The “They Just Won’t Die Tax”

Posted by Dia in Living and Dying and tagged with financial costs, Hospice, humor, palliative care, Talking about dying December 8, 2011

And now, another one from the annals of the absurd.

This time it comes from British Columbia and involves a fee currently imposed on dying people who accidentally live too long. Philip Wolf of The Daily News reports in his article Just Die When It’s Convenient that The Vancouver Island Health Authority demands their terminally ill decline and die on schedule like they’re supposed to. Failure to do so will result in a penalty. Thirty dollars a day for the bed, to be exact.

It just doesn’t get much more ridiculous than this.

Now don’t get me wrong, I understand where they’re coming from. The hour of death is highly unpredictable, and its inability to conform to a calendar can shred the schedules and finances of everyone involved, not just agencies. On top of that, some people who are dying while out on their own, improve dramatically once they’ve entered the hospice system and start receiving good palliative care. And, while on the one hand that can be an undeniable and profound gift, on the other hand it definitely throws a wrench into the financial administration of their cases. I certainly don’t envy those responsible for filling the shortfall. Everybody hates the fact that money has any influence over something as sacred as dying, and I sure wouldn’t want to be the one to remind them.

This of course ties into the larger problem of unaffordable health care costs, for which I don’t have any answers. And I’m certainly not going to try and propose a solution to the VIHA’s problem because, frankly, this level of absurdity may not have one. It has coyote written all over it.

I suspect the VIHA’s dilemma and decision is just the natural outcome of trying to partner bureaucracy and mystery for the dance. Of course bureaucracy will insist on leading and naturally Mystery will tease and refuse to follow. How could this kind of pairing not get ridiculous? Remember the brilliant parody that Monty Python did on this very subject? I found it in a Youtube video. (At least the VIHA didn’t go with this solution.) Here’s Bring Out Your Dead:

copyright Dia Osborn 2011

How Much Money Is A Dog’s Life Worth?

Posted by Dia in Living and Dying and tagged with animals, financial costs, Talking about dying November 1, 2010

Well, Dane the rescue mutt’s digestive troubles mushroomed and Friday turned into an emotional day from hell. He was off his feed on Thursday and by the following morning refused to eat at all. This has never, ever happened. Ever.

This dog has eaten grocery bags, sticks, and bread by the loaf. He vacuums up windfall fruit, grazes on tomato bushes, and chewed an entire crop of carrots down as far as he could get into partially thawed soil. He once frantically tried to swallow an entire fresh-caught mole without chewing when he saw me coming. He eats grass like a cow, cow shit like a fly, and anything at all if it’s started decomposing. He can down a huge, rawhide chew toy in under three minutes and goes through soft bones like taffy.

He’ll eat anything, gladly and at lightning speed. We’ve exhaustively tried to train him not to and failed. Short of a muzzle or strict house incarceration we can’t stop him. So on Friday morning, when he refused to eat, I felt a flicker of real fear.

Then I discovered the brown, splattered stains of diarrhea all over the guest bedroom carpet. (Visit? anyone? anyone?) Next I went out in the backyard and a quick survey of four days worth of dog excrement told me this problem had been developing for a while. Dog flatulence was the least of our problems. Dane had turned into a sick, little, hundred-pound puppy.

I finagled a vet appointment for 1:30 in the afternoon which left my mind roughly six hours to play in the field of worst case scenarios. Bowel obstruction? X-rays and surgery? Another thousands-and-thousands-of-dollars vet bill?

Or euthanasia?

My mind leaped to these extremes for two reasons. First, because I was still reeling from the $3400 cat bill last month. And second, because the hubster (after I put in a worried call at work to let him know what was going on) informed me Dane spent some stolen time five days earlier feasting on rotting, bony, fish carcasses along the banks of the Salmon River. The hubster and visiting friend had taken him with them on their fishing trip, and he sneaked off at one point and gorged himself on fish skeletons. Fast forward to Friday and it was time to pay the piper.

Now, just to take you all off tenterhooks, the boy is fine. The vet concluded the gastrointestinal upset was probably caused by a bacterial infection he picked up while scavenging all the crap. He’s now dining on four, large, butter wrapped, antibiotic pills a day, along with moist cans of bland dog food. He can’t believe his good luck and is touting the benefits of eating rotting fish to all who’ll listen.

