Security is already outside the room and when they hear the first loud noise they will know to come in. No, you will not have to tell them. They know about the family room in the emergency department in summer in North Philadelphia.
What a heartbreaking essay. And how tragic that death by gun violence is apparently routine in North Philadelphia.
> I remember reading an anecdote somewhere that when it's hot out (temperature wise) that physical altercations increase.
The 'build up' to the wet monsoonal season where I am in tropical Australia is well known as 'Mango Madness' season (it coincides with the mango fruiting season).
I have two sisters in the police force, my dad was a doctor and my wife is a psychologist. They all concur that the rate of murders, assaults, domestic violence, divorces, street violence, car accidents etc. all dramatically increase during these couple of months.
When I went on a guided tour through Dubrovnik the guide said -- and I'm paraphrasing her from memory -- that assaults carried more lenient sentences during the warmest parts of summer.
Looks like being cool-headed is more than a metaphor.
Unfortunately it's kind of a joke here in Chicago too. You'll hear everyone saying "Suns out guns out" and crap like that. Especially holiday weekends are the worst. I'm not sure why it's this way, but I have a cop neighbor and he tells me summer holiday weekends are the worst for the force. Tons of overtime to be had and tons of hooligans shooting each other. This year the police union told the officers not to take overtime [1]. Unfortunately I'm worried it will end up in more shootings.
For all the flak Chicago gets in the news for gun deaths, on a per capita basis it's fun death rate is actually a lot better than many other cities in the US.
In one of the machine learning classes we looked at crime data in our city and discovered interesting patterns in how crime seemed to migrate with the seasons. It increased in the summer in some areas, then decreased and moved in the colder months.
Luckily, defensive fire arms still work ok in the summertime.
(sorry for the cheap joke, european here, I still can't relate to the american reality where people run around with fire arms killing each other and you somehow need to blame it on the weather)
I just want to say the style of the article and it's direct, terse language really captures the gravity of the situation and seriousness of the subject.
Two years ago and a day, I could read this and understand the gravity. Two years ago my daughter was born, and now I can't read this, or see commercials from CHOP, or anything else similar without my eyes filling with tears.
I don't know how people lose a child and come back from it. I say I can't imagine, but I do, and it terrifies me.
Indeed this is pretty close to it. It's funny the things which can throw you off too. Striking up a conversation with someone and they ask how many kids you have, or if you are going to try again for that boy or girl. Sometimes it's easy, but Some days it will tip your emotional canoe more than you were expecting.
Exact same boat. My entire life I would consider myself stoic, just generally not moved to tears for anything. I've felt sad, tremendously sad before about things that have had other people losing their minds around me, but crying never really seemed part of my process.
Then the first child came and I can't stand more than a passing glance of kids in war torn areas or have to shut off a news clip where some monster did something awful to a child. My blood boils and my heart shatters nearly instantly.
1 second after my first child was born I realized I had only two fears for the rest of my life: not being a good enough dad and living longer than any of my children.
Many of us fall in this boat- we're untouchable until presented with something we have no control over, and unfortunately fail to realize it until we're thrown into the thick of it.
When my wife went into labor at 26w with #2, it hit like a ton of bricks. I remember vividly sitting in the atrium at LPCH after being told she was going to deliver within the day, and we didn't know what her issues were ("any handful of genetic disorders are likely") I lost it. That moment, seared in my memory. I had an hour alone to digest before I had to go back and be strong for her, and to this day, she hasn't asked me what I did, what I thought. She can look at me and tell by the tears in my eyes what I went through.
And then the NICU director came to visit us, and reminded us, "take the long perspective, there will be ups, there will be downs. But for every down, she's still here fighting to be just like any other normal baby. Thrive on the fact that she wants that more than you'll ever know or the other kids will ever know, and we're going to do our damnedest to deliver that."
Now 18m later, she's doing better than any of them would have predicted. And not a day goes by that I can't see a LPCH commercial without losing it...
To the author and all other doctors...my full admiration for what they go through, the miracles they work, and the strength they confer to families in their most vulnerable times...
Like any parent, it's something you never want to think about and pray it never happens. I have a few friends that have lost a child. I've only discussed it with one of them. He told me all about it during work. He recounted the smallest details and the circumstances like it happened the day before (it was 17 years after it happened). I asked him whether it ever gets any easier and does he still think about his boy. He told me no, it never gets easier and he thinks about him everyday. He pulled out a chain on his neck and there was a little anchor on it. He said he had got it for his son when he was born because they were going to be fishing buddies. That look on his face afterwards, just emptiness. I told him I had to go to the can and went and sat in a stall, bawled my eyes out for a good 10 minutes while I got my shit together.
Having kids of my own I can't even imagine how fucking insane it would be. Don't even want to think about it.
"The depth of the stupidity of the things you will say sometimes is unimaginable." -I'm pretty sure everyone who has ever had to do this has felt the same way.
I had to tell that to my own mother. It was 5 years ago this week. There are no good ways. There are no good outcomes. This is a good article about how bad it is.
I had to tell friends that one of our closest friends had passed away. The only thing I would add to this article is to invite the recipients of the news to sit down first because there's a good chance they'll fall down.
The next sentences confirm that they are not there by accident:
> They know about the family room in the emergency department in summer in North Philadelphia. It is all right. They will be kind.
