pain

Ambient awareness & social media

From Clive Thompson’s “Brave New World of Digital Intimacy” (The New York Times Magazine: 5 September 2008):

In essence, Facebook users didn’t think they wanted constant, up-to-the-minute updates on what other people are doing. Yet when they experienced this sort of omnipresent knowledge, they found it intriguing and addictive. Why?

Social scientists have a name for this sort of incessant online contact. They call it “ambient awareness.” It is, they say, very much like being physically near someone and picking up on his mood through the little things he does — body language, sighs, stray comments — out of the corner of your eye. Facebook is no longer alone in offering this sort of interaction online. In the last year, there has been a boom in tools for “microblogging”: posting frequent tiny updates on what you’re doing. The phenomenon is quite different from what we normally think of as blogging, because a blog post is usually a written piece, sometimes quite long: a statement of opinion, a story, an analysis. But these new updates are something different. They’re far shorter, far more frequent and less carefully considered. One of the most popular new tools is Twitter, a Web site and messaging service that allows its two-million-plus users to broadcast to their friends haiku-length updates — limited to 140 characters, as brief as a mobile-phone text message — on what they’re doing. There are other services for reporting where you’re traveling (Dopplr) or for quickly tossing online a stream of the pictures, videos or Web sites you’re looking at (Tumblr). And there are even tools that give your location. When the new iPhone, with built-in tracking, was introduced in July, one million people began using Loopt, a piece of software that automatically tells all your friends exactly where you are.

This is the paradox of ambient awareness. Each little update — each individual bit of social information — is insignificant on its own, even supremely mundane. But taken together, over time, the little snippets coalesce into a surprisingly sophisticated portrait of your friends’ and family members’ lives, like thousands of dots making a pointillist painting. This was never before possible, because in the real world, no friend would bother to call you up and detail the sandwiches she was eating. The ambient information becomes like “a type of E.S.P.,” as Haley described it to me, an invisible dimension floating over everyday life.

“It’s like I can distantly read everyone’s mind,” Haley went on to say. “I love that. I feel like I’m getting to something raw about my friends. It’s like I’ve got this heads-up display for them.” It can also lead to more real-life contact, because when one member of Haley’s group decides to go out to a bar or see a band and Twitters about his plans, the others see it, and some decide to drop by — ad hoc, self-organizing socializing. And when they do socialize face to face, it feels oddly as if they’ve never actually been apart. They don’t need to ask, “So, what have you been up to?” because they already know. Instead, they’ll begin discussing something that one of the friends Twittered that afternoon, as if picking up a conversation in the middle.

You could also regard the growing popularity of online awareness as a reaction to social isolation, the modern American disconnectedness that Robert Putnam explored in his book “Bowling Alone.” The mobile workforce requires people to travel more frequently for work, leaving friends and family behind, and members of the growing army of the self-employed often spend their days in solitude. Ambient intimacy becomes a way to “feel less alone,” as more than one Facebook and Twitter user told me.

David Foster Wallace on being a tourist

From David Foster Wallace’s “Consider the Lobster” (Gourmet: ):

As I see it, it probably really is good for the soul to be a tourist, even if it’s only once in a while. Not good for the soul in a refreshing or enlivening way, though, but rather in a grim, steely-eyed, let’s-look-honestly-at-the-facts-and-find-some-way-to-deal-with-them way. My personal experience has not been that traveling around the country is broadening or relaxing, or that radical changes in place and context have a salutary effect, but rather that intranational tourism is radically constricting, and humbling in the hardest way—hostile to my fantasy of being a real individual, of living somehow outside and above it all. (Coming up is the part that my companions find especially unhappy and repellent, a sure way to spoil the fun of vacation travel:) To be a mass tourist, for me, is to become a pure late-date American: alien, ignorant, greedy for something you cannot ever have, disappointed in a way you can never admit. It is to spoil, by way of sheer ontology, the very unspoiledness you are there to experience. It is to impose yourself on places that in all noneconomic ways would be better, realer, without you. It is, in lines and gridlock and transaction after transaction, to confront a dimension of yourself that is as inescapable as it is painful: As a tourist, you become economically significant but existentially loathsome, an insect on a dead thing.

