Falling five storeys from a New York rooftop changed my life(smh.com.au)
smh.com.au
Falling five storeys from a New York rooftop changed my life
https://www.smh.com.au/world/north-america/i-was-howling-in-pain-how-falling-five-storeys-from-a-new-york-rooftop-changed-my-life-20200910-p55u9y.html
153 comments
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.
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.
As an old man, my dad was the beneficiary of a lot of love lavished on WW2 servicemen. He loved it. When you have the chance to say a kind word to a combat vet, be assured they'll appreciate it.
God Bless Your Father. He is a great man. Gold bless you.
Thanks! I've often wondered what I'd do in the same situation. But my father put it as he took those risks so I wouldn't have to. I'm grateful to all our combat vets. We should never forget what they did for us.
After i was cured from cancer I also got another look on life. One thing I did was get a motorcycle again and I left my girlfriend. Better to enjoy life right now than live in the future (dreaming of when/if). Now I got another girlfriend and know real love and ride motorcycles with her. Wish I woke up earlier though but better late than never!
A wise man once said “a good partner brings happiness. A bad partner brings wisdom. Take your pick and go for a ride” :)
Those words match my situation exactly!
A sharp reminder for us all. Thanks for sharing.
Thank you for your story. About a year ago I had a fall from about 30 feet. Concussion, both ankles shattered, wheelchair bound for a few months.
The sheer joy and gratitude at being alive after the surety of imminent death was a profound experience. I'm not sure its possible to reach that state of being unless you have been in that circumstance.
As you say, it fades over time. I wish I could channel that feeling every day.
The sheer joy and gratitude at being alive after the surety of imminent death was a profound experience. I'm not sure its possible to reach that state of being unless you have been in that circumstance.
As you say, it fades over time. I wish I could channel that feeling every day.
Do you mind sharing how that influenced your sense of purpose?
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. He didn’t believe me and kept using the bed sheet to try to yank my shoulder back into place. I was howling in pain as I underwent what felt like an excruciating form of medieval torture. When a nurse walked by, the doctor asked her how much fentanyl she had given me. She said she had not given it to me yet.
Horrifying.
Horrifying.
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]
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]
What happens to the doctor in cases like this? Seems like a slam dunk medical malpractice lawsuit but then again it's just one word against another and damages are hard to prove since pain is only experienced in the moment.
In most cases like this, nothing for medical malpractice.
Calculating damages for pain and suffering is usually based on a multiplier of the "economic" damages, the medical bills or lost income from missed work. So in a case where the pain does not result in a longer recovery(or permanent disfigurement or worse) there are no, or nearly no damages. Because of the way tort reform has worked out, it would be impractical for an attorney to represent you unless you can show $25k+ in medical damages, even if it is clear the provider violated the standard of care and it caused you a great deal of pain. Also even in a straightforward case like this, showing that the standard of care was violated is not clear
You could complain to the hospital ombudsman and your insurance co, both to prevent this from happening to others, and because it could reduce your bill.
Calculating damages for pain and suffering is usually based on a multiplier of the "economic" damages, the medical bills or lost income from missed work. So in a case where the pain does not result in a longer recovery(or permanent disfigurement or worse) there are no, or nearly no damages. Because of the way tort reform has worked out, it would be impractical for an attorney to represent you unless you can show $25k+ in medical damages, even if it is clear the provider violated the standard of care and it caused you a great deal of pain. Also even in a straightforward case like this, showing that the standard of care was violated is not clear
You could complain to the hospital ombudsman and your insurance co, both to prevent this from happening to others, and because it could reduce your bill.
Depends on what’s written in the notes - but unless the notes specifically say otherwise, the presumption is that the patient’s recollection is the accurate one, given that this is an unusual situation for the patient to be in, but a routine situation for the doctor.
The lawyer would probably need to subpoena the nurse if the notes didn’t have adequate detail to tell one way or the other. About the “pain is only experienced in the moment” - it wouldn’t be hard to find expert witnesses willing to testify that this was unacceptable medical care. But I don’t know enough about the legal aspects to know how that would translate into a claim for damages.
The lawyer would probably need to subpoena the nurse if the notes didn’t have adequate detail to tell one way or the other. About the “pain is only experienced in the moment” - it wouldn’t be hard to find expert witnesses willing to testify that this was unacceptable medical care. But I don’t know enough about the legal aspects to know how that would translate into a claim for damages.
> the presumption is that the patient’s recollection is the accurate one, given that this is an unusual situation for the patient to be in, but a routine situation for the doctor.
That doesn't make sense to me. The patient is in a shocking situation and intoxicated. More important is that the doctor wasn't even present for the medication so has no evidence at all.
Damages are decided by jury's emotions.
That doesn't make sense to me. The patient is in a shocking situation and intoxicated. More important is that the doctor wasn't even present for the medication so has no evidence at all.
Damages are decided by jury's emotions.
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.
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 patient is not to be trusted.
Our attempts at solving the problem even seems to drive the expert doctors who are actually qualified to do so out of the field. The prescription mills force heavy handed regulations that spook the insurers and hospital legal teams, which leaves two extremes: on the one hand are doctors who can't empathize with the patient and are super strict with any sort of scheduled medication and on the other are doctors whose offices don't see enough patients taking those drugs (or even a single problematic case), so they neither know nor care about the risks and give the drug out freely. Since their numbers are so low, no one thinks to bring up the issue.
The doctors who are most qualified in making the determination are often the ones with the most legitimate patients taking those drugs but all the legal teams and regulators are completely incapable of differentiating them from the prescription mills (excuse me, "pain management centers").
The doctors who are most qualified in making the determination are often the ones with the most legitimate patients taking those drugs but all the legal teams and regulators are completely incapable of differentiating them from the prescription mills (excuse me, "pain management centers").
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?
Could they not check the chart? Is there even a chart anymore?
> 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."
Slate Star Codex wrote about this: https://slatestarcodex.com/2019/09/16/against-against-pseudo...
Basically, an addict wants to look genuine, so a lot of genuine patients have to put up with stuff designed to cut off addicts. Like the scary "FBI warning" that only shows up if you actually pay for a DVD.
Slate Star Codex wrote about this: https://slatestarcodex.com/2019/09/16/against-against-pseudo...
Basically, an addict wants to look genuine, so a lot of genuine patients have to put up with stuff designed to cut off addicts. Like the scary "FBI warning" that only shows up if you actually pay for a DVD.
Flinging yourself from a 5 story building in order to “look genuine” get fentanyl must be pretty common in NYC.
Some doctors take pleasure in telling patients in pain that they make it up and suggest they are just drug junkies looking for a hit.
