Monday, December 26, 2011

"Edna was born in 1918"

"She’ll be 94 years old in January.

...Two years ago I got a call from an Emergency Room. Edna had arrived in an ambulance. She could not breathe and they were going to vent her. I thought it was over. Not the case. Five days in the hospital (steroids, oxygen, antibiotics and 24 hr. care) followed by twenty-one days in a rehab and she was back on her feet.

Edna’s medical problems were caused by old age. There is a valve that allows food and water to flow to the stomach, but blocks it from getting into the lungs. Edna’s did not work well. The result was "aspiration pneumonia". She had two failed operations operations to repair the valve.

There is a treatment for this. They poke a hole in the patients stomach, put in a tube and tie it to a bag that the patient wears on her on hip. Ensure gets fed to the patient via the bag. Nothing goes down the throat. Problem solved. Edna wanted no part of that.

Edna’s been to the emergency room/hospital a total of six times since that first episode. She averaged four days each time. She has had two operations and spent seven weeks in rehab.

...This woman should have been dead (at 92 years old) when she had her first episode. If this were 1981, she would died.

With each brush with pneumonia she was advised that she should opt for the bag. If she didn’t, then she would get sick again.

...she told her Doctors: No bag! I’d rather be dead then not eat or drink again!

...Given the cost of the treatment (100drs of thousands?) over the past 24 months there are questions that society has to ask Edna. (1) Does she have the right to say "no" to the medical alternative? (2) If she says "no", does society (Medicare pays for all of Edna’s bills) still have to pay for the repeated hospitalizations?

In 2011 the answers to those questions are "yes" and "yes". No treatment is without patient consent and every hospital would put out a maximum effort if she were wheeled in the ER door again. America can pay for Edna today. She is a very small percentage of the population. We are still a wealthy enough nation that we can afford to give Edna the treatments and the choices.

That will not be the case in ten years.

...I don’t think it’s possible that the country can provide the level of care that Edna has gotten to all of those other Edna’s out there.

...Does Edna, at 94, have the same medical rights to make choices as does a thirty year old?

If you say no, how do you respond to new knees at 74 and new hips at 84? When you start drawing lines, it’s very hard to stop. less than ten-years the question of what to do about Edna will be asked and answered."


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