Hacker News Reader

Comment by tsm | Hacker News Reader

> The patient was now comfortable, felt well and we retired to our seats to recover. Eight hours later I was again summoned by the stewardess to see the patient, who had developed more chest pain and dyspnoea.

> I found her sitting on the toilet with the underwater seal drain on a high shelf. All the water and air had syphoned out of the bottle into the chest. The crisis resolved when I placed the underwater seal drain on the floor—draining the water back from the chest to the bottle. The air bubbled out of her chest when she coughed. After a few minutes she was almost back to normal, but exhaustion precluded the completion of a third full medical report.

View on HN

Eight hours! It's hard to believe the woman's condition was critical enough to require invasive surgery with these makeshift tools mid-flight, but so stable post-op that the doctors did not recommend an emergency landing. I understand they recommended against landing pre-op because of worries about cabin pressure, but why not after the surgery? She's going to have to come down at some point.

Why further inconvenience everyone else for this moron, if they (clearly correctly) judged her no longer to be in danger?

I really hope that doctors don't provide medical advice based on idiocy(or lack of) of ones actions. If she had to undergo emergency surgery in-flight with a coat hanger, I'm really surprised an emergency landing wasn't recommended by the doctor. The origin of her injury should have had zero bearing on it.

If only we would leave more of these decisions to arm-chair bien-pensants, second guessing two seemingly highly competent medical professionals. I am sure the woman in question would also really have appreciated being settled with the likely ruinous debts resulting from a medically needless emergency landing.

I'm just saying I'm surprised such a decision was made, that's all.

Expecting decision making to be perfect after an accident like that is ridiculous. Bike perfectly valid and commonly used word for motorcycle in many parts of the world.

The attempt to conceal comment seems to be doctor covering his errors after an inadequate physical exam before take off.

Someone trying to conceal wouldn't complain of chest problems before take off. Most airlines would remove you from the plane before even doing an exam, and won't depend on eye doctors potentially flying to do it.

I don't understand your point. If it's no longer an emergency, why require an emergency landing?

When you just did surgery with a knife and fork seems like an urgent enough situation to land?

Maybe not if the surgery was successful. As long as the condition is stable, it might not matter where they land. Might as well land close to wherever she needs to be, instead of in a completely different country.

Liability is a bitch, and ruins society.

How is surgery “successful” when they used a coat hanger? Can you imagine the infection risk?

And sure, fly another 1-2 hr to get to the final destination, but they flew 8+ hours.

It kinda makes no sense.

They mention in passing that cognac was used to disinfect things. Not foolproof, but not exactly a sepsis inducing nightmare either.

Cognac is usually what? 30-40% alcohol?

It needs to be 70%.

https://www.cdc.gov/infectioncontrol/guidelines/disinfection...

The one upside from COVID; no flight will be short of hand gel to sanitise with! Actually, is hand gel even good for that?

It's literally designed to kill bacteria. Funnily enough it does next to nothing against respiratory pathogens like covid which spread through the air not through surfaces.

One of the first things reported about the virus was that it was held together by a membrane of fatty molecules that would easily dissolve with soap. Soap literally kills the virus. So of course everybody decides to wash their hands with alcohol-based sanitiser instead.

I've never quite understood that. But there has been a lot I don't understand these past few years.

Those guidelines recommend 60-95% ABV (and note that effectiveness drops off sharply below 50%) but also report that at least some pathogens are killed in seconds with exposure to 40% ethanol.

If all you have to disinfect your ad hoc instruments is brandy, then use it: way better than nothing.

> Can you imagine the infection risk?

Infection is not an automatic outcome. My grandma was an obstetric nurse, she witnessed surgeons in 1950s Southern Italy performing operations with rusty knives; and most patients would still be ok.

Sometimes we forget that the human race survived for thousands of years without the niceties of modern medicine. It's good to minimise risk, but in the end risk does not mean certainty of bad outcomes.

I would define a surgery's success by the success of the outcome, not by the tools that go into it. How would you define a "successful" surgery?

An in-flight surgery that stabilizes the patient indefinitely is more successful IMO than one with all the best tooling that gets the patient killed.

Not indefinitely. The point of all emergency medical treatment is to stabilize the patient before they get to a proper hospital.

If there are two doctors there saying that the situation is not urgent, then who am I to disagree with them?

The patient was stabilized but the risk of complications still exist. In such an event, it's always better to be in fully equipped and staffed hospital. The only reason not to land the plane is if it is literally impossible to do so.

Maybe she didn't have any kind of health insurance in any country except the one she was traveling to. So when the doctors told her she could endure the rest of the flight, she chose to do so instead of going bankrupt by the medical fees. It would be also insteresting to know if she hid her injuries before boarding for the same reason.

It’s not her decision, it’s the pilot’s decision to divert or not.

The pilot would make that decision based on a third party assessment of the situation relayed to them.

Doubtful. Do people go bankrupt by medical debt in other countries? Seems unlikely to get judgment and collect.

