Miracles and Madness,
Life and Death in Our Health Care System

By Larry Sherber

March 3, 2006 started out as a day filled with promise and excitement; the kind of day that, even if I was lucky, I would only experience a few precious times in my entire life. For on that day my oldest daughter Kim was to have labor induced in order to give birth to my second grandchild. The pregnancy had been a nightmare; in and out of the hospital and the doctor's office, in and out of strict bed rest and partial bed rest for months. Kim had her first child delivered by a midwife 3 years before and was planning the same for her second; but fate stepped in. The midwife that had followed her through the entire pregnancy was called out of town with a family emergency, so, rather than wait, Kim decided to have the on-call doctor, who she barely knew, deliver the baby. The process started in the morning at Northside Hospital, the most productive baby factory in the free world. Around midday a young blonde female bounced into our private delivery room and introduced herself as Dr. Leader. I wondered if the name "Leader" was short for "cheerleader", because that was exactly what she looked like; one in about the 11th grade. I envisioned her using pom poms to deliver my grandchild. Later in the afternoon, as the monitors were telling us that we were soon to have a new little visitor, my daughter turned pale, said she was not feeling well, and asked all her family and friends that had filed in during the day to please leave the delivery room. What occurred soon after was a scene that nightmares are made of. The baby's heartbeat dropped sharply along with my daughter's blood pressure. Luckily the quick-thinking Dr. Leader was in the room in time to make a hasty delivery that may have prevented a catastrophe for our diminutive newcomer, Mary Alice. Unfortunately, we were not out of the woods yet. My daughter spent the night in terrible pain and it was not until the middle of the next day that it was discovered that just before the delivery her uterus had ruptured, along with a major blood vessel, causing her to lose over a liter of blood through internal bleeding. Abdominal surgery saved Kim's life and today I have a mended daughter and a beautiful, healthy granddaughter with more hair than King Kong. A happy ending! A few short months later, in another Atlanta hospital, a young woman experienced the same problem. They rushed her into surgery to perform a c-section, but the baby was stillborn. Because of the rarity of the condition, the ruptured uterus again went undiagnosed. But this time the internal bleeding was worse and the mother was lost as well. A tragic ending! I suspect the thought of what might have been will haunt me for the rest of my life. Even though I know it serves no purpose except to cause myself great mental anguish, it has been impossible for me not to ask the question "Why that unfortunate woman and her baby and not Kim and Mary Alice?" Could it be the work of a loving, vengeful, or even an indifferent God? I don't think so! A devout Christian could explain it by saying "God works in mysterious ways and it's not our place to ask these kinds of questions." Another might use the Calvanistic doctrine: if you are a good person God will favor you with His blessings, implying that Kim and Mary Alice must have been good and the other woman and her child must have been bad. Hell, I'm a Unitarian and those answers just don't fly with me. As was pointed out at one of our Sunday services; we're more comfortable with words that have 4 letters than those with only 3. No, after much soul searching, I have come to the uncomfortable conclusion that sometimes life changing events can only be explained as: blind luck, pure chance, fate, destiny, Kismet, Karma, predestination, predetermination, inevitability, a turn of the wheel, the hand you were dealt, a cross to bear, a row to hoe, a crap shoot, the fall of the dice &ndsah; take your pick. Maybe the stars and planets were all aligned in the right sequence causing the midwife's grandfather to have a heart attack, allowing our cheerleader to do the right thing at the right time; also causing the blood vessel that burst in my daughter's abdominal cavity to bleed slow enough for her life to be saved. Scary to think how fragile life really is!

Now that things are back to normal and I can look at the events of the past months with more rationality and less emotion, it has occurred to me that these medical life and death situations are occurring continuously, probably some at this very moment. This has started me thinking about our health care system, and look out when a loquacious Unitarian such as myself starts thinking about a topic as complex and important as health care. To keep this discussion from getting out of control, today I'd like to talk about 2 subjects: 1) Understanding some of the dynamics driving our health care system and its unequal distribution in our populace, and 2) Some end-of-life issues that are becoming more important as our population ages. First, my customary disclaimer: my experience as a health care professional (only a dentist &ndsah; not a real doctor) and my training as a medical sociologist give me just enough knowledge to be dangerous, but certainly not enough to claim to be an expert. However, one of the great joys in my life is to stir up your hot little minds into exercising your right as free-thinking religious liberals &ndsah; the right to bitch and moan and give your opinions about themes that affect us as individuals and as a society. Today's post-sermon discussion should be a lively one!

