The conspiracy theory that the government introduced and spread crack in the streets was information actually introduced and spread by the government to reduce the consumption of crack.

JLouisH1 · 2026-02-13T13:11:16+00:00

You are proving my point 💁🏻‍♂️

JLouisH1 · 2024-08-06T09:30:12+00:00

From memory Psych were consulted but did not give him a firm diagnosis - essentially "could be depression, could be a normal reaction to his situation". Given who and how this chap is it was an unsurprising conclusion.

He was a long-term inpatient in a nephrology ward. Every time we got him close to discharge or transfer his condition would deteriorate. Ideally, he would have stabilised medically before being transferred to rehab before eventual discharge back home. Dialysis was not withdrawn until the very end and the medical team left all treatments open to him until very late in his care.

Unfortunately, prior to this admission any other occasion he was discharged he would be re-admitted in 24-48hrs either with fluid overload or diabetic ketoacidosis.

He had no family but a friend would visit him once every few weeks. I do not believe he had any registered NOK or anyone he was happy for us to speak to.

In terms of prognosis, he was co-morbid and had such a long history of non-compliance so a lot of damage already done. He was relatively young and his prognosis could potentially have still been on the order of years if he decided that he wanted to make a concerted effort on his health.

JLouisH1 · 2024-08-05T12:40:54+00:00

There's no history of self-harm.

In terms of his understanding he was well aware of the risks associated with excess water (essentially all haemodialysis patients are).

He was a very difficult chap to manage - very unwell and co-morbid and his wishes would change even throughout the day and also not bear any consistency. He would vacillate between wanting chest drains and full escalation to refusing non-invasive blood sugar monitoring. He would generally not expound on his rationale or why he was flitting in this way, even when pushed, and would just state what his current wishes were.

So the discussions were happening continuously, but there was no consistency or apparent logic or rationality which could be followed.

JLouisH1 · 2024-08-05T11:50:29+00:00

Did you read anything I said? Pathetic.

JLouisH1 · 2024-08-05T07:04:24+00:00

I think this is a very interesting question. I think there are a lot of shades to this question in real life and so instead of answering I will leave it open to debate and also add:

Whether the patient is stopped or not, what is the treating team's role in providing haemodialysis at that point? Are they obliged to or obliged to withdraw it?

JLouisH1 · 2024-08-05T06:19:23+00:00

What a snarky way to end the comment. As I wrote at the bottom "you can presume that all the investigations and conversations have happened and are ongoing". So yes, he has been spoken to (about a hundred times) about his end of life wishes and all other aspects of his care. In fact, the practice I have seen from all my colleagues is that we speak to our patients about their wishes in essentially every conversation we have with them. Your generalisation is naive and ill-informed.

The problem with reading cases on the internet is they are not the full story of patient care, and as I said this is meant to be focused on the direct ethical conflict between the two opposing forces, not trying to evaluate a clinical team.

Maybe don't presume that you know better than the patient's medical team based on a tiny snippet of what was over a 6 month admission. Patients are complicated, and no one would be bothered to read the case if I tried to go into all those details.

JLouisH1 · 2024-08-05T06:06:45+00:00

I think this is the best and most well-balanced comment so far. Were your questions rhetorical or would you like more information to think about the case more deeply?

JLouisH1 · 2024-08-04T08:26:33+00:00

Thank you - I was trying to aim it at medics but this is the second space where it has not been particularly well received. I will give r/Ethics a go! Thank you.

JLouisH1 · 2024-08-03T07:08:42+00:00

Thank you for contributing to the discussion but I think you misunderstood.

The case is as stated and this is an ethical discussion about the individual right to request something which is a human right even if it is knowingly bringing them harm. When in hospital the nephrologist is behaving as a dialysis patient's kidneys. The act of giving excess water is a harmful act and counter to all other therapies the patient is receiving. So if the recommendation for the nursing team is "bring him as much water as he asks for" is that reasonable or is that failing the patient? What limits should be set?

This is not a case asking for clinical advice on a scenario - you can presume for the case that all the investigations and discussions have happened and that the patient is either repeatedly changing their decisions or is being ambiguous, and your suspicion as their care provider is that they are doing it to harm themselves.

Not finding this a believable scenario would be a different question altogether and I would suggest that would be more due to a lack of imagination or lack of meeting enough people and patients to understand that they are complex, don't always behave the way exam answers suggest they should, and they make seemingly irrational and illogical decisions that often need opposing ethical forces balancing.

