Archive for August 10th, 2009

My Aunt Fanny!

Sharon August 10th, 2009

The chorus of “all better now” is getting louder.  Paul Krugman has joined the team, noting that even if you have moral objections to the bailout, it must have worked.  Sure.

 In order to believe this you must also believe several things:

  1.  There are no more shocks coming, since, after all, we’re still pretty shaky.  This requires that you pay no attention whatsoever to things like the state of Fannie Mae and Freddie Mac.  2. That a short term recovery now is a recovery indeed. This requires you pay no attention to things depressing consumer spending, like still rising unemployment and increasing debt. 3. That you believe that the government stimulus is not just buying us a cheap jump, but actually stimulating a sustained and sustainable level of economic growth – that is, that we’re going to keep buying cars after cash for clunkers runs out of money, or that we’re going to keep buying houses after we stop paying people to do so.  4. That none of the pipers are going to have to be paid soon. And finally it requires you believe that all the news is realy as good as it seems.  I don’t, and I honestly don’t see how it is possible.

 Here’s just one point, on the recent job numbers that have everyone cheering:

 Recovery?!  My Aunt Fanny!


A Tale of Two Hospitals

Sharon August 10th, 2009

We spent a rare weekend away from the farm, visiting family near Boston, and just relaxing.  It was lovely.  Meanwhile, I was only half paying attention to the news, but couldn’t help noticing the millions of people all over Europe and throughout Canada who were rioting, demanding an American-style health care system to free them from the deep tragedy of theirs.  Oh, wait, maybe I wasn’t ;-) .

 What I was watching was the inanity of the protests against “socialized” medicine and the crazy objections to the idea that poor people shouldn’t die sooner than rich ones.  The emphasis is mostly on a tiny number of examples, many of this false or based on incorrect assumptions, of people who are in some way unhappy with their European or Canadian health care systems.  Now I’m pretty sure if we worked at it, we could find an equal or perhaps even greater (gee, how unlikely is that) number of Americans displeased by their health care system, but you’d never know that.

I was thinking about this as I sat visiting with my aunt, who had recently returned from a summer trip to Ireland, where she had sojurned with her 88 year old mother and 9 year old daughter.  Now her daughter “Lucy” has epilepsy and a number of other disabilities, but hadn’t had a seizure in several years.  While they were travelling in rural Ireland, however, Lucy had a sudden, severe seizure, and my aunt got to experience British medicine first hand.

My aunt’s commentary on this was fairly simple.  She noted that in America, when you enter an emergency room, you are asked three things – your name, the nature of the complaint, and how will you be paying for this.  When she and her daughter arrived by ambulance at the emergency room in Ireland, she was asked, again, three things.  Her name, the nature of the complaint, and would she like a cup of tea?

The experienced with National Health, she observed, was hugely different from that of American hospitals after Lucy’s seizure – instead of doing dozens of tests on Lucy, they did one, the relevant one.  As Lucy was showing signs of recovery that evening, they held her for observation and released her, rather than insisting she remain in hospital for several extra days, just in case, as has happened in the US.  She was seen rapidly, the emergency room was calm and the doctors responsive, and despite the fact that they were not British citizens, there was no charge.  Like everyone I know who has ever experienced any kind of national health system, my aunt’s reaction was that if we did half as well, it would be a huge improvement.  My own observations on that front are similar.

And this, of course, is the clincher – I’ve never, ever, ever heard anyone, from any country with any kind of national health service suggest that they would rather live under the US system.  Not one. 

Contrast Lucy and my aunt’s experience in an emergency room with my last experience in an ER.  My husband’s grandmother, a few months after the death of her husband, took a wrong turn in the dark while visiting her cousin for Passover, and fell down a flight of stairs.  She broke her neck, her leg and her collarbone.  When one says she “broke her neck” it sounds as though she must have died instantly, but that’s not the case.

What happened is this – her elderly cousin, sole caregiver for her husband who had had a stroke, rode to the hospital with her, after calling us to come.  We were visiting my MIL across NY City, and I immediately got up in the night, dressed and took a cab to Queens from Manhattan.  By the time I arrived at the hospital, Inge’s cousin had returned to her husband, because he could not be safely left alone.  When I arrived, she’d been at the hospital for an hour, without a single person examining her. She was still strapped to the stretcher, in an ice cold room without a single blanket (she was wearing only a light nightgown, which was up above her waste, where she was completely exposed), and was weeping with pain and cold.  When I finally managed to orient her, and asked a nurse to attend to the fact that she was in acute pain, the nurse said “Oh, yes, she had a fall, I’m sure she’s just sore.”  This was in reference to an 80 year old woman who had fallen down a long flight of stairs, and who had a visible broken bone, as no one can keep their leg at that angle.

I finally got her warm (she was in shock, very easily recognizable, dangerous and totally ignored) and pain medication, and she became lucid.  A doctor, coming to examine her (three hours after arriving) said that even though the CT scan machine was occupied and even though she was having head and neck pain, he thought she probably didn’t have any serious neck injury, and he sat her upright for her examination, even though that’s just about the first thing anyone learns when they do any medical examination – never jostle a head or neck injury about.   He told her she’d just need light surgery for her broken leg (missed the collarbone entirely, along with the neck injury) and that she could be released to rehab the next day.  I was the one who insisted that she have her neck scanned, and, of course, it turned out that she had a severe break.

