One Year To Live…

I am taking a bit of a sabbatical from working at hospice. It is not from burnout or disbelief in a wonderful discipline. It is just a time to step back to see if there is a better way to use my crazy talent for dealing with death and those that it affects from patient to family to friends. I wish I could tell you why the thought of the final days does not give me the willies. I guess I just view it as much a part of life as being born.

I have spoken many times of the fact that I don’t know of anyone who has beaten the rap. We have all been subject to the gut wrenching suddenness of a car accident or an airplane crash to a relative or someone we know. Death by disease is more commonplace but when it strikes a child or beautiful young mom or dad, the poignancy is magnified and find ourselves asking the perennial question of why? I am always amazed that people question how God could let this happen?

I am looking at all this in a variety of ways. Is there a better way to do Hospice? More importantly how do I get people to understand it better. It was always a bit of deep frustration to see a gurney roll through the front door and know that person had only a little more than a few days if not hours to live. We were glad they came but we could have made things so much more comforting if the had talked to us weeks and months earlier. I remember an eighty something man who accompanied his wife and the sheer acquiescence in his voice as he sobbed,”I just couldn’t do it any more.” Why have we failed to get the message out properly? Dunno.

Understanding comes with the exchange of ideas. Words like death, mortality and even hospice cause a drastic tune out of the senses. It is said that many people who receive the bad news from an oncologist or cardiologist never hear what is being said past the first few fateful words. So many of our patients over the years said they never had the conversation. Docs are an egotistical lot and that is a good thing. They think they can cure you of anything and to tell you that you are going to die is a devastating prognosis that no one wants to tell another human being. Even more so it is an admission of defeat. Finally we are teaching in med school how to improve one’s bedside manner. They are making progress but it is slow in coming.

A friend sent me an article about a group out of New York (where else?) who have put together a series of seminars called, “How to Live This Year as if It Were Your Last.” It actually runs nine months but who is counting? It is not so much for just the dying but for everyday blokes to contemplate mortality. From Wall Streeters to housewives. Now if you look into this it is actually done by two Buddhist monks. Here and now thinking. Don’t put your life on automatic.They probably get a little too mystical for me but I love the idea. What the hell would you do?

To begin Kathy and I have travelled a lot lately so I will not be visiting the Taj Mahal. I am growing weary of long flights and besides the slums and crowded streets of India aren’t exactly beckoning. I would go back and hang out in Amalfi or Hawaii for at least a month or two.Got to have my water fix. I could then eat plenty of pasta without any guilt. Nice glass of red and perhaps a cigar after dinner. Would I opt for the $250 vino? Probably not. Not being frugal but practical. A good question to ask though.

I would of course have my buddy Kath by my side if she could stand it. We just celebrated 45 years last Saturday and at dinner she was still smiling. Do you think she was acting? I have had so many wonderful friends over the years I would at least want to let them know how much they have meant to me. Undoubtedly I would try to wrench every last fun time out of my kids and grandkids but I would have to do it without being maudlin.

I would want to write. A lot more than I do now. No, don’t worry, Ted’s Head won’t become a daily occurrence. Just something to be put away and looked at someday. Then you could decide if I had anything worthwhile to say or if this guy was really as whacky as he seemed.Somewhere I would have to sneak a letter to my wife telling her just how much she has meant to me. I would want to figure out some way to reach out to people I have wronged in some way. Try to just make it right but then again that it might be a tad selfish to think that way. “What the hell took you so long, asshole ?” might be a very valid reply. Hold that thought.

Lastly I might try to put together a course like those far out priests of Zen did in the Big Apple. I would try to free people of their fears and prejudices. That is the most striking thing of knowing the end is near. You would no longer have to put on airs. You could bring out that crazy whatever that resides inside of all of us but convention says no way you can let out. You might want to sing or act. Critics be damned.
Isn’t life nuts?

