Easter

It is now officially Easter Monday. Another late night at the computer scanning the news. Terri Schiavo is foremost on my mind as I think about her starving and dying of thirst. This week's column will elaborate on my personal feelings about the situation. As a physician I understand that there is a time for death, but as a Catholic Christian I also believe that life is precious. I think that given the advances in medicine make what once might have been heroic measures, like a feeding tube, are now routine. There are cases where people can speak, but still require a feeding tube due to other gastrointestinal disorders that do not allow them to swallow or digest food properly. Without a written directive about end-of-life issues, I feel that it is more appropriate to proceed on the side of life. If a person has a DNR (do not resucitate) order, this indicates that no heroic (i.e respirator, etc.) measures be taken. If the person is breathing on their own and the vital organs are fully functioning, but the protionof the brain that affects communication is damaged, a feeding tube and fluids are not heroic. They are life-sustaining just as we would eat or drink to live. The suffering that Terri Schiavo is being forced to endure is a message to all of us to be prepared. There are people who may or may not have our best interests at heart when decisions are made about our lives. We may think that we know someone's desires, but as is often said, it is better to get it in writing.

Maybe I Just Don't Get It

I'm asked my opinion on a variety of subjects. Perhaps it is because I put my views in the newspaper every week or because I am in the public eye quite frequently. Terri Schiavo is the topic of the moment. What do you think about her situation? Shouldn't they just let her die? I'd like to use my aunt as an example. Charlotte was in her mid fifties when she developed Alzheimer's disease. Within less than 2 years she required full time care in a nursing facility. She was only 63 years old when she died of complications from Alzheimer's. At what point should the family and the doctors decided that she should die of thirst and starvation? She was no longer able to feed herself. She needed assistance in all of her daily functions, including getting something to drink, food, wiping herself and eventually being reminded to go to the bathroom. So what is the difference between my Aunt Charlotte and Terri Schiavo? Both were/are essentially non-functioning in the sense of brain activity. Both needed/need full time assistance. Both had/have family members that wanted them to live. One didn't have the support of the legislative branch coming to her aid. One didn't have the media attention. One could still talk, though with no significant intellectual content, at least until shortly before she died. Where do the "mercy killings" end? If Terri Schiavo could talk, we wouldn't be having this discussion. We assume that a person is alive if they can communicate with us in the form that we are accustomed to. Is there a reasonable answer to this dilemma? Her husband, who has collected a couple million dollars for her rehabilitation, of which there has been none noted to date, says let her die. Of course, he'll be no worse off for her death, with the exception that he loses his wife, but at this point that is what he wants. The parents will lose their daughter, which is what they don't want. In essence the only one who has anything to gain by her death is her husband. I could no more have looked my aunt in the eye, even though she would have had no clue who I was, and said let her die from starvation and thirst, than the parents of Terri Schiavo seem to be able to do. I couldn't look at my daughter, who is disabled, and say, "Sorry, honey, time for you to fend for yourself. Your life is not worth living." Michael Schiavo seems to have no problem with that, at least when he appears on television pleading his case to let his wife be murdered through means of neglect. I'm glad that I don't have to make that decision. It would be difficult to live with myself for choosing death over life. For an excellent presentation by a disability-rights lawyer, see the posting by Harriett McBryde Johnson.

Right To Live

The Terri Schiavo case is another example of the justice system gone haywire. We have parents who want to keep their daughter alive, a husband who says he is following his wife's request that she didn't want to end up on life support like her grandmother, a Senate that is bent on making the most of this sad situation for political gain, and a public that is divided on the supporting life or allowing someone to die. The Pope stated one year ago that all life is sacred, whether that person is in a vegetative state or fully functioning. How far does the right to die go? If we start with Terri Schiavo do we then go to all of the people in a vegetative state? What about those that can't fend for themselves like the mentally disabled or the psychiatrically disabled? Do we then not feed those with Alzheimer's disease because they otherwise are not able to feed themselves? Life is precious at any stage from conception through our last breath on Earth. If we deprive Terri Schiavo of food and sustenance, what is to stop the next person who says that my wife, my husband, my son, my daughter, my widowed neighbor, et al, didn't want to be kept alive? Perhaps Terri Schiavo still has some say in this matter? Perhaps her reason for living for the past 15 years is to bring to light the meaning of life? It is said that God works in mysterious ways. Perhaps this is his way of getting us to the point of respecting life? Of course, it appears that many of the circuit judges don't take God into account in any of their decisions.

