Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Falling five storeys from a New York rooftop changed my life

smh.com.au

Post reply on HN
Print view View original

61–70 of 154 posts

Re: Falling five storeys from a New York rooftop changed my life

#61

Post by noir_lord »

nickjj wrote: post #31
WJW wrote: post #3

Earlier quoted context omitted.

Really seems like a "hey nurse did this patient have their fentanyl yet?" would have resolved this issue. Anyway if it's really 100x more potent than morphine you'd think any person that did have it in their bloodstream would not be all that capable of stating that they have not had their medication yet.

> Really seems like a "hey nurse did this patient have their fentanyl yet?" would have resolved this issue. You'd be surprised at how questionable hospital care is run in NY, even with $450 / month insurance with a high deductible. To protect the privacy of the person I know, here's a story from 2-5 months ago: - Person A goes into doctor's office for something pretty common - Doctor requests cat scan or MRI (I forgo…

Over here in the UK they generally mean well, almost without fault every one of my specialists, doctors and nurses have been awesome.

That said man do they fuck up, most recently was a fun one, I had a scheduled appointment, turned up for it, doctor was in his treatment room seeing patients, forgot to see me and went for lunch.

I mean it's minor but I'd checked in, the computer had me as waiting but he'd looked at the list, not seen me and went for lunch - I spoke to the nurse told her I didn't mind waiting while he ate and she tracked him down, he was incredibly apologetic (unnecessarily so, shit happens).

It's inevitable in a system as complex as healthcare that mistakes are going to be made but we probably should assess the proximal causes much like the airlines/plane manufacturers did to reduce the incidence.

Re: Falling five storeys from a New York rooftop changed my life

#62

Post by nice2meetu »

I had a similar, though certainly not as bad experience. I was sitting with friends at a lookout and I wandered off to take a leak. I jumped over a side fence to give some distance, not realizing that there was nothing on the other side.

I realized what had happened. My thoughts were along the lines of "I'm about to be in a lot of pain, I may as well enjoy it on the way down". I was also horizontal on my back.

It ended up being a 10m drop, so not as big as in this story (I went back and measured it another day). It was soft dirt at the bottom, and there was sort of an indent in the cliff at that point so I missed any jutted-out rocks coming down. When I landed I bit through my tongue and was horribly winded, but otherwise ok.

I am religious but also remember making a firm note on the way down that nothing supernatural appeared to be happening, mostly because prematurely assigning meaning when these things happen tends to annoy me. I don't think I ever thought I was going to die, maybe at 10m I didn't have enough time. I just remember looking intensely at everything thinking I probably wouldn't get the opportunity to fall off a cliff again.

Re: Falling five storeys from a New York rooftop changed my life

#63

Post by strstr »

mpalmer wrote: post #2

The most pressing issue for the orthopaedic team was my left shoulder, which was visibly dislocated. Before attempting to reattach it, the doctor told me I would be given a dose of fentanyl: an opioid that is up to 100 times more potent than morphine. He went away, returned and started using a bed sheet to try to pop the shoulder back into the socket. Alarmed, I told him that I had not been given any pain medication.…

The doctor must have been making a bad inference. They must have assumed he had already had been given opiods because he didn't look like he was in that much pain (before the reduction). I wonder if he wasn't guarding his shoulder (because of the spine injury), which would probably make him look like he had already been given painkillers. Dislocated shoulders are incredibly painful if they are in the wrong position. And not particularly painful in the right position.

I can't imagine having a shoulder reduced while having a broken back and ribs (and wrist!). The forces required (and precise positioning) to do it comfortably would be hard if they had a broken back. My shoulder was reduced via the Snowbird method [1], which was not very painful. It requires a ton of force on your spine (and an assistant pulling on you ribs!), so obviously a no-go in this case.

[1] http://www.emdocs.net/wp-content/uploads/2015/01/Shoulder-Re...

Re: Falling five storeys from a New York rooftop changed my life

#64

Post by mikeyouse »

dkdk8283 wrote: post #39
mikeyouse wrote: post #27

Earlier quoted context omitted.

Most fentanyl is administered IV as well, the “100x more potent” stuff is mostly misleading because the doses are different but it is substantially more effective than morphine. My wife does anesthesia and if they’re going to use opioids at all, it’s almost always IV fentanyl. It’s extremely rare that patients report any pain afterwards. Though there’s a big movement toward opioid-free surgery so that’s promising.

As someone who went through a IM nail procedure I couldn’t have done it without opiates. I didn’t get addicted either. It’s a valuable drug that was abused.

Yeah it’s absolutely indicated for some surgeries but unfortunately it’s “defaulted” for many as well, so people end up going home on prescriptions for it after cases where they didn’t really need it. The movement is to ID which cases don’t call for it and then use alternative anesthesia / analgesia to make the post op care consist of extra strength Motrin instead of opioids. The other part is to dramatically reduce the number of doses that people are sent home with. Small barriers to access have a huge impact on addiction.

