Weighing in on Risks

(Note: I began writing this post before the International Olympic Committee decided that ping-pong was a more Olympics-worthy sport than wrestling.  There is now a Keep Wrestling in the Olympics page on Facebook which you can follow if you are interested, or you can visit www.TheMat.com)

All three are very athletic, and I’m sure they’d be pretty good, and they’ve all begged, but I don’t let my kids play football.  Flag football is fine.  So are neighborhood impromptus.  But not official-school-team football where you have 250-pound kids running into 130-pound kids.

It’s not that I’m afraid of my kids’ getting hurt.  Well, yes it is, but it’s a little more complicated.  Given the paragraph above, you might be surprised to hear that my youngest son, who just turned 12, is a wrestler.  For the past few months, I’ve been delightedly watching him compete in tournaments with our local youth wrestling club, and he’s moved up from “novice” (first-year wrestlers only) to “open” since he’s doing so well.

Have you ever watched a high school or college wrestling match?  It doesn’t have the theatrics of professional wrestling.  Instead, it has remarkably strong individuals using incredible force and twisting maneuvers in order to get their opponents off-balance, onto the floor, and into specific positions or “pinning” them on their backs.  It’s actually really exciting.  And it’s really exciting to watch my baby do it.  At least, it is when he’s in the better position, which so far he’s been in the vast majority of the time.  But I did NOT like it when an opponent had a hold of my child’s foot in what looked like a really unnatural position.

So how did an “absolutely-no-football” mom become an enthusiastic wrestling mom?  It actually wasn’t much of a transformation.  My boys are competitive athletes.  They run track and cross country.  They’ve played basketball.  They ride bikes.  They climb trees.  They know how to skateboard.  They’ve learned martial arts.  We hike in national parks.  We do not live a life free from risk.  There is no such thing.  If you hide inside your whole life, that brings it’s own set of dangers.

I look at data.  A doctor’s job is to look at data and assess risks.  To weigh the risks of doing one thing with the risks doing a different thing, or of doing nothing.  I did this with every patient, I help elucidate this for every client, and I of course do it with my family.

Virtually every sport carries a not-insignificant risk of injury.  Different sports have different rates of different types of injury.  One of the most dangerous aspects of high school and collegiate wrestling has been trying to lose a lot of weight quickly in order to “make weight” (since there are weight categories in wrestling, and you get to wrestle someone smaller if you drop into a lighter category, but of course becoming dehydrated and malnourished is a pretty stupid way to prepare for a battle of strength).  There are now rules in place (at least at the high school level) that limit how low each wrestler is allowed to go in weight.

There are a lot of upper extremity injuries in wrestling.  There are a lot of blown-out knees in football.  As awful as these are, they wouldn’t stop me from allowing my kids to reap the benefits of the sports – teamwork, physical fitness, accountability, commitment, sportsmanship, etc..  But the knee and shoulder injuries don’t scare me as much as potential high-velocity collisions or the long-term effects of repetitive head injuries.

Here’s my thinking:  Wrestling has weight classes.  It’s really not possible in wrestling, outside of heavyweight, to have a huge weight differential, but in football it’s quite possible for someone to be run into by someone who outweighs him by a factor of two.  Football, by its nature, involves full-speed body collisions, while wrestling is more of a steady-force-pushing kind of thing.  Yes, there are take-downs in wrestling that involve hitting the floor, but the rates of concussions differ significantly between the two sports.  Also, football practice involves repetitive collisions, and while each impact may be less than what is needed to cause a concussion, a cumulative high volume of sub-concussion head trauma is showing in current research to have long-term effects on the brain.  Again, no sport is totally free of this (cross country or track runners can certainly collide), but I can’t ignore how much of it there is in football.

For now, I am accepting the risks of wrestling because I see how much my son loves it, how much he loves learning the techniques and strategy, how strong he is becoming, and how good it makes him feel about himself.

Risks and benefits.  Different for every individual.  What risks are you willing to take for what benefits?

Scrambled Messages

A snow day on Friday, followed by a blissfully not-over-scheduled weekend, allowed for three days in a row of being able to do a little better than cold cereal for breakfast.  Homemade whole grain waffles on Friday, scrambled eggs topped with chili and arugula on Saturday, slowly cooked oatmeal with cinnamon, vanilla, a touch of honey, and a dollop of low-fat vanilla ice cream and fruit garnish on Sunday.  I love the luxury of morning cooking time!

