The term Death Panels has been bandied about, in heated moments at the infamous town halls and political conferences, as if "they" were required as a tenet of the health care reform proposed by President Obama.
This innuendo and LIE angers me a great deal. The idea that people should discuss their wishes and desires relating to the exit from this life is a good one. Don't make me, or anyone else, try to decide what you would want. And when you don't choose you put me and other healthcare providers, friends, guardians and family in just that position.
I have cared for people in all stages of health and illness including those at the end of life. I have participated in a relatively small number of codes over the years. That surprises me given how sick many of the patients I have cared for were. I have made it my call, many times, to discuss end of life care with patients and their families or guardians upon arrival if the patient appeared in extremis. There are nurses who will not do this. It's a hard discussion sometimes. Not having the discussion worried me more.
So many people act as if they will live forever. This simply does not happen. I feel comfortable calling that a fact. So let's move on, shall we?
It's 230am and 96 year old gray haired Julia is wheeled in from a local nursing home. She is on a stretcher and smells strongly of urine. Her breathing is labored and she grabs out and yells unintelligible words. The look from the attendants bringing her up from the ambulance is impassive. What do you do first?
They slide her onto the freshly made bed and stuff a packet in your hands "from the nursing home." The really nice ones will help you position the patient or help you roll her out of her diaper and help you do a quick visual for bedsores and other skin breakdown. Then they are off and Julie and you are now buddies in crisis for the night.
"Where's Linda?" she hollers. "Who's Linda?" I ask. "She's my daughter. I need her." She then begins to relate stories about Linda that clearly indicate that she is living in the past. Linda is thirty years old and your patient is fifty-two, so she thinks. She has to help Linda. She has to get things ready so the kids will get to school on time. She's on a roll and you listen for any hint of lucidity. By this time, if you are lucky, a coworker has stuck his/her head in and offered to help you get the patient situated.
After cleaning up Julia and putting up the bed rails for safety you get her vitals. She continues to breathe hard and you wonder how much is from debilitated health or a fluid overload in the lungs and how much anxiety and fear is playing into the symptoms you see. Her color is good. The stethoscope is helpful.
She's well-ventilated judging by the air she's moving; maybe she's over ventilated and physiologically overcompensating. Time for labs and trying to figure out when she last got any of the twenty meds listed on the form from the nursing home. If this mysterious Linda would show up you might find out something more than a quick verbal report from hurried attendants and a fact sheet from the nursing home.
You get orders from the doctor if you can get through to him in the middle of the night. Leave a message; dial a pager and go on with your night. You step towards Julia's room and see she is climbing out of bed, or trying to. Is this her normal or is this unusual for her. No way to know yet.
The patient has an irregular heartbeat and the doctor ordered telemetry to "see what she's doing" and an IV lock for medications. Everything is nicely in place and you are making rounds and working with other patients and you hear shrieking and find your IV handiwork is ripped apart and Julia is bleeding all over the bed and the floor.
You mentally curse the doctor who ordered the spaghetti and you start over. You save the patient from herself and hook everything back up. You round more often and marshal the help of other nurses, aides, early tray passers, housekeeping, clergy and lab in one way or another to try to keep the patient safe from her own actions. Julie is only one patient of seven or eight you are caring for this night.
It's 8am and you are very tired. Time to go home.
Pushing back tired hair out of even tired-er eyes you hear your name and Linda has arrived. She wants to know why her mother has a telemetry monitor and an IV lock. She wants to know why she is at the hospital at all. She is a DNR!
People like to think that DNR status means a do not care status. I think of it as an "if I die, let me go status." Some options that can be exercised include the DNI status which is "do not intubate." Some people prefer a "drugs only" approach if their heart stops but don't want the CPR. Give them what they want but make it possible to know by giving them a choice to make their wishes known. If your choice is "life at all cost" then every attempt at resuscitation should be made.
If Linda had been available when her mother was brought in I would have asked her if her mother's behavior was her normal or not. Sometimes this is useful but there are many family members who do not spend enough time with mom in the nursing home to see if she has a problem with something referred to as Sundowners. It is not uncommon for marginally alert patients to get more confused at night. The new environment and people, the noise and the smells, the round the clock scheduled interruptions of labs and medications and assessments all make it worse.
