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What Can You Do?
A few years ago I was doing an annual physical on ‘Marie,’ a very pleasant 80-year-old woman who was born and raised in Montreal. Her father had died of colon cancer in his early 60s, but she hadn’t had a colonoscopy for several years. They had always been fine, and she was getting older, and she just hadn’t done one for a while. I suggested we recheck, she said she was too old and not in the mood, so we compromised with a Cologuard (a home stool sample that is moderately good at picking up colon cancer). It came back positive.
I immediately referred her to GI, who said they could see her in three weeks. I said that wasn’t good enough, explained the situation, and they scoped her the following Monday. They found colon cancer, I called a surgeon, and had the cancer removed (along with eight inches of her colon) later that week. Total time from stool sample results to cancer surgery: Eight days. Pretty good, but still, one of the 12 lymph nodes they biopsied was positive for cancer. Crap. Metastatic cancer in an 80-year-old woman. What can you do?
Well, in this day and age, you can do a lot. So she undergoes four rounds of chemo. Modern chemo has come a long way, and she didn’t feel sick at all. Although she got tired of driving back and forth to the infusion center 20 minutes away. It resulted in clean scans and apparent resolution of her cancer. That was three years ago. She turns 84 next month. She feels great, and all subsequent testing has shown no evidence of recurrence. All cancer patients are not so fortunate. But sometimes modern medicine really can work miracles. Yahoo! Except.
When I called her after the stool sample to tell her that it was positive and she had a colonoscopy scheduled in three days, I asked if she had any siblings. She said she had a younger brother. I told her to call him, and tell him that now he’s got a father and a sister with colon cancer. He needs to get a colonoscopy done. And if it’s been a while, he needs it to be done right now. Which brings up the ‘except’ part of all this: He still lives close to where they grew up – just outside of Montreal.
He called his doctor, and left a message. The following week they called back and made him an appointment. That took some more time. Then they sent him to a GI doc. I’ve forgotten how long each step took, but it took over a year to actually find the cancer and get it out. By that time, he had widely metastatic disease. They tried chemo, but they use older stuff, and he got very sick on it. And it didn’t work as well. So they tried some other things, that made him sicker, and also didn’t work. He died after a very difficult seven months of treatment, at the age of 81.
Now, to be fair, Marie pays extra to be a member of a concierge practice. Going from a suspicious test result to definitive cancer treatment in eight days is pretty good, even in America, but that’s the advantage of this type of practice.
But first of all, the only way I could move that fast is because I have the resources of the American health care system available to me. And secondly, even in a more typical practice, there’s no way that would take a freakin’ year. In America, when we find a positive cancer marker in a patient with a family history of that very type of cancer, we get on it. Now. Her brother might have survived if he had been in the states. Any state. Anywhere.
I saw Marie today for a recheck, and she told me that her brother had died recently, and told me the story I relayed above. I wasn’t sure what to say. I just said, “I’m really sorry.” Or something like that. What can you say?
She said, “I’m so glad Justin Trudeau won. We need someone to make the Canadian health care system more efficient. It’s already one of the best in the world, but sometimes it’s not as responsive as it could be. You know, all the care my brother got, even the chemo – it didn’t cost him a dime.”
I wanted to respond, “Yeah, but it did cost him his life. Screw the dimes.”
But I didn’t. I still wasn’t sure what to say.
What an odd response. First, she tells me that her brother recently died. Then, she discusses the results of a recent election. Then, she compliments the health care system that killed him.
Dead brother. Politics. Nice job. Huh?
Wow. That just seems like a really odd conversation to me.
This is just another illustration of a phenomenon often discussed here on Ricochet. The basic problem of attempting to convince a leftist of, well, of anything at all. They’ve made up their mind. Or heart. Or something. And reality no longer matters.
With Marie, I didn’t even try. First of all, her brother just died, and to me, it seems disrespectful to discuss politics. Even though, in a socialized medicine system, matters of life and death are more dependent on politics than they are science or ethics. But, still, her brother is dead, and I can’t quite make the jump to politics. It just sounds dirty, to my ear.
