How anyone can recover from something as savage as childbirth is beyond me. It is no small miracle that she was able to walk, let alone care for two new babies and herself (with my help, but there's only so much I can do to assist with breastfeeding or healing of major trauma).
At one point I asked all the nurses to leave and not come back for 6 hours in very angry tones.
Serious complications can be quite subtle that unless you answer questions, they may be missed. Having someone come in, listen to your heart and lungs, ask a few questions can't really be replaced with machines.
(It wouldn't even need to know what the odd thing represents; just that it's out-of-expectation enough to require someone to come over and check on you! A bit like asking a family's child to watch grandma while you speak to the mom and dad. All you want the child to do, is to freak out and get your attention if grandma does anything other than what she was already doing!)
Doctors not having to manually probe any signs of heart/lung problems each time they're in the room, would mean that they get either get more time to test each patient for consciousness/lucidity; get time to check on more patients; or (my preferred option) are able to make each check-session shorter and less invasive (no need to sit the patient up to listen to their lungs through their back, for example), and thus less disturbing of a patient's sleep quality (because it's easier to go back to sleep after a short conversation, when you haven't had your blood pressure spike from sitting up.)
The thing people don't seem to understand is the fact doctors also monitor consciousness. Depressed mental state is also a sign of blood loss. The patient's neurological state is important information, it has diagnostic and prognostic value.
The most basic way of evaluating a patient's neuropsychological state is to bother them with questions.
It was like they were obsessed with busy work, I couldn’t tell if they didn’t want me there or if this was VIP treatment to them
It was in another country
Plus my boss kept calling me.
The fact that med school + residency means you basically have to put your life on hold throughout all of your 20s while other people are figuring out the whole “being a young adult in the world” thing leads to very… particular emotional development.
Medical school doesn’t particularly encourage questioning the status quo or established practices.
Some of them can recalibrate after a few years in the real world, but many never really escape that bubble. It’s hard to radically change your outlook on life in your 30s (let alone when you now have to repay huge debt, in the case of many American doctors)
Many of premed kids I knew in undergrad (or the high schoolers aspiring to premed) weren’t motivated by scientific pursuits or an altruistic desires - they just had to be the best. They needed to ace every test (and would argue incessantly with the teachers about it), they had to be in the hardest classes, etc. they became doctors because somebody told them it was hard and well respected.
I imagine that those people become doctors that are disconnected from their patients.
- Rich and respected -> doctor
- Rich but not respected -> lawyer, software
- Not rich but respected -> professor
A lot of people are going to be disappointed. Truth is medicine is a decadent profession, worldwide. In some countries, it's in free fall and accelerating to terminal velocity. In some parts of the world, doctors are hated to the point they routinely suffer physical violence.
The US manages to keep it relevant by restricting supply and maintaining its elite status but I'm not sure doctors are still respected there. Plenty of hackers who think they can do it better than the doctors right here on HN. I'm a programmer myself and I know for a fact a computer could do significant parts of the job. Even psychiatry is in danger due to LLMs.
A computer does a massive part of almost any job today, so I’m not sure what exactly this is trying to say about the profession. Wait until you hear that pilots can’t even fly without an airplane. Total conmen.
> Plenty of hackers who think they can do it better than the doctors right here on HN
Of course they would, it's easy to come up with solutions that are simple and wrong, when one has no point of reference. Hackers understand balancing trade-offs in programming languages or architectures, but can't imagine other fields being nuanced or even more complex. If an LLM cant tell you when to use a monorepo, then it far from telling you when a specific drug dosage is right for a patients set of circumstances.
1. I can use that word, I am one too.
It's hard to describe the effect years of this can have on the mind. Things can get so distorted you feel guilty for eating, for going to the bathroom, sleeping, resting. Normal people things like a weekend or a good night's sleep become luxuries to you. You come home and everyone's already asleep. People start out all starry eyed and thinking about making a successful career out of helping people, but as it nears its end people can't wait to just start making fat stacks already.
