Let me tell you a tale of incompetence, hubris, anger and a near total failure of the medical system.
My sweetie of 58 years has several physical problems including spinal degeneration (a failed lumbar fusion included) and atrial fibrillation. She wears a continuous feed morphine pain pump (embedded in her abdomen) to at least partially manage the severe lower/middle back pain from the spinal degeneration and a pace maker to offset the lowered heart rate brought on by her a-fib medication. i.e. one takes medicine to solve a problem which in itself causes two more problems which requires the implant of various devices to offset the side effects of the medication!) Medical science has a long way to go, believe me! (and this is NOT to denigrate the marvelous advances in medicine we have seen and enjoyed during our all too short life spans!!)
To put it mildly, my sweetie and I have had a few not so fun days of ring-around-the-doctor(s) and nurse(s) with merry-go-round-music playing (a lot of “duh’s” to provide the rhythem) and clown performances in the hall, not to mention yours truly coming with in inch – FIVE TIMEs – of being put into handcuffs and tossed in the local hoosegow.
Sound like an interesting story? You judge for yourself.
Four days ago, Annette slipped into a-fib and for 24 hours, using the medication available to us, we tried to bring it under control. Using the maximum allowable of meds suddenly drove her B.P. up into the high 170’s, old Dad rang the alarm bell and as it was 6 AM in the morning, I tucked her into the car and ferried her the three miles to the hospital rather than call an ambulance and wait-wait-wait for it.
(Gold Star here!) She was received at the ambulance entry with very fast care of the appropriate kind by very competent nurses and a retired male fireman who was converting to be a nurse for a second career! Really nice people. Except one.
As you all know, one of the first things they do at an ER (after making sure you’re alive) is inset an IV needle through which various saline solutions and medications may be administered. A little twit of a tech (not a nurse) came in and , taking the wrong, easy and simple way out, started to insert the IV in Annette’s right (dominant arm) elbow joint. I asked, very politely for her to locate it elsewhere so when, as would inevitably happen, she bent the elbow, the IV entry point would not come under stress. I was informed by the twit that she knew far more than I did on how and where to put it and would I butt out (no please). The only way I could have kept her from taking the easy (and wrong) way out was to physically restrain her (this is the #1 incident where I could have found myself, at minimum) ejected from the hospital. MORE on this later).
Immediate room availability, Annette wired for sound, monitor pinging in the background and paper work done we then waited and waited and waited. And waited and waited. I went to the nurses station and asked what was going on and was informed that they were waiting (too) for the Boston Scientific Rep. (Boston Sci. manufactures Annette’s pace maker) to drive down from Ocala which small city is 40 miles North of us down a very traffic full highway) to “interrogate her pacemaker”. No, our very large hospital had no equipment, capability or knowledge to interrogate the pacemaker to see if it; A. was working; or B. needed adjustment. I’m glad we were not in the middle of the desert somewhere.
Three hours later (now almost noon), her medical readout showing continuous a-fib and hysterical efforts by her pace maker to keep her hearts’ ventricle chamber beats up with the atrial chamber of her heart as it fluttered and thrashed about (now going on 30 hours plus), the very nice gentleman from Boston Sci. showed up, coupled his machine (externally) to her pace maker; made one small tweak which changed absolutely nothing and then provided me with a 20 minute concentrated seminar on pace makers, how to read hospital CRT readouts to be able to tell what a-fib looked like and normal pacing looked like (she was doing both), when to panic and when to watch and wait. Super instructional period and I had a lot of my studying on the subject both confirmed and expanded.
He left. Time passed. More time passed. My sweetie began to hurt in both shoulder (she has had rotator cuff surgery and inactivity intensifies discomfort therein) and back. I went to the nurses station (As an important BY-NOTE, when she checked in to the ER, I filed both a Living Will and Health Surrogate forms with them to go in her records (The THIRD time as they keep loosing the ones I had filed in the past)..
The ER Doctor (unfortunately a young lady- maybe low-30’s max) who was already absorbing a God Complex from her limited M.D. pedigree and ER rotation was not cooperative. I requested a mid- powered analgesic such as hydrocodone to provide my sweetie with some relief from her discomfort. After a five minute lecture on how little I must know about pain meds (Ha!) she grumped and said she’d take care of it. (My wife and I have been dealing with pain medication in varying strengths and formats for the past 35 years and know exactly what works, how and how much, have studied the subject extensively, holding great interest in our own health, the medications we put into our bodies and to insure our maximum quality of life – what’s left of it!).
Twenty minutes later, in waltzed the minimal-ER Doc accompanied by a nurse who was waving around a syringe containing 2 ml. of liquid morphine. (Don’t forget, Annette is already on a continuous morphine feed pump!).
I politely request that they (even said “please”) do not administer that large a dose of morphine and instead please give her a milder form of pain med such as hydrocodone which would help her discomfort without putting her into la-la land. I was given a “sniff” and an ugly look by the ER Doc, completely ignored thereafter and the morphine was administered. (NOTE: This is #2 on my “damn near” getting cuffed, ejected from the hospital and tossed in the local klink).
Predictably, within 10 minutes she was floating about two inches off the bed and couldn’t remember her own name.
Time passes. More time passes. Yet more time passes.
Ah Ha! Mid-afternoon comes along and in comes a physician (I use the term conditionally) who was a member of our Cardiac Group and who had installed Annette’s pace maker two years before (never heard from since).
He proceeded (after completely ignoring my presence) to explain to her in highly technical terms a procedure that was going to be performed on her the following morning called a “cardiac electroversion” which, essentially, was a procedure where they put a paddle on each side of her chest and shock the bejesus out of her in hope that it will cause the heart to drop out of a-fib and back into normal rhythm.
Three minutes into this explanation, I got up and left the room, knowing full well that Annette was wearing a 1,000 yard stare, was nodding and smiling at inappropriate times, not asking any questions and two minutes after the “doctor” left, wouldn’t remember he had even been there. (She asked me, not five minutes later, who was that guy who came in an talked to her because she didn’t remember any of it!)
At any rate, I waited by the Nurses Station until he came out of the room and politely asked him is I might have a minute or two of his time. Please note: This variety of “doctor” is far down the path of “Godhood”, way too self-important for his own good, too busy to be bothered with anything requiring even a slight deviation from his appointed (or is it anointed?) path.
