I read this with my stomach clenched, as the most haunting parts arenโt โrare horror storiesโ, but theyโre the fact that so much of what you describe is ordinary, billable, policy-compliant reality: the overnight transfer because โa bed is openโ, the vanishing prescriber at 2 a.m., the relentless vital checks that ignore sleep as treatment, and a culture where โprotocolโ substitutes for judgment. ๏ฟผ
Your sisterโs night exposes the most dangerous illusion in modern inpatient care: that a building full of staff equals continuous clinical oversight. When pain control, delirium prevention, and basic human needs depend on a single overstretched decision-maker (or none at all), the system can look busy while the patient is effectively abandoned. That gap, between โwe have policiesโ and โsomeone with authority is actually accountable in real timeโ, is where suffering multiplies. ๏ฟผ
And the childbirth story hits another nerve: the way hospital environments can be inherently anti-physiologic. Bright light, noise, constant surveillance, immobilization, coercive threats (โCPSโ), and cascade-style interventions donโt just create emotional distress, but they can change labor dynamics through stress physiology in ways that end up being blamed on the motherโs body. Even if readers disagree with some of the rhetoric, the lived experience youโre pointing to is real: too many โroutineโ processes are designed around throughput, liability, and documentation rather than rest, autonomy, and outcomes that matter to families. ๏ฟผ
What I hope people take from this is not just rage (though the rage is earned), but a clear agenda. If hospitals want to call themselves healing institutions, a few non-negotiables rise to the top:
1. Continuous clinical responsibility for high-risk symptoms like severe pain, meaning timely prescribing authority, not just sympathetic bedside apologies.
2. Sleep, light, and noise as core vital signs (and interruptions justified by evidence, not habit).
3. Protocols with an โoff-rampโ, a way for clinicians to document a reasoned exception and for patients to refuse non-essential interventions without punishment.
4. Transparent accounting of harms (iatrogenic events, infections, preventable deaths) tied to real consequences and incentives to improve, not PR. ๏ฟผ
Wow, you wrote this summary with way fewer words than I did, LOL. Thank you for the validation. We all experience it. The reason I call it Soviet is because the stupidity and suffering imposed by bureaucratic ritual was such a characteristic feature of that system. Totalitarian systems condition us to accept this as normal - necessary and appropriate even. When you read the writings of dissidents and gulag prisoners, thereโs so much similarity. Every time I go into the system with a loved one or myself, knowing this, I come in loaded for bear in order not to be pushed around or mistreated and I get treated as โthat lady,โ โthe daughterโ etc. Iโm the weirdo who thinks and acts like everything is unacceptable, that autonomy and dignity and agency in patients are an inappropriate demand, and Iโm made to feel like the crazy person. This is highly characteristic of a totalitarian system. In any case, appreciate your feedback!
Don't we all know, in 2026, that the reason her sister (and countless other seriously ill patients) don't get adequate pain management is the fear & hysteria ginned up over the so-called "opioid crisis". So it went from getting lots of pain meds and pain being "the 5th vital signal" to where they act like you are a drug addict if you ask for pan management. WHO DID THIS? who created this?
Many other things you complain about here are directly due to OBAMACARE and the ACA ... passed in 2010 and went into law in Jan. 2014. You wanted this. You said it couldn't be reformed, changed or done away with. It gave all power to Big Hospital Chains, Big Pharma and Big Insurance. You touched it, you broke it and now you own it.
I couldnโt put this one down. What a horror these hospitals are. I have my own stories and Iโm sure everyone reading has stories. Something must be done. How do we as a community change it? If left to politicians Iโm afraid I have no hope.
Honest to God I donโt know, except to stay so darned healthy we donโt need them. And to plan our finances such that we can afford home health later when we need it. In the meantime, hope that these alternatives take root and go mainstream.
Amen! Iโm 78, overall excellent health. I stopped seeing my Medicare hmo pcp a few years back when he tried to Coerce me into taking the Covid injections and other shots.
Tried to make an appointment for something minor and was told they โdroppedโ me because I hadnโt come in to see them! Tried to get another appt with a pcp and was told earliest appt 10 months. Went to that appt and they refused to see me unless I signed a blanket โauthorization for treatmentโ so I walked out.
Now seeing a naturopath on my own dime.
Recent visit to ER for odd abdomen pain at night, was given the same protocol coercion you mentioned, invasive CAT scan, etc. ER doc sneered at my concerns about radiation and wrote up AMA against medical advice with โsevere illness and deathโ as consequence!
Home health care is not a solution to much of this... it won't help a cancer patient with intractable pain. An uncle of mine died in home hospice of advanced pancreatic cancer, and the most they could do is keep him doped up on morphine... a 19th century drug. In 2024. He had a choice of being conscious in terrible pain, or doped to the gills with morphine. (Oxycontin isn't strong enough for this kind of pain.)
Home health care is an aide who is likely an illegal alien, working for substandard wages (while some agency takes 50% of what you pay and it is a LOT of $$$) and they will rob your loved one blind. I know this from personal experience.
Also home health care ROUND THE CLOCK -- as a hospital runs round the clock -- costs something on the level of $200,000 a year.
Childbirth is another issue. Your daughter sounds like she was healthy with a healthy pregnancy... so she could have given birth at home with a midwife. But that means "NO PAIN MEDS" and no epidural.
This is why there is new technology and new models that are changing the economics and the clinical face of the care. Youโre talking about the current system. Not the new models. And pain care 100% can be done for cancer at home. You just need a responsive clinician to make adjustments.
