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My Sudden Trip to Hell (linkedin.com)
273 points by EvilTrout 63 days ago | hide | past | web | favorite | 151 comments

Stoics would encourage all of us to internalize our own mortality, not for morbidity’s sake, but because it helps live in the moment. The wake up call stories like this should be simulated by everyone. Imagine if this were you? Live with a fraction of that pain in your heart and try to internalize it. How does it impact our choices? Things like fingers and walking become amazing. I am always happy people share their stories, it helps us all remember our mortality and make good choices every day. Also, I wish the author a speedy and continued recovery in their journey.

People may be interested in Stephen's Colbert on the topic (video):

> That might be why you don't see me as someone angry and working out my demons onstage. It's that I love the thing that I most wish had not happened.

* https://twitter.com/AC360/status/1162183695270387712

Cooper was reading from a GQ interview:

* https://www.gq.com/story/stephen-colbert-gq-cover-story

Colbert was quoting Tolkien.

> I am always happy people share their stories, it helps us all remember our mortality and make good choices every day.

Not for me. When confronted to death or intense pain, everything else becomes insignificant and futile. And when things go back to normal, I tend to forget. I suppose that to be fully functional human beings, we need to ignore the harsh reality of life! Is it really possible to "internalize mortality"? I know some people try very hard but are they immune to anxiety and daily worries, are they happier? I haven't met such a person yet.

Do you stop yourself short?

Honestly answer. Do you face death all the way? Does the immense pain dissipate, and similar thoughts had with no pain attached?

There is gold in the ashes. It is up for the individual to identify.

Death is painful and dreadful. Anxiety ridden. Everyone feels it when contemplating death. Like the Mideveal ages everyone should walk around with a golden jeweled skull.

We plan for life, never for death. Find in the saddest moments, the hardest moments, the beauty the light gives you.

For in death, there are no answers that pertain to life just as life has no answers that pertain to death.

You may have control over living this life, but only if you fully see the beauty that death allows in life.

Don’t let the anxiety stop you.

Darkness, surrounding and surmounting, where no self exists, life boundlessly feeding into the ether and the ether boundlessly feeding into life.

A process of forget, death, decay, growth and born. Where the process is outside all of that.

The process that persists yet you go away.

Think about that darkness there, that scary insurmountable darkness of the persisting process. The persisting process that if it had awareness and wanted to undergo death and growth it could not, yet you are bounded by this process. To always grow and die, either eternally forever or one time in the whole of forever. Both time being a perfect circle and a straight line, you being the one point for all of that eternity.

To be reprised or forgotten about forever.

Darkness shattering.

The paralyzing will, if fostered, cared for, can exhume paralyization and can find a dark addicting taste for the affinity of the unknowable.

Me too.

After every near miss, it takes me a while to trick myself into rejoining the world of the living, where paying rent and doing laundry matters.

Being a geek has been an asset. I can lose myself in solving problems. Focusing on those thoughts to push aside the other thoughts.

This current cycle, I got a puppy. Total pain in the ass. But he still needs to be walked, so I get up and we walk. Rinse, lather, repeat.

I think it comes down to the dichotomy of being human. We have this inevitable end that we know is waiting for us, but we are alive, dammit. For many on HN, that life is full of curiosity, so many things to learn, and so much cool stuff to do and see. Especially for younger people who have not experienced much grief or loss, contemplating this end is especially jarring compared to the vibrancy of life. For others it can be very morbid and bring back bad memories and induce anxiety. I think, ultimately, we should embrace our sometimes unpredictable end and become comfortable with the idea of our end to better celebrate our own lives as we live them. I do think Stoicism is not for everyone and some people just naturally develop a very stoic mindset. Ultimately, a lot of it comes down to controlling what we can and simply accepting the rest as our lot in life as humans (the living and the dying).

An elegant reminder, thank you.

Part of me thinks this person's job is complete.

He started an idea, developed, and has a team to continue it.

He did his role.

What is next for him? Hopefully he has enough money to live without working. Then he can put his efforts into himself.

Well there's no way he gave up his entire stake in the company. I would assume he continues on as part of the board, or at least an advisory role.

> and I would be fully present for all the moments that mattered.

This quote stood out, because as a promise to your family, it really sucks. We never know what the moments that matter to other people are going to be. Big events are nice. But when you think back on your life, how many important moments were from small events? Just having a nice talk, doing a chore with your dad, telling your mom about your day? How many idle comments from friends ended up having a large impact on you?

When dealing with family, you need to be there enough that moments happen, because the scope of their impact on the lives of those around you are not predictable.

On of the things my wife insisted on was that we always got together as a family for dinner. That definitely had a negative impact on my career in that I couldn't be the 'last guy to leave', but it gave me a solid relationship with my kids as they grew. I am glad to this day that she insisted.

Agreed. I hardly ever see my daughter in the morning but make sure that 99% of the time I'm home in time to put her to bed and read a story (she's 8), often it's at bedtime that any worries come out, and I'm so glad I'm able to be there to listen.

If you are a founder/CEO type, you are missing the important events, period. I don't care what your Facebook/Insta/LinkedIn says. On your deathbed, all your success wont buy you another second with your children.