Alright, enough of this madness or as friend told me my stream of consciousness. I hope I don’t bore you but on the other hand it is fun to look at life from a totally different slant. Just letting it rip. As if I had one year to live. It is wild and crazy and well, liberating. I hope in some way you can enjoy that same type of zaniness I put on these pages. With that end so poetically near I can’t tell you how alive it makes me feel. Life is good. I hope you can taste all its beauty. One year to live? I have a lot to do I’ll let you know how I progress.

As always
Ted The Great


When we are near death we don’t worry about how much money we have, whether you are white or black or Muslim or Christian. I don’t care what you think of me. There is a strange devil may care attitude which in the most ironic of moments is the first time in our lives that some of us actually live.

Every day 250,000 die for one reason or another.

In that seminar in NYC one couple divorced. He wanted to buy a motorcycle and she said he was riding alone because she was moving to Paris…without him. C’est la guerre. Another woman with breast cancer went to live with her sister in Hawaii.

With death facing one in the eye we say we want to do this and that. We make our laundry or bucket lists. Why do we have to wait? Why not now? Oh that’s right. You are too busy.

Too Big Not To Fail…..


We were at a dinner party the other night and I sat next to a lovely young woman who by her own admission was an avowed liberal. Fair enough. She said she was for more government and power to the people. I asked her if she felt that universal healthcare was appropriate? Of course. I then asked if we could afford the ultimate in treatment for 320 million Americans. For instance there is a new drug for cancer that would give someone with cancer an extra three months of life but at a cost of $250,000. Needless to say there was a pregnant pause in the conversation.

In these days of presidential aspirations we are being treated to all manner of hyperbole when it comes to what this candidate or that will do for you. Bernie is selling the everything for free Kool Aid and there is a large group that is drinking it up much to Hilary’s dismay. On the other side the Donald is going to build the wall that is bigger and better than anything in China and of course we are going to build a hundred more ships and yada yadda. How are we going to pay for it? Just leave it to Carl Icahn.
Leaving all the discourse aside I have reached the conclusion that we cannot afford one more iota of growth in government. No more programs, departments, sub secretaries or weapons systems. We have grown too unwieldy and beyond any genius of management. We spend $3.8 trillion per annum which is about 20% of our GDP. About $450 billion of that is money we don’t have, ergo the deficit. Including defense we have about 4 million employees in the federal government and nationwide there are 20 million in the employment of the public sector.

We have had a fiasco here in Denver which is the problem in a nutshell. As a center for veterans in the Rocky Mountain region, Denver is home to a rather large and antiquated medical facility. Some 20-25 years ago it was determined a new or renovated medical center was needed. Coincidentally the University of Colorado was building an entirely new campus in nearby Aurora. A proposal was made to share facilities with the Vets with equal advantages to both. The cost was to be around $325 million. Not so fast, TTG. The American Legion of all groups weighed in and said our boys needed a stand alone independent operation. Presto chango our congressional delegation fell in line and now we were headed to a singular development at much higher cost.

The story gets worse. The architectural firm got out of control and started designing block long atriums and zigzagging and curved walls. If you have ever built you know the cost of these versus squared off walls. Beyond belief the whole operation was started without a firm price. Finally they agreed to $604 million on the fly but only if the design was changed to more normal specifications. This agreement was handwritten on a legal pad which the builder and the VA signed. That’s for 1.2 million square feet and 12 buildings….on a yellow piece of paper.
Long story short the bill has now climbed to $1.73 billion and the number of beds lowered from 182 to 148. They still have the custom doors, windows and wooden floors. That does not include furnishings and equipment which add another $340 million. I can’t make this stuff up. And construction will not be completed until 2017. An aberration? No, the VA are having the same types of problems with hospitals in New Orleans and Florida.

Now you say let’s make someone pay for this lunacy. Can’t do that because the project managers and internal designers have taken early retirement. By the rules of Civil Service they are untouchable. I wish it was just the VA. The F35 jet fighter is overwrought with overruns and capabilities that are far less than first envisioned. The web site for Obamacare was originally pegged to cost $465 million but came in at $825 million. Go back to those 4 million workers doing who knows what with little management oversight. I guarantee there are people working in offices on programs that were shut down years ago and nobody knows why they are there.

