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Things I've noticed while visiting the ICU

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Re: Things I've noticed while visiting the ICU

#41

Post by dm319 »

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...

Re: Things I've noticed while visiting the ICU

#43

Post by dheera »

Wonnk13 wrote: post #39

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 ferti…

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.

Re: Things I've noticed while visiting the ICU

#44

Post by tunap »

a_shovel wrote: post #21

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…

>"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.

Re: Things I've noticed while visiting the ICU

#45

Post by citilife »

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.

Re: Things I've noticed while visiting the ICU

#46

Post by rscho »

neonate wrote: post #38
voz_ wrote: post #8

Earlier quoted context omitted.

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.

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.

> 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.

Re: Things I've noticed while visiting the ICU

#47

Post by chki »

dheera wrote: post #43
Wonnk13 wrote: post #39

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 ferti…

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 happenin…

> 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.

Re: Things I've noticed while visiting the ICU

#48

Post by Negitivefrags »

a_shovel wrote: post #21

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…

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.

Re: Things I've noticed while visiting the ICU

#49

Post by skyyler »

ch4s3 wrote: post #31
virgildotcodes wrote: post #19

Earlier quoted context omitted.

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 cent…

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/hpb20220506.432025/ [2] https://vbidcenter.org/wp-content/uploads/2021/10/jama_shran...

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?

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