Risk vs. Benefit

[Frostbit]

Let's move the discussion here and let Gramps suffer in peace.

All medical choices, whether directed by established licensed caregivers or laymen, should balance risk vs. benefits.

The present GLP-1 rage for weight loss is a fine example in my humble opinion. One of the biggest frustrations doing family practice was the realization of how low a percentage of patients actually wanted to invest any effort into their health. "Diet & Exercise" is a cliche' to most, not because they doubt its effectiveness, but because it takes effort. I could burn an enormous amount of bandwidth telling you the endless list of excuses I heard during my career.

So back to risk vs. benefit.

In the obese type2 diabetic that likely prompted their disease with horrible nutrition choices and less than favorable activity levels the instant karma of a GLP-1 might might pass the risk vs. benefit scale. But what about the otherwise "healthy" person who doesn't like what the mirror tells them and wants a more attractive figure (male & female) in a more rapid method with far less work than diet & exercise? I personally know four people using GLP-1's who were never told they will lose muscle mass and strength as well as perceived excess fat. There's also many potential side effects such as gastric paresis that are possible risks.

So where does the risk vs. benefit scale tilt in this case?

I prescribed sleep aides and smoking cessation drugs in my career but always related the potentially huge risk profile. Had a few Chantix users develop profound depression which luckily disappeared rapidly after stopping the drug. I had one Ambien user that failed to heed my advice to use the initial dosing in an observed environment so if a "walking amnesia" occurred someone could intervene. That patient "woke up" in a holding cell after a traffic accident with no memory of even leaving the house.

This is the reason I adamantly urge caution accepting medical advice from verbal studies of one like your Aunt and neighbor.

Your mileage may vary. 0.02

[Newman]

I agree, but extreme pain in particular is a special case. One will try anything, including suicide. (I have a 19th century ancestor who committed suicide and I strongly suspect is was during his painful, terminal illness.)

My ethical concerns surround government assisted suicide, or infanticide, etc.

[scott]

Risk vs. benefit is terribly misunderstood, to our detriment.

A case in point is my mom, who had a fairly early diagnosis of what was then called "Bronchoalveolar carcinoma," a very specific kind of lung cancer The Oncologists said if she did nothing she had 2 years to live. There were multiple treatment options (a combination of surgery, chemo, and immunotherapy) but this new "whiz bang" Da Vinci robot assisted "minimally invasive" surgery was presented as the obvious choice by multiple doctors from different medical systems. The surgery was relatively simple, straightforward, and "almost outpatient." "You'll be home in time to water the garden on Saturday," they said. By that logic it was the right choice.

Except:
1. It had not been used long enough to truly understand the risks and the Surgeon was effectively blind while conducting the procedure.
2. The hospital was covered under sovereign immunity since it was a government hospital - a fact they denied many times until I brought a letter from a state representative outlining the reason for being granted sovereign immunity. This means patients had no recourse for medical malpractice, so risky procedures were biased in favor of taking the risk.
3. NOBODY had done a risk panel to assess which procedures would be better to be used due to the lack of data (which was later disclosed).

As most of you know, that surgery was only successful through the lens of the fact that it got all of her lung cancer out - but none of the complications were even discussed. The surgeon unknowingly entered incorrectly so the robot nicked her stomach, punctured her diaphragm, and she sucked part of her stomach into her thoracic cavity which started spewing bile all around the lungs, including the internal wound. She developed sepsis, spent 5 months in the ICU, 3 more months in inpatient rehab, and another year "recovering" at home and caught a cold which escalated quickly. Then a screening found a spot on her spine, but she was too weak (from the COMPLICATIONS) for any treatment. She died 3 months later, 20 months after her first diagnosis - sooner than she would have died if she had done nothing.

Another list:

1. There was simply no reason to use the robot for an otherwise straightforward procedure without robust safety data. Experiment on the cases that are somewhat "last resort," don't play Lost in Space with my mom if conventional surgery is very low risk.
2. If you won't do something unless you're guaranteed to not get sued, then just DON'T DO IT unless that's the only option available.
3. Properly characterize "experimental," don't say something is proven when it hasn't been proven at all.
4. Patients need to learn how to tell their doctors to fuck off sometimes. Say it nicely, say it directly, and say it with truth and facts on your side (which is very difficult) but be your own advocate because the doctor isn't going to advocate for you - and most of the staff just don't give a shit.

