Tag Archive: Health Care


It’s Free

In the past week, our President proclaimed that as COVID cases in Europe and Canada rise, “It’s going to disappear [in America], it is disappearing.” Additionally, since COVID was a blessing from God, he wants the American people to get the same treatment he did — for free. Think about that, free? It’s free America. COVID is free. As in nada. Just walk to the nearest hospital and order your free COVID treatment.
President Trump’s COVID medication cocktail contained a mix of proven drugs, over-the-counter drugs, supplements, and experimental antibodies only available to those participating in clinical trials. To the average person (without insurance), those medications would cost between $4,300 and $5,145. There is a minor caveat.

Monoclonal antibodies, including one made by Eli Lilly and Co., of Indianapolis, remain under development and are not yet approved for use in the US. The President received it under a “compassionate use” exemption, which the company said it has granted to fewer than ten people. In layman’s terms, ‘compassionate use’ means you are not getting it.

The monoclonal antibodies drug maker Regeneron evaluated the number of multiple dosages required for potential treatment. If I read the information correctly, the maximum dosages they can produce is estimated between 70,000 to 300,000. Maximum prevention doses round out between 420,000 to 1,300,000. Therein lay the math problem. America has approximately 330 million citizens, which of the 1.3 million Americans receives Regeneron? Even if you are lucky enough to receive Regeneron, is there a hospital available with available resources to treat you?

The massive shortfall in US inpatient hospital and ICU bed capacity raises important policy implications for current efforts to address COVID-19. There are not enough hospital beds. To meet the needs ahead, hospitals need to develop contingency plans to expand hospital capacity. Postponing elective inpatient surgical admissions is one straightforward strategy. Still, all hospitals in the US should establish clear protocols to aid decision making on which types of procedures and clinical diagnoses could be safely postponed. Second, the shortage of mechanical ventilators and ICU beds will require hospitals to transition inpatient operating rooms, ambulatory surgical sites, and post-anesthesia care units into flexible ICUs. After years of neglect, the American health system is outgunned.

The miracle vaccine some are desperate to acquire will pose a nightmare for others. What works in one country will fail in another. And Trump’s easy choice this week may not make sense next week. Failing to look at how closing schools’ and our economy to stop an outbreak is likely to surge into years of economic harm. Making choices in the era of Covid-19 isn’t just about fighting a virus; our moral code, ethics, and humanity are also at stake.

But fear not. COVID’s disappearing. Right? Right.

The doctor was quick and to the point. “After all our tests, we believe an experimental drug, consisting of cells manufactured and implanted in the eye to stimulate optic nerve growth and activity, might be the best method of fighting your symptoms. We would require approval from the Food and Drug Administration (FDA) via a compassionate use request that allows experimental drugs to patients outside clinical trials. But getting access to not-yet-approved pharmaceuticals via a compassionate use request is both arduous and challenging.”

What the doctor implied but did not say was, “You will go blind in your left eye because you are not a VIP and associated costs are bigger than the ‘Big Mac Combo Meal 1’ range. Also, you are likely to expire before receiving therapy approval. and, since most experimental treatments rarely work on dying patients, ‘compassionate use’ requests from patients like you become ‘compassionate not.’ In the end, you can still get to heaven with one eye. Ensure you look left and right before merging and change lanes accordingly.”

While paying the $40 copay, I saw Trump’s photo op in front of Walter Reed Medical Center. America’s chief dude made what media sources claim was a ‘photo-up’ by leaving his hospital suite to make a “surprise” drive-by to supporters while undergoing COVID-19 treatment. Trump’s drive-by triggered both safety concerns, outrage, and giving the middle finger to the more than 208,000 Americans who perished. The joyride only occurred because our chief asshole received medical treatments the poor working slob on Mainstreet, U.S.A., will never obtain.