But the whole breakfast thing can be a little confusing, health-wise.  Are eggs “good for you” or “bad for you?”  My ancestors in New Jersey and Philadelphia grew up on eggs.  They’re full of protein.  Good for you.  At some point, the health effects of cholesterol were noted.  Eggs contain cholesterol.  Bad for you.  Researchers later figured out that dietary cholesterol itself didn’t necessarily affect your blood cholesterol level as much as saturated fat.  Eggs only have a gram or two of saturated fat each.  Not really bad for you in moderation.  More research that eggs help raise “good” cholesterol.  Good for you.  Recent study out of Canada that says eggs are second only to smoking in association with heart disease.  Bad for you.

The studies conflict.  But none of the studies are “prospective, double-blind, placebo-controlled” studies (the gold standard of science).  There are laboratory studies, and there are correlational observation studies.  The results of lab studies might not hold out in real life.  The correlations observed in real-life observational studies (such as the Canadian study showing higher consumption of egg yolks in people with higher levels of cardiovascular disease) might not be cause-and-effect, but might actually both be effects of a third factor (i.e. an entirely different cause).

So what, pray tell, are we supposed to do?  This type of situation rears its head frequently.  If I took every study to be ultimate truth, I’d end up starving to death in a sea of confusion and fear.  So here’s how I decided to deal with eggs:

I buy a lot of eggs.  My family eats a lot of egg whites, and a few yolks.  There are lots of nutrients in the yolks.  There is cholesterol and saturated fat in the yolks.  The yolks lend a richness to the flavor of egg dishes and baked goods.  The whites are full of protein, have some other nutrients, and are a good binding agent in baked goods.  If I’m making a banana cake that’s going to feed 15 people and the recipe calls for 3 eggs, I go ahead and use whole eggs.  If I’m making scrambled eggs for my family of 5, I’ll use 4 or 5 whole eggs and an additional 12 to 15 whites.  When I make egg salad, I use a similar ratio to what I use in a scramble.  And we’ll have that type of egg meal maybe once or twice a week, and maybe a whole grain waffle or pancake meal (which will use a total of 2 or 3 eggs in the whole batch) once a week.

So we get protein from the whites, some of the nutrients and rich flavor from the yolks, and not a lot of the fat or cholesterol.  If enough research is done to show overwhelming evidence of either the danger or the benefits of consuming egg yolks, I won’t have to feel guilty for either having poisoned my family or having completely deprived them of essential nutrition.  Eggcellent!

 

 

Averting a Snow Day Crisis With a Connection to Actual DocThoughts

Snow day!  Kids slept in.  In our kitchen, making waffles, my boys happily complaining that it was too bad the snow day hit on a day they had jazz band, but they’d take the snow day anyway.  Wait a minute.  Jazz band.  Band.  Instruments.  “Uh, Mom, do we have rehearsal this Sunday?”  “Yes.  Why?”  “Because our instruments are at school.”

Crud.  This really hadn’t been an expected snow day, so I couldn’t legitimately yell at my boys for not planning ahead (not that doing that would help the situation anyway, even if it had been “their fault”).  Think.  Think.  Phone call to high school office – no answer.  Quick phone call to friend who teaches at the high school to see if anyone’s usually there on snow days.  She said theoretically someone from the custodial staff should be there, so we should try to see if any door to the building is open and catch one of the custodians to let us into the band room, and if we couldn’t get in, she has a key to the building and could go up there with us to let us into the school to look for a custodian.

Sent my high schoolers to try to get in (the main roads had been plowed by this time).  As they were trying a door, a custodian was leaving through another door and yelled to them that everything was now locked and the alarms were on so no one could get in today.  My boys tried to yell back to let him know what was happening, but they must not have been loud enough (surprising for a couple kids who can be plenty loud when they are of the opinion that their parents are being unreasonable), because the custodian got into his car and left.

Crud.  Called teacher friend again to tell her about the situation and to ask if there are generally people in the building on Saturdays, so that we could try again tomorrow morning.  She said that the fitness center should be open, but that the athletic area was locked from the rest of the building, and the alarms would be set.  She suggested emailing the principal in case he checked his email and could contact someone from the custodial staff to meet us there and help us during fitness center hours.

