makinglight

http://nielsenhayden.com/makinglight/archives/010240.html

I've been meaning to write a post about Strokes and Head Injuries (sometime after the long-delayed Trauma And You, Part IV), and this isn't going to be it. It'll just be a few quick notes.

You have two basic causes for strokes. One is an occlusive stroke: A blood clot gets loose and blocks an artery in the brain. This is very similar to a heart attack, where a blood clot gets loose and blocks a coronary artery (or a pulmonary embolism, where a blood clot breaks loose and blocks one of the pulmonary arteries). The other is a hemorrhagic stroke, where a blood vessel bursts, causing bleeding into the brain, your classic apoplexy. This is similar (in some ways) to a ruptured aortic aneurysm.

When you have someone come down with signs and symptoms of stroke (and these vary depending on how big the stroke is and what part of the brain is affected), you have three hours from the time of onset of symptoms to the start of therapy if you're going to treat it with anything other than time.

So.

Here are the rock-bottom symptoms of stroke: Sudden onset weakness, particularly one-sided. Facial droop, particularly one-sided. Slurred speech, or aphasia, or suddenly using inappropriate words. Blurred vision, particularly one-sided. "The worst headache of my life."

What to do: Do not waste time. You don't have it. Note down the exact time the symptoms started. Call your friends from 9-1-1.

I'm sure you've seen those e-mails about How To Tell if Someone Is Having a Stroke. The three tests (arm drift, smile, repeat a phrase). That's called the Cincinnati Stroke Scale, and while it's a wonderful tool, and we use it ourselves, it isn't diagnostic (and lots of things that have stroke-like symptoms, that aren't strokes, are plenty serious all on their own).

What happens when the nice EMTs take the person away:

1) We give him oxygen, and establish an IV. We ask him (or you) all kinds of questions about his medical history, allergies, medications, and particularly what time it started. The clock is running.

2) Once at the ED, the emergency physician will order a no-contrast MRI, and at the same time run down the checklist for why not to give thrombolytics. This checklist is about three pages long ("Any recent surgeries? Any recent tooth extractions?") where any "yes" means the thrombolytic path is closed. The first item on the list is "Has it been more than three hours since the first symptoms?" If yes ... well. Make the patient comfortable and see how things go.

Now that MRI: The brain scan has to be normal. In the early stages of an occlusive stroke, there are no visible changes. Free blood in the brain shows up as a lighter area, and bleeding in the brain means we don't want to break up any clots. Dead tissue shows up as a darker area, and if the tissue has already died, well, no point in going on. Or you could see a tumor, and thrombolytics won't help with that.

3) If the MRI comes back normal, and the patient said "No" to all the questions on the checklist, then comes the big question: "This therapy could kill you. Do you want to go ahead with it?" Being put on thrombolytics is essentially the same as getting an instant case of hemophilia. If you can't answer the question because you can't talk (or can't hear or can't read), because of the stroke, better hope you have a Living Will that spells out what you want done, or have someone with a Power of Attorney for Healthcare standing by to answer for you.

4) If you say, "Yes" to going forward ... the first drops of thrombolytic have to hit your veins inside that three-hour window. That's why helicopters get involved. To get you to an MRI machine, to get you to a center where they have the guys who've done this more than once a year. Then, you have about a 70% chance of getting All Better.

Of course, if you have a hemorrhagic stroke, what you need is a neurosurgeon to tie off the bleeder and relieve pressure in your skull. Different ball game.

Then there are TIAs--Transient Ischemic Attacks. These are so-called "mini-strokes." The difference between them and a full-bore stroke is that the TIAs spontaneously resolve within twenty-four hours. Don't ignore them for that reason: They're a red flag that a major stroke will hit (60% chance) within twelve months.

So what I think is going on with Kennedy: The helicopter was to get him to a good MRI and a major hospital within that three-hour window. The fact that he's calling people on the phone and talking to them means that he's (probably) sitting somewhere watching thrombolytics drip into his veins, bored out of his gourd. Chance of recovery? About 70%.

For all of y'all: If you, or someone around you, have stroke-like symptoms, Don't Screw Around. Call 9-1-1.

As always, I am not a physician. I can neither diagnose nor prescribe. This post is presented for amusement purposes only, and is not medical advice for your particular situation or condition.

tobias_buckell

While doing some administrivia I started up the Brit horror movie The Descent. Plugged in my headphones and let it run in my office, thinking it would be descent grade B+ horror I could listen in on and multitask with. I was quite surprised to find myself enjoying it quite a bit, so I full screened and let it rip.

Some single sentence impressions to pitch the movie:

1) Modern day adventurers descend into a caving system, find modern day gollums, but horror styled (and who don’t get all Serkis on you) ones who eat you. Shenanigans ensue.

2) Deliverance, but with gollums in caves who eat you instead of weird rednecks. Either way, if there’s one thing we’ve learned from Hollywood, it’s be scared of vacationing in the South (Deathproof, Descent, Deliverance, etc).