Before the president left the White House for Walter Reed Medical Center, he received a single dose of Regeneron’s polyclonal antibody cocktail. This experimental drug has shown promise in initial trials in improving symptoms and reducing virus levels in the body but has not received Food and Drug Administration approval. Trump was also treated with Remdesivir, an intravenous antiviral medication shown to help treat COVID-19. Remdesivir’s benefits are modest: reducing hospital stays from 11 to 15 days.

For those with insurance, Remdesivir will top $3,000. How much-uninsured patients would pay remains unclear. Regeneron’s cost has not been publicly shared, but suffice to say it will not be in the ‘Big Mac Combo Meal 1’ range.

Trump’s a ‘Very Important Person (VIP),’ I am not. VIP treatment is a feature of American medicine. Major hospitals throughout the country provide private spaces for celebrities, the super-rich, and the influential. These are the patients who get shielded from the public. VIP’s include foreign nationals from places including Saudi Arabia, China, Canada, and Mexico.

The real coronavirus war cannot be flouted in a presidential joyride victory lap. Memorable scenes of community hospitals fighting on the front lines from California to Maine depicted medical centers nearly overwhelmed by desperately sick people. They are pictures of doctors and nurses working around-the-clock with insufficient equipment. And as of now, there are at least 208,000 COVID victims who cannot take a celebratory joyride. These 208,000 are alumni of the Big Mac Combo Meal 1.

I hope Tuesday, November 3rd, the remaining Big Mac Combo Meal 1 alumni will remember this joyride. I also hope the alumni remember this probably started during Trump’s introduction of  Supreme Court nominee Judge Amy Coney Barrett — the same judge who will likely assist in overturning the Affordable Care Act. That means for Big Mac Combo Meal 1 alumni members. Get it now?

November 3rd.

Exhaustion

Friday, April 3, I briefly stood at the clock mounted above the door. 5:32 PM. “I’m exhausted,” muttered a passing coworker. “Let’s get out of here.”

I stared—5:33 PM.

My day some 34 hours earlier. I walked in, and the crisis swarmed the room. Personal Protection Equipment (PPE) was required in New York, then New Jersey, then New Orleans, then all over. Ventilators were in such high demand that a coworker said she’d sell her soul to the devil.

“Think about that,” I said matter of factly.

“I did,” she muttered.

As she finished, our alliance of State Pharmacies indicated medicines to alleviate breathing difficulty, relieve pain, and sedate coronavirus patients were in high demand. That meant stock was depleting.
Compound that with President Trump. Trump’s comments pushing an unverified Coronavirus treatment of Hydroxychloroquine and chloroquine created shortages. Trump urged the FDA to speed up the off-label use of the drugs for COVID-19 but created hoarding.

“We need supplies,” a New Orleans nurse told us.

“I cannot locate any for you, but I will continue to try,” I spoke into the conference room phone.

An eerie pause, “I have worked four days, sleeping a few hours in my car.”

Another eerie pause. “I cried every day.”

A third eerie pause. Tears of grief briefly filled our conference room speaker. A momentary ruffle, “Pull it together,” she appeared to whisper to herself.

“Ok. Thanks for helping,” she sighed. Click. Dial tone.

I didn’t help at all. All we said was that she and her coworkers stand alone.

Those of us in the room are technically listed as ‘support.’ However, it’s the health care workers who must go out to those in need are paying an even higher price, in terms of their emotional health. They expose themselves to the risk. Work nonstop. They’re unsure if they have Coronavirus. However, they carry on. And I can’t help them. It’s insane.

Driving home, I kept thinking of the two occasions when the United States declared itself to be under attack: Pearl Harbor and 9/11. Coronavirus is the third. While Trump has spent his time bragging about his “terrific” response to the crisis, there’s an uneasy feeling American is on a rudderless ship adrift in high seas. Governor Cuomo once said, “We have to fight with what we have.” To that nurse in New Orleans and others like her, you’re the best we have.

God Bless.

