Today's Note From a Madman

Thursday, April 7, 2005


A Dialogue, Sort Of


I would like everyone to read this as I did, without judging the words because some of them were written with anger. This physician's name I withheld because I don't want others to inundate him with emails, good or bad. I did a lot of research on him (yes, HE is a MAN) and I found his credentials impeccable and impressive. We have been sending emails back and forth. Here they are:


By the way, don't read anything into the the color scheme.

By the way, as a physician with over 24 years experience who is a strong proponent of the right to die and has extensive academic experience including faculty appointments at 3 major US medical schools, I have conducted teaching rounds with hundreds of students and resident physicians in ICU's across the country. Terri Schiavo was absolutely NOT in a persistent vegetative state. Please see for a detailed discussion of PVS. The diagnosis of PVS requires no conscious awareness. she was clearly aware and interacting with her family. That was plainly evident in the video clips. she was a profoundly neurologically impaired woman, but she was not brain dead, nor was she in PVS. The court was wrong to have accepted the testimony of 4 / 6 physicians (paid for by Mr. Schiavo) who concluded she was in PVS and disregard the other two docs who said she wasn't. if she were in PVS, why was she on morphine for pain? Patients in PVS are unaware and have no pain thus they don't need morphine. it was also wrong not to have re-evaluated her in some 10 years. She was not terminally ill. So what was done was to cause the death of a neurologically impaired person. So now do we stop feeding the tens of thousands of folks with multiple sclerosis, dementia, cerebral palsy and swallowing disorders on feeding tubes? how are they any different than Schiavo? how about the mentally retarded who require feeding tubes. do we now kill them all? no matter what the issue, the left will always choose the side that opposes Bush. What if the Republicans had been advocating for removal of her feeding tube? The left would have called that callous murder and been advocating the opposite. Isn't it ironic that that the left opposes the death sentence but was OK with killing Schiavo? Do you see how duplicitous and phony you seem? At least Jesse Jackson had the moral consistency to come down on the right side of this issue. For that he earned the respect of millions. But the predictable left will always take whatever side of an issue that is opposite that of the president. Your irrational hatred of him has impaired your judgment.

That was some email. You really have to read the newsletter better. I wasn't for removing the feeding tube, but others were. As you know, I never edit for content, just spelling and grammar (an example will be when I print this response, I will capitalize all letters at the beginning of your sentences - when I send out an angry email, I usually do the same thing).
What I did say was that I put myself in the shoes of Terri's husband. My wife and I discussed this issue (I am 44 years old, have been married to the same woman for 22 years, have been with her for 27 years and know her for 29) and she said to me that she would want me to act as her living will and that she would want the feeding tube removed.
I said to her that I wouldn't necessarily be able to do that if her mother, my mother-in-law, were to ask me not to do it.
My response is now as it was when I broached the subject: I still don't know what I would do and I can't imagine having to put myself in Terri's husband's shoes.
Next: I am FOR the death penalty. I grew out of being against it after the Son of Sam thing in NYC in the 70's. I am a believer in an eye for an eye. I do have one caveat, however: I believe that if the victim's next of kin asks for leniency, it ought to be granted.
To end. I do think it was deplorable, as does 80 percent of the country, that Tom DeLay and Bill First have used the Terri Schiavo affair for political gain. If you heard the tape, you would know what I mean.
Please feel free to contact me on anything and to send your thoughts for me to print

The senate voted unanimously to intercede in the Schiavo case. Instead of spending so much time trying to find ways to play "gotcha" and opposing everything and trying to "get" Delay, the Dems would be wise to try to actually solve some of our problems. At current growth rates, by 2080 every penny of the federal budget will be spent on health care. Now, there's something we should be putting our energies into.

