This patient presented to the emergency room with complaints of shortness of breath. He is always on three liters of oxygen. He has end stage chronic obstructive pulmonary disease (COPD). He has a bad heart as witnessed by his defibrillator. He used to smoke 4 packs a day.
This is all smoking related disease. He has a barrel chested appearance and the flattened diaphragms. He's thin. This is the COPD metabolic syndrome. Folks with advanced stages of COPD require a lot of energy and calories to maintain their weight. He will never be able to eat enough calories to maintain his weight. In fact, he gets short of breath chewing his food.
He has chronic air hunger for which opiates may be the only answer. There is nothing acute going on here. There is nothing fixable. This is all chronic disease in the end stages of life. This is all self inflicted harm. This is all avoidable. This is not finishing strong.
I admitted a young man in his 30's who had been on prednisone since he was four years old for "refractory asthma". He is a two pack per day smoker. Here's a guy who can't get his asthma under control so he takes dangerous medications with a severe long term side effect profile and he has no desire to quit smoking.
Yesterday, I took care of an open heart bypass patient two months out of surgery who is smoking one pack of cigarettes a day. The day before that, I took care of a patient recovering from a stroke three months ago, who smokes two packs of cigarettes a day. And the day before that I took care of a 450 pound woman with life threatening super morbid obesity who presented with short of breath. She was too big for evaluation of any kind, including physical exam.
Our country has run out of money. We simply don't have the resources to care for people who care for themselves, let alone those people who don't. We have a Federal government pushing poor people into a government insurance program that's broke and that few doctors accept. Medicaid is going bankrupt and it isn't because it pays doctors well. In fact, many doctors don't accept Medicaid because they refuse to work for $4 an hour. Good for them.
Many folks just want the government just to take care of them. They want FREE=MORE. They feel entitled to a living standard they did not earn and they want someone else to pay for it. Just the other day I had a post heart bypass patient upset that his cardiologist said he didn't qualify for disability because his heart was doing just fine after surgery. In his mind, the patient couldn't understand how having bypass surgery wouldn't qualify him for life long disability. I helped explain it:
Happy: Sir, you aren't disabled. If anything, your heart is stronger now than ever before. Heart disease is the number one disease in this country and the leading cause of death. It does not earn you a disability badge nor a handicap sticker. I agree with your cardiologist. You should have a long life of fruitful employment to look forward to.
