The Fast-Rising Tragedies of Death of Despair – A Deep Dive Into Our Current Medical Systems-Part Two-

Joe: I sent you some articles about drinking and how the face of the dying alcoholic has changed. Would you mind sharing a bit about that?

Todd: What do we think about when we think about an alcoholic who drinks himself to death? You think of that white-fisted Irishman slumped over the bar, right?

Joe: I think of a hobo in a suit. I think back to 1930s television, where a guy is holding a paper bag with a wine bottle.

Todd: And we're seeing people in their 20s and 30s now. NPR did an article written by Jessica D., and she lived what she referred to as two lives. She was an immigrant, went to college, and became Kentucky's teacher of the year in 2019 in her early 30s. So, she was this super teacher in Kentucky during the day, but she was drinking hard alcohol at night. She got what's called Alcoholic Hepatitis. Have you heard of that?

Joe: I've briefly heard of it. Could you explain it?

Todd: Well, it's inflammation of your liver from putting bad things in your body, and it can lead to irreversible scarring. And if you don't stop drinking, it can even kill you and it can kill you quickly. Now, this is a healthy, vibrant woman with a career, but this is not an isolated case. She noticed that she couldn't keep any food down; She just couldn't eat anymore, and that's very common with alcoholics because they drink all their meals. So, it ruins the stomach, and they start to get that toxic look which is the yellowing of the eyes. They literally become toxic, and it's just alcoholic liver disease. Now, for people in their 20s and 30s, these cases are up by over 30% right now.

Joe: That is so much, and I can't stress enough that it can happen to anyone. I know people who have started down this road who were all well-educated, but Millennials who got burned by student loans and who are facing the inability to get a house. They are not bums on the street.

Todd: The most dangerous and overlooked are women, young women because it can be part of their personalities to go out and have drinks. And it's more of a threat to women because their bodies are smaller, so they don't process alcohol the same. They also have a lot of pressure with the pandemic, etc., making alcohol a very unhealthy release.

Joe: In one of our earlier episodes, I threatened that we would do a whole episode about medical insurance because I hate our listeners and want to bore them to death.

Todd: Speaking of despair, that's how Joe killed a few people.

Joe: I want to demonstrate to our readers what it’s like to want to drink until you pass out. When I claimed that hospitals are profit centers and medical insurance is basically leading this charge, back in 2020, The New York Times covered the covid insurance profits. Now, before this covid year, the Affordable Care Act came out, and insurance prophets were supposed to be capped. The idea is that everybody needs to buy insurance; it's required. And so, the profits that these insurance companies made were limited because they're supposed to be competitive, and it was supposed to lead people to buy health coverage. It was also supposed to make insurance companies more competitive with each other. I'm not an economist. So, we're just going to link you to articles. But of course, what ended up happening is the opposite. Some of the largest companies like Anthem and Humana, and UnitedHealth Group, just reported second-quarter earnings that are double what they had a year ago before covid, and then it was about double that again before the Affordable Care Act came out.

Todd: You’d think a pandemic would bankrupt these companies, right? All common sense would say that would put you under.

Joe: You’d think so. You would think with the pandemic, then shelling out money for PPE and ventilators, etc., insurance would be losing, but that's not the case. They are just raking in money. As I said, they doubled their profits, and according to this article with the requirements, the consumers should benefit from the excesses they've made in the form of rebates. In fact, that was part of a contractual windfall that if they made too much profit off Americans who needed to be insured by law, they would pay that back to the American system and the people paying for insurance. And that hasn't happened yet. So, this is like the second or third year. The New York Times has done an article about them specifically and how the three major insurance groups haven't paid the American people back.

Todd: Do you think medical doctors will see someone like your father or my grandfather and kind of give up?

Joe: I think that after we have done episodes on how we callous ourselves to preserve our personal narrative, yes. There's only so much sympathy you can have, and I think medical professionals reserve it for people who are making changes in their lives. I don't want this episode to sound like I'm blaming doctors; I blame a medical system that limits the time they have with their patients, and I blame an insurance system that puts a premium on the speed of the process. I actually respect the hell out of the doctors who saw my father and what they wrote on his chart. And I think they actually did want to send him through a processing system that gave him a slightly better chance. I don't think it was the doctor’s fault.

Todd: It’s sad because how low do you have to go? It's one thing to lose jobs, lose financial security, lose your family, your kids, your wife, your ex-wife, but then when your physical health goes, and you feel just horrible, at what point is that not enough?

Joe: Right. You went to Reuters and got some numbers for us on how long you get to spend with a primary care doctor. Would you mind sharing that?

