The Future of Health Care in the United States.

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This should be posted in every doctor’s office.

As the days leading up to 2013 begin to fade in quantity and the changes this new year will bring become more and more evident, many citizens may wonder where is Health Care going in the U.S. and the answer might be simpler than many imagine. It’s all matter of downsizing the population and looking elsewhere.

Because the PPACA is approved by a superior Court of Law and grants Obama and the Congress as correct in the decisions they implanted in 2010, this means that every citizen in the U.S. has to either have insurance or pay a tax (this very same tax will not be called a penalty, or fine, as some people dwelling about in the internet have chosen to refer to it), depending on their income. This tax, which comes from all citizens that generate an income within the country, goes to a big, massive, system which hands out medical care to everybody at an equal, constant and carefully organized rate.

The theory behind this is quite simple: if I make a lot of money, then the government takes more out of me than someone who doesn’t make a lot of money. But that someone, just as me, has the right to be healthy, he or she has the right to get into a hospital and receive medical treatment. If he or she falls ill, there is a chance the government will use my money to heal him or her. It sounds fair, doesn’t it? It is. It’s a socialist approach to a capitalist problem, it’s the best solution anyone could have come up with and it won’t work.

I’d like to tell you a little story: I was flying back from training in Texas. The flight had me take a connection in Houston and then fly home, landing about nine o’clock at night. As I waited, sitting just yards from the counter, I heard my name being called out: I was being upgraded to first class. This all fell as great news, more legroom, less time waiting in line, all the works, and one of the most interesting conversations I ever had.

A burly fellow, probably forty, forty-five years old, sat in seat 1B, just next to me and greeted me with a potent southern accent. He tilted his head and nodded just once; I replied and we got to talking, primarily because he didn’t shut up and I don’t either.

“So, where you flying today?” he said, fixed himself, and turned to me.

I flashed my ticket quickly and showed him my final destination. His eyes opened wide in surprise, as if he was being pranked, in a good way, and he smiled.

“I’m going there too!” He said and smacked his leg, “My God! What a coincidence!”

“It sure is,” I told him, “do you live there?”

“I do, actually,” he replied proudly, “just some miles from the airport.” It’s important to highlight that the airport in my country is located in a very warm, sunny area just about twenty miles from the capital. Right now, this place is brimming with financial activity: a new hospital was built, several Tax-Free zones have been created to promote business and residential housing is constructed in little havens with pools and open green spaces.

“Are you married to a Tica?” He nodded with satisfaction and showed me her picture. She was o.k.

“So you’ve got Social Security?”

“Oh, yes,” he replied with a devious smile. There was satisfaction in it, in that grinning gesture of success, “I take advantage of it.”

“And what do you think of the ObamaCare?” Instantly he hummed, pursed his lips in a disappointed fashion, as if I had insulted him and he was too polite to answer back, and did not respond.

“I ain’t paying them a bit out of my money,” he said. And that’s when I got to think about this plan.

In order for Health-care to work Obama Style, the President and following leaders have to change the mentality of a nation that is not willing to share. One of the primal evidences suggesting this is the controversy behind such a plan; it’s as though people don’t see that eventually, because private and uninsured health services end up imploding and creating immeasurable expenses, the citizens of the U.S. have to get used to and accept the socialist approaches Barack Obama has taken.

And they will. It will take time, but it will happen.

And, for fifty or so years, the Socialist based Obama Health Care system will work perfectly—after the rough adjustment process that is—because people realize that getting a “free” medical service is actually working for them and not against them. Since the monthly quote is smoothly retracted and not abruptly taken away, the process feels as though money is being put somewhere for them; and it is! Social Security services will grow, little by little, and develop itself into a behemoth of bureaucratic procedures. This is where everything goes wrong.

The thing is, some people go to the doctor constantly and rarely get any healthier. These people exist now, they will exist when Health Care turns socialist. These are patients labeled as “frequent fliers”. Then there are the patients who don’t like waiting, otherwise known as “impatients” (creative, I know); this is on the patient side. On the health-care professional side come those who understand that the process is, under the common conception, free, therefore people won’t leave—they can’t afford going to a private MD so they must wait—hence professionals become patient, they become used to this. After all, it doesn’t affect them. Then numbers come into play: a system that fills the medical needs for tens of millions of people will have its flaws. These represent themselves in the form of missing files, unassigned appointments which are actually assigned, system clashes between identical patients and so on. It may seem trivial to mention flaws within the system as a major cause for malfunctioning but it’s justified: these happen from the start.