He whirled in his chair (having sat down by then), scowled at me and very gruffly said, “What?”.. I (very gently and calmly) started to explain to him that, in my opinion , my wife never understood his explanation of the procedure due to being excessively sedated 20 minutes earlier.
He actually yelled at me, “The attending physician determines the any medication given to the patient!” Bang..
I then started (key word “started”) to ask his permission to finish what I had started to say. Never got past started because he had spun around in his chair (his back to me), picked up a telephone and started dialing. Note: This was #3 in the series of anger control exercises to keep me out of jail – but the Senior Partner of the Cardiac practice will hear about this in SPADES!!).
Time Passes. And Passes. Night Falls. I determine to sleep (Ha!) in the “recliner” in the room and stay with Annette all night. (Why, you ask? Need you ask???) The recliner is designed to drive even the most caring and dedicated caregiver out of the room in less than an hour.
At 4AM one of the floor nurses came into the room and administered a medication to Annette via her IV (don’t forget the IV, now). Since he didn’t deem it necessary to let me know what it was, I got up from my recliner of pain, went out to the Nurses Station and asked. The medication was Digoxin. That’s a really powerful medication that is capable of slowing the heart down unto death. It is also to be used VERY carefully in those of advanced years (say 70 plus) as the results of using it on an aged heart can be both abrupt and fatal.
I have been unable to find out (yet) who ordered the medication but it wasn’t all bad because within 15 minutes, her heart dropped out of a-fib, resuming the normal pacing at about 60 beats per minute. Annette went into a very deep exhausted sleep. (A-fib causes one chamber of the heart to beat at high rates (115- 160-+) [and can cause fatal blood clots] as if one were jogging along at a high rate of speed for 36 hours without a break and literally wears your heart down until you are -as I said above – exhausted. It is the equivalent of taking a 76 year old woman and running her through the 24 hour endurance course for Special Forces as far as her heart is concerned.
Time passes. And passes. A fresh Doctor from our cardio group popped in the door (this one is a “she”), sharp as a tack and with the exception of not being fond of listening to you, is much more to trusted as far as knowing her business.
She informs us that since the heart is no longer in a-fib, as soon as the quagmire of paper is complete and discharge stuff is finished, my wife can now go home. No procedure was needed (regardless of the option of the first “doctor”) and a follow up appointment was made with her regular cardio-man.
Shortly there after. in gathering her belongings to leave, she inadvertently flexed her right elbow (remember that damned “easy” IV?), stressed the IV severely and squirted blood in a stream from her closet cabinet across the floor to the edge of her bed where I brought her a towel and she applied pressure to slow down the flow. I summoned her nurse (stat) and she, with an extremely ugly pile of cotton and tape managed to stem the flow of blood (more pressure required).
The nurse grabbed a towel from the bathroom and wiped up the blood (sorta).
The housekeeping staffer was summoned and a very pleasant and totally incompetent middle aged lady showed up, took a second rag and smeared the blood around a second time. Then she took a dirty mop (hadn’t been rinsed in living memory as far as I could see) and mopped the floor, smearing the blood and dirt around and left.
I took a small hand full of clean white paper towels, tossed them on the darkest smears and used my foot to wipe them around. The towels were black when I finished.
I took the hand full of towels and carefully stuffed them into a plastic bag that we had brought along – “just in case” and took the mess out to the nurses station, explained the situation to two nurses and dropped the bag on their large, high priced high-tech, full of monitors desk. One of them carefully picked it up with two fingers and deposited it in the trash. No apology. No “We’ll get it done right!” NO NOTHING. Not a word about HIV and Hep. C or any of the other lovely diseases that lurk in dark corners of hospitals when they aren’t disinfected properly. It was never cleaned up prior to our departure.
That was #4 in my sequence of holding my temper.
#5 in that sequence came an hour later when the discharge papers came along, listing her medication list (incorrect for the third time since her admission as far as pain meds) and did not even list the Digoxin that the hospital itself had ordered from our local pharmacy for her to take upon release from the hospital to keep he heart out of A-FIB!
I got her home, finally, alive, with 3 errors made by doctors and 4 errors made by nurses and an uncounted number of rude encounters and being ignored all within a 48 hours period. Two errors of the doctors could have been fatal. Errors made by the nurses were unforgivable and showed a total disregard (with one notable exception) of patient care or condition and NONE OF THEM paid the least bit of attention to the Health Surrogate form in her file – even when I drew their attention to it and demonstrated the fact that my wife was incapable of making informed decisions due to over-medication.
SUMMARY: I would not admit a dog to a human hospital without a 24 hour advocate (yourself, a trusted friend or someone hired for the job) that stays there 24 hours a day to insure more damage is not done than treated or cured.
PS: This local hospital – large, serving most of the County where I live and several surrounding Counties – has received awards of all sorts for wonderful performance, care above and beyond and gold stars galore. I wonder how much they paid for them.
ive been in your shoes, and unfortunately, due to the lack of concern and /or knowledge the hospital in my neck of the woods let me 13 yr old sister die. Hope things get better
You’re rolling the dice when you enter about any hospital. Glad you & sweetie made it out alive and hope she recovers nicely.
What is the name of this hospital and where is it?
Muck – it will only go down from here as the good nurses and doctors quit because of the onerous obombya care.
Shit is fucked up and bullshit.
Muck, you really know your stuff, and your sweetie is lucky to have such a strong advocate as yourself fighting for her.
It’s wonderful that you can write about your experience here on TBP. Writing is cathartic. Thank God —- errr, Jim —– for TBP!!
Hospitals are a crap shoot. You can go to a crap hospital, but if you have a great doctor it will be a good experience. (I have a friend whose life was saved at a “crap” hospital.) Likewise, a supposedly “great” hospital can turn into a nightmare if you wind up with a shit doctor. It’s all about the doctor(s).
Thank you for sharing your story. I am DELIGHTED, of course, that it all turned out OK for both of you.
Peace
Yup. Sounds about right. I had surgery for kidney stones. I was released even though I could not urinate after. Within 12 hours I’m back getting the stent removed because I am in screaming agony. 2 shots of dilaudid is like a tic tac. Off to a 3rd hospital now. Str8 to a morphine pump. An ultra sound determines they missed the stone and my kidney is blocked and the size of a football. They go in thru my dick while I am awake because there are too many drugs in me now to put me under. A week on a morphine pump for pain with a catheter til my damaged kidney shrinks. The pain was exquisite. Passing a stone is orgasmic in comparison. That is one of my three stories for why I dont trust doctors one bit. I hadnt been to the doc in years til the old lady made me go for a checkup and tetanus shot last week. And now I have the fucking flu. Go to the doc, get sic.
