11 ms·
A Woman Who Needed to Be Upside-Down (2012)
- throwaway0a5e 6y agoI can't be the only one that called it as soon as I read the word "pacemaker". Nice to see that the hospital still went through the troubleshooting flow chart though.
- JshWright 6y agoDo you have a background in cardiology? It may be more likely that the pacemaker would jump out to you as the cause because you're not familiar with the other possible causes.
- throwaway0a5e 6y agoPurely binary performance, it's either working or it's not, is common for digital electronics and rare for body parts. Body parts tend to work less and less well and there's a threshold where it starts causing problems down the line. Body parts also don't tend to have intermittent failures where they can toggle between "working fine" and "not at all" rapidly whereas electronics do. Once they stated that she had electronics in her that became obvious as a likely source of the problem.
- JshWright 6y agoBinary states aren't super rare in biological processes. All the causes the doctor outlines are plausible. My first thought was orthostatic hypotension (it's not at all uncommon for people to pass out almost instantly when they go from supine to standing), or some sort of obstructive shock (with cardiac tamponade being the most likely). Both of those conditions are massively more likely than the pacemaker being intermittently connected, so it make sense to rule out the higher probability options first. 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...
- manquer 6y agoThe way I saw is it like doing a commit bisect. While there were other problems before, this particular problem started after the pacemaker operation, the other problems had stopped. It is like a one bug is fixed and another was created. Either the operation or the device itself was the most likely cause of the change in such a short time frame? 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.
- JshWright 6y agoI totally get where you're coming from. I'm a full time developer, and part-time paramedic. There are definitely a lot of similarities between debugging a program and debugging a person. 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.
- chinathrow 6y agoSame here, but then again, that article is from 2012 and I am sure I've read it before and connected the dots immediately.
- dijit27 6y agoI didn't call it, but I did guess some sort of electrical disconnect.
- rodw 6y agoThis makes me think of that X-files episode about the couple that were compelled to travel west to avoid physical discomfort: https://en.wikipedia.org/wiki/Drive_%28The_X-Files%29 https://en.wikipedia.org/wiki/Drive_%28The_X-Files%29
- dijit 6y agoSometimes I feel this way due to timezones. 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.
- dom96 6y agoAhh, the episode with Bryan Cranston. I really need to try watching X-Files again.
- agency 6y agoAnd written by Vince Gilligan! He also wrote my single favorite X-Files episode "Bad Blood"
- rrauenza 6y agoIs that also the one where swear words are sort of censored in English by the narrator? Another favorite was the Cops spoof. OH -- Also a Vince Gilligan!
- 51Cards 6y agoFactoid for the day: Cranston's work on that episode won him the Breaking Bad role later. AMC wasn't convinced he could pull it off (seeing him as a sitcom comedy actor) until Gillian showed them his work in that episode and he was cast.
- ashleyn 6y ago"Upside down" - my first thought was 2015 George McFly in Back to the Future 2.
- IgorPartola 6y agoThis read like a call to Car Talk. “Doesn’t anybody screen these calls?!”
- extro 6y ago>“You’re hurting her,” a woman yelled. What should we do with people like this?
- black_puppydog 6y agoDunno, give them a gun and hire them for community police work? /s
- imesh 6y agoI don't live in an area with any BLM protests. Instead our boring town has started to freak out about mythical child nappers. Cars have been searched and people have been beaten up by there over reactive types. Different politics, same attitudes.
- dang 6y ago"Eschew flamebait. Don't introduce flamewar topics unless you have something genuinely new to say. Avoid unrelated controversies and generic tangents." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- thibran 6y agoAsk if her name is Karen? https://en.wikipedia.org/wiki/Karen_(pejorative) https://en.wikipedia.org/wiki/Karen_(pejorative)
- dang 6y agoPlease don't do this here.
- centimeter 6y agoNot let them vote, for starters.
- NikolaeVarius 6y agoI legitimately don't understand these types of reactions. At most, this should have prompted is "Well thats different"
- bobloblaw45 6y agoI bet they used a micro usb cable. Sometimes those things can be so janky my phone won't charge unless you kinda fold them and rest the phone on it a certain way.
- kube-system 6y agoMicro USB is great. My first smartphone had Mini USB which was way worse.
- ratsimihah 6y agoThat happens with lightning cables too sadly.
- hinkley 6y agoThe contacts on the lightning cable can be cleaned, which is often my problem. But because they're exposed they have to be cleaned. 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...
- kube-system 6y agoDon't scrape it out, use air duster!
- hinkley 6y agoIf I were forward thinking enough I wouldn't have to do that. But you cram the lint in like you're loading a musket every time you plug a cable into the port.
- mekkkkkk 6y ago(unrelated, obligatory ad rant) 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.
- citiguy 6y agoReader mode to the rescue!
- fizixer 6y agoIs there a name for these kinds of articles? Serious matters of importance wrapped into Harry-Potteresque story lines 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.
- rickyplouis 6y agoSlightly tangential, but in Brave New World they trained future embryos to be rocket-plane engineers altering oxygen levels based on their vertical orientation. > 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."