I'm fine with people sacrificing for their work, but don't try to sell the "I'm doing it all" crap.

I was going to say “I recall when I had sepsis in my teens”, but the truth of it is that I don’t - there’s a six week hole in my memory, that skips straight from lying in a pool of blood and puss on the floor of the kitchen at school, having a mop thrust in my face, to lying in a bed in hospital with tubes snaking out of me.

The weird thing is, despite being unconscious for over a month, I woke up feeling like I hadn’t missed anything, and even now I look back at this with slight disbelief - surely you’re thinking of someone else, surely it wasn’t that long. I felt like I’d been out longer after a general for surgery a few years ago.

They did run a whole battery of neurological tests on me once I was conscious and eating - they were pretty surprised I had no obvious brain damage - I had maintained a fever over 108 for several days, despite ice baths and the, what, 20g of daily antibiotics? I do wonder if there was some, but rather more subtle than what was being looked for.

Re-integrating was weird. For everyone else I’d been as good as dead - they’d seen me carted off in an ambulance, and then a few weeks later term had ended. I on the other hand basically went straight from the end of one school term to the beginning of the next with zero intervening time, and nobody could figure out why I was pissed off. They kept asking me about what had happened - and I answered honestly that they probably knew more than I did.

It also sucked that I had no soft landing back into classes, and in the time I’d been unconscious they’d started calculus - I came back and had to differentiate and integrate and had no frigging idea what I was actually doing - I remember sitting in an A-level maths exam a year later and finally having the revelation that it was about curves and rates of change.

All this because I had what looked like a zit on my knee. It grew until I couldn’t fit trousers over my leg, school offered me a sticking plaster, and said I wasn’t getting out of sport that easily. Then my leg opened up one night fetching water in the kitchen, and I lost consciousness. I’ll never forget the sight of custard in crude oil swirling over the linoleum - perhaps that’s one side effect of the coma - my last conscious moment is vivid in the extreme.

Anyway, that brush with death didn’t change my outlook one bit, but then again I was an invincible 16 year old. The ones since then have definitely left their mark.

it sounds like it was the schools duty to get you medical attention far sooner and they failed.

Yeah, the house’s matron was fired over it - and it transpired that she’d lied on her CV about her experience and qualifications - something that seemed to happen with alarming frequency at the school.

Wow - when I read that article and your experience my brush with sepsis seems quite tame.

I went from feeling fine to I might need a repeat prescription, to having to get a taxi home.

The next day I ended up doing an end run around A&E and went from the lower risk renal ward to the high risk to the ic ward and spent two weeks in Lister.

I am surprised that the US hospital didn't recognise it though - senior Nephrologist who saw me after said its "bloody easy to diagnose"

And yes I did get a blocking for not calling 999 (911) when it happened

> It grew until I couldn’t fit trousers over my leg

Good lord, your school let the thing grow on you without sending you to the doctor!? That's unbelievable negligence!

Oh, my entire leg inflated from the knee down - ended up thicker than my thigh and was agonising to touch.

Negligence was kinda the name of the game at British boarding schools until the late 90’s, and probably still is - “the parents will never believe it” works 99% of the time.

My sister was at a boarding school just 3 years ago and exactly this happened when she broke her ankle - the school nurse told her to get some paracetamol and sleep it off. After seeing the picture of it I had to ring them up, demand that someone take her to the hospital for an x-ray, and they of course sent us an invoice for £50 for "transport to the hospital" anyway. Nothing happened to the nurse even though I complained higher up as far as I know.

If the nurse was a registered nurse you could complain to the NMC.

There's a push to protect the title of "nurse" in England, rather than "registered nurse".

Possibly, I just didn't know this was an option at the time, I only complained with the school. And I really have neither the strength nor the conviction to do it now, it's water under the bridge as they say.

> and the, what, 20g of daily antibiotics

20,000mg, am I reading that right? According to my non-medical background that's a shitload of drugs. Good to be reading this knowing you came out of it ok.

It's probably right, I had a strep B osteomyelitis when I was in my late teens and at one point was on a 2g/hr IV antibiotic IIRC.

for some reason I assumed that he would write about how this trauma would give him a new perspective on what was really important in life, but at the end it sounded like the experience didn’t really change his perspective on desiring to work all the time on his startup and that he was only stepping down because he couldn’t perform 100% and not because this experience changed anything about how he prioritized work/career?

I agree. I find it heartbreaking that the brightest minds of our generation are working on better ways to get spam into people's mailboxes. He more or less worked himself to death just to "enable our customers to deliver a highly responsive, on-demand experience with their marketing and their content."

Surely the world would be better off without further optimising targeted spam.

Read again: he writes that he decided to prioritize his family over work before all of that happened.

He was clearly lying to himself.

If your job is consuming all of your mental space, which is clearly the mindset he describes in the article, there is none left for your family.

I read this as him sharing this painful experience he had with us, but spinning it to show how devoted to his work he has been.

Maybe this is simply because anything I read on LinkedIn gives me that feeling.

A high temperature like 104, combined with pain, definitely warrants a doctor visit. Which doctor (GP, urgent care, ER/A&E)? Let the time, day, and how you feel be your guide.

