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End of life discussions are hard enough

I posted this several years ago. I think that it is worth posting again.(Besides, I don’t know what to make of Rick Santorum.)

When Sarah Palin wrote, “the America that I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death penalty’ so his bureaucrats can decide, based on a subjective of judgment of their ‘level of productivity in society,’ whether they are worthy of healthcare. Such a system is downright evil,” I got physically nauseated. The only reason that former Governor Palin said this was to derail healthcare reform and to try to elevate her own status in the conservative movement. The statement had no basis in reality. My nausea stems not from a lie, but from this person unknowingly making my job harder. Speaking with real patients about real end-of-life issues is incredibly difficult.

The following is an example of an end of life discussion. It has been fictionalized to protect patient’s privacy. A 80-year-old man presented after a fall at home. The patient had been in declining health for some time. He has an abnormal heart rhythm and congestive heart failure. He is on blood thinners because he is at increased risk of developing clots in his heart. The patient is awake and alert on arrival. A CT scan is obtained of his brain which reveals blood between the brain and the skull — subdural hematoma. The patient is admitted to the intensive care unit for observation. Medications are given to reverse his blood thinners. The patient does well overnight in a repeat CT scan (standard practice) performed to see if anything new has shown up. The patient has a new contusion (bruise) on his temporal and frontal lobes.

The patient, who was lucid throughout the night, is now somewhat confused. He is having some problems finding his words. His son, who is an orthopedic surgeon, had been with the patient through the night. The son is now extremely concerned. He wants to know what happened. I review the CTs with him and point out that the contusion is in the area of the speech center of the brain. This should explain his difficulty finding words.The son wanted a repeat CT scan, in spite of the fact that the second scan was only completed four hours ago. I asked whether, if we find a surgical lesion (something that can be operated on), he would like me to call a neurosurgeon. I asked if he wanted his father to undergo brain surgery if it is necessary.

I think this question is more than reasonable. Thankfully, the son never had to make that decision. The repeat CT scan was the same as the second scan. Neurology was consulted. Over the next several days, the patient slowly improved and was able to be discharged to a rehabilitation center.

You know our society is in trouble when a physician has not thought about end-of-life issues concerning his 80-year-old father who has a bad heart. From a medical standpoint, I just want to do what is right for the patient, which is to follow that patient’s wishes. Yet so very few families have talked about end-of-life issues. You don’t want to be in the position of the son where you’re having to make a decision while looking at a CT scan in the middle of an ICU. Instead, you would like to be able make decisions in the privacy of your physician’s office.

I deplore any politician that makes this situation harder. Emotions are overwhelming when families are faced with these types of decisions. Exploiting end-of-life issues for political gain should get those politicians a special place in Dante’s Inferno.

By |2012-02-08T05:57:03-04:00February 8th, 2012|Congress, Healthcare|Comments Off on End of life discussions are hard enough

The Big Fail, Part Two

National Tea Party

I’m sorry. I know I have really spent way too much time on the subject, which is exactly the kind of thing conservatives want. They love for us to focus on things that really don’t matter. I had a small post the other day, which was really meant for my readers to briefly look at and say, “well, that was obvious.” It didn’t really work out that way. So, I’ve written a lot of responses and comments covering three things — The National Tea Party, the new Black Panthers and the NAACP.

Conservatives, for the most part, hate answering questions. Instead, they like to stay on offense. They like to answer a question with a question. If you asked them, for example, why they tolerate racists in the National Tea Party, they will respond with something like, “Why didn’t the NAACP condemn the horrible rhetoric of the New Black Panthers?” Well, the NAACP did condemn the garbage that was spewing out of the New Black Panthers. The NAACP even pointed out that the new Black Panthers are not part of the NAACP. Really, many of the racist statements are coming from representatives of the Tea Party.

The New Black Panthers are a smokescreen to avoid talking about the real issue, racism in the Tea Party. They are a nothing group. They have little or no membership. They do not speak for a large group of African-Americans. They have no power to influence policy. In my mind, I will throw them in with many of the hate groups on the right who are part of those armed militias. I do not believe that they accurately represent any major religion. I find nothing that I’ve seen or heard from this group to be attractive. As a matter fact I find them rather repulsive. A call to kill babies, White or Black or Brown, makes Mister Shabazz an evil, twisted man. Oh, finally, no one attested to being intimated by the New Black Panthers. Not one person.

