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Leftism Is Heartless
I was a third-year medical student (otherwise known as a scut-monkey – responsible for every job in the hospital that no one else wants to do) when we had a 96-year-old woman come in with pneumonia. The resident in charge of me told me to get her old hospital records. I asked the patient if she’d ever been in the hospital, and she said that she had, just once, in this very hospital. Great, I thought – that makes it much easier. No records transfers. This was the early 1990s, and we still had paper charts, which were archived in the basement after six months. So I was hoping her hospitalization was recent.
I asked her when her hospitalization was. She answered, “When I was four years old. Maybe five. I really don’t remember it very well.” I just stared at her. That would be around the year 1897. Maybe 1898 or 1899. That won’t be on the front rack. It was 11 p.m. My hopes for sleep that night were fading fast. So I trudge down to the basement, walk past endless racks of charts, and start digging through boxes back by the heating and air equipment.
One advantage I had was that no one had disturbed these boxes in some time. So unlike the more recent charts, everything was about where you’d expect it to be. And sure enough, I found her chart. I sat down on a box and started reading.
She had gotten very sick very quickly, and her father had carried her into the hospital. She couldn’t walk. She had a fever of 104.5F, was barely conscious, and recoiled when the doctor touched her abdomen. They removed a gangrenous appendix that night and put in drains to help with the infection. There were no antibiotics available at that time.
She remained semi-conscious for days. The surgeon would check on her, and occasionally put in a new drain, sometimes did a sort of lavage, and each day he described exactly how she was doing and what his plan was. I felt like I was making rounds with him in real-time, even though he’d probably been dead for 75 years.
He did a great job. She was in the hospital for over three weeks, nearly dying twice. But eventually, she started eating again, and eventually went home. She walked out of the hospital, after being carried in a few weeks earlier.
And due to the skill of the surgeon and the nurses, despite what now looks like primitive equipment and techniques, I was now seeing this patient 90 years later, after she had had a wonderful life with children, grandchildren, and so on. Her surgeon was dead and gone, but she was not. Outstanding work, sir.
What I remember most clearly, though, was the chart. The entire chart for her hospitalization of over three weeks was one sheet of paper. Filled on one side, and about halfway down on the backside.
And I knew exactly what had happened, every step of the way.
Our charts now are sort of the opposite of that.
They are enormous. I’ll have a patient spend one night in the hospital for a routine CHF exacerbation, I’ll request records, and I’ll get 75 pages of, um, just all kinds of stuff. It’s incredible, really, how much data they can collect on one patient in 24 hours. But here’s the problem.
When I look at those records, what I really want to know is, what did the hospital doctor think was wrong, what did she do to treat it, and how does she think this is likely to go? What might go wrong? What should I be watching for?
The chart I get will include, on page 56, the name of the nurse who changed the patient’s sheets that morning. But it will not include the two or three sentences that I’m looking for. What happened exactly?
It’s like asking for a glass of water and getting thrown into the pool.
Paperless chart systems are designed to generate as much paperwork as possible as quickly as possible. Because in modern medicine, we get paid to produce paperwork, not to take care of sick people. Now, when I make rounds in the hospital, there are nurses up and down the halls working on their mobile PC units. It’s unusual to find a nurse with an actual patient. Because the patients don’t matter. But the documentation does. Thank you, Medicare.
One of the entries from the surgeon in 1898 was something like, “I changed the drain to a new site yesterday. Pt much worse today. I fear that may have been a mistake. We’ll see.” Or something like that.
That is very helpful. He’s telling you what he’s observing, and what he’s thinking. Which is very important. In fact, it’s all that really matters.
In today’s legal environment, such thinking is prohibited. Or at least, you keep it to yourself. Which means that honest communication between doctors has been banned, for all intents and purposes. So if I want to know what happened, I have to talk to the doctor personally, off the record, and ask, “Hey, Sarah, you sent an unstable CHF patient home on freakin’ Spironolactone in 24 hours? What’s up?” And she’ll explain. And it will probably make sense. Off the record. Then, and only then, will I know what’s going on.
So it’s like going back to before we had charts. The only way to get any real information is word of mouth. Like in the days before Sanskrit.
So charts work for Medicare reimbursement. Sort of. I guess.
But they don’t work for doctors. Or patients. Or nurses. They have become useless. Worse than useless. They distract nurses and doctors from what used to be the most important part of all this: The patient.
It makes me sad.
That’s why I’m a bleeding-heart conservative. Leftism is heartless. Big government is heartless. Centralized control is heartless. It always is. There is no other way.
I’m not heartless. That’s why I went into medicine to begin with.
I don’t fit in this system.