Finally, and unfortunately, a socialist system bases itself on trust, something not many countries have. It’s a system in which trust is needed because doctors, with the power to assign appointments, secretaries with the power to change schedules, directives with the power to shift talent from side to side, have contacts on the other end: close friends or relatives become patients, patients need an appointment and they need it fast, friends or relatives become suppliers, suppliers need their product sold and fast—the competition’s better but this one is cheaper—while the rest can wait.
All these symptoms ironically create costs within the system; the system turns inefficient and the costs to maintain these “mandatory” symptoms (they are, pretty much unavoidable) make socialist-based Health-Care one of the most expensive in the long run. Since costs cannot be shift upwards drastically, the amount of money coming in at first will suffice, within years, when the expenses amount to and equal the income of social security, measures will be taken (too late because the expenses accumulate historically) and, eventually, the system will be forced to privatize itself in order to stay afloat. It is a vicious cycle which can be seen in various countries adapting the socialist health-care system, take a look at Russia, Sweden, Finland and such.

But, yet again, our lives work in cycles and this is just another one.

This is a light, summarized opinion about Health–Care. Heck, it’s only a rant at midnight. But it’s a rant from a biomedical engineer hailing from the country in which the U.S. is basing its social security system.



Dr. Flirtatious

A cardiac by-pass, a mitral valve replacement or a ring replacement within the ventricles; they all have three things in common.

1) They all are heart-related,

2) They need the doctor’s utmost attention.

3) You need something to momentarily replace the heart you are fixing.

This “backup” heart is quite complicated to operate.

So, as they cut patient 02115798 open and started with the procedure, I feel nerves grown inside me. It isn’t the first open-heart surgery, in fact, I believe it’s my third or fourth, but I get jittery and jumpy when the blood starts being drained out of the body and into a beeping, careless, cold metal contraption. And I know my co-worker is nervous as well, as her foot taps like a jackhammer, just more graceful. But we shouldn’t be nervous. It’s a typical surgery within the complicated, plus, the doctor next to me has done 1500 of these and not one death on his list.

Pretty good if you ask me.

But the other guy (there’s always another guy) gets me nervous. And gets her on her nerves as well. And it has nothing to do with medicine.

This other guy is the Chief of Cardiothoracic Surgery and a complete player. There’s no female that can reject him–whether they want to or not–to a point in which his wife (who used to work in the same hospital), asked for a transfer because she was fed up of such flirting (and other “issues”). The moment he laid eyes on my co-worker, who we’ll call Michelle, he knew he had another challenge, especially given the ring on her finger. Keep in mind that, like a super Hollywood action star, he always comes in late (because his job asks him to; there’s no need for him when the patient is sawed open and stuff) and says hi with a stupid grin on his face and a loud, confident voice so everybody knows he’s here.

We’re halfway into the surgery and the doctor starts his imposing walk towards the patient. If only patient 02115798 would know what was going on, she’d wake up in no-time. Halfway between the washing room and the patient, he spots Michelle, she straightens her stance and turns to me: don’t be so evident in your discomfort, I think to myself, because if this guy gets angry with a scalpel, patient 02115798 is done.

Time flies by. We’re about an hour into the surgery.

But then I grow uncomfortable. After opening the third ventricle, he turns to be sure Michelle is following up on his fantastic moves. And he looks ridiculous twisting his head almost 180 degrees to look for her. But she’s not there, because Michelle left to the bathroom for a moment and he doesn’t know this: he grows nervous since his prey is gone, it has disappeared and the possibility of banging her in the back of the dressing room has just diminished to zero; he sure wanted to get sex tonight. I think her resistance is as enticing as the ring on her finger. Where has his bounty gone?

“Doctor, doctor!” his assistant calls up, “watch that vein!”

He turns to the patient. The machine starts beeping. Everybody grows tense. There’s quiet and awkwardness as he returns to the real world.

Michelle’s steady walk echoes in the silence. I feel bad about predicting (sort of) the incident and I wonder: what the hell is Dr. Flirtatious thinking right now?

