The Long Good-Bye

Several weeks ago our local hospital announced that it will be eliminating positions and laying off approximately 100 employees. The community is in shock. Letters to the local newspaper contained common accusations: incompetent administrators, illegal immigrants, inappropriate use of the ER by Medi-Cal recipients, overuse of the ER by the uninsured, overbuilding of new facilities, yada, yada, yada. Perhaps all of these things contributed to the budget crisis - I don't work at the hospital, so I don't know.

At almost the same time this announcement was made, a friends' 92 year old mother was hospitalized. I think her story probably has just as much to do with the financial pinch as the reasons listed above. It's also a very common story and is not going to have a happy ending for anyone - not the family, not the hospital, not the mother. It's a modern American health care story - the long good-bye.

It started when Mrs. Dee arrived for a scan of her abdominal aortic aneurysm, which she has done every 6 months like clockwork. Unfortunately, this time she fell in the changing room and broke a hip. She was admitted and within several hours was in surgery for a hip replacement. I was surprised that that was the choice for a 92 year old, but as my friend pointed out, " we couldn't just let her lay in bed with a broken hip". The surgery went as well as could be expected and she was out of bed and sitting in a recliner chair for short periods of time the next two days.

However a 92 year old body doesn't react well to injury and her bowels began to shut down. On the 4th day after the hip replacement, she was returned to surgery to remove intestinal scar tissue from something she'd had done 45 years ago. It helped but she was still unable to take solid foods. Nutrients were being delivered thru the IV and NG tube. After the 2nd surgery, she was too weak to sit so the recliner chair was removed from her room.

Tragically, she also contracted MRSA, was moved into an ICU isolation unit, and started on massive doses of antibiotics. Her mental status was still fairly clear but her speech ability deteriorated. The family now has to gown & glove when visiting her, and she has trouble understanding what they're trying to tell her through the protective masks. My friend made posters with pictures and basic requests she can point to, which has helped communication somewhat.

But she was still unable to eat, so she was returned to surgery a third time for placement of a feeding tube. This decision caused a family split - one half saying, "she's had enough" and the other half saying, "we have to do all that we can". My friend says that the doctors are honest and objective, but the family doesn't want to accept that Mom is dying.

Mrs. Dee has been in the hospital 6 weeks now. In July, she was spry and contented. In September, she is disoriented, in pain, and is dying the death that none of us wants. She has a new hip which will never be used, a barely functioning colon, a feeding tube, IV's, an oxygen mask, a squabbling family, and has not been touched by a non-gloved hand for over a month. She is being kept alive by the talent and marvels of the American medical system, and the stubborn determination of one of her children. Pneumonia is developing now and a ventilator/respirator may be the next step. My friend doesn't want that, but she's outnumbered and outvoted by her siblings.

As an outsider, the process looks cruel and demeaning - but because of the nature of my parents' deaths I was not faced with making those decisions. I feel fortunate for that now.

So, Mrs. Dee has survived for (an unpleasant) 6 weeks and Medicare will be responsible for the majority of her bill. From what I read, the reimbursement rates will not come close to the hospital expenses. And because her initial injury, the broken hip, happened within the hospital one faction of the family is not adverse to the filing of a lawsuit. They have already met with the hospital administrators and are considering "options". (Mrs. Dee's grand daughter told me last week that she has decided not to apply to nursing school after witnessing the verbal abuse and aggression her own family members have displayed. She still wants a health care career, but not one that will put her in the direct firing line of upset, confused family members. )

In the meantime, a 92 year old woman slips slowly, slowly, slowly away and my friend will be left with memories of a long good-bye. How very sad for everyone involved.