Preventive Medicine

This is the final article in my series about medical concerns in regards to a case study on the blog forum (read “Entering the Hospital: Some Facts to Know to Protect Yourself, Part I”).  To briefly recap what has happened in the previous two articles, Mr. S recounts the events and struggles after his wife was hospitalized at the end of November.  She had a complicated medical history, with an ileostomy that was reversed, and was admitted with symptoms of partial bowel obstruction.  Diagnostic evaluation showed that Ms. S had ischemic bowel near the former surgical site, which required resection.  She needed ICU care after the procedure, but was transferred to the floor a couple days later.  However, there were complications, which were related to the type of pain medication she was prescribed, a powerful narcotic called Dilaudid.  Mr. S did advocate for stopping the Dilaudid, but the stupor and breathing difficulties attributed to the medicines, which required ventilatory assistance, were actually symptoms of fluid build-up in the abdomen.

In this article, I would like to discuss several more techniques and lessons you should understand if you find yourself in the hospital setting.  Perhaps the most important thought that I can impress on you is that the hospital is really not the ideal place for sick people.  And yes, I am serious in that statement.  Granted, individuals who are critically ill and injured do need emergent medical treatment, and specialized procedures and powerful medicines in order to save their lives.  But after the patient is stabilized and is no longer in mortal danger, the hospital becomes a dangerous place to convalesce.  A good physician will have a discharge plan in mind as soon as a patient is admitted to the hospital – not because he or she does not want to treat the patient, or is lazy, but to get the patient the appropriate care, whether it is therapy, or continued monitoring, or visiting nursing assistance in the home setting, outside of the hospital.

But that is what common sense would dictate should happen.  And some doctors are not as conscientious of the “big picture,” in terms of the patient’s hospital course.  Common sense in the medical establishment is not quite at the extinction level of the dodo, but it is critically endangered (I guess kind of like Przewalski’s horse, or some other specie where there are only a couple hundred left in the wild).  Mr. S expressed it very well: “I’ve seen big rocks with more sense, and greater ability to listen.”  You can only rely on yourself.  Unfortunately, common sense has largely been replaced by treatment algorithms for specific symptoms (i.e., if the patient has pain, medicate it until it goes away, then search for a now masked cause), and conversations between the patient and physician usually entail ten or fifteen minutes at the bedside asking about pain, bowel and bladder function, eating and appetite, and if the patient can get out of bed or perhaps walk to the bathroom.

Two commentary posts raise interesting points, originally mentioned by Lunamother and echoed by Dancingbear – namely in response to Mr. S’s sentiment that he should have noticed the changes in Ms. S sooner.  They reply that it “WASN’T MY JOB TO LOOK FOR THAT STUFF [emphasis in original text].”  I completely agree that it is the responsibility of the hospital staff to make sound medical judgments using all of the data and information available to them (and if there is not enough available, to obtain it).  This example shows what happens when that is NOT (my emphasis) the case.  I also agree, however, with Expatriate’s quote earlier about being an advocate for your loved one in the hospital.  In the business of medicine now, the hospital is looked at by the CEOs and HMOs as a money-making entity, with hospital beds a prime commodity.  The trick for increased profits is in patient turn-over – the faster Patient A recovers and goes home, the sooner Patient B can be admitted, worked up, and treated, generating a larger hospital bill.

Now, I am not saying that every individual in the hospital is an inept, money-hungry vulture who looks at patients as disease-ridden bank accounts.  Some of us actually did believe the hype, when we first started out, that we were going to help people who were sick and alleviate suffering.  But modern healthcare is not like those Norman Rockwell paintings of the doctor’s office, or Little House on the Prairie where Doc Smith rides to your homestead in his one-horse carriage.  There are still good people, and I work with a lot of them every single day.  But, like everything else in our modern society, there is the rush for results, the I-want-it-now attitude analogous to a fast-food restaurant (and we all know how well some of their resultant products can be), the consolidation of hospitals and resources, resulting in more patients being covered by less staff.  And let’s face it, physicians and nurses are human, and therefore fallible.  That is why there is a healthcare team that rounds on every patient.  The more eyes looking at a problem (be it a disease, a symptom, a riddle, whatever), and the more heads reasoning through it, the better chance something will not be missed, and a successful outcome will be obtained.

