“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
WASHINGTON — A Senate panel on Tuesday introduced a comprehensive congressional plan in response to the growing opioid addiction epidemic.
The bipartisan bill comes as the death toll from prescription opioid addiction continues to skyrocket. In 2016, over 42,200 Americans died from an opioids overdose, according to the latest CDC data — five times higher than in 1999.
The epidemic has affected every state in the country, making the issue a top priority on both sides of the aisle.
Congress has previously addressed the crisis by giving agencies more funding to research solutions and distribute grants, such as the $3.3 billion that was included in the massive omnibus spending bill last month. But critics said that interagency reform, not just funding, was necessary for long-term results.
The ambitious new measure, now under consideration in the Senate’s Health, Education, Labor and Pensions committee, includes 40 bipartisan proposals intended to drastically expand the ability of multiple government agencies to address the ongoing crisis.
Provisions in the bill would encourage further research at the National Institutes of Health to develop nonaddictive painkillers, urge the Food and Drug Administration to recommend certain limits on the number of opioids prescribed to a patient, and call on the Centers for Disease Control and Prevention to collect more data about overdoses, which officials can then use to more effectively combat the epidemic.
The legislation also includes Jessie’s Law, a proposal that would give doctors greater access to medical records documenting a patient’s addiction history.
The White House last month released the outlines of its own three-pronged approach to combating the epidemic, which would prioritize decreasing opioid overprescription, expanding access to treatment and curbing the supply of illegal drugs entering the country from elsewhere. The proposal drew controversy over President Donald Trump’s suggestion that some drug dealers be subject to the death penalty.
Legislation to aid law enforcement efforts to combat the epidemic fall under the jurisdiction of the Senate Judiciary Committee, although the measure introduced Tuesday does outline requirements for the FDA and Custom Border Patrol to more effectively detect and seize illegal drugs, like fentanyl, that cross U.S. borders.
The panel is aiming to move the bill through the committee by next week and send it to the full Senate for consideration. Their House counterparts are planning to move forward on similar proposals by Memorial Day.
WOONSOCKET, R.I. — CVS Health has moved a step closer to completing its acquisition of insurer Aetna Inc. after stockholders of both companies overwhelmingly approved the deal. The combination must still pass the scrutiny of regulators, however.
More than 98% of CVS shares were voted in favor, while about 97% of Aetna shares voted to approve the deal. The merger is expected to close in the second half of this year.
“The combination of CVS Health and Aetna brings together two complementary businesses with an expanded set of unique capabilities to create a new, community-based open health care model that is easier to use and less expensive for consumers,” said Larry Merlo, president and chief executive officer of CVS, in a statement.
Whether megamergers such as the CVS-Aetna combination or the planned tie-up of Express Scripts Holding Co. with Cigna Corp. will actually deliver lower costs or any other benefit to patients and health care providers remains to be seen, according to some industry observers and analysts. What they will unquestionably accomplish, though, is yet more massive concentration in the health care industry.
If both deals are completed, all three of the nation’s largest pharmacy benefits managers will be linked to three of the largest insurance companies. CVS, Express Scripts and UnitedHealth already process more than 70% of all U.S. prescriptions.
The final hurdle for the CVS-Aetna deal will be to convince antitrust enforcers that their combination will in fact result in efficiencies that lower health care costs and produce better outcomes. According to a Bloomberg News report, mergers and acquisitions involving PBMs such as CVS are usually investigated by the Federal Trade Commission, but in this case the Justice Department’s antitrust division, which handles health insurance mergers, is investigating the merger, since it combines a PBM and an insurer.
The wave of consolidation has drawn harsh criticism from the National Community Pharmacists Association. “We’re seeing the growing balkanization of the health care industry, a world in which patients may be forced into a health care kingdom — the CVS-Aetna kingdom, the Cigna-Express Scripts kingdom, the UnitedHealth-OptumRx kingdom — where the borders aren’t porous, and patients are stuck with what they get,” said NCPA chief executive officer B. Douglas Hoey.
Other industry observers question how much cost savings will be left to pass on to consumers after paying for merger-related costs and servicing a ballooning debt load. CVS, for example, reportedly issued about $40 billion of investment-grade debt to finance the acquisition, which would make it the third-largest corporate bond sale on record, if accurate.
In any case, the main impetus for both the CVS-Aetna combination and the Express Scripts-Cigna deal may have been the interests of Amazon.com in moving into the highly dysfunctional U.S. health care field.
