Tuesday, August 25, 2009

Betsy McCaughey is full of shit. Yes, this is a rant.

Because AFN aired the Daily Show episode with Betsy McCaughey last night (again) I have decided it's time to throw in my two cents.

McCaughey claims that, according to the bill, doctors are awarded quality points based on consultations with patients concerning living wills and whether or not patients adhere to those consultations. As she reads it, this means that a doctor's score could lower if a patient does not adhere to the wording in their living will - and this is bullshit, because it is almost impossible to quantify. I could make a living will right now and, god willing, not have to use it for another 40 or 50 years - by which time my original doctor will either be dead or no longer practicing medicine. If I decide to go against the will what can Medicare do, retroactively lower my doctor's quality rating?

Rather, the purpose of the bill is to have doctors strongly encourage their patients to make living wills because of the time, money and heartache saved in the future. Their quality points will be based on whether doctors have the conversations; if those conversations include all the required talking points; and if they follow the schedule, having a living will discussion with a patient every 5 years.

Because the bill lists what doctors must discuss, including resuscitation, sustenance, hydration, McCaughey feels - actually, I'm not exactly sure what her problem is here because she never quite details it. Somehow discussing life-sustaining procedures in detail - which is what those elements mentioned above are - gives doctors too much decision-making power in life or death situations. After all, when "most people" are healthy they are all for "pulling the plug", not wanting to exist in a vegetative state and all that, but when the time comes (if a situation occurs where their living will takes effect) they might feel differently and want to change their minds.

Of course, when the time comes the person in the coma is unable to change their mind, hence the reason for the living will. Also, who are these "most people"? Did McCaughey take a survey of people in comas to determine how they felt beforehand? Did she ask five of her colleagues? Could she possibly be making a baseless assumption?

As for the detailed language - ok, let me admit that I am a strong supporter of living wills, even more so of living trusts. After my mom's death took the family by surprise my father had a trust created. It included details, exhaustive details, about finances and medical possibilities such as in a coma but responsive, in a coma but unresponsive, and listed exactly what my father would want done in each situation. For example, if he ended up in an unresponsive state: I do not want artificial means keeping me alive. I want to be provided with food and water sufficient to keep my body performing and medicine, if necessary, to keep my free from pain, until my body naturally expires. So, no ventilators or anything like that, just let me die painlessly and with a bit of dignity. I'm sure it was worded better in the legal document, but you get the idea. Obviously "most people" don't want to imagine anything so horrible happening but the living will is there just in case it does. "Most people" probably also don't realize how many contingencies there can be. A living will, then, provides a sort of death insurance.

But for McCaughey, the living wills clause is disgusting because doctors are (according to her) penalized if patients or their families - and wait, there's the real issue: families. It's not a matter of the patient in the coma changing their mind - they can't; they're in a coma - it's the fact that families will not have any say. It's the son who can't believe his mother wouldn't want to be kept alive at all costs; the husband not wanting to let go of his comatose wife; or the parents selfishly keeping their daughter as a vegetable for 12 years because they refuse to believe she would want anything different. Of course, Terry Schiavo didn't have a living will, only the word of her husband, but even is she did it's possible her parents would have challenged a will court.

A living will allows you to choose either life or death. You can decide that you what to kept alive with all possible means and with any future medical breakthroughs; or you can decide to just peacefully expire, regardless of what others believe should happen. Pro-choice at its finest.

No wonder the fanatic right is foaming at the mouth. Nevermind that Palin and others endorsed living will consultations while they are in the local/ state spotlight - they were just looking out for their constituents. But to support anything seemingly pro-choice on a national level - a clause that allows an individual to make decisions about their bodies - now that's just disgusting.