[80zephyr]

Risk vs. benefit is terribly misunderstood, to our detriment.

A case in point is my mom, who had a fairly early diagnosis of what was then called "Bronchoalveolar carcinoma," a very specific kind of lung cancer The Oncologists said if she did nothing she had 2 years to live. There were multiple treatment options (a combination of surgery, chemo, and immunotherapy) but this new "whiz bang" Da Vinci robot assisted "minimally invasive" surgery was presented as the obvious choice by multiple doctors from different medical systems. The surgery was relatively simple, straightforward, and "almost outpatient." "You'll be home in time to water the garden on Saturday," they said. By that logic it was the right choice.

Except:
1. It had not been used long enough to truly understand the risks and the Surgeon was effectively blind while conducting the procedure.
2. The hospital was covered under sovereign immunity since it was a government hospital - a fact they denied many times until I brought a letter from a state representative outlining the reason for being granted sovereign immunity. This means patients had no recourse for medical malpractice, so risky procedures were biased in favor of taking the risk.
3. NOBODY had done a risk panel to assess which procedures would be better to be used due to the lack of data (which was later disclosed).

As most of you know, that surgery was only successful through the lens of the fact that it got all of her lung cancer out - but none of the complications were even discussed. The surgeon unknowingly entered incorrectly so the robot nicked her stomach, punctured her diaphragm, and she sucked part of her stomach into her thoracic cavity which started spewing bile all around the lungs, including the internal wound. She developed sepsis, spent 5 months in the ICU, 3 more months in inpatient rehab, and another year "recovering" at home and caught a cold which escalated quickly. Then a screening found a spot on her spine, but she was too weak (from the COMPLICATIONS) for any treatment. She died 3 months later, 20 months after her first diagnosis - sooner than she would have died if she had done nothing.

Another list:

1. There was simply no reason to use the robot for an otherwise straightforward procedure without robust safety data. Experiment on the cases that are somewhat "last resort," don't play Lost in Space with my mom if conventional surgery is very low risk.
2. If you won't do something unless you're guaranteed to not get sued, then just DON'T DO IT unless that's the only option available.
3. Properly characterize "experimental," don't say something is proven when it hasn't been proven at all.
4. Patients need to learn how to tell their doctors to fuck off sometimes. Say it nicely, say it directly, and say it with truth and facts on your side (which is very difficult) but be your own advocate because the doctor isn't going to advocate for you - and most of the staff just don't give a shit.

Wow. This is the first I heard about your mom. My condolences.

Mark

[80zephyr]

The flip side is that doctors can be wrong too. Look at my cluster headaches as an example. I think I told this group about the
time a medical procedure was performed on me that almost blew my penis off?

I have plenty of stories of medical incompetence.

Mark

[phillygirl]

Risk vs. benefit is terribly misunderstood, to our detriment.

A case in point is my mom, who had a fairly early diagnosis of what was then called "Bronchoalveolar carcinoma," a very specific kind of lung cancer The Oncologists said if she did nothing she had 2 years to live. There were multiple treatment options (a combination of surgery, chemo, and immunotherapy) but this new "whiz bang" Da Vinci robot assisted "minimally invasive" surgery was presented as the obvious choice by multiple doctors from different medical systems. The surgery was relatively simple, straightforward, and "almost outpatient." "You'll be home in time to water the garden on Saturday," they said. By that logic it was the right choice.

Except:
1. It had not been used long enough to truly understand the risks and the Surgeon was effectively blind while conducting the procedure.
2. The hospital was covered under sovereign immunity since it was a government hospital - a fact they denied many times until I brought a letter from a state representative outlining the reason for being granted sovereign immunity. This means patients had no recourse for medical malpractice, so risky procedures were biased in favor of taking the risk.
3. NOBODY had done a risk panel to assess which procedures would be better to be used due to the lack of data (which was later disclosed).

As most of you know, that surgery was only successful through the lens of the fact that it got all of her lung cancer out - but none of the complications were even discussed. The surgeon unknowingly entered incorrectly so the robot nicked her stomach, punctured her diaphragm, and she sucked part of her stomach into her thoracic cavity which started spewing bile all around the lungs, including the internal wound. She developed sepsis, spent 5 months in the ICU, 3 more months in inpatient rehab, and another year "recovering" at home and caught a cold which escalated quickly. Then a screening found a spot on her spine, but she was too weak (from the COMPLICATIONS) for any treatment. She died 3 months later, 20 months after her first diagnosis - sooner than she would have died if she had done nothing.