As for the tetanus, before I get dogged on that, but if I aint bleeding, I aint working. Everything is sharp round here. Trying to keep up with that toothless bastard I work with is gonna kill me someday. 18 years older than me and damn he is a working ass. If anyone is interested in micro hydro power let me know.
T4C
It was only a few weeks ago when you got into it with an ASSHOLE doctor right here on TBP. I don’t believe that fucker has been back since! HA!
Upon further reflection I should like to modify my statement and say it’s the NURSES who make all the difference between a good hospital stay, and a bad one.
Sorry, Muck. What a sad thing to have happened.
My son went to hospital with abdominal pain. It did not improve, and the hospital where he was did nothing, but suspected appendicitis, but said he would have to wait for a “specialitst” – perhaps 12 hours. My wife was willing to wait, but I said fuck that, it ain’t happening, and drove him to another recommended hospital that supposedly could operate immediately if it was deemed to be required. There, appendicitis was diagnosed, and he was put in line for surgery.
The line was around 6-12 hours, but could be longer – despite us having been told he could go in immediately (an emergency had occurred bumping him from the line, they said). What the fuck says I to the attending physician (I think it was probably more strongly worded than that.)! Attending says “it will probably be ok.” At which point I am going ballistic. “Probably? What the fuck is probably?!!!”
I ask him if he had kids. Yes he said. I asked him what he would do if it was his kid. He hummed and hawed, then said he would get him immediately into surgery, somehow.
I immediately began calling all the hospitals in the area, and found one with an open room, and was able to get a young local surgeon who was on call in to do the surgery. Private ambulance trip to the next hospital, and total time from me making calls to him going under was under 2 hours.
Turns out his appendix had burst, and his abdomen was rapidly becoming infected. And a 12 hour delay, or more, could have been very serious indeed, said the young surgeon (very impressive young man).
Moral of the story – as Muck says – you must have someone there to protect the interests of your loved one. In Muck’s situation, there is a chance I would have ended up in jail, as I really would have gone full-on ballistic. Maybe not though – I have found self-righteous anger almost always works and gets results – so long a you are right. Muck was obviously right.
My wife was initially very surprised at how aggressive I was in getting him treated – she felt the doctors surely must know what they were doing. After the final outcome, she now knows very differently. And she was very apologetic that she had not joined more forcefully in the fight. She simply did not understand it could have gone very wrong.
One other little matter, and it is an indictment on the system, I suppose – I was able to get him in as soon as I did because money was no object. People without that leverage would be at the mercy of the system.
Muck – I am very sorry for your experience, and very pleased that in the end the outcome was ok.
T4C – unfortunately, there are a lot of very bad nurses out there, too. And some good ones. The system is full of holes.
T4C – you were talking about egos, and I was talking about competence. Was not taking a shot at you – just kinda double clarifying the point.
You are right – in general, incompetence is the norm in just about every field. Incompetence no longer results in the person’s genes being eliminated from the gene pool – in fact, the most incompetent now breed like rabbits. That will do wonders for the world going forward, I am sure.
I spoke to a former manager that worked for me, who has risen to be head of production at a fairly large plant not overly long ago.
He said the turning point in his career came one day when he was complaining about the quality of the supervisors and employees, and how it made getting the job done very hard indeed. I pulled him aside and told him “Stop complaining. The world is full of bad employees, bad supervisors, and bad managers. Accept it, and get over it. Find a way to overcome, and don’t waste time complaining about it.”
He said he thought about it, and decided I was right – the world was full of incompetence. And he determined to stop using the incompetence of others as an excuse for poor performance. And his career has taken an upward trajectory ever since.
Most folks ignore my advice (go figure) – I have given that exact advice many times. However, I am very pleased that a young man took it on board and has decided to succeed despite the obstacles incompetent folks put in his way.
I went through cancer treatment, two operations and 34 lovely radiation treatments 4+ years ago. It was an eye opener.
I had several issues with the treatment I received in the course of the two operations and the discussions of treatment options between those two procedures and immediately after them. I wrote them up in a brief letter to my doctor. He didn’t quite crumple it up and throw it away right in front of me but that would have been the next step. He regarded it with all the enthusiasm of a daisy pushed into his hands by a hare krishna at the airport.
The nurses I encountered were uniformly kind and solicitous of my welfare. The doctors were assholes. What struck me, more than anything, was how casually contemptuous they were. I asked a lot of questions. I wanted to know what was going on. And it really bothered them. I wasn’t asking as I was being sedated or anything, staring up at a needle and shrieking, “What’s that?!” I didn’t take extra time in the consultations I had scheduled. But I made them explain to me exactly what was supposed to happen. I found that they repeatedly left out information. “Oh, yeah, most of the radiation isn’t even aimed at your tumor. It’s aimed at your lymph nodes.” At one point I had a choice between a third operation or radiation treatment. Eventually, I narrowly chose the radiation treatment and the doctor who would have performed the third operation then told me, “Oh, yeah, I would have had you go through a course of radiation afterward anyway.” I’m not a punch a stranger sort of guy but I almost made an exception for that guy.
I finally ended up having a shouting match behind a closed door with an oncologist at the end of which he grudgingly admitted that, well, yeah, he hadn’t told me everything despite my explicitly asking him to do so multiple times. But then he gave himself the out that “Oh, you’re an engineer? Yeah, engineers are hard to deal with.” As though showing casual contempt for your patients is excusable depending upon their occupation.
On a related note, my best friend told me that when his father went into the hospital a doctor friend of my best friend advised him to feel absolutely free to argue with the doctors and nurses treating his father, to be polite but not show them deference, to trust his judgement and only let them reasonably talk him out of his convictions with evidence, not appeals to authority.
