#hosptials

[macgyvermedical]

I have a character who gets shot in the side and her friends sensibly realize she will die without actual surgery. Unfortunately there are also people who still want to kill her, so staying put in a public place isn't ideal. How do I determine how long she absolutely positively must stay in the hospital? And what are the risks of leaving early?

The reason hospitals exist is because there are many situations in which a person doesn't have the skill, equipment, and/or ability to take care of themself at home.

Maybe the person can't keep anything down and needs IV fluid to stay hydrated. Maybe they have altered mental status for some reason and can't keep themself safe. Maybe they need assessments for changes to their status around the clock. Maybe they need a medication that is dosed based on an assessment that they can't do themself. Maybe they need a treatment or medication that is too dangerous or side effect prone to give outpatient.

Any of these, among many others, are reasons people might have to stay in a hospital.

For surgery/trauma specifically, a pretty standard checklist has to be met for someone to go home. They have to:

Be able to hold down fluids (with oral anti-nausea medication if necessary)

Have tolerable pain with oral pain medication

Be back to (or very close to) their baseline mental status

Be able to pass gas

Be able to urinate

Finish their course of IV antibiotics (in the case of trauma or an intestinal surgery)

Be able to understand and follow their care plan at home (when to take meds, how to change dressings, when to come back for follow ups, when/how they can bathe, etc...)

Once these are all met, the person can generally go home safely. For some people and surgeries, this takes a few hours, for others this takes weeks or even months. Some people may even need to go to a rehab center or a skilled nursing facility before they can go home safely (especially if they can do everything but the last one).

Someone who is shot in the side and needs surgery likely had the bullet penetrate their peritoneum- the sac that holds their abdominal organs. This probably injured some intestine, which means she will need IV antibiotics and runs the risk of part of the bowel dying or failing to work as it should after the surgery.

If she was really proactive and there were no complications*, she could probably meet everything but the antibiotic requirement within 24 hours.

Now, after 24 hours, even if she'd met all the requirements except the IV antibiotics, she'd still have to leave against medical advice, or "AMA". This means that the best course of treatment, the IV antibiotics, has to take place in the hospital, and she would run the risk of complications (peritonitis) by skipping out before they were done. If she could convince the doctors to give her oral antibiotics**, she might even be able to leave without the high risk of peritonitis that comes with bowel surgery.

Speaking of complications, the main complications would be dead bowel (which would cause a lack of bowel movement/passing of gas, and vomiting), and peritonitis. For either of these, she would have to come back to the hospital and spend possibly a week or more with an NG tube or more IV antibiotics.

*This is something that would require her to start working on her checklist the second she got up to the floor. Trying to pee, being really aware of when she passed gas, drinking clear liquids like it was her job the second she was allowed, refusing IV meds if there was any other option, etc... It would not be fun or comfortable, and this assumes of course there are no complications.

**This is something that is surprisingly difficult to convince doctors to do. I have had many, many times when a patient is either refusing IV access, we can't get an IV in them to literally save their life, or the patient is leaving AMA and still needs antibiotics, and even so no one will change the IV antibiotics to oral or IM. If you are a pharmacist or a hospitalist I would love to hear reasons and if there are some magic words I can say to get alternative antibiotics for my patients.

[mysharona1987]

[trenchcoatimpala]

Hey guys! It’s been a hot second since I wrote something, so I’m here with a little ficlet. I am still writing something bigger (4k words currently and still going) so that is coming. But in the meantime, enjoy this little one-shot filled with established relationship Destiel and Dean in a hospital. 

wc: 1.2k

Also on archive

Dean found himself drifting off to the sweet litany of beeping monitors. The sound was like a lullaby in his head, the slow beep beep beep beep nothing more than a whisper, telling him to sleep. It rocked him on gentle waves and coaxed him closer to unconsciousness, although, a Dean that wasn’t pumped full of pain medication would understand that the beeping had nothing to do with his drooping eyelids and everything to do with said pain medication. 

Sleep was welcome to his aching body. He knew it was bad, it had to be if he was in the hospital and not some rundown motel, but his mind was foggy enough not to worry about just how bad. 

He came and went from consciousness, only waking when a nurse came to check on him or the drugs wore off and the pain started to creep in. His head hurt like a motherfucker and there was a throbbing ache in his leg and ribs that caused his breath to stutter every time he inhaled. 

