[NOTE: As I mentioned yesterday, our power outage continues, and, thanks to having to decamp to a hotel last night, I didn’t have time to produce new Insolence. So I thought I’d repost a “classic” from 11 years ago that I don’t believe I’ve ever reposted before during vacation or otherwise. It represents a sort of blogging that I haven’t done for years, just a personal story with nothing to do with my usual topics, such as pseudoscience, quackery, clinical trials, and basic science. This story is based on a real patient encounter from around 25 years ago, but details have been changed.]

I don’t recall if I have mentioned this before on the blog, but for about two and a half years when I was doing my graduate work in the laboratory back in the early 1990’s, I moonlighted as a flight physician with a helicopter medical transport service in Cleveland. This is probably about the most interesting thing about my life, and it never fails to cause listeners’ ears to perk up when I mention my brief time trying to make like Tom Cruise in Top Gun (you know, before he went all mental on us) and swooping in to rescue patients. Of course, the actual experience wasn’t exactly like that (although most of the helicopter pilots were ex-military, many with combat experience in Vietnam, and, on occasions when we had to go out for public relations runs (kids just love checking out a real helicopter), they would be sure to do an impressive swoop over the crowd both before landing and after taking off but before leaving, a maneuver which had a tendency to cause my face to turn a rather sickly shade of green. Most unlike a fighter pilot. Those were good times.

But in reality, this job was usually 80-90% boredom (sitting around the call room waiting for calls, often killing time reading journals or playing around on Usenet–believe it or not, this was before Netscape and before the wide availability of access to the web), 10-20% drudgery (routine runs transporting patients who weren’t unstable, runs that made me feel more than anything else like a glorified babysitter in a spiffy flight suit), and 1-2% sheer terror. Let me tell you docs out there: You haven’t lived until you’ve tried to do chest compressions in a cramped helicopter in the middle of flight on a windy day, just you and the flight nurse, without the usual crowd of helpers that descend upon codes in the hospital. Shifts were typically 12 hours long from 7 AM to 7 PM or 7 PM to 7 AM, and, because I was the moonlighter, I usually got the night shifts. The level of activity ranged from not getting a single call (and, bliss of bliss, getting to sleep all night) to going on a run shortly after arriving for my shift, going on run after run without making it back to base until quitting time or even later. The worst runs of all, the ones that I always dreaded, usually came in near the end of a shift, at 5 or 6 AM. They were almost always very bad, and not just because they’d guarantee that I wouldn’t be getting off work on time and making it back to the lab by a reasonable hour in the morning.

This run was definitely that.

It was early on a Monday morning in late summer. I hated doing Sunday night shifts, mainly because right after finishing the shift I’d have to go straight to the lab and work another 12 hours or more with no break. This was long before the days of 80 hour work weeks. I learned things going out on helicopter runs that I’d never have learned otherwise. I also learned things about myself that surprised me, not the least of which was the very fact that I actually could do the job, something I doubted when I first signed up to do it because it was the thing that nearly all the surgery residents did when they were in their lab years. There had only been one run that shift. Fortunately, it had been a routine cardiac run. We had picked up the patient at a small community hospital and transported him to the cardiac Mecca down the street from the hospital that was home base to my residency program, deposited him safely in the CCU, and headed back without incident. I had plopped down on the less-than-plush bed in the physician’s call room and promptly started sawing logs.

Only to have my blissful sleep shattered by the shriek of my pager. I fumbled for my glasses and looked at the clock. 5:30 AM. Shit. That means I’ll be late getting back. I grabbed my bag and hat and stumbled out the door to be met by my nurse, the pilot, and his copilot, all of whom were making their shambling way towards the helipad. We all got in, and soon the engine fired up, the rotors started spinning, and the bird started to shudder as it strained against gravity. Over my headphones, report was coming in. Apparently this was a single car MVA (motor vehicle accident), with a single victim, a young female, who was reportedly unconscious at the scene. That’s all we knew as we roared off into the pinkness of the just pre-dawn sky. In the back of my mind, I thought about my fellow residents back at the County Hospital and how grateful they would be for my bringing them a new customer right before their shift change at 7 AM. (There were two trauma teams, and switchover time between the two of them was 7 AM; again, this is before the days of the 80 hour work week. When we did trauma, we did 24 hours on, 24 hours off, for up to two months at a time. And it wasn’t exactly 24 hour on, but more like 30, because we had to round and make sure all our patients were tucked in before we could leave for the day, and once a week there was a 4 PM conference that we were expected to stick around for, even if it was our “day off.”)