Another list:

1. There was simply no reason to use the robot for an otherwise straightforward procedure without robust safety data. Experiment on the cases that are somewhat "last resort," don't play Lost in Space with my mom if conventional surgery is very low risk.
2. If you won't do something unless you're guaranteed to not get sued, then just DON'T DO IT unless that's the only option available.
3. Properly characterize "experimental," don't say something is proven when it hasn't been proven at all.
4. Patients need to learn how to tell their doctors to fuck off sometimes. Say it nicely, say it directly, and say it with truth and facts on your side (which is very difficult) but be your own advocate because the doctor isn't going to advocate for you - and most of the staff just don't give a shit.

So sorry she and you all had to go through with that. I have definitely learned that the doctors don't always know best and you do really need to be educated and be an advocate. Unfortunately, however, like in the case of your mom, time is simply not on your side. For my sister, we've had time for me to do my research and be able to question, push back, and oftentimes educate the doctors. In her case she had an amazing team of neurosurgeons that very quickly came to trust me. But that was only after I refused to allow the nurse to give her what was basically a blood thinner, the night before surgery. They had already done it once, her numbers tanked, and she couldn't have the surgery. I argued with the nurse the next time, made them speak not to the surgical office, but to the surgeon himself before she gave it to her. The surgeon cleared it, she tanked again, they first canceled the surgery, then decided to do something else. She bled out after the surgery but they revived her. After that he gave me his cell phone number and I continue to text him now, even if her issue isn't in his arena because he's actually a surgeon that cares and will intervene for me/her whenever it's needed. Last time he did so he told me that he had no power, but that he was really calling the doctor (who he didn't even know) to let them know that he was following her case, that I usually knew what I was talking about as I pay a lot of attention to what is going on with her, and he acknowledged that it was also primarily so that the treating doctor would treat her as someone who mattered, rather than just a number.

[Frostbit]

The flip side is that doctors can be wrong too. Look at my cluster headaches as an example. I think I told this group about the
time a medical procedure was performed on me that almost blew my penis off?

I have plenty of stories of medical incompetence.

Mark

And plenty of mechanics are blamed for failing to fix a poorly maintained car, just sayin'.

[80zephyr]

And plenty of mechanics are blamed for failing to fix a poorly maintained car, just sayin'.

And you are right.

Mark

[80zephyr]

So sorry she and you all had to go through with that. I have definitely learned that the doctors don't always know best and you do really need to be educated and be an advocate. Unfortunately, however, like in the case of your mom, time is simply not on your side. For my sister, we've had time for me to do my research and be able to question, push back, and oftentimes educate the doctors. In her case she had an amazing team of neurosurgeons that very quickly came to trust me. But that was only after I refused to allow the nurse to give her what was basically a blood thinner, the night before surgery. They had already done it once, her numbers tanked, and she couldn't have the surgery. I argued with the nurse the next time, made them speak not to the surgical office, but to the surgeon himself before she gave it to her. The surgeon cleared it, she tanked again, they first canceled the surgery, then decided to do something else. She bled out after the surgery but they revived her. After that he gave me his cell phone number and I continue to text him now, even if her issue isn't in his arena because he's actually a surgeon that cares and will intervene for me/her whenever it's needed. Last time he did so he told me that he had no power, but that he was really calling the doctor (who he didn't even know) to let them know that he was following her case, that I usually knew what I was talking about as I pay a lot of attention to what is going on with her, and he acknowledged that it was also primarily so that the treating doctor would treat her as someone who mattered, rather than just a number.

When my dad was alive, I was in the same boat as you. One time, he had a lot of blood in his eye. Took him to emergency, and we waited. And waited. Finally, I asked the desk what was the hangup, the on-call doctor was bicycling!! When I got snitty, one of the nurses said "he has a right to have time off to". Like fuck he does, he was ON CALL.

Mark

[Frostbit]

When my dad was alive, I was in the same boat as you. One time, he had a lot of blood in his eye. Took him to emergency, and we waited. And waited. Finally, I asked the desk what was the hangup, the on-call doctor was bicycling!! When I got snitty, one of the nurses said "he has a right to have time off to". Like fuck he does, he was ON CALL.

