
A Woman Who Needed to Be Upside-Down (2012) - ColinWright
https://www.discovermagazine.com/health/vital-signs-the-woman-who-needed-to-be-upside-down
======
rickyplouis
Slightly tangential, but in Brave New World they trained future embryos to be
rocket-plane engineers altering oxygen levels based on their vertical
orientation. 

> The first of a batch of two hundred and fifty embyronic rocket-place
> engineers was just passing the eleven hundred metre mark on Rack 3.  A
> special mechanism kept their containers in constant rotation. " To improve
> their sense of balance," Mr. Foster explained. " Doing repairs on the outside
> of a rocket in mid-air is a ticklish job.  We slacken off the circulation
> when they're right way up, so that they're half starved, and double the flow
> of surrogate when they're upside down.  They learn to associate topsy-
> turvydom with well-being; in fact, they're only truly happy when they're
> standing on their heads." 

------
murican22
Reading this article makes one appreciate just how much expertise doctors
have.  As soon as the doctor was presented with a few symptoms, he was able to
begin running through a checklist of problems related to this specific issue
and arrived relatively quickly at the solution. 

Many doctors are able to routinely do this for dozens of ailments under
intense pressure, making them even more impressive. 

~~~
jerome-jh
And unfortunately some doctors cannot make a proper diagnostic even after
visiting them several times, and having a rather uncommon, but not rare,
condition.  First hand experience. 

Well that's life. 

~~~
abrookewood
I'm not surprised by that.  There is an exhausting amount of information that
they have to digest & recall.  It makes sense that they would assume that the
most common conditions are likely to be the cause of your ailment.  Maybe AI or
automated diagnosis could help in the future, by suggesting rare conditions
that fit the symptoms as well as the common ones. 

------
jerryr
If you enjoyed this article, you might also enjoy _The Man Who Mistook His
Wife for a Hat and Other Clinical Tales_ by Oliver Sacks.  It’s a book of
essays about brain function and disorders, but each begins with an individual
who exhibits particularly unusual symptoms.  They don’t have tidy resolutions
like this article, but the book is well-written and engaging—-as are the rest
of Dr. Sack’s writings. 

~~~
archagon
Just started reading this.  It's really sucked me in, but it also fills me with
a sort of biological dread.  Something goes wrong with your brain-meat and
suddenly you find yourself teleported 40 years into the future every time you
look in the mirror, or become an unstuck, powerless spirit inside your own
body. 

------
phyzome
I cringed at the part where they're yelling about epinephrine and IVs, and
Jason has to barge in and put her upside down again. 

~~~
forgotmypw17
I think it is illustrative of how important it is to have someone who cares
about you and knows you around when dealing with doctors. 

~~~
koheripbal
An incredibly tiny percentage of cases presenting to the ER are unique and
necessitate a friend or family's help in diagnosis - let alone treatment. 

~~~
TallGuyShort
I call bullshit.  I have more children than average and during every single
labor & delivery I've caught paperwork problems and mistakes in communication
while my wife was too distracted to pay attention to such things herself.  All
minor, but given the option I would always want an advocate on my wide who is
purely there for my own benefit and who isn't experiencing a major medical
problem at the time. 

~~~
forgotmypw17
Just someone being there will cause staff to pay more attention to a patient. 

------
derefr
> Or her blood pressure could be so low that blood reached the brain only when
> she was upside down.  Blood pressure that low could have been triggered by an
> allergic reaction, anaphylactic shock, or severe dehydration. 

So, if this is a generic thing about low blood-pressure,
including—potentially—low blood-pressure _from shock_... then could inverting
someone who's going into shock in the field (where an ambulance is not yet
arrived), be neuroprotective—ensuring they keep _some_ oxygenated blood near
their blood-brain barrier to feed their brain, long enough to stave off brain
damage until EMTs can arrive and get a saline+steroid IV into them?  Would it
work for all types of shock?  Toxic shock, for example? 

I know that in the case of the article, the cause turned out to be a
malfunction of the pacemaker itself, but is the doctor's original line of
thinking still valid? 

~~~
alexpotato
This is why they have, no joke, inflatable pants [0] more commonly known as
"Military Anti Shock Trousers(MAST)". 

I am not a dr (IANAD?)  but the idea is that you inflate the pants around a
patient's legs which helps both push and keep blood out of the lower limbs and
closer to the hear and brain.  In principle, you could do the same by tying a
tourniquet around each leg but the MASTs probably cause less tissue damage and
are more adjustable. 

