A Long, Long Time Ago (Updated 7/22/15)

A Long, Long Time Ago (Updated 7/22/15)

   Or so it seems.  It's been awhile since my last posting, the time disappearing as I spent time with my mother as she came out of rehabilitation therapy.  As mentioned earlier in my post on hospitalization, she had suffered a fall, was hospitalized and placed into a short-term rehab facility.  Now, back at home, she winces with pain as she walks, each jolt possibly a reminder that she was both lucky (that there was no nerve damage) and that the next fall could be much worse.  So I was there at her home (no internet), building railings and safety bars and making and cancelling her appointments, cooking some meals and watching some television with her...all in all, a grand prelude to her upcoming 90th birthday.

   Much of what she is going through in those facilities is being covered by her insurance (her bill for her 2-day visit to the hospital, one day to the emergency room and then the next day to the admitting ward for observation, was nearly $20,000...her room at the rehab facility, shared with another person, was being billed at $900 per day).  And for those of you not in the U.S., or at least not dealing with health insurance in the U.S., the bill for such insurance is itself quite a shock.  When my wife and I retired, we discovered that paying for our own insurance was a rather large piece of our retirement costs (our health care premium costs were typical at nearly $1,000 per month, each).  The Affordable Care Act (colloquially known as Obama Care), did two things;  one, having health insurance was now mandatory and came with a penalty if you did not join or did not prove that you had other health coverage; and two, it brought down the cost of obtaining such insurance (our premiums are now half of what they were, although the coverage is much less and comes with a $3,000 deductible --ours was $2,000 before-- which means the first $3,000 worth of medical bills are your responsibility; those who have difficulty paying even the lower premium can get subsidies if they meet certain criteria).  Those who jump off the radar, so to speak, and opt to take their chances without obtaining insurance or paying the bill, will simply jump to an emergency room at a hospital, for which the collective taxpaying public will be billed.  It's far from perfect, and far more complicated that this simple summary, but unlike the efficient medical systems of many other countries throughout the world (and indeed, many in Congress did not want this health care plan approved, even though they offered no alternative), this plan is a good start.  Hospitals have more or less set their prices, as have the insurance companies.  And yes, the bills are still quite high, and the testing quite extensive (and billable); but again, it's a start.

   In a comment to an article in The New Yorker by Dr. Atul Gawande, Associate Professor of Medicine at Georgia Regents University, Sandeep Khurana, wrote: ...it is worth noting two factors, in addition to those that Gawande mentions, responsible for this pervasive approach to health care: the corporatization of medicine, and a fear of lawsuits.  For the most part, health-care institutions enforce a corporate-style model of productivity, which has turned health-care providers into assembly-line workers, under constant pressure to manage many patients in a limited amount of time, in order to generate the most revenue possible.  In addition, a fear of lawsuits compels physicians to see each medical decision and patient-care interaction through a legal filter.  Physicians who are sued become hypervigilant, and practice defensive medicine, which costs more.  Patients with headaches get CT scans to rule out tumors, and patients with viral infections are given antibiotics out of an abundance of caution.  The corporate structure is here to stay, and legal oversight is necessary for patient protection--both require significant reform to change the status quo and to achieve a higher standard of practicing good medicine.

   Still, at what point would a person turn down medical help, especially in a serious injury?  Given a choice, and if fortunate enough to even have a choice, a person injured in an accident or a shooting or an explosion (or a fall) simply wants life to return to normal.  So it was interesting that National Geographic brought up the subject of "blast" injuries and brain trauma in an article titled Healing Our Soldiers by Caroline Alexander.  New studies are showing a strong explosion having a Jello-like effect in the brain: Studies show that the key mechanical factors associated with brain injury are an increase in intracranial pressure and the brain’s motion relative to the skull.  The blast wave, or overpressure, affects the brain immediately upon impact with the skull.  Pressure in the brain returns to normal after only a few milliseconds, but brain motion can occur for hundreds of milliseconds after impact.  To further explain, the author writes: In the field a single blast event represents a virtually simultaneous amalgam of distinct components, each uniquely damaging.  Ignition sparks a chemical reaction, an instantaneous expansion of gases that pushes out a spherical wall of gas and air faster than the speed of sound.  This shock wave envelops any object it encounters in a balloon of static pressure.  During this fleeting stage—the primary blast effect—the individual does not move. An abrupt fall in pressure follows, creating a vacuum.  Then comes the secondary blast effect, a rush of supersonic wind that floods the vacuum, hurling and fragmenting objects it encounters, weaponizing debris as high-speed, penetrating projectiles.  One physics researcher, Charles Needham, studying sound blast effects put it this way on the results from an explosion in a room:  The entire sequence lasted some 65 milliseconds.  One hundred milliseconds is the minimum time it takes for a human to react to any stimulus—it had taken less than five milliseconds for the shock wave to hit the gauges on the walls.  As Needham pointed out, “Anywhere in that room—it’s on you.”

   The explosions, as with my mother's fall, are surprises and sometimes come with devastating aftereffects.  In the soldiers' case, it might mean brain trauma now or later in life.  In my mother's case, it might mean an occasional wince of pain from her fractured bone pieces in her spine.  But the health care costs, and the caring from sons and daughters and mothers and fathers and aides and nurses and doctors, will all remain, and all despite the costs.  And in those cases, life "as usual" often grinds to a halt (or at least, a slowdown).  My mother was lucky, indeed, I was lucky.  She's alert, she's walking (albeit with the aid of a walker at times), and she's still alive...and after any trauma, isn't that all that we would want, to simply go back to where we were just a few short days ago.  We should all appreciate what we have now, our life as it is now;  for tomorrow may bring about a substantial change in that life, making what we have today seem something that existed a long, long time ago.