Mark

In 1984 we embarked on our first traveling nurse gig to Savannah, Georgia. In that era the nursing shortage was in full swing so hospitals had to hire travelers regardless of origin. Being from the Philly area (Delco, there I admit it PG) we were their perception of the dreaded Yankees. I got written up and threatened with termination because I did not stand and give up my seat and chart at the nurses station when a doctor arrived. The asshole never said a word to me but immediately went to the "head nurse" with his complaint. The head nurse called me into the office, explained the rules, and said, "We're sick and tired of you Yankees coming south and trying to change things".

Now the horror story related to Mark's post.

I worked on an Urology floor that had a lot of post-op patients. One of mine was a fresh post-op radical prostatectomy. He had two Jackson-Pratt drains in. They are a thin tube with a squeeze bulb on the end. You open the small port, squeeze the bulb then close the port creating a gentle suction that will drain fluid from a surgical site. Usually the fluid is Serosanguineous, a result of the body's inflammation from the surgery. It should never be frank blood.

Both JP's were filling with blood at a rapid rate indicating an active bleed. It was about 6:00PM. There was no available list of on call physicians phone numbers. You had to call the nursing supervisor who would then call the doctor. When I called the nursing supervisor she came to the floor and saw the frank bleeding, which I kept tract of in volume. The patient already lost over 400cc's. She then told me the doctor left orders he was not to be disturbed with calls until 8PM because he was going out to dinner. I asked who was covering and was told he was. The poor supervisor was stuck. I made a deal with her that I would call (this guy had a rep as a real prick) and take the flack but the call had to be made. She wrote the number on a piece of paper and left it on the desk for plausible deniability on how I got it. I placed the call.

The guy was livid. He tried to tell me I didn't know blood from body fluid and he would be in around 9PM to check. I calmly said, "That's fine. I'm sure the ER doc will eventually figure out he needs transfused when he's called to the code in an hour when your patient codes". The guy went nuts. "I'll see you shortly, your career is over".

What a joke. I was a traveler and would just take another contract elsewhere but I would be damned if I would let my patient potentially die for this asshole's dinner plans.

He stomped in about 40 minutes later. Barged past me into the room and drained the JP's himself watching the fill with blood. Went out to the desk and called the emergency OR team to prep.

He never said a word to me after that but eventually warmed up weeks later, and would chat and asked me how I was doing. There was about a week left on our contract and he said it was a shame that I would be missed. I asked him to step into the utility room with me and told him that if he didn't act like a prick all the time the other nurses, who were also good, would be more likely to be the asset to his practice that they could be. His answer, "I'll try".

The patient on the other hand figured out what I did and at discharge gave me his contact information inviting me to hunt deer on his property if I wanted.

[phillygirl]

In 1984 we embarked on our first traveling nurse gig to Savannah, Georgia. In that era the nursing shortage was in full swing so hospitals had to hire travelers regardless of origin. Being from the Philly area (Delco, there I admit it PG) we were their perception of the dreaded Yankees. I got written up and threatened with termination because I did not stand and give up my seat and chart at the nurses station when a doctor arrived. The asshole never said a word to me but immediately went to the "head nurse" with his complaint. The head nurse called me into the office, explained the rules, and said, "We're sick and tired of you Yankees coming south and trying to change things".

Now the horror story related to Mark's post.

I worked on an Urology floor that had a lot of post-op patients. One of mine was a fresh post-op radical prostatectomy. He had two Jackson-Pratt drains in. They are a thin tube with a squeeze bulb on the end. You open the small port, squeeze the bulb then close the port creating a gentle suction that will drain fluid from a surgical site. Usually the fluid is Serosanguineous, a result of the body's inflammation from the surgery. It should never be frank blood.

Both JP's were filling with blood at a rapid rate indicating an active bleed. It was about 6:00PM. There was no available list of on call physicians phone numbers. You had to call the nursing supervisor who would then call the doctor. When I called the nursing supervisor she came to the floor and saw the frank bleeding, which I kept tract of in volume. The patient already lost over 400cc's. She then told me the doctor left orders he was not to be disturbed with calls until 8PM because he was going out to dinner. I asked who was covering and was told he was. The poor supervisor was stuck. I made a deal with her that I would call (this guy had a rep as a real prick) and take the flack but the call had to be made. She wrote the number on a piece of paper and left it on the desk for plausible deniability on how I got it. I placed the call.