In the case of one of my relatives, the result was confirmation they had the flu (and too late for Tamiflu or the like to be effective). In my case, it was intestinal perforation that (six months later) led to part of my large intestine being taken out.

Big congrats to this guy for getting through it.

Considering the bills for a condition like this, I'd be wondering if it's even worth it to go to the doctor. My life isn't worth the destitution visited on everyone I know necessary to keep me alive, and I can't imagine the moral calculus his family had to go through.

I'm glad this guy could get the care needed to survive, and I wish him the very best in his recovery.

He's Canadian I believe; so while I'm not sure how his care in NYC would be billed, I think it would be still covered by OHIP (the public health insurance in Ontario Canada) or maybe travel insurance.

Certainly all the care he received in Toronto would have been covered, assuming he's Canadian.

Don't want to spark a healthcare debate, but want to mention that I bet NONE of the non-US readers on HN would have given a single thought about the costs involved if this was happening in their countries.

It's wild to me that the potential financial impact of this was part of the picture for many of the US people reading it (especially the startup founders who are probably without insurance right now, and this would leave absolutely financially ruined for life).

I am from Europe and I can confirm that nobody would even consider the "costs involved". It's just not something you think about.

I am puzzled by why the richest nation in the world prefers to spend 3.1 billions of dollars on arming Israel, or spend $700 billion military budget (even though its territory isn't being threatened in any way), rather than provide universal healtcare and education to its citizens, who live in fear of becoming sick.

I mean, I can understand why if you own a military supplier company, you'd rather have it that way. But I don't get why voters do not want universal healthcare.

It's a cultural thing. Americans, by and large, hate other Americans. The idea that someone else is getting something "they didn't earn" induces rage in the American brain. This is why you see people willing to spend $10 to avoid accidentally giving $1 to a welfare recipient who "doesn't deserve it" in their eyes.

Was this attitude common even before the civil rights act of 1964, despite the confederation?

Last poll I checked, universal healthcare is supported by over 70% of Americans. We want it. We don't have a democracy to get it. It's that simple. A country where the person who gets the most votes doesn't win is not a democracy. And that's just the start of why it's not.

> even though its territory isn't being threatened in any way

It isn't threatened because of its powerful military; also why Europeans can spend all that money on healthcare instead of defense: a benevolent democracy to provide safety. Not to mention it stokes the richest economy and innovation.

Nothing is for free so benevolence is out of the question.

Payment comes in many forms. When a dictator on the other side of the world needs a "democracy" shot, or a country needs some additional sanctions for national security, the fact that European countries offer support makes the difference between greed/aggression and a "righteousness".

A surgeon gets paid to cure my illness ... therefore he can't be kind or have good will toward me? How about a non-volunteer firefighter risking his life?

Benevolence is performing kind, charitable acts, from a desire to do good. It implies that you do not ask or expect payment in return. And it would intrinsically apply to people, not countries. A fireman might help you regardless of being paid or anything other than the desire to do good. But international diplomacy and politics leave no room for benevolence.

You're saying all the US leadership chain (the people with the authority so decide strategy) agreed to spend billions extra just as a charitable act for another continent. The only way I can take the best interpretation of this is to assume you're joking.

Benevolence does not imply anything about payment, but the interest in another's well-being.


> It isn't threatened because of its powerful military

Seriously? You'd expect an invasion from Canada, or Mexico?

I am not against a powerful military, but it seems the US has gone way beyond that and mostly projects its force around the world, with poor results to show for everyone including the US.

You’ll find the US already spends comparably per capita. They just get much less for the money.

Nope. I'm in Australia and enduring a living hell due to not being able to afford medical (dental) treatment. Affordable healthcare is not a problem that is exclusive to the US.

> Don't want to spark a healthcare debate, but want to mention that I bet NONE of the non-US readers on HN would have given a single thought about the costs involved if this was happening in their countries.

UK, and I wouldn't think about it - it's just not a consideration.

I will caveat that by saying dental care is not free[1], but the prices are reasonable - maximum charge £270 (for a single course of treatment and anything within two months of it, for treatments such as bridges, crowns, and denatures), and "If you require urgent care, you'll pay a Band 1 charge of £22.70."/ "There's no dental charge [...] if your dentist has to stop blood loss".

[1] unless you receive certain benefits

Before the ACA, I contracted, and only carried catastrophic coverage on myself. I had no coverage until my yearly bills reached $5k, but that was also my max out of pocket. My insurance ran $63/month - which was ridiculously cheap and the worst I could ever be "ruined" was $5k.

Keep in mind I live in the backwoods of a small state in the US and could have a catscan in an hour, an MRI tomorrow, would likely only wait 15-45 minutes at an ER, had access to proton cancer treatment years before a single person in Europe had it, and was covered by MD Anderson, the top rated cancer treatment center in the world.

The extra money the US pays into healthcare isn't all for naught.

I have told my story over and over so anyone truly interested can look in my history as I won't write it all again, but I lost my life due to America's system and have sunk further as an ironic consequence of only having access to it. Every time these topics come up I see people defending it or making claims that are simply false.

