Hospitals Are Terrible

What’s with the air bubble fear!? I got that too with an IV drop in Korea, watching the air bubble slowly moving in the tube and thinking am I gonna die? But clearly I didn’t …

Last time I was in hospital they woke me up every hour to ask me if I could remember my age and date of birth [SPOILER: I could]*. There was a kind in the bed opposite who pleaded with them with tears running down his cheeks to move him somewhere he could sleep. Eventually they did, but it took them 24 hours to find a bed.

The other thing is when you’re reasonably compos mentis and you’re sharing a room with somebody who isn’t, and they’re not meant to get up and they keep trying to and you can see they’re going to fall out of bed and injure themselves any moment and you’re frantically ringing for an attendant and they’re all busy elsewhere and you can’t go and wrestle the other patient down because you’ve just had major surgery and what the fuck do you do?

*They were right to do so. I had a major haematoma and they needed to know if my brain was still in gear.

First-born son was in NICU for a month. Nearly killed all of us.

In a semi-private room with my son right now. The lack of sleep alone from the doubling of nurse doctor etc. visits is insane. Even in a private room it’s bad. How is it that hospitals don’t understand that sleep is absolutely necessary for healing? And of course my wife is staying in the room 24/7 with him and she doesn’t get any sleep either and gets more irritated and angry as the days (two now and likely at least five more) go on helping no one.

Staff who walk in without knocking and just start talking, interrupting a last moment with family before surgery, that turns out to be *the* last moment.

Staff who address old people in wheelchairs as if they are small children. No, actually even small children shouldn’t get addressed in such a patronizing way.

No, doctor, these parents have been in the NICU 24/7 for weeks, you just showed up, you don’t own the place.

No, Bob, if you’re Dr. Smith, then I’m not “Chris”, I’m “Dr. Jones”, or “Prof. Jones”, or at least “Mr/Ms Jones”.

Why again were the hospital charges alone for that outpatient surgery $40K, not the $20K discussed?

Yes, you’re the doctor, but a second opinion on a scan is not an outrageous assault on your competence.

If I ever look to need intubation for more than a very clearly limited time, just let me die.

shared rooms do allow other patients to look out for each other (e.g. press the call bell if the person in the next bed can’t) and also for the nurses to watch several beds at once. I’ve visited elderly relatives (with dementia + complex needs) in hospital and always ask for them to move to the bed nearest the nurses station to be watched more. that wouldn’t work if everyone had single rooms.

Having been a nurse for 30 years, I’d say you barely scratched the surface here. Boy, oh boy could I tell you stories…

Infection control… When I was a young nurse, the “wards” contained up to 20 beds. Yes, with the muslin almost see through curtains around each one. Big difference? In those days ALL nurses WASHED their hands between patients. Period.

Today, if you see any staff member come into your room, demand that they wash their hands before they touch you or anything else in the room. If they say they already did, or used that fake anti-bacterial gel, tell them to wash again. Or throw them out. Husbands and hefty girlfriends are very good to have around in case that becomes necessary.

Hospitals are run by the administration. They determine the staffing levels.
The for profit Insurance companies try to spend as little money as possible.
The doctors have become high end labor.

for the benefit of our American commenters id like to point out that the NHS and the Aussie system also have shared rooms, but there is no profit incentive in those systems. I think it’s just the way we do things, and have done since the era of the Victorian sanitarium. When you get sick you have a role to play, a new social position, and traditionally in your new position you lose the right to privacy and are expected to endure your measure of pain.

I’m sure this has nothing to do with the relative status of doctors and the rest of the community!

Three men are laying in a recovery room and the first man says what a terrible time he had he came in for a appendicitis and the surgeon left a sponge in me during the operation. I had to be cut back open to retrieve it. The second man says thats nothing I came in for a gall bladder operation and my surgeon left a scalpel in me and they had to cut me back open and get it out of me. Just at that moment the surgeon for the third man walks in and asks “has anyone seen my cellphone.”?

Hospitals aint ever going to be pleasant places to be in (they’re full of sick people), but really there is no excuse for cross infection or for serious sleep deprivation. I had a nightmare – literally – spell in hospital a few years ago because of this last.

On cross infection, what MamaLiberty said. The hospital’s Infection Control Manager (I assume US hospitals also have these) should keep staff, particularly all those distinguished honoraries who think their skilled hands are far too distinguished to carry bugs, in a state of perpetual terror on this. On sleep deprivation, the only argument for shared wards was the “monitor a bunch of patients at once” one, but with really cheap monitoring equipment (including CCTV) these days that no longer need apply.

And improving the aesthetics (green fluorescents, etc) is dirt cheap and will add significantly to both patient and staff comfort. Just do it already.

Thanks belle, my wife does bear the brunt of it, as I’m now back in DC caring for the younger son, who will come back up to Philly with me tomorrow. He should be okay eventually.

It is amazing to me how much she has to manage our son’s care to ensure he’s got the best of it (and thank god for her, I couldn’t fight with the doctors (mostly) and nurses (sometimes) all the time). E.g, He’s scared to death of getting his blood drawn and it takes 4 people to hold him down to get him to go it and he has pulled out his IV in the process more than once (which then has to be put back in) yet they would order up new draws each day, whether they needed them or not, and sometimes more than once because this department doesn’t talk to that department to know that they could each use the same draw.

And this all in a Children’s hospital, as if they’re all little adults and all the little pokes and prods and sticks and vitals and whatever are minor annoyances, instead of potentially big fights. It’s just maddening.

Belle–

In stead of my own recent venture into the health care system compliments of Trump for my first panic attack, I offer this, in memory of my dear mother, just now four years out from her death.

