I have been thinking all week about "Disoriented, Irritable, Combative".

Actually what I have been thinking about is how often it seems like people with TBIs don't want to go to the hospital, don't want to be looked at, refuse to be treated at all, until it's too late.

And about how much I do not know how this ought to be dealt with. How much persuasion is reasonable.

I have no answers to this, actually.

This is a pity.

Basal skull fractures are when the base of the skull is fractured. Battle's Sign is bruising over the mastoid process (the bump just behind the ear on each side), raccoon eyes is heavy bruising in both eye sockets. Both Battle's Sign and raccoon eyes are late signs: It can take hours for them to develop. By the time they show up I hope you already have your patient at a hospital.

Le Fort fractures are fractures of the facial bones. A Le Fort Type I fracture is a fracture of the maxilla (upper jaw), from side to side, along the bottom of the nose. The upper teeth kinda move around as a unit. A Le Fort Type II fracture, a pyramidal fracture as it's sometimes called, runs from the side of the upper jaw to the top of the nose on both sides. A Le Fort Type III fracture is when all the facial bones have broken off the cranium. It runs from side to side through the eye sockets.

The interesting thing about them is how they got their name. Dr. René Le Fort, a French surgeon (1869-1951), devised the classification by hauling cadavers to the roof of his house in Paris and dropping them, face first, onto the pavement.

With Le Fort fractures you often see difficulties with the patient's airway. With both basal skull fractures and Le Fort fractures, expect TBI.

I promise you, if you keep someone awake for an excessive period they will get sleepy or otherwise show altered mental status. Even if they don't have a brain injury.

If you have someone with the mechanism of injury to make you suspect brain trauma you may want to awaken a person several times during the night, to assess if some other symptoms have developed.

A patient you can't wake up is another matter entirely.

Dizziness, vomiting, headache, and confusion are far more reliable guides to a deteriorating situation than sleepiness.

(I'm getting sleepy right now and I don't have a head injury.)

My memories returned during the day, slowly, all except the five minutes that immediately preceded the accident. No nausea or headache to speak of, though. I wasn't worried at the time, regaining my lost memory was a delightful experience that felt as if taken from a novel.

Reading your text today, 27.5 years later, I realise I should have been more worried at the time.

Well, it is entirely reasonable to not want to go to a hospital. The ER is incredibly boring, and if you're not badly hurt, it takes forever to be seen and get out. But a patient in shock isn't necessarily going to exhibit good judgment. If the patient is someone you know well, you have a clear idea of what normal is. If they're normal, great! They still banged their head, and probably have other injuries. Depending on the patient, it may take more or less persuasion... or you may not persuade at all, just say "we're going Mom."

Yes, it came up last fall with my mother. She had a classic face forward fall and tried to break her fall with her arms (of course). Large bruise on her forehead, deep bruise in the eye socket, fractured wrist, and badly bruised knees. She didn't feel unusually bad after a fall that severe, and didn't really want to go to a hospital. I insisted, because she'd gone shocky and a minor fall shouldn't do that. No one else could much tell, but no one else had a 30 year baseline on her either.

With someone you aren't as close to, it's tougher. You can't depend on trust the same way. It's still better to err on the side of hospital if they hit their head tho. And even a minor blackout *should* make most people at least be quiet if you say "we're going." If it doesn't, well... It might be safer for them if they go anyway.

Actually, hyperventilation (hypocapnia) causes the brain to shrink; the problem is the electrolyte disturbances that follow (metabolic acidosis/respiratory alkalosis). Under controlled circumstances -- i.e., the OR -- hyperventilation is a tool for shrinking the brain intraoperatively, for a short period of time.

A stroke or bleed can be pretty major by the time clinical signs show up. My personal opinion is, any unhelmeted head that hits gets sent to the hospital, no arguments allowed. Any helmeted head can be assessed on the spot by a knowledgeable individual (EMT, nurse, etc.) and monitored. The delay of 4 hours in Natasha Richardson's case is what ultimately led to her untimely death, although a serious bleed would still have left her with TBI.

The brain is pretty amazing. I saw a quote from a neurosurgeon once that said we can scoop out brain and have a functional patient, or we can get a pinpoint lesion and end up with a nonfunctional patient. We can't tell until the patient wakes up which one it will be.

Clinical signs of TBI are the same in animals. If you think your dog has gotten hit in the head, go to the veterinary hospital. Some of the larger referral practices and most of the veterinary teaching hospitals have at least a CT if not an MRI.

For anyone interested in what scans look like, I recommend the Whole Brain Atlas.

Confession: I was in my forties before I realized that this expression refers to tiny points in your vision, and not to the shapes that cartoon characters see. That is, the cartoon thing is a joke about "seeing stars", but I've never been hit on the head, and I've seen a jillion cartoons. So you see my confusion, he said defensively.

(Now watch it turn out that some head trauma causes more complex disruptions to the visual field, such as...)

One of my research advisers was in a car crash, got a bump on the head, and ended up with a lesion that caused her to forget the name of the organism she was working on. As far as I could tell from her account, it just didn't take hold in her memory for a few months.

Brain injuries are interesting as long as I hold them at a fictional distance, then they become scary as anything.

My next thought was "How interesting that I can forget all that rather important stuff before I forget how to assess my own A&O score..."

Apparently the whiplash had caused some bleeding in one of the blood vessels at the base of his skull that led to a clot which eventually broke off and ended up in his brain.

I was entirely coherent at this point, though, and I quickly got up and did a mental inventory. I knew where I was, what I had been doing all day, I had retained my sense of balance, and I clearly understood I needed to be seen by a doctor. I was living in the dorms at this point, so I just walked to a friend's door and knocked on it. I actually laughed out loud at his reaction when he opened the door--I guess he doesn't often see people with more red than skin color in their face. I asked him if he had a driver's license, and if so, if he could maybe take me to the hospital.

Thinking back, I'm not sure why I didn't call an ambulance. The idea never entered my mind. I guess my feeling was "hey I can walk and talk just fine, how bad can it be?" Then again, having a friend drive me might actually have saved me some time.

I must have gotten incredibly lucky because the doctor refused to believe that such a small wound was caused by what I described to him. I'm a pretty big guy, and when I jump from a run, there's a LOT of momentum. As far as I can tell, the only consequences of that extremely stupid jump were a headache from hell for about a day (no other symptoms of brain injury at all) and a tiny scar that runs across my hairline where no new hair will grow.

Having said that, I do not plan to repeat the experience and would not recommend it to anyone.

Having held a brain the consistency is a bit firmer than jelly, I would say like the feeling of memory foam. It definitely gives, but the jello idea is a good visual showing the movement that the brain sustains in a TBI.

I was entirely coherent at this point, though, and I quickly got up and did a mental inventory. I knew where I was, what I had been doing all day, I had retained my sense of balance, and I clearly understood I needed to be seen by a doctor. I was living in the dorms at this point, so I just walked to a friend's door and knocked. I actually laughed out loud at his reaction when he opened the door--I guess he doesn't often see people with more red than skin color in their face. I asked him if he had a driver's license, and if so, if he could maybe take me to the hospital.

