Tonight I write about the needs of people. Not people whose needs are filled on a daily basis by their spouses, or families, or jobs, or hobbies, or friends. But there are a host of people out there in need of something- otherwise unfulfilled in their lives- but unaware of what that something is. Some of these people are mentally ill. Some are addicted to substances. But this entry is about another category of person-one that I have been fascinated by since I was in medical school: Lonely, sane people.
On a given Saturday night in the Emergency Room, the crazy people and drunks are abound- but also tucked away, in corner bays, are 22 year old college kids, far away from home with stomach aches. There are 82 year old women with children on the other coast with chest pain. There are 50 year old divorcees with headaches. And after $1000 of tests show "nothing serious," more often than expected these people will ask a simple question: "Please, doctor, can I stay the night?"
When I was 23, I fell almost 3 stories. I broke bones, and had a concussion, and came inches from my death. And I was hospitalized for almost 3 weeks. And at the end of this ordeal, on my last day, I found myself terrified to leave. The nurture that the hospital provided went beyond my broken body. And despite all of the needle sticks, the mistakes, the frustration- call buttons pressed with no answer- catheters left in too long- I derived something in those 3 weeks that I needed for months before the accident: An emotional hug.
A hospital overnight stay costs $1500, even for an uncomplicated patient. This cost takes into account nursing, supplies, a percentage even pays the janitors, keeps the lights on. But the cost doesn't take into account human need. Yes, the homeless man who needs a roof over his head and a cup of soup- it's easier to wrap the brain around giving him a bed. But that 22 year old? Who is to say she won't derive as much, or more from a night of hospital loving? Maybe that night will inspire her in some way to find that feeling of nurturing in a more appropriate place, like a relationship, or in work that she loves, or in giving to her community. And the 82 year old- maybe this is the first, and only human touch she's had in months. Maybe she just needs a reminder in kindness, to make it through another year of arthritis and television.
In an ideal world, perhaps we'd have a special floor in every hospital for these folks. Perhaps funded by those of us with more love in our lives. In reality, 9 times out of 10, our answer to the question is unfortunately no. We don't have the funds for admissions for no good reason. That isn't the point of a hospital. Mental health can be provided in an outpatient setting. Lonely isn't a diagnosis. The arguments I've heard go on and on.
And as I watch these folks walk out, I send them virtual hugs from afar, and hope that they find what they need out there, in a world that is tough on those without.
Tuesday, March 31, 2009
Tuesday, March 17, 2009
9 pm Negligence
My readers, however many of you there are out there. I have spent the last few months in work purgatory, so many apologies for not writing for a while. I will get back to work now on a more consistent basis.
Someone I know died this week. And I was especially touched by her death in many ways. For one, it was a preventable death brought on, at least in part, by negligent health care provided by doctors and nurses (both responsible in this case- but mostly the doctors). I was also touched by how the various members of her family coped with this death.
For starters, the recently deceased was 89 years old, lived independently with her 90 plus year old husband, and in almost every way defied the odds and the norm of what the lay person thinks of "elderly" in that, despite her dementia and quirks that was assuredly due to her age, she was one of the most spirited, self-sufficient and remarkable people I have ever met. She always wore a smile, and despite a memory that failed her, she knew her family well and remembered what they meant to her. Last week she had hip pain and was found to have a small hip fracture which was supposed to be an easy repair but ended up being a larger repair once the orthopedic doctors took a look inside. The surgery went quite well and she was walking, talking, complaining, and acting very much herself by a few days after the operation.
One of the more common post-operative conditions, especially in elderly patients, is one of ileus. Here, the motility of the bowel slows to a halt, and the result is one of what we docs refer to as pseudo-obstruction (pseudo in that the bowel is not actually blocked or twisted, but instead is so slowed or dilated that the end result is the same). And that result is nausea, vomiting, abdominal pain, and a general state of misery. The standard of care for such a state is to give medications for nausea, and place a nasogastric tube from the nose to the stomach which decompresses the stomach of food and air refluxing backwards up the bowel. This tube is placed for comfort, but more importantly to prevent vomiting which inevitably comes with ileus and obstructions after enough time. In all patients, and especially the elderly, vomit can easily pass the epiglottis and travel down the bronchus into the lungs- an event called aspiration. There the acid mixed with food causes a burn called chemical pneumonitis as well as bacterial pneumonias. The end result can be very bad for the lungs.
