[HN Gopher] Things I've noticed while visiting the ICU
___________________________________________________________________
Things I've noticed while visiting the ICU
Author : exolymph
Score : 98 points
Date : 2022-11-18 20:21 UTC (2 hours ago)
(HTM) web link (trevorklee.substack.com)
(TXT) w3m dump (trevorklee.substack.com)
| HEmanZ wrote:
| These threads always have lots of people jumping on doctors and
| their decisions/callousness/lack-of-reason/etc.etc.etc. My wife
| is a physician (OBGYN) at a major city hospital that primarily
| serves a very poor population. I'd like to share her schedule,
| and see if you think what kind of care you could perform under
| these circumstances:
|
| Monday - Friday - Wake up at 4:30 AM - Get to hospital by 5AM to
| start rounding on patients - Sometimes work inpatient all day
| sometimes clinic thrown in, but usually not done working until 7
| PM, without even a 15 min break or a chance to eat a meal (15
| hour day) - Come home and do about an hour of notes - At least
| once per week, wake up in the middle of the night to deliver a
| patient who asked for that kind of continuity of care.
|
| Saturday: - Wake up around 5am to be in by 6am to start the day -
| Work inpatient, usually without time for a 15min break for food,
| until 10AM SUNDAY (28 hours shift)
|
| Repeat 49 weeks/year (days of 24/hr shift can vary and she
| usually gets one weekend off/month). Her average time at the
| hospital last year was 96 hours/week.
|
| How much confidence do you have that you'd be able to take care
| of a complicated pregnancy at the end of a 28 hour shift, having
| not eaten for more than 24 hours, having 10 other patients on
| your mind, and having had only a couple of hours sleep the night
| before? It's no wonder to me anymore to me birth outcomes are so
| bad in understaffed hospitals in poor areas...
| thfuran wrote:
| That sounds illegal.
| HEmanZ wrote:
| Nope, not where we live.
|
| I have seen administration do some blatantly illegal shit
| around physicians with COVID, but I don't want to write that
| up here.
| rscho wrote:
| Doctors answer: yes. And?
| chips_n_fries wrote:
| And she is not a resident or in a training/certification
| program?
| DoingIsLearning wrote:
| > So, when it comes to prescribing (...) Giving psychiatric
| medicine "as needed"? Go wild.
|
| This implies a lack of duty of care which is painfully unfair.
|
| As a counter story to this I have a friend of mine who is a
| _former_ ICU nurse with a gigantic scar on her forearm.
|
| I much later in our relation found out that the scar is from a
| patient who basically ripped her forearm biting down on it while
| she was trying to stop him from tearing out a central line in his
| own neck.
|
| It's ironic that in trying to stop a patient from having a
| massive central line bleeding she ended up bleeding herself.
|
| Outside hospitals we fail to realize how disoriented and
| irrational patients can get when coming out of anesthesia or with
| certain diseases.
|
| So yeah 'as needed' is absolutely right because everyone is
| entitled to work in a safe environment.
| maxerickson wrote:
| The solution to difficulty booking doctors isn't to pontificate
| on how to allocate their time, the solution to difficulty booking
| doctors is to make more doctors.
|
| There's lots of levers that could be pulled in the US. Cut down
| on undergraduate requirements, incentivize large health systems
| to fund more training (people like to complain that the federal
| government only funds a fixed number of residency slots, as if a
| trillion dollar industry is just absolutely helpless to do
| anything).
|
| Medical care suffers under the bizarre idea that central planning
| and capacity management will control costs. Meanwhile, costs are
| spiraling up and up and up. Train more doctors and all the stupid
| games being played to optimize their utilization start to go
| away, because it is less worth it when demand is less than
| supply.
| spfzero wrote:
| I get what you're saying, but I don't think more doctors is the
| answer. Hospitals will only hire the absolute minimum number of
| doctors they can possibly get away with, other than the ones
| who actually bring in new business.
|
| This is the reason: as soon as the medical industry has
| established a consensus price for some procedure or other item
| of care, the hospital administration starts to work on figuring
| out how to do it for the least possible cost. The price has
| been set in stone, no need for further justification. Medicare
| or whoever WILL pay that much. The price is fixed so the only
| knob left to turn is cost, and cost will be reduced all the way
| down, until service is just above a level so poor that patients
| would decide to stay home.
| natosaichek wrote:
| Totally agree. Also, let people open more medical care
| facilities. Right now "Certificate of Need" legislation is
| killing lots of viable options for care _outside_ hospitals.
| e40 wrote:
| On why there are too few doctors:
|
| https://www.theatlantic.com/ideas/archive/2022/02/why-does-t...
| ntonozzi wrote:
| .
| maxerickson wrote:
| It's not illegal for other entities to fund residencies!
|
| I anticipated your argument in my other comment...
| NegativeLatency wrote:
| Just getting accepted to a medical school is pretty hard unless
| you're amazing/very good at the tests.
|
| Had a cousin and a friend (both I would characterize as smart
| and hard working) take several years after undergrad and
| eventually "settle" for physicians assistant schools.
| j-bos wrote:
| I personally want my doctors to be amazing and very good. For
| now tests a a fair proxy for that, it's the 8 years that seem
| ridiculous, esp when looking at non US countries.
| ncrmro wrote:
| I woke up in the ICU after getting hit on my motorcycle with a
| brain bleed and ton of other damage and all I can say it I'm
| super grateful for everything they did.
| Ensorceled wrote:
| I noticed a lot of the same things when my dad was in the ICU.
| Some additional thoughts:
|
| 1. "Almost every patient has delusions and nightmares" I
| personally felt "off" when visiting my father. The sounds,
| smells, lights and constant buzz of activity all contributed to a
| feeling of being in a surreal dreamworld. Lack of sleep
| contributes. I can't imagine what my father experiencing.
|
| 2. Food was HORRIBLE. One meal was a low quality hamburger on a
| plain, white bread bun with a slice of "american cheese", fries,
| iceberg lettuce salad with a couple of slices of cucumber and a
| single slice of tomato, a container of apple sauce and glass of
| milk. Lots of salad dressing and ketchup. They wouldn't let us
| bring better food into the ICU and my dad didn't want to "make
| waves".
|
| 3. Family is critical. My father got better care because I, or my
| brother, was there to act on his behalf. Having obnoxious family
| members is worse than having none from what I saw.
| tomcam wrote:
| Very well thought out article, but I promise your life will
| improve if all you do is read the caption on the first image.
| parker_mountain wrote:
| This is not a picture of a real hospital. This is a picture of
| Mystic Falls hospital, from the CW show "The Vampire Diaries".
