Tuesday, October 15, 2019

For Those Who Are Beyond Middle Age and Dependent On Medical Services

If you are like me (age 78) or of similar vintage, and have some condition that requires regular medical evaluation or treatment, you may experience the same thoughts as listed below.   This is an online conversation between college alumni (on year behind my graduation date), and the return of one individual from a near fatal experience, and two others in his class.   This is an open discussion, however please consider as such, but respect the privacy by not broadcasting the names of the individuals:

Robert J Biggar rjbiggar@gmail.com via listserv.pomona.edu 

8:53 AM (1 hour ago)
 to CLASSOF1964
I shared with you some of my experiences with end of life care, something we all face at our age. Mostly, it was a message that I am okay and hope to recover fully. 

However, there is more to this story that may be worth sharing. I emerged from this horrendous ordeal with at least a prospect of full recovery. I have peripheral neuropathy that may never go away, which amounts to fuzzy toes when I move them. These are minor issues. Mainly, my brain is intact so far as I know. I have retrograde amnesia, which is a blessing as I remember nothing of going to hospital ore the surgery or post-surgery recovery. It must have been painful but I don't recall ever having any pain. I am told it not unusual. Nature is kind in this way.

I have, however, a sense of guilt that I survived. The cost of my care was well over a million dollars. I don't know how much because bills are still coming in. Fortunately, I have Medicare, as we all do, and also secondary coverage from my 30+ years of service time (Tricare for LIfe) which should pick up most of the remaining costs. In this I am lucky. 

For those who have not gone through the Medicare experience, I learned that Medicare covers 80% of the costs and Tricare the rest (assuming Tricare is accepted--I found out that isn't always the case). Medicare is limited, however, For a given event (defined as continuous hospitalization or recurrent hospitalization with a gap of less than 2 months between admissions), you have 60 days worth of full coverage and 30 days of lifetime coverage. I was in for 68 days, meaning I lost 8 days of lifetime coverage I cannot get back. However, assuming I don't return to the hospital for two months, my 60 days of recovery renews.

That's the legalese. The guilt comes from the notion that I am not worth the million dollars (or more) spent to save me. At 77-years-old, I have nothing more to contribute to society and the money would be better spent on more worth social programs. Of course, I wasn't in control of any decision making. It happened and I am through to the other end.

But in the course of rehabilitation, I observed those around me. So many of them have no realistic prospect of recovery: 300-pound women with strokes paralyzing half their body, 95-year-old men with terminal heart failure or metastatic tumors in their brain. Yet they too get all the attention and effort the rehab hospital can offer, their own million-dollar terminal care package, before being sent to an assisted living, skilled nursing facility. Even the physical therapist I worked with (I had one, but others had 3 or 4) acknowledged to me privately that it would be a futile exercise.  I dn't know what they do if they don't have secondary insurance to pay the 20% Medicare doesn't cover.

I don't have answers. These folks have every right to the same 90-day care effort that I had, regardless of their prospects of recovery. Still, I fret about the cost to society. We have limited resources and they should be used to better advantage.

Frederick Lukoff

9:16 AM (1 hour ago)
 to CLASSOF1964
Very interesting post, Bob.  The medical profession often runs the machine in cases where you wonder about the utility.  There is the question of cost to society, but also simply the well-being of the patient.  When my mother was 92, she broke a hip getting out of bed, and after a month or two of a variety of complications, it was clear to me at least that there was no light at the end of the tunnel.  Yet we received a proposal to do several thousand dollars of dental work on her!  I don't know about you, but I'm not really fond of the dentist's chair.  Anyway, I declined, and she died within a month, dental matters having been the least of her problems.  We recently had wills and the equivalent of living trusts prepared here, which include instructions for possible times of dementia.  There are also instructions filed with the family physician not to revive under specified circumstances.

You refer to the insurance aspects of your case, but it seems to me that you were the victim of a medical fault.  Severing the mammary artery  when closing up a patient, thereby damaging his lungs and leaving him a month in a coma, seems like a clear case of medical malpractice that should result in liability of the physician's insurance, thus not yours.  What do I not understand?

From the language of your post, it seems clear that the brain is functioning just fine.  Welcome back!


Rebecca Novelli rjnovelli@comcast.net via listserv.pomona.edu 

9:34 AM (1 hour ago)
 to CLASSOF1964
Bob raises an important question, one that I'm pondering as I, too, am the beneficiary of costly and ongoing medical interventions. I don't think I'm worth saving now either, but I'm grateful to continue living and find in life a delight that I didn't experience earlier. I'm currently participating in a clinical trial. I wonder if this outrageously expensive care, some of it covered by a drug company, could perhaps yield information that will ultimately benefit others? If so, our care is potentially worth something. Further, the philosophical and ethical questions raised by denying treatment to people who are long past their sell dates may be more than most humans can address. Surely, there must be classmates who deal with these policy questions. I hope they will provide a better perspective.


Freedom's just another word for nothing left to lose.

- Kris Kristofferson

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