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Falling five storeys from a New York rooftop changed my life

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

#101

Post by akiselev »

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.

Relax completely and go limp (easier said than done). Tense muscles will exert more force on the things they're attached to like bones and organs, usually in opposing directions, which is what causes damage from otherwise trivial impacts. That's why, all other things being equal, drunk drivers experience fewer injuries in auto accidents - slower reaction times mean they don't react in time to tense up for the crash.

The human body is incredibly resilient under the right circumstances. The most striking incident in recent memory is Shayna Richardson [1]. She face planted (excuse the vernacular) into a parking lot on her first solo skydive and survived... to give birth to her son eight months later (both are alive and well today).

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

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

#102

Post by sk5t »

WJW wrote: post #3
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.…

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.

FWIW, I had a pretty bad bicycle accident and was administered morphine, dilaudid, and fentanyl (in that order) at various times in the hours following. Only dilaudid had any affect at all on my clarity of thought.

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

#103

Post by [deleted] »

mikeyouse wrote: post #27
mattr47 wrote: post #24

Earlier quoted context omitted.

I've had both morphine via IV and fentanyl via a lollipop. Both were in Afghanistan and as far as pain relief goes the morphine was way better for me, because I got a large dose in my bloodstream. I totally understood at that point why people get addicted to that stuff. I did not care about anything at that point. The fentanyl just did not have a strong effect on me.

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.

[deleted]

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

#104

Post by QuantumYeti »

TwoBit wrote: post #88
rootusrootus wrote: post #49

Earlier quoted context omitted.

> The meaning is clearly that there shouldn't be a gaping hole on the top of a 5 story building that people can access. Or at least that you shouldn't walk around a building you're not familiar with at night. Looking at the pictures, I'd vote for another option. The roof of that building isn't designed for casual use. The wall around the edge of the building is calf-height with no railing. What they're doing is likel…

How do you know it's calf height? Did I miss that in this classically drawn out prose? There's a picture with him leaning over a ~4 foot high ledge. That ledge wasn't it?

I think this is the ledge being referred to:

https://static.ffx.io/images/$zoom_0.188%2C$multiply_1.3545%...

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

#105

Post by DoingIsLearning »

mncharity wrote: post #80
jrochkind1 wrote: post #69

Earlier quoted context omitted.

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 o…

Sorry I was unclear. The distinction between "blame the pilot" and "determine root causes, so we can work to prevent recurrence", is relatively familiar in an aviation context. So say, a recurrent checklist failure, might prompt checklist improvement, rather than merely blaming pilots. Perhaps shortening a landing checklist, by moving items to a less tense approach checklist. So I attempted to illustrate by analogy,…

> head-down engagement in physical manipulation, might have distracted from patient communication and care management.

No, a spade is a spade, the patient clearly said the Doctor didn't _believe_ him.

This isn't an in-the-zone 'tunnel vision' moment from the doctor, this isn't high stress shutting off the outside world, or CSR type reaction. This is someone _assuming_ a patient was telling a lie, who then lacked the duty-of-care to confirm it, before inflicting unnecessary pain.

I am all for checklists, they are a big part of my work processes and they are desperately needed in many medical and nursing workflows, but this particular case is just lack of common sense and duty-of-care.

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

#106

Post by ramraj07 »

everydayDonut wrote: post #42

I don't understand how he takes no meaning out of this. The meaning is clearly that there shouldn't be a gaping hole on the top of a 5 story building that people can access. Or at least that you shouldn't walk around a building you're not familiar with at night. Anyone who thinks there's no meaning to take from these kind of events is wasting a huge opportunity to learn that small things like a gap in a roof can mean…

This is thoughtful but stupid because it goes in the wrong direction - new York is already at being close to the pinnacle of protecting people from their own stupidity so to speak - does this person take zero responsibility for ambling in the dark on an unknown terrace without looking _while_ drunk? When do we tell people they are just clumsy and need to own up to it? Many new york rooftops are closed for this reason because their insurance premium goes up, thanks to people like this author.