What I really wanted to talk about here were some of the grim choices I considered during those six, hellacious hours of uncertainty, most of which revolved around the following question: Financially speaking, just how much is a pet’s life actually worth?

Most pet owners eventually face a vet bill formidable enough to consider the question and feelings can run pretty high about what the answer should be. There are, of course, the two extreme camps.

1) People like this:

“Yeah, it is great when people have no money to care for their pet so they put it to sleep. They usually get another one too. Hope you are not that stupid. Pets are a luxury item and you need to be prepared for these type of problems.”

And 2) the “it’s just a dog” people:

“I don’t know what the rest of you are smoking but its just a dog. I can see someone spending that kind of money to fix your child’s leg but not a pet!…In my opinion, you should let your dad take care of the problem, put it out of your mind, and pick up a new healthy dog at a shelter.”

But while both these views share the gift of moral simplicity, neither addresses the complex reality that an explosion of new, medical interventions has forced on us.

Once upon a time veterinary options were limited and, when it got serious, there was no choice at all. It was just time to put Spot or Whiskers down. But the evolution of veterinary medicine has catapulted us into a brave new world where, for those lucky enough to have deep pockets, there are now some real medical miracles available. There are currently surgical and pharmaceutical treatments for animals that rival human ones, both in complexity and cost, but the majority of pet owners don’t have that kind of money. In fact, these days most of us are struggling just to meet the demands of our own human, health care needs.

So if the first claim was true, that people who can’t afford new, higher vet bills shouldn’t have pets at all, it would eliminate a large number of potential pet owners. Personally, I shudder to think what would happen at animal shelters across the country if this ever happened. Adoptions would slow to a trickle and the number of animals being euthanized for non-medical reasons would balloon.

On the other hand, most people would (thankfully) disagree with the second opinion…that we should look at our pets as disposable possessions, like Bic lighters or paper plates.

So where does that leave the rest of us? How are we supposed to navigate the conflicting requirements between taking in a beloved companion and not being able to afford catastrophic costs?

Well first of all, I think the original question, How much is a pet’s life worth?, is inherently flawed. The life of an animal can no more be measured in monetary terms than the life of a human being can. Life is life. It’s sacred. It’s one of the great Mysteries. We can’t create it or even make it last all that long once its appeared, and it’s ridiculous to try to reduce something transcendent like that to a pile of cold, hard cash.

Yet, here’s the rub: Even though ultimately we have no control over this thing called life, we’re still all assigned as stewards. We’re each responsible for at least our own and, every time we drive a car, own a pet, have a child, or vote on a health care bill among a million other things, we’re also shouldering responsibility for the lives of others. There’s no escape. And while sometimes this responsibility is a beautiful, luminous gift, sometimes, like when we have to make a life and death choice for ourselves or another, it can morph into a near-unbearable burden.

I cried off and on all morning, waiting to take Dane to the vet. His illness unexpectedly sucked me down to a place where I found myself considering The Choice. There was a possibility that we might be facing yet another vet bill mounting into the thousands of dollars and we had to decide whether we could really afford it. For whatever reason, Dane has been a disastrously expensive pet. Over the course of the last five years, between health issues, accidents, special nutrition needs, and a strong predatory instinct, he’s cost us into the five digits. We never dreamed a pet could cost this much. His needs have eclipsed the expense and work required by every other animal we’ve owned combined, and yet we continue to adore him because he’s an affectionate, joyous, grateful dog who tries so very, very hard to make us happy.

But in the end, we’re not among the lucky few with unlimited financial resources. At some point, because Dane is the wild, fragile, phobic, allergic, epileptic, boisterous, playful, smart dog that he is, the mounting costs are going to exceed what we can pay without jeopardizing other critical family needs.

And that, my friends, is where I think the real question lies. Not How much money is a pet’s life worth? but How do I balance the financial needs of my pet with the financial needs of the rest of us? At what point exactly do my spending choices move me from being a caring, responsible pet owner into a negligent parent, spouse, offspring, or general member of society? Our pets are a big responsibility but they’re by no means the only one. This will always be a difficult question because there’s no firm answer, each case is unique, yet most of us will eventually have to answer it one way or another, either consciously or by default.

