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Feature Articles - The Cost of Cheating Death

The Cost of Cheating Death

Canada’s health care system continues to be under review. Accountability is one of the main issues of discussion as all the provinces put forward their cases to the federal government for more funding. Health care is a huge tax burden on the citizens of Canada. But what does health care really stand for? Care how? Where in the Hippocratic Oath of 400 B.C.E. is there reference to the need to interfere with a person’s life destiny? And the ensuing cost both financially and otherwise? And what is the real cost of health care?

The following is a story, a fantasy, based on actual incidences. It is woven with factual material. All prices given are approximate, and are according to a publicly financed health care system. They may not reflect real prices. Physicians and surgeons bill separately from hospital costs which are developed by the regional health units in their budgets. To determine a completely itemized breakdown of costs is just about impossible, particularly for a lay person. Which means that there doesn’t seem to be a tracking system. At present the cost of a hospital bed in the Vancouver Coastal Health Authority is under review because the existing cost of $1,065 per day charged by the hospitals does not factor in all the services in CCU and ICU. Prices are artificial and do not measure the true cost.

“Albert?” called Nurse-Angel Florence as her musical voice drifted like the song of a nightingale over the heads of the new arrivals at Transition Station D. Albert sat quietly to one side, letting his thoughts drift amongst the colours and flowers that surrounded him and the multiple mathematical figures on a chalk board in front of him, then 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 shortly. He’s just completed his experience and is due Home. He’s expected to ‘drop dead’ at four o’clock this afternoon. Trouble is, he’s from the 21st Century North American continent where ‘drop dead’ has been changed to ‘cardiac arrest needing resuscitation.’ They’ve become 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. The last few were rather easy,” added Albert. “They were from 1,000 B.C.E. when people accepted these things. This ignorance of the 21st century sure makes the job harder to handle. If only humans understood that it takes twice as long for transition when they resist.”

“It would be a good idea for you to 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. You’re so good with figures. Better take a large roll of tape with you for this one.

He’s lived a pretty closed life. He’s made his fortune, got his retirement home on the golf course, and has no material worries at all. Trouble is, he’s been so focussed on earning his living that he forgot to live. And he forgot to take care of himself. So it may be hard finding a channel to communicate with him. His mind is pretty clouded with third-dimensional material thoughts and he hasn’t a clue about any other world and existence but his own.”

“I’ll keep you posted,” said Albert as he picked up a nearby adding machine and a rather large roll of tape.

He was getting used to this kind of work. He had chosen to take on the job of Transition Angel for a while in an attempt to understand humans more, as to why they just don’t seem to grasp relativity. Very few had understood him during his own sojourn on planet Earth and it puzzled him. He shook his head frequently in dismay and could often be overheard muttering, “Will they ever get it?”

In a flash Albert found himself in the living room of a very elaborate condominium, the golf green visible through the picture window. Rob Hasalot sat beside his wife Iona watching a golf game on television.

It was five minutes to four. Albert tried to make himself visible by turning up his light but Rob and Iona were too focused on the golf game. He whispered in Rob’s ear, “Hello Rob, it’s time for you to come Home. I’m here to take you Home.”

There was no response. Rob and Iona were completely absorbed by the action on the TV. The leading contender was just about to make his final putt to the eighteenth hole when Rob felt a searing pain shoot down his left arm. Within seconds the pain engulfed his heart and he gasped, not in celebration at the successful putt on the TV but in agony from the daggers that were stabbing his chest.

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

Iona, still focussed on the TV golf green, thought at first that Rob was cheering on the golfer. But, with a glance sideways she realized that her husband of fifty-five years was in distress. He slid off the sofa and onto the floor. He was unconscious. He had stopped breathing. For a moment she sat stunned, in silence and panic, then ran for the phone and dialed 9-1-1. Fortunately the ambulance station was just a couple of blocks away.

Years before Iona had taken a course on CPR and now it was coming in handy as she rolled Rob onto his back, tilted his head, pinched his nose and began breathing into his mouth.

Albert stood casually by and tried linking through again to Rob’s mind but try as he might there was no avenue of communication. Rob’s mind was so 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. Meanwhile Iona kept breathing away down his mouth.

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

Silence.

Within minutes an ambulance pulled up at the front door. Two paramedics rushed in with their equipment, their monitors and their direct link to the hospital emergency department. Iona stood to one side, shaking, in disbelief.

“He can’t die,” she pleaded. “What would I do without him? What will the children do? The grandchildren need their grandfather.”

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

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 of relativity? 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…”

While still working on stabilizing the still unconscious Rob the paramedics picked him up gently and put him onto the stretcher, tucked him in and carried him out to the ambulance. While they were doing this Iona phoned her oldest son, “Bill, your dad’s just had a heart attack. Meet me at the hospital.” She grabbed her coat and handbag and got into the back of the ambulance and sat to one side while the paramedic kept an eye on Rob. Albert, along with his adding machine and yards of paper tape, appeared beside her and continued working with numbers.

Moments later the ambulance doors were opened and Rob was whisked away by the paramedics and attendants to the emergency department. Iona ran behind and at admissions answered all their questions and handed over his health card. She was asked to sit in the waiting room while the emergency team continued to work at stabilizing her husband.

“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. “Best go and tell his wife that he will be away from the floor for a while and that we’re transferring him to C.C.U. (Cardiac Care Unit)... We’ll need an angiogram, and possibly angioplasty, complete blood count, kidney function, liver function, sodium/potassium, blood gas, chest x-ray,” yelled the specialist as she headed out the door to meet with the family.