Fire and Ice

First of all, here are the links to the great blogs participating in this month’s Blog Chain:

orion_mk3 – (link to this month’s post)
Ralph Pines – (link to this month’s post)
areteus – (link to this month’s post)
Catherine Hall – (link to this month’s post)
bmadsen – (link to this month’s post)
pyrosama – (link to this month’s post)
magicmint – (link to this month’s post)
meowzbark – (link to this month’s post)
tomspy77 – (link to this month’s post)
BBBurke – (link to this month’s post)
writingismypassion – (link to this month’s post)
Proach – (link to this month’s post)
randi.lee – (link to this month’s post)
BigWords - (link to this month’s post)

The topic is simple, yet complicated: Fire and Ice.

I wanted to write about a fire in one of the country’s biggest hospitals. One of the survivors was a 19-year-old technician who had been interned due to a dry-ice burn. He also got burned due to the fire. Ain’t life a bitch? He works as a fireman now.

Then I realized I didn’t want to seem so tragic. After all, tragedy is pretty much what I see everyday and I get sick of it on occasion.

I want to try something different: I want to talk about the physical impossibility of feeling fire and ice at the same time. It was half past two o’clock in the afternoon; we all sat in a crowded auditorium waiting for the head of neurosurgery to begin his presentation on the vast improvements my country has seen in the field of hydrocephalus in infants.

I sat between the prettiest nurse I had ever seen and the director of Medical Equipment in the hospital. Both are equally important in completely different planes.

There was a murmur; from the faint voices I could hear someone complaining of the lack of air conditioning while others spoke last night’s soccer game. Some even indulged in politics and corruption. I eavesdropped them all. It made for some good entertainment while I waited.

Then they all hushed. The doctor entered. We all rose quickly; I felt it. There was a dramatic silence, an aura of respect loomed over him and excitement buzzed around me; I was probably surrounded by many medical students looking up to him. And he went up the stairs, one step at the time, a relaxed breath between steps, and I felt it again. And he turned to us and he smiled.
We all smiled back. He sat down. There was quiet.

And then I felt fire. My insides burned, the temperature rose to immeasurable levels and there was acid boiling inside me. I clenched my fists and closed my eyes. Did the nurse notice? Did the director notice? Did anyone? No, I don’t think so. I closed my eyes again. Slowly the heat began to creep up to walls of my stomach, burning every inch of my gastrointestinal duct with a fizzing effect, as if frying fish. I felt weak.

Then it happened.

Everything turned to cold. Little lumps of freezing embarrassment covered my skin and caused my hairs to rise upwards. The drops of sweat in my forehead froze with the impossible surge of cold wind seeping into the auditorium. I was nervous; I rubbed my arms but stopped halfway. I knew it would not be tragic, it was a normal reaction, but it’d be loud.

And then, it gargled, like sticking a hand through a tuba, it gargled. It murmured, almost laughing at me, and my entrails rumbled like thunder. Fortunately it stopped there. My stomach succeeded in breaking the silence.

She smiled. Someone else smiled. They all heard.

And I had to invent a new Biomed’s rule:

Don’t try the new Indian place at the corner when you have meetings.

A death in the hospital, a death in the news

At about seven o’clock in the morning, she came out of the hospital, escorted by seven policemen and the endless sea of reporters. Her face was not frightened which confused me; if anything, it scared me. She was calm, she was–and I believe I can say it with complete assertiveness–at peace.

She just looked at the news cameras and smiled. Then she lowered her head in shame. No make-up, bristly gray hair on her head, with the occasional hint of black, and serene green eyes behind wrinkles, a lot of wrinkles. They seemed too weathered, she wasn’t that old.

I made my way near a wall, not to disturb anyone. I came in for the machines, I told myself, and not for the patients.

Then I noticed it; she was a nurse. White dress, closer to her skin that it should have been, a white hat and pale panties. Why a nurse? People pushed and shoved, they wanted to get a look, perhaps shout something. No, some of them even nodded with satisfaction. The policemen loaded her into the back of a squad-car gently and drove off. She left behind a needle. A single needle.