ACA was a horrible compromise because the right would not allow proper Universal Healthcare. In my state, as in many, there is a gap where you can be denied a subsidized ACA plan and Medicaid. I fall in that gap and get nothing but the privilege of buying a full priced ACA, poor coverage, plan for something like 7-800usd a month plus something like 6000usd yearly deductible plus the multi thousand coverage floor you mentioned. All of which is impossible for me. I did things right. I had a significant savings when this happened, spent most all of it on this stuff, I have a few hundred a month pension I was lucky to have, it doesn't cover my needs, I have no insurance or benefits. I was denied disability. This is America.

Someone else below also brought out the "I know lots of people from Europe who come to the USA for superior healthcare" line as well. I lived in Europe and never met or heard of a single person who did this. It surely happens. But its not "lots" nor proof of some superiority.

I recently got another diagnosis after having to really fight and spend a lot because the system is so broken. The 3-5min you get and insane costs for everything hinders care. I was already on the edge as my history points to...and have been trying desperately to move back to Europe where its not perfect, but even in the paid, private system I would have access to for the first years I can get far superior care to here for less. But the hits just keep coming and I don't see making it anywhere now. I wish people would care about others and how this system hurts them, rather than their politics. I will lose my life because of politics I never chose to be born into and that have continually reduced my quality of life. I just cannot understand why people continually deny this is the case and fight against that which helps all of us. I have mostly passed anger and am in intense disappointment on the issue. I just want to live. I am not allowed to.

That's great as long as the insurance company deigns to cover you. Before the ACA, that was not guaranteed.

Universal Healthcare is generally only a thing in Canada and the EU. It's great if you need to wait a few months to see a doctor, but I know plenty of Canadians and Europeans who come to the US for medical care so they don't have to wait.

Not Europeans — while you might have to wait for non-emergency things (depending on the country), emergencies are treated immediately. And I've never heard of anyone from the EU going to the US for medical care, that actually sounds rather amusing :-)

> And I've never heard of anyone from the EU going to the US for medical care

It definitely happens, especially for things like plastic and reconstructive surgery.

I don't know how it is in Europe, but those sorts of things are not typically covered by insurance in the US, except in cases where the reconstruction is related to a medical condition or accident (I got a nicer nose after breaking the original in a bicycling accident; the reconstruction was covered by health insurance). I assume those coming from EU to US for treatment would be self-pay for the treatment, yes?

I have no idea how payment would be arranged. It's possible that if a country's national plan covers something but no providers are in-country, they would cover the cost.

Some hospitals in the US are free for everybody (some research hospitals and hospitals for sick kids) and I assume that would extend to Europeans.

It may not be perfect, but if I had to choose between having to wait weeks or months for non-emergency care, and risking financial ruin and unnecessary death if I come down with a drastic disease, the choice seems clear.

If you need emergency care, you don't have to wait (UK). My grandfather had a fall recently where he hit his head, and had a brain CT within two hours (he fell about 1am; he was admitted, assessed, treated, and discharged by 6am). A family member had an urgent referral for a mammogram last Thursday, and was assessed and given the results today.

Routine GPs appointments can generally be gotten within a week, and emergency[1] appointments (where we wait until the GP is done at the end of the surgery, and are then seen) if the triage nurse determines you need to be seen sooner can be gotten on the day. You also have the option of speaking to your local pharmacist, many of whom can prescribe medication for certain conditions if appropriate, or otherwise point you at suitable over-the-counter primary care.

A number of places also have walk-in centres for minor ailments where you don't need an appointment, and they generally have long opening hours (8am-10pm, 365 days a year for my local one). Urgent dental care is also available 24/7 in many places.

You may have to wait longer for non-emergency / non-priority / time-insensitive treatments - my routine MRIs have a lead time of about 8 weeks, and a specialist referral can be something in the region of 6-12 weeks (sometimes longer) - but I think that's a fair trade off. You do of course also have the option of paying for private care as well if you don't want to wait (often NHS doctors / semi-retired doctors working evenings in my limited experience).

[1] bit of a misnomer really - urgent but not critical is more accurate

If you have a condition now you will be seen the same day even if it's not an emergency. I had a high fever for a couple of weeks and finally decided to see a GP - got an appointment in 2 hours of the call to the surgery, GP told me to go to the ambulatory care department at the nearest hospital(nothing to do with emergency care there) and I was admitted and seen pretty much within an hour of arriving. Spent several days over the next month in and out of the hospital, had some treatments done = no bill was ever produced.

Also when my wife had to get an MRI done going private wasn't that much quicker than NHS - you still had to wait a couple weeks through her private health insurance at work.

My wait for a routine MRI is about 2 hours....

My wait for a specialist referral is 2-3 days and any delay is usually on my end.

There are just some things the US healthcare system accidentally does much better than Europe.

So you want to tell me that from the point when you ring your healtcare provider saying "I want to get an MRI done", to you lying down on the table being scanned the time is around 2 hours?

I'm Dutch, and I've never had to wait for more than a week to see my GP. Never more than a month for a procedure.

Additionally, when I lived in the US, we got a special Dutch health insurance plan for temporary expats. They sent us a letter that if one of us ever had to go to the hospital, they'd fly them over to the Netherlands unless the situation required immediate attention.

