Tuesday, February 23, 2010

The Gift of Humanity

Current Medical Knowledge and Perspective:

A Slight Shift in Perspective:

There is a long history of individuals leaving the narrow field of medicine to pursue an attempt to give back to humanity the gifts given to them by their patients and colleagues in the field.

Hippocrates left us the legacy of medical ethics, now truncated, but it doesn’t change the fact that he gifted us by philosophy after his training was in medicine.

Leonardo da Vinci was a medical anatomist, but we know him from his artistic and inventive self: The Renaissance man.

“Che” Guevara left medicine to follow what his heart told him was important after being transformed by witnessing politically induced poverty.

The life, death, misery and miraculous beat of medical care sends a message of metamorphism to our minds, bodies, and souls.

Yet this ascension to a greater calling is only partially mentioned in Gina Kolata’s very excellent article on “A Murder Suspect’s Worth to Science.”

There are some wonderful points brought up in this writing: the problem of being diverse in a bland environment, the arcane and mostly communally contrived significance of medical research, and the meaning of insanity as a political labeling device to guard against discomforting genius.

But an overriding value to the story of a woman failed by the science establishment and denied tenure after decades of service is less about individual madness and more about the story of the insanity of our current political system.

It is the person bankrupted by illness. The worker denied benefits and starved of any hope of retirement. The small business that exists only at the whim of the larger universe despite the meritorious virtues of hard work and great intellect. And the inability of change to occur from within the confines of a monopolist institution.

The failure of the capacity of medicine to consistently heal and support its own has throughout history led physicians to turn to art and humanitarian concerns.

It is the constant “Unbearable Lightness of Being,” where political forces can retire surgeons to house painters, but still not rob them of their self conceptualism and their knowledge of medical specialty.

It is the old historical saw of the disenfranchised doctors, declared insane and poisoned with drugs, but still not restricted from choosing whether their transient effervescence of life will be sculpted to weigh in a perspective of lightness or heaviness of purpose and positive spiritual intent.

It is the choice to embrace Nietzsche or to nurture and care for all peoples in a manner not demonstrated by the boundaries of their own training.

A decision to echo the terrorism of the treatment received or to protest the federal funding choice to destroy innocent life but not to enable the lives of the same.

The “once” physician is the “always” healer of humanity. This is not an energy that politics can whittle away.

And the Hippocratic Oath lives on, including its cautions against abortion, prejudice, and physician assisted death, even if not fully voiced anymore in medical graduation ceremonies.

The gift of the words of Hippocrates will persist long after our current medical system is replaced by the next.

Because a physician’s gift to humanity does not require a medical system.

Hippocratic Oath - original translation

I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

But I will preserve the purity of my life and my arts.

I will not cut for stone {this refers to brain surgery}, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

Note on Hippocratic Oath:

The relevance of these words is worthy of review in light of the fact that many modern medical schools either do not say The Oath or use a version with many parts deleted or rewritten.

Margaret Mead explains the dilemma of the destruction of The Oath as she discusses its relevance to the world of medicine:

"For the first time in our tradition there was a complete separation between killing and curing. Throughout the primitive world, the doctor and the sorcerer tended to be the same person. He with the power to kill had power to cure, including specially the undoing of his own killing activities. He who had the power to cure would necessarily also be able to kill... With the Greeks the distinction was made clear. One profession, the followers of Asclepius, were to be dedicated completely to life under all circumstances, regardless of rank, age or intellect – the life of a slave, the life of the Emperor, the life of a foreign man, the life of a defective child..."

Special Connections

My musings in my last blog were about illness and medicine’s power to connect the classes of humanity.

Such as the vignette of a lower class drug addict with an IV pole dripping antibiotics into a bandaged infected arm helping at an under funded medical facility by holding a confused person with a brain infection while a physician used a needle to draw spinal fluid from the spine. The confused person being a formerly wealthy person infected with a chronic illness now acutely ill. The chronic illness springing from the selling by a poor non-medically cared for person of their own tissue of blood, which unknowingly was infected by a common illness left untreated in poor populations.

Literature, especially dispensed news, has the same class connective capacity.

And here I turn to some thoughts gathered after enjoying an amusing editorial column in The New York Times by Nicholas D. Kristof entitled, “I Cost More, but I’m a Specialist.”