As we circled the site, which was a parking lot near the two lane road on which the crash had occurred, we learned more. Apparently, the car had gone off the road and hit a tree at high speed. Usually, given the time of day, a crash like this occurs because the driver fell asleep at the wheel. We also learned that her blood pressure was very low, and she was unresponsive. All exhaustion left me. In fact, I was keyed up so high that I had to briefly talk myself down and remind myself that my being that nervous would do no one any good, least of all the patient. The entire flight took less than 10 minutes, as we were not far from the scene, and I knew from experience that it would probably take about 10 minutes to get back to the County Hospital, the regional Level I trauma center.

The helicopter landed on a section of the parking lot that EMS had marked off. We were out before the rotors stopped spinning, heads held low as we ran awkwardly towards the ambulance, the wind pushing down on us hard. EMS pointed to the ambulance, meaning that they had already gotten the patient into the ambulance and were working on her there. We headed that way. Out of the corner of my eye, I saw the car, a small vehicle that I could not identify, so twisted it was against a tree.

We arrived.

There, in the back of the ambulance, two EMS workers were a blur of action. I looked at the monitor. Not good. BP 70/40, pulse 120. Two large bore IVs were in and fluid was pouring in. One of the workers was at the head, trying to intubate the girl, who had been immobilized on a backboard with a cervical spine collar and whose face was covered with blood from an enormous scalp laceration. Her clothes had been partially cut away to allow the placement of EKG leads and a blood pressure cuff.

“I haven’t been able to get it,” he informed me.

“Let me try,” I said, and jumped into the back of the ambulance, not feeling at all confident in my ability to do an intubation under such conditions. Around there, most paramedics in units trained to do it were pretty good at intubating, and if they couldn’t get it I had serious doubts that I could do it. I sincerely hoped that I wasn’t forced to do a surgical airway (cricothyroidotomy. Fortunately, they were still able to bag her, and her oxygenation was acceptable.

I could see why he was having problems. She had swallowed a lot of blood and had facial fractures, and the suction wasn’t working well. I swallowed, grabbed the laryngoscope, and gave it a go, while my nurse did her assessment.

“Crepitus on the right, muliple rib fractures. Heart sounds weak. Breath sounds decreased on the right.”

Even as I was working to secure an airway I instructed her to get a chest tube setup ready. Given the blood pressure, though, I realized that the patient might be better served by us just getting her intubated and getting her on the helicopter, our version of a “scoop and run.” Putting a chest tube in in the helicopter to drain the blood and reexpand her lung would be a pain, but if she was bleeding from other sites the delay to get the chest tube in could mean the difference between life and death.

Under ideal circumstances, intubation is not that difficult. You take the laryngoscope and gently lift the base of the tongue and epiglottis to reveal under the light of the scope the vocal cords, doing so without cranking on the teeth. When you see the vocal cords, you take the endotracheal tube and put it right between them into the windpipe and then gently blow up the balloon to seal the space between the tube and the wall of the trachea. Under conditions like these, where you can’t bend the neck for fear of causing paralysis if there’s a cervical spine injury, there’s blood all over the place pooling in the back of the mouth, and space is limited, intubation can be a major challenge.

Fortunately, and much to my relief, this time it was a challenge that I was up to. I had had my doubts.

Once it was clear that the tube was in the right place and that we were able to ventilate the patient, I decided that we should get her on the helicopter. We were gathering our supplies and preparing to move her when it happened.

“Doc,” one of the paramedics said. “I can’t get a pulse or blood pressure.”

We all looked at the monitor in unison. No rhythm. Shit.

We began chest compressions, and one of the paramedics charged up the defibrillator while another one quickly cut what clothing remained covering her torso and placed conductive pads on her chest. I grabbed the paddles.

“Clear!” Everyone moved back momentarily.

Electricity caused the girl’s body to shudder, as if she were plunging her chest at the life-giving electricity.

Still no rhythm. I turned up the juice slightly according to ACLS protocol and charged up the paddles again. Shock. Still no rhythm. I did it a third time. Nothing. Double shit.

We began chest compressions again and continued the ACLS (Advanced Cardiac Life Support) algorithm, administering drugs sequentially, followed by shocks. I plunged a 14-gauge IV catheter into the right side of her chest in case she had a tension pneumothorax from all of her rib fractures. There was no rush of air and no change in her vital signs (or lack thereof). We kept working, with chest compressions, interrupted by the administration of drugs and shocks. We ran to the helicopter, doing chest compressions all the way. A cardiac arrest after blunt trauma is almost always not a survivable event. Even for a witnessed arrest after blunt trauma, the odds of reversing it and saving the patient are very small, particularly in the field. We had to try, and try we did, but none of us had any illusions about our chances for success, as the helicopter took off. Even so, getting her to the hospital was the only hope she had of survival, no matter how slim that chance was. We continued CPR and the complete ATLS (Advanced Trauma Life Support) protocol the entire way to the hospital.

