Thursday, May 22, 2008

TIH=prob GS

(The greater the time in the hospital, the higher the probablility of getting sick). Patients often wonder why we try to get them out of the hospital so fast after surgical procedures. I would love to say something trite like it is the government of the insurance companies but in truth, it is so they don't get something nasty.

That goes for us as well. I am trying to invent a mupirocin shower additive and use that gelled alcohol sanitizer so much that I smeel like vodka. It is hard not to run into the resistant bugs. People are surviving horrible things that a few years ago would have been fatal. As the hospitals are full of sicker and sicker patients we have meaner and meaner bacteria.

The good news is that after we manage to save someone from deaths door but has to be on long term TPN and dialysis because their gut and kidneys haven't come back, the government wont pay for the life saving antibiotics. This is because the catheter is infected even though any catheter placed in the body will become infected eventually.

This just proves one of the major principles in medicine: No good deed goes unpunished!


SeaSpray said...

I love your little blog title equations -no one else does that. :)

Since surgery is on my mind since leaving my last comment I will comment here and then I am going to do something even if it's wrong!

I hear you and I know you are right.

And it bugs me about the catheters. That's just not right. Can't you docs rally and fight inane decisions made by people who don't actually work hands on in the business/medical arena?

Years ago there was this news reporting doctor (deceased now)who once said "People should fight like hell to stay out of the hospital and if they are a patient in the hospital, they should fight like hell to get out."

He stated that people can become more sick because of what they can pick up in the hospital and that was back before all this news about super bugs and antibiotic resistance became so prevalent.

I NEVER want to go home right after an SDS. Don't get me wrong...there's no place like home, there's no place like home, there's no place like home. ;)

BUT...I had two awful incidents where I was discharged all happy and breezy,feeling good and glad to go home post-op and on the 10 mile or so ride back home became so violently ill with vomiting for HOURS that I will do ANYTHING to avoid that. I was a little queasy with my 1st c-section and 1st knee surgery-not great but not a big deal.

But then in March of 04 s/p knee repair the post-op experience from hell in my home. I was in the family room in recliner with leg up vomiting non stop into a bag. Husband had to call doctor who ordered a suppository. The problem was I was so sick I couldn't even get up to walk anywhere, etc and so never could take it. Our electric also went off shortly after getting home and so it was getting cold and dark. (Kind of funny now)I didn't realize how stressed everyone was until the lights came on around 9 and my then 15 yr old son jumped up, shot his arm straight out with pointed finger toward the kitchen like he discovered land and exclaimed "LOOK! We have LIGHT!" :)

Then May 04 after going to OR with 1st kidney stone, met the SDS criteria for discharged, was eager to go and the same thing happened.

I also realized after both kidney stone episodes back to back that morphine and Dilauded also make me violently ill. So now after being admitted, going to OR again 2 weeks later I made it my mission to tell everyone, even housekeeping (kidding) that anesthesia makes me sick.

This WONDERFUL anesthesiologist really listened and he said he gave me a special cocktail when I woke up in the OR-not recovery-the OR. he was proudly telling me what he had done. I was so alert and even though I had another stent was anxious to leave and did things faster than the nurses wanted me to and I was out the door...AND I was fine when I got home. I have been stented 5 times since then and stayed in the hospital after 4 of them and one I went home without a problem.

So I told my surgeon that if I go in for this SDS I want to stay over. He said we'll see but I could tell he wasn't keen on it. I know you and he are both right...I just REALLY don't want to be sick like that again. I mean the staff can give you medicine, they can keep you hydrated and if it's a problem...they are there.

I always tell the anesthesiologists ahead of time now, but it is a concern.

Truthfully...I am a germaphobe at heart. (see Trench Doc"s Germaphobe post on my sidebar favorites)I actually wonder how clean that remote, the bed rail, the phone, the floor the bathroom is. It really bugged me to see that the nurses stored a wheel chair (that wheels all around the hospital)right on the shower floor where people stand to take their shower. I usually use flip flops but still. AND I have seen where nurses were careless getting rid of a room mate's urine and hadn't lifted or cleaned the toilet seat. I wiped it with a soapy paper towel. I never said anything.

Oh and I am not crippled with fear-I just notice these things or I wouldn't have worked with them. I am just careful professionally and personally.

And then there is the added expense of an overnight stay- not exactly small change.

So I guess I should just suck it up and tell my self that with vomiting...this too shall pass.

SeaSpray said... is so weird to me after writing this 1st comment that I have already been a pt in the hospital and now tomorrow going back in to SDS and as usual...I have concerns about going home too early afraid that I could end up sick from anesthesia...which lasts for hours once home.

And then there is the point of your post...trying to keep the patients from picking up something.

But I also know from experience that when my urodoc removes a stent,lasers, and whatever else he does that I have a good chance of getting kidney/bladder spasms as well as nausea/vomiting post-op from anesthesia after being sent home. I want to do whats best but...