Double Casualties of America’s Broken Medical System
INTRODUCTION to Medical Madness Category
Caution: Some content in this post may be disturbing to certain individuals.
DOUBLE CASUALTIES of America’s Broken Medical System
“They have killed me. They have f——- killed me.”
Andy McMillan, an hour before he died from a medication overdose.
Months after my husband’s death, I found a letter he had written in his journal for me to find. It began: “If you are reading this, then the worst has happened.”
On March 6, 2014, my beloved spouse Andy had exhaled his last two breaths into my mouth, as I frantically tried to administer CPR to him, to no avail.
The hospital staff had refused to respond to our daughter’s urgent pleas for help when Andy suddenly stopped breathing. Someone had placed a “Do Not Resuscitate” order in his chart without our knowledge.
The attending hospitalist that night had stubbornly refused him care–not even effective pain management—and then illegally, medically abandoned him to an inexperienced nurse.
After many hours of Andy having suffered pain that he rated as “14” on a scale of “1-10,” I had finally persuaded a friend, the head of the hospital, to get Palliative Care involved. They prescribed three medications—two of them novel to Andy and one of them new on the market–to be initially administered ten minutes apart.
As five of Andy’s friends and family were gathered around his patient bed, chatting with him during what unexpectedly became their final visit, the nurse quietly added each of the medications to his IV in turn and properly spaced. But she forgot to check his vitals between each dose. (Andy was chemically sensitive, at risk of having a serious reaction to certain medications, including suppressed breathing or a heart attack.)
I was standing near to him, where I had spent the previous nine years, one month and three days since we had received his diagnosis with a presumably fatal illness of aggressive cancer that we had creatively, determinedly transformed into a chronic, manageable condition with our self-designed integrative approach to surviving and thriving with a serious illness.
When I heard Andy’s first loud gasp, I knew immediately what was happening.
Before I could get to him, he gasped a second time.
I shoved the others aside and jumped on his narrow patient bed, placing my body over his. I struggled to lift his heavy head to face it towards mine so I could place my mouth in a position to breathe life-saving air into him.
He released two long exhalations into me, like last kisses.
And then his spirit left his body.
∞
What followed immediately was my long fall into an abyss of despair.
Crazed with grief, I pulled off most of my clothes and pressed my body to Andy’s, desperately wanting to be as close to him as possible one last time.
Anyone in earshot was subjected to the heart-piercing sounds of my uncontrollable screaming, weeping, and sobbing, interspersed with brief periods of pitiful, child-like wailing and whimpering.
During all that time, two of Andy’s childhood friends were stationed in chairs at the door like sentinels, to prevent any staff from entering the room. It was five hours before my daughter could convince me to leave the hospital room and let us all go home that night.
I finally agreed to go, but with one condition: Andy’s body was coming home with us. I refused to sign any papers authorizing the state-required autopsy for a patient who dies in less than 24 hours after admission into a hospital.
“They are not going to do one more indignity to my husband’s body!” I insisted.
The attending hospitalists and implicated hospital administrators no doubt were relieved over that refusal, which meant I had zero chance of winning a wrongful death lawsuit against them. Without any autopsy results to prove that Andy had died from a drug error, a court would have ruled based on what appeared on his death certificate: multiple myeloma.
After our daughter made arrangements with an alternative funeral company to transport Andy’s body home, I got dressed and put on his Baltimore Colts cap, pulling it down to hide my eyes before taking the long walk down the hallway and past the nurse’s station in front of the elevator to make my escape. I did not want any staff members to see the pain and rage in my swollen, bloodshot eyes.
As we made our way to the elevator, there was no traditional “walk of honor” ritual of all the on-duty nurses and doctors lining either side of the hallway to show respect for the loved ones of a patient in their care who has just died.
Such a tribute would not have been appreciated by me anyway.
In my mind, all the competent, compassionate, respectful medical providers who had kindly helped us for a decade had become indistinguishable from the medical managers, gatekeepers, bad actors, bean-counters and blackguardly doctors who had made Andy suffer unnecessarily and ended his life prematurely. All were guilty by association with the medical industry, even if they did not deserve it; even if they were embarrassed by it or despised it themselves.