When we arrived, we did a rare hot unload (usually we waited for the helicopter rotors to come to a complete stop before unloading the patient) and moved to the elevator, one of the nurses standing on the bottom part of the gurney continuing chest compressions, and straight to the trauma bay, where the assembled team was waiting to pounce.

“How long has she been down?”

“Twenty minutes.”

The trauma team took over, and I became mostly a bystander, pushed to the side and no longer needed, having discharged my function. Discarded. I was used to it, though. In this case, I was actually almost relieved. After all, my function was to get the patient to the hospital in as good a shape as I could, after which all that was left was some quick paperwork and then back to the base or on another run. I moved to a counter where I could work on my paperwork and still see what was going on in the trauma bay. (Even the worst human disasters that I saw and transported had to be reported dispassionately on the same form every time.) Meanwhile, a whirlwind of activity swirled about the patient, with shouted instructions rising above the fray every so often. They worked another 20 minutes with no success. 40 minutes without rhythm, even with effective CPR, was hopeless. It was time. Her pupils were fixed and dilated.

“Call it,” the E.R. attending said to the trauma chief resident.

“Time?”

“6:40 AM.”

The crowd that had been either helping or watching dissolved away, leaving only the girl, blood and discarded wrappings strewn about, and the nurses who had the unpleasant job of cleaning up the body and preparing her for the morgue. It became very quiet. The housekeeping staff moved in to begin to clean up, to make the trauma bay ready for its next occupant, whose outcome, we all hoped, would not be so tragic. I watched as they worked. The girl was so young, no older than college age if that, and so still, the endotracheal tube protruding from her mouth, no longer hooked up to anything. She was so young. Her blood alcohol level had been reported as zero; so this wasn’t a case of her having been out partying all night and then cracking up her car. As I later learned from a nurse who had called her parents to come to the hospital while the trauma team had still been working on her, she had been on her way to work at her summer job at a nearby campground. She had been planning on starting college in a mere few weeks. I wondered if she had brothers and sisters. A boyfriend, too, maybe. If not for one moment of weariness, she had every reason to anticipate a long life, complete with a fulfilling career, marriage, and children.

No more. The universe is certainly a cold, uncaring place at times.

It was a hell of a way to start the week. But at least I knew I would be going home later. And my wife would be there. After we got back to base, I loaded up on coffee before daring to get into my car to drive to the lab. No one asked why I was so untalkative that day.

Comments

  1. #1 DevoutCatalyst
    March 10, 2017

    Good reading, I didn’t know this side of you. EMCrit did a similar post recently, good stuff likewise:

    https://emcrit.org/podcasts/golden-rule-by-ashley-liebig/

  2. #2 madder
    A different place
    March 10, 2017

    I know that “untalkative” feeling. In a former life, I too dealt with matters of life and death. Keeping a clinical perspective helped, mostly, until one time it really didn’t. My significant other could tell that there had been a bad case when I all but went mute. A week went by before I trusted myself to open my mouth about anything other than the most trivial banalities. And then it was good to have that hand to hold, because I did have to say the words and tell the story.

    Here’s to all the significant others out there who have to listen to the hard and painful tales, even though they didn’t sign up for those jobs.

    Stories like these need to be told. Partly because the storytellers need to get them out, and partly because the world needs to know that it has people in it who are willing and able to take on this kind of work… even though they’re not machines.

    These days, my job is much more on the “life” side of those life and death matters, but I remember those times with a kind of fondness. Being the person who steps up to get someone through the worst possible time is rewarding in a way that’s hard to describe.

    This was well written, Orac, and thanks for putting it out there.

  3. #3 Dorit Reiss
    March 10, 2017

    This site needs a better Facebook button than like.

    Thank you for the story.

  4. #4 Michael J. Dochniak
    Minnesota
    March 10, 2017

    I’ve said this before and I’ll say it again, Orac is the Mark Twain of science blogging.

    A copter ride full of emotions.

  5. #5 JP
    March 10, 2017

    I believe Travis may have sunk to a new low. Well, it might be a tie with trying to impersonate lilady.

  6. #6 Rick
    March 10, 2017

    I trained as a neonatologist in the US Army. (in the 1980’s when neonatology was relatively novel and had not penetrated far into the community). We had helicopters and were not precluded from serving the civilian community. I remember many helicopter transports to various locales in Washington state (where the weather gan be really grim). I’ve often said one has only so many helicopter-hours in his lifetime. It is a finite but not knowable number and is not the same for each individual. I know I have used up mine.

  7. #7 Johnny
    127.0.0.1
    March 10, 2017

    Yeah, you’d think a 32 year old man wouldn’t be so childish, but I guess it’s just Travis J. Schwochert 239 S Church St Endeavor, WI 53930 physical age, not his mental age.

