Friday, June 29, 2012

WWMWD? (What would Marcus Welby do?)

I'm hippity hopping and bippity bopping my way to work yesterday on a gorgeous, sunny, warm day and listening to a discussion on NPR regarding end of life care.

Strange contrast, but then again that's what makes life interesting; it's what keeps you alert.

Palliative care was the term that kept popping up. Palliative care is the dignified, holistic treatment for terminally ill patients that balances comfort giving with realistic understanding of the situation at hand. As opposed to shoving tubes down peoples' throats, injecting IV's into their arms, administering boatloads of drugs and talking to them as children while they linger on in pain, hopelesness, and bewilderment.

Whenever this topic comes up, the aging baby boomers become a major part of the discussion. This disturbs me because I am an aging baby boomer.

The point of view is that there are a hell of a lot of us slipping into old age and quality of health care is going to become a major issue.

The fact that interested me was that doctors tend to avoid all this medical intrusiveness when the end approaches for them. Most doctors choose to "die well", a euphemism for dying peacefully at home surrounded by family. Euphemisms abound regarding this topic. "Heroic measures" - all the dramatic life saving, life extending procedures that are performed to extend the life of someone who is on the short list on the road to hell. Or heaven as the case may be. "Futile care" - applying cutting edge technology to keep a person "alive" as long as possible no matter what the prognosis.

Doctors have access to any medical care they want but they choose to turn their back on it and die naturally. This fascinates me.

If that is a doctor's point of view, why are the rest of us used as pincushions?

Part of the problem is our culture. We do not accept death in this country, so family members think they are being loyal by doing whatever it takes to fight it.

Part of the problem is doctors. They are in a delicate situation. Even if they despise administering futile care, if the family wants it, advising against it makes the doctor look like he is trying to save time, money or effort; makes him look cold hearted.

The biggest evil is the medical system itself. The worst case scenario is doctors who use the fee-for-service model to do everything they can, no matter how pointless, to make money. I prefer to believe this is a small per centage of the problem.

More commonly, doctors are fearful of litigation and do whatever they are asked to avoid getting into trouble.

I listened to this doctor on NPR and read an article online written by another doctor They both said that doctors wonder why people put family members through this agony; the doctors see the consequences all the time, the suffering and indignity and they know there is a better way. One doctor pointed out the excessive cost of life extending procedures and said "what it buys is misery we would not inflict on a terrorist." Pretty much sums it up by someone who has been in the trenches.

Pain can be managed better than ever and people can find a way to die in peace at home. Hospice care provides people with much more dignified and better final days. There are studies out there that have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures.

I was in the hospital last week with an IV jammed into the back of my hand, which is nothing compared to what other people I know have been through, and still I felt helpless and imagined myself back there, older and sick, with lots of other stuff jammed into my body, being wheeled around like a rag doll.

No thanks, baby.

This country has a lot of growing up to do and our systems need to be uncorrupted.

Gonna be a slow process.

I keep a kit in my bed table. In it are a gun, heroin, a machete, sleeping pills, and 1.75 liters of Crown Royal. I have a travel kit with the same supplies.

When the Grim Reaper comes knockin' ain't nobody gonna strap me to a table and talk to me like a three year old.

I'm going out with guns blazing, baby. And a pretty good buzz, to boot.

1 comment:

  1. I'm from the generation before the aging baby boomer generation and I think I need one of those kits.