This article is discussing murder victims and people who died from violent crimes. They talk about barring the family from the body so the police can inspect it.
In such circumstances, it seems understandable that people may react strongly. How would you feel if you just learned that your loved one was (a) dead and (b) you aren't allowed to see them? Having security on hand, but out of sight, seems prudent.
U.S. hospitals serve people of all classes; people with low impulse control are positively correlated with the criminal classes; people with low impulse control are more likely to behave impulsively when given bad news. It's unfortunate, but true.
I have a few acquaintances who work in hospitals; it's quite amazing how the people they see in the course of their work differ from those I encounter in the course of mine own.
To put it even more simply: people under stress sometimes do unwise things, and little is more stressful than the first throes of grief. Planning for this is how you protect them from the potential consequences of their own grief-stricken rage.
Rather than call the families of homicide victims members of the 'criminal classes', perhaps you should consider the inordinate amounts of stress they are under. Your acquaintances see people at the worst moments of their lives; hopefully we can all be granted a little leeway in that situation.
> I just want to say the style of the article and it's direct, terse language really captures the gravity of the situation and seriousness of the subject.
Quick comment about how your it's instead of its caused an English parsing error in my brain:
I read until the comma and because I saw it's, I assumed I missed a word in the first part of the sentence - I though it may have been something like "I just want to say I evaluated the style of the article and it's direct, it's frank, it's spot on!", but re-reading it didn't reveal anything I missed. I then considered some less common writing styles/expressions. None of that worked out, so I read past the comma and figured out what happened. All this happened in the span of a second or so. Not sure what it was about this particular sentence that caused me to stop at the comma, I don't think it happens often.
Are hackers not human, sir? Have we no hearts? May we not cry?
We make a world not only for ourselves. In so doing we must above all else be kind. We must not lose sight of what and who we are, lest we invent cruelties beyond any yet known to history. May God forgive us if we fail in our charge - for no one else will. Nor should they.
Because even HN readers might need this advice, or wish we had when the time came. Software lifecycle isn't the only lifecycle we will have to deal with.
A subject I understand more than I can put into words. It's a duty I have had. A 17 year girl died of an overdose. It was my responsibility to tell the mother, father, pastor, brothers, sister. They were there all night in the tiny, chilly waiting room, after notified their comatose child was brought in.
Some kind of party had been going on when mom and dad were out for the evening. The young woman and assorted friends doing drugs. She passed out, it was hours before anyone thought to check out how she was.
I called in all the docs there were to call. We tried every trick there was known to try. Then heart rate fell to zero. All the effort came to nothing. Everyone was quiet, mumbled their sorrow, and slipped out the private staff access door. That is everyone but me.
That morning was about the hardest I ever faced, even in the decades since. Sure others have died on my watch, one cause or another. But that time was different. I knew I had to say it, give the worst possible news, the unnecessary death of a child, to grieving parents. I truly did not know how such a thing can be said, what phrasing is best, what stings the least?
I don't know how, but summoning the courage I walked out to where they were sitting. I was nearly in a trance, not only from lack of sleep, but stunned by the magnitude of what I had to speak. And I said what happened, the child passed away, never awakened despite the heroic efforts of so many healers sweating all at once.
I sat there for a moment, no more to say, listened to the mournful sobs. Though I felt a failure, more than anything I had no comfort to provide. They didn't find fault, they were not angry that we could not do more.
Seriously, a moment too stark, too profound to ever forget nor would I want to relinquish it. No repeat is necessary, the lesson deeply embedded, the value of life, the meaning of words, the merit of a healer's human voice, these are all worth keeping.
The article is basically saying not to flip out, but "When you get home, do not yell at your husband. If he left his socks on the floor again today, it is all right." We all know that this doesn't just happen after someone dies on the operating room table.
Seriously people, if your spouse is not cheating on you, beating you, or throwing the family money to the casino, lighten up about the little stuff.
Somewhat related - One of the reasons my significant other decided to not go into emergency medicine was the high rates of PTSD in ER physicians and nurses: "We don't have good numbers, but the incidence of PTSD in emergency physicians is probably around 17%" [1].
So while I can respect the stoicism and clear focus on the emotions of the mothers of victims, I hope the author and other ER doctors also take some time for themselves to deal with the trauma they experience.
My twenty one year old daughter died two months ago. A young policeman came to my door. It was the first time he had to do the job mentioned in the article and he did it very well.
I have very little memory of those first few hours. I now know what it is to be insane. I was so disconnected from reality that people have told me that I had long conversations with them that I have zero recollection of. The only thing I clearly remember was telling the officer that I had a gun upstairs and that if he didn't take it, I was going to murder the man responsible for her death within the hour. It was the most matter of fact confession of planning a murder imaginable.
After a couple of hours, I saw a Facebook post of hers and lost it, the insane calm left me and I bawled my eyes out.
It's her birthday tomorrow. I miss her so, so much.
Anyway, the point of this post: my daughter died of an overdose. She was at a party, a man gave her powdered pure fentanyl claiming it was cocaine. I have no idea why. She snorted some and overdosed soon after.