    On a hopefully lighter note –

    I’ve had the chance to take several helicopter rides on several different flavors of aircraft, and fortunately, while they were all (mostly) serious, none were as serious as the story told by our host.

    The most lighthearted ride (and my favorite) happened in one of those glass bubble helos, also piloted by an ex-military pilot, with combat experience in Vietnam.

    I climbed in, . I jumped into a seat that was little more than a lawn chair, shut the door, and “locked” it with a latch more suitable for a screen door, snaped the seatbelt loosely around myself, and said in a cocky voice “show me what this pig can do”.

    He did.

  8. #8 Johnny
    127.0.0.1
    March 10, 2017

    Can a brother get a preview button?

  9. #9 doug
    March 10, 2017

    I believe Travis may have sunk to a new low.

    Wasn’t he babbling about some sort of 1/t function not long ago?

  10. #10 Chris Hickie
    March 10, 2017

    A pediatric drowning code in ER at end of a 36-hour PICU call shift left me quiet like that. I didn’t have anything left in me to go with the attending to tell the family their child had died.

  11. #11 Eric Lund
    March 10, 2017

    I climbed in, . I jumped into a seat that was little more than a lawn chair, shut the door, and “locked” it with a latch more suitable for a screen door, snaped the seatbelt loosely around myself, and said in a cocky voice “show me what this pig can do”.

    He did.

    There is a school of thought that claims that helicopters do not fly; they are repelled from the ground by their ugliness. I presume that pilot does not subscribe to that school of thought.

  12. #12 Brian Seiler
    Houston
    March 10, 2017

    I have a question. I have it on good authority (smarty pants folks on the internet tattling on bad televised medicine – the very best of authorities) that it does absolutely nothing to apply electrical stimulation to asystole and you should never do that, unless you really want to cook the individual in question. However, in this story you talk about the patient having “no rhythm” but still applying regular shocks. Is that different from asystole or have the ACLS protocols just changed that much over the past couple of decades?

  13. #13 neonatal giraffe
    March 10, 2017

    Orac. This is doxing. https://en.wikipedia.org/wiki/Doxing

    I won’t leave this site alone until you substitute my driver’s licence number, address, and age with innocuous placeholders.

    This is over the line. Johnny and Doug seem to get a kick out of inserting my address, age, and licence plate number whenever possible.

    For example this line here from Johnny:

    Yeah, you’d think a 32 year old man wouldn’t be so childish, but I guess it’s just Travis J. Schwochert 239 S Church St Endeavor, WI 53930 physical age, not his mental age.

    Can be turned into:

    Yeah, you’d think a neonatal giraffe wouldn’t be so childish, but I guess it’s just Fendlesworth from Newcastle-upon-Tyne, England physical age, not his mental age.

    Doesn’t that sound better!

  14. #14 Lawrence
    March 10, 2017

    If you just stopped posting, it was cease being a problem.

  15. #15 JustaTech
    March 10, 2017

    I’ve ridden in a helicopter once (scenic flight in Hawaii) and it’s an experience I can skip in the future. My uncle (Navy pilot) described landing a Sea King on an aircraft carrier as trying to land on a postage stamp in a bathtub.

    My aunt the ER doc has great stories, but she only shares the funny and/or heroic ones (usually). The one about a kid who went to the ER for blue balls was hilarious.

  16. #16 Johnny
    127.0.0.1
    March 10, 2017

    Johnny and Doug seem to get a kick out of inserting my address, age, and licence plate number whenever possible.

    I can’t speak for friend doug, but, yeah, it’s a silly thing that I, in fact, do enjoy. But you have to ask yourself, Travis J. Schwochert, do you enjoy disrupting these blogs more than I enjoy giving you Google-juice?

    Of course, if you didn’t disrupt this (and several other) blogs with your silly comments, as documented here, http://lizditz.typepad.com/i_speak_of_dreams/2017/02/the-fendlesworth-mystery-or-travis-j-schwochert-we-see-you.html then I’d have no reason to carry on.

    If you stop (or our host tells me to stop) then I will stop.

  17. #17 Johnny
    127.0.0.1
    March 10, 2017

    There is a school of thought that claims that helicopters do not fly; they are repelled from the ground by their ugliness. I presume that pilot does not subscribe to that school of thought.

    The version I’d heard is that helos don’t fly, they just beat the air into submission.

    To be honest, I wasn’t I wasn’t in the mood to discuss the finer points of aerodynamic theory. I was plenty busy trying to cinch up my seatbelt, not grabbing on to the only thing in the cockpit that there was within reach (that happened to be the one thing that the pilot was very clear that I shouldn’t touch) and keeping the ear to ear grin off my face (darn it, I was a professional, and it was serious business).

