[Weisberger] did not want to die alone in her apartment. But if she went to the hospital, she was afraid that she would get the coronavirus there and die among strangers, cut off from the people she cared about....Why does a retired nurse, a medical professional, hate hospitals so much? And why does she look to an acupuncturist to "ease any pain"? (The key word is "ease" not "any.")
Ms. Weisberger had long ago planned for her end of life: a friend had promised to sit with her in her last days; an acupuncturist would ease any pain; when it was over, an undertaker would ice her body until burial. Alone in her apartment [one night when she felt symptoms of a heart attack], with the city mostly locked down, she realized that whatever happened to her in the next days or months, she would likely face it alone.
“It’s going to be horrible not being able to get out of bed to go to the toilet or get food,” she said.
The answer, I'd say, isn't that nurses in general reject professional medical care, it's that the NYT chose to quote this particular rejecter of medical care because she happens to have been a nurse.
I experience this NYT article as part of the "death panels" agenda — getting old people to accept their fate and go down easy.
पोस्ट्स
१३३ टिप्पण्या:
Is this helping? Maybe.
One of the analytical stories in the wake of the coronavirus epidemic will be the number of COVID deaths due to VAP (a real thing), ventilator acquired pneumonia. So while COVID will deliver many to the hospital, bacterial infections will be the direct cause of death. She is a nurse, she knows the risk of going to a bacteria farm (aka hospital) when you are 90 years old and immuno-compromised.
I experience this NYT article as part of the "death panels" agenda — getting old people to accept their fate and go down easy.
You figured it out, Professor. Next comes the mentally ill and severely physically handicapped.
I'm glad she has a friend willing to sit with her during her final days, especially "not being able to get out of bed to go to the toilet or get food". Many people can't find people willing to empty their bed pan and feed them. So they hire professionals, at a hospital, to do these things. Sort of like how this lady plans to hire an acupuncturist while a friend works around the needles to move this lady around and get her bed pan.
At Peace Pavilion West, we honor Gaia’s instruction, and the native tribes of The Great White North.
We push our wise old vessels out to sea on ice floes. They drift away solemnly. We cry. Some in The Community pretend to cry.
It is (S)cience.
Namaste.
And, why shouldn’t old people like me “go down easy?”
The death panels thing is obviously wrong.
I’m Catholic. I regard this life as a test and an illusion.
I retired to try to realize as fully as possible my artistic ambitions, to take care of my health and to contemplate my mortality, to make my peace with God.
I plan to go down easy.
"getting old people to accept their fate"
Which is so different from everyone else's fate. Death, it's just unacceptable. There ought to be a policy. Better yet, a Constitutional right.
"and go down easy"
Better to fight a futile fight, without loved ones, at great expense, sedated and hooked up to a ventilator.
I thought women's autonomy and reflection on the morality of their choices was all the rage on the left, emanating from the Constitution even; why not when it comes to death?
She doesn't hate hospitals. She hates the idea of dying alone and intubated, without her family and friends around her.
Fear of hospital infection or neglect is reasonable enough. But amazingly some nurses are antivax, into woo and essential oils and crap like that.
Might be the BSN/ADN difference in education.
You were struck by the nurse part, I was struck by the idea that anyone can plan for their death. Things in birth and in death rarely work out the way we plan.
And it is interesting to me because I know a lot of nurses, the ones who don't work in the ER have no real fears about getting Coronavirus. I'm guessing at this point, they trust their hygiene practices.
Also to your point, yeah they want us to be stoical now. They can't afford to take care of us all.
To that end, we're all supposed to have a "conversation" with about our final wishes.
But it's as fake as the "conversation" about race. There's only one answer: sign a full DNR, now. There are no choices. That part is BS. Agree to their terms for your death.
Every health care professional I know personally has told me they don't want to be anywhere near a hospital at the end of their life. They want to die at home.
Yeah, if you're 89 years, god bless ya -- you've outlived 95-98% of the human population.
And, if you die, well, unless a car hits you, it's probably considered "natural causes".
Wanting to die at home around your things and your family is not an unusual concept. A lot people feel that way. BCV you could kind of split the difference if you die in a nursing home - you could personalize the space and your family could spend a lot of time there with you, but now you can't do the latter in any kind of care facility, and a hospital would be even worse-dying in an ICU unit, next to other dying people, with none of your familiar things around you and no visitors allowed? You're surprised someone doesn't want that?
If I got it and it were serious, e.g. I were quite old or had other complicating health factors, there's NFW I'd be put on a ventilator, since most of those people don't make it anyway and I would never consent to dying in that fashion. I'd go home and either make it through, or die in my own bed with my family and my art/books/houseplants/music/view of my backyard around me. Not to mention access to our priest.
"Ann Althouse said...Why does a retired nurse, a medical professional, hate hospitals so much?"
Eh, am as anti-NYTs as it's possible to be, but I don't think this is as wacky/out there/uncommon sentiment as you might think. I know a couple of nurses who have spent time working in hospitals and I get the feeling they very much want to not be patients there if they can help it. This retired nurse's reliance on acupuncture fits your thesis better; I don't think its unusual for medical professionals who've worked in hospitals to dislike hospitals and want to avoid them.
A lot of medical professionals are dubious about the value of end of life care. There must be some reason for this, although for the life of me I can't think what it is.
Fear. Pain. Loneliness and despair. Where is the next Dr. Jack Kevorkian?
"I experience this NYT article as part of the "death panels" agenda — getting old people to accept their fate and go down easy."
Amen, sister Ann. Amen.
But when Frank Bruni and Maggie Haberman get up there in age, it will be a different agenda.
"Boomsday" by Chris Buckley was a funny take on this attitude. Us boomers are "encouraged" to kill ourselves by the younger generation. We take up too much space and money. The saved Social Security payments then could be used to fund the Green New Deal. Wise spending!
It can't be said enough: Fuck the New York Times.
"Why does a retired nurse, a medical professional, hate hospitals so much?"