I live in the midwest and it takes me about a month to get an appt with my GP. If I want to see an NP, and block out about 4 hours to sit in the office, I can be seen that week, usually.

not really, in most EU countries you don't wait for emergency problems

That doesn't describe the experiences of any of my former EU co-workers. (They're still in the EU, just not coworkers any more.)


Wasn't intended to be a jab... just a reflection on my own reaction reading it. Up until reading the parent comment, not once did I think about the potential financial ruin of this family (whereas the comment suggested that that was one of the immediate thoughts in his/her mind).

I personally find it interesting and worthy of discussion that different developed nations can have such different "risk profiles" for entrepreneurs. If anything, it makes me respect US founders even more... since when they set out (and presumably don't have insurance yet), they are risking far more (i.e. their family's long-term financial destitution) vs. a founder in a country with public healthcare.

Not an expert on this, just my reflections.

How are these "jabs"?

It would NOT be covered by OHIP. He'd need travel insurance, which most Canadians have via benefits (depending on how established his company was, he may or may not have it). Most travel insurance will pay up to the point of bringing you back home when it's medically safe.

Generally OHIP does not cover medical care outside of Canada.[1] Apparently they'll cover $400 CDN per day of US hospital stay, so probably less than 4%.

I sure hope he had travel insurance. Likely did as most companies offer it for employment travel.

[1] https://www.cbc.ca/news/canada/windsor/medical-emergencies-i...

So what? He's Canadian. Good luck to the debt collectors trying to collect that.

That would align with what American’s do when getting treatment in Canada.

Yes. You have one life, and it’s worth living with or without money.

Spoken like somebody who has money. Do you have any idea how much pain and suffering a person can endure due to having no money? I don't think it's your place to say that person's life is worth living.

Growing up in total poverty, raised by a single mother who fought cancers and died twice on operating tables let me tell you one thing.

Money is nothing. Poverty won't make you unhappy.

Humans are good at finding new baselines. Poverty will simply become your new normal and the little things of life will still bring you joy. Seeing a loved one will still make you a smile. Life is worth living even without any ressources.

> Money is nothing. Poverty won't make you unhappy.

I'm sure the millions of people living in poverty, dying of treatable diseases and starving to death right now are ecstatic about it. Or are we just pretending those people don't exist?

> Poverty won't make you unhappy.

I'm glad you and your family managed to beat the odds, but this is demonstrably false on a statistical level.

From my experience, poverty do increase your sadness and make your life really harder. It yanks away a lot of control from you and your ability to exert your free will is reduced. It also comes with stress, especially in countries without social networks and safety nets.

It won't however make your positive moments any less important. You will be more likely to suffer from mental health issues but that's statistics and they don't represent daily life of people accurately.

If you are not suffering from something such as depression you will still find satisfaction from social encounters, from your community and your family. Unless living in a dangerous situation, your will still be able to feel content about your life. Love will still matter just as much.

That being said, this is my experience living below the poverty line in Canada where healthcare and social programs exists.

What do you mean by your mother died twice? Serious question

One surgery had complications, they had to remove a large portion of her carotid artery during an emergency procedure. She was dead for a bit too long and suffered brain damage from it. The other time, she bleed out from a hysterectomy.


My brother killed himself recently. So yes I do.

And nowhere at all did I suggest "a person's life is not worth the money."

You're attacking a strawman and being deliberately annoying.

I like to think of it as demonstrating why this type of argument is useless and counterproductive.

It's not working. That kind of childish parroting irritates even people who might otherwise agree with you.

twoquestions seems more concerned about impoverishing everyone they love.

Is your life worth subjecting your family to a lifetime of debt?

This is a serious question people ask themselves whenever they get sick. It's one no one should have to ask, but one many Americans have had to sincerely consider.

I entertain similar thoughts, though less out of lack of value for my own life than sheer stubborn spitefulness for the predatory health care industry in the US. Sure, i could exhaust all my money and I might live, but I think I might actually rather die just to keep it out of their grubby hands.

Can anyone make a good guess on how much this would have cost here in the US and if it had happened in Canada ?

If it had happened in Canada the cost is zero. We don’t have deductibles or anything like that for these sorts of surgeries. Drugs yes, operations no.

In the US the cost must have been in the millions. I know people who ran up several million dollar bills during cancer treatment.

do they deny you treatment if you don't have that kind of money?

I don't know the current (post-ACA) situation, but the short answer about the US's emergency care laws is "sometimes".

For instance, suppose you trip and fall, and in catching yourself, shatter your shoulder joint.

The emergency room would be obligated to keep that from killing you -- making sure the bone fragments weren't going to sever an artery or anything, stitching up open wounds and the like.

The emergency room would not be obligated to restore you to (as much as possible) functioning. If you need an expensive 20-hour surgery with a team of specialists to put all the pieces of your shoulder back together, well, that's too bad. Sure, your shoulder will heal into an immobile lump without treatment, but it won't kill you, so not actually an emergency.

No, they cannot deny essential treatment in the US due to financial issues. The type of treatment can be argued about and fiddled with (elective surgueries and whatnot, prisioners needing co-pay money they do not have, etc). But in a life-saving case like the one in the article, they cannot not deny treatment. As another example, if you need a C-section, you are getting a C-section.

