This morning my very dearest friend in the world called to tell me that her sister, Sue, had died. It was not a surprise; she was yet another victim of COVID-19. To date 120 million souls have died from this modern plague. The SARS-CoV-2 virus is a killer to be sure but it is so much more than that here in the United States. This virus underlines with a red magic marker the many ways that our health care system, the most expensive in the world, fails us at the end of life.
The modern, for profit, hospital is rarely designed for the dying. My regional hospital is pretty typical; trauma patients are airlifted to a regional trauma center and anyone else on the edge of life is shuttled off to the nearest skilled nursing facility in the blink of an eye. The insurance industry has a great deal to do with those kinds of decisions, that and financial bottom lines. Although 72% of hospitals in the United States with 50 or more beds have a palliative care program (read comfort care only,) these are mostly large nonprofit hospitals in big cities.
This brings us to yet another layer in this particularly grim scenario. The physicians in acute care facilities are ill prepared for the tsunami of dying patients that COVID brings their way. Not one doctor that was treating Sue had a clue how to keep her comfortable with a ruptured bowel (yep, COVID can do that.) They wanted to do surgery, knowing full well that she wouldn’t survive, but they didn’t know how to dose pain medication for a dying woman. Sue was eventually treated appropriately, but only because my friend is a Hospice nurse. SHE told the doctors how to prescribe the necessary medications.
I guess I don’t have to remind anyone that this is 2020, a year that will live in infamy in our imaginations for a lifetime. There is no reason – NO REASON – for anyone to die alone and in pain in a supposedly well off and modern nation such as the US. Yet that is exactly what is happening, right here, right now. It’s time to address this. This website and this blog are my ongoing contributions to furthering the education of Americans on how we die and how we can do it better. We. Can. Do. Better.