All I want to happen is that someone somewhere reads about what happened to my daughter and reminds their kids that without proper testing kits, they have no idea what the fuck they are taking. Drugs may not be bad, but some people certainly are.
My condolences to you. I can't imagine the pain of losing your child, I can only think of losing my younger brother and watching what my parents had to deal with.
I've come to hate fentanyl... In the past couple years it has become significantly more widespread, and in the completely insidious way you describe. People think they're buying heroin (or worse, cocaine, at least if they're a heroin user, they have some tolerance to opioids), and it's laced (or completely replaced) with fentanyl.
I'm a paramedic in a nice suburban area. I've been doing this a little over a decade now. I managed to make it a good long while without having to deliver life changing news to a parent. In the past two years I've done it way too many times.
I'm so sorry for your loss. I have witnessed your pain in others, and I know that it's beyond my comprehension...
From a harm reduction perspective, what would the minimum testing kit to differentiate fentanyl from other physically similar-appearing drugs look like?
It probably uses a marquis reagent, which could theoretically be made at home, as it is just a mixture of formaldehyde and sulfuric acid[0]. There are also websites[1] that have a key describing the colors that a number of substances produce on reaction with various reagents.
When I was an active heroin addict, I would do a small test shot of new
product before doing a normal dose. If it was too strong, then the match-head sized shot would get me off, and I would know to go easy on it. If nothing happened, I would wait 5 minutes and then raise the dose, until I was where I wanted to be. I somehow managed to avoid overdosing in the 8 or so years I was using. I don't know what part of that can be attributed to caution or luck, but there was probably a lot of luck involved. Either way, that chapter of my life is over, and I am grateful to have come out alive.
My pet hate as a phrase, "I know what you're going through", and variations - "I understand how you feel"...
Far better: "I cannot pretend to understand how you're feeling", "I can't imagine...". Perhaps with "I can only appreciate how difficult it may be", and so on.
One thing remains the same, it's always my least favorite task as a paramedic.
Please do not hate Fentynal, hate the people choosing to use it. As a person who suffers from chronic severe pain due to a near fatal illness, I can tell you that For people like us Fentynal is a life saver as far as the quality of life it provides to those who need it. It is one of the few medications I can take as it does not metabolize in the liver, if any does it is a tiny amount. Fentynal also does not come in a powdered form they are taking a liquid version and mixing it into powders, other then that one form all other preparations are majorly tamper resistant being either in a matrix that almost makes it impossible to even be affective in the system or on a patch which breaks down over time to slowly release in the body. Of course there are exceptions, but please do not hate the drug, hate this sick bastards that are using it to increase their illegal sales! (my apologies to the OP for hijacking their question.)
When I say I hate fentanyl, I mean I hate the illicit and recreational use of fentanyl. I'm well aware of its legitimate uses (it's my go-to analgesic in the back of the ambulance). The drug itself isn't 'good' or 'bad', it's just a chemical... it's amoral.
All fentanyl, legal or otherwise, starts out as a powder (generally as the salt, fentanyl citrate, though illicit labs produce a number of variations...). You're right that there is no powdered form sold legally, but most of the illicit sales come from labs in Mexico and China, and is indeed in powdered form.
I am close to someone in your exact situation who was able to switch to medical marijuana from fentynal and other opioids after dealing with near fatal withdrawal effects. By no means hate fentynal, but perhaps save a bit of hate for regulators who criminalize or perpetuate the criminalization of non-addictive, inexpensive alternatives to opioids to protect pharmaceutical company profits.
I cannot fathom this experience, but even though you are a stranger I am truly sorry that you have had to go through this loss, i wish we could give legit hugs over the Internet or give some other more meaningful semblance of humanity/support than some bytes on a webpage.
I admire the self control you had in telling the cop about your gun despite knowing what you wanted to do with it.
If you are married, I have seen a pattern where the loss of a child severely impacts the marriage negatively. Try to resist that if possible.
I don't know who you are, but I am giving you the biggest hug in my head.
I'm not sure about testing kits, but there is naloxone, which is becoming part of standard operating procedure in reversing overdoses and is even available OTC in some states. If something is learned from your daughter's death, I hope that the availability of naloxone becomes better known and even more widely adopted.
My parents were devastated when my brother died. Coping with his death very nearly killed my mother, and almost certainly killed my father. As cliché as it sounds, there is life after death, and you have loved ones who will help you through this. Not believing that probably worsened my parents' state of mind. I wish you strength, peace, and light in the coming months.
The problem with fentanyl is that it's so potent, it's very easy to _massively_ overdose on it. Beyond what the standard dose of narcan can reverse. It's not uncommon to need three or four times the normal dose, and I doubt most people buying it OTC (or through a harm reduction program) are getting that much.
My youngest brother died of a Fentanyl overdose just nearly a year ago. We assume he thought it was heroin, but whatever was going around at that time managed to kill almost a hundred people in the same weekend. Truly a horrible, horrible drug.
I know it doesn't count for much right now, but I promise that things do get better in time. If you ever need to chat, feel free to message me anytime.