Zipped off an email to the principal.  Hoped he would see it.  Thought some more.  Checked to see what was up on Facebook.  Saw a post that talked about how snow days were decided.  Clicked to read the full article.  There was a quote from the superintendent.  The superintendent……. maybe he would be in his office?  Zipped him an email, and then called his office – he answered his phone!  I explained our predicament.  He said he’d call me back in a minute.  Phone rang a minute later, and our superintendent told me that the head of the district’s custodial staff would meet us at the east doors in 15 minutes to let us in.

Disaster averted.  Instruments retrieved.  And in the meantime, the principal had emailed back that there would be someone in the building Saturday morning who could help, so even if we hadn’t been saved today, the situation could have been fixed tomorrow.  Thank you emails were sent to everyone involved.  Snow day has been enjoyed to its fullest, with a houseful of teenage boys (and one 12-year-old, but I’ll count him as an honorary teen).

So here’s where Doc Thoughts come in.  It’s easy to panic, but panic doesn’t get you anywhere.  When you take a deep breath, you can think of people who might be able to help you, and even if they can’t help you directly, they probably know someone who can.  I had a new client this week who was referred to me by someone I had just met earlier that day, who realized that this person was in a state of crisis and could use my help.

How many steps to link any actor to Kevin Bacon?  How many steps to find someone who can help you?  Networking works.  We all know people.  A large part of what I do professionally is figuring out who to go to and where to get the right information to help people.  Sometimes it takes a few steps, but I get there.

Breathe.  Think.  Make a couple calls.  Send a few emails.  Someone likely will be able to unlock the door for you.

 

Corrected Cornbread Recipe

As promised, here is my cornbread recipe.  I’m writing it this morning so you’ll have time before the big game to pick up a few ingredients you might not have on hand.  It’s made with whole grains, and has way less saturated fat than standard recipes.  It does have sugar, but not a ton.

First, preheat your oven to 425 degrees.

Next, line a 9×13 (or 9×11) inch baking pan with unbleached parchment paper.  (*Note – using parchment paper makes for ridiculously easy clean-up, and it saves you from using any unnecessary grease/oil/butter/etc. to keep stuff from sticking.  It really is a marvelous invention.)

Then in a large mixing bowl, stir together:

1 cup whole wheat pastry flour (Bob’s Red Mill (local folks – it’s cheap at Hiller’s) and Aarowhead Mills are two good brands) – whole wheat pastry flour is ground really fine, and works very well in cakey things, cookies, etc., but it has more fiber and protein than white flour, and is a bit more flavorful.

1 cup whole grain corn flour (Bob’s Red Mill makes it) – you can substitute whole grain corn meal if you can’t find the corn flour (but locally they carry it at Hiller’s and at Natural Food Patch, and sometimes at Westborn).  The corn flour gives it a really rich, cakey taste and texture, but if you prefer a sandier, crunchier texture then use a medium grind whole grain cornmeal instead.

3 teaspoons aluminum-free, double acting baking powder

1/2 teaspoon baking soda

Then add in:

2 eggs

1/4 cup canola oil

1/4 cup honey or maple syrup or agave syrup

1-and-1/4 cup low-fat buttermilk (the stuff from Trader Joe’s is really good) (*Note – If you substitute something else for the buttermilk, reduce the amount to one cup, skip the baking soda, which is only there to work with the acidity of the buttermilk, and add an extra full teaspoon of baking powder instead.  If you want to make it dairy-free, you can substitute a can of creamed corn, but that adds some extra sugar, so you can reduce the honey/maple syrup/agave syrup.  Or use soy milk or whatever substitute you usually do.)

Optional – some thawed frozen corn  (make sure they’re thoroughly thawed or warmed, otherwise they’ll affect the baking and you’ll end up with little raw spots)

Stir together just until smooth, put into the parchment-lined baking pan, and bake in the 425 degree oven for about 25 minutes.

Enjoy!   And enjoy the game, commercials, and (hopefully) chili!

Correction

I can’t believe no one caught me yet on my mistake!  I misspoke – I said there wasn’t saturated fat in the cornbread, but it is made with two eggs, so there IS saturated fat from those, and there is a tiny amount in the canola oil and low-fat buttermilk (the Trader Joe’s brand I mentioned only has 1% fat).  But it’s way less than if it were made with the butter or shortening that standard recipes call for, and if you use egg substitute it knocks the saturated fat level close to nothing.

Sorry about that!  I have fixed the post.  And once again, enjoy the Superbowl!

