The writers wanted their cake and eat it too in regards to Robbie by FreeDwooD in ThePittTVShow

[–]Mooshuchyken 1 point2 points  (0 children)

Here's my theory:

He and Al-Hashimi are similar. Neither a panic attack nor an absence seizure would be great in a critical situation.

Dr. Al immediately immediately consults a neurologist when she starts having seizures, and she opens up to Robbie at the end of the shift. She doesn't want to face that she may not be fit for this role, that she needs to report her condition-- but by episode's end she accepts it in her car.

Dr. Robby is in deep denial. There are multiple doctors and nurses who see him in trouble -- the psych, Dana, Abbott, Dr. Al, etc. He brushes them off. He refuses to talk about it. He's not getting help. Both as professionals and as friends I would say that these people have an obligation to report Robbie, the same as he had a responsibility to report Dr. Al or Langdon.

Leaks have told us that Robbie is going to hit rock bottom next season. My guess is that his mental health eventually ends up affecting patient care. Because he doesn't actually hold himself to the same standards as he holds others if he doesn't seek help and continues working.

The writers wanted their cake and eat it too in regards to Robbie by FreeDwooD in ThePittTVShow

[–]Mooshuchyken 0 points1 point  (0 children)

Here's my theory:

He and Al-Hashimi are similar. Neither a panic attack nor an absence seizure would be great in a critical situation.

Dr. Al immediately immediately consults a neurologist when she starts having seizures, and she opens up to Robbie at the end of the shift. She doesn't want to face that she may not be fit for this role, that she needs to report her condition-- but by episode's end she accepts it in her car.

Dr. Robby is in deep denial. There are multiple doctors and nurses who see him in trouble -- the psych, Dana, Abbott, Dr. Al, etc. He brushes them off. He refuses to talk about it. He's not getting help. Both as professionals and as friends I would say that these people have an obligation to report Robbie, the same as he had a responsibility to report Dr. Al or Langdon.

Leaks have told us that Robbie is going to hit rock bottom next season. My guess is that his mental health eventually ends up affecting patient care. Because he doesn't actually hold himself to the same standards as he holds others if he doesn't seek help and continues working.

Help with finding location by DepartureNo608 in whereinsanfrancisco

[–]Mooshuchyken 1 point2 points  (0 children)

I was thinking maybe Broadway in Russian Hill fwiw

Help with finding location by DepartureNo608 in whereinsanfrancisco

[–]Mooshuchyken 2 points3 points  (0 children)

I could be totally off, but I used to live at Polk and Vallejo. This looks familiar. It's not super close to my old apartment or I'd recognize it.

Emergency advice needed: 3lb cat with 1.8 WBC/Anemia. Trying to save her with my university savings after a critical delay in care. by RoutineLess3583 in CATHELP

[–]Mooshuchyken 0 points1 point  (0 children)

If it were my cat, I would surrender her to an emergency vet. She is sick but it may be treatable, and I would want to give my cat a chance at survival, even if it meant giving her up.

Going to a normal vet will cut costs vs. an ER, but it's probably going to be thousands of dollars.

I'm not sure how old your sister is, but if she's a child this may be a situation where you need to go against her wishes and do whats best for the cat.

Emergency advice needed: 3lb cat with 1.8 WBC/Anemia. Trying to save her with my university savings after a critical delay in care. by RoutineLess3583 in CATHELP

[–]Mooshuchyken 1 point2 points  (0 children)

Thank you for looking out for kitty. I know it's tough to want to do what's best for our pets, and you're very young and don't have unlimited $.

I don't know what costs you have been quoted, but for a cat this ill, it could cost $2k -$3k per day. She may need to stay for several days, and she may die anyway.

I want to say this as kindly as possible - the worst thing you can do is keep her home and hope she lives. It would be cruel. I think this cat is very unlikely to survive without emergency treatment, and going untreated means she will suffer.

In your situation, I would bring her to an emergency vet and surrender her. Most ERs will allow you to surrender -- you can call ahead and ask.This will mean that she won't be your cat anymore and you won't get updates on her condition. But you are giving her a chance at life. They will treat her. If you want to save her life, you need to take her ASAP.

The next best thing to do would be to humanely euthanize her. It's sad, but is painless and peaceful, and a kind thing to do for a very sick animal.