It seems absolutely as straigtforward as I wrote. From that article:
"American drug and law-enforcement officials, concerned about the dramatic surge in overdose deaths from pharmaceutical opioids (165,000 from 1999 to 2014), cracked down on both legal and illegal distribution, opening the door for Mexican heroin, which sold for five to ten bucks a dose"
A trusted source of a heroine-like drug was removed, so the cartels increase production of heroine. But fentanyl is more profitable, and
"The cartels mix fentanyl with heroin because once an addict has shot that mix, they won't go back to "just heroin," since they can't get high on it anymore."
I am a physician, and there has been a "state of emergency" declared in my province due to a fentanyl overdose "epidemic". Although I use this drug routinely, it is incredibly unsafe outside of a clinical setting. Unfortunately, these are not your stereotypical "bad" people that are dying from overdoses, but your average young people who just happen to experiment. It's utterly awful, and I feel for you. I hope this trend (if you can call it that) ends soon.
It is hard to support my parent comment, but it is true: addicts are not good young girls/boys anymore. And if someone 'experiments' with hard drugs like cocaine or heroine, he/she is statistically-definitely addict with all consequences. One doesn't simply stop after first dose, that's why non-medical drug use is illegal.
Same in my case. I tried LSD, cocaine, MDMA and DXM, and each of these only once in my life. I saw no point in doing any of them again, and I had no problem whatsoever refraining myself from it.
> And if someone 'experiments' with hard drugs like cocaine or heroine, he/she is statistically-definitely addict with all consequences. One doesn't simply stop after first dose, that's why non-medical drug use is illegal.
This is definitively wrong. They do not meet the medical criteria for substance use or substance dependence. Nor is it statistically probable that a person eventually will, given that they have taken the drug at least once.
Can't downvote so responding instead: this is the kind of harmful misinformation that stigmatizes even responsible drug use and makes it less safe for all. Please educate yourself and reform your beliefs on the matter, and stop spreading it.
Also do you realize what you're saying to the author of the root comment? Shame on you.
Can you please provide a link to addicts-per-'those who used cocaine/heroine' ratio? I can't find exact numbers supporting common medical knowledge (e.g. 1/5 for cocaine).
> And if someone 'experiments' with hard drugs like cocaine or heroine, he/she is statistically-definitely addict with all consequences. One doesn't simply stop after first dose, that's why non-medical drug use is illegal.
Even though I'd also like to see such a link, I'd argue that because you're the one making a rather strong (purportedly factual) statement, it's up to you to provide evidence for it.
Don't get me wrong: I don't have a strong conviction on this matter. I really do want to see some evidence to inform my own point of view.
That said, the vast majority of my friends have used cocaine, as have I. Most of them multiple times. None of them have a problem with cocaine.
I'd never encourage someone to experiment with cocaine or heroin because it can be quite dangerous. But misinformation is potentially even more dangerous.
I've taken cocaine exactly one time in my life. That being said, I would never touch meth, heroin or crack even once.
People will do drugs, I accept that. I just want them to know the actual risks of what they are doing. I can't stop adults choosing to take drugs but maybe I can remind a few people to be a lot more careful and to be less trusting of their suppliers.
Addiction is a complicated problem and labeling the addict as 'bad' is an antipattern. Modern society should be able to approach everyone from a position of dignity and humanity - dehumanizations erodes both parties in an interaction. 'You deserve to die because of your past history' is a brutal, ethically untenable stance.
Then again, considering we have limited resources for dealing with this problem, pretending all users are the same when we damn well know they aren't is probably not the most efficient approach.
I wasn't claiming statistics or individual differences don't exist.
From the point of view of outcomes and efficiency it's better to approach people as individuals and not as statistics, or even worse, statistics with moral binning into good and bad. The logical argument is that humans are complex and it takes a lot of time to gather sufficient data to be correct.
I can dig out references if you like but medical facilities which focus more on individual-to-individal interactions rather than on factory like throughput work better.
Well sure you can cite evidence where treating people as individuals is beneficial and optimal, my dispute was that this is always the optimum approach.
Then again, considering we have limited resources for dealing with this problem, pretending all users are the same when we damn well know they aren't is probably not the most efficient approach.
Yes, groups that society consider to be trash or defective from the get go. Not "those people" who don't "deserve" such things to happen to them. The law enforcement response to opiods versus crack in the 80s shows us how society views these groups, and what the solution is (militarized police for one, "treatment" for another).
The people who are overdosing from the Fentynal problem are doing so mostly unknowingly. Dealers are "spiking" their heroin with it in an effort to boost sales as when someone OD's from taking heroin, the user community takes that as being a great batch of heroin and the OD being caused by someone who is not very tolerant to heroin. It's a sick and disgusting game that dealers are using. Again it's not the drug and generally not the users who are OD'ing that are bad, it's the sick twisted dealers out to make more dope money!
I didn't read what GP wrote as those "bad" people deserve to die (nobody deserves to die IMHO but that is another subject) but that it is not the hardcore, everyday drug users who die but the average-kid-nextdoor who is experimenting.
experimenting with drugs which, even if they are what you think they are, can be fatal. Especially when mixed (as they often are) with alcohol and other narcotics.
There isn't some special shield around newbie drug users to protect them from consequence. I find the whole concept bizarre, they are well within their rights to experiment but then they own the consequences.
> but your average young people who just happen to experiment
That's exactly how "stereotypical bad" people start out. It's just that fentanyl kills them faster, while other drugs leave them time to self destroy until we no longer have any empathy.
