Death Benefits – Read the Small Print

Of the side effects listed on the sheet accompanying all prescriptions, one of the scariest is the admission that our pills could cause death. This is considered a bad thing. But, maybe we shouldn’t jump to conclusions.

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Death Benefits

by D.C. Lozar

The certificate I handed to my doctor said I was dead.

What’s more, it recommended (in no uncertain terms) that he approve an immediate autopsy, as my demise was suspicious in light of my young age, lack of family history, and excellent health. Indeed, Dr. Finn commented last year that if I took care of myself, I could expect to live another eighty years. I shook my head as he squinted at the document. This was why we still had human doctors – apparently, medical scanners made mistakes.

“It says here that you’re dead.” Dr. Finn had been old when I was a child. Not that he looked it. He had a trim build, fair complexion, and only a touch of gray along his temples: Such were the benefits of modern medicine, of pills, to be precise. His ocean-blue eyes filled with concern as he looked up at me. “How do you feel?”

“Fine.” I did feel well. For the last two weeks, a sense of quiet calm, a resting balance of my mood and body, had washed over me so that I was never hungry, tired, or irritable. I flew through my work projects, completed routine home chores happily, and found I had a reserve of energy and time left over to spend with my wife. We spoke more than we had in years, went on dates, and took up hiking. “Never better.”

“How’s your appetite?”

“I’m not hungry.” Curiously, I hadn’t eaten anything for several weeks.

Dr. Finn listened to my heart and lungs, checked my pupils, and felt for a pulse. His hand trembled as he did the exam, and I remembered one of his pills gave him the shakes. Taking my middle finger, he pinched it hard between two of his own. “Does that hurt?”

“No.” It didn’t – not even a little.

Frustrated, his voice hinting at his growing apprehension, he ground his knuckle into my sternum so hard I felt he might break a the bone. “Painful?”

“No.” Alarms went off in my head. Until today, nothing I’d ever presented with had rattled Dr. Finn’s professionalism. “What’s wrong?”

“How have you been sleeping?”

“I haven’t needed to.” Not sleeping, I’d finished next year’s taxes, read three books, and written some op-ed columns. In fact, I was starting to think that whole thing about needing eight hours a night was a complete scam.

“Okay…You need to be completely honest with me, James.” Dr. Finn slumped back in his rolling exam chair and folded his hands on his lap. His expression was pained but forgiving – he wanted me to know he wouldn’t judge me. “Are you doing anything differently? Have you traveled out of the country? Has anything strange or unusual happened to you recently, anything at all? This is important.”

Perplexed, I shook my head.

He leaned forward. “Are you taking drugs?”

“Not drugs.” I hesitated, wondering if I should mention it, unsure if there were any connection. “Just some herbs I found on the Internet.”

“What kind?”

“They’re all natural, completely legal.” They were. I hadn’t even needed to pay customs to ship them from Costa Rica.

“What’s in them?” The corners of Dr. Finn’s eyes crinkled, a sure sign he was on the trail of a diagnosis.

“I don’t know. They’re supposed to make you happy.” I was defensive and worried that we might be getting off track. The website said the herbs were of an ancient and rare variety, blended using a secret family recipe, and only available for a short time. They guaranteed users one hundred percent satisfaction, or they would refund our money. Indeed, the reviews were all five stars and overflowing with glowing testimonials. In retrospect, I will admit, I neglected to check if the customers were verified purchasers but, at the time, their endorsements convinced me to give the stuff a try. “Besides, I ran out two weeks ago.”

“How long did you take them for?”

“I don’t know, about a month.”

“Why didn’t you order more?”

It was a valid question. I had tried, but the website, an amateurish endeavor with a hand-drawn smiling skull as a logo (an element I initially took to be a creative, albeit ironic, marketing tool) said supplies had run low. Potential patrons were advised to check back regularly for updates. Additionally, individuals, like myself, who had finished their course of supplements, would not need to reorder as they had taken enough to guarantee eternal happiness. So, I answered truthfully. “They ran out.”