Nursing facilities routinely turn away patients seeking post-hospital care if they are taking medicine to treat opioid addiction, a practice that legal experts say violates the Americans with Disabilities Act.
After discharge from the hospital, many patients require further nursing care, whether for a short course of intravenous antibiotics, or for a longer stay, such as to rehabilitate after a stroke. But STAT has found that many nursing facilities around the country refuse to accept such patients, often because of stigma, gaps in staff training, and the widespread misconception that abstinence is superior to medications for treating addiction.
In Ohio — where 100 people a week died of opioid overdoses between August 2016 and August 2017 — a trade group representing more than 900 care facilities said in a written statement that none of its member facilities accepts patients who receive methadone or buprenorphine for addiction.
In Massachusetts, another state that is reeling from a flood of opioids, a nurse case manager at Boston Medical Center said it can be “next to impossible” to find a place that will accept a patient who takes these medications.
“It’s so bad — you’re just begging and pleading with these places,” said Maureen Ferrari, a nurse case manager who for nearly a decade has worked at Boston Medical Center finding post-hospital placement for patients. She said only two nursing facilities in the Boston area accept people on addiction medicines, adding that this roadblock can harm patients and turn a two-day hospital stay into one that is a week long, driving up health care costs.
“It’s well-settled in the case law that people with opioid use disorder have a disability as recognized under the ADA,” said Sally Friedman, legal director of Legal Action Center, a nonprofit policy and law group based in New York City.
“Opioid addiction is a chronic disease like any other, and nursing homes should be ashamed of themselves for excluding people who are receiving the most effective form of treatment for this chronic disease,” Friedman said.
Yet the law has not been enforced when it comes to people addicted to opioids, experts say, and many nursing facilities and industry leaders seem unaware of their obligations.
“The imperative to provide people with addiction with medication has not percolated,” said Leo Beletsky, an associate professor of law and health sciences at Northeastern University.
Officials with a handful of state long-term care organizations polled by STAT, including trade groups in Wyoming and Montana, said they did not know whether facilities in their area had policies on how to continue addiction treatment among patients admitted to their facility, something experts said is unsurprising.
“There is a lot of confusion about what is legal and not legal,” said Dr. Sarah Wakeman, an addiction specialist at Massachusetts General Hospital, who added that her team faces difficulty finding post-hospitalization placement “every single day” for people who take medicine for addiction.
“There are facilities that do not understand that they are not allowed to do this,” she said.
In an effort to combat this confusion, the Massachusetts Department of Public Health in 2016 issued guidance for nursing facilities caring for patients who take medicines for addiction. The state’s circular letter asserted that care facilities must provide medication-assisted treatment for people who are already on it, and who otherwise are eligible for admission. A spokesperson said that the department addresses any concerns related to the topic that are brought to its attention, and that it reviews a facility’s policies and procedures when conducting a nursing home on-site visit. But the agency has not tracked complaints about addiction-related admission denials.
“There is a lot of confusion about what is legal and not legal. There are facilities that do not understand that they are not allowed to do this.”
Dr. Sarah Wakeman, addiction specialist at Massachusetts General Hospital
The U.S. Department of Justice has begun an investigation of detention centers that don’t make medication-assisted treatment available to inmates with addictions. And Beletsky, citing federal government sources, said a campaign to boost ADA enforcement among care facilities may be on the horizon.
It’s a move that can’t come too soon, he said. Failing to enforce the ADA for people with opioid use disorder “is a missed public health opportunity that is probably measured in lives,” Beletsky said. The Department of Justice declined to comment.
Refusing care to people on medication for addiction can have dire consequences because pressure to stop these proven treatments could open the door to relapse and overdose.
Part of the reticence to accept patients with addiction stems from unfamiliarity with the medicines used to treat them. Nursing facilities may not have a clinician licensed to prescribe buprenorphine on staff, for example, and facilities may be unaware that the patient’s primary care doctor often can continue to provide the medicine.
“We have faced hurdles even when clinicians who are discharging patients stable on medications to treat opioid use disorder are willing to continue prescribing these medications while patients are recovering at facilities,” Dr. Sabrina Assoumou, an infectious disease physician at Boston Medical Center, wrote in an email.
Treatment of addiction is also an unfamiliar process for many facilities, where resources often already are stretched thin.
“You are taking on a chronic disease that you may not have the infrastructure to deal with,” said Dr. Wes Klein, an internist and the medical director of Duffy Health, a community health center in Hyannis, Mass. “That may scare people a little bit.”