Everyone starts out that way. Some stop, some turn into stereotypical bad people. It's a real shame when anyone at the first stage overdoses and dies. Still a shame for the latter group, but they have more culpability for their own death by continuing to do something they know could/will eventually kill them.
Nobody starts of planning to get addicted. And while they certainly should realize that's a risk I'm not sure it ever factors into anything. Much like harsh punishments don't actually deter crime.
Sometimes we take decisions without being fully aware of the consequences (or simple choosing to ignore the consequences), but this doesn't make us less responsible. Nobody drives intoxicated planning to have an accident, for example.
And of course punishments deter crime. Not the crime that happens, obviously, but the crime which is never committed. There would be more rape, theft and murder if there were no consequences at all.
the same way all the high speed accidents happen to people that started driving at the «harmless» speed of 20km/h.
What I want to say is that demonizing marijuana can allow a bad comparison in the form "marijuana did nothing bad to me, all the thing they say about drugs are nonsense, so I can move to other drugs and be ok".
Truth is marijuana is harmless, compared to almost all the other drugs, including alcohol and tobacco.
A surprisingly large chunk of the population has tried opioids, a relatively small percentage become the classic druggie. Much like alcohol is common, but only some people have major issues.
The difference is how long the average person can stay a casual user.
Good thing you didn't murder him, he might not have known that wasn't cocaine, and going to jail for that would not have been something your daughter wanted.
The threat to murder was more of an expression of the mother's grief than an actual threat — in such grief and shock, humans tend to want to find someone to blame. In her right mind I'm sure the mother would never truly consider murder.
I don'the understand why people miss drug abusers, even if it is their own children. I would love to hear my son'a dead if he's stupid that bad to get an overdose.
I have told parents their child has died. It may not be 'right', but in every case, even when both parents are present, I'm talking to the mother.
I am a father of three. Were I in those horrible shoes, I'm quite certain I would feel that my wife was the one "being told". Maybe that's just some misplaced "macho" attitude on my part, but it's always been true, in my experience.
It is certainly a general rule that fathers are not seen as being equal parents; I think FT_intern's point is that they should be treated as equal parents. The headline's casual dismissal of fathers is symptomatic of a societal failing.
My prior comment was ill-considered and unnecessarily combative, for which I apologize.
My own experience includes a mother who did in fact mostly raise me, but also a father who was generally feckless in a wide variety of ways. On reflection, I strongly suspect I have based my understanding of parenting dynamics in families with two worthwhile parents primarily on wishful thinking - excusable in a child, perhaps, but not so in a grown adult. I'll keep an eye out for that in future.
It's not nonsense at all. You not understanding something is not evidence that it makes no sense.
My brother is my nephew's primary caregiver. It just worked out better that way; it was easier for him to take time off of work because his wife was the one with the good health insurance and working in the more stable industry. Over the years he's had many stories of being literally the odd man out. It's not a big deal to him, but it's the case. Just another one of patriarchy's leftovers.
That said, I think the article is fine as it is. A lot of emotional impact in writing comes from specificity, from authenticity in detail. She is telling her story, and telling it so that we feel it too.
It's not so much an 'equal parent' thing, in my opinion. Like I said above, I'm a father of three (I'm up feeding our 4 month old twins right now actually...), and we're absolutely 'equal' parents. My wife handles a larger share of the childcare duties, just like I handle a larger share of the landscaping... It's just the division of labor that works best for us. We're both very aware of, and quick to correct, attitudes that she's somehow more of 'parent' than I am (e.g. when she goes out in the evening, I am not "babysitting"...)
So, I am very sensitive to your point, and I think it's an important one, but i don't think it's the primary motivator for the use of "mother" in the article.
I suspect the reasons are (at least) twofold. The primary demographic served by this ER doc has a very high rate of single mothers. I'm not making commentary on that beyond the simple fact that it is the reality. My guess is most of the time she's talking to the mother because the mother _is_ the only parent present.
When the father is there though, I studied he feels as I do... In that awful moment, I would want the doctor's attention on my wife. I would want as much support as possible for her in that time. I'll make do on my own for now... Like I said, that's likely misguided chivalry or a 'macho' attitude on my part, but it's my honest take on the situation, and I suspect I'm in the majority.
I normally wouldn't bother with a follow comment about a typo, but I think it seriously impacts the readability (like I said... feeding twins in the wee hours of the morning...)
I have no doubt that you're in the majority; stereotypes very often exist for reasons of statistical predictive power. But that doesn't mean that we shouldn't recognize and push back against the stereotypes, for the sake of those who aren't (or even more importantly don't want to be) part of that majority.
Wild speculation: the Philadelphia youths subject to rampant gun violence may have a trend of lacking a male adult influence in their lives. In which case, this physician delivering news to <parents> might too often be delivering the news to only the mother.
It's abstractly difficult to inform a person that their close family member has died, potentially from violent causes, possibly very suddenly.
But come down this hallway, now, to tell this woman that her child is dead; this is what it will be like. You'll need to change your clothes first; you'll need to practice first; and this is what it will do to her, and what it will do to you.
I (obviously) found this very powerful, and while there's some compromise involved in adding in these carefully-selected specifics, it's worth it.
I've been a private military contractor for more than thirty years.