In this wonderful tidbit of fun, he mocks the American medical system by playing as if “News Care” were much like “Medical Care.” Also that his role was that of a “Specialist,” and thus as the title says, he should “Cost More.”

This column is hilarious. He notes that a co-pay would be nice at times and that he might be sending bills to those who have been reading his work, which should generate concerns about whether one is “out-of-network.” Read this story if you can!

But consider the unfunny side of it as well: Many people who are career artists are not adequately reimbursed for their work by our current system.

And with the availability of new communications, this gap is expanding in many areas instead of contracting with our new costing capacity.

Don’t get me wrong. I love sharing music, books, and news stories in "peer to peer" relationships. But this doesn’t make it right or fair or correct that the author isn’t getting a reimbursement from their work.

Just as it isn’t fair for a physician or a hospital to work without reimbursement on a portion of their patient populations.

And I am no less concerned about the plight of humanity’s advancement by the sharing of literature than I am about their access to healthcare.

Humans, in fact, become healthier, more prone to group problem solving and more enlightened to possible solutions when they are better informed. And news creates a “buy in” that makes the educated population, and all those they reach with their eloquence, a part of the potential solutions instead of solely the problem.

And a lack of news capacity – a lack of freedom of speech – boils small problems into isolated stews of simmering invectives that burst forth in a spew of terrorism acts. Like an infection that never received antibiotic care, these puss filled boils of human thought can spread from the equivalent of a bad pimple to a contagious caldron of unrelieved angst. And all this because the person couldn’t write a published editorial that allowed him or her some constructive critical feedback cleverly packaged with emotional empathy and action oriented diverse positive solutions.

The arts, including news journalism, should be no less enabled than our medical health system. Both are required for the health of America. And both the arts and medicine simply “cost more” than they are currently reimbursed.

We’re all specialists in this vignette of human class connectivity.

Bargaining With Our Lives

I saw the tail end of “old health care” – before the effective actions of the insurance world and the blossoming of government medical plans and new medical schools.

Our medical school’s “new hospital” opened and accepted the overflow of patients from a county long term facility as well as an acute care hospital not enabled to handle all their inmates - I mean inpatients.

There were few nurses, so those people did nursing paperwork to keep the place open instead of patient care. The caretakers were medical interns, residents, and the patient care technicians who tried to handle all the bedpans. Since there were open wards in most areas, the patients often helped out with nursing tasks: A man with an IV dripping antibiotics into his bandage wrapped infected arm helped me hold a confused man with a brain infection so that I could place an emergent needle in his back to get cerebrospinal fluid to effectively order the medications to help him. It was days before the administration got around to scolding me for accepting the timely aid to save the dying man’s life.

There were so many ill people. Everyone but the very rich got this same health care, so it was a mix of indigent, middle class, immigrant and a large group of people from the newly discovered and thoroughly frightening HIV virus. People with AIDS at that time were simply doomed to die of strange infections as we didn’t yet have the medications to make it quiescent and diagnose/treat the odd bugs. Some of these new infective agents swept through our non AIDs patients who were immunocompromised simply by having their bodies fight their original admitting illness.

Sickness doesn’t bring wealth. But a lack of wealth brings poor nutrition and illness. So no matter what “middle class” our patients were in before their semi-voluntary admission (they didn’t want to be sick or in the hospital but there is no where else to go), they would leave poor.

We even had some folks who had been rich and upper class before the unknown and thus non-avoidable chronic infections from things as simple as having had a blood transfusion affect them. The blood likely came from a poor person without adequate health care.

It was everyman, everywoman, and everychild.

Now I hear the complaints of everyperson and I smile. So great to be upset only that the care professionals don’t mimic customer service agents and put on a “happy lying face” as they “sell you something you don’t need.” Wonderful that you are irritated at a speck of ink on a paper bill sent from some billing company whose computer is intentionally stuck in an endless loop. Big whoop that no one will practice bad medicine by providing a non-existent physical exam and inadequate actual treatment over a phone.

Go to your foreign country if you want that budget X-ray. Buy a cheaper car, a toaster, and adopt an immigrant worker to care for your lawn while you’re there, since your life is all about bargains. And don't be surprised if the local wages, expenses, and taxes make the study no bargain at all.

