entering the twenty-first century with people living well into their eighties and nineties; forty- and fifty-year-old women (an age that once marked the end of life) are giving birth; aging, withered bodies are being sustained by transplants, respirators, and feeding tubes, while women and men voluntarily hook themselves up to the Kevorkian death machine when they can no longer tolerate the pain of living with debilitating diseases.
It's no wonder that we've been misguided into thinking that our doctors, our external healers, are deities capable of performing the greatest of miracles. We don't just pray for such miracles; we expect them. When a doctor fails to meet our ever increasing demands for youth and immortality, we sue. We scream malpractice. Doctors work in fear of litigation, often feeling it necessary to order a battery of unnecessary and expensive tests.10
An Era of Alienation
For the first time in history, we're a generation for the most part sadly lacking the wisdom of those who went before us. We've abdicated responsibility for our health and turned our health problems to teams of specialists. And these doctors, not being generalists, are not in a position to see us as whole human beings. The result is alienation of the doctor and the patient.
We seem to have lost touch with common sense, that inner knowing that tells us the baby's cold needs to run its course, or you should elevate your foot and stay off it if you've twisted your ankle—the doctor would say the same thing. There was a time when cultures relied on this most valuable resource, common sense.
We have lost sight of the fact that healing messages are as individual as the beings searching for a cure. Because of medical progress, it has become easier to view the human body as a machine: take a number, line up, cut it out, cut it off; get the broken or diseased part fixed; forget about it. We have become faceless body parts in the medical maze. Doctors admit that it's easy to forget there is a person attached to the gallbladder, the lung, the breast.
One surgeon shared a story with me. He had recently done a routine gallbladder surgery on an older woman. Returning to his office for the postoperative exam, she stood clutching her fine leather bag as he breezed in to check her progress. He started talking, asking her questions. He didn't recognize her, but that was a pretty common thing since he had gotten so busy. He didn't recognize lots of patients. But the woman had this puzzled look on her face. "Who are you?" she asked indignantly, stopping him dead. Momentarily he thought, "Who am I? I'm the surgeon." He realized that he had never examined this woman while she was conscious, and that through arrogance he assumed all his patients knew him; after all, he was the doctor. This was a defining moment for him, and he actually left his group practice shortly after this seemingly benign encounter. This woman, with the gallbladder, clutching her bag, brought this well-known surgeon to his knees.
Dare or Death: It's A Game of Life Roulette
Life Roulette. The stakes soar faster than the wheel can turn. As we throw down a growing stack of cash for one more try in the game, pieces of doctors and patients dissipate among the ashes of malpractice, managed care, dwindling resources, and the needless, violent deaths. Children. Old people. No one is spared the pain of a medical system crying out for change. Perhaps it's the dwindling financial and human resources, or the mutant bacterial strains that antibiotics will no longer heal. Or is it cancer? AIDS? Violence? Guns? Gangs? Our inner city emergency rooms are turning thousands of patients away. Lined-up in halls, in waiting rooms, on park benches, their plea becomes a whisper lost in the murky residue of noise, cars, sirens and too many others. Quiet moments at any emergency room are rare, and they come suddenly, like the yellow-green stillness that falls over the trees, streets, and trailers just before the tornado's black funnel sweeps victims in its wake. While some patients are fortunate enough to have family or insurance to care for their needs, others are forced to seek solace in shelters rather than in the arms of a loved one. Others die, unnoticed, under bridges, near trash cans, in back alleys, in their cardboard beds.
Are We Managing Care, or Is It Managing Us?
Every one of us suffers for the needless excesses of our health care system. When most of our grandfathers, fathers, sons, or lovers were across the ocean fighting in World War II and women were working in factories, national health care dollars spent were about $4 billion. Half a century later, in 1992, the money spent on health care each year had soared to $800 billion, and conservative estimates indicate that number will soon exceed a trillion dollars.11
Back in 1940, most health care costs for doctors and hospitals went to cover the most serious, acute conditions. Today the situation seems to have flipped: the seriously ill are forced home in two or three days, no longer able to get well in a hospital setting. These are stays that in the past were treated in hospital settings for eight to ten days. Now, thanks to the health insurance industry, major surgical procedures for things such as mastectomies warrant a twenty-four-hour stay, while treatments for chronic conditions such as arthritis, pain, depression, and high blood pressure eat up about 70 percent of the current health care budget. According to the U.S. Department of Health and Human Services publication Healthy People 2000, more than 33 million Americans are functionally restricted from daily activities because of such chronic conditions.
Managed care has become our solution to the rising costs of health care. But insurers further muddy the waters by insisting that our care be dictated by the dollar and the day. Too many days, too much money equals time to go home. You're still sick, you say? The ever-tightening noose of managed care and its capitation system have become part of medical treatment delivery, while patients, doctors, families, government leaders—everyone—is asking, why? We are told that because as a nation we shell out $950 billion annually to care for our sick, we need to find ways to cut costs, so that everyone can be served. We can no longer afford to pay for everyone to be treated for every ailment.
We are the only industrialized nation with no comprehensive system of health care delivery. More than 37 million Americans have no health insurance, and 22 million working poor go untreated because they cannot afford adequate coverage. Others, with the right amount of money, the right job, and the best insurance, continue to enjoy the luxury of being covered for elective procedures. The health care controversy even took over the 1992 presidential campaign, placing First Lady Hillary Rodham Clinton under a microscope of public scrutiny. There were focus groups. There was testimony. There was posturing and grandstanding. And everybody was trying to get on the list of speakers: the special interests, the hospital administrators, the business leaders, the doctors, the patients, the insurers. Everybody had to have his or her story heard. But try as the First Lady might, she could not make the pieces of the puzzle fit. And now that the dust has settled after the whirlwind of a failed attempt, it's clear that no winners emerged from this damaging battle. Some favored a national health care plan. Some were vehemently opposed. Some only cared about protecting their niche in the health care arena. The patients— and when you think about it, we're all patients at some point— wanted affordable, accessible, quality care. To make matters worse, the golden crescent of scientific evidence that's all wrapped up in the double-blind bind of clinical trials and proof, kept raising its ugly head, as a few brave souls tried to consider alternative options to conventional care. And now, several years later, we're still puzzled. We ask, How did this happen? What role did we play? Many are quick to blame the other guy: the hospitals; the doctors; the insurance companies; the uninsured; the government; the gangs; the guns; the immigrants; the homosexuals. No matter who gets saddled with the blame, the questions remain: Who will pay? Who will get care, and who will die without it?
The answer may not be the cure. Perhaps the simple truth of healing is connecting or reconnecting to the inner healer within each of us. Maybe it's learning to live with grace and ease, with or without cancer, AIDS, or addiction. Or could it be that we have to unleash the power of centuries of knowledge, taking a little wisdom and a little loving and mixing it up with a lot of common sense? Many doctors today think that we have lost touch with our generational wisdom. Generations before us knew the answer. They had a special tea for this and an herb or poultice for that. Only when things