I have worked with with healthcare professionals for decades, have never once met seen an MD or nurse take pleasure in seeing a patient in pain. I’ve interviewed over 10,000 people to date.
We live in two different computer simulations I guess.
We live in two different computer simulations I guess.
> Basically, an addict wants to look genuine, so a lot of genuine patients have to put up with stuff designed to cut off addicts.
It's much stupider than that.
Addicts want the drug.
So all of the indicators of addiction are actually indicators of wanting the drug.
So anyone who wants the drug is, ipso facto, an addict.
There's no element of addicts trying to look more genuine. Look at that list of red flags:
- Complaining of a need for a drug.
- Asking for more of a drug.
- Asking for a particular drug by name.
- Sometimes taking a drug on your own initiative.
It's much stupider than that.
Addicts want the drug.
So all of the indicators of addiction are actually indicators of wanting the drug.
So anyone who wants the drug is, ipso facto, an addict.
There's no element of addicts trying to look more genuine. Look at that list of red flags:
- Complaining of a need for a drug.
- Asking for more of a drug.
- Asking for a particular drug by name.
- Sometimes taking a drug on your own initiative.
Let's not go too far to one-sided cherry picking.
https://intervention911.com/common-signs-of-drug-seeking-beh...
- laiming they need more drugs to replace a lost or stolen prescription
- Misrepresenting their symptoms
- Frequent visits to multiple doctors, including a willingness to travel to a different city or state to see a new physician – a phenomenon called “doctor shopping”
- Unwillingness or inability to provide a complete health history or contact information for previous physicians
It's possible for a non-addicted person to do this, but actual statistics matter.
https://intervention911.com/common-signs-of-drug-seeking-beh...
- laiming they need more drugs to replace a lost or stolen prescription
- Misrepresenting their symptoms
- Frequent visits to multiple doctors, including a willingness to travel to a different city or state to see a new physician – a phenomenon called “doctor shopping”
- Unwillingness or inability to provide a complete health history or contact information for previous physicians
It's possible for a non-addicted person to do this, but actual statistics matter.
Many of these things are uncommon, but not particularly rare among non-addicts.
> Claiming they need more drugs to replace a lost or stolen prescription
Have you really never lost a prescription? I've lost portions of mine once or twice (i.e. I had a week left and lost the bottle). Luckily not having mine is more of an annoyance than anything, but I can empathize for someone in pain who lost theirs. Stealing medications is common in addicts as well, and for every addict that steals a prescription, there's someone that legitimately did have their prescription stolen.
> Misrepresenting their symptoms
If this can be shown objectively, I can't see any way a non-addict would do this. I fear that it sows distrust between the patient and the doctor, though. The doctor is always looking for signs of the patient misrepresenting symptoms, and the patient is always worried that the doctor is going to think that they're misrepresenting their symptoms.
> Frequent visits to multiple doctors, including a willingness to travel to a different city or state to see a new physician – a phenomenon called “doctor shopping”
Uncommon, but it wouldn't be entirely shocking for someone to travel for access to a better doctor. This wouldn't be that out there for someone who has cancer, for example.
> Unwillingness or inability to provide a complete health history or contact information for previous physicians
I've moved a few times in my life. My complete health history probably involves 30 or so doctors if we go back to childhood. I don't think I could even name all of them, much less have contact info for them.
The statistics do matter, but we're talking about subjecting people to pain here. The evidentiary bar should probably be higher than "you did a thing that addicts are statistically more likely to do". I think especially so when the worst case scenario is that we give an addict a fix. I'm not advocating drug use, but the harm caused seems pretty minimal, beyond the cost of administering that dose in a hospital.
> Claiming they need more drugs to replace a lost or stolen prescription
Have you really never lost a prescription? I've lost portions of mine once or twice (i.e. I had a week left and lost the bottle). Luckily not having mine is more of an annoyance than anything, but I can empathize for someone in pain who lost theirs. Stealing medications is common in addicts as well, and for every addict that steals a prescription, there's someone that legitimately did have their prescription stolen.
> Misrepresenting their symptoms
If this can be shown objectively, I can't see any way a non-addict would do this. I fear that it sows distrust between the patient and the doctor, though. The doctor is always looking for signs of the patient misrepresenting symptoms, and the patient is always worried that the doctor is going to think that they're misrepresenting their symptoms.
> Frequent visits to multiple doctors, including a willingness to travel to a different city or state to see a new physician – a phenomenon called “doctor shopping”
Uncommon, but it wouldn't be entirely shocking for someone to travel for access to a better doctor. This wouldn't be that out there for someone who has cancer, for example.
> Unwillingness or inability to provide a complete health history or contact information for previous physicians
I've moved a few times in my life. My complete health history probably involves 30 or so doctors if we go back to childhood. I don't think I could even name all of them, much less have contact info for them.
The statistics do matter, but we're talking about subjecting people to pain here. The evidentiary bar should probably be higher than "you did a thing that addicts are statistically more likely to do". I think especially so when the worst case scenario is that we give an addict a fix. I'm not advocating drug use, but the harm caused seems pretty minimal, beyond the cost of administering that dose in a hospital.
Moreover, addicts suffering withdrawal are... suffering. This is the reason I put quotes around "genuine" in my original comment. The distinguishing factor between suffering from withdrawal and suffering from another source of pain is a moralizing judgement call on the doctor's part.
Would you also say that a painful cleaning of an infection is also a moralizing judgment against a patient who wants to avoid short term pain?
[deleted]
> 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 forgot which one is which) based on symptoms
- Person A gets the scan
- Doctor evaluates results and says to book surgery in a hospital ASAP as it's probably cancerous
- Person A books surgery
- Hospital gives prep instructions to be performed by Person A 48 hours before surgery
- Person A does everything and goes in for surgery
- Person A is prepped for surgery and is put under anesthesia
- Surgeon comes in and looks at the scan in the operating room
- Surgeon says this scan is nothing to worry about and surely doesn't warrant surgery and it's not a tumor or cancer
- Person A is wondering how the surgery went after coming to from being put out
- Nurse says no surgery was done and even she was able to look at the scan and see nothing was wrong
- Person A is told to go home and wait 4-6 weeks to self heal
So let's ignore thousands of dollars in bills (deductibles). All of this could have been avoided if someone actually looked at the results of the scan before going through the motions of putting someone under anesthesia and a massive amount of stress.
That's only 1 of many stories. In another case someone I knew had their blood drawn twice in the hospital because the 2nd nurse didn't believe them when they said they just got their blood drawn by another nurse 10 minutes ago. The vials were literally next to them, about 3 arm's lengths away.
