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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

#251

Post by tomcam »

QuercusMax wrote: post #132
tunap wrote: post #44

Earlier quoted context omitted.

>"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 monito…

Last time I was in the hospital (in 2016 with a broken arm) it was very difficult to sleep because the bed had some device that pokes you every so often to make sure you don't develop bedsores from lying too still. This makes sense for someone who might be in there for weeks, but I was barely there overnight!

Nightmarish yet darkly comical. Sort of torture adjacent…

Re: Things I've noticed while visiting the ICU

#252

Post by ThePadawan »

xyzzyz wrote: post #237
throwaway892238 wrote: post #226

Earlier quoted context omitted.

So, they're complicated, they're expensive, they're necessary... why don't we have the state pay for them? We spend 720 Billion dollars on the military. Would it be useful to send a couple of those billion to make ICUs less expensive?

Where do you think state money comes from? Even if it’s the government that foots the bill for ICUs, in the end it will still be paid collectively by all of us regular people.

Well good thing regular people don't ever need to use ICUs.

Re: Things I've noticed while visiting the ICU

#253

Post by samanator »

Something I've learned about the ICU and hospitals in general when my brother was passing away is that they are not designed for large families. I have 10 siblings (9 now?) and the hospital would only allow for 3 guests at a time. The head nurse in the ICU would only allow for 2 guests at a time, parents included.

We had to fight, trick, and sneak in order for all of us to be together with him in his last days (e.g. we would loiter outside the hospital picking up discarded guest stickers and pass ourselves off as other people).

What I learned from this is that I do _not_ want to die in a hospital.

Re: Things I've noticed while visiting the ICU

#254

Post by ThePadawan »

tunap wrote: post #44
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 monito…

More than 10 years ago now, I was in the ICU for myocarditis, leading to bradycardia, a very slow heart rate.

During the night, it would drop to 40 (which is still fine), but sometimes below 30, at which point my heart monitor would blare an alarm, waking me up and scaring the absolute bejesus out of me, raising my heart rate immensely. A nurse would walk in, see that I was fine, and leave again.

This occurred nightly for a few days.

Re: Things I've noticed while visiting the ICU

#255

Post by stordoff »

I spent about ten days in a UK ICU with Covid-19, so figured I'd share a few comments based on my experience. I was in a room for one person, so I've no idea who else was in there. I didn't suffer any delusions/hallucinations, other than my memories of the first night being a little hazy (which can probably be put down to being moved at 3am unexpectedly and possible hypoxia). However, after I discharged, I felt like I could still hear the > There are many consults, but the ICU attending is king (or queen) / Sometimes nurses are the footsoldiers of the ICU regent, and sometimes they’re governors

It's hard to say specifically was making the calls, particularly as the PPE made it a little difficult to recognise people, but it definitely felt like there was continuity of care - treatment plans were discussed well in advance, and usually didn't change unexpectedly. The recommendations from the physiotherapist and nutritionist (my appetite was virtually non-existent), as well as my own requests, were followed by all of the staff involved as far as I could tell.

> Everyone agrees that sleep is important, but nobody has any idea beyond that

I couldn't sleep for the first two nights, but beyond that, I didn't find this to be an issue. I'd go to bed around 10:30, and wasn't disturbed until about 8 o'clock the next morning. As I understand it, HR/BP/O2 monitors could be checked from an adjacent room, and most of the non-critical alarms were muted (I believe they were still audible to staff outside of my room). There were a few times staff came in to check/adjust something, but never more than once a night (that I noticed at least).

> The ICU is a good place to not die, but a bad place to recover

I'm not sure I can agree with this. I was moved back to a ward for a few days before I was discharged, and felt that I would have recovered better had I stayed in the ICU (though I understand why that's not practical). The room of eight had two dementia patients who would yell out for most of the night. Obs were taken about every three hours, which woke me every time (BP was taken with a pressure cuff rather than the arterial line which was used in the ICU, and I wasn't routinely wearing a finger sensor). As a result, I got very little sleep until I was discharged. It was also much more difficult to get the attention of staff at times.

Re: Things I've noticed while visiting the ICU

#256

Post by _xnmw »

There should be a name for this, "medical theatre", analogous to security theatre. A brilliant performance art, with all its buzzing machines, expensive insurance, bright lights, pretty graphic logos, well-dressed specialists and doctors that aren't able to apply their knowledge correctly because they can't get simple things right, like letting patients sleep properly or recording and passing on information specific to a patient. All of this because the emphasis is on the "system" rather than the patient, and the solution is "more system". There is no amount of procedure that can replace genuine care and concern for a human being -- this man's father was lucky to have someone who was spending time with him observing these things, and presumably helping the staff avoid mistakes, and probably helping with the feelings of paranoia and hallucinations as well.

Re: Things I've noticed while visiting the ICU

#257

Post by nativecoinc »

notacoward wrote: post #190
chki wrote: post #84

Earlier quoted context omitted.

> 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.

> make you bitter or even resent the person And that's OK? I happen to think it's not, that bitterness and resentment hurt everyone involved, and I know that it's possible to resist those feelings. How, exactly, does the person who succumbs get to play Good Guy?

No one’s said that it makes them Good Guy. Only Human.

Re: Things I've noticed while visiting the ICU

#259

Post by rscho »

chrismorgan wrote: post #243
rscho wrote: post #88

Earlier quoted context omitted.

I'm sorry but curiosity and creativity are certainly the n°1 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 unimagi…

> n° Since you’ve used a slightly fancy Unicode character: I found U+00B0 DEGREE SIGN unpleasant here, and it took a brief bit of thought to understand. (A capital N would probably have helped a little, but the degree sign is still disconcerting.) The character you want is №, U+2116 NUMERO SIGN. If you happen to be using a Compose key, `Compose N o`. For less fancy options, “#” and “number ” would both be better choi…

not all of us live in the US

Re: Things I've noticed while visiting the ICU

#260

Post by rscho »

Gatsky wrote: post #245
rscho wrote: post #88

Earlier quoted context omitted.

I'm sorry but curiosity and creativity are certainly the n°1 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 unimagi…

Curiosity is essential. Eg guy with chest pain and trop rise gets sold by ED as a NSTEMI. But why is the pulse pressure so high? Hang on what is that scar on his back? Oh he had an aortic root repair 20 years ago after a car accident... Ok I’m calling in the radiologist at 2am to do a CT angiogram. Sure enough, his aortic root repair is failing, and he has new onset AR. Curiosity saved that guy’s ass, following the p…

So curiosity as a remedy for systemic failure to perform a full exam and actually do the job correctly in the first place? Not a very convincing argument.
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