Some addiction experts have begun partnering with nursing facilities to make sure the addiction treatment a person receives in the hospital isn’t a barrier to the next step in their medical care.
Center for Behavioral Health, a group of four addiction treatment centers in Las Vegas and Reno, Nev., began offering educational sessions on medication-assisted addiction treatment for nursing facility staff when some expressed discomfort with the medicines. The sentiment stemmed largely from a lack of experience with the addiction medicines — and a common misconception that medication-assisted treatment for opioid addiction represents replacing one addiction for another.
There is a “total lack of understanding and knowledge of medication-assisted treatment,” said Dr. Lesley Dickson, an addiction psychiatrist at Center for Behavioral Health. “Most doctors don’t even seem to know what it is.”
The reaction, Hales said, has been “surprisingly positive.”
“Most people go off of the stigmatized version of medication-assisted addiction treatment,” Hales said. “Then when you throw out what it really is — the raw data, the patient success stories — they are like, ‘Maybe this isn’t what I thought it was.’”
Wakeman’s team, too, recently began a partnership with two area nursing homes. The team provides prescriptions for patients admitted to the facilities so they can continue to take methadone and buprenorphine, and offers guidance if questions arise about proper dosages or other logistics.
“We need to think about how to help these facilities and how to support them in caring for a population they are not used to caring for,” Wakeman said. The needs of patients with addiction, many of whom may be younger than those who traditionally have stayed in nursing homes, “may be different from what facilities have historically thought about.”
WASHINGTON — Sen. Bernie Sanders (I-Vt.) will introduce a bill Tuesday that would impose jail time for pharmaceutical executives whose companies engage in manipulative practices when marketing opioids.
The legislation would impose a 10-year minimum prison sentence and fines equal to an executive’s compensation package if the individual’s company is found to have illegally contributed to the opioid crisis. It would also impose an additional fine on those companies of $7.8 billion — one-tenth the annual cost of the crisis, per a 2016 estimate.
The bill outlined a number of mechanisms by which the Department of Health and Human Services could demonstrate such liability, including by mandating written justifications for pill orders that seem medically unreasonable. And the legislation would establish an opioid reimbursement fund, to be administered by HHS, that would collect the fines levied under the new law and distribute them to other federal departments.
The bill would also prohibit companies from direct marketing of opioid products without adequate warning of their addictive properties and establish a reimbursement fund that would collect revenues from the penalties imposed.
In many cases, the bill’s proposals take aim at the most-cited perceived misdeeds of opioid makers and distributors.
Purdue Pharma, which manufactures the opioid painkiller OxyContin, announced in February it would no longer directly market the drug to doctors, a major shift for the company that has shouldered an increasing share of the blame for the national crisis.
McKesson, a drug distributor, is said to have shipped 5 million opioid pills to a West Virginia town with 400 residents over a two-year span.
Those two companies are among a larger group of manufacturers and distributors being sued in a consolidated case in an Ohio federal court. The Department of Justice said earlier this month it planned to file an amicus brief in the case.
Sanders’ new effort is the latest in a spate of opioids-related bills, but takes aim at pharmaceutical companies more explicitly than others. Some version of an opioids-related bill is seen as the last major legislation likely to be pursued on Capitol Hill prior to midterm elections in November.
Rep. Greg Walden (R-Ore.), who chairs the House Energy and Commerce Committee, has said he hopes to bring a legislative package to a vote by Memorial Day.
The Drug Enforcement Administration (DEA) is attempting to reduce the oversupply of opioids in an effort to curb the number of painkillers sold illegally.
Specifically, the agency is proposing a rule that would change how it sets limits on the amount of opioids drug companies can make every year.
“Under this proposed new rule, if DEA believes that a company’s opioids are being diverted for misuse, then they will reduce the amount of opioids that company can make,” Attorney General Jeff Sessions said Tuesday during remarks he gave on the opioid crisis in North Carolina.
The opioid crisis has hit communities across the country hard, and death rates continue to climb. Some areas have seen a large influx of pills into often small communities, and policymakers are grappling with how to curb the number of painkillers that are sold illegally.
West Virginia Attorney General Patrick Morrisey (R) says the proposed rule is the result of a lawsuit he filed against the DEA seeking more transparency and input in the process the agency uses to determine how many opioids can be produced each year. The lawsuit was placed on hold in March after Sessions asked the DEA to evaluate its policies on crafting production quotas for opioids.
“The reform sought by DEA proves the impact of our lawsuit is still reverberating in Washington and producing real results capable of ending the oversupply of deadly and addictive painkillers that has killed far too many,” Morrisey, who is running for the Senate, said in a statement.