It functions as a sociopath breeding ground. Basically weeds out your humanity by punching you until you like it, hammering you until you get good at it so that you fit into the system. Some people just quit when faced with that, others try to take it and end up committing suicide. One of the most haunting stories I've ever heard was about young woman asking her attendings about suicide methods after a patient killed himself. They thought she was an interested student who was trying to learn about stuff so they happily dispensed all the information they knew. She efficiently and painlessly killed herself not even a day later.
People who make it out of this process might enjoy good pay and lifestyle depending on the country and the specialty they chose. It definitely costs them, though.
The power to repair people, fend off suffering and death. That's religion level power. It's bound to warp everything around it like a black hole.
It would take a society of exceptional sanity to handle it right.
Disconnected? Probably. But I think that's intended and part of the current medical model. It's not necessarily a bad thing when focusing on long term positive outcomes in aggregate. But it certainly feels inhumane at times to the individual and their loved ones.
But lack of sleep can impair immunity and disturb blood pressure and heart rhythm. Keeping someone with major trauma under stress (like being constantly awake) can make them more likely to die.
When sleep deprived, the brain enters REM sleep even while awake. That's what those hallucinations are.
I have had the misfortune of experiencing this twice in my life so far; the first on a month-long car trip with my buddy and the second while i was the caregiver/caretaker for my Mother. In both cases it was my lack of sleep which made me very difficult to be around.
1) Sleep Deprivation - https://en.wikipedia.org/wiki/Sleep_deprivation
2) Also Related; The medications that change who we are - https://www.bbc.com/future/article/20200108-the-medications-...
So whenever you note that somebody's behaviour has abruptly changed, always ask two questions; a) Are you sleeping well? b) What medications are you taking and what diet are you on?
When someone dies in the hospital what happens in the inquiry? Examine the symptoms of the person who died and how to detect them. Add another check.
If they left someone alone for 2 hours or 4 hours and they passed away during that time, what would the headlines read? "General Healthcare left the patient alone for X hours and didn't even bother to check on their well being."
She's super cute, intelligent and active but also extremely demanding and had a lot of problems with dermatitis, tummy aches, KISS syndrome and other stuff that made her not sleep well and cry a lot (and she's super loud).
It also made me respect single parents 10000 times more than before. I can't imagine handling a situation like that alone.
Fear based decisions don’t always lead to the best outcomes, though I am in no way dismissing the fear :)
Of course it's a trade-off I'd gladly make again but it still sucks that I will never feel as well rested day-to-day as I did before kids.
How odd. Why do hospitals not cluster these interactions together — the "while I've got you here..." experience?
In the case of a pregnancy, I'm assuming these "briefings" are things like trying to teach the new parent things they'll need to know when they go home; or giving them status updates about tests done on their new baby if they're in the NICU, and so forth. These all seem like things that could wait.
Is the point to use the infodumping as an excuse to do the tests?
Honestly, the truth is hospitals are designed to do this. The entire purpose of the place is to have people moved into it so that these constant checks and examinations as well as treatments can be done most efficiently. The idea is to rapidly notice and react to changes in the patient's condition.
In programming terms, the core function of a hospital is to poll and update the patient's state in a loop that runs while consent is given and until cured or dead. The polling frequency is calibrated according to knowledge of the patient's general condition and the specific pathology being treated.
If you know the patient could bleed out and die after some surgical procedure, you want to check periodically that this is not happening. How frequently do you check? Depends on what you predict could happen. If you think the worst that could happen is a small and slow bleeding, then you can check less often. If you think there's risk of major bleeding, then you want to check frequently, possibly even constantly.
As son and father in an end of life situation there was no gap to contemplate or allow us to connect it was drugs injection, food, check if he ate, back again, pick up tray, more drugs, check on his breathing, bathroom break (needed assistance).
Dad was probably OK with it but we never had a chance to just have a moment and possibly say something we never would have. He died at 8:40pm on my birthday of all days as I sat next to him.
We made it clear we wanted to be left alone over night, had reasons for why (neurological issues that are exacerbated by poor sleep) and they largely respected that. Maybe if we didn’t have that excuse it would have been worse. Shit, even the vending machine salads were pretty good. Didn’t love sleeping on a foam bench for 5 days, but we felt quite positive about the delivery center we had our child at in the US.
