Death March

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“Have you made out a living will? Something that says what you would like your doctors to do if your heart stops and you stop breathing?” My computer cursor hovers over the selection boxes.

No response.

I look up.

The man sitting in the chair before me gives a suspicious squint. “This is about that Obamacare crap isn’t it? Those death panels?”

“No, sir.” I sigh. “I ask all of my patients over age 65 this question. I like to start having the conversation well before it is actually needed. I have done this for years before the ACA even came into effect. You just happened to have turned sixty-five since your last physical.” I try to give a reassuring smile.

More skeptical scowl.

“So what do you think of the death panels?”

“Sir. There are no death panels.”

Still scowling.

“I don’t want to answer that question. You will just pass that on to the government.”

“No. It doesn’t work that way.”

He is not convinced. There is no “Refuses To Answer Question Because Of Inherent Mistrust Of The Government And The Medical Establishment” button. I wish there were, though, and I wish it would get sent to congress. Instead I click, “Decision Not Made, Reference Materials Provided.” People used to engage when I asked this question. Now they just shut down.

“Well what do you think of Obamacare, then? I feel bad for all of you doctors.” His scowl softens a bit.

“Truthfully, it has not affected me that much. It is affecting patients more. Some good. Some bad. Let’s talk about your blood pressure…”

He interrupts. “No. Tell me more about what you think about Obamacare.”

“Sir. That is 11,000 pages of legislation.”

He continues staring at me expectantly.

Aw, dang.

I will touch on a few observations I have made regarding the Affordable Care Act in the next several days….

Stay tuned!

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115 thoughts on “Death March

  1. Check that box for me: I have a living will. Even more so after my mother changed her mind two days before she died. She told the nurse that she wanted another chance. So there she was, in intensive care, the doctors ready to do a colonoscopy on this 91-year-old patient. Her Living Will was recorded in her chart: DNR DNR DNR. Bam! She was on the machine. What happened? Then we fought with the hospital–and found a young doctor to sign off. And the administration said No. Somehow, some way we were finding a physician to examine her and say ok to the DNR. Twenty minutes off the machine she was at rest. Check that box: YES!!!!

    Liked by 1 person

  2. I am a participant in the greatest socialized medicine program, and affordable care act. It is something called M-E-D-I-C-A-R-E. Someone cares. See it? C-A-R-E. Don’t get me started. The TIME magazine of the past week or so discussed the $190,000 heart surgery. It’s simple for me: Medicare is the answer. 11,000 pages? I had to leave two physicians I liked (before I was 65): they were taking only Medicare. No insurance, no plans. Cash and Medicare. No assignments. No Humana, no United Health Care, no nuthin’. And that was how I found it in the UK. But one thing I learned there: 6 months wait for an MRI “over there”–unless I had the cash, then and there. Make sense? Awaiting the physician response. :o)

    Liked by 1 person

  3. I would want a DNR when I am a lot older, We have 27 elderly patients where I work, the youngest normally late 70s. Only about 8 in total have DNRs. A lot of families don’t like it, and if the doctors decide to issue a DNR due to a poor prognosis, there can be hell to pay.It is something that should be decided a lot earlier than we do over here.

    Liked by 2 people

  4. Oh boy. I’m sorry but I have a really hard time being understanding of anyone this ignorant. Willful ignorance is a form of duncery that makes it so hard for me not to pull out a newspaper and smack someone on the nose. The other aspect of this I find laughable is that these same people who fear the government is trying to acquire specific information about them are NEVER important enough to garner that kind of attention. Get over yourself, because chances are you are not nearly clever enough to be a threat to the established power apparatus with your “in depth subversive intellect.” Just answer the bloody question and then go read a book.

    Liked by 4 people

  5. I once had a woman tell me she didn’t want to give her daughters the HPV vaccine (which I was recommending), because she heard it was a government trick to sterilize girls. Um, say what? Luckily, we had a nice discussion, and she listened as I reviewed the vaccine and the reasons for it. Once she understood it was to prevent cancer and other conditions caused by HPV, she decided she wanted them to have it, and both of her daughters left that day with their first dose. She was a good mom, but it shows you how easily people get caught up in the conspiracy rumors that constantly circulate.