3) Actress Natalie Mendoza gets covered in blood and kicks gollum ass with climbing pitons (in all honesty, if I dig deep, probably the shallow reason I Netflixed the movie).

So some spoilers.

Mendoza’s character (Juno), as is hinted very strongly in the first ten minutes, was having an affair with MacDonald’s (Sarah) character’s husband, who then dies in a horrible accident (along with their daughter). Juno isn’t much help with a grieving Sarah, so this caving expedition (to a new cave no one has mapped out) with a large group of friends, is sort of her way of trying to set things right. She seems to be someone who struggles to face how to handle these things, and chooses action and activity (is the first one up in the morning to run, constantly full of energy) as if she keeps moving emotional things won’t catch up. It’s her decision to mislead the group into the caves, where she explains it was her idea to find something new that they could name. She pitches it as something she’s doing for Sarah, but angry, they point out she’s a bit egotistical, and it could well be that she wants some glory.

So they get trapped in the cave system thanks to a plot-convenient cave-in and these gollum things start attacking them. They all scatter in panic, and Juno gets all ass-kickery on the damn things, using a climbing piton to good effect. Her physical-based character and reactions are again defining the character.

Then her damn friend Beth comes running up behind her at the tail end of the melee. Having been jumped out of the dark by X number of gollums, Juno spins and thrusts, sadly, spiking Beth through the throat.

You know what, that’s understandable. If a bunch of pasty, big-eared, flesh-eating gollum type things jumped my ass, and I’d had to fight for my life with a climbing spike, and someone tapped me on the shoulder at the end of that, I’d frigging spike them the throat too.

I mean, who the hell is going to walk up to someone who’s just split the skull of a freaky creature of the dark and spook them? I mean, it’s bad enough when you do it in real life when someone’s just trying to get something out of the fridge and they jump up in the air like a startled cat. What do you think’s going to happen when you bust out of a shadow in this situation? Yeah, that’s right, your ass is going to get run through the throat. I guaran-frigging-tee it.

Juno’s pretty freaked out, Beth gargles a lot and drops, but not before stealing her necklace. Juno takes off. Everyone runs around a lot, and one by one they’re all picked off, as happens in movies like this. I jumped a few times, some good little scares.

Sarah, meanwhile, goes from post-traumatic former soccer mom type to blood covered gollum-killer, using bones as weapons (she’s ready to take on the apes from 2001, but she screams louder). But in her meanderings, she stumbles across poor blood gargling Beth, who tells her Juno spiked her, and by the way, Juno’s necklace is obviously a gift from her dead husband. They must have boinking each other.

So Sarah’s having an all-around bad day.

Eventually, it’s just Sarah and Juno together. Juno hasn’t exactly been forthcoming with the fact that she accidentally killed a good friend of theirs, she tells Sarah a sort of ‘Beth died… you know… back there.’ They both face a long journey ahead of them to try and find the surface, with many more gollums along the way. So Sarah piths Juno in the leg and heads off down a tunnel.

Now, to be fair to Sarah, she just found out that Juno was screwing her husband, so this is sort of a crime of passion. But on the other hand, Sarah keeps hallucinating seeing her dead kid, she’s screaming like a pyscho all the time, and something tells me she’s not quite level in the head. Why? Because Sarah doesn’t escape, she slides down the end of the tunnel, and in the end, is seen sitting on a ledge near a small fire imagining she can see her dead kid as the gollums scream and, presumably, draw nearer.

Although the movie was a fun ride, I kind felt left with a weird taste.

For one thing, do horror movies hate women? They all die. The ostensible heroine just ends up batshit crazy at the end, killing a potential ally against the gollums and then not even seeking a way out.

A couple days ago I saw another horror movie where a woman is chased and scared through a whole movie, and then ends up captured at the very end. Usually the motif is that the woman runs scared all through the movie, until the very, very last moment, where she either comes up with a bit of a trick/subterfuge to kill the bad guy, or finds herself a capable man. I remember watching the last one, where the bad guy is getting ready to run the woman over while she’s sitting next to a copy who has a gun. Said chick never goes for the gun until fifteen minutes later, when the cop friggin’ tells her too (and she protests, oh no, I can’t do that, I can’t shoot the gun. So help me, anyone dumb enough to say that just needs run over quick anyway, there’s just no survival sense. Most woman I know would have grabbed the gun within seconds ‘how do I use this frigging thing, dying cop, and tell my quickly.’). Plus, the bad guy is always male.

As a result, the fact that both strong women in Descent dies (and as a result of bad feelings over a man, see, the long arm of the patriarchy extends even to the dark depths of a cave), sort of disappointed me. I mean, come on, Maslow’s hierarchy of needs?

Sarah could have waited until they got to safety and then stabbed Juno’s leg and shoved her back down the pit. That would have been good.

And then there’s the other obvious element, Juno being the antagonist, a bit of a stretch, okay, fair enough, but she’s also the only non lily-white chick in the group.

