thinking about the time a professor said the phrase “it’s just like the judeo-christian concept of turning the other cheek—” to which i immediately said something like “you mean the christian concept? it doesn’t appear in judaism” and he looked at me like a startled slow loris.
I didn’t know what a slow loris was and had to look it up and
This patient isn’t usually mine, but today I’m covering for my partner in our family-practice office, so he has been slipped into my schedule.
Reading his chart, I have an ominous feeling that this visit won’t be simple.
A tall, lanky man with an air of quiet dignity, he is 88. His legs are swollen, and merely talking makes him short of breath.
He suffers from both congestive heart failure and renal failure. It’s a medical Catch-22: When one condition is treated and gets better, the other condition gets worse. His past year has been an endless cycle of medication adjustments carried out by dueling specialists and punctuated by emergency-room visits and hospitalizations.
Hemodialysis would break the medical stalemate, but my patient flatly refuses it. Given his frail health, and the discomfort and inconvenience involved, I can’t blame him.
Now his cardiologist has referred him back to us, his primary-care providers. Why send him here and not to the ER? I wonder fleetingly.
With us is his daughter, who has driven from Philadelphia, an hour away. She seems dutiful but wary, awaiting the clinical wisdom of yet another doctor.
After 30 years of practice, I know that I can’t possibly solve this man’s medical conundrum.
A cardiologist and a nephrologist haven’t been able to help him, I reflect,so how can I? I’m a family doctor, not a magician. I can send him back to the ER, and they’ll admit him to the hospital. But that will just continue the cycle… .
Still, my first instinct is to do something to improve the functioning of his heart and kidneys. I start mulling over the possibilities, knowing all the while that it’s useless to try.
Then I remember a visiting palliative-care physician’s words about caring for the fragile elderly: “We forget to ask patients what they want from their care. What are their goals?”
I pause, then look this frail, dignified man in the eye.
“What are your goals for your care?” I ask. “How can I help you?”
The patient’s desire
My intuition tells me that he, like many patients in their 80s, harbors a fund of hard-won wisdom.
He won’t ask me to fix his kidneys or his heart, I think. He’ll say something noble and poignant: “I’d like to see my great-granddaughter get married next spring,” or “Help me to live long enough so that my wife and I can celebrate our 60th wedding anniversary.”
His daughter, looking tense, also faces her father and waits.
“I would like to be able to walk without falling,” he says. “Falling is horrible.”
This catches me off guard.
That’s all?
But it makes perfect sense. With challenging medical conditions commanding his caregivers’ attention, something as simple as walking is easily overlooked.
A wonderful geriatric nurse practitioner’s words come to mind: “Our goal for younger people is to help them live long and healthy lives; our goal for older patients should be to maximize their function.”
Suddenly I feel that I may be able to help, after all.
“We can order physical therapy — and there’s no need to admit you to the hospital for that,” I suggest, unsure of how this will go over.
He smiles. His daughter sighs with relief.
“He really wants to stay at home,” she says matter-of-factly.
As new as our doctor-patient relationship is, I feel emboldened to tackle the big, unspoken question looming over us.
“I know that you’ve decided against dialysis, and I can understand your decision,” I say. “And with your heart failure getting worse, your health is unlikely to improve.”
He nods.
“We have services designed to help keep you comfortable for whatever time you have left,” I venture. “And you could stay at home.”
Again, his daughter looks relieved. And he seems … well … surprisingly fine with the plan.
I call our hospice service, arranging for a nurse to visit him later today to set up physical therapy and to begin plans to help him to stay comfortable — at home.
Back home
Although I never see him again, over the next few months I sign the order forms faxed by his hospice nurses. I speak once with his granddaughter. It’s somewhat hard on his wife to have him die at home, she says, but he’s adamant that he wants to stay there.
A faxed request for sublingual morphine (used in the terminal stages of dying) prompts me to call to check up on him.
The nurse confirms that he is near death.
I feel a twinge of misgiving: Is his family happy with the process that I set in place? Does our one brief encounter qualify me to be his primary-care provider? Should I visit them all at home?