All about freezing to death

Ice mask, C.T. Madigan / photograph by Frank Hurley
Creative Commons License photo credit: State Library of New South Wales collection

From Peter Stark’s “As Freezing Persons Recollect the Snow–First Chill–Then Stupor–Then the Letting Go” (Outside: January 1997):

There is no precise core temperature at which the human body perishes from cold. At Dachau’s cold-water immersion baths, Nazi doctors calculated death to arrive at around 77 degrees Fahrenheit. The lowest recorded core temperature in a surviving adult is 60.8 degrees. For a child it’s lower: In 1994, a two-year-old girl in Saskatchewan wandered out of her house into a minus-40 night. She was found near her doorstep the next morning, limbs frozen solid, her core temperature 57 degrees. She lived.

The cold remains a mystery, more prone to fell men than women, more lethal to the thin and well muscled than to those with avoirdupois, and least forgiving to the arrogant and the unaware.

Were you a Norwegian fisherman or Inuit hunter, both of whom frequently work gloveless in the cold, your chilled hands would open their surface capillaries periodically to allow surges of warm blood to pass into them and maintain their flexibility. This phenomenon, known as the hunter’s response, can elevate a 35-degree skin temperature to 50 degrees within seven or eight minutes.

Other human adaptations to the cold are more mysterious. Tibetan Buddhist monks can raise the skin temperature of their hands and feet by 15 degrees through meditation. Australian aborigines, who once slept on the ground, unclothed, on near-freezing nights, would slip into a light hypothermic state, suppressing shivering until the rising sun rewarmed them.

The exertion that warmed you on the way uphill now works against you: Your exercise-dilated capillaries carry the excess heat of your core to your skin, and your wet clothing dispels it rapidly into the night. The lack of insulating fat over your muscles allows the cold to creep that much closer to your warm blood.

Your temperature begins to plummet. Within 17 minutes it reaches the normal 98.6. Then it slips below.

At 97 degrees, hunched over in your slow search, the muscles along your neck and shoulders tighten in what’s known as pre-shivering muscle tone. Sensors have signaled the temperature control center in your hypothalamus, which in turn has ordered the constriction of the entire web of surface capillaries. Your hands and feet begin to ache with cold.

At 95, you’ve entered the zone of mild hypothermia. You’re now trembling violently as your body attains its maximum shivering response, an involuntary condition in which your muscles contract rapidly to generate additional body heat.

And after this long stop, the skiing itself has become more difficult. By the time you push off downhill, your muscles have cooled and tightened so dramatically that they no longer contract easily, and once contracted, they won’t relax. You’re locked into an ungainly, spread-armed, weak-kneed snowplow.

As you sink back into the snow, shaken, your heat begins to drain away at an alarming rate, your head alone accounting for 50 percent of the loss. The pain of the cold soon pierces your ears so sharply that you root about in the snow until you find your hat and mash it back onto your head.

But even that little activity has been exhausting. You know you should find your glove as well, and yet you’re becoming too weary to feel any urgency. You decide to have a short rest before going on.

An hour passes. at one point, a stray thought says you should start being scared, but fear is a concept that floats somewhere beyond your immediate reach, like that numb hand lying naked in the snow. You’ve slid into the temperature range at which cold renders the enzymes in your brain less efficient. With every one-degree drop in body temperature below 95, your cerebral metabolic rate falls off by 3 to 5 percent. When your core temperature reaches 93, amnesia nibbles at your consciousness.

In the minus-35-degree air, your core temperature falls about one degree every 30 to 40 minutes, your body heat leaching out into the soft, enveloping snow. Apathy at 91 degrees. Stupor at 90.

You’ve now crossed the boundary into profound hypothermia. By the time your core temperature has fallen to 88 degrees, your body has abandoned the urge to warm itself by shivering. Your blood is thickening like crankcase oil in a cold engine. Your oxygen consumption, a measure of your metabolic rate, has fallen by more than a quarter. Your kidneys, however, work overtime to process the fluid overload that occurred when the blood vessels in your extremities constricted and squeezed fluids toward your center. You feel a powerful urge to urinate, the only thing you feel at all.