The National Tea Party is a major element within the conservative movement. Top Republican officials have begun to distance themselves from the racial rhetoric of people like Mark Williams. The frustration that many Americans feel is legitimate. I believe that the Tea Party has taken those frustrations and is trying to use them for personal gain. Specifically, Republican gain. The problem isn’t taxes. The problem is Congress. The problem is that good people on both the right and the left have worked hard to elect who they thought were “good” officials. Whether it was the Contract with America or the recent Democratic takeover of Congress, Americans have had their expectations dashed time and time again. We’ve seen Congress become a rich man’s country club. More than half of the Senators are millionaires. A significant number of Representatives are well off. Lobbyists are smiling. Major corporations are smiling. Profits for major corporations continue to increase while wages have been stagnant for almost 25-30 years. This is our problem. Wedge issues are not our problem. Until we fix Congress, we’re going to continue to have groups like the Tea Party prey on the frustrations and anger of Americans.

By |2010-07-18T21:36:33-04:00July 18th, 2010|Congress, Media, Race|Comments Off on The Big Fail, Part Two

Immigration and the confusion of the Right

Obama recently talked about immigration reform:

A friend of mine has written an interesting post (funny and not serious) on immigration. His political ideology is clearly to the right of center. He is a businessman who has done well and unfortunately has bought into a lot of the rhetoric of the Right. He and many others in the conservative movement have charged that Obama has no intention of protecting Arizona and other states from economic refugees. (This is the term that I use for illegal immigrants because it more precisely defines why they’re here and why they’ve been allowed to stay here). The attack on the Obama administration has come from a two-pronged approach — First, the president has failed to protect the country from a growing threat. Secondly, he does not listen to us, the American people, who have cried out to have something done.

Let’s take the second allegation first. My friend has followed the lead of other conservatives and has looked at polls. Polls? Conservatives are suggesting that the president should not lead, but instead should follow American public opinion. I love this myopic view of American political life. It was less than four years ago when these same conservatives were telling us that we needed to follow Bush and not look at the polls. As a matter fact, just before the invasion of Iraq, a country that did not attack us was never a threat to us, Americans favored continued weapons inspections by a vast majority over a military invasion. It was okay for President Bush to ignore the polls, but Barack Obama must follow them.

What threat? (Like an Al Qaeda threat or a Soviet Union take over the world kind of threat?) Economic refugees have been allowed to pour into our country because it’s beneficial to business. Both Democrats and Republicans have had opportunities to stem the tide but they have failed. Why? It isn’t like these economic refugees are a solid voting block for Republicans or Democrats — they can’t vote! Therefore, they have no political power. The businesses that hire them — they have the political power. Whether it is agriculture, construction or the restaurant industry, a large segment of our economy depends on cheap labor. Cheap labor is like crack to business. They simply cannot get enough of it. If they can’t find enough cheap labor here in the United States, they will move manufacturing to Mexico, Thailand or China. We have seen this. We all know this to be true yet, for some reason, conservatives are bashing Obama for something that was already in place before he took office.

Of course, this brings me to President George W. Bush. He was in office for eight years. Where were the calls for his impeachment over his immigration policy? (He didn’t develop one until he was in office for over seven years.) During the go-go years of the housing bubble, millions of immigrants poured into this country and most conservatives said nothing. Why? Immigration was a problem then and it’s a problem now.

Conservatives want it both ways. They want the federal government to spend money on things that they want money spent on and they still want to shrink the size of government. The Obama administration has deported more economic refugees in this first year than any other administration in history. The Obama administration has set aside over $400 million to strengthen border security and hire more border agents. Conservatives whine about Barack Obama being weak but when he stands up and says the Constitution has given border security to the federal government, conservatives whine about states’ rights. Which is it? Defend the constitution or not?

Fixing the problem with immigration is easy. For the most part, economic refugees come here to get jobs. Clamp down and increase fines on businesses that hire economic refugees. Continue to enforce the current laws. If economic refugees cannot get jobs, they will not come here. This is extremely simple and it will work, but there is no political will on Capitol Hill to do this. The business lobby is too strong. If Congress begins to listen to the people instead of the lobbyists and comprehensive, meaningful immigration reform is passed, we will have one less hurdle in order to completely fix this problem. This last hurdle is clearly the toughest. What do you do with economic refugees who are already here in the United States? To me, the answer does not matter. We just have to come up with an answer. No matter what the answer is someone is going to be furious.

The problem is that conservatives are not serious. Once conservatives walk into the offices of the American Chamber of Commerce and demand that they began to clamp down on members who are hiring economic refugees, then I’ll believe that they are serious. Once the American Chamber of Commerce comes out and openly denounces businesses that are hiring these illegal immigrants, then we will have a chance to get meaningful comprehensive immigration reform passed through Congress and signed by President Barack Obama.

By |2010-07-11T09:19:22-04:00July 11th, 2010|Bush Administration, Immigration, Party Politics|Comments Off on Immigration and the confusion of the Right
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