Two days later, and two months after we first met, I fill out his death certificate.
Looking back, I reflect: He didn’t go back to the hospital, he had no more falls, and he died at home, which is what he wanted. But I wonder if his wife felt the same.
Several months later, a new name appears on my patient schedule: It’s his wife.
“My family all thought I should see you,” she explains.
She, too, is in her late 80s and frail, but independent and mentally sharp. Yes, she is grieving the loss of her husband, and she’s lost some weight. No, she isn’t depressed. Her husband died peacefully at home, and it felt like the right thing for everyone.
“He liked you,” she says.
She’s suffering from fatigue and anemia. About a year ago, a hematologist diagnosed her with myelodysplasia (a bone marrow failure, often terminal). But six months back, she stopped going for medical care.
I ask why.
“They were just doing more and more tests,” she says. “And I wasn’t getting any better.”
Now I know what to do. I look her in the eye and ask:
“What are your goals for your care, and how can I help you?”
A beautifully written account of what it is like to be a good doctor, whose only concern is: “how can I help”.
One of the greatest doctors I’ve known in my life, Marc Smaldone at Fox Chase Cancer Center, asked my mom this. And he helped her. God, did he help her. He helped all of us.
yeah bro i got drafted :/ yeah op typed me out and tagged me and everything and then left me to rot in the drafts instead of posting me. it could happen to you too stay aafe out there
So basically, Dolly the sheep was an accident. They were trying to clone sheep cells, and they ended up unintentally generating an embryo, which turned out to be viable, hence we got Dolly.
The method they used proved unsuccessful in primates, and the risk of cloning primates (and thus humans) outweighs the benefits (because there really aren’t any real benefits, scientifically speaking), so they don’t do it.
Where it’s most likely to be used is in agriculture, cloning livestock embryos.
What they use cloning for is stem cells. Cloning adult cells to create stem cells means they don’t need embryonic stem cells, which is probably the most important thing that came from cloning research in the past 25 years.
The reason it was so important was that it proved that you didn’t need an embryonic cell to clone live animals. The nucleus of an adult cell contains all the DNA you need to clone, because Dolly was cloned from an adult cell, which was previously unheard of. Now they know that adults cells can be reprogrammed back to an embryonic stage, and was a major breakthrough for stem cell research.
So basically, we don’t hear about cloning anymore because they aren’t doing anything that is so exciting it will capture the world’s interest, like Dolly did. But it was a major scientific breakthrough that is still very important.
One of my favourite cloned animals is Kurt, a Przewalski’s Horse who was cloned from the preserved samples from a horse that died in the 90’s so that he can hopefully introduce some additional genetic diversity into the Przewalski’s Horse population. Oh hey there’s actually two clones of this one horse now, the second one is Ollie who was born last year. Kurt is now about four years old. Last I checked he was at the San Diego Zoo.
We don’t tend to clone animals that are more common because we already have a very efficient machine for making sheep, it’s called sheep.
I don’t know a ton about it, but cloning is happening in domestic horses!
I went to a polocrosse (pretty much lacrosse on horses) clinic last year taught by a top Australian player, and she told us about a horse of hers that was going to be cloned.
She had this World Cup-calibre Australian Stock Horse gelding named Plucker. For non-horse folks, a “gelding” is a castrated male horse. Geldings are much more common than stallions, and stallions are also not allowed to play polocrosse in competition for safety’s sake. Plucker proved to be such a phenomenal playing horse throughout his life, though, that some folks got together and decided his line ought to be resurrected so it can be continued.
It’s not common, but it’s not unheard of. It’s just crazy expensive, which is why it’s more common in polo— “the sport of kings”. I can’t speak for any other disciplines. I’d be shocked if racing wasn’t the most pervasive, though
There is an event horse named Chili Morning who’s been cloned several times, and his clones are the first to really show promise in the competition ring!
Thank you for further confirmation that, as a general rule, if something usually isn’t done because it’s needlessly expensive and overall superfluous, you can assume horse people are doing it anyway
“we already have a very efficient machine for making sheep, it’s called sheep.”