First, let's try to simplify the situation. There are three main issues we deal with in our health care delivery system: cost, quality, and accessibility. Low cost, high quality, and easy accessibility is the goal. Unfortunately, when one area improves, at least one must suffer. Any 2 can advance, but always at the expense of the 3rd. It's a zero sum game until we have unlimited funds; and that's not likely to occur given our propensity toward expensive, unnecessary wars and the fact that we already spend a higher percentage of our GDP on health care than any other Westernized country. You know, this is really depressing- let's talk about something more enjoyable, for example, what it would be like if Unitarians ran the world. Yes! No, it's our responsibility as good citizens to deal with all important issues, even the tough ones, so let's move on. If we, as a society, are interested in a fair and effective health care system we must juggle these 3 areas until we find the right combination. Even a brilliant mind such as my own does not have the complete answer to this complex problem. I do, however, have lots of self-proclaimed intelligent ideas on the topic which time does not allow me to introduce. Anyone in desperate need of a boring conversation can see me after the service and we can broach the subject.

At this point in the discussion it is appropriate to introduce one of our 7 Unitarian Universalist principles: "The right of conscience and the use of the democratic process within our congregations and in society at large." Oops, someone in our society at large forgot about conscience in our health care system: over 40 million Americans, mostly working poor, are without medical insurance; medicaid recipients with I.Q.'s below 150 cannot negotiate the system to receive decent medical care; and most of the rest of us struggle with insensitive insurance companies and stressed out health care workers. The democratic process doesn't seem to be helping the situation because the corporations who benefit from preventing a more balanced and equitable health care system have stopped any progress in that direction. Case in point: Hillary Clinton's health care proposal released in the 90's. The minute that plan was made public the airwaves were inundated with corporate sponsored TV commercials containing twisted half truths and statements that the government was going to take over our health care and dictate how we would be treated. These scare tactics are usually effective against an uninformed electorate that is conditioned to react emotionally to anything they see or hear- God forbid we should actually study a proposal before forming an opinion. Polls showed that over 70% of the country was against the plan before anyone bothered to find out what it was all about- so much for the democratic process!

So, what we have is a multi-tiered system: what I perceive as one with 4 levels. Tier #1) The well-off who have excellent coverage in their corporate subsidized insurance policies and can afford to pay for their deductibles and co-pays. Tier #2) The bulk of our population: working Americans and Medicare recipients who pay rising premiums for health insurance with larger deductibles and co-pays for a steadily decreasing amount of care from increasingly corporate-controlled health care workers. The war in Iraq is nothing compared to the one raging between insurance companies and its enrollees. A friend of mine who worked in the health care insurance field for many years showed me an industry magazine article describing strategies used by some insurance companies to deny and stall the payment of legitimate claims. These were so institutionalized that a whole new jargon had been created for just these kinds of tactics- scary stuff! Tier #3) The beneficiaries of Medicaid, who face an increasingly complicated system of medical care funded by steadily decreasing funds from the states and the federal government that support it. They are the bottom feeders of health care recipients and often receive what any American would describe as substandard care. A book entitled "Mama Might Have Been Better Off Dead" describes the horrors and futility of patients lost in this hellish bureaucracy. And finally we come to Tier #4), the aforementioned 40 plus million citizens who aren't given access to medical insurance through their jobs and are the least able to afford individual policies and expensive health care. The thought of standing by helplessly and watching a loved one die of a treatable disease while living in the most powerful and affluent country in the world should be unthinkable- yet it happens every day. By the way, the richest nation with the best and most advanced health care, the United States, is the only developed country in the West that doesn't have a safety net for its populace – shame on us!

The land of the free should also include the freedom to have some input into not only the way we live, but also the way we receive medical treatment. It's time again for another Unitarian Universalist principle: "To affirm and promote the inherent worth and dignity of every person." I learned how important this statement is in the field of medicine from an oncologist who I interviewed in graduate school, and who, I am proud to say, is also a UU. He had changed his approach to healing, incorporating the treatment of his patients' psychological and spiritual needs, as well as their cancers. He included them in all treatment decisions, utilizing alternative methods such as music and massage therapy, and faith and spiritual healing, along with traditional methods of Western Medicine. His patients' stress levels had been lowered, his cure rate had risen, and he had renewed his faith in his profession. I applaud his efforts.

