Re: State Of Decay Year One-CODEX License Key
Bernd Manison
And I think this happens sometimes. For all I know, maybe it happens quite a lot. If it does, I never see these people. They very wisely stay far away from hospitals and the medical system in general. I see the other kind of people.
At first these sacrifices will be minor. The COPD means you have to breathe from an oxygen tank you carry around wherever you go. The PVD will prevent you from walking more than a few feet at a time. The ESRD will require three hours dialysis in a hospital or outpatient dialysis center three times a week. The IDDM will require insulin shots after every meal. Not fun, but hardly inconsistent with a life worth living.
Eventually these will add up beyond your ability to manage them on your own, and you will be sent off to a nursing home. This will seem like a reasonable enough idea, and sometimes it goes well. Other times it gives you freedom to develop a completely new set of morbidities totally unconstrained by what a person in any other situation could possibly be expected to survive.
And you will die, but not quickly. It takes time for the heart to give up, for the lungs to fill with water and stop breathing, for the toxic wastes to build up. It is generally considered wise for the patient to be on epic doses of morphine throughout the process, both to spare them the inevitable pain as their disease takes their course and to spare their family from having to watch them.
Nevertheless, this is the way many of my patients die. Old, limbless, bedridden, ulcerated, in a puddle of waste, gasping for breath, loopy on morphine, hopelessly demented, in a sterile hospital room with someone from a volunteer program who just met them sitting by their bed.
I feel bad making fun of it, because it is clearly heartfelt. This is part of the problem with hospital poetry. It is very heartfelt, whereas I think most popular poetry comes from people who have strong emotions but also some distance from them and a little bit of post-processing. And unfortunately doctors, who are on this decades-long quest to prove they are actual people with real feelings and not just arrogant robot-like people in white coats who know a very large number of facts about thyroiditis, just eat this sort of thing up.
Doctors and nurses eat this kind of thing up and put it on shiny plaques that go on the walls of the hospital. (I suggest a wall near the gastroenterology unit, to expedite care for people who start vomiting.)
The senses are under constant assault. Smell is the worst. There are some people who can identify different infections by smell. Pseudomonas aeruginosa is supposed to smell fruity. Gardnerella is supposed to smell fishy. Clostridium is supposed to smell like the worst thing you can possibly imagine covered in feces and left to rot on a warm summer day.
I think if I were very debilitated and knew I would die soon, I would want to go to that park or one like it on a very sunny day, surround myself with my friends and family, say some last words, and give myself an injection of potassium chloride.
And so every time I hear that phrase I want to scream, or if I cannot scream, to find some book of hospital poetry that really is a book of hospital poetry and shove it at them, make them read it until they understand.
I concur, though of course we need to restrict the amount of jobs he holds at a time so that he actually has the time to write. (Plus I imagine he might also appreciate having a chance to sleep every now and then.)
(In the original this is a satire on selfishness and lack of charity, not on end-of-life care; it would have been hard for Clough to foresee that officious striving to keep people alive would become a problem.)
Most Catholic hospitals, to the total consternation of those on the conservative side of the actual faith, are currently funded by your tax dollars through medicaid, medicare, and the private industry tax known as health insurance premiums.
I could easily imagine a day when thawing out the cyonically preserved may be possible, but that nobody will want to do it because the population pressure on available jobs will be so bad that the popsicles will be looked at as a lower form of life than illegal aliens.
Buddhism, you see, is what I ended up turning to in my years wandering away from the faith- as all Cradle Catholics seem to do in their late teens and early 20s. Some return. Many, many, many do not. I returned because I learned the one secret that Zen Buddhism has that Catholicism does not, that atheism does not:
Speaking of Metamed, I was curious if you guys marketed yourself to insurance companies (life & health, mainly). No doubt they do the same sorts of things, but it may be good for them to have an outside company look at, for example, the chances of survival from disease x with the best treatment and so forth.
Or is there too much liability for them to venture away from what the actual attending physicians recommend?
On the other hand, I can imagine that my parents might not be a big fan of having to deal with her constantly. And you could potentially end up having to take care of four grandparents, which would be difficult. I guess there are trade-offs.
And who by fire, who by water,
Who in the sunshine, who in the night time,
Who by high ordeal, who by common trial,
Who in your merry merry month of may,
Who by very slow decay,
And who shall I say is calling?
And who in her lonely slip, who by barbiturate,
Who in these realms of love, who by something blunt,
And who by avalanche, who by powder,
Who for his greed, who for his hunger,
And who shall I say is calling?
What advise would you give someone in their mid-thirties who has a normal BMI? What are the most important measures one can take to better ones chances to not end up in a nursing home bed somehere in need of someone to turn them over?
Spot on. I am a respiratory therapist. My fantasy is to have skilled nursing facility that does not send anyone to a hospital. What is treatable at the SNF is treated. Everything else is comfort care.
Again, comming late to this discussion but agree with Michael Vassar that you are wonderfully articulate in your outrage. Hold onto it and turn it toward what is possible. Something always is possible even if you have to invent it for the rest of us.
I feel like I have to respond to the opinion that dying at home is the best thing. For a very few it can be. For most, it places too much of a burden on the family or staff of the residence. Most families and for that matter, small, light-care care homes are not equipped or qualified to provide the necessary care and comfort to a dying patient.
Very well put together. I would like to use this to teach and talk with medical students and interns about death/dying/pt ed/etc. Do you have a specific way in which you would like this to be cited (actual name vs pseudonym, etc)?
On the one hand, the adult in me is damn glad my mother already has a living will with do-not-resuscitate orders. The adult in me considers death-by-potassium-chloride in a nice, sunny park to be a proper way to go, dignified and humane.
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