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Feature Articles - The Cost of Cheating Death

The Cost of Cheating Death

So how much does it cost to have a heart attack? How much does it cost to have by-pass surgery? What is the cost to our own life? Read on.

The following is a fantasy based on actual events, woven with facts. All prices are approximate, as best a lay person can comprehend, and are according to a publicly financed and subsidised health care system. They may not reflect real costs that are most probably much higher.

This is the version published in the Vancouver Sun, Monday, March 10, 2003, page A13. For the full version, which includes thoughts on Relativity, click here. And because the article did touch people, we are including the public response.

“Albert?” called Nurse-Angel Florence. Her musical voice drifted like the song of a nightingale over the heads of new arrivals at Transition Station D. Albert sat quietly to one side, his thoughts drifting amongst surrounding colours and flowers and the multiple mathematical figures on a chalkboard in front of him. He recognized Florence’s beautiful voice and slowly nodded his shocking white head of hair towards her.

“I see you are ready for your next assignment,” she said gently.

“Yes,” replied Albert with a broad smile. “Where am I going this time?”

“Earth,” she answered. “We have a new arrival expected to ‘drop dead’ at four o’clock this afternoon. Trouble is, he’s from North America where ‘drop dead’ has become ‘cardiac arrest needing resuscitation.’ As you know, they’re afraid of death and dying. And then there’s free will that gets in the way. So this could be a bit of a tricky one for you.”

“That’s fine. I need a challenge,” added Albert. “If only humans understood it takes so much longer for transition when they resist.”

“You’d better take your adding machine along with you, Albert,” continued Florence. “Keep a running tab on events won’t you? We need it for our records. Better take a large roll of tape. He’s lived a pretty closed life, made his fortune, got his retirement home on the golf course, and has no material worries at all. His mind is pretty clouded with material thoughts and he hasn’t a clue about any other world and existence but his own, so it may be hard to communicate with him.”

“I’ll keep you posted,” replied Albert and in a flash he found himself in the living room of a very elaborate condominium, a golf green visible through the picture window.

Rob Hasalot sat beside his wife Iona watching a golf game on TV. It was five minutes to four. Albert turned up his light to make himself more visible but Rob and Iona were too focussed on the golf game to notice. He whispered in Rob’s ear, “Hello Rob, it’s time for you to come Home.”

No response. Rob and Iona were completely absorbed by the TV. The leading contender was making his final putt to the 18th hole when Rob felt a searing pain shoot down his left arm. Within seconds it engulfed his heart.

“Oh, oh,” he exclaimed as he slumped forward in his seat.

Iona thought Rob was cheering on the golfer, then realised her husband of fifty-five years was unconscious. She ran for the phone, dialed 9-1-1 then began CPR. Albert stood casually by and tried linking again to Rob’s mind. It was full of golf, things, and more things, bank accounts and business.

“Rob!” yelled Albert. “Can you hear me?”

Silence.

“Rob,” he tried again, this time a little more softly. “I’m here to take you Home. Your family and friends are waiting for you on the other side of life, in the other world. Can you see the light?”

Silence.

Iona kept breathing down Rob’s mouth.

“Rob,” Albert pleaded. “Can you see the light? I’m here to take you Home!”

Silence.

Within minutes an ambulance pulled up at the front door. Two paramedics rushed in with equipment and a direct link to the hospital emergency department.

“He can’t die,” Iona pleaded. “What would I do without him?”

One paramedic was already in communication with the local hospital describing the circumstances; “We have a 78-year-old male, weighing about 240 lbs., with M.I. (mycardial infarction).”

The other began checking for vital signs, and noting there weren’t any, began shock treatment.

“Oh dear,” thought Albert as he pulled out the adding machine and inserted the roll of tape. “Here goes. One more chalked up for free will, or is it ignorance and fear? One ambulance call - $54 ($396 non-resident); two paramedics; bedding, got to be washed; mask to be sterilized; rubber gloves, two pairs; one syringe; one shot of Lidocaine; oxygen; another syringe; one shot of nitro-glycerine…”

The paramedics picked up the still unconscious Rob, put him on the stretcher and carried him out to the ambulance.

Iona phoned her oldest son, “Bill, your dad’s just had a heart attack. Meet me at the hospital.” She got into the back of the ambulance and sat to one side while Albert, along with his adding machine and yards of paper tape, appeared beside her.

Moments later the ambulance doors were opened and Rob was rushed to the emergency department. Iona ran behind and at Admissions answered all questions and handed over Rob’s health card.

“One emergency bed, $1,065 a day ($1,970 non-resident); attending physician, $352.08; nurses; rubber gloves,” continued Albert, his fingers almost invisible with their incredible speed. “E.C.G., $65; syringe; three vials of tPA (tissue plasminogen activator), $4,200; sheets to be washed; I.V.; charts; …. Oh, my goodness,” continued Albert, “this is going to be a costly one.”