Todd: So, appointments in the world range from in Bangladesh to 48 seconds to 22 minutes in Sweden.

Joe: 48 seconds? That's a hand wave, not a doctor's visit.

Todd: Yeah, it also says 20 minutes in the United States, but now it is more like 17 minutes. And of course, the shorter you talk to the doctor, the less likely they will get all the right information. Shorter visits mean poor health for the community. Alternatively, the longer the doctor’s visit, the healthier the community. This came from a study done in Cambridge. According to them, shorter visits mean more wrongful diagnosis, more paperwork, more prescriptions written, and ultimately more doctor burnout. But for all of you who have never been to Bangladesh, we have that same service here in America. It's called Zoom. Have you been to those clinics?

Joe: Yes, I have done Zoom clinic meetings before.

Todd:  No, not zoom online. It is an actual clinic named Zoom.

Joe: Oh, really?

Todd: They're like franchises for urgent care visits. It's like speed dating. They get in, and they get you out. It is the worst health care you’ll ever see. It is like Bangladesh speed. How do you feel about just being able to just commit people for their own protection?

Joe: Circumstantial. If they're an immediate danger to themselves, I believe it's a good thing. I think that just purely going by data and research. You can separate somebody from a place and bring them to a group of people that encourage them. A break like that is actually a really good (not a solution), but a start to a solution to keep somebody from harming themselves. But the problem is I also believe in personal freedoms. So, the idea that you would do this for everybody who is habiting themselves to death, I don't know if that's moral. Generally speaking, we cannot commit everybody. We need a quality of life and a medical system change - not an emergency care change.

Todd: This is coping with stress, right? A lot of this is a coping method for younger people. And this leads to that 30% of liver failure and liver hepatitis.

Joe: I didn't realize until we had done our episode about errand fatigue how many businesses now run off the gym membership model. I'm currently signed up for a credit monitoring system, and if I forget to cancel it next year, I must pay them $300. So, I wrote myself a note in a Google doc to cancel it at a certain time. But there are so many people I know who will keep paying that. Same thing with most rewards programs. So, what I'm thinking now is we have talked about medical billing, and we had medical billing as sort of a side mention in a totally different episode. I'm starting to really be convinced that most medical billing runs off this type of errand fatigue.  

Todd: I guarantee that I have paid many medical bills that my insurance probably would have covered if I had just had the time and energy to fight it and actually follow up.

Joe: Exactly. There are legal experts who specialize in contract writing who cannot diffuse what a medical bill is explicitly saying - how they're describing your bills, how to pay them and what you're paying for. It’s crazy that an entire medical industry has cropped up around basically errand fatigue. Basically, they are charging people in a way where they don't know exactly what they're being charged.

Todd: You’d think that profession would be above that, right?

Joe: I think they are. I think the doctors are doing their thing, and then behind the scenes, the bean counters are the ones figuring out the most efficient way to bill people and that is doing it in a very tiring, grading way that makes you exhausted to even read their bill. So now we're getting into a period where covid has scared people away from the hospital in general. Combine errand fatigue that you feel reading a medical bill, the time that the doctors don't have for you, and now you think about how many people don't want to go to a hospital because they're afraid to get covid.

Todd: Yeah, a lot of small practices had big declines in the revenue to the point that they are actually having to privately raise money with things like GoFundMe pages. With all this shortage of doctors and covid, the Texas Medical Association found out that 68% of their state doctors had their hours cut because of covid, and 62% of them were being paid less.

Joe: You’d think that would be the opposite. You'd think during a plague, they would want their doctors on hand and well-paid and ready to fight a pandemic. Instead, they had such a drain on people not showing up because they didn't want to get sick from going to the hospital. Did you have any friends that did this? Do you know anyone who avoided the hospital like me?

Todd: A lot. There are even people in the studio raising their hands right now.

Joe: These hospitals, were they able to apply to the government for financial aid, anything like that? Was there a government grant for hospitals?

Todd: Well, one of them did a GoFundMe page, and they raised close to $100,000.

Joe: Oh my God. For medical practice during a pandemic, that is so crazy. Was it the GoFundMe guy or the Kickstarter guy who recently went in the news to say that they were embarrassed that their page is now being used to fund disease-fighting? They were like, my page was never supposed to be a replacement for medical insurance.

Todd: Well, those are the people who need the help, the sick people, right?