This article didnโt only leave me completely gutted for Katy to have experienced this traumatic event, but also give me a sense of peace to know Iโm not alone and what Iโve seen and witnessed. If someone like Katy, who knows and understands the system, is treated/handled in such a way, then what does that say for us common folk? The medical establishment needs a complete dismantling in order to rebuild a system that will actually work for the patient instead of working to line the pockets of hospital execs.
This is one of those essays that makes your body tighten because itโs describing something so many of us have witnessed, either from the bedside or inside the system, and yet weโve collectively normalized it as โjust how hospitals are.โ
The most haunting theme here isnโt the fluorescent lights or the beeping (though those matter). Itโs the illusion of care: a building full of people, devices, policies, and โprotocol,โ while the one thing a human being in crisis actually needs, timely clinical judgment with authority, can be absent for hours. Your sisterโs night reads like the purest expression of that: nurses who care, but canโt act; a patient in agony, but no prescriber reachable; a system that can move a patient across facilities at midnight for bed logistics, but canโt reliably deliver pain relief.
As a physician-scientist, I also felt the accuracy of what youโre pointing at with โroutineโ interruptions. We treat sleep like a luxury add-on when itโs literally a biologic therapy: immune function, delirium risk, pain sensitivity, glucose regulation, wound healing. And then we create inpatient environments that are anti-sleep by design, and act surprised when delirium, agitation, and โnoncomplianceโ show up. Thatโs not a patient problem; itโs an environmental toxin we built.
The birth section is similarly painful because it names something many people sense but canโt articulate: when โprotocolโ becomes a substitute for evidence and consent, it turns low-risk physiology into a cascade of interventions, often in a setting that is already hormonally hostile to labor (light, noise, surveillance, time pressure, fear). Whether a reader agrees with every framing choice or not, the core moral point stands: threatening families with CPS to enforce non-emergent compliance is a grotesque misuse of power. It erodes trust in medicine far beyond obstetrics.
What I appreciate most is that you donโt stop at indictment; you hint at a path forward. If hospitals are going to remain the place we run to for rescue, they have to become more human-compatible for everything else. That means, at minimum, a few non-negotiables:
1. Real continuity and real overnight accountability for pain, delirium, and deterioration, no more โthe building is open but decision-making is closed.โ
2. Sleep-preserving defaults (and interruptions justified by clinical necessity, not habit).
3. Protocols with consent and off-ramps, where clinicians can document judgment and patients can refuse nonessential steps without coercion.
4. Serious investment in hospital-at-home / decentralized care for the large portion of inpatient โworkโ that doesnโt actually require a hospitalโs trauma-culture machinery.
Your question lands like a challenge: if this was โlegal, standard, and indefensibleโ for a well-connected family, what happens to everyone else who doesnโt have the time, language, stamina, or social capital to fight all night? Thatโs not just a personal tragedy; itโs a policy diagnosis.
Thank you for writing the thing people whisper about in hallways!
When I asked about sleep interruptions as a patient (4 years ago)... I was told A. it was required for insurance purposes (if you died or got really sick and they didn't check on you.. you'd sue them!) and B. the residents & doctors do "rounds" extremely early in the AM so they can do patient care the rest of the day. They would wake me up every morning at 5:30-6AM and then act really surprised that I wasn't awake -- then accused me of laying around in bed and not "exercising". This was literally during COVID protocols when nearly the entire hospital was in lockdown mode and I couldn't leave the floor. Who gets up before 5:30AM to "exercise" anyways? why would it strike them as odd a patient was ASLEEP at that hour? BTW, these were all young interns about 26 years of age.
That sounds incredibly frustrating, and many patients have shared similar experiences. Hospitals are typically organized around safety protocols and clinical workflow rather than around normal human sleep patterns. As a result, the system can unintentionally work against rest, even though rest is an important part of recovery.
You also raised an important point about experience. Early in training, interns are often focused on completing tasks and following protocols, sometimes with limited perspective simply because theyโre still learning. With time and more patient interaction, many physicians develop a deeper appreciation for how exhausting hospitalization can be and how important sleep is for healing.
A few things are often happening behind the scenes:
1. Nurses are required to check vital signs, medications, IV lines, breathing status, and neurological changes at scheduled intervals. Part of this relates to safety and liability, but much of it is genuinely intended to detect early signs that a patientโs condition may be changing. Unfortunately, these necessary checks can interrupt sleep.
2. In many hospitals, labs are drawn around 4โ5 AM so results are available when medical teams begin rounds. That allows physicians to make decisions about medications, imaging, procedures, and discharge planning earlier in the day. While it helps coordinate care, itโs certainly not ideal from a sleep perspective.
3. Demanding training schedules
Interns and residents are often responsible for many patients while working long hours, and mornings involve moving through a detailed checklist before rounds. That pace can sometimes make interactions feel rushed or less thoughtful than intended.
That said, your reaction is completely understandable. From a physiological perspective, sleep is not a luxury during illness, but it supports immune function, metabolic balance, cognitive recovery, and overall healing. Being awakened very early and then expected to feel energetic or ready to exercise isnโt very realistic.
There is also growing awareness of this issue within medicine. Some hospitals are beginning to explore changes such as:
1. clustering overnight tasks so patients can have longer uninterrupted sleep
2. delaying non-urgent vitals or lab draws when clinically appropriate
3. creating quiet hours or protected sleep protocols for stable patients
Medicine is gradually recognizing that sleep disruption in hospitals is a real and important problem. Your comment highlights an important gap between how hospitals traditionally operate and what patients actually need in order to recover, and conversations like this are part of what helps move systems forward!