I would have asked Linda if her mother had ever indicated what her preference was if she were to die given her age, her breathing troubles and her propensity to make very poor choices due to confusion. I cannot rely on this patient to tell me what she wants.
I did not have an hour, right away, to dig through the paperwork and try to figure it out. In settings where you have enough staff or ancillary people who can skim the chart looking for key information its helpful, and quicker to know.
I have met some doctors who are comfortable with DNR status and even a few who would permit it in their operating rooms but many doctors are very uncomfortable with DNR status and some refuse to write the order for it on the chart. Some will not respect it although many will. There is an underlying feeling, so I have heard expressed, that DNR status ties the doctor's hands and keeps him from being able to do his work.
There are nurses who don't care for the concept either although spending a lot of time with very sick patients exposes you to many ethical and moral thoughts about quality of life. I do not recall ever knowing a nurse who wanted more quantity over quality of life. You see things when you do this sort of work.
I am the type of nurse who wants you to have your dignity and have your say. Sometimes all you can do is honor this request for someone. I cannot impose my will.
Comfort in care is sometimes all we have to offer. At some point in many lives the mantra for cure is not useful. Some health problems and, of course, agedness can not be cured.
If I choose to be a DNR I think I will have it tattooed on my forehead. At least there won't be any mistake as to my intentions should the question arise.
What about you? Are there situations you have experienced or teachings and religious beliefs that influence what you believe? Have you ever watched someone die and then, reawaken and express that she is really pissed after she was resuscitated because her DNR status was not respected and she would have to die again? I have.
Are you afraid to have the conversation periodically and let others know what YOU want?
Sherry
Friday, August 28, 2009
Wednesday, August 19, 2009
It Takes a Village to Preserve the Dignity of our Elders
I was involved in home care with a couple of different agencies for two and a half years. It can be a real eye-opener seeing how people cope, or don't, with their limitations and limited resources.
I was sent in to evaluate and draw blood work on a gentleman who was was very frail and malnourished. He was absolutely selfless in his care of his wife who had suffered a stroke. He lifted her in and out of bed into her wheelchair, did the cooking and his home was filled to excess with piles of clean laundry and bags of trash. He really needed help but he did have some interesting ways of getting things done. I enjoyed how he used his pliers and other handyman tools to cut up medication for his wife. It was not so amusing to see what kinds of food they were eating and it was a struggle to get him to accept care for himself. He constantly tried to get me to do things for his wife instead of him.
Families can be the reason the sick, disabled or elderly person lives well or struggles. I took care of a gentleman who was unable to go up and down stairs without a valiant effort and a lot of help from his sons. He was "trapped" in an apartment over a garage. In the winter ice would freeze up the stairs and it was a dangerous climb to get to him. His family was slowly remodeling the "basement" area of this structure so he could live down there and be a little more able to get out and do for himself. They were good kids! Unfortunately he died before the work was done. :^(
In the same neighborhood I had another patient who was very very fragile. He was a 92 year old widower living alone. Every day I would go into his home and find him with new skin tears, bumps and bruises. He got meals on wheels and split the food between lunch and dinner and that was about the only part of his situation that "worked." He had four grown children, some of whom lived in the same town, and they did not visit or help out. The furnishings and decor were from the seventies. Even the dust was from the seventies.
I found him one day making out his bills and discovered that it took him hours to write a couple of checks to pay bills. He had trouble seeing and holding a pen but somehow managed. He struggled to read the small print on his bills and it was just such a sad thing. I wondered why someone didn't come by and do this chore for him once a month. There were doorstops on the floor to trip over, too heavy for me to lift and I finally picked up on the fact that when he sat on the side of his bed in the morning he slid right out onto the floor.
Every time I visited him I had to call his doctor, write orders for antibiotics and bandages and call his family. There was never a visit that didn't include a patch up job. Eventually we had to discharge him from home care, with the cooperation of his doctor, because his children had decided they didn't need to help out because "he has a nurse." These home visits are typically from half an hour to an hour, more in an emergency but certainly not a substitute for a caregiver. Sometimes, much as you hate it, you have to discharge a patient from home care because you are "perpetuating an unsafe situation."
