Sunday, April 4, 2010

Helping Patients Face Death, She Fought to Live - Readers' Comments -

Among many readers' comments:

While Dr. Pardi's individual, personal story is by itself sad and
tragic for her, and for those who cared about her and were devoted to
her, Dr. Pardi as a very wealthy and well-connected individual was
able to pursue whatever aggressive treatments and extraordinary care
she wanted to in her frantic wish to cling to life at all costs,
because she could pay those costs. She not only had health insurance
but she also had great personal wealth; her husband was a portfolio
manager. This gave her the wherewithal to pay for whatever she
decided she wanted to try.

This story is so typically American. We laud, highlight, and are
fascinated with the stories of high status and high net worth
individuals like doctors married to portfolio managers, but as a
country we are quick to cumulatively begrudge the average or poorer
hard-working American even the most basic help with basic health
care. For God's sakes, the Arizona legislature just voted to abandon
S-Chip, leaving 47,000 children without health insurance. How many
children, how many ordinary people could have been helped by the huge
fortune of money that was spent on just this one person? She had the
luxury of indulging her every whim, and have her wishes honored to
the nth; she had the means to give herself what the insurance
companies would not countenance, while other people are lying in the
gutter with treatable illnesses, and we as a country just step over
them and keep right on walking.

The other thing about this story that really bothers me is that it's
a sucker punch to the palliative care profession, just when it needs
more good press, so that people can be properly informed about their
options. It is a not-so-subtle sabotage and undermining of a medical
specialty that is trying hard to reverse the current trend of "spend,
baby spend", and help people understand both their personal
situation, and that oftentimes less is more.

While I know that no one really ever knows how they themselves will
deal with something really awful until it actually happens to them,
Dr Pardi's story appears to have the dramatic edge because she had
the means to indulge her denial and her wish to live by doing
whatever she wanted to and having whatever she wanted done for her.
But the reality here is that as a society we can't afford to indulge
each person's every wish, while we have no compunction denying basic
care to hordes of equally deserving, but woefully under resourced
fellow citizens, who might have to mortgage their house or take their
children's tuition money to implement that level of self-indulgence.

My family was so grateful for the care my mother received from the
excellent staff of the Mount Sinai Visiting Doctors Program and the
VNS Hospice Program, all of whom gave her extraordinary basic, good,
common sense care, when she was declining with Advanced Alzheimer's
at the age of 96. It was just the right kind and amount of care for
someone in her condition. And as her family, we felt extraordinarily
lucky to have access to professionals who wanted to spare her from
suffering, from unnecessary aggressive interventions, and make her
comfortable while not unnecessarily prolonging what was a very poor
quality of life at the end.