A Matter of Life and Death

I've never really thought of this as one of those indulgently self-serving my-opinion-on-something-you-probably-don't-care-about blogs. As you all know, I do have very strong opinions about pretty much anything it's possible to have an opinion about, but in normal circumstances I wouldn't feel the need to thrust those upon my faithful readership, whether it exists or not.

However, I've read a few things in the past few days that have really gotten me thinking and, since there isn't anything interesting to report on here in Madrid anyway (with the exception of some sun, at long last), I've decided that venting my frustrations is probably more appropriate in this forum than in the mass of comments at the bottom of these news stories (the letters to the editor of the internet generation and, therefore, populated mainly by crazies who like to hear themselves talk).

I love google. Despite recent signs that they're making the inevitable fall to the dark side, they really know me. And as long as I refrain from thinking about how sinister and creepy that really is, I usually really enjoy the links they provide for me at the top of my gmail. Today it was an article about the high costs of premature births. If you don't feel like reading the whole article, the gist is basically that not only do premature infants, which account for about 13% of babies born in the U.S., eat up an incredible amount of financial resources (this is the emphasis, since it is a Business Week article) but that a huge proportion, especially of severely premature babies, suffer from moderate to severe birth defects for the rest of their lives. The piece tells the story of baby Ryan, who was born at 28 weeks and now suffers from a plethora of physical, neurological and learning disabilities. I was shocked to learn that babies born at 22 weeks are considered viable these days and (crossing our fingers here) doctors may be able to push that to 20 weeks in the next few years.

This may be incredibly insensitive of me, but I think we are finally going too far. At this rate, soon we'll be able to grow babies in incubators from conception. And although this is good news for my figure (haha), it is, at the very least, ethically questionable. Is it really responsible to save every single premature child? It might be hard to accept, but we are the Earth's children and it might serve us well to remember that mother knows best. Certainly there are extenuatiing circumstances sometimes - the mother's health is in danger or there is a terrible accident or some other calamity that prevents the baby from being carried any longer. But, in general, we have to accept that nature knows what it's doing. Miscarriages are natural. Yes, they can be devastating on an individual level, but rationally, they happen for a reason. That fetus was not viable, whether we can keep it alive in an incubator or not.

Even more disturbing was this 1991 article about how parents of premature infants have less and less say over what heroic measures are taken to save their children. I didn't find any more current articles in a quick search, but if this trend has continued, it's absolutely abhorrent. I can see where the rationale would come from in this pro-life society we live in, but that doesn't make it right. In this article, a mother was chastised by doctors after questioning "when do we say enough is enough" when her premature TRIPLETS suffered from serve brain hemmorhages that most often lead to cerebral palsy or severe retardation. From the article:

When...she asked the neurosurgeon if he would consider not reviving the baby if he went into cardiac arrest. She said the doctor replied, "I'm not your executioner."

When that article was written, the mother had quit her job to stay at home and care for the three boys, then 4 1/2 years old, all with seizures and cerebral palsy, one blind and another paralyzed on one whole side of his body.

So why do we do this to our children? I'm not talking about a few weeks premature here. I am talking about severe prematurity. Is it really because we value the sanctity of life so dearly? Do we really just want to give these tiny, helpless, dying creatures a shot at the good life?

I hate to be cynical, but I think the answer lies in both of these articles and it comes down to that number one motivator. No, not love. Money.

It turns out that although insurance companies love denying the claims of 9/11 rescue workers, middle aged mothers dying of breast cancer, elderly patients who may have filled a form in incorrectly, and pretty much anyone else seeking medical care in the U.S. they pull out all the stops when it comes to keeping premature infants alive. This may be partially thanks to Federal regulations passed in 1985 with somewhat vague bereaucratic wording about how far doctors have to go to save infants. No doctor wants to be labeled a baby killer. But this is also probably because the insurance companies fear being labeled as "anti-life" by crazy evangelical groups. Also dead babies and grieving young parents are much more sympathetic plaintiffs in lawsuits than old people with lung cancer. The fact of the matter is that insurance companies will approve any and all heroic measures to save preemies, even highly experimental procedures.

Now, 17 years later, we can see in the Business Week article what the result of that is: Neonatal Intensive Care is a big time profit maker for hospitals, unlike the rest of their operations. It turns out that highly specialized, invasive medicine, the kind that insurance companies are guaranteed to approve, is fantastic for the bottom line. Need emergency care? Sorry, not a priority. But we will build new NICUs wherever we can find a few square feet to build a new state-of-the-art facility.

And if NICUs are such good money makers and, in this corporate age, hospitals have to figure out ways to be profitable, it makes me worry that too much is being done to save preemies not only because it is in their interest, but also because it is good business for the hospital. Why would you allow a parent cheat you out of hundreds of thousands of dollars worth of profit by suggesting you not take heroic measures?

It is true that all of this practice and experimentation has had some positive effects. We are now much better at keeping premature babies alive and have taken signiciant steps to reduce the chances of "complications", as they say. But at what cost? How many children and families have suffered from our overzealousness?

