiting hours, allowing patient’s loved ones to remain with the patient as much as they would like. We hope that patients and their families don’t view hospice and palliative care as a “death sentence.” Although patients in hospice no longer get curative treatment such as radiation or chemotherapy, there is always treatment available to maximize comfort and relieve any suffering.
DW: Why would a patient choose to enter hospice care?
AM: Hospice is a much more hands-on and intimate form of care for both the patient and their family, to help them at a particularly difficult time of life. A hospice nurse often comes to the home several times per week. While regular doctors are not able to provide this kind of care, hospice teams are specialized to take care of the multidimensional needs of patients reaching the end of their lives.
DW: How long do patients generally remain in hospice care?
AM: Patients are eligible for hospice care if their doctor determines that they are terminally ill and have less than 6 months to live if their illness runs its usual course. According to the National Hospice and Palliative Care Association’s Hospice Care in America factsheet, median hospice stay is only 21 days, although many patients lives could be improved greatly by entering sooner. Many doctors wrongly see turning to hospice as giving up on their patient, although hospice is truly just making the choice to maintain the patient’s quality of life rather than continuing with curative treatments long after the hope for curing the patient’s sickness is essentially gone.
DW: When patients make the decision to go into hospice care, is there usually agreement among the family members? Does the family tend to respect the patient’s decision?
AM: This can often be a point of contention, and before the patient decides to enter hospice the palliative care team will generally meet with the patient and their loved ones to explain the goals and benefits of hospice. Hospice teams are trained experts in mediating discussions between the patient and their family about goals of care.
DW: How do doctors approach the topic of hospice care with patients?
AM: The move to hospice care can come by the doctor calling a meeting with the patient and their family to discuss goals of care when curative measures are no longer effective. Sometimes, however, the patient and family independently make the decision to consider hospice and can ask their care providers to discuss palliative care options.
A person who lived a life as full, rich, and dignified as Harmon Killebrew deserves to live out the close of his life in the same way; with dignity, compassion, and care. Hospice is meant to allow Killebrew and his family to celebrate whatever time is remaining, and remember his great contributions to the game of baseball and the people he loved and who loved him. Let us do the same, as we celebrate the life of one of baseball’s all-time greats.
As Lou Gehrig said in his famous speech as he began to succumb to the disease that is now known by his name, today Killebrew is “the luckiest man on the face of the earth.” Though Killebrew will soon pass away, he will live on in the minds and hearts of Twins fans and fans of the game everywhere, as one of the most beloved and greatest our wonderful pastime has ever known.