Let me help you with that one, Emerita. My wife is a retired professional nurse, and she would answer as follows:
"Hospitals are filthy places. The techs and phlebotomists sit their filthy tray that they've carried all over the hospital on your bed. They never alcohol down the the bedside table and bathroom every morning like we used to do. No one washes their hands when they come in your room. They don't even bother to tell you their name. You never see the same nurse twice. You don't even know if they are a nurse, because they don't wear a name tag. Most of them aren't registered nurses. You can't get any sleep. No one washes you if you cannot or gives you a back rub. No one asks if you are comfortable or need anything. If you demand to see the nursing supervisor and complain about any of these things being substandard care, nothing changes."
I watched every one of these things happen, multiple times, within the last ten years at three of the "best" hospitals in the Philadelphia area as my wife recovered from a shoulder repair, two total knees, and a cholecystectomy. By the way, the physicians and surgeons, who should know better, also fail to wash their hands when they come into the room (there is this mysterious, white ceramic object in the corner that has faucets and everything but no one seems to know what it is for).
"Nurses" (RNs) today are largely poorly educated, low-skilled, lazy, and unprofessional in how they interact with patients, but they are still slightly better than the "multi-skilled technicians" whom the hospital has hired to replace most of them with. If you can escape the hospital alive and without a drug-resistant infection, you can count yourself especially blessed by fate.
Does that help?
The nurse may judge that she would likely die anyway on a ventilator if it comes to needing one, and she may be correct.
They always have some reason for publishing one anecdote but not some other anecdote. The plural of 'anecdote' is not 'data', Wolfinger not withstanding.
Why does a retired nurse, a medical professional, hate hospitals so much
That's where you acquire MERSA and other maladies. I worked a VA ICU (as a psychologist) for a year. Despite posted infection control warnings, MDs typically waltzed into MERSA patient rooms with their interns in tow and no one was gowned up. They spread it quite effectively.
BTW, I love the name Schatzi.
"nosocomial"
While I agree with her on not wanting to be isolated from loved ones when one is dying, I don’t agree that using acupuncture for pain control or avoiding a hospital because of Covid is a good choice. If one is going to die of a heart attack anyway and accept that is the way way one is going to die, why not go to the hospital and get some real pain relief?
If she dies at home during this time of Covid, most likely the people she counts on to be with her won’t be there either. Or they could carry the virus to her right there in her home. Her only hope is to die quickly, either at home or in the hospital.
I read this article as a discussion on how dying alone is a sad reality for the elderly dying of Covid, or dying of anything. Unless one has relatives or friends who are willing to gather together with others outside their own households to attend a dying family member or friend, dying alone is a real fear and reality.
As for dying while on a ventilator, I can’t think of any worse way of dying. The chances of surviving Covid after being put on a ventilator at an older age is not good. However being put on a ventilator is a personal choice. Hopefully one is conscious when it happens so it can be stopped if that’s not one’s choice.
“Probably the best published information we have so far is from the Intensive Care National Audit and Research Center (ICNARC) in the UK. Of 165 patients admitted to ICUs, 79 (48%) died. Of the 98 patients who received advanced respiratory support—defined as invasive ventilation, BPAP or CPAP via endotracheal tube, or tracheostomy, or extracorporeal respiratory support—66% died.
Compare that to the 36% mortality rate of non-COVID patients receiving advanced respiratory support reported to ICNARC from 2017 to 2019.”
https://www.physiciansweekly.com/mortality-rate-of-covid-19-patients-on-ventilators/
"It's very concerning to see how many patients who require ventilation do not make it out of the hospital," says Dr. Tiffany Osborn, a critical care specialist at Washington University in St. Louis who has been caring for coronavirus patients at Barnes-Jewish Hospital.
That concern is echoed by Negin Hajizadeh, a pulmonary critical care doctor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell on Long Island, N.Y.
"We have had several patients between the hospitals across the Northwell system that have come off the breathing machine," Hajizadeh says. "But the vast majority are unable to."
https://www.npr.org/sections/health-shots/2020/04/02/826105278/ventilators-are-no-panacea-for-critically-ill-covid-19-patients
This is why we need government run Nationalized Health Care! No one will ever die, ever again.
Feel the hope.
How did the NYT find this lady? Do they knock on random doors asking for human interest stories?
Why does a retired nurse, a medical professional, hate hospitals so much?
My mother, who worked for decades as an LPN, hated hospitals and nursing homes for refusing to allow the elderly to die.
She hated the extraordinary efforts, mostly dictated by the desire to avoid lawsuits from greedy survivors, to revive old people who had been vegetating in beds for years or decades.
My grandfather refused to go to the hospital. He lived to be 97. Died at home of a stroke and injuries from the resulting fall. Always said, when refusing hospital visits or care: "I'm not going to a hospital, they are full of sick people.". Said with a nice Boston Irish brogue besides.
I'm sure the meth and heroin dealers are still in business. Buy some of both, take the heroin for the pain, and when death approaches, load up on the meth and.you won't care if you're alone.
BTW Schatzi is German for Sweetheart.
Big Mike said...
Next comes the mentally ill and severely physically handicapped.
Why not? We've made it very easy to kill off unwanted children.
A very intelligent person asks, "Why does a retired nurse, a medical professional, hate hospitals so much?"
She doesn't "hate" hospitals so much -- as a nurse, she fully understands how dangerous they are in spreading diseases, called "nosocomial infections" - a name designed to confuse people.
"The impact of hospital-acquired bloodstream infections" (Wenzel et al, Emerg Infect Dis. 2001 Mar-Apr; 7(2): 174–177.)
From the abstract:
If we assume a nosocomial infection rate of 5%, of which 10% are bloodstream infections, and an attributable mortality rate of 15%, bloodstream infections would represent the eighth leading cause of death in the United States.
We all die alone. That is the Great question and mystery that it escapes all the collectivist
Sharp insight Althouse.
