Peeling The Onion

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  • 11/20/2006
This is not a real news story -- it's from today's edition of The Onion.

But it could be real if we don't address the building momentum towards evidence-based medicine and its cost-centric vs. patient-centric worldview.

End-Life Crisis Marked By Extravagant Spending Spree
The Onion, November 20, 2006

TOLEDO, OH—Ever since his retirement nearly a decade ago, area resident Oscar Subitzky just hasn't been the same. What began as a single, uncharacteristic extravagance—the payment of $15,000 for a coronary angioplasty to expand his narrowing arterial wall—has given way to a growing number of personal luxuries, from the latest brand-name heart medications to the most advanced palliative care. The unusual developments have led concerned family members to suspect that the once prudent and conservative 74-year-old widower is undergoing an acute end-life crisis.

"Sure, the operation seemed a little indulgent at first, but we could tell it was really important to Dad, so we didn't try to stop him from having it," said daughter Martha Welsch, 46, who can still remember when her father didn't need "pricey doodads" like defibrillators and cardiopulmonary-resuscitation devices to be content. "We all thought this was going to be a one-time thing, that it was just something Dad had to get out of his system, and then things would go back to normal," she said.

"Unfortunately, one surgery quickly became two surgeries, which soon turned into three surgeries," Welsch added. "That's when we realized the whole thing was a lot more serious than Dad just wanting to get a clogged artery cleared."

Subitzky's end-life crisis began when he suddenly left a secure job as an accountant at the age of 65. Welsch admitted she didn't quite understand what had come over Subitzky until he announced six months after his retirement that he had started seeing a cardiologist nearly half his age.

"You hear those stories about men in their late 60s all of a sudden coming home with an expensive new pacemaker or deciding to get work done on their kidneys out of the blue, but Dad just never seemed like the type," Welsch said. "If he honestly thinks that spending thousands of dollars on blood transfusions is going to change the way he feels inside, I'm afraid he's got another think coming."

Lately, Welsch said, between "all those fancy new breathing tubes he now wears," and the company of a new live-in nurse only a few years older than some of his grandchildren, she sometimes doesn't recognize her father.

"What's he going to do next, gallivant off to some $10,000-a-day, all-inclusive hospice?" she wondered.

In addition to throwing money around "like there's no tomorrow," as Welsch puts it, Subitzky has also reportedly grown obsessed with his appearance, examining his body for lumps, bruises, or signs of congested veins dozens of times a day. According to son Patrick Subitzky, 39, who admits to being a little embarrassed by his father's newfound vanity, the older man's obsession with his looks has also resulted in a "ridiculous new diet" of only dark-green leafy vegetables, fruits high in citric acid, whole-grain cereals, and absolutely no meat or dairy products.

"I love him and everything, but I don't know who my father thinks he is anymore," said Subitzky, who cringes every time his elderly father speeds around town in that "loud and flashy" ambulance. "He's even talking about a trip to Denver to see some heart specialist there. Whatever happened to the Oscar Subitzky who hated to travel?"

According to psychologist Elizabeth Schulz, who specializes in mortality-identity issues, an end-life crisis is an emotional state of fear and anxiety that often affects men and women between the ages of 65 and 100, and is usually sparked by the uncomfortable realization that one's time on earth is limited.

"Individuals in the middle of an end-life crisis are usually easy to spot, as they tend to foolishly acquire big-ticket items such as liver transplants to compensate for feelings of growing inadequacy," said Schulz, who in the past several years has observed increasing numbers of clients suffering from the common disorder wheeling themselves into her office. "While these shortsighted material purchases will often work at first, leaving the individual feeling rejuvenated and even energized, in the long term they have very little effect."

In the meantime, Welsch is hopeful that her father will eventually move beyond his present situation into a better place.

"I'm praying this is just a phase that will pass," Welsch said. "Hopefully in a couple of months this will all be over."

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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