Even the c-section seemed absolutly brutal, at one point I was convinced one of the surgeons placed his foot on the table for leverage, given how much movement there was to her body.
As if the physical trauma wasn't enough, being in a room with multiple first-time parents struggling to breastfeed as both they and their children cried, then being visited and probed every hour by medical staff with ineffective pain relief, /and/ having work out how to care for your child when the only communication path is basically through an amplitude modulated scream -
Honestly, I've had some low points in my life, I thought I had a high tolerance for physical and emotional pain, but I can only describe what my wife experienced this week as total, crushing anguish.
At one office job, we regularly worked from home around 9-10am and would only commute after the morning rush hour faded away.
Move standup to 10:30am so Todd can sleep in
It's also a handy way to keep raises small. Oh you are being a human and we don't give raises to people who are human. Meets expectations, 2% raise.
sleep in
to sleep until later in the morning than you usually do
But also that is 2:30 p.m. for the other two guys, i.e. prime "still caffeinated and in the zone" time ;)
Good teams make it after everyone would have reasonably absorbed their coffee. But some teams get pushed earlier. Particularly if there are people in EST, CST, and definitely if you've got people in India, where 9 am PST is when you should be reading your kids bedtime stories.
Also, women require more sleep than men on average.
> Women need on average 11 additional minutes of sleep each night.
SO has it reverse, she wakes up at 7-8 am even at the weekend and is unable to get back to sleep.
I'm still a night owl. 12am is the baseline. 1am is not uncommon. 2 or 3am is occasional. I can attend a 9am. I prefer 10 or later. Most of my team does as well, and they all rise earlier than I do.
Basically for status updates, you’d just put it in Slack. We had a bot that prompted us. We did have a weekly meeting, but it was at a reasonable time for everyone.
A team I was on while there had some APAC people, and we even managed to have meetings with them, by scheduling them in afternoon hours for the U.S. Worked out pretty well.
First of all, the standup isn't daily, it's twice a week. People still miss it for reasons (kids, doctors appointments, ...), and it's just... accepted. There's a general culture of trust.
Other than that, Slack threads go on twice as verbose and long as in other places I've worked. There's a general deluge of pull requests going around certain times of the day and they're always reviewed within an acceptable time frame. In between delivering PR's you simply pick up other work, we're all seniors that know how to work independently, I'm not sure if you could achieve the same thing with a bunch of juniors mixed in unless they have the right attitude as well.
Crepuscular and nocturnal predators require tribes of humans to have some number of members who are tuned to be either awake before sunrise or awake long after sunset. Without people with genes to go bed late and wake up late we wouldn't be here having this conversation.
In modern society the former are lionized and the latter are villified as making bad choices.
Wouldn't a tribe that is able to do as I can have the greatest evolutionary advantage and thus outcompete the tribes requiring specialization like you describe?
I'm sympathetic to your situation -- but with all due respect, this would seem to be a strategy with a vanishingly small likelihood of benefit.
"Trying" to sleep is also doomed to failure, of course.
Personally, what works best for me is modeling solutions to issues in projects (work or otherwise).
I originally tried this, hoping for the benefit of "sleeping on a problem". I don't think it's been particularly successful for that (though it could be subtly so, I guess), but it has about a 90% success rate for inducing sleep within 15 minutes. :)
My solution and yours might be the same thing (distraction from the goal of sleep), but I'd worry about the stimulation of video, the light from the screen, disturbing partners, etc. And also that I might get interested, and stay up for hours instead (this is my failure mode for reading before sleep).
Thinking about projects prevents me from sleeping. It's the surest way to keep me up with my mind racing for a few more hours. If it works for you, great!
The "mode" for watching Netflix for 15 minutes is turn it on, watch for 15 minutes, turn it off. I won't claim it works for everyone, but it does help settle my mind at night.