By 87 degrees you’ve lost the ability to recognize a familiar face, should one suddenly appear from the woods.

At 86 degrees, your heart, its electrical impulses hampered by chilled nerve tissues, becomes arrhythmic. It now pumps less than two-thirds the normal amount of blood. The lack of oxygen and the slowing metabolism of your brain, meanwhile, begin to trigger visual and auditory hallucinations.

At 85 degrees, those freezing to death, in a strange, anguished paroxysm, often rip off their clothes. This phenomenon, known as paradoxical undressing, is common enough that urban hypothermia victims are sometimes initially diagnosed as victims of sexual assault. Though researchers are uncertain of the cause, the most logical explanation is that shortly before loss of consciousness, the constricted blood vessels near the body’s surface suddenly dilate and produce a sensation of extreme heat against the skin.

There’s an adage about hypothermia: “You aren’t dead until you’re warm and dead.”

At about 6:00 the next morning, his friends, having discovered the stalled Jeep, find him, still huddled inches from the buried log, his gloveless hand shoved into his armpit. The flesh of his limbs is waxy and stiff as old putty, his pulse nonexistent, his pupils unresponsive to light. Dead.

But those who understand cold know that even as it deadens, it offers perverse salvation. Heat is a presence: the rapid vibrating of molecules. Cold is an absence: the damping of the vibrations. At absolute zero, minus 459.67 degrees Fahrenheit, molecular motion ceases altogether. It is this slowing that converts gases to liquids, liquids to solids, and renders solids harder. It slows bacterial growth and chemical reactions. In the human body, cold shuts down metabolism. The lungs take in less oxygen, the heart pumps less blood. Under normal temperatures, this would produce brain damage. But the chilled brain, having slowed its own metabolism, needs far less oxygen-rich blood and can, under the right circumstances, survive intact.

Setting her ear to his chest, one of his rescuers listens intently. Seconds pass. Then, faintly, she hears a tiny sound–a single thump, so slight that it might be the sound of her own blood. She presses her ear harder to the cold flesh. Another faint thump, then another.

The slowing that accompanies freezing is, in its way, so beneficial that it is even induced at times. Cardiologists today often use deep chilling to slow a patient’s metabolism in preparation for heart or brain surgery. In this state of near suspension, the patient’s blood flows slowly, his heart rarely beats–or in the case of those on heart-lung machines, doesn’t beat at all; death seems near. But carefully monitored, a patient can remain in this cold stasis, undamaged, for hours.

In fact, many hypothermia victims die each year in the process of being rescued. In “rewarming shock,” the constricted capillaries reopen almost all at once, causing a sudden drop in blood pressure. The slightest movement can send a victim’s heart muscle into wild spasms of ventricular fibrillation. In 1980, 16 shipwrecked Danish fishermen were hauled to safety after an hour and a half in the frigid North Sea. They then walked across the deck of the rescue ship, stepped below for a hot drink, and dropped dead, all 16 of them.

The doctor rapidly issues orders to his staff: intravenous administration of warm saline, the bag first heated in the microwave to 110 degrees. Elevating the core temperature of an average-size male one degree requires adding about 60 kilocalories of heat. A kilocalorie is the amount of heat needed to raise the temperature of one liter of water one degree Celsius. Since a quart of hot soup at 140 degrees offers about 30 kilocalories, the patient curled on the table would need to consume 40 quarts of chicken broth to push his core temperature up to normal. Even the warm saline, infused directly into his blood, will add only 30 kilocalories.

Ideally, the doctor would have access to a cardiopulmonary bypass machine, with which he could pump out the victim’s blood, rewarm and oxygenate it, and pump it back in again, safely raising the core temperature as much as one degree every three minutes. But such machines are rarely available outside major urban hospitals.

You’d nod if you could. But you can’t move. All you can feel is throbbing discomfort everywhere. Glancing down to where the pain is most biting, you notice blisters filled with clear fluid dotting your fingers, once gloveless in the snow. During the long, cold hours the tissue froze and ice crystals formed in the tiny spaces between your cells, sucking water from them, blocking the blood supply. You stare at them absently.

