Dying Days

Each day my dad awakes to a breakfast of roughly 20 medications. He spent his life smoking, eating a diet of mostly processed food, and not exercising. Now at the age of 72 he is a very sick man. He's had several heart attacks, heart surgery, he has COPD, and his circulation is very poor. He has been in and out of hospitals and nursing homes 13 times. Each time he is released, he goes home and smokes, eats process foods and watches tv until his body gives out again and he has to dial 911. He has racked up bills of well over $700,000.

I've come to live with him to take care of him. Unlike the doctors, I follow the details of my dads end of life experience. His doctors have provided him with the prescriptions. Every now and again he visits them at the various hospitals where they work. They ask him how he's feeling and he tells them he feels terrible. He wants to hide things he thinks will jeopardize his autonomy, like that he has fallen. The brief conversations between the doctor and patient lead to the western solution to every malady, medication. A complex system, the human body at the end of its life, is treated by a simple system. Take old person to doctors work place, read a few vitals, have a talk, prescribe and/or adjust medications that are currently available, and/or maybe schedule a surgery.

The last nursing home experience seemed to transform my dad from a very sick patient to someone whom the authorities deemed acceptable to live on his own, with his sons assistance. Things have gotten worse in this first week. What took place inside his body? The excitement of going home after 2 1/2 months energized my dad. Day one back home he went through his mail, talked on the phone to family, and finished off the day with in his easy chair watching his tv. He also ate a double cheeseburger. The next day he began to feel worse. Since then he's been eating less, sleeping more and he has become far less steady on his feet. Was the cheeseburger a mistake? What took place at the nursing home versus my dads home? The pills and their doses were adjusted, but what was the real change that brought about the improvement?

Confounding factors, such as diet, exercise, and emotional state have not been considered. Some of the pills are simple compounds found in natural food such as KCl and folic acid. What if the patient has decided to give up their wicked ways and eat plenty of fruits and vegetables to get these nutrients? Would that alter the prescription? Then we have the Zoloft to treat depression. It's depressing to be this sick. Perhaps it is unnecessary to pharmaceutically deal with the fact that you are in need of so many pharmaceuticals. Let the patient be sad. Sadness, perhaps, is not a medical condition. To a doctor and the healthcare industry he, as a generic patient, has been understood. Sad? Zoloft. Next problem. To those of us outside looking in, the problem is that he is also a living breathing thinking human being. At the doctors he is probed and interviewed at regular intervals. New paths are set. If he gets worse, its because of the illness or the lack of following the path. If he stays the same or gets better, it's due to the path. Unknown to the doctors is the path outside of their purvey that might have an equal influence on his physical and mental well being.

I think of myself, this blog and why my message does not have an impact whatsoever. I have good points. The industries of biopharma and healthcare are sick. They need to be cheaper, more effective and offer more opportunities. More communication is needed. The science needs to be more rigorous. In spite of my reasoning and the solutions I have proposed, I am not taking into account the confounding factors. Society doesn't like a nattering nabob. An anonymous blog is a poor format to influence others. Just like the doctors and their pills, I am not taking into account the complexity of the system of which I speak. I might have a good remedy, such as the concept of certification of laboratory staff and their work, but I did so here on this blog. Like an ineffectual medicine, I introduced my remedy in the wrong place. It cannot reach the location where it will do the most good. Likewise, a medical remedy may work at a cellular level, in a mouse or culture dish, but how will we get the same mechanism of action to work in a person?

Note: That's just an example of a system that also doesn't bring about change. I write the blog for practice getting ideas out of my head. 

The Cargo Cult message here today is a lesson I am learning as I watch my dad struggle. It is not enough to memorize the parts of an airplane and what they do.

You can learn about the parts, who makes each part, what the name is in Spanish and know nothing about what makes the airplane fly. Now look at the human body:

Each part has its own doctor. The body however is more than parts. That is the area in which the Cargo Cults of medicine must study. What makes a body live, think, age and eventually die?

Doctors and pharmaceutical companies are also mere parts. The leaders of healthcare must invest in understanding the system of healthcare itself. How does the system effect an individual, such as an old man who takes 20 pills every morning. In time we should advance our understanding of life and death, the system we have to  deal with it, reduce the amount of pills, and paradoxically treat the body through all of its stages of life.