Thursday, January 6, 2011

Death Panels and End-of-Life Planning

I was living in California when my grandmother, Elsie McIntyre Mitchell, was hospitalized for the last time. My family called me and said that she wouldn't last very long, so I took a week off from work and flew to Arizona to sit next to Elsie in her hospital bed. It was hard to look at her, puffed up from years of Prednizone, osteoporosis making her bones crumble each time she moved. She had been a looker, with shapely legs ending in sling-back toe-less heels, dancing with a harmonica in her mouth as she played Irish ditties. I can still see her eyes get wide and then crinkle into a smile as she watched me watch her bend the notes. I think she was buried in her favorite dress. It was white with little green 4-leaf clovers all over it. She believed in the luck o' the Irish (even though she was British/Scottish) and used to send us out into the fields of her Canadian farmhouse to find 4-leaf clovers and report back with any leprechaun sightings.

After Elsie died, when we went through her books, we found hundreds of dried 4-leaf clovers pressed between the pages.

One day in the hospital, she turned to me and said, "I can't wait to see who you marry." I always used to think that what she said was prophetic, that I would find someone to marry who she would have loved. So far, I haven't been that lucky. Perhaps, while looking for some 4-leaf clovers, I will meet somebody out in a field.

The other thing that she said to me in the hospital, over and over again, was that she wanted to go home. She knew she was dieing and she was miserable in that hospital. She wanted to die in familiar surroundings, in the bed she'd shared with her husband for an amazing number of years. With the smells of every apple pie she'd ever made, still lingering in her kitchen. I felt helpless when she told me this. I wanted to grant her this last wish. But neither me nor my family really knew if it was even possible. Based on what I know now, I would have made it happen.

If Elsie's doctor had taken the time to sit down with her a few months earlier and bring up the difficult subject of how she wanted her doctor and her family to handle the end of her life, she could have made her wishes clear to all of us and perhaps could have spent a few more moments of happiness before she passed on.

It's THIS type of End-of-Life Planning that was a part of the recent health reform bill and it's THIS that became one of the biggest and cruelest Republican lies. Betsy McCaughey, the champion of anti-death panelators, tried to push her bullshit on the Daily Show, of all places, pandering to the audience with flirty little glances and never answering Jon Stewart's questions. She was just adorable. And a big fat liar. She, Sarah Palin, Glenn Beck and the rest of Fux No-News entertainers called the funding of end-of-life planning "death panels" a million times so that the Republican base became thoroughly convinced that my grandmother, instead of receiving vital information that would have eased her mind through her final days, would have been taken off of the monitors, taken off of the drugs, kicked out of the hospital and denied care "because she was too old to spend money on."

For a while, I've wondered why this had to be in the bill at all. Didn't doctors just do this counseling anyway? Elsie's doctor didn't. He was a good doctor too. But we rarely saw him. Maybe he just didn't have time, like most doctors these days who, because of insurance companies, have to shove as many 15-minute patient appointments as possible into one day, in order to make any money. But it's the government that Republicans said they didn't want in between them and their doctor. I guess they prefer those nice insurance companies.

Then today I watched Atul Gawande, a cancer doctor, interviewed on The Rachel Maddow Show and then again on The Colbert Report (I'm kind of uncomfortable with the fact that he's on a book tour but is called in as an opinionator on Maddow and the guy interviewing him pushed his book too. Should that bother me? I dunno.) and I finally understood why this had to be part of a bill.

By legislating that doctors need to be paid for the time they take to help people plan for their end-of-life care, insurance companies would be required to cover expenses for the doctor's time. This would work as an incentive for doctors to a) get educated on end-of-life planning and b) offer this service to their patients. Patients wouldn't be forced to do anything. The doctor would just advise them that there were a few things about dieing that they might want to know, some things they could do that could ease the pain for themselves and their loved ones.

My grandmother suffered in that cold hospital room for a few weeks longer. She was well cared for. But at night, all of us got to go home and she was left all alone. This is a terrible thing, I think. If she had been in her own bed, in her own home, she could have been comforted by our presence and the scent of her familiar life around her. Instead, she finally lapsed into unconsciousness and my mother had to make the decision to turn off the life support and essentially, end her mother's life. My mother has never forgotten this.

End-of-life planning could have helped my grandmother and could have prepared my mother for what she had to do. There are many grandparents who are still alive today, who would benefit from this type of counsel. It's unforgivable that Republicans have purposely lied about and blocked this section of health care reform. Unforgivable. Look at my grandmother's face. Wouldn't you have wanted to help her go home too?

Rest in peace, Elsie Mitchell. I miss you, but I hold the many beautiful things you taught me, close to my heart. There are still as many "damn fools" in the world now as there were when you were here. I don't think any of them know how rare and magical 4-leaf clovers are and there's not a leprechaun in the bunch. But I promise, if anyone ever asks me to marry them, I will make sure they are not just worthy of me, but also worthy of you.