That said, fiscally, it's a total gamble in the US these days. You may be saddled with a $20/mo debt that will likely never end ever, or you may be facing a bill for $1M that is due in 30 days. The range is essentially unbounded and unknowable in any real way.

US healthcare is shockingly cruel, financially speaking.

Sometimes they do. A person at my mom's work need an organ transplant, but they denied them the surgery because their finances didn't show they could afford it, let alone the medicine you need to take for life after that to fight off rejection.

I really don’t know. They usually say everybody gets treated but I would guess quality will suffer. Or you will get relaxed as quickly as possible.

“Released” not “relaxed”. You won’t be relaxed after getting the bill.

But most will be covered by the insurance company, or not?

Be ready to spend months or years on the phone fighting with the insurance though. It’s not uncommon to receive a $300k bill that you then have to clear up with many many phone calls.

What? Go to the ER, save your life, then declare bankruptcy. That's the American way. What destitution on everyone you know? I don't understand what you mean. You think your family would be happier with you dead instead of bankrupt?

A friend of mine had her young brother suddenly developing a narrow line on the skin, growing quickly; 24 hours later both his arms and legs were amputated to keep him alive.

I am wondering if having allowed emergency wide-spectrum antibiotics freely for such cases would help? Time seems to be extremely critical in such cases.

> I am wondering if having allowed emergency wide-spectrum antibiotics freely for such cases would help?

The problem is you also need emergency physicians available equally freely and ubiquitously to identify the need. Unnecessary use of powerful, broad spectrum antibiotics has significant potential adverse personal and public health consequences, and the general public is not qualified to appropriately assess need for use.

That's called Lymphangitis and it's a sign that there is an extreme underlying infection, usually by the same bacteria that this article is about.

I would consider it a mandatory equipment of the household. Primarily I take them on trips to remote 3rd world countries where you can't rely on quick quality health care, even though most of the time I come back home with them untouched. For me its usually Sumamed, plus whatever specific for destination (malaria pills, stomach/throat, eyes etc.). Just beware of the expiration - they may lose potency and better renew them.

I am not sure I would use them at home in case you describe though - I would just run to emergency if possible. Also antibiotics don't work with viruses, fungus or parasites, so its not a panacea.

You really don't want people to have ready to use antibiotics at home. It's already very difficult to contain bacteria resistance to antibiotics.

Very soon people would not only die from rare bacteria related decease but any kind of random bacteria infection.

Your points are valid, people are irresponsible with antibiotics, however consider that e.g. 1 hour drive to emergency would cost you an arm, literally, whereas quickly eating 5 pills of wide-spectrum antibiotics would keep the infection at bay and give you time to drive to ER without any adversarial effects on your future life. What would be your choice?

The dichotomy is wrong. If you allow people to have antibiotics at home, enough of them are gonna chew them like vitamins to spread antibiotics resistance even faster. Then when you have your emergency, sure you can eat your pills, but it's not gonna do shit.

The only remotely viable solution is improving access to ERs.

What about an alternative where any usages have to be reported and measured and incorrect usage has an increasing penalty. It starts small and only ramps up with repeated abuse.

If you don't consent to the rules, that is fine, you aren't allowed the drugs at home (same as today).

That is impossible to enforce.

Like the parent said, lots of people will pop those things like candy. In very short order they won’t work at all.

> The only remotely viable solution is improving access to ERs.

Telemedicine plus improving 24-hour pharmacy distribution and equipping them for rapid door-to-door delivery of critical meds (possibly by drone) might work, and might soon be more viable than ERs for the particular use case.

ER access addresses a lot more problems and probably wins aggregate cost/benefit analysis for the foreseeable future.

If that was allowed, it might save hundreds in the short term and doom millions in the long term.

Of course I'd do whatever it took to save myself or my loved ones. Anyone would. That's not a good basis for government policy.

(Also, being honest, the number of situations where powerful antibiotics now vs. at the hospital would make a difference and the people involve realize that and administer them has got to be tiny. We can't make policy based on low-probability hypotheticals.)

> If that was allowed, it might save hundreds in the short term and doom millions in the long term.

It might save hundreds and but also kill thousands in the short-term, too: powerful broad spectrum antibiotics aren't without adverse effects, perhaps especially if taken in a genuine emergency that just isn't the kind of emergency the user thinks it is.

My choice would be to take the antibiotics. And that's all the problem. Because maybe I wouldn't need them, because well, you don't lose an arm from infection everyday. And I'd like to say that all the people who would have access to antibiotics would be better than me at knowing when to take or not to take them, but I guess not.

Obviously, this is a long known issue. My stash mostly just expires or gets used while travelling in places like Himalaya or remote tropical jungles where it really makes a difference. My wife is a doctor so that helps.

A single guy having strict antibiotics discipline doesn't mean anything when you have 1 billion+ countries like India where strong generic antibiotics are sold to anybody over the counter (at least that was the case in 2010).

Once I didn't have them on Kilimanjaro and I went from being perfectly OK to almost passing out within 1 freakin' hour from extremely strong gastro infection. Luckily peace corps members of the team had some and they almost immediately helped a lot (I still had what one can call a shitty experience of the peak, albeit successful). In situations like these you don't care about long-term good of the mankind, you just want to survive, far from any professional help.

What was the cause of the amputation?