| If I remember correctly, the guy on the left is an evil vampire
| hunter (the vampires in the show are mostly heroes, except when
| they're evil and trying to take over the world), and the doctor
| on the right is maybe a vampire? Or she might just be friends
| with a vampire but not realize it. Or she gets killed by a
| vampire. I forget and refuse to look it up. It's a really
| stupid show.
| bombcar wrote:
| I suspect it IS a real hospital, depending on if the show was
| set in a hospital or not. If they only needed it for a few
| scenes, you just rent out a hospital or something that looks
| similar enough.
| bbarnett wrote:
| No, it's a real hospital, and a real scene, but they're all
| reverse vampires.
| bombcar wrote:
| Isn't a reverse vampire just a blood infusion doctor?
| a_shovel wrote:
| I don't have much personal experience with hospitals, but there's
| a trend I've noticed across several articles now where the
| medical system is characterized by an unpredictable and frequent
| alternation between extreme competence and extreme incompetence.
|
| The author's dad was being seen by a variety of highly trained
| specialists all working to treat him, but "people need to sleep"
| seems to be a recent discovery in the ICU world, and if his
| family hadn't been there to help, every new nurse would have
| tried to give him the same medication that gave him a bad
| reaction, over and over, just because there wasn't an established
| place to write that (obviously important) information down.
|
| I've read that food with better nutrition than regular hospital
| food may reduce mortality rates by as much as _half_ [0]. That 's
| such a huge effect that it's shocking that hospital food is just
| expected to be bad. Everyone says nutrition is vital for health,
| but hospitals don't seem to care.
|
| I think the root problem is cost-cutting. Management cuts costs
| until the brink of disaster, and tries to hold it there for as
| long as possible. This is not a system that strives for the best
| outcome for patients within reasonable limits of the resources
| available; this is a system that attempts to extract as much
| value as possible from the patients, and patient death is only
| prevented as a means to that ends.
|
| [0]
| https://www.sciencedirect.com/science/article/pii/S073510972...
| blue039 wrote:
| tunap wrote:
| >"people need to sleep"
|
| Sleep is almost impossible with regular check-ups... 30 min or
| 60 min, don't remember. Excepting the comatose and most
| medicated(maybe not?), a person's sleep cycle is unable to
| reach REM when a stranger approaches and fiddles on regular
| intervals. I would think monitoring from afar(sensors, cameras)
| would be more beneficial, but I was informed the liability
| factors preclude such remote monitoring.
|
| edit: to add context, I slept in the room on separate occasions
| with 2 family members. While tests were not performed, the
| regular checks were mandated. I was exhausted after my shifts
| ended.
| cactus2093 wrote:
| From reading the abstract you are completely mischaracterizing
| this study.
|
| For the average person healthy food usually means food with
| fewer calories and more micro-nutrients, like eating more
| broccoli and less white bread.
|
| This study is about malnourished patients who need more
| calories than they can even digest from an average meal so they
| need specialized high-calorie foods that are customized for
| their own metabolism. It's essentially exactly the opposite of
| what "healthy food" means in any other context.
|
| So it has nothing to do with any narrative about cost cutting
| and the quality of ingredients used in hospital cafeterias.
| cco wrote:
| A closer reading of the intervention shows that it wasn't
| _just_ "more calories".
|
| But I think that is missing the forest for the trees, what
| this study showed is that when a patient is left on their
| own, they consume an inadequate diet that _puts their health
| at risk_ in a hospital. By a big margin!
|
| I would imagine, though the study didn't show this, that the
| primary factor in recovery here was having a human
| (dietician) actually paying attention to your recovery. On
| intake they put together a plan, and followed up routinely to
| ensure that the patient has consuming their diet.
|
| The GP's point is valid, hospitals are missing out on a 50%
| increase in health outcomes because they're letting patients
| fend for themselves with regard to nutrition. You're right
| that it isn't as easy as spending $6 per meal vs $3 to buy
| "better" food. But what it means is that hospitals are
| failing their patients because they aren't thinking and
| acting with a holistic eye towards patient outcomes.
| Negitivefrags wrote:
| I don't think the problem is cost cutting. I think the problem
| is just the same problem that every human enterprise has.
|
| Most people just don't give a shit outside thier immediate
| responsibility.
|
| Looking at the global view and actually making changes that
| require persuading other people is a hard and often thankless
| task.
|
| Many people who do give a shit get this crushed out of them
| early in their career by the negativity you will face if you
| try.
|
| Much easier to just accept the status quo.
|
| Occasionally you get a group of people who really care and come
| together determined not to let things be crappy and they can
| form an organisation that is significantly more effective for a
| time. But once the rot of "We can't fix things" sets in, it's
| really really hard to turn things around.
| msrenee wrote:
| Cost cutting is definitely to blame for how understaffed
| hospitals are. Then Covid happened and it got even worse.
| It's definitely not all due to Covid though. Even the "not-
| for-profit" medical group in my area has been pushing doctors
| and PAs to take more and more patients, well past what
| they're comfortable with. Nursing staff has been cut down to
| nothing compared to 10 years ago. Wages haven't gone up to
| match the increase in workload.
|
| Again, this started before Covid, the pandemic just
| highlighted how much these cuts screwed over both healthcare
| professionals and patients.
| rscho wrote:
| I work in a hospital, and occasionally in ICUs. You're wrong.
| Most workers are very much jaded, but they do care. Problem
| is, the system crushes you to death if you don't set pretty
| harsh limits to protect yourself. In a lot of cases, that
| means de-humanizing your work, put your feelings aside and
| work like a machine. Good little machines are just what
| management wants, right? Now higher management... wow, those
| people really don't give a hoot about anything that's not
| themselves!
|
| A second major contributor to inertia, is that the
| initiatives from lower echelons are usually set for failure
| by the intricacies of bureaucracy. And said bureaucrats are
| completely unimaginative about what they could do to fix
| things, because they never leave their office to see what's
| really happening in the trenches. So yes, in fine the problem
| is the extreme stupidity stemming from human collective
| behaviour. Complain, and suddenly _you_ are the problem!
| gowings97 wrote:
| What percent of patients have a medical need to be woken up
| every few hours then?
| rscho wrote:
| You'd be surprised to see what happens to staff going
| against waking up patients all night. You get the
| "dangerous sloth" sticker on your forehead real quick on
| the morning grand rounds.
| halpmeh wrote:
| Everything you said is spot-on, but, brining things full
| circle, the lack of "shit giving" could be due to cost
| cutting. People don't have an incentive to care. The end
| result, vis-a-vis their personal situation, is unchanged
| whether or not they go the extra mile. Part of this is
| because they exist in a rigid corporate structure hyper-
| focused on value extraction and not at all focused on the
| development of human capital.
