

The Woman Who Needed to Be Upside-Down - danso
http://discovermagazine.com/2012/jul-aug/06-vital-signs-woman-needed-upside-down

======
powertower
This sounds a lot like the occasional support request that comes in to me....

At first it's dis-believable and impossible, and you think the person is
crazy, but after "troubleshooting" something rational pops up.

I can't tell you how many times this has happened. But it really doesn't help
having a product/service that manages (on Windows) an underlining system of
Virtual Hosts, dozens of configuration files, Apache, PHP, and MySQL, and a
bunch of other software and tools
(<http://www.devside.net/server/webdeveloper>).

~~~
pavel_lishin
It very much reminds me of one time when I had a spare screw that had fallen
behind the motherboard, in the case.

Every once in awhile, I'd bump my desk and the computer would shut down, and
wouldn't boot until I thumped it. ("Russian components, American components,
ALL MADE IN TAIWAN!")

Completely baffled me until I was upgrading something with a friend, and he
found the little guy rattling around.

~~~
mikeash
My favorite example of this was a user who wrote to me about audio streaming
software that he could use with classical music, but that disconnected when
used to stream rock and roll.

After a great deal of highly baffling troubleshooting, I finally figured it
out. The streaming software sent the music over UDP, where each packet
contained a pre-set amount of audio encoded with a lossless codec. Classical
compresses better than rock, so it generated smaller UDP packets. The guy had
somehow managed to set the MTU of his LAN interface to 1200 bytes, and the
software was using IPv6, which doesn't do IP-level fragmentation when the MTU
is below 1280 bytes.

When playing classical music, every audio packet was less than 1200 bytes.
When playing rock, an occasional packet would not compress well and end up too
large, then fail to send. The software would then abort the connection in
response to the error.

~~~
greatquux
Wow, that is absolutely insane. You get major kudos for going to all that
trouble to find out the answer to that one.

~~~
lsh
Agreed - you are my hero for today.

------
tokenizer
This was a great story, and really demonstrates the value of being calm and
accessing a situation. This could have easily turned into a worse situation
had the doctors forced the man to drop his wife and then examine the
situation.

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raldi
It's like the medical version of the 500-mile email.

~~~
sateesh
In similar vein here is a case of the programmer who couldn't login to his
system when he entered password standing up. <http://netlib.bell-
labs.com/cm/cs/pearls/sec0510.html>

~~~
lelandbatey
Now that is an interesting story, and one I've never seen before. I'll have to
keep that in my back pocket.

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kevinconroy
Good to remember the next time you get a bug report from a user. Perhaps your
system really isn't as perfect as you think it is.

~~~
arkitaip
Truly. The story reminds me of all the times I've coded and stumble upon a bug
that simply shouldn't happen because it defies logic. It usually takes a nap
or re-write to realize the impossible bug was a minor typo.

~~~
robgough
The worst are when you spot a bug that means the functionality should never
have worked in the first place, yet somehow has been working fine in
production for years. I really rather hate those ones.

~~~
mindcrime
"Hate" isn't even a strong enough word for how I feel when that happens. The
cognitive dissonance is so strong and discomforting that I don't even have a
word for it. I mean, there you are, looking at a bit of code that absolutely,
totally, _could not possibly work_ , and yet you know that it has been
working. When I encounter that, I suspect I feel something like what the
characters in H.P. Lovecraft stories[1] feel when they come face to face with
some terrible, grotesque, eldritch being that _could not possibly exist._

Iä! Iä! Cthulhu Fhtagn! Ph'nglui mglw'nafh Cthulhu R'lyeh wgah'nagl fhtagn!

[1]: <http://en.wikipedia.org/wiki/Cthulhu_Mythos>

~~~
mchahn
Whenever this happens I am tempted to "debug" the non-problem but I know it
would be a waste of time to find out why something worked. Drives me crazy.

------
Jun8
IDEABOLT: Create a central repository of interesting cases and diagnoses, with
a super intuitive UI, make it freely available to _all_ MDs in the world to
fill up and consult, sort of like the github for doctors.

You can make money by being the intermediary to find subjects for experiments,
e.g. "For a study we are looking for identical twins who cannot see from birth
but now one has restored vision where the other does not".

Does something that looks remotely similar exist?

~~~
colomon
I've been thinking about this for a while, in more general terms. Last year I
had an issue with my eye. I bumped around from doctor to doctor (including one
eye specialist) for nine months, for at least half of that period on two
different antibiotics and a ten minute a day eye cleaning ritual. Finally when
nothing seemed to be working I was bumped up to an eye doctor at a bigger
hospital two hours away. Within a minute of seeing me, he had a diagnosis. It
involved no medicine at all, cleared up the problem within 48 hours, and still
seems to be working fine nearly ten months later.

My thinking is that a properly programed medical diagnosis expert system
probably could have figured out the issue by the second or third trip to the
doctor. Further, my guess is that a nurse who has been properly trained to use
such a system would be at least as accurate as your average doctor.

Unfortunately, my next guess is that any such system would be opposed by the
medical establishment and quickly sued into non-existence by patients it made
mistakes on (even if the rate of such mistakes was significantly below that of
normal doctors).

~~~
rksprst
You're right physicians as a rule generally dislike software like that (partly
because of their egos and distrust of software and partly because of job
security). There are so many edge cases and so many examples physicians could
give you of the AI/computer being wrong. A simple example is that any software
will need input regarding the patient's history, his/her vitals. Right now
heart rate data in ICUs is fed every second to storage systems. Let's say the
this is a NICU and the baby's heart rate is suddenly elevated to extreme
levels. The software would assume that something is wrong with the baby, when
in reality a nurse is simply taking a blood sample and the baby started
crying, being agitated by the nurse/needle. There are a lot of examples like
this, it's a non-trivial problem to build use machine learning to take all of
these factors into account to produce a diagnosis/treatment/intervention plan.