"getting old people to accept their fate and go down easy"
Movin' 'em from the ICU to the ECU*
*Eternal Care Unit
For me, getting old people to accept their fate, the same fate that awaits us all, wasn’t the underlying point of this article. Who doesn’t fear dying alone? Who would not want to avoid being put on a ventilator? The article does nothing but heighten anxiety and stress, which can exacerbate preexisting health conditions or cause other physical symptoms. How is this helping? This article is attempting to highlight the shortage of PPE and restrictions put on visiting sick or dying patients. It is an article that is devoid of hope or useful information. What about all of the wonderful, heartwarming stories about communities that are connecting with elderly neighbors to deliver meals and meds, provide virtual companionship, and the hope that prayers for a swift end to the virus will be answered soon than later, by the sacrifices we are all making right now?
Phidippus
Your wife does not know the nurses I know. We have two in the family. Both finished university degrees and then further nursing education. Both work long hours. We do the shopping for one since she has no time. We know her friends who are nurses, of whom I would say similar things.
Seemed to me that the actual issue right now, and quite apart from all the (justifiably) cited issues with hospitals mentioned by commenters, is that with the lockdown in place she has access to exactly NONE of the things that she expected would ease her exit: the acupuncturist, the soothing presences, the caring companions and caregivers ... all that's in the toilet for the forseeable, and all she has to look forward to is the off-chance that someone might discover her death in time to keep her body from rotting in place like something out of Faulkner. And there aren't any solutions for that other than calling a hospital and asking for emergency transport, but thanks to the bioethicists we are all on the learning curve that says someone sick and her age probably won't even get that. Thanks, bioethicists.
Stay out of hospitals. Plenty of nurses say that because they've seen people killed or made more ill by Doctor or Nurse mistakes. They're people and people make mistakes.
Plus, there are plenty of germs floating around. People go in for X disease, and before you know it, they got x and Y disease.
“We all die alone. That is the Great question and mystery that it escapes all the collectivist.”
Humans are social beings. If a dying human is comforted by the presence of another human it has nothing to do with collectivism. It has everything to do with being a social being. Even many animals in the wild attend their dying.
My mom was a nurse, and she opted to die at home at 86, without major medical intervention for pancreatic cancer. Surrounded by her kids and grandkids. Her experience of death in the hospital setting probably informed that choice. Kind of surprising to see Ann echoing Palin's "death panels" nonsense.
Once you get past a certain age, a lot of old people decide that going to Hospital and increasing your chance of living a couple more years isn't worth it. And if you're terminally ill, you're just prolonging the situation.
I don't see this as a "death panels agenda"but as the article states: For New York City’s 1.7 million older adults, this has become a second epidemic: the fear of dying alone. For many, it will do more harm than the virus itself.
It is reporting on the reality and ways folks are confronting it.And given the rate of infections in the hospitals, it doesn't take a medical expert to understands the risks and why one wants to avoid the hospital as much as possible.(Bay Area Guy good work to link the acquired infections.)
ipab was a feature buried in the stimulus
I know an old guy, 80s, head of psychiatry at a major hospital. He says at his age the benefits of giving up drinking and other possible things are measured in days. Not worth it. He hasn’t resigned to anything, he simply weighed costs and benefits.
Megaera said...
Seemed to me that the actual issue right now, and quite apart from all the (justifiably) cited issues with hospitals mentioned by commenters, is that with the lockdown in place she has access to exactly NONE of the things that she expected would ease her exit: the acupuncturist, the soothing presences, the caring companions and caregivers ... all that's in the toilet for the forseeable
I totally agree with this.
My sister died last year of cancer, at home surrounded by loved ones, having been in home hospice care for a few months. My father wants to die this way when his time comes. He's in his 80s and healthy although has been slipping into Mild Cognitive Impairment. He called and asked me if he were to get COVID, if there is hospice for that. He doesn't want anything remarkable done to keep him alive, but he also doesn't want to die in tremendous pain. I don't know that there is a die-at-home with pain mitigation option in the time of COVID, is there? I totally understand this woman. I understand my dad.
I also think one of the cruelest things is watching dementia patients in nursing homes being kept separate from those they love. It's heart wrenching.
Planned Parent? There is precedent. That said, the reasons to be judicious about visiting hospitals is to control the social contagion that has forced mismanagement of resources and to mitigate cross pollination.
My father-in-law, 86 years old, Korean War vet, is one of my all-time favorite people. He hates to admit that he's lost a step from his vigorous youth, but that's life. He accepts it. He takes pride in his adult children, and his several grandkids.
Every winter, he gets nailed pretty hard. Mild pneumonia, flu, cold, something. I'd say in the past 10 years, we've taken him to the doctor/hospital maybe 1 or 2 times a year.
Even he knows, that due to his age, and fragility, the common cold could finish him off. So, if he wants social distance, we comply. If he wants to see his grandkids, we comply. If he needs to go to the ER, we do it. If he feels it's mild, and wants to rest at home, we do it. Not a big deal. Nothing different from what millions of families cope with for decades -- without shutting down the economy in a fearful panic.
"Nurses" (RNs) today are largely poorly educated, low-skilled, lazy, and unprofessional in how they interact with patients, but they are still slightly better than the "multi-skilled technicians" whom the hospital has hired to replace most of them with. If you can escape the hospital alive and without a drug-resistant infection, you can count yourself especially blessed by fate.
I would emphasize the word "today" in that comment. It is clear that quality in nursing has gone way down because there is a shortage of people who want to do that work and the educational requirements are greatly lowered.
Anyone who can get an AA degree can start out as a nurse and work their way up. Getting a BA or BS is a lot easier today than it was 40 years ago. Can you imagine how easy it is to get an AA?
"At 89, She Fears Dying Alone More Than the Coronavirus Itself/She wants to be surrounded by loved ones when she dies. Not intubated and isolated in a hospital" (NYT).
Well, that's a fair claim, but it is incongruent with NYT beliefs and past performance. Anyway, Planned Parent, there is precedent.