    Liked by 2 people

  6. I don’t have a living will, although I should – i may look into that. It had been suggested when i was going through some medical procedures, but I didn’t feel I needed one at the time. I think I’ve changed my mind. Thanks for the reminder Victo.

    Obamacare is pretty divisive in the US huh? As a Canadian (and one who has had a lot of medicalattention inthe last ten years) I am obviously in favor of socialized medicine. Obamacare is a start albeit a rocky one. i was surprised that Obama actually tried to move in that direction. The truth is that health care consumes a huge amount of money and requires much higher taxes. Here in Canada we pay almost 50% of our income in taxes. Mind you we have a lot of other social programmes as well – but a lot of that is healthcare. It is my observation – having worked in the US for 6 years – that many young Americans live at a level of consumption that is incompatible with maintaining adequate health care. In other words, they spend what they have and more, so that should they get sick, they do not have the resources to address it. This is going to become an even greater drag as the population ages – and some hard decisions will have to be made. Short of just allowing people to die who do not have the money to maintain their health care, the only answer will be to use a huge tax increase and borrowing to pull revenue from the future and pray that the books can be balanced at a later time. In other words, dump it on our children and their children.

    Interesting topic Victo. I shall eagerly await your coming posts.

    Liked by 2 people

    • I had a patient say a few months ago that they were never going to get insurance. Their plan was that the hospital, if they got really sick, would get them on emergency Medicaid so they could recoup their money. Sad thing is, they are kinda right. That is how it works often times.

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  7. Ah, I was literally the voice of the ACA. The podiatrist I worked for sounded like your patient. So I’ll be waiting to hear your take on things.

    We were absolutely forbidden to utter the word Obamacare. It made for some interesting conversations. Better than the death panels, I had callers who wanted information about the microchip implantation that was required by the ACA. (Are you really going to say there are no stupid people?)

    Liked by 2 people

      • We must have very different operating definitions of stupid. 😀 Regardless, our collective comments from the previous post about fear still stand. Respect and compassion, patience and understanding…especially in a professional setting. I rarely got yelled at while working the phone lines at ACA/Healthcare.gov, while those around me got cussed out a lot. There were several reasons for that.

        In my real life (as I recall it when I had one), I don’t tend to suffer fools gladly, and never understood why anyone would want to. :p

        Liked by 2 people

  8. I watched my Dad struggle day after day with MND. His last week I came within inches of doing the job for him. I didn’t. I’m still sorry I didn’t nearly thirty years later. What stopped me, the thought my mom would not be by his side when he died.
    Two days later she was, just the two of them, but that week was hell, for both of them. A living will would not have changed that week.
    I don’t have a living will but my family are very well informed of my thoughts and if they hear the words “catastrophic brain injury”, they must say goodbye I do not want any treatment.

    Liked by 1 person

  9. I signed a new Living Will just before surgery a few years ago, and it caused a fight with my husband. Why? you ask. Well, because I named my oldest daughter as my health care proxy instead of him. Again, why? Because I knew I could trust HER not to have the plug pulled at the very first sign of any irregularities.

    On a somewhat related note, I have also already made the arrangements for my body to be taken to the local medical school when the time comes. My mother did that, and it made it so much easier for us when she died – we didn’t even have to call the medical school, the hospice nurse did that for us. I want my own kids to be spared the cost and grief of a funeral – when the time comes, of course, which hopefully won’t be real soon.

    Liked by 3 people

  10. Oh boy……I’ll try to stay focused and keep my eyes from crossing.

    Living Wills sure make it easier for those left behind. That’s something people need to think about as well. What WOULD we was us? When the ‘bad thing’ happens, it’s too late to ask the questions.

    Liked by 1 person

  11. I am looking forward to your take on ACA. I have some pretty strong opinions myself, but I’ll hold off expressing them, since I am interesting in hearing opinions from a medical practitioner.

