not for the faint of heart...4-6-20

Captivated by a headline:  A Brooklyn I.C.U. Fighting for Each Life   I sipped a steaming cuppa, sank into the nightmare of front line health care delivery.  Because this is my work.  Health care delivery.  And I really wanted to know what the reality was out there.  This bird’s eye read fundamentally shifted my perspective.  Contributing to this shift is my formidable opinion about the state of our national health care delivery.  An opinion that has been brewing for decades. 

After more than thirty years working within it’s confines, doing my damn-dest to create change from within, I exited in 2005.  The time required to grovel, manipulate and finagle with prescribing physicians and insurance providers simply to offer uncompromised quality service…well, it was eroding my soul in ways I could no longer bear. The delivery system was so obviously, and in many ways corruptly, broken.  I was done.  The last fifteen years have been dedicated to forging my own way of providing.

But my history and sometimes my treatment is intimately tied to the mainstream so I remain fascinated.  The Brooklyn story illuminates much more than how we are dealing with this pandemic.  The huge scope of the current situation casts a much broader light, if we’re willing to look.  This mandate to “fight for each life”, is this really the utmost goal of health care delivery in the midst of this chaos?  How did this become our national medical imperative?  When did death become a failure?  

In so many culturally pervasive ways we have willingly traded our vitality for security.  We have propped ourselves into a corner with health care insurance, pensions, life insurance, financial planning, car insurance.  We work ourselves to the bone to insure that we will never be uncomfortable.  At the very bedrock of this?  Underneath this frantic scramble?  Our squeamish unwillingness to face our own mortality.   To that end we have unwittingly fostered a health care delivery system built to insure that everything possible will be done to “fight for each life”.

Also in the New York Times, What You Should Know Before You Need a Ventilator.  Recommended read if you think that this device will surely save you.  This contraption that is in such “short supply”.  Of course there are not enough.  It is simply the next unreasonable way to insure that we will all live through this.  We won’t.  And if our health care delivery follows the Brooklyn model we will lose an irreplaceable resource: countless incredibly dedicated medical personnel.  People who could be guiding us with a different logic, a rationale much broader than most of us are willing to bear.

I know what I am about to say is controversial.  Will be uncomfortable to hear.  Goes against the grain of what we’ve been spoonfed.  But here’s my dream: a cadre of skilled medical personnel in every community dedicated to triage.  What’s triage?  The assignment of degrees of urgency to decide the order of treatment for a large number of patients.  Some people need help fighting for life.  Let’s provide that.  Some people need palliative care.  What is palliative care? Relieving pain without dealing with the cause or cure of the condition.  Not every person in respiratory distress needs to be intubated for a ventilator, a treatment so painful that medical coma induction is a necessity.  Medicine has come light years in the area of skilled relief of physical suffering at end of life.  If we decide to resource this other outcome, we can mitigate suffering.  Let’s provide that.

I’m sorry.  But this is the time, if you haven’t already, to read about advanced care directive   I am particularly fond of Five Wishes  with it’s simple straightforward language.  Become informed.  Then make two concrete moves: have a directive on file in your medical record.  But more important, because it is your loved ones and family that will be present to make these hard decisions, have those difficult conversations.  Make your wishes known.

I’m done now.  I remain dedicated to healing and this felt like the best offering I could make in this moment.  Thank you for reading all the way to this point.  I have so much more I want to write about that is incredibly positive.  I am feeling that as well.  But this is what I need to say this morning.  Be well.  Take care.  Be informed.

In the service of love,
Bella