loss for words

I made it home. And I am already depressed.

Today was my first day back in the hospital and I am convinced that there is something seriously wrong with the way we practice medicine here. I never saw it before. I guess because that's all I ever knew. It took me over two hours to wade through the patient assigned to me's charts (yes, multiple--there's the nurses paper chart, the other paper chart, the computer program where you can access all the labs, x-rays, etc, the computer program where you can access the patient's past medical records that have been scanned in, the computer program where you can print a progress note for the patient and yet a different computer program where you can print the changeover sheet.) The patient is taking no fewer than 20 different medications and 10 additional prn (as needed) meds. She has been taken care of by probably 20 different doctors and at least as many different nurses. She has pneumonia and acute respiratory distress syndrome and congestive heart failure and chronic obstructive pulmonary disease and morbid obesity and obstructive sleep apnea and hypertension and acid reflux and pseudotumor and osteoarthritis and a brain aneurysm and bipolar disorder and chronic lower back pain and cellulitis of her right calf and a few other things not worth mentioning. A fancy machine is breathing for her and she is now developing bed sores. She has a tube in her nose that goes down to her stomach so she can receive liquified nasty tasting calories. Her potassium was a little low yesterday so we put some extra potassium in her feeds today. We give her a little of this, go up a little on the dosage of that, and continuing tweaking until she is just "perfect." We will continue to tweak her to perfection until she dies, likely right here in her ICU bed.

Yes, patients in Africa die too. But not like that.

Are we really doing what's best for our patients? Doing "no harm?" Somehow I don't think so.