| lazyasciiart wrote:
| I don't know why the haldol reaction didn't go in his chart,
| but the whiteboard in the room (which is present in every high
| level hospital room I've been in) is _exactly_ where the TV
| information and other patient preferences should be, and is the
| second best place after the chart to put a drug reaction. Cost
| cutting has nothing to do with "nobody wrote it on the place
| for writing it".
| colechristensen wrote:
| >The author's dad was being seen by a variety of highly trained
| specialists all working to treat him
|
| The training doesn't really matter. Context is very important
| as is caring about doing a good job. You'll find a severe lack
| of both in hospitals. You eventually have to stand up and
| defend yourself against bad healthcare... or search endlessly
| for good healthcare which is terribly difficult to find.
| citilife wrote:
| For point #4 (about sleep) and point #5 (about delusions) - these
| are probably related. If you don't get enough sleep you get
| rather paranoid.
|
| Having been in the ICU with various family members I notice they
| check on you A LOT and that often will wake you up. This lack of
| consistent sleep (either from injury, illness or checks) make
| people rather paranoid. Further, sitting still and waiting often
| makes people a bit stir crazy.
| ivraatiems wrote:
| My wife is a physician who works in a critical care setting. She
| did not read or approve this post; these are my thoughts as
| someone who hears a lot about the other side of this environment:
|
| For the most part this seems like a sensible and reasonable
| article communicating what must have been an extremely difficult
| situation for the author. In case the author reads this: I'm
| really glad your dad got better and I know everybody working in
| the hospital appreciated the amount of patience and restraint it
| seems like you showed in helping him without being that patient
| family member who goes off the handle about everything. (There
| are so many of those.)
|
| Many of the issues the author points out are very real -
| constantly-rotating doctors, attending disregarding consults once
| the consult leaves the room, the ICU not being set up for
| anything but bare survival - all of that is totally true from
| what I understand. I think, if anything, the author fails to
| understand how systematic and critical those issues are when he
| says things like this:
|
| > So, digestive issues, hormonal issues, and mental issues all
| get short shrift. Basically, if there's an obvious symptom, a
| consult will come in to try to treat the symptom. Then they'll
| take another test in a day or so, see what happens, and go from
| there. There's no sense of a scientific method, reasoning from
| first principles, or even reasoning from similar cases though.
|
| I don't think this is giving the medical practitioners a fair
| shake here. Doctors do a huge amount of this kind of reasoning
| and research, even in the ICU. The trouble is often not a lack of
| reasoning, but a matter of, as with everything else you note,
| resources. Like you realized, the goal of the ICU is "keep
| patients alive at all costs, and worry about their comfort once
| they're able to be alive without our help for a while." Judgments
| are made with that in mind. It's not that they can't do reasoning
| about complex problems, it's that spending time on a complex but
| non-fatal problem means somebody with a potentially fatal problem
| won't get that time, and that's not what the ICU is for. Anything
| that can be solved later... will be solved later.
|
| So the real question is not "Why didn't they help this patient
| with his digestive issues?", it's "Why didn't they move this
| patient out of the ICU once he reached the point where non-life-
| threatening digestive issues were relatively of any importance?"
| possiblydrunk wrote:
| From personal experience, one of the most frustrating things
| about the ICU (if you're there for any anything beyond a day) is
| dealing with the variability in the availability, skills, and
| temperaments of the nurses on duty. The 'right' nurse can make a
| huge difference in how fast the patient recovers and how
| difficult the stay is.
| mberning wrote:
| I think people expect that things could go significantly better,
| if the "system" were better. I disagree. In most cases, by the
| time they hit the ICU, you have a patient that is circling the
| drain from old age and chronic conditions and all you can do is
| manage it. No amount or quality of care is changing the outcome.
| jeffrallen wrote:
| Hospitals make you sick. Intensive care unit make you intensively
| sick. What a tragedy that something we need so much is so bad for
| us.
| [deleted]
| osmano807 wrote:
| Surgeon here. I'm about more surprised by the discussion here
| than from the article itself.
|
| > 2. There are many consults, but the ICU attending is king (or
| queen). There's a concept called _doctor 's autonomy_. The
| attending physician has the primary "guard" of the patient care,
| so unless dynamics of power, consultations are more like
| suggestions than law. So, the final care is generally dependent
| on the attending physician, for good or worse, be lack of
| confidence in the other physician be his perceived better
| understanding of the disease.
|
| > 3. Sometimes nurses are the footsoldiers of the ICU regent, and
| sometimes they're governors. I saw examples of nursing saving and
| harming patients while disobeying orders. They have a co-
| participation in care and generally have studied to a degree that
| enable them to make some decisions.
|
| > 4. Everyone agrees that sleep is important, but nobody has any
| idea beyond that. We have decades worth of knowledge, but _de
| facto_ we don 't have a systematized and validated way of sleep
| care. We have studies on daytime nap and on sedatives effects on
| quality of sleep, but no full truths. Some day we'll have a
| better care.
|
| > 6. The ICU staff is literally constantly changing. The
| institutional memory are the patient medical records. If the
| Haloperidol adverse reaction was not noted in there, it was a
| fault of the care providers. Sometimes nurses chooses to ignore,
| and the repercussions should be analyzed case by case. The cited
| whiteboard worked as an "expanded" medical record, as registering
| that trigger could be seen as too tangential to a disease focused
| medical record.
|
| > 7. The ICU is great at managing acute issues, and struggles a
| lot more with longterm issues. Long term issues are not the
| concern of ICU. If it's not critical, the care can and maybe
| should be postponed until better. Of course, we have to be
| prudent, for example bowel function could be potentially urgent
| if not intervened early. Frequently I could and should not treat
| patients depression on an ICU, but it's reasonable to treat
| intrusive symptoms of early post-traumatic stress disorder, for
| example.
|
| Free T4 is the method used to assess thyroid hormone
| supplementation, not TSH. Delirium, delusions, illusions and
| hallucinations have a non-pharmacological and pharmacological
| treatment, and antipsychotics are not the only ones used.
|
| > 8. The ICU is a good place to not die, but a bad place to
| recover. The ICU is meant to give patients a better opportunity
| to not be critical anymore. When they're not critical, we start
| to deescalate our measures, such as monitoring and IV lines, for
| example.
|
| People are different, and so are doctors. As the good, so the bad
| sprouts everywhere.