I wanted never to see them or any other medical provider or facility ever again.
My life as I had known it was over. I wanted to die.
Ten years later: Another Double Tragedy Associated with the Medical Industry
In the early morning of December 4, 2024, Brian Thompson, CEO of UnitedHealthCare insurance corporation was methodically gunned down on a New York street by an angry, driven young man, Luigi Mangione, who was allegedly on a mission to bring attention to the deadly malignancy in the healthcare insurance industry: i.e., denials of insurance coverage of necessary medical care.
Since that event, many posts on social media for Thompson and his bereaved family, friends and colleagues have been appropriately sympathetic.
But the news of the brutal assault also has uncorked a shocking outpouring of pent-up rage and horror stories by patients and their loved ones, directed against health care insurance companies and the medical industry in general.
Many posts have hailed the shooter as a folk hero, even a modern-day “saint,” who may have committed the horrendous act of violence to shine a bright light on an immoral insurance system that victimizes hundreds of people daily by denying them coverage for necessary medical care.
The CEO and others like him have been painted as the villains in this story—guilty by their enmeshment with the larger industry within which they work and the shareholders to which they are accountable. Brian Thompson, authorities surmise, was targeted because he was employed by the company with the worst record of denying coverage to patients.
As is often the case, neither “take” on this situation is that simple or accurate.
In my view, both men are victims of America’s broken medical system. One man’s life has been ended. Another man’s young life has been forever ruined. Both outcomes are tragic. Both “deaths” were premature and unnecessary. Both losses have left behind grieving families and friends.
Violence is Never the Right Choice to Solving a Problem
Violence against individuals can lead to more violence–even a war. Very rarely does it ever result in any long-term solution to a problem. More often, it only creates new ones.
For example, World War I was precipitated by the assassination of Archduke Franz Ferdinand of Austria by a young Serbian man. It led to the deaths of an estimated 15-22 million people (thirteen million of them civilians) and created conditions conducive to the worldwide spread of the 1918 flu pandemic, which was responsible for a third of all the military deaths.
Lasting, humane, socially responsible change typically comes instead not through acts of violence but through awareness, introspection, organizational change, education, governmental action, advocacy, meaningful transparency, and accountability[1] to change attitudes and achieve system-wide reform.
The Practice of Defensive Medicine
Our modern medical system (including alternative medicine practices) has become so profit-driven, fragmented, over-specialized, dehumanized, and bureaucratized it is no longer able to faithfully fulfill the first principle of the Hippocratic oath: “Do no harm.”
Ironically if you Google “defensive medicine” most likely you will find links to many articles pertaining to the concerns of medical providers, their insurers and stockholders about the need to protect their business enterprises from lawsuits by patients (or their families), how to safeguard their licenses to practice medicine from possible penalties imposed by medical oversight agencies and defend their businesses from cyberattacks.
To some providers, any patient or oversight entity should be viewed as a potential risk that could interfere with their main raison d’etre: making money.
To protect their interests, such risk-averse providers may order unnecessary and unwarranted procedures, tests and visit assessments for patients; punt them to specialists, even when it’s not indicated, to obtain second opinions that are likely to conform to what the provider has already recommended; and order unnecessary follow-up visits and more testing.
During intake of new patients or at the onset of certain treatments (like controlled substances or procedures like surgeries) providers require patients to sign consent forms verifying they were properly informed of the risks of such treatments and documenting that were they advised in advance about practice policies. (Some of those documents patients never actually see, let alone have the time to read and comprehend the fine print before signing them.)
Providers and their staff spend an inordinate amount of their shift doing lengthy, notoriously incorrect “electronic health record” documentation of every patient “encounter,” to avoid any plausible impression by an outside reviewer (in the event of adverse outcomes or accusations by patients or loved ones) that the provider did not do his or her exhaustive due diligence in the performance of their job.
In the process, countless patients are “exhausted” of their time, emotional energy, money, dignity, and trust in their provider.