And the winner is...

The latest to be set free is...Robert Blake. It amazes me the level of attention paid to the rich and famous in California. Scott Peterson on the other hand wasn't as lucky. Of course, he wasn't famous until after he was caught, tried and subsequently committed for murdering his wife, Laci and their unborn son, Conner. Then the case of Michael Jackson becomes stranger and stranger with each passing day. I know that California sets the trends along with New York for the rest of the nation, but if these are the trends in our criminal justice system, I hope they stay on the East and Left Coasts.

Locally, the election season has been verrry, verrry quiet in Freeport. An occasional opinion piece or non-policy statement is in one of the local papers, or the announcement of the opening of a campaign headquarters is in the news, but where are the policy statements, where are the agendas, where are the plans for our city. We will be getting a new mayor and we may not know much about who will be running our fair city. There is no candidate bashing by either of the candidates, which is good, but there is no dialogue with each other or with the community, which is not good. We are less than three weeks from the election and there is no heat being generated. I haven't heard if there any debates even scheduled, yet. I can't find anything in the news that presents George Gaulrapp's positions on anything other than I'll work with the people and listen to the people statements, but nothing concrete about how to bring in businesses, how to keep businesses, and how to keep out the cronyism that plaugues our city, as well as many others. Pat Leitzen Fye at least has a forum by which we can identify some of her perceptions and plans, though we still need dialogue or discourse between the candidates to put their points of view into proper perspective. How will each fair under scrutiny and pressure? Where is the discussion about what direction our city will take with either one as the new leader. We're waiting for the fire in the campaign, or at least a few sparks.

Snap Judgment

What is it that makes some people snap? We have the Lefkow case with Bart Ross, the Polish electrician immigrant, disfigured from mouth cancer, and mad at the world. Then we have Brian Nichols, up for rape and sodomy charges, now to be tried for three, most likely four, murders. And within the same week, there are the eight dead at the Sheraton Hotel in Brookfield, Wisconsin. Shot by some guy, whom people are speculating didn't like the sermon, so he mounts an assault against the pastor, killing him, his son, and five other innocent people, before turning the gun on himself, just like Bart Ross. Now we won't know the full answers to what makes people like this tick or explode. We'll here how we are supposed to protect the judges. Lawmakers will make their impassioned speeches calling for more federal funding. It will be all over the news until the next big story comes along.We'll remember the names of the killers and most likely the names of the judges involved, but how quickly will we forget the names of the other victims? How many of the other victims names will even be known or mentioned after their much-too-soon funerals? We'll move on to the office NCAA basketball pool and not give much thought to those that were laid to rest, many at a very young age. All before their time should have been up.

We Think We Know

It is hard to fight prejudice. Whether it is racial, religious, cultural, class or familial. We think we know what is happening in our own little world, where everything should be so cut and dry. We look at the killing in Chicago of Judge Lefkow's husband and mother and we think, "Oh, Mathew Hale must have had something to do with it. He said he wanted her dead and someone took him up on it." Then it turns out to be a down-on-his-luck electrician who carried a major grudge because of a malpractice claim. He hides in the house and when Mr. Lefkow discovers him, he shoots Lefkow and then his elderly mother-in-law, who heard the shot. As fate would have it, he gets pulled over for faulty brake lights, and the world discovers who the killer in Chicago was. I was just reading recently how Hitler was the target of an assasination plot prior to the start or around the beginning of WWII. One of the generals placed a bomb in a briefcase intended for Hitler. An underling, in tidying up, moved the briefcase just enough behind a desk, that Hitler's life was spared. It just goes to show that it is often the small things, the brake light out, the moving of a briefcase, that often change the course of history. Ask Bill Buckner about a ball going through his legs or Steve Bartman about a ball going off his glove in the stands. Baseball, life, death, it all plays out in the small things that sometimes make a big difference. Now we have the judge in Atlanta and two others, so far. We think we know what is going on, but I don't think we have any idea.