 

The Cornbread

As promised, here is my cornbread recipe.  I’m writing it this morning so you’ll have time before the big game to pick up a few ingredients you might not have on hand.  It’s made with whole grains, and has way less saturated fat than standard recipes.  It does have sugar, but not a ton.

First, preheat your oven to 425 degrees.

Next, line a 9×13 (or 9×11) inch baking pan with unbleached parchment paper.  (*Note – using parchment paper makes for ridiculously easy clean-up, and it saves you from using any unnecessary grease/oil/butter/etc. to keep stuff from sticking.  It really is a marvelous invention.)

Then in a large mixing bowl, stir together:

1 cup whole wheat pastry flour (Bob’s Red Mill (local folks – it’s cheap at Hiller’s) and Aarowhead Mills are two good brands) – whole wheat pastry flour is ground really fine, and works very well in cakey things, cookies, etc., but it has more fiber and protein than white flour, and is a bit more flavorful.

1 cup whole grain corn flour (Bob’s Red Mill makes it) – you can substitute whole grain corn meal if you can’t find the corn flour (but locally they carry it at Hiller’s and at Natural Food Patch, and sometimes at Westborn).  The corn flour gives it a really rich, cakey taste and texture, but if you prefer a sandier, crunchier texture then use a medium grind whole grain cornmeal instead.

3 teaspoons aluminum-free, double acting baking powder

1/2 teaspoon baking soda

Then add in:

2 eggs

1/4 cup canola oil

1/4 cup honey or maple syrup or agave syrup

1-and-1/4 cup low-fat buttermilk (the stuff from Trader Joe’s is really good) (*Note – If you substitute something else for the buttermilk, reduce the amount to one cup, skip the baking soda, which is only there to work with the acidity of the buttermilk, and add an extra full teaspoon of baking powder instead.  If you want to make it dairy-free, you can substitute a can of creamed corn, but that adds some extra sugar, so you can reduce the honey/maple syrup/agave syrup.  Or use soy milk or whatever substitute you usually do.)

Optional – some thawed frozen corn  (make sure they’re thoroughly thawed or warmed, otherwise they’ll affect the baking and you’ll end up with little raw spots)

Stir together just until smooth, put into the parchment-lined baking pan, and bake in the 425 degree oven for about 25 minutes.

Enjoy!   And enjoy tomorrow’s game, commercials, and (hopefully) chili!

 

 

The Doc is Thinking Chili for the Superbowl

I’m excited for this Sunday’s game.  Well, not really for the game itself, but for the menu.  Don’t get me wrong, I enjoy football.  I just don’t feel any particular allegiance to either of the teams playing in this year’s big game, so while I know I’ll appreciate watching the skill of the players, I won’t have that much interest in the final outcome, which kind of makes for somewhat dull watching.  Therefore, my plan is to focus primarily on the commercials and the food.

We’re having a few friends over, and I’ll be serving chili and cornbread, along with various other munchies.  Chili is a huge hit in my house – my husband and boys get really excited when they see that I’m purchasing ingredients for it.  And they specifically really love my chili, which totally does good things for my ego.

I don’t think I had ever made chili until I had a super-yummy version at a friend’s house.  There was cinnamon in it.  I had never thought to put that type of spice into a tomato-based dish.  I was intrigued, and it prompted me to experiment boldly with the flavors and spices that simmered in the pot when I made it myself.

I cook a lot.  My whole family cooks.  We love food.  We love how it tastes, how it smells, the textures, the colors, the thrill of experimenting and creating, how it makes us feel to feed people, pretty much everything about it.  And (surprise, surprise) I personally get a great deal of satisfaction out of making yummy stuff that’s healthy.  I really love being able to feed people without guilt.

Which brings me back to my chili.  First of all, it’s very low fat.  I either make it with super-lean beef, ground turkey breast, or no meat at all.  I always use tons of beans (mainly kidney beans, some black beans, and when going vegetarian I will sometimes add lentils), so it’s super high in fiber and protein.  I use several cartons of chopped tomatoes, and a lot of onions and garlic, so it’s got plenty of vegetables.  The next part is where I don’t want you to roll your eyes and walk away:  I don’t add any salt, and I use low sodium broth.

Americans in general consume way too much sodium.  We’re used to the taste of salt in certain things, and chili is one of them.  But in the years since I’ve developed my chili recipe, I’ve never had anyone complain, ask for a salt shaker, or not have seconds (or thirds).  Here’s the trick:  Give the taste buds so much to think about that they don’t even remember to look for salt.

