Healthcare junk w/Elok

[Unorthodox]

So, I'm a respiratory therapist. 

So is hEt.  i'll attempt a summoning.

[Buster's Uncle]

And there she is. 

[Unorthodox]

oh, she might enjoy being able to share stories with people that can't just nod and pretend they understand the words like I do. 

[Buster's Uncle]

I might just love love love the stories, too.

[hEtErOdOx]

Well. I’m glad to know that MD stupidity is the same in the adult world as in the NICU…

I’ve been a primary NICU RRT for 25 years. With my skill level and the way they staff us, I’m always in the NICU unless it’s an overtime or on call shift. When I’m out of the NICU, I pray that they give me Peds or surgical…adults on Vents and BiPap are terrifying. Once, a doc wanted me to put a guy with an esophageal tear on bipap…which is about the worst thing you could do.

Healthcare is breaking my heart since covid, but I reached a really bad place 3 weeks ago. We had a 30 weeker, mom had been ruptured for 5 weeks before delivery, and the baby started out pretty strong, but progressively got worse over the first few days. Our RRT’s brought up multiple concerns with the MD’s that were ignored…until the patient coded. Turns out, the lungs were infected with a really, really bad bacterial pneumonia. Somebody should have caught that…oh wait, the RRT’s did suspect that…and were ignored.

The problems arose when none of our physicians group agreed on how to treat the baby, and the RRT’s actually at the bedside were ignored. This patient was on 3 different ventilators multiple times over a 2 week period, culminating in a doctor pulling this patient off a vent she didn’t like, despite having a stable blood gas for the first time in days. She was pissed we pulled the patient off that vent a couple days earlier, despite being told multiple times that we were maxed out on settings and couldn’t ventilate the patient on that vent (The jet). I spent an entire shift with crap blood gases, CO2’s in the 80’s to 90’s (really bad) maxed out on the Jet settings, and when the baby’s poor mom asked me if they were going to live, I couldn’t tell her yes. And I broke.
The baby was transferred to the local children’s hospital the next day, mostly so that there would be consistency in care and order sets. But they’re  still on the vent and will probably end up with a tracheostomy, and a lot of that is because of the egos of our doctors.

I used to love my job, but healthcare just sucks since Covid.

[Bertilak]

My direct interactions and stories with the American healthcare system have involved my parents.

My mother died in 2020 after she suffered prolonged complications from a late diagnosis of a potentially congenital defect in her tricuspid valve. A defect in her tricuspid valve caused increasing deleterious health effects from the regurgitation of blood into her liver and related organs. She required consultations over multiple years with medical professionals and different facilities for treatments on breast cancer, unexplained chest pain, a rare calcareous growth on her tricuspid valve, mysterious issues in her respiratory system, and problems with liver functionality. Temporary replacement of her deformed tricuspid valve in the late 2000s produced brief relief, but an experimental surgery in 2020 for permanent replacement of her potentially defective tricuspid valve resulted in her death.

My father developed pneumonia in the middle of 2023 and has required continuous mechanical ventilation for survival from late 2023 through the present day. His treatment in certain medical facilities directly illustrated the strain on medical staff in hospitals. Medical staff in hospitals even explicitly denied ideal care plans because the hospital staff lacked adequate staffing for ideal treatments on my father. Facilities in California have provided decent through substandard treatments. His deteriorated current physical health partially emerged from his neglect of his physical health over the previous few decades.

[Buster's Uncle]

When they found my dad's cancer, it was already stage four, and they were REAL quiet about it when they sent him home to die.  SOMEbody had screwed up -several; he'd been looked at on the regular before- and killed him.  That's hard to live with.

Mother's mother died two months to the day before him, of complications from neglect in a home - she fell into a coma, and went unmedicated for an extended spell before they transferred her to a hospital.

It was very expensive in both cases, paying a LOT of people to neglect my father and grandmother to death.

Not a fan of the System here.

[Green1]

Urgent care told me my cancer was a UTI and the abdominal pain was that I needed to stretch and lose weight.

Turn up at ER doubled over and they find a gall bladder smack full of stones and stage II bladder cancer! The hospital doctors were laughing "Yeah... just call it a UTI and be done with it. Sounds like urgent care".

For -months- I was struggling and working in misery.

Good thing is I am not going to be peeing in a bag and am unlikely to die from this. But I start chemo/ radiation later this month.

Really, really set back my plans. I had just gotten a degree in my 50s  and was doing draftsman work for a maritime company.

[Buster's Uncle]

Ouch.

Dude.  Anything I can do to be helpful on the innerwebs, just say; I care.

[Green1]

I am doing okay.

My partner works and I have quite a bit of pad and stuff going on. My rent is literally 600 a month for a 2 BR. I found the place abandoned, talked to the landlord, helped evict the squatters and cleaned the place up for me and my daughter to move in. Been here 10 years.

If anything, I can now legally smoke weed via LA MMJ programs and being I am in a state with expanded Medicaid, they are covering almost everything doctor-wise.

Though it's kinda screwed up. I was recovering from back to back to back surgeries and am just getting better, now chemo and radiation coming.. sigh.

