Posts Tagged ‘end of life’

In Memoriam, Dr. Lee Lipsenthal

September 22nd, 2011

We have not even to risk the adventure alone; for the heroes of all time have gone before us. The labyrinth is thoroughly known. We have only to follow the thread of the hero path. And where we had thought to find an abomination, we shall find…God.
—Joseph Campbell

Such has been my experience with Dr. Lee Lipsenthal. Lee was the co-founder of Finding Balance in a Medical Life, a recognized leader, teacher and pioneer in the field of provider wellness. He was internationally known for his research work with my friend Dr. Dean Ornish in preventive cardiology. He was also well known in the field of Integrative Health, and past president of the American Board of Integrative Holistic Medicine.

Lee Lipsenthal, MD - Enjoy Every Sandwich - Nick Jacobs, FACHE - HealingHospitals.comAlthough Lee’s entrance into medicine was traditional, (a BS from George Washington University, his MD from Howard and an internship and residency at the Medical College of Pennsylvania), he started on his truth path of healing as a resident, where he developed the first multi-disciplinary cardiac rehabilitation program in Philadelphia, a plan that addressed stress reduction, exercise and nutrition teaching.

He then went on to become the Director of Cardiovascular Services for the Benjamin Franklin Clinic in Philadelphia, as well as a staff physician at The Pennsylvania Hospital. In this role, he developed treatment programs for patients with heart disease or risk of heart disease; he developed corporate wellness programs for national companies, and consulted on patients with cholesterol disorders at the hospital.

But who was the real Lee Lipsenthal? Lee was a hero who embraced the adventure and led the way for us all. In an incredibly selfless and positive way, like all heroes, Lee “lost himself and then gave himself to all of us.” He mastered the transformation of consciousness, and taught us all to look deeply inside ourselves. Lee’s life and teaching was always about the powers of life and their modulations through the action of man, and Lee’s actions led us all to a better place; a place of healing, love and understanding. He did this through his words, his music, his soul and his heart.

Lee Lipsenthal, MDLee captured the imaginations of many of us and gently drew us into his circle of positive influence where he provided a psychological center for our lives, he fed our individual and collective souls and he helped us to experience life at its fullest. He often took us to the edge of self-discovery, but he always took us to a place of peace and love. He could literally show us the “belly of the whale,” and then bring us back to a deeper understanding of our lives, our abilities and our spirits.

In many ways he helped us transcend our humanities so that we all could emerge into a deeper reality of serving our fellow man. He taught us that, as a person, if we don’t listen to the demands of our own spiritual and interior life, we will drift dangerously off-center.

Lee was our center. Lee was our friend, our mentor, our spiritual guide and our hero.

Lee passed this week, surrounded by his wonderful, loving family, and our hearts are breaking from the loss, but also reveling in the joy of having known him, having shared him and always loving him.

Learn more about Lee’s extraordinary journey, and his wonderful book, Enjoy Every Sandwich below.

You will be inspired and moved.

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The Budget Impasse and Death

July 16th, 2011

David Brooks wrote a very interesting column last week in the New York Times entitled  Death and Budgets,” in which he explains the current Washington D.C. budget impasse and compares it to our collective inability to come to grips with our own mortality.

David Brooks - The New York Times - Nick Jacobs, F. Nicholas Jacobs, FACHE - healthcare - healing hospitals - SunStone Consulting

David Brooks | Josh Haner/New York Times

His treatise quotes S. Jay Olshansky, one of the leading experts on aging, who argues that life expectancy is now leveling off, and others who say that, we are marginally extending the lives of the very sick. Brooks goes on to articulate that, “A large share of our health care spending is devoted to ill patients in the last phases of life.”  Then enumerates upon the fact that, as a country, we will be spending $1 trillion dollars annually, double Medicare costs right now, on Alzheimer’s disease alone by 2050.

His closing thoughts revolve around the fact that “unless we confront death and our obligations to the living like his friend who was recently diagnosed with ALS, we will not be able to reduce health care inflation and balance our budgets. “ He then concludes that “we think the budget mess is a squabble between partisans in Washington. But in large measure it’s about our inability to face death and our willingness as a nation to spend whatever it takes to push it just slightly over the horizon.”