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 forgot which one is which) based on symptoms
- Person A gets the scan
- Doctor evaluates results and says to book surgery in a hospital ASAP as it's probably cancerous
- Person A books surgery
- Hospital gives prep instructions to be performed by Person A 48 hours before surgery
- Person A does everything and goes in for surgery
- Person A is prepped for surgery and is put under anesthesia
- Surgeon comes in and looks at the scan in the operating room
- Surgeon says this scan is nothing to worry about and surely doesn't warrant surgery and it's not a tumor or cancer
- Person A is wondering how the surgery went after coming to from being put out
- Nurse says no surgery was done and even she was able to look at the scan and see nothing was wrong
- Person A is told to go home and wait 4-6 weeks to self heal
So let's ignore thousands of dollars in bills (deductibles). All of this could have been avoided if someone actually looked at the results of the scan before going through the motions of putting someone under anesthesia and a massive amount of stress.
That's only 1 of many stories. In another case someone I knew had their blood drawn twice in the hospital because the 2nd nurse didn't believe them when they said they just got their blood drawn by another nurse 10 minutes ago. The vials were literally next to them, about 3 arm's lengths away.
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.
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.
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.
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.
I find it bonkers that the surgeon had no prior involvement in reviewing the case before the patient is brought into the operating room.
That's really scary.
That's really scary.
Requiring a surgeon's consultation before scheduling seems like it would be a huge hassle to arrange, and greatly reduce the amount of surgeries they could perform.
Beyond that, I'm not sure what benefit there would be to a surgeon independently reviewing the case early. Thinking about what they'll need you do in tomorrow's surgery would distract them during today's surgery.
Beyond that, I'm not sure what benefit there would be to a surgeon independently reviewing the case early. Thinking about what they'll need you do in tomorrow's surgery would distract them during today's surgery.
When I had cancer surgery, it was the surgeon (literally "the consulant") who consulted with me. He looked at the scan with me and explained my diagnosis and prognosis. We had at least one more meeting before the surgery, and I still see him every year for follow up (I think he's cutting me loose next year after six years - I will miss him he's a nice guy). Isn't this how it normally goes?
At least with the surgeons I know in the United States, they have days devoted to clinic and days devoted to surgery. They meet with nearly all their patients beforehand to evaluate their conditions and discuss the options. The exceptions are emergent cases or if a surgeon (resident, fellow, or attending) is assisting on someone else's case that was seen in clinic by the primary surgeon.
My understanding is that (1) the patient has the right to be explained what the surgery will be, what is their prognosis, what are the risks etc, so they can give informed consent - not sure who other than the surgeon could do this; and (2) that surgery needs to be planned, the surgeon needs to know how many nurses they will need, whether they need any assisting surgeons etc. This is all medical knowledge, a surgeon is not waiting in an operating room and operating whoever they bring in.
The whole story smells of very bad medical practices (and I'm speaking with the perspective of someone living in a formerly communist country, not some medical Mecca).
The whole story smells of very bad medical practices (and I'm speaking with the perspective of someone living in a formerly communist country, not some medical Mecca).
You're conflating bad medicine with cheap medicine. Unnecessary surgery is exactly what I'd expect from bad medicine charged at "whatever the seller wants" prices.
That sounds like malpractice but I dunno.
>- Person A goes into doctor's office for something pretty common
>- Doctor requests cat scan or MRI (I forgot which one is which) based on symptoms
>- Person A gets the scan
>- Doctor evaluates results and says to book surgery in a hospital ASAP as it's probably cancerous
>- Person A books surgery
>- Surgeon comes in and looks at the scan in the operating room
>- Surgeon says this scan is nothing to worry about and surely doesn't warrant surgery and it's not a tumor or cancer
This seems really unusual. I'd also say that (as someone who lives in NYC), I can't imagine things going this way.
I have never heard of a surgeon not reviewing the radiology reports, preparing a surgical plan and consulting with the patient pre-surgery.
If this is true, it's flat-out malpractice.
Given the sheer number of people, resources and precious operating room time involved in ordering, prepping and performing surgery, your story stretches credulity well past the breaking point. To put a fine point on it, I call bullshit.
I had surgery a couple years ago. I had specific symptoms and went to my doctor.
He referred me to an actual surgeon who ordered an MRI. The MRI showed what we expected it to show and then the surgeon ordered an additional scan to cover more area to make sure he understood exactly what was necessary. He then recommended surgery.
Not taking the surgeon's word for it, I sought a second opinion. Fortunately, my ex's brother was a surgeon in the same specialty and he offered to look at the MRI (I would have gone to another surgeon myself had he not been available to me).
He completely concurred with the surgeon and I had a successful surgery.
However, the normal process for surgical procedures, especially since there are significant pre-surgery protocols including medical history workups, blood work, discussions about what the surgery entails and risk factors, as well as a pre-surgery consult with the surgeon and/or his scrub nurse.
What's more, the surgical team (not with the patient) will meet at least once pre-surgery to review the surgical plan (which includes reviewing any imaging), and this may result in additional testing if there's any ambiguity.
And none of that is optional. What's more, on the day of the surgery during prep they will mark the location to be operated upon and confirm, multiple times, via existing imaging, discussions with the patient to confirm, specifically, what the surgery is for and what procedure is to be performed.
All of that is done before any sedation or anaesthesia is administered.
So no. That's not a credible story.
>- Doctor requests cat scan or MRI (I forgot which one is which) based on symptoms
>- Person A gets the scan
>- Doctor evaluates results and says to book surgery in a hospital ASAP as it's probably cancerous
>- Person A books surgery
>- Surgeon comes in and looks at the scan in the operating room
>- Surgeon says this scan is nothing to worry about and surely doesn't warrant surgery and it's not a tumor or cancer
This seems really unusual. I'd also say that (as someone who lives in NYC), I can't imagine things going this way.
I have never heard of a surgeon not reviewing the radiology reports, preparing a surgical plan and consulting with the patient pre-surgery.
If this is true, it's flat-out malpractice.
Given the sheer number of people, resources and precious operating room time involved in ordering, prepping and performing surgery, your story stretches credulity well past the breaking point. To put a fine point on it, I call bullshit.
I had surgery a couple years ago. I had specific symptoms and went to my doctor.
He referred me to an actual surgeon who ordered an MRI. The MRI showed what we expected it to show and then the surgeon ordered an additional scan to cover more area to make sure he understood exactly what was necessary. He then recommended surgery.
Not taking the surgeon's word for it, I sought a second opinion. Fortunately, my ex's brother was a surgeon in the same specialty and he offered to look at the MRI (I would have gone to another surgeon myself had he not been available to me).
