Medicine and Money

I have had this show on my DVR (thanks to my husband who recognized this is my kind of programming) for the last few weeks, and finally started to watch it last night. It is fascinating. You should check out Medicine and Money on PBS. I can highly recommend it. Makes perfect sense to me.

Let me add that just because my husband recorded it for me doesn't mean that he is interested in watching it. He saw a couple of minutes and said, I don't need to watch this. And he is right. This is what he lives every day.

One of the patients they highlighted is very sick. Tubes, wires, monitors everywhere. She has been there for 10 months. I turned to him and told him that in no way would I want to be hospitalized without being able to communicate or feed myself for 10 months. This may sound harsh, but it was obvious even to me, without any medical training, that she wasn't going to recover no matter how much faith her son had. And I am a believing person. I believe in miracles, but come on ... this woman isn't going to make it. She was sick before she even was taken to the hospital after suffering a stroke. Now she has a feeding tube, breathing machine, is non-verbal, and on dialysis.

The hospital ethics committee had to issue a DNR (do not resuscitate) order because the family wasn't budging. The family believed that this is what she would want - to be kept alive as long as possible using whatever means necessary. Really? Did she write that down? The hospital told them that if she gets another infection/symptom they will not treat it as it is an indication that what they have been doing will not work. They will make her comfortable, but no additional symptoms will be treated. I wish I knew what the final outcome was! As one participate rightly pointed out "we all will die eventually".

And this is where I get all opinionated with my views on prevention. Remember my post about health-care, it's like that - sure to ruffle some feathers. If you are of the mind-set that you want to be kept alive at all costs for as long as possible what are you doing before you land in the hospital to make sure you are extending your own life by whatever means are necessary? Think about your life while you still have it to enjoy. Don't spend a little bit every day slowly killing yourself with things you know could cause you harm and then expect medicine to be the super-hero that invokes whatever means are necessary to keep the pronouncement of death from falling upon you. Eventually you will die, too!

Lest I sound like a hypocrite I do take my own advice. Another program I would suggest watching is Forks Over Knives. I have nearly transitioned over to a plant-based diet. Why? Not because I care about the cows and chickens - I watched those shows too. And I felt bad for a few days, but not enough to make me to do anything. But this program actually persuaded me to change because I could connect the dots and it made sense to me. I eat well, exercise and am only 6 lbs away from my goal weight now. I feel amazing. I was bragging to my husband that not only are my pants falling off, but my skin looks better and I have more energy than I did before. That must mean good things are happening on the inside too. I digress.

Medicine is amazing, but extending life when it has been exhausted isn't what it was intended for! No wonder medicine is so expensive. We are keeping people alive (possibly against their true wishes because they failed to tell someone or write them down) who by all accounts have already died. The woman I previously mentioned, just her care alone, has cost 5 million dollars over 10 months and will only continue to accrue costs directly to Medicare. In other words we will pay that bill with our taxes.

If something happens to me. I don't want my family grieving and holding out hope beyond a reasonable time. I don't want to be kept alive for weeks and months just because it is technologically possible when all medical indications suggest my "life" will not recover. I don't want to rob my family of their life because they are spending their time at my hospital bed hoping for a dramatic recovery. I don't want to drag out the inevitable. I don't want to cause a financial burden to either my family or my fellow citizens who could possibly be on the hook for it. Personally, I don't think that is right.

I am OK with dying. I don't want to die right now, but I want to have a life to live not merely a semblance of life.

When did it become a bad thing to die after you have lived a long life? I don't know of anyone who thinks they would like to die in a hospital hooked up to machines. Ideally, I would like to die an old woman in my sleep after a full day holding hands with my husband. I know that is unrealistic, but  I want to have the freedom to die on my own terms when the time comes, and with dignity. Until then I want to enjoy it.

I need a living will and medical directive. I don't want anyone guessing what I might want, or feeling guilty if they don't go to extreme measure just because they don't want the guilt associated with making a decision; a decision that I realize would be hard to make. I will make it for myself and leave them without guilt for following what I expressly have decided. It is the least I could do for those that I love. Now to get it done.

The program also touched on rising c-section rates, mammography, and PSA screening as well as highlighting specific states that are making good health care decisions with their patients and bringing down total health care costs at the same time. That is a win-win.

I think of my dad who is turning 60 this year and hasn't had an annual physical in at least the last 5 years, maybe longer. He looks like a healthy guy, his family risk factors lean towards Alzheimer's and Parkinson's disease (the slow death) and not heart disease, diabetes, or cancer.  Our family (both sides) have all died from natural causes, and my grandfather (80 years old) would still be here if he hadn't had knee surgery. It was a blood clot (PE) a few days post-operative that killed him. But he had bad knees from being obese. One could make the argument that if he hadn't spent 30+ years overweight, he might not have needed knee replacement and thus no blood clot. Or maybe the doctor shouldn't have agreed to replace the knee until he lost weight.

I completely understand why my dad doesn't want to go see a doctor. If you look for something hard enough you will eventually find something. His view is he would rather not know what is going to kill him. Especially when you consider that just because you screen for something doesn't mean you actually have it, or that it will be life threatening. Yeah, I would rather not know in that case, too.

Have you seen the PBS program Medicine and Money? What did you think? Are you going to watch it now:-)

Do you have a living will or medical directive?