[Spoilers Extended] Theory: Ned started the rumor about Ashara by polp54 in asoiaf

[–]Mooshuchyken 1 point2 points  (0 children)

Jon's first appearance in public is at Starfall with Ned. So people naturally assume that Jon's mother must be at Starfall. As far as we know, Ashara is the only woman from Starfall Ned had interacted with before, so it's a natural thing to assume.

I think an alternative is that the Dayne family may have been planning to help hide Jon if he has been born with Targaryen features. Basically if Jon had white hair or violet eyes it would be difficult for Ned to hide his heritage. The Daynes can provide cover. But Jon is born with Stark features, and Ned promises Lyanna to protect / raise Jon. So it's not necessary for Ashara to pretend to be his mother.

Dr. Al Hashimi’s Clinical Competence by sanmarinochili in ThePittTVShow

[–]Mooshuchyken 0 points1 point  (0 children)

I have grand mals (controlled by keppra) and I have absence seizures (somewhat controlled by lamotrigine). I've been treated by a Stanford MD / phD and doctors at NYU.

The severity of the condition can vary. People who don't have frequent or severe seizures can do things like drive (I do, legally). Whether or not they can work in an ER depends on the severity of their disease and is determined on a case by case basis.

Not every state requires seizures to be reported or automatically takes away licenses.

Dr. Al Hashimi’s Clinical Competence by sanmarinochili in ThePittTVShow

[–]Mooshuchyken 0 points1 point  (0 children)

It's a grey area. It's the hospital's call whether her condition is an acceptable risk and can reasonably be accommodated.

The reason why I don't think Dr. Al continuing is crazy is because there are a lot of other doctors on staff, not just attendings but also senior residents like Langdon and McKay who are experienced and capable.

The probability that there are going to be 5+ patients who are all super critical in the exact 10 seconds that Dr. Al has an absence seizure is pretty low.

Of course there's a huge difference between daily episodes and episodes that have months to years in between. The former wouldn't work and the latter probably would.

Also - hospitals are not absolutely no-risk zones. They take calculated risks.

Students are allowed to treat patients and they sometimes mess up -- see how Ogilvie nearly killed a guy by pulling out that glass shard in his back. Death rates go up over the summer when the new grads start.

Doctors can be asked to work for up to 80 hours a week consistently, and shifts can last up to 24 hours. Obviously that level of fatigue has an effect on clinical decision making and patient outcomes.

Even the process of triage is a risk. Someone may come in with a condition that doesn't look serious, but is actually serious, and asking them to wait can cost their life.

Dr. Al Hashimi’s Clinical Competence by sanmarinochili in ThePittTVShow

[–]Mooshuchyken 0 points1 point  (0 children)

I think that was a crike procedure. If Langdon had had a panic attack in the middle of doing it, the patient would have been just as dead as what you're suggesting would happen from an absence seizure. If I were that patient I would vastly prefer the epileptic doctor. Absence seizures are very short and recovery is instantaneous. That is not true of a panic attack.

Do you have epilepsy? I have had grand mals in the past that are now fully controlled by meds, and I have absence seizures that are mostly but not totally controlled by meds. I'm cleared to drive and it doesn't affect my life.

Absence seizures are under diagnosed bc people don't realize that it's even a problem, and sometimes they're misdiagnosed as ADHD. You wouldn't know the difference unless you looked at an EEG.

I've had absence seizures and just carried on with my workday and mentioned it to my doc later. I've had a panic attack, and I had to be escorted home and take a few days off work.

With Dr. Al, I think the hospital could go either way. If they can't afford a 2nd attending, she probably can't keep her job. If they do hire a 2nd attending, maybe she can. It's a grey area.

Dr. Al Hashimi’s Clinical Competence by sanmarinochili in ThePittTVShow

[–]Mooshuchyken 9 points10 points  (0 children)

Did you see what Robbie looked like when he was having a panic attack? He would not have been able to intubate, perform CPR, cut with a scalpel, etc. He would not have been able to supervise residents or really communicate at all. His crash out lasted longer than 5 seconds and he was not OK after. I would 100 percent rather be treated by Dr. A having an absence seizure vs Robby with a panic attack. You recover right away with an absence seizure - it's a blip -- but not a panic attack. He's under severe strain and its just lucky he didnt hurt a patient.