So, okay, it’s still enjoyable for what it is. Some will complain about the above paragraph, or the sort of freshman level feminist critique, because they’ll say I’m taking the fun out of the movie by being over sensitive. I’m not a sensitive dude, it usually takes a bat or lots of repetition for me to notice this stuff. And I’m not condemning the movie at all. The movie is still well written. If so many horror movies I saw didn’t struggle with women not being strong enough to defend themselves, and if minorities in general were cast or played with as heros more often, then this movie would not suffer from that repeated circumstance.

It’s like the magical negro. There’s nothing wrong with The Legend of Baggar Vance, The Stand, or the Green Mile, when each minority character is a guide of wisdom to the white characters. But when you keep seeing that over and over again it lessens those movies somewhat, because it’s a cheap template. And likewise, Descent reuses the same template and doesn’t rise above it.

Still a well written movie, but so well written that I started to expect a bit more. By itself, a great movie. Viewed against others, I had that taste in my mouth I mentioned earlier.

How do you beat something like that?

Well, one simple way is in the movie Death Proof, by Quentin Tarantino. I have a nascent sort of critique of it, which is that Death Trap, in one small way, can be argued to be a feminist critique of the traditional horror chick chase movie.

Before I embarrass myself with this theory, I’ll state that I know I risk sounding like Jane on the TV series coupling when she walks into Jeff’s apartment and sees a poster of ‘Attack of the 50 Foot Woman’ and says “oh, you like feminist cinema! I do too!”

So here we go. In Death Trap, for the first 1/2 of the film, maybe slightly less, a group of woman cavorts, hangs out, and chills. Because the movie has spent so long building up their characters people expect that maybe these characters will be the ones that go on through to the end… oh, no, Stuntman Mike, the bad guy, runs into their car with his ‘Death Proof’ stunt car and kills them all.

The movie sort of resets: again, a group of gals gets together for some fun in Tennessee, they go to test drive a car, and Stuntman Mike shows up in a new DeathProofed car and starts ramming them (overlay some Freudian fun here. In fact, I really wish this film had been out in college when I was doing critical theory).

Now, in classic horror movie template, these woman would be victimized by Stuntman Mike until the last few minutes, where by some trick, last minute act of desperation, or by finding a man, they, or at least one of them, would survive.

But no, after one initial round of getting rammed by this crazy psycho and forced off the road, Kim (played by Tracie Thomas) pulls a gun on Stuntman Mike and f*&king shoots him.

At this point, the departure from a traditional horror flick becomes quite interesting. Stuntman Mike screams like a little girl, shocked that his victims are fighting back. He takes off in his car.

The women confer with each other and decided to hunt him down, grabbing a large piece of pipe and taking off after him. Mike, who’s pulled over and is freaking out, has lost all power, authority, and control of the situation. The male-power fantasy and domination of these woman has been stripped away, revealing a sad person, not a menacing faceless evil.

They ram his car and bash him with the pipe, and then he’s the one on the run as they start bashing his car (with Kim shouting ‘take it up the ass motherf&*ker’ with each bash, for more Freudian filtering fun). The woman have flipped it over, are in complete control, and they catch up to this guy, pull him from his car, and bootstomp his face into the pavement.

Okay, it’s not feminist cinema, Tarantino has stocked the film with beautiful women in tight clothes, and lets the camera do the male point of view thing all throughout. However, he’s subverted some of the unthinking layers in an interesting way when the women regain power in a dramatic way.

Tarantino also mixes up ethnicities. He has (gasp) two black women. Jungle Julia dies in the first crash, in the second, Kim is the one with the piece that shoots back. Rosario Dawson is Latina. Zoe Belle is Aussie. By having a range of people, Tarantino doesn’t have to act like he’s on eggshells, because viewers aren’t as likely to interpret the actions of any single minority as a stand in for all. If you have some variation you can get on with multiple characterizations and not stumble into as many pits.

Had the Descent included a bit more of that sort of subversion, I think it may have transcended my B+ rating and into something higher.

All in all, though, still not a bad 2 hours.

Originally published at Tobias Buckell Online. You can comment here or there.

makinglight

http://nielsenhayden.com/makinglight/archives/010237.html

• All sorts of neat visual ideas in this collection of modern typography. Look: slab-serif Avant-Garde! And what’d these people do to piss Teresa off? (via Kottke)


• How food portion sizes have changed over the past twenty years, also via Kottke. I noticed a decade or more ago that my capacity for pizza had seemed to have diminished since my teenaged years; I see here that it may be because pizza slices have grown. I know bagels have grown, too, but the examples in the article ping my shenaniganometer. For one thing, the two images are obviously the same (probably stock) photo scaled to different sizes. For another, they claim that bagels the bagels of my youth were a measly three inches in diameter. No way, unless your standard is those crappy frozen things from Lender’s.


• I’d heard of Colonel Blimp, but never actually seen any of the original cartoons, until now. (via ¡Journalista!)


• Joel Priddy wonders what Wolverine comics would have been like in the ’50s. Also, the labels on these homemade bottles of flavored liquers Priddy and his wife gave out a couple years back look like they go pretty well with those beers Patrick just linked to in the sidebar.

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