He completely concurred with the surgeon and I had a successful surgery.
However, the normal process for surgical procedures, especially since there are significant pre-surgery protocols including medical history workups, blood work, discussions about what the surgery entails and risk factors, as well as a pre-surgery consult with the surgeon and/or his scrub nurse.
What's more, the surgical team (not with the patient) will meet at least once pre-surgery to review the surgical plan (which includes reviewing any imaging), and this may result in additional testing if there's any ambiguity.
And none of that is optional. What's more, on the day of the surgery during prep they will mark the location to be operated upon and confirm, multiple times, via existing imaging, discussions with the patient to confirm, specifically, what the surgery is for and what procedure is to be performed.
All of that is done before any sedation or anaesthesia is administered.
So no. That's not a credible story.
100x more potent just means you will give 1/100 the dose for the same effect.
Around here, fentanyl is used in ambulances. Biggest side effect is it can stop your breath if it’s more than the dose given in lollipops (field-style first aid thing), so you have to keep an eye on the patient.
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.
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.
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.
>Really seems like a "hey nurse did this patient have their fentanyl yet?" would have resolved this issue.
i somehow think that a medical doctor should be able to tell whether a person has an opioid [at least in a pain relieving dose] in their system.
i somehow think that a medical doctor should be able to tell whether a person has an opioid [at least in a pain relieving dose] in their system.
[deleted]
I've dislocated my shoulder twice. The first time they gave me strong opiates and then put it back in. It was painless.
The second time the doctor said pain killers would be dangerous and insisted I have absolutely no pain killers in my system before reseting it.
His description of it feeling like medieval torture is apt.
The second time the doctor said pain killers would be dangerous and insisted I have absolutely no pain killers in my system before reseting it.
His description of it feeling like medieval torture is apt.
I've dislocated my shoulder once and it was reset without any pain killers.
While the method indeed is quite similar to medieval torture, it was certainly not the worst pain I experienced that day.
Although I might have been lucky that the doctor worked in a ski resort and was very skilled in "the art of resetting shoulders".
While the method indeed is quite similar to medieval torture, it was certainly not the worst pain I experienced that day.
Although I might have been lucky that the doctor worked in a ski resort and was very skilled in "the art of resetting shoulders".
My first one with the opiates was at a ski resort too! First run of the day, dislocated on the bunny run. Ironically, it relocated itself when I stood up, so I was like, "oh hey it's ok!". Then I started doing arm circles to prove it was ok, and that's when it got stuck out. :(
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 more.
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 more.
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.
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.
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.
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.
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.
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.
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.
> 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.
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.
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)
That's true and it's only recently that I realized the importance of it. It's imperious that patients be accompanied by a loved one or someone they can trust to look out for their interests and provide an adversarial viewpoint to the medical staff. Patients who are gravely injured/sick can not advocate for themselves and doctors will not listen.
I was recently hospitalized after an accident and was unable to have any family with me because of covid measures. As a result I received the worst medical care I've ever experienced. Including but not limited to: waiting 8 hours in the ER with four broken limbs and no painkillers, having procedures done with no painkillers that required them, being given dangerous dosages of drugs because of a miscommunication between teams despite my protests, having sequels from surgeries that were never addressed by the medical team and that I was too high to ask about, having to program my own medical bed so that it'd stop shaking my broken limbs after 5 hours of unanswered pleading with the staff, having to solve severe complications from the drugs with the help of my family doctor, not eating anything for a week without anybody getting worried... I could go on. I'd experienced similar issues during previous hospital stays, these sort of things happen regularly in hospitals, but I always had someone trustworthy with me to point them out and make a fuss before they became real problems.
I was recently hospitalized after an accident and was unable to have any family with me because of covid measures. As a result I received the worst medical care I've ever experienced. Including but not limited to: waiting 8 hours in the ER with four broken limbs and no painkillers, having procedures done with no painkillers that required them, being given dangerous dosages of drugs because of a miscommunication between teams despite my protests, having sequels from surgeries that were never addressed by the medical team and that I was too high to ask about, having to program my own medical bed so that it'd stop shaking my broken limbs after 5 hours of unanswered pleading with the staff, having to solve severe complications from the drugs with the help of my family doctor, not eating anything for a week without anybody getting worried... I could go on. I'd experienced similar issues during previous hospital stays, these sort of things happen regularly in hospitals, but I always had someone trustworthy with me to point them out and make a fuss before they became real problems.
They're also known for thinking their always right and not asking the team if the patient got their painkillers is exactly in character for that stereotype.
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 came back on their own. Afterwards, the nurses found the patient was labeled incorrectly.
I've told my wife and mother (mom is an RN) that if any of our family go into the hospital they are not to be left alone.
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 came back on their own. Afterwards, the nurses found the patient was labeled incorrectly.
I've told my wife and mother (mom is an RN) that if any of our family go into the hospital they are not to be left alone.
This is why checklists have become are a huge thing in the medical field.
In your scenario, imagine if the first nurse had it drilled into her that she must tick a box on the patient checklist, which lies very visible next to the patient and is almost impossible to not notice, and you have a physical system that makes it difficult to commit mistakes
In your scenario, imagine if the first nurse had it drilled into her that she must tick a box on the patient checklist, which lies very visible next to the patient and is almost impossible to not notice, and you have a physical system that makes it difficult to commit mistakes
That sure would be nice.
I haven't had any problems of this scale, but my doctor can't even schedule a follow-up appointment 3 months in advance.
They can't even use a calendar, much less a checklist.
My pills are prescribed for 3 months and they always manage to hem and haw and almost miss the window as if the passage of time was a recent concept that their practice was unequipped to deal with.
On the other hand, every psychiatrist I've ever had, had no problem getting my anti-psychotics or anti-ADHD medications sent to the pharmacy inside of a day.
I haven't had any problems of this scale, but my doctor can't even schedule a follow-up appointment 3 months in advance.
They can't even use a calendar, much less a checklist.
My pills are prescribed for 3 months and they always manage to hem and haw and almost miss the window as if the passage of time was a recent concept that their practice was unequipped to deal with.
On the other hand, every psychiatrist I've ever had, had no problem getting my anti-psychotics or anti-ADHD medications sent to the pharmacy inside of a day.
A lot of medical software is severely lacking, and general practitioners often operate solo practices where they operate by the doctor's preferences (which might make everyone else's life very difficult, such as the people who have to handle recurring appointments). I've been around some doctors that will do things like ban using the recurring appointments because when they double click the appointment it takes them to the "edit recurring appointment" page, not the "take patient notes page". So yes, their office may be literally unequipped to handle the passage of time because either their EHR system sucks, or the doctor is making everyone else's life hard.