  18. #18 Panacea
    March 10, 2017

    @Brian Seller: it’s always been that you don’t shock asystole, and technically you still don’t. The defibrillator doesn’t start the heart rhythm it STOPS the lethal heart rhythm. . . . with the hope a healthy or at least functional rhythm will then start. Something that will perfuse the organs.

    Problem is, it can sometimes be difficult to tell the difference between asystole and fine V fib. . . and that you DO shock.

    Shocking asystole probably won’t hurt, after all there is no rhythm to interrupt. And we’re giving drugs along with this that have a chance of working whether they’re in asystole or V fib.

    Bottom line is, asystole is a fatal non-rhythm. If you do nothing, the patient is dead. So we very often do see practitioners shock it, especially in young people for whom we pull out ALL the stops.

    Orac, thanks for sharing this story. It was moving.

    @Chris Hickie: I was the primary nurse for a 19 year old illegal migrant worker who got stabbed in the heart. We cracked his chest in the ER, sewed up the hole in his heart, pumped him full of fluids and blood but we couldn’t get his heart going again.

    We didn’t even know his name. He didn’t speak English.

    After the surgeon called it, I told the charge I was on break and went and sat outside the ambulance bay for 20 minutes. No one said anything to me about it; they just picked up my patients and let me decompress.

    I was very glad later to find out the police had found out who he was and contacted the family. It bothered me to think they would never know what happened to their son.

  19. #19 Wzrd1
    March 10, 2017

    @Johnny, you’ve not truly flown in a helicopter until one is helping to pick foliage from crevices in the undercarriage.

    And yeah, the version I heard also “Helicopters don’t actually fly, they beat the air into submission”, it was also on tee shirts worn by UH-1 pilots.
    Aircraft that had many, many holes that were epoxy patched in the floor, caused by incoming AK-47 rounds in Vietnam.

    We also flew a lot in Little Birds (OK, on benches outside of the bird) and Blackhawks. The latter, imbuing me with great faith and trust when we were given a totaled bird for extraction training, which had survived (even if totaled) an RPG round to the fuel tank.
    You trust any fuel cell that can take that kind of punishment and the crew still gets to land and walk away from!

    Autorotation: Something that is rarely an available option in a military helicopter. No altitude to trade for rotor velocity.

  20. #20 Science Mom
    http://justthevax.blogspot.com/
    March 10, 2017

    Thanks for sharing that Orac; it does show another side of you.

  21. #21 Science Mom
    http://justthevax.blogspot.com/
    March 10, 2017

    I’m glad to see that Travis Schwochert is getting irritated over the blowback for his heinous comments and other “hobbies” like stealing usernames and following me around the interwebz making disgusting comments. Travis you are a vile nob and only getting a fraction of what you richly deserve.

    I won’t leave this site alone until you substitute my driver’s licence number, address, and age with innocuous placeholders.

    You’re in no position to make demands sweetpea. Get lost and no one will give you a second thought or mention.

  22. #22 Michael J. Dochniak
    Minnesota
    March 11, 2017

    Out of curiosity, I did a patent search using the key words “David Gorski” and “inventor”.

    There were zero (0) hits.

    Surprisingly, there were 5 patents granted to a gentleman whose last name was Orac.

    @ Orac (David H. Gorski),

    Have you ever attempted to patent something?

    If you have, I’d like to read about that “crappy” experience.

    • #23 Orac
      March 11, 2017

      You clearly don’t know how to search, then. If I’m feeling generous, maybe I’ll send you the patent number.

      OTOH, it was a gene patent in the 1990s; it was might have been invalidated by the recent Supreme Court decision that ruled that genes were not patentable.

  23. #24 Michael J. Dochniak
    Minnesota
    March 11, 2017

    Now that I have Panacea’s and Johnny’s attention, I’d like to share an introduction that I’ve created for my upcoming book titled, Healing the Mind – Alzheimer’s Disease – Thinking Patents (2008 – 2016).

    The brain is an extremely complex organ that defines your uniqueness. As you age, though, your brain may be susceptible to a terrible disease. Alzheimer’s disease is the third biggest killer in the developed world after cancer and heart disease. It is considered an irreversible, progressive brain disorder that slowly erases memories and thinking, and eventually eliminates the ability to carry out the simplest of tasks. Medical science continues to make substantial progress in the search for therapeutic interventions and a cure. Since 2008, hundreds of Alzheimer’s-related patents have been granted by the United States Patent and Trademark Office in an effort to eradicate this deadly disease. To better understand these inventions, Michael J. Dochniak has written this informative book to provide an easy-to-read summary of these patents. Within the summaries are inventor-profiles and news articles that are insightful and pertinent. Pioneering and worldly inventors originate from Australia, Chile, England, and Hawaii. At the beginning of several chapters, you will read about one of the early signs and symptoms of Alzheimer’s. Most important, Healing the Mind – Alzheimer’s Disease -Thinking Patents (2008-2016) is about keeping your brain at peak performance as you age.

