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Joel BelzVoices Joel Belz

Measuring health guesses

Don't assume the healthcare industry has it all right

The staggering numbers so typically associated these days with the coronavirus are bad indeed. But it’s hard to know how accurate all the numbers are. They may be high. They may be low. But journalists should not pretend that they’re precise. 

Asheville Pastor Bob Drake used to talk about the difference between gnosis (abstract knowledge) and epignosis (specific knowledge gained through personal experience). In God’s providence, I gained some epignosis about healthcare issues during 23 days of the waning 2020 calendar. That’s because late one October night, while sleepily making my way through a dark room of our house, I stumbled, fell, and fractured the femur in my left leg. 

I couldn’t move and had to be taken by ambulance to the brand-new emergency room at our regional hospital—where over the next month I received prompt, sensitive, and helpful care.

In God’s providence, I gained epignosis about healthcare issues during 23 days of 2020. 

Such care is not always predictable. Teaching the art of healthcare to a group of 12,000 employees in a dozen hospitals in western North Carolina is no easy assignment. Some will get it. Many won’t. Creating uniformly high standards is especially hard when there’s suspense about who will be running the show and what the standards will be. 

Only a few months before I checked in, the hospital and most of its assets and subsidiaries had been sold lock, stock, and barrel to a giant healthcare company from Tennessee. The signals of tension I was getting from staff from hour to hour were altogether real. The debate within the healthcare community over the relative benefits of for-profit vs. nonprofit structures was being put to the test—right where I could see it up close.

Other tensions also were evident. Part of the assignment for hospital workers was to promote both healing and comfort for my badly fractured leg. A much more elusive part of their assignment was to keep in mind my 7-year-old diagnosis with Parkinson’s disease. Even highly trained neurology specialists respond to some new problematic issue for a Parkinson’s patient with a simple “Sorry, we’re not quite sure just what’s going on. We’ll just have to charge that one up to Parkinson’s for now.” 

So now I live not only in the state of North Carolina but in the state of confusion as well. During my fourth week in a hospital bed, I lay there trying to wrap my drug-infested brain around some enormous problems. I hadn’t listened to the national or international news for three weeks or more, but I was tuned in to hyperlocal hospital news: bickering, squabbles, tensions of new ownership.

It all makes me wonder. We’re told that something approaching 360,000 Americans died during 2020 due to the coronavirus. We’re rarely reminded that something more than 3 million Americans died—of all causes—during that same 12-month stretch. 

Sometimes we’re told “underlying factors” played a part in coronavirus deaths, but it’s hard to know how large a part that was. Is 360,000 coronavirus deaths the right number? Too high? Too low? It’s hard to know. But it is sloppy journalism just to assume that the number is accurate. Future journalists and historians will be debating. 

Hospitals show us what we don’t know, but they can also concentrate the mind on what we do. In bed I could not help thinking of a song my father used to sing. I wish someone would sing it now. 

The Great Physician now is near, 
The sympathizing Jesus.
He speaks the drooping heart to cheer
Oh, hear the voice of Jesus!

Comments

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  • Laura W
    Posted: Sat, 01/16/2021 10:03 pm

    I know for my state they are dividing out which deaths had Covid-19 as an underlying cause versus a contributing factor (about 90% of the total list Covid-19 as the underlying cause). I'm guessing the percentages are similar elsewhere, but yes, this could all end up looking quite a bit different in hindsight, one way or the other.

  •  David H's picture
    David H
    Posted: Tue, 01/19/2021 06:58 am

    Yes, I recently met with my cardiologist who spent most of the time complaining and trying to figure out the new software system. And, after reading a lot of Schaeffer recently, I was struck how we really do view man as a machine. Apart from Coram Deo we are simply guessing.

  • HJ
    Posted: Sat, 01/23/2021 01:57 pm

    Why the need to diminish the deaths from COVID? What does it accomplish, except to try to discredit and humiliate the healthcare profession? Is this modern world incapable of admitting that they too are vulnerable to the scourge of infectious disease that regularly decimated their ancestors? Do we think we are better than those who endured the Black Death, the plague of Athens, the plague of Justinian, or even the recent Ebola outbreaks in Africa? Humans have perished in the millions from infectious disease for centuries. What is it about the hubris of the twenty-first century that makes people insist that it cannot be an infectious disease causing all this death this time?

    As for determining causes of death, people really do not understand what death is and how it comes about. Ultimately, when the body dies, the paths it takes to death, all caused by diffferent triggers, ultimately end up looking the same at the end - everyone, except perhaps those blown to bits in an explosion, dies of shock, which is an enormously complex series of events that cause greater and greater chaos in the body as it breaks down. When someone dies from a gunshot wound that was deliberately inflicted by somebody else, they do not die from the bullet directly. They may die of hemorhagic shock, due to blood loss after the bullet tore through their blood vessels, or from obstructive shock, if the bullet lodged in their heart muscle, or perhaps even septic shock, as the bullet carried bacteria into vulnerable organs in their body and caused massive infection. But, they still die, and the person who fired the bullet deliberately at them is still charged with murder. So it is with COVID. With the virus's capability of binding to ACE2 receptors that exist throughout the blood vessels of the body, the virus may in one person cause death from interstitial pneumonia (the lungs are rich is ACE2 receptors), as the virus causes thickening of the walls of the alveoli, blocking oxygen from entering the blood; while in another, it causes clots in the blood vessels that cause death from heart attack, or stroke, or pulmonary emoblism as the clots created by the presence of the virus lodge in vital areas cutting off blood flow; while still others may die of organ failure as the delicate circulation in the kidneys become blocked by small clots formed due to the virus and the kidneys, which are vital to keeping the acid-base balance in the body, fail, causing the whole body to go into imbalance as the resulting acidosis poisons other organs. COVID is the bullet that triggers the cascade of events that leads to death, and like the person who deliberately fired the bullet, COVID is still charged with causing the death.

  •  FVoltmer's picture
    FVoltmer
    Posted: Mon, 01/25/2021 11:07 am