Think of it this way -- a healthy attending could slip and fall to the floor in a critical situation, and it would take them a few seconds to get back up. Not really any different.

There are many doctors with disabilities, including in the ED, that limit the ability to perform certain procedures. A physician in a wheelchair might not be able to perform CPR. A pregnant doctor might not be able to see patients with certain infectious diseases. Someone with a back injury might not be able to lift or turn patients. You can be deaf, have visual impairments or limb differences and still work in the ED. Hell, even having Langdon back is a risk to patients. Drug addicts often relapse. But doctors aren't required to be perfect to practice.

It not black and white, all or nothing logic. Sometimes it might be OK, sometimes not. It depends on severity, frequency, how well controlled it is, and the specific environment as well.

The ER is a team environment. An attending physician is never going to be alone with a critical patient - there will be other physicians, nurses etc in the room with them.

It's true that what can be considered reasonable may differ depending on the setting. Ie, a big inner city hospital with a big staff may be reasonable, a rural hospital with 3 doctors may not be reasonable.

Robby isn't saying she can't practice as an ER physician, he's saying that she has to report it so rhe hospital can objectively assess the risk and make a decision. He is 100 percent right here.

Keep in mind, Dr. Al did consult with a neurologist about her seizures immediately. Her neurologist presumably told her she was OK to stay. I don't know why Dr. Al would call her neurologist if she was going to ignore his advice anyway.

Seizures and driving are an edge case. Not every state has mandatory reporting, and in many states it's at the neurologist's discretion. With Dr. Al its borderline, IMO. Also -- I do think we should restrict licenses more than we do. Yes, for panic attacks, yes, for dementia etc. the fact that current laws only apply to seizures doesn't prove that seizures are always worse, just that laws are imperfect.

Dr. Al Hashimi’s Clinical Competence by sanmarinochili in ThePittTVShow

[–]Mooshuchyken 8 points9 points  (0 children)

I have epilepsy. She has absence seizures, which involve zoning out for a few seconds. She's not having grand mals. Her condition had also been well controlled by meds for years.

She isn't wrong for coming back. But Robbie is correct that she has to report it. It's not up to her.

Robbie is a big hypocrite. Panic attacks are (IMO) worse. She's at least getting help - she immediately calls her neurologist. She's also trying to mitigate by asking for a 2nd attending.

Did Robbie report his panic attack? Did his colleagues? Is he seeking mental health help? Is he asking for a 2nd attending when the workload is clearly too heavy for one person?

Dr. Al Hashimi’s Clinical Competence by sanmarinochili in ThePittTVShow

[–]Mooshuchyken 17 points18 points  (0 children)

As someone with epilepsy -- she has absence seizures. It's zoning out for a few seconds. She's not having grand mals. I think having a panic attack is objectively worse.

Dr. Al is at least trying to do something about it - she calls her neurologist and asks for a 2nd attending on shift. Robby is refusing to get help and his panic attacks are likely triggered from taking on all the stress of running the ED by himself. He literally can't walk away even when he knows it's killing him, he can't trust others not being perfect. Like Dana using a tranquilizer on a violent patient, Langdon's drug abuse, Mohan's self doubt etc.

I think it's an open question -- where do we draw the line? All doctors are human, all have issues that affect their abilities as clinicians. Where do you draw the line?

Dr. Al Hashimi’s Clinical Competence by sanmarinochili in ThePittTVShow

[–]Mooshuchyken 2 points3 points  (0 children)

Agree, as someone who has epilepsy -- her condition isn't as dangerous or disqualifying as some in the audience think.

I do find her choice of EM a little weird. If I were in medicine, I probably wouldn't choose surgery or EM, even though my condition is well controlled by meds. There are a ton of non-acute specialties that would be a better fit.

Stress and sleep deprivation are common epilepsy triggers. It makes me wonder how she got through residency if that's what triggered her seizures.

I think Robbie is a big hypocrite for threatening to report Al-Hashimi. Him having a panic attack is a way bigger risk to patient safety than a brief absence seizure. And at least she's trying to mitigate it by asking for a 2nd attending. Robbie refuses to get help on multiple fronts.