Thinking back, I'm not sure why I didn't call an ambulance. The idea never entered my mind. I guess my feeling was "hey I can walk and talk just fine, how bad can it be?"

I must have gotten incredibly lucky because the doctor refused to believe that what I described to him caused so little injury. I'm a pretty big guy, and when I jump from a run, there's a LOT of momentum. As far as I can tell, the only consequences of that extremely stupid jump were a headache from hell for about a day (no other symptoms of brain injury at all) and a tiny scar that runs across my hairline where no new hair will grow.

Having said that, I do not plan to repeat the experience and would not recommend it to anyone. 1 out of 5 stars.

Are kids more resilient when it comes to that kind of thing? I know some injuries are a lot worse when you're an adult.

*That is the point of having a nice thick skull, after all. Getting a brain injury involves either some underlying pathology which makes it easier to damage the brain, or a really good blow that goes through the bone (or rarely, a blow to the thinner part of the skull).

I am the clumsiest person on the face of the planet (just for embarrasment's sake, I was once scrubbing the butcher-block top of our dishwasher, and sneezed, cracking my forehead on the top. Twice.) I didn't know if I was just really lucky, thick-skulled, or if there was something about wee brains that helped protect them during the inevitable coffee-table incident.

The one that still makes me angry was the one at a day camp when I was eight or so. We were in a hayloft at a farm, and I didn't hear the warning not to slide off the hay in one part of the barn. I slid down the hay, through a hatch, onto the concrete floor of the barn. I was knocked out for at least a minute. The "treatment" administered by the camp was that they let me sit on a couch rather than do the next camp activity (only after my initial protests) and eventually let me call my mother to pick me up early (which she didn't like). No one besides me really seemed concerned that I fell 8-10 feet onto concrete.

I did learn, though, and when I had my next big concussion (while in grad school, I ran full speed into a pipe in the dark) I insisted on a trip to the ER. It was a nice boring trip, fortunately, although I wish they could have given me some advice on how to treat the following week of unending nausea. And yes, I still got my Ph.D., so my brain must not have sloshed too badly.

(The only time I felt more stupid was the time I turned my back on the sheep.)

I'm so glad it's not just me. The sad thing is, if I ever show up to work, dinner, or a funeral with an eyepatch on, no one is going to be surprised.

This sounds like a great opening line for a novel about adventurers stuck in a bad place.

I forget which book I have about skiers and Ski Patrol that talks about the Seckrit Ski Patrol methodologies to manage belligerent head injuries (of which Ski Patrols generally see quite a few). It usually involves more than one person, and sometimes management of the injured person taking a swing at one patroller before they can get the injured person (usually male in this case) safely secured in the toboggan.

This sounds like a great opening line for a novel about adventurers stuck in a bad place.

The only time I felt more stupid was the time I turned my back on the sheep. To this day, I will never forget the bleating and the insidious smell of lanonlin. And the wool. The wool going over my eyes.

I had a fall about eight years ago which got me MRIs and CAT scans but no lasting effects; apparently slowly crumpling to the floor before banging one's head reduces the trauma.

The funny thing is that I'm pretty sure I did NOT hit my head in that fall; I have clear memories of rotating scenery (very like the cinematography used to indicate that someone is falling!), and of thinking, "OMG, if I knock one of Mom's decanters off and break it, she'll kill me!" The worst I would have been was mildly shaken up.

I was knocked unconscious during a football game played during gym class when I was 13. I have no memory of anything between the game and waking up in a hospital bed about four hours later. I had apparently be out for about a minute, had finished school and gone home on my bicycle. My mother took me to the hospital after dinner when I started acting strangely and being unable to answer simple questions.

Jo Walton's account above makes me feel much more lucky about what might have happened, but it also begs the question about school and teacher responsibility. In 1969, should a gym teacher been more proactive?

I was never one of the jocks, so I'd never had a good relationship with gym teachers.

In fact, until they made it clear how long she'd been without medical treatment, her outcome didn't make any sense. Getting any treatment within the first hour (ideal) or out to the first three hours (not ideal) makes a difference in the overall prognosis.

Steve C. @ 29:

Is that an excerpt from Baaaad Sheep, or from Three Bags Full, But None for Ewe?

Actually, it was from the Thomas Harris thriller, The Violence of the Lambs

I was about 12, going to a parochial school in Westwood, Ca. Last day of school in SoCal, hotter than the hinges of, and we had a benediction service. I started feeling woozy and got permission from the teacher/nun to leave the church. I got as far as the sanctuary rail and collapsed, banging my head on the railing. Woke up a few minutes later in the nurse's office.

Mom didn't and doesn't drive, and Dad was in Antarctica, so it took her a while to get to the school. By the time she did I was judged to be fine; I'd just had a mild heatstroke event.

As far as I can tell there were no lasting effects, but obviously the powers-that-be made a decision that a trip to the hospital wasn't needed.

Ski-knowledgeable accounts (mostly on The Ski Diva with reference to EpicSki and Teton Gravity Research forums) I've read of Natasha Richardson's injury add that the Ski Patrol tried to encourage her to go get medical attention as quickly as possible. My own personal encounters with Ski Patrol (when my husband--helmetless--fell and broke his shoulder) backs up my own personal conviction that when the Ski Patrol advises you to do something related to medical treatment, it's usually a Good Thing. In DH's case, Ski Patrol recommended ambulance transport--no siren needed, but that was a bloody strong recommendation and somehow between the time they loaded him in the toboggan and I skied downslope to meet up with him at the First Aid station, they'd convinced him and he was loaded up, waiting for me to follow the ambulance down the hill to the hospital.

Ski Patrol. If you're a skier and you get hurt on the slope, listen to them. They know what they're doing--and their paramedic training is significantly higher than the basic first responder training I've had as a teacher.

I remember Mannix and a host of other detective shows from the 60s and 70s where that scenario happened every week. If that had really happened, poor Mannix would have been a piece of drooling wreckage before very long.

Change of topic:
Why do Scotsmen wear kilts?
Because sheep have learned to recognize the sound of a zipper.

I'm sorry, I tried to resist the urge (she said sheepishly).

I am so very very glad that the one bicycle accident I was in did not involve a head injury, because that was before minors were required to wear helmets. I refused to go near the bike again until I had one, thank you very much.

I do remember the surprise I felt that I instinctively did the correct roll. My only injuries were whiplash and a cut on my leg from a piece of glass— not bad for getting knocked by a car into the middle of a busy intersection.

B Durbin... Poor Marlowe...

"I caught the blackjack right behind my ear. A black pool opened up at my feet. I dived in. It had no bottom. I felt pretty good - like an amputated leg. (Upon awakening) My throat felt sore, but the fingers feeling it didn't feel anything. They were just a bunch of bananas that looked like fingers."