Psychiatrists seem to operate out of groups more often (I see far fewer solo psychiatrists). Groups mean that you have to have EHR software that works well enough to transfer patients between doctors, and you have to have standards set up to where doctors can read patient histories from other doctors. Basically your EHR system needs to be functional, which has nice side effects like making scheduling and prescription refills work correctly.
Psychiatrists seem to operate out of groups more often (I see far fewer solo psychiatrists). Groups mean that you have to have EHR software that works well enough to transfer patients between doctors, and you have to have standards set up to where doctors can read patient histories from other doctors. Basically your EHR system needs to be functional, which has nice side effects like making scheduling and prescription refills work correctly.
Everyone in a hospital should have an advocate with them. My girlfried was going through treatment and one day they tried to give her a shot, insisting that she needed it. She is deatly allergic to most things. I pushed back, refusing the treatement. They were looking at the wrong chart.
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.
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.
Jesus christ man that is terrifying beyond belief. Glad your dad pulled through, hope he sued them and won.
You should complain to the medical board. If the guy is too lazy to look at the chart, what else isn’t he doing?
I had spinal fusion and due to an unrelated issue ended up on the medical floor instead of the neurologist floor overnight. I had zero pain medication after a significant surgery and couldn’t sleep. The floor nurse and useless hospitalist straight up accused me of attempting to get pills.
The surgeon came to do rounds in the morning and was visibly shocked, and the overnight bozos didn’t do other stuff, because they never read the orders.
I had spinal fusion and due to an unrelated issue ended up on the medical floor instead of the neurologist floor overnight. I had zero pain medication after a significant surgery and couldn’t sleep. The floor nurse and useless hospitalist straight up accused me of attempting to get pills.
The surgeon came to do rounds in the morning and was visibly shocked, and the overnight bozos didn’t do other stuff, because they never read the orders.
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...
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...
I had a tooth extraction without numbing when I was a kid. Dentist didn't believe it hurt because so many kids freak out for everything dentist related.
Since then I've had many injuries, but in terms of acute pain, that was the worst. Only thing that came close was when my appendix burst.
Since then I've had many injuries, but in terms of acute pain, that was the worst. Only thing that came close was when my appendix burst.
This is an incident that desperately needs an application of the Five Whys.
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.
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.
> Small barriers to access have a huge impact on addiction.
At the expense of those who legitimately need it. Given how ridiculous the current climate has become, I would almost certainly preemptively purchase black market opiates prior to a procedure if the timing allowed for it. (At this point, I almost feel compelled to keep some on hand for family in general based on past experiences.)
At the expense of those who legitimately need it. Given how ridiculous the current climate has become, I would almost certainly preemptively purchase black market opiates prior to a procedure if the timing allowed for it. (At this point, I almost feel compelled to keep some on hand for family in general based on past experiences.)
I have a small bit left over from my surgery in my freezer in case of an emergency. It’s been a number of years but I’m planning to keep it around.
I remember when they were pumping my dad with propofol and fentanyl for a hemorrhagic stroke to medically induce a coma and let the brain heal. It was like flipping a light switch knocking him out instantly.
I'm scared of this stuff after seeing what it can do to a full grown adult but totally understand the medical necessity for it as it saves lives.
I'm scared of this stuff after seeing what it can do to a full grown adult but totally understand the medical necessity for it as it saves lives.
[deleted]
I had morphine for appendicitis. It didn't appear to do anything for me. :(
Any time I've had any sort of opioid the only thing it did for me is make me feel extremely sick.
You may have needed a higher dose. That sucks though.
Many psychopaths assume a position where they are given trust and they can exercise control over vulnerable people without being questioned. I have seen these people working as pain specialists. They get money from pharma industry and prescribe ineffective pain meds or do it in a way that harms the patient. Some tools in their box are telling patients their pain is only in their heads, that they are nothing wrong, asking patient if they come to get drugs, prescribing opioids where other way are more effective, cutting the doses so people feel withdrawals and so on. The biggest nightmare of these people is medical cannabis as it changes perception of pain and in many cases they lose power over patient.
Ehh. Not the worst thing. People with Ehlers Danlos have to pop visibly dislocated joints back into place daily (and yes, it's very much painful as fuck)
Arguably the most horrifying is when a male dislocates their hip and one of their testicles falls back into that area. You can imagine what happens when somebody attempts or succeeds in shoving the bone back into it's socket when there's a testicle also sitting in the socket. May be more traumatizing for the nurse that shoves it back in once they realize what they've done :D
Arguably the most horrifying is when a male dislocates their hip and one of their testicles falls back into that area. You can imagine what happens when somebody attempts or succeeds in shoving the bone back into it's socket when there's a testicle also sitting in the socket. May be more traumatizing for the nurse that shoves it back in once they realize what they've done :D
Reseating a dislocated joint without pain medication, without any other context, is not the horrifying part.
Damn man, please have some compassion for others who may not have as high a pain tolerance threshold as you. Not everybody experiences everything exactly the same.
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 what I do from this point on. I have been given a second chance at life – and it’s up to me to make the most of it.
The article is clear that there was nothing intentional about this fall, but as a tangent, this excerpt does make me think about people who jump intentionally.
This line of thought is a bit ghoulish, but as far as I know about 90% of people who make an "unsuccessful" suicide attempt never commit suicide [1]. There are confounding variables galore here --- maybe it's the toughest cases who pick the most reliable methods; 10% is still way above the population risk for suicide --- but I've wondered if there's some way to give people that "oh, I'm going to die, and I don't actually want that" feeling that is apparently not uncommon [2] without actually hurting them.
[1] https://www.hsph.harvard.edu/means-matter/means-matter/survi...
[2] https://www.newyorker.com/magazine/2003/10/13/jumpers
> 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 what I do from this point on. I have been given a second chance at life – and it’s up to me to make the most of it.
The article is clear that there was nothing intentional about this fall, but as a tangent, this excerpt does make me think about people who jump intentionally.
This line of thought is a bit ghoulish, but as far as I know about 90% of people who make an "unsuccessful" suicide attempt never commit suicide [1]. There are confounding variables galore here --- maybe it's the toughest cases who pick the most reliable methods; 10% is still way above the population risk for suicide --- but I've wondered if there's some way to give people that "oh, I'm going to die, and I don't actually want that" feeling that is apparently not uncommon [2] without actually hurting them.
[1] https://www.hsph.harvard.edu/means-matter/means-matter/survi...