“He’ll have to have a few tests,” announced the physician. “We’ll need an angiogram, and possible angioplasty, complete blood count, kidney function, liver function, sodium/potassium, blood gas, chest x-ray.” She headed out the door to meet with the family.

“Angiogram, $327.50; anaesthetist, $132.76,” muttered Albert. “Blood tests, $127.53; chest x-ray, $65; MRI angiography, $1,200, for possible ventricular wall aneurysm…”

Iona’s two sons and their families, all in shock, surrounded her when the physician approached.

“Do whatever you have to,” cried the eldest son, “whatever it takes to keep him alive.”

“We’ll do our best,” replied the physician, “but there are no guarantees. He has had a very severe heart attack and we’re having a difficult time stabilizing him.”
Iona and family were left to wait.

Diagnosis - occlusive coronary artery disease, multi-vessel involvement, requiring quadruple coronary artery by-pass graft surgery (CABG).

Albert stood quietly by and shook his head in dismay. “Can’t they see it’s his time to come Home?” By now the adding machine tape was in loops up to his knees. “I.C.U. bed at $1,065 per day, ($1,970 non-resident) for two days while awaiting surgery, that’s $2,130 ($3,940 non-resident)…”

“There’s a 30% chance that your husband will survive,” commented the physician when she interviewed the family regarding the surgery. “And he will have to stay in Intensive Care for possibly two months.”

“Just do it,” replied the second son. “We can’t let him die. We have to give him a chance.”

Albert shook his head again. “Will they ever understand that dying is natural? Why aren’t they thinking of consequences? Why aren’t they thinking about Rob’s future and what he will have to endure - the pain, the humiliation, loss of dignity…?”

He tried again, “Rob? It’s Albert. I’m here to take you Home. Can you hear me?”

Still silence. Rob’s eyes opened. He was vaguely aware of the room around him but was pumped with drugs that impeded any form of clear communication.

“I’ll have to try again later. Better get back to Florence and give her an update.” With that Albert vanished and reappeared at the Transition Station holding trails of tape.

“Florence,” he said sadly, “we’ve got a long one here. He’s going for quadruple by-pass.”

“You’ll need another roll of tape,” she replied. Within a blink of light Albert was standing in the operating room. A special team had been pulled together for a marathon session.

Albert began: “General cost to the hospital for an uncomplicated routine by-pass surgery, about $18,000 to $28,000; Bridine; more rubber gloves; laundered uniforms; sterilized tools; surgeon, $ 1,331.92 plus three additional arteries at $253.10 each, and a pacemaker at $507.46 - that’s a total of $2,526.68; two assistants, $764.63; one anaesthetist, level nine for five hours, $823.20; scrub nurse; circulating nurse; by-pass technician; electricity; lights; I.V.; blood; cotton battons; heart-lung machine…”

The first surgeon made an incision down the centre of Rob’s chest and exposed his heart. Simultaneously several incisions were made in his leg and a length of vein was removed. His heart was stopped and his circulation was maintained with a heart-lung machine. The surgeons diligently sewed sections of the vein to each aorta and to a point below the blockage. The heart-lung machine was then disconnected allowing blood to flow back into Rob’s coronary arteries.

At this point Rob was beginning to see a tunnel of light and a faint image of Albert. He was leaving his body and felt wonderful warmth.

The surgeon and anaesthetist yelled, “We’re loosing him,” and quickly began massaging the heart to get Rob’s functions back.

“That’s another $382.41, plus $44.36 for the anaesthetist, level 11 for 15 minutes,” continued Albert.

Rob felt himself sucked back into his body, then fell back into oblivion.

The breastbone was wired together, and the pericardium and chest were sewn up.

The last staple, and Rob was cleaned up to go to recovery where two nurses stood waiting for him.

“Wash the sheets and uniforms; clean the floors; garbage pick-up…” kept on Albert as he followed them down the hall.

Albert knew Rob was resisting, and the surgeons and hospital staff were doing their best to follow the family’s wishes of keeping him alive. But Rob’s body was shutting down. His kidneys were failing.

“I’d better go back and get some help,” said Albert sadly and with another flash of light he was back at the Transition Station.

“Oh dear,” sighed Florence. “This calls for extreme measures. We’ll have to get some of his family to go back down to Earth and stand round him. Maybe he’ll hear one of them calling his name, or maybe he’ll see them in his mind. I know, we’ll call on Bing Crosby. He was well known for golfing. Maybe he could croon in Rob’s ear a little. In fact, I’d better come myself.”