So basically, Dolly the sheep was an accident. They were trying to clone sheep cells, and they ended up unintentally generating an embryo, which turned out to be viable, hence we got Dolly.
The method they used proved unsuccessful in primates, and the risk of cloning primates (and thus humans) outweighs the benefits (because there really aren’t any real benefits, scientifically speaking), so they don’t do it.
Where it’s most likely to be used is in agriculture, cloning livestock embryos.
What they use cloning for is stem cells. Cloning adult cells to create stem cells means they don’t need embryonic stem cells, which is probably the most important thing that came from cloning research in the past 25 years.
The reason it was so important was that it proved that you didn’t need an embryonic cell to clone live animals. The nucleus of an adult cell contains all the DNA you need to clone, because Dolly was cloned from an adult cell, which was previously unheard of. Now they know that adults cells can be reprogrammed back to an embryonic stage, and was a major breakthrough for stem cell research.
So basically, we don’t hear about cloning anymore because they aren’t doing anything that is so exciting it will capture the world’s interest, like Dolly did. But it was a major scientific breakthrough that is still very important.
One of my favourite cloned animals is Kurt, a Przewalski’s Horse who was cloned from the preserved samples from a horse that died in the 90’s so that he can hopefully introduce some additional genetic diversity into the Przewalski’s Horse population. Oh hey there’s actually two clones of this one horse now, the second one is Ollie who was born last year. Kurt is now about four years old. Last I checked he was at the San Diego Zoo.
We don’t tend to clone animals that are more common because we already have a very efficient machine for making sheep, it’s called sheep.
I don’t know a ton about it, but cloning is happening in domestic horses!
I went to a polocrosse (pretty much lacrosse on horses) clinic last year taught by a top Australian player, and she told us about a horse of hers that was going to be cloned.
She had this World Cup-calibre Australian Stock Horse gelding named Plucker. For non-horse folks, a “gelding” is a castrated male horse. Geldings are much more common than stallions, and stallions are also not allowed to play polocrosse in competition for safety’s sake. Plucker proved to be such a phenomenal playing horse throughout his life, though, that some folks got together and decided his line ought to be resurrected so it can be continued.
It’s not common, but it’s not unheard of. It’s just crazy expensive, which is why it’s more common in polo— “the sport of kings”. I can’t speak for any other disciplines. I’d be shocked if racing wasn’t the most pervasive, though
There is an event horse named Chili Morning who’s been cloned several times, and his clones are the first to really show promise in the competition ring!
Thank you for further confirmation that, as a general rule, if something usually isn’t done because it’s needlessly expensive and overall superfluous, you can assume horse people are doing it anyway
“we already have a very efficient machine for making sheep, it’s called sheep.”
You order a package off Amazon. When the Amazon delivery guy shows up to your door, instead of giving you the package you bought, he beats the shit out of you. Then, when he sees that you are not dead yet, he calls all of the Amazon delivery people in the area and they all proceed to beat the shit out of you. Miraculously, you survive. Another miracle: a friend in your neighborhood caught the assault on video. After a month of recovery and extensive hospital bills that you have no idea what to do with, the video has gone viral. You read the comments below. “This is what happens to people who fuck with Amazon!!!” Someone says. “I’ve never been beaten up by Amazon employees, and I’ve been using them all my life!” Someone else comments. Later, you start to see articles popping up about your story. They all mention that when you were 17, your license was revoked for reckless driving. In a Facebook post on your mom’s feed, someone is going on a rant about how not all Amazon delivery guys are bad, and that if you look really close, the “bad” ones are just stressed out. Your name is trending on Twitter. Jeff Bezos films a response to your attack, denouncing the video of you getting beaten to within an inch of your life by his employees as becoming “a symbol of hate towards Amazon.” The people who attacked you still deliver packages around your neighborhood. You saw one of them just yesterday as you were watering your plants. You still can’t pay your hospital bills. Your phone dings- Twitter again. “Maybe if you didn’t order from Amazon,” someone pipes up, “this wouldn’t have happened!”
