Daughter from California Syndrome | Hacker News Reader

Daughter from California Syndrome

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This came up in the "How Doctors Die" discussion the other day: https://news.ycombinator.com/item?id=26685244

Exactly my thought. It was 13 days ago though. You beat me to it, deleted my other comment :)

Edit: I wonder how many submissions are bred by the discussion here.

Specifically here: https://news.ycombinator.com/item?id=26685894

This reads a bit like the medical profession's inability to acknowledge its own fallibility.

I don't know if I would have qualified as a "daughter from California", but I have intervened in the care of a couple of family members, and in one case in particular it was for a pretty flagrant cock-up.

I'm busy with my own life. I haven't always been able to visit relatives as often as I'd like. I try to ask questions about their health when the topic comes up, but I also have to trust them and their caregivers to be competent.

But when there's a serious life event, I'll show up, and bring curiosity with me, and sometimes that uncovers mistakes made by people who are simply less invested in the well-being of my relative.

In my grandfather's case, some long-term health issues got him admitted into a home hospice program. Overall, it was a great program. But, he was in it for well over three years. Home hospice is structured to last for around six months. There's a common drug cocktail of benzodiazepines and opioids that gets administered in increasing dosages to bed-ridden hospice patients, to help "ease them along". It's not common knowledge that this happens and it can be done without the family's knowledge or consent. In cases involving pain or anxiety or end-of-life care, it's a kindness.

But the medical literature specifically advises against it in elderly patients that are still mobile, because it significantly lowers their blood pressure and when they stand up it can cause them to pass out.

That's what happened to my grandfather. He got banged up pretty good and admitted back into the hospital, which is a bad place to spend much time when you're elderly. He was hallucinating when I saw him and his mobility was far worse than it had been when I saw him several months prior.

So, I started asking questions, got caught up to what was going on, started pressing the matter, and finally got to pitch his case to a visiting internist, who reviewed it and then agreed that somebody had put him on the wrong program at some point and the rest was just a combination of game-of-telephone and just-following-orders.

Dosages were gradually decreased, he regained full consciousness, got some PT, got out of the hospital, and had another couple of years of grandchildren and great-grandchildren and friends and so on.

"Daughter from California Syndrome" may just as well be a term for the systemic errors that many people in medicine would prefer not to acknowledge.

I don't think that the proverbial daughter necessarily has to be wrong. It's just a description of a sudden flurry of engagement by someone who has been distant from a dying patient. It's probably misguided in a lot of cases, but not all.

That's reasonable, but I'm getting an odor of dismissiveness from the article when for example it wraps up with, "see also: Karen".

The article could probably stand to have a section added to it with references like "Errors in Health Care: A Leading Cause of Death and Injury" (https://www.ncbi.nlm.nih.gov/books/NBK225187/) as a point in favor of those cases that aren't misguided. I'm not the right person to add that though.

(Aside: it occurs to me that some might interpret these comments as being more severely critical of health care workers than I actually am. Overall I regard them as experts and defer to their expertise.)

I liked the last line: ‘In California, the "daughter from California" is known as the "daughter from New York".’

Almost missed this until I went back to check. I liked:

See also:

* Dunning–Kruger effect

* Karen (pejorative)

I laughed out loud at that as well. Although I guess in a westward expansion type scenario, where children "go west", it does make more sense that the child would be returning 'home' to the elderly parent in the east.

This amounts to torturing someone for your own comfort instead of doing what's in their best interest.

I have heard it described as "prolonging their death, not their life."

Given that this is a forum with strong international participation I'd be interested to hear what non-Americans think about this. As an American, I believe that our culture has a very unhealthy attitude toward dying (often thinking about it as "if" instead of "when"). I think that attitude drives a lot of bad decisions surrounding end-of-life care (both for ourselves, and for loved ones).

I know that attitude about euthanasia differ pretty markedly in other countries. How about the attitudes re: death and dying? Are the "attitude problems" I observe an American anomaly?

I don't know if my experience is representative, but those I've known who have been terminally ill have all been calmly accepting of the fact after all reasonable options were exhausted. Same for their respective loved ones. One of my relatives went through assisted euthanasia before the illness got really bad, and it was mostly a respected decision by everyone. This is in Europe.

it's definitely consistent across the anglosphere in my experience.

indeed, one of the non- American sensitivities, given other nation's relatively socialised medicines, is the application of comparatively redundant/ inefficient/pointless treatments on individuals nearing their end of life, because a lot of medical treatments assume the patient actually has prospects of recovery or the ability to gain utility from the outcome of a treatment. for instance, should you provide socialised elective (or otherwise) surgery to a 98 year old with dementia. what about physio for their "recovery period"?

you can get a lot of pressure for treatments to "do something" (both from family members and from cost-recovery incentives... course in for profit systems those problems don't go away, and this is not addressing the issues with medicine that would genuinely require family intervention)

I think more interesting differences could come from cultures within America; do Irish Americans have different attidues than urban modern atheist ones, for example.