| pmarreck wrote:
| Excellent criticisms (having dealt with my mom's passing in 2020)
|
| I noticed that the incessant beeping all night has decreased
| quite a bit, of late (at least in my local hospital, St. Francis
| Heart Center)
| rootusrootus wrote:
| As a counterpoint, my experience with my dad being in the ICU was
| great. They saved his life a couple times when he needed to have
| his heart paddle-started. And they managed to stabilize him and
| let him get sleep as much as possible so he could be transitioned
| out of the ICU. I never once got the impression that anyone was
| incompetent, or that they were having trouble remembering
| strategies, reactions to medicine, etc.
|
| But this was Kaiser. Other hospitals may indeed be a shit show.
| wahern wrote:
| I wonder if there's a selection effect where on the one hand
| particularly demanding people avoid Kaiser because of the
| somewhat impersonal policies and practices, and on the other
| hand as an HMO Kaiser enjoys a much lower percentage of
| indigent and high-risk patients, which altogether permit Kaiser
| to build a system around the 80% instead of the 20%.
| chiefalchemist wrote:
| When when one of my parents had a stroke years ago, we spent a
| week in the ICU. It was a special ICU for stroke victims. The
| care and staff were exceptional. We were lucky such an ICU was in
| our area.
|
| On the other hand, subsequent hospital visits (non-ICU) were a
| cluster fuck. Noise, lights on, nurses constantly waking my
| parent up, could-care-less doctors, etc. And getting healthy
| enough to be transferred to an extended care facility was a shit
| show. It's was like the hospital but worse. Both experience
| seemed to have little to do with health and recovery.
|
| My point is, the article author is in for a shock once his dad
| gets out of the ICU and into the "general population". I can't
| imagine that's going to be better than the ICU. I hope I'm
| mistaken.
|
| My take away from this experience is:
|
| 1) Make choices that maximize your health the best you can.
|
| 2) If you can, be rich - like fuck you money rich. The kind of
| rich where your "general population" hospital experience will be
| like being in the ICU.
| rscho wrote:
| Rich people always get the worst possible care, in my
| experience. Life-prolonging care, yes. But at what cost? Those
| are the people that get the most "experimental" medicine out
| there. Rich people select for the most greedy docs, not for the
| most capable ones.
| [deleted]
| warner25 wrote:
| > There's no sense of a scientific method, reasoning from first
| principles, or even reasoning from similar cases though. It's all
| shooting in the dark, and most of the time I felt like I could
| have done just as good a job on these longterm issues...
|
| This articulates very well what I've usually felt when dealing
| with doctors. It's like the story of a programmer finding that
| his code outputs 5 when it should be 4, and then adding...
| if(return_value == 5): return_value = 4
|
| ...to fix it, and being satisfied. What I _want_ is something
| like in the television show _House._ The main character is
| unhinged and anti-social and takes extreme risks, but at least he
| demonstrates curiosity to really figure out and understand the
| root of what 's going on. To be fair, I don't actually think that
| doctors lack curiosity or are incapable of doing this, the
| medical _system_ as it 's set up just doesn't allow it. For
| chronic issues, I've usually figured them out for myself, as a
| layperson, by persistently keeping track of things, searching the
| web, reading, and experimenting over months and years.
| rscho wrote:
| I'm sorry but curiosity and creativity are certainly the ndeg1
| enemy of the patient, especially in ICU settings. Curiosity and
| creativity are grandpa's medicine, and a total antithesis to
| evidence-based modern medicine, that attempts (and largely
| fails) to be an application of science instead of the whims of
| the decision-makers.
|
| What you should want is curious and creative _researchers_, but
| precise and totally unimaginative clinical staff. Those are
| often the same person. See the problem? You want protocols
| applied down to the last detail. You want nothing left out of
| standard operating procedure. That's what kills patients in
| practice.
|
| You might mean creativity in the sense of "let's have guys who
| think about the right things, and search for rare diagnoses and
| analyze stuff to see what could work, like Dr House". But that
| simply can't be done in practice. You can't be testing for
| every rare thing, because the tail of low probability diagnoses
| is much too long! And believe me, you _really_ don't want
| creative doctors around...
| titanomachy wrote:
| If medical treatment was actually as formulaic and fully-
| solved as you imply, we wouldn't take the best students of
| every generation and make them spend ten years training to
| become doctors. We'd just have nurses, checklists, and
| diagnosis flowcharts.
| rscho wrote:
| I'm precisely not implying that medicine is currently
| "fully solved". I'm implying that we should strive to
| gather more information, synthesize it better and study how
| to make it useful.
|
| As a clinician, I'd say yes to a bicycle for the mind. But
| currently, my job is already plenty full with worrying
| about applying what's known in a correct manner without
| seeking to break new ground while treating patients, which
| would be very dangerous and given the odds of success, very
| stupid. What I'm implying is that the general public has a
| completely skewed view about what really kills patients in
| the ICU: mundane infections and "medical errors", which are
| not really errors at all but in a large majority of cases
| failures and complications of usual procedures.
| jmhmd wrote:
| The main thing that House MD has, that no other doctor in the
| world has, is not so much his superior intellect. It's that he
| and _five_ other doctors spend 100% of their time on a single
| case, and can sit around all day discussing it, trying
| different things. If real world doctors had even a fraction of
| that luxury, you would see a lot more of what you describe.
| lazyasciiart wrote:
| Also, the cases are usually in desperate enough straits that
| "here, swallow this seagull poop!" doesn't get hints thrown
| out of the hospital.
| coding123 wrote:
| Jeez, no kidding. I imagine if they made a realistic doctor
| show they'd be constantly showing the doctor at the bar (on
| days off) trying to make money on side gigs like health
| startups.
|
| Stumbling in a hangover to appointments on "work days" and
| giving everyone the same diagnosis as the last (and likely
| whatever sickness they themselves had recently). Also giving
| everyone fluids and an ativan so the patient says - "i feel
| much better doc".
|
| It's kind of an open secret that the ER just gives a
| diagnosis of dehydration, provides fluids and ativan to get
| the pipe rolling and charge $4k a pop. Sure they might catch
| a case of undiagnosed covid, rsv or something else from time
| to time.
|
| Also I'm not kidding but I would LOVE such a show.
| [deleted]
| kingsloi wrote:
| Interesting take.
|
| I was in a paediatric cardiac ICU when my daughter battled with
| heart disease for 7 of her 8 month life. Another dad who we got
| close to in the ICU said the phrase "practising medicine says it
| all...".
|
| My experience is same same but different. It was during COVID, so
| we welcomed the nurse change, sad/happy to see one go and welcome
| another. Paediatric ICUs and their staff, I'd say are top tier in
| most respects. Parents are involved with most/all decisions, and
| nurses/drs respect most wishes, don't like your child being
| disturbed at night for non-100%-necessary stuff? Ask social
| services (etc) to print out a sign with your wishes and stick it
| on your room door. May not 100% work, but worth a shot. It did in
| ours.