The original recipe that I got from my friend called for a bunch of cumin.  I like cumin, but it’s one of those spices that asks to be accompanied by salt.  And I don’t like an overpowering cumin flavor.  So I cut that down a bit.  I went much bigger on the cinnamon, and ran with the theme of spices you would normally think of when baking Thanksgiving desserts.  I upped the chili powder, played with the oregano proportions, and generously added some other goodies from my baking/spice cabinet that brought an exquisite depth and complexity to the dish.  Some of my culinary creations are decidedly mediocre, but I put all modesty aside when talking about my chili.  It rocks.

I have very few secrets, but at this point in time I still don’t share my recipe.  I think the main reason is that by keeping it to myself, if someone is in the mood for it they have to see me and spend time with me – it keeps me needed (but don’t worry – my family knows where it’s written down, so if I die the chili will live on).  So if you’re feeding people this Sunday, try making a pot of “liquid gold,” as my husband and kids call it.  Open your spice jars, hold different jars next to one another, smell the combinations, see what speaks to you, and go for it.  Don’t be timid when you add the flavors – chili is not a subtle dish.  And next post, I’ll give you my cornbread recipe – it goes great with the chili.

Response to Critique of Chapter 1 of “Your Hospital Guide”

I have to admit, I love receiving positive feedback.  It makes me feel like I’m on the right track, doing the right thing, being helpful, etc..  But the concerns and suggestions I receive help me to improve at a much quicker pace, propelling me to better communicate my thoughts.  A non-perfect critique prompts me to re-evaluate and re-think things in a more intense way than just re-reading my own words and listening to any kudos that have been tossed my way.

I received a phone call yesterday afternoon from a close family friend who is a retired Ob/Gyn physician.  This man is a remarkable doctor, beloved by his patients, and he managed single-handedly from halfway across the country to keep me sane through a significant scare during my pregnancy with my third child.  I have the utmost respect for him both personally and clinically.  When he started the phone conversation with “I’ve been reading your blog, and I want to talk to you about something you’ve written in your book’s first chapter,” I listened very closely.

His concern was specifically, “Don’t allow perfection to be the enemy of the good.”  He agreed that having someone with you in the hospital is extremely important, but is afraid that people will read my advice to have someone there at all times and if they are not able to do so, may give up on the idea of a Hospital Buddy completely, or not understand the most important anticipated times to have someone there.  Some of those most important times include when a person is medically unstable, when someone is having surgery or is post-surgery, when procedures are being done, and when medical teams are rounding.  And I am extrapolating from his concern to think that after taking to heart my advice, perhaps someone might avoid going to a hospital when needed because they do not have someone to go with them.

So as I do my final edits of my book, I will work in the above thoughts.  However, I am going to have to take my seatbelt analogy a bit further here as I work in those thoughts.   I don’t want to water down the force behind my original exhortation to try whenever possible to have round-the-clock Hospital Buddy presence.

You are most likely to be involved in a motor vehicle collision when you are in an intersection.  Certain intersections have statistically higher rates of collisions.  Collisions happen more frequently in icy conditions.  If you had a finite number of seatbelt hours, you would make sure to buckle up on an icy day while driving on a two-lane country road without shoulders.  You would buckle up when going through the intersections in which accidents were most frequently featured on the evening news, and try to click your belt through most intersections in general.

This may end up providing you with enough protection.  It is certainly better than never wearing your belt.  Problem is, depending on your speed, road conditions, and general traffic patterns, you may hit intersections at times that differ from what you had anticipated, and you’ve got your belt on too early or too late to cover the actual crossing.  It doesn’t account for the metal trash can that blows into the road in front of you, the car door that opens into traffic, the oil slick on a clear day, or the wasp that flies into the car.

So the best thing to do is to have your seatbelt on at all times, and you should do whatever you can to do so.  When you have only limited seatbelt time, you should try to have it coincide with your statistically most hazardous driving time.  And when you have to drive somewhere because you are fleeing from immediate danger, and the car does not have seatbelts, you should drive anyway, keep as alert as possible, and accept the potential risk.