Some of the companies I was working for had very impersonal procedures to handle deaths.
I offered a few times to personally inform the family / next of kin for the guys that were working with me directly but that request was always denied because it was not "cost efficient".
So I always did the trip on my own.
The loss hit them like a truck every time, I have a few memories that make me wake up in the middle of the night three days a week but the look on a mother's face when you tell her that her son is dead is something you will never forget as long as you live.
Still, I am glad I went to see every family of everyone I lost in all those years. There was crying and screaming and tears and a lot of blaming, I even got slapped a few times but I always told them I'll be in a hotel nearby for the next days and if they want to talk they can call me any time of the day.
Some never called but after a day or two most invited me back to their home or came by and we had a few long talks over the next days until I had to go.
I've been in touch with most of those families over the years and I heard a lot of times that it gave them peace to know that I was there when their son / brother / husband / grandson died and that I came by personally to try to comfort them before they got "the letter".
I wish everyone that you will never come into this situation because it's almost as hard and unfair to be the messenger as it is to be the recipient of that message.
This comment will be unpopular. When you have gone through something like that, how can you continue to do the work you do? How can it still be worth it? I do not know what exactly you do, but could it someday be someoneelse telling this to your family?
Well, you do seem judgmental. If parent had talked about military or police, would you have posed the same question? If not, why not? I'm no pacifist, but I also don't like to follow orders, so I wouldn't do any of that work. And yet, who am I to judge?
> If parent had talked about military or police, would you have posed the same question?
If he had talked about the military, yes I would have posed the same question. That people in the US seem to be okay with paramilitaristic private companies is beyond my understanding, but I was not criticizing this here. I am honestly interested in his motivation, because I cannot think of anything I would do with these consequences attached. Maybe when not doing it would make it even worse, but I do not think this applies here. There is another thread where a doctor describes the same horrors, but his motivation is clearly that sometimes his actions can actually avoid this. Yes a soldier could save his friends in a battle, too, but to me the most effective way would be to convince his friends to not go to the battle in the first place, maybe even by leading by example.
> Well, you do seem judgemental.
As seen above, I am a bit, at least I might have a different view on things. Still you can talk to each other and my question is not political but emotional: Just how can you keep going?
If he had talked about the police with this number of losses, I would also ask how you can keep going and not become either depressed or politically active. While there are police deaths, that many OP is describing here are not normal if you look at international statistics, since OP does not seem to be some sort of national police chief, who has to visit every relative of a dead officer and I guess would already be a kind of politician trying to solve the issue.
Well, the distinction between military and paramilitary is indeed a subtle one. But I don't see a problem dealing with deaths of ones colleagues. They swore the vow, or took the money, and they knew the risks. It would be very hard for me to handle responsibility for those we had killed, however. And that's why I'd never kill except in self defense.
It does not change my view on private military. I do not think mercenaries should exist at all. I am a fan of a strict monopoly on the use of force by the state, which in foreign states should be backed by the UN. For me it is a question about moral. Similar to the death penalty, there might be cases where you think someone deserves to be dead. I just think that especially when dealing with bad criminals law must never be opportunistic and must at all times have the moral upper hand. I think when ultima ratio has to be taken, it should be taken by individuals who later have to account for their actions. Law should never allow it.
His post perfectly answers my question. I can see why this is a huge motivation.
I don't see why your comment would be unpopular. These are valid questions.There is no easy answer to them tho without understanding the bigger picture.
When I was young joining the army in my country was an easy decision, the money was good and it was a safe job. Recruiters would tell you that you could make an impact on the world and make it a better place for everyone while making enough money to easily fund your kids future and live a good life if you do the job long enough and are willing to put blood, sweat, and tears in.
But within a few years, I realized that what I did had no impact whatsoever, and the money was only good if you went home in one piece or alive at all.So I quit and specialized in tracking down war criminals in the private sector.
It is a long way before you see some of these people in front of the International Criminal Court for example. Many don't even make it there.
You ask how I could continue the work I did?
I had the chance to talk to these people sometimes for an hour sometimes for days before handing them over and one question I always asked was "What do you think would have been necessary to keep you from doing what you did?" and most of the answers boiled down to "nothing, besides a bullet maybe".
And that is exactly the reason why people like me are necessary. You can't sit down at a table with these guys and talk them out of it. There is real evil in this world. And these people are the living proof.
They think they are invincible and above the law and when you see how long it takes to bring these people to justice you begin to understand why they think that way.
Now I'm retired. So no, I am pretty sure the cause of my death will be natural some day.
As far as I'm concerned I don't need to write a book about what or how I did what I did. And outside those trials, my name will never be mentioned anywhere.
But the families of all the people I worked with that died and all the families and mothers that suffered by losing their sons and daughters and husbands because of the war crimes that person ordered will get a little bit of peace, knowing that no matter how rich or powerful you are there are people coming for you willing to give their lives so you rot in jail for what you did.
I was completely unaware that there is a long established market for mercenaries to catch war criminals.
Can you say more about clients and rules of operation?
What is the relationship to the multi-billion mercenary sector (Blackwater/Academi etc.) the Bush administration created to make its wars more palatable?
I don't see how the "mercenary sector" was created by Bush administration. For instance, Blackwater got its first government contract after the USS Cole bombing, from the Clinton administration.
