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We’re all familiar with the thousand-yard stare. It’s that blank, dead-eyed expression assumed by those confronted with an excessively horrible reality. Stunned into submission, the brain retreats into green pastures filled with ponies and rainbows, while the eyes are left transmitting their neuronal impulses into the cerebral equivalent of the waste basket. I’ve seen this stare more than usual this week, and in two entirely disparate groups of people: med students and patients.
As my colleagues and I proceed into the final two weeks of our anatomy course (and by “proceed” I do of course mean that we’re desperately blowing air into our water-wings while staring in wide-eyed terror at the tidal wave of information crashing down all around us), the strain is starting to show on some folks. Our first exam wasn’t terrible. Certainly it was challenging, but the giddy feeling of taking our first medical school exam mitigated somewhat the abject terror of failure. After our second exam, however, the giddy feeling wasn’t around to provide soft, cushiony succour in our time of need. The written exam, as with the previous exam, was tough but reasonable. The lab portion of the exam, however, was bloody ridiculous. Imagine a small piece of string tied to a pin, which is in turn sticking into a tiny, brown squiggly thing in the middle of a mass of other tiny, brown squiggly things. Name that squiggly thing.
The expressions on our faces as we left the lab-exam were doubtless those that would be seen on the faces of our nation’s top generals if they’d just been told that the country had been invaded while everyone was on a coffee break–a strange mix of disbelief, anguish, and the faint hope that the alarm clock is going to ring any moment now. After years of effortlessly sailing through the rarified air of academic achievement, we had well and truly felt the wax melt from our wings. But you know, just as I was beginning to feel sorry for myself, I met some other folks who gave me a little bit of perspective.
I’m doing a Geriatrics elective this term. I’m not going to lie and say that I’m doing it because I believe that old people are the future of medicine (they are), that I’m inspired by the elderly (I’m not), or that I’m filled with compassion (stop laughing). Truthfully, I did it because military medicine is for better or worse my milieu right now, and the elective has me working with veterans in the VA system. I’m sure I’ll post some HIPAA-approved impressions of this elective and my patients as time goes on, but I wanted to talk about the thousand-yard stare I saw on a few of the old guys as we rounded.
I’m going to let you guys in on a little secret. Gather around, and let’s bond: I’m terrified of getting so old and decrepit that I’m at the mercy of others. It’s not just because I’m a bastard by nature and I’m scared that everyone I’ve annoyed throughout my lifetime would surround me and beat me to death with their walkers. No, it’s a terror of becoming what I saw in the hospital the other day: an old guy lying in bed, pierced with tubes, staring dully at the ceiling as the beeping of machinery and the whir of fans provide a souless accompaniment to the EKG lines dancing on the monitor; the warm-up act before the Reaper arrives.
It kills me that medicine has come to this, and you’d better believe that I’ll be posting more about it. As I look at these people, dying slowly with no friends or family present, I just want to put my hand on their shoulder and give them some human contact. You’re not passing unnoticed, dammit, because I’m going to notice. And sure, doubtless it’s stupid, futile, or naive, and maybe the experienced docs are rolling their eyes, but I just don’t think it’s right that our old veterans are passing this way. Perhaps even the patient is beyond caring, but I’d just like them to know that their service hasn’t been forgotten, that their passing isn’t unmourned, and that as they lie there on the hospital bed, a military officer is passing by and gives a damn.
So yeah, a poor exam score doesn’t seem so bad right now.
A very odd transition, the start of med school, and the strident claims of Comcast that my apartment complex doesn’t exist all conspired to deprive me of internet access for some time. You, deprived of my scathing wit, have doubtless fallen into a deep depression. Fear not, I’ll be posting some stuff here in the next week concerning my initial foray into medical school. I’ll also get around to finishing my pre-med guide, assuming I receive a steady supply of booze, food, and naked pictures from my female readers.
So I finally got around to watching the episodes of Dr. Horrible’s Sing-Along Blog. I’d heard about it a week ago, but only the incipient demise of the free streaming version (tonight) was enough to overcome my innate procrastinator. It is, to put it bluntly, pure genius. I like Whedon’s stuff anyway, but this was awesomeness on a stick. That it co-starred Felicia Day (with whom I’m totally in love) made it that much sweeter.
