[FRIAM] bad covid story

Mon Dec 27 13:55:20 EST 2021

Here's a story that didn't involve an emergency that triggers my rage.

I'm sitting at a urology clinic waiting for someone.  Everyone is sitting quietly.   Some are elderly and look unwell.  The people with them, some also older spouses, are doing their best to get them through what may involve a whole sequence of treatments.  They whisper.  One could imagine some of the situations could be humiliating.

Now a guy a little older than me comes in.  By comparison to the others, he is relatively healthy and young.   I count my blessings I am not him.  I guess he is a basket case for reasons I can't explain.  He starts talking and proves it.   Turns out this guy -- thoughtful enough to talk loud enough to be heard 100 feet away -- was frustrated by his inability to empty his bladder.   He went to an urgent care where they installed a catheter.   (I wonder who goes to an urgent care for such a procedure?)  Now a day has passed.  He decides he hates the thing.  He arrives at this specialized urology clinic -- one that schedules appointments months in advance -- without an appointment.

He proceeds to be abusive to the desk staff and nurses and wants to talk to a doctor.   He carries on for 15 minutes at least and works through different people to try to get the answer he wants.   He will only use the name of a person (by now four of them) when it is someone that doesn't push back on his demands.  They get names like "Miss Whatever."  Eventually they consent to check the catheter, etc. to ensure it is properly installed but otherwise he must follow the guidance of his original urgent care doctor and wait for the scheduled removal.  The rest of the patients, including the person I am with, just had their appointments delayed.

It was very hard not to volunteer to help him with that catheter.

Marcus

________________________________
From: Friam <friam-bounces at redfish.com> on behalf of glen <gepropella at gmail.com>
Sent: Monday, December 27, 2021 11:23 AM
To: friam at redfish.com <friam at redfish.com>
Subject: Re: [FRIAM] bad covid story

What process do we use to vet the "ministers"?
Do we need policies and procedures for things like "aura massage"?
Do you remove the ventilator to give them the pill?
How much does "whatever that method may be" cost? And who will pay for it?
How much should doctors' and nurses' and finance staff *practice* their proper scripts for what they can and can't say to patients? 10 hours per week? Just in med school?
How many edge cases should doctors have to *calculate* through to handle wackos like anti-maskers? What about, say, Christian Scientists? How complex do the logic diagrams need to be?
How do we set the standard for *when* to tell family members the patient died? Who sets that standard? What committee?
Should the doctor wear body armor or have a body guard present when informing the family of a death? How much do we pay for such things? Does the body armor have to be sterilized? Are the body guards unionized? Who pays for their liability insurance? Should they carry guns?

Pffft. As I said, you're being ridiculously idealistic. It's fine to engage in wishful thinking and dream of unicorns. But don't use that as an excuse for idiots who cause more problems than they solve. Moreover, don't use your magical thinking to apply a guilt trip to an already stressed workforce.

On 12/27/21 10:11, Eric Charles wrote:
> Letting people try long shot, even mystical attempts, to save a person we are virtually certain is going to die is less cruel. (If we can let ministers pray with patients, we can give them a Vitamin D pill.)
>
> Finding a way to let people see their dying family member, whatever that method may need to be, is less cruel. (The idea that the doctors have to calculate the risk of being accused of murder if they arrange it is a negative aspect of the situation, not a positive one.)
>
> When you are virtually certain a patient is going to die, not saying "I won't won't let you die" is less cruel. (It is cruel to the patient, it is cruel to the family, and, frankly, the idea that anyone should have to say such lies is cruel to the person saying the lie.)
>
> Not going out of your way to convince a family to come to the hospital if you know you won't let them in, is less cruel.
>
> Not seeking them out while they are still in fight-mode, to tell them in person that the patient died, is less cruel.
>
> Being prepared for extremely negative reactions in situations where extremely negative reactions are likely to occur, is less cruel.
>
> Not blaming them for your leaving the profession, after a series of unforced errors on your part, is less cruel.
>
> Do you remember the UK case with Alphie Evans? When the doctors decided the kid should have to stay and die in a UK hospital, rather than be transferred to a hospital where doctors wanted to try a long-shot treatment? Alfie Evans not allowed to leave country, UK court says | CNN <https://www.cnn.com/2018/04/25/health/alfie-evans-appeal-bn/index.html> That was about as dystopian and cruel as health care rules can possibly get, and it followed all the laws and statutes and policies that existed for rational reasons. As a fan of dystopian stories, I can assure you that it is common for them to feature bureaucracies following rationally constructed laws and statutes.
>
> I do agree with Marcus that it would have been much better if the family had proactively identified someone who would more closely follow the treatment path they wanted. I don't know what the initial path to hospitalization was.
>
> <mailto:echarles at american.edu>
>
>
> On Mon, Dec 27, 2021 at 12:28 PM glen <gepropella at gmail.com <mailto:gepropella at gmail.com>> wrote:
>
>     This is unadulterated bullshit. Sure, perhaps in some ideal world, where all people are rational and all systems are frictionless, "the process could have been much less cruel". It's bullshit in Frankfurt's sense because it's not quite a lie and it's not quite the truth. And given your (EricC) ability to think clearly and pay attention to detail, we can only assume you *know* it's bullshit.
>
>     If it could have been much less cruel, then please suggest the concrete modifications to the current byzantine set of laws, P&Ps, cultural norms, agency recommendations, political forces, etc. that would get us from here to there. (Not the impractical nonsense in your bullets like patients' family members prescribing meds that nurses will administer. Really? Sheesh.) If you cannot get us, practically, from where we are now to that less cruel place, then you're just blowing idealist smoke.
>
>
>     On 12/27/21 09:18, Eric Charles wrote:
>      > Even if, by the time the story starts, he was going to die no matter what happened, the process by which that happened could have been much less cruel.
>     --
>     glen
>     Theorem 3. There exists a double master function.
>
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--
glen
Theorem 3. There exists a double master function.

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