Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Things I've noticed while visiting the ICU

trevorklee.substack.com

Post reply on HN
Print view View original

91–100 of 387 posts

Re: Things I've noticed while visiting the ICU

#91

Post by misterprime »

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…

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.

Re: Things I've noticed while visiting the ICU

#92

Post by chiefalchemist »

lazyasciiart wrote: post #65
ryandrake wrote: post #55

Earlier quoted context omitted.

> 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.

> 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?

Re: Things I've noticed while visiting the ICU

#93

Post by neonate »

rscho wrote: post #46
neonate wrote: post #38

Earlier quoted context omitted.

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.

I'd like to hear how elders are treated in these societies that don't fear death as much.

Re: Things I've noticed while visiting the ICU

#94

Post by ch4s3 »

skyyler wrote: post #49
ch4s3 wrote: post #31

Earlier quoted context omitted.

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?

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...

Re: Things I've noticed while visiting the ICU

#95

Post by kingsloi »

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.

Re: Things I've noticed while visiting the ICU

#96

Post by rscho »

chiefalchemist wrote: post #36

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 exte…

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.

Re: Things I've noticed while visiting the ICU

#97

Post by cco »

cactus2093 wrote: post #35
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…

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 metabo…

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.

Re: Things I've noticed while visiting the ICU

#98

Post by Eleison23 »

questime wrote: post #25
wellareyousure wrote: post #11

Earlier quoted context omitted.

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 i…

> 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.

Your human dignity is not predicated on how much pain you're in, how awake you are, or how able you are.

Re: Things I've noticed while visiting the ICU

#99

Post by skyyler »

ch4s3 wrote: post #94
skyyler wrote: post #49

Earlier quoted context omitted.

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?

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...

>Department of Defense--Military Programs

I wonder if that means they're subtracting portions of the DoD budget that aren't technically military operations.

Re: Things I've noticed while visiting the ICU

#100

Post by ChrisMarshallNY »

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.

Post reply on HN