For us, because Dane is only one member of a larger family, someday we’ll probably have to make The Choice and it will probably be devastating and, yes, money will probably play a role.

But let’s be clear. While finances may set the final parameters for what we can give him medically, money will never, ever define his worth to us. It can’t. It can never measure the depths of his big, beautiful, generous heart, or the love, joy, and adventures we’ve shared, or our unending gratitude at being chosen, for at least a little while, as the stewards of his life.

The $3,000 Cat Will Live

Posted by Dia in animals and tagged with animals, financial costs October 13, 2010

I went across the street to check on Tinkerbell this afternoon and am delighted to be able to give you the following update:

It’s been a little over a week since she was attacked and the old gal is looking terrific. I mean, really. Wow. I looked it up to see how cat years translate into human ones and I can only hope I’ll look as good as she does after major surgery in my eighties.

The incision (which runs around roughly a third of her torso) is healing beautifully and she goes back to the vet tomorrow to have the staples out. Evidently, Dane’s teeth didn’t actually puncture the skin so at least there’s no danger of infection there. The damage was due to crushing and shaking and was mainly internal. She’s been off of pain meds for a few days and, while she’s clearly still feeling tender, she’s not crying anymore or growling when someone reaches out to touch her. They had a cone on her head at first but she’s been so good about not licking any of her wounds that they were able to take it off fairly quickly. She can now climb up and down on Neighbor Son’s bed, where she sleeps, with the help of some makeshift stairs and she’s eating well. And gloriously, there’s no more gurgling sounds when she breathes so the lung involvement is improving, too.

She was shaved over nearly half her body for the surgery but is being pretty good natured about how ridiculous it makes her look. I’ve been worried all week that the trauma might radically change her personality. She was a very sweet cat before the attack and in the first couple days afterwards she became suspicious and hostile. But the fear and trauma seem to be slowly resolving as well and, while she looked pretty groggy while I was over there, she was also surprisingly affectionate.

She still refuses to go outside however, and Neighbor Lady fears that she may never be able to coax her out again, but I mean really…who can blame her? If I thought there was a gigantic, black, hairy, quick creature with fangs lurking outside my front door, waiting to crush and shake me to death the minute I stepped outside, I’d be doing take-out and Netflix till hell freezes over. You go, girl. Be strong. Stay safe.

There’s even a little silver lining to the whole thing: she’s lost some weight from the ordeal which is a good thing since she was fat as a pillow before Dane got a hold of her. Overall, Tinkerbell is doing far, far better than we, as Dane the Cat Mauler’s owners, have any right to expect. She’s still got some healing work ahead of her but Neighbor Lady seems to think she’s going to be just fine.

I sat on the bed to pet her for a while and the little darling was purring like a motorboat and rubbing her head against my hand whenever I stopped. She bore me absolutely no malice whatsoever, even though it was our negligence that caused the whole thing, and frankly, it made me feel like shit. Smaller than shit. Suddenly, I realized that up until that moment I’d just been thinking about her as a generic kind of every-cat. That cat. And as a dog-not-cat person it meant that, other than the generic compassion I feel for all animals, I didn’t really care. Even though Tinkerbell is the one who bore the brunt of the assault and suffered all the pain, fear, and indignity it entailed, all my concern was really for Neighbor Lady.

Actually, if I was to be really honest, my concern has only been about a quarter for Neighbor Lady and the rest for us. (There they are in all their glory again, Ladies and Gentlemen…Wheedle and Cheat.)

But sitting there looking down into her cat eyes, that were so full of genuine affection and good will as they gazed back up into mine, (not the slightest shadow of harm or grudge to be seen), I kind of fell in love with her on the spot. Powie! Just like that. I melted and suddenly felt a wave of remorse that was truly, truly painful. Up until that moment (even with a $3400 vet bill) I hadn’t really gotten it, how bad we’d been as dog owners. Oh, I knew we were legally responsible and financially responsible and I knew we had a responsibility as good neighbors to step up to the plate. But somehow I didn’t get the suffering. I just didn’t understand until Tink looked up at me with those big, innocent eyes and suddenly I was aghast at my cavalier attitude.

