“Money can’t buy life” —Bob Marley (1945-1981)
My wife, Pam, and I recently celebrated our 25th wedding anniversary. We have decided of late to stop giving each other gifts on such occasions in favor of providing each other experiences. We both have enjoyed times visiting Las Vegas but have always done so in association with a business conference. For our 25th celebration, we decided to give each other a trip to Las Vegas, free from any associated work.
A fair amount of time was spent in the casinos. We are both competent enough to play blackjack for hours on $100, sustained by the drink lady and table conversation. Few places on the planet are as entertaining when it comes to people watching, and we certainly enjoyed some much-needed time away from the cellphone and email.
We elected to spend one day driving out to the Grand Canyon, a natural wonder that must be experienced in person, since pictures just cannot capture the awe-inspiring grandeur of the place. Pam and I had visited the canyon a few years earlier on another Vegas trip, and we both remembered the experience fondly. I was doubly excited because, as we had done on the first trip, we rented a shiny red Mustang sports car. When you commute in a Prius like I do, which I am convinced has four hamsters under the hood giving it power, you can understand the appeal of having all those horses from 0-60 at your command, if only for a brief while.
On our first trip to the canyon, we drove to the west side, past the Hoover Dam (which we visited) to the portion on the Hualapai Indian Reservation. With the exception of the Grand Canyon Skywalk that opened on the canyon rim to some controversy in 2007, what really appealed to me concerning the reservation management of the canyon was how it was left in its natural state. As a tourist, you could walk right up to the edge of the rock wall and take in the canyon as it has been viewed for thousands of years. For a price, you could visit the Skywalk, but it was not required and, personally, I found it unnecessary. On that first trip, I did not begrudge the reservation for the money-making Skywalk, since it was a curiosity in an otherwise untouched scene. That visit was a humbling and deeply-moving experience of beauty that I will never forget. I was looking forward to repeating the experience.
The day of our recent second visit was blustery and even a little chilly. The scenery on the drive to the canyon was as I remembered, grand and cinematic like the Westerns I watched as a child. I was in a good mood. Our first indication that things had changed at the reservation park was the significant increase in buildings and monetary charges for parking and entering the park. We found the cost of our visit had increased dramatically from the first trip, and there were far more opportunities to part with your money, with the recent addition of several souvenir shops. This salute to capitalism for the reservation’s benefit did not bother me, and I was more than willing to buy my ticket for the canyon experience I remembered. That all changed when the bus dropped us off at the Grand Canyon Skywalk.
The open, unspoiled vistas I associated with this area a few years before were now blighted with solid grey-brown walls of fencing. The only “open” area was a 50-foot section of canyon edge that was guarded and supervised. The scene was further degraded by a chain-link fence ringing a vehicle park that was built right up to the canyon rim in support of the commercial Skywalk, sporting trucks, debris, and sterile gravel ground cover. The obvious design of all the fencing and view obstruction was to funnel the public towards the Skywalk to pay more to see the canyon, free of the fences (of course we had already paid to be driven out to the site).
Bob Marley’s last words to his son Ziggy as he lay dying from cancer in a Florida hospital were, “Money can’t buy life.” I believe Bob was expressing to his son what I was experiencing as I stared at the damage reservation officials had imposed on the beautiful canyon scene from my memory. In an effort to squeeze a few extra bucks out of this natural wonder, they had destroyed what originally had made it a “wonder.” Saddened and somewhat dejected, Pam and I walked a long circle around the fencing and enjoyed the canyon view as it was intended while sitting on a rock a few feet from the edge. We were quickly accosted by a park official who shooed us back to the sterile fenced area and even had the gall to suggest we were treading on ground never walk on by humans and he also mentioned there were rattlesnakes. Really? With all the fence-building, no human had tread on the other side of the fence? What self-respecting snake would be within a mile of the car park? In short, the Hualapai Indian Reservation canyon tour which had so inspired me was a thing of history. I will certainly never make the trip to this section of the canyon again.
Why am I relating this story, and what could it possibly have to do with medicine? I entered into the profession of medicine because I was intrigued by the beauty of helping others and developing a skill that was valued by society (and perhaps a few too many re-runs of “M*A*S*H”).
I do not deny that the prospects of making a comfortable living as a physician certainly influenced my choice, but this was not my primary driver. I was enthralled and inspired by the idea of medicine in service to humanity, the country and the community.
Today I see medical decisions being driven more from a profit motive rather than a basic need to help patients. Medicine in the United States is looking today more like a business opportunity and less like an essential human right and service. Like the reservation canyon destination, the beauty of this profession is becoming subsumed by the drive to sell medical products and services. We are somewhat insulated in federal medicine from these, in my opinion, very negative economic forces on modern medicine—but we are not immune. I feel Bob’s final thought would be no less poignant or prophetic if it was adjusted slightly to, “Money can’t buy medicine.”
“13. The delivery of good medical care is to do as much nothing as possible.” “Laws of the House of God,” —Samuel Shem
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