Much of our society has become very independent and interdependence is eschewed as being too much trouble, not any fun or interfering with the privacy of the more able bodied people in the extended family. I have heard people say "I have my own family to take care of," and not think another word about it. I fume because I imagine that these parents did selfless things for their children like keep them alive until they could care for themselves....... that's a rant for another time.
Cliche, maybe but it does take a village....... to preserve the dignity of our elders.
I was sent in to evaluate and draw blood work on a gentleman who was was very frail and malnourished. He was absolutely selfless in his care of his wife who had suffered a stroke. He lifted her in and out of bed into her wheelchair, did the cooking and his home was filled to excess with piles of clean laundry and bags of trash. He really needed help but he did have some interesting ways of getting things done. I enjoyed how he used his pliers and other handyman tools to cut up medication for his wife. It was not so amusing to see what kinds of food they were eating and it was a struggle to get him to accept care for himself. He constantly tried to get me to do things for his wife instead of him.
Families can be the reason the sick, disabled or elderly person lives well or struggles. I took care of a gentleman who was unable to go up and down stairs without a valiant effort and a lot of help from his sons. He was "trapped" in an apartment over a garage. In the winter ice would freeze up the stairs and it was a dangerous climb to get to him. His family was slowly remodeling the "basement" area of this structure so he could live down there and be a little more able to get out and do for himself. They were good kids! Unfortunately he died before the work was done. :^(
In the same neighborhood I had another patient who was very very fragile. He was a 92 year old widower living alone. Every day I would go into his home and find him with new skin tears, bumps and bruises. He got meals on wheels and split the food between lunch and dinner and that was about the only part of his situation that "worked." He had four grown children, some of whom lived in the same town, and they did not visit or help out. The furnishings and decor were from the seventies. Even the dust was from the seventies.
I found him one day making out his bills and discovered that it took him hours to write a couple of checks to pay bills. He had trouble seeing and holding a pen but somehow managed. He struggled to read the small print on his bills and it was just such a sad thing. I wondered why someone didn't come by and do this chore for him once a month. There were doorstops on the floor to trip over, too heavy for me to lift and I finally picked up on the fact that when he sat on the side of his bed in the morning he slid right out onto the floor.
Every time I visited him I had to call his doctor, write orders for antibiotics and bandages and call his family. There was never a visit that didn't include a patch up job. Eventually we had to discharge him from home care, with the cooperation of his doctor, because his children had decided they didn't need to help out because "he has a nurse." These home visits are typically from half an hour to an hour, more in an emergency but certainly not a substitute for a caregiver. Sometimes, much as you hate it, you have to discharge a patient from home care because you are "perpetuating an unsafe situation."
Much of our society has become very independent and interdependence is eschewed as being too much trouble, not any fun or interfering with the privacy of the more able bodied people in the extended family. I have heard people say "I have my own family to take care of," and not think another word about it. I fume because I imagine that these parents did selfless things for their children like keep them alive until they could care for themselves....... that's a rant for another time.
Cliche, maybe but it does take a village....... to preserve the dignity of our elders.
Tuesday, August 18, 2009
What is Basic Medical Care?
The definition of basic medical care is probably a little different from one provider to another and from one consumer/patient to another.
It would require coordination and cooperation across the medical community from government and public health services to community and private practices.
Feel free to comment and add your own ideas.
Basic medical care must include periodic medical exams, provision of first aid and medications to relieve pain and suffering and conditions such as infection. It should include simple xrays to diagnose fracture for example.
Medication such as inhalers to ease breathing would also be included. Assistance with birthing would be covered when provided by persons trained in and skilled at that type of care.
In addition to this immunizations and/or testing to prevent/detect common childhood diseases and diseases that occur in captivity or close quarters should be included. This would include vaccines against whooping cough and testing to diagnose tuberculosis. It would also include access to birth control information and medication and condoms.
I would include extraction of broken or diseased teeth in basic medical care as well.
Educational instruction regarding hygiene/sanitation, nutrition would be provided as well as family planning, if requested.
I would encourage end of life care discussions... way ahead of time.
Psychiatric screenings and access to counseling would also be part of basic care.