Neighbor Lady joked with me a couple of times about our $3,000 cat and I looked up at her and told her Yeah. I feel like we’re her godparents now. She laughed and I laughed along with her so she wouldn’t realize I was serious as a heart attack. I do feel like I’m responsible for her in some way now. I want her to live to be twenty-five years old, gray, and crippled so I can keep going back over, rubbing her head, and hearing her purr.

I love that cat.

The $3,399.28 Cat

Posted by Dia in animals, role models and tagged with animals, financial costs, forgiveness, Relationships, role models October 5, 2010

I’m home again. Finally. Two weeks is a long time to be away, even when I’m away somewhere that I love.

We traveled all day yesterday to get back here. Up at 4:00 a.m., long drive down to St. Louis, long wait at the airport, long flight with two stops in Denver and Salt Lake City, then home sweet home at 8:00 at night. I was frazzled, exhausted, and shutting down hard. My cell phone went dead around 2:00 in the afternoon, so I didn’t pick up the two frantic voice mails left on it until after recharging around 9:30 p.m.

That was when I learned that Dane the mangy, rescue mutt, oh mighty predator of predators, attacked the neighbor’s sixteen year old cat Tinkerbell in the afternoon and mauled her pretty badly.

The first voice mail was from our daughter (voice trembling uncontrollably) telling me that the attack took place but everything seemed to be okay. Daughter was house-, dog-, and garden-sitting for us while we were gone. Daughter was overwhelmed by those additional duties on top of the five course load she’s carrying this semester at college and the thirty hour week she works as a waitress. Daughter couldn’t manage Dane’s afternoon walk so she called Sweet and Helpful Neighbor Lady across the street who cheerfully offered to help. But Daughter didn’t realize that Neighbor Lady had cats and made the mistake of taking Dane Cat-Hater over to her house off-leash. The rest, as they say, is now history.

The second voice mail was left about four hours after the first. It was from Neighbor Lady (voice also trembling uncontrollably) letting me know they were at the vet where they’d discovered that Tinkerbell was not okay at all. In fact, Tinkerbell had multiple broken ribs and a punctured lung, and surgery on her was going to cost about $3,000. She was sobbing into the voice messaging center that they couldn’t afford it and, if we didn’t pay for it, they were going to have to put her down. I about shit. Then I told the hubster. He about shit, too.

Which is when I first noticed the interesting little voices piping up in my head, having a spirited referendum in there. The first voice (naturally) was Guilt.

I told you! I told you a thousand times. We should have made it a rule that he’s always on leash when he’s out of the house!

The next voice was Blame.

It’s the hubster! The hubster hates leashes! He refuses leashes! And how in the hell could Daughter not know that Neighbor Lady didn’t have cats? We’ve been neighbors for thirteen years for godsakes!

Then Wheedle and Cheat chimed in.

Y’knooooow…mentioned Wheedle. It must be close to an hour and a half since Neighbor Lady called.

Yeaaaaah, that’s right…seconded Cheat. I wonder…what-oh-what could have happened since then?

Do you think they may have already put her down? continued Wheedle. It would be so sad…

…so sad…echoed Cheat.

But it wouldn’t cost us nearly as much…suggested Wheedle.

It would save us a fortune! chimed Cheat.

It would put the cat out of its suffering, too…said Wheedle.

It would be a kindness, Cheat nodded his head emphatically.

Maybe…Wheedle tilted his head to one side and gazed up at the ceiling…we should just say we didn’t get the message and call in the morning?

How compassionate! Cheat agreed.

Compassionate? said Guilt much struck.

Can we really do that? said Blame perking up.

It was only after this exchange that Tattered Shred of Decency finally spoke up.

Oh, come on you guys, her voice was gentle but firm. Couldn’t you hear the anguish in Neighbor Lady’s voice? Tinkerbell is like her child. We can’t dump this off on her.

But we don’t even like cats, muttered Cheat.

Remember how Tinkerbell used to come in our backyard and shit in the pea gravel pathways? reminded Blame.

And y’knoooow…Wheedle slithered back into the conversation. Tinkerbell is a very, very old cat…

There was a significant pause here. It was a hurdle even for Tattered Shred but she powered up and managed to clear it.