|
| Sleep is somewhat respected as this is when babies develop/heal
| best, unfortunately it's an ICU, and these are sick kids who need
| 24/7 complex care, so there's sometimes little wiggle room. I
| attended a conference in Chicago on heart disease and it's
| outcomes (npcqic.org), and sleep and proper nutrition (not just
| feeding TPN) are definitely hot topics. I know the NICUs are
| extra hard on any additional sleep/disturbance other than 100%
| necessary.
|
| But shoutout to nurses, drs, any medical staff, ICUs are sterile,
| haunting, traumatic places. I witnessed things I can never
| forget. They do the same, and have to do it again, and again.
| anjc wrote:
| > the next time you have trouble booking a surgeon or even a
| gastroenterologist, you can remember that America's supply of
| surgeons and gastroenterologists is being disproportionately used
| by the AARP crowd.
|
| What a horrible sentiment.
| gopher_space wrote:
| It's painfully easy to start thinking in numbers when you're
| paying six thousand a month to warehouse your grandmother's
| body.
|
| The number of tests people want to run on someone we all hope
| dies tomorrow is insane.
| notacoward wrote:
| Funny, I pay even more than you mention to support my own
| mother in relative comfort in a nursing home, and I don't
| find it "painfully easy" to think that way at all. I
| certainly don't hope she dies tomorrow. You might want to
| reconsider saying such things in public.
|
| Note: my mother, not my grandmother, and I _have_ lived that
| ordeal for several years. Some interaction is still possible,
| but recognition has been beyond her for a while. As long as
| she seems to take some pleasure in her surroundings, no
| matter how dim or muted the signs, you won 't catch me
| framing my thoughts about her in terms of dollars I could
| save.
| gopher_space wrote:
| Sounds like your grandmother can still recognize and
| interact with people. Mine was basically a warm body for
| the last five years of her life.
|
| Prolonging that existence is not a kindness in any sense,
| and I hope you don't have to go through such an ordeal.
| chki wrote:
| I think a more generous reading of the comment you are
| replying to could be (and probably is reasonable): It is
| hard to pay a lot of money for somebody that is living in
| agony with no chance of getting better, where death might
| be a good option for them personally. I would not
| understand the comment to criticize supporting people
| living in relative comfort.
| notacoward wrote:
| "Warehousing her body" suggests otherwise. When people
| talk about someone as a "body" they usually mean
| insensate IMX. People whose loved ones are in pain tend
| to use different, even more colorful, language. I know I
| did, when that was the case.
| chki wrote:
| > People whose loved ones are in pain tend to use
| different, even more colorful, language.
|
| The human experience varies wildly and I would not make
| such assumptions. Caring for somebody without the hope of
| improvement for years can make you bitter or even resent
| the person that no longer resembles the one you loved.
| Mezzie wrote:
| What's terrible about it?
|
| I'm a younger (34) person with substantial healthcare needs (I
| have MS). Everything is always oriented towards the old, and I
| also pay taxes that are used to support them while getting
| nothing in return despite having similar needs.
| jewayne wrote:
| You also seem to have MCS: Main Character Syndrome.
| notacoward wrote:
| > I also pay taxes
|
| Do you really get _nothing_? And who is paying for whose
| care? You mention taxes, but they 've probably been paying
| taxes even longer. And why do you think health care is a
| strict _quid pro quo_ anyway? Some of us believe care should
| be allocated where it 's needed, not where it's paid for. Put
| another way: why is it a problem that they _are_ getting
| care? Isn 't it that you _aren 't_? This doesn't have to be a
| zero-sum game. If you feel that you're in competition with
| someone else for care, the problem is pretty clearly that
| there aren't enough providing it.
|
| Saying others have less right to health care is pretty
| terrible no matter _which_ way the finger points.
| cliquecover wrote:
| It's horrible but true. How do you budget for and prioritize
| access to scarce resources?
| polishdude20 wrote:
| In a way I think this is ok though? Like, when I reach that age
| I sure as hell hope I'll have more access to doctors than
| younger people?
| notacoward wrote:
| I had a strong reaction to that too. _Of course_ we devote more
| health-care effort to people in the last 5-10 years of their
| life, which primarily (but not entirely) means older people.
| There is practically no world in which that wouldn 't be the
| case, because everyone's health trajectory eventually trends
| downward. By the time someone reaches the ICU (other than as a
| result of trauma) not only the immediate problem but likely
| several others will have progressed to problematic levels.
| That's also where the most labor- and dollar-intensive
| treatments tend to be applicable. It's just basic statistics,
| really. Cars also cost more in maintenance late in their life
| cycles, and so do many other things. A flat age distribution in
| the ICU would be _super weird_ and probably an even worse
| allocation of resources.
|
| I don't think the author really meant that to come across as
| callous as it sounded. Probably just poor choice of words. I'm
| only addressing it because _someone else_ reading it here might
| interpret it in more of an "older people stealing from younger
| ones again" kind of way for demographic or ideological reasons.
|
| ETA: it already happened as I was writing this.
| questime wrote:
| Because of demographics this is a problem we will have to
| confront regardless - do you think medicare/medicaid spending
| will become 80% of government spending?
| virgildotcodes wrote:
| Maybe with higher taxes and a reallocation of defense
| spending we'd be able to sustain a more humane society for
| longer.
|
| Is it indefinitely sustainable? Not sure. I don't know if
| it's as easy as just extrapolating from recent trends because
| there may be countless unknowns from biomedical advances to
| climate destabilized societies to being turned into
| biological batteries for our machine overlords in the next
| few centuries.
| ch4s3 wrote:
| Having medicare operate under a fee for service model will
| never be sustainable in the long run. We already spend $
| 755 B on Medicare, which is roughly equivalent to the DoD's
| $ 767 B, and Medicare is notoriously wasteful[1][2].
|
| [1] https://www.healthaffairs.org/do/10.1377/hpb20220506.43
| 2025/
|
| [2] https://vbidcenter.org/wp-
| content/uploads/2021/10/jama_shran...
| skyyler wrote:
| https://www.usaspending.gov/agency/department-of-
| defense#:~:....
|
| >In FY 2022, the Department of Defense (DOD) had $1.64
| Trillion distributed among its 6 sub-components.
|
| Where are you getting this 767B number?
| ch4s3 wrote:
| The treasury department's website[1]. I wonder if your
| link is rolling in the VA? I can't quite tell.
|
| [1] https://fiscaldata.treasury.gov/americas-finance-
| guide/feder...
| skyyler wrote:
| >Department of Defense--Military Programs
|
| I wonder if that means they're subtracting portions of
| the DoD budget that aren't technically military
| operations.