The proposed rule hasn’t been filed in the Federal Register as of Tuesday afternoon, but Morrisey’s office sent out a copy.
According to the document, the proposed rule would let the DEA take into account the extent to which pills are sold illegally when setting production quotas for opioids.
It would also consider “relevant information” from various agencies from the Department of Health and Human Services and its agencies, such as the Food and Drug Administration, the Centers for Medicare and Medicaid Services, and the Centers for Disease Control and Prevention. States could also have input and request a hearing if it believes a quota is excessive.
“The current regulations, issued initially in 1971, need to be updated to reflect changes in the manufacture of controlled substances, changing patterns of substance abuse and markets in illicit drugs, and the challenges presented by the current national crisis of controlled substance abuse,” the rule states.
The public comment period for the rule is 15 days.
Sessions also announced an agreement with 48 attorneys general to share prescription drug information to combat the diversion and trafficking of painkillers.
As the number opiate prescriptions hit a TEN YEAR LOW and OVERDOSE DEATHS hit a TEN YEAR HIGH.. hospitals are reporting serious shortage of injectable opiates.. The DEA is looking for ways to justify cutting the opiate production quotas for the pharmas. When statistics strongly suggests that there is current not enough opiate prescriptions filled would not be enough to meet the valid medical/therapy needs of the intractable chronic pain pts let along the other 70-80 million chronic pain pts and those acute pain pts dealing with pain from a accident or medical procedure.
I wonder if the DEA will use the CDC’s 64,000/yr drug overdose deaths… and overlook or ignore the fact that abt 1/3 of those numbers have nothing to do with opiates and abt 35K are due to ILLEGAL OPIATES and there are no published stats as to how many of all those 64K overdose drug deaths are in fact SUICIDES.
But the TRUTH AND FACTS have never gotten in the way of the DEA doing what they want to do…
In the clip, a man identifying himself as a business owner claimed that a Jacksonville employee named Melinda Power had demanded that military flags be removed. In addition, the unnamed business owner claimed Power told a combat veteran customer he had done “nothing” for the country. Video shared by a local news outlet included an image of a citation:
The same news article reported that the citation had to do with the amount of signage displayed by Jaguar Power Sports, not the military flag, and included video (without audio) of interaction between Power and the anonymous customer. In early accounts of the 16 April 2018 dispute, employee Katie Klasse quoted Power as saying the unnamed man’s service “didn’t matter.”
But when the veteran was interviewed by the same station, he himself stated that in fact Power said his opinion on the citation “doesn’t really matter at this point” as she was present only to discuss city ordinances:
Changes made to Jacksonville’s signage ordinances, if any, are not clear based on social media commentary. However, according to citycode enacted in March 1987, the flags on display at Jaguar Power Sports do appear to be violating City of Jacksonville Building Inspection Division Sign Laws:
Sign Exemptions
… United States of America, State of Florida, and Local Government flags (Duval/Jacksonville) may be displayed.
[…]
Unlawful Sign Structures
… Consists of streamers, ribbons, pennants or wind activated devices, multiple flags, including multiple flags of states, governmental units, balloons, including individual and giant balloons which are inflated and tethered for support which encompass an area or areas, singularly or in aggregate, greater than twenty-five (25) square feet.
Jaguar Power Sports was cited but not fined for the flag violation, and Jacksonville’s mayor later said that code would be amended to allow military flags to be flown in the manner permitted for American flags as of 17 April 2018.
Amberly Lago survived a devastating motorcycle accident and endured 34 surgeries and extreme chronic pain. She joins Megyn Kelly TODAY to share her story, as recounted in her book “True Grit and Grace: Turning Tragedy Into Triumph.” She says her leg was “completely shattered” and explains why she chose not to have it amputated.
In the 1980s, France went through a heroin epidemic in which hundreds of thousands became addicted. Mohamed Mechmache, a community activist, described the scene in the poor banlieues back then: “To begin with, they would disappear to shoot up. But after a bit we’d see them all over the place, in the stairwells and halls, the bike shed, up on the roof with the washing lines. We used to collect the syringes on the football pitch before starting to play,” he told The Guardian in 2014.
The rate of overdose deaths was rising 10 percent a year, yet treatment was mostly limited to counseling at special substance-abuse clinics.
In 1995, France made it so any doctor could prescribe buprenorphine without any special licensing or training. Buprenorphine, a first-line treatment for opioid addiction, is a medication that reduces cravings for opioids without becoming addictive itself.
