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Quality of life at issue Williams case poses difficult questions By Larry Tye, Globe Correspondent, 7/9/2002
What happened to the aging slugger reflects colliding trends in American medicine: Patients today regularly are operated on for life-threatening cardiac and other conditions into their 80s and 90s, often with good results. Yet doctors and patients also are becoming more sophisticated in appreciating that true success means improving the quality as well as longevity of life. ''Was the potential of adding quality of life years for Ted Williams enough to justify the expense?'' asks Dr. Deeb Salem, chairman of medicine at New England Medical Center and a cardiologist who has written about such tradeoffs. ''With the things I have heard about his weak heart and his multiple strokes, it may have been questionable.'' The notion that care afforded a sports star would touch off a wider debate about medicine is not new. It happened after word spread that Magic Johnson and Arthur Ashe were HIV-positive, when Mickey Mantle secured a hard-to-obtain liver transplant, and when Alonzo Mourning went public with his little-known kidney disease. Williams's surgery 18 months ago almost ensured it, too, would be controversial. It was partly a matter of how sick the 82-year-old ex-Red Sox was, with his history of two strokes, weak heart muscle, and lung problems. It also was the fact it took doctors 91/2 hours to replace a leaking valve on the left side of his heart and repair a ring on the right, and that there were post-operative infections, a backup in body fluids, and repeated respiratory complications. Finally there were his mounting bills, presumably paid for mainly by the federal Medicare program, and the fact all this was happening as US health costs are soaring and planners are talking about the need to ration care. So did Williams benefit from the heart and other treatments he got? Several close friends are raising doubts, and saying that Williams, too, was becoming depressed about his confinement to a wheelchair, loss of peripheral vision, difficulty eating or even breathing on his own, and mounting isolation. ''He didn't like that life. He hated it,'' says 91-year-old Elden Auker, a former teammate and friend for 60 years. ''He was ready to go. I think he was ready before now.'' Williams's eldest daughter, Bobby-Jo Williams Ferrell, agrees, saying her father ''let me know in no uncertain terms that this was a nightmare for him.'' She also blames her half-brother, John Henry Williams, for keeping her away from her father the last year and limiting access of many old friends. While John Henry Williams has not been available for comment, Ted Williams's cardiologist defended the slugger's son yesterday. ''If there was one single factor beyond Ted's own intrinsic competitive drive and courage that was crucial in his survival and maintenance of quality of life, it was the efforts of John Henry Williams ... He was constantly with Ted, constantly attentive to the details of his care, constantly asking questions,'' said Dr. Jeffrey Borer, the New York cardiologist who operated on Williams and coordinated his care. Borer concedes that ''Ted's recovery was complicated and took a long time,'' but he added, ''I don't think there's any question that providing Ted with extra time and the quality of life he had was a beneficial thing.'' Whatever the reality with Williams, his case raises wider issues of how Medicare and other insurers should weigh a patient's age and health in deciding whether to pay for expensive treatments. And whether America, again facing double-digit inflation of health costs, is ready to consider rationing treatment. ''In many ways, we're in a worse situation than we were 10 years ago. We can't say `no' to people at the end of their life, we can't say `no' to families,'' says George Annas, a medical ethicist at the Boston University School of Public Health. Dr. Tom Delbanco, a professor at Harvard Medical School, agrees, saying, ''The American way is to do everything for everybody.'' Joseph Barisano understands the reluctance to ration. ''Usually people who go through a triple bypass or whatever go through a bit of depression. I think Ted felt that way, too,'' says the 77-year-old Barisano - known in his band-leading days as Ray Barron - who had cardiac surgery two years ago, despite the fact that his lungs were in as bad shape as his heart. ''We all want to live.''
This story ran on page F8 of the Boston Globe on 7/9/2002.
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he unfolding portrait of how dependent and even despondent Ted Williams was over his last 18 months is again raising questions about whether someone that old and ill should undergo procedures as intrusive as his open-heart surgery.