Distrubed Sleep under Anesthesia

[J_Dawg_27]

Is it odd that a patient can get a disturbed sleep when they are heavily sedated after an operation?  Maybe as their consciousness raises but seems weird at 10% just after surgery.

[Calahan]

This has been reported before as a bug and Tynan has said it's WAD.

I understand, but I think it's fine. It serves the design purpose. Thanks for mentioning anyway.

[TheMeInTeam]

I'm not sure what "design purpose" it could possibly serve, aside from "this isn't worth the time to differentiate it".

[Dargaron]

Perhaps encouraging the creation of separate hospital rooms, rather than a single large room for anything from surgeries to flu treatment?

Although if that's the case, a better solution would be to make diseases infectious...so you'd want to keep the plague victims separate from the bleeding people separate from the folks awaiting Bionic limbs..

[BoogieMan]

For whatever reason it's been stated as working as intended even though it seems that is completely nonsensical.

How you can disturb someone who anesthetized to such a degree you can perform surgery on them? You could throw them down stairs and they wouldn't know until they woke up.

It's always been something that has befuddled me.

Perhaps encouraging the creation of separate hospital rooms, rather than a single large room for anything from surgeries to flu treatment?

Although if that's the case, a better solution would be to make diseases infectious...so you'd want to keep the plague victims separate from the bleeding people separate from the folks awaiting Bionic limbs..

Except that makes it harder to get the impressive hospital bonus and makes you wonder why you can link multiple medical beds to a single vitals monitor, if they are all immediately adjacent to each other anyway.

If we could slate what medical beds are used for it would help. You could make a ward for people who are going to undergo surgery or otherwise have extended stays, and another for routine visits so you don't have to micromanage it. Would also help keep the people who are seeking medical attention for bruises from taking the good medical beds instead of basic beds in the hospital.

[Dargaron]

I didn't say I thought it was a GOOD design purpose. Just something that would fit with the basic design philosophy (as I understand it) behind Rimworld: in order to encourage space management, cramming lots of stuff in one room is generally discouraged. For example, it's best to have a dedicated freezer rather than just freezing one's entire storage because the energy cost increases with the size of the room, so you may as well put the non-perishables in room-temperature storage. Recently, I figured out it's best to have one room for the Butcher's Table and one room for the stove, since the Butcher's Table increases dirtiness which makes the stove less effective: previously, I'd just had one dedicated "kitchen" room, with Brewery, Butcher's Table and stove. Now I need to allocate more space for these workbenches.

Re: the point about Impressive Hospital: Couldn't the same case be made for bedrooms vs. barracks? It's certainly easier to make a single, impressive room and fill it with multiple beds than to make an equally-impressive room for each of your colonists.

Re: Hospital Monitors: I can't say much about that; I usually don't get that far. But that WOULD be a possible design inconsistency. Maybe it's an intended trade-off? You CAN have more effective medical beds, but at the cost of potential mood problems? Personally, I don't think that's a particularly good argument, but I could see someone seriously making it.

[BoogieMan]

I meant that as agreeing that individual hospital rooms would be nice if the game would reward it with something other than just reduced disturbed rests. That's the only thing it has going for it, unfortunately. All for extra resources, labor, and more space required. Not a good trade.

[Bozobub]

"Unconscious" does not imply "unaffected by external stimuli".  Yes, disturbing the rest of people in immediate post-op (where you are held until you recover from anesthesia) does impact outcomes, overall, in real life, whether or not they remember it in any way.  For example, the person you throw down the stairs may not remember it happening but they'll still retain any injuries, and could even die.

Try asking any doctor — I just did, in fact — because the white papers are a PITA to find on Google, but here's a couple:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407258/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4735557/

Plus a nurse's guide on the subject: https://books.google.com/books?id=tRx0qiZ5lEQC&pg=PT193&lpg=PT193&source=bl&ots=E_bdDowQDi&sig=Ew07Om7YepOGPQkgnQpVrk-1Fys&hl=en&sa=X&ved=0ahUKEwjdne2ZmoLWAhUSS2MKHcohC6gQ6AEISzAF

Tl;dr?  Yes, the current mechanism is reasonably close to reality, as an abstracted model.  Yes, people in private or semi-private rooms tend to do better, statistically, than those in multiple-patient rooms, and a big part of that is undisturbed sleep/rest (or as close as you can get in a hospital).

Important note:  AFAIK, vitals monitors simply do not work at the moment.  Much like the quality of meds doesn't affect treatment (only surgery itself) at this time.  I believe both issues are scheduled for A18 fixes.  You can, however, link each monitor to EIGHT beds each, when they're working properly as they did in the past (much like how tool cabinets behave with workbenches).  Each bed, however, can only link to one monitor.

[BoogieMan]

Yes obviously they would still get injured. It doesn't make them invulnerable..

From what I got from those, the results were from sleep periods after the procedures and the effect of pain medications on restfulness. As in sleeping during recovery after anesthesia has worn off.

I could see it happening on occasion with periodic bouts of some awareness but that would seem to be the exception, and not the rule. Or more in line with existing mechanics, was only triggered by actual work going on the room, such as mining or other loud disturbing actions. Not someone simply walking through an autodoor across the room.