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  12. Yes, I have a living will, but must change my power of attorney and also my regular will. Life sure is a b—h sometimes.

    About the ACA. People watch Fox news and read propaganda by radial Tea Parties that is circulating on the Internet. I believe these are some of the reasons skeptics are suspicious about the government. I’ve read pages of articles that were handed around by employees at a governmenmt run hospital. It was hard to believe that I was working with nurses and other employees that were so gullible.

    Liked by 1 person

  13. We struggle with talking about advance directives with our patients. Another big challenge is for the family to agree to Hospice care in a timely manner. Many people do not understand that hospice is just another form of medical treatment to aid the patient to a comfortable but inevitable end of life. People have come out of hospice because the care is so good and the stress is gone. I think getting people to think about how they want to end their life is respectful and sound medicine. I have been trying to get my “AD stuff” in order and it is a daunting task, but the peace of mind will be worth it.

    Liked by 1 person

  14. Please come to Canada we need good doctors! There’s such a shortage overall of docs here it’s crazy.
    On the other note, we don’t have a living will yet but I was just suggesting to Mr. Gibber a couple days ago that we really should get that done.

    Liked by 1 person

    • Hmmm Shortage of docs but socialized medicine works? Hmm? There are five dear friends of mine who are not “money grabbing” doctors but can not deal with the current reimbursement rate of $12.50 for a Medicare/Medicaid
      client when they actually care to spend time with a client and don’t do a 15 minute or less exam as preferred by some HMOs. If someone is willing to get through medical school and give up their personal energy to help others they should be paid so they can afford trips to be able to relax. Again, I wonder why there is a lack of doctors in Canada if socialized medicine is so wonderful?

      Liked by 3 people

      • I do not have an answer for the doc shortage. Maybe a lack of training slots? However, it is interesting that the Canadians who comment on my posts are overwhelmingly positive about their system. Medicare/Medicaid reimbursement is an insult to patients who carry it and an affront to the medical professionals who treat them.

        Liked by 2 people

      • We have a couple of issues wth doctors here. Gibber lives in a northern city where the weather is not very good. Doctors tend to gather where the weather and working conditions are the best. It is hard to get them to areas where the conditions are poor or the quality of life is poor. I may be wrong but I think Gib lives in a city where there is a lot of natural resource production but it is a new city with little in the way of quality of life – no museums, no plays, no art community, etc. Here in Ottawa there are a lot of doctors and a number of big hospitals, including a childrens hospital thats serves a large area including some of our Arctic (by plane). Even so, it is hard to get a family doctor as many have formed clinics where they are paid for services and do not have to take care of the administrative tasks associated iwth having an office. Our system pays a flat rate to a family doctor for each visit and/or procedure, so many doctors are choosing specialities as they are more lucrative. Many have left for the US where their income can be double or greater. Surprisingly, some also , especially those with families, move from the US to Canada for the quality of life – lower gun violence, lower murder, lower violence in general. There has also, in the past, been concerns about the number of graduating positions (as you guessed Victo) not growing as fast as the need for doctors (to match retiring doctors , emmigrating doctors and increased demands). I’m not sure where that stands right now.

        Anyway, the quality of care is very good, it is just that it seems that the days of the family doctor are fading – now one goes to a clinic and sees the doctor who is available, which is really not as comfortable for some people. It also requires the patient ot be detailed in their history and knowledgeable of their condition. This has lead to many only seeking help when it is an emergency – which has overloaded our emergency room system. This is an on going battle. So the system is not perfect but care is good in the long run.

        Liked by 1 person

      • Good response. A dilemma. Living here in Florida since 1980, I am amazed at the number of Canadians who do the 6 months and medical care, complain about US medicine, then return north all fixed up. Puzzling. It seems as though complaints about medical care are universal.

