A Few Answers To Questions You Always Wondered About

October 11, 2017 | 14 Comments » | Topics: Answers

How does a doctor go about revealing to his patient that he has a terminal illness?

They teach us to get down to the patient’s level, so it doesn’t feel like you’re talking down to them (literally and figuratively). But, ideally you wouldn’t tell them bad news in the waiting room. You would want to do it in an exam room or your office, where both of you can sit comfortably facing each other.

I was surprised to learn there is actually a really structured way on how to tell a patient bad news. Literally a 6 step process that all physicians are taught to follow.

For this example lest say the patient has lung cancer.

Generally the first step involves saying something like What is your current understanding of your condition or what have you been told so far this is to determine how much the patient knows. Because if the patient has been told the news by the radiology staff or another physician, you are just going to look stupid when you deliver the actual news (that the patient has cancer).

The second step is to say something like I’m sorry, but I have some bad news or I’m sorry, I truly wish I had better news for you this is what we call a warning shot. Basically it primes the patient’s brain to accept the following sentence. These phrases help lessen the anticipation. Because, in a way, you have already told the patient the bad news without actually saying they have cancer.

The third step would be to actually say the news. Something like I’m sorry, but I have some bad news. The biopsy indicates you have invasive lung cancer some interesting things about this phrase is that it’s short, simple, and pretty much universally understandable by anyone who isn’t familiar with medicine. Things we aren’t supposed to say would be like you have stage 4 small cell carcinoma instead of just you have cancer. Because a patient might misunderstand what you are saying.

The fourth step is to just be quiet. After you break the news to them the patient’s brain will be flooded with emotion, adrenaline, and all kinds of thoughts. The rule of thumb is to be quiet for at least 10 seconds. It’s important to let the patient process the news.

Interestingly, the hard part isn’t even telling them they have cancer. It’s answering any questions they might have and being supportive without being too emotional. The fifth stepis to find out if they have questions and provide them with answers. Some hard questions a patient might have would be, Is this because of the smoking, is this my fault, did I do this to myself, am I the reason my children will grow up without a mother? or the patient might just break down. I imagine it would be incredibly difficult to keep composure if the patient says something like I just found out my wife is pregnant and there is no chance I will get to witness the birth of my first child.

The last step is to develop a plan for follow up care. Find out what the patient’s goals are. Do they want chemo or just hospice care? Chemo would offer a slightly increased life span (the life expectancy might increase from 3 months to 5 months) but your life could be miserable during those two extra months. Some patients know the prognosis is terminal no matter what is done, and they choose not to have any chemo so their last few months on earth can be a happy and comfortable experience. So, depending on the patient’s goals (extending their life vs maintaining their quality of life) you would help them accordingly.

 

 

What car is the easiest and cheapest to repair and maintain? 

My father was a high level import mechanic. We had a huge house when I was a kid because he was so good at wading through weird problems with strange cars. He would often spend hours Renaults, Peugeots and Skodas, he learned to speak foreign languages and called Europe late at night for parts and advice.

I am now passing his advice on to everybody here. These are the cars he drove and kept for his family. He kept these cars because they were easy to work on and he didn’t want to come home from a hard day at work to have to fix a Saab or fight the electrical gremlins that are so common in Hyundais.

My father passed in 2011. But he would be happy I am sharing his advice.

Jeep Cherokee XJ Any year

When you look under the hood of the XJ you find that there is lots of room down there. It’s an inline 6 and it has one cylinder in front of the other so that to the left and right of the engine there is a lot of room. Most of the time on 6 or 8 cylinder trucks the top of the engine takes up most of the space under the hood. On jeeps the engine is long and narrow. On the right side facing the car are the intake and exhaust manifolds. On the left the are the oil filter, cooling hoses and evap system.

What goes wrong?

Waterpump- On most cars you need to take off the valve cover and get kind of deep to replace a water pump. Not on jeeps, it is right out front, you just have to remove the thermostat and water pump. Easy!

High Speed Wobble- Jeeps commonly get a death wobble at high speeds. There are 3 steering components under the jeep that are easily accessible and the car doesn’t need to be jacked up to fix it.

Valve Cover Gasket- Pretty common thing to fix on any car.

Struts- No compressor needed to swap struts.

Exhaust- The exhaust system sits low enough from the car and the car sits high enough up that you could probably do most exhaust repair without jacking the car up.

Changing oil on these jeeps is a pain in the ass.

91–97 Honda Accord

Like the jeep it has a lot of room underneath the hood. I have never heard of anybody getting rid of one of these because the engine was bad. Most of the time it’s wheel issues or transmission issues that causes somebody to move on.

What goes wrong?