How Doctors Die by Ken Murray
It’s Not Like the Rest of Us, But It Should Be
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found
a lump in his stomach. He had a surgeon explore the area, and the diagnosis
was pancreatic cancer. This surgeon was one of the best in the country. He had
even invented a new procedure for this exact cancer that could triple a
patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a
poor quality of life. Charlie was uninterested. He went home the next day,
closed his practice, and never set foot in a hospital again. He focused on
spending time with family and feeling as good as possible. Several months
later, he died at home. He got no chemotherapy, radiation, or surgical
treatment. Medicare didn’t spend much on him.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t
die like the rest of us. What’s unusual about them is not how much treatment
they get compared to most Americans, but how little. For all the time they
spend fending off the deaths of others, they tend to be fairly serene when
faced with death themselves. They know exactly what is going to happen, they
know the choices, and they generally have access to any sort of medical care
they could want. But they go gently.
Of course, doctors don’t want to die; they want to live. But they know enough
about modern medicine to know its limits. And they know enough about death to
know what all people fear most: dying in pain, and dying alone. They’ve talked
about this with their families. They want to be sure, when the time comes,
that no heroic measures will happen — that they will never experience, during
their last moments on earth, someone breaking their ribs in an attempt to
resuscitate them with CPR (that’s what happens if CPR is done right).
Almost all medical professionals have seen what we call “futile care” being
performed on people. That’s when doctors bring the cutting edge of technology
to bear on a grievously ill person near the end of life. The patient will get
cut open, perforated with tubes, hooked up to machines, and assaulted with
drugs. All of this occurs in the Intensive Care Unit at a cost of tens of
thousands of dollars a day. What it buys is misery we would not inflict on a
terrorist. I cannot count the number of times fellow physicians have told me,
in words that vary only slightly, “Promise me if you find me like this that
you’ll kill me.” They mean it. Some medical personnel wear medallions stamped
“NO CODE” to tell physicians not to perform CPR on them. I have even seen it
as a tattoo.
To administer medical care that makes people suffer is anguishing. Physicians
are trained to gather information without revealing any of their own feelings,
but in private, among fellow doctors, they’ll vent. “How can anyone do that to
their family members?” they’ll ask. I suspect it’s one reason physicians have
higher rates of alcohol abuse and depression than professionals in most other
fields. I know it’s one reason I stopped participating in hospital care for
the last 10 years of my practice.
How has it come to this—that doctors administer so much care that they
wouldn’t want for themselves? The simple, or not-so-simple, answer is this:
patients, doctors, and the system.
To see how patients play a role, imagine a scenario in which someone has lost
consciousness and been admitted to an emergency room. As is so often the case,
no one has made a plan for this situation, and shocked and scared family
members find themselves caught up in a maze of choices. They’re overwhelmed.
When doctors ask if they want “everything” done, they answer yes. Then the
nightmare begins. Sometimes, a family really means “do everything,” but often
they just mean “do everything that’s reasonable.” The problem is that they may
not know what’s reasonable, nor, in their confusion and sorrow, will they ask
about it or hear what a physician may be telling them. For their part, doctors
told to do “everything” will do it, whether it is reasonable ornot.
The above scenario is a common one. Feeding into the problem are unrealistic
expectations of what doctors can accomplish. Many people think of CPR as a
reliable lifesaver when, in fact, the results are usually poor. I’ve had
hundreds of people brought to me in the emergency room after getting CPR.
Exactly one, a healthy man who’d had no heart troubles (for those whowant
specifics, he had a “tension pneumothorax”), walked out of the hospital. If a
patient suffers from severe illness, old age, or a terminal disease, the odds
of a good outcome from CPR are infinitesimal, while the odds of suffering are
overwhelming. Poor knowledge and misguided expectations lead to a lot of bad
decisions.
But of course it’s not just patients making these things happen. Doctors play
an enabling role, too. The trouble is that even doctors who hate to administer
futile care must find a way to address the wishes of patients and
families.Imagine, once again, the emergency room with those grieving, possibly
hysterical, family members. They do not know the doctor. Establishing trust
and confidence under such circumstances is a very delicate thing. People are
prepared to think the doctor is acting out of base motives, trying to save
time, or money, or effort, especially if the doctor is advising against
further treatment.
Some doctors are stronger communicators than others, and some doctors are more
adamant, but the pressures they all face are similar. When I faced
circumstances involving end-of-life choices, I adopted the approach of laying
out only the options that I thought were reasonable (as I would in any
situation) as early in the process as possible. When patients or families
brought up unreasonable choices, I would discuss the issue in layman’s terms
that portrayed the downsides clearly. If patients or families still insisted
on treatments I considered pointless or harmful, I would offer to transfer
their care to another doctor or hospital.
Should I have been more forceful at times? I know that some of those transfers
still haunt me. One of the patients of whom I was most fond was an attorney
from a famous political family. She had severe diabetes and terrible
circulation, and, at one point, she developed a painful sore on her foot.
Knowing the hazards of hospitals, I did everything I could to keep her from
resorting to surgery. Still, she sought out outside experts with whom I had no
relationship. Not knowing as much about her as I did, they decided to perform
bypass surgery on her chronically clogged blood vessels in both legs. This
didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her
feet became gangrenous, and she endured bilateral leg amputations. Two weeks
later, in the famous medical center in which all this had occurred, she died.
It’s easy to find fault with both doctors and patients in such stories, but in
many ways all the parties are simply victims of a larger system that
encourages excessive treatment. In some unfortunate cases, doctors use the
fee-for-service model to do everything they can, no matter how pointless, to
make money. More commonly, though, doctors are fearful of litigation and
dowhatever they’re asked, with little feedback, to avoid getting in trouble.
Even when the right preparations have been made, the system can still swallow
people up. One of my patients was a man named Jack, a 78-year-old who had been
ill for years and undergone about 15 major surgical procedures. He explained
to me that he never, under any circumstances, wanted to be placed on life
support machines again. One Saturday, however, Jack suffered a massivestroke
and got admitted to the emergency room unconscious, without his wife. Doctors
did everythingpossible to resuscitate him and put him on life support in the
ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took
over Jack’s care, I spoke to his wife and to hospital staff, bringing in my
office notes with his care preferences. Then I turned off the life support
machines and sat with him. He died two hours later.
Even with all his wishes documented, Jack hadn’t died as he’d hoped. The
system had intervened. One of the nurses, I later found out, even reported my
unplugging of Jack to the authorities as a possible homicide. Nothing came of
it, of course; Jack’s wishes had been spelled out explicitly, and he’d left
the paperwork to prove it. But the prospect of a policeinvestigation is
terrifying for any physician. I could far more easily haveleft Jack on life
support against his stated wishes, prolonging his life, and his suffering, a
few more weeks. I would even have made a little more money, and Medicare would
have ended up with an additional $500,000 bill. It’s no wonder many doctors
err on the side of overtreatment.