    Any suggestions?

    • #25 Orac
      March 11, 2017

      Um, why are you pimping your book here?

    • #26 Wzrd1
      March 11, 2017

      Why, I most certainly do have a suggestion for your book, MJD.
      Use it as a suppository.

  24. #27 Michael J. Dochniak
    Minnesota
    March 11, 2017

    @ Orac,

    I forgot, Orac’s minions rarely read books unless it’s about brewing beer or it’s the lasted AARP magazine.

    Because RI’s major audience is +60 years old there may be interest?

    Also, I need to show Panacea that I’m not a cheater and Johnny doesn’t have a clue.

  25. #28 Narad
    March 11, 2017

    OTOH, it was a gene patent in the 1990s; it was might have been invalidated by the recent Supreme Court decision that ruled that genes were not patentable.

    They’re still listed, though.

  26. #29 Johnny
    127.0.0.1
    March 11, 2017

    Gene patents, eh? Probably be MJD’s next book. It’ll probably be out next week, unless the USPTO site goes down.

  27. #30 Gilbert
    March 11, 2017

    You, or someone you love, may die because of a gene patent that should never have been granted in the first place. Sound far-fetched? Unfortunately, it’s only too real…

    Why? Because the holder of the gene patent can charge whatever he wants, and does. Couldn’t somebody make a cheaper test? Sure, but the patent holder blocks any competitor’s test. He owns the gene. Nobody else can test for it. In fact, you can’t even donate your own breast cancer gene to another scientist without permission. The gene may exist in your body, but it’s now private property.

    http://www.michaelcrichton.com/patenting-life/

  28. #31 doug
    March 11, 2017

    Well, Travis J., I sat in a courtroom a couple of days ago as a Crown prosecutor said “Choice have consequences …”. It applies here.

    You have repeatedly come to Insolence as sock puppets, knowing full-well that Orac prohibits that. You have made a nuisance of yourself. You have impersonated other commenters, and attempted to impersonate a much-liked and respected long-time commenter who has passed away. That latter act alone has earned you a huge measure of contempt. You have harassed others. You deliberately set a trap to try to obtain IP addresses from other commenters. You’ve put our host in a position where he may have blocked legitimate new commenters as a side effect of sparing all of us from you. You’ve wasted a lot of his time. In short, your conduct has been despicable. If you attempted similar things in physical space, you would very likely find yourself in a courtroom, and on the reserved seat, not in the gallery.

    You came back over and over again after I and others began to name you explicitly in comments and others began to both name you and include your address. You didn’t protest, but instead made childish replies and still you came back again and again. Why you are now protesting will remain a bit of a mystery, but I’m guessing you have discovered that if you sow a crop, eventually it will be ready to reap. If you plant pot in your own front yard, you can’t be too surprised if someone who takes a dim view of such agricultural exploits notices. Choices have consequences.

    Your solution, as others have suggested, is simple: stay away. If you really want to come back, knowing full well that the types of arguments you will likely try to make will most probably be refuted most ever time, you might try asking Orac to allow your return, either under your own name or a once-and-for-always pseudonym. If I were in his position, I’d blow you as raspberry and banish you forever, but it most certainly isn’t up to me.

  29. #32 Gilbert
    March 11, 2017

    I’d blow you as raspberry

    Everywhere you dang go — Promiscuous Pokemon furries.

  30. #33 doug
    March 11, 2017

    Suggestions? Why yes! (said in the peculiar voice of the character from The Simpsons

    I see Wzrd1 beat me to making reply, but I’ll still quote from a 1961 song by Alex Comfort (an actual published author of some repute)

    If you really want to know where we think it ought to go,
    Well, we’ll tell you where to put it if you like.

    • #34 Wzrd1
      March 11, 2017

      Quotes, unlike myself, age well.
      Notable, the quote doug made was from the year of my birth.

  31. #35 Alain
    March 11, 2017

    Gilbert@30,

    Since when does owning a gene patent turn the owner of the patent into a psychopath?

    Alain

    • #36 Wzrd1
      March 11, 2017

      When one either has a child rapist as a character, who also has a small penis or one is a journalist of the same name as the character in the literary work and is in a dispute with the literary work’s author.
      https://en.wikipedia.org/wiki/Small_penis_rule

  32. #37 Johnny
    127.0.0.1
    March 11, 2017

    Also, I need to show Panacea that I’m not a cheater and Johnny doesn’t have a clue.

    Hey, we all got needs.

    I freely admit that there are times I don’t have a clue. In the words of Scott Adams, “Everybody’s stupid about something”, or if you prefer Dirty Harry “A mans got to know his limitations”.