“How are we doing?” a nurse asked, she was blond, petite, and was exactly Dean’s type, but unfortunately, being bedridden and out of it meant that he couldn’t exactly turn the charm on easily. Not to mention, he was already taken, he had no reason to flirt.

“‘M’kay,” Dean slurred in response.

The nurse checked his eyes, changed his bandages, and the whole time Dean let his attention fall in and out of focus. The nurse was wearing some kind of flowery perfume that made Dean want to sneeze, but somehow he managed to keep his bodily fluids to himself. 

“Don’t worry, we’ll have you out of here in no time,” the nurse said as she gave him a pat on the cheek, checked over the monitors one more time, and then left the room. 

“Who’s worried,” Dean mumbled to her retreating back as he let himself flop back against the pillows, smiling as the morphine she’d given him reached his system. 

The next time someone came into his room, he was pleased to see that it was Sam, with Cas in tow. 

“Hey Dean,” Sam said as he sat down in the chair by his bed. 

“Heya, Sammy,” Dean replied with a smile.

“How’re you feeling?” Sam asked. 

Dean shifted his gaze to Cas and couldn’t help but let his smile grow. “Peachy.” 

“Do you remember what happened?” Cas asked as he sat down in the chair on the other side of Dean’s bed. 

“‘S a little fuzzy,” Dean admitted, still only having eyes for Cas. 

“That ghoul threw you good,” Sam said. 

“Straight through the window,” Cas chimed in. “You hit your head pretty bad on the concrete.” 

“But not before the ghoul kicked out your leg,” Sam added. 

Dean groaned. “No wonder I feel like I was just run over by a stampede.” 

“We’re working on your discharge papers,” Sam said as he clapped a hand down on Dean’s shoulder, Dean winced at the impact. “Sorry.” 

Dean waved him off with a grunt. “When do you think I’ll be out of here?” 

“They’ll probably want to keep you overnight to monitor you,” Cas replied. 

“Awesome,” Dean mumbled. 

“I’ll go see if I can negotiate a change to that plan,” Sam said as he stood up. 

Once Sam was gone, Dean grinned lazily at Cas. “Hi.” 

“Hello, Dean,” Cas replied warmly. 

Dean reached up a hand and gently ran his fingers over Cas’s face. Stubble scratched at the pads of his fingers but Dean liked the pull of it. He took in the bags under Cas’s eyes and the scab forming on his left cheek, but in searching Cas’s blue gaze he found concern there.

“You look worried.”

Cas huffed a broken laugh. “Of course I’m worried, you’re hurt.” 

“‘S nothin’, ‘ve had worse.” 

“You haven’t had a concussion to this severity before, I know that much,” Cas said as he reached out and took Dean’s hand in his own. 

Dean liked the feeling of Cas’s warm palm fitted into his, and he said as much, leaving Cas to laugh in amusement. Dean felt a dopy grin spread across his face and he let himself get lost in those blue eyes again. 

“I love you,” he blurted out, unable to stop himself. 

Cas squeezed his hand. “I love you too.” 

Dean drew his lips into a pout. “What, no kiss?” 

Cas rolled his eyes. “I’m not kissing you while you’re this drugged up.” 

Dean’s pout grew. “Why not?” 

“Because it would be inappropriate,” Cas replied. Dean crossed his arms like a petulant child, of course that proved difficult due to his broken ribs, but he tried anyway. “Don’t hurt yourself,” Cas warned. 

“It’s not like I’m not aware of my actions,” Dean argued. 

Cas sighed. “Dean, we’re in a hospital, I’d much rather kiss you once we’re back in our bed, preferably after you’ve brushed your teeth and taken a shower.”

Dean uncrossed his arms and nodded slowly. “Okay, that’s fair.” 

Cas did kiss the back of Dean’s hand to make up for it and Dean let his fingers thread with Cas’s. 

“I wish I could heal you,” Cas said softly. “I hate that I can’t.” 

Dean squeezed Cas’s hand and put on his best reassuring smile. “It’s okay. Besides, if you healed me I wouldn’t get you doting on me like this.” 

Cas frowned but there was a small twinkle in his eyes. “Still, I hate seeing you in pain.” 

“‘M not in pain.” 

“You might change that sentiment once the drugs wear off.” 

Dean didn’t have enough energy to respond so he let his eyes close and when Sam returned to the room, he found them like that, Dean dozing off and Cas sitting resolutely by his side. 

“Dean’ll be good to go in a few hours,” Sam announced as he plopped into his previously vacated chair, tearing Dean from his almost-slumber.

