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When You Get Sick: The Character Of Those Around You

There’s an endless list of bad things about being sick. But what happens to the relationships you have with people around you when you become ill?

Let me tell you about a man I know. I will call him Bill, even though that’s not his real name.

Bill is a vital man in his 60s with two grown daughters. A few years ago, he was diagnosed with a serious illness. His illness isn’t going to kill him right away, but it has profoundly affected his ability to work and enjoy all the things he used to enjoy. Worse, he has had a difficult time with his doctors figuring out what exactly is wrong and the best way to proceed.

But all of this isn’t really the hardest part for Bill. The hard part for Bill is how his friends and family have reacted.

Bill’s two daughters have handled his illness in two different ways. Although she’s not a doctor, his older daughter has been doing everything she can to help her dad make sense of his problem and figure out the right things to do. Bill’s other daughter is a different story. She seems unable to come to terms with her father’s illness, and so has been almost entirely absent from his care.

Bill’s friends have had varied reactions, too. A few have been like his oldest daughter. Others have almost entirely disappeared. One of the people he thought was his closest friend stopped talking to him not long after he was diagnosed. Another, in the course of a conversation about his illness told him to stop being so self-absorbed. “I’m not sure what happened,” Bill told me.

It’s hard to be judgmental about people’s reactions. Everyone handles issues around death and serious illness differently. Who knows what baggage each of these people who have abandoned Bill carry around with them that caused them to react that way?

Still, the people who have stood by Bill also carry baggage with them — but are able to put it aside in order to help their friend. To me, the ability to do this is what defines character.

And so if you get sick, you’re going to find out a lot about the character of the people around you. The family members and friends who you thought were there for you unconditionally may not be. Then what?

Well, it’s part of a larger point.

If you get sick, no matter who you have around you, you need to realize that you are the one who has the most at stake. That you’re the one who cares the most about whether you’re being seen by the right doctors, that all of your questions are being answered, and that your personal and emotional needs as a human being are being tended to. You can hope that the people around you will step up and do their part, but you should plan for the possibility that they won’t, and be prepared to be your own best advocate, and your own best friend.

I think it’s the kind of advice Bill would give you.

*This blog post was originally published at See First Blog*


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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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