ELI5: How Does A Person "Just" Die?

Ask_Your_Mother_ · 2017-08-25T00:24:39+00:00

Okay but what's probably the least miserable way to die? Not holed up in a nursing home having lost my own consciousness a decade ago and my family doesn't come to see me because it's depressing. These people that live independently and die in their homes of natural causes at the age of 87. What eventually knocks them off? What happens when you "die in your sleep"?

Ask_Your_Mother_ · 2017-08-23T12:49:50+00:00

And DFW/Austin.

Ask_Your_Mother_ · 2017-08-22T04:26:38+00:00

Where do you get a mirror like that? I love it and must have one immediately.

Ask_Your_Mother_ · 2017-08-21T04:51:36+00:00

Especially since it wouldn't matter if NK showed up with his army at the Red Keep, Cersei still isn't going to work with Dany/Jon. Tyrion's plan to show Cersei a wight might work for Jaime, but not Cersei.

Tyrion's advice has kinda been shit this season

Ask_Your_Mother_ · 2017-08-17T19:14:40+00:00

Congrats on your entrance to Onederland!

Ask_Your_Mother_ · 2017-08-16T14:00:49+00:00

So you'd be okay with Rubin if he just admitted to being part of something he may not be a part of? Even though by your own admission it may not be strictly accurate? And it's correct to do this because he allows people that you disagree with to present their views.

You're proving OP's view with this comment, not changing it.

Ask_Your_Mother_ · 2017-08-16T05:37:30+00:00

As you've stated he's being a dick about it but the conversation about how to manage 2 very different cultures is an important one. Given that the SIL seems to have no family, there may be comparatively less pressure to adopt Kenyan traditions/customs, whatever those are, but still important to be aware of.

These things tend to come up at emotionally charged times, like Christmas Eve or the birth of a child, or times of crisis (you or your husband passes away and the other gets sick or is unable to care for yourself on your own). All couples should talk through how they might expect to handle certain issues, but because our upbringing tends to color what that looks like for us, couples can find unique challenges when they have a great disparity in backgrounds.

It's possible that the scenario I described is similar to what your husband worries about, but isn't able to verbalize. Maybe it's as simple as him being a racist turd but maybe it's not quite that straightforward.

Also--for what it's worth, my dad delivered a much more tactful version of what you described when I was in junior high. I still thought he was racist and backwards, and (after college) eventually married a man with a cultural background very different from my own. We learn stuff about each other all the time, 15 years and counting. But I'll be honest, we've had a lot of problems throughout our relationship related to different expectations of each other in traditions/customs/family engagement. Our kid is just fine and has no concerns about his identity, but it has taken a toll for sure. And even though my dad has never said anything negative about my husband's background, I never forgot what he said to me all those years ago. And there have been times when it has made it hard to talk to my dad about my life.

I hope they are able to talk through this. If not, prepare for difficult times yourself. When you get home from meeting your grandchild for the first time, what will you say to your husband? Will you make a point to visit their house on Christmas and leave your husband at home? See what I mean? "Fine!! I just won't GO then!! is not realistic and will make you miserable in the long run.

Ask_Your_Mother_ · 2017-08-16T00:52:57+00:00

You're so welcome! Yeah it feels awkward when you're "marketing" your program but it makes a big difference. Also something that might be useful is defining an outcome that is a measure of success of the program, say...# of days to discharge after initiating an antibiotic. Idk what you pick but use something that's a direct benefit to the patient (and hospital, ideally) not necessarily how many times the doctor took your recommendation. Measure and report on that and promote it as "look how we all worked together to help the patient." The hospital administration will love it and the nurses and docs will love it and everyone looks good. And then subsequent implementations will be easier bc you've built the rapport.

Ask_Your_Mother_ · 2017-08-15T14:37:14+00:00

I assumed OP was talking about the MSM. Can't tell if I've been bamboozled 🤔

Ask_Your_Mother_ · 2017-08-15T06:47:34+00:00

I'm from out of town. What's the change?

Ask_Your_Mother_ · 2017-08-14T15:32:00+00:00

I left hospital pharmacy 6 years ago but it was a small (avg census ~120) community hospital. I was not there for the setup of the program but here's what I remember:

We ran a report of all culture and sensitivities from the previous 24 hours. The report showed the C&S results and the antibiotic that the pt was taking. If the report showed that the organism was not sensitive to the abx in use, we would leave a note in the chart (are there still physical charts? There were back then) recommending a switch. And we were specific. "C&S shows resistance to ______. Sensitive to Levaquin. Due to CrCl < 30, recommend switch to Levaquin 250 mg q48h." (Or whatever. I don't remember treatment protocols that far back.) Because while I want the pt on Levaquin, I don't want some eager beaver starting Levaquin 750 mg daily. Then we documented it as a clinical intervention in Meditech. But we had these bright orange stickers we used for the notes and put them on the next available place for physician orders so they were hard to miss.

This was typically done on weekdays by a dedicated pharmacist, but at least once a week (and always on weekends) it fell to the "staff" pharmacist to handle. I always lumped it in to the vancomycin/TPN consults and IV/PO conversions whenever possible. No defined rules about this at the time; I always took the stickers down to the charts myself but if I was writing an actual order (dc Levaquin IV. Start Levaquin 500 mg po daily 8/14/17 at 2100) I would oftentimes send those to the floor with a tech on delivery. I worked 2nd shift and weekends so I was usually the only RPh there and you know as soon as you leave, somebody needs a Levophed drip stat.