 

“It is in the nature of medicine that you are gonna screw up. You are gonna kill someone. If you can’t handle that reality, pick another profession. Or finish medical school and teach.”

~ Gregory House ~

Dr. House’s comment while substituting as a guest lecturer. Unfortunately, Dr. House’s statement to the interns occurs all too often. It happened to me this past Friday. I likened it to something out of Charles Dickinson’s Tale of Two Cities.

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair . . .”

I returned for my post-operation evaluation. Good News. The operation was successful. Bad News. The symptoms remained relatively the same. My neuro was positive that removing the tumor would make some positive impact.

Studying the medical history, a sharp, bright, neurological nurse looked at my medical history, then she squinted and studied further. Her first poke went unacknowledged. With careful forethought, she grabbed a piece of the neuro’s flesh, twisted slightly. Turning to look where she pointed, the neuro read. He read again. And again. He pulled up the MRI from 2015. And he read. Read again. And again.

They excused themselves.

Ten minutes later, several doctors, en mass, poked and prodded. They left, leaving the neurological nurse and me to kill time quietly. After eons of seconds, she sympathetically smiled me. “We believe you have Parkinson’s.”

Pause . . . Long pause. 

I must have had this WTF expression, but just as she was about to follow-up, the flock of physicians returned.

“In 2015, the MRI we performed indicated over seven supratentorial FLAIR hyperintense lesions or plaques. We should have noted these. We misread the MRI. While there is no one single test that can verify Parkinson’s, this finding and your symptoms demonstrate the diagnosis. Unfortunately, your Parkinson’s has been untreated for at least five years.”

“All this time I was told, ‘nothing to be done,’ we recommend a psychiatrist…”

“Was awful,” he interrupted. Soulfully searching for the right words, “I am sorry.”

The tumor still had to come out. The remaining portion of the tumor still residing in my neck still remains. All the while, physicians had either denied my symptoms or attributed to the tumor was wrong. All those years of pain and suffering. All it took was for a twenty-year veteran neurological nurse to read the chart and connect the dots. 

I am still processing, but I left in peace. “Why?” one would wonder. Well, I found some level of peace in the doctor’s words.

“Better than a thousand hollow words is one word that brings peace.”

~ Buddha ~

I’ve given a lot of thought to various things over the past couple of days. I’ve looked at my life realized there’s this innate knowing that I won’t be here that much longer. I came to this realization yesterday. After spending much of the weekend in pain and hardly being able to move, I dislocated the patella on my right knee (meaning the kneecap moved out of place). I performed a battlefield maneuver and popped it back into place. 

Although painful, a dislocated is not what I considered a significant injury for me (the absolute term, ‘for me’). That’s not to suggest that a dislocated kneecap isn’t a major medical issue. It’s just that for all I have been through, I more or less considered the event as just another indignity to accept.  

Patients like me suffer all kinds of indignities. One such indignity is the requirement to bare all in the presence of young athletic-looking clinicians, where gravity has pulled cellulite into waves of hills and valleys that any miniature skateboarder would drool. I am also told to record my weight and contact the clinician should we suffer excessive weight loss.

Have you recorded your weight?” my physician asks.

No,” I paused. “Well, sort of,” I state.

Meaning?” she asks.

I take my weight every morning, but I can’t bend my neck to record it. So, I base my weight loss upon how much flab I can grab.”

Another slight pause filled the room.

Ever see that ‘Special K’ cereal commercial ‘Pinch an inch?’

Yeah,” smirking.

Well, I modified it to ‘Grab a foot.’ If I can grab more than a foot, I let you know.”

Just once, while disrobing and having some perky young face stare, I just want to say, “Welcome to your future bitch.” But I never do.

Another indignity is realizing just how fast my body has aged. Theoretically, I should be years away from such aches and pains. Now I’m comparing over-the-counter body rubs with 80-year-olds. I’ve gotten into some heated arguments over the value of Aspercreme, Icy Hot, Ben Gay, BioFreeze, Myoflex, Capzasin, and the like. We often bet on results.