As it happens I'm a licensed medical professional, and as such I'd hate to have someone think that I was practicing medicine beyond my scope of practice. And I'd hate to think that someone went and hurt themselves because of something that I said, or failed to say, or didn't explain clearly enough. So I hang on a disclaimer, and say "I'm not a doctor. If you have a real medical question, ask a real MD."

Other folks who've died secondary to head trauma: Octavia Butler.

Generally brains are pretty well protected (we do live long enough to reproduce and raise our young), and we recover well-enough from concussion. But when things go wrong with brains, they go really wrong in a remarkably short period of time. You really don't want to have some nice doctor talking to the family about organ donation, do you?

Trauma is the #1 killer of folks under forty in the USA. (After forty it's various medical causes -- but trauma is still right up there.)

Since other people have shared their "I'm so clumsy stories", I thought I'd share mine.

I once got a black eye by hitting it on the doorknob. Honestly.

You see, my dog's bed was behind the door. When I walked towards the door, he stood up at just the right time in just the right way to trip me midstride. Over I went, hitting my eye on the doorknob. Up I got, feeling silly, and then I watched with mortification as my eye got swollen and a beautiful shiner developed. Instead of going to the hospital, I iced it and spent the next couple weeks explaining that I wasn't a battered woman -- that I really did hit my eye on a doorknob.

I guess I should have set the embarrassment aside and let the doctor tell me that all I needed to do was to apply ice to bring down the swelling.

But I will say this: Please, I beg of you, see a doctor within the year. And if your checkup shows high blood pressure, for god's bring it down.

Baaaaaa Humbug!

Their son was on the football team and got a concussion. They took him to the doctor and brought a note to the school that he was to cease playing football or practicing until cleared. She also spoke directly to his coach about it

Two days later mom came to pick kid up for a doctor's appointment and found him on the football field, Coach had not stopped him at all.

He has permanent brain damage, anger and impulse control problems, memory loss and a considerably lowered IQ. The outcome is that he probably will not make that up again because of the damage.

It's a terrible shame. And a warning to others too.

Especially since it generally takes a rare convergence of events to actually hit one's eye on a doorknob. It's POSSIBLE (e.g. LLA@49), but I suspect the number of people who have really gotten a black eye that way is fairly small.

Does the story trace back to some well-known movie or something? Back to anything at all that's identifiable?

Dunno, you're alive, to me that seems more important than being an inspiration. Death is a pretty lousy alternative. (also isn't much consolation, because having a permanent disability happen as an adult is really painful... mine are all a lot more minor, but they still *suck*)

And you're exactly right about strokes. A family friend had several tiny ones over the last five years. They've seriously damaged his reflexes, so he no longer is able to enjoy his favorite hobbies (flying model and full size aircraft). He knows it isn't safe... and he knows that the odds are good the strokes came from smoking his whole life.

Odds are very good the only reason he's still here is he called 911 for the worst one, when his hand mysteriously stopped working.

... I went back to my place, good old 3-D. I no sooner opened the door than they were at me again. This time I was ready. I smashed my eye into his fist, I forced my ribs into his boot, and the first thing I knew I was flat on my back in the hall. He was standing above me now. He spoke.

THIRD READER:

Look, buddy. You do this every night. This is not your apartment. You're in 3-D. This is 3-A.

(Jean Kerr, "Don Brown's Body")

It's quite amazing that some people survive much worse than what seems to have happened to Natasha Richardson. A few years back, the QB of the Pittsburgh Steelers was riding his motorcycle without a helmet and went headfirst into the car he crashed into. He's still playing football and led his team to a Superbowl victory this year.

Hollywierd always gets that wrong. There is no safe way to hit someone and knock them out.

(When the writer's done a little more research, and shifts to the administration of anesthetic agents, they're still getting it wrong. There's no instant anesthetic either.)

Joyce @41: Yes, they can be dangerous. All it takes is for your head to be lined up with a fence post when you bend over and the sheep takes exception to your posture. As I found out. Luckily I didn't see anything but red while I rubbed my head and butt.

Scraps @ 50: I work with non-human primates who occasionally get a stroke (by accident, we're not studying strokes). I've seen arm (and leg) paralysis slowly improve over time. Since our monkeys don't have the speech centers, I can't draw any parallels there. Head injuries always have surprises, including during recovery.

They told me to get in the ambulance and go to the hospital; I said I had to take the horse back to the stable. Then I tried to get up, and I realized they were absolutely right. At the hospital, they x-rayed me, decided nothing was broken and sent me home with a list of things that, if they happened, would signal an immediate need for medical attention.

I had a splitting headache for two days but no other ill effects, and since this happened about 35 years ago, it doesn't worry me. But if I hadn't been wearing a helmet, I would definitely be dead.

On the other occasion, I was on my way to TA a class, and one of my students was an EMT. Strange role reversal, that was-- in a chemistry lab, *I'm* the one meant to be looking out for my kids' health and safety...

I think it may have come to be a stereotype because the bruise I came up with was the classic shape that happens when fist meets face, and the part of the face met is the eye.

In other words, it was a beaut of a classic shiner.

In retrospect, I suppose I posted in part because Jim's excellent discourse made me realize that not only could I have suffered brain damage (and was too embarrassed to go to the hospital and make the necessary explanation) but that women (and men) who regularly suffer such abuse are at high risk of ongoing brain damage.

I don't want to hijack this thread. It was just the first time that I connected my moral outrage and feminine solidarity for anyone in a physically abusive relationship with the possibility that our society is made so significantly poorer by the loss of these victims' cognitive abilities.

In general, individuals with TBI have about 30 times the risk for epilepsy compared with the healthy population

It goes on to say that the risk of epilepsy increases even more for combat-related TBI.

Yet another residual benefit of the Iraq War.

According to the Joint Theater Trauma Registry, compiled by the U.S. Army Institute of Surgical Research, 22 percent of the wounded soldiers from these conflicts who have passed through the military's Landstuhl Regional Medical Center in Germany had injuries to the head, face, or neck. This percentage can serve as a rough estimate of the fraction who have TBI, according to Deborah L. Warden, a neurologist and psychiatrist at Walter Reed Army Medical Center who is the national director of the Defense and Veterans Brain Injury Center (DVBIC). Warden said the true proportion is probably higher, since some cases of closed brain injury are not diagnosed promptly.

It's a recurrent problem for me-- if I haven't remembered to eat much of anything earlier in the day, it usually manifests when I've crouched down to take a look at something and then everything goes woozy for a few seconds when I stand up. But that's somewhat an improvement on the times when I've been sitting/lying down for too long and then get up to walk across the room, because then there tends to be a delayed effect; by the time it hits, I can be 5-10 ft. away from a convenient piece of furniture to hang onto.

My wake-up call was getting some work done at a dental clinic, where they did a blood pressure reading before getting to work.

I forget the actual numbers, but when the lady doing the reading read them to her supervisor, she insisted on a second read: "That can't be right; he'd be dead."