Now look at the new health care: People are still poor after having a long term or severe illness. That hasn’t changed at all. But less of these folks die, there is a better overall quality of life, and less people suffer a long term or severe illness.

And yes: the suffering of long term or severe illnesses is unevenly distributed within our population. Those who have health insurance or governmental coverage are more likely to suffer for a shorter period and are more likely to have a mild illness due to prompt treatment. And they are less likely to incubate and spread illnesses to infect others.

Health insurance and governmental coverage turn what could be long extended illnesses that contagiously sweep over the entire population into shorter, milder and just plain “annoying” medical problems that initiate a trip to the doctor.

Health insurance and governmental coverage benefit everyman, everywoman, and everychild.

Physicians and hospitals have a memory of the past. It is a living horror of misery, disease, insufficient funds, inadequate infrastructure and non-available people that are needed to provide the most basic of care.

The ignorant will always look for false bargains.

The medically enlightened will fight for every funding source available to provide health care to every man, every woman, and every child.

Without funding there will be suffering and disease for all.

Monday, February 22, 2010

Healthcare as Genocide and Terrorism

When we enable healthcare, we are making decisions about life.

There is the foreground decision: the fact that money dedicated for healthcare is intended to help humans.

And the background decision: the fact that money for healthcare means less money for the provision of food, shelter and other necessities to humans.

But within the foreground decision is a landmine: the fact that some of the money dedicated to helping humans with healthcare is earmarked for practices that destroy life and promote future terrorism.

These practices destroy life by the very nature of using a finite resource- money and human efforts that it purchases- to end human lives by the act of abortion.

The promotion of terrorism is that politically enabled genocide makes individuals less attached to the social groups in which they were falsely nurtured. The value given to children in the womb is a direct reflection on the value that the “power elites” are enabling for the defenseless pregnant woman and those who care about her life.

It is the equivalent of political terrorism: the monetary enablement of violence by the assassination of the innocent which is carried out for political purposes: the desire to not have to plan for that normal segment of the human natural population.

And federal monies for healthcare are distributed in specific fashion. Those who are enabled to abort by the federal government are more likely to be covered by federal programs such as Medicaid, which are common among the poor, the disabled and the unlucky.

This should be cause for concern for the 2.7 million people who are now jobless and facing the loss of even an unemployment check. They are one supplement away from the federally subsidized genocide health practices.

Yitta Schwartz, a woman who left behind 15 living children and over 200 grandchildren, noted that “If you leave a child or grandchild, you live forever.”

Additionally, you don’t have to be quite as concerned about the government’s habit of not planning for the retirement needs of the elderly population.

Because it seems that there is no “safe retirement plan.” Social security is insufficient in a monetary sense, and without children there is no one to care whether your check is cut or not if you are ill or disabled.

And the disabled have long been rendered sterile by our system long before they have had the option to even become pregnant. “Wards” have often been sent to be sterilized without their consent by politically appointed guardians – and robbed of any philosophy or protective affiliations that might stand up for their reproductive rights. It is no error that church and state have been politically separated, despite the “One nation under God” beginning.

Perhaps we should look at what happens in the military, prisons, state hospitals, and places where political prisoners or the poor are ensconced.

The government – by federal subsidy and promotion of abortion – is killing selective groups of people based on political criteria.

It is arguing about healthcare. It is not arguing about how to feed the children, house the homeless or fund retirement for the elderly.

But why should they plan these things when their active plan is to promote the abortion of the unborn of those outside of political favor – other people’s children - instead?

This is genocide. This is the seed of terrorism. This is the individual who recognizes that they are alone, not by their personal attributes, but because of political plans for their own disenfranchisement and the genocide of what should have been their society.

What you sow is often what is harvested. And genocide begets genocide by terrorism.

So be very careful when you sow the seeds of genocide.

Federally funded abortion is funding terrorism and genocide.

Sunday, February 21, 2010

Many Voices, Many Choices

I cling to the idea that I may have a choice in the delivery of medical care.

There. That’s it. That is exactly why I fear a loss of the single payer health system (governmental programs such as Medicare, Medicaid, and the Veteran’s Administration) and I fear a loss of the Medical Insurance Supported Systems.

