tag:blogger.com,1999:blog-1406547525301395071.post4967905731302809097..comments2023-09-19T04:20:38.429-07:00Comments on Status Iatrogenicus: Ventilating Corpses and Resurrecting the Dead: The State of Modern Critical Care MedicineScott K. Aberegg, M.D., M.P.H.http://www.blogger.com/profile/17564774546019869201noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-1406547525301395071.post-47512496540111899042014-06-24T21:26:32.386-07:002014-06-24T21:26:32.386-07:00NYT LTACH Article, June 24, 2014<a href="http://mobile.nytimes.com/2014/06/24/health/life-goes-on-at-long-term-acute-care-hospitals.html?_r=0" rel="nofollow">NYT LTACH Article, June 24, 2014</a>Scott K. Aberegg, M.D., M.P.H.https://www.blogger.com/profile/17564774546019869201noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-68511417117349008722014-02-12T16:13:24.421-08:002014-02-12T16:13:24.421-08:00Thank you for this candid narrative. It is my str...Thank you for this candid narrative. It is my strong opinion that most doctors just plain SUCK at presenting reality in an honest in candid way that allows families to make rational and pragmatic decisions for their illness-stricken loved ones. I regret that you had to go on this roller coaster ride. I hope it turned out OK in the end.Scott K. Aberegg, M.D., M.P.H.https://www.blogger.com/profile/17564774546019869201noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-91140605212450941912014-02-12T15:37:18.612-08:002014-02-12T15:37:18.612-08:00I had never even heard of an LTACH (at least not b...I had never even heard of an LTACH (at least not by name) until my dad wound up in the hospital this last time, this time being put on a ventilator and when they tried to wean him off they couldn't so they they started talking trach and saying he would then have to be sent to one of these LTACH's I'd never before heard of; , they told us we would not be able to stay with him like I was doing at the hospital and would be rather inconvenient to drive back and forth to see him every day, so would mean he'd have to there by himself? was making for a hard decision situation, especially for long-term prognosis of recovery with the only other option they giving us being hospice/comfort care, which leads to what talked about in this article, of "possible?" certain death, certainly a not knowing how long he might survive given the chance of being able to keep him on ventilator locally; they finally, at that point, gave us a 10 day option, with there being other issues such as needing and being given dialysis, with the goal of it, at least initially, hopefully "jump-starting" his kidneys, which, after 3 times, not happening, getting back into the previous issue, only with more pressure, actually, this time of the hospice route, rather than pressure to LTACH, which in some ways just made it worse and made us more want to go that route to at least give him a chance but they weren't even wanting to do that anymore really at that point. But another issue is that for all that they told us they couldn't even tell us if he could even go to the LTACH in the first place; that the LTACH itself would have to decide if they would even admit him; that they would have to come assess him first, so to begin with wanted to see if they come do that because if they wouldn't take him it would all be a moot point anyway and learned later that if wanted to keep him on dialysis, which would be no point in going to LTACH otherwise, would be even more difficult to send him there anyway, with far fewer beds for patients needing both trach management and weaning as well as dialysis. And all of that without even taking into considering his overall medical diagnosis and condition he was in before the incident that led to this situation, which is what I'd wanted to be included in this decision in the first place. It took the dialysis not working to finally get that doctor to even begin to ask those other questions even though he somewhat knew about his underlying medical condition but not how he actually had been before this incident; he had not seen him for about 6 mos., during which time he'd had some other situation occur, which had caused him to have considerably declined during that time. He finally said that, as somewhat stated in this article, that being the case, that even sending him to LTACH, he would not recover past the point that he had gotten to before this acute incident, and therefore not really a good plan to send him to LTACH. btw, we did have a "brain dead" test run, an eeg, which they told us only tested for seizure activity, which it did not show; that the neurologist was basically clinically observing for brain activity; it was difficult to determine with eye contact because of his severe glaucoma; of course he couldn't talk anyway because of the ventilator; he was restrained so difficult to determine by hand movement, etc; he was severely hard of hearing so difficult to determine by response to conversation; mainly had to observe by reaction to pain, mostly when inflicted by wound care treatment, which did seem to indicate definite brain activity and there were occasions when he was able to speak over the vent to seem to say he basically just wanted to go home and get away from all the interventions. He had expressed such before this situation began to occur that he had not wanted to live in such a way. <br />/DonnaAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-62290570589307636962014-01-14T19:05:39.117-08:002014-01-14T19:05:39.117-08:00Good points. I commiserate with you, Sir. Good points. I commiserate with you, Sir. Scott K. Aberegg, M.D., M.P.H.https://www.blogger.com/profile/17564774546019869201noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-8946120035700133462014-01-13T22:51:20.577-08:002014-01-13T22:51:20.577-08:00well I have been a medical ICU director in 2 count...well I have been a medical ICU director in 2 countries ( third world and USA) and been doing ICU for 15 plus years , we are first and foremost hostages of a legal system, where professionals are denied back up by their administrators and by the medical societies , where research should be used to answer such questions, where patients should be responsible in part for their health and their non compliance, where " I want everything done doctor" is a phrase all too often heard on the phone spoken by a family member who may have not seen their "beloved " in months , where the ICU doctor is like a lost soul in the desert really with no help from anybody.....when did your hospital administrator asked u the last time if u needed help? Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-6844679416647698812013-07-06T00:19:45.841-07:002013-07-06T00:19:45.841-07:00totally agree. totally agree. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-1107618514563976022013-06-12T04:35:10.299-07:002013-06-12T04:35:10.299-07:00Love this. Thanks for your attention to the matter...Love this. Thanks for your attention to the matter.<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-14202533728557604312013-03-05T11:41:01.788-08:002013-03-05T11:41:01.788-08:00Good to see that you are still mad as hell and, fu...Good to see that you are still mad as hell and, furthermore, that you are not going to take it any more.<br /><br />Keep 'em coming.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.com