We spent 12 hours in the emergency room with beds literally so closely crammed together that there was no room for a chair, and chairs were forbidden.  I was 3 months pregnant with Asher, and I stood on my feet for 11 consecutive hours, until Eric’s father arrived to take over attending her.  She was finally admitted, after the neck injury and collarbone were detected. 

Eric’s grandmother was slightly deaf, and when forced to lie flat on her back, often couldn’t understand what was being said to her.  When she realized her neck was broken and she would require massive surgery to repair it, she was very concerned that her wishes that no heroic measures be taken be respected if it seemed likely she would die.  My husband and I were the bearers of her power of attorney, and asked that it be invoked, and she agreed – we asked the hospital employees to make absolutely sure they were familiar with her documentation (which we had on hand, sent over by her attorney), and that before any major medical procedure occurred, we be consulted.  They agreed.  Then, during the early hours of the morning, while my husband and I were asleep (and yes, they knew our number) during some action that a nurse took, her neck was jarred further and my husband’s grandmother went into spinal shock.  Without our consent she was put on a ventilator and kept alive against her intentions, expressed will, every request, our request and all documentation.

Arriving at the hospital the next morning, my husband and I and her daughter spent the day trying to get the ventilator removed so that Inge could die in peace as she had always wished.  The doctor who had put her on the ventilator against her consent had “ethical issues” with letting her do as she had chosen, and as we had asked, and was in surgery and would not deal with her.  She was in a great deal of pain, and very clearly able to express her wish to let go.  Despite the fact that surgery to repair her neck injury was admittedly now impossible, despite the fact that even before she was an 80 year old woman in mixed health and there was an excellent chance she would not have survived the surgery, despite the fact that the hospital had demonstrably contributed to her condition by handling her roughly and moving her neck without support before they were certain of the extent of her injuries, despite the fact that she lacked the will and desire to live as a quadrapelegic, they felt they knew best.  I’ve rarely felt so much despair and anger at anyone as I did dealing with the hospital in this case.  I felt we’d failed her – Eric and I had promised her that this would not be the kind of death she would have.  I remember weeping hysterically in the hallway, after the fourth or fifth doctor came along to cover the legal ass of the hospital and showed absolutely no concern for Eric’s grandmother or her wishes.

Finally, after a very long, miserable day, Inge was removed from the ventilator on which she should not have been placed, and allowed to die.  She had incurred tens of thousands of dollars in medical costs, received terrible care, and was kept waiting even for death, by the estimable American medical system so many people are fighting so foolishly to keep. 

What’s notable about this story isn’t the story itself, it is that I could actually tell two or three other ones about the American medical system, but won’t, for lack of space.  I could, for example, talk about why my son, at 6 weeks old, was admitted to a hospital to be treated for a disease he did not have, and for which the only evidence was a screw up by two separate lab technicians.  In the meantime, he was tortured – he had 6 spinal taps in a matter of a few days, and we consented, because every time we questioned the doctors, we were told he would die if we took him out of the hospital, and it would be our fault.  And no, I do not exaggerate here. 

I could tell other stories, belonging to friends and family – but all of them are mostly the same – they talk about a health care system where doctors, nurses and administrators have been forced to be so fearful of a lawsuit that they run up costs beyond reason, but where competence and kindness cannot be rewarded.  I could tell more stories of long waits to see specialists (we’re always threatened with waiting – but I’ve never waiting longer in any country than the US to see people), of bankruptcies, and early deaths, and more commonly, unnecessary suffering. I could tell you terrible stories that work in every direction – of doctors driven out of practice by escalating insurance costs and huge amounts of paperwork, of patients deprived of basic medical care, of desperation.

And I can’t tell you those stories in other countries, not because there are no horror stories, not because no one in any other country has ever had a bad experience with medicine, or wanted something they could not have – but because en masse, there is no one who would choose the American system over any other rational system.  If you can name a large population from a developed country with national health care clamoring for an American style system, please, enlighten me.  Instead, what I hear overwhelmingly from across the world (and have heard for decades) is Thank G-d we don’t have American health care.

The big question, of course, is whether we can afford it.  Well, if you’ve been watching the news about Fannie Mae and Freddie Mac, you will see that they are slowly but definitely sinking into the sea, and about to create an economic crisis far greater than anything Bear Stearns or Lehmans ever could.  We will certainly spend money we can’t afford on that.  There will almost certainly be more stimulus we can’t afford.  There will certainly be more bank subsidies we can’t afford.  We are spending money in Afghanistan and Iraq we can’t afford, at huge cost to human lives and to the nation.  Our whole world is things we can’t afford.

The difference is this – a reasonable health care system actually gets us something. It will save us billions in wasted ass-covering.  It will give people access to a basic need – everyone gets sick or hurt eventually.  It will create a society of greater equity and lower suffering.  Of all the things we cannot afford, it is the only one proposed that’s really worth having.