“Super,” Dean yawned as he cracked open an eye to look at his brother. 

Dean spent the rest of his hospital stay eating pudding and watching crap TV and when he was finally wheeled out of the building and helped into the backseat of Baby, he let out a sigh of relief. 

“I hate hospitals,” Dean grumbled as he leaned into Cas’s shoulder. 

“I know,” Cas replied as he ran a hand through Dean’s hair. 

The car ride was silent after that, and when they got back to the bunker Dean was practically carried down the stairs and into his room. Cas helped Dean clean up and then he collapsed onto their bed and Cas joined him. 

“You owe me a kiss,” Dean said as he looked over at his husband. 

Cas smiled and scooched closer to Dean, placing a hand on his cheek and drawing him in. Their lips met in a soft kiss, but Dean deepened it the first chance he got and Cas grinned into his mouth. 

When they pulled apart, Dean felt like he was floating. “That was worth the wait,” he said. 

“I’m glad,” Cas replied as their hands tangled together under the sheets. “Now try to get some rest.” 

“Okay, Mom,” Dean grumbled. 

“I certainly hope you don’t see me as an equivalent to your mother,” Cas said, slightly affronted, but teasing. 

Dean shoved gently at him, which caused his ribs to twinge painfully, but he ignored it. “No way in Hell.” 

“Good.” 

“Love you,” Dean said over a yawn as he squeezed Cas’s hand. 

“Love you, too.” 

Dean fell asleep with a smile on his face, despite the throbbing pain of his injured limbs. Cas was the only medicine he needed. 

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[mysharona1987]

[robertbrancatelli]

A Slow Heart

I have a slow heart. That’s better than having no heart at all, which I’ve been accused of a few times in my life, but that’s another story. Who told me I have a slow heart? People in white lab coats at the hospital and, later, at my doctor’s office. “You’re suffering from bradycardia,” they informed me. “You mean the third baseman for the Saint Louis Cardinals?” They looked at me. “Just…

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[freenewstoday]

New Post has been published on https://freenews.today/2020/12/18/italian-nurse-couple-brings-family-love-to-icu-burdened-by-covid-19/

Italian nurse couple brings family love to ICU burdened by COVID-19

ROME — The pandemic has posed unprecedented challenges for families around the world managing work and home life.

For the Di Giacobbe family, the juggling is even trickier since mom and dad are intensive care nurses in the same COVID-19 hospital. They spend their days trying to provide their patients the type of personal care and attention they give their children.

The family will celebrate Christmas together this year — parents Maurizio Di Giacobbe and Glenda Grossi managed to both get Dec. 25 off. But they won’t have grandparents, aunts and uncles around their holiday table. They want to protect them.

“So we will be with our three children, the dog and the two cats,” Grossi said on a rare Saturday when both parents were home at the same time, decorating the Christmas tree with Tiziano, 4, Arianna, 9, and Flavio, 10.

When the pandemic first erupted in Italy last spring, and no one knew how to mitigate its spread, the parents wore surgical masks around the children and developed a “virtual hug” to express their love. For the children, it was a game. But their parents knew first-hand just how deadly COVID-19 was.

“I don’t want to say we got used to seeing people die, but we were going to work with a kind of feeling of resignation” that at most they could provide their patients with dignity in their final moments, Di Giacobbe said.

Over time, doctors figured out which therapies worked better. “Now, instead, we are fighting,” he said.

Still, Italy now leads Europe with the most COVID-19 deaths — more than 65,000.

In many ways, the couple bring the love of a family into the COVID-19 ward, knowing well the importance of touches, caresses and video calls with their patients’ loved ones outside, who are otherwise barred from visiting.

Grossi tears up when she remembers one of her first patients at Rome’s Tor Vergata COVID hospital, Fabio, a 43-year-old father of three who married his partner in March while he was hospitalized with COVID-19.

“I remember that day when Fabio made the video call to his wife and children, he touched his chest with his hand and said: ‘They need to intubate me, I’ll see you soon.’” As Di Giaccobe sits by her side, Grossi’s voice cracks.

“’See you soon’ never came true unfortunately, because Fabio didn’t make it.”

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[azahar]

it’s scan day After my last bout of "difficultitis" early last month the day has finally come for the next CT scan.

[naplesgolfguy]

Larger, modern emergency room on tap for NCH Downtown Baker Hospital in Naples. We are fortunate to have excellent healthcare including 4 hospitals in Collier County!Another great reason to retire or relocate to Naples Florida!

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