Some staff also are traumatized by their experiences in providing care to patients while working within the humanity-stifling constraints of an already under-staffed, litigation risk-averse, HIPPAA-paranoid, CYA-motivated, over-burdened, emotionally draining health care system. Such conditions were exacerbated by the unusual challenges and technical advances that emerged during the COVID-19 worldwide pandemic (e.g., telemedicine), that necessitated urgent changes in care delivery methods, and new training demands.
Often, providers are frustrated themselves with insurance denials that make proper care for their patients infeasible, and with the mind-bending, often repetitive paperwork required of them to justify the claim, and with reimbursements that are slow to come and often insufficient.
Of late, there has been an exodus of doctors and staff in response to these changes in their working conditions. Especially relevant to this discussion is the increase in violence (threatened or actual) against providers by patients or family members. The recent killing of the CEO no doubt has exacerbated their already elevated and legitimate concerns.
That said, the people who most need to practice “defensive medicine” are the patients, not the providers. For they are the ones most likely to suffer irreparable harm or even death from medical encounters.
Before COVID-19, medical errors were the third leading cause of deaths annually in the U.S., after cardiovascular events and cancer.[2] That is a travesty and should be an embarrassment for the medical industry.
A Wake-Up Call?
Sometimes a shocking tragedy can lead to meaningful change in a system.
The terrorist attacks of September 11th on American soil, for example, revealed serious weaknesses in the U.S. intelligence gathering systems that contributed to our vulnerability to such an attack and motivated the development of better coordination between agencies, enhanced safety measures and the development of new screening technology and procedures.
In 1912, the sinking of the Titanic exposed social and economic inequities in society that enabled rich passengers to have access to the insufficient number of lifeboats on board, while poor immigrant families were locked in lower compartments to go down with the ship to the bottom of the Atlantic. Many others survived the sinking but treaded freezing water and screamed out for help that did not come (even though the partially filled lifeboats were close by) until they died from hypothermia. The death toll of that terrible night, on the maiden voyage of the gigantic, elegant, and supposedly “unsinkable” vessel, was 2,200 passengers and crew.
The public outrage over the socioeconomic injustices reflected in that event led to the establishment of an income tax in this country, its due date for reporting being the 15th of April each year, the anniversary of the Titanic sinking.
The murder of Brian Thompson, and the threat of copycat attacks, has caused healthcare insurance companies to beef up their security measures for their executives. In my view, to rely solely on this narrow approach would be like putting a band-aid on a hemorrhage.
Our badly broken medical industrial complex needs comprehensive reform. Now.
One of the incoming President’s cabinet picks, Robert F. Kennedy, Jr., has proposed a nationwide program to “Make America Healthy Again.” Except for some of his specific concerns (e.g., the unsubstantiated risk of vaccines and presumed safety of raw milk) that would make health outcomes worse, his mission is laudable.
However, before we can make America healthy again, we need to make American health care safe and healthy for both patients and providers. An important first step is to recognize that modern medicine is no longer a “noble profession”—it is a profit-oriented business. To believe otherwise is dangerously naïve.
“Do Your Part”
Andy’s sweet farewell letter to me, with tear-provoking reminders of the amazing life and love we had shared for 40 years, closed with one last request:
“Do your part, honey. Then come join me.”
Andy and I had planned to co-author a book about our experience with the medical system to share with patients and their caregivers the strategies we used to enable him to survive and thrive with an aggressive cancer and live three times longer than other patients with similar diagnoses.
In this subcategory for my blog, and in our upcoming memoir and advice book Bold and Relentless (see Books), I intend to do my part by speaking to many of the issues that made Andy’s and my life more difficult than it needed to be and to systemic problems in the medical industry that have greatly worsened since Andy died in 2014, making our healthcare system even more “malfunctional.”
I hope you will join me in this effort in whatever (non-violent) ways you can.
See Resources for recommended books and relevant handouts.
[December 14, 2024]
Endnotes:
- Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, by Marty Makary, MD, (New York: Bloomsbury Press, 2012)
- Martin Makary and Michael Daniel, “Medical error—the third leading cause of death in the US,” British Medical Journal, May 3, 2016 https://doi.org/10.1136/bmj.i2139