Most patients do NOT clinically need the vitals checks. Thats just untrue. A mom with a newborn overnight? The cancer patient just getting pain management? These are liability-driven, and pure bureaucratic culture.
Having been married to a spouse who has had heart issues over many years I have experienced hospital care for her in California, Oregon and Nevada - including the birth of two daughters and two heart attacks and a complete cardiac arrest and multiple ER visits and multiple ambulance trips two of which were to hospitals more than 150 miles away. Here are some of things I have learned from that as well as managing a union health plan for many years. First, hope you don't need to go to a hospital in December, January or February - most ERs and beds are full due to spiking flu and other cases like Covid or pneumonia at that time. Second, in ERs the PAs and experienced nurses are often much more experienced and better at diagnosing and implementing the right remedy or treatment compared to the doctors in the ER. Third, the quality of care and the way a patient is treated can vary by the hour, the day, the time of year and the staffing at the moment - even in the very best hospital. What does not vary? The focus on charting every single thing so it can be billed.
My elderly mother, in her last weeks of life, cracked a vertebra and was in extreme pain. An ambulance came to take her from her assisted living โhomeโ to the ER which was practically empty. She was put in a room and then everyone disappeared. I sat with her writhing in agony for maybe 20 minutes then called the nursing station. โHer doctor has been assigned but is on a phone callโ I was told. Another 15 or 20 minutes pass and I again call the desk. โThe doctor is on a very important phone callโ I was impatiently told. After a further 15 or so minutes, I became impatient myself and walked down to the nursing station: โGet someone immediately or itโs going to get unpleasant here. My mother is in agonyโ. I may have accidentally loudly bumped my hand on the top of the desk. Sure enough, right then there just happened to be a doctor available who came to help my mother.
The head nurse said โYou shouldnโt be making threatsโ. I explained to her that I wasnโt threatening, just predicting the future. She said โwe have our proceduresโ but fell silent when I pointed out that sounded more like practicing bureaucracy than medicine, and maybe they should try the latter.
They swooped our grandson into NICU for no reason. He was pink, no fever and no distress (possible meconium) but our daughter has great insurance and is young, easy target. And tried to keep him longer bc they said mom needed to go home and rest.. so gross. So arrogant. staff are either too dumb or to scared to question. He spent his first three days away from mom being pumped full of sugar water(to keep infants calm). Our healthcare system is disgusting.
Why do you say this is Soviet-style? This sounds like unregulated capitalism where there has been too much consolidation allowed to happen (e.g. insurance companies buying hospital systems) and profits placed above evidence-based care.
When these complaints come up, it's often said that the free market hasn't worked. I would argue, it hasn't been tried. This isn't American capitalism, it's riddled with antitrust violations, collusion, anti-competitive behavior, and other monopolistic nonsense that is illegal under current law. Enforcement needs to happen here. But to answer your first question, I wasn't really talking about the economics. I was talking about the culture and the environment of hospitals - the totalitarianism, the protocols, the threats, the dehumanization, the bureaucracy, the ugliness, the inhumanity.
But Katy, it is NOT a free market. Not any more. Maybe not for a LONG time. Obamacare turned it into a government system where the hospitals, doctors, insurance, EVERYTHING is government regulated. You wanted it. You voted for it. You told us we couldn't do away with it. You said we should be punished with "mandate fines" if we refused it!
If it is "Soviet" (*it really isn't, that's crazy hyperbole)... then who made it so?
Right. There is no free market. But this wasnโt my point - this article wasnโt about the economics, whether itโs a socialized system or not, thatโs not this article. The Soviet reference is about the culture. The culture. The culture. Of hospitals. They are totalitarian systems in the way they treat people and the rituals and bureaucracy and the submission and the coercion.
Katy, I get that it is flawed. I get it that you are devastated by your sister's care (or lack thereof). But nothing here is "Soviet". It wasn't caused by socialism or lack of training (US medical school is the world's elite top) or lack of spending (we spend insane amounts of money) -- it is a combination of our hospital & insurance SYSTEMS, and a complete inability ON THE LEFT AND THE RIGHT to design anything remotely different, more fair or affordable.
Respectfully, I feel like you donโt read what I write. I specifically said I was not talking about socialism (which is an economic structure. Iโm talking about a culture problem). And I never once even hinted that it was training. I write a lot about affordability. But that was not remotely the focus of this article.
I'm extremely sorry for your sister. However in both stories, it feels like a lot is left out. Where were your sister or your daughter's ACTUAL PHYSICIANS? They should have been present, at least sometimes or left instructions! from reading this, I have the impression neither woman had their own physician! You do have the choice to refuse care OR leave a hospital for another hospital. Given your job, I doubt you were in a remote rural area with only one hospital.
As for childbirth... there are home-like birth centers and a healthy young woman can opt for a midwife. A lot of what you wrote are things your daughter could have easily found out in advance, and made choices about how to handle things. I also don't hear anything about her husband intervening -- I am unclear why this job went to YOU.
And some of this stuff is awfully nitpicky: they do not offer you STEAK because it is $$$$ compared to normal food offerings. If you really hate the food, have a family member bring you a takeout meal. You can even order DoorDash! and they don't have operable windows because many hospitals are high rises and people could FALL OUT! offices & stores also don't have operable windows. It would make heating and A/C impossible to run!
Lola youโre either making the exact points in my piece (about my sisterโs actual doctors, or the need for more home birth and birth centers) or youโre wrong on the facts. There is in fact steak on the patients menu. Cardiology patients arenโt allowed to order it.