Excellent point. I wonder if those who equate Blackwater with "mercenary sector" would also equate U.S. Navy’s Military Sealift Command with "mercenary sector" as well?
I don't know. Is the U.S. Navy's Military Sealift Command a private entity that sends armed employees or contractors to war zones to fulfil military roles?
I should have phrased this better. There have always been mercenaries of course, and I believe there has been an uptick in US government use after the end of the cold war under Clinton. I'm however under the impression that the growth since 2001 has been unprecedented, as is the fact that the number of private sector employees deployed to war zones by the US government outstripped military deployments. So a qualitative change seems to have taken place during that time, even if it was just the continuation of an earlier development.
I could easily be wrong though, because I'm having trouble finding precise and dependable information online – if you have some good pointers about the growth and changed role in US politics of mercenaries, I'd be interested in reading them.
I have no numbers, but I'd agree the use of contractor forces has expanded. However, it clearly was an emerging trend already during the Clinton era, and even before that.
I did not want to be impolite, so I took some time to think if I can answer your question in a way that would satisfy you.
Unfortunately, I don't think I can and this also would do no good for the original topic. I hope you can understand that.
If you are interested in the topic what I would recommend is to try to get a better understanding how the investigation in war crimes is handled, especially after a country pulls all or a large part of its armed forces from a conflict region like Iraq or Bosnia.
You will probably make some interesting discoveries that will satisfy your curiosity .
Good luck.
> I had the chance to talk to these people ...
> They think they are invincible and above the law ...
Just out of curiosity, not saying any side is good or bad, but did you ever run into someone whose rationale was "Because I was 19, Dude. Because, but for the grace of god, it would have been me in the ditch with a bullet in my head."?
Disclaimer: This comment might be disturbing for you, so feel free to skip it.
Yes, I heard a lot of excuses, especially in Africa.
But it never really mattered to me in a way that I would have said to even a single one ok I let you go and you disappear and spend the rest of your life doing good to make up for what you did.
Some things these people did are beyond what any normal person can imagine.
If a 20 yrs old is in tears and tells you that he was high and ordered to do what he did three years ago and that he was a child soldier for most of his life, then it's just human to feel bad for what happened to him. No kid on the planet should go through that kind of hell.
But if you make the decision to shoot a man in the stomach and let him bleed out, then behead his kid in front of his eyes and rape his wife in front of a dying man before cutting her throat because you claim you were ordered to do so, that is the end of a chain of bad decisions that you made in the past.
I did not walk a single mile in his shoes, so I can't judge if I would have acted differently in his situation with a past like that and being drugged out and forced to do horrible things even before that. But if you make this decision then you also need to be aware of the consequences.
That must have taken its toll on you. I'm glad you did the right thing by those families. No-one should have to learn about something like that by text or impersonal phone call.
When I occasionally start to think my work in technology is overly important or that the woes of my startup projects are unbearably heavy, I'm glad I can be humbled by something like this. This doctor has responsibilities and gravity I will never know. Great article and great doctor. Wow.
I know this will sound cold, but why is this story here? Does it really fit the guideline of "anything that gratifies one's intellectual curiosity"?
I've shoehorned it into my rationalization for being here as advice on how to have an extremely difficult conversation, but it still feel a bit macabre to have this here.
I would say that this does in some way gratify my intellectual curiosity. I hope to never find myself in this situation, but it's good to have some guidelines if I ever do.
My father died younger than 50 years old when I was a child. My mother was left behind with several small children and financial struggles. On the day of his funeral there was a funeral of an 18 year old boy afterwards. She has told me she consoled his girlfriend and when she saw the young girl standing there crying, she thought that even though her own situation was as bad as it could possibly get, this was even worse. Must have been a strange moment for her. Maybe even a bit uplifting, as perverse as this sounds.
Other people's tragedies can be cathartic, or at least so I recall being taught in high school English class from nearly two decades ago. Knowing that someone has it worse than you do can make you feel better about your own situation, not due to schadenfreude but just by helping to put things in perspective.
I've been blessed to be very inexperienced with funerals. Two grandparents, an aunt, and a high school classmate. With my grandparents, we knew it was coming and had lots of chances to visit in the preceding year. Granted you always wish you'd done so more, but those ones are relatively easy to handle and feel like family reunions mostly. My aunt, who committed suicide around age 50, was much harder, despite her having dealt with mental illness all her life such that it wasn't out of nowhere. My grandfather, who outlived her by three years, was devastated (his wife, my grandmother, not being around as she'd passed away 45 years earlier).
When my friend died, I saw his parents quite a few times in the following year. Every single one of those times weighed heavier on my mind than any of those three funerals, despite those having been for family members who I knew quite well. When comparing these early life tragedies to older people passing, the only similarity is death.
One of my best friends died of an overdose a few years ago. His mother was informed in a horrible way.
The police called her and told her that her son had overdosed and was on the way to the hospital. In the middle of the call they all of a sudden say "actually, he's dead!" like it was nothing special. His mother of course screamed out loud, which made the police upset (they said "hey, it's not my fault" or something like that, I don't remember exactly).
I normally have great respect for the police but I think this was handled catastrophically. They showed very little sympathy.
