Monday, October 28, 2019

Planetary Intelligence Is A Constant; Population Is Increasing

h/t Kenny



















Behold, the dangers of listening to the horseshit they put in the Washington Compost, and mistaking it for factual information:
Falls remain the leading cause of fatal and nonfatal injuries for older Americans. Hospitals face financial penalties when they occur. Nurses and aides get blamed or reprimanded if a patient under their supervision hits the ground.
But hospitals have become so overzealous in fall prevention that they are producing an “epidemic of immobility,” experts say.
This is easily solved.

Waive all your rights to sue in case of a fall, accept full responsibility for all injury and damages in writing, including to any other parties, and consent to binding arbitration with capped damages, and we can talk.

Refuse, and you're full of shit, and your ass can stay in the wheelchair, or in the bed with the siderails up. Once you're back in your house, you can play by any rules you damned well please, as it should be, okay? But in my house, it's my rules. Fair is fair.

If you make it past that hurdle (literally) we can talk about mandatory drug and alcohol testing (because people lie, pretty much 75% of the time, about that), and about how many people got to the hospital because they fell at home in the first place, and were too stubborn and stupid to use things like a light switch, their eyeglasses, walkers, canes, crutches, etc., and are now lined up for a shiny new titanium hip to replace their new three-piece femur, because they had to get to the bathroom right this minute, in the dark.

Last night's genius wanted to be released, despite being drunk at 3-4X the legal limit, and not able to recollect how he ended up on his face in the street, right up until the CT revealed he had a major brain bleed. Pull the other one, Einstein, it has bells on it.

I had one lady, brought in because she was too weak to get up for seven hours after a fall at home, tell me she was leaving. I told her to go ahead. And waited. And waited. She could barely raise her voice, let alone her body.

Look, I get that it's frustrating when your 60-, 70-, or 80-year old body doesn't act like it does in your still-18-year-old head. But it isn't my job to mollycoddle your weak grasp on reality. It is my job to make sure I don't have to explain - or lose my license and livelihood - for why you're on the floor of your room on your ass, especially when you're frail, feeble, confused, broken, or on narcotic medications. If you could do Gene Kelly's "Singin' In The Rain" with full choreography, you wouldn't be in the hospital, now would you, smartypants?

This is on my bucket list. But not as a patient in the hospital.

"Patients are idiots" should be carved in stone above the hospital front door, because they won't let me wear a button that says DLTDHYITAOYWO. (I'll help out: "Don't Let The Door Hit You..." work the rest out yourself.)

And hockey pants with pads, and crash helmets should be mandatory attire after age 70.
You tell me which is sillier; dressing that way, or those neat-o zipper scars on your hips, and 6-9 months of OT/PT learning to walk again in your 70s and 80s. If you don't fail, stay in the hospital endlessly, get pneumonia and twenty other opportunistic infections, and then just die.
Because in case you didn't notice, you don't bounce as well as you did when you were five or ten years old.

When someone tells me that 98% of tort lawyers are literally dying of starvation due to lack of business, then we can talk about "overzealous" fall prevention from the medical professions.

Until then, it's crybabies wanting to have it both ways. If you don't like being group punished (and sorry about that, but make no mistake, you are) for the 25% of people (minimum) who're just conniving weasels and outright morons, punch them in the throat in the waiting room, and then go burn their ambulance-chasing lawyers' offices and homes.

But thanks for the entertainment.

You'll win this argument when pigs fly outta your butt.

I truly enjoy taking care of people, and I want each and every one of them to go home and enjoy life as near to whole as human wisdom and the medical arts can make possible. Even when they're not smart enough to figure out that I'm going to act in their best interest, even (especially) if it pisses them off or spoils their plans right this minute. Me and my coworkers easing off for ten seconds can turn into 5 years of court appearances, and six-figure damages. Or someone dying.

Alongside that consideration, someone's momentary butthurt is not a medical complaint, it's a character flaw for them to work out on their own.


Don't like hospital rules? Don't get sick, injured, or old. (As if, but that's the truth of it.)
No one's going to come to your house to enforce them on you. Problem solved.

26 comments:

Anonymous said...

