Both Sides of the Fence

A Tosa resident since 1991, Christine walks the dog, cooks but avoids housework, writes and reads, and enjoys the company of friends and strangers. Her job takes her around the state, learning about people's health. A Quaker (no, they don't wear blue hats or sell oatmeal or motor oil), she has been known to stand on both sides of the political and philosophic fence at the same time, which is very uncomfortable when you think about it. She writes about pretty much whatever stops in to visit her busy mind at the moment. One reader described her as "incredibly opinionated but not judgmental." That sounds like a good thing to strive for!

What would Grandma say about "Kill Granny" ?

Kill Granny, healthcare, Mom

It used to make me crazy when people said "Oh, I'm so glad ________ isn't around to see this mess."

But lately, I've been thinking I'm so glad Mom's not here to be preyed upon by people who want to scare old people in order to preserve their own interests in healthcare and finance.

"Kill Granny" is the sensational buzzphrase for a propaganda campaign that claims the Obama administration is seeking death panels to condemn the old and the disabled.

What's really being talked about is paying physicians to spend time talking to patients about what their wishes are when the end of life is near. If the patient wanted to talk about these issues at length, Medicare would pay for a counseling visit every five years.

If you've ever heard about a health care power of attorney or a living will, that's what this is really about. Now, you can make out your own and send it to your doctor. But how much better it would be to actually talk to him or her, ask questions, make sure that he or she and you understand enough to make good decisions.

Right now, physicians are pressured not to spend much time with patients. They are paid for procedures, not talk about difficult important things. Giving them time to spend talking to patients about life and death issues is a good idea, not a bad one, as long as the patient's wishes are guiding the discussion.

I don't know a physician who would attempt to coerce a patient to change her mind. I know many who would be glad to help a patient clarify her own thinking. Perhaps your physican has already done that with you. We're still fortunate here in the Milwaukee area to have a good supply of physicians who do what needs to be done, whether they are paid for all their time or not.

If Mom were alive, she would be scared by the buzz. It would be spreading like wildfire around the seniors in the community in which she lived. But once she'd gotten the real scoop, she'd be outraged by the crass manipulation of vulnerable people.

It might be enough to make her turn Democrat for good. A life-long Republican, she'd just about decided to vote for Obama if she lived long enough.

We were fortunate enough to have had those end-of-life talks and those legal documents, and we put them to use twice.

My dad had a series of strokes at 89 and was not going to recover from them. He was comatose and having constant seizures. When he developed pneumonia, we said it's time to stop life-extending treatment. The nurses on the hospital floor didn't agree with our decision not to use antibiotics, to let pneumonia be "the old man's friend," as it once was called. 

Even with full understanding of Dad's wishes and legal documents supporting us, we went through a terrible battle. Finally the chief of hospital staff said, "If I were this man, I would want my wife and daughters to make the same decision," and the battle ended. Dad was allowed to die.

Around age 85, my mother's health and quality of life had declined to a point where she talked frequently about moving on. But when it was time to replace the original implanted defibrillator ($30,000) that shocked her heart back into rhythm, we wheedled and badgered  her to agree to getting a new one. The replacement (we thought it was just a new battery) cost $90,000, we discovered to our shock later. But it was paid by Medicare, and we had her another two years--good  years for us, tolerated years for her.

Then at almost 87, her pain constant, falling often, mental abilities fading, cardiac medications no longer doing the job, the defibrillator shocking her heart often, it became clear to everyone that it was her time.  We asked her, and she said yes. Please. The doctor in the emergency room, where she'd been taken after a fall and a series of defibrillations, quizzed her, and satisfied that she was able to make decisions, agreed.

Her own doctor? Nowhere about. With fewer and fewer physicians caring for  more and more older patients, with more pressure to see patients fast, the primary care doctor, the one who knows you best, perhaps the most important member of the healthcare team, too often has disappeared.

The technician did his computer magic to turn off the defibrillator. Six hours later, Mom died in my arms.

Death is not optional. But today, it can be hard to know when it's time to go. How much better to think about this beforehand, and have everyone on the same page.

Mom would have said "We live too long," speaking of those who have lived into their 80s and beyond. She wouldn't have wanted the government telling her what to do. But neither would she have wanted a healthcare system prolonging life when the end is in sight mainly because there's money in doing that.

If Medicare had said  "sorry, we won't pay $90,000 for a replacement defibrillator" when she was 85, she'd have been relieved. It would have seemed just to her.  I think we'd have accepted it. It would have been good to have an honest discussion with a physician about costs and expectations in making the decision. That didn't happen.

Mom would have been in favor of a healthcare system that gave her more access to a family doctor -- even if it meant less access to cardiac subspecialists.

She would not have wanted a system that extended the lives of grannies but didn't take care of their children and  grandchildren.

She'd have thought we could figure it out. She was a nurse, and she knew a lot about what it would take. And she'd have known we couldn't get very far if we kept telling each other lies.

Personal responsibility starts with finding and telling the truth.

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