No Room on the Balance Sheet for Truth or Humanity
by Barbara Sumner Burstyn
September 22, 2003
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?
Barbara Sumner Burstyn is a freelance writer who commutes between Montreal, Quebec and The Hawkes Bay in New Zealand. She writes a weekly column for the New Zealand Herald (www.nzherald.co.nz), and has contributed to a wide range of media. She can be reached at: firstname.lastname@example.org. Visit her website to read more of her work: http://www.sumnerburstyn.com/.