Some surgeries would be covered such as emergency ceasarian sections.
I suppose the larger debate would be on what would not be covered. If certain procedures and medications and care are "basic" then it begs the question of what is "advanced" or "intermediate" and beyond the scope of basic medical care. Who gets to decide?
What are your thoughts?
It would require coordination and cooperation across the medical community from government and public health services to community and private practices.
Feel free to comment and add your own ideas.
Basic medical care must include periodic medical exams, provision of first aid and medications to relieve pain and suffering and conditions such as infection. It should include simple xrays to diagnose fracture for example.
Medication such as inhalers to ease breathing would also be included. Assistance with birthing would be covered when provided by persons trained in and skilled at that type of care.
In addition to this immunizations and/or testing to prevent/detect common childhood diseases and diseases that occur in captivity or close quarters should be included. This would include vaccines against whooping cough and testing to diagnose tuberculosis. It would also include access to birth control information and medication and condoms.
I would include extraction of broken or diseased teeth in basic medical care as well.
Educational instruction regarding hygiene/sanitation, nutrition would be provided as well as family planning, if requested.
I would encourage end of life care discussions... way ahead of time.
Psychiatric screenings and access to counseling would also be part of basic care.
Some surgeries would be covered such as emergency ceasarian sections.
I suppose the larger debate would be on what would not be covered. If certain procedures and medications and care are "basic" then it begs the question of what is "advanced" or "intermediate" and beyond the scope of basic medical care. Who gets to decide?
What are your thoughts?
Saturday, August 15, 2009
My Prescription Costs How Much???
Every day innumerable prescriptions are written and placed in the hands of patients. What happens next? This vignette explains what happens commonly in this country.
Keep in mind I have a great deal of experience in medications used to treat illness and a familiarity with the current costs of most medications due to my current career experience. Joe may be fiction but the prices are not.
Joe is a 57 year old diabetic. He has been given prescriptions for insulin, syringes, lancets, a glucose machine, test strips and two oral medications from his doctor. He goes to his local pharmacy and drops off the prescriptions.
When he goes to pick them up he realizes that the cost is going to be in the neighborhood of $30.00 for the machine, at least $60.00 for the test strips for a month, 10.00 for the lancets, 7.00 for the syringes, oral medications (basic $4.00 department store pharmacy to hundreds of dollars for many others on the market) and Insulin (cost is just over $40.00 per vial for regular insulin to hundreds of dollars per vial for other types of insulin).
The very least he will spend for that month's worth of medicine and testing supplies is $115.00. Most likely his pills won't be amongst the low cost offerings at the department store and his insulin will cost much more than the example. Most diabetic meds are not offered on the low cost formularies.
He will also have an office visit to pay for and, due to the usual co-morbidities found with diabetes, down the line will be paying for medication to control cholesterol and blood pressure and his doctor will most likely prescribe medication with a dual purpose that tends to protect the kidneys from the ravishes of diabetes.
So....... what happens when the consumer has good insurance? He has a copay of ten or twenty dollars a prescription. He might think he's paying too much but having insurance brings the bill down significantly. If he accepts generics, where available, it will save him money.
Now...... what happens when the consumer has no insurance? If he has a job or a source of income and can afford it he may get the ones on the department store formularies and skip the insulin and testing supplies. If the doctor instructed him to test his blood sugar three times a day he may only test once. He makes decisions based on a analysis of his resources.
If he doesn't have a job, has a low paying job or has to spend every last penny on food, shelter and utilities he may skip purchasing the medications altogether.
Choosing either of these two options leads to undesirable outcomes. Depending on the coping skills available to the consumer he may become depressed or angry due to his inability to take care of himself. Not controlling his blood sugar has health consequences too.
If he applies for a new job to improve his income there is commonly a waiting period of several months and some limit coverage of pre-existing health problems.
In home care I met creative husband and wife teams who shared medications or who changed their every twenty-four hour meds to a thirty-six or forty-eight hour schedule.
If Joe cannot afford his medications what might I suggest to help Joe and his doctor? They should review printouts of the available formularies from all the major department stores and drugstore chains in the office since many have plans to cover the older, tried and true, cheaper medications.