If it was supposed to encourage the players to more carefully design the hospitals, it would make more sense for the effects to focused on normally sleeping patients, and not those medically unconscious. But people who are just sleeping usually end up less affected by disturbed sleep because they are simply not there as long, even though there is no doubt that they would be more affected by sleep interruption.

In general the overall mechanic should be partially redesigned IMO. Compared to current effects - less harsh on anesthetized and more harsh on regular sleepers. Getting woken up multiple times can be really aggravating.

[TheMeInTeam]

I didn't say I thought it was a GOOD design purpose. Just something that would fit with the basic design philosophy (as I understand it) behind Rimworld: in order to encourage space management, cramming lots of stuff in one room is generally discouraged.

Only for bedrooms.  Efficiency dictates many other things being in the same room is more efficient.  High impressiveness + beauty in a big dining/work/rec room is a good example.  It's not a global trend in Rimworld that spacing is encouraged.

And the tiny penalty is more a nuisance on what is a pretty rare action.  It's not self-consistent in the game either, which is why the only explanation I'm buying is the "it's rare and not worth committing resources to do differently". 

Inconsistent implementations can't serve a design purpose unless the design is itself inconsistent...not something a rational thought process puts together. 

To illustrate with an extreme/silly example: Tynan could implement raisin rain in A18, then roll up here and states it serves a "design purpose" even if it trivializes the need for food for the rest of the game at random (thus negating the function of the game's food mechanics).  There's nothing saying he can't do that.  However, without a viable rationale for that or how it makes the game better it'd be a tough sell that it improves the game or that it actually serves a coherent design purpose.

Disturbed sleep under anesthesia isn't that crazy, but it draws similar logical questions under scrutiny...again unless the rationale is that making a different state than sleep isn't worth the tiny amount of utility that would give to the game.

[Bozobub]

Once again, the current mechanism directly simulates actual real-life results rather well, in this case.  There's only so granular the sim can/will get, folks.

[TheMeInTeam]

Once again, the current mechanism directly simulates actual real-life results rather well, in this case.  There's only so granular the sim can/will get, folks.

Have you been under general anesthesia?  It's nothing like normal sleep or disturbed sleep.  To me it felt more like a short time skip.

Also, "simulates real life decently" is not this game's MO.

[Snafu_RW]

FWIW in my previous game one of my ppl /in a permanent deep coma/ kept getting disturbed sleep (& eventually unhappy nudity) debuffs.. go figure

[BoogieMan]

Once again, the current mechanism directly simulates actual real-life results rather well, in this case.  There's only so granular the sim can/will get, folks.

You state that as a fact, when I don't really think you should. I doubt a really definitive amount of research has been done on it because deliberately negatively affecting a patients recovery would be unethical. Also, I read the links you posted and commented on the result but you seemed to have ignored that.

Even if somehow people who are anesthetized were disturbed by someone simply walking by, it's not something they would actually be aware of. If it somehow negatively affects recuperation, again, they wouldn't be aware of it.

Source: Being with 3 people who came out of anesthesia related procedures and surgeries and talking about it with them. They were aware of nothing. Sometimes not even the first time or two they awoke after it was wearing off. Nurses came in many times to check up on them, and family members came and went. They were usually still tired because being anesthetized isn't like actual sleep, due to lack of REM sleep. But they didn't wake up in bad moods from all the disturbed sleep...

[Bozobub]

Once again, the current mechanism directly simulates actual real-life results rather well, in this case.  There's only so granular the sim can/will get, folks.

Have you been under general anesthesia?  It's nothing like normal sleep or disturbed sleep.  To me it felt more like a short time skip.

Also, "simulates real life decently" is not this game's MO.

Once again, what you *remember* doesn't mean a thing.  Any repercussions still exist, whether or not you are aware of them, hence my example of throwing a post-op patient down the stairs; whether or not they remember it happening, they WILL still retain any injuries.  "Disturbed sleep" can (and does) encompass MANY different possible events, many of which you won't be consciously aware of, even if they more or less wake you up at the time.  Go on, try to aver you remember everything when you're half-wakened by someone in the room with you; you're gonna have to try very hard, though, because I just don't buy it, especially when you're recovering from general anesthesia.

There's only so granular the sim can or will be; you're basically quibbling over a label, nothing more.  Anesthetized sleep IS still "sleep", as well, your problems with that fact aside.  Nor do your anecdotal observations negate actual statistical results.  Did you or BoogieMan bother following any of those links?  And furthermore, if you think this game isn't a sim (of "real life" in a sci fi setting) what, exactly, do you think it is?

The current mechanism, whether by accident or design, simulates actual statistical outcomes of disturbing post-op patients.  What, exactly, is the problem with that?

And how are you surprised, BoogieMan, that research on post-op care exists o.O'?  If you HAD read those links, you wouldn't be so gobsmacked, that simple.  No, you don't have to intentionally inflict disturbances on patients, to document the statistically probable effects if disturbance happens.  If you get off yer duff and do some research, you'll find many more results — it's somewhat of a pain, because white paper titles are often worded oddly, but the results are there — or you could ask a doctor, which (again) I DID; luckily, I have a tolerant family practicioner =).

It doesn't matter what you doubt; I trust MDs, both in reference and in person, over your opinion.