"Nurses" (RNs) today are largely poorly educated, low-skilled, lazy, and unprofessional in how they interact with patients, but they are still slightly better than the "multi-skilled technicians" whom the hospital has hired to replace most of them with. If you can escape the hospital alive and without a drug-resistant infection, you can count yourself especially blessed by fate.
I would emphasize the word "today" in that comment. It is clear that quality in nursing has gone way down because there is a shortage of people who want to do that work and the educational requirements are greatly lowered.
Anyone who can get an AA degree can start out as a nurse and work their way up. Getting a BA or BS is a lot easier today than it was 40 years ago. Can you imagine how easy it is to get an AA?
@robother, first, yes, many people who are very elderly and terminally ill do wish to die at home surrounded by loved ones. But that doesn't make death panels a piece of nonsense. You've been hanging around Democrats too effing long.
consideration
“She doesn't hate hospitals. She hates the idea of dying alone and intubated, without her family and friends around her.”
My father died in the house my mother picked out and tastefully decorated, with one of his sons wiping off his face. He started to wake up, then sighed, and died. My mother, about 15 years earlier died I the night at a hospice about 20 miles away. She was drugged up enough the last couple days on morphine that she may not have realized where she was, but we still wish that we had been able to do for her what was done for our father. My partner definitely doesn’t want to die in a hospital, or any other facility. She has done that once already, and hates them for having spent way too much time in them, including with the MERSA after hospital malpractice flatlined her. Almost two months of hell. It didn’t hurt that the nurses were stealing pain meds from the patients at the time. Girl down the hall had had a leg amputated, and wasn’t getting her pain meds. She screamed a lot. That only ended after my partner convinced her surgeon that she wasn’t getting hers either, and he got law enforcement involved. For those who know VEGAS - it is the one that always show up on CSI (under a similar name). We are hopefully moving close to her daughter and two of her grandsons, and will have a guest suite, that should make having family around easier. As I have noted before, she is a pack rat, who loves her pretty things. She is insistent here, about dying at home. I worry about my three brothers, whose extended family has one kid, in the next generation - mine. This is one of the reasons that you go through all of the bother and pain of raising kids.
Lots of commenters have already, sussed out the reasons experienced Nurses in their 90's would refuse to submit themselves to hospital care. I'll flesh out a little bit more.
Nurses, if they are smart, perceptive, and have some sense of self, and the big picture, have experienced lots of death. Nurses that work hospitals, have experience with death that was not supposed to happen. Hospitals by mission statement, exist to cure the sick. Hospitals are not end of life care. So hospital nurses have wrestled with the meaning of life question, and have their personal answer to the question.
All life is precious. No life on earth is eternal. Life on earth, is incomprehensibly short. Less than a blink of an eye.
While I have plans to see my great grandkids, (the oldest grandchildren are 10) I am under no illusion, I am owed that. Life is fleeting, and I work to live in today, fully engaged. Having had a cancer event 6 years ago, I got my mind right with death. It's no big deal. Not worth obsessing over, and surely not worth fighting. I don't have the genes to make it to 90, but I already have a living will. No Intubators, no heroic measures. Make me comfortable, and I hope, in the end, I can find a dose of morphine to get me to the other side.
As much as I sympathize with the old gal, presumably the reason why loved ones are not permitted in the ICU to hold the hand of the croaker is the same reason why they shouldn’t be in the room holding hands with the croaker at home. As overblown as this disease has been played, the final tortured moments of the croaker alone and forgotten in a miserable impersonal space is the stuff of nightmares and gruesome battlefield scenes. I saw it in more than one rice paddy in the I Corps.
- Krumhorn
Not only do I not fear dying alone, I'd prefer it. In reality, most of us do really die alone. Nobody is going with us. You are at your worst. There is really nothing left to say that doesn't feel awkward, except "I love you." People around you are uncomfortable the whole time, and for me it's really a very personal thing between me and GOD, or nature, or whatever, but I've spent my whole life with others and this thing I need to do alone. I'd really prefer to die on a mountaintop somewhere, or in battle, or doing something dangerous and exciting, but if I have to die in a hospital I'd want it to be alone, not in pain of course, but without others having to struggle though that with me. They will get their own death to experience.
I am not a nurse. If anybody intubates me at age 89 I will kick them in the nuts or slats, whichever is there. I do not fear death, only an artificially prolonged mechanically induced intubated IV-infested painful and helpless ending.
NYT reports to justify the social contagion and rationalize sequestration and other extreme measures to flatten the curve and prolong the pandemic.
My very elderly mother with Parkinson’s disease re-affirmed to me just yesterday that her living will states she is DNR and not to be put on a ventilator under any circumstances. I don’t think she would let us take her to the hospital even if she fell and broke her hip. She is holding up better than many people much younger than she, including my daughter, who is taking care of her grandmother for the duration. When you remember the Great Depression, World War 2, and the smallpox and polio epidemics, one more nasty bug inspires little fear. She is a deeply faithful Christian who wants nothing more than to be reunited with my late father.
Inga,
'Social beings' is still a point of view with philosophical foundations, and legal/political/moral consequences. So is the idea that the world we live in is one of scarce resources, but a lot of evidence bears this out.
How comfortable are you that your point of view should make the laws/policies which decide who gets resources in a world where those resources are limited?
100% 75% 50% What if you're wrong about some things?
Please let me know before you turn your point of view into a poltical crusade.
Palin's "death panels" nonsense
It’s only none sense if you ignore the plain evidence of it. Even Our Lord Obummer argued that the old granny should take the red pill rather than get a hip replacement. The UK formalizes it as an amount of money equal to quality adjusted life years. If the treatment is more than that amount, it’s No Bueno.
- Krumhorn
As a nurse, she probably knows that hospitals right now are pest houses of corona virus. The idiot New York authorities contaminated the hospital ship with virus cases after it was to be reserved for non virus cases.
Phidippus,
My hospital experience resembles nothing like you relate. Nothing.