Joe's doctor should know the approximate costs of the drugs he prescribes After all he is the main person who can determine if a cheaper (more affordable) drug is metabolically equivalent.
The doctor's office should have a list of the most current resources to help patients get meds at reduced cost or free. Some manufacturers have programs to apply to. Some doctors and nurses do provide this info and some are unaware that such resources exist.
The doctor must ask the patient about his insurance or ability to pay for medication. Many doctors do not have this conversation with their patients. Nurses are good at ferreting out this sort of information.
If this discussion doesn't occur Joe may not tell his doctor he cannot afford to fill the scripts. If his labs or exam results are bad the doctor may whip out his prescription pad and write for yet more medication that Joe cannot afford. Joe may be labeled as "non-compliant" when that isn't the true reason for him not following his doctors instructions.
The system is broken. It works for some people and against many others. We need to find ways to fix that.
Keep in mind I have a great deal of experience in medications used to treat illness and a familiarity with the current costs of most medications due to my current career experience. Joe may be fiction but the prices are not.
Joe is a 57 year old diabetic. He has been given prescriptions for insulin, syringes, lancets, a glucose machine, test strips and two oral medications from his doctor. He goes to his local pharmacy and drops off the prescriptions.
When he goes to pick them up he realizes that the cost is going to be in the neighborhood of $30.00 for the machine, at least $60.00 for the test strips for a month, 10.00 for the lancets, 7.00 for the syringes, oral medications (basic $4.00 department store pharmacy to hundreds of dollars for many others on the market) and Insulin (cost is just over $40.00 per vial for regular insulin to hundreds of dollars per vial for other types of insulin).
The very least he will spend for that month's worth of medicine and testing supplies is $115.00. Most likely his pills won't be amongst the low cost offerings at the department store and his insulin will cost much more than the example. Most diabetic meds are not offered on the low cost formularies.
He will also have an office visit to pay for and, due to the usual co-morbidities found with diabetes, down the line will be paying for medication to control cholesterol and blood pressure and his doctor will most likely prescribe medication with a dual purpose that tends to protect the kidneys from the ravishes of diabetes.
So....... what happens when the consumer has good insurance? He has a copay of ten or twenty dollars a prescription. He might think he's paying too much but having insurance brings the bill down significantly. If he accepts generics, where available, it will save him money.
Now...... what happens when the consumer has no insurance? If he has a job or a source of income and can afford it he may get the ones on the department store formularies and skip the insulin and testing supplies. If the doctor instructed him to test his blood sugar three times a day he may only test once. He makes decisions based on a analysis of his resources.
If he doesn't have a job, has a low paying job or has to spend every last penny on food, shelter and utilities he may skip purchasing the medications altogether.
Choosing either of these two options leads to undesirable outcomes. Depending on the coping skills available to the consumer he may become depressed or angry due to his inability to take care of himself. Not controlling his blood sugar has health consequences too.
If he applies for a new job to improve his income there is commonly a waiting period of several months and some limit coverage of pre-existing health problems.
In home care I met creative husband and wife teams who shared medications or who changed their every twenty-four hour meds to a thirty-six or forty-eight hour schedule.
If Joe cannot afford his medications what might I suggest to help Joe and his doctor? They should review printouts of the available formularies from all the major department stores and drugstore chains in the office since many have plans to cover the older, tried and true, cheaper medications.
Joe's doctor should know the approximate costs of the drugs he prescribes After all he is the main person who can determine if a cheaper (more affordable) drug is metabolically equivalent.
The doctor's office should have a list of the most current resources to help patients get meds at reduced cost or free. Some manufacturers have programs to apply to. Some doctors and nurses do provide this info and some are unaware that such resources exist.
The doctor must ask the patient about his insurance or ability to pay for medication. Many doctors do not have this conversation with their patients. Nurses are good at ferreting out this sort of information.
If this discussion doesn't occur Joe may not tell his doctor he cannot afford to fill the scripts. If his labs or exam results are bad the doctor may whip out his prescription pad and write for yet more medication that Joe cannot afford. Joe may be labeled as "non-compliant" when that isn't the true reason for him not following his doctors instructions.
The system is broken. It works for some people and against many others. We need to find ways to fix that.