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      • A horrible shortage of docs. It takes 6 months to a year to get in to see a specialist more often then not. It takes about 6 months to get an MRI if one is needed. The GP I got…I was really lucky to get. There were no docs left available for patients up here and they brought him in. Many who’ve lived here for years still can’t get a family doc. I don’t know where people get that socialized medicine is all that. If we have to go to emerg, it’s an 8-12 hour wait unless you’re dying pretty much. Things are far from perfect that’s for sure. I think every one who works hard for an education should get paid what their worth but it’s just not the case in this world sadly.

        Liked by 2 people

  15. Just been going through the questions of the living will with my Dad. Each immediate family member were given a copy. Palliative care gives you the chance at anytime to change your mind about your care regardless of what you said you wanted or didn’t want. Every day is different when you may reach that time in life when you are out of options for say inoperable cancer. What you decide today may not be the choice you want to do tomorrow, but having something in place today helps all those around you when you are perhaps unable to communicate your choices. It has little legal binding in New Zealand unlike other countries.
    You can never be too early to have a living will. That said, it’s time I looked into one for myself.

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    • It is the having the conversation with family early so that everyone is on the same page that is so important. No one has to feel guilty, then. We are only carrying out the wishes of the individual. No anguish over having to decide to “pull the plug” or “making mom suffer” by not pulling the plug. And yes, anyone can change their mind at any time. As you point out, things can always change.

      Liked by 2 people

  16. We have that conversation with EVERY patient who gets admitted to the hospital, even if it’s just, “I assume that you would want everything done if your heart were to stop beating or you were to stop breathing…” to the 28 year old who comes in with appendicitis. We keep the signed page in a bright green folder in the front of the chart. We have clear definitions for various “goals of care” that can be documented – and pretty much every staff carries a little pocket card in their ID badge to know what each one means.
    Please excuse my ignorance, but I don’t really understand what the government and “Obamacare” have to do with living wills and DNRs. Also, what is a “death panel?”

    Liked by 1 person

    • The ACA added legislation that affects documentation of many things in Medicare patients. One is asking about end of life preference. Many politicians who opposed the ACA then started telling people that there would be panels who would decide if you lived or died, if you were worthy of the resources. That translated into, “The government is trying to kill old people!”

      Liked by 1 person

  17. I have the Organ Donor card in my wallet, a Living Will that says DNR, and if the students or researchers have any use for what’s left after the organs are gone, it all theirs. I won’t even be watching, I’m hoping I’ll have better things to do. 😉

    Liked by 2 people

  18. I’ve been wondering what doctors think of it all, look forward to reading your posts on the subject!

    And “There is no “Refuses To Answer Question Because Of Inherent Mistrust Of The Government And The Medical Establishment” button.” Hahaha!

    Liked by 3 people

  19. People approaching 65 read all the articles, hear all the news and hype about how 65 is the new 40. How this is the best time of our lives. We’re vital. We’re important. We’re free. We’re starting new chapters of our lives. We’re smarter. We’re more confident. We’re in better health. We’re just crone-awesome.

    Then we come to your office and you ask us this?

    Thanks a lot, buzzkill.

    : )

    Liked by 1 person

  20. Terrific conversation ! Thanks. My former (now divorced) husband and I made Living Wills, got Long Term Care Insurance, and signed up for the Cremation Society at the same time we signed up for Social Security and Medicare when we turned 65. I’m now 78 and haven’t used any of the above, except for Medicare for which i’m eternally grateful. I live in a Naturally Occurring Retirement Community with a bunch of marvelous and wise women aged late 70’s to mid 90’s. We’re so put out at the way old people in assisted living places and nursing homes are treated we have a covenant to help each other stay here as long as possible, We have relatives to mind our DNR’s when “the time” comes. Meanwhile we will continue playing word games and being grateful for each day we’re alive. Also I’m appalled at the misinformation and downright mule-headedness of people opposed to Obamacare. i keep cheering every time I read a positive news article about it. P.S. I love the irony of the beautiful pictures you post with your writing. Or is it hope?

    Liked by 3 people

  21. Pingback: My Article Read (4-16-2015) | My Daily Musing

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