Free Flight, Free Speech

Dear FlightGear Colleagues,

I am distressed, almost beyond words, at the shootings in Alexandria, Virginia, in which, among other, Congressman Steve Scalise was critically injured. The press is reporting the shooter, identified as James Hodgkinson, who has died of his injuries after police returned fire, was an self-avowed Progressive, had volunteered in the presidential campaign of Bernie Sanders, and apparently was an active blogger who frequently railed against both President Trump and the Republican-majority congress. Although, at this time, the reporting does not say his actions were politically motivated, it is very likely in my opinion, that for some reason, his political beliefs played some part. This is a tragedy all the way around!

I want you all to know that as a Democrat and Progressive that I absolutely deplore this violence against Rep. Scalise and the others and stand with President Trump, Speaker of the House Paul Ryan, and Minority Leader Pelosi in their statements condemning the actions of the shooter and that it does not represent, in any way, the sentiments of myself or those of the vast majority of Progressives. That will be borne out in the statements from Progressive-leaning organizations around the country all declaring that there is no justification for this act of violence.

What the shooter did is not how we Americans properly and patriotically address our political disagreements. That is what the ballot box, freedom of speech, and the unfettered ability to contact our elected representatives to express our opinions is for. In my lifetime, I have seen the awful impact on our country as a result of the assassination of President Kennedy, and the attempted assassinations of Presidents Ford and Reagan, as well as numerous members of congress, the most recent I recall being Rep. Gabrielle Giffords (a Democrat) and now Rep. Steve Scalise (a Republican). These acts, even when politically motivated, can never be justified, and are an aberration that cannot be condoned under any circumstance.

That is my statement. I do not make it to start an argument or debate here on the forum, but as a Progressive Democrat to express my horror at what has happened.

SkyBoat

Hoping for prompt recovery to those injured

Dear FlightGear Colleagues,

This evening, among all the shooting victims, I remain very concerned about the condition of particularly Rep. Steve Scalise. Having worked in a trauma center for nineteen years, I have seen more shooting victims than I can count (including the Springfield, Oregon Thurston High School shooting in May 1998).

As the hospital has released information to the media, the report on Rep. Scalise is very concerning. Rifle bullets, shattering bone internally and bouncing around inside the body interior is a worst case scenario. Not only does the round damage internal organs and blood vessels, but bone fragments become tiny spears flying in all directions through the tissue causing even more damage. I've been told by trauma surgeons that the bullet, depending on its manufacture design, can spin or tumble through multiple organs before finally coming to a stop. Fortunately, the report is that Rep. Scalise is still medically stable, but there is also the announcement he faces additional surgeries.

In this kind of situation, trauma surgeons work on a principle of priorities of what needs to be operated on first just to save the person's life and allow the patient to stabilize for a number of hours (or days, depending on the situation) and then they do the next most critical surgery on the list. A bullet that has passed through several organs can do an enormous amount of damage. To be blunt, if it had nicked or pierced the congressman's aorta, he would have bled out so quickly that as the scenario has been described, he likely would have died out there on the ball field. In some respects it is a miracle he didn't anyway.

So, I am holding all the victims in my thoughts and prayers, but especially Steve Scalise. He is far from being out of the woods yet to survive this horrific attack.

See my next post on how to understand "medical condition states" and the use of the term "stable".

SkyBoat

Dear FlightGear Colleagues,

If you have been following the news about the shootings in Alexandria, Virginia, (later the other shooting in San Francisco, or even the London apartment building fire) you have heard reporters trying to discuss the medical condition of the victims. From what I have seen and read, the media is not doing a very good job of being consistent in describing the information that is being released by the hospitals.

So, since I have extensive hospital trauma experience, I thought I'd give you a quick primer of what "medical condition states" are, so you will be better informed than most of the reporters.

The medical condition of every patient in the United States (and most western countries that I have heard about) is a standardized list, and actually can be found on this Wikipedia page: https://en.wikipedia.org/wiki/Medical_state. If you have a friend who is a reporter, kindly and gently give him or her this link.

Here are the states (i.e. category of a set of parameters defining the person's medical situation)