Steak? in the hospital? LOL!!! you said your daughter was not allowed steak! I thought she was a obstetrics patient (who needed protein)! You have a fantastic hospital. None around here (world class teaching hospitals) offer steak on the menu -- it's all pretty "healthy stuff", but usually good quality & fresh. You can order off a menu! however my bad luck was to have my appendix rupture during the COVID lockdown and they were very short-staffed -- I got no choices, terrible food, often cold sandwiches served in a foam clamshell at crazy times of day (but charged the same $$$$$$ as if I had recieved hot gourmet meals!).
I am puzzled why your hospital serves STEAK but has no homelike birthing center. We have 'em all over.
Isn't it OBVIOUS why cardiac patients would not be given foods like steak or fried items, because of the CHOLESTEROL and SATURATED FAT?
Lola, again, you misread the article. My daughter was starved. My father, the heart patient, was deprived of steak but was allowed metabolic poisons like fruit loops and processed muffins. If you are still believing that saturated fat causes heart disease, you havenโt kept up with the science. I refer you to the FDA commissionerโs book called โBlind Spotsโ about all the things the medical establishment has gotten wrong. Thereโs an entire chapter on saturated fat. Your experience during COVID sounds about right - this is why humans should not be forced to endure hospitals. Theyโre incompatible with health and healing.
I'm extremely sorry for your sister. However in both stories, it feels like a lot is left out. Where were your sister or your daughter's ACTUAL PHYSICIANS? They should have been present, at least sometimes or left instructions! from reading this, I have the impression neither woman had their own physician! You do have the choice to refuse care OR leave a hospital for another hospital. Given your job, I doubt you were in a remote rural area with only one hospital.
As for childbirth... there are home-like birth centers and a healthy young woman can opt for a midwife. A lot of what you wrote are things your daughter could have easily found out in advance, and made choices about how to handle things. I also don't hear anything about her husband intervening -- I am unclear why this job went to YOU.
And some of this stuff is awfully nitpicky: they do not offer you STEAK because it is $$$$ compared to normal food offerings. If you really hate the food, have a family member bring you a takeout meal. You can even order DoorDash! and they don't have operable windows because many hospitals are high rises and people could FALL OUT! offices & stores also don't have operable windows. It would make heating and A/C impossible to run!
I can't think of a better-written description of how rotten-to-the-core our hospital care is.
I met someone who actually lived in the USSR. The way she depicted it sounded preferable to our health care system, which is more crony capitalism than Soviet-style. And if one of the key problems is the profit motive, the free market wouldn't seem to me to be the solution.
I really appreciate the solution you proposed at the end.
Yes, Moorea, it's so egregious. People often say that the market isn't working. The market hasn't been tried. These are illegal monopolies colluding on prices. Enforcement of our antitrust laws, and many other laws on the books, is at least part of the answer. And many other proposals I've written about. I think about my inlaws' experience in Italy's hospitals, which are terrible. Socialist bureaucracies aren't the answers either.
We went through a huge "come to Jesus" moment in 2009-2010 when we were debating Obamacare. You are old enough to remember it very well. We were told there would be a public option, and there never was one. Obama, Hillary, Biden, Kamala have all said publicly "no public option EVER". Because that's the only way to force people to buy Obamacare on the exchanges. Oh and huge unfunded subsidies for "certain people".
We did nothing to reign in the power of Big Insurance or Big Pharma, because when threatened... back in the 90s... they made those "Harry & Lois" commercials where old people screamed about "taking money out of their pockets". That killed Clinton's reforms dead in the water.
So here is a reality check: if you cannot even stop Big Pharma from running expensive TV ads for mostly useless medications... you are helpless. If you cannot cap medical costs... you are helpless. If you cannot get med schools to double enrollment of AMERICAN CITIZEN students... you are helpless. (We have about half as many doctors as in the EU or elsewhere, and they earn about 2x-3x as much salary.) More doctors would equal more & cheaper care.
Nobody is willing to even discuss any of this, Katy, because of the miserable infighting over Obamacare and the left's total unwillingness to admit their big once in a lifetime "reforms" did not work one tiny bit -- literally everything is worse today than in 2010... higher costs, less care, more chaotic hospitals, etc. More medical bankruptcies. NOBODY is talking about new reforms, since Obamacare escaped the "chopping block".
Well said. From what Iโve heard traveling around Europe, the health care systems in the UK and Spain are awful. Socialist bureaucracies indeed. Well, sort of a dysfunctional capitalist-socialist hybrid.
Several months ago, my ex was extremely distraught about the prospect of losing her job when the NHS was undergoing restructuring. I couldnโt understand why she was overreacting โ we all have to deal with layoffs sooner or later. Later, I realized it was probably because she had no marketable skills since she was a cog that that contributed essentially nothing.
Itโs so sad!! The waste of human potential. Especially for the nurses who have a natural gift for love and service. To grind them into the gears of this machine is so wicked.
Yes, so sad and so true. I know multiple nurses in the states who quit the profession because the working conditions didnโt allow them to do their job right.
I suspect the same phenomenon is happening in the UK because most nurses there are contracted from other countries.
My ex was not a nurse but rather a mid-level worker who did nothing more than tell others what to do (as best as I could gather).
I have hope that we are at a turning point. At least I pray that we are. Thanks for sharing your stories Katy.
From your mouth to Godโs ears!!
