bob-zahn-didn-t-george-washington-floss-cartoonMe (in grocery): Why are you taking a picture of the almond cookies?

Lucy (my daughter): Dad! Spencer loves almond flavored sweets. We’re Snap Chatting.

Spencer is up to his knees in snow in Hartford and we are in Mobile. In the world where “selfie” is the trending word, people think they need to know everything about everybody, instantly. This has taken a lot of mystery out of life and out of death. Look at Phillip Seymour Hoffman’s tragic death. I don’t know how word got out but rumors about the place (bathroom), situation (using heroin), and backstory (“Oh, he had a problem for years. Went to rehab and told some interviewer that he was back on the stuff) were Facebooked, Intagrammed, Snap Chatted, Four Squared and Twitted before the ambulance left his his “Greenwich Village pad.” We have no clue what his last words or thoughts were but, based on my experience with patients in similar situations, it must have been along the lines of “Oh crap!” For all I know, he may have posted that to his Linked-in account before dying. I wasn’t in his Linked-in circle.

Things were different in George Washington’s time. Based on rank speculation on PBS, experts in the field of 18th century medicine (or maybe just people willing to be quoted by PBS) have ascertained that Mr. Washington suffered at some time or another from diptheria, tuberculosis, smallpox, dysentery, malaria, and pneumonia before finally succumbing from what was likely a bacterial infection in his neck area (possibly Ludwig’s angina or Lemiere’s disease), all diseases that are treated today with antibiotics or prevented with vaccination. Well, Washington actually may have died of blood loss anemia (his physicians bled him of 2/3rds of his blood volume in an attempt to cure him). All present at the death agreed that the former president’s last words were “I die hard, but I am not afraid to go.”

I doubt those were his last words. It was important at the time to give great men great last words. What we know for a fact is that after losing most of his blood he was able to summon the strength to tell his docs to “Go away!” and stop taking any more of his blood. In this case, I suspect his doctors’ last words on the subject were something along the order of “Oh crap,” because they were seeing their paycheck lying dead in the bed and, as the last in attendance, it may not have been the best resume builder. We also know that today this infection if treated appropriately almost certainly will not lead to death.

Most people today, when given a choice, seek medical care when they fear death might be an illness outcome. If they have insurance they will come to a physician’s office for a skin infection. The reforms included in the Affordable Care Act include mechanisms to ensure access, allowing infections to be treated early with antibiotics. No American should have to “die hard” from a skin infection.As a rule the the cost is a lot more than a lancet and a bucket (the tools needed to treat President Washington’s final illness) and even more so if the person waits until they are near death.

In our hospital we serve an uninsured, poor population and generate bills that we hold people responsible for. Last year almost 700 people risked bankruptcy to wait in our waiting room, hoping that they could get antibiotics to cure their skin infection. 350 of them had no insurance coverage but were able to leave only owing us about $750 with 10 days worth of antibiotics in hand. Over 150 of those waited too long and had to be admitted. Half of these were uninsured and owed us on average $11,000 for their 3 day hospital stay. On average, this is half of their total income for the year. If our governor had accepted the Medicaid expansion, many of these people would (as of January 1) be able to access the health care system without fearing death or bankruptcy but by his inaction remain uninsured.

Maybe our doctor-governor will issue some lancets, buckets, and last words.