Bit of an exaggeration, because it was right, and I wasn't dead. But despite no insurance, I did find a doctor to check it out. He started me out with some 'free sample' blood pressure meds, and wrote me a prescription for meds I could pick up for cheap at WalMart. Also suggested that I pick up a blood pressure monitor, which I did; and the numbers I reported back (and other tests) suggested that the meds got my numbers down to a reasonable range.

Hollywierd always gets that wrong. There is no safe way to hit someone and knock them out.

(When the writer's done a little more research, and shifts to the administration of anesthetic agents, they're still getting it wrong. There's no instant anesthetic either.)

Yeah, the casual concussion (either delivered upon the guards, or received by the hero) is something that has annoyed me in contemporary TV fiction.

I had read an article in a 1960s American Heritage, written by a doctor, describing how much was wrong with television violence then. Apparently even as a kid he was studying medicine, and would describe to his friends the potential complication of the 'just a shoulder wound' that the hero took — the shoulder bones are relatively delicate, and don't mend well; major blood vessels run through the shoulder and would be damaged.

I can't recall if he had anything specific to say about concussions. He did say that people rarely die as quickly and as easily as TV suggests.

turtle @#3: In addition to Jim's points, if someone goes to bed with a concussion, that's likely to be a few hours they aren't getting treated....

Yes! Playing at the park when I was about 5, I misjudged and jumped off a swing, landing directly beneath it. This was not one of today's plastic swings — it the seat was solid wood, and it smacked me in the head. People from a picnic table nearby came over to see if I was all right, and I thought they poured a pitcher of Kool Aid over my head. What else could that rush of red liquid be?

What's rare is isolated brain injuries. Usually you see them along with other injuries. The person has a brain injury plus a facial injury plus a penetrating chest injury plus a couple of long bone fractures ... it gets challenging.

Still, trauma is the number one cause of death among Americans ages one through forty-four. Keep a high index of suspicion when the mechanism of injury suggests brain injury, and be prepared to take rapid and effective action (which will probably consist of dialing 9-1-1) if you start seeing signs and symptoms.

A friend of mine was in a car wreck on Monday-- she's fine, car did its job, here's to seat belts and airbags-- and got a bump on the head. She didn't go to the hospital for the simultaneously reasonable and shitty reason that she figured the emergency room would be more of an insurance hassle, but once I was done driving her to empty her valiant but mortally wounded car and talk to her insurance guy, I dropped her at Student Health. She still had a headache three days later, and for all I know, may yet.
And this is without a concussion.

Meanwhile, strokes. Yes. The number eight cause of death for Americans 25 to 44, when it goes up to the number six slot for 45-54, number five for 55-64, and number three for ages 65+. (Heart disease and cancer still lead the pack for ages 45+.)

If you smoke, stop. If you have high blood pressure, get it under control. A TIA (Transient Ischemic Attack, AKA "mini-stroke") is a warning sign; don't ignore it. There aren't a whole lot of funny stroke stories.

I keep seeing "Joint Theater" as a stand-alone phrase. Vertebrae doing Shakespeare?

#68 ::: Linkmeister:

I've heard of a movie which tracks the plausible consequences of someone being shot through the shoulder. Anyone know if it actually exists and if so, what it's name is?

Vertebrae doing Shakespeare?

Either that or actors getting high.

The same day as the injury, the doctors are fine with him going to a party in the hospital. He's sitting up in a bed, in a room with loud music and flashing lights, smiling happily, and bobbing his head to the beat of the music. Yeah...

Even though I was 50 at the time, I'd been doing martial arts for 20+ years and also box. You learn to cope and function in situations where your physically impaired, or rather dazed! :) My first thought was that I might be having a heart attack, but I had no chest pain and my heart was beating just fine. Then I became concerned that if the spinal sensations kept increasing at the same rate, that I might actually pass out. I figured that I better go tell someone what was going on while I could still talk and explain it.

My wife wasn't terribly happy when I walked in with the calmest of voices and mentioned that something strange was happening and, that if it continued at an increasing rate, that I could conceivably pass out. We decided to go to the emergency room. Unfortunately, even though I no longer get motion sickness like I did as a kid, I found trying to ride in a car to be terribly nauseating. We made it about a block, then I got out and walked home.

We next tried EMS. The firetruck got here first, as is normal around here. I described things to them, but by then I had pretty much plateaued and things were not getting any worse. I just had a killer headache. I found out much later the magic question is, "Is this the worst headache you've ever had?". It was!

They took my blood pressure and stuff, and couldn't find anything wrong with me. We cancelled the ambulance and I decided to ride it out a bit. Three days later, and with a large amount of web research, I wasn't getting any worse, but my headache wasn't getting any better. We decided to go to the emergency room again. Driving no longer made me nauseous (at least if I was driving, yes I know, that was poor judgement on my part).

Even though I was easily hitting 15 on the Glasgow Scale above, the doctor asked a few questions and immediately pegged the problem. Cranberry colored spinal fluid and a CAT scan later and I was immediately shipped off to a hospital with a neural unit.

I was incredibly lucky! A cerebral angiogram showed that I had had a subarachnoid hematoma. Eight days in the hospital, followed by another cerebral angiogram, showed that that was it. There were no other visible problems.

That was 6+ years ago. My memory's not as precise as it was some years ago, but that doesn't seem to be directly related, and could just be age. I'm a little bit dingier, but that could also just be age (or perhaps getting hit in the head too much!). So, again, I was incredibly lucky and, if I have any related to the trauma, I only seem to have minimal neuro-deficits.

Nowadays I don't strain as much when picking up heavy things and I will take the time to sharpen the chainsaw instead of trying to pick up heavy branches. I think one of the key things for me was the 'worst headache' question. I would have probably handled things differently if it had been asked early on. As it was, I was quite fortunate.

All questions of inspiration be damned. I'm just glad to see you posting again, and I'm grateful that you're willing to take the trouble do so.

I've missed having you around.

My grandmother fell in the hospital. She'd been in for three weeks with pneumonia, and they were about to release her but wanted one more chest X-ray. She was terribly weak, but they made her stand for the X-ray. Apparently she fell straight backwards and hit the back of her head on the hard tile floor.

When I got to the hospital a couple of hours after it happened, she had raccoon eyes, and I almost passed out when I saw her -- it is a very...dramatic symptom. She had contracoup lesions and resultant problems from frontal damage. It was kind of a classic textbook case, and would have been interesting if I'd encountered it on rounds on my (at that time) recent neuropsych internship, but with my grandmother? Not so much.

I got back on the bike and rode to work very carefully. Then I tweeted about the fall and mentioned it to my colleagues. I reckoned if I did anything the least bit funny, they would call an ambulance immediately.

I had a headache for much of the day, but nothing else happened. I've been much more careful about ice since then.

Your co-workers sure are a tough audience.

My basic rule of thumb is that real people are way more fragile than major character in movies, and at the same time, way *less* fragile than minor characters.