    You, on the other hand seem to think that copying Alzheimer’s patents and half a day on Google makes you an Alzheimer’s expert.

  33. #39 Alain
    March 11, 2017

    Wzrd1@36,

    ouch 🙂

    I will leave Crichton’s fertile imagination about doomsday scenarios for his book and instead focus on reality. Psychopath will be psychopath, a$$h*le will be a$$h*le and troll will be troll; no need for gene patent to turn into one of these.

    Alain

    • #40 Wzrd1
      March 12, 2017

      It was a hilarious episode of literary history.
      Or something.

  34. #41 Alain
    March 12, 2017

    Wzrd1@41,

    I agree, the lit critique was found to be at the short end of the stick…

    Alain

  35. #42 Alain
    Venting my spleen @ disaster recovery
    March 12, 2017

    Hello Team,

    Today, I faced an impending disaster in that my oldest brother needed urgent help and has been since weeks (this the reason I’m not as active as I used to here). My brother was getting homeless this Wednesday and I had to involve a bunch of social workers in Quebec’s psycho-social hotline to take care of him temporarily while my cousin (who I am living with) will take a work truck tomorrow morning to move out all his furniture here while I prepare the bedroom.

    The key point is that, he’s been on the move since forever and never lived in a place more than 4 months except a single place where he lived 1.5 year under the most stringent supervision I’ve witnessed him to submit to (the owner of said place was a cop married to a lawyer and the cop had a good idea of what he underwent into).

    Given what I know about his issues, behavior and his psycho-social well-being, I am thinking about possible solutions and their constraint and one of them is that, I have to spend the major part of a day, with him, always available, to help. Yet, I will need to take care of my life, and goals. Given these two opposing constraint, there is one solution: he will have to do the same daily activities as I do. One thing that make it easy is that he submit every minor and major decisions to everyone else because he’s afraid to make a mistake and he do make some huge ones from time to time.

    I’ll be checking this Wednesday (my weekly day off from work) with McGill university’s legal clinic to have a contract made that we can sign but the main gist is that, I’ll be bringing him to work every day, at least this week and later on, we’ll both get back to school (I still need to finish high school despite having went to an university in the past but after high school, we’ll both go to a French language university to get a bachelor in the very same field; that’ll be part of the contract).

    I’m open to suggestions, inputs, questions and ethics related venting but please be aware that I’m 40, he’s 43, same disability as me and his situation has been a work in progress for over 100 persons since all of our life.

    Alain

  36. #43 Chris
    March 12, 2017

    To kind of bring this back on topic: My oldest child was a frequent flyer to emergency department of the Children’s hospital from his second day of life to just before his third birthday. Twice for seizures (the latter due to a now vaccine preventable disease) and about four times for croup, where he would come in with a oxygen level less than 90% (one time he was examined with some kind of light and camera down his throat to check for epiglottitis, one of the two who examined remarked they were seeing much less after the introduction of the Hib vaccine, which my son was just a few months too old to have received).

    During one of the croup trips there was commotion in the ED while we waited for our son to be checked after getting medication and assignment of a room (back then the meds required a minimum of an overnight stay, with him it was usually three days). I stood at the exam room door, but backed away when I saw a gurney being rushed by with lots and lots of blood on the covers that were over a small body.

    A couple of years later we moved from our tiny house to the larger one we live in now (location was dictated by real estate prices). It just happens to be under the helicopter flight path to that hospital which is about six blocks away. Every time one flies over I think about the family who is going to have a bad week, month, or years.

  37. #44 Chris
    March 12, 2017

    Alain, I wish I could help you. I do not know the laws of Quebec, but if they are like they are here there is not much one can do unless they are a danger to others.

    If he does not pay the rent for his housing, someone may need to take over his finances. But if it is his behavior, that is another matter… and it gets a bit sticky. Unfortunately my extended family had to deal with this. I am not privy to the details, just to the reactions and comments at family gatherings. Good luck to you.

  38. #45 Li D
    Australia
    March 12, 2017

    To all who work in emergecy medicine, in whatever capacity,
    I would like to say thankyou.
    I very much appreciate the insight the author has given here.
    Thanks for reposting it after all this time.

    Im gunna put a link up to a video ( actually a historical montage of several
    ads specific to motorcar accidents ) that many Australians watched and ( hopefully ) learned
    from.
    As a commenter above notes, pain and grief often
    continue for years.

    https://youtu.be/Z2mf8DtWWd8

  39. #46 herr doktor bimler
    March 12, 2017

    I’ll still quote from a 1961 song by Alex Comfort (an actual published author of some repute)

    Words cannot express my delight in discovering that someone else remembers Alex Comfort (gerontologist, historian of medicine, anarchist, author, poet, general all-round good guy).

