I mentioned these videos in class and I highly recommend you watch the eye-opening 15 minute talk by Dr. Diane Meier on long term care (just scroll to the bottom): http://www.healthaffairs.org/issue_briefings/2009_08_20_fact_vs_fiction/2009_08_20_fact_vs_fiction.php
I worked with Dr. Meier at Mount Sinai Medical Center and she is such a ground breaker in Palliative Care advancement. She is the director of the Center to Advance Palliative Care at Sinai and is a Geriatrician/Palliative Care physician, but she is planning to take a 1 year leave to move to DC and work on healthcare reform.
If you follow the topic, her name will continue to appear like in her recent Newsweek article on the Death Panel controversy. In her powerful healthaffairs.org speech, she talks about 2 patients at the end of their lives, each of whom have VERY different experiences. If we want to control costs, this issue urgently needs to be pushed to the forefront of the political discussion. The way we treat very sick and very elderly patients sometimes defies all reason and I have always wondered why. Is it the way we educate medical students? Is it our pervasive fear of death? Demands from patients and families? Is it all about money and physician incentives?
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Obviously there are tons of factors at play with how we treat end-of-life care, but I've recently become very interested in how the US culture plays in. We have here what tends to be a very extreme discomfort with pain and dying and an extreme desire to wipe all suffering out of our existence while seeing those who are suffering as weak. Pain's just not cool here, be it mental emotional, and we would sooner give someone antidepressants than a tissue and a shoulder and a hug. The same comes into play with dying, I think. We can't accept that suffering is a part of life. We haven't quite mastered the whole preventing dying thing yet, but we won't give up on taking away all the symptoms. I suspect this approach is more to alleviate the suffering of people surrounding the person dying than the actual person. We try to sweep everything unpleasant under the rug with costly medications and procedures, whereas, if we could just accept suffering and learn how to deal with it and grieve, we could perhaps exact a less traumatic dying experience while saving money. Just a thought, obviously, and I would love to hear other ideas!
Kierkegaard was not a bootstrapper. If you think of prominent American philosophers, you're not likely to come across any who don't espouse reinvention in one way or another. As early as Emerson and as late as Kerouac, Americans strive to be part of the New World. Death doesn't fit conveniently in that framework, because it's the one thing we will never overcome.
But I think it's possible to change the story. Frame it in God for the thumpers, Rumi for the yogis, and dust-to-dust for the Danes -- respect for dying and the process of death has a place in the American narrative. We think of the Wal-Mart employee in Missouri as the cardinal image of American isolationism and denial, but an equally viable image is that of several generations of women holding vigil over the bed of a dying matriarch. The story is there, but it needs to be told more. In one pathway, stories breed acquiesence to belief, which in turn begets policy (down the line).
"The best I can say about death is that it eliminates a lot of options." -Tom Robbins
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