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Letting Go, Holding On

Yesterday on Terry Gross’ Fresh Air™, and in today’s (August 2nd) New Yorker, Atul Gawande spoke about his amazing article “Letting Go- What should medicine do when it can’t save your life?” Anyone who reads loves the in depth articles in the New Yorker, but this one is praiseworthy.

I am one of millions of Americans living without health insurance. It’s a simple economic decision: reduced circumstances and hard decisions. I had not used my health insurance for over 10 years and could only afford coverage with a 2,000 deductible. Now I can no longer afford that. Western medicine and the American healthcare industry has ministered to rich, insured people who ignored their bodies for decades and expect the magical medical machine to “fix them”. My Mother got shingles, and after being misdiagnosed and overmedicated she is now marginally ambulatory, and soft-in-the-head. What homeopathic or alt med could have treated has turned into chronic disability. At least she has full medical coverage- because my father was a government employee. I have been self employed for over a decade and can no longer afford coverage. This week I got a gum infection and treated it successfully with calendula tincture, massage and silicea. I have to pay attention to my body.

Back to the article- what struck me was Dr. Gawande’s empathy. In the Doctor’s office they seem to be counting the minutes they have to spend with you. They don’t pay attention to the patient, but to what they or their practice can bill and get paid for. I have done taxes for a recent medical school graduate and they do have hundreds of thousands in student loans to pay back. I understand their financial burden, but not to the detriment of the patient’s quality of care. It seems that they regularly do procedures that do not benefit the patient, but only cause further suffering and increase revenues.

Once you enter a Hospital the assumption is, “What else can we do?”. If the insurance is paying, why not do anything and everything? America’s love affair with medical technology leads in the wrong direction. Dr. Gawande’s firsthand experience with death and dying offers a new option: paying attention to the quality of life of those with terminal illnesses. His descriptions of painful, unnecessary, and costly procedures that add to pain and still do not save the patient’s life are harrowing.

I am an accountant and have advised business owners on how to stay in business for over 28 years. I look at Income versus Expenses because that is what keeps one in business. Somehow looking at expenses in medicine and medical care is verboten, sacrilege, and anathema. Dr. Gawande’s thoughts were heartening for one who would welcome the “public option” and a reduction in spending on healthcare. A rational review of cost-benefits for end-of-life healthcare expenditures is needed. Let’s discuss costs without name-calling and hyperbole. The criticism of ‘death committees’ which muddied the healthcare debate appears silly and illogical in this context. We need cool heads and clear priorities in this conversation

Americans who have coverage often expect Sisyphean efforts to save lives. The difficulty in ‘letting go’ is both logical and obvious. In Dr. Gawande’s article the American public is rarely told “he/she is dying”, or are counseled on how to make the transition into a peaceful death. How many of us have sat at the bedside of a loved one who was insensate, plugged into tubes and machines and really not ‘there’? I have, and my family vowed not to be put into that position ourselves.

The fact that we don’t want to admit that death is coming, is a symptom of our current predicament. My Opinion is that we do not want to look at our, or a loved one’s, death because we think that everything is “fixable”. The fact that Medicare spends billions extending painfully lives of people who have never paid attention to their bodies other than to indulge and never exercise is appalling. Not facing the reality of poor health and death is stupid and appalling. We must face reality, take responsibility for our actions and our health ourselves. We are mortal.

We are fixable. The Economy is fixable, unemployment is fixable, and the war in Whateveristan is fixable. They are not – our Gods have feet of clay, and are generally unwilling to tell us the truth. Whether that truth is “Your wife is dying and we need to do everything to make her comfortable”, “we bailed out the wrong guys and don’t know how to get your job back”, or “we’re not so sure we can win this war” – it would be welcome to hear the truth. However, the truth remains unsaid because we only want to hear what makes us comfortable.

Dr. Gawande’s article addresses the lengthy process of making death a peaceful transition. His practical experience details the lengthy and difficult methods of preparing patient & family for a placid and less painful end-of-life. ‘Arriving at an acceptance of one’s mortality and a clear understanding of the limits and possibilities of medicine is a process – not an epiphany.’₁ Do you think the problem might also be our short attention span? Our unreasonable expectations that everything can be fixed quickly? One of the downsides of specialization of professions (and the dearth of a well-rounded education) is that we think what professionals can do is limitless and guarantees a “happy ending’. Our current predicament, both financially and medically, proves that throwing money at a problem will not ensure a positive outcome.

As a Big D Democrat but a financial realist, I applaud Dr. Gawande’s truthfulness and his empathy. We need doctors and politicians to give us the hard realities; to make difficult, not emotional decisions; and admit when they are flummoxed. If Greenspan could have said “I fucked up, and I don’t know what happened” before Congress perhaps our faith in the economic system and our politicians would be higher that it is.

We need more truth tellers and professionals like Doctor Gawande.

Footnotes:

p. 47, col. 1; Annuals of Medicine, “LETTING GO’, Atul Gawande, the New Yorker, August 2nd, 2010 (Vol. LXXXXVI, No. 220, Conde’ Nast, New York, New York.

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