1. Critical. This is the most important one for our purposes. It means that the patient has an injury or illness so acute that they cannot maintain their own life support without assistance. This includes the use of a respirator for breathing, devices that control heart function, and specific medications that assist the body with just staying alive all of which requires (ideally) an Intensive Care Unit. The goal of the use of these methods is to get the patient well enough (i.e. healed enough) that they can be withdrawn and the person can live without their supportive functions.
2. Serious. Once a patient can essentially maintain their own body's systems, while still needing certain medications or auxiliary devices to assist the healing process, then they can be "upgraded" to Serious condition.
3. Fair. Fair condition can be a person who is still very ill, or whose expected condition (the prognosis) may have to be "downgraded" to serious if the treatment does not work as hoped. Of course, a person who has been in Serious condition and is upgraded to Fair is generally an indication the individual is getting better but not yet ready to be discharged. In many modern hospitals there is what is called an Intermediate Care Unit. This is for patients who generally are recovering from Critical or Serious status and do not need the full services of an Intensive Care Unit but are not well enough yet to be transferred to a medical unit.
4. Good. A patient who is in good condition is responding well to the treatment, is generally in no danger of a more serious state (although in the event of something like a cardiac event or a stroke, this situation can change from Good to Critical in the matter of a few moments), and is likely well on the way to being discharged.
5. Undetermined. How can a patient be in an undetermined state? I've actually seen a few rare cases where that was the situation. In one instance the patient had had a neurological event and though seemingly medically stable (I'll talk about this misused term below), could not communicate with the outside world by any means. This was eventually diagnosed as "Locked-In Syndrome" in which all ability to control the voluntary muscles of the body is suddenly broken. It turned out to be a rare kind of spinal cord injury. Since the patient had conflicting symptoms and vitals, the individual was classified as "Undetermined" until one very smart neurologist figured it out.
6. Dead. Well, you probably guessed it had to be in the list somewhere. Dead is an official medical state when all bodily functions cease and the individual does not respond to any form of acute treatment.

So, when hospitals issue a statement about the condition of a patient, they are required by Federal Law to use one of these standardized words. They can also, with the permission of the patient or the family, issue more details about what is going on with the patient in that condition. This is based on HIPAA (Health Insurance Portability and Accountability Act) regulations; that is the reason you have to sign a HIPAA consent form when you are admitted to the hospital and once a year for your primary care provider.

Stable: A patient's condition can be stable or unstable and it can be applied to each of the states above (except Death, of course, though in the case of "The Princess Bride" one can be "mostly dead"). Generally speaking a patient who is in critical condition and stable is responding to the life support and course of treatment in a positive way and their condition is not dropping below the parameters set (deteriorating). Being in critical condition and Unstable is not a good situation, because it almost always means the body is not able to keep up with the applied life support, and there are upper limits to those when more is simply not enough to stop the person from dying. That is, of course, the most emotionally difficult scenario anyone can face. I had to (with my brother and sister) make that decision in 2012 with our mother. At that point being medically informed was both a blessing and a curse.

The important thing to know is that "Stable" is not a substitute for "Critical" or any of the other states. It is a description of how well the patient is keeping within the parameters set that are design to facilitate the healing process. In most cases, the longer a patient is stable in a given medical state, is an indication they are getting better.

Now you are better informed than any reporter I have heard or read today regarding the situation with those shot in Alexandria. And like I said, my ability to understand the statement the hospital issued about Rep. Scalise is deeply concerning to me.

Skyboat

Well, as a rather conservative character, someone who deals with a lot of twisted minds (and with some experience in being shot at), I have of course my own take on this. Just in a few points:

1.) when someone shoots you (or otherwise attacks with lethal weapons), it is a life-changing experience. You can be lucky and the physical injuries heal completely, even, often the physical healing also goes so and so far. The mental damage, one takes, never heals, it just changes people. And it is not just that life appears afterwards more intensive as some novel writers describe (but yes, it does on some days). On other days, you get quite suspicious about someone standing at the next corner or a car parked on the other side of the street. There is something in you, that doesn't allow you to just go out and live without looking over your shoulder after that, ever. So, the "survivors" will still have some hard times ahead, far beyond hospital treatment.

2.) Call me an old-fashioned kind of jar-head or what other derogative terms are around for people like me, but personally, I think, going with a firearm for someone unarmed (or as it is politically correct labeled, a "Civilian target") is almost the most cowardly thing for me to imagine (bombers are even lower on the ladder, but then, the air goes really thin there). This kind of attack was born out of a quite twisted perception of reality, a perception that was so strong in the perpetrator's mind that any ethical considerations had been out of the picture. Basically the mindset of any other of those infamous shooters like Loughner, Lanza, Thornton, ... just to name some.
Now, to make the underlying point clear here: We talk with those shooters and without exception, about the mental condition, not the political. We live in a world of big words. Politicians, activists and all kind of opinion-makers (yes, speaking media) use harsh terms and heat up hate and willingness to violence. It's nothing new. Those demagogues spill their big and violent words and then deny all responsibility if someone who is honestly a beer short of a six-pack takes them for real, as a working instruction. It is inevitable because there are always a few around, who have the mindset for it and just need a reckless agitator to incite them. Which makes the question, whether there should be laws to make such agitators responsible a quite interesting one. In my opinion. By all means, Charles Manson got locked away for life for a reason.

On a personal side note: While we had over the last decades mostly violent attackers from the left side of the spectrum, it had already been the other way around at other times. The point is, those people are always inspired by the extreme. This has not much to do with the mainstreams (except maybe for the not so smart use of words sometimes). A liberal and progressive like SkyBoat will not get a gun and go out and shoot conservatives and a conservative like me (who, funny thing, actually believes in the freedom of the individual, which is the base of "liberalism" before the word was hijacked) won't go out and shoot liberals. More than 99% of all people would not do that, regardless where they stand politically. The problem is, again, always the extreme outside of the spectrum. So maybe we should start to clean up our respective sides and get some of the louder and violence-inspiring figureheads on the leash?