With the change in policy, the majority of buprenorphine prescribers in France became primary-care doctors, rather than addiction specialists or psychiatrists. Suddenly, about 10 times as many addicted patients began receiving medication-assisted treatment, and half the country’s heroin users were being treated. Within four years, overdose deaths had declined by 79 percent.
Of course, France has a socialized medical system in which many users don’t have to worry about cost, and the country also developed a syringe-exchange program around the same time. Some of the users did sell or inject the buprenorphine (as opposed to taking it orally, as indicated), though these practices didn’t result in nearly as many deaths as heroin does.
“It seems that the French model raises questions about the value of tight regulations imposed by many countries throughout the world,” wrote the author of a study on the phenomenon, the French psychiatrist Marc Auriacombe, in 2004.
Just what are these regulations? In the United States, doctors must take a special, eight-hour class to get a waiver that allows them to prescribe buprenorphine. The classes can cost money and force even more tasks into doctors’ already packed schedules. In one study, 10 percent of doctors said they didn’t even know how to get the waiver. According to Andrew Kolodny, a psychiatrist who studies addiction at Brandeis University, some primary-care doctors might frankly be daunted by the prospect of working with addicted patients—a sentiment that’s also reflected in physician surveys. Meanwhile, there is no special training class required to prescribe prescription painkillers, Kolodny points out. (There’s also a cap on how many buprenorphine patients a single doctor can have, though Congress is considering waiving this limit through new legislation.)
There are multiple other issues in the American health-care system that make accessing buprenorphine difficult for addicted people. Medicaid pays for a substantial chunk of all drug-abuse treatment, but state Medicaid programs impose limits on when and how they’ll cover buprenorphine.
Finally, doctors know that if they sign up to prescribe buprenorphine, all the local heroin users will flock to them, potentially crowding out their other patients, says Stanford University professor of psychiatry Keith Humphreys. “Doctors also want to take care of kids with colds, and adults with bad backs and cancer patients and the panoply of humanity that they know how to take care of,” he said via email. One way to resolve this would be to require doctors who are licensed to prescribe prescription painkillers to also prescribe buprenorphine.
The result of all this is that many addicted people just can’t find a doctor willing to prescribe them buprenorphine on demand, especially if they want insurance to pay for it. For example, The Atlantic looked up Parkersburg, a city of 30,000 people in West Virginia, the state with the most overdose deaths, on Suboxone.com, a site that lists buprenorphine providers. We found 10 doctors within a 50-mile radius who prescribe buprenorphine, and we attempted to reach all 10.
Some of the contacts appeared to be in the same office. We were told one doctor had a waiting list for patients, three doctors did not accept insurance and charged hundreds of dollars a month in cash, one had a number that was disconnected, and, finally, one was both accepting new buprenorphine patients and took insurance.
“If you really want someone who’s addicted to seek treatment, you have to have it be less expensive than using heroin,” Kolodny said. For many addicted Americans, that’s not currently the case.
The Drug Enforcement Administration likes to use something called a “sneak-and-peek warrant,” a search warrant that allows agents to enter and search a property without notifying the owner as a normal warrant would require. Officers operating on a sneak-and-peek (officially, a Delayed Notice Warrant) typically aren’t allowed to take any evidence they find on-site — but they do frequently trash the place, faking a burglary to explain their break-in.
Sneak-and-peek searches were authorized by the Patriot Act and, as is often the case with this law’s provisions, quickly became more useful for the federal drug war. But the trouble with fake-robbing people is it can lead to unintended, dangerous consequences, like those experienced by an Oregon storage locker manager named Shawn Riley.
In December, The Oregonian reports, Riley was tied up and held at gunpoint by alleged drug traffickers who believed he’d stolen the cache of marijuana they’d stored at his facility. It turns out the DEA was the real culprit; agents had done a sneak-and-peek and confiscated 500 pounds of pot. “The danger of violence is obviously real, and this case makes it very evident,” said Cleveland State criminal law professor Jonathan Witner-Rich, a warrants expert. “Someone could have been killed.”
Marijuana is legal in Oregon, and the 500 pounds was allegedly set for transport to Texas. The DEA declined to comment to The Oregonian. Bonnie Kristian
“I’m just the night doc,” you said. You said it with emphasis as if that explained everything and dismissed your incompetence, your lack of compassion, your failure to care. Unfortunately my sister was “just the patient,” who lay suffering hours before her death and the RN was “just the nurse” withholding the morphine that the daytime doctor had ordered for air hunger and agitation. The nurse called you in to manage me when I asked her to give my sister a touch of morphine; she was crying out in pain from her hypoxia.