But doctors still don’t over-treat themselves. They see the consequences of
this constantly. Almost anyone can find a way to die in peace at home, and
pain can be managed better than ever. Hospice care, which focuses on providing
terminally ill patients with comfort and dignity rather than on futile cures,
provides most people with much better final days. Amazingly, studies have
found that people placed in hospice care often live longer than people with
the same disease who are seeking active cures. I was struck to hear on the
radio recently that the famous reporter Tom Wicker had “died peacefully at
home, surrounded by his family.” Such stories are, thankfully, increasingly
common.
Several years ago, my older cousin Torch (born at home by the light of a
flashlight—or torch) had a seizure that turned out to be the result of lung
cancer that had gone to his brain. I arranged for him to see various
specialists, and we learned that with aggressive treatment of his condition,
including three to five hospital visits a week for chemotherapy, he would live
perhaps four months. Ultimately, Torch decided against any treatment and
simply took pills for brain swelling. He moved in with me.
We spent the next eight months doing a bunch of things that he enjoyed, having
fun together like we hadn’t had in decades. We went to Disneyland, his first
time. We’d hang out at home. Torch was a sports nut, and he was very happy to
watch sports and eat my cooking. He even gained a bit of weight, eating his
favorite foods rather than hospital foods. He had no serious pain, and he
remained high-spirited. One day, he didn’t wake up. He spent the next three
days in a coma-like sleep and then died. The cost of his medicalcare for those
eight months, for the one drug he was taking, was about $20.
Torch was no doctor, but he knew he wanted a life of quality, not just
quantity. Don’t most of us? If there is a state of the art of end-of-life
care, it is this: death with dignity. As for me, my physician has my choices.
They were easy to make, as they are for most physicians. There will be no
heroics, and I will go gentle into that good night. Like my mentor
Charlie.Like my cousinTorch. Like my fellow doctors.
Ken Murray , MD, is Clinical Assistant Professor of Family Medicine at the University of Southern California
1. The time I landed at UCLA for 9 days, by the 3rd day, I was out of intensive care and I was now awake. An intern came to see me and I asked if I should be doing anything? Whether it was the same guy or another, someone came by and demonstrated how i should suction my throat because i had a tube there. Of course I failed to keep up with it because I had no notion of time. A nurse came in the evening. An orderly greeted her asking if she wasn’t supposed to be on vacation. She said something happened and her vacation was cut short. She looked at my throat tube and foud a lot of pink gunk in there. She began to suction my throat for a long time then stopped saying, I will stop now because you would go into [a severe coughing fit]. She scolded the student doctors who came to look in on me saying, you have him on nothing but saline. I had been in hospital for 3 days and had lost a lot of blood. She began feeding me thruogh my nose tube, withdrew fluid from the tube to look at my stomach fluid. I got wonderful care from her while i was in her ward for those 3 days. My last 3 days in the hospital, I was sort of abandoned and when my sister came to visit me, they relased me and she took me home. They gave me an old pair of khakis and a t shirt to wear since I had no clothes but a hospital gown.
2. My buddy said his dad went to Kaiser Hospital in San Berdu with a leg injury. While there, a nurse dropped the needle that had come loose from his leg. She picked it up off the floor and reinserted it. Soon he was sick with fever and feeling horrible. This went on for a time while the doctors were clueless about what to do. I told my distraught buddy about a guy who had been in the hospital for a month or more, he had been cut open at the belly and his case sounded like my buddy’s dad. My buddy said he was in no mood to talk to anybody about medical experiences. His dad did not have to die. Maybe a year later, my buddy went to nursing school. soon enough he told me that he learned his dad should have been cut open just like the dude I had told him about.
Wow, this thread is pretty much similar to my experiences.
Three years ago I spent 6 months in and out of the hospital because of gall bladder attacks. On several trips to the ER because the frequency of my visits(gallbladder attacks generally happen at night when offices are closed) I was accused of being a drug addict. The only drugs that stop a gallbladder attack are narcotics. A few times they gave me demerol (fucking bullshit no help drug) which would take my pain from an 8 to a 6 because I was “showing signs of being a drug addict.” Anybody who has ever had a gallbladder attack is showing signs of being a drug attack because they literally need drugs to make that awful pain stop.
Muck- Every time I went into the hospital I would always have my IV inserted into my hand. This always pissed off the nurses. I have no idea why,
Fred- Much like you I would always ask what they were injecting into my body. This always pissed off the nurses. I have no idea why.
GeneralT, I could use some micro hydropower help. Thank you for the offer
This was interesting reading, however I’m wondering..
does the medical system go berserk on you for refusing treatment you don’t agree with?
My daughter at the moment is having food intolerance problems –as does every family member only not as severe and my brother has spent yrs at gastroenterologists and hospitals for tests…and my daughter wants to avoid this. So she just avoids the foods that don’t agree with her. but it leaves her with few choices of stuff to eat (that she likes).
Waiting for a nanny state meddler to report me for medical neglect and the SWAT team invasion. My daughter is 17 and smart enough to know that “care” is not always in your best interest.
Sad to say but it is imperative that you become your own doctor these days. I’ve always referred to da interwebz as The Oracle and it really pays to consult The Oracle regarding all symptoms that might necessitate a doctor visit and then consult The Oracle to research the diagnosis and suggested treatments provided by the doctors. A good stack of old fashioned medical books helps as well. I’ll be eternally grateful to AWD for his advise. Luckily I have a great family doc that I trust and he is fantastic at helping me make sense of the things I’m told by other docs.
I’ve got too many stories of bad docs to relate here but I agree with T4C……..Muck definitely needs to write up his experience and send it to all the big wigs at the hospital he trusted with his sweetie and beyond. It does help. I went to the biggest hospital in my area to see an orthopedic surgeon to talk about having some hardware removed which required full sedation and a trip to the OR. Despite being there for over an hour and seeing the surgeon in the hall, she couldn’t be bothered to even stick her head in the door and meet me even though her PA was all set to put me on the surgical schedule. I wrote the same letter to about 4 different big wigs including the corporate offices letting them know why they wouldn’t be getting the opportunity to bill my insurance or receive any of my co-pay/deductible dollars. I received letters and phone calls about a week later. Less than a year later I got a letter from the surgeon herself “inviting” me to follow her to her new place of employment as she was leaving the hospital. I like to think my letters helped with that.