We definitely lived through times when not everyone was attached to a safety harness when going to a protection less terrace. I understand the absolute need for employee protection in a work environment, but as long as precautions are taken so that truly vulnerable populations (kids) can't be harmed even when they are paying attention, communities need to grow up and not coddle everyone's laziness to pay attention to their surroundings like this.

See for example rules done right in this regard - Amsterdam doesn't mandate helmets for bikers.

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

#107

Post by kls »

kls wrote: post #34
papeda wrote: post #4

From the end of the article: > To come so close to death does not provide a shortcut to wisdom or contentment. It doesn’t answer all your questions or eliminate your weaknesses. I’m fundamentally the same person I was before, but with one big difference. I’m viscerally aware how tenuous our existence is. How you can be walking on solid ground only to find it suddenly disappear from beneath you. The meaning comes in w…

Years ago I had a legitimate attempt by taking a combination of a full bottle of opiates and benzos (A pretty deadly combination). I was pretty hell bent on being dead. I know at the time, my thoughts where use a gun (I am a big second amendment advocate, so was not going to be a statistic in the argument), carbon monoxide, pills or hanging. The reason I bring this up, is I actually think there are two main branches…

Wanted to add, that I also ponder if Mass shootings are a form of this internal anger suicide but rather than internalizing the anger as self loathing they externalize their desire for non-existence as being the result of others actions so they want to lash out before they achieve the same results.

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

#108

Post by refurb »

WJW wrote: post #3
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.…

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.

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

This is off topic, but when a drug is 100x more powerful, they just give 100x less of it. So whether you get morphine or fentanyl the effect is approximately the same - and that's intentional.

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

#109

Post by _-___________-_ »

ramraj07 wrote: post #106
everydayDonut wrote: post #42

I don't understand how he takes no meaning out of this. The meaning is clearly that there shouldn't be a gaping hole on the top of a 5 story building that people can access. Or at least that you shouldn't walk around a building you're not familiar with at night. Anyone who thinks there's no meaning to take from these kind of events is wasting a huge opportunity to learn that small things like a gap in a roof can mean…

This is thoughtful but stupid because it goes in the wrong direction - new York is already at being close to the pinnacle of protecting people from their own stupidity so to speak - does this person take zero responsibility for ambling in the dark on an unknown terrace without looking _while_ drunk? When do we tell people they are just clumsy and need to own up to it? Many new york rooftops are closed for this reason…

> Amsterdam doesn't mandate helmets for bikers

The whole Netherlands, in fact.

I was under the impression that very few countries mandate helmets for cyclists. Australia, NZ, anywhere else?

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

#110

Post by ghufran_syed »

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.…

This is just bad medical care, assuming the description is correct. Even if they had been given the pain meds, you move the shoulder slightly to see how well the pain medicine is working, if it’s not working well enough (= patient shows evidence of significant pain), you give more pain medicine. But it’s hard to get to some level of analgesia that can control the peak of the pain that will happen during joint reduction, but also not cause respiratory depression. That’s why personally I give sedation to my patients instead of just pain medication, that’s what I’d want if I had to have the procedure done.

But if in fact it was the orthopedic team that did the reduction, they are not trained to give the same level of sedation as emergency specialists or anesthesiologists. So there is a temptation on their part to give some dose, not titrate to effect, and then just “get on with it” to save time. What they should do, and do in fact do in my institution, is have the emergency medicine doc give sedation, and then they can happily do their procedure without torturing the patient... Or the emergency docs do the sedation and reduction, which we tend to do for patients who don’t require other inpatient orthopedic care.

[Edit: Also, Bellevue is a residency training site, so this was probably a first or second year resident (they are the ones that most need the experience of shoulder reductions) https://med.nyu.edu/departments-institutes/orthopedic-surger.... But legally, the attending (supervising) physician is responsible for the care given by all the residents they are nominally supervising]

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