Re: Falling five storeys from a New York rooftop changed my life

#65

Post by WalterBright »

Tronno wrote: post #28

Reading this gives me flashbacks of my own fall from about 45 feet, which broke my spine, pelvis, and ankle. The initial days after the surgery were confusing, painful, and scary. If the fractures had been another half inch to the right, I would have been paralyzed for life. Indeed, I lost control over my bowel functions, and for a few agonizing days was unclear if I would ever get them back. I learned how to insert…

My father served in the 8th Air Force at a time when the odds of completing a tour were about 20%. The airmen had various ways of coping with this, my father's way was to simply accept that he wasn't going to make it and just do his job as best he could.

He told me that after the war, whenever he felt down, he'd think about what a miracle it was he survived, and would feel better.

He lived to be 93.

Re: Falling five storeys from a New York rooftop changed my life

#67

Post by Andrew_nenakhov »

qub1t wrote: post #56

If you actually find yourself falling from a similar height as described in this story, what can you do to maximize your chances of survival? Try to impact feet first? Sideways and cradle head with your arms? TFA says head impact is the main thing that determines who survives and who doesn’t, but other than that no clues as to what to try to do in the situation.

you can't really do anything. Unless you are prepared for a fall, all you would be able to think is ... 'oooopsss', followed by an impact sound.

So it's all is down to luck.

Re: Falling five storeys from a New York rooftop changed my life

#68

Post by mncharity »

DoingIsLearning wrote: post #47
mncharity wrote: post #40

Earlier quoted context omitted.

Doctors, surgeons in particular, are both project manager and individual contributor. At peak IC work load, the manager role gets starved for cycles. A failure to track "X was intended - did it actually happen?" is a typical of this. Having someone with you can help. "He's right, Doctor, the nurse hasn't yet ...". A role of maintaining a clear picture of project state, making sure everyone is on the same page, and mo…

This is a really long winded way of being apologetic about bad practice. Patients lie all the time, but if a patient warns them they have received no pain medication or muscle relaxants or whatever, then their job was to check their medical record or with the staff nurse if it was true or not. Any other argument is a distraction.

Consider "Weather is bad all the time. It's the pilot's job to run that checklist as written. Then this (hypothetical) plane wouldn't crash so often. Any other argument is a distraction."

In UX design, there's "stupid users, they keep doing it wrong", versus seeking to understand user errors and prevent them. In medicine, with medical error a leading cause of national death, those are blaming individuals, versus seeking to understand errors, and systemically reduce their prevalence.

Re: Falling five storeys from a New York rooftop changed my life

#69

Post by jrochkind1 »

mncharity wrote: post #68
DoingIsLearning wrote: post #47

Earlier quoted context omitted.

This is a really long winded way of being apologetic about bad practice. Patients lie all the time, but if a patient warns them they have received no pain medication or muscle relaxants or whatever, then their job was to check their medical record or with the staff nurse if it was true or not. Any other argument is a distraction.

Consider "Weather is bad all the time. It's the pilot's job to run that checklist as written. Then this (hypothetical) plane wouldn't crash so often. Any other argument is a distraction." In UX design, there's "stupid users, they keep doing it wrong", versus seeking to understand user errors and prevent them. In medicine, with medical error a leading cause of national death, those are blaming individuals, versus seek…

I get it, but in this case it is the DOCTOR basically thinking "stupid users". Nobody was endangered, the patient was just put in a heck of a lot of pain because the doctor assumed they were lying or wrong and it wasn't even worth checking, because their pain didn't matter that much to the doctor.

The hospital is a PRIME place for systems meant to avoid mistakes. (Although your example with checklists and pilots is odd; the checklist IS such a system, a remarkably successful one. And over the last 10 years, is used more often in hospitals too. I guess you could say that every checklist should have TWO people check it off or something, but it's such successful technology at reducing mistakes I'm not sure I've seen this suggested).

But no system can make up for doctors who don't respect patients or care about their pain.

Re: Falling five storeys from a New York rooftop changed my life

#70

Post by cameronh90 »

noir_lord wrote: post #61
nickjj wrote: post #31

Earlier quoted context omitted.

> Really seems like a "hey nurse did this patient have their fentanyl yet?" would have resolved this issue. You'd be surprised at how questionable hospital care is run in NY, even with $450 / month insurance with a high deductible. To protect the privacy of the person I know, here's a story from 2-5 months ago: - Person A goes into doctor's office for something pretty common - Doctor requests cat scan or MRI (I forgo…

Over here in the UK they generally mean well, almost without fault every one of my specialists, doctors and nurses have been awesome. That said man do they fuck up, most recently was a fun one, I had a scheduled appointment, turned up for it, doctor was in his treatment room seeing patients, forgot to see me and went for lunch. I mean it's minor but I'd checked in, the computer had me as waiting but he'd looked at th…

Almost exactly the same thing happened to me (also in the UK), except rather than checking me in, they had transposed a couple digits on my NHS number and checked in a random person. Not sure if the NHS number has a check digit, and if not why not, but I digress...

Rather than going to lunch, after I sat waiting for 3hrs they closed the department. When I went up to let them know I hadn't been seen yet, they apologised profusely, called back the specialist - who had already left - and saw me after closing time.

Post reply on HN