With yet another roll of adding machine tape Albert, Florence and the new support team arrived in ICU. Rob lay tied to all kinds of machines with dressings over his chest, needles in his arms and a towel to cover his genitals. He was intubated to a ventilator, NG suction, three IV lines, one central line into the jugular vein, two chest monitors, catheter and bladder bag, an arterial line to monitor oxygen content of the blood, and a whopping tube in the groin catheterizing his femoral artery for kidney dialysis. The room was filled with sucking, beeping and busy-ness as Rob lay oblivious.|

“That will be $1,065 a day for the bed,” continued Albert. “Let’s see - nursing staff on 24-hour observation; cleaning staff; machines; IV; tests; Comprehensive Care Team $307,19 for the first day; initial dialysis, $341.4; medications…”

Family visited frequently, cried and cried, and pleaded for Rob to get better, “Come on Dad. You can pull out of this. There are so many more things that we can do together. There are so many more golf games to be played. We need you Dad.”

It had been a month and still there was no change. Then one night, when the team from the Transition Station was standing around together, glowing with all their light, Florence sensed a slight opening in communication with Rob.

“Go on Bing,” she whispered. “Go and sing him a song.”

Bing walked over beside Rob’s bed, leaned casually against the wall and began, “Red sails in the sunset, way out on the sea. Oh carry my loved one, Home safely to me.”*

There was a flash of recollection, a coming to. Rob was finally becoming aware. He was still unable to open his eyes but he could see from inside himself.

“Where am I?” he asked in his thoughts.

“You’re in hospital, in ICU,” replied Florence. “You’ve had heart surgery and you’ve been in recovery for over a month now.”

“Where is everybody?” asked Rob. “I can’t see anyone.”

“You’re not alone,” continued Florence. “There’s myself, and Albert (he’s under that pile of calculator paper there), and Bing, and….”

“Bing? You mean Bing Crosby? My favourite singer and golfer?”

“Yes,” replied Florence. “And with Bing come your mother and father, and many others in your family who want to see you well and happy, and make that journey Home, like you are meant to.”

“Home?”

“Yes, Home. It’s your time to come Home.”

“I’m beginning to feel my body,” Rob interjected sharply. “It really hurts. My chest. It hurts. My whole body hurts. What are all these machines?”

“At this time they are keeping you alive,” replied Florence.

“Is that how I am living then?” replied Rob.

“Yes,” added Florence. “That is, here on Earth.”

“How long will I be like this?” he asked.

“At least another month, and then some. You see your kidneys have failed and you require continuous dialysis, and your respiration is not running on it’s own properly yet. And….”

“Please. I feel like I’m a machine.”

“Well, you could come Home with us,” replied his mother and father as they moved forward into view. “We’ve been waiting patiently for you to see us.”

Meanwhile, a gentle clicking and mumbling could still be heard coming from under an enormous mountain of paper tape, “So that’s 30 days in ICU, $31,950 ($59,100 non-resident); kidney dialysis, $1,680; Comprehensive Care Team for 30 days, $4,575.07; consultant visits, $692; tests, $3,825.90…”

Florence stepped forward, as did Rob’s mother and father. They held out their glowing hands towards him. “Come on Home son,” said his mother gently. “All you have to do is want to be there, and you will.”

It was easy, almost effortless, as Rob moved away from his body. The monitors in the room beeped loudly and alarms rang. Within seconds the cardiac unit arrived.
“Extra grease; more rubber gloves; suction cups need cleaning…” continued Albert.
“We’re losing him,” cried a nurse. “Try again.”

“Come on Robert,” whispered his mother with great love. “A little further now and you’ll be free. See the light? Feel the love and the warmth? You’re coming Home now son.”

Flatline.

“He’s gone,” said the cardiac team. “We’ll have to inform the family and prepare the body for their visit.”

Rob and his parents had already started on the road Home. There was music, lots of music. There was warmth, lots of warmth, and love. There was light - and a most beautiful golf green ahead.

Albert still had a few more calculations. “Clean up; prepare room for the next patient. Approximate grand total, $74,929.52, give or take a few thousand dollars. For non-residents multiply that by 185 percent, that’s $138,619.61! Oh my. Just think of how much cheaper it would have been if he’d accepted going Home the first time. There’s a cost to cheating death.”

Angel Albert turned off his adding machine, gathered up the miles of tape and disappeared.

For information on costs billed to and paid by the Medical Services Plan in B.C. please visit the Ministry of Health Pay Schedule.

* Red Sails In the Sunset, words by Jimmy Kennedy, music by Hugh Williams, 1935 charted #1 by Bing Crosby.
** Love Is Just Around the Corner, words by Robin Gensler, recorded by Bing Crosby

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