๐๐๐
I read this with my stomach clenched, as the most haunting parts arenโt โrare horror storiesโ, but theyโre the fact that so much of what you describe is ordinary, billable, policy-compliant reality: the overnight transfer because โa bed is openโ, the vanishing prescriber at 2 a.m., the relentless vital checks that ignore sleep as treatment, and a culture where โprotocolโ substitutes for judgment. ๏ฟผ
Your sisterโs night exposes the most dangerous illusion in modern inpatient care: that a building full of staff equals continuous clinical oversight. When pain control, delirium prevention, and basic human needs depend on a single overstretched decision-maker (or none at all), the system can look busy while the patient is effectively abandoned. That gap, between โwe have policiesโ and โsomeone with authority is actually accountable in real timeโ, is where suffering multiplies. ๏ฟผ
And the childbirth story hits another nerve: the way hospital environments can be inherently anti-physiologic. Bright light, noise, constant surveillance, immobilization, coercive threats (โCPSโ), and cascade-style interventions donโt just create emotional distress, but they can change labor dynamics through stress physiology in ways that end up being blamed on the motherโs body. Even if readers disagree with some of the rhetoric, the lived experience youโre pointing to is real: too many โroutineโ processes are designed around throughput, liability, and documentation rather than rest, autonomy, and outcomes that matter to families. ๏ฟผ
What I hope people take from this is not just rage (though the rage is earned), but a clear agenda. If hospitals want to call themselves healing institutions, a few non-negotiables rise to the top:
1. Continuous clinical responsibility for high-risk symptoms like severe pain, meaning timely prescribing authority, not just sympathetic bedside apologies.
2. Sleep, light, and noise as core vital signs (and interruptions justified by evidence, not habit).
3. Protocols with an โoff-rampโ, a way for clinicians to document a reasoned exception and for patients to refuse non-essential interventions without punishment.
4. Transparent accounting of harms (iatrogenic events, infections, preventable deaths) tied to real consequences and incentives to improve, not PR. ๏ฟผ
Thank you for writing this so plainly.
Wow, you wrote this summary with way fewer words than I did, LOL. Thank you for the validation. We all experience it. The reason I call it Soviet is because the stupidity and suffering imposed by bureaucratic ritual was such a characteristic feature of that system. Totalitarian systems condition us to accept this as normal - necessary and appropriate even. When you read the writings of dissidents and gulag prisoners, thereโs so much similarity. Every time I go into the system with a loved one or myself, knowing this, I come in loaded for bear in order not to be pushed around or mistreated and I get treated as โthat lady,โ โthe daughterโ etc. Iโm the weirdo who thinks and acts like everything is unacceptable, that autonomy and dignity and agency in patients are an inappropriate demand, and Iโm made to feel like the crazy person. This is highly characteristic of a totalitarian system. In any case, appreciate your feedback!
Don't we all know, in 2026, that the reason her sister (and countless other seriously ill patients) don't get adequate pain management is the fear & hysteria ginned up over the so-called "opioid crisis". So it went from getting lots of pain meds and pain being "the 5th vital signal" to where they act like you are a drug addict if you ask for pan management. WHO DID THIS? who created this?
Many other things you complain about here are directly due to OBAMACARE and the ACA ... passed in 2010 and went into law in Jan. 2014. You wanted this. You said it couldn't be reformed, changed or done away with. It gave all power to Big Hospital Chains, Big Pharma and Big Insurance. You touched it, you broke it and now you own it.
I couldnโt put this one down. What a horror these hospitals are. I have my own stories and Iโm sure everyone reading has stories. Something must be done. How do we as a community change it? If left to politicians Iโm afraid I have no hope.
Honest to God I donโt know, except to stay so darned healthy we donโt need them. And to plan our finances such that we can afford home health later when we need it. In the meantime, hope that these alternatives take root and go mainstream.
Amen! Iโm 78, overall excellent health. I stopped seeing my Medicare hmo pcp a few years back when he tried to Coerce me into taking the Covid injections and other shots.
Tried to make an appointment for something minor and was told they โdroppedโ me because I hadnโt come in to see them! Tried to get another appt with a pcp and was told earliest appt 10 months. Went to that appt and they refused to see me unless I signed a blanket โauthorization for treatmentโ so I walked out.
Now seeing a naturopath on my own dime.
Recent visit to ER for odd abdomen pain at night, was given the same protocol coercion you mentioned, invasive CAT scan, etc. ER doc sneered at my concerns about radiation and wrote up AMA against medical advice with โsevere illness and deathโ as consequence!
Home health care is not a solution to much of this... it won't help a cancer patient with intractable pain. An uncle of mine died in home hospice of advanced pancreatic cancer, and the most they could do is keep him doped up on morphine... a 19th century drug. In 2024. He had a choice of being conscious in terrible pain, or doped to the gills with morphine. (Oxycontin isn't strong enough for this kind of pain.)
Home health care is an aide who is likely an illegal alien, working for substandard wages (while some agency takes 50% of what you pay and it is a LOT of $$$) and they will rob your loved one blind. I know this from personal experience.
Also home health care ROUND THE CLOCK -- as a hospital runs round the clock -- costs something on the level of $200,000 a year.
Childbirth is another issue. Your daughter sounds like she was healthy with a healthy pregnancy... so she could have given birth at home with a midwife. But that means "NO PAIN MEDS" and no epidural.
And yes exactly on childbirth. She donโt need pain meds or an epidural except because of the ungodly effects of pitocin.
This is why there is new technology and new models that are changing the economics and the clinical face of the care. Youโre talking about the current system. Not the new models. And pain care 100% can be done for cancer at home. You just need a responsive clinician to make adjustments.