[0] - [https://en.wikipedia.org/wiki/Military_anti-
shock_trousers](https://en.wikipedia.org/wiki/Military_anti-shock_trousers)

~~~
prputnam
I've been out of EMS for a few years now, but these have (or had at least)
fallen massively out of favor. 

Effectively, you could artificially keep the patient alive by using MAST
pants, but they inevitably crash when they were removed.  My old service had a
few pairs tucked back in a closest, but none on any of the rigs.  I'm quite
certain they aren't in allowable by protocol in most places at this point. 

A pretty wild device, nonetheless! 

EDIT: Quick edit to throw in that I have heard tales from the old heads of
using them to stabilize pelvic fractures, too. 

~~~
sterlind
Even if they crash, couldn't MAST pants be useful in ambulances in order to
deliver patients alive to the OR?  Or did it somehow make them less likely to
survive than not using them at all? 

------
throwaway0a5e
I can't be the only one that called it as soon as I read the word "pacemaker". 
Nice to see that the hospital still went through the troubleshooting flow
chart though. 

~~~
JshWright
Do you have a background in cardiology?  It may be more likely that the
pacemaker would jump out to you as the cause because you're not familiar with
the other possible causes. 

~~~
throwaway0a5e
Purely binary performance, it's either working or it's not, is common for
digital electronics and rare for body parts.  Body parts tend to work less and
less well and there's a threshold where it starts causing problems down the
line.  Body parts also don't tend to have intermittent failures where they can
toggle between "working fine" and "not at all" rapidly whereas electronics do. 

Once they stated that she had electronics in her that became obvious as a
likely source of the problem. 

~~~
JshWright
Binary states aren't super rare in biological processes.  All the causes the
doctor outlines are plausible.  My first thought was orthostatic hypotension
(it's not at all uncommon for people to pass out almost instantly when they go
from supine to standing), or some sort of obstructive shock (with cardiac
tamponade being the most likely).  Both of those conditions are massively more
likely than the pacemaker being intermittently connected, so it make sense to
rule out the higher probability options first. 

What I'm not sure about is why they started doing diagnostic tests (especially
ones where the patient was quite clear on what the outcome was going to be)
without an IV in place...

~~~
manquer
The way I saw is it like doing a commit bisect.  While there were other
problems before, this particular problem started after the pacemaker
operation, the other problems had stopped.  It is like a one bug is fixed and
another was created.  Either the operation or the device itself was the most
likely cause of the change in such a short time frame? 

In software dev a bug being created as side effect solving another usually
means QC missed it, perhaps here too? 

I don't know if surgeons do checklists or some else normally verifies post op
on the procedure( peer review?),  and are there ways to verify the device
before and after insertion , if it was software dev that's what I would
recommend .  While surgeries and medical practice has lot of regulations and it
cannot be changed easily, the principles are sound, and other fields like
airline pilots do similar things. 

~~~
JshWright
I totally get where you're coming from.  I'm a full time developer, and part-
time paramedic.  There are definitely a lot of similarities between debugging a
program and debugging a person. 

The doctor in the post was also working off the base assumption that this was
a bug that got shipped in the last release (surgical complication leading to
interval bleeding, leading to hypotension; surgical complication leading to
cardiac tamponade; etc).  My original point was just that the answer that was
obvious to the commenter was actually pretty low on the probability list, and
it only seemed obvious because they had an incomplete mental model of the
system as a whole (something that happens in software debugging as well).  As
it turns out, it was the correct answer, but the correct approach (on average)
would still put "failure of the pacing leads" pretty low on the list of likely
causes. 

There are a lot of checklists used in surgery.  For instance, immediately
before any procedure, there is a "time out" to make sure everyone is on the
same page with the right patient, right procedure, and right location.  I'm not
aware of any checklists specific to pacer leads, but I don't spend much time
in the OR these days. 

------
bobloblaw45
I bet they used a micro usb cable.  Sometimes those things can be so janky my
phone won't charge unless you kinda fold them and rest the phone on it a
certain way. 

~~~
kube-system
Micro USB is great.  My first smartphone had Mini USB which was way worse. 

~~~
ratsimihah
That happens with lightning cables too sadly. 

