10 What Should My Healthcare Be?

Athena was tired of all the medical appointments. When she knew that her long health battles were nearing their end, Athena had assumed that her medical appointments would taper off. She had pictured having more time with family and friends, and to reflect over and enjoy her life. Yet the opposite had been true. Somehow, the medical appointments had multiplied, so much so that she could barely keep track. Nearly every day, Athena was heading off to the next appointment, so that all she could think about was getting there, going through the ordeal, and getting back. And when she didn’t have an appointment that day, she was trying to process and recover from the last one or prepare for the next one. Athena appreciated the medical care. It might be keeping her reasonably comfortable and even slightly prolonging her life. But when it seemed like all that she did was attend appointments, she wondered whether it was worth it.

Healthcare

Healthcare is a relatively straightforward issue for most of your life: maintain the best healthcare you can to most preserve, improve, and extend your life. If you need medication, surgery, or therapy to correct a disabling, annoying, debilitating, or progressively diseased condition, then get it, go through the recovery process, and hope to come out the other side healed. That equation changes, though, with end-of-life care. No sense, for an obvious instance, in getting that knee-replacement surgery so that you can resume your tennis and golf games, if your prognosis does not indicate your return to full activity. Other instances are less obvious. You might well treat a bacterial infection causing a cold. But whether to begin or continue medication for high cholesterol or hypertension, for two other examples, might be a much closer call, especially if your prognosis is short and bleak. The goals and forms of healthcare can subtly or markedly change as your transcendence nears.

Goals

Better health in the course of a terminal illness can make your transcendence a more-peaceful and confident transition. If you can experience fewer medical complications, have less pain, and retain greater cognitive capacity, you may retain greater clarity and assurance. With better health in the course of your demise, you may have greater physical, mental, and emotional capacity to make or receive visits, for the company of loved ones, and for fruitful conversations, remembrances, and reflections. You may also be able to extend the time that you have for those activities and the clarity you have for preparing or adjusting your estate plan, completing and withdrawing from business interests, and arranging home modifications or transitions. Extending your time or preserving your capacities in the time that you have may also aid your family members in adjusting their own affairs in anticipation of your departure. Better health in the course of a terminal illness can even lead to restored lucidity just before departure, which can be a huge blessing for surviving family members. Make sustaining your health a core part of your plans and preparations. 

Preventive

Preventive care is the general medical discipline directed to preventing disease. Some preventive care may be unnecessary or even unwise in the course of a terminal illness. With doctor approval, you might, as already suggested above, properly discontinue medications or therapies the goal of which is to ward off long-term, chronic illness like heart disease, especially if those regimens have side effects or complicate your other end-of-life care. Yet although you may abandon some preventive care in the course of a terminal illness, preventive care may still play a helpful role. Physical and mental exams, lab tests, and other screenings may catch emerging conditions, the complications of which you might avoid with antibiotics or other medication, dietary changes, or other simple adjustments or remedies. Don’t ignore the salutary role of preventive care during the course of your demise. If your doctors recommend preventive exams, tests, and screenings, and they can justify them to you in the context of your approaching transcendence, then consent and cooperate. Doing so may improve your journey.

Curative

Curative care is that general medical discipline directed to fighting and curing disease. Your medical team may not be able to cure the medical condition that is calling for your transcendence. Yet the same regimen that they would recommend and apply to cure the condition may be the regimen they recommend for slowing its progress, extending your life, or improving the quality of your life in the remaining time you have. Curative cancer treatment, for instance, may usually involve chemotherapy, radiation, surgery, or a combination of those regimens. Yet those regimens have their own side effects and risks. Your medical team may not recommend any of those regimens given the advanced stage of your disease. Or they may recommend one or more of those regimens in a modified form to slow if not cure the disease. Listen to and question your medical team, and consent to treatment that they can justify to you in the overall evaluation of your condition and goals. Don’t abandon all curative care if it could potentially improve your course.