And secondly, because if the death of her brother won’t convince her that perhaps socialized medicine is dangerous, then there is certainly nothing I can say that would convince her.
So I just nodded my head sympathetically. What else could I do?
There is a reason that conservatives lose a lot of arguments with leftists. What can you do?
With metastatic cancer in an 80-year-old, there is a lot you can do. Marie is living proof. But leftism is a metastatic disease with no known treatment. It just spreads and spreads, killing its hosts as it goes. And there’s nothing you can do to stop it. Marie is living proof. She still believes in leftism. So would her brother, if he were still living. But he’s not.
This no longer matters, of course, now that non-leftist opinions are categorized as hate speech. We couldn’t debate ideas now even if we wanted to.
But even when we were allowed to discuss ideas and ethics, we often didn’t. Because, well, why? What can you do?
Published in General
Many people love politics more than life itself. Even on this website, if not especially on this website, that cannot be surprising.
One reason I’m conservative is that I love life more than politics. I want my government to leave me alone. I do not want to depend on my government to get a colonoscopy done.
Leftists seem more comfortable with politics playing a central role in their lives. Conservatives value liberty over political power.
The way I would slychologize Marie is that she is *assuming* a constant high standard of care, based on her experiences with you and others in the American healthcare system, so she thinks the only variable that needs to be optimized is cost.
Well I nominate this for post of the year.
However, I must say that I am incredibly biased because the entirety of my life experiences support the narrative of this post. My father is an American Doctor and for some weeks of the Summer, we used to vacation in Canada and live among the people of rural British Columbia.
I remember him talking to an older guy who got in a fight with a messed up nose, (Rural British Columbians are more like rural Americans than they are like Justin Trudeau in both good and bad ways. Mostly good.) Apparently, he was walking around with a messed up nose for several months. On the truck ride home, my Dad said to me, “This is expletive health care. Everyone says how it’s free but it’s expletive health care.”
Other experiences with Canadians have confirmed that it takes a long time to get any medical treatment. For cancer, this can easily be a death sentence.
My Dad also encourages men of a certain age to get a colonoscopy. “No one should die of colon cancer. Colon Cancer is the only cancer that shows up early and can be treated without any serious complications early on. You just cut out and the polyps and it’s no big deal.”
There is an argument that American healthcare spend alot of money on not so useful tests but colonoscopies aren’t one of them from what I hear.
I didn’t know there were good ways to be like Justin Trudeau. I still have a lot to learn, I guess.
Reading it again, I guess you didn’t exactly claim there are good ways to be like Trudeau.
Those last two sentences really sum up where we are in America today.
I don’t know what treatment like you gave her costs, but I’m on Medicare, and I’m not sure my fellow citizens owe me a million dollars worth of treatment. I think there are some situations in which you just fold your tent and go away.
This sounds plausible to me. On the other hand one presumes she was purposeful in choosing concierge care exactly for its advantages over ordinary care. Some guilt is probably in the picture here, too.
In my experience, rural British Columbians drink too much, party a bit too hard and a little too prone to fistfights. And if they are friendly with you, they will admit plainly and fairly.
However, Justin Trudeau would have avoided a fistfight because of vanity and cowardice. In general I think men should avoid violence like the Southern gentleman Atticus Finch. Atticus Finch would have avoided violence out of genteel nobility and whereas Trudeau would have worried about how a scar would affect his blackface. Very different motivations.
Question re: concierge care, @drbastiat: How does it work when going to a specialist? I remember Doc Jay, who had a concierge practice, saying that could be a problem. But he left Ricochet before you joined, as far as I know, much to our disappointment. So much time has passed since then, I’m sure it has changed.
Here’s an NHS story for you:
My brother-in-law, who lives in Scotland, recently had a very serious medical event. He had a “trial run”–much less serious–of a similar nature, a few years ago, but it was thought to be an anomaly, and nothing was done about it at the time. So this episode, which was very serious, is the second of the same sort of thing with a couple of years.
