PERSPECTIVE ON HEALTH CARE : A System That Could Make You Sick

My mother, who is 85, was in the hospital for a month last summer, admitted for some vague abdominal pains. She came out permanently paralyzed in her right hand, having had a stroke while there, and unable to walk, having fallen between the rails of her bed and breaking her hip. By the time she was discharged, she also had suffered a pulmonary embolism, pneumonia and drug-induced psychosis with indications of paranoia and a tendency toward suicide. As to this last (she was heard to murmur, “I wish I were dead”), several costly consultations were held with psychiatrists who determined that she was “depressed,” possibly due to her health setbacks.

For this experience, the bill to the Medicare and Medi-Cal branches of government (not counting the doctors’ bills) came to $87,025.69, more money than my mother ever earned in her life, more money than she ever saw at one time or in one place or ever dreamed of seeing.

What my mother did dream of as a girl was an education (she never got beyond the first year of high school, when her father died and she had to go to work to support her mother and sister) and music lessons (she loved Chopin, Beethoven and Mozart and wanted to become a classical pianist). She later had dreams for her children (summer trips, music lessons, good schools, nice clothes), none of which she could afford.

My father was a secondhand dealer (later an “antique” dealer; he ran Gerber’s Antiques on Melrose Avenue for many years) and my mother worked in the store with him. My parents never went on a summer vacation. They never stayed in a good hotel (on necessary car trips, they stopped at motels, whose price my father always bargained down). They never bought a house, never bought a car newer than 10 years old, never had health insurance or a retirement fund. Before my father died of leukemia in 1965, the family’s savings went to hospital bills until the City of Hope accepted him for the last weeks of his life.

When I look at my mother’s hospital bill, I am confused by the great generosity of this society to treat my mother to oxygen (a tube clipped to her nose) at $192 a day (I think of how she might have breathed the air on a tropical beach in her healthier days for that kind of money); to numerous “nutritional consultations” at $40 each (I think of how many fine meals she might have had at one of those Melrose restaurants); to room and board for $27,225 (I think of the house she and my father could have bought instead of living in apartments, with my sister and me sharing the one bedroom and my parents sleeping on a couch in the living room).

I don’t know what to make of this kind of inequity; after my mother fell out of the hospital bed and broke her hip while in her drugged and confused state after the stroke (itself possibly drug-induced), the hospital decided it wise to constrain her in a “posey” (straitjacket) a cost of $83.75, which was charged six times over a period of several days. Did she wear these out? Did they get lost? Or does the charge refer to tightening and loosening of the ties each day?

There are charges (on the days she was nearly comatose on morphine) for self-care training ($35 for 15 minutes), charges for occupational evaluation ($88 for 30 minutes), functional training ($68 for 30 minutes), a dose of Mylanta for $12.63 and an acetaminophen tablet for $3.95. There’s a charge for one ounce of “odor eliminator” at $4.88 and two incontinence pads for $20.82. A dose of castor oil is $5.68. The last entry on the bill is for “wipes, tissue, 2 ply” at, astonishingly, “00.00” cost.

Perhaps I should be grateful for the measures that were taken to maintain my mother’s existence (and which continue in the nursing home) but I wonder if there ought not to be some limit to them, some moderation in dispensing these astronomically priced services. I don’t think it’s for me to decide, nor for anyone to have to say about a loved one, “Never mind, that’s enough.” But our resources are spinning away. If we can’t set limits as individuals, then society must do it and do it soon.

As the health care of the future comes into being, I hope it will leave resources to benefit us at the beginning and middle of life. Let it be proportionate and fair, but also wise, not only according to our sense of humane treatment but also according to our common sense.

Our priorities are off if all our resources go to extraordinary measures that merely prolongthe end of life.