I hope you watched this production, minions. Now, you must go and purchase it. Right now. While I watch.
Except you, Felicia. You and I should be getting ready for our date.
Yes, yes, I’ve been away. But never fear, I’m back in a position to expose you to the searing brilliance of my mind. Expect more posts soon. Incidentally, posts for the next month will be of a general nature, and will then gain a far more medical flavour in August. Enjoy.
Of the many trials of moving, getting rid of books is perhaps the most torturous for me. Ordinarily, you’ll get one of my books only by dint of an elaborately planned operation utilising a crack team of ninjas, special forces, and high-rent prostitutes. But today, I came to the conclusion that most of my academic books, along with a smattering of rarely-read paperbacks, would not journey forth to the promised land with me.
Of course, actually throwing away a book is unthinkable–an unspeakable crime in my mind that ranks right up there with burning books or, say, wiping out an entire species. Thus bound, I resolved to donate them to the local library, bolstered by the delighted (and dare I say dulcet) tones of the librarian who received my inquiry as to how they’d prefer to receive of my plenty. And so it was that I set the stage for one of the most gut-wrenching experiences I’ve had since that odd-tasting hamburger from the airbase chow-hall.
Such was the level of my beneficence that I required a little library cart in order to transport my books into the library. Not that the librarians (none of whom were as lithe as I’d fantasised about on the phone) would have minded watching my rippling muscles straining under the load of humanity’s acquired knowledge, you understand, but such distractions in the past have proven hazardous, with many a keeper-of-the-books bearing the scars of past papercuts.
Acquiring said cart, I pushed it towards the door and briefly imagined myself as a librarian, smiling benevolently down at the young seekers of knowledge dragged into the library against their will by well-meaning mothers. Occasionally, I passed a genuinely enthusiastic young user of the library, and wished him the strength to bear the inevitable mocking of his peers until he possessed the power to crush their day-labourer future selves though the sheer power of his superior intellect. And then, sunshine.
I begin to remove the (my!) books from my vehicle, and place them on the cart. It is then that the horror begins, slowly rising up my throat to gleefully strangle my brainstem. For there, laid out to see for any passerby, are my books.
I’ve never felt so violated.
Each time I return to the cart with another stack of books, I see them there, forlorn, with bright spines bravely displaying their titles to a cold world. The people walking by barely spare them a glance; there is nothing special here for them. For me, it is though I have stripped off my clothes and spread-eagled myself on the pavement for the amusement of strangers. A brief check of my own sobriety and the hurried repression of rising memories of unrepentant inebriation assures me that this is not the case, and that I’m just feeling that way.
Carrying the last of my books to the cart, and wheeling it towards the waiting door of the library, I feel that I’m abandoning well-loved companions. These books have been with me for longer than most of my friends, and haven’t borrowed nearly as much money. In the cool of the library proper, surrounded by library patrons murmuring in quiet tones their requests for directions to the Starbucks, the sensation of the surrounding books is palpable.
I tell myself that here my books will find new homes, and be loved by new readers. That, though I will miss their titles on my shelves, I do a good thing by passing on books to others. I remind myself of how heavy books are to move, and of the hernia the moving guy got when he tried to lift my box of books I’d forgotten to mark as “heavy”. I laugh, and feel better.
Goodbye, little friends.
I’m not going to get into the habit of writing brief comments on current news stories, but I had to throw this one out there. Alanis, this is irony. Oh, how I laughed and laughed.
Somewhere in Moscow
So there I was, watching the cold grey light of a new day filter through the windows of the luxurious Moscow apartment belonging to the exhausted Russian beauty laying next to me. Opening her eyes and seeing me awake, she stretched like a cat and then, nestling close, asked what was on my mind.
“I have one of the most read blogs on the planet,” I replied, “but I haven’t posted to it in some time.” Her eyes widened, clearly not understanding.
“But you’ve just saved the free world from a threat that, at the request of major world governments, the general populace will never know of.”
“I know.” I shook my head. “But those ungrateful bastards will undoubtedly assume that I’ve been sitting around watching re-runs of Scrubs while neglecting their clamouring for more of my words.”