[2] https://www.newyorker.com/magazine/2003/10/13/jumpers
I’m reminded of the film The Game (1997), but I won’t say more as to not spoil anything for anyone.
Its been 23 years I think the embargo on spoilers is up.
The spoiler-y part is in the comment I replied to; my referencing the film in that context makes clear what spoiler I’m alluding to without making it obvious to those who haven’t seen the film or are otherwise unaware of the plot.
I try not to get in the way of a narrative just to make my own minor point, which is that it’s a good film on a hard topic, and if this topic interests you, perhaps so too will this film.
Thanks for the chuckle, nonetheless.
I try not to get in the way of a narrative just to make my own minor point, which is that it’s a good film on a hard topic, and if this topic interests you, perhaps so too will this film.
Thanks for the chuckle, nonetheless.
There's a whole market for that. Roller coasters, haunted houses/corn maze etc. They get people as close to the edge of that feeling as possible. They won't get that full effect though because people know they are safe. If you wanted to get the full effect you need to break the illusion that customers signed up for midway through. Convince riders that the roller coaster is broken while they're still going full speed. While in line for the corn maze have a sociable "couple" (staff) go before you. While you're going through have one of them start screaming running back past you - you continue and find the other "dead", background music turns off, bright lights, "exit the maze immediately" over a loud speaker... cue chainsaw man.
Go parachuting. The split second before the chute catches is something else.. terrifying. Especially if you tandem jump. I imagine bungee jumping is similar.
I did a tandem in the Middle East and the instructor kept joking about how I wasn't Arab and didn't have faith and it would be so easy to clip me off the parachute :D
"Lol"
"Lol"
Thank you for the best surprise birthday party idea ever!
Nathan for You S01E05:
"Nathan makes a haunted house scarier by convincing visitors that they have contracted an airborne disease."
https://en.wikipedia.org/wiki/List_of_Nathan_for_You_episode...
"Nathan makes a haunted house scarier by convincing visitors that they have contracted an airborne disease."
https://en.wikipedia.org/wiki/List_of_Nathan_for_You_episode...
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...
https://webcache.googleusercontent.com/search?q=cache:V_siZl...
There's also a 2006 documentary titled "the bridge" about the same topic. The real footage is not for the faint of heart, though.
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.
I think he was making a joke. :)
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 of why people attempt to commit suicide, neither or which is for thrill seeking. Those two branches are those that feel a tiredness that normal people just don't feel. It an unreal tiredness like you want to go to sleep and never wake up. You really don't want to be dead but you don't want to go on like you are, eventually something happens, you get overwhelmed and you see no other way. You cannot think about anything past just not being tired in your soul.
I think the second has a form of self loathing and self hate possibly combined with that tiredness. I think this reflects in the way people choose to commit suicide. I think jumpers have to be of the latter mindset, because jumping off a building was the furthest thing from my mind. When I committed to it, I just wanted it to be over. I did not want to suffer, I did not want to fall thru the air contemplating my mortality, I just wanted to not exist. I think jumping, suicide by cop and those type of attempts come from an internal anger at oneself, I did not have that anger, I was just tired. I specifically chose to OD because I figured it would do the trick and the fact that going out in euphoria seemed to me to be the next best thing from the instantaneousness of a bullet. I survived by pure chance and luck and am thankful I did and am better now, have not had a thought in years, but my point of the post was to say I think there is a pattern to the way people choose to commit suicide.
As for the experience without dying, for the particular way I felt, the only thing I could suggest is if someone offered to put me in a drug coma for 3 months then wake me up and see if I wanted to go back for another 3 months. I would have taken that option in a heartbeat. I just wanted a break from life.
I think the second has a form of self loathing and self hate possibly combined with that tiredness. I think this reflects in the way people choose to commit suicide. I think jumpers have to be of the latter mindset, because jumping off a building was the furthest thing from my mind. When I committed to it, I just wanted it to be over. I did not want to suffer, I did not want to fall thru the air contemplating my mortality, I just wanted to not exist. I think jumping, suicide by cop and those type of attempts come from an internal anger at oneself, I did not have that anger, I was just tired. I specifically chose to OD because I figured it would do the trick and the fact that going out in euphoria seemed to me to be the next best thing from the instantaneousness of a bullet. I survived by pure chance and luck and am thankful I did and am better now, have not had a thought in years, but my point of the post was to say I think there is a pattern to the way people choose to commit suicide.
As for the experience without dying, for the particular way I felt, the only thing I could suggest is if someone offered to put me in a drug coma for 3 months then wake me up and see if I wanted to go back for another 3 months. I would have taken that option in a heartbeat. I just wanted a break from life.
> I just wanted a break from life.
I feel that often.
Even a drug coma isn't enough. I'd come back to new bills and house maintenance or other little adult annoyances like that. And my friends and family would age without me.
My ideal vacation would be: Quit work at 5 pm Tuesday, do whatever I like for a year, and come back to work at 9 am Wednesday.
I feel that often.
Even a drug coma isn't enough. I'd come back to new bills and house maintenance or other little adult annoyances like that. And my friends and family would age without me.
My ideal vacation would be: Quit work at 5 pm Tuesday, do whatever I like for a year, and come back to work at 9 am Wednesday.
Yes I agree on the bills etc. It was more of a if someone could wave a magic wand and I just did not have to deal with it for 3 months, just knowing that I would not have to deal with it, at that very moment would have been such a relief.
I had that feeling of if I could just walk away from my life for a year too, just leave it all for a year and maybe I would be better. Tired in the soul is the only way I can describe it to people. At the time I did not suffer from depression and I was not depressed, I have ADD and had a bunch of life event stack up on top of me to where my ADD was so bad that I could not put one foot in front of the other. Something as simple as washing the dishes seemed like moving a mountain.
I had that feeling of if I could just walk away from my life for a year too, just leave it all for a year and maybe I would be better. Tired in the soul is the only way I can describe it to people. At the time I did not suffer from depression and I was not depressed, I have ADD and had a bunch of life event stack up on top of me to where my ADD was so bad that I could not put one foot in front of the other. Something as simple as washing the dishes seemed like moving a mountain.
I wonder if there's a way to jolt one's brain into the right place for the first scenario without coming as close to death as possible. Seems like there's a lot more out there for thrill seekers than tired people.
And I have to say, having experienced the tiredness but not the "tipping over" I find myself pretty afraid sometimes.
And I have to say, having experienced the tiredness but not the "tipping over" I find myself pretty afraid sometimes.
