Do everything you can not to get admitted to the hospital

Imagine this:  You are sick.  You are the sickest you’ve ever been.  You want to die.  You almost did die.  You want to bury your head in your cozy bed for the next two years.

But you’re not in your bed.  This bed has plastic for covers and sandpaper for sheets.  You need to throw up every thirty minutes but you have to share a bathroom with someone you don’t know, who is also sick.  Your room has four walls but one of them is a curtain, behind which this same someone is talking loudly on the phone.  You want to be alone, but you can’t shut the door.  You want to sleep, but someone is constantly waking you up.  You want your favorite jammies but someone has taken away all your clothes.  You need quiet but something is always beeping.  You begin to feel better and want some of your mother’s chicken soup but all they have is Cup-a-Soup.

It is no secret that being hospitalized sucks.  I have been overnight in the hospital as a patient four times, and each time by day two I was begging to go home.  With each of my three children I called my OB after the first night, wanting to know why I couldn’t just leave.  The one other time, when I had preterm contractions and the kept me for observation, when they wouldn’t even let me out of bed, was far worse because I did not even have the distraction of a newborn.  My butt was numb from the mattress, the coffee was undrinkable, there was no DVR or On Demand, and I was really hungry because someone forgot to tell me that if I wanted food I had to call and order it.  My second child was in the NICU, and once someone from the postpartum floor actually came and got me from the bedside of my child to take my vital signs.

Historically, hospitals were generally, and justifiably, feared.  The earliest ones were really no more than almshouses or insane asylums.  Infection was rampant and conditions were horrible.  Dr. James Jackson and Dr. John C. Warren, upon deciding that Harvard Medical School needed an adequate place to teach, had to go out and explain why “respectable and worthy persons” should require a hospital.  These persons included widows, good women whose husbands had deserted them, families in which accidents had used up savings, and servants.  Wealthy people stayed home and doctors came to them.

Of course, during this time, around 1820, doctors couldn’t do much for people anyway.  In fact, doctors in most parts of the country readily acknowledged that  people who got better did so because they had rest, quiet, good food, and a clean environment.

In a post I wrote about a year ago I quoted Oliver Wendell Holmes:

What is the honest truth about the medical art?  By far the largest number of diseases which physicians are called to treat will get well at any rate, even in spite of reasonably bad treatment.  Of the other fraction, a certain number will inevitably die, whatever is done; there remains a small margin of cases where the life of the patient depends on the skill of the physician.  Drugs now and then save life; they often shorten disease and remove symptoms; but they are second in importance to food, air, temperature, and other hygienic influences.

History repeats.  In 2013, Dr. Harlan Krumholz, a professor of medicine and public health at Yale School of Medicine, described a syndrome that emerges in the days and weeks after a hospital stay: “Physiologic systems are impaired, reserves are depleted, and the body cannot effectively avoid or mitigate health threats.”

He called this period of vulnerability post-hospital syndrome.

What does Dr. Krumholz recommend?  Better food, quieter wards, preserving patient dignity, more sleep, more physical activity. These ideas are not new.  They are, arguably, the earliest therapeutic tools of medicine.  Just because we have antibiotics and angioplasty does not mean we can’t continue to provide these simple remedies.

In the meantime, do everything you can not to get admitted to the hospital.  It’s bad for your health.

Shirie Leng, a former nurse, is a recently retired anesthesiologist who blogs at medicine for real.

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  • JR DNR

    We have a lot of research on how bad sleep deprivation is – it clearly effects health outcomes. I don’t understand why a good nights sleep isn’t a priority for patients staying in the hospital. Just a quick sampling:

    http://en.wikipedia.org/wiki/Sleep_deprivation

    A lot of the studies listed are newer, but they re-confirm or expand upon older studies.

    • guest

      It’s because the hospital administrators who make decisions about staffing, which is the primary driver for the hospital conditions which allow/prevent adequate sleep at night, are not aware of these studies and don’t really care.