Joe: I think the very least thing we can say is GoFundMe and Kickstarter were not intended to be medical coverage for anyone at any point, and the website owners of those websites agree with that. They don't believe in it either. Now, why are we kind of drifting into cancer territory? While I was looking into my father's death, I had a conversation with one of the people who worked in the medical examiner's office, and they told me that when my father passed, it was “natural causes.” However, natural causes is also a catch-all term, and death of despair is a catch-all term. It doesn't have an actual technical definition. But is it natural to die when you have all these illnesses from drinking, and your liver is shutting down? And they said basically yes; they will. They will write ‘natural causes’ when you have all of these illnesses (no matter your age) because it would cost extra money to do an autopsy or call the hospital and get them to tell them what the most likely cause was.

Todd: But it’s a good use of time to explore deeper. I know it's different when it's your own family but as an overall rule.

Joe: I think it would be a good use of time to know so that we have good statistical data for it. In my father's case, it would have been a waste of resources to do an autopsy. I believe that it would have been unnecessary to find out exactly what killed him. Except for the cause of death, I would have liked to add that number to the statistics of how he died. If it was liver damage, I would have liked him to be counted among the 89K people who died that month of liver failure. If it was cancer, I would have liked it counted toward that. I believe in numbers, and I believe in having data for these things.

Todd: I always get furious when someone passes away, or let's say someone dies of lung cancer - what's the first thing they say? Oh, did they smoke? And they dismiss it as they got what they deserved.

Joe: It is so funny you mentioned that - the question of what they did to put themselves into that danger. Whenever anyone dies, people ask how it happened. And then when somebody says, oh they smoked, they drank, they whatever, it makes them feel better because they can check that box that they did something wrong. If they didn’t do those things, then it's a fluke. If somebody else does something wrong, then they somehow deserve it.

Todd: Well, when you get to my age, pushing 50, any time a celebrity dies that you have followed all your life, you start doing the math, right? I got 12 good years left, right? And when your father passed, you went into a bit of a spin. You started looking at your own life, right?

Joe: Oh, absolutely. I started looking at my health because a lot of his health risks matched mine. I looked at his health chart and I was like, heck, I'm working on half these things and the same genetics. I have gotten more tests, and I've done more for myself to take care of myself at my age than he has at his age. When he was 38, he didn't work out. He didn't eat right. He generally treated himself very poorly, but I can always do more. And that's kind of what our show is about. Our show might as well be called: I could always do more for myself.

Todd: And about hope. If your father had more self-awareness, if he had a little hope, whether it be a new relationship, a new job, a new hobby, or just a new group that he joined to get better, it might have empowered him to take better care of himself.

Joe: I think at the time before he passed, every other week when I talked to him, I was trying to convince him to keep going in to see the doctor. He was fed up and he was tired. He didn't like being processed. He didn't like seeing people and feeling like he was a burden on them. He didn't like having the doctors look like they were tired of dealing with his problem. So, he stopped going and every other week, it was me talking him back into making appointments and keeping them.

Joe: I have been at some lows like that, and I kind of know what your dad was feeling. You just don't like the way you are looked at by people -looking down on you. It's that pity look. It's a horrible feeling to have people just feeling sorry for you.

Joe: I've felt that. One of my best interactions with another human being was during one of my ER visits. My stomach had shut down for unrelated reasons to drinking. I thought it was a drinking issue. I thought I quit too late and that I had done something to my liver or my kidney. But they tested me, and I was fine. It was basically ulcers. And he came back to me, and he shut the door. He asked my family to leave, and he said he had good news - everything was fine. But I'm going to talk to you alone anyway, and then he talked to me about drinking, and he asked how long I stopped. And I told him, and then he kind of had a very frank discussion with me where he said, you won. You got off scot-free, so keep going, and regress; don't fall off the wagon. If you can avoid it, don't hurt yourself. It stunned me. I generally did not seek much support. I went my own way, and I barely talked to the doctors about it because so many of them processed me. But having somebody stop and actually have a frank conversation with me - it was the first time that it happened, and I'll never forget it. He gave me a term that I keep using which is, don't be great. Don't try to be the best or accomplish something all at once; just try to have more good days than bad.

Todd: I like that. Because we try to be perfect, but we can't, and then we feel guilty when we fail again.