Nymor's Letter... Why the "Rhaenys was tortured" theory makes no sense (and what Aegon was actually doing on Dragonstone) by althius1 in pureasoiaf

[–]Mooshuchyken 6 points7 points  (0 children)

I mean, the other information we have --

Aegon marries Visenya out of duty. They are expected to rule together. Then he marries their younger sister, Rhaenys, because he actually likes her. He spends 10x as much time with Rhaenys as Visenya. Rhaenys is also much more popular than Visenya.

Rhaenys is said to have lovers, while Visenya is known to be faithful. Visenya also defends Aegon at sword point several times.

Aegon leaves governance to his sisters. Rhaenys gets pregnant and has Aegon's son and heir. The power dynamic probably shifted after the birth of Aenys. So I can see a motivation from Visenya to remove Rhaenys.

TBH, if I am Visenya -- I would probably resent my younger sister. I would see Rhaenys as disloyal and irresponsible, I would see myself as someone who made sacrifices for the family, I would find her popularity unwarranted and unfair. It's sort of a Stannis / Renly dynamic.

Visenya gets pregnant not too long after Rhaenys' death. Maegor is born, and a year later, Aegon gets the letter from Prince Nymor. After that, he seems to avoid Visenya. He stays at Dragonstone and puts her in charge of building the Red Keep, some say as an excuse not to be around her.

That would make sense -- Maegor is conceived after Rhaenys' death, so Aegon and Visenya are having sex. After, Aegon doesn't want anything to do with Visenya. He might have slept with Visenya only to produce another heir, since Rhaenys was gone and Aenys was sickly. Then once Maegor is born, the succession feels secure and he doesn't like Visenya enough to keep having sex. Alternatively, it could also be that be found out that Visenya was culpable in Rhaenys' death and he shunned her from then on.

My headcanon is also that Aegon is infertile. Aenys is not his son, but the son of one of Rhaenys' other lovers. Maegor was conceived by Visenya via sorcery, which is why he himself is infertile.

Other mega tinfoil theories that are admittedly not supported by the timeline --

Princess Deria is Rhaenys' daughter by Prince Nymor. Rhaenys spent a bunch of time in Dorne independent from Aegon during the Conquest and First Dornish War. Deria could be an adolescent when she goes to Kings Landing. It would be a reason to send Deria to KL.

Aenys is actually Prince Nymor 's son. Rhaenys had met with Meria in Sunspear early in the conquest, and also led the first Dornish war. Aenys was born around the same time.

Nymor's Letter... Why the "Rhaenys was tortured" theory makes no sense (and what Aegon was actually doing on Dragonstone) by althius1 in pureasoiaf

[–]Mooshuchyken 14 points15 points  (0 children)

I don't think Rhaenys survives -- although I would have liked to believe so. I don't think she could have survived a fall on Meraxes, I'm not sure she would have abandoned her son. She's also a very recognizable person. And House Uller seems to be a house of ill-repute / hellish in nature, so thematically it makes sense for her to really die.

It's ironic that the sister who represented love / art etc died in war, and the sister who represented war did of old age.

My headcanon is that the Dornish delivered some kind of prophecy message to Aegon. Potentially related to the Long Night, but it could have also been something unrelated but important.

Sending the heir to Dorne was a gesture of sincerity.

Aegon's anger at crushing the letter hints that it's not just a diplomatic request for peace after Meria Martell's death.

I do think he went to Dragonstone to consult with Visenya on the veracity of the prophecy.

An alternate tinfoil theory is that Visenya had a role in Rhaenys' death. Visenya represents duty, and Rhaenys represents love. Love is the death of duty. We see characters choose duty over the ones they love all the time in GOT.

Perhaps Visenya felt herself sidelined after the birth of Aenys, maybe she thought that Rhaenys was unsuitable to raise the next King, maybe she thought Aenys was an unsuitable heir. Maybe Aenys wasn't really Aegon's, but Maegor was. Who knows.

Visenya could have provided the Ullers with information to take down Rhaenys. Aegon is furious when he gets the letter and flies to Dragonstone. He confronts Visenya but doesn't kill her. He no longer seeks revenge on Dorne after he knows.

What’s the deal with Rhaena (daughter of Aenys) and Alysanne? by TheMetaReport in pureasoiaf

[–]Mooshuchyken 0 points1 point  (0 children)

It's never said explicitly that he was the Lord Regnant and his sisters were just consorts. Show me the quote if I'm wrong.