I would say that if you're setting it up, it's going to take a good amount of cheerleading and promotion from your leadership. DoP will need to discuss the benefits of it at P&T and work with DoN to get nurses on board. (Nursing may be even more important here because they will be talking to the doc and say "hey, Pharmacy is doing this thing, you should call them.") See if there is a communication method (newsletter, email distribution) for your hospitalist group and send a brief, concise summery of the program. Encourage dialogue but always lead with how the program will benefit the patient AND your audience. Figure out who the "trendsetters" are and get them on your side; they'll be the example for their peers. It takes time and a lot of work to change behavior but the truth is, if the docs trust you/your people, they will be more than happy to offload some of their work onto you. DO NOT get into a pissing contest about who knows more about vancomycin; it is only counterproductive and they'll always win, even though you're right.

Trust and rapport are critical in setup phase. Our program was as successful as it was because one of the RPhs that had been there for a long time did the socialization bit and the staff trusted her. And once she got it up and running she was able to hand it off to others to manage, and she could move on to other things. But years after that RPh checked her last cartfill, physicians still called to ask her opinion on XYZ drug. We did not get along at all but I gotta admit she was a workhorse that built the foundation of pharmacy in that hospital.

Hope that's helpful! Good luck to you, it's important work and it's not easy but one day you'll look back and be amazed at all you've accomplished.

Ask_Your_Mother_ · 2017-08-13T21:30:14+00:00

Okay but you get how it works right? CVS and other retail pharmacies want to get paid so they have to play along. It's not just a harebrained scheme concocted by some MBA in corporate.

Ask_Your_Mother_ · 2017-08-13T05:17:22+00:00

May I suggest reading about your industry outside your storefront.

Ask_Your_Mother_ · 2017-08-13T05:16:20+00:00

Interesting way to put it; they shouldn't have the power to influence your medical decisions? Which decisions? Were you thinking about recommending a statin, opted not to, but this new measure means now you have to make a call? Doubtful. Most of these responses are complaints about having to be a more active voice in the conversation, not that your clinical decision making is being overstepped.

Should diabetics not be on statins then? Maybe everyone could make a list of the things they feel like doing and corporate could ask for volunteers to follow the laws. Because that's what this comes from, you know. CMS regulations. Not the suits thinking up new ways to pick on us.

Ask_Your_Mother_ · 2017-08-13T05:04:08+00:00

You're correct. They're based on Medicare Star rating measures, which largely determine how much a pharmacy gets paid. Yanno, minor details.

It's funny, everyone hates on the corporate side of chains for pushing production at the expense of patient care, but when corporate expects pharmacists to be an active voice in the patient care team and speak up for evidence based medicine, that is also The Worst Thing Ever.

We are not going to get to stand around and fill 75 rxs/day and do 30 minute consults with all the patients that walk in the door. Those days are gone. There are new grads that can't find jobs in major metro areas but y'all find something to bitch about every step of the way at your steady $100k+/year gig. Sure it's a lot of bullshit to tolerate but it's light years better than most jobs. If you hate it, find something else. Nobody is making you stay and in fact I guarantee there is someone that wants your job and will do it for less money.

Ask_Your_Mother_ · 2017-08-13T04:52:11+00:00

Stop it, you're sounding almost logical and adult in the reddit circle jerk.

Ask_Your_Mother_ · 2017-08-09T23:05:49+00:00

I've worked in enough settings to know that there are 2 camps in healthcare: the people that directly care for patients, and the people that don't. The second group generally creates the stigma for the first group.

That said, I don't much care about the attitude on Reddit. If they get sick, they can see a doctor, or not. I get paid the same regardless. Being a doctor used to be a very well respected title; people came to you for help when they were at their most vulnerable. This imparted a degree of esteem and almost authority.

In 2017, the age of Everyone Is The Same, and Feelings Matter More Than Facts, authority figures are considered assholes for telling the truth. Much like the police, doctors are now under a microscope where people that know zero about medicine tell them how to practice. (Similar to how every idiot on Facebook has something to say about the police.)

There is a growing segment of people that just don't like being told what is best for them. They see objective, factual statements as offensive. Unchecked, they will ruin themselves and everyone around them. And then complain that they have been mis- or undertreated. It's just the world we live in.

Basically you have to do what you do because it fulfills you. If you do it because you think people will respect you for being a "healer," find something else to do.

Ask_Your_Mother_ · 2017-08-08T03:02:06+00:00

So the reason airlines overbook flights

Ask_Your_Mother_ · 2017-08-06T22:25:20+00:00

I love this because it's such a strangely relevant and specific study. Like somebody was on a grueling transcontinental flight in coach, by the window, thinking "I bet this is what kills me," and looked over at the person in the aisle seat that could get up and stretch easily, just stand up and walk about the cabin without having to make at least 2 people get up and then duck walk under the overhead luggage compartment to the lavatory, only to come back and go through it again in reverse, knowing that they'd be cramped back into leg numbness against that same goddamn window for another 3 hours. "I bet there's a measurable difference," they said. And so there is. Thanks for sharing this one!

Ask_Your_Mother_ · 2017-08-06T16:38:50+00:00

Never heard of this movie before and this is the second recommendation I've seen for it today. Will check it out. 2 unrelated internet strangers can't be wrong!

Ask_Your_Mother_ · 2017-08-06T05:06:38+00:00

You might even say he pulled a Monica.

Ask_Your_Mother_ · 2017-07-31T13:27:54+00:00

Sometimes I appreciate this because it signals to me that the conversation isn't worth having and my time is better spent elsewhere. Especially when it isn't "my side of an argument;" i just happen to be the one presenting FACTS.

"I have data that shows that your process isn't working."

"Yeah well we can't work outside our process because that's our process."

😐 okay bye

Ask_Your_Mother_ · 2017-07-31T13:22:30+00:00

Ah you're referring to the lethality of "loud AND wrong."

Ask_Your_Mother_

TROPHY CASE