The guy was livid. He tried to tell me I didn't know blood from body fluid and he would be in around 9PM to check. I calmly said, "That's fine. I'm sure the ER doc will eventually figure out he needs transfused when he's called to the code in an hour when your patient codes". The guy went nuts. "I'll see you shortly, your career is over".

What a joke. I was a traveler and would just take another contract elsewhere but I would be damned if I would let my patient potentially die for this asshole's dinner plans.

He stomped in about 40 minutes later. Barged past me into the room and drained the JP's himself watching the fill with blood. Went out to the desk and called the emergency OR team to prep.

He never said a word to me after that but eventually warmed up weeks later, and would chat and asked me how I was doing. There was about a week left on our contract and he said it was a shame that I would be missed. I asked him to step into the utility room with me and told him that if he didn't act like a prick all the time the other nurses, who were also good, would be more likely to be the asset to his practice that they could be. His answer, "I'll try".

The patient on the other hand figured out what I did and at discharge gave me his contact information inviting me to hunt deer on his property if I wanted.

As you know, my mother was a nurse. She was hired by Mount Sinai Hospital in NYC sight unseen. They were known as "coal cracker" nurses. Any nurse from Northeastern PA was given priority for hiring because their programs at the hospitals were top notch and they were given a lot of leeway. My mom learned quickly not to take any crap from doctors and she always said the smart docs knew the nurses could save them or bury them.

This week I got to start my day after the holiday with a not so quick trip to the ER for my sister. At some point during the night her trach became dislodged, causing her severe discomfort. We couldn't get it back in. The nurse and the respiratory team at the ER wanted no part of trying to put it in or take it out, so we waited about 2 hours for the doctor to come by. It was a resident. She was obviously young, but then introduced Doogie Howser as her supervising doctor, along with a medical student who accompanied them. He looked terrified. As soon as the three of them huddled around my sister she sat up straighter in the bed and said something which they couldn't understand, with quite a bit of authority. The word was "pee". They looked at me and I told them "she has to use the bathroom". I then explained to her that she had a purewick in (a temporary non-invasive catheter that the nurse put in immediately, just in case, so as to avoid trying to get her on and off the guerney for what turned out to be about a 6 hour visit). I then added to my sister that it was nice of her to demand help with going to the bathroom from the 3 doctors that were there.
To Doogie Howser's credit he laughed and said "well I have two hands and if there's something I can do to assist I'm happy to help". He's clearly not a surgeon.

I generally get on well with most of the doctors that my sister has had to deal with. The long term ones have been great. The newer ones for newer issues can be a bit difficult at first. I laid out a resident a few months ago when she tried to assert that I wasn't my sister's proper "next of kin" and therefore she didn't need to speak with me about whether or not she could be medically cleared for a major back surgery the next day while having just come off of 50 percent oxygen, had a stent put in for gall stones in the bile duct, was presumably still actively dealing with pneumonia and sepsis and had an active bleed after the surgery to remove the gall stones, necessitating an emergency surgery the next day (which was only 2 days prior to the discussion about whether or not she should be cleared for major back surgery for the following day). While she advised me of the law on next of kin (I never reveal I'm an attorney unless it's absolutely necessary) my cell phone rang. I looked at, let her know it was my sister's other neurosurgeon calling me back and since he was in Scotland I'd be taking his call. I'd also let her know that before she cleared her for the new surgery she better check my sister's history of active bleeds post surgery requiring at least one called code after an otherwise successful surgery. The respiratory therapist that had apparently been trying to get in to see my sister while I was laying out the Resident laughed a bit when I apologized for my forcefulness. She just shook her head and said "sometimes you've got to let them know how it is, no matter their degree". As expected the Residen refused to give me any information, however the next morning the nurse advised me that the surgery was cancelled. When her surgeon finally returned my call I let him know that the surgery was cancelled. He said he didn't know where I was getting my information from that he still had it scheduled. I let him know the nurse told me when she took my sister's breakfast order (knowing that food is a big no no before surgery he knew I was right). I know him and he's a great surgeon, but a little more prickly than her other neurosurgeon. The other one spoke to him for me and tried to get him to call me back that Sunday night, to no avail. It's ok. he would have been better served to have called me back so that he didn't have to eat crow that I got his surgery canceled. He could have canceled it himself, which he was amenable to once he spoke with me.