There are three pieces to the puzzle. First and foremost is the agency. People have champagne tastes on beer budgets because it is not their nickel. They put everything into the design and then proceed to submit change orders well into the project. They have no profit and loss statement to worry about. They intentionally lowball the estimates. Usually the viability of a project is judged by its ability to make economic sense. They know that once we get into this or that the government vis a vis the politician will come through with the additional funding. But if the real facts were known if never would have gotten off the ground in the first place.

The second piece is our elected representatives who have gotten there because they have brought this to that governmental spending piece to their home district. He or she will do everything in their power to keep it there and crow to the electorate. And of course the supplier is there contributing to his campaign. Northrop Grumman, Raytheon et alia have strategically made sure that some portion of that ship or plane is manufactured in every congressional district in the country.

That is just bricks and mortar and hardware. We have not even begun to speak of medicine and wellness. Day care, food stamps, anti poverty programs, housing, transportation, airports…shall I continue on? The enormity and complexity of the problem boggles the mind. Forgive me if the latest and greatest idea doesn’t give me a warm fuzzy.

My solution is this. For the next two to four years we do nothing new. Congress and the executive branch twiddle their thumbs.They can do that. We put the departments on a budget. You want to do this? Then eliminate that. Forget about balancing the budget by 2020. Do it now at all cost. Now you and I can vote the bums out.We can all give up our sacred cows. But you and I know that won’t happen and that is why I say we are too big not to fail. It’s inevitable and incredibly sad.

As always,
Ted The Great


It is estimated that due to fraud and poor management the US Government pays out over $125 billion on funds annually that are unnecessary or illegal.Over the last five years, the GAO said it has made 440 recommendations across 180 areas where federal agencies can cut back on fragmented, overlapping and duplicative spending programs, but as of November 2014, only 29 percent of the actions were fully addressed, according to the report. Congress refuses to hold their feet to the fire and bureaucrats stonewall.

We have a debt of over $18 trillion. How much of that as noted above is the residue of waste and fraud ? We pay interest on that every year. That is the most galling of all to me.

Over the past three years, the Government Accountability Office found 162 areas where agencies are duplicating efforts, at a cost of tens of billions of dollars. Government agencies are spending billions on new mapping data — without checking whether some other government agency already has maps they could use.It took the GAO three years to identify the federal catfish inspection programs in triplicate, inefficiency of fragmented military uniform procurement, and overlap in almost 80% of drug treatment programs. I rest my case.

Naive or Stupid?….

There are times when I stumble upon things that have been under my nose for months or years and of course never noticed. It can be an occurrence or a modus operandi that causes me to shake my head. Sometimes in disbelief. Sometimes in disgust. Just part of everyday life and I missed it.

I had to go to the dentist upon my return from London. A week long toothache forced me into it. I thought I was Superman. Not to go into detail but it was a problem to be addressed and not in one sitting. The dentist prescribed an antibiotic and some painkillers….Vicodin by name. I really never gave it a thought.

By sheer happenstance there was a vignette on PBS that evening of a young man who had been a rising gymnastic star in the 90’s. A severe injury required surgery and you guessed it, Vicodin was prescribed. This wasn’t some nee’r do well loser but a highly dedicated and accomplished athlete. He got hooked and rehabbed on three separate occasions.He has now been clean for two years.I ripped up my scrip and put my investigative hat on.

This has been described to some degree as a heroin problem. A bit of a misnomer as the epidemic had its start in opiods. For whatever reason people were given pain killers but not for a couple of days but in some cases years. Doctors, lawyers, teachers, moms, dads and their kids. When they either ran out or the pharma supply became too expensive people turned to heroin as a more affordable option.

The causes are multiple. Yes, as in alcohol or other related addictions there are genes passed on in about 40% of the cases. To the rest it is an acquired taste. Got to be hip, got to be cool, man. In all of these areas dopamine is enervated and it feels good. The reality of pain is present but so is the euphoric state one gets in and it sure beats reality for a lot of people.

