Needless Death

Needless Death

There was an editorial in the Oregonian, my local paper. Access to healthcare. Woman’s death an also an indictment.

The main thrust of the piece was that this needless death would not have occurred if the patient had had access to healthcare. The patient was uninsured and health care is expensive.

Friends and family report that in the past weeks and months she had often had fevers and felt ill.

She was found unconscious in her apartment and eventually died at age 44 of the complications of subacute bacterial endocarditis, an infection of a heart valve that than fester for months before it kills. The classic, and horrible, example of subacute bacterial endocarditis was in Alfred S. Reinhart, a medical student in the pre-antibiotic era who kept a journal as his disease progressed:

At any rate, at approximately one-quarter to twelve that night, I remember distinctly getting up from my chair and from the table, where my books lay, and taking off my suit coat. No sooner had I removed the left arm of my coat, than there was on the ventral aspect of my left wrist a sight which I shall never forget until I die. There greeted my eyes about fifteen or twenty bright red, slightly raised, hemorrhagic spots about 1 millimeter in diameter which did not fade on pressure and which stood defiant as if they were challenging the very gods of Olympus. … I took one glance at the pretty little collection of spots and turned to my sister-in-law, who was standing nearby, and calmly said: ‘I shall be dead within six months.

I see morbidity or mortality every month in the uninsured and vulnerable patients. I have helped bankrupt many a patient over the years treating their catastrophic infection. That is not uncommon, with maybe 45,000 deaths a year and is, unfortunately, the American way:

What should happen, the moderator asked hypothetically, if a healthy 30-year-old man who can afford insurance chooses not to buy it—and then becomes catastrophically ill and needs intensive care for six months? When Dr. Paul ducked, fondly recalling the good old days before Medicare and saying that we should all take responsibility for ourselves, Blitzer pressed the point. “But, Congressman, are you saying the society should just let him die?” At that point, the rabble erupted in cheers and whoops of “Yeah!”

I have no argument with the basic idea that the most wealthy county in the history of the world should provide basic health care to its citizens. But I want to point to two other ideas in the piece:

She never called her doctor friend or sought mainstream care.

and

Working against Mia was her disenchantment with mainstream medicine. She found providers rushed, impersonal and unaffordable…The care she received in the last months of her life was from naturopathic physicians and acupuncturists, practitioners she believed in because they took the time with her, but, critically, whose services she could afford.

Endocarditis is my bread and butter. It is a tricky and unusual disease whose protean manifestations require training and experience to recognize, training and experience no acupuncturists or naturopath will ever obtain. I would love to see the progress notes of the acupuncturist and naturopath. I wonder what mis-diagnosis and useless treatments they gave the patient as the infection destroyed her heart valve and ultimately her life.

Mia died young in large part due to the lack of affordable health care in the US. She probably also died because she received her care from those who, while they wish to be primary care providers, are completely unable by training and experience, to recognize serious illness. It is sad on so many levels.

Vaccine-preventable diseases: out the front door, ...
Points of Interest: 3/2/2014