Since 2005 I have written  many times about this issue. In fact, one of my most quoted experts on this topic is a previous Pittsburgh resident, former Colorado Governor Richard Lamm, who spoke openly about the immorality of “inter-generational resource theft,” where the voting senior citizens have pulled the majority of the healthcare resources away from the children of our nation. According to Lamm, this generational robbery has contributed to produce one of the highest infant mortality rates in the civilized world  and has provided the resources allowing our seniors to squeak out another few months or days of life.

I also remember one of my Carnegie Mellon professors, Ian Rawson, PhD, describing the resource challenges presented in certain extremely conservative states where they have refused to fund organ transplants for children.  Obviously, those who voted most often and most passionately were the seniors themselves who could then use those resources for mechanical life support or surgeries on the frail elderly that neither extend nor improve the quality of their lives.

As a former hospital CEO, it seemed clear that the medical schools had taught the Northern European philosophy that “Death at any time is failure.”  It seemed that the very reality of our mortality was overlooked.  Having had responsibility for funding a palliative care unit in my last hospital, it struck me as sad that the vast majority of patients being admitted there arrived for the last week, day or few hours of life, and the “life extending measures that had be foisted upon the patient and their families” prior to that time neither reversed the disease nor improved the quality of their lives.  Unfortunately, some of this is about income for the provider, but most of it is about our inability to face the end of our time here on earth.

It was always disconcerting to see a priest or minister as a patient in critical care screaming out in fear of their own death.  It would seem that they, of all people, could find peace in the upcoming transition. So, what about the rest of us?

In closing, and this too is my “one note samba,” until or unless we begin to reimburse for wellness care, embrace death as part of life, and stop rewarding our scientists for “not sharing their ideas” with each other, we will continue to act pretty much like my daughter’s dog, Chipper. Tail-Chasing-R-Us, and Washington DC is currently engaged in chasing a tail that could easily wipe all of the china off the dining room table.

All we seem to see are blades of grass in our fields of dreams.

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Engage With Grace

November 26th, 2010

Excerpts from: Chapter 18 of  Taking the Hell out of Healthcare

by Nick Jacobs

When Dying is Finally Enough


The Dichotomy of Death

On Thursday evenings from 1970 until 1975 there was a standing invitation to play pool at Jim’s Dad’s house.  Now, the truth of the matter was that, as young school teachers, most of us barely owned houses, let alone a pool table, so one of my colleagues parents’ opened their home to allow us to have some safe recreation. During those innocent days of my mid twenties, many of the world’s problems were solved. Jim’s father was a wise old philosopher in his early sixties,  a retired coal miner who loved to be around the kids.

One night, we began discussing religion, faith, and death as we mechanically yelled out lines like “16 in the side pocket.”  The discussion became particularly heated when it came to hypocrisy of our healthcare system. We kids or at least this kid listened in amazement as old Carl explained how life was in the old days. His relatives from the old country had salves and ointments, herbs and mustard plasters that took care of virtually every ailment known to man, and when they failed and death was inevitable, death was accepted. He used to laugh and say, “But now, everyone wants to go to heaven, but nobody wants to die.”

It was then that the subject changed to today where there was truly a cure for nearly everything, or so it seemed at age 23.  Get sick? Take a pill or get a shot. But then, a few weeks earlier, my father had been diagnosed with lung cancer and was given less than a three percent chance of survival. As Carl and I discussed this situation, he put his arm on my shoulder, and wished me luck. At 58, my dad was still a young man, and neither my education, my prayers, nor my love would be able to save him.

The American way of death seems to be that death is not acceptable at any age, at any time or for any reason. Death is rarely seen as the inevitable future that we all face. Our American system of death is that it should not  happen. Death is no longer accepted as part of life. Oh, yes, we hear those words, but when it is our loved one, they are very difficult to embrace or articulate.

Our medical schools, our nursing schools, our technology schools train  our students in most cases that death is failure. This is why we have a system of health care that is crumbling under our very eyes. Through drugs, machines, and other advances, we have the ability to allow individuals to live longer than ever in the history of mankind. It is absolute reality that more people will have an opportunity to live longer than 100 years of age than ever in history, but at what cost, and with what degree of quality?

Engage With Grace - The One Slide - Nick Jacobs, FACHE - Healing Hospitals - Taking the Hell Out of Healthcare

Because of our culture, we fight death until we are shocked by it, and the result is that we, as families miss the wonderful opportunity to allow our loved one a peaceful, beautiful, comforting transition.