- jerryr 6y agoIf you enjoyed this article, you might also enjoy The Man Who Mistook His Wife for a Hat and Other Clinical Tales by Oliver Sacks. It’s a book of essays about brain function and disorders, but each begins with an individual who exhibits particularly unusual symptoms. They don’t have tidy resolutions like this article, but the book is well-written and engaging—-as are the rest of Dr. Sack’s writings.
- archagon 6y agoJust started reading this. It's really sucked me in, but it also fills me with a sort of biological dread. Something goes wrong with your brain-meat and suddenly you find yourself teleported 40 years into the future every time you look in the mirror, or become an unstuck, powerless spirit inside your own body.
- derefr 6y ago> Or her blood pressure could be so low that blood reached the brain only when she was upside down. Blood pressure that low could have been triggered by an allergic reaction, anaphylactic shock, or severe dehydration. 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?
- alexpotato 6y agoThis is why they have, no joke, inflatable pants [0] more commonly known as "Military Anti Shock Trousers(MAST)". 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. [0] - https://en.wikipedia.org/wiki/Military_anti-shock_trousers https://en.wikipedia.org/wiki/Military_anti-shock_trousers
- prputnam 6y agoI've been out of EMS for a few years now, but these have (or had at least) fallen massively out of favor. 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.
- sterlind 6y ago
- fred_is_fred 6y agoI really miss the Discover Magazine medical diagnosis podcasts about stuff like this. I don't work in medicine at all but I loved the mystery/problem solving aspect - reminded me of being on call for platform services, without the human life aspect of course.
- MetaDark 6y agoWhile reading this I thought it sounded familiar, and realized this is exactly what happens in the Grey's anatomy episode "Love Turns You Upside Down". Interesting that it was based on a real life situation, it seems like a lot of episodes are.
- phyzome 6y agoI cringed at the part where they're yelling about epinephrine and IVs, and Jason has to barge in and put her upside down again.
- forgotmypw17 6y agoI think it is illustrative of how important it is to have someone who cares about you and knows you around when dealing with doctors.
- koheripbal 6y agoAn incredibly tiny percentage of cases presenting to the ER are unique and necessitate a friend or family's help in diagnosis - let alone treatment.
- lmilcin 6y agoI know multiple stories from just my family of people who only got adequate help through persistence of their family member or significant other. 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.
- wolco 6y agoSurprised they can't smell the difference.
- kjeetgill 6y agoThat kinda talk is exactly why the parent holds that sentiment. I get that to a doctor you're being evaluated against a statistic, but as a patient I'm obviously invested in my particular circumstances. Not blaming anyone, but nobody feels reassured being treated that way.
- pedrocx486 6y agoNon-American here, I can't be the only one to find the use of "coughing spell" (especially "spell") on a medical setting... Weird. Maybe it's my understanding of the English language and how I perceive that word.
- pmahoney 6y agoSee "(Entry 4 of 5)", the second noun definition of spell [1]. "an indeterminate period of time" or "a stretch of a specified type of weather" as in, "we've had a long dry spell; I hope it rains soon". It does not sound particularly strange or unscientific to me. [1] https://www.merriam-webster.com/dictionary/spell https://www.merriam-webster.com/dictionary/spell
- JoelMcCracken 6y ago“A fainting spell” also comes to mind. It seems a bit archaic but I think it’s clear and unambiguous.
- dang 6y agoA perfect reply. Thank you.
- murican22 6y agoReading this article makes one appreciate just how much expertise doctors have. As soon as the doctor was presented with a few symptoms, he was able to begin running through a checklist of problems related to this specific issue and arrived relatively quickly at the solution. Many doctors are able to routinely do this for dozens of ailments under intense pressure, making them even more impressive.
- jerome-jh 6y agoAnd unfortunately some doctors cannot make a proper diagnostic even after visiting them several times, and having a rather uncommon, but not rare, condition. First hand experience. Well that's life.
- deleted 6y ago[deleted]
- abrookewood 6y agoI'm not surprised by that. There is an exhausting amount of information that they have to digest & recall. It makes sense that they would assume that the most common conditions are likely to be the cause of your ailment. Maybe AI or automated diagnosis could help in the future, by suggesting rare conditions that fit the symptoms as well as the common ones.
- nitrogen 6y agoThe pattern matching could easily be automated. It's basically a game of 21 questions. Doctors sometimes fail here by getting too fixated on prior probabilities ("this condition is very uncommon so you don't have it"). 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).
- fluffernutter 6y agoMaybe the patterns change and that is what makes humans good at it and automated things not.
- jolmg 6y agoGoing to the hospital must've been interesting. I wonder if she, in her mid-60s, was seated upside down in the car, or if the man carried her upside down through public transport.
- FpUser 6y agoI cant't help feeling so happy that this poor woman has such an amazing husband. Best wishes to this couple.
- RickJWagner 6y agoNow we know Diana Ross's inspiration. Upside down Boy, you turn me Inside out And round and round