The Tribune

By DIANE PHILLIPS

A physician who is widely respected was discussing health care with a few friends one day when someone asked him casually whether or not he thought a certain patient would be better off in the hospital. “This is not an emergency,” the good doctor retorted matter-of-factly. “The hospital is the worst place for a sick person to be, especially if they are elderly.” His chilling words landed on my ear with the kind of impact I’d expect if someone held a concrete block in mid-air and dropped it on my little toe.

Ouch, I winced. Ouch. Ouch. What did he just say? Either I misheard or this was sheer blasphemy, the doctor I revered all but pronouncing hospitals as places unfit for humans. That’s a slight exaggeration of the good man’s disdain, but that’s how badly it shook me. Isn’t a hospital the one safe place we don’t want to end up but are grateful it’s there just in case we do?

That brief conversation might have faded like the desire to have dessert after two bowls of spaghetti had it not been for another doctor hundreds of miles away just this week saying virtually the same thing the first doc shocked me with years ago. This time, the good doctor added a few frightening facts, none of which, by the way, were very flattering to the human body or mind. It appears that the first good doctor who warned of the impact of hospital stays was right – an extended hospital stay does little to improve our general health, and can even reverse it, both mentally and physically, and the effects only get worse as we age and are more likely to spend more time in the hospital.

So why is there a potential danger associated with an extended hospital stay? What happens to us when we are being coddled and cared for, when doctors and nurses and techs and aides surround us? What goes wrong (excluding the fainting spell we feel coming on when we get the bill before insurance has finished tabulating?)

There are two basic impacts, one on the nerves and muscles of the body and the other on the brain. The human body is meant to stand and walk, activities hard to pull off when confined to a hospital bed which is carefully designed to ensure that we are prone.

Muscles atrophy and vanish faster than car keys left on the kitchen counter in a home with an 18-year-old boy. According to the most recent doctor’s assessment based on more than 20 years of practice and seeing patients in hospitals nearly every day of the year, the body of a young, healthy male adult loses up to 30 percent of its muscle mass in two weeks in a hospital stay.

A single day’s muscle mass loss

And it’s far worse for seniors. Those in their Seventies or older can lose one month’s worth of muscle strength in a single day. Muscle deconditioning can begin almost immediately, beginning their turn to mush within hours of being placed in the hospital bed. The average patient loses two to five percent of muscle mass per day.

For someone with a little age, like those who remember rotary dial phones and words to Frank Sinatra ballads, the danger is more extreme. Older patients face much graver loss – up to 10 percent of muscle mass per day. At that rate of deconditioning, the long-term bedridden patient at home or in a medical facility will eventually turn into a human jell-O mold, upper arms as wobbly as a limp carrot, legs as shaky as a water glass on a high-speed vessel.

Even for the young, healthy patient, for every week in a hospital bed, it takes two full weeks to recover. One to two odds, not terrible, not the kind of stat we want to take to our grave with us.

That is why doctors and nurses encourage patients to get up out of bed, walk the halls, ignore the stares at your gown that ignores your pleas to stay closed in the back, avoid eye contact if you weren’t successful. Focus on the movement.

Deconditioning sounds like something you do to a vehicle that is crying out for a little love, or maybe a cooling system, but understanding the rapid rate of physical deconditioning under certain conditions is an important part of knowing where your body stands.

Hardest on the mind

Hospitals are even harder on the brain. The lights that never fully go off, the noises, the squeak of nurses’ shoes or a food or medical trolley, the incessant interruptions throughout the night to take vitals or provide sleeping meds when you are snoring contentedly, all the ambient sights and sounds of a place that never sleeps deprives patients of the deep sleep to which they are accustomed.

Patients in a hospital room for more than a few days often suffer delusions or what is known as hospital psychosis. They walked in or were wheeled in perfectly normal and now they may be seeing zebras on the ceiling or boats in the hallway. They may feel someone is trying to whisk them away, off to a dump or to another planet. They ask if they are crazy but they are sure of what they are seeing and feeling and they are scared. Their thoughts are real and frightening as hell. They will recover but the longer they remain in the unnatural setting of a modern hospital in western culture, the greater the risk of mind and body loss while physicians try their best to fix whatever landed the patient there in the first place.

Despite my rebuking the good doctor for telling the small crowd that a hospital was not the best place for a patient’s overall health, I know that he recognizes the critical importance of such a facility, whether for emergency, exploratory or planned surgery when warranted or needed to save a life or improve the quality of life for the patient. So please accept this little tale of two sides of the good stay-the bad stay, not as an insult to any facility or anyone working within the hallowed halls of a hospital, but just as an eye-opener that what may be good for one aspect of the human body can boondoggle the other.

But then we are very complex beings, aren’t we?