Going Long.......

I seemingly always have library fines.  Somehow I haven’t figured out that I can renew things online or just make a notation about due dates.  The last one would have cost me about $76.00 for an overdue book my daughter had out all summer.  I surreptitiously blamed her sloppy teenage ways and the sympathetic librarian bought the story. The fine was reduced to $16.00.  Whew.  Dodged a budgetary bullet there.

I have since checked my local library account online.  It has many updated features, which I was unaware.  The research databases are amazing now and so are the personal account services.  What surprised me the most was the expiration date on my library card.  It was 3/31/2107 nearly 96 years away.  I will be 145 in the year 2107.  Will I make it?  Has medical science progressed that much?  Do I want that kind of longevity?

With my father’s debilitating illness, I have cautiously warned my children that if I were to be that impaired, “Please just take me out at 50 feet.” Perhaps my humor is a bit dark for most audiences.  The older ones rolled their eyes as usual, as my younger daughter told me “sure I’ll take you out to dinner Mom.”  What a sweetheart.

But his illness raised certain questions on the course of the rest of my life  (In which I'll bore you with in other blogs) and certainly choosing options for my death.

Do we all want to live that long?  What would be the cost to society of that length of living? What would be the cost to my loved ones?  Now I understand what actuaries actually do for a living or for the living.

As a physician, you often see people kept alive after catastrophic events such as strokes, car accidents, cardiac conditions, etc.  The cost of an average ICU stay mounts to thousands to tens of thousands per day.   Whether the Republicans like it or not, we all bear this expense in the cost of Medicare, Medicaid, Federal Taxes, or private insurance.  It’s political slight of hand on whose pocket it actually comes from. The talk of “death panels” gave a grim spin of this rationing of care.  But is it rationing or just rational?

Giving the Republicans a break for a change (just this once), I do give them some credit for the notion of self-determination.  We all should have the right to decide our fate to some extent, certainly in such personal decisions as death.  This brings up the topic of Advanced Directives.  I just signed mine and you should too. As a pitch for the opposing team, President Obama was the first United States President to sign an Advanced Directive in 2009.

Advanced Health Care Directives are also known as Living Wills, Personal Directives, Advance Directives or Advanced Decisions.  They are instructions to the medical personnel or the family on what actions should be taken when a person is no longer able to make decisions for themselves.  Another form is a Health Care Power of Attorney or Health Care Proxy, which is a specific person, designated by the patient to make decisions on behalf of that patient when they no longer can.  They are simple forms, easy to complete but vary from State to State.  I will leave the legal stuff to the lawyers to argue incessantly about.

I was my father’s health care proxy given my medical background.  I knew he didn’t want extraordinary means to keep him alive.  Medically, given his condition, I knew that aggressive therapy was not rational.  And I was by no means rationing. Just as an aside: Hospice care was wonderful, exemplary and should be an option for any family faced with impending death.

Every adult should think about these important decisions. Whether you are middle aged, young adult or more importantly elderly.  It takes much of the guilt out of the equation of death, especially among the living.

I probably won’t face a firing squad when my time comes. I already face my daughters on a daily basis in the carpool line when then are usually ready to shoot me for my cursing, singing with my iPhone or weasel driving habits, but at least now they know what do with me whether my death is soon or in 2107. In the meantime I hope to be checking my online library account for those damn fines. Given my habits though, I could rack up quite a boodle over the next 96 years.