Hey, Mr. Rufus?” smiling.

What are you pawning today?” he responds in a crusty voice.

I got some Nurofen Gel. Straight from Europe.

Been there and done that kid,” he grovelingly responds. “You lose. So, fetch me another cup of coffee.”

Damn,” I muttered.

I cringe at the person I was yesterday. I know the wisdom that comes with age is hard-won, but I could do without the flash of wince-worthy moments from my past—like worrying I was old at 23 or 25. 

My life is littered with perceived indignities: first date, first real sexual experience, first presentation to a crowd, first proctology exam, first colonoscopy, and so on. Looking back, these seem so inconsequential. Real indignities are harder.

The fantasy of living until a ripe old age and dying in your sleep, while making love, scuba diving, or sailing is fiction. The real indignity is that many of us will die precisely like me–through an extended period of mental or physical decline. Nearly half of those my age will succumb to Alzheimer’s, not to mention diabetes or cancer.

The latest indignity occurred during the January 14, 2020, Democratic debate. For all the concern over healthcare, and the attempts by the current GOP led administration to repeal healthcare, the real indignity is that no candidate has neither proposed a plan nor discussed long term care for an aging population. The indignity of indignities is that no presidential candidate (Trump included) realistically discusses how to care or budget for generations to come. Thus, all candidates align on this common theme: They seductively offer hope without providing any hope.

And the infuriating indignity . . . is that we’re on our own.

Welcome to your future, B****.

Over several weeks, many have queried about why I haven’t sought additional treatment. It’s a fair question that often has nuanced answers. Probably the best answer I heard comes from Andrew Luck.

Having worked in the medical field, many patients have chosen the quality of life over treatment. That choice can be hard for family and friends, but for the most part, people who can make decisions for themselves have the right to refuse any treatment. The reasons vary. For some, there are associated health problems with treatment. For others, it’s age. Others, it’s a moral decision. And so on.

Coming to the end of life, I had one goal: die in the least objectionable way. Of course, doctors have arsenals loaded with weapons against infirmities of the body. Unfortunately, medicine focuses on longevity, not quality. Need an example? Me. I take 13 different drugs daily, three are required before I’m able to get up change clothes. The rest are ingested via a carefully crafted schedule. As I told my mother, medical technology is terrific, but sooner or later, the body wins.

I’ve often said to my physicians, “We all know I’m going to die. Help me die in dignity.” Therein lay the truth; everyone knows I’m going dying. It’s just a matter of when not if.

During a recent walk with my parent’s dog, Skip trotted ahead. He looked back with sympathetic eyes that could only say, “. . . you look like shit.” Sometimes in my humorous way, I reflect upon Doc Holliday’s witty quip (Wyatt Earp 1994), “I wake up every morning looking in the face of Death, and you know what? He ain’t half bad.”

Why am I deciding now?

During the past 35 years, I’ve not known a day without pain. What I learned from the military, from football, and my ol’ man was to suck it up, take the pain, sacrifice the body for the good of the team, and if required, for the good of the country. I’m aware of the physical toll of that profession as well as the traveling of my business. Throughout years of travel, I fought through pain and injury while simultaneously remaining stoic. I felt breaking through the pain helped proved myself. I accumulated significant damage.

Like many sitting behind their desk right now, I silently “self-medicate” to keep fighting at peak performance. Pills hide the pain from 8 partial ligament tears in my left knee, with 6 in my right. I was partially paralyzed from a spinal injury nearly forty years ago; had bone chips removed from my spine; feet suffer from severe arthritis that sometimes the left foot locks; experienced two concussions; one eardrum tear that requires hearing aids; had a silent heart attack; cracked some ribs; fractured a wrist; suffered a shoulder separation; have cervical stenosis; lumbar osteoarthritis; and now a cervical spinal tumor, and multiple sclerosis.