War of the Words

How do we make it in society when there are so many factors that undermine our ability to communicate with one another? It would seem that it shouldn't be that difficult to be civil. Loving, well maybe not always, though that was the intent of the Master. Do we have to like one another? Not if we find their actions or behavior reprehensibible or unacceptable. But is that most likely the case, or is it that people don't see our point of view and we label them, henceforth, "dumb, ignorant, prejudiced, stupid, ill-informed, etc., etc."? Some of the worst offensed occur within our family dynamics. Come on, even the first mention of murder in the Bible was Cain slaying Abel.
Jealousy turning to anger turning to rage. Out of control. Feelings get hurt. Physical violence and pain. The wounds heal, sometimes, but the pain lingers. The joy of recovery from making amends and coming to terms with our innate differences. "Hey you, did you come to fight? Have you come to the rescue?" asks the lyrics in Hey You by Tommy Stinson. I don't really know. I'd like to think that we are here to rescue, but what happens when someone doesn't want to be rescued or refuses to be rescued? I found that with a mother who was determined to find a way to end her life. 24 years ago, she found that way.
I find myself looking for answers again with a daughter, whom I may have mistakenly given the wrong name. My mother's. It is not a question of life and death, but a question of reconciliation and learning to live with one another. Was it fate or was it serendipity? Happy Birthday to you, my daughter! How the heck are we to know what becomes of a life? How much influence can we assert, and how much should we? Generations of struggling to decide how much? how little? how often? truth and consequences? lies and deceit? Where are the answers and what are the answers? Eternal questions and answers are there in the Bible, in the tales of our anscestors, but how do these relate to a modern society that puts the emphasis on wanting it now, getting it now, and damn the consequences. It plays on the minds of the strong, but preys on the mind of the weaker, but the lines are getting blurrier all the time.
It all goes to back to prayer and faith. Sometimes we hear the answers, but they are not the ones we want to hear, so we shut them out. I forget that it is in the silence, the pauses between the prayers, that God is often the clearest. I'll sign off now and listen for my answer.

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Out of the Loop

I spend four days in California for a conference and come home with bronchitis and otitis media (both ears, no less!). Was it the cool weather, the enclosed plane ride, or the three day migraine upon arriving there? Who knows, but an extra six hours of sleep today may have been of some help, along with the Garlic-Mulein ear drops and fasting.

Catching up on the news: Found out today about two very nice people in Freeport passing, Mrs. Treasure Larkin and Mrs. Irma Ludolph, two people who gave a lot to Freeport in their own special ways. Then there was the heartbreaking, yet inspiring story of former patient, Carol Sager, who's liver, allowed her nephew to live, after she died from complications from a stroke.
The stories about Judge Joan Lefkow and the death of her husband and mother continue. Let us hope that the killer(s) are captured soon and that she and her daughters can try to resume a normal life. At least as normal as one can expect under such circumstances.

Sunny (HA!) Southern California

Here I am in Holywood and the weather is wet and cool. Still warmer than Freeport, but not the sit in the sun and warm my bones weather, either. I always think about the changes that I can make in writing my column, or in my practice and now I am inspired to push forward with the project of improving the level of care for the patients in Freeport and the surrounding communities. There is a standard of excellence in the metropolitan areas for diabetic foot care
and now we need to transfer this to more rural communities like our own. There is a great deal of hope and promise in the field of diabetic foot care and wound care and this needs to be the standard not only in the big cities, but in the smaller communities, as well. My associate and I are at the international Diabetic Foot Conference in Hollywood. It is an international who's who in diabetic foot care. My first priority is to find more ways to educate the populace and then find a way to get our wound care center up and running. There is much work to be done, but it will be worth it if we can help more of the population with diabetes.