Doesn’t matter, she finally crossed her arms over her chest. Neighbor Lady loves her and can’t bear the thought of losing her. Not like this. Don’t you remember all the times Neighbor Lady helped us when we were in a tight spot?

Nobody answered.

Has she ever, ever done anything to hurt us? Or anybody else for that matter?

Silence.

And is the pain she’s in right now any fault of her own?

Four heads hung down in shame and wagged slowly back and forth.

So the hubster and I called her back. Neighbor Lady and Neighbor Hubster were still at the vet and Tinkerbell was still alive. Only somehow, during that hour and a half delay, the surgery’s cost had grown from $3,000 to $4,000. And by the time I actually talked to the front desk person to give her our credit card number, the upper estimate had mysteriously mushroomed to $5,000. I wasn’t sure what was going on but at that point I thought it wisest to let the clinic know we were capping the amount we’d pay at $4,000. Privately, the hubster, Tattered Shred, and I remained flexible about covering more, but we didn’t want the emergency clinic thinking we were patsies.

The final amount topped out at $3399.28 and we considered ourselves lucky. (Could that be what the clinic was trying to accomplish by raising the upper end?)

I’m not sure why it’s so much harder to be a good human being when large sums of money are involved, but it is. Thousands of dollars just hurts. Ow. However, the fact that Neighbor Lady is such a genuinely good and loving person made it a whole lot easier for me to step up to the plate and do the right thing.

Is goodness contagious then?

(Shittiness certainly is. I admit if the cat had belonged to the lady who lives behind us, the one who wanted to chop down our apple tree to keep a few apples from falling in her yard, the referendum in my head would have been longer and the outcome uncertain.)

It’s the old Golden Rule I guess. Be unto others as you would have them be unto you.

Only you know what? Neighbor Lady doesn’t have any strings attached where her be-unto is concerned. She’s not kind and decent because that’s how she wants to be treated in return. It’s just who she is. She’s a naturally stellar human being. Frankly, I don’t think I’ll ever be that good a person but at least her influence helped raise me a little higher this time around. Maybe if I put a little effort into it there could be some kind of trickle down effect from all this. Next time I’m dealing with Apple Tree Hater, maybe I’ll strive to be a little more understanding and forgiving, too.

Maybe this incident could even morph into something that winds up improving our little part of the world. I owe it to Tinkerbell to at least try.

This morning, the hubster and I drove past a dead cat flung to the side of the road that had been hit and killed by a car. I felt the twinge of regret I always feel with roadkill and then heard the hubster mutter, That better not be our three thousand dollar cat. We looked at each other and started laughing as we realized that for the first time, for whatever time she has left, we’re now heavily invested in the welfare of a feline.

Could it get any stranger than that?

A Parrot’s Grief

Posted by Dia in animals, Depression and tagged with animals, Beliefs, denial, Depression, Economy, financial costs, Gratitude, Grieving, Living and Dying, Relationships, Respect, Science, Surprise August 27, 2010

We once had two dogs. They joined the family two years apart, lived most of their lives together frisky and inseparable, then died at the end, also two years apart. Our big guy died first. Swift and unexpected. He was fine and healthy for years and years, and then one day got sick and three days later died. Just like that.

Our second dog was lost without him. For a month following his death she withdrew. She’d still come to us if we called and try to look happy to see us, but as soon as her duty was done she’d slip away to the corner where they used to sleep together and lie down again, eyes open and unfocused and numb.

We were heartbroken for her and heartbroken for ourselves. We all missed him terribly.

But time worked its magic and one day, for no particular reason, she returned. She followed me around the house that morning, trying to flip my hand up on her head with her nose again, and my heart eased knowing she’d be okay. We had two more wonderful years together before she, too, eventually died.

There’s a lot of controversy on whether animals experience emotions, but the suggestion that they can’t feel things like simple grief makes me angry. I usually try to respect the beliefs of others but, because this particular belief is so often used as a justification for exploitation, neglect, or abuse, I don’t respect it. I find it suspect. The claim is far too riddled with conflicts of interest to take at face value. Besides, in five decades of living, every interaction I’ve personally had with animals and birds, (and reptile, fish, and even a few insects believe it or not) has confirmed that these other strange and wonderful companions I share my world with feel a great deal, even if most of the time I don’t understand what exactly that is.