I think it’s simply unlikely because debt is always preferable to a life threatening emergency.

That being said, from a global perspective, “bankruptcy” is not a good measure of economic burden. There are worse debt outcomes than bankruptcy.

Bankruptcy is actually quite a piece of cake in several US states. In fact most of them even let you keep your home.

Bankruptcy is not some sort of a financial death sentence. In fact you’ll even be able to get access to credit almost immediately, because the default risk just after bankruptcy is extremely low due to the fact that you can’t declare bankruptcy for another 2-3 years.

Yes, your credit score is trashed for the next 6-7 years, but it’s also trashed with an insufferable amount of medical debt.

I would be much more upset about a 6 figure medical bill if I had 6 figures in liquid assets than I would be if I owned nothing besides some home equity.

If I have 6 figures of liquid assets, I’m wiped out, but if I own nothing, I declare bankruptcy and have a clean slate.

That’s what I was alluding to. Part of the high bankruptcy rates in the US are because we have very liberal laws about bankruptcy.

Not only do you get to keep your home, but the majority of people who file Chapter 7 keep everything.

That’s not to say we don’t have issues with medical costs… I’m just speaking generally about using bankruptcy rates as an indicator.

Can you share more about people keeping everything?

They’re called “no asset chapter 7” filings.

The TL;DR is that the law allows you to “exempt” certain assets, mostly, basic necessities that people need to live a basic productive life. The point of bankruptcy is to make people pay what they can reasonably afford, not to make them pay every penny possible. The types of assets that chapter 7 does take away are things that poor people often don’t have anyway.

https://www.nolo.com/legal-encyclopedia/what-is-chapter-7-no...

I think TV and movies have led people to believe that people “lose everything” when they file bankruptcy and end up on the streets. That’s just not reality, at least in the US.

I wager to say that to most people in the developed world such thoughts would not occur, and almost certainly not to Brits (that are used to the NHS).

The NHS is garbage. After experiencing them once I took on a private health insurance that cost me £300ish per month.

So now my taxes paid for the garbage public healthcare system that I didn’t want, and then I had to pay for the private insurance.

Unfortunately most people aren’t that fortunate to be able to easily justify spending extra £300 a month on health insurance so they just cope with the NHS.

Wow, only £300? Private insurance in the US is so much more than that. When you get care, is a portion paid by NHS and the remainder from the private company? Or maybe the existence of NHS puts healthcare costs much less than that in the US.

> When you get care, is a portion paid by NHS and the remainder from the private company?

It’d be NHS if the non-urgent treatment would be immediately available from them (which is basically never), otherwise I’d be sent to a private hospital.

> Or maybe the existence of NHS puts healthcare costs much less than that in the US.

This probably helps, but the US healthcare costs are just fucked for no good reason. I like to look at South Korea as an example of reasonable costs in a healthcare system that’s 100% private (the government just picks up the tab afterwards).

> the US healthcare costs are just fucked for no good reason.

Amen to that.

> I like to look at South Korea as an example of reasonable costs in a healthcare system that’s 100% private (the government just picks up the tab afterwards).

From Britain you don't have to look that far abroad for this: Germany would suffice, AIUI, or maybe even just across the Channel to France. (But, hey, congrats on leaving the club of civilised nations.)

It's mostly lower because the scope of private medicine in the UK is generally a lot narrower: it's used for getting fast access to specialists and elective surgery, and a nicer room in hospital. If there's a serious complication when having your private hip replacement you're probably going by ambulance to an NHS ICU. Ditto emergency care. So a lot of the expensive parts of healthcare fall on the NHS even if you have private cover.

Something a little similar happens in the US: as a visitor you can get travel insurance including private medical care for much less than regular private insurance, because the insurance company isn't on the hook for long-term problems, just for a medevac back to your home country.

Yes, mate, you might complain about the NHS and you might wait and you might curse it, but you'd not entertain the idea of going bankrupt because you needed medical care.

Have you ever had to navigate the US health care system?

Delhi was the nearest airport , India has[1] one of the cheapest healthcare in the world which is considered acceptable.

Tones of people fly to India to get major surgery done , medical tourism is a booming industry there.

For a British resident it wouldn't be even a factor on the top of the mind as they would be used to NHS covering everything and most people would expect travel insurance to cover this - it probably would have

[1] even in 1995

destination was Delhi - mmaybe no good medical option en route?

Having been the "is there a doctor on board" doctor before: you make the call based on what's in front of you and the turmoil that would result from a precipitous landing. The case I had to be involved with was a relatively uncomplicated chest pain. I couldn't rule out angina, but the patient was stable and they had aspirin and it started halfway into a 4-hour flight. The patient remained stable all the way through and I released the individual to EMS on the other end. I don't see what an early landing would have bought in my case, and I'm not sure what it would have bought here.

> underwater seal drain

He's saying that the water bottle was draining fluid from her chest, but she/someone put the bottle on a high shelf, so it drained back into her chest.

This is why you don't immediately leave post-operative patients to take care of themselves.

Reply on news.ycombinator.com