Maybe its the Iowa Nice thing, and Iowa work ethic. I've quizzed HR people, they take it as a given. The manager that hired my son out of collage, stopped at his resume because of his state of birth and high school. My nurses were professional, caring, good communicators, and efficient, lingering just long enough to allow me questions, then on to their rounds. Dr's made their rounds early, and nothing but courteous, attentive.
As always, its a bell curve, but nothing like you described
What's wrong with a "natural death"
It seems it happens to everyone.
And you can certainly be Catholic and refuse extraordinary medical care. It's right there, in the doctrine. Other people are not supposed to refuse you care however, and you're still supposed to get food and water. But chemo? intubation? etc etc. Optional.
As a nurse she probably saw enough delayed death in hospitals. An elderly neighbor of mine got a DNR order in order immediately after returning from a hospitalization/intubation. She died at home with her family 6 months later.
RK said...
How did the NYT find this lady? Do they knock on random doors asking for human interest stories?
Carlos Slims tells them what stories to write and narratives to push.
This lady may exist.
She may have actually said these things.
You cannot take that for granted with the NYTs though.
I think she is simply saying she knows if she goes in a hospital, no one will be allowed to visit her, and she’ll die alone and lonely without any chance of the comfort of a friend or loved one. Visitors are not allowed in a lot of (all?) hospitals right now. If she knows she doesn’t have a strong chance of coming through an illness, what point is there in going to an environment where she’ll be surrounded by strangers and the discomfort of a hospital environment?
My dad almost died due to a sudden urinary tract infection during a cruise. Heroic work by the doctors got him through the night. Half a year later he died at 95 after going in and out of hospitals with recurrent infections and losing his mind in the process. He was headed steeply downhill even at 93 and I think he would have been better off dying quickly and painlessly the first night. But that isn't an easy decision to make.
Thank you Inga for posting the information about the success rate of ventilators from the NPR story. I wondered how effective they have been given the intense focus on them as part of the preparedness for an outbreak and as the solution to the problem. If those same results continue, vents save 1/3 of the COVID-affected people using them.
My brother in law late mom said at 90 that she didn't want to go to the hospital because they kill old people. On balance, she was right.
A hospital killed my mother. And she was a "founder" , a nice gift giver to that hospital but they but they killed her all the same.
Half day moderation, I see.
Shatzi Weisberger, 89, a retired nurse
Funny, my first thought is......she's probably not a nurse, but she knew one on TV.
Second thought, she should have had kids!! They would have escorted the reporter to the door.
Third, why is 3rd-person omniscient even allowed in a newspaper?
Quality health care is where you find it. A trained and well disciplined system is possible. In Atlanta that means Emory. For hip, back and knee replacements Emory uses a dedicated Hospital that forbids sick people being admitted and has no public ER. And their medical personnel are the best in the country. Their success over the last 10 years has also been built on a functional digital communication system.
It can be done right.
All hospitals are not created equal.
Many of them will wake up a person a couple of times a night to check their status.
And with lots of noise making sleeping hard.
And the infection rate varies. Some hospitals are great at controlling it, I was very impressed by USC Keck, and their procedure for hand sanitizer. Others, not so great.
And if you are in your last days, I have observed a lack of dignity in professional settings. My Grandmother died at home, and it was a loving environment, and my Aunt died in a Nursing Home, and it would have been better for her health wise, if she had died at her home. In fact, if she was home, she may have lived longer. Cost was about the same.
She has passed Dr. Emanuel's expiration date by 14 years.
robother said...Kind of surprising to see Ann echoing Palin's "death panels" nonsense.
Except Palin was right. The legislation did include provisions for death panels. The fact that they weren't called death panels is irrelevant to their function.
Wow, what a surprising take on that article. My main takeaway was that the lockdown is removing everything the old woman had been expecting to have to ease her own death.
I am curious, though- how much time have you or the readers of this blog spent in a hospital as a patient or the close relative of one? My mother is a retired RN who will be 72 in a few weeks- she is adamant about not dying in a hospital or nursing home, and I have promised her that I would obey her wishes.
Then there’s the doctor going room to room with a necktie hanging out.
Just from a health standpoint I can understand not wanting to be in a hospital if it is possible to avoid it. There are lots of diseases bouncing around those places. That being said this particular woman seems to have a fatalistic mindset regarding Corona. I can understand how those feelings emerge when you hear about the mounting death toll on the news, but Corona isn't the disease to get that mindset over. Even at highest risk group in age, mortality rate was still only like 15%. That is a huge chance to survive. Do not go gentle into that good night. I doubt there is a single one of her family members that would prefer her to have a 'good death' now with Corona in lieu of a much crummier death five years later. A 'good death' is just the consolation the living are forced to take when they can no longer be with the ones they love.
Hospitals: you go in the front door, but leave via the back door.
No thanks...
Dying in hospital can be tortured compared with hospice at home. Not sure home hospice is going to be still available.
But if she went to the hospital, she was afraid that she would get the coronavirus there and die among strangers, cut off from the people she cared about....
This is entirely logical as well. The way we handled this virus was just plain stupid.
We locked everyone down and told them they would die unable to breath if they caught COVID-19 and that this was a completely new virus only found in one small nursing home in Kirkland, WA.
Everyone with flu like symptoms rushed the hospitals and the 5% or so that had COVID-19 infected the health care industry. In places that were at the right weather conditions COVID-19 exploded.
We told them stupid shit like masks don't work unless they are n95 masks and that the death rate was over 3%.
Almost as if the media wanted to panic everyone and cause problems.
You'd think an advance directive would keep staff from putting you on a ventilator?
In any case, there are probably worse deaths than dying in the arms of Morpheus. And so long as the purpose of the morphine is pain relief it's not considered (medically at least) as euthanasia. Even though everyone knows that it depresses CNS function and at the end this likely brings death a little sooner than it would have come otherwise.
I suspect many would die at home if only they were sure they could self-medicate with IV morphine on demand, at any dose they wished to take.
The "death panels" agenda was a leverage point argued by the spreaders of social contagion, which was, ironically, a first-order forcing of mismanagement of resources, cross pollination, and excess deaths.