I also note that there are a lot of people currently unemployed in the country. A demise of the insurance system – which seems to be on its death spiral anyway – will throw more people into unemployment and render others into a loss of stock dividend support. And there doesn’t seem to be much public support for the destitute – more of a Puritanical approach that more perfect planning should have been in the past.

With more than one system of health insurance, at least some people retain the option to not be covered at all.

And I don’t agree with everything that is “scientific medicine.” So I fear being an involuntary part of something that may “scientifically state” that the only “sane” option that I have is to have an abortion or undergo a surgical procedure or take a certain pill or receive a vaccination. And some people don’t even like blood transfusions, which actually isn’t a great idea, not with the latent viruses that we haven’t yet formally discovered and thus cannot identify with blood pre-tests.

Over the centuries, people have been subjected to “medical care” administered for political reasons against the choice of the patient. This still occurs in The United States – recognize that prisoners, wards of the state due to “supposed” mental insufficiencies or weaknesses, and members of the military all have their right to choose in medical care removed. Their consent to care is not an issue because it simply isn’t required.

I fear the advent of a “single payer government run” system.

In some government run system localities assisted suicide is on the verge of being legal. Abortion is legal. If you need an organ transplant and are older then you do not qualify. And “futile care” could be easily defined by what the “single payer” feels they can afford to provide. Which isn’t much in poorer places of our nation.

Sure. It might look like a good idea right now. You may have confidence that the politicians have been able to feed, shelter, and provide appropriate work for everyone that you know. But this is not the case in every part of The United States. And your view may change with the next election. So be careful in trusting them entirely with your health and “throwing away” all other options.

Your view may change at the blink of being “let go” from a place of employment. You may find yourself unable to pay your bills and unable to fund a move from your home to a smaller place because of no “buyer” for your home, and then being arrested for trespassing when the bank claims your home as their own. You may suddenly be a prisoner with no funding and no place to go or food to eat when released from the jail. Your “reactions” to your situation may seem “odd” to the prison health system, leading to involuntary medications.

Or you may be moved to a place where medical care for the destitute is non-existent because the hospital has no funding and there is no fear of malpractice because the system has no funds to entice an attorney to care. Or you may simply be a sexually naive teenage girl or a child, when the public health decision is made to give you an unneeded and unproven, potentially destructive, vaccine.

Maybe not. Maybe you are not a part of the 2.7 million people who are jobless and facing the loss of their unemployment checks. I sincerely hope that this is the case. Maybe your world is perfect and you live in England (so why comment on our systems at all?) and love their single payer system. Again – I wish you the blessings of all great fortune.

But remember that fortune is a fickle friend.

I fear the single payer system of healthcare because I am afraid it will lead to mandatory medicine for all.

I think that we have too much of that for too many people already. And if history repeats itself as people claim, then we will have more of it in the future.

And mandatory can mean that a healthcare location is ordered to offer procedures of which they are ill trained or ill prepared to perform, but suddenly must do because there is no other system as back up.

So I cling to the three party system – the governmental medical system of the sick poor called Medicaid, the “free for all possibility” to be “non-covered, ” and the system of voluntary medical insurance.

Only by avoiding a single party health provider system can we be offered the option of not receiving the health care that we feel is inappropriate.

One voice in our health care is no voice at all.

Friday, February 19, 2010

Part of the Positive Plan

People have personal energy.

Entertaining an opinion – no matter what it is –gives support and momentum to an issue.

Healthcare reform is a subject that many people are keeping alive by lending their personal energies. It seems that there is some personal identity that is invested or created by the expression of an opinion about healthcare.

This was a curiosity to me until I realized:

Many of us in The United States are literally and figuratively “Out of Plan”. We don’t qualify and/or can’t purchase plans (simply by lack of availability) that provide the needed coverage.

There is a density and a transparency: Each health plan has rules, billings, and payments that are heavy and dense. But when we protest these, it is like beating our fists in the air: we become transparent to any force that could help.

Many of us simply “just don’t seem to exist” when the idea of true healthcare coverage is raised.

And there is the pervasive understanding, as expressed in a quote from a recent New York Times article entitled “Do We Really Want the Status Quo on Health Care?” that “America’s poor health statistics are a result of social inequities and a large underclass.”