The Oracle is fantastic for researching medical matters and numerous fantastic forums exist where you can read the experiences of others and post questions. I learn more from forums that I ever do from doctors. Still, you have to sort the wheat from the chaff.
AWD
When my father-in-law was with us, we were able to be with him 24 hours while he was in the hospital and then even when he was in terminal care… to make sure that he got the best care possible. We’d heard these sort of horror stories and seen first hand from my own multiple hospital stays how bad the treatment in hospitals can be.
Thanks for this wonderful firsthand story!
@willieb
Micro hydro
Leave an email address, and I will need a picture of your water source to begin with
You will be amazed how little water you need
Boss man is off grid on a small spring feeding a liitle man made pond
Im on a seasonal stream
Back on topic, get a dnr tattoo (do not ressucitate) on your chest over your heart like I did
The wife’ll shit, but its somewhat comforting
Another good idea is to get your living will and healthcare powers of attorney in order NOW. Keep a couple of copies handy in a secure location at home and give a copy to your family doc and maybe a trusted friend. Take copies with you to all new doctor visits. Muck is correct when he says that they do not always make it into your records.
Make sure you get “wet ink” copies, not photocopies. Don’t be afraid to consult your family doc regarding living wills. They can be very helpful with fine details.
I’ve been told that due to HIPA laws, docs can refuse to discuss your care with family members in some situations so powers of attorney are essential to avoid being passed off to a court appointed advocate.
Man! Is there ANY part of our lives our so called leaders have not fucked up?
Muck’s experiences are not uncommon. I think my dad spends half his life keeping my mom from being killed by doctors and nurses. Her health is bad and he has saved her from at least three mistakes that could have killed her or done permanent harm. He calls them savages.
Muck, I’m truly sorry to read of you and your sweetie’s medical nightmare. It just enforcers what I already know from experience. The majority of doctors and nurses are complete and arrogant idiots whom wouldn’t trust to dump a slop bucket much less perform any sort of medical care.
Best regards and hope you and Anette never meet such medical incompetence again.
To sum it up – they just don’t care. They get to charge you what ever they want, no matter what the outcome.
search “whale” + “medical mafia” and educate yourselves about our medical system
Holy TBP! I get up, check my mail and TBP and find a whole wealth of comments on a story I wouldn’t have thought Jim would have published yet!
I thank you all for you good wishes, examples and believe me T4C, I’d count you on the Gold Star side of the ledger! We did have decent nurses, several exceptional and several duds. Kinda like an abbreviated Bell Curve with steep ends.
I neglected to mention to any one there that I’m a retired Engineer (Electronics, Optics and Mechanical) but in the atmosphere flowing sluggishly (with bad smells) around that ER, I doubt anyone would have even cared.
@Zarathustra: Thanks for publishing that article. Yes, I have also run into situations where several close friends (MD’s) have passed on – none of them in a hospital and none of them “by surprise”. It seems that when they have gotten their ticket punched and the expiry date is approaching, they always seem to have an adequate supply of morphine, methadone, phenobarbital or other drugs available to make the passing possible when, where and how they desire – usually at home with family, peacefully and comfortably.
Would that society would allow us to do the same (i.e. Oregon and Washington greatfully excluded)..
All in all, thanks to all for your good wishes and stories. For me, writing is a relaxing, stress relieving activity and believe me I so needed that after I got Annette home!
MA
@Llpoh: Good for you! I’m so glad you took matters into your own hands and got him the hell out of the interminable waiting and got that popped organ removed. Nothing like peritonitis to lock up your abdomen, be unbearably terribly painful and fatal if not immediately treated by both eliminating the source of the infective material and loading the patient with antibiotics. You get a Platinum Star!!!
MA
When you go to the Emergency Room make sure your Doctor is a board certified Emergency Room Physician.
AWD worked in Emergency Rooms and he was an Internal Medicine Physician. Not to say AWD was not on top of his game, not at all. It’s just they receive different training as a baby doctor.
The IV in the elbow joint. Also known as the antecubital Fossa of AC for short. The reason the tech was insisting on the AC is because that’s the easiest place to start an IV. I would evaluate the tech wanting to use the AC on how long he or she looked for an alternate site. If they spent 10 15 minuets looking and decided that was the best location that would be one thing. If they walked in and went straight for the AC without looking at both arms then you had a new tech that was just learning.
I have no problem navigating the healthcare system because I know which Doctors to use.
Muck why did you wait 4 days? From what you described above your wife’s heart condition is very unstable. I would not delay treatment in the future. Go to her Primary Cardioglist and speak with them ask if in the future they would work you in for an emergent office visit to avoid an ER visit.
Best wishes,
Sorry to clog up this thread muck. I have been trying to find some help with this project and was surprised and happy to see the Generals offer.
The listing is up June 1 and I have decided to go off grid here if possible.
http://www.realtor.com/realestateandhomes-detail/W4052-Hanke-Ln_Lily_WI_54491_M76770-99159?row=67
[email protected]
Damn iPad changed my handle. ‘Twas I above
GeneralT, you’ll have to click through the pictures. The spillway is about 60 yards from the house.
The medical establishment is a bureaucracy. They make decisions like any other bureaucracy. Which is to say poorly and absent any common sense. Also like any other bureaucracy incompetence, and arrogance are rampant.
If you don’t want to be at their mercy you have to take control of your own health. It takes a lot of time and effort to educate yourself and take the necessary steps. Unfortunately in today’s world of GMOs and chemical farming you pretty much have to raise a large part of your own food to be able to eat well.
Every time a doctor solves a problem for you they create more problems. My own mother is a perfect example. They’d start her on one medication, which had side effects (they all do), so then they’d prescribe another one to counter the effects of the previous med. Before you know it she’s ingesting this cocktail of nearly twenty-five different meds and feels like crap ALL the time. Finally she just says to hell with it and stops taking any of them and quit going to the doc as well. She feels much better since ditching them.
My attitude is that doctors and hospitals are great for fixing injuries and putting you back together when you have broken your body, but if I ever get diagnosed with a serious illness I intend to go home and take some pain killers and then go out in the garage and close the door and start my car and let it put me into my eternal rest, rather than endure treatment from the medical establishment.