This time, the EMT’s had to take him to the hospital in the middle of the night. The closest hospital isn’t much more than a clinic with a couple of observation beds (their web page proudly boasts that they have an X-Ray machine!), so he had to be taken to the next one up the food chain, quite a piece down the road. They were able to do some very basic tests, but he needs a battery of neurological tests to see exactly what’s wrong and if this problem (which is a frightening one) is going to recur or needs to be treated as a chronic condition.
They don’t have the equipment to do any sort of neurological testing, so they sent him home the following morning. (Their web page proudly boasts that they have an X-Ray machine, too! And tells us that patients with conditions like acute appendicitis (which is not what my brother-in-law was suffering from) have to be transferred to a tertiary unity for surgery. There are ten members on the medical staff, and air transfers to the hospital are made via fixed wing aircraft from the local airfield because the hospital helipad was closed in 2014 due to safety concerns: I reiterate–this hospital is the bigger, “step up” level from the hospital in my sister and brother-in-law’s closest town.)
The “tertiary” hospital where he needs to go for the neurological testing (I’m assuming they’ll start with an EEG, which hasn’t been done yet) is six-plus hours away and involves, among other things, coordinating with a ferry schedule to get there. The tests aren’t scheduled yet. They are in the process of setting them up–perhaps sometime around Christmas.
That will put the delay at well over four months since my brother-in-law’s episode.
My sister, who flirted with Leftiness after she and the rest of my family went back to the US in 1978 but has long since recovered, is beside herself with both worry and disgust.
Who is going to make that call? Ezekiel Emmanuel said to cut it off at 75. A million dollars? I would wager that the lady with the colon cancer didn’t cost that.
Glioblastoma? Stage 4 pancreatic cancer? Sure. I watched close friends wage war against those and it got them nothing. But it was their decision, not an insurance company nurse or a government bureaucrat. It’s up to you to determine the DNR, not someone else. This is America, dammit.
And then you run into stories about Canadian MPs and even Provincial Premieres coming to the States for Medical treatment. They have been practicing medical apartheid for some time now. And yet they have convinced Canadians that their system is “equitable.”
We shrug off what happens up north too easily. But bad ideas up there end up bad ideas down here.
I fear we are headed this way in the United States. And the Democrats will say, “We had no other choice.”
Except that Medicare is insurance, that you paid for, and isn’t the program going bust.
Medicaid on the other hand…
It sounds as if your sister and brother-in-law live somewhere in central Africa!
Thank you Dr. B for sharing the brutal nature of cellular cancer and the competent, compassionate response to this disease. Also, to juxtapose the medical systems that can either empower or inhibit those trained to apply ‘every means necessary’ to combat its progress. Maybe a post for another day.
That response from me would be the personal, selfish takeaway. Being married to a medical oncologist for 16+ years, the most intimidating start to a conversation is: “I know your wife”. My typical response, with sincerity, is: “I’m sorry”. (The spouse is the last to know). The conversation ensues toward their, or a loved one’s, recovery or hopefully how everything that needed to be done, was done, while earnestly absorbing a life-story. There are several Ricochetti battling, recovered, in remission or personally affected by this dreaded disease. It is often in the forefronts of our conscious. I encourage all those in this fight to remember:
Now that the all-important PSA is out of the way, let’s move toward the psychological cancer of leftist thought that I think was Dr. B’s culmination. Gad Saad in The Parasitic Mind (if you haven’t read it, please do) describes it as a:
We must approach the current leftist movement as a mental illness, a psychological cancer, less than a campaign. Mental illness is not something to be ignored, encouraged, toyed with or thrown around in the pejorative, but seriously engaged. It is time to seriously engage the current woke phenomenon as a mental illness or a personality disorder, not just a phase someone will grow out of.
In other words, it simply can’t be about ‘owning’ the woke. Discretion is the better part of valor:
It does no justice to an anorexic to merely point out their deficiencies or to tell an addict to ‘Just say no’. This is usually low-hanging fruit, maybe even schadenfreude to a certain extent, as so many leftist arguments are indefensible and simply degrade into ad hominem attacks.
