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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

#61

Post by lazyasciiart »

jmhmd wrote: post #52
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.

Also, the cases are usually in desperate enough straits that “here, swallow this seagull poop!” doesn’t get hints thrown out of the hospital.

Re: Things I've noticed while visiting the ICU

#62

Post by [deleted] »

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…

[deleted]

Re: Things I've noticed while visiting the ICU

#63

Post by notacoward »

chki wrote: post #51
notacoward wrote: post #40

Earlier quoted context omitted.

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.

"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.

Re: Things I've noticed while visiting the ICU

#64

Post by gopher_space »

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…

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.

Re: Things I've noticed while visiting the ICU

#65

Post by lazyasciiart »

ryandrake wrote: post #55
chiefalchemist wrote: post #26

Earlier quoted context omitted.

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 cigarett…

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.

Re: Things I've noticed while visiting the ICU

#66

Post by thfuran »

HEmanZ wrote: post #60

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…

That sounds illegal.

Re: Things I've noticed while visiting the ICU

#67

Post by b112 »

bombcar wrote: post #23
parker_mountain wrote: post #3

Earlier quoted context omitted.

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 sh…

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.

No, it's a real hospital, and a real scene, but they're all reverse vampires.

Re: Things I've noticed while visiting the ICU

#68

Post by languageserver »

theNJR wrote: post #57

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…

> 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

Re: Things I've noticed while visiting the ICU

#69

Post by ivraatiems »

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?"

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