Tuesday, May 10, 2011


May 10, 2011:

To keep health care costs down Obama has proposed a rationing system where doctors, as I understand it, would consult with patients and their families toward the end of life as to the advisability of continuing expensive care that isn't going anywhere, just to preserve life a little longer. And the Republicans have called these death panels. Well, can I raise my hand here? Give me a death panel any time over what people go through now. By most standards I'm an old man, 74; my father died at 75, my brother at 70, but so far I've dodged the bullets and my health is pretty good, so far as I know. An elaborate series of heart tests a couple of years ago revealed that the chest pain I was feeling climbing hills was probably acid reflux disease, as I passed the tests with no blockages revealed. But I do have a heart murmur. Probably a valve problem. I've had the heart murmur, however, since my first physical revealed it at the age of four or five, so I think I can live with it.

Maybe, then, I could live another decade. Or I could die tomorrow. Or tonight, which would be a pity because we're going out to a friends' house for dinner. Who knows? We all live under the constant threat of losing our lives and we learn to live with it. But at 74 you can't help but think about these things, and I've done a lot of that, and I hope I'm as ready as a man can reasonably be to say, ta ta. The only thing I really dread about the process is precisely the kind of care that the elderly all too often receive: my mother, seven and a half years in a nursing home, babbling, losing her teeth, strapped down in a wheelchair all day long, pointing to the floor where she saw things that weren't there. My wife's mother, in constant pain from arthritis, with a bad heart, at 84 telling her daughter over and over again, please, don't do anything to sustain my life, even signing a document to that effect. But her daughter is here with me and her mother was in Detroit, that's where her two sons were, too, and they wouldn't hear of it. Thus at 84, at the suggestion of the doctors and the insistence of the sons, even with my wife trying to explain to them that mother doesn't want it, they did open heart surgery. She told us afterwards she prayed to the god she believed in, the Catholic god, to die on the operating table. Instead she died three weeks later.

What did that cost? A hundred thousand? And for what? My mother's care over those seven plus years cost a quarter of a million dollars. This system is crazy. If I ever start losing my mind the way my mother did, or my grandmother, I hope I have the courage to swim out in the ocean farther than I can swim back from and give myself to the crabs. I've eaten plenty of them in my life; I'd just be returning the favor. One of my friends, when I asked him if he had long-term care insurance, said yeah, it's a Colt .45.

I've just seen too much misery, too many people kept alive so the survivors don't have to face facts, to think I want to go through that. Did you ever hear what the Irish poet W. B. Yeats had put on his gravestone? "Cast a cold eye
On life, on death.
Horseman, pass by."
That stays with me. In the Middle Ages people kept memento moris on their desks, their tables, their shelves, to remind them they were mortal. As a culture, we need to get used to it; we need to plan for it, with much firmer legal documents providing real penalties if they're ignored, as my wife's mother's was. And we need to rethink the medical profession's commitment to saving people at all costs. Death panels? No, but if you're dying, and it's coming soon, you should have a choice about how to handle it, and the medical profession needs to be trained to provide the counseling that would make those choices plain. I love life, and it will be sad to say goodbye to what the Chinese call the 10,000 things, life's abundance, the extraordinary late light on the water, for example, that I'm going to see tonight at our friends' house, with a great blue heron maybe to pass by to give this scene its exclamation point. But there are values larger than life. One of them is dignity. I hope I have the courage, if I have the opportunity to make such a choice, to choose dignity over life at the end.