| ch4s3 wrote:
| As with many of these categories it can be hard to pin
| down accurate numbers.
| MBCook wrote:
| I didn't read it as an indictment (why are we wasting all this
| money on people who are dead soon anyway?) but more of just a
| straight observation that makes sense if you think about it but
| probably isn't what most people would expect if asked
| unprompted.
| questime wrote:
| It's politically toxic to discuss but a ton of money goes to
| keeping people not dead (not really alive either). You could give
| a lot more people medicare/medicaid if we let a 90 yr old with
| dementia/diatebetes/etc. pass with dignity.
| TheOtherHobbes wrote:
| Any form of euthanasia runs into the legal and moral problem of
| who decides? And why?
|
| You might think everyone wants to act in the best interests of
| their relatives, but of course that's not true. Some people
| will want to speed the natural process along because that
| inheritance looks really appealing, and no one is really going
| to miss the old guy/gal anyway.
|
| Besides, that's not really the problem. The problem is
| profiteering by insurance companies and the hospitals they
| (effectively) run for profit, with patient wellbeing as a
| regrettable requirement they have to put some effort into.
| itestyourcode wrote:
| Is it the same dilemma if we can kill one to save more?
| wellareyousure wrote:
| Yes, certainly people in medicine are aware.
|
| > we let a 90 yr old with dementia/diatebetes/etc. pass with
| dignity.
|
| Often it's a 4 week old baby.
|
| For every 1 sophisticated family member, there are 19
| unsophisticated ones, who toss a weighted coin and, if it's
| heads, they decide they want their dying, non-responsive
| relative - possibly their baby, possibly their mom, etc. - to
| be kept alive at all costs. I don't know if this is politically
| toxic as much as it is cultural, and possibly globally
| cultural.
| questime wrote:
| > Often it's a 4 week old baby.
|
| You are stretching the word often, most people in the ICU are
| close to the end of their life. A lot of people don't realize
| but most of the time if you needed to spend weeks in an ICU
| you are probably not "living" in a dignified way. Almost all
| ICU doctors/nurses I've talked to would rather have a DNR in
| their old age than live like that.
| Eleison23 wrote:
| Your human dignity is not predicated on how much pain
| you're in, how awake you are, or how able you are.
| z3rgl1ng wrote:
| This is an oft-repeated piece of received wisdom that is
| empirically untrue.
|
| https://www.statnews.com/2018/06/28/end-of-life-health-spend...
| robocat wrote:
| Wow: just sample bias! We need to also look at the old people
| who had expensive care and survived (95% of costs in that
| article). Money does gets spent on hospital care just before
| death (5%), but predicting how to avoid "wasting" that money
| is hard.
| voz_ wrote:
| I don't think its politically toxic, but rather, extremely
| humane that we care for our elderly. The real unfortunate part
| is that we, in the working class, have to make due with sharing
| slices of the pie so more money can go to our exploiters and
| owners - especially in the US, we are such a wealthy nation,
| and yet here we are bickering around who deserves care based on
| age. Sad.
| MBCook wrote:
| > I don't think its politically toxic
|
| Ever hear of the Obamacare death panels? The ones where
| doctors would decide if your loved one was too old and
| shouldn't get treatment?
|
| Yeah. That's this.
|
| What it really was that Medicare would pay for consultation
| with doctors (?) to discuss end of life care and setup living
| wills and DNRs and such if the person wanted.
|
| That way if something happened and they were taken to the
| hospital they could be treated the way they wanted to be and
| not stuck in a coma on a vent for the rest of their life if
| that was against their wishes.
|
| But the Republicans branded then "death panels" (which for
| political purposes was _brilliant_ ). So the choice of having
| help making those decisions was removed.
| questime wrote:
| I disagree, spending on these things is growing at 2x GDP
| growth so yes more of the pie is going to this. What I'm
| suggesting is that at some point the pie isn't big enough for
| this. No matter what happens eventually standard of care will
| roll back/fewer people will be covered etc. Ideally we can
| innovate out of this situation but after spending 8 years
| working in healthcare I've gotten cynical about it.
| neonate wrote:
| We don't care for our elderly. We fear death.
|
| If our society really cared for the elderly, they would be
| integrated and respected, not segregated and shunned. We do
| the latter because we fear age, sickness, and death. Fear
| isn't caring.
| rscho wrote:
| > We fear death
|
| In the US. It's perhaps the most striking difference that
| hit me during my stay overseas. In the Old World we
| occasionally get people completely panicking about their
| own death. In the US, seemingly _everyone_ is like that.
| neonate wrote:
| I'd like to hear how elders are treated in these
| societies that don't fear death as much.
| rscho wrote:
| I'd wager: not very differently. But not out of fear. The
| social isolation of old age is the same everywhere. Young
| people have their own lives to live.
| croes wrote:
| Where do you draw the line? At what age, what illness do you
| refuse to treat a patient even though he may not want to die?
|
| You could give a lot of people medical treatment with a proper
| healthcare and tax system. Why don't we try that first?
| chiefalchemist wrote:
| Many of the top causes of death, per the CDC, are from diseases
| that can be prevented or naturally mitigated. We're all going
| to get old. We're all going to die. But carrying two or more
| "pre-existing conditions" into your later years is going to
| decrease your quality of life, as well as your use of
| healthcare.
|
| My point is, what's not sociopolitically allowed is discussing
| how personal choice as well as normalized systematic issues
| (e.g., urban food deserts) are killing us, slowly. It's
| unfashionable to suggest someone's weight is (ultimately)
| unhealthy. But the USA wants to have its cake and eat it too,
| literally. That's not working out. It's not sustainable.
|
| Finally, not to get off topic but over the last couple of weeks
| there's been a thread or two on HN based on acticles suggesting
| the GDP and similar "classics" economic metrics are hiding
| underlying social issues. That is, for example, healthcare care
| contributes to the GDP (or whatever) but that healthcare is for
| diabetes, opioids, faltering mental health, etc. We're falling
| apart but not to worry the economy is doing just fine.
|
| It's complicated. But to your point, the fact that some
| important topics are ofc limits isn't helping. Until that
| changes the status quo will continue.
| nativecoinc wrote:
| There's a lot of talk about supposedly un-PC, taboo subjects
| that are just not so.
|
| We have many common diseases that are outright labeled
| "lifestyle disease". And tabloids scream at you with
| headlines like "This one weird thing will dramatically
| [increase/decrease] your chances of getting Alzheimers".
| Impolite subject? Sure, telling _an individual_ that they
| should just lose weight is an asshole move since it won't do
| any good, so in _that_ sense it is uncouth. But as a general
| background noise that we are all supposed to accept? Oh, it's
| not taboo at all.