[80zephyr]

In 1984 we embarked on our first traveling nurse gig to Savannah, Georgia. In that era the nursing shortage was in full swing so hospitals had to hire travelers regardless of origin. Being from the Philly area (Delco, there I admit it PG) we were their perception of the dreaded Yankees. I got written up and threatened with termination because I did not stand and give up my seat and chart at the nurses station when a doctor arrived. The asshole never said a word to me but immediately went to the "head nurse" with his complaint. The head nurse called me into the office, explained the rules, and said, "We're sick and tired of you Yankees coming south and trying to change things".

Now the horror story related to Mark's post.

I worked on an Urology floor that had a lot of post-op patients. One of mine was a fresh post-op radical prostatectomy. He had two Jackson-Pratt drains in. They are a thin tube with a squeeze bulb on the end. You open the small port, squeeze the bulb then close the port creating a gentle suction that will drain fluid from a surgical site. Usually the fluid is Serosanguineous, a result of the body's inflammation from the surgery. It should never be frank blood.

Both JP's were filling with blood at a rapid rate indicating an active bleed. It was about 6:00PM. There was no available list of on call physicians phone numbers. You had to call the nursing supervisor who would then call the doctor. When I called the nursing supervisor she came to the floor and saw the frank bleeding, which I kept tract of in volume. The patient already lost over 400cc's. She then told me the doctor left orders he was not to be disturbed with calls until 8PM because he was going out to dinner. I asked who was covering and was told he was. The poor supervisor was stuck. I made a deal with her that I would call (this guy had a rep as a real prick) and take the flack but the call had to be made. She wrote the number on a piece of paper and left it on the desk for plausible deniability on how I got it. I placed the call.

The guy was livid. He tried to tell me I didn't know blood from body fluid and he would be in around 9PM to check. I calmly said, "That's fine. I'm sure the ER doc will eventually figure out he needs transfused when he's called to the code in an hour when your patient codes". The guy went nuts. "I'll see you shortly, your career is over".

What a joke. I was a traveler and would just take another contract elsewhere but I would be damned if I would let my patient potentially die for this asshole's dinner plans.

He stomped in about 40 minutes later. Barged past me into the room and drained the JP's himself watching the fill with blood. Went out to the desk and called the emergency OR team to prep.

He never said a word to me after that but eventually warmed up weeks later, and would chat and asked me how I was doing. There was about a week left on our contract and he said it was a shame that I would be missed. I asked him to step into the utility room with me and told him that if he didn't act like a prick all the time the other nurses, who were also good, would be more likely to be the asset to his practice that they could be. His answer, "I'll try".

The patient on the other hand figured out what I did and at discharge gave me his contact information inviting me to hunt deer on his property if I wanted.

Excellent story Frosty. Good for you.

Mark

[80zephyr]

As you know, my mother was a nurse. She was hired by Mount Sinai Hospital in NYC sight unseen. They were known as "coal cracker" nurses. Any nurse from Northeastern PA was given priority for hiring because their programs at the hospitals were top notch and they were given a lot of leeway. My mom learned quickly not to take any crap from doctors and she always said the smart docs knew the nurses could save them or bury them.

This week I got to start my day after the holiday with a not so quick trip to the ER for my sister. At some point during the night her trach became dislodged, causing her severe discomfort. We couldn't get it back in. The nurse and the respiratory team at the ER wanted no part of trying to put it in or take it out, so we waited about 2 hours for the doctor to come by. It was a resident. She was obviously young, but then introduced Doogie Howser as her supervising doctor, along with a medical student who accompanied them. He looked terrified. As soon as the three of them huddled around my sister she sat up straighter in the bed and said something which they couldn't understand, with quite a bit of authority. The word was "pee". They looked at me and I told them "she has to use the bathroom". I then explained to her that she had a purewick in (a temporary non-invasive catheter that the nurse put in immediately, just in case, so as to avoid trying to get her on and off the guerney for what turned out to be about a 6 hour visit). I then added to my sister that it was nice of her to demand help with going to the bathroom from the 3 doctors that were there.
To Doogie Howser's credit he laughed and said "well I have two hands and if there's something I can do to assist I'm happy to help". He's clearly not a surgeon.