Dr. Finn adjusted his wire-rim glasses and harrumphed. The disregard he entertained for alternative medicine was well known to both his staff and patients. Here now, was proof. I could practically hear the gears locking into place as he prepared his monolog about the dangers of self-medication. Rather than listening to the rant, I decided to mollify him before he started. “I should have asked you.”

“Well, yes,” he admitted nonplus.

We waited another moment for his prepared speech to re-arrange itself into something that might be a better fit for my particular circumstances. “Be that as it may, the real problem is simply that you have no heartbeat, respirations, or vitals. Your body temperature is that of room air; you feel no pain, and, by your own admission, you are not sleeping or eating, and these hard facts leave me with no alternative but to conclude that you are, as much as it pains me to say it, clinically dead.”

“That sucks.” It wasn’t the most profound thing to say, but I challenge anyone, given the same circumstances, to come up with something better.

“Of course, there will be no fee for today’s visit.” Dr. Finn walked me to the door and shook my hand. “I don’t have a license to treat the dead.”

“What next?”

“I’ll say you died due to natural causes – in particular, an overdose of imported herbs – and sign the death certificate this afternoon. The medical examiner is a friend of mine, so I think I can get him to sidestep the autopsy.” There were soft tears in Dr. Finn’s eyes. He wiped them away with a trembling finger. “I’ll miss you, James. You were one of my favorite patients.”

“Goodbye.” I felt awkward. It was like he was waiting for me to hug him or pat him on the back. Maybe he was looking for forgiveness for having let me die, for failing me, or maybe it was hard for someone who spent their career preventing death to see it smile back at them. I gave him a fist-bump. “I feel okay.”

“I’m glad,” he sniffed. “I’ll call your wife and let her know the bad news.”

I thought about how that might go. “You don’t need to, Doc. I’ll tell her myself. First thing. I think she’ll take it better coming from me.”

He cocked his head to one side, unsure but relieved. “You were very young. Your death will come as a shock. Tell her to call if she needs any pills to help with the grief.”

I moved toward the exit. “I’ll let her know. Thanks.”

Dr. Finn gave me an apologetic nod, and I left.

Now, here’s where it gets weird.

Being dead in the modern hi-tech world does not “suck.”

Au contraire (I’m learning French), it’s the best thing that’s ever happened to me.

I can break any law I want, and no one can arrest me. I fly for free, watch movies without a ticket, and never worry about dying in a car accident or natural catastrophe. My debt is annulled, and my wife cashed in my life insurance policy for an exorbitant sum – owing to my prior statistically low probability of death. Needless to say, whatever preliminary qualms she held about the diagnosis (we considered getting a second opinion but then thought better of it) have since evaporated.

When we married, we vowed to stay together “until death did us part,” but neither of us feels like we need to take this literally. We’ve always felt a deeper than mortal connection, and now, with no financial concerns, we’ve been able to quit our jobs, travel, learn new languages, and enjoy our lives together with a freedom that would never have been possible if I were alive.

So, when the smiling-skull website procured a new but limited supply of herbs and offered them to the public, I wrote a glowing testimonial, taking care to document that I was a verified and exceptionally happy customer.

I did leave out the part about dying.

They’ll find out soon enough. Besides, it’s like what Dr. Finn explained when I asked him why he still took his pills when they gave him the shakes. “Everything has side effects, James. You just have to learn how to live with them.”

Cowboy Medicine

My grandfather was a cowboy, a salt-of-the-earth man of action, who told heart-warming stories of the old west. One of his favorites involved him getting kicked in the face by a horse and then upsetting my grandmother by blowing cigarette smoke out of the hole in his cheek. He competed in rodeos on bucking broncos, drove cattle across Colorado, and rode the rails as a hobo during the depression. He was a tough old cowpoke, and I thought nothing could stop him.

His cancer proved me wrong.

Learning the Ropes

Charlie Lozar didn’t go softly into that good night, but he did go, and I think part of the reason I became a doctor was to pay homage to him. This was a man who brought newspaper clippings and a story to every office visit, someone who wanted eye contact and honest answers, and who paid for the time it took to listen with the only currency a cowboy values – stories.