  40. #47 herr doktor bimler
    March 12, 2017

    Notable, the quote doug made was from the year of my birth.

    Get offa my lawn, youngster.

  41. #48 Alain
    March 12, 2017

    Chris,

    Behavior.

    Al

  42. #49 Alain
    March 12, 2017

    Chris,

    Furthermore, he’s way belong excellent with finance.

    Al

  43. #50 Chris
    March 12, 2017

    Unfortunately unless he is a danger to himself or others, you most likely can do nothing. Our extended family desperately tried to get a family member to use the county outpatient psyche clinics after she was released from the psyche wards in two states… she refused. There was no legal way to get her to take her meds or visit those clinics.

    Though she did seek help from a naturopath who used homeopathy. That did not work. The details are not important, but she is buried next to her stepfather. Le sigh.

    There is this odd balance between incarcerating a person with mental illness who is harmless versus determining a person with behavioral issues is dangerous. Then the question is who is in danger from this person. Themselves or others, like strangers. No one in our extended family knew our relative was in danger of herself!

    Though, if your brother’s behavior is such that he poses an issue that caused him to be evicted several times, you might have an argument. Those behaviors need to be documented, and make sure it is not from just one person. This is very important when you need to get help from social services agencies.

    I am not a lawyer. I am just part of an extended family that has dealt with this. Plus I have an adult autistic child who got yet another weird letter about his disability benefits today. Oh, wow… just when I think we have all together I get another wrinkle in the system! AAAARH!

  44. #51 Chris
    March 12, 2017

    My reply is to Alain.

    Why is Darrell pimping a Vinu article? Is he a sock puppet? Seriously? I am sorry, Darrell, but Vinu is not a qualified medical researcher and his papers are not worth the electrons used to store them on any server.

    • #52 Orac
      March 12, 2017

      Darrell was a Travis/Fendlesworth sock. He has been taken care of. Dude had to reach back to 2007 to find someone to impersonate.

  45. #53 Jay
    March 12, 2017

    Hi Darrel,

    Yes I’ve read it and the research it cites, it suffers from major flaws:

    1) English isn’t Vinu’s first language, he badly translates sentences to alter their meaning and won’t be told.

    2) He only selectively reads what he wants to read, ignoring history and denying reality.

    3) There is no evidence that the vaccines on the schedule cause food allergies. Bleating about IgG4 levels doesn’t translate into actual allergies:

    “American Academy of Allergy Asthma & Immunology practice parameters do not support the use of any determination of IgG4 levels in the diagnosis and management of food allergies.”

    4) The long term impact of vaccines are obtained via such things as the Vaccine Safety Datalink. Something Vinu just can’t see when he sticks his head in the ground screaming “there’s no evidence”.

  46. #54 Tsu Dho Nimh
    March 12, 2017

    Orac … I’ve been on the ground waiting for a chopper, and there is no more beautiful sound in the world than the noise of those rotors in the distance.

  47. #55 Gilbert
    March 12, 2017

    there is no more beautiful sound in the world than the noise of those rotors in the distance.

    I think the standard guerrilla gardener would disagree. That and countries with only a marginally effective air defense where the rotor sound is then punctuated by people standing on rubble piles and ululating.

  48. #56 Michael J. Dochniak
    Minnesota
    March 12, 2017

    Johnny writes (#37),

    You, on the other hand seem to think that copying Alzheimer’s patents and half a day on Google makes you an Alzheimer’s expert.

    MJD says,

    Sick humor:

    Old Johnny goes back to the hospital and the doctors say, “Johnny, you have two serious problems and one is worse than the other. Which one would like to hear first?”

    Johnny bravely says, “Give me the worst news first, I can take it.”

    The doctor sadly says, “You have advanced cancer and less than about a year to live.

    Without hesitation Johnny loudly asks, “Is that it?”

    The doctor quickly replies, “No, you also have Alzheimer’s disease.”

    Johnny smiles and says, “Geez….I’m sure glad I don’t have cancer!”

  49. #57 Eric Lund
    March 13, 2017

    there is no more beautiful sound in the world than the noise of those rotors in the distance

    Count Bruce Cockburn among the people who would disagree.

  50. #58 Pickwick
    March 22, 2017

    Orac,

    Thanks for your story. I work in a hospital in your state now, and I appreciate learning more about the critical care side of things. In my role, it’s seldom that my ability to remain calm and efficient will directly affect a patient’s chances of survival, but that did happen yesterday, and it made me reflect on how glad I am that there are so many people, doctors, nurses, EMTs, pilots, and others, who can master their emotions and anxieties well enough to provide care in those situations. Good on you and on every other professional and paraprofessional for accepting that stress.

    Strengthened my resolve to go back to school and get more knowledge and training so I can do the same.