    • Chiked

      I was once admitted to the hospital and every morning the doctor would come in and ask how was I doing. On the third day, I felt like punching him in the face and say….”How the F$%? do you think I am doing”. I have not had more than two hours of uninterrupted sleep for 3 days now. How would you feel if you went 3 days with no more than 2 hours of sleep at a time.

      I think the key to resolving our healthcare crisis is to reeducate doctors. If after 8+ years of education they don’t get the fact that sleep is the primary way the body heals itself, the system needs a reboot.

  • Shirie Leng, MD

    Yes, staffing is a big part of the problem. But so are hospital routines and schedules that benefit the system and not the patient

    • RenegadeRN

      Hospital routines are a big problem. As a former 7pm-7 am NICU nurse, there are certain care components done only on night shift… Such as bathing babies at 3-4 am..labs draws and other studies – so the doc coming in the next morning will have them in the chart…no thought to establishing normal circadian rhythms.

      New parents wonder why babies usually don’t sleep worth a hoot if they have spent any time in the hospital..because we woke them up in the light and messed with them!

  • http://www.dpsinfo.com LaurieMann

    I agree – when you are sick do whatever you can do to be sick at home. If you have surgery, get out of bed as soon as you possibly can and walk out the door as soon as you possibly can.

  • guest

    Great post. I’ve been in the hospital after 2 uneventful childbirths. I cannot imagine being in there as a sick, vulnerable person.

  • Suzi Q 38

    ‘……In the meantime, do everything you can not to get admitted to the hospital. It’s bad for your health.”
    I agree.
    My last hospital stay was supposed to be for 5 days after my cervical spine surgery.

    I took one look at my filthy room and bathroom.

    I had to also consider the overworked and inattentive nurses, the frequency of interrupted sleep with vitals, blood work, physical therapy, pain management teams, etc. Are all of these people truly necessary?
    Sometimes, I would be polite but ask: “Who do you want to see? What is your purpose? Who authorized your visit? Does my insurance cover this and is this truly necessary? Why?….”

    It didn’t start off well when I asked the visiting nurse (I had 3 during my stay) to remove my catheter and she handed me a bed pan. What was I supposed to do with that with my catheter still in place? When we (my roommate and I) pushed the call button, no one would come to our aid. We could have fallen out of bed or started crashing and no one was the wiser. My roommate was a nurse, and we just had a great time. She couldn’t believe it either.

    Once, I was so desperate to get help for my roommate that I got out of bed with my IV pole in tow and walked out of my room and directly got the attention of a nurse. She was visibly annoyed, but I told her that it was better than the two of us calling in the nurse advocate to help us.

    Anyway, I begged to leave after 24 hours and actually got my wish at 30 hours. My daughter is a nurse, so she took care of me for a couple of days. I didn’t want to catch c difficle or Mersa, so I left.

    I complained later, when I was safely at home.

    The advocate told me that a “team” went to my exact room, and saw how dirty my room and bathroom was. Also, having that many visiting nurses can not be good for patient care.

    • querywoman

      When I spent eight days in the hospital for serious pneumonia in 2012, all I could do was lie there and let people take care of me.
      I don’t remember sleeping much except for when my internist knocked me out and brought in a pulmonologist.
      I was okay with midnite interruptions. I often got baths at night.

  • querywoman

    The eight days I spent in the hospital with serious pneumonia taught me to appreciate modern hospitalization quite a bit! It has its uses!

  • leslie fay

    AMEN! As a retired RT of 40 years I can’t tell you how many times I tried to tell people that! Lights are on all the time, etc. While obviously some critically ill people require constant care, once they are past the initial crisis they need some reasonable time for rest and decent food-neither of which you will find in a hospital. I’ve had the misfortune of being hospitalized once in my life for a brief period. Yikes! pretty much no sleep for 48 hrs. The first night was spent in the ED because there were no beds available and anyone whose ever worked there knows it is a constantly noisy place and the little curtain that separates you from everyone else is not ‘soundproof’(big surprise). Then there’s the a.m. labs done at 1am followed by the a.m. EKG at 2am because of the staffing and the need to have everything on the chart for the doctor when he arrives in the (real) morning.

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