Blink and Blogs

How much information does it take to make a decision? Is it possible that we gather too much information before we move ahead? How many tests can doctors order before a diagnosis is made? Will it be too late by then? We find ourselves in the Catch-22 of waiting for availability for the tests, waiting for the results, waiting for a decision to be made about what type of treatment is needed, and then waiting for availability for time for the treatment. There are too many patients and too few doctors. So tests are ordered to buy time. The clinical judgment gets skewed because we start to rely more on the tests than our clinical skills. The reimbursement keeps decreasing as insurance companies try to squeeze out every last penny from the doctors and the collection tactics for those that have private insurance become ever more unscrupulous. The best and the brightest, who once migrated into medicine, are now joining the corporate sector or technology where they can make more money with fewer hassles. How do we encourage our children to go into medicine where they will incur huge debt, long hours, and more headaches. The liberal left promotes universal healthcare, but don't look at the failures of those systems, or the fact that in the European countries, physicians either have little or no tuition, and thus little or no debt coming out of medical school. We could all be more altruistic if that were the case here. As we know, it isn't.
So we need to find more efficient ways to practice medicine like the example in Malcolm Gladwell's book, Blink, another great book by the author of The Tipping Point, in which he describes the protocol followed by the emergency department at Cook County Hospital for possible heart attack victims. Another possibility is to have greater access to online medicine, where the experts in a given field are available through Blogs or another dynamic forum. It is happening slowly, but too many physicians are leaving the field and it is especially notable in rural areas, where the reimbursement is lower, the risk of malpractice continues to be great and the income does not always pay the rent. We are in need of a paradigm shift in medicine. Right now, there continues to be more questions than answers and America is getting sicker.

Where Does it End?

About three blocks from where my wife and I used to live in the Edgewater neighborhood of Chicago a judge's husband and mother were executed. U.S. Judge Joan Lefkow had been threatened in the past by a hate group. Her life was thought to be in danger, but from the newspaper reports (Chicago Tribune and Chicago Sun Times) it appears that with the man who threatened her life in jail under the terrorism guidelines for incarceration, that the level of security was decreased. Now there is a woman who lost her elderly mother and her husband of 30 years, Michael. I know the type of building. A two-story greystone much like the one my wife and I lived in for five years. The Edgewater neighborhood is replete with these types of buildings. The area has long-established families and young professionals. The Lefkow's have four daughters. The youngest is still in high school. She will not have her father to walk her down the aisle, because her father is now dead. What message is sent to our society? The BTK mass murderer desperately sought attention to his gruesome deeds. He longed for notoriety. Now we can hope that he rots away in solitary confinement for the rest of his days. Let him languish in anonymity. Suicide bombers in Iraq and Israel kill dozens or more than one hundred. Each day seems to bring new attacks. Someone is shot in a radio studio or another rapper is killed and we don't blink an eye. Are we that desensitized to the violence? Why does it take a 9/11 to create communal outrage at the killing in our society? Each life is worthy of something. We are so concerned about putting people to death like Terri Schiavo , who has done nothing wrong except to be in a coma, that we cannot be bothered with real crimes unless they capture the headlines. I don't know where we start, but a good place may be to respect life from the beginning. Mother Teresa had the right frame of mind when she said, "But I feel that the greatest destroyer of peace today is abortion, because it is a war against the child - a direct killing of the innocent child - murder by the mother herself. And if we accept that a mother can kill her own child, how can we tell other people not to kill one another?" at the National Prayer Breakfast in 1994. We need to reflect on her words and her message. We need to pray fervently as she did for an end to the taking of innocent lives. We need to pray for life and peace. We need to pray for an end to the violence. Some days it seems to be our best hope.