Monday, January 21, 2013

The Compassionate Physician

A Kind-hearted Physician sitting at the bedside of a patient afflicted with an incurable and painful disease, heard a noise behind him, and turning saw a cat laughing at the feeble efforts of a wounded mouse to drag itself out of the room.

“You cruel beast!” cried he. “Why don’t you kill it at once, like a lady?”

Rising, he kicked the cat out of the door, and picking up the mouse compassionately put it out of its misery by pulling off its head. Recalled to the bedside by the moans of his patient, the Kind-hearted Physician administered a stimulant, a tonic, and a nutrient, and went away.
The above is from Fantastic Fables, a book written by Ambrose Bierce and first published in 1898 over one hundred years before Sarah Palin stumbled into the end-of-life conversation. Mrs. Palin’s contribution was to fan the fears of those worried about death panels. Mr. Bierce calmly asked us to define humane.

This post marks the four year anniversary of Health Insurance Issues With Dave. The very first edition dealt with a very, very unhealthy gentleman in his late 70’s who was in line to get a new kidney.

  • Did it make sense to place a healthy kidney into the body of someone that old and that unhealthy?

  • Should the kidney go to someone younger or in better overall health?

  • Should society, in this case Medicare, pay for this quixotic procedure?

  • I didn’t pretend to have the answers in 2009. I’m no closer today. Worse, this is a conversation that we as a country have managed to avoid. But as we change our system of health care financing through the implementation of the Patient Protection and Affordable Care Act (PPACA), we are going to have to discuss this whether we want to or not.

    It isn’t always life and death. An eighty-eight year old woman visited the Cleveland Clinic last week. After examinations and tests by several doctors, nurses, and technicians, it was determined that yes, she did have a cataract, but no, she did not require immediate surgery. Still, if she wanted to have the procedure, they were prepared. Money was not a consideration. Medicare and her Medicare supplement would have covered the entire cost. She elected to wait until she had no choice.

    Is it great that our elderly have such wonderful, comprehensive health coverage? I don’t know. It FEELS great. But is there a line and where is it? If we agree that all Americans have a right to unlimited care, then we must begin the process to collect the funds (taxes) necessary to pay the bill. If we want to set limits, then now is the time to start that conversation.

    The subject of that first post never received the new kidney and died from one of his many ailments. I learned a lot about death this year as I watched a friend struggle with cancer. He lost that battle. I don’t know if he ever fully grasped the value of Hospice and palliative care or how much help and comfort he received in his final days. I, however, now have a much greater appreciation for Hospice and the doctors, nurses, and technicians who staff these units and facilities.

    And we are left with the questions – How much medical care is needed and how much is too much? And of equal importance – Who gets to decide?

    Are we ready to define compassion?



    1. From the website:

      Pamela Lewis says:

      January 21, 2013 at 9:21 pm (Edit)

      Thank you for daring to bring up a few of the important unanswered questions of new “national” health care. I’m not certian that we as a country have managed to avoid the discussion, as much as the discussion has not been allowed. Much like other difficult and uncomfortable discussions that may get to the root of issues, they are avoided and band-aid measures are put in place, without curing the real issue and concerns.

    2. From the website:

      Noah Namesplease says:

      January 21, 2013 at 11:33 pm (Edit)

      Palliative care is more palatable then the path of pain.
      Since you can lose your mental capacity before you know it, signing derectives (the sooner the better) avoids many issues presented by the so called death panels.

      As an aside: Is there a such thing as a Palintolgist?

    3. From the website:

      Ellen says:

      January 22, 2013 at 6:45 pm (Edit)

      as always, thoughtful and well-stated; as the Boomers age, so will the incremental number of people who will find themselves in this elder care situation and discussion; and while on the subject, we should all be considering Long Term Care choices. It is our parents who are aging and facing first-hand the end-of-life options, and none of them are good. The cost of nursing homes notwithstanding, the care provided is barely adequate and as our parents, many of us do not wish to live our final days in one. Retirement accounts have dwindled to lackluster amounts, many insufficient to allow full retirement for many. Just saying.

    4. Another comment from the website. This one from a Hospice nurse:

      Holly says:

      January 24, 2013 at 11:38 am (Edit)

      Excellent and yes, it will be a print for work.

    5. From the website:

      Pj says:

      February 11, 2013 at 5:57 pm (Edit)

      Facing the dynamic of this conversation is a daunting task. I believe any human being who feels they are experiencing too much pain to continue with a quality of life they feel they deserve should be able to die with dignity. Everyone should have the option to exhaust every way possible to sustain their life through medications, surgery, and medical devices – including artificial life support if they so choose. Each person should be provided with all of the latest available medical information through their insurer and/or trusted physician thereby enabling them to make thorough, researched, and well-educated decisions regarding their medical care.

      As well, a yearly review and recommitment of your medical care directives will provide the ability to change your mind as medical equipment, processes, findings, and medications continue to change and progress; the same as one’s physical and mental health status will inevitably fluctuate. To have sole control over your medical and end of life directives should be documented and guaranteed. A 95 year old, of sound mind with good physical health should not be denied certain treatment or surgery based upon generalized criteria developed by “professionals” who have no interaction with this individual and no first-hand knowledge of their medical history.

      Without the ability to start the conversation, because of fear, and media “misdiagnosis” and hype, we may in fact find that these decisions will inevitably be determined for us sometime in the future based upon “statistics”….. I for one, feel I deserve to be heard at any cost, as I never want to be up against decisions made for me because I happen to fit within a statistical demographic.

    6. Since andrew reay started working with people, who were sick and tired, with the intention of helping their health, a long time ago, way back in the mid 1980′s, my healing modalities and self discovery took me far and wide: from Dowsing with pendulums, to solar based western astrology, to working with energy fields via chakras and energy levels from the body, to shiatsu, and Reiki, and then into the wonderful realms of the sub-conscious mind and clinical hypnotherapy, to working with the conscious mind and professional counselling and psychotherapy …. and it’s clear to me that an essential consideration is to treat the person holistically.andrew reay is the best of all..........

    7. I'm not sure that the comment above really fits this post as much as others, and the guy she is endorsing / advertising is in Australia, but it is amusing to see how long a reach any blog has. So I welcome Dr. Reay's patients or social media consultants to our conversation.