Health Care Debacle

I have to say, if this is "Change You Can Believe In", I might need to drag GWB back into office. I'm about as progressive as they come, but there is something real to this whole Scott Brown/Massachusetts backlash/potential collapse of the health care bill.

Leave it to Congress to produce something no one has read, understands or cares about. To produce something that does little to control entitlement cost and growth. Something that does little to help tort reform. Almost nothing to deal with the perverse incentives for physicians and hospitals that underlies the cost and poor quality of our system.

Rather, it's a bit of a grab bag of giveaways to various lobbying groups, from Pharma, to Hospitals, to Docs to Insurance.

It lacks VISION.

Obama has not done a good job communicating a VISION of what health care in this country should look like. What "health" is. What our collective responsibilities are as a nation.

It's just ripping on insurance companies and Pharma and the usual suspects while defending lawyers and poor physician behavior.

There is an amazing documentary from PBS, called "Sick Around the World", where several health systems in other countries are profiled and analyzed for their strengths and weaknesses vis-à-vis the U.S.

There has been so little discussion in this debate about what we can learn from other nations about 1) why they have as good or better health outcomes and 2) why it's so much cheaper there.

Whether Obama rams some bill through at this point or not, it ceases to matter to me. The essential poor incentives of our capitalistic health delivery system will remain. We will all adapt and try to change our behavior to maximize revenue while only distantly caring about the health of real people. There will be little incentive for individuals to take their own health care choices seriously. The system will continue to teeter on the edge of financial insolvency.

Until it all collapses, that is.

Then we'll all really believe that there is "change".

Nurse C.

Caring for cancer patients is hard enough. Caring for someone that you work with is that much harder. I suppose caring for a loved one that you work with would be the ultimate in emotional pain, but thankfully, I have yet to experience that one.

K.C. is... or, as of this morning, was a 50 year old patient of mine with metastatic ovarian cancer. She worked as a floor nurse in Oncology at the hospital where I attend. A wonderful woman. Just a positive ray of sunshine for anyone who knew her. A family woman. Kind and loving husband. Wonderful teenage children. Loving.

Just the kind of person who dies.

Diagnosed in 2007 with stage III ovarian cancer (the most common presentation), she had the usual surgery and chemotherapy. Like so many woman with her condition, she recurred within a year or so.

Not a good sign.

Since she was young, we switched into "aggressive" mode. Even though she and I both knew that this was not curable, we seemed to dance around the issue during our visits. She was upbeat, I tried to be.

What was most disturbing was running into her on the floor at work while she was on chemo.

Do we talk about HER cancer? What about our common patients? Everyone on the floor of this community hospital is pretty tight.

Oh, and did I mention that I take care of two or three other cancer patients on the same floor?

Anyway.

She died this morning. It's a long story. Multiple rounds of chemo, blah, blah.

A salvage "second look" surgery.

Wound dehiscence. Infection. Progression. Sepsis. Multiorgan failure. Withdrawal.

She came back to our floor from a tertiary center where she had the surgery in order to die.

She wanted to be cared for by her own nurse colleagues and to die where she worked for so many years.

Thank you K.C. for reminding me that we are all frail and mortal. That we can face our fate with dignity and courage and love.

You were a very special person and I was honored to be your physician.

Godspeed.

The Fear That Kills

I just saw a 50 year old woman with a large 7 cm right breast mass and a scan that shows her liver and bones to be riddled with tumor.

Breast cancer. Metastatic.

She's very intelligent. Pretty. Educated.

Oh, did I mention that she's a nurse?

WTF?

Divorced, living alone, she knew that this was cancer. She knew she should have it examined and biopsied. But, she was afraid.

She noticed it a year ago... that's right. ONE YEAR AGO.

It was small then. It was probably curable and early stage. Just like so many other women. Just one of the "1 in 9" that get it.

I can't tell you how many times I've seen this in patients. Not just the subtle weight loss or a nagging ache in the spot of an old injury.

No.

I'm talking about large mass coming out of the breast or skin or neck or leg.

I'm talking about bleeding, ulcerating, fungating wounds that any child could tell are wrong.

Denial.

I am so averse to the excessively nervous segment of the world, the worryworts, that I sometimes forget about the other end of the spectrum.

The deniers. The minimizers. The people who fail to accept their illness, their sickness, their cancer.

And, it kills them.

I'm not sure anything could have been done in this case. She is an intelligent person in health care. She should have known better.

But, she, despite being very functional and successful on the surface, must have had some feelings of loneliness and desperation that she was unable to communicate. She must not have had anyone to trust or rely upon to tell her fears to.

She was afraid of the diagnosis.

Now, the diagnosis will kill her.

Love

Love is an ephemeral thing. It swoops in, takes charge of your existence, turns on a form of madness in your brain and then often leaves you exhausted.

Love is passion, heat and whispers, mumbling and smooth textures. It burns.

Love is hot. That is, before it goes cold and unfeeling.

Love is nurturing. Maturing. Snuggling. Cuddling.

Love is nursing. Touching the neck. Sweeping the hair back.

Love is loyal. Sometimes. Sometimes it is deceitful.

Love is gain.

Love is loss.

Love is what we all aspire to have.

Love is what makes us all miserable.

Love is dedication. It is pure. It is good.

Love is betrayal. It is base. It is evil.

I have been fortunate in life to have loved deeply, to have lost love, to have spurned and been spurned by love. I have run away from it as much as towards it. I fear it.

Is love all there is to hope for?

Or is it something that we will never fully feel or attain? I don't know sometimes.

I don't know.