> The first of a batch of two hundred and fifty embyronic rocket-place engineers was just passing the eleven hundred metre mark on Rack 3. A special mechanism kept their containers in constant rotation. "To improve their sense of balance," Mr. Foster explained. "Doing repairs on the outside of a rocket in mid-air is a ticklish job. We slacken off the circulation when they're right way up, so that they're half starved, and double the flow of surrogate when they're upside down. They learn to associate topsy-turvydom with well-being; in fact, they're only truly happy when they're standing on their heads."
Many doctors are able to routinely do this for dozens of ailments under intense pressure, making them even more impressive.
Well that's life.
The expertise, and IME this is rare, is in turning vague descriptions into matchable patterns, prompting for more detail when needed, and explaining things at the appropriate level (which for some patients might be quite high, others quite low).
Though I am from Poland and I don't consider Poland to have adequate medical system.
When you are really bad you may not be able to explain to medical staff what is going on. There are cases in life threatening condition that are misdiagnosed as drunk. You need a family member to tell the medical staff that no, they are absolutely positively sure you are not drunk.
And that was just one instance among many where me and my wife were the best--and most accurate--advocates for our son's care.
It's not that doctor's are dumb or uncaring: they're simply stretched thin and feel they have to play by restrictive rules put in place to help prevent lawsuits.
It is absolutely crucial, in my opinion, to have someone who truly cares about you accompany you if you must go into a hospital for any reason.
Not blaming anyone, but nobody feels reassured being treated that way.
I'm not saying that doctors are dispassionate, but that doctor will be spending at most half an hour with the patient, if you're lucky, while your family will be with you the whole time, listening attentively.
All doctors, even the best, are busy, tired, and overworked, and no matter how much they want to give you all the attention you need, they're not able to, in part because how our medical system set up, and in part because that's just... reality.
And they're going to not notice something all the time, even the best doctors in the best hospitals.
And if the best doctors are fucking up, what about the ones who are not so good?
If you want a good outcome, you need your own advocate, be responsible and inquisitive, and you can't just leave it to the doctors.
It is this attitude that is the problem, in my opinion.
Every patient is special and unique, and "modern" medicine just fails to admit it and treats everyone like a fucking steam engine.
Pardon the profanity, but I've seen too much of this shit my limited experience with the medical system to know better that doctors are best treated as powerful and dangerous tools, and not sentient beings, until proven otherwise.
If you had ever accompanied someone with a serious condition, you would probably think differently.
I don't have that much experience in this area, yet I've personally witnessed several occasions when family advocating for a patient saved their life.
And, sadly, vice versa as well.
This is in the U.S, in major cities, in hospitals that were recommended as being above average by those in the know (medical professionals and other patients.)
From my experiences, healthcare advice is designed for the most likely scenario given an imaginary average person- and it is incredibly important to take an active role in conversations with medical professionals (I suppose unless you happen to be perfectly average in every way and experiencing the most likely ailment given your description).
It absolutely needs to be a collaboration whenever possible.
So, if this is a generic thing about low blood-pressure, including—potentially—low blood-pressure from shock... then could inverting someone who's going into shock in the field (where an ambulance is not yet arrived), be neuroprotective—ensuring they keep some oxygenated blood near their blood-brain barrier to feed their brain, long enough to stave off brain damage until EMTs can arrive and get a saline+steroid IV into them? Would it work for all types of shock? Toxic shock, for example?
I know that in the case of the article, the cause turned out to be a malfunction of the pacemaker itself, but is the doctor's original line of thinking still valid?
The position you're referring to is known as the Trendelenburg Position. The benefits were thought to lie not so much with increasing perfusion to the brain, but bringing more blood back to the heart (known as preload), thereby increasing cardiac output and increasing blood flow to vital organs. If you're interested in this, there's some neat physiology called the Frank-Starling law .
However, it turns out that in practice, cardiac output doesn't actually improve. In fact, this position also increases the risk of fluid build up in the lungs (pulmonary oedema) and can worsen cerebral perfusion . Therefore, it's falling out of favour in the context of shock. A compromise might be to elevate solely the legs, but its efficacy is also being questioned.