You paint taking drugs as something every "kid" does and drugs like something innocuous, cocaine certainly is not.
If your daughter took cocaine it has probably a lot to do with your attitude towards drugs as a parent.
I volunteer with drugs addicts and drug areas. My work along with other 10 people or so is telling them how terrible drugs are and to offer alternatives(teach them a job, organize and create a community, make them stronger against those that will try to initiate kids, offering model or reference for dysfunctional families...).
Sometimes it is really really tough job as you have to remain strong in surreal situations. But in the end it is probably the most rewarding feeling you can experience in life when you see the people you helped to recover and even prosper in life.
Most kids and adults use alcohol. Prof. Nutt, one of the leading experts on drug use in the UK, wrote:
"MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places."
(He was then sacked from his position advising the government, and then all the other scientists resigned from the committee he chaired.)
While it's good to question the highly dubious criteria to separate legal from non-legal drugs, I think all these studies showing alcohol as the worst drug fail to account for the fact that if used in a responsible way, the harm caused is practically zero.
A person who likes to drink a cup of wine or a beer two or three times a week, and doesn't do so when driving, receives and causes no harm in practice (I know, there are studies about increasing cancer risks due to alcohol, but no more than with meat and other non-drug products). This is not true of cocaine, heroin or even tobacco, where there is no such thing as a harmless dose, and it is controversial in the case of cannabis.
I've taken a harmless dose of cocaine: I drank coca tea in the Andes. That this is harmless seems less controversial than either alcohol or cannabis.
It's in any case difficult to separate "responsible" and irresponsible use of drugs when deciding on policy. Either alcohol should be banned, or all the less-dangerous drugs should be legalized.
What puzzles me is that alcohol is available OTC and anxiolytics and psychedelics are not. My 2 uncles died in relation to their alcohol abuse. Both of them mostly due to low availability of psychiatric care after their respective divorces (that happened before they started drinking). We have no infrastructure to help people get up after their lives come apart and the only available drug has zero potential to improve their situation.
> if used in a responsible way, the harm caused is practically zero.
And yet so many people struggle with using alcohol in a responsible way.
Alcohol is, incidentally, the only household-name drug that can actually kill you from withdrawal. Believe it or not, even though heroin withdrawal is miserable, as long as the person is taken care of and kept hydrated, they won't die from it. That is not true of alcohol; a person suffering from acute alcohol withdrawal can literally die from the direct effects of the withdrawal themselves.
In a pinch, opiates can actually be used to help a person detox from alcohol and mitigate the life-threatening seizures (and the pain). Benzos are much better for this, though, and are more commonly used in medical detoxification scenarios.
Maybe "overall, alcohol was the most harmful drug," but it's because it's the most used one. The "harm to others" score is not by individual, and there is a large difference in the number of users.
It's also the most acceptable and very commonly consumed anywhere and everywhere. People are ridiculously casual about drinking to intoxication then carrying on their business as usual in public.
In a WHO survey they had that 42% of the US population had tried marijuana and 16% cocaine. And that's just people who admitted it in a survey. So it's pretty widespread.
I've worked as a hospital chaplain in a big and well-respected urban teaching hospital.
From a teaching point of view, I'm really glad this article by Dr. Rosenberg is available. For two reasons...
1. I wish I had seen it during training. It's spot on in every respect. Dr. Rosenberg's advice to stay with the bereaved, and enter with them into their grief, is good advice. There's no way to do it without simply doing it.
2. It's good that Dr. Rosenberg is teaching doctors to do this work. Often enough in the past, the Saturday night emergency department staff just said "page the chaplain" when they needed to deliver bad news. We chaplains don't mind doing our jobs, but that leaves the frightened family hanging while we scramble to get to the ED and figure out who / what before sitting with the family. And, there's always some practical decision-making that takes time. For example, a Roman Catholic patient needs a Roman Catholic clergy person. So, "page the chaplain" keeps people waiting.
If you ever have to do this, do everything you can to avoid physically looking down at the bereaved people. Don't stand over them. Sit on the floor if you must. Some waiting rooms have low coffee tables or side tables. That's a good place to sit.
In teaching hospitals, the new residents (fresh-out-of-school doctors) start July 1st every year. And, they staff the ED on weekend nights. So they are getting their first sustained taste of violence, right at the top of the summer heat. They went into medicine to heal people, not to pronounce them. So this is a big shock for them. The ED unit clerk should still page the chaplain, even if the doctor delivers the bad news.
This epidemic of violence is awful. For my part, I count strong narcotics with guns, knives, and cars as instruments of that violence. It's horrible that doctors and other hospital folks have to learn how to do this. But they do. It's horrible that families have to hear this bad news. But they do.
This article should be posted on the wall of every toilet stall in every high school in the country. Why there? Simply because everybody will see it and have a chance to read it in private.
It doesn't have to be a child in the sense of being young. No parent should have to outlive their offspring, especially when they are very close daily. I witnessed the effect on a 90+ year old mother of the sudden unexpected death during sleep (natural causes) of her daughter who was almost 60 but very vibrant.
It was crushing. The mother never recovered any of her joy in her own life and only lived another 2 years.
What a heartbreaking essay. And how tragic that death by gun violence is apparently routine in North Philadelphia.
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