So, let's say I'm 76 years old. Is it a bad idea to stand on one game leg on the top rung of a ladder and lean way over to swat a roach on the ceiling if I am in the midst of a vertigo attack? I just wanted to check.

Anonymous said...

I was chatting with a friend the other day about getting older and not being able to do stuff any longer. Right on queue, my 18 month old grandson came blasting into the room, face-planted, got up and kept on going.

I pointed at the kid and said "Yeah...that's another thing I can't do any more..."

Just found out the pain and numbness in my arm is emanating from my spine, in my neck. Collateral damage from Cancer therapy, no doubt.

I'm only 56, and am having to come to grips that my body has aged horribly in the last few years, and there are things that I need to do (like work, with a side business that I have) that I cannot any longer. I can do the software work, and hardware setup, but any ladders and traversing through attics is out.

boron said...

just don't take my Foley the second day post-op (full Whipple) 'cause you want to prevent a bladder infection and then scream at me when the bed alarm goes off; I gotta stand to pee and the six gals at the station just dealt themselves another round of 7-card stud

FredLewers said...

It's only a bad idea if you don't have video documentation.

Old NFO said...

Yep, getting old DOES come with limitations... Whether we like it or not! I'm finding more and more I 'pay the man', rather than attempting to do stuff I did 20 years ago with NO problems. Because 'I' don't want to visit the hospital...

Anonymous said...

My 89 year old Mother is healthy as a horse and fully capable of walking anywhere she wants. Thankfully her arms, back, and legs are in great shape. She is insulted when you told her she has to be more careful. Now get her to explain how come her life alert had the ambulance take her from her apartment to the ER with a cut in the back of her head after she fell backwards TWICE this year?

These aren't from getting in and out of the tub or something risky either. The falls are from just walking across her living room and kitchen. I wonder how many other times she has fallen, or almost fallen? The doctors and nurses did try to help by having the Occupational and Physical Therapy folks out to coach her both times. I think their lessons are finally sinking in. I am doing what I can to reinforce their advice.

It is tough for her, but also bad for us that worry about her too. We had to convince her to move to assisted living, after thirty years of living independently by herself. At least now we have the nurses and attendants at assisted living watching out for her too. Her new apartment is also designed to be safer too.

Rambling, but please keep them safe despite their protests Aesop.

Cederq said...

I remember those days fondly as you are leaping to grab an elderly patient from falling and are one second too late... the battles we nurses fought to restrain patients that the doc and family did not want sides up or a restraint vest and bed alarm on. We nurses ask management to implement those release forms to absolve us and the hospital from fall liability and corporate counsel in their esteem-able wisdom decried it was not necessary or ethical...

Badger said...

So important to pay attenton to the warnings at home, especially if a fall is an uncharacteristic thing. Wife fell, and TL;DR, turned out later to be side-effect of a Rx given to treat a side-effect of a previously DC'd Rx - as in "out of the blue let's slaughter all your white cells." She went in the bus with the pretty lights & then got her very own first chopper ride as well. ICU nurse told me later 'bout another 36 hrs" and that would been all she wrote. She was very grateful, it was a big eye-opener.

But anytime for a couple weeks that she (occasionally) bitched about "assistance" or Gates belt, etc., I'd remind her how self-sufficient she felt lying on the carpet. Boom - compliance achieved. Replay that where pride gets in the way... and the part about 36 hours later.

Reltney McFee said...

While I agree with your points and position (not any sort o surprise, I guess...), this issue certainly illustrates the concepts of both "mixed blessings" as well as "adverse consequences".

Mixed blessings: Good News: with suitable restraints, patients are considerably less likely to fall, and then secure a life ending/life changing injury.

Bad News: with suits of a certain predilection (like, both stupid and cheap), adequate staffing to meet the needs of the restrained patients in a timely manner, is not present. So Grandma/Grandpa (or, at my advanced age, uh, me!) HAS to pee, and will not/cannot overcome 6 or 7 decades of habit and training, and HAS to get to the bathroom to do so. And, in the course of over-topping the side rails, performs and fails a Gravity Challenge.

