Vox Populi, our weekly live chat on the week’s events begins tonight at 7:00pm PDT. Hope to see you then!
AdLib 3 hours ago
Already here…..working elsewhere on line but will be back at 9!
MurphTheSurf3

2 hours ago
Hey Murph!
AdLib 2 hours ago
OH! You are actually here…in person!
MurphTheSurf3

2 hours ago
Okay, see you then (or along the way(!
AdLib 2 hours ago
Yep, tis me!
AdLib 2 hours ago
Well, while you’re here…Trump is dead, yes?
AdLib 2 hours ago
See ya at 9. P.S. I did not push Vox at Yabberz in the last two days. I will do so for next Friday. I think we made a good impression on most.
MurphTheSurf3

2 hours ago
He gave a virtual concession speech today!
AdLib 2 hours ago
Okay, sounds good.
AdLib 2 hours ago
I have been working hospitals all day….I need to catch up.
MurphTheSurf3

2 hours ago
Hospitals?
AdLib 2 hours ago
Yes, I have taken up another job as a Health Care Advocate (a spin off of my Navigator days) and I was battling hospitalists about extended care for a client.
MurphTheSurf3

2 hours ago
That is too damn great of you, Murph!
AdLib 2 hours ago
Any success?
AdLib 2 hours ago
Thank you. I got really interested in the workings of the system and have become quite good at naming reality.
MurphTheSurf3

2 hours ago
Oh yes…I usually put them back on their heels.
MurphTheSurf3

2 hours ago
That is a pretty valuable and rare skill today!
AdLib 2 hours ago
Here is todays battle. I had to wrestle with a hospitalist today who seemed to be pushing to cut off XXX’s nutrition because he pulled out his nose feeding tube (nasogastric tube). I pointed out that for him in every other area, neurology, cardiac, hematology, oncology, pulmonology things are status quo. His current feeding problem is not an end of life issue and his advanced directive does not state that sustenance be withheld unless he is terminal. She told me that unless they can keep the nasogastic tube in place they will not be able to provide sustenance. I asked why a PEG Tube (Percutaneous endoscopic gastrostomy ) could not be implanted (like another of our guys has). She said that given his risk factors this would be inadvisable. I pointed out that he had just had neurosurgery under general anesthetic and the PEG Tube procedures require only a local and a general light sedative. She then said that we should try the nasogastic tube again tonight with better restraints and a more careful watch to keep him from pulling it out. Failing that, she said, a PEG insertion should be considered. I am going to be sure that is in his notes tomorrow. So I am going back to the hospital tomorrow morning to be sure his orders reflect this.
MurphTheSurf3

2 hours ago
I had this ready to print because it was in my log.
MurphTheSurf3

2 hours ago
Wow. So is this “hospitalist” a top level doctor? Is she the final word on things?
AdLib 2 hours ago
Hospitalist are basically Primary Care Physicians who are meant to serve as your family doctor while you are in the hospital, overseeing care, and coordinating treatment plans. What they also do (but do not admit) is provide medical reasons for pushing people out of hospitals it their homes, to nursing homes, to hospice. You can block them if you know what to say and how to say it. What I posted to you is now in three e mail boxes at the hospital in question..a major medical center with a fine rep.
MurphTheSurf3

2 hours ago
Excellent! That’s fantastic work, Murph! Can you go over their head if you need to?
AdLib 2 hours ago
The email makes it clear that I will challenge them on ethical grounds. The emails went to the chief of hospitalist practice; to the neurosurgeon and anesthesiologist who led the brain surgery team that worked on him last week (very successfully), and to chief of neurology. There are several more steps.
MurphTheSurf3

2 hours ago
Great! The idea of starving a patient because they’re having an issue with the nasogastric tube is crazy. That person is very lucky you’re there.
AdLib 2 hours ago
I represent people from my area who need to be represented. I ask that they name me in an advanced directive as a health care representative and spokesman AND appoint someone who they (and I) trust as their medical power of attorney using an instrument that was created by the Mercy Health Care Systems.
MurphTheSurf3

2 hours ago
That’s a lot of trust but they are smart to do it, having you as their rep!
AdLib 2 hours ago
What she, and a nurse were trying to do was to get the family to consider the idea “as the best course of action for the comfort of the patient.” It is an easy argument to put forward since the patient does appear to be distressed and that often flattens the familyy.
MurphTheSurf3

2 hours ago
As rep, I have no power…only the medical power of attorney holder does….but I have influence and that is the lever.
MurphTheSurf3

2 hours ago
I’m no expert in this area but an operable issue is whether they are suffering in pain. Secondarily is the quality of life, if they have no hope of recovery or consciousness.
AdLib 2 hours ago
Hey PPO!
AdLib 2 hours ago
The thing is that I also make it clear that I understand the good reasons for difficult decisions to both the family and to the doctors and nurses. Last week I had someone who was moved from ICU and the family did not want this done but it was time and the space was badly needed for others with more critical needs. The hospital was happy for my support in this.
MurphTheSurf3

2 hours ago
Murph – You can argue on behalf of the patients though which goes a long way!
AdLib 2 hours ago
Hi guys n gals. Sorry, won’t be much use today, was diagnosed with AMG macular degeneration yesterday, got an injection and am flying oon one ocular wing right now.
pinkpantheroz

2 hours ago
Ad….this person is in pain, largely emotional and the quality of life right now is for shit….but if he begins to take nutrition that will pass….I have seen it.
MurphTheSurf3

2 hours ago
Damn, PPO! It’s got to take a lot of strength to be on here like that.
AdLib 2 hours ago
Hi PPO…AMG macular degeneration…..long term prognosis.
MurphTheSurf3

2 hours ago
Murph – It’s got to be given a chance.
AdLib 2 hours ago
Only one eye has it. DG, Ad, and Ive been toild there is long term treatment to keep it where it is now and not get worse, so I’ll be doing that
pinkpantheroz

2 hours ago
PPO Good.
MurphTheSurf3

2 hours ago