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Healthcare & money

“We have established the most enormous medical entity ever conceived and people
are sicker than ever.
We cure nothing! We heal nothing!”



The Hospital (1971)


My close friend was systematically tortured over a three-year period and was eventually killed. No, she wasn’t a fighting soldier in the Gulf War. Neither was she a detainee being held in Guantanamo Bay, nor was she abducted and imprisoned by foreign terrorists. She was a casualty of today’s healthcare system. Let’s call her Vivian. The name means “full of life,” which she was until her HMO put her through the fourth circle of hell.

There’s a vicious cycle that is well known to most who jump onto the assembly line known as the healthcare system. That conveyor belt feeds you into the meat grinding machinery called bureaucracy. You must move at a preset pace stopping at each and every physician’s office and testing site. The results are then neatly compartmentalized and never fully integrated into a well functioning efficient system. The end result is the marginalization of the patient for the sake of expediency and profit. Today’s system is so dysfunctional that even the profit bottom-line is often compromised due to entrenchment.


Vivian showed signs of serious cardiac disease three years ago. She was initially sent to her primary care physician (PCP) who performed a standard physical exam with some targeted blood and cardiac tests. Abnormalities were found so she was prescribed cardiovascular meds. Her symptoms stabilized temporarily but returned after a few months. She goes back to her PCP, repeats the same initial tests, and then was referred to a cardiologist. The cardiologist then recommends more tests and more meds. Both the cardiologist and the PCP write separate reports that go into a main computer system without ever conferring with each other by phone or in person.

This scenario repeats itself until Vivian develops symptoms of pulmonary compromise. She’s sent back to her PCP who then refers her to a pulmonologist. The pulmonologist then puts her through another battery of tests and prescribes additional meds without directly conferring with either the PCP or the cardiologist.

The cardiologist theorizes that the heart condition is being aggravated by the pulmonary condition and the pulmonologist theorizes that the lung condition is being aggravated by the heart condition. This vicious cycle continues for a full year while Vivian is getting sicker and weaker. She is up to 15 meds a day, has had a barrage of tests, yet, her doctors are unable make a definitive diagnosis.

One morning Vivian wakes up unable to catch her breath, feeling very weak and dizzy.
She’s taken to emergency where she waits for hours before finally being seen by a doctor and then eventually being checked into the hospital for an overnight stay.


 



“She can’t breathe   . . . we’ve been here for 4 hours.”

Pay It Forward
(2000)




These emergency visits and overnight hospital stays continued regularly for the next two years with Vivian becoming weaker as her health continued to deteriorate. Her doctors were still not communicating with each other or to her, the patient. Information was either incomplete or extremely misleading. Vivian was on the verge of panic.



“That killed him.”

Medical Miscommunication



A couple of months before she died, I began taking her to her doctor’s appointments more frequently and more actively acting as her medical advocate. Before then, her HMO was making it difficult for her to get copies of her own records and, in turn, I was having difficulty getting access to them as well. Some of the reason was denial on Vivian’s part which she admitted to me later.

I think Vivian was also embarrassed because I and only one other mutual friend were able to provide any type of direct advocacy and support. Many family members of patients feel overwhelmed and paralyzed by the medical bureaucracy.

The HMO rhetoric condones family and friend patient advocacy but the policies are in direct contradiction to these pursuits. The medical staff is programmed to deflect information in a way that’s very discouraging and even intimidating. In my experience, there were times the medical staff appeared to be members of an elite alien race plugged into a master brain with protocols and priorities set in place at the expense of human safety. If you don’t follow the rules and ask too many questions, you run the risk of a hostile confrontation.




“… A survivor. Unclouded by conscience, remorse, or delusions of morality.”


Alien
(1979)



Vivian was finally diagnosed with severe aortic valve stenosis, an ultimately fatal heart condition unless corrected by replacing the damaged heart valve. Vivian was cryptically told that her heart could stop at any moment. She still had to find a surgeon and get a surgery date. Time was of the essence.

A couple of days later she landed in ER, yet again, for about the 15th time in the last three years. She called me from her hospital bed. “I’m back in the hospital but I’m okay.” Right. I was standing at her bedside within 15 minutes. She had finally negotiated both a surgeon and a surgery date within two weeks. The only problem was, she couldn’t stay out of the hospital long enough to be admitted into the hospital for the scheduled surgery. The insanity continued.

Two minutes after I arrived she had a cardiac episode. She grabbed her chest, breathing hard with long intervals in between. I immediately buzzed the nurse who looked at her vital signs and gave her a nitro tablet. Within a few minutes she was breathing more normally but her blood pressure was still low.

“Well, they can’t send you home this time,” I said. Vivian then informed me that she was to be discharged the following day. “That’s complete insanity! Your heart just made an unscheduled somersault which required immediate medical attention. You are now so weak you can’t even get up by yourself to take a pee! How the hell are they going to send you home?”

A few minutes later the attending physician comes into the room doing her rounds. She didn’t look more than about 25 years old. She confirms that Vivian is to be released the following day. I pointed out to the doctor that Vivian’s heart almost failed just a few minutes earlier and that she needed 24 hour nursing. I was told very flatly that the family should arrange for a hospital bed and private nursing to be set-up in Vivian’s home. The doctor then announces, “Her insurance doesn’t cover her stay in the hospital until her surgery date. That’s two weeks away.” She then left the room like a DMV employee leaving for a coffee break. Que sera, sera.



“. . . if you want service in a service economy, you pay for it!”