I haven't heard of such stories here personally (Germany), it may exist, though my guess is that such behaviour is reserved for the upper class. There's also only one article on wikipedia in another language for this concept.

Health insurance is compulsory (most have the basic form that is cheap and subsidized and some have fully private insurance).

We have another issue though: Doctors and clinics have admitted to overtreating private patients even if an operation is risky or won't be too benefitial (e.g. artificial hips at an age 85+ or similar). Just to cash in 6 figures because the private plan is known to pay it. In such cases relatives will of course also have an influence on such treatments.

Edit: style/grammar Edit2: what i have witnessed personally is that it's very easy to get pills for anything in the US. I once had a torn toe nail and got codeine for 40 days, that totally baffled me. I would not have gotten opioids at home for such a thing, maybe Novalgin for a few days on request and over the counter NSAID else

Yeah, it can go either way. The profit motive means private facilities have an incentive to charge for care as long as someone is willing to pay, even if there's not a 'real' long-term benefit. On the other hand, some of the scare tactics in the US that have been used against government-run health care is that some bureaucrat is "rationing" care, deciding when it's "worth" paying for a procedure, which is of course true.

Then again, as in the German model, there's nothing preventing you from paying out-of-pocket or acquiring additional private insurance coverage above what the state provides.

And of course it's a personal issue, how much money you are willing to spend and how much you are willing to undergo to prolong your life, however briefly.

As for pills, after too many decades of dependance and addiction, it's getting harder to get narcotics in the US (finally?)

I'm currently sitting with my leg up being iced after an ACL replacement surgery on Thursday. My prescription for an opiate is for 20 pills (3 days worth) and has no refills. As it runs out in a day, I've talked to my doctor, and it sounds possible-but-not-easy to get a new prescription, if necessary. I'm hoping to not need it, but it at least sounds possible if I do.

Oh, I hope you recover soon!

> there's nothing preventing you from paying out-of-pocket or acquiring additional private insurance

Of course not, but from what I whitnessed, it's not really common. One ongoing personal health issue has changed my thinking about it (the commons plan treatment is more or less absent or negligent at best) but I do get strange looks when I tell that I pay out of pocket for that, even from colleagues that I know have similar issues and are much more wealthier than me. At some point they have had enough docs and gave up, living with it.

You also cannot add general private health insurance as an addon (only stuff like dentist coverage), but you need to make a switch-once-and-for-all decision to private insurance (there's no going back to the subsidized commons model, it's possible via exceptions, but generally very hard). The earlier in life you do make this decision to switch, the cheaper the health plan gets - at an older age there's chances they will deny you or exclude treatment for known health issues & ask heavy prices. Switching between different private health plans is also difficult, for the same reasons. Although since 2010 or so, insurers must reserve 30% or so of accumulated capital to be transferred in case one switches private insurance funds. But old plans before that "don't vest" or how to say, when switching. The saying goes "it's easier to get divorced than to switch your private helth insurance"

I have an example from Ukraine, where an acquaintance of mine spent insane amount of money on "care" on her elderly, sick grandmother (90+) yo. When public hospitals refused to continue care due to uselessness, she took her grandmother to private ones, who happily took her miney, and couldn't stop.

It was about 10 years ago. Acquaintance's monthly salary was about $700 (that's Ukraine, after all), so she took debt etc.

6 months later and $15k in debt, grandmother still died.

I had a lot of sad thoughts about entire situation - I understand the wish to help loved one. I understand the wish to live. I understand that it was much easier for me to look more objectively at the entire situation...

I hope if my time will come, I won't be a burden for my family and will be able to make conscious decision.

It’s a sad situation all around. Do you trust the public professional or start paying?

Then once you start paying - how can you stop?

This exists in programming too. People joining a project often start pushing for it to include every great idea they heard about at their last job (or the one they bounced to/from). Psychologically I think it's the same thing. Call it "Developer from Google Syndrome" I guess.

I think a better one would be a manager who was not participating much who, when learning of some major illness of a code center, diagnosed by an external consultant, attempts to fix it and instead makes things worse.

The metaphor would be that if the manager was doing their job they would agree with the diagnosis of the consultants.

Thinking about it perhaps it's not a manager but a senior developer. Someone with some limited power.

I really don't think that is similar at all. The proverbial daughter is desperate to regain some sort of lost connection with a dying parent before it is too late. Maybe she feels that she needs to make up for all the care and attention she didn't give while the parent was healthy. Maybe she is in shock for not realizing the situation earlier.

How is this like a programmer switching jobs?

Get an advanced health directive worked out well before you need one.

My father did, and I never really thought about that too much, but it no doubt removed an amazing amount of confusion from my life at a time when I was not emotionally in good shape to deal with it wisely. As soon as I got back home, I sat down and immediately did the same, for my daughter's sake.

Just kidding; of course I didn't. I should get on that.

I can certainly empathize with the daughter from California. Life moves very fast and the lucky few notice before it’s too late.

> See also

> Dunning–Kruger effect

> Karen (pejorative)

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