A case in point:

One of my first hospice patients had a parrot she said she’d smuggled over the border from Mexico twenty years earlier. She was a wild, untamed kind of woman and her parrot was just like her.

I don’t remember now what kind he was, but he was smallish, maybe a little bigger than Snowball the dancing cockatoo, and he spent most of his time in those final days perched on the valance above the window next to her bed. I was a little nervous at first because family members warned me that sometimes he flew down on people, swooping at them again and again, testing to see if they would duck and run. He was a fierce little thing, tolerating only a handful of people and attacking the rest, but he clearly loved and needed that woman lying on the bed and was made achingly vulnerable by her approaching loss.

He never flew down on me. I used to speak to him gently when I was on that side of the bed, changing her sheets or dressing or incontinence pad, and he’d closely monitor everything I did, anxious and curious, sometimes fluffing up into a ball of down and shaking his head rapidly, raising his wings for a moment like he just couldn’t stand the uncertainty anymore, then settling back down to watch and wait again anyway. He’d sidle back and forth along the length of the valance, first to the left, then to the right, over and over again like a loved one pacing the corridors of a hospital. He knew something was wrong and it seemed to fill him with unease.

Once I saw him fly down to the bed while I was in and out of the room, doing laundry. She was asleep and he seemed to want to just be next to her, to touch her. He awkwardly waddled up next to her head, curling into the warmth still emanating from her. He bent his head over next to her mouth as though checking for breath and just stayed there for a long time, frozen, his feathers brushing her lips. My heart broke for him and I wanted to pick him up, cradle and croon to him, but I knew he’d bite me if I so much as extended my hand.

First her sister told me and then her daughter. How he wept on her body when she died. He flew down from the valance to her chest and started nuzzling and nipping at her, trying to make her respond. Stroke him. Yell at him. Anything. But when she didn’t move he went still and stunned, and it was then that he started making the strange, small noises, noises unlike anything they’d ever heard him make before, like sobs. His head bobbed slowly up and down to the rhythm of the sounds, and her family just stood there around the bed, surprised and stricken by his grief.

Later, when the men from the funeral home came to remove her body from the room he attacked them. Viciously. Angry and hysterical, he dive bombed at their heads repeatedly until one of the men ran in the bathroom to hide. The family finally captured him and put him in his cage while they took her body away.

I’ve often thought about him over the years and hoped that he eventually found someone else he could trust, someone he’d allow to love him, to bring him back in healing and wholeness.

Like just about every other person I’ve ever known, the deep emotional bonds I’ve shared with animals over the years have provided me with a well of strength, beauty, unconditional love, and hope. My ties to these companions have helped shape me, often healed me, and even saved me, more times than I can count. I really, really hope that some day soon we’ll grow past the economic and scientific need we have to deny the depth of their vulnerability to us, and instead forge a higher, kinder relationship based on mutual respect. They’ve already given us all so much. They deserve something far better than what they’ve gotten in return.

You’re Not Dying ‘Til We Say You Are

Posted by Dia in Uncategorized and tagged with denial, financial costs, Living and Dying, medical paradigm July 2, 2010

In the last post I mentioned how our society tends to quarantine the dying in unconscious and insidious ways, thereby making them harder to see and harder to reach. Since then I’ve been thinking about one method of quarantine in particular that’s surprisingly effective. It involves who gets to declare whether a person is really dying or not and has evolved out of our current medical paradigm.

In The Hour of our Death, Phillippe Aries, a twentieth century French historian, says that prior to our modern medical age the first person who knew that dying was an imminent event was usually the person who was doing it. Not so today. When was the last time you heard anyone announcing that they were dying without a battery of medical tests and a doctor’s validation?

This is because, in today’s world, doctors are the guardians of the portal. Only they are allowed to officially declare that someone is dying and even then, only after administering exhaustive tests followed by exhaustive treatment regimes that fail to work. (That’s the scientific methodology for figuring out if we’re dying or not by the way. If nothing works, then we are.) This simple mechanism of controlling the diagnosis serves to make the majority of dying people invisible by removing their authority to 1) know that they’re dying in the first place and 2) even if they do realize it, communicate it in a way that anyone else will believe.