If you are on a business trip in a city where you don’t know anyone, and you develop appendicitis or have a heart attack, don’t avoid or delay going to the hospital because your wife isn’t with you.  But your wife or brother-in-law or friend should drive into town as soon as possible to join you.  If you break a hip and have hip replacement surgery planned for tomorrow and your sister is only available to be with you for 24 hours, have her come in for the surgery and the time immediately following.  But if you can think of a friend who might be able to be with you until then, and someone to be with you after your sister leaves and at the time you’re discharged home, call them.  And when you have an elective, non-urgent surgery, test, or procedure coming up, plan it during a time when people will be able to be there with you.

Please keep your comments, feedback and questions coming!  I appreciate all of them immensely.  And Dr. Ronnie, how do you feel about my sending you my full manuscript this week for a second opinion?

“Your Hospital Guide” Part 5 (of 5) of Chapter 1 (Always Have Someone with You in the Hospital)

Choosing your Hospital Buddy/Buddies:

Who should be your Hospital Buddy?  You should be accompanied by someone you trust to take accurate notes for you, someone who will speak up for you and question people when necessary, and who is able to put up with you when you are in a less-than-perfect-health-induced crabby mood.  It should be someone with whom you are comfortable sharing medical information.  It also should be someone with whom you have discussed your general medical goals and wishes, including what you would want done in a life-threatening emergency (if this person is not your legal medical proxy (someone to whom you have given the legal authority to speak for you in a medical situation if you are incapacitated), he must know who your legal medical proxy is and how to reach that person).  This person could be a spouse, partner, family member, friend, or a hired Hospital Buddy (there are private nurses available for hire, as well as trained non-nurse hospital companions who can especially be helpful overnight).

It is tiring, both physically and emotionally, for someone to be your Hospital Buddy.  Therefore, you might want to line up a few people, if possible.  This will enable people to take turns, so that everyone has a chance to get home (or to a local hotel) to shower (guests are not allowed to use patient showers), sleep, and attend to any other urgent matters.  If the hospital stay is only for a couple of days, then one person should generally be adequate.  If the hospital stay stretches beyond two or three days, it helps to call in the reinforcements, even if only for a few hours each day or a few overnight shifts.

When people to whom you are not close enough to ask them to be your Hospital Buddy ask what they can do to help, request that they help hold things together at home.  If your Hospital Buddy is your spouse or someone else you live with, ask a neighbor to take in your mail and take care of your pets.  If you have young children, have a friend, family member, or trusted adult babysitter stay with them so that your spouse can be with you.  Other help-offerers can be asked to bring dinner the first few nights you’re back in your house.  The more people you allow to help you, the less pressure you’ll feel like you’re putting on any one person.

“Your Hospital Guide” Part 4 (of 5) of Chapter 1 (Always Have Someone with You in the Hospital)

My hospital has specific visiting hours.  Won’t the nurses kick my Hospital Buddy out?

What about visiting hours?  In general, most nurses are lenient about allowing people to stay beyond designated visiting hours, provided visitors are quiet and considerate of roommates.  With resistant hospital personnel, your best bet is generally a calm, well described explanation of how your/your Hospital Buddy’s presence is actually assisting the nursing staff (help with keeping the person comfortable, assistance with getting to the bathroom, bringing a person water, general psychological support, help remembering details when communicating with doctors, etc.).  Getting permission from your doctor is also extremely helpful, as it can help avoid objections from a later shift of hospital staff who might not be familiar with your Hospital Buddy system.

It is much simpler to have a companion stay overnight when there are private patient rooms.  In a private room, there is generally more space for a convertible chair or a cot.  When there is a roommate in the picture, there can occasionally be resistance from a roommate’s family or from nursing staff to overnight Hospital Buddies, and this is best dealt with ahead of time, with permission from your attending physician.  Make sure you address the hospital staff’s concerns (e.g. you will keep noise levels low, you will respect a roommate’s privacy, you will keep the cot/sleeping chair as out-of-the-way as possible), be as polite as possible to the hospital staff, and remember to thank them for accommodating your request.

Why is it even an issue to have someone stay overnight?  And why are there ever limits on visiting hours?

When you understand the objections to overnight visitors, and the reasoning behind visiting restrictions in general, you can easily address any concerns, and are much more likely to obtain the permission that you require.

The short answer to why you need to argue for overnight stay permission is that the hospital is trying to ensure a restful environment for all its patients, and visiting hours tend to be noisier than other times.  However, it is more complicated than that.  The information in the later chapters of this guide (in the section describing “The Places,” which is currently slated to be Section 4, but that could change) will help you to understand many of the factors that play into how a hospital functions, and you will be able to use this knowledge to advocate effectively.