This is a relatively new phenomenon. In the late 80’s to early 90’s the wunderkinds of the world starting coming out with some impressive arrays of drugs to handle a lot of things. Cancer, high blood pressure, and of course pain. For some unknown reason back problems, neck pain, arthritis, headaches became more prevalent or at least more obvious. This was also the time the drug companies were allowed to advertise directly to the consumer via print or electronic media. If you had an ailment they had a solution for you and wanted you to ask for it by name. No, as a matter of fact you should demand it. And people did by the carload.

At first the doctors weren’t so much complicit as obedient. I have got a lot of pain and you owe it to me to prescribe or I will go elsewhere. What is a guy or gal to do? The multiplicity of regimens and specialties compounded the problem because no one knew how all these things would affect someone if taken in unison? The companies paid for studies and for testimonials. In essence we got more and more hooked. Some of it undoubtedly was an improvement in symptoms and quality of life. But some of it was downright abuse.

There were alternative forms of pain management from physical therapy to meditation. Wonderful ideas but time consuming. It is so much easier to take out pad and pencil. Besides we have been indoctrinated, and willingly by the way, that we can take a pill for whatever ails us. It is the proverbial three legged stool of patient, doctor and drug company.

I am not the Women’s Christian Temperance Union nor am I without sin as it relates to an occasional alcoholic beverage. But after working on Wall Street et alia I watch it like a hawk. How would I handle a la la cocktail? I have no idea but I am not about to roll the dice to find out. Do I want to accuse my fellow man out of disdain? Not really, but when I see the cost to us as a society I have to sit up and take notice.

The outcomes are staggering. There are 12 recovery centers in Manchester, NH where the TV show originated. The woman director who was recovering herself said the wait lists were endless. If she put in 20 more centers there would still be backups. These aren’t only the big cities but small to medium sized America. I hear of a heroin problem and I think Detroit or Chicago. Not Greeley, CO or a small hamlet in Maine.
In 2012, 259 million prescriptions were written for pain killers in the US. We are 5% of the world’s population and yet we use almost 90% of most name brand opiods. The chain starts with the doctors but amazingly 70% of the time ill gotten goods are provided by family and friends who get them written by their local GP’s. They either got their own doc to prescribe or the infamous “pill mills” that have really had made their name in Florida.

We can call them victims of a progressive society and its ability to come up with incredible products without real knowledge of long term consequences. We can cite the greedy docs and pharma who will always figure out a way to turn a buck. Or we can look at ourselves as being dismissive or all of the above. Name your poison The problem is not going to go away and in the long run it is you and I that will pay for the remedies. You don’t have to be naive or stupid to figure that one out.

As always
Ted The Great


Fully 52 million of our fellow citizens have participated in recreational prescription drug use. Last year there were over 25,000 deaths attributed to prescription drug overdose.

The US and New Zealand are the only two countries in the developed world who publicly advertise pharmaceuticals.

Opioid Addiction Disease Basics
Opioids are any of various compounds that bind to specific receptors in the central nervous system and have analgesic (pain relieving) effects including prescription medications such as oxycodone and hydrocodone and illicit substances such as heroin

Opiod addiction is federally described as a progressive, treatable brain disease

Any type of opioid can trigger latent chronic addiction brain disease
Opioid addiction disease occurs in every American State, County, socio-economic and ethnic group

Over 100 Americans died from overdose deaths each day in 2013
Drug overdose was the leading cause of injury death in 2013, greater than car accidents and homicide

About 8,200 Americans die annually from heroin overdoses

About 75% of opioid addiction disease patients switch to heroin as a cheaper opioid source

Adolescents(12to17yearsold) Every day, 2,500 American youth abuse a prescription pain reliever for the first time

Nearly 1 in 20 high school seniors has taken Vicodin, 1 in 30 has abused OxyContin

Over 50% of individuals 12 years or older used pain relievers nonmedically from a friend or relative

The number of opioids prescribed to adolescents and young adults (ages 15 to 29) nearly doubled between 1994 and 2004

In 2010, more than 6,600 women died from prescription painkiller overdoses (18 each day)Every three minutes, a women goes to the emergency department for prescription painkiller misuse
or abuse