The author, Nicholas D. Kristof, hastily notes that The United States is number one in country healthcare spending, but about number forty in terms of the parameters that are used to judge the “health” of the system. We spend a huge amount of money on a product that doesn’t meet our country’s needs. We are poor managers of healthcare spending and provision.

And The United States has healthcare infrastructure! We have hospitals, labs, high technology machines, and highly trained individuals. We have surgical centers and clinics and emergency rooms galore! Many of these places, things, and people are not in use because of a lack of benevolent and/or effective management.

There is no terrorism in the news concerning healthcare inequity: no burning hospitals, no planes crashing into insurance companies. Only the expression of opinions, editorials and spirited debates on the subject of what is the next best path.

We are in the midst of a peaceful revolution of healthcare provision. Those of the underclass who note inequities are expressing themselves with words.

Speak up! Let your personal energy be a part of the positive revolution!

Thursday, February 18, 2010

Loving Haiti

Pictures of Haiti show a “sea of people” without any shelter waiting for the predicted rains.

In contrast, we pass unused large buildings awaiting lease on a daily basis in Austin Texas.

And it seems that there isn’t much ability for the Haitians to rebuild their island when their people are standing hungry and unsheltered on the ground where the infrastructure needs to be built.

The solution seems obvious: move the displaced Haitians in small groups to areas in The United States where food, water, and sanitation are not issues. This would allow some working space to rebuild the island, and protect the needy people from disease brought about by inadequate life sustenance.

More importantly: this would allow these folks to be in a position where they could plan the rebuilding of their homeland.

Charitable organizations have raised enough money to be able to fund quite a relief effort. But the money needs to be effectively managed by experts in rebuilding demolished worlds – the hard ware of the places and the software of the peoples.

At the same time: it is necessary that the Haitian people are enabled to help in the rebuilding efforts. Although they lack experience in re-building worlds, the rebuilding of their own world will not be sustained unless they “buy into” the ideas and “make them their own.”

Fortunately, the mental work of rebuilding can be accomplished remotely with the help of technology.

I recall pleasurable summers at “sleep away” camp. The food was good and plentiful, there were interesting activities, the beds comfortable, and there was no need for transportation or fancy clothing to partake in the activities.

I envision the majority of Haitians being moved to this type of a situation. And folks from the charitable organizations, local colleges, and surrounding communities being available to assess these folks for skill sets and health/nutritional status.

The idea, of course, is to have the well and skilled Haitians begin immediately to build anew their communities in advance of returning to their island. And the unwell and unskilled among them need to have some help obtaining skills and health. And while the impaired are rehabilitated into the useful, the native Americans can provide assistance.

If there are appropriately skilled and well Haitians available, these folks could return to the island with assistance and guidance from excellent high technological infrastructure building experts from The United States. This would allow these folks to be familiar with the structures that they will spend the remainder of their lives maintaining.

The folks from the United States would be selected on the basis of their team building skills as well as their expertise: they should be able to build moral, buildings, roads, and bridges simultaneously.

There should be a high technology computer sponsor: one that sets up large screen computer TV’s in the camp areas. Every morning and evening the plans and progress in their homeland can be presented and a group of well skilled Haitians could guide the displaced populace in the changes in infrastructure and planning that are taking place.

This progress could be shown on news programs to reassure people who donated money that their funds are being appropriately spent. Kind of a “thank you note” as well as a reminder of the great amount of work and funding that is necessary to rebuild worlds.

The Haitians outside their homeland would be working on achieving health and life skills necessary for their new communities. It seems that there has been ongoing concerns about the care and sheltering of children: new situations and supplies must be familiar to the caretakers prior to returning to a rehabilitated home place.

Child and adult development need to be planned and established by Haitian leaders in the displaced communities, and implemented with the assistance of the Americans, so that this can continue once these folks return to their homes.

Activities in the temporary communities should be a mix of education and cultural sustenance. Haitians need to remain proud and celebrate their heritage. They also need to make rapid progress to a new level of technological comfort so that they can participate in the world economy of remote knowledge communications.

And this plan would allow for some positive news on American television. It would be like a serial growth of a new world. A garden grown by the seeds of world donations sent to Haiti, and nurtured by the Haitians, along with any requested assistance from American plant experts.

But most importantly: It will be the Haitians creating the oasis from their own decimated island.