Things I've noticed while visiting the ICU • Hacker News Board

Re: Things I've noticed while visiting the ICU

#51

Post by chki » Fri, Nov 18, 2022, 9:54 PM UTC

notacoward wrote: post #40

gopher_space wrote: post #30

Earlier quoted context omitted.

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.

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…

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.

Re: Things I've noticed while visiting the ICU

#52

Post by jmhmd » Fri, Nov 18, 2022, 9:55 PM UTC

warner25 wrote: post #37

> 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…

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.

Re: Things I've noticed while visiting the ICU

#53

Post by croes » Fri, Nov 18, 2022, 9:57 PM UTC

questime wrote: post #5

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.

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?

Re: Things I've noticed while visiting the ICU

#54

Post by nobody9999 » Fri, Nov 18, 2022, 9:59 PM UTC

voz_ wrote: post #6

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 ne…

>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.

Re: Things I've noticed while visiting the ICU

#55

Post by ryandrake » Fri, Nov 18, 2022, 9:59 PM UTC

chiefalchemist wrote: post #26

questime wrote: post #5

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.

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 sy…

> 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.

Re: Things I've noticed while visiting the ICU

#56

Post by lazyasciiart » Fri, Nov 18, 2022, 9:59 PM UTC

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 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”.

Re: Things I've noticed while visiting the ICU

#57

Post by theNJR » Fri, Nov 18, 2022, 10:00 PM UTC

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.

Re: Things I've noticed while visiting the ICU

#58

Post by halpmeh » Fri, Nov 18, 2022, 10:00 PM UTC

Negitivefrags wrote: post #48

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 negativ…

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.

Re: Things I've noticed while visiting the ICU

#59

Post by [deleted] » Fri, Nov 18, 2022, 10:00 PM UTC

voz_ wrote: post #6

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 ne…

[deleted]

Re: Things I've noticed while visiting the ICU

#60

Post by HEmanZ » Fri, Nov 18, 2022, 10:01 PM UTC

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...