It’s really quite brilliant.

This current stage of development springs from our modern desire for tests, certifications, and proof. If a dying person can’t provide us with these things then we tend not to believe them. After all, how could they possibly know if they’re dying or not? They’re not a doctor. (Unless they are, in which case we’re a little more likely to believe them. But even then we’re going to need to see the scans.)

Now, there are a number of reasons why this creates a problem. On the personal level:

1) It denies our sovereignty over our own body, and

2) If we know we’re dying and no one believes us, it makes us feel invisible and crazy.

And on a strategic, fiscal level,

3) It makes a dying diagnosis the most expensive diagnosis that money can buy,

4) Most doctors are loathe to tell someone they’re dying, so many either postpone doing it until it’s too late for the information to be of any real use, or they never do it at all, which

5) Is a huge problem because insurance and Medicare won’t pay for hospice care without a doctor’s referral.

But all that being said, there’s still another reason which is the primary one I wanted to explore here:

6) This mechanism of control takes our primal need to deny death and institutionalizes it into the very system that oversees the dying.

Needless to say, this gives our powers of denial quite a boost. It sets up a bewildering array of hoops to jump through and there’s nothing denial loves more than hoops, because the more complicated it is to face something, the longer we can put it off.

So it’s no longer just anybody who can announce it’s my time anymore. Only doctors can. But even then, it’s not just any doctor. It usually requires a specialist, maybe two or three of them. But even a specialist can’t pronounce until they’ve done all the tests. Blood tests, panels, x-rays, scans, ‘oscopys, surgeries, and more. And they have to administer all the treatments, too. Then the treatments to treat the side effects of the treatments. Then the experimental treatments. And of course all this costs a fortune which sets up hoops of insurance and loans and savings being depleted and assets being used up first.

(Which, come to think of it, is the other way of figuring out whether we’re actually dying or not. If we run out of money and can’t pay for any more treatments, then we are. So in some cases, insurance administrators are actually the guardians of the portal.)

It’s odd to me, how in some ways we’ve come to equate dying with treatments. Are there still treatments left? Then we’re not dying yet. No treatments left? Then we are. But this is all wrong. Treatments have nothing to do with dying. Dying happens independently. When we’re dying, we’re just dying. There may be zillions of treatments left still to try but none of them are going to work. Why? Because we’re dying. In this case going through all the treatments first is primarily about satisfying the mind: our mind, the minds of our loved ones, the doctor’s mind. It’s our modern way of answering the question: Is it my time? If all the treatments fail then the answer is yes.

In any case, what all this hoop-jumping does is enable us to postpone the acknowledgment that yes, I am now finally, definitely, incontrovertibly dying for as long as humanly possible, sometimes far beyond anything that could be considered rationally productive. In fact, sometimes it can even postpone the diagnosis until after we’ve become terminally unconscious, at which point we never have to face it at all. And it offers another benefit as well. It also allows the rest of us to avoid facing our fears about death. Because as long as we can believe that someone isn’t dying then, in our mind at least, they’re not. Even if they are. Poof! Dying has disappeared and we don’t have to fear it for a little while longer.

But there’s a cost to this denial and it’s a price that every one of us will eventually pay. As each of us enters our dying time, this kind of institutionally backed denial automatically places us in a kind of perceptual quarantine.

Our society doesn’t want to hear that we’re dying. They don’t want to know. Even after the point is reached where we who are dying are ready to accept it, ready to commence the end-of-life tasks required for wrapping things up and saying good-bye, the society around us will still only want to hear the stories about cures. And because we can’t deliver that story we’ll be marginalized, shrouded, and ignored. Our laws and social policies will funnel most of the resources to those who are still willing to fight to live, and we and our loved ones will have a far more limited amount of help, if any, available to us.

I’m going to close this post with a quote from an article in the Literature, Arts, and Medicine Database:

In today’s world we encounter “invisible death,” a somewhat paradoxical name because its invisibility allows the savage beast free rein. Death is no longer “tame” because we deny its existence so effectively we no longer develop personal and communal resources to give it meaning. Death’s invisibility enhances its terror; our culture’s loss of spirituality enhances death’s meaninglessness.