What Makes You Special?
I speak with people from across the country about health care programs, delivery of service, availability and cost and there is an underlying theme to much of the discussion. I DESERVE the best. Well, I ask, what about those other guys?
We live in such a selfish culture.
In the mainstream news, print, e-print and television the magic number 47,000,000 million is cited repeatedly as the number of people in the United States that do not have any type of healthcare coverage. I don't know if I care if the number is correct or if it is half that. I know that many health care dollars are wasted on cover your butt care and that waste is built into the system. Meanwhile, people are suffering and dying from lack of care.
When a person does not have basic coverage to see a family doctor many things can happen. Here is what I've seen. Some wait, hoping to feel better. Many use home remedies and hope to feel better. Others run off to the ER at the first sign of illness while others are rushed to the ER when a fulminating illness breaks loose like a festering wound. I think watchful waiting and home remedies are fine but when that doesn't work, and before someone ends up terribly sick, there should be other options. Our emergency rooms should not be used for basic health care.
Some hospitals have a fast track option and a nurse or other health care professional will do an intake triage and point the person in the right direction. If it appears you are having a heart attack or your toe fell off you get rolled into the emergency room area. Otherwise, if you have a fever and feel crummy and don't appear overtly contagious you get sent to the fast track clinic.
This triage is cost driven but it also keeps you from spending time in an area of the hospital that is more likely to have contagion, trauma and long wait times. Whether people like it or not resources are parsed out to make the best use of skills, time and money.
Still, either of these options will probably cost more money than if you could call up your own doctor and be seen by someone who has gotten to know you. When people drift from one provider to another continuity of care is lost and sometimes the bigger picture is harder to see. Having an ongoing relationship with your health care provider might save your life.
I said we have a selfish culture. What makes your need outweigh the needs of others when it comes to getting coverage and care? Are you smarter, richer, more disabled, older, younger........
What makes you special? Our society devalues the elderly, the fat, the homeless, the poor, the homely, the addicted, the unkempt, the undereducated, the alcoholic, the mentally ill and the chronically ill. (Thanks Eric for the edit)
"Well, they did it to themselves...." is a popular comment on why some people don't deserve care. What secrets about what you do are you hiding? What makes you special?
There are medical procedures and care I would prefer, on a philosophical level, not to have my taxes fund. But, being a realist, for the basics of care it doesn't matter.
Having basic health care should not be a privilege in this country. And people need to focus on more than themselves. Use those skills you learned in kindergarten. Share. Care.
We live in such a selfish culture.
In the mainstream news, print, e-print and television the magic number 47,000,000 million is cited repeatedly as the number of people in the United States that do not have any type of healthcare coverage. I don't know if I care if the number is correct or if it is half that. I know that many health care dollars are wasted on cover your butt care and that waste is built into the system. Meanwhile, people are suffering and dying from lack of care.
When a person does not have basic coverage to see a family doctor many things can happen. Here is what I've seen. Some wait, hoping to feel better. Many use home remedies and hope to feel better. Others run off to the ER at the first sign of illness while others are rushed to the ER when a fulminating illness breaks loose like a festering wound. I think watchful waiting and home remedies are fine but when that doesn't work, and before someone ends up terribly sick, there should be other options. Our emergency rooms should not be used for basic health care.
Some hospitals have a fast track option and a nurse or other health care professional will do an intake triage and point the person in the right direction. If it appears you are having a heart attack or your toe fell off you get rolled into the emergency room area. Otherwise, if you have a fever and feel crummy and don't appear overtly contagious you get sent to the fast track clinic.
This triage is cost driven but it also keeps you from spending time in an area of the hospital that is more likely to have contagion, trauma and long wait times. Whether people like it or not resources are parsed out to make the best use of skills, time and money.
Still, either of these options will probably cost more money than if you could call up your own doctor and be seen by someone who has gotten to know you. When people drift from one provider to another continuity of care is lost and sometimes the bigger picture is harder to see. Having an ongoing relationship with your health care provider might save your life.
I said we have a selfish culture. What makes your need outweigh the needs of others when it comes to getting coverage and care? Are you smarter, richer, more disabled, older, younger........