"Why does a retired nurse, a medical professional, hate hospitals so much?"
They see what goes on in hospitals.
My mother became a nurse at age 49 and worked in hospitals until she retired at 73 to care for my father, somewhat hobbled by diabetes. She told us never to seek elective surgery and to agree to surgical procedures only if they were necessary, given the many surgical errors that commonly occur, among other perils of hospitals. (The greatest danger in any surgery is going under anasthesia.) There are also errors of medication, which can be injurious or even fatal. Hospitals are also petri dishes of bacteria.
My father's cognitive functioning was permanently affected by medication he received while in hospital. Even though my mother was a nurse and sat by his side advocating for him, the doctors disregarded her concerns about the effects the medicine was having on him--they made him seem as if he was suffering dementia, and they assumed he had come in to the hospital in that condition. She finally prevailed upon an intern to convince someone to have my father's orders changed. She convinced him that my father had NOT had any cognitive deficiencies before entering the hospital and the "dementia" type behavior he was exhibiting was not normal, but a result of the medication. The intern was able to convince someone to cease the medication. My father became coherent almost immediately. (But, alas, damage had been done to his short-term memory.)
For those who think this is not real, my employee who was diagnosed a little more than a week ago was hospitalized yesterday. She is 21. Uncle-in-law is now in ICU. He is in early 60s. They are unrelated cases.
"'Nurses' (RNs) today are largely poorly educated, low-skilled, lazy, and unprofessional in how they interact with patients, but they are still slightly better than the 'multi-skilled technicians' whom the hospital has hired to replace most of them with. If you can escape the hospital alive and without a drug-resistant infection, you can count yourself especially blessed by fate."
I will say this: I have been hospitalized several times: multiple times 22 years ago while being treated for leukemia, and again about a dozen years ago when I spent four days in hospital with pneumonia. In my experience, the nurses were always caring, considerate, and responsive. It may be that in recent years the hospitals' ever greater push for profits have changed conditions such that nurses cannot now be as attentive and conscientious as was the norm in my experience: they may be over-worked and overburdened with too-high patient loads and too little assistance.
I'm an introvert. I think I'd prefer to die alone.
Ken B-- I know they're out there, the good ones, like in any field. My wife knew some when she was working. But nowadays, around here at least, the lack of clinical preparation (e.g. sterile technique, keeping track of fluid I/Os) is disturbing and the overall genuine compassionate work ethic seems to have gone largely missing.
It's good to know that if I'm in a accident or otherwise can't avoid going in the hospital, that I might get lucky.
Congrats to the nurses in your family and here's hoping that they keep up the good work for the people who are helpless and have no one else to stand up for them-- especially against those physicians who are themselves careless or have poor judgement.
Shatzi, bless her heart, and her interest in death (and the attention that interest generates which she seems to enjoy) is no stranger to the Times. They covered her funeral in 2018.
They used a lot of black and white photos in the funeral story so I know it was serious journalism.
Why does a retired nurse, a medical professional, hate hospitals so much?
Perhaps she doesn't hate hospitals so much as realize that doctors there have blind spots, being soldiers in the battle against disease and not noticing "collateral damage", the patient's connections or sense of control over her life. Atul Gawande says something about this in this excellent Being Mortal.
“ Who doesn’t fear dying alone?”
I think dying in a crowd is scarier. Imagine going down in an airplane with a couple hundred other people, all terrified and screaming. Much better to be alone. It would be bad to die believing no one loved you, but the need to have them attending your bedside... is that really the important part?
She told us never to seek elective surgery and to agree to surgical procedures only if they were necessary, given the many surgical errors that commonly occur, among other perils of hospitals.
A good way to lead a short life. No surprise at this source.
"A good way to lead a short life."
So, you recommend that people have elective, non-necessary surgeries?
Well, I guess your income once rested on that, so, no surprise. (BTW, my parents both lived to near-80 and 80, respectively, so their avoidance of needless surgeries was no detriment to their lifespans. Others on both sides of my family have lived even longer without resorting to unnecessary surgeries or other procedures.)
The idiot New York authorities contaminated the hospital ship with virus cases after it was to be reserved for non virus cases.
I was wondering how they managed to cross pollinate and almost immediately contaminate a whole new facility. Was it planned? Incompetence? Wow.
“Inga,
'Social beings' is still a point of view with philosophical foundations, and legal/political/moral consequences. So is the idea that the world we live in is one of scarce resources, but a lot of evidence bears this out.”
—————————-
“How comfortable are you that your point of view should make the laws/policies which decide who gets resources in a world where those resources are limited?
100% 75% 50% What if you're wrong about some things?
Please let me know before you turn your point of view into a poltical crusade.”
———————————-
This is my opinion. I have no plans to turn my opinions into some crusade. You are free to do as you please.
“It would be bad to die believing no one loved you, but the need to have them attending your bedside... is that really the important part?
To many people it is. Even more so, I think it’s important to the family members themselves to be at the bedside of a dying loved one. The dying loved one often is unconscious and may not know who is there or not.
My opinion and observation based on 35 years of nursing and taking care of many dying people over the years.
A hospital is exactly where I'd want to be in a critical situation I had a decent chance of surviving. It's not my choice for a place to die peacefully--too impersonal. Give me decent palliative care at home any time. Not everyone has the luxury of this choice, but some terminal illnesses are predictable enough.
Elective surgery can be very life-changing for the better. My double hip replacement 19-years ago was considered an elective surgery.
My wife is a retired nurse. About 10 years ago, we completed our living wills. She was adamant about not wanting any terminal care beyond drugs for pain relief. At the time, I didn't understand her position. I thought I'd give modern medicine at least several days to see if they can save me before terminating care if there was no improvement. I didn't understand her attitude but agreed to abide by her wishes.