My team moved our daily standup later in the day to accommodate my delayed sleep phase and it's been extremely helpful to getting a full night's uninterrupted sleep.
like: complain about gunmen, not guns.
methodologies and weapons do not kill people. people kill people.
that said, here's a riddle:
q: what is the difference between a methodologist and a terrorist?
a: you can negotiate with a terroris, but not with a methodologist.
also, what nradov said, here:
This is why my doctor advised (during a bout of insomnia a few years ago) not to use those "blackout" shades. They completely confuse your brain. My doctor said to sleep with the blinds open so your body can naturally reset its clock with the sunrise and sunset. Thankfully, this was in the Summer in a midwestern state, so I got back on track, but I still had to make some adjustments when daylight savings and Winter started.
Your strategy was the other recommendation my doctor said to use. Anything that allows your body to naturally find its biorhythm is the best.
For waking up you'd need some kind of timed control, either old-school mechanical or maybe a smart relay. I've found that a single well-placed smart bulb programmed to ramp up over the course of 15 minutes works well to wake me up, but I'm pretty sensitive to light during sleep.
I went into a rabbit hole a while back of investigating whether it would be possible to light a room in my house equivalent to the summer sun, so I could avoid SAD during the long nights of the British winter.
Taking that 35,000 lumen light above, even assuming it's lumen rating is accurate, in a 3 by 3 metre room, that's less than 4,000 lux, and that's if it was entirely focused on the floor area. Direct sunlight is 32,000 to 100,0000 lux. The sun is just really bright. Normal indoor home lighting is about 100 lux.
The most efficient LEDs on the market are 200 lm/watt, so a reasonable lower bound for the amount of lighting you'd need for a 3x3 room is 1440 watts to get to the minimum 32k lux, but you'd have to factor in electrical inefficiencies and the directionality too.
All that being said, those corn cob bulbs are fantastic and do make you feel a lot better. Just not quite the same as relaxing on a hammock in the garden, sadly.
Context: I struggle with insomnia and use blackout shades.
My diet also changes in the Winter. I cut off caffeine at noon and restrict phone and screen time in favor of physical activities in the later afternoon. It takes about two weeks for my body to adjust fully to the changes, but then its fine throughout Winter. Even when I'm getting less sunlight because the sun is going down sooner.
I never knew how much your diet will affect your sleep and biorhythms until I started making changes. Even small changes can have big effects on your sleep cycles.
Hope that helps.
In Summer I tend to have more carbs and proteins, along with bigger meals for both lunch and dinner since I tend to exercise later outside then during Winter. The extra amounts in both for energy allow me to be active longer before the sun goes down.
In the Winter, I tend to reduce carbs and front load my day with them, so that in effect, by the time the sun goes down, my body is running down on their energy stores for the day. I also tend to reduce proteins and only increase them if I have a heavy day for example if I have both weight training and some higher impact cardio like hockey or indoor rock climbing or snowboarding.
In Winter I tend to have a bigger lunch and smaller dinner which helps to focus in the reduction in energy. Generally by the time 7 or 8pm rolls around, I can feel my body starting to tune down for the day and signals my body is getting ready for sleep. A hot shower usually puts me over the edge. I can get into bed and I'm out cold in a few minutes.
Hope this helps.
From time to time I'm looking into ketogenic diet and find it always inspiring how others manage carb and fat. I try to avoid carbs and if I eat them I always try to get my body moving, be it a light walk (so, not exactly practising full keto..). Main meal for me is dinner... I like how digestion and energy restoration is taking place mainly at night's rest. I don't experience problems falling asleep when giving my body food it needs. I'm usually not bothered by feelings of hunger til late afternoon (intermittent fasting so to speak, fat goes a long way..). Most important habit for good sleep seems to be "lay down, don't touch phone".. Hope this inspires, too :)
(eventual recommendation "the ketogenic bible, wilson/lowery")
I’ve found blackout shades useful for when I’m not sleeping a schedule correlated with the sun (eg work at 4 am) or external artificial light (streetlamps).
"Dang, my alarm woke me up at 8:30am while I was sleeping like a baby because of my blackout shades" doesn't sound like a problem anyone is having.
In a more mundane context, I've been fortunate to organize my schedule such that I don't use an alarm to get up in the morning. So I can let my body figure out how much sleep I need.