A look at how we give care in the last moments

After a 5-month hiatus, I've returned, spurred by the threat of being booted from the blog's byline and the looming presence of another semester...

I want to share two articles on end-of-life care. If you have some time, read Atul Gwande's article in the New Yorker. (I really, highly, strongly recommend this article -- essential reading)

Next, read a shorter article on the same topic in the New York Times.

Gawande's article presents the end-of-life debate with perfect juxtaposition of fact, reason, and emotion. I found myself releasing my breath in long, deep sighs, as if to comfort myself with the control.

What happens when we are faced with a situation when tubes and pills and caustic solutions running into our veins and breathing machines and new organs leave us in more pain, more depressed, and alive not one day longer? On the day of our diagnosis, or even our birth, did we imagine ending our struggle like this?

"Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or 'It’s O.K.' or 'I’m sorry' or 'I love you.' "

A cultural phenomenon has led us to a place where we believe if we acknowledge death we acknowledge defeat.

I recently read a spiritual book that implored its readers to remind themselves of their mortality each day, then ask, "How do I live, knowing I will die?" By acknowledging death (for some this is more imminent than others) we free ourselves from trying to escape it and allow ourselves to focus on living.

This same concept can be applied to how we view, expect, and provide medical care in the last years, months, and hours of our lives.

Symbolism--That which makes us human

This summer, I taught Sociology. One lesson was that of Herbert Mead and Symbolic Interactionism. His theory of microsociology focuses on the meaning we ascribe to our individual interactions. Without going further into his theory, Mead relies on the tenets of Evolutionism, which states that language and self-consciousness are what sets human apart from animals.

Today, there was an NPR piece titled, What Makes Us Mentally Modern. Without mentioning Mead, it is an excellent exemplar of the importance of symbolism in our daily lives. Rather than researching when we become bipedal, the piece asks, when did we development symbolic thought? "Museums are full of bones under glass — fossils that can tell us when we became physically modern. But how do you find a fossil of a symbolic thought?"

Sociologist or not, it is worth a listen.

For-Profit Post-Secondary Schooling

In the education world, there is much debate on relatively recent influx of for-profit post-secondary institutions in American education. Everyone has seen ads for Phoenix University, and you probably know someone is who currently enrolled. In fact, Phoenix, the behemoth of the for-profit sector, currently enrolls more students than all of the Universities of California (e.g., Berkeley, Los Angeles, Santa Cruz, etc.) and the Ivy League schools combined (as cited in the Frontline piece below)! Thus, like it or not, for-profits are becoming pivotal players in our society.

Do these institutions fill a void in post-secondary education that 4-year schools and community colleges cannot cover?  That is, are they providing a much-needed service in our knowledge-based economy and our nation's endeavor of democratic uplift?

Or do these companies prey on people who are ill-equipped to succeed in college and leave them with seemingly insurmountable debt? Does their undying obligation of profit compromise the social benefit they provide? Specifically, do they exploit Pell Grants (tax-payer funded loans for students) for profit?

In my search for answers, I have come across three recent media pieces on this issue (For now, they will have to suffice until the peer-reviewed literature catches up). I think all three are illuminating and stoke the debate.

Frontline
College, Inc.

NPR: All Things Conidered

For-Profit Colleges Encouraged Fraud, Used Deceptive Marketing, GAO Reports

New York Times:
For-Profit Colleges Mislead Students, Report Finds

Through reading, hearing, and watching these pieces, the opponents' skepticism is well-outlined. For now, I tend to agree. To be fair though, we are still collecting facts. To be determined...

Solving the Textbook Problem

As I see it, there are three problems with textbooks: (1) content, (2) publishing, and (3) medium. That is, publishing companies have a heavy hand in deciding what content students learn, which is somewhat problematic in a democracy (but expected within a capitalistic society). In addition, as information grows and increases exponentially, it is becoming more difficult to maintain the relevancy of content. Second, a select number of publishers in California and Texas dominate the publishing industry, which is predominantly financed by K-12 school districts and college students. Finally, the idea of lugging a five-pound tome to and from school only to read 40 pages seems antiquated.

Given these problems, do we have solutions? Excitedly, we (seemingly) do. Through open-sourcing and e-readers, adapting solutions seems to be within reach. In a recent NYT piece, ($200 Text Book vs. Free. You do the Math) the plausibility of these options are addressed. The article's author, Ashlee Vance writes, "Over the last few years, groups nationwide have adopted the open-source mantra of the software world and started financing open-source books. Experts — often retired teachers or groups of teachers — write these books and allow anyone to distribute them in digital, printed or audio formats. Schools can rearrange the contents of the books to suit their needs and requirements."

Will this be the panacea? Doubtful. Is it an improvement from the current state of textbooks? Likely. The article is a worthy read, and I hope this issue gains more cultural and political momentum.