Reality check. Then system is broken. Do not expect good results from broken systems. How would you proceed if you sought medical treatment in a middle eastern hospital? That is closer to the reality.
Now quit whining unless you are prepared to cull the source of the problem.
TacticalZen
Please enlighten us on YOUR plan to cull the source of the problem.
Muck is right. I wish he was by my side when Ihad my hospital experience.
I had a heart attack on the job and was transported to the nearest hospital by a fellow employee.The hospital did a wallet biopsey and determined I was treatable. They then administered a aspirin, hooked my arm up to a litre bag of heprin (anti coagulant) via IV, called an ambulance and I was transported to another hospital that had a cath lab that was open on Sunday. I was in a great deal of pain waiting through the ride and being admitted to the second hospital, then after what seemed to be a very long time I was wheeled into the cath lab. A second bag of heprin was hooked up because (as I found out later) the second hospital’s policy is to use heir own supplies. Unfortunately the first bag was not removed and kept running into me. After the 100% blockage was cleared and stinted in one of my cardiac arteries I was wheeled into the intensive care unit.
Not long after that I started bleedng profusely from the site in my goin area where the catheter was inserted. I guess they use this site because there is a very large artery there to easily access. The bleeding was due to the second litre bag of heprin. The overdose of anti coagulant would not allow the small surgical site to close up. I had three nurses taking turn putting presure on my groin. That didn’t work so they got a devise that could have had its origin from the Spanish Inquisition. All night this pressure tool was on my groin. The pain this devise yielded was worse than the heart attack. Eventually the wound closed well enough for the torture devise to be removed. I found out what what happened afterward by overhearing the nurses whispering while they thought I was asleep.
I’m just glad I’m still alive.
My junk looked like what I invision Barny the Dinosaur’s would look like. Beware of hospitals and never assume their staff know what they are doing. Ask lots of questions…if your able.
TacticalZen
Dahum!! You’re just BRILLIANT!!! Great commentary! Very enlightening! Post moar often!!
/end sarc
Sorry to hear about your dreadful experiences, Muck.
My wife and I have spent a lot of time in hospitals/doctor’s offices during the past two years or so, and especially in the past few weeks. We have had no bad experiences, but a sufficiently pointless experience that we will simply not go to an ER if it can in any way be avoided. Going to an ER for anything other than trauma it almost always a waste.
That said, we have excellent experiences with two doctors in particular in juts the past 3 weeks ( particularly stressful time). After reading this thread I feel particularly blessed to have found these dedicated, caring, excellent professionals. To, T4C’s point, not only do each of them recognize how critical their nurses and techs are, they lean on them. One doctor admitted to us she would be nearly worthless without her head nurse.
The Healthcare Industry is severely, ridiculously fucked up, but there are also many extraordinary, committed wonderful professionals (at all levels) out there.
Wow Muck, so sorry and glad to hear your wife is home.
My dad just left the hospital yesterday after being rushed by ambulance Thursday due to his blood thinners finally, after 15 months, starting to turn on him.
I not only get to run interference with hospital staff, I have to run interference FOR hospital staff against my dad.
Dad refuses to hear what he is told. Refuses to accept that his diabetes, multiple hip replacements, 12 meds a day, afib, arthritis, clogged arteries and a heart beat that runs about 40 beats a minute and 76 year old age means that he may die anytime soon.
He also agrees to every procedure or medication and never asks a question.
This is my second decade of “helping” him navigate his health and the system. They are ALL making me insane.
Even though you don’t believe, I’ll mention you both in my prayers tonight. Bless you Muck, your wife is a lucky woman.
If you want to have a happy life avoid lawyers and doctors, especially hospitals.
Steph S, my millennial babe.—Want to avoid gallbladder attacks? E.C. says, put hot castor oil packs on your abdomen, more on the right quadrant side for several hours. More information available at EdgarCayce.org as there is more to it.
It works.
Muck–Sorry to hear about your experience. Getting old is a bitch. So…This is my experience. I never knew what was wrong with me. I felt like I was dying. Of course, like church, I avoid doctors religiously.
My heart rate was 40 beats per min. When ever I walked up the stairs, it would drop to 30-35 beats per min. Just the opposite of what should happen. I was tired just walking up the street and had to stop often. I said, “Homer, you’re not in a grave, but you sure have one foot in it”. “You’re not goin’a make it, you’re dying”. I thought, I’m sure there were some who knew me, upon hearing of my funeral and not able to attend would agree that it met with their approval.
I even attended am A-Fib seminar put on by doctors looking for business. It may have been the free buffet provided by the hospital that was the real incentive. However, getting an expensive risky operation, wasn’t up my alley. But the food was good.
In Whole Foods, browsing the vitamin section, I came across a bottle of liquid ‘ionic trace minerals’. Remembering back about how important trace minerals are and how the vegetables in America are mostly depleted of trace minerals and how minerals are more important than vitamins, especiall if you don’t have any. I decided to it a whirl. “Can’t hurt”, I said to myself just before I was rushed to the hospital–no, just kidding.
In one week (I swear) after taking the trace minerals, my heart rate went to 70 beats per min and increased when I exerted myself. My blood oxygen, which I have always taken daily, has always been in the mid 90.
It saved my life! And that’s my Les Schwab moment.
DISCLAIMER
I am not a doctor, I never wanted to be a doctor, nor have I ever thought of being a doctor. So, consult your health care professional, that the one who isn’t a lawyer, but has his hand in your wallet, just the same, who refuses to talk to you and sees you as a cash cow. And, when they kill you or greatly wound you, you can go the the other guy that has his hand in your pocket called a lawyer. America, What a country!
I’m glad to hear the lady is doing better. However, as a general comment, if fail to become informed about what health is (optimal function), not just absence of symptoms, and how it is produced, we can hate the hospitals all we want, we’re still likely to end there regularly. MD’s are nothing but celebrities, trained in the “science” that is sponsored by the medical establishment/pharmaceutical corps. They are taught to believe that only they know. The rest of us is taught to believe that same thing….
@Sender to: We didn’t wait 48 hours.. It was 24 hours with me checking BP/HR every hour or so to see if ever increasing doses of sotolol would bring things back into the ball park. I checked with her Cardio-man’s PA to what the max total dose in 24 hours could be . Last 40 mg. dose popped her BP up to almost 180/130 and that’s when I loaded the wagon and trundled off to the ER (at 6AM – the beasts of the night had fled and the day’s traffic had not started/
I got her in on a gurney in 2 minutes flat and things went down hill from there.