What makes you special? Our society devalues the elderly, the fat, the homeless, the poor, the homely, the addicted, the unkempt, the undereducated, the alcoholic, the mentally ill and the chronically ill. (Thanks Eric for the edit)
"Well, they did it to themselves...." is a popular comment on why some people don't deserve care. What secrets about what you do are you hiding? What makes you special?
There are medical procedures and care I would prefer, on a philosophical level, not to have my taxes fund. But, being a realist, for the basics of care it doesn't matter.
Having basic health care should not be a privilege in this country. And people need to focus on more than themselves. Use those skills you learned in kindergarten. Share. Care.
Discussing the End of Life
It's no secret that we all die. But it is not uncommon for people to shield themselves from the great unknown. Our society puts youth on a pedestal and caters to it as if it were a goddess.
There are creams, injections, weight loss programs, make up, hair replacements, hair coloring, exercise machines that purport to do all the work, medications and a host of other youth chasing remedies to ward off disability, aging and death.
How many people shield their children from the death of the elders? Some children are led to believe that Grandma went on vacation when in all reality she died. I have known people who "refused to damage" their children by allowing them to attend a funeral of a grandparent.
It is very common to say that one has gone on "to his reward" or "passed away." These are well known euphemisms for death. When cloaking the reality in vague terms such as these people unconsciously push death away. When children are "protected" from the truth the process robs them of the richness of participating fully in the circle of life. When we avoid the conversation we cheat ourselves. We cheat our families and our friends.
We also have a very self-oriented society and a culture of false self-esteem. People are rewarded for doing things halfway and hit brick walls when they seek the approval of larger society where others are mirrors. It's quite amusing at times and downright disgusting at others. It is time to put the selfishness aside.
We are all going to die. It is not necessary to dwell on it but it is important to discuss it if only to make sure our loved ones - our decision makers - know what to do if the time comes when we cannot speak for ourselves.
Do you have a living will or a healthcare power of attorney? I do.
I don't intend to get into the various cultural and religious reasons for the choices people make at the end of life. There are those who want "life at all cost." There are others who only want to die once. I met someone who survived a code and got an earful of accusations as she lamented she would have to die again. There are those who believe that quality of life is the most important thing.
You don't get to choose for everyone. You get to decide what YOU want, communicate it and move on with your life. Best part of this is if you document what you want you might actually get it instead of being at the mercy of another's decisions. I have had discordant conversations where an elderly person has said "I've had a good life. If I die, let me go." Ten minutes later out in the hallway the son or daughter is saying "Mom's out of her head." Occasionally Mom might be out of her head but mostly Mom knows what she wants and the kids have a hard time accepting it.
There is nothing like discussing the decision, with my family, on what to do after my mother lay critically ill from burns she suffered in a house fire. She wasn't getting better but I had the knowledge of what she would most likely choose from things she had said to me about "her time." I knew what she didn't want. That helped.
Don't you want the important people in your life to know? Discussion brings enlightenment and clarity to the murkiness of fear in a culture that ignores and disenfranchises those that do not glow with youthfulness.
Stop being afraid.
There are creams, injections, weight loss programs, make up, hair replacements, hair coloring, exercise machines that purport to do all the work, medications and a host of other youth chasing remedies to ward off disability, aging and death.
How many people shield their children from the death of the elders? Some children are led to believe that Grandma went on vacation when in all reality she died. I have known people who "refused to damage" their children by allowing them to attend a funeral of a grandparent.
It is very common to say that one has gone on "to his reward" or "passed away." These are well known euphemisms for death. When cloaking the reality in vague terms such as these people unconsciously push death away. When children are "protected" from the truth the process robs them of the richness of participating fully in the circle of life. When we avoid the conversation we cheat ourselves. We cheat our families and our friends.
We also have a very self-oriented society and a culture of false self-esteem. People are rewarded for doing things halfway and hit brick walls when they seek the approval of larger society where others are mirrors. It's quite amusing at times and downright disgusting at others. It is time to put the selfishness aside.
We are all going to die. It is not necessary to dwell on it but it is important to discuss it if only to make sure our loved ones - our decision makers - know what to do if the time comes when we cannot speak for ourselves.
Do you have a living will or a healthcare power of attorney? I do.