This article didnโt only leave me completely gutted for Katy to have experienced this traumatic event, but also give me a sense of peace to know Iโm not alone and what Iโve seen and witnessed. If someone like Katy, who knows and understands the system, is treated/handled in such a way, then what does that say for us common folk? The medical establishment needs a complete dismantling in order to rebuild a system that will actually work for the patient instead of working to line the pockets of hospital execs.
๐ฏ!!!
Found my way here through Alex Berenson's substack discussing your article. ๐โโ๏ธ
This is one of those essays that makes your body tighten because itโs describing something so many of us have witnessed, either from the bedside or inside the system, and yet weโve collectively normalized it as โjust how hospitals are.โ
The most haunting theme here isnโt the fluorescent lights or the beeping (though those matter). Itโs the illusion of care: a building full of people, devices, policies, and โprotocol,โ while the one thing a human being in crisis actually needs, timely clinical judgment with authority, can be absent for hours. Your sisterโs night reads like the purest expression of that: nurses who care, but canโt act; a patient in agony, but no prescriber reachable; a system that can move a patient across facilities at midnight for bed logistics, but canโt reliably deliver pain relief.
As a physician-scientist, I also felt the accuracy of what youโre pointing at with โroutineโ interruptions. We treat sleep like a luxury add-on when itโs literally a biologic therapy: immune function, delirium risk, pain sensitivity, glucose regulation, wound healing. And then we create inpatient environments that are anti-sleep by design, and act surprised when delirium, agitation, and โnoncomplianceโ show up. Thatโs not a patient problem; itโs an environmental toxin we built.
The birth section is similarly painful because it names something many people sense but canโt articulate: when โprotocolโ becomes a substitute for evidence and consent, it turns low-risk physiology into a cascade of interventions, often in a setting that is already hormonally hostile to labor (light, noise, surveillance, time pressure, fear). Whether a reader agrees with every framing choice or not, the core moral point stands: threatening families with CPS to enforce non-emergent compliance is a grotesque misuse of power. It erodes trust in medicine far beyond obstetrics.
What I appreciate most is that you donโt stop at indictment; you hint at a path forward. If hospitals are going to remain the place we run to for rescue, they have to become more human-compatible for everything else. That means, at minimum, a few non-negotiables:
1. Real continuity and real overnight accountability for pain, delirium, and deterioration, no more โthe building is open but decision-making is closed.โ
2. Sleep-preserving defaults (and interruptions justified by clinical necessity, not habit).
3. Protocols with consent and off-ramps, where clinicians can document judgment and patients can refuse nonessential steps without coercion.
4. Serious investment in hospital-at-home / decentralized care for the large portion of inpatient โworkโ that doesnโt actually require a hospitalโs trauma-culture machinery.
Your question lands like a challenge: if this was โlegal, standard, and indefensibleโ for a well-connected family, what happens to everyone else who doesnโt have the time, language, stamina, or social capital to fight all night? Thatโs not just a personal tragedy; itโs a policy diagnosis.
Thank you for writing the thing people whisper about in hallways!
When I asked about sleep interruptions as a patient (4 years ago)... I was told A. it was required for insurance purposes (if you died or got really sick and they didn't check on you.. you'd sue them!) and B. the residents & doctors do "rounds" extremely early in the AM so they can do patient care the rest of the day. They would wake me up every morning at 5:30-6AM and then act really surprised that I wasn't awake -- then accused me of laying around in bed and not "exercising". This was literally during COVID protocols when nearly the entire hospital was in lockdown mode and I couldn't leave the floor. Who gets up before 5:30AM to "exercise" anyways? why would it strike them as odd a patient was ASLEEP at that hour? BTW, these were all young interns about 26 years of age.
That sounds incredibly frustrating, and many patients have shared similar experiences. Hospitals are typically organized around safety protocols and clinical workflow rather than around normal human sleep patterns. As a result, the system can unintentionally work against rest, even though rest is an important part of recovery.
You also raised an important point about experience. Early in training, interns are often focused on completing tasks and following protocols, sometimes with limited perspective simply because theyโre still learning. With time and more patient interaction, many physicians develop a deeper appreciation for how exhausting hospitalization can be and how important sleep is for healing.
A few things are often happening behind the scenes:
1. Nurses are required to check vital signs, medications, IV lines, breathing status, and neurological changes at scheduled intervals. Part of this relates to safety and liability, but much of it is genuinely intended to detect early signs that a patientโs condition may be changing. Unfortunately, these necessary checks can interrupt sleep.
2. In many hospitals, labs are drawn around 4โ5 AM so results are available when medical teams begin rounds. That allows physicians to make decisions about medications, imaging, procedures, and discharge planning earlier in the day. While it helps coordinate care, itโs certainly not ideal from a sleep perspective.
3. Demanding training schedules
Interns and residents are often responsible for many patients while working long hours, and mornings involve moving through a detailed checklist before rounds. That pace can sometimes make interactions feel rushed or less thoughtful than intended.
That said, your reaction is completely understandable. From a physiological perspective, sleep is not a luxury during illness, but it supports immune function, metabolic balance, cognitive recovery, and overall healing. Being awakened very early and then expected to feel energetic or ready to exercise isnโt very realistic.
There is also growing awareness of this issue within medicine. Some hospitals are beginning to explore changes such as:
1. clustering overnight tasks so patients can have longer uninterrupted sleep
2. delaying non-urgent vitals or lab draws when clinically appropriate
3. creating quiet hours or protected sleep protocols for stable patients
Medicine is gradually recognizing that sleep disruption in hospitals is a real and important problem. Your comment highlights an important gap between how hospitals traditionally operate and what patients actually need in order to recover, and conversations like this are part of what helps move systems forward!