Wow. Mark was the CEO of one of the first startups that I worked at in Toronto. I recall him being very driven and focused. It seems like these qualities helped him overcome this enormous challenge.

Wishing you the best, Mark.

Terrifying. Could it be that stress caused the Streptococcus pyogenes infection? It would be the most sensible explanation. I imagine being a CEO of a startup is a very stressful role, causing suppression of the immune system and thereby S pyogenes had a chance to proliferate. I have no idea, just speculation.

It was absolutely caused by unconscious emotions (like stress). The following part just made me laugh out loud:

> This mainly involves infection by the Streptococcus pyogenes bacteria and more commonly affects young, healthy adults. I didn't do anything to get it, it just happened - like being struck by lightning.

The jarring contrast between medicine's ability to perform surgical miracles, like those described in the article, and it's total inability to understand what causes illness, is just comical. I guess there is money in one and not the other.

Do you have anything to back up your claim it was caused by the stress? That seems like a pretty big claim to make.

It was absolutely caused by a witch casting a curse. She should be sought out and burned at the stake and put on trial.


It was absolutely caused by unconscious emotions (like stress).

I cannot imagine a mechanism whereby stress causes a human body to create a bacterium, effectively from out of nowhere. To synthesise it. Do you have any evidence or even a posited mechanism for this amazing claim? Or is your claim that the illness isn't caused by this bacterium?

No-one is claiming that stress synthesizes bacteria, that is a laughable strawman.

We are surrounded by bacteria at all times. If stress were to weaken your immune system, then you might be more easily infected by them. This seems completely plausible to me (likely, even). It is not a great leap to describe this link as stress "causing" the infection, even if it might be better to describe it more precisely. Perhaps "stress meant he couldn't fight off the infection as he normally would have"?

Not saying I completely buy into it as an explanation for this specific case - but stress can compromise the immune system making it easier for infections to occur.

This bacteria is part of our normal microbiota. The immune system suppress them to not wreak havoc.

I am disturbed that he was almost sent away from the hospital if it weren’t for the persistence of his business partner that it was something that needed further investigation.

It’s a common thing due to the fact that doctors see too many trivial, common cases and apply Occam’s razor.

I had the same experience in a big, prestigious hospital. After a surgery went wrong they insisted I’m ok and getting better despite my less and less vigorous protests. When they finally accepted to investigate this more thoroughly they realized the severity. The story repeated itself through multiple surgeries. Even just hours before the last one they insisted I should be getting better and again only investigated after several pleas. Which was very surprising considering that when going into this last surgery my chances of survival were under 15%, I was basically in septic shock and already mostly unconscious due to the illness and medication.

I think a doctor’s diagnosis starts with assuming basic issues and escalating later rather than the other way around. It might make sense statistically... unless you’re among the unlucky few.

Would those cases be considered misdiagnosis and incur reliability to the doctors?

This was terrifying.

How does an infection like this happen though? What can you do to prevent it?

The thing with this man is that he assumed he had the flu:

> By the time I landed in New York that day in February, I felt a flu coming on. The next 48 hours was a marathon, so I resolved to push through.

And he also experienced some very non-flu like symptoms:

> by Wednesday night I was running a serious fever and my left leg was in a surprising amount of pain.

Despite having a high fever and pain, he didn't go to the hospital until he actually collapsed the next day. Had he sought medical treatment as soon as the leg pain manifested, his outcome might not have been as dire.

In many cases, probably nothing. But here's what I'd do:

Stay away from places where a lot of different people touch a lot of different things - and if you have to touch those things, wipe them down first with antiseptic wipes or similar.

In addition to this - take care not to let (or get, if possible - not always easy, depending on what you do for a living, your hobbies, and just life itself) wounds happen on your skin or mouth. If you do get a wound (cut, scratch, bite, etc) - try to take care of it properly immediately; clean it, apply dressing, etc. In the case of mouth wounds (ie - you bite your tongue or lip hard enough to draw blood), about all you can do is a salt rinse and keep your teeth brushed.

Stay away from hospitals and care homes and the like - seriously, one of the best places to get an infection is in a hospital or doctor's office. It seems counterintuitive, but when you have a place where sick people congregate, not everything is going to be "squeaky clean" even when they are regularly cleaned.

You might take the extreme step of wearing some kind of mask to reduce the inhalation of bacteria and/or viruses. It won't completely stop it, but it will reduce it a little.

Don't hang around sick people? If a coworker shows up to work sick, you might want to go home yourself (explain to your boss why, first - and let them make a decision as to who should go home - likely, they'll send the coworker home first). Unfortunately, so many people have kids, and are "carriers" of stuff that don't affect them much because they do have kids, but if you don't have kids and/or don't hang around kids much - you can pick up things that way easily.

Always wash your hands thoroughly after using the bathroom. Elbow out the door if possible (or use a paper towel to open the door).

Avoid stress (easier said than done for some people) - ultimately, though, stress does weaken the immune system; this is known. Better is to understand when you are stressed, and what forms stress can take, so you can know when you are under it. Some kinds of stress aren't always easily apparent. Note that this might also apply to "good stress"; I'm not sure. If you are tired and "stressed" from an extreme workout, I am not sure if that helps or hinders your immune system during your recovery...

