Human Heal Thyself

"No one should die because they cannot afford health care; no one should go broke because they get sick. If you agree, please post this as your status for the rest of the day."

This statement has been cropping up as many people's status message on Facebook lately. A statement of unity among, from what I can tell, many of my friends that believe in equity and fairness in our society. Those people that do not feel it is right that some members of our community are suffering consequences as serious as bankruptcy and even death because they don't have enough money to get the health care they need, which just seems wrong. It seems just as wrong as people starving because they can't afford food or sleeping outdoors because they can't afford shelter or being shot during some other country's war. I would like to think I am among that group of people yet I have found it difficult to cut and paste that simple statement on my Facebook status window. I think this is because some part of me understands this little sentence seems somewhat inadequate and off the mark. It is an oversimplified view of a complex problem. I feel guilty for not posting it because I am afraid people will think I don't agree with it, yet I feel guilty posting it because this statement implies that fairness and equity exist in the world and they don't.

The concept of equity is a good one - one that we strive for and one that we should try to attain, but we never will . . . and that is okay. That is why we have emergency departments that accept patients regardless of their bank accounts, why we have food banks for those that can't afford to feed their families and why we have unemployment insurance for those that lose their jobs. I am proud to work in an emergency department. One of the most important educators in my medical school experience, Terry Mengert, had an excellent take of the ER in our society. "The Emergency Department is the one last place in our society that can truly be called sanctuary. In the ED we care for all those that request our care, regardless their ability to pay us, their religious beliefs, their gender issues, their crimes toward society or their personal demeanor towards us. Who else can say that?" What is wrong with the Facebook statement is not the intent to reinforce the need for equity in our society, it is the fact that is misses the forest for the trees.It should not cost $4800 to fix your daughter's broken arm, which was an accident on the playground, but it does. It does because now we have to pay for all the administrators, insurance billers, lawyers and support staff required after someone sued the hospital after not being able to resuscitate their 450lb loved one after diabetic & heart related physiological collapse. It does cost that much to pay for the care we gave that homeless patient in the ER with hypertensive encephalopathy because they never got the education, medication and simple medical care needed to avoid this disaster. It does cost that much because we had to have the latest 64-slice CT scanner now that the 32-slice is considered sub-optimal when the for-profit hospital next door has one. Just because we can cure one person of a disease when we allocate unbelievable amounts of money and resources trying to, it does not mean we can do it for all. Especially in an environment when we are creating more problems to fix than we have resources to do so.

We are creating a society that, more and more, is expanding the gap of inequity, promoting the habits and building a foundation for more need in the future. The haves and have-nots. The educated and ignorant. We don't fund early education for our children, we let corporate America market self-centered ideals and self defeating gratifications to increase their sales now despite the unhealthy lifestyle that comes of it later. We have abandoned the dedication to community and responsibility to ourselves that promotes self respect and respect of others. We have anonymized one another in order to pursue our selfish interests without having to accept the guilt that comes with trampling on those around us to climb higher. How do we abdicate ourselves of the feelings of self-disgust that should arise? I fear that we create funds and institutions to care for those that are marginalized by our values and then feel we have done the right thing by sewing up the wound that we ourselves created. We then ask payment for it anyway or are outraged when we can't afford to have our self-inflicted injuries repaired. I see this all the time when a neglected parent from a nursing home comes into the ED with bed sores and in poor health. They live alone in that place with staff paid to care for them so that the family can pursue their lives without the burden if this illness or the infirmity of old age. When the time comes and this elder is succumbing from the infections of neglect the family throws money at the system saying, "Do everything you can!" or the scream of how unfair the system is that they can't afford to have everything done. I worry that this is not always because they feel the pain of the imminent death of a family member but rather they feel the guilt of the years of neglect and now want us to delay death so that they can either rectify their behavior or simply avoid the reality that their parents are going to die alone and delirious from infection and they were not there. Death, disease and injustice are not going to go away and we can't expect them to and we can't pretend they don't exist for our own comfort. When we do, we lose something by not embracing the lessons and life they have to offer in return.