I take issue with your next statements.
First: "the senate voted unanimously to intercede in the Schiavo case"
If you read s3099 and s3100, you'll see that there was dissent.
Mr. Frist: "Nothing in the current bill or its legislative history mandates a stay."
Mr. Levin: "In light of that assurance, I do not object to the unanimous consent agreement under which the bill will be considered by the Senate."
See the difference?
Mr.Frist: " Simply put, it allows Terri's case to be held in Federal court. The legislation permits a Federal district judge to consider a claim on behalf of Terri for alleged violations of constitutional rights or Federal laws relating to the withholding of food, water, or medical treatment necessary to sustain life.
The bill guarantees a process to help Terri but does not guarantee a particular outcome. Once a new case is filed, a Federal district judge can issue a stay at any time 24 hours a day. A stay would allow Terri to be fed once again. The judge has discretion on that particular decision. However, I would expect that a Federal judge would grant the stay under these circumstances because Terri would need to live in order for the court to consider the case. If a new suit goes forward, the Federal judge must conduct what is called de novo review of the case. De novo review means the judge must look at the case anew. The judge need not rely on or defer to the decision of previous judges.
The judge also may make new findings of fact, and from a practical standpoint this means that in a new case the judge can reevaluate and reassess Terri's medical condition."
Those were quotes.
Next, your point about "gotcha"
Have you read or heard what Tom DeLay and Bill First said on the tape when they didn't know that they were being recorded? The "gotcha" is on the other side. Not to mention that the Republicans control the House, Senate and Executive branch of the Federal Government. Clearly by saying the Democrats are playing "gotcha" you, as I assume you've learned from the Republican Talking Points, are attempting, as DeLay stated on the tape, that somehow the Democrats are running things. They are not. (I have a copy of the tape for anyone to hear if they so choose)
Third, on this site alone, the progressives (and that means I am calling the right "regressives") have put forth 2 separate strategies to save both Social Security and Medicare. All we have heard from the President is "Private Accounts" with no real plan. President Bush has also admitted that "private accounts" won't solve the "solvency problem" of Social security and Dick Cheney estimated that it would cost "Trillions of dollars" over the long haul to institute private accounts.
Feel free to email anytime

I don't want you to take away the feeling that I have no respect for you or your beliefs. I do. In fact, as I have said in our first exchange, I didn't necessarily agree with Michael Schiavo's decision, but if there were a decision to be made, I do believe it was his to make.
Some of this email was edited out for Madman's personal reasons)

There is one other thing that bothers me, when you stated "The task of doctors today is to figure out how to deliver care within the constraints of the marketplace," (this was found on some private research I performed) it appears to me that you are putting dollars ahead of patient care. I know the 2 go hand in hand, but everyone, regardless of their ability to pay should have access to excellent health care.
I am bothered by GW Bush's law he signed as governor of Texas in 1999, which a hospital in Texas used to end the life of an infant against his mother's wishes. The law states that if she could arrange for a new facility to take her child, they would allow the child to be transferred and be put on life support, as long as it's paid for. The mother of this child had no insurance, at least none that would have allowed her to move the child. The child, at the hospital's discretion, took the baby off life support.
The correlation to the 2 stories is staggering: Terri Schiavo would be able to live because her parents could afford it but a 6 month old baby was sentenced to die because his mother couldn't afford it.
I am for life. ALL LIFE. I am for the Death penalty because I believe in an eye for an eye. I am for a woman's right to choose. Until those who are pro-life and anti-abortion can come out and tell me what they are going to do for a woman who gets pregnant; wants to keep her child; has no physical way to pay for the doctor, the hospital, the first few months of life, etc, I will be for a women's right to choose. Fix this, and then we can talk.
Here's a wacky, but plausible situation:
A man and a woman get married. The Woman quits her job to become a stay-at-home mother. The man, who has health insurance through his job, dies unexpectedly. The woman is ordered by a doctor to stay in bed for the balance of her pregnancy. She has no family to help her financially.
What is she to do? Where is she to go? Who will look out for her before her baby is born and after?
Here is another side note: If President Bush was to get his way in regard to Social Security (allowing for the fact that he actually has not proposed a plan as of yet), there might be no survivor benefits for this woman as well.
All life is precious to me, not only those that can afford it.

