Tuesday, March 25, 2008
In order to remove an otherwise inoperable tumor, surgeons have extirpated more or less a woman's entire intestinal tract, taken away the tumor, and re-installed her guts. The operation took fifteen hours, at least two anesthesiologists, and who knows (because the article doesn't say) how many surgeons and nurses and aides. The extraordinary effort was required because of the location of the cancer, at the backside of the abdominal cavity, enwrapping itself amongst the blood supply to those gut organs. High fives all around.
It's not that it's not amazing. It's a salad of surgical steps steeped in transplantation techniques, and a melange of magic, making mayhem manageable. Had I done it, I'm sure I'd have found it exciting and dramatic, and I'd no doubt be impressed as hell with myself. TV cameras, interviews. I might even have convinced myself it was worth it; it's obvious the patient thinks so, and I don't mean to diminish that. She looks like a very nice person. (In the print version, there are pictures.)
Even forgetting for a moment that when a cancer insinuates itself into blood vessels it is almost certainly incurable (because in doing so it invades into the bloodstream and spreads elsewhere), I don't think it's unreasonable to be skeptical. Because it seems a good example of the dilemma of health care costs driving us into medical bankruptcy. In asking whether it's appropriate to do such a thing, am I out of bounds? Considering it -- given the finitude of resources -- a waste of money, am I heartless? Were I the patient, would I think differently? (Well, I think I can answer that last one in the negative: I happen to recoil [admitting the chips are not yet down] at the idea of that many people and that much money being devoted to the personal old fuck that is me, and I tell myself I'd not allow it.)
I guess it's a matter of the particular versus the abstract. The woman is a person whom many people no doubt know and love. Were she my friend or relative, were I looking her in the eye, I'd likely feel differently, and so might you. But as a matter of policy I find it troubling; or at least a good subject for discussion. I remember being outraged at Ronald Reagan (one of a bazillion times) when, shortly after demanding reduced federal funding for health care, he got all misty over a girl who'd just had (or maybe was asking for) a liver transplant (I think it was) and chipped in a few bucks for her fund. But it's how we think. Or don't think, depending on how you look at it. If we tear up in wonderment when we read such a story, then we must also be willing to pay: well up; pony up. But if we think it's an imbalance in equity, then we must also be willing to say so when it's grandma.
In my area there's an increasing crisis in hospital bed availability, and it extends to adjoining counties. Projections suggest impending shortages of surgeons nationwide. Medicare will go bust on its current trajectory. Looking at this spectacular (as in "spectacle") operation seems a good way to frame the debate: should it have been done? Should there be parameters: age, odds of cure, projected costs? Number of people required, or time taken up in an operating room? Are insurers obliged to cover such things? Is Medicare? If not, are we okay with "heroic" (I have a problem with that term, too) care being given only to those that can afford it?
I have opinions, but not answers. Answers can only come from confronting such questions straight up, in Congress and in the voting booth. Cost, benefit, society. Taxes, deficits. Priorities. In these times, of all times, it feels like the clock is ticking. Meanwhile, I wish the lady well.