|
| It is of course completely irrational considering the toll
| that the actual disease would have on me, but I am in part
| afraid of getting something like T2 Diabetes just because of
| the social stigma of getting a Lifestyle Disease (sort of
| like a negative lifetime achievement award).
|
| And as far as critique is concerned: I've been thinking
| lately that the term "lifestyle" can be misleading for about
| 30% of our lives. Because being "sedentary" is a lifestyle
| now, and many of us spend a whopping 50% of our waking,
| everyday lives being very sedentary in an office. (As for the
| non-waking time we seem to be stuck with sedentariness.) When
| I think of "lifestyle" I think of choices, but having a job
| is hardly a choice for most people. So if the powers that be
| really want to hold us 100% accountable for our own bad
| choices, then they should at least give us standing desks,
| those small walking treadmills, the opportunity to _go
| outside_ and walk for longer phone calls and meetings, etc.
| ryandrake wrote:
| > My point is, what's not sociopolitically allowed is
| discussing how personal choice as well as normalized
| systematic issues (e.g., urban food deserts) are killing us,
| slowly. It's unfashionable to suggest someone's weight is
| (ultimately) unhealthy.
|
| The recent push to try to re-frame obesity as healthy,
| fashionable and sexy seems particularly bizarre and
| unexplainable. It's the opposite of what happened with
| cigarettes, which started out as fashionable and healthy,
| then slowly became known as unhealthy and finally fell out of
| cultural fashion.
| lazyasciiart wrote:
| I think the root of it is recognition that mental health is
| as important as physical health, and that losing weight
| isn't as easy as many people assume, and shouldn't be done
| the way many people try - so actively shaming and
| criticizing fat people for being fat is of negative health
| utility overall.
| chiefalchemist wrote:
| > o actively shaming and criticizing fat people for being
| fat is of negative health utility overall.
|
| Fair enough. But then what do you suggest we do as an
| alternative to normalizing diabetes and obesity?
|
| To your point - kinda - about losing weight. Changing
| behavior isn't any easier when there are too few
| environmental signals to nudge behavior in a more healthy
| direction. As humans, we are wired to assume the norm we
| see around us. How do we reverse the tide when abnormal
| (and unhealthy) has been normalized? When everywhere you
| look, there are people just like you?
|
| I do agree. Mental health is important. But a component
| of that is (dealing with) adversity. I'm certainly not
| condoning repetitive malicious bullying, but the current
| climate has outlawed any/all references to traits
| connected with being unhealthy. At this point there are
| no social deterrents, are we really better off?
|
| Have we robbed Peter to over-feed Paul?
| ch4s3 wrote:
| It's pretty well know and often discussed that up to 1/3 of
| Medicare spending is wasted. Being fee for service doesn't help
| but neither does spending 13-25% of all medicare dollars on end
| of life care[1].
|
| What's worse is how much of Medicare's wasted spending goes to
| harmful treatments.
|
| [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/#:~:te
| x....
| [deleted]
| w10-1 wrote:
| It's a tough situation, and I'm glad his father is finding help.
|
| I've spent a fair bit of time in ICU's on both sides. I think the
| observations and conclusions show misunderstandings. Generally,
| opinions are not ignored, nurses don't go wild, the patient
| population makes sense for an ICU, the institutional memory is
| actually fantastic, etc.
|
| And most importantly: "There's no sense of a scientific method,
| reasoning from first principles, or even reasoning from similar
| cases though" This is complete and utter hogwash, borne of a
| difficult experience.
|
| They key idea is this: in complex cases, doctors have to identify
| the condition that matters most, and prioritize that.
| Collaboration is necessary to get the picture and give care, and
| perhaps to consider alternatives, but it's not how you make
| decisions.
|
| It's hard to see symptoms ignored or under-treated. But it's very
| likely that delusions do not make a difference in the patient's
| recovery, but something like lung surfactant matters most. So
| everything from fluid intake to drug dosage and activity are
| direct accordingly. Unless they're symptoms of the main issue,
| discomforts can be prioritized later after the main issue
| resolves.
|
| "Identifying the main condition" means understanding the actual
| insult and the healing process for this patient; understanding
| how symptoms, labs, and imaging reflect all the conditions i.e.,
| how it presents (and skews labs or self-perception); and
| understanding how all the interventions may interact with the
| disease/disability states, from drug interactions to liver and
| immune-system complications, etc.
|
| It's not uncommon for other doctors and nurses and patient
| advocates to have some slice of this complex picture, but it's
| the attending who has it all, and the experience of other cases
| and knowledge of the underlying conditions and interventions.
|
| And, for the most part, the attending is not responsible for
| explaining their understanding or reasoning to anyone. They do
| offer reasons and make records, but there's no place or time or
| even audience for comprehensive account of why other alternatives
| weren't considered or followed.
|
| Science, and medical trials, try to isolate single factors to get
| reproducible outcomes. Medicine in the ICU has to accommodate
| multiple factors, by focusing on the main disease/healing process
| and optimizing for that.
|
| As for value to society: good ICU attendings are key to good
| outcomes for patients and their families. It takes decades to get
| good. They produce far, far more value than they're paid, largely
| because they do it as a mission. If they see people, particularly
| those who enjoyed the benefit of their dedication and service,
| disrespecting and misunderstanding them, it's likely to dissuade
| them from continuing or dissuade others from their difficulties.
|
| So complain all you want about digital advertising and go full-
| disruptive to fossil fuels, but please be very, very careful when
| attacking health care. Otherwise we'll end up with Russian
| hospitals where you bring your own materials and pay your friends
| of friends for side work.
| Wonnk13 wrote:
| For context see my comment here
| https://news.ycombinator.com/item?id=33625584#33647770
|
| One thing that this article touches on, but I think needs to be
| emphasized even more is that the stark reality is that the only
| advocate for the patient is the patient themselves, or perhaps a
| caretaker.
|
| The burden is on me to ask questions about fertility and sperm
| banking because my oncologist is well... an oncologist not a
| fertility expert. I have to ensure that every department is
| communicating with every other department.
|
| Hospitals and physicians are fantastic at solving discrete
| issues, but the bigger picture is often lost in the chaos. I can
| do it as a technically adept 34 year old, it's horrifying to
| think about how someone closer to 80 goes about it.
| dheera wrote:
| I was in an ICU for a week after a cardiac arrest. I don't
| remember much of it other than a lot of hallicunations.
|
| I had family there to advocate for me, but there's no way in
| hell I would have been able to advocate for myself. I was
| literally seeing things around me in the ICU room that didn't
| exist. My family were probably the only ones that realized that
| that wasn't the real me.