Can we please just acknowledge the sheer absurdity the “Kuzon’s Parents” disguise scene:
Deadass Katara just stuffed her shirt with melons, did nothing else to even pretend that she was older than 14, Sokka put on what was probably an incredibly fake-looking beard and pulled the most shakespearean accent he could muster.
They just saunter on in with their son who looks literally nothing like either of them, but also almost the exact same age. The headmaster probably just thinks “Fuck it. Okay. Benefit of the doubt. I’m not particularly well-versed in the ethnicities of the colonies maybe this is just normal. Adoption maybe? Good skin care?”
And then when he asks their names, Sokka just comes out guns blazing with surnames- which is implied (but not confirmed) to be sort of nobility status. And not only is their cover story that they have surnames in the first place, but that their name is Fire. Wang Fire and Sapphire Fire.
Can you imagine just being a Canadian school principal meeting a student’s parents for the first time and you just see these rogue teenagers showing up saying “Hello yes my name is Sir Jason Toronto and this is my wife Poutine.”
I need to start NFL-posting on here so that you nerds can get caught up on all the stupid-ass jokes I can’t reference because none of you watch american football. You guys don’t even know about god peed that one doesn’t even require context
I’ll remember this every so often and chuckle to myself
I’ll remember this
every so often and
chuckle to myself
Beep boop! I look for accidental haiku posts. Sometimes I mess up.
my friend took in a stray and she’s the cutest kitty ever but he named her oil so whenever he sends a picture of her me and my other friends look like we’re roleplaying as the US military
Can you tell I like computers? Can you tell I’m autistic? I hope so!
Welcome back fuckers to this tumbly tumble dryer I claimed as my own. Today’s garbage fire wonders if there’s a difference between a tumble dryer and a normal dryer.
So a couple weeks ago, after putting an extra 4GB of sketchy eBay RAM into it, my 2007 no-name custom-ish PC I got for $6.25 from the thrift store was ready to exist a little better than 1GB of RAM. Because my autism desires stupid bullshit, I decided I must try to use it online. One problems, however: I haven’t any ethernet to my room because I’m a bitch. Now, I could solve this with a USB WiFi adapter, but the computer hates it and refuses.
Instead of doing the sensible thing and giving up, I decided it needed to get stupider. I present to you: stupid computer shenanigans.
What you are witnessing is a short ethernet cable connecting the PC to a 2013 Dell business laptop to steal its internet for its own personal gain.
And it works!
They always say that, “if it works, it isn’t stupid,” but this is still stupid.
It was such a pain to get working. It’s almost as if computers don’t usually steal WiFi from a laptop running a different Windows version. It took quite a while of trying to setup networks on the PC and allowing it to take WiFi on the laptop. But, eventually, it connected.
Firefox no longer works with Windows 7, but thankfully I have an old version of Firefox from 2022 laying around and it works.
The experience was… not fast. It’s almost like it’s siphoning internet from a laptop through garbage nonsense and trying to render it with a Core 2 Duo and 5GB of DDR2-800 RAM. But hey, it worked! It was stupid, but it worked! Surprisingly, it wasn’t the worst online experience I’ve ever had. Have you tried to use the internet on a 2DS or Wii U? No, of course you haven’t! And if you have, shut up.
“you’re an adult, you can’t get in trouble with other adults” < person who has never interacted with a cop, psychiatrist or landlord once in their life
Isn’t ssooo crazy that the ‘defender of women’s rights’ constantly attaches and harasses women who aren’t hyper feminine looking all the time or who otherwise don’t fit in to the gender binary
online fandom is so fun because we’ll be talking about very serious character moments and analyzing them and stuff and there will be a lull in the discussion and someone will be like “and then they fuck about it” and then we’re all like yeah and then they fuck about it
Silly silly question but could I please have some encouragement? I've deleted ChatGPT and Shein and now I'm working on weaning myself off Temu and CharacterAI.