So, most people have speaking parts, but not starring roles. That sounds about right.

One would think anyone who's been alive long enough to be a scriptwriter would at least have experienced having a foot or arm fall asleep.

I will make one small point. In the ED, you *can* differentiate between subdural, epidural, and to some degree, subarachnoid bleeds by plain (no intravenous contrast) CT scan and a lumbar puncture. But the end result is the same either way: call neurosurgery.

A bunch of us were talking about, as non-neurosurgeons, given the same situation with Richardson, whether we'd say fuck it and do a emergent craniotomy (burr hole) in the ED.

The consensus was that most of us would, but only after explaining in great detail how we weren't neurosurgeons, and it was either that or die on the way to the other hospital. And reams of consent forms. Gotta love lawyers.

Speaking of which, TCM just finished showing Houdini. I especially liked the scene where Tony Curtis locks himself inside his employer's big safe. Everybody panicks and, before he can let himself out, they blow the door open with explosives. Tony walks out, waving the smoke off his face, but I didn't see anything oozing out of his ears.

I recall a character who had been in a coma for months having the strength to walk down several long hallways and then down a flight of stairs. Oh, yeah.

We figured that his buddy put him in the hospital; it was the hospital that put him in the ground.

---------

Skiing. Some of my saddest stories are skiing stories. One minute there's a bunch of friends having a great time in a beautiful place, and they're young and happy and healthy and beautiful and rich, and the next minute it all goes straight to hell. And the look on the friends' faces is the worst of it.

It is given to no man to know the day or hour.

If the patient has waited more than 4 hours (as reported it took for Ms. Richardson), you're likely to have brain herniating through your burr hole. By that time, a CT scan is behind the curve (CT doesn't show edema as well as MRI), and MRI takes too long for an unstable patient.

I suspect that by the time she reached the hospital she had already gotten to transtentorial herniation, or at least swelling into the cerebellum. Once the brain reaches that level of swelling, the surgeon has to take off the calvarium, which is a salvage procedure, really. If they did that, in her case it didn't work.

Studded tires. They're pretty common 'round here in the winter.

However, studded tires do not protect against the other great scourge of cyclists... railroad tracks and metal sheets. Last fall I hit a railroad track *just* wrong, and had a nasty fall. I was very lucky, and took the brunt of the impact with my knee. Almost all the damage was to the nice thick cushion of muscle around my knee. The usual injury for the way I fell isn't a busted knee, it's a broken femur, up near the hip socket. (next most common is a head injury, but my helmet was untouched)

On the whole, I'll take the knee.

Which is very sad.

What I've done since then is stick to salted or gritted roads on icy days. (I'd taken the scenic route with the unsalted bike path that day.)

Generally:
A fictional example of this phenomenon can be observed in Busman's Honeymoon, by Dorothy L Sayers, where the victim suffers a blow to the head sufficient to fracture his cranium, and still manages to move about and do a number of things before dying.

The police chief in the village researches the matter in Taylor's Medical Jurisprudence*. The scene that riffs on the story of the gentleman thrown from a chaise in 1859 is one of my favorites in the book ("his premature death must have occasioned much lamentation among the crinolines").

-----
* Which we have, albeit in a later edition. It's one of the books we keep on the top shelves, because the pictures would be upsetting for the children who have free run of the books they can reach.

My cycling-on-ice accident involved turning right (which is across the traffic, in the UK) from a gritted to an ungritted road. Did a pretty decent side breakfall, and very little damage (elbow friction-grazed through three layers of clothing). The outcome would have been very different if I hadn't slowed and let the following car turn right ahead of me...

Re. concussion in novels, didn't Nancy Drew get knocked out in nearly every book, with nothing more to show for it than a slight headache?

And yes, if you need that "bullet wound" the hero can still function with, I understand that grazing through the outside of the upper arm is slightly plausible, versus the many important bits which are likely to get involved in the often-used-in-fiction bullet through the shoulder.

Almost-but-not-quite-completely-unrelated, according to Morbidity & Mortality Weekly Report (CDC), there are estimated to be more than 86,000 falls per year in the USA related to dogs and cats - mostly dogs. Most cats I know excel at the game of "wait until the human is in the process of stepping over you, then move so you'll be in the way where their foot will come down" - especially on the stairs and when the human is carrying something large...

I had been bothered by the intensity of the damage with respect to a 1-hour delay, thinking that there had to be something else going on -- like a ruptured aneurysm prior to the fall -- but once I saw the revised timeline, it all made more sense.

This kind of situation is exceedingly rare. Dr. Jan Garavaglia (Medical Examiner for Orange County, Florida) reported on a suicide in which the gentleman shot himself in the back of the head, which was not immediately fatal. He then stumbled to the railing of the bridge -- possibly intending to throw himself over -- and instead passed out in a position that left him resting on the railing, head down over the water. He was found dead, in this position, with his gun holstered. The initial impression was that he'd been murdered, but the evidence* led to a conclusion of suicide.

*Including the degenerative bone disease in his neck that was causing severe, unrelenting pain. He put the gun right above his neck.

On any given day, I get a lot of e-mails from publicists. Some are silly, some are embarrassingly unprofessional, most are completely unrelated to what I cover. Occasionally, one is downright shameful -- callous, even offensive. One of those landed in my inbox today. The headline of the pitch is, "NEWS REPORTS REVEAL NATASHA RICHARDSON’S DEATH MAY HAVE BEEN PREVENTED WITH U.S. HEALTHCARE." And yes, the point of the e-mail is that socialized medicine killed Richardson, whose fatal skiing accident occurred in Canada.

Well, if Michelle Malkin thinks that it's Canada and not that brain injury, that killed Richardson, who am I to argue?

If they get kicked (moved in front of you walking) or partly stepped-on (above trick) a couple of times, they'll learn fast what a steady walk means. That said, while I had a rabbit, I developed a distinct shuffle. (Rabbits don't learn so good....)

I'm pretty sure this is meant to be a feline social thing, which just interacts poorly with their "buddy" being 5-10 times their weight and height.

Short form: I was rear-ended by fully-loaded tractor-trailer while I was stopped on the freeway (there had been another accident earlier, where a truck had lost a load all over the road, and the crews were still cleaning that up).

Car rolled and spun; I was thrown out of my seatbelt (yes, I was wearing my seatbelt properly; however, the seat back was broken by the impact and the seatbelt had nothing to hold me against) and put a lovely headstar in the windshield, on the passenger side, with the back of my head. I also broke three ribs and whiplashed my upper back, and acquired an assortment of comparatively minor cuts and bruises.

My memory of the accident goes from "I am stopped on the freeway and should turn on my hazard lights" to "I am upside down and there are paramedics in my car. Something is seriously wrong here." I don't know if I was actually unconscious, but the memory gap is probably about 10-15 minutes.

The first thing I remember saying was to answer the question, "Do you know what happened?" with "I think there's been an accident, is anyone hurt?" (Which was really an incredibly stupid thing to say, and I'm still embarrassed by it all these years later, not to mention by what I might have been saying before my memory and social censors came back online.)