The twit who stuck in the IV in her elbow never looked anywhere else to see if she had any other accessible veins (of which she has plenty) and over my objections..
Thanks for the comments..
MA
Homer- They cut out that organ so its all good now.
@TE: Damn, I’m sorry about your Dad. Some people just don’t take any interest in their own health, the meds that get pumped into them and just come into a an MD’s office or ER with pain or problem and trust they will be fixed by following instructions.
We aren’t like that. Nothing goes into our bods unless I’ve researched it (especially side effects and interactions) and I do the research from a minimum of 5-6 sources.
My sweetie is 76, in generally good health except for things that are wearing out – walks with me (dedicated) 7 days a week, does as much outdoor gardening and such as her bod permits. In other words – she’s as active as she can be. I’m 78, go to the gym 3 times a week, beat the shit out of lymphoma (for now anyhow – had the chemo port popped out the other day) which was a 20 year fight. I weigh less than I did in high school and it’s all healthy meat and muscle (including a lot of my head!). BP runs 115/75 and except for arthritis in a few places (that get shot at by my pain manager now and then), I’m just fine and feel as good as I ever did. Of course, the genes contribute something to it but there have been times in the past where it was mind over matter as far as not just rolling over and quitting.
I’ll roll and quit someday too – just at my timing, location and method. I’m having too much fun to think about it anymore anyhow.
Keep up the good work with your Dad and try to make his life – at this point – as enjoyable as you can.
My best to you and him…
MA
@Zarathustra: Your article reminded me of one other tale. My Grandfather…. He was a surgeon, volunteered for WWI and was a Major in charge of a horse drawn version of a mobile MASH unit in a number of nasty places over in France. Strafed one time by a Krout pilot who didn’t see the Red Crosses on the side of the wagons. Same pilot returned the next day and parachuted two cases of champagne into the hospital compound (i.e. circled wagons a-la wild West) with an apology note about shooting them up the previous day.
Eventually my grandfather owned a small hospital in Independence, Kansas where I was born.. Mr parents lived at the time in Wichita Falls, TX and when time for me to arrive, they drove up to Kansas and my grandaddy delivered me. He was fairly well off, except that he had all his savings in Cuban Sugar and lost every dime when Batista took over. Such is life.
They eventually moved in with Mom and Dad and I in Jackson, Mississippi, when I was a young squirt when he could no longer work and had to take care of my Grandmother who had everything wrong with her from diabetes to Alzheimer’s (although back then it was not defined) and didn’t know anything or anyone around her and couldn’t do anything for herself. I mean anything.
So he, my Mom and Dad and I took care of her for – oh, I remember about 6 years until she passed. My Grandad was 87 by then, sharp as a tack and worn clear out. (He did most of the 24 hour a day care).
One day, about a month after Grandmother passed, he called me into his bedroom, shut the door, gave me hug and told me that he was leaving. I broke down crying – I loved my Grandad a lot – but he explained until I understood that no one needed him anymore and that he had done his best to fulfill his obligations to care for my Grandmother until she died and he had nothing left in life he wanted to do.
He made me promise not to cry when he left (leaving the “left” to my imagination) and that he was going to a better place.
The next morning, Mom found him dead, comfortable, with a letter (which I never got to read) next to the bed and an unmarked bottle of pills on his bedside table. He died like Doctor’s die. Planned ahead, thought out, timed for maximum usefulness in this life and then exiting stage left, quietly, with dignity and a minimum of fuss. All I ever wished was that I had been allowed to be with him and hold his hand when he died. I got a little pissed at him over that but got over it.
I’vd outlived both my parents – so I must have some Grandfather genes lurking around to help me out.
I’ve never stopped loving him..
MA
I was lucky to go to Stanford Med where I was treated like a queen. I know those days will one day end-obamacare.Best wishes to your sweetie.Hope she feels better,and gets better care
Muck
Your sweetie is lucky to have you by her side. Thanks for sharing.
By choice, all my doctors are females, including my urologist (I have prostate cancer), whom I am thinking about asking out for a date since she fiddles around with my private areas twice a year. JUST KIDDING ABOUT THE DATE ANGLE, FOLKS.
Women are great doctors. We kid around, they listen to me, I them, and take it from there. Works like a charm. Maybe I’m lucky.
In July 2011 a gallbladder attack sent me to the ER. Subsequent surgery to remove the offending organ revealed cancer on my liver. Next month marks 4 years of getting to know the inner workings of MUSC Charleston very well as they have all but eradicated the cancer on my liver. Throughout it all, my confidence in and respect for the guys and gals that work so hard to make every patient’s stay as pleasant as possible. The doctors and staff have unfailingly been very professional, responsive to my questions and concerns and completely forthcoming about each new procedure or drug.
I mention this only to give my Doc and his staff at their teaching hospital the recognition their world class operation richly deserves. They are wonderful, loving and hardworking people and I cannot say enough good about them. I am grateful for their dedication and wish everyone here could experience the benefits of a hospital and its staff working well, just as I have.
Muck, sender to was me, damn iPad changed my name. I know and understand just a little bit about an Emergncy Room. The individual starting an IV in the AC without looking else where was a new tech. Never let anyone but an RN start an IV, they don’t pay the techs shit and they change every month.
Muck FYI, if you are in an Emergency Room and you feel like you are being ignored, fall on your knees and Thank God in Heaven, you are blessed. You don’t want to be the focus of attention. If it takes hours to be seen, every minute that goes by count your blessings.
If you see a large number of people in scrubs running to your room and some one saying sir please follow me, that’s the time to get concerned, that’s the time to worry about an outcome!
You had a great experience, your wife went home with you.
Read these words once or twice! You”ll remember them.
Muck I also know you don’t ascribe to God. Talk to my preacher El Stucky, he’ll save your mortal soul from hell fire and damnation. God loves the twisted fucker!
TacticalZen says:
Reality check. Then system is broken. Do not expect good results from broken systems. How would you proceed if you sought medical treatment in a middle eastern hospital? That is closer to the reality.
Now quit whining unless you are prepared to cull the source of the problem.
______________________________
Got it. The cure for the US health care system is for it’s hospitals to be bombed by the Israelis and Saudis.