Then my mother got sick. She apparently aspirated one night while sleeping. She hesitated to go to the hospital (she was 85) but my sister finally got her there. They diagnosed her with pneumonia and recommended she be put on a respirator in the ICU. Again, my sister talked her into it. She was there for 10 days and got progressively worse. One night, she had a stroke that would have left her severely brain damaged. My sister and I agreed that it was time and we terminated her care. She died about an hour later. The image of her struggling for breath during that last hour haunted me for several years. The guilt I felt for ordering the end to her care, effectively killing her, still bothers me.
I will not put myself or my family through that. My living will (updated just 2 months ago) now matches my wife's wishes. We have it in writing and we've told all of our family members what our wishes are. My wife, the retired nurse, has seen a lot of unpleasant things during her career. I should have listened to her sooner.
The NYT encourages patients to reject modern medicine except where it agrees with the Left's narrative and objectives.
Make the NYT go two-ply and stop using ink. Scoring at 10cm would be handy, too.
"Elective surgery can be very life-changing for the better. My double hip replacement 19-years ago was considered an elective surgery."
I would say that has to do with the categories created by health insurance companies to justify not paying for certain procedures. That one would be recommended to have a double hip replacement--and that one would consider and agree to such dramatic surgery--reflects the urgent need by the patient to have relief from chronic pain and/or to gain functional mobility. That is, I would consider it necessary for quality of life, and "elective" only in the very narrow definition that "necessary" means "to prevent death."
My problem with the political wielding of the "death panels" charge is that it places off limits any rational discussion of a Medicare system that spends 30% of its annual budget on the 5% of folks in their last year (and a third of that in their last month.) Many old folks have written directives against extraordinary measures, but if they are not in shape to enforce those directives, other family members may not be around or willing to go up against Hospitals pushing against that. The bias of the doctors, particularly in specialties is for doing whatever it takes to prolong life. The fact that their financial interest (and that of the Hospital) coincides with that professional bias drives much of that statistic. For every 86 year old like my mother who died in complete command of her faculties and made known her wishes to the end, there are how many old ones alone and weakened, swho scarcely know what their doctors are recommending,, much less the hell that being intubated on drips for surgeries they will never recover from will be. And if no family member is around to second guess?
As a lawyer doing due diligence for securities offerings by large healthcare systems, I saw many examples of doctors who were finally caught abusing this system, and kicked off medical staffs, but not before years of causing immeasurable suffering to helpless elderly.
Howard said ...Elective surgery can be very life-changing for the better. My double hip replacement 19-years ago was considered an elective surgery.
Good lord, man! What happened that you needed those surgeries?
I will bet that rehab was not a lot of fun.
"Good lord, man! What happened that you needed those surgeries?"
Disco.
I haven't read any of the comments yet but wanted to chime in on the topic of a health care worker dreading going back to hospital, like the 89 yo nurse in the cited article.
I retired 13 months ago after 36 years in surgery: I worked in the navy and in 2 private practices, and in teaching hospitals, private hospitals and community hospitals. In fact I still work several weeks per year covering call at 2 large hospitals; I sort of enjoy it, seeing old friends and co-workers but I do it mostly for the money, to keep me out my savings.
Something that surprises me is I have come to quietly dread ever having to enter those hospitals, or any others, as a patient. Not totally sure why, except I feel like I spent enough time in them already and I don't to be there when my time comes. If I clutch my chest and drop the floor this afternoon I will allow myself to be taken in (to a specific one, definitely not the other) and hope they can pull me through. But otherwise if I have a critical illness I'd rather just pass away at home, most especially if I can make it to my late 80's before that day arrives.
Morbid topic, can't explain it. But the old nurses opinion makes perfect sense to me. Now, back to read some comments.
Phidippus,
I'll join those saying a word in defense of nurses today, knowing some pretty impressive ones. But while I must imagine there are some wonderful techs out there, one of them colored my opinion of all the rest while checking my wife's vital signs. Which I know is unfair of me.
Tech: Looks at instrument, shakes head, says "hmm."
I: "Everything OK, ma'am?"
"Her pulse. It's two-eighty," she said in a tone well-suited to report a pulse of ninety-seven. She consulted her instrument again, without visible alarm.
I pause. I could not just have heard her right. "Excuse me - did you say one-eighty?"
"No. Two-eighty. That's very high," she added helpfully. I stared at her. "I'll make a note on her chart," she said. This she did, and left.
So I took my wife's pulse manually. It was running around 105, certainly elevated. And I contemplated two reactions to a measurement of 280 bpm that I would find acceptable: 1) This machine is obviously malfunctioning; or, 2) The patient is actually dying, I must get help right away!
But no. The box measured 280, so 280 it is. Let me note that on her chart.
My mother died at 37, my son at 42, my brother at 45. They all escaped the problem of old age. I miss them all. They would have preferred this problem.
Appreciate what you have. Don't worry about what may not happen. Treat each day as a gift. Practice gratitude. You will die. Most of us don't know when. So much we don't know. I know where I am going, but still have purpose here. Be not afraid.
We let fear become our master. It should be a friend that reminds clerks at the checkout counter to wear masks. A friend who reminds us that the oaf intruding into our personal space, may be death come to Sammarah, and to back off. Don't be stupid. Wear masks. Wear gloves. The true death rate for Wuhan 19 is likely closer to one in a thousand, than over one in a hundred. Be careful, but don't be afraid.
Kind of OT:
WHO: There is no evidence wearing a mask in public setting prevents COVID-19 infection
KUTV, Salt Lake City, 4/7/20
Evidently, the science is settled.
Blogger Tomcc said...
Kind of OT: WHO: There is no evidence wearing a mask in public setting prevents COVID-19 infection
KUTV, Salt Lake City, 4/7/20
Evidently, the science is settled.
Note the word "prevents". That is a weasel word. It implies that unless something is 100% effective, don't bother. The flu vaccine does not "prevent" you from getting flu. It just helps reduce the chances you come down with it. Wearing a mask reduces the chance you will get Wuhan 19,and reduces the chance you will give it to another. So true, but a lie.
There are very few things in life with 100% certainty, death, and democrats wanting to tax you, are among the few.