So, I shudder inwardly as an “expert” loads yet another program onto my computer, knowing that the extra clicks I’ll be forced to make are stealing seconds of time away from my patients. Individually these moments are meaningless, but cumulatively they consume the time physicians have to listen to non-clinical information. Worse, the problem is growing with doctors spending 40% of their day with computers and 12% with their patients as documented in The Journal of General Internal Medicine. https://www.ncbi.nlm.nih.gov/pubmed/23595927

“Promise me, you’ll always make enough time for your patients,” said my Grandmother, a stout strong-willed woman who made hasenpfeffer with jackrabbits. The practice of medicine is about people, about hands-on-experience, and about service to the community. It is built on a vow to “do no harm” and ends with a commitment to ameliorate suffering. It is not the practice of turning your back on a patient as you log in their data. It is not about making sure every box is checked off so some analyst’s pie chart is statistically significant. It is not about telling a patient they can’t be seen because the computers are off-line. We are aping Joe Friday on Dragnet, “Just the facts, Ma’am. Just the facts,” and our patients don’t like it as published in JAMA. http://archinte.jamanetwork.com/article.aspx?articleid=2473628

To make money as a cowpoke, my Grandfather and his friends trapped skunks for their fur. They kept them alive in a shed until they had enough “critters” to make it worth skinning them. Each night, after sharing stories over the campfire, they drew straws to see who would go feed and water their little zoo. Each man had been sprayed once or twice and had learned how to use a burlap sack as a shield. Over time, the skunks started to get used to the men so that they were almost domesticated. Until one day when a greenhorn the boss hired only a week earlier drew the short straw. Not recognizing the new hand, fifty skunks let loose at once. The smell was so bad my Grandfather freed all the skunks and burned the shed. The moral of this bedtime story: just because something seems to be working doesn’t mean it’s a good idea.

Technology does save lives. It has improved the human condition. It just doesn’t save time. Each click is like a small grain of sand, an insignificant unit of measurement by itself, and yet people die in the desert all the time. In The American Journal of Emergency Medicine, physicians spent 44% of their time logging data instead of doing direct patient care – that’s almost half their day. No wonder the lines are so long. http://www.sciencedirect.com/science/article/pii/S0735675713004051

A glut of drop-down menus, templates, check boxes, and protocols has made us think practicing medicine is as easy as domesticating skunks. We’ve started to think that every disease and person fits into a box, that the tap-tap of a keyboard is more important than the lub-dub of a heartbeat, and that we can use Facetime rather than face-to-face time to treat our patients when they live four blocks away. Maybe I’m just an old-fashion sawbone, but this kind of medicine stinks as bad as that shed.

Technology is to physicians as fire was to the first people: an excellent tool as long as it’s controlled. So, if you’re a medical administrator, please reconsider collecting data that won’t add real value to the office visit. If you’re the government, realize much of what a doctor does is not quantifiable so stop making us count the number of brush strokes it takes to make a painting. If you’re a patient, please understand that we are drowning in granules of sand and some of us don’t even know it. If you’re a physician in the trenches, remember to listen and try not to turn on the computer until you patient is done telling you their story.

Because a good story is the strongest medicine I know.

Your Magic Mask

senior bald man in yellow shirt shows disturbance

Your Magic Mask

by D.C. Lozar

I’ve had it rough; I’ve had enough.

Give it to me straight, Doc; I’ll be tough.

Listen close, I said please.

Don’t say no, I’ve paid my fees.

It’s true I smoked and drank.

But I also put money in the bank.

So what about that magic pill?

I’ve got a place for you in my will.

My friend Johnny said you’re the best,

not at all like all the rest.

Old Man Death came knocking at my door.

But, I told him I was seeing you at four.

I saw it on the news the other day.

It’s the cure, but the HMOs won’t pay.

They said go see your doctor and ask.

Said to lift up your magic mask.

Deaf, dumb, and blind: Who me?

I’m not guilty of any responsibility.

There’s no cause and effect.

My health is due to your neglect.

I was young. I know better now.

Was that a furrow in your brow?

It’s true, I won’t change my ways.

But, I haven’t used up all my hospital days.

Did you hear what I just said?

It’ll be your fault if I end up dead.

Don’t give up on me, Doc. Don’t lose hope.

Just think about it while I grab a smoke.