Adverse consequences: I expect that you, in your Nursing school, had a lesson (or more) on "The Hazards of Immobility". I certainly did. So, while the restrained patient is certainly more safe from the previously mentioned failed gravity challenge and the attendant consequences (like Ortho or Neuro referral), loss of muscle tone, lack of stimulation leading to increased confusion from that patient's baseline, holding urine which encourages UTI development (which any Nursing Home nurse who has been on the job longer than 12 hours can tell you will INCREASE, further, the confusion), are nly some of the foreseeable adverse consequences.

All of which are more likely in the setting of limited (or entirely inadequate) staffing.

So, I'd rate the article as probably a 1/10 for veracity, in that there IS such a thing as adverse effects of immobility.

The art is to identify the optimal trade off with regard to which adverse consequences are least likely to injure your patient.

Of course, risk averse differently clued suits will elect the option that appears to offer no adverse consequences.

Yet, I've never seen them tame that particular unicorn. Let alone raise them in herds.

Justin_O_Guy said...

I wonder how many hips popped the ball off and Then they fell.

Anonymous said...

I've got zero time for adults refusing to take personal responsibility, or for whining about a medical condition they have.

cyrus83 said...

Signing a waiver seems ideal. I signed one once for the urgent care place when they proposed shipping me off to the ER out of an abundance of CYA because there was a teeny-tiny chance that the symptoms could have been something life-threatening.

I totally get why they had to make the recommendation, and I would have taken it if I hadn't already been on meds and regularly monitoring for the other problem with my primary. I really didn't feel like wasting ER resources and a few thousand dollars to satisfy the urgent care's need for caution. I did see the relevant specialist when they were open the next day and for only about $100 they confirmed I was in the clear.

LSWCHP said...

I may be crazy, but you honestly don't sound to me like the kinda guy who enjoys caring for people. I always think of you as a Gunny in the Corps.

Not being critical here...Lord knows the world needs drill sergeants...hell...I was one myself many years ago...I guess you must just be a "tough love" kind of nursing practitioner. :-)

Paul T said...

I’m a physical therapist working in home health so I’ve got to walk the fine line of preventing falls while encouraging people to be more active. Trust me, it’s the latter part that’s harder. We can show people how to properly use their walker or cane, adjust the house to make clear pathways, good lighting, and teach good strategies to build strength and balance, etc. Our biggest problem is that people just don’t listen.

On one side you have the people who impulsively keep jumping up and walking around without their assistive device and trip on their oxygen tubing. On the other side you have the people who got so weak and fragile because they spent the last 3 decades slumped on their couch, and they can’t be convinced to do anything else. I have had many discussions with patients trying to convince them why they should be able to walk; “But why do I need to walk when everything I need is right here?" (Pointing to TV, refrigerator, pill box, and pee bottle).

It’s hard to explain to some people that in previous eras they would have long ago been eaten by a pack of hungry wolves.

Glen Filthie said...

I suppose when you get old, often your noggin starts acting up too.

When I get old enough I am going to move down to the hospital you are working at and move right in! I’ll request you as my personal care attendant and will expect the finest service and accommodation! I will insist on pre-warmed bedpans because stainless steel is always cold, and that all my complaints be addressed and resolved at once! You will definitely need to brush up on your bedside manners Aesop!

I’m gonna bring my AR15 too. You know how to clean an AR, right? :)

Jar(egg)head said...

I'm in my fifties and still work out five days a week. I can still ace the USMC PFT for my age bracket. Why do I do this, you ask? So I don't have to deal with the assholes who work in hospitals.

Anonymous said...

Well, that was a five star rant. Ohio Guy out.

Anonymous said...

1) In my last hospital stay (I have lost track of how many surgical procedures I have had under general anesthesia) I was real impressed at their watching out for falls. Since I am in total agreement with their desire to protect me I went along.
2) Given that I have severely degraded equilibrium I really DO take care to avoid falling, even/especially at home.
3) When the Ortho specialist told me in the most cavalier fashion that can't ride my HD any more I wanted to punch him in the face. Hey, it's no big deal, right? My wife told me to cut him some slack since be hardly knows me and obviously has never ridden a "Real Motorsickle."
4) Many thanks to the young ladies who stopped the arterial bleeding while wiping off the leavings from a black bean burrito dump as big as my arm.
5) God bless the people who work to help the sick and injured. When I went home from the cardiac unit after surviving a widow maker nobody expected my to live through I left a thank you note to the staff who brought it off.
6) Extra kudos to the EMTs who pulled off a code save when I lost heartbeat and respiration.
_revjen45

BZinID said...