America epidemiology Expert Alyssa Milano:
“Trump can make history as the first President to be impeached twice.
See? He advocated potential Treatments for the Covid-19 virus; Which is an Impeachable offense
of course, poor little Alyssa isn't Quite smart enough, to realize that this would mean that this would mean that President Trump would not only
Be the First impeached President to be reelected (after impeachment), but would mean that
President Trump would become the ONLY President, IN THE WORLD, to be exonerated of TWO impeachments
PresbyPoet: I agree with much of what you wrote. I found it noteworthy in light of the recent CDC recommendations.
The reason to wear a mask, even if one is healthy, is to avoid to the possibility of spreading the virus as an asymptomatic carrier. Wearing a non-N95 mask does nothing to prevent exposure from others.
Francisco D, my orthopedic surgeon thinks it was a slight birth defect from being a huge tall neanderthal baby crammed into my mom's small womb. Basically my front end was out of alignment. Enrolled in FDA trial for metal on metal resurfacing. Figured two in one surgery was easier. I am able to do sprinting and jumping after 19-years the x-rays and serum metal ion tests are perfect. I would be a wreck or dead by now if I didn't get the bionics.
Howard,
That is pretty amazing. You had one hell of a surgeon.
Shall we call you the $6 Million man? Well, make that $600M with inflation.
Francisco D: I had my bilateral hip replacements much earlier than I suspect Howard did -- long enough ago that resurfacing was not at all A Thing, and the metal on metal implants I have were even somewhat controversial. But, like Howard, I can attest to the life-altering benefits of a THA well done -- my surgeon swore it was the one procedure he did that got an immediate positive response because despite the rough nature of the operation itself, patients experienced an immediate, almost total relief from what for most had been a universe of grinding, non-stop pain. That said, recuperation from a THA isn't exactly easy or comfortable, but it's miles better than, say, shoulder or knee replacement rehabbing. With my antediluvian version of the procedure I'm not quite so physically capable as Howard, but it was all sufficient unto the evils of the day, and I still rejoice therein.
Howard: that is impressive, and if I may, somewhat miraculous. One of my Aunts had a hip replacement, and another one (replacing the replacement) after about 10 years. She was not doing either sprinting or jumping.
Megaera:. Thanks for pioneering metal on metal THRs. Your risk taking benefited me and thousands more. The early ones could be problematic, but for those that succeeded, people had remarkable outcomes, especially for younger patients. If they work right, they self polish to perfection in vivo. It helped pave the way to m/m resurfacing.
I got lucky tomcc. Traditional THR saws off the head and neck of the femur, then they drill out the marrow, and stuff the implant down the hole. Typically the bearing is 28cm, about 1/2-size of the real thing.
Resurfacing saves the head and neck of the femur, the bone is loaded naturally from the outside and the metal bearing diameter is the same as your natural joint. This allows for no restrictions once fully healed.
"My mother died at 37"--And mine at 35. Yes, I'm sure she'd have preferred to face the problem 40 years later instead, but as things were, she died at home, not in a hospital, knowing that they couldn't cure her and that was no place to be.
This was a very long time ago. There are better treatments now for what killed her, but at the time, it was a good choice.
Francisco D, they billed the insurance company$88,000. I had it done at the Joint Replacement Institute in LA, one of the top places in the world. Doc Mike might not agree because they were UCLA guys.
My problem with the political wielding of the "death panels" charge is that it places off limits any rational discussion of a Medicare system that spends 30% of its annual budget on the 5% of folks in their last year (and a third of that in their last month.)
Excess budget. The problem is progressive prices that do not reflect medical care.
The issue of Planed Parenthood (i.e. excess deaths) and Planned Parent (e.g. self-abortion) can be considered separately, but there is rational cause to not normalize these progressive practices, let alone to allow a single/central solution. The State should not be in the business of sanctioning, let alone operating abortion chambers.
I had it done at the Joint Replacement Institute in LA, one of the top places in the world. Doc Mike might not agree because they were UCLA guys.
The best joint guy in LA is at St Johns and takes cash only. No insurance, The best joint guy in Orange County is at Hoag and also takes cash only. He charges what Medicare allows but his overhead compared to most ortho pods is 1/3.
serum metal ion tests are perfect. <
My students talked to a guy at SC hospital who had to have his hips redone for metal allergy. Nickel I think.
Morbid topic, can't explain it. But the old nurses opinion makes perfect sense to me. Now, back to read some comments.
I agree completely. My hospital where I worked very hard, including organizing a trauma center, has been sold to an order of nuns who hired a Pepsico executive as CEO. I would not be hospitalized there for anything. Actually, I would not wish to be hospitalized for anything but elective surgery.
I experience this NYT article as part of the "death panels" agenda — getting old people to accept their fate and go down easy.
Data point of one: My 88-year-old mother-in-law, healthy, highly educated, sharp as the crease on Barack Obama's slacks, told us if she gets sick she's not going to the hospital to spend her last days with tubes shoved down her throat. I think it's a common sentiment and has nothing to do with technocrats' plans.
old us if she gets sick she's not going to the hospital to spend her last days
Years ago, when I still thought I would have an academic career doing outcomes research, I put together a proposal to care for the "frail elderly," defined as those over 85 , for UC , Irvine medical school where I was a professor.
The data I used confirmed that Medicare utilization goes to a peak at 70 and declines after that.
Most of the folklore about the elderly is wrong. They don't want "everything done."
I've been through this with a number of elderly relatives. Only one really wanted "everything done" in a way I found difficult to comprehend. The others mostly managed to make it home when it became clear the hospitals couldn't realistically do much more. Home hospice care was a godsend. One got stuck in a long-term care facility I couldn't spring her from, but even she signed a DNR. She was very clear about not wanting to be dragged back to a hospital. Earlier, when the hospital treatment really had had something to offer, she was fine with it when necessary. She died at 95.
Thank, Treks, but I’m locked down. Can’t go anywhere for awhile.
A hospital is a terrible place to be when you are vulnerable to disease.
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