Critical Care (1979)




I stayed with Vivian in her hospital room that day for over five hours.  After our encounter with the warm and fuzzy on-call doctor, Vivian gave me the phone number of another doctor who was on duty when she was brought into ER previously. He gave her his personal cell number in case she needed an in-house boost to “move things along.”

The doctor answered my call after only two rings. His last name, coincidentally, was the same as my maiden name so that’s the name I used when introducing myself. I explained what had occurred and strongly requested he facilitate in moving the surgery date up and make sure Vivian remained in the hospital until then. He assured me he would do all that he could. The last thing he said to me was, “Don’t worry; she’s going to be okay.” To which I responded, “Thank you.”



“You are going to be OK.”

Scrubs (NBC comedy series)



Bless him; the doctor came through. Vivian’s surgery date was scheduled early the following week and she was to remain in the hospital until then.

In spite of last minute efforts, that was the last time I saw Vivian alive.

The valve replacement surgery was supposed to take 3 – 4 hours. She ended up in surgery for 14 hours. By the time the surgeon decided to close her up, her heart was so weak that it stopped every time the pressure of the ribcage compressed against her heart as they were trying to close the wound. So they sent her to recovery, still under sedation, with an open chest wound. She never regained consciousness and died the next day.

The information I received leading to her death is very vague, piecemealed, and much is unsubstantiated. Here’s what I was able to reconstruct: When the surgeon opened Vivian’s chest and began working on her heart, he realized that three of her heart valves were damaged. Two were damaged severely and the third was only half-way functioning. Instead of closing her up immediately and giving her the news that she needed a heart transplant, the surgeon decided to try to “patch-up” a heart that was beyond repair.

After three years of bureaucratic torture, being continually marginalized and treated with disregard and disrespect, Vivian was ultimately misdiagnosed. This led to the wrong surgical heart procedure which was doomed from the beginning. The woman is now dead yet the circus of human misery continues as if nothing happened.



“. . . the doctors word is law!”


They Shoot Horses, Don’t They? (1969)



I’m sure there was an internal review of her case, although, I don’t know the outcome. I also don’t know if there was an autopsy but there certainly should have been. I do know the family had the body cremated within a few days after her death. It took almost two months for Vivian’s death certificate to be signed. As far as I know, no action was taken against the healthcare provider, the hospital, or any of her doctors. Vivian was 67 years old at the time of her death.

This would be the perfect time for me to launch into a big pitch justifying the need for a single payer universal healthcare system. Most Americans agree that healthcare is a right and not a privilege and should be equally available to all. But I’m not going there. I’m sick and tired of pointing out the sick and tired.

We have a pay-for-profit healthcare system that is unlikely to change for the better anytime soon – okay, I finally got the message. The objective of this system is for the large health intermediary insurance companies to make a shitload of money at the expense of every human being possible; sick or otherwise. It doesn’t take an economist or a medical expert to figure out that the insurance company is always going to win and the patient, at some point, is going to lose, too often with their lives.

If we are going to capitalize on the sick, meek, and vulnerable, let’s do it with a sense of pride and, yes, maybe even a little humanity. Let’s begin by legalizing euthanasia. If it’s not profitable to keep people alive, then we can at least do everything possible to allow them to die with a minimum of pain and suffering and a modicum of dignity. We already produce actuarial tables for what is viable to invest in the health of patients. When the investment goes past the point of profit, the patient would then be informed that their condition has been deemed “terminal” and offer them an all expense paid euthanasia and funeral package. Friends and loved ones can be thoughtfully incorporated into the entire process, including euthanizing the patient. This helps to meet the emotional needs of the patient’s community circle and would minimize lawsuits.



“I wouldn’t leave you here this way.”

One Flew Over the Cuckoo’s Nest (1975)



You could offer a more elaborate “Super Package” if the patient would agree to be put into a coma before they expire. That way you could harvest all the healthy organs to sell on the open market to the highest bidder. That seems much more dignified and respectful than having a tiny pink dot put on your driver’s license, saying “donor” in case you get mangled-up in a car accident with the prospect of having some usable parts remaining if you die. I have nightmares about getting into a car accident and having a paramedic check my driver’s license saying, “This one probably won’t make it anyway. I hear Memorial Hospital is low on livers and kidneys this week.” Adios muchacha!



“There have always been two types of doctors . . . both are addicted to profit.”
“This is human sacrifice.”


Coma (2012)



Let’s not overlook the opportunity to market the very edible and tasty parts of the human body. It could be an inexpensive food source especially for the poor. This would open up an entirely new food industry that would also expand employment opportunities. Think of the exciting and new ways the chemistry of the brain could be altered with this new human-based food source. The research field of psychopharmacology would be rescued from obscurity.

To make sure people accept the idea of eating “people parts”, you just lie to them and say this new food is bioengineered soy. This might also help slow down the GMO labeling movement that’s been concerning the public. GMOs are already being consumed in 60% of our store bought, overpriced, processed foods. Eating affordable GMOs still sounds better than the thought of eating highly contaminated dead people.



“Soylent Green is made out of people!”

Soylent Green
(1973)




But wait – we’re not done yet. The little more than skeletal remains left of the patient can now be hygienically and economically disposed of through cremation. The family can then decide if they want Dad to decorate the fireplace mantle or to bury him in the back yard.

What am I saying? I’m not thinking straight. Now I’m just talking crazy! The loss of my dear friend has caused me enormous grief and I’m probably fallng into a deep depression. How am I going to get through each and every agonizing day of my life without the threat of doing something irrational and drastic? Hold-on -- no worries. I’m told they already have a pill for that – and then some.



[This antipsychotic] . . . is approved to treat depression in
adults when added to an antidepressant.