Drivers side wheel bearing- This one is a pain to fix, it requires a press and a cutoff tool.

Warped Rotors- Often because of a bad wheel bearing. These cars have hub over rotor which means you need to take off more stuff than you should have to for getting wheels off.

Timing Belt- I have seen timing belts on these go for 100k and more, but at some point you will need to do a timing belt.

– Alexander Nerad

 

 

 

What is it like to be a Navy SEAL Sniper

My initial reaction was to decline answering this question. Not an easy question to answer -almost uncomfortable for me. I am not quite sure how to address such a personal question…I recognize the fascination that the public has with this strange profession & skill -both morbid and sensationalized at the same time. So here goes.

As a 12-year SEAL and Sniper, I spent the better part of my adult life learning, using, refining and living this skill, yet I find it difficult to put into words “what is it like to be a sniper?”. In the Teams, older snipers and team leaders look for more “solitary and quiet” individuals that have focus and a “quiet” about them. Some individuals have a “comfortable knack” and a natural feel for navigating any environment unseen -the training takes this “knack” to a whole new level. An additional skill that is sought-out, honed and refined is something we call “Bubble Compartmentalization” -or the ability to block everything else out for long periods of time, except specific visual and observation skills -basically the ability to sit still, observe and calculate without losing your mind.

There is nothing glorious or sexy about the job. It is very hard on your body -and its not something you would want to chat about at a cocktail party. In my experience -people already have a formed opinion of what type of person you must be, what morals you have and that you must be a little “off”, long before you even meet them. You spend days crawling, climbing, slinking, stinking -getting bit by every bug, scratched by every thicket -attempting to relieve yourself while laying on your side, looking thru night vision or scopes for endless hours, sleeping in 15 minute bursts -just to get to a “target area”. Once on the target area – you do the business of a sniper, usually in support of a SEAL assault team that comes in fast and hard in helicopters  -then fastrope down onto the target -take it down, then board and fly away. Now your work begins again -exfiltration, the art of getting out of the target area (sometimes with some very angry enemies running around trying to figure out what happened). 

There are so many different skill sets that need to be constantly refined -as Sniper tactics, equipment, weather, enemy and ballistic trajectories change dramatically in an Urban-Sniper role. It is one thing to be able to hide in a jungle with vast areas of cover and concealment -it is an entirely other thing to be an effective sniper in a City or Urban Warfare environment. The difficulty factor goes way up. The amount of practice, study and hours spent mastering every type of environment (shooting from buildings, helicopters, ships, shooting thru glass, walls, different mathematical calculations for temperature, humidity, altitude, load, etc….it is a non-stop learning game -in addition to your other SEAL missions. 

When I tell people that there are many complementary skill sets as a Sniper and a CEO of a company, they think I am absolutely crazy, but there are many. A good CEO is there to “support” his team and help make them look good. Not the other way around. To defer attention…and not be a jackass. The ability to focus on getting from A to B without being distracted, the ability to operate and maintain a company’s focus thru constant changes, and adapting rather than causing panic. The ability to not have an ego in the game at hand and not make the mission, goal or success, “about me”, but rather about everyone else. To use your power only when the moment is required -not flaunting it for all to see. 

I apologize if this long-winded answer in the end does not give you the “meat and potatoes” of how it feels to be a sniper, but I find it extremely hard to clearly articulate something so personal and yet job oriented. There are many good books out there that do a hell of a job telling specific stories and giving blow-by-blow accounts of combat sniping missions. I was trained on the 50-caliber McMillian and Barrett Sniper Rifle by Carlos Hathcock (http://en.wikipedia.org/wiki/Car…).  He was a guest instructor to my sniper class, he was a good man and a great teacher.  His book is a good book to start, but I feel my personal stories do not have a place here in this forum, so I hope I stayed on topic about how it feels….

– Michael Janke

 

 

 

How does a war veteran feel about the NFL/kneeling situation?

As a vet, I don’t feel “disrespected”.

I swore to defend all rights. Especially the unpopular ones that most people disagree with. Those ones need protected the most.

What does make me feel disrespected is when you drag MY service into YOUR argument and get offended on MY behalf.

Veterans are fucking tired of being brought out like dancing poodles for the fucking GOP and conservatives of this nation to further their own selfish, backwards, and archaic ideas.

That’s disrespectful to us.

We are living, breathing people with our own thoughts and ideologies.

We don’t belong to your team. We don’t belong to any team.

We swore to uphold the Constitution. Part of that Constitution is these players doing exactly what they are allowed to do – peacefully protest.

Showing 100% reverence to a nation or symbol of the nation is NOT patriotism, it’s nationalism.

And history has shown that nationalism is a very dangerous idea.

– Val_Hallen