Friday, July 25, 2008

Going to die in jail...

Hospitals are really jails in disguise.
It's unbelievable how many of my patients are in 4-point restraint, all for a variety of reasons.
One of them is a mentally retarded young man whose childhood is ravaged by constant seizures - he pulls out his NG tube twice a day because he hates them, but the tube is the only way to reliably feed and medicate him. Hence, everyday is a game of perseverence, to see who will give up first - the doctors putting the NG tubes in or the kid pulling the tubes out. There are many other things wrong with this case, but it is beyond the scope of our topic today. We'll call him Mr. G and we'll come back to him another day.
Another is altered and his only instinct is to leave the hospital (isn't it funny how no one wants to stay in the hospital and be healed?). And so he is restrained. I was walking past his room when he flagged me down, asking for help to get up off the bed. I innocently went to the nurse and asked for assistance, when she told me the patient doesn't know what he's doing and there is no way he's getting off that bed.
Another man is a true disaster of 4-point restraint. He was a young vibrant man when he came in with encephalopathy. He then went into a coma and is now slowly coming out of it. The disastrous part is that he is not conscious enough to voice his desire in an understandable way, but he is conscious enough to try and escape from his bed. So what do we do? We sedate him, to prevent him from leaving in his half-altered condition, but also to delay him from ever gaining his full consciousness. And thus everyday we set him back from recovery with Haldol, so that the nurses and the doctors are not bothered. I wonder if he will ever get out alive.
Many times I hear people begging and screaming for water...and the screams go unnoticed. As a medical student, I have to bother the scary nurses for permission to provide screaming patients with water, because some of them may be NPO, and some attending surgeons may literally kill me if I set back their scheduled surgeries with drops of water. But NPO is really a euphemism for starvation, and it is a brutal penalty. Many times patients are held on NPO for many days as the surgery date keeps getting rescheduled at the convenience of surgeons and at the mercy of hospital politics. It really is a form of torture.
Many hospital prisoners are allowed to execute themselves. How? We leave old, frail patients alone in their room, and as they get up, they are bound to fall, hit their head, and never move again. I can't count the number of patients whose plugs are being pulled this week - some of their deahts will be a direct result of hospital negligence and lack of fall precaution when one should have been instated.
So what do we get when we add 4-point restraint, torture, mind/behavioral control with sedation, and execution together?
We get a US hospital. There is one right where you live. And once you agree to enter, you'd better hold on to your consciousness. If you become altered, you may never get to leave ever again. If you don't listen to them, they will restrain you. If you try to escape, they will quiet you with sedation, and you'll never live to tell anyone what happened to you.
I would never want to be in a US hospital, not as a doctor and definitely not as a patient.

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