I don't intend to get into the various cultural and religious reasons for the choices people make at the end of life. There are those who want "life at all cost." There are others who only want to die once. I met someone who survived a code and got an earful of accusations as she lamented she would have to die again. There are those who believe that quality of life is the most important thing.
You don't get to choose for everyone. You get to decide what YOU want, communicate it and move on with your life. Best part of this is if you document what you want you might actually get it instead of being at the mercy of another's decisions. I have had discordant conversations where an elderly person has said "I've had a good life. If I die, let me go." Ten minutes later out in the hallway the son or daughter is saying "Mom's out of her head." Occasionally Mom might be out of her head but mostly Mom knows what she wants and the kids have a hard time accepting it.
There is nothing like discussing the decision, with my family, on what to do after my mother lay critically ill from burns she suffered in a house fire. She wasn't getting better but I had the knowledge of what she would most likely choose from things she had said to me about "her time." I knew what she didn't want. That helped.
Don't you want the important people in your life to know? Discussion brings enlightenment and clarity to the murkiness of fear in a culture that ignores and disenfranchises those that do not glow with youthfulness.
Stop being afraid.
Friday, August 14, 2009
Ideas not Answers
With the waging of ugly misinformation campaigns being reported in the news I ponder what the average person really knows about the underpinnings of different parts of the health care system. There is a lot I don't know but I have an insider's view of the hospital and the work comp components. Having worked home health I have also toured a lot of homes. Sometimes the "system" works but there are many reasons why it doesn't.
I don't think it's possible to overhaul the complex network of systems that dovetail into each other but we can certainly look at ways of tweaking what we already have. Being bold and assessing the current positives and negatives is a good way to start. This doesn't require huge committees of shirts but should include those in the trenches. The ones receiving the care and the ones providing the care know the problems intimately.
Change is hard to deal with. It's scary. But if we don't emphasize what works and be brave and move away from what doesn't then the number of people in this country who don't have even the most basics is going to increase.
Don't underestimate the value of the care. Nurses tend to operate from a perspective of care. Many doctors have been trained to operate from a perspective of cure. Sometimes cure isn't possible. We are all going to die some day.
I don't think it's possible to overhaul the complex network of systems that dovetail into each other but we can certainly look at ways of tweaking what we already have. Being bold and assessing the current positives and negatives is a good way to start. This doesn't require huge committees of shirts but should include those in the trenches. The ones receiving the care and the ones providing the care know the problems intimately.
Change is hard to deal with. It's scary. But if we don't emphasize what works and be brave and move away from what doesn't then the number of people in this country who don't have even the most basics is going to increase.
Don't underestimate the value of the care. Nurses tend to operate from a perspective of care. Many doctors have been trained to operate from a perspective of cure. Sometimes cure isn't possible. We are all going to die some day.
Thursday, August 13, 2009
The Haves and Haves Not
Millions of people in the United States do not have health insurance. Others have inadequate or limited plans. How is it that the citizens of the land of plenty and opportunity can be happy with the fact that almost fifty million people are at risk? There are many reasons ranging from economic to a belief culture of it-won't -happen-to-me to lack of availability. I think that change is hard. But not changing has more consequences.
Some cannot afford to pay while others had insurance and lost their jobs and the insurance that was provided with it. Some employers do not offer health insurance benefits and self-employed or entrepreneurs may find themselves priced out of the market.
Some people cannot envision a time or an incident that might result in illness or disability. They can afford it but do not bother to enroll or may miss payments.
Some cannot find insurance at any cost due to pre-existing conditions.
If you don't have insurance do you sweat it or do you just figure that there's always the ER. I mean....... this is America...... they won't turn me down.....
Some cannot afford to pay while others had insurance and lost their jobs and the insurance that was provided with it. Some employers do not offer health insurance benefits and self-employed or entrepreneurs may find themselves priced out of the market.
Some people cannot envision a time or an incident that might result in illness or disability. They can afford it but do not bother to enroll or may miss payments.
Some cannot find insurance at any cost due to pre-existing conditions.
If you don't have insurance do you sweat it or do you just figure that there's always the ER. I mean....... this is America...... they won't turn me down.....
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