Joe: If you're dieting and you have a day where you eat a ton of pizza and ice cream, it's fine. Don't kill yourself over it. Just try to have more good days that week than bad. Same thing with drinking, same thing with anything you're doing. After talking to the medical examiner, I thought about grief kind of the same way where you don't want to cut off grief; you want to take its course and mourn and have that emotion. And I thought about it the same way, which is just to have more good days than bad. Something I had to really question is when I talked to my family, I didn't have all the information yet. And so, I told them death of despair is basically what it looks like. They wrote natural causes, but really it was liver diabetes, high blood pressure, all these things. Mostly it was the death of despair and him not wanting to be processed by the hospital. It took the pressure off the people. My family especially felt better when it was the drinking. When they could think, oh, the reason we had stopped talking to him and he is no longer with us is because of drinking; that made them feel validated. They didn't feel guilty for not having reached out to him, but it was an uncontrollable force that every one of us will face at some point. Everybody will die at some point. But mortality by all types of cancer has been dropping since the 90s due to better technology and better awareness. If you look up the mortality of any type of cancer, the rate that people are surviving all cancers is crazy. It's getting good. But the problem was that my father was being processed like cattle through the medical system. He was being fed through a line, and they didn't discover a lump on his spine quick enough, and they did not know it was associated with what was happening with the stomach. So, the only way I found this out wasn't through his medical records. It was so recent that it happened. It didn't show up on his paperwork. I didn't see it in his medical records. I only knew about it when I called the medical examiner. She let it slip; she was looking at his paperwork, and she saw a note that it was potentially cancer-related and that it was not something that had malignant and spread because they were tracking the wrong things. When he went to the hospital, they had so much to look at in such a short amount of time that they missed it.

Todd: They watered it down and addressed the most immediate stuff that they could.

Joe: Right. If someone comes in with seven potentially lethal symptoms from different causes, all of which are despair-related, what are you going to look at? Well, they will not tell him to go through an x-ray unless he obviously has a lump or something. So yeah, that is actually my question that I was going to ask you is - would you tell your family if they were all saying it was drinking, as that relieves them of guilt for stopping communication. But do you go back and tell them it was potentially cancer?

Todd: After this conversation, I would say it's death by despair. But to me, I'm still having a hard time separating this from suicide. I mean, they got to be related.

Joe: Yeah, that is a good question. Like that Kentucky teacher, the young people are drinking themselves into a bad liver or hepatitis liver. Would that be considered a form of suicide if you drink yourself to that so quickly?

Todd: When you're older, yes. I think when you're young, you really are not thinking about the consequences. So, you can see you're a danger to yourself, but I don't think you really know just yet. I think as you get older, it becomes more of a choice. But then it gets more ingrained in your day-to-day life and gets harder to break.

Joe: I think the takeaway I'm having from this is everybody is worn out. And everybody is tired, and everybody is equally being processed in the slow soul-draining errand fatiguing way. The only thing we can take away, or the one I will take away, is to try to listen when people tell you that something hurts. And I guess, readjust the face of who's hurting. Transition from what we talked about where a death of despair used to look like an old Irishman drinking at a bar. Yes, it's hard to adjust the face of somebody who is ingrained in pop culture as a dying drinker. It's hard to adjust that from an older person over their middle years, somebody who has lost their wife and kids to drinking and is now about to drink themselves the rest of the way to the grave. To see that as a mid-30s mother who has a job, that is a jump that my brain just can't make, but I think I have to.

Todd: Well, another jump is your father. He had beautiful children and grandchildren. He could have enjoyed that, and it's a shame that he just passed on all those miracles to where they decided they didn't want to be part of his life. That's a tragedy to me.

Final Thoughts

So, what killed my father? He was tired of being processed. He was tired of the screen we've let corporations build around our essential services. He was tired of the errand fatigue and constantly filling out applications as if he was signing up for another online newsletter. He was tired of doctors treating his medications like a cable subscription. So, you want the heart and liver package for $400 a month or just the blood and stomach basics for $200 a month? But most of all, economic despair killed him.

When I found his old resume, it broke my heart. The man held adult jobs but never cracked $12 bucks an hour. In his old essays, He talked about how much of a disillusion it was to move his kids into the cheapest neighborhood in Portland, which cops and renters still refer to as felony flats. His writing sometimes felt like a patriotic fever chill, early signs of being shaken long before more morals had been sanded dulled by the system. He wrote that he woke up one day feeling like America didn't care for its people. Germany had pride in its Fatherland. Russia is looked after by the motherland', except America is a landlord, not a parent. And she only cares for you if you're a breadwinner. If she can stop taking responsibility by rationalizing that you've made poor choices, she will.

Did my father refuse to be processed by the medical system out of stubbornness? Did he catch his cancer too late? Based on his records, it looks like he was mid-discovery. Stand in line here, step in front of the machine, put your hands up, turn around - oops, there’s a dark spot. So, the scans came back too late, not that it mattered. My father was on his way out anyway. His pseudonym when he wrote was stranded on earth, and when I arrived to clear out his apartment, there was nothing for me to do. My father, a renter of the American dream, died with his bags packed and ready to go.