Four hours prior to this, she had entered the hospital dressed as a nurse. The uniform, she had gotten from a used clothing store just a couple of blocks down; the hospital guard trusted her, uniforms are usually a giveaway, and did not ask for her ID. I don’t he checked her purse either; doesn’t matter, she would have stolen the needle from a supply room.


And she knew what she was doing: injecting a huge air bubble then a hefty dose of adrenaline in the main bloodstream would cause anyone an irreparable arrhythmia.

Accelerate the heart past control, sending it to overdrive and forcing a heart-attack, while killing the brain. It seemed the perfect crime. Discard the needle in a junkie-town and you’re home free.

How powerful are needles?

But she didn’t leave. She injected the patient slowly and she cried. The monitor started beeping, it piked with alarms and signals. The lonely nurse on duty at 3 am rushed and found her sitting next to the patient.

“Rest now, my friend,” she said, patting a frail, almost grayish hand, “rest now, my dearest.”

The nurse on duty could do nothing. She was dead within minutes.

The Benevolent Murderer killed her best friend, Lilly, who was on renal support, blood monitoring and, occasionally, a respirator. Lilly was 55 and had been diagnosed with acute diabetes just months past. Her condition dropped to delicate and then to terminally ill in just months. Doctors just waited. Relatives just waited. The Benevolent Murderer didn’t.

Would you wait?

Do something! But don’t smoke…

And the flick of the switch would determine months of hard labor. The first-ever artificial Heart Machine to be completely independent in Costa Rica was to be put through its paces—giving the doctors the chance of working on a completely blood-free heart—and we were nervous because of three things:

–       The patient depends solely on the machine and nothing else. If the machine fails, doctors can pump manually but still need the machine to know whether they are pumping right or wrong.

–       The machine is brand new. Brand new things can either work or not, there’s something called Murphy’s Law.

–       The hefty price tag (three hundred and twenty thousand dollars).

Well, make that four: we were the techs in charge of acting in case anything went wrong.

“Start the pump,” the doctor said with a focused voice and his assistant turned flicked the switch. A comforting beep followed and my partner and I sighed quietly, “start the cardioplegia auxiliary pump,” another comforting beep followed, “start the artificial lung (How does that song go? Too much oxygen will get you high, not enough and you’re going to die? That’s what this does.)”

Silence. My heart stopped.

I looked at the patient and then remembered the file—I took the liberty of reading it even if doctors didn’t let me—specifically the age: fifty-four years old. And there he was with his eyes closed, his mouth ajar and a plastic tube shoved down his throat, his ribs were completely open and his heart was, at that precise moment, still. It was paralyzed.

I also remembered how the doctor had reacted when he opened the patient up. It’s not comforting when you see a doctor go: “wow”, even if it’s mute and unimpressed. He looked up at me, for just a second, and flicked his head, inviting me.

“Check this out,” he passed his blade over the main artery connecting to his heart. The artery did not get cut. He passed it again: nothing. He turned to his assistant and asked for a tougher blade (usually less precise), “this is what happens when you smoke for thirty years. His veins are so calcified the blade won’t go through; we’re going to have to replace them all. This has just become a sextuple by-pass.”

I’m an engineer. I’m not a doctor. And still, the adrenaline rushing through my body at that precise moment sent shivers up and down my body. Or was it the cold air? It didn’t matter. I was in front of scientific greatness.

I remembered when he said: “It’s time to turn on the machine,” and I felt back to reality. How many seconds had I been out of reality? I turned to the doctor and his eyes—the only visible emotion , the rest hidden behind a mask, hair-cap and anti-glare eyeglasses—were honestly scared.

“Do something!” he screamed. We both turned to the machine and I scanned the screen, cursing at myself silently. If it had been more than two minutes, then the patient was as good as dead. Then I saw it, I saw the reason why the artificial lung hadn’t started, but did it matter at the moment? Absolutely not.

I flicked the switch from auto to manual, something the doctor should have done first, before even connecting the patient. The beeps continued, the hoses filled with blood, oxygen was sent where oxygen was needed, temperature was sent where temperature was needed and life was injected where life was needed.

Everything went back to normal. The patient survived and is now recovering from a sextuple by-pass. He is considering quitting smoking. And he doesn’t remember anything, only feeling cold for a moment. And the doctor never saw his mistake. Perhaps he was too scared, or he did noticed and didn’t say a word.