IronBatman

I left 8 years ago. I've never been more happy and success is so much easier to come by in the states. You get rewarded for your hard work, not for being related to your boss (like in Egypt).

Anyways, I would suggest getting a student visa to start, get a PTO, get a Job, Get an H1B visa, get sponsored for green card, then get citizenship. Should only take 12 years. Easy peasy (it isn't actually that easy, bassem probably came in the money route after investing 500k into a business).

Also, this is just general advice. Almost every Egyptian wants to leave Egypt. That doesn't mean that Egyptians in the states will have the time (or desire) to walk them through the process. I get FB messages, and sometimes phone calls from people I don't even know who want me to baby them through it. Coming to America requires independent hard work, and you won't make it here for one month without being able to take care of yourself (cook, clean, study, work at least part time).

As a physician, my anecdotal experiences seem to be the opposite really. Just recently I had a patient with hepatic encephalopathy admitted, but refusing to take lactose. Traditionally, in this situation doctors would put restraints (soft limb or mittens) and place ng tube to prevent the patient from worsening encephalopathy, lose airway protection, or go into a coma.

I had a nurse just flat out refuse to place an NG tube because the patient (which is encephalopathic) is refusing (everything, might I add). This is getting ridiculous because we are swinging so far towards pro patient autonomy, the do no harm part of our oath becomes meaningless. This patient eventually was so encephalopathic that she couldn't protect her airways, got sent to the ICU where she was intubated and had an ng tube placed about 6 days after admission. Such wasted time, resources and suffering because of (in my opinion) gross misunderstanding of the limits of patient autonomy/consent.

I'm curious if you have come into situations like those, because in my personal experience they are much more common than they were even just before the pandemic.

This is hepatic encephalopathy so not psychiatric condition, but a medical condition caused by liver cirrhosis not processing ammonia which causes toxicity in the brain. So technically medicine, but the role of consent and autonomy is still very much at play.

What I'm asking is your opinion about the limitations of autonomy/consent?

Yes I use motivational interviewing when I'm talking to patients about weight loss or medication adherence. Doesn't really apply when the person is as yellow as Pikachu and thinks she is in a police department in 1998.

I think the issue is that she nurse objecting without understanding autonomy/consent. Just a few years ago nurses object for safety issues, not to have half baked philosophical discussions about the limitations of paternalistic medical practice. Ultimately, if the patient is deemed to have capacity to consent and they are refusing treatment for hepatic encephalopathy, then they are also deemed to be sound of mind enough to just let out the door (since they don't want to be treated and are totally all there mentally). In reality we know that isn't true. We know if we let them leave, they will be dead within a few days. We know they don't have a clue what they are refusing. We know what we have to do to save them. But we are frozen with fear that a family member will sue us or post on social media that we tied down their lovely grandma and shoved a tube down her nose before pumping her with lactulose that made her shit herself.

I wish I could say a motivational interview solves everything, but when the person is incapable of comprehending where they are, how sick they are, or how their decision will determine if they see next week or not... we just to follow our oath and do no harm.

I'm Egyptian. It is controlled by Israel through Egypt. It's a part of an agreement with Israel. In return Israel hasn't tried to steal the Sinai for 3 decades.