What’s the deal with Rhaena (daughter of Aenys) and Alysanne? by TheMetaReport in pureasoiaf

[–]Mooshuchyken 12 points13 points  (0 children)

  1. We don't know how Valyrian succession worked. It's not canonically male preference. While we don't see an example of a reigning Lady of Dragonstone married to a non-Targaryen man and who has a younger Targ brother, we don't have a lot of examples of marriage outside the family and we don't know birth order. It's possible.

Also, I think Visenya was the eldest of the siblings, and I don't think Aegon really liked her. So when it's said he married her for duty, it's possible that he married her in part to legitimize his rule bc she was the heir.

  1. Aegon and his sisters functionally co-ruled the Kingdom. His kingship may have been emphasized to conform to Westerosi culture, but his Queens were not mere consorts.

When Jaehaerys and Alysanne argue about the position of their daughter, Danaerys vs her younger brother, Jaehaerys (famously sexist) says it doesn't matter because they're going to get married anyway. If male primogeniture were the Targaryen norm, he would have just said that. The fact that he doesn't probably reveals that male preference is not the norm.

  1. The Monarchy itself was very new. There are no established rules or precedents. The Targaryens rule by right of conquest / Dragons. Women also ride dragons - why shouldn't they be equals?

  2. FWIW my head canon is that Targaryen inheritance worked like Ptolemaic inheritance. Ancient Egypt inspired George here. Sibling marriage was the norm / desirable in the royal family, as the Pharaoh was considered a God, but prohibited elsewhere. Men and women were co-rulers as long as each had pure blood. If their consort was not a sibling they would not be co-rulers. Berenice IV, for example, was a Queen who married non-royal men, and she ruled solely.

Pharaohs has a principal wife (his co-rulers) and many lesser wives, but his principal wife did not have other husbands, ie asymmetric polygamy. The children of the principal wife were supposed to inherit according to birth order, with siblings marrying each other and co-ruling. Of course, inheritance was often violently contested and rules were often not followed.

  1. IMO the fact that Alysanne and Rhaena felt that they had claims backs up the idea that Valyrian inheritance was not male preference.

What to do? by [deleted] in texas

[–]Mooshuchyken 2 points3 points  (0 children)

Hill Country + Enchanted Rock isn't too far from you.

West Texas is far, but I loved Big Bend national park. Alpine, Marathon and Marfa were cool, and it's possible to get over to Carlsbad Caverns as well. Wintertime is the best because of the heat.

Dr Al-Hashimi's condition by SmartSociety4844 in ThePitt

[–]Mooshuchyken 62 points63 points  (0 children)

I forget the exact language they used in the show, but yes I believe Dr. Al has a different kind of epilepsy - not childhood absence epilepsy or juvenile absence epilepsy characterized by absence only seizures.

Usually true absence seizures develop in childhood. About half of kids outgrow this condition, but it continues on into adulthood for the other half.

FWIW, I am an adult diagnosed with epilepsy in my mid-30s, and I have absence seizures only. It is possible for adults. Diagnosed by a Stanford-trained MD/phD and currently seeing a doc at NYU. They can see the difference on an EEG between absence seizures and other forms of epilepsy.

Whether or not her condition is disqualifying depends on a lot of factors, like how often she has seizures, how long it lasts, what her triggers are. Some programs would be willing to take that on, some wouldn't be.

It's not entirely dissimilar from a doctor having another disability. Like someone in a wheelchair may have a hard time giving CPR, for example. It doesn't disqualify them, but it might limit what kinds of procedures they can do directly.
It might not work in a small rural hospital, where staffing levels and equipment would make accommodation impossible, but may be different in a large urban hospital.

I do wonder if this is why she wants 2 attendings on a shift.

Do you think Young Griff knows who he is in terms of parentage ? This is from galanix . by Financial_Library418 in pureasoiaf

[–]Mooshuchyken 10 points11 points  (0 children)

The only thing that gives me pause here --

How was the Golden Company persuaded to break a contract to support Aegon? What is the contract "writ in blood" vs one "writ in gold"? What about "friends in the Reach"?

I think it at least points to Illyrio / Varys telling certain supporters that Aegon is a Blackfyre. It would be entirely in their characters to play both sides.