I generally get on well with most of the doctors that my sister has had to deal with. The long term ones have been great. The newer ones for newer issues can be a bit difficult at first. I laid out a resident a few months ago when she tried to assert that I wasn't my sister's proper "next of kin" and therefore she didn't need to speak with me about whether or not she could be medically cleared for a major back surgery the next day while having just come off of 50 percent oxygen, had a stent put in for gall stones in the bile duct, was presumably still actively dealing with pneumonia and sepsis and had an active bleed after the surgery to remove the gall stones, necessitating an emergency surgery the next day (which was only 2 days prior to the discussion about whether or not she should be cleared for major back surgery for the following day). While she advised me of the law on next of kin (I never reveal I'm an attorney unless it's absolutely necessary) my cell phone rang. I looked at, let her know it was my sister's other neurosurgeon calling me back and since he was in Scotland I'd be taking his call. I'd also let her know that before she cleared her for the new surgery she better check my sister's history of active bleeds post surgery requiring at least one called code after an otherwise successful surgery. The respiratory therapist that had apparently been trying to get in to see my sister while I was laying out the Resident laughed a bit when I apologized for my forcefulness. She just shook her head and said "sometimes you've got to let them know how it is, no matter their degree". As expected the Residen refused to give me any information, however the next morning the nurse advised me that the surgery was cancelled. When her surgeon finally returned my call I let him know that the surgery was cancelled. He said he didn't know where I was getting my information from that he still had it scheduled. I let him know the nurse told me when she took my sister's breakfast order (knowing that food is a big no no before surgery he knew I was right). I know him and he's a great surgeon, but a little more prickly than her other neurosurgeon. The other one spoke to him for me and tried to get him to call me back that Sunday night, to no avail. It's ok. he would have been better served to have called me back so that he didn't have to eat crow that I got his surgery canceled. He could have canceled it himself, which he was amenable to once he spoke with me.

Being an advocate for a family member is tough. My sister was diabetic, and with as much time as she spent in the hospital, she could have had a wing named after her.

Anyway, I was at my shop one day and I got a call from my mom. She was crying. She had just taken my sister to emergency for an infection. My sister laid there for hours, screaming and crying before they helped her. My mom said she couldn't take it anymore and asked me to see if i could fix it.

Well, a few weeks later, in the middle of the night I got a call from mom that my sister had to go in. I took her in and watched the minutes tick away, as she laid there crying in pain. After about an hour I asked the nurse where the doctor is. "He's on the third floor doing his rounds". I said "he, there is only one doctor in this entire hospital"?. Yep. One doctor in the whole damn hospital.
Well, I got up and started to leave, and she asked me where I was going. I told her I was gonna get the doctor. She said "I'll call security". I told her "lady, there is not enough security in this hospital". Then she said she would call the doctor right now if I sat down again. And the doctor appeared a few minutes later.

Well, I demanded that someone call me about the treatment my sister received. It was a nun, since this was a Catholic hospital. Suffice it to say it never happened to my sister again.

Mark

[phillygirl]

Being an advocate for a family member is tough. My sister was diabetic, and with as much time as she spent in the hospital, she could have had a wing named after her.

Anyway, I was at my shop one day and I got a call from my mom. She was crying. She had just taken my sister to emergency for an infection. My sister laid there for hours, screaming and crying before they helped her. My mom said she couldn't take it anymore and asked me to see if i could fix it.

Well, a few weeks later, in the middle of the night I got a call from mom that my sister had to go in. I took her in and watched the minutes tick away, as she laid there crying in pain. After about an hour I asked the nurse where the doctor is. "He's on the third floor doing his rounds". I said "he, there is only one doctor in this entire hospital"?. Yep. One doctor in the whole damn hospital.
Well, I got up and started to leave, and she asked me where I was going. I told her I was gonna get the doctor. She said "I'll call security". I told her "lady, there is not enough security in this hospital". Then she said she would call the doctor right now if I sat down again. And the doctor appeared a few minutes later.

Well, I demanded that someone call me about the treatment my sister received. It was a nun, since this was a Catholic hospital. Suffice it to say it never happened to my sister again.