But I knew who I was, where I was, and about what time it was. I think I greyed out or blacked out when they moved me out of the car onto the stretcher, because I don't remember that part very clearly at all (they gave me a blanket and told me to tuck it around my face and arms to protect me from breaking glass, then there were loud crunching noises, then they started to slide a backboard under me, and then I was on the stretcher).

I remember asking in the ambulance if anyone had my purse because that's where my insurance cards were.

The ER x-rayed me and scanned me (I'm pretty sure CT scan because I don't remember it being noisy). Another point of ongoing embarrassment is that I was so uncooperative; I whimpered and moaned when they had to move me around, and I couldn't roll over onto my side for them to X-ray me, they had to get a tech in to roll and hold me. (I did, at least, apologize for being difficult.)

After all the scans and such, they gave me a shot for pain and one for nausea, and were ready to release me to my husband (who I still think folded time and space to get from Maryville, TN to Cleveland, TN as fast as he did). I stood up from the bed, turned grey and sweaty, and started swaying. They sat me back on the bed, tried three times with no success to take my blood pressure, and started an IV.

I dozed off, and when I woke up about four hours later I could stand up without getting sick, so they went ahead and discharged me with scrips for pain and nausea (but no muscle relaxant, which still pisses me off -- I'd been in accidents before, and knew damn good and well that muscle relaxants are more helpful than narcotics in the week following).

It ended up being almost six weeks before I was able to go back to work, although that was mostly my fault for not pushing my own doctor hard enough to refer me to physical therapy (among other things, the first thing the PT showed me was how I could get into and out of bed without screaming -- I'd been sleeping in an office chair tipped back and my feet up on another chair for a month).

And given that I had dizzy spells for the better part of six months, I am (A) more inclined to think Dale was right and the ER should have admitted me for observation, and (B) damn lucky I didn't end up with worse outcomes.

The first thing I remember saying was to answer the question, "Do you know what happened?" with "I think there's been an accident, is anyone hurt?" (Which was really an incredibly stupid thing to say.../blockquote>

Piffle! I think it's very sweet, and implies good things about your character. And where you're embarrassed about being "uncooperative", I'll point back to your prior passage:

the seat back was broken by the impact ... and [I] put a lovely headstar in the windshield, on the passenger side, with the back of my head. I also broke three ribs and whiplashed my upper back, and acquired an assortment of comparatively minor cuts and bruises.

That's called being badly hurt. Wich definitely excuses "I whimpered and moaned when they had to move me around, and I couldn't roll over onto my side for them..."!

You're right about the muscle relaxers and PT, though.

Cats vs. rabbits. important: rabbits have about half the skeletal mass of cats (relative to total mass). They are much more fragile. You kick or partly step on a cat a couple of times and it yowls and runs away and acts offended (then refuses to move the next time you're having to climb the stairs carrying a large heavy box). Do that to a rabbit and it will probably have a broken back...

JanetM @113

I "wasn't very cooperative" about lying down for radiography when I'd dislocated my shoulder either: or to put it another way, a normal change in posture from sitting up to lying down was no longer in the list of things I could do; being rocked onto my back with my legs bent in sitting position (strong person on either side moving me) then straightening my legs once I was lying down was possible. The tech did offer to throw me onto the table (told me I could scream/swear as loud as I wanted, the room was soundproofed) but I didn't like that option. Your inability to roll over on your own sounds perfectly reasonable for a person with that level of injury.

I remember him. He was in Coverup with Jennifer O'neil(sp?)as a male model/secret agent and his photographer, right?

It doesn't say stupid to me.

If it makes you feel any better, I did the exact same thing.

At slightly less velocity, it sounds like, as I avoided the concussion and walked myself to hospital, but I needed 3-4 stitches in my scalp.

And felt like a total buffoon.

Indeed, but I'm not talking about full-strength kicks or putting even half my weight down. Basically, shoving them aside with my foot, just hard enough to make the point that when I want to go somewhere, they need to get out of the way.

Note that my rabbit died of old age, in his seventh year. This, despite spending his life chewing through an unreasonable number of wires, including live power cords. (aka "The War of the Wires".) And eating through my Euphorbia pseudocactus, despite spines and supposedly-caustic sap.

Chickens were a lot harder to kill. They had this annoying tendency to pull their heads in on their neck so you didn't have a good target, and if the hatchet wasn't sharp enough you'd just break their neck without cutting the head off.

Jim @#126: That thing is pretty buggy. On answering the second question, I got this:

Your answer was

Microsoft VBScript runtime error '800a0006'

Overflow: 'CInt'

/quiz/index.asp, line 147

PS: to moderators/webmasters: OK, auto-closing stylistic tabs (i, b) after a paragraph break is vaguely reasonable. But "blockquote" probably shouldn't do that! (Certainly, it, like all comment tags -- should be auto-closed at the end of the comment!)

I agree entirely.

Sadly, we are helpless, cringing slaves before the mighty incomprehensibility of Movable Type in this matter.

...or are we supposed to be 'cringeing' slaves?

JanetM, I think "is anyone hurt?" does say you were a little confused, but not stupid, and speaks volumes about your compassion and concern for others. I just hope that in a similar situation I can be that "stupid."

I wear one because of a college roommate who had to drop out of school after a simple bike accident.

While biking home late at night he somehow fell. He recalled he was going quite slowly, no more than 6 or 7 mph, because it was dark. There were no other cars, bikes or pedestrians around.

Patrick continued home. Another roommate- a med student- noticed the signs of a concussion. We brought him to the hospital: other than the concussion he seemed fine. No fractures, no stiches needed, no 'chiseled spam' road rash.

Except he lost his grad-school-going intelligence. His was a real Algernon moment. He could read newspapers but not his own notes. He could understand TV shows but not lectures.

His brother put law school on hold and flew out to California to help, but even with his brother shadowing him he couldn't handle school. He dropped out and left for physical rehab in Colorado.

He didn't return to school in the next 2 years. After that I lost track: I don't know if he ever went back to grad school or his original career track.

Since I didn't feel anything much beyond "mumph, that was annoying!" and over-stretched spinal muscles, I assumed I was okay. But now this thread has me feeling paranoid. Especially since I woke up Sunday morning feeling excessively hung-over. But I'm attributing that to having stayed up until O'Dark-thirty embroidering madly. Right?

And what was the deal in Jo's LJ post about no one who gets hit in the head can understand French?

My now-faded memory tells me it was a very bad concussion he had-- all the force of impact that should've gone into a broken helmet (or at least broken skin and bones) went straight to his head. I recall his parents helped him get extensive tests within a couple of weeks of the accident.

Single-biker accidents were common at my school, especially in winter after the leaves fell and made slick covers along the paths.

He felt perfectly fine on the day they released him, but later that day he laid down for a rest and slipped into a coma. He never woke up. Father S. was/is devastated, but was grateful Bob was able to visit Mt. Carmel before he died. He is also grateful that Bob passed, rather than partially recovering.