|
| The hallucinations stopped happening as soon as I was moved to
| a normal patient room for the rest of my recovery, and I have
| full working memory of that normal patient room.
| chki wrote:
| > The hallucinations stopped happening as soon as I was moved
| to a normal patient room for the rest of my recovery
|
| To be fair (and this is also true for the article itself), it
| might be difficult to distinguish cause and effect here.
| Being moved into less intensive care means that you are more
| stable which might lead to other issues becoming better in
| the following days regardless of whether you are in the ICU
| or not.
| voz_ wrote:
| Great, well written article, I wish your father a speedy
| recovery.
|
| Anecdotally, when I was in the hospital (much more minor, at a
| much younger age), they kept waking me up at 3am to draw blood
| and clean and do god knows what, and the light outside my room
| was constantly on. It felt... at best annoying, at worst,
| downright jarring and disruptive. It certainly feels like the
| sleep and rest parts of recovery and care need to be revisited.
| bombcar wrote:
| There was an interesting article that showed "state of the art
| delivery rooms" from the 1950s - and they were ALL oriented
| around the doctor and nurse's convenience.
|
| Now we've moved back toward "birthing centers" which focus on
| the mother and the baby; perhaps it is time for something
| similar to grow across all aspects of care.
| nobody9999 wrote:
| >Anecdotally, when I was in the hospital (much more minor, at a
| much younger age), they kept waking me up at 3am to draw blood
| and clean and do god knows what, and the light outside my room
| was constantly on. It felt... at best annoying, at worst,
| downright jarring and disruptive. It certainly feels like the
| sleep and rest parts of recovery and care need to be revisited.
|
| After ACL reconstruction surgery many (~30) years ago, I was
| required to stay overnight due to both the general anaesthesia
| and the lateness (late afternoon) of the procedure.
|
| I had a similar experience with the nurse coming in every two
| (2) hours to take my vitals. I was trying to sleep, but she
| kept waking me up. I groused about wanting to rest, but was
| informed (direct quote) "this isn't a hotel!"
|
| And it's not. Rather it's a money printing facility for the
| owners of the health care system that runs the hospital.
| [deleted]
| dm319 wrote:
| For older patients and those with significant co-morbidities, we
| often advise against intubation and ICU admission in the UK.
| Usually if the disease process can't be reversed on the ward with
| current therapy, it is often unlikely in this group of patients
| for it to reverse on ICU. However, it does depend on the context.
| There was an interesting article that talks about doctor's
| choices as an end-of-life patient [1] - they often choose not to
| opt for aggressive life-prolonging treatments because they know
| how it is like. I think that doctors need to improve the way we
| talk about death with patients, and doctors can be just as guilty
| as everyone else at ignoring the inevitability of death.
|
| [1] https://www.zocalopublicsquare.org/2011/11/30/how-doctors-
| di...
| the__alchemist wrote:
| Elephant in the room, related to the article's first point: We
| have to tackle ageing. Many of the other diseases (cancer, heart
| conditions etc) and causes of mortality are highly correlated
| with it.
| lazyasciiart wrote:
| Heart conditions, for one, aren't caused by aging - they are
| caused by being around for a long time so that the slow process
| of atherosclerosis has time to become dangerous. We need to
| prevent that process from happening by following standard
| health advice, really.
| georgeg23 wrote:
| The hallucinations sound like a side effect from lorazepam
| (Ativan) -- something hospitals give almost everyone but is a
| hardcore drug.
|
| Consider asking nurses to stop administering it after you do your
| own research.
|
| https://www.webmd.com/drugs/2/drug-6685/ativan-oral/details#...).
| Fatnino wrote:
| I went to the hospital for debilitating shoulder pain.
|
| Came out 3 hours later with an xray that showed nothing wrong
| and a bottle of Ativan. Still no idea why they gave that to me.
| I didn't take any of the pills.
|
| And the bill came out to over 7 thousand dollars.
| copperx wrote:
| It's hard to pin it down to a single drug. Having had both my
| grandmother (80) and mother (60) in the ICU, and both got
| hallucinations without Ativan. It could be so many things:
|
| * The aftermentioned lack of sound sleep
|
| * Anesthesia
|
| * Painkillers
|
| In the case of my grandmother, hallucinations and incoherence
| lasted about three months after she was home. My mother's
| lasted about 2-3 weeks. It was scary. They both eventually
| recovered. But it is true that nobody in the hospital bats an
| eye when acute dementia-like symptoms are mentioned. "It's
| normal," they say.
| ChrisMarshallNY wrote:
| About 26 years ago, I spent some quality time (7 days) in ICU. I
| wasn't just at Death's Door. I was pounding on it, and loudly
| demanding admittance.
|
| _> Everyone agrees that sleep is important, but nobody has any
| idea beyond that. _
|
| I didn't sleep for pretty much the entire week. I was on lots of
| opiates and opioids, though, so I spent most of that week in a
| weird quasi-sleep "dream state."
|
| I don't recommend the experience.
|
| Most expensive hotel I've ever been in.
| theNJR wrote:
| My wife just gave birth and it was my first multi-night hospital
| stay. The midnight pokes and checks were infuriating. It also
| doesn't help that dads aren't the patient after a birth, so they
| aren't fed or given a bed. Constant nurse changes were difficult
| too.
|
| On the plus side, I was surprised at the decent quality of food
| given to my wife. Steamed vegetables and mid grade proteins with
| every meal.
|
| After two nights we made the case to be discharged. Everyone,
| including nurses and family, thought we were crazy to leave so
| early. Best decision we made and my wife recovered great. With
| the built in iOS medication reminder app and a blood pressure
| monitor I was able to manage her just fine.
| languageserver wrote:
| > After two nights we made the case to be discharged. Everyone,
| including nurses and family, thought we were crazy to leave so
| early.
|
| In my country you don't even stay a single night if everything
| goes fine. There is no medical need for parents and child to
| stay at any hospital if there were no complications
| misterprime wrote:
| Congratulations! We just went through the same thing and
| decided to leave after one night in post-partum. It's much
| better to be at home if there's nothing concerning that needs
| medical attention.
|
| Side note: it was surprising how well the "dad chair" served as
| a place to sleep after being awake for 24 hours.
| ed25519FUUU wrote:
| I'm fresh off of spending 24 hours in the ICU and I can say the
| OP is right. It's impossible to actually "recover" there at all.
| My singular goal while there was simply to get home to my bed,
| even if it meant I could potentially die. I didn't care. I wanted
| out.
___________________________________________________________________
(page generated 2022-11-18 23:00 UTC)