I'm not an advocate of genetic cleansing or anything and I'm not suggesting we go back to the days of leaving premature or disabled babies by an open window on a cold night, but I do think we should be able to trust our health care establishment to help us make good choices, not necessarily the most profitable choices. Some babies are surely better candidates for long term incubation and innumerable procedures than others. And if a parent doesn't want their child to suffer, they certainly should have that right.

Our practice of saving all premature babies, no matter what, is certainly not the only thing wrong with our health care system, but I think it does underscore the problem of a self-devouring system: hospitals are forced to emphasize acute care and very high specialization to stay afloat, discouraging healthy people to be interested in staying healthy, which raises health care costs, which the insurance companies pass on to the consumer through higher premiums and the denial of claims, as well as even more questionable meathods. Heaven forbid you don't have adequate insurance. It is not a sustainable system.

Now, in a mostly unrelated topic, let's venture to the other side of life. As you must know, Tim Russert, the well-known right-leaning (ahem) host of Meet the Press died of a massive coronary last Friday. And, of course, when someone dies it is time for everyone they ever disagreed with to posthumously bury the hatchet and praise their former foe, no matter how much they criticized them in life. The New York Daily News, which, by the way, I do not recommend reading, ever, hates it when we don't conform to this silly societal obligation, criticizing Arianna Huffington in this bizarre gossip (?) column.

Apparently his fans are upset that Huffington, an adversary of Russert's, waited several days to make her own posting acknowleging Russert's death and that, when she finally did, "her detached wistfulness didn't even amount to faint praise".

Sorry, people, but death, no matter how untimely or tragic, doth not a hero make. Why are we forced to churn out worthless sentimental bullshit whenever someone dies? Why should we praise someone in death who we wouldn't praise in life? Personally, I think it is an insult to the complex people we are and the nuanced ways we choose to live our lives to gloss over all the relationships, conflicts and, yes, mistakes that make us whole and real. For someone who made a career out of interviewing people of disparate perspectives and encouraging people to argue with each other, I would think Russert would agree.

It is possible to empathize with the family, reflect on the fagility of life and appreciate the days we have without selling out our beliefs. Or it should be anyway.

Seasons Greetings

This will peg me as a California girl for sure, but I have to admit I've never really understood the seasons before. Winter lasts until March? Summer doesn't begin until late June??? I just always figured that the seasons were kind of... off. Maybe so they'd match up with the solstices? Honestly, I never really gave it very much thought.

Even in Sacramento, where we have something approaching seasons and temperature variations, it just didn't always make a lot of sense. And southern California? Forget about it. Everyone knows that the winter is the best time for the beach.

So imagine my surprise upon realizing that there may be some factual basis for our seasonal lore. Take for example the idea that March "comes in like a lion and leaves like a lamb". Although I could always understand generally what this would mean, I had certainly never experienced it and, I think, got it into my head that the people who make these things up have somewhat of a penchant for exaggeration.

The one age-old saying I did not find to be true here in Madrid was the classic "April showers bring May flowers". I was hopeful, but it turned out that the April showers just brought more showers.

In any case, I'm still waiting for summer.

My big night out

Last night I went out to dinner, which is not something I do very frequently. It's expensive and generally I enjoy the food I cook just as well. But it is nice to have someone wait on you and do the dishes. So anyway, I was out having dinner. Quite embarassingly, this was an "american" themed restaurant, but that's the only place you can go for a real steak or some ribs. Not to mention the free refills. It turns out I am an American, whoda thunk?

About halfway into our meal, this enormous group of about 20 come in. No big deal. Then they proceed to sit all 10 of the children at their own massive table in the middle of the restaurant before the adults retreated back to their own massive table somewhere in the back. Great. Thanks. Aren't children annoying to eat with? Don't they get in the way of all your adulty fun? Instead of, say, leaving them at home or (gasp) not having them in the first place, I now have an excellent idea, courtesy of Spanish child-rearing - Just abandon them and let the rest of the patrons deal with your rugrats while you go enjoy your beer.

Now I like children and I've never been able to understand people who claim to hate children, since we all were children at one point and one day even these carefree annoying brats will be just as disillusioned and dead inside as you are. Plus, if we want the human race to continue (debateable), we'll have to deal with them.

That said, I shouldn't need to enjoy the wonders of unsupervised childhood while I'm trying to eat. I sure hope those adults had a good enough time to justify me having to sit through the 15 minute cell phone ringtone symphony, 5th movement, courtesy of little José. And I know you're trying to be a good parent and keep your child healthy, so I understand why you tell them they can't have a soda. But you can walk away from the tantrum that ensues. We can't. Neat trick. Furthermore, if your children are not old enough to read a menu or use a fork properly, you probably shouldn't be leaving them to their own devices. They could choke or something. Plus they WILL use their chicken fingers to chicken fingerpaint all over the table with the ketchup.

And Spanish people don't even tip.

Getting sick in Spain and various other health-related observations

This past week our apartment was struck by the plague. Miraculously, I managed to escape virtually unscathed, with only a day or so of runny nose to complain about. It must be something about my crap diet and complete lack of exercise that gives me such an impenetrable immune system. Although I was lucky to be spared, being the only well one in a house of death and disease leaves one with some rather unfortunate responsibilities - tending to the cholera victims.