So on the third day after her hip repair, the beloved great-grandmother, grandmother, mother, and wife developed an ileus and vomited 3 times. Sometime that day her son, who luckily was there visiting, began to advocate on her behalf for something to be done. An IV bag ran out. The bed was not cleaned. And the vomiting continued. Despite promises from doctors, trained, board certified MDs, to place the tube, one was never placed. At 7pm, she vomited and aspirated into her lung a good deal of her vomitus. She was intubated in an intensive care unit an hour later when I found out what had happened, and then died of complications stemming from this by midnight. Just like that- a woman who successfully underwent a big operation, carefully performed by watchful, skilled physicians died from medical neglect just days later.
Now the question is what her family is to do with that anger. Do they bottle it? Do they sue the hospital? I will devote my next blog to lawsuits and medical malpractice, every doctor's nightmare. For now I'd ask you to think about how enraging it is when a life is on the line, and you trust people to cherish that life, and not treat it like a nuisance in a workday- and mistakes happen and the life is lost. There's no making up for that mistake. Money, apology- maybe they help, but they do not heal.
Someone I know died this week. And I was especially touched by her death in many ways. For one, it was a preventable death brought on, at least in part, by negligent health care provided by doctors and nurses (both responsible in this case- but mostly the doctors). I was also touched by how the various members of her family coped with this death.
For starters, the recently deceased was 89 years old, lived independently with her 90 plus year old husband, and in almost every way defied the odds and the norm of what the lay person thinks of "elderly" in that, despite her dementia and quirks that was assuredly due to her age, she was one of the most spirited, self-sufficient and remarkable people I have ever met. She always wore a smile, and despite a memory that failed her, she knew her family well and remembered what they meant to her. Last week she had hip pain and was found to have a small hip fracture which was supposed to be an easy repair but ended up being a larger repair once the orthopedic doctors took a look inside. The surgery went quite well and she was walking, talking, complaining, and acting very much herself by a few days after the operation.
One of the more common post-operative conditions, especially in elderly patients, is one of ileus. Here, the motility of the bowel slows to a halt, and the result is one of what we docs refer to as pseudo-obstruction (pseudo in that the bowel is not actually blocked or twisted, but instead is so slowed or dilated that the end result is the same). And that result is nausea, vomiting, abdominal pain, and a general state of misery. The standard of care for such a state is to give medications for nausea, and place a nasogastric tube from the nose to the stomach which decompresses the stomach of food and air refluxing backwards up the bowel. This tube is placed for comfort, but more importantly to prevent vomiting which inevitably comes with ileus and obstructions after enough time. In all patients, and especially the elderly, vomit can easily pass the epiglottis and travel down the bronchus into the lungs- an event called aspiration. There the acid mixed with food causes a burn called chemical pneumonitis as well as bacterial pneumonias. The end result can be very bad for the lungs.
So on the third day after her hip repair, the beloved great-grandmother, grandmother, mother, and wife developed an ileus and vomited 3 times. Sometime that day her son, who luckily was there visiting, began to advocate on her behalf for something to be done. An IV bag ran out. The bed was not cleaned. And the vomiting continued. Despite promises from doctors, trained, board certified MDs, to place the tube, one was never placed. At 7pm, she vomited and aspirated into her lung a good deal of her vomitus. She was intubated in an intensive care unit an hour later when I found out what had happened, and then died of complications stemming from this by midnight. Just like that- a woman who successfully underwent a big operation, carefully performed by watchful, skilled physicians died from medical neglect just days later.
Now the question is what her family is to do with that anger. Do they bottle it? Do they sue the hospital? I will devote my next blog to lawsuits and medical malpractice, every doctor's nightmare. For now I'd ask you to think about how enraging it is when a life is on the line, and you trust people to cherish that life, and not treat it like a nuisance in a workday- and mistakes happen and the life is lost. There's no making up for that mistake. Money, apology- maybe they help, but they do not heal.
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