Saturday, August 7, 2010

Ghost of the Christmas Past

He sat there seething in his infirmity. His words were both hearty and calamitous: hearty; because they were full of thought, fight and angered brilliance and calamitous; due to the ensuing storm of survival.
I had BACOD (chemotherapy regimen) him to a baldness that would not allow the hair follicles ever to show the tendrils of growth on his head, leaving the scalp bland and slightly wrinkled. Then, as if that was not enough, I had to CHOP (chemotherapy regimen) and ICE (chemotherapy regimen) him till his eyelashes had dissolved into the lids and the lenses behind the corneas had shopped their acuity for the opacity of a thin veil of cataract. The ghostly remainder of his being was the full juice and vigor of his beautiful mind.

“Non-Hodgkins Lymphoma, man what a misnomer for this disease.” He said all entangled in his thought of self and non-self. Fear of death and passion for living, side by side in a play for life and death both focused on his visage contorting it to their own intensity. “What do we do now that all of this chemotherapy has failed?” He asked.

‘You might qualify for a Bone Marrow Transplant. That would be an option.” I replied thinly, knowing the cubicles of bureaucracy and insurance advisors would no way allow him to traverse the grid of the tightly knit culture of, “preserve the share-value,” and have a chance at life.

The concept interested him. “So how do we go about it?” He asked. And the process deemed as doomed for failure in my fears slowly rolled the circumference of its wheel. After an arduous twenty-two days, while he lay in the hospital bed hiding, dodging or fighting one co-morbidity after another, the cost of his medical care continued to climb and the tally on the bill kept turning a new page ultimately to an astronomical six-figure value. Those days of indecision, denial and incoherence cost three times as much as the chance that he had hoped for.

Time just wasn’t on his side and neither were the bean-counters. And it dawned upon me the concept of rationed care. Was that the right move? Had I planted the seed of discontent when the potential for response much less cure was so remotely miniscule?. But then, there was a chance ever so slight, even after all that contemplation. Had I not taken the oath to protect, preserve and foster life? Does life have a monetary cost?

These are some of the questions that marshal us into a new era of sobriety. Economies of scale are hampered in their asset values and the ultimate victims to this monocular vision are the bodies and souls of tortured humans.

But, then there is this issue of cost and productivity and the fact that 50% of medical costs are spent on the last six months of life gives one pause. And yet with all this hoopla about costs and age, as one reflects, these “last six months of life” must be dissected and evaluated on different scales; age, chronic disease, chronic dependency on equipment, projected benefit and survival and future pressures on society.

Unfortunately we as humans have choices to make between pragmatism and emotions. Whatever the ultimate decision is at the individual level, we as a society should learn to happily abide by it after all the rancor and pain has subsided.  Discussions of these issues must be done at an honest intellectual level, not for political, personal or self-gratifying gain and not especially by the fleeting, surreptitious guardians of finance. It must not be a 5-4 Court decision nor should it be a mandate on the society. This crucible must contain the individual wisdom of all participants- the people. So, in the end we shall finally arrive at, “Readiness is all.”

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