I have attached a PowerPoint presentation that I have given at many hospitals and conventions about health care economics. In it are several slides that document the past and future of HC spending. The reality is quite clear, at the current rate of spending, by 2080, every penny of the federal budget will be spent on health care. We have borrowed over $7 trillion (see national debt clock), most of it to pay for health care (all of it in the last 50 years). The current hyperinflationary spending pattern is unsustainable and will cause a collapse of the US economy within this century unless there are fundamental structural reforms. The simple truth is, we are living way beyond our means. The social security issue pales in comparison to the health care spending crisis. Bush is wrong about social security, the situation is far worse than he says. We are looking at health spending exceeding 20% of GDP before 2015 with premiums exceeding $18,000 per year per employee by 2020. I am in Chicago right now speaking at a national convention on this very subject. GM now spends $5.2 billion per year on health care premiums. $1800 is tacked on to every car just for it. The projections of their liability to their employees and retirees over the next 20 years exceeds their entire market capitalization. Without major reform of entitlements, especially health care, the US economy will collapse due to a fatal debt burden. The interest on the debt alone is $200 billion! We spend more than twice as much per capita on health care and do not rank anywhere within the top twenty nations on any health parameter. A key driver of the outsourcing of jobs is that health care costs make US companies uncompetitive. So unless you have a gold mine somewhere, we have to live within what we can afford. Technology has gotten to the point where we can spend infinite amounts on health care leaving nothing for anything else and borrowing all the time to pay for it. Entitlements now account for the bulk of the federal budget. We're broke, we just can't admit it yet.
As for the ethical dilemma you describe, there are innumerable variations on the theme. I don't propose to have an answer but certainly endorse ethical discernment processes in such situations. As the dollar continues to slide, the pressure will continue to build for entitlement reform. It's inevitable.
(The PowerPoint Presentation will be available, with the approval of the Physician, on this weekend.- NG)

I am familiar with the GM dilemma. And I agree that Medicare and Medicaid are huge problems, much, much more so than Social Security. We have been speaking about it on madman for a long time.
I am going to print your thoughts and I hope you contribute more.
I would love to have your ideas on how to fix it.

(By the way, I just bought a Chevy Cobalt, partially due to the fact that GM is the single largest provider of health care for its employees - even though Wal-Mart is the largest employer in the US - in the US and the car is labor-made in the USA. It also had the best safety rating in its class and my daughter will drive it soon.- NG)

I enjoy respectful discussion. Don't believe everything you find on the internet (in regard to the research I did on the good doctor). I don't understand why Mr. Schiavo didn't let her parents take her home and care for her? If they were willing to render that care and pay for her tube feedings, why not? He could have been granted a divorce and moved on with his life. No one would blame him if he did. She had no advance directive, so her wishes could not be verified. It was based upon disputed hearsay. As a parent, if it were my child and I want to bathe them and turn them and hook up the bag of ensure everyday...for my child....I should have that right. after all, she wasn't brain dead or in a PVS. spouses come and go but parents are forever.

(As a "By the way") I don't remember the year. The Schindlers' did take Terri home a few years ago. It lasted for 3 months when they realized that they couldn't take care of her.

Well it certainly wasn't like it was close or anything. (Regarding the Senate Vote)

It didn't need to be close (the Senate Vote on Terri Schiavo). The vote wasn't a vote. It was an oral agreement. They do this thing all the time.

I just want to say that I appreciate our conversation and hope to have more such chats. It's a great thing to have a civil discussion that started as a contentious argument. I thank the good doctor and hope to be able to thank him again in the not-too-distant-future. I believe we have more in common than either of us realizes.


By the way, the good doctor has a health care plan that will be published either in Weekend Madman or Monday's Madman. -NG


-Noah Greenberg

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-Noah Greenberg