Death Due to Private Nursing?
An email conversation about the news of the day.
April 16 2002 11:24 AM

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So it's Tuesday, which means everyone's out with their science sections. And there's almost too much to catch up on. My Boston Globe has a pretty neat report on the unusual ecology of Mount Kilimanjaro, which manages to traverse five different climates, from tropical rain forest to arctic glacier, as it rises from base to peak. And the New York Times' science pages have my favorite line in the news so far today. Inside its technology ooh-and-ahh piece about the coming generation of unmanned machines for fighting wars, electrical engineer Dr. M. Franklin Rose points out all the advantages: Robots keep soldiers out of harm's way, do the laborious and boring tasks, and keep going long after a soldier is exhausted. They also have one more advantage, he says, though he is oddly tentative about this one: "And they have no fear, at least in current embodiments."

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It's always the medicine part of the science pages that draws me in most, though not surprisingly, I suppose. Two Times pieces in particular caught my eye. One was about people who've been hiring private nurses to accompany sick family members when they're in the hospital. And the benefits do seem hard to deny: not having to wait for 20 minutes after buzzing for a nurse to get you to the bathroom; having someone by your side to double check the medicines you're getting or be sure you're not getting bed sores. Still, all the downsides mentioned in the article ring true to me, and I can't see the notion taking off. Every once in awhile, we'll have a patient who's brought in his own nurse. They are expensive—up to $75 per hour, as the article mentions. And we hardly ever let them do very much: They're not accountable to us, so we would never let them dispense drugs or do physical therapy or carry out any other necessary work. They tend to not get along very well with our own nursing staffs, which makes it harder for our nurses to do their jobs. And worse things do happen. The story about how Andy Warhol died at age 58 the day after a routine gallbladder operation is chilling and one I had never known before reading the Times piece. He had his own private duty nurse continuously at his bedside. The medical staff was apparently thrown off their routine by this—and perhaps lulled into thinking he needn't be checked on as carefully as usual. But he was sick and getting too much fluid. And it was far too late before the surgical team knew it. Gads.

The other piece was really a series of unconnected pieces all touching on obesity. One presented a bunch of researchers and evidence suggesting that maybe obesity doesn't cause poor health after all but is just a symptom or side effect of it. In that case, losing weight could not only fail to do any good but could even do harm. I wasn't buying too much of the argument, though. To be sure, there are healthy people who happen to be obese. And there are some important studies raising questions about whether losing weight necessarily translates into improved health. Yet never mentioned are the other studies finding remarkable improvements from sustained weight loss—decreased blood pressure, fewer heart attacks, reduced diabetes. Even the Times seems to agree. Two other articles in the science section today are all about the public health benefits of efforts to measure and reduce obesity: one on the new height and weight charts for children (which no longer track height and weight separately but as a proportion of one another, a more useful and accurate method); the other on the rampant problem of obesity among Mayan children in the United States. One particular question about all this for you, though, Natalie: When did the Times decide that calling the obese "fat people" was OK?

As for your questions about operating on kids, I'll have to pick up that thread again in my next missive. I find I'm already rambling on this morning. I can tell you, though, it is different operating on children. But I had no idea that the Office of Human Research Protection was changing the rules restricting experiments on children. What are they proposing?

Atul

Atul Gawande, a surgical resident in Boston, is a staff writer on medicine for The New Yorker and author of the new book Complications: A Surgeon's Notes on an Imperfect Science.

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