[Buster's Uncle]

Have you seen E_T's butt cancer thread?

I burned a weekend once making him laugh while he was in the worst of radiation/chemo...

[Metaliturtle]

Have you seen E_T's butt cancer thread?

I burned a weekend once making him laugh while he was in the worst of radiation/chemo...

Didn't burn anything, you showed up in your way for a buddy, that's building up.

[Buster's Uncle]

Sure, but it cut into an obligation I'd made to Elok to read and respond to his excellent novel - which got delayed a couple days right there when I hadn't been fast to begin with...

That's priorities straight, but you know, sucked...


The Texas years sucked that way, too.  My sister needed me more, but Momma didn't stop needing me while I was a thousand miles away and some things DID fall through the cracks.

[hEtErOdOx]

Medical staff in hospitals even explicitly denied ideal care plans because the hospital staff lacked adequate staffing for ideal treatments on my father.

This is an unfortunate reality in the current environment. During Covid we worked significantly understaffed just trying to keep people alive, and now administrators seem to think we should be understaffed all the time, because we did it back then. It’s a money grab.

[Elok]

I have no patient care experience pre-COVID, since I only graduated in '21.  So I have no grounds for comparison there.  I've never worked NICU and never want to; babies scare me.  But we have similar stories where doctors want bizarre or stupid things done with the ventilator, and all you can do is shrug and try to mitigate the damage.  It isn't nearly so tragic, though, because most of our patients are elderly, self-destructive, or both.  When a 78yo COPDer dies in the ICU, it's sad but not earthshaking.  That's just what happens at the end of COPD.  If a thirty-year-old meth user with an eighty-year-old's organs dies, we're mostly annoyed with the kid for wasting our time and his life being an idiot.  It's very rare for me to encounter the genuinely tragic, where death isn't the expected outcome for the patient's age or lifestyle.  I don't want to work in NICU and see little preemies die because mommy hit the bottle.  I'm callous enough as it is.  If you can take it, I salute you.

Adult work I guess has its challenges in that a tremendous amount of your job involves dealing with death.  This is a function of math; if two-thirds of people with dying relatives come to terms with it pretty quickly and sensibly, and most of the remainder will take a while to accept it, and the tiny little 10% nubbin left over are basically insane about it ... well, what that adds up to is that a decent-sized ICU will ALWAYS have at least one ventilator patient who has no hope and is being kept alive because basically the doctor and the family are playing chicken.  They stay and take up the bed/room and sometimes get in ugly fights with the doctor and threaten to take them/us to court.

Then there are hearts.  Open-heart surgery is top-flight stuff.  We do, I'd guess, something like eight of them per week.  It's obviously important, and I'm glad to live in a world where it can happen, but I don't know any RT who enjoys doing them.  I'll do them, because I have to, but hearts are pretty much my least favorite kind of work.  Basically, how a heart works is, they get intubated in the OR for the surgery, then brought up and connected to our vent to recover.  As soon as they go on our vent, the clock is ticking.  We have six hours to get them off the vent.  See, an uncomplicated extubation post-CABG is defined as one where they get off the vent in four to six hours, and the doctor gets reimbursed at a higher rate (and gets better-looking statistics, which patients are known to shop for) for uncomplicated extubations.  Naively, this makes sense, because quick extubations are associated with better outcomes, but I think this is because healthier patients get off the vent faster.  If you take a weaker patient and rush them off the vent, you aren't improving their outcome, you're just gaming the system for cash.

When I do hearts, I have basically no authority over my own vent.  The RN, the NP or PA, and the surgeon are calling the shots, even though they don't really understand the vent, and they will prioritize quick extubation even if it's under circumstances an RT would never tolerate normally.  Everything's big rush and big egos and the stupidity gets dialed up to eleven.  Now, we have it particularly bad because one of our CT surgeons is a strong contender for the most immoral person I've ever met.  The other one is at least a decent person, who will take it philosophically if a patient just needs a little extra time to wake up or stabilize.  But this guy ... I've seriously seen him extubate a patient who coded on SBT.  For you non-RTs, this means we set the vent to let him breathe on his own to see if it was safe to take him off, and he responded by trying to spontaneously die.  Long story.  He ultimately survived ... for a couple of weeks.  Then he got transferred to the floor, coded, and actually died.

The other awful thing about hearts is that the patients aren't "allowed" to die.  If you die within thirty days of open-heart surgery, it makes the surgeon look bad.  So you can't be DNR and you can't go palliative, no matter how bad it gets.  This can be taken to ridiculous extremes; we recently had a lady who was obviously in awful shape the moment she got out of the OR, went back a couple of times, got a tracheostomy, waxed and waned for the full thirty days and more, and STILL was not allowed to die in peace.  The family were talking about hospice within like four days of her surgery.  Doctor wouldn't cooperate.  She wound up transferring to a rehab facility, with the express intention of going to palliative/hospice/comfort care once she got there.  The whole thing was a tremendous amount of needless suffering and wasted resources, and all of it was on account of the surgeon.