Palliative care, a.k.a., hospice care, provides that transition.  In a hospice program, we experience love in all forms until death. Hospice provides a womb-like environment where love can replace fear, where family can be the center of that love, and where the transition can be a beautiful, healing journey for everyone involved so that it becomes a peaceful transition.

What Can You Do?

Do your personal homework. Begin to talk to your loved ones early on about their wishes.  Make those wishes as clear as you can. Do not be fearful that anyone will let you die before your time. Trust that your family or friends can support you in your intentions, and be sure that you put everything in writing that you possibly can. Most importantly, however, try to find peace with yourself.

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Healthcare Reform. . . It’s only just begun

March 10th, 2010

This week’s Bloomberg Business Week magazine featured a phenomenal and very personal story of healthcare that actually captures many of the challenges around healthcare reform.  The author, Amanda Bennett, takes us on a journey that she has titled, “Lessons of a $618,616 Death.”  The true title, however, should have been, “How Do You Put A Price on 17 Months?”  In this article, Ms. Bennett takes us on the step-by-step, blow-by-blow journey that ended with her husband’s death.  She and a friend painfully reconstructed every page of his medical records, every dollar paid by her insurance companies, and every charge made by the various doctors and hospitals that treated him during the last years of his life.

Business Week end-of-life issue - Nick Jacobs - healinghospitals.com
Amanda Bennett and Terence Foley

She showed 1.) the grand total of charges, $618,616, 2.) the actual monies paid by the insurance companies to the hospitals after contractual negotiations, $254,176, and 3.) the total paid by her family, $9,468. In the article, she described the 30% overhead/administration costs, the costs of experimental drugs inside and outside of trials, and the 4,750 pages of medical records that were amassed during this time. For those of us who have “spent our time” trying to live within, cope with, and better understand America’s healthcare system, there were no surprises.  For those of us who have watched a loved one take this cancer journey with all of its mysterious unknowns, there were also no surprises. Ms. Bennett’s quote, “The system has a strong bias toward action,” was, I believe, the most poignant in the entire piece.

A few weeks ago, I had lunch with a very healthcare-savvy individual who, when I jokingly referred to death panels, almost came across the table at me.  She did not believe it was funny.  To say that she was passionate would miss the point.  Only the day before, I had spoken with another very intelligent healthcare reform advocate who indicated that the entire concept of death panels emanated from a payment code that reimbursed physicians for simply (or in some cases finally) talking to patients about their alternatives.  I had heard other explanations, but neither mattered.  What matters is that, in many instances, we are not discussing appropriate alternatives or revealing the quality-of-life issues often overlooked before beginning long courses of experimental drugs, or oncology drugs that may not have any positive impact on the health outcome of the individual.

Interestingly, Ms. Bennett did indicate that for all of the time, money, and pain invested in this journey, no one could confirm that her husband’s life was actually extended by these medical experiences.

Someone once described America’s healthcare system to me like this:  You walk into Nordstrom, order several three-thousand-dollar suits, a dozen shirts and some handmade, silk Italian ties, then turn to the person beside you and say to the clerk, ‘”He is paying for this.”  Our heroine Ms. Bennett did mention the fact that her husband would probably have questioned the use of all of these funds in this manner and the relationship that these expenditures might have had on all of the other people in the world who might have been helped by these dollars.

Taking the Hell Out of Healthcare by Nick JacobsWhen healthcare reform is discussed, it is personal.  It is also deep, and it is costly, but the bottom line always comes back to this: “How do you put a price on 17 months?”  In my book Taking the Hell out of Healthcare, I discuss the journey that my father and our neighbor took together over about a 17 month period.  Both diagnosed with lung cancer, my father decided to go for it all.  He had surgery, chemo, radiation, more radiation, and more chemo.  My neighbor, a man without significant health insurance coverage, decided to spend his time with his family.  They both died on the same day.  My father died in a cold, tertiary care hospital where no clergy was present, his family members were not all able to be there with him, and it was over.  In contrast, our neighbor died peacefully in his home, surrounded by his entire family.

Ms. Bennett did say that she was glad that she was not a bureaucrat having to deal with these issues.  Frankly, I wish that she was!

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