Back in February of 2013, I was riding my bike through the little town of Garwood, NJ, a tightly packed little strip of chain stores and fast food outlets, when I noticed a car door open a few feet ahead. “Well here it comes,” I thought, “the second most common type of bike crash.” Three days later I woke up in University Hospital in Newark, flat on my back, with a tube coming out of my arm. There was a nurse with a clipboard. Fox News was playing on the TV set. I don’t think I was technically in a coma — I did remember a few things, being wheeled into a large machine to get an MRI, accusing the paramedics who saved my life of kidnapping me and planning to send me to a CIA black site, someone fishing my wallet out of my pocket and examining my ID. — but it was close. The nurse had a grave, yet compassionate expression on her face, and as she explained to me the long road ahead, how I would have to learn how to walk again, how difficult it was to recover from such a severe head injury, I realized something didn’t seem right. I began to wiggle my toes. I didn’t feel like a cripple. Besides, Fox News was so irritating, I probably would have gotten up out of my coffin to change the channel. “I think you’re mistaken,” I said, putting one foot on the floor, walking over to the TV set, and changing the channel to MSNBC. “I can walk just fine.”
It turns out that she had simply taken the wrong clipboard. I had suffered a severe concussion that knocked me out cold, and kept me off my bike for the better part of two weeks, but I had been lucky. There would be no permanent damage of any kind. A month later, I was once again cycling 100 mile loops through the mountains of Warren and Sussex County. My finances weren’t so lucky. I had no health insurance. I hadn’t had a real job in two years. I had no savings. When I got the bill for $73,121 dollars, it might just as well have been a trillion. There was no way in the world I could pay it. Fortunately, in addition to having no money, I had no assets. All it took was a do it yourself bankruptcy manual, $300 dollars in court fees, and a few hours in front of my desk, and I was debt free. That $73,121 dollars, in effect, had never existed. It was just a figure on a piece of paper, something for the accounting department of your doctor and your insurance company. It was nothing like paying a dentist $3000 for a root canal, for example, or saving up $30,000 dollars to get a set of implants. The costs of dentistry are real, tangible, and rarely, if ever, covered by your insurance company.
To reverse Marx, history repeated itself, only with me it was first as farce, then as tragedy. The year after my severe, yet easily overcome head injury, my mother fell and broke her hip. Three years later, this Spring, she fell and broke her hip for the second time. That she would die was a foregone conclusion. She was 81 years old, at the end of the natural life span. She had also been severely ill for years, much sicker than I had realized, kept alive by an elaborate regime of prescription drugs, which regulated her heart rate, built up her already spare muscle mass, headed off the ever present danger of infection, and kept her bones from shattering every time she banged into a door frame. The first serious illness was going to kill her. That serious illness came in the form of a bad case of the flu last March. She fell, and broke her hip for the second time. The flu destroyed her respiratory system for good. The hip surgery destroyed her digestive system. The surgery on her intestines destroyed her mind. According to the paperwork I eventually got from Medicare, it cost over $120,000 dollars to keep my mother alive for the Spring in a totally disabled, mentally incapacitated state, and I won’t fault the doctors and the two hospitals for going through the motions to save the life of a woman past the end of her natural life span, but here’s what I will question.
During those two months of hell, there was only one person in either of the two hospitals or nursing homes where they warehoused my mother’s cadaver who gave me the unvarnished truth, a nurse specialist at Overlook Hospital in Summit who explained to me with brutal clarity that at best my mother would wear a colostomy bag for the rest of her life, that her mind was no longer capable of processing information and that the “rest of her life” would be measured in weeks, perhaps months, but certainly not years. At the time, I thought this nurse was cold, even callous, but now recognize her as one of the few one intelligent, independent minded health care professionals I’ve ever met. My mother’s own doctor, a man whom for my mother was a combination of priest and father figure, the only person who could get a semi-lucid reaction from her at all during those last two months, seemed more concerned with being liked than with preparing my mother for the inevitable. He lied to her about the colostomy bag. “There was a chance the procedure could be reversed,” I heard him tell her. Surely he knew better. He had also misdiagnosed her earlier that Winter, failing to give her antibiotics for the pneumonia she had developed as a side effect of the flu. My mother’s doctor was not a callous man nor even an incompetent one, just someone in denial watching a movie he had seen seen dozens of times before, going through the motions, and pretending it would all be different if only he followed the usual script.
In some ways the American system of health care is a system of wealth care. Had my mother needed a long term stay in a nursing home, it would have cost well over $100,000 dollars a year. Even without the planned Medicaid rollback, I would have had to liquidate my mother’s assets before the end of the Fall. For profit health care is more about the extraction of what’s left of the wealth of the middle-class, not about health care. Those fat cat insurance industry CEOs are getting fabulously wealthy off of people like my mother. Lots of nice, 5-bedroom McMansions in suburban New Jersey are getting built off of the profits made from warehousing the elderly. It’s a system that needs to be torn down and replaced with socialized medicine. But the health care professionals, the doctors, nurses, lab technicians, orderlies and custodians are not insurance industry fat cats or nursing home profiteers. They are simply people going through the motions of a script that’s perfectly appropriate for a man in his forties recovering from a bike crash, but woefully inadequate when it comes to preparing a woman in her 80s for the inevitable.
Perhaps it was better when the Catholic Church ran the hospitals. Atheist though I am, I recognize that Christianity assumes that we’re all going to die, and that preparing an elderly patient’s soul for death is as important as guiding a younger patient’s body through the steps of the recovery process. All the doctors and nurses save that one knew my mother was going to die, yet insisted on forcing her through a checklist of steps that assumed she was going to recover. The absurdity of scheduling an outpatient visit for a dying woman it took a nurse and orderly almost an hour to get out of a chair and into bed so she could go through a “post surgical checkup” was obvious to me, a layman. It should have been obvious to the staff at the hospital, and probably was, yet it was that unspoken reality nobody could address openly. The nursing homes, euphemistically called “recovery centers,” are required by Medicare to discharge patients who aren’t making sufficient progress. There was a genuine possibility, at one time, that had my brother and I not been able to afford the $160 a night fees out of pocket, that they would have simply wheeled my mother out to the street and dumped her on the side of the curb. The people who would have committed that atrocity would not have been evil men and women who enjoyed seeing the elderly suffer – that’s not why they went into geriatric medicine – but simply people going through the motions required of them by the for profit health care system, cogs in a machine “just following orders.” Thankfully it didn’t happen, and thankfully, my mother didn’t live to see the hellscape that’s soon to be forced upon the American people by Donald Trump and the Republicans.