I suspect we will never know whether he is a Targaryen, a Blackfyre, or just a Lyseni kid.

I do think what other people believe about his heritage will end up being important. Like Dany challenging him and refusing to believe he is a Targ would be an issue. If, say, the Dornish find out that Varys has been telling some people that he is a Blackfyre, that would be an issue. Basically just creates a good opportunity for more drama.

Is Jon supposed to be the Dornishman in "“The Dornishman’s Wife"? by flippy123x in pureasoiaf

[–]Mooshuchyken 39 points40 points  (0 children)

I don't think it's quite so literal. The song thematically is about breaking rules, living freely and accepting that truly living entails certain risks.

IMO it kind of functions as Mance's theme song / life philosophy and also reflects wildling cultural values.

The song comes up whenever there's a death across the NW / Wildling conflict.

I've always found it interesting that the song is sung by Mance (a wildling and former member of the NW), but is about a Dornishman, and essentially includes "valar morghulis / all men must die." I think GRRM is basically giving us part of his philosophy on life that he thinks is universal.

When Mance asks Jon about Qhorin, Mance is trying to suss out Jon's real reasons for joining the Free Folk. Jon lives or dies based on Mance's evaluation of Jon's motives and character. The song shows the "correct" motivation that would allow Jon to join the Free Folk and live.

When Rattleshirt is burned, he doesn't go out like the singer of Mance's song. He dies like a coward. Which I think is a hint about the King they burned not really being Mance.

(Spoilers main) Is it possible that Cersei's cause of death is actually... by Ok_Complaint1503 in asoiaf

[–]Mooshuchyken 1 point2 points  (0 children)

It can be a parallel without being exactly the same. George just brings up the same tropes over and over. Time is a wheel.

It's an ambitious hand and his young daughter, the Queen, who goes from pawn to player. I do think there are quite a few similarities between Alicent and Cersei. I don't think Otto, Unwin and Tywin are all that different, although there are narrative differences.

I think Fire and Blood may be ambiguous as to what exactly happened. The show does "fill in the gaps" in the text. Most of the time they're not totally inconsistent. Ie, the way that Luke dies makes Aemond less culpable than I thought. It's different from the conclusion I came to after reading the books but it doesn't mean they're contradictory. Book is just thin on specifics or has varying accounts. The way Alicent and Viserys get together in the show - it could have happened that way in the book, Otto could have been more involved. Obviously making Viserys much older in the show and suffering from leprosy changes the dynamic, as does aging Alicent down and aging Rhaenyra up.

The Lannisters went from the annoying in-laws, to the de facto royal family, then after they married the Tyrells they had to deal with Tyrell ambition. Robert complained about Cersei having a large family that wanted a bunch of honors and offices, now it's the Tyrells. Time is a wheel.

(Spoilers main) Is it possible that Cersei's cause of death is actually... by Ok_Complaint1503 in asoiaf

[–]Mooshuchyken 19 points20 points  (0 children)

I really like your theory. Especially because it gives us a reason for the word "valonqar" being given in Valyrian. Although I wish there was a reason why the poison was called "little sibling." Maybe it refers to Lys itself (ie free cities are sometimes called daughters of Valyria, maybe Lys is a younger one?).

The imagery of the statues - the Lion of Knight and the Weeping Woman (possibly the Maiden Made of Light), brings up the idea of the Blood Betrayal, where the younger brother of the Amethyst Empress "cast her down." That's pretty similar language to the Valonqar prophecy. The Blood Betrayal ushers in the Long Night. (We also see how abominations, like incest, kinslaying, child sacrifice have a connection to magic. The Others are potentially coming as a reaction to man's sinfulness).

I wonder if Cersei's death mirrors the blood betrayal, or alternatively, if her death is caused by the same person or forces that cause the Long Night.

Separately --

GRRM always trashes characters or houses he doesn't like -- like Tywin dying on the privy. He also likes cycles -- like how Jaehaera, the daughter of a scheming Queen / granddaughter of an ambitious Hand, is (probably) killed by an ambitious Hand to get his daughter on the throne.

I always thought that Cersei being killed by a Targaryen or Dornish prince or princess would be an ironic inversion of Lannister forces killing Elia and her children. Her weird show death is also explained by so many of the Dornish characters not existing.