Saturday, September 10, 2011

Changing views in healthcare (NOT a poem!)

I heard a grieving father talk last month on NPR about experiences with a miscarriage.  He spoke of the lack of ritual for such events, and how he and his wife lived through this difficult time.  This caused me to think on death and inevitability and societal norms.  Why, I wondered, had death become so separate from our daily lives?  I knew the when: it was about the same time as the establishment of the American Medical Association, and their monopoly on health care.  We now take their expertise for granted.  Over the past hundred years illness and death have moved away from the family home into cleaner settings.  Mortality rates have dropped precipitously for many diseases and ages.  Expectations of cure have escalated.  

But why were we so eager to give away our intimate knowledge of death?  That may be the easiest of all questions to answer:  We are really tired, as a species, of dying.  It just sucks.   “It is a fearful thing to love what death can touch,” said the anonymous poet and we are exhausted by fear. 

It is my considered opinion, as a hospice nurse and poet, that the pendulum of reliance on healthcare to have the answer to all our ills may start to swing back, may have already reached the top of its arc and may be ready to head the other way.  We see it in the easier acceptance on the part of doctors that they may need to call in the hospice team.   We see it in the numbers of families calling hospice instead of remaining in a healthcare setting where they would die among people and machines whose sole purpose is to postpone the inevitable. These people aren’t requesting assistance to die.  They want to let nature take its course and they want to be surrounded by love. They want to go home in more than one way.

There are many things that medicine can do, chiefest of which is to prevent disease.  We have not effectively used medicine for that purpose, however, as in a capitalist society we find that money is to be made in greater quantities by illness than it is by health.  Big pharma, hospitals, diagnostic labs and yes, many physicians, are reimbursed at higher rates and for longer periods of time for long term, chronic illness than they are for preventing such illness through education.  Big money days may be at an end though, just as the polar ice cap is about at an end.  The poor, the elderly and the underinsured will no longer be invited to the Chronic Illness Party.  They (we) will be dying at home more often.  Death will find its way into our neighborhoods.  Our relatives will be dying comfortably at home cared for by us.  Our children will not grow up believing that death is always accompanied by car chases and heavy gun fire.  Young people and their aging parents will once again have conversations about end of life wishes and legacies.  We may re-establish rituals to help us survive our grief—perhaps black armbands will come back in vogue to mark us as a people apart, returning to life again after death has come one inevitable step closer.  

1 comment:

  1. The medical establishment (can hardly call it a health care system now) is all about bringing in the bucks. Now they're trying to take away our freedom to use herbals and other natural means of maintaining our own well being. No doubt, it's partly the bean counters who conspire to deny us the dignity of a peacefully assisted parting. I'd love to imagine the pendulum swinging back, but can't imagine the masses waking up enough to demand it. History tells us that money wins. Sad truth to swallow.