I was recently at a medical/technology conference and the physicians in
attendance were all actually in support of moving to using machine learning/AI
(selection bias though, that was what the conference was about). They would
rather have a machine with a 5% error rate than a human with 20% error rate.
They believe that the role of physicians is going to change and become more of
a management role as technology catches up.

~~~
colomon
Sounds like the mother of all selection bias, but still this makes me hopeful!

------
mynegation
As a big fan of House MD and a software engineer I have always been wondering
how often doctors turn to the web to look up strange cases, or is there a
benefit in creating a better structured and curated site specifically for
that? I guess WebMD is this kind of site, but could someone knowledgeable in
medical practice share the thoughts on that?

Granted, once I knew she was on pacemaker, I figured that this has something
to do with electrical connectivity. But then again, may be this is consequence
of my poor soldering skills and watching too much of House MD.

~~~
lesterbuck
A few months after IBM's Watson won Jeopardy, the IBM Research team came to
the Texas Medical Center in Houston for a dog and pony show about its
possibilities for health care. They presented for two hours to an auditorium
of a hundred doctors and administrators from TMC, one of the premiere medical
communities in the world. From a technical point of view, it was pretty
impressive what Watson can do, reading everything, never forgetting, assigning
weights to knowledge over time, able to explain where it got an answer. But
when the time came for the doctors to respond ... ouch! One male doctor said
"I already have access to a $500,000 decision support system and I don't use
that. Why would I start using your stuff?" Another woman cardiologist said she
could see using Watson on about ten percent of her office appointments, but
she had a hard time seeing how to integrate it and not be slowed down for the
other 90% where it was unnecessary. Doctors are a tough crowd.

The Ruby Rogues podcast had Conrad Barski, author of Land of Lisp, a while
ago:

[http://rubyrogues.com/043-rr-book-club-land-of-list-with-
con...](http://rubyrogues.com/043-rr-book-club-land-of-list-with-conrad-
barski/)

Barski is a medical doctor who gave up medicine to code. He explained how it
just didn't fit the medical culture to be interested in thinking deeply about
an interesting problem, House MD not withstanding. Medical training is
designed to give real time answers to presented problems, and it is, er...,
'highly discouraged' to tell a patient "That's an interesting case you have
there. I'm going to go google that tonight and I'll have more information in
the morning."

~~~
sp332
When I was young enough to be in pediatrics, my doctor once pulled out a
pocket-sized electronic device and keyed in my symptoms. The result it
suggested matched his guess, but it was unusual enough he was reassured to
have a second opinion :)

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mbubb
Reminds me of a children's joke - which i didn't even think was funny at the
time - but enjoyed anyway:

"Dr, Dr! Every time I drink a cup of coffee, I get a stabbing pain in my right
eye..."

(google it if you don't remember)

Exhibits, the same kind of ability to see the whole situation and make a
diagnosis

------
gizmogwai
Disclaimer: I worked as software engineer for a CRM device company.

From what I learned during my medical training, this king of issue is not so
uncommon, but it is usually diagnosed very easily. Her peacemaker can be
disabled using a simple magnet. This is a common test in nearly all protocol
to check how the heart is working without the help of the device. Doing this
simple test while upside-down would have shown that the paecemaker was
effectively working in that position. That should have be enough to ring a
bell to most of the cardiologists.

------
duwease
I just keep wondering why he was picking her up by the ankles in the first
place..

~~~
quantumstate
It someone is feeling faint it is standard practice to lower their head to
increase blood flow to the brain. Presumably her husband knew this. I felt
faint after donating blood recently (I have low blood pressure) and they have
a standard piece of foam to lift your legs up while lying on a bed.

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criswell
I had a feeling she just had a screw loose.

~~~
corin_
She's pretty talented if her craziness can cause a heart monitor to indicate
that her pacemaker has stopped working.

~~~
shawabawa3
The joke was that the problem was a screw loose in the pacemaker...

~~~
corin_
Can't believe how far that went over my head.

~~~
fghh45sdfhr3
It was a crappy reddit style joke , and I hope it gets down voted.

~~~
MattSayar
It was funny, and I don't regret reading it, but I regret reading it here.

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akg
How did they get her to the hospital if she needed to be upside-down the
entire time?

~~~
tkahn6
She probably 'sat' with her back resting against the bottom of the seat and
her legs around the headrest.

~~~
danielweber
I had no idea "Mork & Mindy" was a documentary.

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Dinoguy1000
No comment on the overall story, but as soon as I heard the description of the
man carrying her, and he said "I'm her husband", my thought was Izumi Curtis
and her husband Sig. =D

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kang
Sorry, but I couldn't resist mentioning House. One of the episodes had similar
situations. <http://en.wikipedia.org/wiki/Dont_Ever_Change_(House)>

Since in there they say patient has "Nephroptosis, also known as 'Floating
Kidney'", which is a listed medical condition, conditions like OP should not
be uncommon.

~~~
danbee
Correct link: <http://en.wikipedia.org/wiki/Don%27t_Ever_Change_(House)>

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vinutheraj
Great story. But I wonder what would have happened if she was not five feet
and him seven feet tall !

~~~
tsotha
I was wondering about her husband. She's 60 years old, so he's presumably in
the same age range. How many 60 year old guys, even big guys, have the
strength to carry a full grown woman around by her ankles for a half hour?

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alliemobley
This is the sweetest story I have ever heard in my life!

------
scrumper
People who enjoyed this story will love a book by neurologist Oliver Sachs
called "The Man who Mistook his Wife for a Cat."