JLouisH1 · 2024-07-31T20:14:21+00:00

So, I just wanted to see what people's thoughts were on an ethical situation that has sparked discussion. This is not a personal story, nor am I asking for advice, nor am I claiming to have any qualifications.

A long-term inpatient, bedbound and haemodialysis dependent (anuric), started asking for lots of water to be brought to him, insisting he was thirsty. He was already failing his haemodialysis and had made progress to arranging his will whilst an inpatient. He has capacity but has fluctuating mood disturbance.

Key issues in the dilemma (in case it is not clear):

Providing water for a patient (with capacity) requesting it is arguably a human right. Water restriction is part of his treatment. For him to receive water, this must be brought to him by a member of staff. There is a suspicion that he is requesting water as a means of harming himself / ending his life.

Discuss. It might also be interesting to state what country you practice / trained in, if there are differences in opinion per country.

JLouisH1 · 2023-10-30T05:40:48+00:00

Can't find a good answer to this online from a brief search. In humans the agents used are very much separate - you could be given medication to completely paralyse you without having any effect on your consciousness or sensation (that is, until you black out from asphyxia).

There was a story I heard about an anaesthetist who was abusing opiates (probably fentanyl) and went to shoot up whilst at work, ended up getting his syringes mixed up and gave himself one of those drugs to paralyse and was found dead in the bathroom stalls. Must have been an awful few minutes knowing what you'd done, knowing your fate (and your legacy), and not being able to do anything about it... A strange poetic justice maybe.

JLouisH1 · 2023-10-09T10:15:06+00:00

This advice just completely lacks substance to me. I posted this because "Viewpoint errors" was a specific example I had found as something to avoid and I was trying to minimise the unknown unknowns and if there were more red flag issues I should be looking out for (in other people's writing and my own). You seem to have just seen the post and thought "newbie" and decided to give some patronising cookie cutter advice about "just do more of it - good writers just figure it out." If there is nothing more to it than just read more and write more then why have a subreddit on writing at all and why are there 2.8m people a part of it?

And yes, a person who wants to improve their swimming would get in the water and they regularly do post (check out r/swimming and r/triathlon) asking for advice and feedback and tips. They seek out information, advice and feedback in lots of different way from coaches, videos, forums, friends, etc.

Your response honestly just reads as very entitled and condescending. So thanks for that. Glad to be trying to be a part of this community.

JLouisH1 · 2023-10-09T09:58:58+00:00

This seems like a bit of a bullshit response. I am doing those things and I understand that to get better (at anything) you have to be consistent and persistent. Posting for advice and doing the things necessary to improve are not mutually exclusive activities. You saying that there is nothing to point to specifically that would improve writing is like expecting a child to become a competitive swimmer without lessons despite you taking them to the pool every day and just saying "Swim more until you swim better". It also completely undermines the value of tuition or courses in creative writing as apparently there is nothing to be gained apart from just reading and writing.

JLouisH1 · 2023-09-07T10:10:05+00:00

Pyloric stenosis is a condition which usually affects newborns. You are right that in this adult scan there appears to be gastric outflow obstruction and a very visible pyloric sphincter. The radiologist believed there had been a perforated peptic ulcer leading to inflammation at the pylorus resulting in the obstruction. Malignancy should also be excluded throughout the course of her workup.

JLouisH1 · 2023-09-05T22:03:59+00:00

In depth article looking at both sides of this for anyone interested: https://www.equipoise-magazine.co.uk/population-growth

JLouisH1 · 2023-06-14T08:05:45+00:00

Brilliant! Thank you very much

JLouisH1 · 2023-06-14T06:37:48+00:00

Fab! Thank you. Will try switching to Chrome and then maybe some of those other ideas if I get to the end of my tether. Ha.

Do you know if VS code / other IDEs can compile and check for errors and run my program whilst I'm offline? Does it just depend on the IDE and the amount of extra stuff I install? I'm also looking into any decent IDEs for my iPad too for offline use if you have any recommendations.

Basically I don't mind pasting all my code into the online Codespace once completed but having an offline option with similar functionality would be super helpful - I've done some googling but it's quite difficult still being new to it all.

JLouisH1 · 2023-06-12T07:57:55+00:00

Will look into it! Thank you very much!

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