Andrew Luck, the former first overall draft pick and one of the NFL’s league’s brightest stars, eloquently summarized my thoughts. When questioned this past Saturday about his surprise retirement, Luck stated he could no longer take the years of pain and rehabilitation from a host of injuries.

It was not the first time a professional athlete stepped away during the prime of their career, but Luck was one of the more vivid examples of a player weighing the consequences of continuing a career. His decision to retire didn’t occur in the limelight, in front of a cheering crowd. “I’ve been stuck in this process,” Luck said during his retirement press conference. “I haven’t been able to live the life I want to live. It’s taken the joy out of this game. It’s the hardest decision of my life. But it is the right decision for me.”

I echo the same thought; it’s a hard decision, but it’s the right decision. Thus, that’s where I’m at, stuck for thirty-five years. In truth, I have not lived the way I wanted to live. The decision to choose a treatment or not to choose treatment isn’t easy. My body is tired, and I’m tired. Eventually, technology loses – the body wins. The body always wins. Pain has devoured my body, my mind, and my soul.

All of us, at some time or another, will be at a similar crossroad. At some point, one will have to prioritize their health or personal well-being rather than the good of a team or a company. We have to learn to invest in ourselves.

I once heard a nurse refer to the cancer clinic waiting room as “cell block death.” She refused any notoriety as the originator, but its description stuck.

Cancer can be the ultimate waiting room. We wait for a diagnosis and then to learn more about our diagnosis. We wait for test results. Then we are in the ultimate waiting room after treatment, waiting to find out if our cancer will return and if we will ultimately survive our cancer. We wait for years wondering if we are safe, if we have beaten cancer.

The woman sat across from me, emotionally lost, either as a result of a broken romance, life changes from a serious illness, or maybe a demanding employer. In my time, I’ve seen a lot. Even though my shinning armor had rusted, I reached back into my days of dreamlike knighthood and reached out.

Huh? I’m sorry?

I asked if you were ok? You seem concerned.

Oh,” collecting herself. “My bossed called. Asked if my cancer treatment would impact my brain and thought process.”

God,” I said horrifyingly. “I am so sorry.

I am only on my second treatment. I have breast cancer, not brain cancer. I never experienced anything like this before. Have you?”

Ah,” chuckling nervously. “Ah,” pausing again, “Three weeks ago, a supervisor called the sister of a deceased employee three hours after the funeral and demanded when she would ship the company laptop to Information Technology.

Oh my God,” raising her palm to her lips. “That’s awful.

Yup,” with a pause. “When HR heard, HR sent an email to all managers to never, ever do that again, that any communications with a deceased employee’s family comes from HR.” Rolling my eyes, “Imagine, someone had to tell them this.

Sheesh,” shaking her head in disbelief.

Yeah, idiots are out there. Unfortunately, some are in management. When I was in consulting, I witnessed a CEO ghost-pepper mad that the company hadn’t fired an employee prior to receiving a liver transplant, ‘…it was going to affect our health-care plan,’ he stated.

She chuckled, “What kind of consulting was this?

Healthcare.

She roared in laughter. “Yet, here you are.”

Irony of ironies.” shrugging.

I handed a business card and requested that should she ever need someone, to either write an email or call. She smiled, slipped the business card and mouthed the words ‘thank you.’ In the days following, she has not contacted me.

Contrary to the public perception, the statement “first, do no harm” it isn’t a part of the Hippocratic Oath at all. “First, do no harm” is from “Of the Epidemics.” I’ve met many a ‘professional,’ both in and out of healthcare. Let me say this, helping the sick is ‘optional.’

For all on the road to kingdom come, it’s up to us to take care of the sick, the disabled or those in pain. If we see someone struggling with a heavy load or difficult task, we step in and share their burden – share the pain.