Mark

That is excellent. When my sister first had her aneurysm it was all new and incredibly scary. We were so lucky with the care that she received. The neuro team also knew her personally, so that was incredible. The following year she had a post surgical stroke and once she was out of ICU and up on the stroke floor things deteriorated a bit. My bil and I were there for every meal time except 2. Those two times she choked and they began discussing a feeding tube. She had a feeding tube the year prior while she was in the hospital (2 months) and I was there when they took it out. That was scarring for me. So when they were discussing putting one back in because hospital staff couldn't properly feed her without her choking I lost it. It had, admittedly, been a long month and I took it out on someone I shouldn't have...the nurse practitioner. In my mind, she was the boss of the nurses. I should have spoken to the Director of Nursing. I just remember saying to her that either the staff was too lazy or not trained properly to be able to ensure that my sister could eat without having a gd feeding tube.I also told her if I had to take a leave of absence from work to come to feed her 3 times a day I would, but they would be receiving my bill for it as well. Since she was perfectly capable of eating safely with assistance, there was no need for that kind of invasive surgery just because they couldn't sit there with her for 30 minute, cut up her food small, and make sure she drank something every 3 bites. She didn't get the feeding tube and they had me train the staff.

I also told on a charge nurse who told me her staff was too busy to take my sister outside one day for fresh air, which was the doctor's orders. I was pissed. Not because they were too busy. I understood that. I also understood that a doctor saying something was not as easy as accomplishing it. My sister had 3 trees of medications going into her iv, plus the monitors, etc. There was every possibility that she wasn't going to make it and this was possibly the last time she'd breathe fresh air. I didn't take a minute from being in that room that day, knowing that this might happen and it might be the last time she would feel the sun on her face. I wanted to be there for it, so I left sticky notes, told the nurses, etc. if I got up to use the restroom. It wasn't that it couldn't happen, it was her telling me that someone else was more important than her. It was the presentation, not the news. I didn't even mean to tell on her, but clearly she wasn't liked by the other nurses, because when a little of it came out the nurses pressed me to tell the whole story. I received an apology from her the next day and I was told that she was never to be made a charge nurse again. As I said, we mostly got great care and I couldn't be more grateful to the entire medical team that cared for her those two years.

[80zephyr]

That is excellent. When my sister first had her aneurysm it was all new and incredibly scary. We were so lucky with the care that she received. The neuro team also knew her personally, so that was incredible. The following year she had a post surgical stroke and once she was out of ICU and up on the stroke floor things deteriorated a bit. My bil and I were there for every meal time except 2. Those two times she choked and they began discussing a feeding tube. She had a feeding tube the year prior while she was in the hospital (2 months) and I was there when they took it out. That was scarring for me. So when they were discussing putting one back in because hospital staff couldn't properly feed her without her choking I lost it. It had, admittedly, been a long month and I took it out on someone I shouldn't have...the nurse practitioner. In my mind, she was the boss of the nurses. I should have spoken to the Director of Nursing. I just remember saying to her that either the staff was too lazy or not trained properly to be able to ensure that my sister could eat without having a gd feeding tube.I also told her if I had to take a leave of absence from work to come to feed her 3 times a day I would, but they would be receiving my bill for it as well. Since she was perfectly capable of eating safely with assistance, there was no need for that kind of invasive surgery just because they couldn't sit there with her for 30 minute, cut up her food small, and make sure she drank something every 3 bites. She didn't get the feeding tube and they had me train the staff.

I also told on a charge nurse who told me her staff was too busy to take my sister outside one day for fresh air, which was the doctor's orders. I was pissed. Not because they were too busy. I understood that. I also understood that a doctor saying something was not as easy as accomplishing it. My sister had 3 trees of medications going into her iv, plus the monitors, etc. There was every possibility that she wasn't going to make it and this was possibly the last time she'd breathe fresh air. I didn't take a minute from being in that room that day, knowing that this might happen and it might be the last time she would feel the sun on her face. I wanted to be there for it, so I left sticky notes, told the nurses, etc. if I got up to use the restroom. It wasn't that it couldn't happen, it was her telling me that someone else was more important than her. It was the presentation, not the news. I didn't even mean to tell on her, but clearly she wasn't liked by the other nurses, because when a little of it came out the nurses pressed me to tell the whole story. I received an apology from her the next day and I was told that she was never to be made a charge nurse again. As I said, we mostly got great care and I couldn't be more grateful to the entire medical team that cared for her those two years.

When my sister died, I was 43. And I remember thinking how strange it was gonna be without her to take care of. It is a tough cross to bear.

Mark