Palliative

Palliative care is a specialized medical discipline focused on relieving symptoms of disease, whether or not your medical team can cure the disease. The goal of palliative care is to improve the quality of your life, in whatever stage of life and disease you find yourself. Palliative care, more so than preventive care or curative care, may be where your medical team places the emphasis for you, based on your diagnosis, prognosis, and the nature, stage, and course of your disease. Palliative care may address and relieve otherwise-debilitating symptoms like pain, nausea, fatigue, and shortness of breath. Palliative care can include medications, therapy, equipment, procedures, and any other medical intervention that would reduce or relieve symptoms. A skilled palliative care team can also help address healthcare-related issues like paying for medical care, transportation for medical care, and temporary housing while receiving medical care. Seek the assistance of a qualified palliative care team. Their intervention and support may be a godsend on your journey to transcendence. 

Hospice

Hospice care is the specific form of care devoted to end-of-life issues, typically when physicians diagnose a patient with six months or less to live. Hospice care may incorporate and depend heavily on palliative care. Your medical course at the end of life may require or recommend medical intervention for relief from disease symptoms. But palliative care may be appropriate for patients at any stage of life, not just in the course of a terminal illness. Hospice care, by contrast, is for the terminally ill. Hospice care, devoted specifically to those facing a terminal illness or otherwise at the very end of life, adds spiritual and practical components to your care, appropriate for the end of life. Hospice especially focuses on keeping you in your home or another setting where you can have the company and reassurance of your loved ones. Hospice care may rely on a team of physicians, nurses, aides and attendants, medical social workers, counselors, and trained volunteers. Hospice services may be available to you in your home, a nursing facility, the hospital, or a special hospice facility. Seek hospice services as a part of your healthcare on your journey to transcendence.

Complementary

You may find that complementary medicine can and should play a role in your healthcare on your journey to transcendence. Complementary medicine involves holistic therapies like massage, vitamin or other dietary supplements, music therapy, biofeedback, aromatherapy, visualization, reflexology, chiropractic or osteopathic manipulation, acupuncture, journaling, and art therapy. Complementary medicine can also include specific forms like yoga, tai chi, reiki, and qi gong, associated with Eastern religions, forms, and practices. Practitioners refer to these non-traditional disciplines and practices as complementary medicine when used alongside traditional forms of Western medicine like medication, surgery, and physical therapy. Practitioners may refer to these non-traditional disciplines as alternative medicine when used in place of traditional Western medical practices. Use your discernment when incorporating complementary medicine in your healthcare in the course of your journey to transcendence.

Integrative

As just suggested, your medical team may be more than willing to permit you to incorporate complementary medicine into your healthcare regimen in the course of your end-of-life care. Medical practitioners may justify and treat a mix of traditional and non-traditional medical practices as integrative medicine, even when they have training in only one form. The point is that you should get to choose. Listen to your medical care providers, but don’t let negative attitudes about complementary medicine affect your decision to incorporate them into your healthcare, if you discern that is your best course. Some of the finest Western medical institutions and medical practitioners in the world welcome complementary medicine within an integrative medicine approach. It’s your journey. You make the best of it, while listening to and relying on a skilled and balanced medical team.

Experimental

Experimental medicine involves studies on humans to test and validate new medications and procedures that may have benefits in preventing or treating disease. Do not look at experimental medicine as a sure or likely way out of your demise. Its purpose isn’t to offer renewed hope of a cure. Its purpose is instead to advance medical knowledge through experimentation on human subjects, when the outcomes of that experimentation remain largely unknown. Experimental medicine can cause serious side effects on its human subjects, as the consent forms that you must sign to participate will show. Experimental medicine may hasten your demise or worsen your course, rather than accomplishing the opposite. It may also require time-consuming travel, appointments, testing, and treatments, consuming your limited time and distracting you from other preparations that may be far more important to you. Beware experimental medicine. Be wise. 