I can tell you after I had my attempt, when I returned to rational thought it scared the crap out of me. So when I decided that it was a done deal I took efforts to hide my body. I did not want to be found, I live in a chain of islands and went to a remote island where no one goes. My intent was that I knew that there is a lag time between drugs taking effect and the actual physical death. Anyways, I choose the island because it is not connected via bridge and no one ever goes to it. It was by pure happenstance that a young couple was camping on that island that day.
Anyways, I bring this up because there was systematic planning in my mind. If you find yourself going over the details it's time to raise your hand and tell someone. I did not really give a shit at that point so actually telling someone would have been easy but I also did not want people to thing I was seeking attention.
Anyways, when I came too I was pretty surprised to find that I was still alive and I set about a plan to ensure that I did not attempt again. For about a year, I would envision my daughters walking down the aisle without me, my sons seeing their first born. My wife, experience this all without me and growing old alone. It was enough for me to see the effect and pain my absence would cause other people. For the time, I could not live for myself, but I could live for them. Eventually I learned to live for myself again.
I find myself pretty afraid sometimes.
My contact info is in the profile, I am a complete stranger. Sometimes they are the easiest to talk to. If you ever find yourself at the tipping point, my door is always open, please contact me if you get there.
Anyways, I bring this up because there was systematic planning in my mind. If you find yourself going over the details it's time to raise your hand and tell someone. I did not really give a shit at that point so actually telling someone would have been easy but I also did not want people to thing I was seeking attention.
Anyways, when I came too I was pretty surprised to find that I was still alive and I set about a plan to ensure that I did not attempt again. For about a year, I would envision my daughters walking down the aisle without me, my sons seeing their first born. My wife, experience this all without me and growing old alone. It was enough for me to see the effect and pain my absence would cause other people. For the time, I could not live for myself, but I could live for them. Eventually I learned to live for myself again.
I find myself pretty afraid sometimes.
My contact info is in the profile, I am a complete stranger. Sometimes they are the easiest to talk to. If you ever find yourself at the tipping point, my door is always open, please contact me if you get there.
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.
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.
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.
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 life or death
And he goes back at the end! He feels the fear like he should, looks at the gap and is more concerned that he'll learn the wrong lesson than learning no lesson!
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 life or death
And he goes back at the end! He feels the fear like he should, looks at the gap and is more concerned that he'll learn the wrong lesson than learning no lesson!
> 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 likely trespassing, and they chose to accept the risks. The meaning to take from this experience is that you should be extra careful when you go places that are clearly not meant for you to be.
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 likely trespassing, and they chose to accept the risks. The meaning to take from this experience is that you should be extra careful when you go places that are clearly not meant for you to be.
> 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.
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
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$multiply_1.3545%...
https://static.ffx.io/images/$zoom_0.188%2C$multiply_1.3545%...
There is a picture with him sitting down on the ledge next to where he fell. The top of the wall is below his knees.
https://static.ffx.io/images/$zoom_0.221%2C$multiply_2.7195%...
https://static.ffx.io/images/$zoom_0.221%2C$multiply_2.7195%...
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.
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.
Also in Amsterdam - canals mostly have no railings along their canals to prevent people from falling in.
I heard a story that dead bodies of men kept getting found in the canals with alcohol in their blood and their flies undone. As you can probably guess, intoxicated men were attempting to urinate in the canals and ended up falling in and drowning. Rather than building railings, they built more public urinals.
I heard a story that dead bodies of men kept getting found in the canals with alcohol in their blood and their flies undone. As you can probably guess, intoxicated men were attempting to urinate in the canals and ended up falling in and drowning. Rather than building railings, they built more public urinals.
> 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?
The whole Netherlands, in fact.
I was under the impression that very few countries mandate helmets for cyclists. Australia, NZ, anywhere else?
In the U.S. most states have a helmet law but only for children: https://www.helmets.org/mandator.htm
He's just an idiot as far as I'm concerned.
Idiot only if he didn't learn from it. No one needs to be chastized for one momentary lapse in judgement, as long as they own up to it.
The article is well written, so I don’t think he is an idiot. He made a mistake.
They found that half of the patients who fell from the height I did – 18.2 metres
Some high school physics:
s = 1/2 at^2 about 1.98 sec of free fall time.
v = at which gives us about 43 mph of impact velocity.
There was a time I was a volunteer at the SF General ER room when I was considering going to the medical school.
We had a guy who fell from a 5 story parking lot that survived with a broken foot. The police came and he wouldn't say what had happened and the whispers behind the ER room was he was probably pushed but he is afraid to speak.
When the ER doctor came to examine him, the doctor asked about two other old scars.
What is this scar? I was stabbed once. What is this other scar? I was shot once.
Yep, talk about nine lives.
Some high school physics:
s = 1/2 at^2 about 1.98 sec of free fall time.
v = at which gives us about 43 mph of impact velocity.
There was a time I was a volunteer at the SF General ER room when I was considering going to the medical school.
We had a guy who fell from a 5 story parking lot that survived with a broken foot. The police came and he wouldn't say what had happened and the whispers behind the ER room was he was probably pushed but he is afraid to speak.
When the ER doctor came to examine him, the doctor asked about two other old scars.
What is this scar? I was stabbed once. What is this other scar? I was shot once.
Yep, talk about nine lives.
TFA mentions a key bit at the end: landing on, and crushing, two plastic milk crates. Crumple zone.
Working in residential construction since the 1980s I've seen several people fall from that height. None of them injured all of them were not direct falls most of them were scrapes along walls. I've also seen way more people fall from step ladders two or three feet tall and get injured worse. One case in the early 90s a painter exterior work about 32 ft tall fell from maybe 26 ft his primary concern was not spilling his paint landed in a koi pond on his butt didn't spill the drop of paint.
A construction worker friend was working about 40 feet up on an extension ladder when the base went out. He said the hard part was resisting the urge to jump off, but they had been taught (correctly) that all jumping will do is increase the rate of falling. He rode it to the ground and was ok.
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.
So it's all is down to luck.
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
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
> 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.
Wow, is this true? I've noticed that when small babies are picked up, there's a difference in their weight, depending upon whether they want to be picked up or not. Like, by doing something with their body, they are able to make themselves lighter or heavier -- perhaps by clinging more (or less) to the person picking them up, and perhaps by tightening (or loosening) their muscles.
I'm a pilates instructor, if you have any sources that discuss the effect of tense muscles & force, I would really appreciate it. Thanks :)
Wow, is this true? I've noticed that when small babies are picked up, there's a difference in their weight, depending upon whether they want to be picked up or not. Like, by doing something with their body, they are able to make themselves lighter or heavier -- perhaps by clinging more (or less) to the person picking them up, and perhaps by tightening (or loosening) their muscles.