As GOP leaders continue marching the American Health Care Act through the legislative process, we are left with bickering pros and cons of affordability and coverage. As one who’s earned a livelihood from the healthcare industry, I view legislative gladiators from the cheap seats and ponder, “If you can’t afford health care, should the state let you die?

The current House plan relies on government tax credits, regulation of the insurance industry, and continued government funding to keep the low-income population insured. Yet in-between weeds, down in the fine print no one ever reads, one can find insurance reforms are positioned so carriers can offer a wider array of policies that pick up less of the tab for getting care. Additionally, Insurance companies can charge the oldest enrollees as much as they want, roll back the Medicaid expansion thereby eliminating approximately 11 million of the nation’s poorest from health care and eliminating healthcare services of poorer via planned parenthood.

In February 2017, Cardinal Burke noted, “Catholic health care, by its constant and careful attention to the perennial moral teaching of the Church, safeguards and promotes the respect for all human life from the moment of conception to the moment of natural death ...”

Sounds wonderful, but there are little safeguards that promote the respect for all human life from the moment of conception to the moment of natural death. Our faith-based nation spends a hell of a lot time upending/defending Roe vs. Wade, but the notion we protect all human life from conception to natural death is bullshit. The back hallways of healthcare facilities are littered with the strewn, discarded and neglected. These hallways are filled with the “let them die” arrogance. We simply do not care about the respect of human life.

Both Bernie Sanders and the Pope have stated similar positions, “…access to health care regardless of income” is a right. Technically speaking, even one without health care can get health care coverage via a hospital emergency room. And in truth, both the Affordable Care Act and the GOP’s American Health Care Act provides opportunities for health care access. Now whether one can afford that access is an entirely different matter.

Health care is not mentioned in our Constitution or the Bill of Rights. Yet our Founding Fathers rightfully focused on life, liberty and justice. Conservatives continue to believe in personal responsibility, limited government, free markets, individual liberty, traditional American values and a strong national defense.

Several years ago, a 17-year-old senior at T.C. Williams High School wrote:

“… it must be noted that the key word in said act is “affordable.” The American people struggle on a daily basis to make ends meet, worrying about groceries, bills, and car payments. For better or for worse, that is capitalism, and as a country the United States has stayed true to its ideals. Nevertheless, the competition of the game of life should never have to be a game of life and death.”

Health care coverage is extremely complex. By nature, medical clinicians, Buddhists, Christians and many others of faith are concerned in their own way in the alleviation, control and ultimately the removal of human suffering. The American psychiatrist M. Scott Peck began his bestselling book The Road Less Travelled with the statement “Life is difficult.” He added, “This is a great truth, one of the greatest truths.”

Borrowing from Peck, the current health care debate is difficult. The disparity between health care and American values is crudely displayed as political views, politicians, managers, and administrators impact who receives what level of proportioned health care. While hospitals are forced to meet sometimes arbitrary measurements of performance, financial incentives are dolled-out on the backside. Lost in all this is what matters. For instance, what may matter more to a patient is the intangible and unquantifiable aspects of care experience. On what measurable performance scale can it be recorded that a dying patient is helped through denial, anger, and resentment to peace and serenity?

Of course, we can mimic Rep. Roger Marshall’s (R-KS) holy view to wash our hands. Marshall used Jesus to justify his opposition to Obamacare by explaining that poor people will reject health care.

“Just like Jesus said, ‘The poor will always be with us.’ There is a group of people that just don’t want health care and aren’t going to take care of themselves. Just, like, homeless people … I think just morally, spiritually, socially, [some people] just don’t want health care. The Medicaid population, which is [on] a free credit card, as a group, do probably the least preventive medicine and taking care of themselves and eating healthy and exercising. And I’m not judging, I’m just saying socially that’s where they are.”

Can we afford to be spiritually ignorant as some politicians? Should society claim that if one can’t afford health care, they die? No. At this point, both societal value and the American Health Care Act are morally unaffordable.

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