These are extreme examples and statements, I know, but I use them to illuminate a subtle but important difference in the need and utilization of the support systems in our country and our world. When we create a society that expects all seemingly unjust things in our world somehow rectified we are setting ourselves up for disappointment. We are also ignoring the fact that most of this injustice is OUR responsibility to avoid in the first place. Epidemic obesity, diabetes and the sequela can be avoided and we should not feel outraged when the health care system can't support the consequences of these diseases when we sold them the 64oz high fructose corn syrup soda and hamburgers in the first place. They ate them because they did not know any better, did not have the education to know how to make better choices or simply found the self-destructive comforts they offered the only solution to their emotional pain or simple hunger. We made vegetables and the environment to cook and eat them in impossibly expensive so that $2.99 grease meals is all they can afford. We package sugar and salt in such a manner that it offers nearly the addictive pleasure of heroin. We teach kids that drugs, guns and gangs are an easier way to make money and find a family & respect than their own communities through our TV and advertising.

Yes, people should not die because they can't afford healthcare. They should live healthy lives filled with friends, education and community. They should help those around them to find similar lives of value and self-respect and THEN, when luck or the odds turns on one member of the community, the other members should come to their aid and help them back onto their feet. That is what a community originally meant and what we have lost in our overpopulated, anonymous and selfish megalopolis that we have grown into. Don't buy that new car - hire a skilled mechanic to fix and tune your old one and help them feed their family. Ride your bike to work or walk even. Spend that those extra hours you would work to make the money for that car payment in your garden with your children or on the sports field playing soccer with them. Spend time at home, with your friends and family, not at work trying to make "more". When you are feeling lonely and isolated in this anonymous world, go out into your community for a walk, talk to your neighbors, read a book or paint a picture. Respect yourself and want MORE from yourself when you look into the mirror, not more from the world around you. When it comes time to vote, spend money on your kids and pay for more teachers not more police to incarcerate the kids we have already failed. Teach your children your values or the values you aspire to through example, because they will learn them anyway if you don't. If you are at work and never home, if you are always unhappy despite your bigger house or car, if you medicate all painful things with alcohol, mindless entertainment or huge amounts of starchy salty food . . they will learn.

This is more of a topic than I can address here and I have more passion for it than I realize. I see that a large part of that passion comes from my own unhappiness with my choices. I am the most selfish person I know. I always have been. Medicine is a pipeline for me to care for others, to give rather than take and to fill that need, yet living life as a doctor and training in this field seems to foster the self-centered behaviors and ego which I struggle with. I was reminded of this recently when my grandmother passed away and I felt I did not have the time to travel to my mother's side and be present. My mother cared for my grandmother these last many years during her bout with Alzheimers. She did it at home by herself. I offered what I could on the phone, my medical knowledge and guidance. I helped educate her on hospice and the value of it at this time. It was something, but not the same as being there with her. My friends in Seattle just adopted a new baby boy. I have not had time to find them a present or travel there to see the new addition they have waited so long for. In residency your life is owned by the training and what little time you have left-over you become very stingy with, or at least I do. I see more and more in the world around me how this short-sighted and self-centered approach to life is creating so many of the problems that are breaking our back as a society.

It is unfortunate that bad things happen to good people and we as a community should be there to help them, but we can't fix every problem and some people will be left behind. The only reason it seem so much more a tragedy now is that it is often not fate or chance that's responsible for the majority of people bankrupted by healthcare or the innocent civilians killed in armed conflict. We are. We created the coronary artery disease that suddenly stopped a father's heart unexpectedly with our promotion and love of leisure over exercise and fatty foods over healthy agriculture. We created the need for oil and the armed conflicts that arise when the pressure to control it forces one group of people to dominate another. We created the disenfranchised gangster member that shoots a rival teenager with an AK-47 because that gang is the only family he has ever had or ever will.

We can't fix these problems with more money, more hospitals and more police. We shouldn't be led to believe that we can.