This illustrates a recurring theme in modern medicine; the human body & disease is so complex and poorly modelled, that it's often not possible to translate intuition or first principles of physiology into treatment. Instead, one relies on real world studies like those reviewed in  - AKA 'evidence-based medicine'.
I am not a dr (IANAD?) but the idea is that you inflate the pants around a patient's legs which helps both push and keep blood out of the lower limbs and closer to the hear and brain. In principle, you could do the same by tying a tourniquet around each leg but the MASTs probably cause less tissue damage and are more adjustable.
 - https://en.wikipedia.org/wiki/Military_anti-shock_trousers
Effectively, you could artificially keep the patient alive by using MAST pants, but they inevitably crash when they were removed. My old service had a few pairs tucked back in a closest, but none on any of the rigs. I'm quite certain they aren't in allowable by protocol in most places at this point.
A pretty wild device, nonetheless!
EDIT: Quick edit to throw in that I have heard tales from the old heads of using them to stabilize pelvic fractures, too.
> Passive leg raise, also known as shock position, is a treatment for shock...
"If the face is red, raise the head. If the face is pale, raise the tail."
Once they stated that she had electronics in her that became obvious as a likely source of the problem.
What I'm not sure about is why they started doing diagnostic tests (especially ones where the patient was quite clear on what the outcome was going to be) without an IV in place...
In software dev a bug being created as side effect solving another usually means QC missed it, perhaps here too?
I don't know if surgeons do checklists or some else normally verifies post op on the procedure( peer review?), and are there ways to verify the device before and after insertion , if it was software dev that's what I would recommend . While surgeries and medical practice has lot of regulations and it cannot be changed easily, the principles are sound, and other fields like airline pilots do similar things.
The doctor in the post was also working off the base assumption that this was a bug that got shipped in the last release (surgical complication leading to interval bleeding, leading to hypotension; surgical complication leading to cardiac tamponade; etc). My original point was just that the answer that was obvious to the commenter was actually pretty low on the probability list, and it only seemed obvious because they had an incomplete mental model of the system as a whole (something that happens in software debugging as well). As it turns out, it was the correct answer, but the correct approach (on average) would still put "failure of the pacing leads" pretty low on the list of likely causes.
There are a lot of checklists used in surgery. For instance, immediately before any procedure, there is a "time out" to make sure everyone is on the same page with the right patient, right procedure, and right location. I'm not aware of any checklists specific to pacer leads, but I don't spend much time in the OR these days.
Pocket lint in the socket also keeps it from seating. Digging that out is like playing Operation. The bits you can break are on the sides, so you have to push straight in to scrape out the lint.
I really should learn to put my phone in my pocket wrong way up so it doesn't catch all that crap...
Boy, you turn me
And round and round
What should we do with people like this?
Context should be an important factor when deciding to intervene and how to intervene. If I encountered such a situation in a hospital, I would have interpreted it as unusual and beyond my comprehension, but it would not have struck me as an intent to cause harm. People tend to go to a hospital for help. Those who hurt others in a hospital would likely do so through violence.
I'm not suggesting that she should not have intervened, but she (and the security guard) should have understood the situation first.
At most, this should have prompted is "Well thats different"
Another favorite was the Cops spoof. OH -- Also a Vince Gilligan!
I saw it exactly once, when it first aired on October 11 1996. I was 13 years old and it left enough of an impression that I still remember that moment vividly to this day.
If one appreciates, as I do, when media can make them experience feelings strongly, regardless of the pleasantness of those feelings, then one must admit it is was a great achievement.
Not too long ago I saw this news article https://www.wtae.com/article/pennsylvania-attorney-general-s... for example and this town is quite close to where I grew up.
I think there are definitely people who have a circadian rhythm that would compel them to move west due to feeling more “in-tune” with the west and continually chasing that feeling.
It does not sound particularly strange or unscientific to me.
They really make it hard to resist ad blockers. I cannot concentrate on the text with everything blinking and new ads loaded in constantly. Such a death spiral to try to compensate for low ad revenue by making sure to get extreme amounts of ad views from the few suckers that are exposed to them.
Should we call such articles Harry-Potter journalism?
There's also related style of articles, very popular in NYTimes, that could safely be called Ulysses journalism.