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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

#71

Post by jdeibele »

chasd00 wrote: post #33
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 happens a lot. my stepfather was in the hospital, a nurse came in and gave him a shot of morphine and walked out. another nurse came in and before my mom could stop her gave him another dose. He coded from the overdose but pulled through. my sister worked as an admin in some department at a hospital I can't remember. a patient coded and they did nothing because they were marked do not resuscitate but the patient…

I've gone to visits with a partner with metastatic breast cancer, my father with colon cancer, and my mother with metastatic lung cancer.

It's incredibly useful to have two sets of ears listening to what the doctors are saying so that you can clarify what they said.

All too often we weren't given anything in writing except what I was doing myself. That's improved quite a bit but it's still amazing to me that people downplay the usefulness of electronic medical records and the printouts that you usually get.

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

#72

Post by chadd »

WalterBright wrote: post #65
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.

Interestingly, the way the survivors have reckoned with it in the past 10-15 years at the end of their life was to build a number of monuments to their units at the 8th air force museum in Georgia. It's worth a visit.

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

#73

Post by Infinitesimus »

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…

Do you mind sharing how that influenced your sense of purpose?

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

#75

Post by anotheryou »

DoingIsLearning wrote: post #55
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…

> The wall around the edge of the building is calf-height with no railing It doesn't matter how fit you are, all it takes is a strong wind gust, so many people underestimate this. That kind of roof access is meant for maintenance work only.

To add to that: don't ever sit or stand on any covers, you might fall down a chimney

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

#76

Post by klyrs »

corobo wrote: post #58
klyrs wrote: post #8

Earlier quoted context omitted.

This is one of the most pernicious aspects of the opioid crisis. Doctors are taught to be hypervigilant regarding "drug seeking behavior" which is pretty much a 1:1 list of behaviors of people whose suffering is "genuine." Number one criteria seems to be that the patient is requesting medication. In so many cases, the patient is the most reliable source of information... but when it comes to pain management, the pati…

I understand where they're coming from but could they not loosen the rules for the person who has a clearly visible injury? Could they not check the chart? Is there even a chart anymore?

There's plenty of chart, but far more hubris. In my experience, everybody writes in charts, but the rare doctor who reads them is a saint.

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

#77

Post by scubbo »

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 take your point, but this is absolutely not it. The commenter above you is saying that, if the "checklist item" for a doctor who is told by a patient "I didn't get pain medication yet" is not "verify that information", then the checklist _itself_ is wrong and needs to be changed. There's minimal negative impact (a delay to treatment if the patient was lying) and huge positive impact (avoiding doing a procedure without appropriate pain medication)

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

#78

Post by TaupeRanger »

a_t48 wrote: post #38
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.

I had morphine for appendicitis. It didn't appear to do anything for me. :(

You may have needed a higher dose. That sucks though.

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

#79

Post by TaupeRanger »

aidenn0 wrote: post #32
yellowstuff wrote: post #21

Earlier quoted context omitted.

I don't have hard statistics, but there's a New Yorker article about survivors of Golden Gate Bridge suicide attempts that says many of them regret the attempt and don't try again. The people who survive jumping off a bridge is probably pretty close to a random sample. https://webcache.googleusercontent.com/search?q=cache:V_siZl...

100% of the people that don't survive never try again either though.

What's your point? The post you replied to is just saying "of people that survive, most wish they wouldn't have tried it." If the sample is indeed random, that means most who didn't survive would feel the same way.

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

#80

Post by mncharity »

jrochkind1 wrote: post #69
mncharity wrote: post #68

Earlier quoted context omitted.

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 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, that describing a common reason why something happens, isn't being apologetic, or a distraction. Here, it seems possible that head-down engagement in physical manipulation, might have distracted from patient communication and care management. As that flavor of failure is not uncommon.

Regards tech to reduce mistakes, it will be interesting to see AR attempt to blend medical records with point of care. To see the patient, is to see their status. To administer an injection, is to have it recorded. But yeah, culture change is core, and hard. And tech doesn't yet provide great leverage on that. Or sometimes, as with VA OR teams composed by randomized assignment, something non-ideal has been knowingly chosen for its larger-scale properties, and the tech task is to mitigate negative impact. By for instance, detecting when meds were requested, but absent a team familiar with working together, didn't happen. There was a VA trauma surgeon shopping around a request to implement that years back.

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