Number One cause of deaths in the USA......medical malpractice. Maybe if medical "professionals" didn't kill so many of their patients, you wouldn't have the litigious environment you currently enjoy in your chosen profession. Sure there's dumbasses who SHOULD be wheeled out; but if I just spent the night because the doc wanted to run more tests (and everything turned out peachy fine), I'm walking out the next day and not riding a wheelchair to the front door. Your rules don't trump my rights to just walk the fuck out. What are the hospital's rent-a-cops going to do? Tazer/mace me? Tackle me and cuff me? Shoot me? Can't see staff physically assaulting/restraining a person who demands to leave, thereby ENSURING a lawsuit, all over an attempt to get someone to comply with a policy that exists for the purpose of avoiding lawsuits. Seems lose/lose situation.

Aesop said...

@BZ in ID
Quote an authoritative source for that bullshit stat, with the actual data to back it up.

You'll find it's from the same sort of pull-it-out-of-your-ass "science" from whence came the hazards of second-hand smoke, and globull warming, backed by zero actual research to make it stick.
I.E. non-existant.

Thanks for playing, and we have some lovely parting gifts for you.
And watch out for the chip on your shulder; it's making you blind as well as stupid.

Aesop said...

@LSWCHP,

I've worked entirely in emergency medicine for over two decades.

My current patient population has become overwhelmingly homeless batshit crazy drunks, dopeheads, and general shit-for-brains losers who would make priests and nuns change their opinions on euthanasia.

When I get legit patients who need care, and for a bonus, with an IQ higher than room temp., which is increasingly rare, instead of a kick in the ass, they get that care, and with the same zeal you read here to want to throttle the wastes of skin and oxygen who have swarmed my practice in the last decade, waste my time and energy, and would suck out my very soul, if I let them get to me.

If you read up on the history of medicine, something we lost was a backbone.
After the French Revolution, all medical care in France was free, and hospitals specialized on one thing, which allowed data to be gathered and compared on what worked and what didn't, which transformed medicine from medieval withcdoctoring to modern evidence-based practice, with one proviso: the minute you decided you were smarter than your caregivers, they picked your palette up, and deposited it on the sidewalk, and bid you good luck in your future endeavors, because you were kicked the fuck out of the entire system.

We never should have left that model of care delivery.

A solid 1/3 to 1/2 of all patients I see are idiots, and/or a total waste of time. It's job security, but I'd rather work less and spend more time on the ones that need to be there. This is what happens when your medical decisions are made by Congress and lawyers instead of doctors and nurses.

Robin Datta said...

DLTDHYITAOTWO - Urban Dictionary
https://www.urbandictionary.com/define.php?term=DLTDHYITAOTWO

George True said...

In his later years, my dad would sometimes lurch and stagger like a drunken sailor. Most likely due to inner ear damage ftom his years as an artillery officer in the Army. We worried all the time that he was going to fall, but he absolutely refused to use a cane.

As retired Army, he would go to Luke AFB for his doctor appts. One day he came home from an appt with a cane. It seems his doc at Luke wrote a script for the cane, and ordered him to use it. My dad was a It Col, the doc was a full Col. So, since the gov't issued it to him, and a superior officer ordered him to use it, he used the cane from then on.

John Wilder said...

Well said. The Mrs. father recently decided that his femur needed to be in multiple parts, so he threw himself to the floor to accomplish same. After his surgery, it hurt to walk. Not me, him.

The Doctor indicated that should he not walk and do his physical therapy, he could and would just stay in that bed forever.

He's up and around and home.

Anonymous said...

Aesop,

for your next medkit post, have you ever heard of zipstitch?

https://www.amazon.com/ZipStitch-Laceration-Kit-Surgical-Home/dp/B07KBFVHY6/ref=sr_1_4?hvadid=78477707353483&hvbmt=be&hvdev=c&hvqmt=e&keywords=zipstitch&qid=1572452799&sr=8-4

Be glad to hear your practical thoughts...

Aesop said...

Ask, and ye shall receive:

https://raconteurreport.blogspot.com/2019/10/minor-wound-refresher.html