The brain is a weird thing.

I meant that Bob died due to TBI, not TIA.

Considering that the French for 'ram' is 'bouc', you found out what it's like to have the bouc thrown at you?

Jim@126, re Harman@130: Is the crash what's supposed to be amusing? I also found it on 2 tries, once immediately and once after one question. I also wonder about a quiz which rates identifying the mitral valve as "very difficult".

Friend of mine died last fall from slipping off his porch roof; he apparently landed on his feet, but the footing was bad and he went over backwards and hit the base of his skull on the corner of a concrete step. It severed his brainstem and though the body kept breathing for two days he was dead from the instant he hit. According to witnesses his eyes were open and never blinked.

Brain injury is not your friend.

It might make sense-- more skeleton can probably support more strength at the cost of needing more calories.

A good EMT will put a folded towel in the lumbar void. "Padding the voids" is supposed to be part of the backboarding skill.

I do seem to remember there were strange hallucinations, though. Not things or people, just roiling colored (but mostly silvery) blobs in my vision.

I don't recall them doing that, though it's possible I just hurt enough that I didn't notice whatever support a towel may have provided. Or they may have been "competent" but not "good". Dunno.

And I'm now wondering about me: we got hit by a Big! Scary! Blizzard! (9 inches, woo hoo. In Boulder, for Ghu's sake!) last Thursday,

We were fortunate enough to be out of town until it had all melted. Avedaggio took photos for us though.

(There seem to be quite a few of us ML bit-players in the Boulder/Longmont area... and oh look the Farmer's Market will be starting up soon!)

Yes, indeed, properly padding between the torso and the board is a point in the longboarding station.

It makes a big difference, particularly in prolonged transports over bad roads.

Mine was caused by my rheumatology -- my brain swelled and smushed against the skull and bled on the left frontal side. I knew something was wrong the first few days and went to the hospital three times. The doctors at the upper-level hospital (where my insurance helicoptered me twice) were ready to put me in the psych ward because the techs read the first MRI wrong. Fortunately, someone read it right.

Then I really don't remember a lot the next few days. I was seeing extra parts of things on the right -- I thought the nurses might hurt me because they had a third side of their face on my right (too much SF, huh?) and I tried to escape so they restrained me one night. I couldn't make any good words come out, either, so I couldn't say anything.

On my birthday, the 10th, I had the angiogram and I was also able to understand people who talked to me, although I still had trouble remembering things and words. Then I started getting better and went to a brain rehab program for six days and am home.

I'm taking prednisone and two anti-convulsive meds to prevent more problems. I was off the HRT for a month and don't seem to need it, so I've stopped that.

Soren, I felt so guilty getting better quicker than you did, but it took me much longer to get better the first stroke, so I know there's a good chance you will, too.

LLA @ 49 ... It was a car door being helpfully opened as I bent down to open it that earned me a black eye.

[0] Or should that be "cohneth nde inollegutn"?

What happened according to the police reports, medical records and other people: it was winter and I was five. It was mid-December in South Dakota, so the street I was crossing was wide, flat and covered with snow and ice. Midway across, I was frightened by an oncoming car.

If I had kept walking, it wouldn't have hit me. Hindsight being twenty-twenty, I tried to turn around and slipped on the ice. The car would have missed me if the driver had swerved without trying to brake. Unfortunately for myself and the driver, he slammed on the brakes and lost control of the car, which then hit me and sent me into a snow-covered curb. Luckily, the car managed to stop before it crushed me against the curb.

At the time the paramedics came on scene, I was fine. I was taken to the local ER, and while they were examining me, I lost consciousness. Then I stopped breathing and my heart stopped. My mother was in the hall outside the exam room. She remembers hearing them yell code and seeing a crash cart wheeled into the room I was in.

After they stabilized me, I was airlifted by helicopter to a children's hospital in Minnesota. I don't know why they did what they did next, which was to shave the right side of my head and drill two burr holes. My mother claims that at some point, the plan had been to drill another and remove a section of skull, but since they didn't find any swelling, they quit after the two holes. She also thinks the entire hospitalization could have been avoided if they didn't make me lie down during the initial ER exam. I didn't come across any blow-by-blow description of the surgery in the medical records, so I'm inclined to take that with a grain of salt.

This was in 1980 and I don't know what was standard procedure for TBI then. I didn't have any other injuries except a scrape on my chin. I haven't really had any major neurological problems following the injury and if the accident's immediate aftermath wasn't so dramatic, I wouldn't necessarily classify it as a serious accident.

Every time I learn new information and statistics on TBI, I'm profoundly struck by how lucky I was -

"A serious TBI is about 30% fatal. Of those who recover, around 99% have permanent neurological deficits."

- and how grateful I am that this happened when I was young. At the tender age of five, my concept of mortality was pretty much non-existent and I hadn't seen any horror movies featuring drills and skulls. As an adult with the ability to reflect and brood, I would be horrified to be recovering from brain drilling. I can and do squick myself out when I absentmindedly rub the scar under my chin or run my fingers across the two dents in my skull, but it's not the same.

I apologize to all if I've been too long-winded, to Yog and other forces of righteousness for not knowing what URL to submit (indeed, still being a little unclear on what that is) and for not figuring out how to elegantly include the excerpt from James MacDonald's original post like other more experienced members of the board. By way of excuse, it is possible that I have some brain damage...

...and back to the shadows of lurkdom I go.

The "URL to submit" is generally used if you want people to be able to follow you to your own blog. You'll note that if you click on my name you get to mine. It's optional; don't worry about it if you don't want to. (I'll speak to Patrick about clarifying the fact that it is optional while the email address is mandatory.)

As for quoting, all we do is use the computer's cut and paste function to get the text into the "Write here" box. You can make it stand out using the "emphasized" tag explained in the HTML Tags section above the text boxes.

We can talk elsewhere about what URLs are and how to do cut and paste and blockquotes. You did just fine here.

I don't know if a CAT scan was available in your local hospital in 1980. I remember hospitals doing fund drives around then to buy 'em. They were new tech and nowhere near as fast as they are now. I expect that the burr holes were to see if there was any free blood, to relieve pressure, and, if necessary, to go further for neurosurgery.

Opening holes in skulls to relieve pressure works. It's also medicine on the cave man level. Skulls from ancient burials showing trepanation and subsequent bone-growth have been found all over the world.

There's some evidence that sitting a head-trauma case up is helpful, to let gravity be your friend and help drain fluid and limit brain swelling, but in your case I don't see that it would have made much difference.

The number one reason that a little kid's heart stops is because respiration has stopped.

Little kids aren't just miniature adults. They have proportionately larger heads, and so tend to hit head-first when they're thrown. And when about to be hit by a car, adults tend to turn toward the vehicle, while kids tend to turn away, producing different typical injury patterns.

Again, thanks, Heather.