Are there techniques to engage those in the throes of mental illness? How do we present reality in a convincing manner to leftists who have refused to accept reality? This is an earnest question to all Ricochetti – would love to add these tools to the debate toolkit.
And that is the scary part. Even when she had her own experience to compare it to, the best she could do is, “Well yeah, they killed him . . . but it’s free!”
Except it’s not free. What are the tax rates up there?
When we lived near Rochester, NY (2000 – 2018) we learned that the big weak point in the Canadian medical system was getting preliminary scans, tests, and diagnoses. Wait times to get a preliminary scan, test, and diagnosis were generally measured in months. Many patients died while waiting for a diagnosis, or like in this story, the diagnosis came too late for treatment to have much chance of success. The people who died awaiting diagnosis don’t appear in the system effectiveness statistics, so it’s very hard to push the system to improve the diagnostic care. Statistically the system didn’t let a sick person die because the person hadn’t been diagnosed as sick. It’s just a random death. And as long as those “random deaths” don’t become too frequent, they don’t affect the overall life expectancy statistics.
Many medical practices in Buffalo (NY) performed a lot of diagnostic work on Canadians. Since diagnosis is often relatively inexpensive (compared to many treatments), people (well, at least wealthier people) were willing to pay for it out of pocket. Apparently once they had a diagnosis, even if it was from a U.S. doctor, they could push ahead to try to get treatment in the Canadian system.
I will, of course.
Keep in mind that Canada’s health care system doesn’t have built-in alternatives. In the UK, you can bypass the NHS if you’re willing to pay. They even have private health insurance.
In Canada, bypassing the NHS requires leaving the country, though the trip isn’t too onerous. You don’t have to travel to India after all.
It is interesting that “Marie” did choose to pay extra for concierge service, despite her faith in government based care. Or maybe it’s just that it’s not Canadian.
You can’t beat leftists because they have: open doors, open minds, and open hearts. They are so full of their opens, there’s no room for anything else. Anyone who says differently, is as you say, a hater.
Holy crap!
I get there’s a certain fatalism when you reach that age. But still…
They’re right next to us, have to compete with us send some folks to train here, to get treatment etc. As we become even more socialist than the Canadians, I suppose it will be private illegal physicians in Mexico that make the difference, but technology will be relatively frozen. The same thing will happen to everything and we’ll fix matters by getting the government more involved.
I have a bit of experience with design of hospital helipads, and even two car garage hospitals (my MIL’s description) in the US will have a helipad. Frequently it is an area of the parking lot that can by ‘roped off’ when needed. The fact that a ‘hospital’, or perhaps it was the local government, would allow some kind of encroachment (helicopters require a dedicated “glide slope”) or lack of maintenance to shut it down, due to ‘safety concerns’, is criminal.
What is wrong with people?
I wrote a review of Gad Saad’s book. I liked it.
That’s a powerful story on so many levels and your last sentence sums it up. The Leftist mindset destroys mind, body and soul because it doesn’t see the whole person or the history – you did and saved a woman’s life. Very well written – so many messages – thank you Doc!
You’re going to think less of me for this scolding, but you self-censored, Doc.
Yes, I just came away from four days of (mostly) conservative speakers at Hillsdale, where Michael Knowles was talkin’ my language and inspiring the young kids. But, I’m also inspired (and a little worked-up) to the calling to speak the truth with love.
The truth is, if ‘Marie’s’ brother had been under your care, he’d be alive today, like ‘Marie.’ That’s a truth you could have spoken with genuine sorrow and sympathy. And ‘Marie’ might have to go away and think about it. If she really didn’t like hearing the truth, she could find another doctor, although I bet she’d have trouble finding one as good as you.
Knowles said (paraphrasing) in his speech that the conservative emphasis on freedom of speech isn’t really all that useful if you don’t have something to say — and then say it.
Conservatism is a bottom-up effort. It’s going to take one person at a time being converted to liberty by people like us speaking up.