'It Was the First Time I Cried in the Operating Room'
spiegel.de
spiegel.de
I’m amazed not only by how bright and dedicated he is (he gave me his personal cell while I was working with his data), but by the enthusiasm and optimism he displays while working with children with horribly aggressive cancers.
These people are true heroes.
Not just catholic saints, people that contributed to establishing them and such.
“Arguably Australia's most famous soldier is neither a general nor a Victoria Cross recipient, but a stretcher bearer who served briefly in the nation's first major campaign”
Yeah, I don't think I could take a (software) job where screwing up meant people die (or are even very seriously inconvenienced - e.g: airline booking systems), I don't want that responsibility on my head.
My props to the people who do the countless jobs where messing up means terrible things (in and out of software), and not just lost revenue and 'downtime'.
I should probably do a write-up on how this worked, it was a pretty creative solution to a very hard problem and as far as I know it never failed to work in production. The machines are still in use in some places after all these years, never ceases to amaze me how long lived some of those projects were. Atari ST as the hardware, software in a combination of GFA basic and 68K assembler, just about every port on it used to drive some output or read a sensor.
Testing it was a long and labor intensive process with a first stage in simulation, then a second stage on a machine with all motors powered off except for the servos, then a run in 'air' but with a turning spindle and finally two real runs, one in aluminum and one in steel.
The electronics were tested separately, we found that one of the early mobile phones (ATF-3) was really good at getting latches to trip that shouldn't trip.
I learned a lot on that job, but it wasn't fun to work with the guy that ran that company, I wrote about this here:
https://jacquesmattheij.com/the-start-up-from-hell
Apologies for the missing images, I still have to do some re-routing of my old gallery.
That's very reasonable :-)
I've worked on very safety-critical systems before. It's fun!
For one thing, you get to do things right. Sure, there are deadlines, but nobody dares to tell you to leave things half-baked. If it takes time, then it take time. Shoo, manager.
For another, you must dive deep into the behaviour of your embedded (mechanical/electrical/software) system and understand all its corner cases, even in the face of faults ("OK, so we're doing this operation, and now a cosmic ray hits and a crucial bit flips in RAM -- do we have a detection and safe reaction?")
Apart from the fun-ness, realise you're not in it alone. You'll be supported by a bunch of your fellow engineers double-checking your work, testing the system, etc., so your confidence in the system is quite high.
I like it.
Did that scare you at the time, or was it immediately clear it was the good kind of creative?
It's this kind of subtle interaction between hardware and software where it is super easy to make a stupid mistake and to end up regretting it the rest of your life. Making sure that machine stayed off when it had to was super important, some of those servos were the size of buckets and would happily rip your arm off when powered up, the chuck on the largest machine that we did was 6 meters, to cut wheels for harbor cranes. Really nothing to fuck up with.
I'd be very interested in hearing more about this! I've recently re-designed the safety system for my company's product, and I chose to keep it purely hardware based (using safety relays) rather than involving any software, purely because it's so much harder to guarantee that software will be failsafe.
And all of those will have a software component.
I've written a bit more about how it worked in another comment.
The big thing to keep in mind here is that an ST is a very limited machine when it comes to IO and that just about every port was already occupied so I somehow had to make this work safely without having additional ports for e-stop i/o in the budget.
If I had to do it again in the present I would never have consented to using such an I/O hamstrung platform to begin with and I would use an FPGA to do all the control logic.
Here’s an excerpted chapter: http://lithub.com/aneurysm/
0.05% per year chance for a person that is 32 years old leaves 50*0.05 = 2.5% chance of rupture during the remaining life of the patient, whereas the operation itself has a 5% chance of failure.
It's reminiscent of the downside of scanning for just about everything in patients without symptoms.
Now you’re talking about a possible 1% difference and the negative affect on someone’s life from the anxiety of knowing they have an aneurysm. I also wonder if the operation is less risky with a younger patient. While it may have been better to never have known you have an aneurysm, once you do know the decision isn’t obvious to me.
He did offer his opinion for himself, but being older changes the equation. In her case she did have initial symptoms that lead to the scan, but they were likely unrelated.
