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Book Review

‘The Cost of Hope’ by Amanda Bennett

An intimate look at end-of-life care

“The Cost of Hope” by Amanda Bennett.

How much money should be spent to prolong a life? This question arose in the recent Supreme Court debates on the Affordable Care Act. With at least one-third of Medicare dollars now spent on tests and treatments, many of them futile, in the last year of life, it’s reasonable for society to challenge the sustainability of “doing everything’’ for everyone who’s gravely ill.

But for a family member who is facing the imminent death of a loved one, it’s not easy to take such a clear-eyed view of the economics of health care. Someone who did is Pulitzer Prize-winning journalist Amanda Bennett. In March 2010, she wrote an article for Bloomberg Businessweek called “Lessons of a $618,616 Death,” in which she recounted the costs of the seven-year struggle to cure her husband’s rare kidney cancer. Bennett begins the acknowledgments of her new memoir, “The Cost of Hope,’’ by thanking the editor who gave her the opportunity to expand that article into a book.


Luckily, that’s not the book she’s written.

While “The Cost of Hope’’ does contain some discussion of health care costs, the heart of Bennett’s moving and intelligent memoir is her marriage.

Like Joan Didion in “The Year of Magical Thinking,’’ Joyce Carol Oates in “A Widow’s Tale,’’ and Kay Redfield Jamison in “Nothing Was the Same,’’ Bennett finds, in her grief over her husband’s death, an opportunity to explore their fascinating and complex life together.

Bennett met Terence Foley in China in 1983. She was a Wall Street Journal correspondent, and he worked for the American Soybean Association — or so he said.

Foley is a larger-than-life character, and Bennett paints him vividly and affectionately.

It doesn’t take long for the reader to fall in love with this guy and also with his wife, the warm and honest narrator of their story.


As Foley’s cancer progresses, we ache for him, Bennett, and their children. We also empathize with Bennett’s desire, in the years after Foley’s death in 2007, to track down the physicians who cared for him, to make sense of the decisions made during his illness.

What doesn’t feel compelling, though, are Bennett’s forays into the financial aspects of Foley’s care, or of health care in America generally. Perhaps this is because, other than for a very brief period, her family is never in any danger of going without health insurance. Perhaps it is because the emotional costs of heroic medical care are more interesting than the monetary costs, important as those are.

Bennett’s five-page listing of the items Foley left behind — “San Francisco cable car conductor hat . . . Unused urine sample cup . . . 67 guitar picks” — is devastating. Her report of the varied prices of his CAT scans — “$550 in April 2001 at EPIC imaging in Portland to $3,232 in 2006 and 2007 . . . in Philadelphia” — isn’t.

Bennett has written a deeply felt memoir wrapped in a rather half-hearted discourse on the economics of health care. Ignore the wrapper — and savor its rich contents.

Suzanne Koven is a primary care internist at Massachusetts General Hospital and writes the monthly “In Practice” column for the Globe. She can be reached at inpracticemd
@gmail.com or through her website, www.suzannekoven