Ultimately, though, you can't control everything, and you have to live your life. There's probably no way to trace back to where this guy picked up his infection. If I had to make a guess, maybe the gym? It could have easily have been during a run or a walk outside as well. Or just some door he pushed open to go into a room or building. The bacteria/viruses that cause these kinds of infections and issues are all around us, and our bodies do a fairly good job of keeping them at bay. But sometimes, bad luck happens.

I'm not up-to-date on these bacteria. It's shocking to me that at this day and age we still don't have good treatments.

Would bacteriophage have helped?

This reminds me of the time that science fiction writer Peter Watts got necrotising fasciitis, and wrote a series of sardonic blog posts with gruesome photos (seriously - gruesome) about it:


He was never in a coma, though, so got to be a bit more chipper about the whole thing.

PathFactory received $15M in funding:


Amount of traffic to pathfactory.com is negligible:


It's a sign of what it's like to be an American that the following stood out to me:

The timing of his illness is rather unfortunate, as it caught him in New York, rather than Toronto, which probably cost him a lot of money.

If I'm an American visiting Canada then I would also be charged for any medical services I get in Canada as I do not pay taxes there nor have insurance in Canada.

edit: And the fees aren't trivial. https://www.qch.on.ca/uploads/Finance/Fees%20for%20Cdns%20wi...

Why are you assuming the author was uninsured in NY? Lots of Candadians buy travel health insurance when visiting the US.

Even with your unfair comparison: if you have health insurance in the US, it's quite easy to pay higher fees than you would uninsured in Canada. For example, compare Fidelis Care Silver[1] ambulance charge ($150 after deductible) with Canadian ambulance charge ($240 CAD -> $180.75 USD). The completely uninsured Canadian pays only $30 more than the insured American, and that's if the American has already paid their $1700 deductible, and has paid their premiums (which are more than the taxes Canadians pay toward their healthcare). And that's literally just grabbing the first US plan I looked at: I'm sure that there are worse insurance plans out there which people are forced to take.

[1] https://www.fideliscare.org/Portals/0/Members/ComparisonChar...

Pay for it with taxes, pay for it with premiums and bills. You’re paying for it.

No one works for free, the medicine costs money. The money comes from somewhere.

Yes, but consider that the US taxpayer pays per capita more or less what the Canadian taxpayer does on health care, while covering only Medicaid and Medicare.

The Canadian, on the other hand, doesn’t have insurance premiums or deductibles.

(For the record, I hate the CND health care system. It’s just that, knowing both systems, the US’ is worse :)

> No one works for free, the medicine costs money. The money comes from somewhere.

Why do some people think this is a shock?

Nobody thinks medicine is ever going to be free. That's a strawman position. You might as well argue in favor of universal toll roads by saying that roads are never going to be free, so suck it up and accept that you're going to pay $50 one-way every time you commute, and $200 one-way every time you get groceries: The people who protest that aren't saying roads are ever going to be free, they're just saying that better payment models exist.

> Pay for it with taxes, pay for it with premiums and bills. You’re paying for it.

Pay for what? CEO's billion-dollar salaries and luxury jets? I'm pretty sure Canadians aren't paying for that.

The doctors’ and hospital administrators’ sports cars aren’t cheap either.

Neither are their 500K student loans nor their delayed work opportunities until 35.

Hating on a Dr. for having a nice car is BS, but what you mention are failures of America.

Only America trains their Dr. until they’re 35, while having them do nothing towards their medical degree in their undergrad.

Only America saddles then with $500k in debt.

Remove both barriers, and presumably you’d have market forces push more ppl to the profession reducing wages.

"Remove both barriers"

How do you train a neurosurgeon? That level of specialization comes from maybe a few hundred in the U.S. With that level of scarcity (and demand), their time is going to be priced accordingly.

In school.

But s/he needn’t have a B.Arts in management to apply to med school first.

I don’t know what you mean by “Maybe a few hundred”. Do you mean schools or neurosurgeons?

If 1., there are only 150 med school for all Dr. in the US, contributing to a very low number of Dr. Per capita.

If 2. They study medicine. Do residency. And train on the job for the rest of their lives... just like today [0]

[0] actually one of the reasons for medical errors, a top three killer in the US, is that most Dr. don’t update their knowledge one thy finish their residency. :S

And when you make healthcare a for-profit business, everyone pays more.

Just seems to cost a lot more in total in the USA than it does elsewhere.

This kind of stories I find them scary but inspiring at the same time. Quite interesting.


The Wikipedia article mostly talks about Type I NF. The author of this post had Type II NF, which is not necessarily associated with the same preconditions as Type I NF.

From Wikipedia:

> For reasons that are unclear, it occasionally occurs in people with an apparently normal general condition.


You are not a licenced medical practitioner. Telling people that kind of stuff face to face gets you into serious trouble, what makes you think it's okay to do so on-line?

"your adrenals are gone"

Wtf. Adrenal crisis [1] would be fatal. You're talking nonsense.

[1] https://en.wikipedia.org/wiki/Adrenal_crisis

Is it appropriate to offer unsubstantiated medical advice on HN?

No, and it’s off topic because he didn’t even have the flu.

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