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Point of View with Barb
Sumner Burstyn - September 22 2003
No Room on the Balance
Sheet for Truth or Humanity
Published
On Dissident Voice
As a columnist, there's a constant tension between aiding the story
by revealing the personal and sticking with ideas and facts to neatly
shroud it.
But sometimes that barrier is breached - the experience so extreme
that there is little option but to exploit personal experience.
This is one of those times. A few weeks ago I visited a family
member in hospital in Los Angeles. If you believed all his stories,
his life was worthy of a John le Carre novel. He'd been a gentleman,
a spy, a businessman with contacts in underworlds too secret to
talk about.
What was indisputable was his Continental charm and his role as
a loving father and generous benefactor when times were good.
Now he was living in LA at the pleasure of a wealthy, insincere
widow of similar late age; his retirement fund, we joked privately
among ourselves. Until he became ill.
One week laid low by the flu was enough for his girlfriend. She
trucked him off to a hospital in LA, a free county facility serving
the poor in a society that likes its disenfranchised as invisible
as possible. The only place to take an ageing boyfriend, past his
use-by date, an illegal alien with no health insurance.
They admitted him for tests and a few days later the verdict was
in: hairy cell leukemia, a highly treatable blood cancer with an
80 per cent cure rate.
So far so good. By the time I got to LA, he'd been in hospital
a few weeks and they were champing at the bit to release him. He'd
been treated aggressively, they said, with a new form of continuous
intravenous chemotherapy.
He's cured, the two doctors and social worker declared almost
as soon as I arrived at the hospital. They looked me in the eye,
two young women doctors with the earnest appearance of doing good
for the poor and reassured me his blood tests were clear.
But his girlfriend didn't want him back. After all, he wasn't
walking or eating. He was malingering, she said. It's his choice,
said the social worker. He could do both if he wanted to, said the
doctors in unison.
I sat with him and massaged his dry hands and watched as he struggled
to swallow a sip of water, his skin flaking, his eyes dull, his
charm and vitality drained.
Finally, we agreed he needed to go home to Spain, where he'd lived
for many years. Was he well enough to travel the 15 hours to Madrid?
The answer came from the head physician at the hospital. Absolutely.
Then came the surprise. The hospital would pay his airfare.
I was amazed. Time, I thought, to rewrite my narrow view of user-pays,
my biased sense that in a pure market economy not even sympathy
trickled down.
The arrangements were made swiftly. He arrived in Madrid groggy
in his wheelchair, almost unconscious with exhaustion, his hospital
release papers grasped in one hand. His daughter drove him another
five hours to a nursing home to recuperate.
After three days he was back in Madrid, admitted to hospital and
desperately ill. Just 10 days after being discharged as cured and
almost healthy from hospital in Los Angeles, he was dead. The cause
of his death: full-blown bone marrow cancer.
Now the questions. Did they know? Those young doctors with their
clipboards and honest-eye answers. Did they willfully mistreat him
with a cheap alternative to buy enough time to remove him from their
hospital and their balance sheet?
And what about those second-degree bedsores, the one on his backside
the size of a CD? Did they not consider those an impediment to 15
hours in economy?
Or the bedsores on the heels of his feet, forced into shoes he
hadn't worn in weeks?
And his liver that had ceased to function a few days after he
arrived? Had that been a normal, healthy organ on the day they discharged
him?
We won't know until his medical records arrive - at 25c a sheet
the bill will come to more than US$200. But it may take months,
the hospital admitted, before they process the request.
And the social worker, the woman who made all the arrangements
and stood by nodding seriously as the doctors reassured me he was
cured? On the telephone from her desk in the acute ward, she had
little comment. "I didn't know he was that sick," she said dully.
When I asked her how she felt working within a system that was
either incompetent or downright dishonest, she said she didn't know
how she felt.
Perhaps there was another explanation for the death of a man declared
well enough to leave her hospital? She didn't know.
When asked about the ethics of flying a dying man around the world,
she sighed loudly and said she didn't know.
Maybe, I suggested, it was all a ruse to get a costly patient
without insurance off their hands. She remained silent on the phone.
And did she think his treatment barbaric or inhuman? She really
couldn't comment, she said before hanging up.
So no facts or figures this week. Just the sad tale of a man who
died. An anonymous, uninsured number on an admission sheet at a
public hospital in LA. In the end his family did not expect a miracle.
Probably no treatment would have saved his life.
But there are other ways to die. Ways that afford dignity, that
control pain and suffering and afford the sufferer some degree of
comfort.
Except in a society where socialized medicine is an anathema.
In that world there's no room on the bottom line of a balance
sheet for truth or dignity or humanity. There's no room for the
practice of social work, let alone medicine.
And in the end, there's just that nagging question: were they
incompetent or did they lie?
ENDS
© Barbara Sumner Burstyn, 2003
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