Actually I don't know what it was that descended upon us with such savage delight, but my nursely duties left me with plenty of time to diagnose my patients with the aid of The Internet. The Internet is a wonderful thing. One of my favorite things is using it figure out all the incredibly rare diseases/conditions/disorders I might have. Feeling tired? It's probably multiple sclerosis. Have a headache? Definitely a brain tumor. Upset tummy? Crohn's disease. I could go on and on. Thanks to these amazing medical skillz I was able to tentatively identify symptoms of several fairly serious conditions, but finally came back to my original diagnosis of "nasty virus".

Amid all the neediness and insatiable whining/moaning on the ward, I did learn several things about the Spanish and their take on healthcare.

First of all, brace yourself, there are no over the counter drugs in Spain, at least not in the way we're used to. It is impossible to anonymously drag yourself into your local drug store and surreptitiously hide your anti-diarrhea medicine in amoungst your orange juice and chicken soup. No no no. Instead you must march into a special pharmacy (during normal Spanish business hours - i.e. hardly ever) and describe the symptoms in detail to a white-coated pharmacist, who, just to make you feel more embarassed, is always, always a very pretty and well made-up woman, who will then proceed to explain that you're not really that sick. The spaniards are very into allowing the body's natural healing processes to be in control.

Don't get me wrong. In principle, this is an amazingly refreshing perspective. We do overmedicate. And allowing the plebs to medicate themselves probably isn't really that smart, when I really think about it. However, listening to a pharmacist lecture you on the body's natural healing processes and refuse to sell you medicine is not really that reassuring when you just want something to MAKE IT STOP NOW nor that helpful when you have to return home to the black death with nothing in hand save a few tylenol and box of disgusting salty gatorade "rehydrating" juice. Principles go out the window when you have to go home and face the anthrax.

I've been to the pharmacy a few times now and I can't understand how they stay in business when they always refuse to sell you their wares. They must make up for it in toothbrushes or something.

Secondly, I have no idea how to go about getting to a doctor here. In a few absurdly melodramatic moments, I was ordered to "call an ambulance". This was ridiculous for many reasons. Where I come from, ambulances are reserved pretty much exclusively for actual life threatening emergencies. Or in my mind they are anyway. Also where I come from, ambulances are expensive. And they will charge you, whether you're the one who called them or not. So if you aren't in danger of dying in the next few minutes, you will manage to drag yourself into your car, into a bus, into a cab before you are reduced to calling an ambulance. Ambulances are good for when you're pinned under something heavy.

Rationally I knew that emergency healthcare is free here and so should have been able to make the logical leap that ambulances would also be provided courtesy of the government, but I was so trapped in my American corporate healthcare mindset that I didn't even realize it. And just think - the Spanish aren't out abusing their free ambulance service or anything. It seems as though emergency care could be provided for free without the risk of freeloaders using emergency vehicles as some kind of private taxi service.

Although I did manage to keep anyone from calling any ambulances, I did do some research about seeing a doctor in Spain, just to have the knowledge if it were ever actually necessary. From what I've seen of the Spanish approach to health, they probably wouldn't do anything anyway. But I found it interesting that one of the principle complaints about the socialized healthcare in Spain (and other european nations) is the long wait time in the emergency room. This is also one of the primary arguments used against universal healthcare in the US - the standard or care isn't as high, you will have to wait for hours, etc. I want to know what American hospitals these critics have been going to, must be fancy rich people credit-check-in-the-parking-lot hospitals. In my world, emergency room visits always involve long waits, even in our sacred free market. I don't see anyone's demand for shorter waits affecting anything back home either.

Politics aside, there are a few other observations I've made about health in this country in my time here.

Chocolate is considered health food. So are fish sticks and cheese. I don't mean that people talk about them as if they are health food, that I don't really know. But I do know they are marketed as healthfood. Did you know, for example, that the milk in chocolate has calcium? And protein? Or that the fish deep under that breading is good for you? And cheese, well it's practically made of milk. Those peta anti-milk campaigners would not get far in Spain. I know that in America we certainly market our fair share of unhealthy things as being healthy, but the Spanish have taken it to a truly absurd level. Plus, actually healthy products don't blare their healthiness at you, like you would see in American supermarkets. Bran flakes are just bran flakes, no special health benefit. But chocolate. Yes. Feed your kids tons of chocolate. It does a body good.

Europeans like to make fun of Americans for being fat. Yes, ha. Ha. Ha. I know, I live there. Oh yes, we invented fast food, packaged food, processed food, frozen food, whatever disgrace it is you want to throw in my face today. But the fact of the matter is that Americans eat junk food knowing full well how bad it is for them. We just don't care. Whatever. Whereas the Spanish can (and will) put a few cups of lard in something and then call it healthfood just because one ingredient happens to be vaguely healthy. And they love our convenience food. There are entire stores that are dedicated solely to frozen foods. And what's that around the corner? Not a McDonalds?! Just wait a few decades, they'll catch up.

Anyway, the plague has finally lifted and things are getting back to normal around here. The rain has mercifully stopped, at least untl later this week, so I'd beter go out and enjoy it.