Wednesday, August 19, 2009

Whether the Weather: Dry Heat vs. Humidity

With Ramadan right around the corner and the wind making a Mary Poppins-esque turn, the weather here has changed from a heat blown up from the depths of hell to a more tropical humid nightmare. While I could take the time to figure out how it can be 110F with 80% humidity in the desert without anyone of those elements canceling the other two out, I am instead reminded of something my father told me on my first trip to Vegas. It was the beginning of August and, as you might expect, it was insanely hot. This was also my first experience in a desert, or dry, environment of any sort and having grown up accustomed to suffocating humidity, the heat of Vegas was having its effect, leaving me constantly dehydrated (I hardly drank any alcohol because I was always so desperate for water) and, well, hot. When I mentioned this to my dad during a phone call home he told me that I couldn't be having a problem because, after all, the weather in Vegas was "only a dry heat." At the time I found it odd that my father, over in Maryland, could be telling me, the one in Nevada, that the I couldn't possibly be noticing the heat because it was "dry" - and I still find that notion incredibly absurd.

Yes, humidity can be miserable; a brief visit to the Southeast USA during summer will assure you of that fact. You step outside and almost instantly become damp not because of sweat, but because of the moisture in the air. If you buy cotton candy at a baseball game there's a good chance it will start to melt before you can eat it. Air conditioning fights in vain against the onslaught, always leaving you with a feeling of being slightly moist despite the 75F temperature inside. And of course, the heat doesn't dissipate at night but instead hangs there, suffocating, oppressive. I have a friend whose vegetables rotted on the vine one summer the humidity was so bad. There's no question it's hot because you can feel it, sticking to you.

The addage for dry heat, on the other hand, is that you don't feel it; apparently without moisture guiding your senses your body will be oblivious to the furnace you're standing in. This is absolute bullshit. The hint is in the title: DRY HEAT. Have you ever opened an oven door and, as the blast of hot air washes over your face, thought to yourself, "Man, I wish I knew if the oven was ready because I can't feel a thing"? Did you know that it's difficult to breathe in 125F weather because the air is, literally, burning your lungs? The same effect happens to your eyeballs when the windblows. When I first moved to LA, also during that first Vegas trip, I would get spontaneous nosebleeds because my sinuses were so dry. Or ask my husband the joys of working in the Kuwait desert where it easily reaches 134F and tools cannot be left outside because touching them, even while wearing gloves, will seriously burn your hand. Because it's fucking hot.

Yes, I know that the body's natural cooling system works better in dry heat because the sweat can actually evaporate, but when the heat gets over, say, 105F then your cooling mechanisms go into overdrive. This leads to faster dehydration and delirium caused by said dehydration. During the summer in the SF Valley the temperature would reach 104F in the shade, which offered no respite from the heat but merely safeguarded you from getting a sunburn. Oh, and the fact that dry weather leaves you feeling like a raisin and looking like a piece of chalk you're so ashy. There have been days I've drunk over a gallon of water and still felt thirsty and sluggish.

I performed a quick online search of "dry heat vs humidity" and found several forums related to people moving from one type of weather to the other and it seems the majority are overwhelmingly in favor of dry heat. After all, you can sit outside without becoming drenched in sweat after only 5 minutes! Though considering the pro-dry heaters tend to refer to coastal SoCal in their defense I think what they are actually enjoying is a Mediterranean climate. And I admit, when it's 90F and dry the heat is actually manageable and even be pleasant. It certainly feels hot, but it's not too bad. However, I can assure you that these same dry heat proponents have never experienced heat above 115F or even 110F. These increments may seem small but trust me, you feel every degree as it increases. 120F feels different than 115 and waaaay worse than 100, so much so that I cheered the arrival of humid weather.

Seth and I went for a walk yesterday around 6:30pm, about the same time I would normally go out because it's actually cooler then than at 5am. Though we were quickly covered in a combination of sweat and air moisture we both felt content because we could breathe easily, our blood didn't feel as though it was boiling and the air didn't smell like burning. It was nice. It was a relief. So the next time you hear the phrase "but it's a dry heat" please smile and do everyone a favor: punch them in the face.