Up until recently, thoughts of end-of-life issues were always somewhere off in my distant future. Well I'm 59 and the future has arrived with alarming speed. If I was born in 1900 I wouldn't have to deal with these issues because I would already be dead for 16 years; the average life expectancy back then being only 47 years old. But that statistic has increased by over 30 years in the last century so, as long as I'm here, I think I'll check out my options. A national poll has revealed that American citizens are more afraid of dying in some sterile hospital environment, hooked up to painful life-extending machines, than we are of death itself. The latter is inevitable, the former potentially under our control. The aging baby boomers, once consumed only with quality of life issues, are now also considering their mortality along with their plans for retirement. I envision the formation of a whole new profession: after-life travel agents. This might be a typical scenario: "Hello, Everlasting Happiness Travel Agency, my name is B. Boomer and I'm interested in planning my final exit from this earthly existence. My first question is: can I use frequent flyer miles? I'm a little short of cash and it's almost impossible to get a decent rate on an end-of-life bank loan. I can &ndsah; great! Now what about a decent exit hotel &ndsah; remember I'm limited on what I can spend. No, the Hilton Hospice sounds a little pricey. Yeh, Motel One, with a continental cremation included – perfect!"

Yes, the baby boomers newest obsession is death and all its related issues. Thanks to us life extending technology is in the news. Cryonics, the freezing of diseased or dying humans and then thawing them out in the future when new medical treatments have come available, is no longer science fiction. However, most boomers, who are used to vacationing in warm weather climates, are looking for more comfortable ways to stall the work of the grim reaper, perhaps from DNA or stem cell research. (Please don't bring up the subject of the veto by that superintellectual in the whitehouse of the bill passed by congress to advance stem cell research &ndsah; my doctor says its bad for my blood pressure.) Unfortunately, we, as a nation, have misused every new technology from splitting the atom to miracle drugs; think of the abuse potential from these recent medical discoveries. Imagine growing Sadaam Hussein's brain in Arnold Swarzneggar's body or cloning an army of Dick Cheneys and Jerry Falwells. (gag)

At least for the immediate present, until these technologies are advanced and mainstreamed, we have to be satisfied with finding a kindlier and gentler way to deal with death. In 1975 there was one hospice in the United States; today there are thousands. For the first time in our history we are starting to give priority to the "good death" rather than religious, cultural, and family traditions. Hospice health care workers are interested in relieving physical pain while treating patients' psychological, emotional, and spiritual needs. From "Mama Might Be Better Off Dead" comes this tidbit of information: "almost a third of all Medicare dollars go to patients in their last year of life," more often than not paying for expensive, hopeless treatments that only extend their suffering. The wish list for that money, which could do some real good for people with some longevity and quality of life remaining, is endless. Another fact that defies common sense is that about 1/3 of legal "no resuscitate" directives are ignored by doctors and hospitals. Hello! If someone goes to the trouble of making a legal living will that clearly states they do not want to be resuscitated in certain hopeless situations, shouldn't we respect that person's wishes? I'm calling the common sense police right now!

What discussion of end-of-life issues would be complete without mentioning that ever-expanding institution: assisted living. I recently moved my mother out of her apartment and onto an assisted living campus. I think they use the word 'campus' to entice potential elderly residents by convincing them that they're going back to college. Because each aging individual has different needs, the industry has produced multi-levels of care with increasing creativity. Remember the time when you moved directly out of your residence and into a nursing home? Well, those days are long gone! On just one campus we have independent living, light assisited living (for those who need only 10 hours of assistance without the extra calories), regular assisted living, a high functioning memory unit (sometimes called neighborhoods to make the residents feel less institutionalized), a low functioning memory unit, a nursing home, and last, but not least, hospice. I figure with all the professional assessments necessary to move you down the ladder, plus the time involved for each move, the average person should think about taking up residence on the campus of their choice somewhere in their mid-40's to make sure they receive the maximum benefit from each level. My guess is that the baby boomers will further expand and complicate the system by compartmentalizing hospice into treatment for the barely dead, the hardly dead, the partially dead, the mostly dead, the almost dead, the probably dead, and the last level: the completely, definitely, finally, and mercifully dead. I preferred the old system of 2 categories: alive and dead, but it's the new millennium and nothing is that simple anymore!

I know I've probably made most of you depressed with today's subject material, so I'd like to end this sermon on an optimistic note. Just because we, as a society, have screwed up our health care delivery system seemingly beyond repair, doesn't necessarily mean that we've run out of time to make the required corrections. To quote one of history's great statesmen, Winston Churchill: "Americans will always do the right thing, after they have exhausted all other possibilities." Let's hope he was right!