~~~
hinkley
The contacts on the lightning cable can be cleaned, which is often my problem. 
But because they're exposed they have to be cleaned. 

Pocket lint in the socket also keeps it from seating.  Digging that out is like
playing Operation.  The bits you can break are on the sides, so you have to
push straight in to scrape out the lint. 

I really should learn to put my phone in my pocket wrong way up so it doesn't
catch all that crap...

~~~
kube-system
Don't scrape it out, use air duster! 

~~~
hinkley
If I were forward thinking enough I wouldn't have to do that.  But you cram the
lint in like you're loading a musket every time you plug a cable into the
port. 

------
MetaDark
While reading this I thought it sounded familiar, and realized this is exactly
what happens in the Grey's anatomy episode "Love Turns You Upside Down". 
Interesting that it was based on a real life situation, it seems like a lot of
episodes are. 

------
jolmg
Going to the hospital must've been interesting.  I wonder if she, in her
mid-60s, was seated upside down in the car, or if the man carried her upside
down through public transport. 

------
fred_is_fred
I really miss the Discover Magazine medical diagnosis podcasts about stuff
like this.  I don't work in medicine at all but I loved the mystery/problem
solving aspect - reminded me of being on call for platform services, without
the human life aspect of course. 

------
FpUser
I cant't help feeling so happy that this poor woman has such an amazing
husband.  Best wishes to this couple. 

------
RickJWagner
Now we know Diana Ross's inspiration. 

Upside down

Boy, you turn me

Inside out

And round and round

------
extro
>“You’re hurting her,” a woman yelled. 

What should we do with people like this? 

~~~
brazzy
Forgive them for misinterpreting a very unusual situation? 

~~~
II2II
Perhaps.  On the other hand, she played a role in escalating the situation.  It
took a doctor stepping in to find out why the woman was being held upside
down. 

Context should be an important factor when deciding to intervene and how to
intervene.  If I encountered such a situation in a hospital, I would have
interpreted it as unusual and beyond my comprehension, but it would not have
struck me as an intent to cause harm.  People tend to go to a hospital for
help.  Those who hurt others in a hospital would likely do so through violence. 

I'm not suggesting that she should not have intervened, but she (and the
security guard) should have understood the situation first. 

------
rodw
This makes me think of that X-files episode about the couple that were
compelled to travel west to avoid physical discomfort:
[https://en.wikipedia.org/wiki/Drive_%28The_X-
Files%29](https://en.wikipedia.org/wiki/Drive_%28The_X-Files%29)

~~~
dom96
Ahh, the episode with Bryan Cranston.  I really need to try watching X-Files
again. 

~~~
agency
And written by Vince Gilligan!  He also wrote my single favorite X-Files
episode "Bad Blood"

~~~
rrauenza
Is that also the one where swear words are sort of censored in English by the
narrator? 

Another favorite was the Cops spoof.  OH -- Also a Vince Gilligan! 

------
IgorPartola
This read like a call to Car Talk. “ Doesn’t anybody screen these calls?!” 

------
pedrocx486
Non-American here, I can't be the only one to find the use of "coughing spell"
(especially "spell") on a medical setting... Weird.  Maybe it's my
understanding of the English language and how I perceive that word. 

~~~
pmahoney
See "(Entry 4 of 5)", the second noun definition of spell [1]. " an
indeterminate period of time" or "a stretch of a specified type of weather" as
in, "we've had a long dry spell; I hope it rains soon". 

It does not sound particularly strange or unscientific to me. 

[1] [https://www.merriam-webster.com/dictionary/spell](https://www.merriam-
webster.com/dictionary/spell)

~~~
JoelMcCracken
“A fainting spell” also comes to mind.  It seems a bit archaic but I think it’s
clear and unambiguous. 

------
mekkkkkk
(unrelated, obligatory ad rant)

They really make it hard to resist ad blockers.  I cannot concentrate on the
text with everything blinking and new ads loaded in constantly.  Such a death
spiral to try to compensate for low ad revenue by making sure to get extreme
amounts of ad views from the few suckers that are exposed to them. 

~~~
citiguy
Reader mode to the rescue! 

------
fizixer
Is there a name for these kinds of articles?  Serious matters of importance
wrapped into Harry-Potteresque story lines

Should we call such articles Harry-Potter journalism? 

There's also related style of articles, very popular in NYTimes, that could
safely be called Ulysses journalism.