[I see that in my post up above that I failed to even mention sub-arachnoid bleeds. I'll remedy that soon.]

I remember the fund drive they had going in Inverness back in 1983 or so, during our visit there -- folks with collection cans in the train station and similar places -- raising funds to bring a CAT scanner to the highlands. (I don't know where they had to take patients before that, but it couldn't have been a fast transport no matter where.) We donated our spare change, and got little metal lapel buttons in return.

But then he asked me WHY people go unconscious as a part of the initial concussion.

I told him it was an electro-chemical disruption of the brain and that it was time for bed.

Does anyone have a better answer for me before he asks again in the morning? I need all the Good Mom points I can get!

Other causes of LOC include disruption of the blood flow, and possible cardio-respiratory disturbances as well.

I'm not sure we'll be able to pinpoint the causes of LOC until we're all inside a giant MRI and can watch as some one gets hit accidentally -- it's not the kind of study that would be approved for humans, and it would still be tricky in animals.

If the exact mechanism of that electro-mechanical disruption is known, it isn't known by me.

But for more on concussion, particularly in regard to sports by teens, check here and here.

His comment was "well, that's not a very clever survival trait!" It's been a surprisingly interesting topic. He's now focused on how you could get brain scans of people who were likely to get hit in the head (special helmets on boxers?) to find out more.

Neat stuff.

There's some left/right mixing up that I'm doing, but other'n that nothing seems to be wrong. And I mix that shit up all the time.

All my friends are notified to call the authorities if my brain suddenly goes out.

Disoriented, he urinated on the ambulance and the EMTs, deciding against all the witnesses there that he was drunk, didn't bring him to the hospital. Meanwhile, he had a hemorrhagic stroke and by the time the doctors got him to a CT, he had to be put in a coma for a couple of weeks. Miraculously, he seems to be not-bad-at-all now.

So what I'm not telling you is that the guy is black. He's a Somali social worker living in Oslo. The event started a huge brouhaha over the definition of racism and immigrants and blah blah blah.

My question was always how the EMTs could leave him when there was a serious question over whether or not he had TBI or was just being drunk.

I've been thinking about this for days. I hope somebody reads this. The human body does not have a scrotum. The male human body does. To ignore that aspect of this sentence is to presume that the human body is by default male and is only female as an anomaly.

Consider your language choices carefully, please.

This is, of course, both nonsense and obvious sexism.

I reject it utterly.

"There’s one other place on the human body where this is true: The male scrotum."

And now I'm wondering just how the homology breaks down, but I'm too squeamish to actually investigate.

Martin G. @177,
My question was always how the EMTs could leave him when there was a serious question over whether or not he had TBI or was just being drunk.

Simply put, inexcusable sloppyness, perhaps (probably? I'm not sure) with some amount of racism involved.

A group of friends and I once had a longish debate over whether a certain person was a mammal or not. We decided it couldn't be proven. Birds are warmblooded, so we couldn't use that, and when someone said "He has hair", it was refuted with "Tarantulas have hair*. I'm not convinced." And since the man in question had (and still has) never fathered a child, we could not prove he was interfertile with mammals and therefore one himself.

* Yes, we all knew they don't actually. It was just for the fun of it.

Beowulf, actually.

Yes. Absolutely. But that didn't happen, which is part of the point.

I'm not a doctor, and I have never had training as a doctor. How am I supposed to know that the default human body has all parts? Is this not even a little bit related to the idea of there being bicycles, and then a subset of that are women's bicycles? (As an example of a subject I am familiar with.)

Jim said: "The default human body has all organs and structures. I might as easily (and correctly) write that the trachea and bronchial tree are lined with specialized cells covered with moving cilia. The only other place in the human body of which this is true are the fallopian tubes."

You may have easily have said that, but you didn't. How am I supposed to know that your training presupposes something that I am not able to presuppose because I have not had that training?

It is honestly outside of your realm of comprehension that it is possible for me to read that line and consider that you mean the default is male? That surprises me.

Well, I guess it doesn't. I didn't think anyone would respond, but I presumed I'd be utterly dismissed even if you did. Should I thank you for bothering to consider my remarks? Did you, at all?

And, while I'm at it, I am now much more careful when I open doors where I can't see the other side of them. Thank you for that.

If Jim had responded with "You may not have realized this, but when speaking about medical things, the default human body is assumed to have all parts," that would have explained it, and would have given me helpful information.

To dismiss my concern, which was exceedingly politely worded, accused the author of no ill will or misdeeds, and instead asked nicely for concern and consideration when choosing words, with the nastiness of it being nonsense and utter sexism, well, fuck that.

Instead of educating someone into a world that they didn't know, you instead just acted rudely. And to what end?

Your post didn't seem exceedingly polite to me, and it did seem to be accusing Jim of either ill will or a misdeed. You said that he had constructed a sentence that contained or implied the idea that the default human body is male, and you told him to choose his words carefully, which implies that he doesn't already choose his words carefully.

His response to you was a little snappish, maybe, but since he is a medical professional, and you were telling him what you thought he had done and telling him what he should do instead, that's understandable, in my opinion. If you had opened this particular door with a question, instead of an accusation, I believe you would have received a different response.

Emily WK strongly believes various bad things about Jim, so it was clear that she would find something bad in anything he'd say.

I think I'd give that a Not Proven. Emily came across as one of those finger-wagging types who append their demands with "please" to sound polite*. But some people use those constructions and mean that "please", or have picked them up without hearing the slap-in-the-face undertones that I (and Jim, apparently) react to. This may just be an unfortunate clash of prose styles; they happen on the internet.

I didn't intend my anecdote as a pile-on, by the way. It leapt to mind because it happened about three days ago now. (Context: Calvin's assertion that bats are bugs. No? Then what are they? etc.)

-----
* Whereas it's actually worse with the "please" in that position than without it at all. That's a construction I'd expect to hear from a superior giving orders to an inferior. Not appropriate in this context.

Emily WK strongly believes various bad things about Jim, so it was clear that she would find something bad in anything he'd say.

I didn't see anything in her "view all by" to indicate a previous history with Jim, or anything in what she said that could tell me definitively what her motives are. Everything you say about "people" is true, but I don't think it's necessarily wise to try to infer what kind of person someone is from a few comments. She may, in fact, not be the kind of person you're describing...but that doesn't make her comments any more polite.

Emily went into that interaction sure that Jim was wrong, and looking to tell him so. If her initial comment had been less sharp-tongued and peremptory, Jim would have explained the convention whereby the default human body has all organs and structures, and everything would have been fine.

Unfortunately, since she didn't imagine that he might be speaking precisely and in good faith, she didn't leave room for him to explain that convention of anatomical description. Instead, she said his language presumed that the human body is by default male and is only female as an anomaly.

She was wrong. It's a possible implication of his comment, but it isn't the sole possible reading, and in fact it wasn't the correct one.

I can tell you from experience that Jim reacts badly to being told he must mean or be implying [whatever], when he knows he neither meant nor implied that.