“Surely your millions of readers must understand that a man of your calibre has limited time to dispense wisdom, in between world-saving military missions, paradigm-shifting scientific discoveries, and the complete satisfaction of women all over the world!” she cried.
“You’d think so,” I mused, “but I’ll make it up to them. While I was sitting here contemplating how to improve the bronzed magnificence of my rippling abs, I decided to solve the health-care crisis in the United States.”
“Incredible!” she breathed. “You satisfy me in every way, including intellectually! Can you tell me what the solution is?”
Of course I can.
It’s like this
There’s something like 47 million uninsured people in the nation, if the breathless caterwauling of the press is to be believed. In a completely unexpected turn of events, posturing by congressional politicians–who incidentally have a superb healthcare plan that shockingly isn’t available to the peasants general public–has been completely ineffective at solving, well, anything. Fortunately for you, faithful reader, I’m around to sort things out. My ridiculously powerful intellect will light the way, leaving politicians to pursue their own noble tasks (liquor and prostitutes) in their natural habitat (expensive hotel rooms). Bastards.
Economics
People with no real schooling and/or liberal arts degrees (but I repeat myself) can’t seem to grasp basic economic principles, such as supply and demand. Medical professionals, especially doctors, are in limited supply. This is going to become especially true once the baby-boomers truly start sucking the life out of the medical system, as they have for just about every other aspect of life as they’ve whined their way through their self-absorbed, self-righteous, petty little lives.
Doctors will become rarer than a straight model in an Aber-Crombie catalogue. For those of us holding the coveted title of doctor, it means that we’ll be able to demand high salaries, fast cars, and a hooker allowance in any employment contract. For you, the teeming masses of the sick, it means that you’ll either have no access to care, have access to care that will destroy everything you’ve built up over your lifetime, or you’ll be making friends with the strange, smelly guy in the ER who is perfectly content to spend twelve hours sitting there because it’s air-conditioned and the nurses have nice arses.
Not ideal, I think you’ll agree.
Thus, crying “free healthcare for everyone!” is not only moronic, but completely impossible. Not only does everything have a cost, but it ignores a very simple fact: when something is free, people don’t value it.
Incidentally, arguing that people have a “right” to healthcare is also grounds for being slapped like the weeping socialist that you are, because you can’t have a right to something that is the product of other people’s labour. This is called slavery and a lot of people have died to prevent this pestilential idea from spreading. Rights are inherent, and do not require other people. In the wilderness, you can exercise every real right: say what you like, worship as you choose, carry a weapon if you want, and wander around without restrictions. But try demanding that someone take care of your health needs in the middle of nowhere and you’ll suddenly understand that healthcare isn’t a right, it’s a service.
But shouldn’t we take care of each other?
You know, I really do think we should. But we need to do so rationally, taking into account the foibles of human nature that guarantee free-loading and abuse of the system if we allow it. First, we need to acknowledge some fundamental principles:
1) Medical professionals are in limited supply, perform a valuable service to the community, and are not our slaves.
2) When something is free, people will use/take it, even if they don’t really need it. There’s no motivation to preserve the resource, as self-interest trumps group interest in a phenomenon known as the Tragedy of the Commons.
3) Medical care costs money, which has to come from somewhere. There is no free ride.
4) We, as a society, have to decide where our priorities lie. What do we want our society to look like?
Fair enough, I’m ready to hear the solution.
Two problems exist with the current system.
For those paying for medical care, it’s ridiculously expensive. Insurance often will not cover the full costs of procedures and, in an effort to increase profits for shareholders, will often dictate medical decisions that they have absolutely no business being involved with. For those without health insurance, especially those with major health problems (e.g. cancer), medical treatment can wipe out a lifetime’s worth of work and cause people to lose their homes.
In contrast, those who have their medical bills paid for by various government programs have little incentive to limit their use of the medical system. The slightest health-problem, even if caused by poor life-style choices, can be presented to a physician for little more than the cost of their time. The payment scheme of these programs towards physicians is appalling at best, involving labyrinthine paperwork (for which the physician is not paid) and time-consuming hoops through which the harassed doctor must jump. Unsurprisingly, primary physicians are telling the Medicare program and its ilk to get stuffed at an ever-increasing rate. Good luck finding a medical doctor willing to put up with such idiocy in ten years.