Insurance

To avail yourself of anything other than emergency medical care, you must generally have a means of paying for it. If you are under age sixty-five and not permanently disabled, your payment for healthcare services generally depends on private health insurance. If you are employed full time, your employment likely provides health insurance. If you plan to terminate your employment, you may elect COBRA continuation coverage, although you typically have to pay for it, and you may find equivalent insurance at much lower cost on the private market. Once you reach age sixty-five, you may qualify for Medicare. Plan to enroll in Medicare in the months leading up to your sixty-fifth birthday. Medicare, though, may not be enough to pay for the medical care you need or desire. Supplemental private insurance is available to provide for greater coverage than Medicare alone provides. Many senior citizens arrange and pay for supplemental private insurance. The cost can be low or even subsidized and free in some instances. Medicare, Medicaid, and many private health insurances may pay for hospice services. If you don’t have obviously advantageous healthcare insurance already arranged, consult a qualified independent insurance agent to present the best options to you.

Access

Maintaining private health insurance or qualifying for Medicare or Medicaid with supplemental insurance should help you pay for most if not all of the medical services you need. Yet your ability to pay for medical care does not guarantee your access to it. Medical practices don’t always take new patients, even when those patients have critical needs. You may live in an area where medical services that you need are unavailable or in such short supply that you face delays in receiving them. Or medical services may be available in your area, but you may lack transportation to them. If you face issues accessing medical care that you cannot resolve through your own efforts or with the help of your spouse, adult child, or other family member or friend, get help from your physician’s office, a medical social worker, your local social services agency, your church, or another qualified representative if you can. While you may wish to remain in your home and local area, consider a temporary move to another area where critical medical services are readily available, if you cannot get those services in your own area. Your medical condition remains a significant factor in the assured course of your journey to transcendence. 

Spiritual

Your healthcare also has a spiritual component to it, as even medical practitioners dedicated to their own healing arts will acknowledge. Your spiritual condition, including your attitude, trust, faith, confidence, and assurance, affects your physical and mental condition. Your prayer, worship, fellowship, fasting, and other devotion may be far more important to your health and course in the last leg of your journey to transcendence than the medical care you receive or don’t receive. Don’t ignore your medical care or your diet, exercise, and health in general. Keep up a responsible medical regimen, as your medical team advises, so that you have the comfort, clarity, and capacity you need. But at the same time, and to a greater degree, lean on your spiritual disciplines while accepting the spiritual encouragement of others. Miracles happen, influenced by the hearts, posture, confession, and character of those who seek, see, and welcome them.

Reflection

How is your health, aside from the disease or other condition bringing you to the end of earthly life? Can you make some adjustments in diet, exercise, or lifestyle to relieve health stresses and improve your general health condition, to strengthen you for your transcendent journey? Are you cooperating with your medical team for exams, tests, and screening, so that they can address emerging conditions to preserve your health and capacities? Has your medical team recommended curative measures that may slow the progress of disease while helping you retain your mental and physical capacities? Do you need palliative care to reduce and relieve symptoms? Have you enlisted hospice care to coordinate palliative care at home among your beloved family members? Are you interested in integrating complementary medicine in your regimen? If so, do you have your medical team’s support? Have you enrolled in Medicare or do you have private health insurance to pay for needed medical services? Are you facing problems accessing the medical care you need? If so, can you enlist professional health advocates to gain that access or recommend alternatives? Are you relying on prayer and your other spiritual disciplines appropriately? Do you desire spiritual support from your pastor or church?

Key Points

• Healthcare continues to be a significant interest in final earthly days.

• Preventive measures may abate to some degree but can still help.

• Curative care may continue but shift toward slowing disease progress.

• Palliative care can relieve symptoms and improve quality of life.

• Hospice care coordinates medical care with home and spiritual life.

• Complementary medicine may play helpful roles in symptom relief.

• Integrate medical disciplines for your greatest quality of life.

• Beware experimental medicine for the side effects and burdens.

• Qualify for Medicare and maintain health insurance to pay for care.

• Get help with transportation, housing, and other care-access issues.

• Lean into spiritual disciplines as a foundation for continued care.

Read Chapter 11.