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Saturday, November 28, 2009

SALLY MORRIS: TO BE OR NOT TO BE - THE HUMAN FACE OF HEALTH CARE

"In 2005, as the Agency for Healthcare Research and Quality’s director, Carolyn Clancy edited a seminal book (Ethical Dimensions of Health Policy) explaining why health care should be put on a genocidal basis. Ezekiel Emanuel wrote a chapter in Clancy’s book, on how to end the ‘traditional Hippocratic health-care approach’ and bring in a ‘population-based’ system to cut costs. He complains of ‘the dominant Hippocratic tradition of medicine’, where doctors have been ‘inculcated with the notion that their primary duty is to the patient for whom they are caring.’ He warns that the public is suspicious about the intentions of those who would deny the life-saving care, and methods of doing that must ‘allay their suspicions and reassure them about the integrity of the decision-making process.’

 November 8, 2009, the AHRQ released a recommendation that women under 50 stop having Routine cancer-detecting mammograms and discouraged physicians from encouraging their Patients from self-examination which might lead to early detection and cure of breast cancer.

The reasoning is that it isn’t worth the risk. The “risk” is the “unnecessary anxiety when there’s a‘false positive’ reading”.

 The AHRQ is the official advisory agency for our proposed national health care plan.

 Nature is never even-handed in her gifts. We will celebrate my sister Melissa’s birthday on December 14. Our mother recalls when our family went to meet Vice President Richard Nixon’s plane. Pat looked at the child, gazing back from huge blue eyes, and said she was the “most beautiful child she had ever seen”. Like so many other young girls, Melissa fell in love with horses. Unlike most, however, she became a prize-winning equestrienne. Our mother has her ribbons. A terrible bout of mono left her bedridden for eighteen months. When she recovered she decided she wanted to learn all she could about photography.

 

She went to Minnkota Power Cooperative, and asked to work “for free” in return for learning how to use their equipment. Legendary industry pioneer Andy Freeman hired her and, at age sixteen, she began her career – one noted for her creativity, generosity in helping others, bubbly personality and her work ethic.

 

We viewed her marriage with apprehension, but she gave her love, her loyalty and her trust and went to Florida with her husband to look for a new job and a new life. She found work with a newspaper and then at a television station, where she became a producer. Our fears were borne out - her marriage ended. Often, in those days, Melissa would call me. She’d recount hilarious stories about her “ridiculous life” - always laughing at herself. Once she told me she’d been to the beach on the Gulf. “I was alone. Suddenly a dolphin leaped out of the water in this perfect arc in the sun. It was so beautiful!” She loved the tropics.

 

She called once to tell me she was thinking of moving. I said she ought to buy a house. One day she sent us a photo of her new home – a grand, lovely 1920’s –era vintage home with palm trees and a veranda, an American flag right there, in front. I was so proud of what she had done. Never did she ask or accept help with this. She restored it, decorated it. She became a collector of Indian art and antiques. She decorated her front porch like a scene from the Arabian Nights. She promoted the historic district of Ft. Myers and her home was listed there. She edited and produced the neighborhood association newsletter. She continued to add to her prized collection of Christmas decorations.

 

Melissa could never resist an animal in distress. She once had a parrot, finches, tropical fish, three cats and a gigantic dog, Mr. Pickles. She never knew how old the pets were because they were all abandoned and found in shelters. She was crying when she called to tell me that “Lisa died.” Lisa was her cat. In later years, when she was in Rochester, Minnesota, at the Mayo Clinic, she would often visit the Humane Society to visit the animals, pet them, talk to them, hold them, sometimes walk the dogs.

 

We talked often in those days. She would chat amiably with our kids about movies or music. One day she called and I heard something else in her voice. She said she’d discovered a lump in her breast. She wondered anxiously if it might just be a “fatty deposit or something like that”. I told her to go and get it checked at once. She promised she would, but swore me to secrecy. I agreed on condition she see a doctor. Days passed. I called again. She “hadn’t had time”. I threatened to tell our mother if she didn’t do something. She promised again. Finally I called her at work. That did it. She found out it was cancer.

 

We persuaded her to go to the Mayo Clinic. Thus began a fourteen-year battle. In that time, she won international awards for her work in television. She learned to cook Indian food and joined a flower club. She designed and created beautiful landscaping. She went sailing with friends on the Gulf. She and our brother toured London. We talked about going to Savannah, which she knew and loved – or to New Orleans, which I knew and loved, but a crisis at home prevented me from going and when that abated her health was declining again, so we never adventured together.

 

She bought a piano and took lessons, she wrote a mystery story based on local lore, went swimming, walked on the beach, listened to steel bands, read voraciously (gothic novels and Civil War history), took up painting and did a richly beautiful portrait of her Labrador, Gus, dreamed about buying a Gypsy Vanner horse. Her interest in photography never waned and her work was brilliant and intuitive. On one occasion, finding a horse show in town during a visit to Mayo’s, she took photos of horses. Owners flocked to ask if she could photograph their horses too. She considered starting a photo studio.

 

When she had to go on disability she was forced to sell her beloved home. She was philosophical about it, believing that a new door was opening. And she found a turn-of-the-century home in less costly Mississippi and made it her own. I referred to the color of one room as “pleasemor pink” in reference to the wintergreen candy. She called her new home “Pleasemoor”. “It has such a happy sound,” she said. She brought our parents and a brother and sister there to share it with her in what was to be the last year of her life. She passed away in Mississippi on August 14, 2008. She was only 48 years old.

 

Was her life worth prolonging? Had she been screened as a routine, the cancer might never have metastasized. She might still be with us. Had she not gotten help when she did she would have been gone within the year. But instead she had fourteen years – much of it in the shadow of her fight with cancer. She made the most of every hour, every minute. She was beloved by her friends, co-workers (who called her the “Rainbow girl”), her family and her pets. I’ll always be grateful she was with our parents for a last wonderful year.

 

Melissa, through all those years, paid ample income tax as a single person with no dependents, as well as property taxes. Her employer provided insurance and later she paid for her own.  No one who asked for her help was ever turned away. She regularly sent contributions to an “adopted” disadvantaged child in a third world country. She kept the photos they sent.

 

 

I have never known anyone like Melissa. She was funny, talented, strikingly beautiful, loving, creative. Maybe you know someone like her. (Or maybe you just know someone's sister or daughter . . . or mother.) Sometimes I see a little of her in my own beautiful and talented young daughters. I wonder what life will have in store for them. I hope that they will have the opportunity to have every chance to fulfill their promise and dreams.

 

I hope that a “health care system” that views saving life an undesirable result of “misguided” application of the Hippocratic Oath and an “’outmoded’” concern for the individual patient” will not cut deprive them of that promise.

 

 

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