A civilized, yet ridiculous argument ensued about the dangers of respiratory depression in a patient who was clearly dying. You and I, physicians and colleagues, were arguing over 2 mg of morphine when you said, “I’m just the night doc.” I’m still shaking my head over the absurdity. Instead of assessing the situation you felt the need to pass the buck until morning. Does no one die on your watch? You were so busy, not being a physician, that you must have missed the oxygen saturation in the 70s and the flipped T waves predicting my sister’s imminent demise.
The life and death stakes were not high, the end result would have been the same. We both knew that, so why did you feel the need to distance yourself from your decision to withhold medication with a just statement? “I’m just” means that you are under no obligation to act. You were telling me in essence that you were a just an overnight placeholder in the ICU. When we are just doctors we are not our best selves.
A more honest, although equally lame statement would have been, “It’s not my job.” However, that declaration begs the questions as to whose job is it to orchestrate patient care after dark? Having been a doctor for three decades, I can’t remember a time when my obligation to care for patients stopped at dusk. That implies that patients can only expect our best selves in the daylight hours. Did I miss the memo, has medicine gone so far away from patient care that this shift work mentality is the norm or were you “just an ass”? What if you’re only a Wednesday doctor, but you’re working on Friday, will you wait until Wednesday to treat? The absurdity boggles my mind.
I don’t blame you for my sister’s death, everyone knew she was dying. She had asked for resuscitation measures to be stopped. However, in saying I don’t want extraordinary measures she never said, “I welcome a painful, oxygen starved, horrible death.” I had promised to be there with her, and I had explained the likely outcome. She trusted me to watch over her as a sister, not as a physician and I couldn’t do it. My real anger is directed inward, and I can’t forgive myself for leaving the hospital. I let you drive me away in the last few hours of my sister’s life, because I was angry and powerless. I couldn’t “just be a sister.”
Every one of us as health care professionals that night had a duty to care and we all failed due to our individual arrogance. I used your lack of compassion as my excuse to avoid facing the last three hours of her life.
We wear many hats as physicians but can we ever just be family members? The family relies on us, to translate complex medical speak, to help them understand the big picture and to act as liaisons with other healthcare providers. We usually do this willingly and in my experience, it unfortunately also allows us to keep our distance from our own very painful human experiences. I know that I am much stronger in a medical crisis when I am in “doctor mode.” You, the night doc and the night nurse wouldn’t let me be a doctor that night, thus the power struggle at the bedside. I would love to give you credit for urging me be the sister instead of the doctor, a much healthier way to grieve, but that wasn’t your intent. You made it clear that there would be no team decisions despite the fact that I had been there all night, knew my sister’s wishes intimately and had watched her oxygen saturation plummet and the T waves dip.
If I hadn’t been a doc, would you have been more compassionate towards my family? Were you practicing defensive medicine because I was there? Who better to understand compassionate palliative medicine than me, your senior colleague?
As we kept our distance from death, by arguing a moot point, my middle sister ignored us and kept her promise to my dying sister. She prayed, “Hail Mary, full of grace” softly in my sister’s ear, a comfort to both of these women of faith. She did not distance herself; she immersed herself in the process of helping another die. If we had set our collective arrogance aside perhaps we could have acted as a team and stayed in the moment with a suffering fellow human being. Patients are never just patients; my sister was a vibrant and brave mother, sister, wife, and friend. All of us failed to recognize what a profound privilege it would have been to assist another to die with dignity and grace. None of us were there three hours later when my sister passed away with a team that included a kind nurse, a compassion physician, and my sister with faith. I can’t forgive either of us for being “just doctors,” there’s no dignity in that.
Over the years, I have found myself in similar situations with Mother, Father-in-law, Mother-in-law and wife. Some end of life issues, others just poor/inept care being provided or lack of care being provided. Depending on my perception of the severity of the violation of what is the standard of care… depends on how I approach the offending healthcare provider.. If it is rather minor infraction, I will try to muster up my “most diplomatic approach”… depending on their response determines if I drop directly into my “take no prisoners mode”… after running my own pharmacy for 20 yrs.. I still have this “boss demeanor ” that I can bring to the forefront at a moment’s notice. I have been known to – on occasion – piss off hospital nursing staff… for not doing their job… at least at that point I know that I have got their attention. Typically, things change.. in the right direction… it is gratifying to know that my loved ones are getting the medical attention that they need/deserve.