Weaning

The story you told me as I aged into understanding
And away from the early years of infantile amnesia
Was that I loved the bottle, and had one until I was nearly four.
My earliest memory was during a trip when I was two or three
And dropped my bottle—I can still see it shattered on the pavement;
You always told me I said “I have two pennies”
Boasting I could afford a new bottle. I have since bought many bottles
That I could not wean myself from as you did me from you.
And now you, with my consent, are weaned from a tube
That fits so clinically and neatly down your nasopharyngeal
Tract to your stomach, which could never stomach fish,
Because as you told me, your mother ate fish
When pregnant with you and got horribly sick,
Which of course in what you could never grasp
As Lamarckian made you hate fish too.
So Mom I willfully starve you, weaning you from useless life
As you did me from your useful self to those
Countless bottles of milk, soda and now wine,
And I return the favor. “Weaning” was the medical term used,
As if what you did for me was the same act of love.
You weaned me to life—I wean you to death.

I am glad you’re migraines are doing better – as someone who has fought with them for years (and whose life was literally changed by sumatriptan) I certainly understand.

And – you are right about hospitals! My experience comes from three sources – having spent more time in them than most people (though much less than many others); having worked in a hospital pharmacy for about 3 years while in college; and having a mother who was a nurse in a hospital for about 30 years. All of this made me want to spend as little time in them as possible. It is not surprising that putting more people in a room than is, from a health perspective, desirable isn’t limited to the US – it’s much worse in Russia, for example (where my mother-in-law was a doctor.) It is traditional, even though bad. If doctors and others could be convinced to wash their fucking hands more often, many things would be better. But, like Belle, I’ll note that one of the things I liked the least while working at a hospital was hearing – very regularly – the doctors literally scream at nurses where patients could hear them, very often for things that nurses could do nothing about (like, the fact that there are only so many minutes in an hour or hours in a day, or that the doctor had messed something up.) Working around doctors did more to lessen my respect for them than anything else has ever done.

Larry Arnold, I should have said l.

Hospitals are terrible because they’re not designed to achieve any particular end. What they are, their services and how they are delivered, their physical plant, all of it, is the result of the historical accident of where the battle lines settled in the constant war among a myriad of autonomous forces.

The last revolution in medicine — 150 to 100 years ago — was so successful that it succeeded in creating new conditions that made the state of play it established obsolete. We now have specialties in medicine because the knowledge base and array of interventions has expanded. And for the same reason we now have outpatient care as a standard, not just a luxury provided by society doctors to the very rich. The last revolution created the success that made those two things possible, but it left structures in place, specifically the hospital as the center of medical care, that served the needs of the old system, but are now inherently dysfunctional.

If we had another revolution and were able to design things from scratch, we would disassemble the hospital. The hospital is only central to medicine now because that made sense at the time that Osler passed on. It no longer makes sense. The successor institutions to the hospital that we designed would not have the internal contradictions that make hospitals terrible.

A gentle reminder with respect to the physicians.

As someone who has spent a bit of research and instructional time working on empathy in healthcare professionals, I’ve found it good to remember that residents (the newly minted MDs) are not treated with particular empathy by their supervisors and the system. They work very long shifts, are being educated using public humiliation, and are routinely expected to be personable while working miracles. It’s no wonder that the least human of them behave badly. And for all of them, the least slip is magnified by the dire circumstances in which its made. The same is true of all healthcare workers, to one extent or another.

Some specialties attract a disproportionate number of assholes (cough, cough, neurosurgeons, cough), of course, and some specialties (pediatrics, palliative care) attract people who incline to kindness, but it’s the system we need to work on.

As for rooms and expenses, well, it’s telling that when the nurses unionized at the U of Iowa hospitals, one of the things they wanted to negotiate in their contracts was staffing, because then and now, there are safety concerns for patients, and burnout concerns for the nurses. The university was adamant that they would not negotiate staffing, because even for a non-profit, cost control is job one.

Americans could have the system that addressed many of these things. As people have noted, there would still be a lot of anger and frustration on the part of patients and families–it’s and irreducible part of human illness. But we, as a nation, have decided not to put the money and effort into it we’d need to.

That’s probably true everywhere.

Was neurosurgeon a typo? The reputation for the highest incomes may tend to attract, um, highly-driven overachievers to that specialty. Then, they find they are the targets of torts.

My wife was in an NHS hospital for more than a week after emergency surgery. We spent hours in A&E before she was admitted, but once they decided she needed surgery things went pretty smoothly. There were I think 8 people in a room. Thankfully there was no TV. (You could rent a TV but no one did.) Someone came around with a cart of newspapers you could buy; it was one Guardian and seven Daily Mails in our room. We didn’t see many doctors but the nursing staff was excellent. It was more of a no-frills experience than a US or Canadian hospital but it was completely acceptable.

When I was in the hospital a few years ago I learned the answer to a question that had troubled me for years. When you wash your hands, you turn on the water with non-sterile hands, wash your hands and then touch the (non-sterile) tap again to turn off the water. Every time the nurse came into my room, she dropped a paper towel over the tap, turned on the water, washed her hands, turned off the water with the paper towel and then dried her hands with the sterile side of the paper towel. Every single time she came into the room, I was glad to notice.

My recovery room story was that I woke up having oxygen forced into my lungs which is not nice because it is very high pressure and it never stops so you can’t breathe out. Evidently my oxygen level was not coming up fast enough. After I woke up the humble orderly was summoned to push me back to my room, and it was he who noticed that the other end of my oxygen tube wasn’t plugged into the oxygen tank, it was just lying on the blanket. He just quietly plugged it in and took me away without saying anything to the recovery room staff.

#36 – totally agree re neurosurgeons and assholes, with the exception of pediatric neurosurgeons, who in my experience are universally saints. I’d add orthopedic surgeons to the high asshole quotient list. And pathologists belong on a different list, closer to pathological.