The system doesn’t care about my concerns, of course. It’s heartless.
My patients do care. But they don’t matter any more than I do.
In a leftist system, all that matters is leftism.
And leftism is heartless.
Published in General
When I was a surgery resident and before that an intern, I had a senior resident who was a fanatic about patient privacy. He would not touch a patient without asking permission. Touching the bedclothes without permission was another forbidden act. These were County Hospital patients so he, and later I, considered it even more important to preserve their dignity. I nearly went into practice with him but he was in Florida and I was in CA with a wife who did not want leave LA.
I want to go out as I came in: screaming at the top of my lungs and covered with someone else’s blood.
That may work out for @bossmongo but probably not the rest of us.
Maybe the best we can hope for is to go out peacefully in our sleep like grandpa, not screaming in terror like the passengers in his car.
It’s wonderful. Magic.
My friend is home already, with a whole bunch of pills to take, but he’s in his own bed and his wife has the delightful pleasure of taking care of him. And he’s not dead.
I often joke that my main job is playing a complex and boing computer game. Occasionally I get to do some nursing.
Didn’t Imperforate Anus open for Quiet Riot in 1989 at The Roxy in Boston, MA?
All mediocre comedy aside – the OP here is a good example of the result of mediocrity gaining control of large systems. Even if their intentions are good ones, they are laughably incapable of creating the outcomes they want. Coding the number of steps a nurse takes during the day and making that information digitally available doesn’t do anything for the patient, which is what a large part of focusing on billing vs. care results in.
This chowderhead here, this inept clownshow. Based on his obvious capabilities, I’d limit his responsibilities to pouring small cups of coffee, and even then, I want those cups to be double-checked. Because he had no idea what he was doing in Obamacare, other than expanding government influence over our lives, and helping create an even larger nation of Julias.
This among the most objectionable things you have ever said. It is not through magic but through reasoned empiricism we are mitigating the weakness of our flesh. If we relied on magic, we wouldn’t notice the Cornovirus at all because the immuno-compromised and the weak elderly would already be dead. Corona Virus in a weird way is a luxury disease. We are luxurious because Western Civilization encouraged an intellectual elite to advance our knowledge. Also, because the Catholic Church adopted Aristotle.
Magic is for the Marianne Williamson types, not reasonable people.
I thought it was for The Germs. Maybe that was another concert.
I absolutely loved this story.
One thing that makes my blood go cold is when I read about how in the future, all surgeries might be handled by robotic surgeons.
Putting aside for a moment the thoughts about what if there is a computer glitch, my worry is that a small infant, of any size really, cannot feel comfortable if a piece of intimidating equipment is operating on them. I mean, yes they would be out cold due to drugs, but still.
I once underwent hypnosis in a group setting for resolving any past birth trauma. And several amazing things happened: one was that I stopped feeling being pushed out of the birth canal. Since it was apparent I hadn’t died, I was mystified.
Then the next memory that flooded my being was the feel and sound of the wonderful doctor who had delivered me. He was singing Christmas carols as he walked with me around the room. When I came out of the hypnosis session, I knew this was not an implanted memory, as the only things my adoptive parents had told me about the doctor who attended my birth was that he was Jewish.
I also figured out that the reason that I did not feel pushed through the last part of the birth canal was that I was a Caeserian birth.
I mention this hypnosis session to show that every memory we experience, even as newborns, is part and parcel of our humanity
I call it Manufactured Complexity. It’s the making of a process more complex than it needs to be in order to efficiently and effectively deliver the good or service in question. We humans seem to have a natural affinity for creating manufactured complexity. Since nature (manifested in the hard sciences) is complex, we seem to have an instinct that man-made things must be complex too. (And it’s not just created by lawyers and accountants.) Often it starts with good-faith “tweaks” and fine-tuning. That is followed by “plugging of loopholes”, and seeking of greater control over the action of others, enforced by increased legal consequences. Then it really metastasizes when the expert class gets their hooks in and works to protect and amplify their self-image. A useful skill in getting things done, is to be able to identify complexity that is needed and that which isn’t. I am convinced that one of the sources for the loss of faith in “experts”, other than their errors and unwillingness to own up to them, is the instinctive sense that the (often expensive) expert guidance is really unnecessary, other than to comply with the strictures of Manufactured Complexity (the circle is unbroken).
The ironic thing is that the nurse-step-counting is straight out of archaic Taylorism, when old time industry tried to make humans into machines on the factory floor. It’s been long discredited as a useful or effective form of management. Very illuminating that the Left, well-exemplified in “Dear Leader” above, has an instinct for such retrograde forms of human interaction.