Most patients do NOT clinically need the vitals checks. Thats just untrue. A mom with a newborn overnight? The cancer patient just getting pain management? These are liability-driven, and pure bureaucratic culture.
There are so many aspects requiring improvement in healthcareโฆ
Having been married to a spouse who has had heart issues over many years I have experienced hospital care for her in California, Oregon and Nevada - including the birth of two daughters and two heart attacks and a complete cardiac arrest and multiple ER visits and multiple ambulance trips two of which were to hospitals more than 150 miles away. Here are some of things I have learned from that as well as managing a union health plan for many years. First, hope you don't need to go to a hospital in December, January or February - most ERs and beds are full due to spiking flu and other cases like Covid or pneumonia at that time. Second, in ERs the PAs and experienced nurses are often much more experienced and better at diagnosing and implementing the right remedy or treatment compared to the doctors in the ER. Third, the quality of care and the way a patient is treated can vary by the hour, the day, the time of year and the staffing at the moment - even in the very best hospital. What does not vary? The focus on charting every single thing so it can be billed.
100% right Patrick!
My elderly mother, in her last weeks of life, cracked a vertebra and was in extreme pain. An ambulance came to take her from her assisted living โhomeโ to the ER which was practically empty. She was put in a room and then everyone disappeared. I sat with her writhing in agony for maybe 20 minutes then called the nursing station. โHer doctor has been assigned but is on a phone callโ I was told. Another 15 or 20 minutes pass and I again call the desk. โThe doctor is on a very important phone callโ I was impatiently told. After a further 15 or so minutes, I became impatient myself and walked down to the nursing station: โGet someone immediately or itโs going to get unpleasant here. My mother is in agonyโ. I may have accidentally loudly bumped my hand on the top of the desk. Sure enough, right then there just happened to be a doctor available who came to help my mother.
The head nurse said โYou shouldnโt be making threatsโ. I explained to her that I wasnโt threatening, just predicting the future. She said โwe have our proceduresโ but fell silent when I pointed out that sounded more like practicing bureaucracy than medicine, and maybe they should try the latter.
Hospitals are disasters.
They swooped our grandson into NICU for no reason. He was pink, no fever and no distress (possible meconium) but our daughter has great insurance and is young, easy target. And tried to keep him longer bc they said mom needed to go home and rest.. so gross. So arrogant. staff are either too dumb or to scared to question. He spent his first three days away from mom being pumped full of sugar water(to keep infants calm). Our healthcare system is disgusting.
Why do you say this is Soviet-style? This sounds like unregulated capitalism where there has been too much consolidation allowed to happen (e.g. insurance companies buying hospital systems) and profits placed above evidence-based care.
When these complaints come up, it's often said that the free market hasn't worked. I would argue, it hasn't been tried. This isn't American capitalism, it's riddled with antitrust violations, collusion, anti-competitive behavior, and other monopolistic nonsense that is illegal under current law. Enforcement needs to happen here. But to answer your first question, I wasn't really talking about the economics. I was talking about the culture and the environment of hospitals - the totalitarianism, the protocols, the threats, the dehumanization, the bureaucracy, the ugliness, the inhumanity.
That makes more sense! Thank you for the explanation.
But Katy, it is NOT a free market. Not any more. Maybe not for a LONG time. Obamacare turned it into a government system where the hospitals, doctors, insurance, EVERYTHING is government regulated. You wanted it. You voted for it. You told us we couldn't do away with it. You said we should be punished with "mandate fines" if we refused it!
If it is "Soviet" (*it really isn't, that's crazy hyperbole)... then who made it so?
Right. There is no free market. But this wasnโt my point - this article wasnโt about the economics, whether itโs a socialized system or not, thatโs not this article. The Soviet reference is about the culture. The culture. The culture. Of hospitals. They are totalitarian systems in the way they treat people and the rituals and bureaucracy and the submission and the coercion.
Katy, I get that it is flawed. I get it that you are devastated by your sister's care (or lack thereof). But nothing here is "Soviet". It wasn't caused by socialism or lack of training (US medical school is the world's elite top) or lack of spending (we spend insane amounts of money) -- it is a combination of our hospital & insurance SYSTEMS, and a complete inability ON THE LEFT AND THE RIGHT to design anything remotely different, more fair or affordable.
Respectfully, I feel like you donโt read what I write. I specifically said I was not talking about socialism (which is an economic structure. Iโm talking about a culture problem). And I never once even hinted that it was training. I write a lot about affordability. But that was not remotely the focus of this article.
I'm extremely sorry for your sister. However in both stories, it feels like a lot is left out. Where were your sister or your daughter's ACTUAL PHYSICIANS? They should have been present, at least sometimes or left instructions! from reading this, I have the impression neither woman had their own physician! You do have the choice to refuse care OR leave a hospital for another hospital. Given your job, I doubt you were in a remote rural area with only one hospital.
As for childbirth... there are home-like birth centers and a healthy young woman can opt for a midwife. A lot of what you wrote are things your daughter could have easily found out in advance, and made choices about how to handle things. I also don't hear anything about her husband intervening -- I am unclear why this job went to YOU.
And some of this stuff is awfully nitpicky: they do not offer you STEAK because it is $$$$ compared to normal food offerings. If you really hate the food, have a family member bring you a takeout meal. You can even order DoorDash! and they don't have operable windows because many hospitals are high rises and people could FALL OUT! offices & stores also don't have operable windows. It would make heating and A/C impossible to run!