I'm a pilates instructor, if you have any sources that discuss the effect of tense muscles & force, I would really appreciate it. Thanks :)
Babies don't magically change weight. It's just when they are fighting being picked you are probably being forced into a position with less mechanical advantage.
It doesn't seem to make sense logically, if you think of weight as mass * gravity. But hypothetically speaking, if the baby can do this -- https://www.youtube.com/watch?v=f5Wks63Ng0Y -- don't you think the weight will be different to whoever is picking the baby up?
We don't pick up the baby as a single movement. If we did, then yes there can be no magical weight change. But in reality, there's a bit of a choreography involved. Perhaps the baby holds up its arms, you put your arms below its shoulders, you raise it slowly. During this process, surely it can control how much of its weight you perceive?
We don't pick up the baby as a single movement. If we did, then yes there can be no magical weight change. But in reality, there's a bit of a choreography involved. Perhaps the baby holds up its arms, you put your arms below its shoulders, you raise it slowly. During this process, surely it can control how much of its weight you perceive?
You're right, just using the wrong terms. The baby's weight is fixed at mass * gravity, it doesn't change. What changes is the force required to accelerate the baby upwards, which is the delta between the force of gravity (the baby's weight) and any upward forces opposing that gravity. So if the baby pushes upward with it's feet to help you, you have to exert less force to lift the baby.
Scientifically speaking, the weight of an object cannot change unless gravity changes or it's mass changes. The forces required to accelerate that object in a particular direction vary wildly based on all kinds of things that exert a force on the object.
Off topic, but that does make me curious how "weight" works in an environment where you're exposed to more than one gravitational field. Like if you're close enough to two black holes to be affected by the gravity from both.
Scientifically speaking, the weight of an object cannot change unless gravity changes or it's mass changes. The forces required to accelerate that object in a particular direction vary wildly based on all kinds of things that exert a force on the object.
Off topic, but that does make me curious how "weight" works in an environment where you're exposed to more than one gravitational field. Like if you're close enough to two black holes to be affected by the gravity from both.
A neighbor fell four stories through a burned out building and endured years of pain and depression which drove severe alcoholism (3.5L of vodka daily) and eventual suicide.
Easily could have been killed, and the story would have been a young man aged 32 died gruesomely after falling five stories. A life barely lived, a death barely known.
And yet he didn't! That cooler box, those planks just inches from denying him one more day.
I am an atheist but such stories always evoke a delightful supernatural indulgence. I was vicarious with my enjoyment when he said "The world seemed to vibrate with a new intensity".
I am an atheist but such stories always evoke a delightful supernatural indulgence. I was vicarious with my enjoyment when he said "The world seemed to vibrate with a new intensity".
The people who put the milk crates there saved his life.
I've said it here before that, even with the best doctors on staff, you don't want to end up in a modern hospital alone, without a friend or family with you.
The quarantine restrictions sound horrifying.
The quarantine restrictions sound horrifying.
So basically the headline is misleading.
This is the teeniest way a potential deadly fall can change your life.
This is the teeniest way a potential deadly fall can change your life.
I had an accident last year, much less scary but required a trip to a level 1 trauma ward and brain surgery with over a month in the hospital.
I remember well the daily list of questions - what day is it? Where are you? Who's the president? It took me a while to realize that these questions were a quick way to evaluate your mental health. I shudder to think how many times I got them wrong. I was so proud when I realized that my room had a whiteboard where they wrote the date every day, and all I had to do to was look to know what day it was. I told the nurse, feeling like I was cheating, but they didn't care - I guess if I had the mental capacity to figure that out it was good enough for them.
I remember well the daily list of questions - what day is it? Where are you? Who's the president? It took me a while to realize that these questions were a quick way to evaluate your mental health. I shudder to think how many times I got them wrong. I was so proud when I realized that my room had a whiteboard where they wrote the date every day, and all I had to do to was look to know what day it was. I told the nurse, feeling like I was cheating, but they didn't care - I guess if I had the mental capacity to figure that out it was good enough for them.
You are seen everyday by a team of MDs if in a NYC hospital. I have been in a very similar situation, yes one of those “it’s a miracle you are alive” scenarios. I was run over by a truck. There are morning rounds, EVERY patient is seen. Everyone.
MDs just don’t “stop coming by”, this is an absurd statement.
> As my discharge date approached, the occupational therapists stopped coming by and so did the doctors. After a week in the hospital, the staff were ready for me to leave, and I was, too.
MDs just don’t “stop coming by”, this is an absurd statement.
> As my discharge date approached, the occupational therapists stopped coming by and so did the doctors. After a week in the hospital, the staff were ready for me to leave, and I was, too.
Amen. Thanks for sharing. As a cancer survivor, this resonates.
What an incredible story. Is this what Carl Jung would call "synchronicity"?
This story is like a true crime story written by an unreliable narrator.
“It was dark by now. I was tipsy, but not more so than a regular Saturday night.”
What a strange piece of [fiction || non-fiction].
“It was dark by now. I was tipsy, but not more so than a regular Saturday night.”
What a strange piece of [fiction || non-fiction].
I fail to see how can anyone expect anything else at the quite high roof ledge than air.
I think article is missing part of him being either drunk or high, where there would be clear wisdom to stay sober when you are on the roof, there is no other explanation unless he is few years old toddler.
I think article is missing part of him being either drunk or high, where there would be clear wisdom to stay sober when you are on the roof, there is no other explanation unless he is few years old toddler.
One of his his take away should be certain-assumptions could be deadly.
How did it change his life?
Amen. Thanks for sharing. As a cancer survivor this resonates.
Seems level headed...didn't sue anyone because it was his fault. Amazing.
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 own catheter to avoid the embarassment of having it done for me.
The following weeks were spent wheelchair-bound in a rehab facility, where each day brought surreal new challenges, but also small increments of progress. A year later, all bodily functions have been restored, with only minor limitations.
If you have also been struck by disaster, and narrowly escaped by sheer miracle, you will understand the intense gratitude and sense of purpose that one is filled with in such circumstances.
Gratitude for all the little things that were almost taken away forever - wiggling your toes, playing a sport, walking to the store, using the toilet unassisted. Gratitude for all the help, care, and healing from medical staff, without which life would be awful and pointless.
And a deep sense of purpose, as you realize how short and fragile that life is. It is a powerful reminder to learn, build, and grow while you still have the resources and opportunity.
I think about it less as time goes on, but sometimes I will see the ground rushing at me, or glimpse a flash of the life I almost had... and it keeps me on my toes.