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

Her three sons and their families, all in shock, now surrounded Iona when the physician approached them.

“He can’t die,” cried their eldest son. “He has to see his grandchildren grow up.”

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

“We will do our best,” replied the physician, “but there are no guarantees. He has had a very severe heart attack and we are having a very difficult time stabilizing him. We are taking him into the Intensive Care Unit, and from there we’ll be making several tests. We will let you know when you can see him.”

The surgeon returned to the unit and left Iona and her children to wait, and wait.

Meanwhile Rob had finally been stabilized and was whisked away from one lab to another, the most painful test being the angiogram where a nerve was his in his groin. Diagnosis - occlusive coronary artery disease, multi-vessel involvement, requiring quadruple coronary artery by-pass graft surgery (CABG).

Albert stood quietly by while all this was going on and shook his head in dismay. “Can’t they see it’s his time to come Home?” he asked himself. 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 going ahead with the surgery. “And he will have to stay in Intensive Care for maybe a month as least.”

“Just do it,” replied the eldest son. “We can’t let him die. We have to give him a chance.”
Albert shook his head again. “Will they ever understand that to die is not failure? 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? Why aren’t they thinking about what he will have to go through, the pain, the humiliation, where all modesty, all dignity, goes out the door?”

Albert shook his head again, and again. He went back to take another look at Rob who was still unconscious. Machines were hooked in all around him, and he was being prepped for surgery.

“Rob?” he tried again. “Rob? It’s Albert. I’m here to take you Home. Can you hear me?”
Still there was silence. Rob’s eyes had opened and he was vaguely aware of the room around him but by now he had been pumped with all kinds of drugs which impeded any form of clear communication.

“I guess 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 calculator tape.

“Florence,” he said sadly. “We’ve got a long one here. He’s going for quadruple by-pass. He’s just barely conscious and I still can’t reach him. The family decided to go for the surgery even with only a 30% chance of survival. It’s not going to be easy.”

“You’re going to need some help Albert,” she replied. “Better take along a nurse. There’s Theresa. She’ll know what to do. And, you’ll need another roll of calculator tape.”

Within a blink of light Albert and Theresa were standing side by side in the operating room as Rob was wheeled in. A special team had been pulled together for a marathon session which was no doubt going to last up to about five hours.

Albert began, “General cost for an uncomplicated routine by-pass surgery, cost to the hospital, about $18,000; 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…”

Albert kept count as the surgeons began the procedure of opening up Rob’s chest and Theresa stood quietly glowing nearby. The first surgeon made an incision down the centre of the chest. The heart was exposed by opening the pericardium. Simultaneously several incisions were made in the leg and a length of vein was removed. The heart was stopped and Rob’s 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 the coronary arteries.

At this point Rob was actually beginning to see a tunnel of light and a faint image of Albert and Theresa. He was starting to leave the body and felt a wonderful warmth but 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 suture, 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…” kept on Albert as he followed them down the hall.

The surgeons had been successful, but in the meantime Rob was losing body functions. His kidneys were failing.

Albert and Theresa both shook their heads this time. They knew that Rob was resisting, and of course, the surgeons and hospital staff were doing their best to follow the family’s instructions of keeping him alive. But his body was shutting down.

“I think we’d better go back and get some more recruits,” said Albert sadly to Theresa and with another flash of light they were both 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. And I’d better come myself. We’ll pull all the stops for this one. Theresa, could you watch over things here at the Transition Station?”

With yet another roll of calculator tape Albert, Florence and the new support team arrived in the Intensive Care Unit. There they saw Rob 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 there, oblivious.

Nurses were on 24-hour watch.

“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, $341.49…”

Family visited frequently, cried and cried, and pleaded for Rob to get better. They kept telling him, “Come on Dad. You can pull out of this. There’re so many more things that we can do together. There’re 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 were 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 against the cold 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 comes 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. You’ve done what you set out to do in this life experience.”

“But I can’t leave here,” he cried. “Who will look after my family?”

“We will,” replied Florence. “You have raised them well, and they are ready to take care of themselves, and the folks from the other side will always be with them to make sure they are all right - like guardian angels.”

“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, living 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.”

At this point Bing stepped forward and sang, “Love is just around the corner…”**

Meanwhile, a gentle clicking could be heard coming from under an enormous mountain of calculator tape. Albert was still working with his figures calculating every cost at every minute, “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 his mother and father, and they held out their glowing hands towards him. “Come on Home, son,” said his mother. “All you have to do is want to be there, and you will.”

It was easy, almost effortless, as Rob found himself moving away from his body. “But what of Iona and the boys?” he queried.

“They will grieve for a while, just as you will grieve for a while at missing them. But it won’t be for long. It will seem like minutes before you are all reunited again.”

At that very moment the monitors in the room began making beeping noises and the nurses in the station went on high alert. The cardiac unit was called and within seconds the team arrived with their equipment.

“Extra grease; more rubber gloves; suction cups need cleaning…” continued Albert from within his mountain of paper.

“We’re losing him,” cried the nurse. “Try again.”

They tried again, and again, but still the signal was getting weaker and weaker.

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

Flatline.

“He’s gone,” said the cardiac specialist. “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, and with him on either side to give comfort were Florence and Bing. There was music, lots of music, and a most beautiful golf green ahead.

Albert still had a few more calculations to do. “Clean up; prepare the 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. You’d think it was a sin to die. There’s a cost to cheating death. Maybe that’s why these folks can’t understand relativity. They’re afraid of what they can’t see, and what they don’t know, of what’s relative.”

Angel Albert turned off his calculator, 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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