Lola youโre either making the exact points in my piece (about my sisterโs actual doctors, or the need for more home birth and birth centers) or youโre wrong on the facts. There is in fact steak on the patients menu. Cardiology patients arenโt allowed to order it.
Steak? in the hospital? LOL!!! you said your daughter was not allowed steak! I thought she was a obstetrics patient (who needed protein)! You have a fantastic hospital. None around here (world class teaching hospitals) offer steak on the menu -- it's all pretty "healthy stuff", but usually good quality & fresh. You can order off a menu! however my bad luck was to have my appendix rupture during the COVID lockdown and they were very short-staffed -- I got no choices, terrible food, often cold sandwiches served in a foam clamshell at crazy times of day (but charged the same $$$$$$ as if I had recieved hot gourmet meals!).
I am puzzled why your hospital serves STEAK but has no homelike birthing center. We have 'em all over.
Isn't it OBVIOUS why cardiac patients would not be given foods like steak or fried items, because of the CHOLESTEROL and SATURATED FAT?
Lola, again, you misread the article. My daughter was starved. My father, the heart patient, was deprived of steak but was allowed metabolic poisons like fruit loops and processed muffins. If you are still believing that saturated fat causes heart disease, you havenโt kept up with the science. I refer you to the FDA commissionerโs book called โBlind Spotsโ about all the things the medical establishment has gotten wrong. Thereโs an entire chapter on saturated fat. Your experience during COVID sounds about right - this is why humans should not be forced to endure hospitals. Theyโre incompatible with health and healing.
So stop going to hospitals.
I'm extremely sorry for your sister. However in both stories, it feels like a lot is left out. Where were your sister or your daughter's ACTUAL PHYSICIANS? They should have been present, at least sometimes or left instructions! from reading this, I have the impression neither woman had their own physician! You do have the choice to refuse care OR leave a hospital for another hospital. Given your job, I doubt you were in a remote rural area with only one hospital.
As for childbirth... there are home-like birth centers and a healthy young woman can opt for a midwife. A lot of what you wrote are things your daughter could have easily found out in advance, and made choices about how to handle things. I also don't hear anything about her husband intervening -- I am unclear why this job went to YOU.
And some of this stuff is awfully nitpicky: they do not offer you STEAK because it is $$$$ compared to normal food offerings. If you really hate the food, have a family member bring you a takeout meal. You can even order DoorDash! and they don't have operable windows because many hospitals are high rises and people could FALL OUT! offices & stores also don't have operable windows. It would make heating and A/C impossible to run!
You sound like the best sister and grandma, Katy.
I can't think of a better-written description of how rotten-to-the-core our hospital care is.
I met someone who actually lived in the USSR. The way she depicted it sounded preferable to our health care system, which is more crony capitalism than Soviet-style. And if one of the key problems is the profit motive, the free market wouldn't seem to me to be the solution.
I really appreciate the solution you proposed at the end.
Yes, Moorea, it's so egregious. People often say that the market isn't working. The market hasn't been tried. These are illegal monopolies colluding on prices. Enforcement of our antitrust laws, and many other laws on the books, is at least part of the answer. And many other proposals I've written about. I think about my inlaws' experience in Italy's hospitals, which are terrible. Socialist bureaucracies aren't the answers either.
We went through a huge "come to Jesus" moment in 2009-2010 when we were debating Obamacare. You are old enough to remember it very well. We were told there would be a public option, and there never was one. Obama, Hillary, Biden, Kamala have all said publicly "no public option EVER". Because that's the only way to force people to buy Obamacare on the exchanges. Oh and huge unfunded subsidies for "certain people".
We did nothing to reign in the power of Big Insurance or Big Pharma, because when threatened... back in the 90s... they made those "Harry & Lois" commercials where old people screamed about "taking money out of their pockets". That killed Clinton's reforms dead in the water.
So here is a reality check: if you cannot even stop Big Pharma from running expensive TV ads for mostly useless medications... you are helpless. If you cannot cap medical costs... you are helpless. If you cannot get med schools to double enrollment of AMERICAN CITIZEN students... you are helpless. (We have about half as many doctors as in the EU or elsewhere, and they earn about 2x-3x as much salary.) More doctors would equal more & cheaper care.
Nobody is willing to even discuss any of this, Katy, because of the miserable infighting over Obamacare and the left's total unwillingness to admit their big once in a lifetime "reforms" did not work one tiny bit -- literally everything is worse today than in 2010... higher costs, less care, more chaotic hospitals, etc. More medical bankruptcies. NOBODY is talking about new reforms, since Obamacare escaped the "chopping block".
Well said. From what Iโve heard traveling around Europe, the health care systems in the UK and Spain are awful. Socialist bureaucracies indeed. Well, sort of a dysfunctional capitalist-socialist hybrid.
Several months ago, my ex was extremely distraught about the prospect of losing her job when the NHS was undergoing restructuring. I couldnโt understand why she was overreacting โ we all have to deal with layoffs sooner or later. Later, I realized it was probably because she had no marketable skills since she was a cog that that contributed essentially nothing.
Itโs so sad!! The waste of human potential. Especially for the nurses who have a natural gift for love and service. To grind them into the gears of this machine is so wicked.
Yes, so sad and so true. I know multiple nurses in the states who quit the profession because the working conditions didnโt allow them to do their job right.
I suspect the same phenomenon is happening in the UK because most nurses there are contracted from other countries.
My ex was not a nurse but rather a mid-level worker who did nothing more than tell others what to do (as best as I could gather).
Yes the middling bureaucratic administrators and paper pushers are generally not providing much value and thatโs speaking charitably.
Ha! Iโll say. Very diplomatically said.