Paternalistic medicine isn’t really a thing anymore so on these edge cases I think it makes sense to discuss the risks with the patient (which is what was discussed at the beginning of the story).
A bit of googling will give you lots of articles on the subject, the same kind of evidence exists for prostate and other cancer screenings as well as other diseases.
It’s a detailed history of cancer and spends some time talking in detail about how statistics determine at what age preventative testing makes sense given false positive risk.
The surgeon had to do the math with her, instead of wondering, whether she understood the risks or not.
Unfortunately, many people are illiterate with numbers, so you cannot assume that in that person's head numbers like 5% and 0.05% do not both translate to "negligibly small".
In any case, I really don't miss it. Some of my days were so insane that I realized at some point that I seemed to be subconsciously wiping my memory of it at the end of the day. Even as a founder trying to launch a startup, my craziest days paled in comparison.
Not saying my experience is anything like separating a conjoined twins or dealing with pediatric cancer, but just that I can relate to your thankfulness of having a job that's not that intense, by any measure.
I wouldn't live there if you payed me, and certainly never with a family.
Side note, did you hear about the cop who was going to testify against the PD and ended up dead? The PD there is corrupt as fuck.
http://www.baltimoresun.com/news/maryland/crime/bs-md-ci-gtt...
Among other things, they would carry BB guns to plant if they happened to shoot someone.
Video Appears to Show Baltimore Police Officer Planting Drugs
https://nytimes.com/2017/07/19/us/baltimore-police-video-dru...
> The fabricating-evidence charge is a misdemeanor, which carries a maximum penalty of three years’ imprisonment and a $5,000 fine. Misconduct in office is a common-law offense, which means that the court is free to impose any penalty that does not constitute cruel and unusual punishment.
> Prosecutors said the video prompted them to drop more than 110 cases involving the three officers in the video from Pinheiro’s camera.
That's 110 people who either were innocent and terrorized by the police, or were guilty and escaped justice due to police incompetency. Either way, not a good look.
Prosecutor in this case the same State's Attorney Mosby who tried (and failed miserably) the Freddie Gray manslaughter/murder case.
To play devil's advocate: If you're going to reason that way, you should also consider the number of actual criminals who were punished only because of planted evidence.
I'm not advocating corruption - I still think it probably warrants the death penalty due to its cancerous and widespread impact on innocent people.
We shouldn't have to revisit that decision on the merits just because some police officer who disagrees with it unilaterally breached the social contract. We should just punish him. Severely.
It sounds like you're suggesting that ethical reasoning done by previous generations is somehow binding on future debates, almost like some form of case law.
> As a society, we've already chosen that we'd rather see a perpetrator walk free than imprisoned without proper evidence.
I wonder if you're failing to make a distinction between what people will say in public vs. their private thoughts on the matter.
He's a much stronger man than I. I wouldn't have lasted a week.
To me, the more interesting moral aspect of this is that a surgeon who hadn’t done this before accepted the case because it would be interesting and challenging. I’m only paraphrasing a little; that was basically his description of it in the article.
I had a surgery in my hips which the doctor said the same, he wanted to do the surgery to improve his research and even asked me to use my files, anonymously obviously, in his presentations and research.
I think we all are interested in our work, and he said that every case is different, I'm not sure if experience would help much.
I do wonder how much effort it took in total to prepare this procedure. CT, MRT, research, rapid prototyping of bones and other structures for analysis and practice runs... it seems they used all the tools they could.
A real trolley problem would involve three conjoined twins, of which one has a good chance to outlive his siblings, yet an intervention exists that can save both of them by depriving him of critical organs.
https://en.wikipedia.org/wiki/Principle_of_double_effect
http://www.catholicculture.org/culture/library/dictionary/in...
The ethical anguish there was compounded by making the patients old enough to tell the surgeons that they would rather sacrifice their own life to save their sister, than to be the sole survivor--who would then live only because her sister and lifelong constant companion is dead. The scriptwriters also stirred the pot by putting one in a coma to remove the possibility of explicit consent.
At the time, it stretched my suspension of disbelief.