But the system is not full-proof.  That is where the patient and loved ones come in.  We are, like Mr. S for Ms. S, or my grandmother for my grandfather, or my parents for me, the first and last line of defense.  It is OUR body, OUR health, OUR life.  We may not know all of the medical language, or how to read all the tests, or whatever.  That is NOT an excuse to follow blindly.  Especially today, in the digital age, where symptoms and diagnoses are as close as our computer, the answers at our fingertips through sites like Google or WebMD.  We know what our baseline is, we know how we should feel and act.  This is true for a loved one as well – if they are not acting properly, but cannot say something, then we must ask questions and demand answers.  If something does not seem right, in terms of new or worsening symptoms, or unnecessary testing, or a treatment that does not make sense, or does not help, you need to ask why.  Why is it being ordered?  By whom?  What is going to be learned?  If it does not work, what else can be done?  Again, you may not have all the answers, but we are all blessed with our common sense and gut instincts.  And if your medical team –  whether it is the nurses, or physician’s assistant, or doctor – is skirting questions, giving you half-answers that really do not resolve anything, or refusing to see you or answer questions outright, make noise.  Demand to talk to someone else.  Get in touch with the nurse manager, or the hospital’s patient advocate.  There are resources and avenues available for you.  Just DO NOT be quiet and sit around while you are uneasy about your own or your loved one’s medical care!

I am happy to report that Ms. S’s symptoms did improve, with the appropriate care and off the offending medicines.  But she was not discharged from the hospital until almost three weeks after her initial transfer.  There was one final response post on the topic of several herbal remedies, such as Daily Detox (which I quickly tried to look up on-line for an ingredient list, but I did not find one off-hand), dandelion tea and milk thistle treatment at discharge to “help cleanse toxins and metabolites.”  Please let me offer one final suggestion/warning.  Know what you are taking into your body, whether it is prescription medications, food, drink, over-the-counter substances, or herbal remedies.  While marketed as “all-natural,” botanical therapies and related phytochemistry have the potential to be extremely potent and have unexpected interactions and side effects.  I am not saying to avoid using these compounds (one has only to remember that acetylsalicylic acid, or aspirin, is derived from willow bark, and taxol, a potent chemotherapeutic agent, from the bark of the Pacific yew tree), but alert your healthcare provider what you are on, so that they have this information when prescribing other medications.  For example, people who take St. John’s wort need to be very cautious about taking aspirin, since the active compounds in both thin the blood and can synergistically increase the risk of bleeding.

Now, please indulge me a few final thoughts in closing out this series.  First, even before you enter the hospital, make a list of all of your medications, with dosages, times that you take them, and for what condition.  Right now would be an ideal time – seriously, it could save your life.  Include any allergies to medications, as well as foods like shellfish, or substances like CT contrast dye (also known as IVP dye).  On the reverse side of that piece of paper, write down all of the medical conditions you are being treated for, such as diabetes, heart disease, stroke, atrial fibrillation (an abnormal heart rhythm), kidney or liver disease, etc., as well as the name of the doctor and specialty that treat each condition.  It is also very important to list all of your surgeries, when they happened, what side (if appropriate), where, the name of the surgeon (if you remember), and if there were any complications.  Make several copies, then place one in your wallet or purse, give another to your spouse, parent, or healthcare proxy (HCP, or someone who understands your wishes, and will make medical decisions for you in the event you are incapacitated), and your primary healthcare provider.  Keep the other copies in a secure filing system or fireproof box for emergencies.  You will need to present this information (or instruct your loved one or HCP) to any emergency room physician or doctor who sees you and is actively managing your care in the hospital.

Once in the hospital, evaluate every physician and nurse, and ask them about everything that they are doing.  If you are going in for surgery, discuss why it is necessary, how it is expected to help, what are potential alternatives, as well as all of the possible risks and complications.  But also realize that all of the statistics and percentages that are quoted are for specific populations, which may or may not accurately represent your particular situation – you are one individual, and the odds of something happening to you, whether positive or negative, will eventually work out to either 0 or 100%.  If, after all of this information, discussion and thought, you decide to go ahead with the surgery, write on the site with indelible marker the night before, AND mark everything else (the other limbs, the other side of the abdomen, etc.) as DO NOT CUT HERE, or something to that effect.  As an example from my particular instance, I heard afterward that the orthopedic surgeon who saw me initially for my knee problem had accidentally amputated the wrong leg on another patient.  Take every means to protect yourself, and do not be that patient.

It might seem paradoxical, but I do not like doctors, I do not trust doctors, I do not want to see doctors, especially after working in the medical field.  They are, unfortunately, a necessary evil in this fallen world.  Learn to take care of yourself and try to avoid the hospital at all costs.  I agree with the comment in the forum, “If you’re not [f*cked] up when you get here, you certainly will be when you leave.”  A hospital is full of sick people, and is certainly not an ideal setting for convalescence, especially in a weakened state.  Infections, medication interactions, and medical errors occur in hospitals.  But amazing treatments and recoveries are also possible, and lives are saved and changed.  I trained as a doctor to learn what to look for in order to maintain health in myself and my family (as well as my pets, oddly enough), to avoid illness whenever possible, and to be a better listener and caregiver than my original orthopedist.  I wanted the wisdom to recognize conditions that were benign versus those that required urgent care and intervention.  I hope to share more of this knowledge in future articles.  The information I have presented here – in the setting of a case study where a concerned husband champions the proper medical treatment for his ill wife – I hope that you will find useful and will serve you, if you or a relative, unfortunately, do have to enter a hospital.

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