That wasn’t a solution.
Shut up, I’m getting to it. Those of you with college degrees that didn’t have classes in which you talked about your feelings will be familiar with the concept of a rationing mechanism. Essentially, we need a filter to take a limited resource and ensure that it reaches the people who really need it. Simultaneously, we need to ensure that people with serious health problems don’t shy away from seeking medical care due to cost considerations. In short, we need to decide that we, as a society, want a country in which no-one loses their life-savings or their house due to an illness, but also a country in which the lives of the working populace aren’t sacrificed upon the altar of the sick, old, or infirm.
How can such an impossible task be accomplished, you ask? Can even my piercing intellect truly have a solution? Yes indeed.
A two-tiered system.
One of the tiers will be a comprehensive catastrophic national heathcare system, paid for by increased taxes. Socialists, you can hug yourself for joy now, if you like. Capitalists, I’d remind you of the concept of value for value. There is no free ride, and increased taxes are the price we’d have to pay for such a society as I described above. Fortunately, the tax rate wouldn’t have to be nearly as high as is seen in Europe, because I’m smarter than that.
The rationing mechanism for the national healthcare system would be the health problems themselves. I’m not entirely sure when the line would be drawn, but I’m thinking probably anything more serious than a simple fracture of the arm, or long-term illnesses such as Lupus. Such injuries are self-limiting, as few people deliberately get into serious car accidents, develop cancer, or have a heart-attack.
And the second tier?
Is the one that deals with everyday medical care and the part that makes this whole thing so bloody brilliant. For everything less serious than an arm fracture (say), such as coughs, colds, flu, and so on, medical care would be a purely private system. Families would still have health insurance, but it would be drastically more affordable (I’m talking like $10 a month) because there would be no possibility of the health-insurance company having to pay out exorbitant sums of money for major medical problems.
With a small co-pay for each doctor visit (say, $5 to $10), the rationing mechanism is that people are suddenly drastically less likely to visit the doctor for a minor cold that will go away by itself with a few bowls of hot soup and a day in bed. For those who couldn’t afford even that small amount, the cost is low enough that community groups (churches and the like) could afford to help out the truly needy. Suddenly, the community is taking care of itself again.
The final change I’d make is to require all health insurance companies to be non-profit. Now, I’m a hardcore capitalist in many ways, but insurance companies haven’t been subject to actual capitalist economic pressures for a very long time and they’ve abused their position. The current situation, in which the cost of patient care is competing with the interests of shareholders is intolerable and must not continue.
I’m…stunned.
Of course you are. This comprehensive overhaul will drastically reduce the workload of the primary care system and remove one of the main reasons why new physicians are shunning that speciality. It provides a rationing mechanism for basic care, allowing full access to healthcare at an affordable price while avoiding the mess that a full-on socialised healthcare system has wrought in Europe. It simultaneously allows people to work and live without worrying about losing everything if they are injured or become sick, creating a society in which we all look out for each other when things get serious.
Of course, you realise that this will never happen.
Probably not, but I might send along a copy to the Obamarama team on the off-chance they’re looking for ideas. In all likelihood though, it’ll only happen when I am King.
Yes, that’s the reason I’ve decided to write a blog. To be absolutely honest, it’s mostly because I’m entirely too lazy to actually sit with something as archaic as a pen and paper to write out my thoughts. While I have no illusions that anyone other than myself will give a monkey’s about what’s going through my head, I do derive some amusement from the idea that occasionally some errant internet traveller, lost beyond hope of redemption in the internet wilds, will stumble across my words and then head screaming back into the wilderness. Since I’m also off to medical school here shortly, and will be spending some time in the military (again), perhaps the occasional post I make will cause Google to send a unsuspecting denizen my way. If that’s you, welcome. If you’re interested in my military or medical experiences, I’m happy to relate them. If you’re here to complain, bugger off; this is my party and I’ll dance how I like. Right then, off we go.