“I think they’ll be fine,” a voice from overhead says. “The damage looks superficial. We expect that the blisters will break in a week or so, and the tissue should revive after that.”

If not, you know that your fingers will eventually turn black, the color of bloodless, dead tissue. And then they will be amputated.

You’ve seen that in the infinite reaches of the universe, heat is as glorious and ephemeral as the light of the stars. Heat exists only where matter exists, where particles can vibrate and jump. In the infinite winter of space, heat is tiny; it is the cold that is huge.

David Foster Wallace on leadership

From David Foster Wallace’s “The Weasel, Twelve Monkeys And The Shrub: Seven Days In The Life Of The Late, Great John McCain” (Rolling Stone: 13 April 2000):

The weird thing is that the word “leader” itself is cliché and boring, but when you come across somebody who actually is a real leader, that person isn’t cliché or boring at all; in fact he’s sort of the opposite of cliché and boring.

Obviously, a real leader isn’t just somebody who has ideas you agree with, nor is it just somebody you happen to think is a good guy. A real leader is somebody who, because of his own particular power and charisma and example, is able to inspire people, with “inspire” being used here in a serious and non-cliché way. A real leader can somehow get us to do certain things that deep down we think are good and want to be able to do but usually can’t get ourselves to do on our own. It’s a mysterious quality, hard to define, but we always know it when we see it, even as kids. You can probably remember seeing it in certain really great coaches, or teachers, or some extremely cool older kid you “looked up to” (interesting phrase) and wanted to be just like. Some of us remember seeing the quality as kids in a minister or rabbi, or a Scoutmaster, or a parent, or a friend’s parent, or a supervisor in a summer job. And yes, all these are “authority figures,” but it’s a special kind of authority. If you’ve ever spent time in the military, you know how incredibly easy it is to tell which of your superiors are real leaders and which aren’t, and how little rank has to do with it. A leader’s real “authority” is a power you voluntarily give him, and you grant him this authority not with resentment or resignation but happily; it feels right. Deep down, you almost always like how a real leader makes you feel, the way you find yourself working harder and pushing yourself and thinking in ways you couldn’t ever get to on your own.

Lincoln was, by all available evidence, a real leader, and Churchill, and Gandhi, and King. Teddy and Franklin Roosevelt, and de Gaulle, and certainly Marshall and maybe Eisenhower. (Of course Hitler was a real leader too, a very powerful one, so you have to watch out; all it is is a weird kind of power.)

Now you have to pay close attention to something that’s going to seem real obvious. There is a difference between a great leader and a great salesman. Because a salesman’s ultimate, overriding motivation is his own self-interest. If you buy what he’s selling, the salesman profits. So even though the salesman may have a very powerful, charismatic, admirable personality, and might even persuade you that buying really is in your interest (and it really might be) — still, a little part of you always knows that what the salesman’s ultimately after is something for himself. And this awareness is painful … although admittedly it’s a tiny pain, more like a twinge, and often unconscious. But if you’re subjected to enough great salesmen and salespitches and marketing concepts for long enough — like from your earliest Saturday-morning cartoons, let’s say — it is only a matter of time before you start believing deep down that everything is sales and marketing, and that whenever somebody seems like they care about you or about some noble idea or cause, that person is a salesman and really ultimately doesn’t give a shit about you or some cause but really just wants something for himself.

Yes, this is simplistic. All politicians sell, always have. FDR and JFK and MLK and Gandhi were great salesmen. But that’s not all they were. People could smell it. That weird little extra something. It had to do with “character” (which, yes, is also a cliché — suck it up).

Gottman on relationships

From THE MATHEMATICS OF LOVE: A Talk with John Gottman (Edge: 14 April 2004):

So far, his surmise is that “respect and affection are essential to all relationships working and contempt destroys them. It may differ from culture to culture how to communicate respect, and how to communicate affection, and how not to do it, but I think we’ll find that those are universal things”.

Another puzzle I’m working on is just what happens when a baby enters a relationship. Our study shows that the majority (67%) of couples have a precipitous drop in relationship happiness in the first 3 years of their first baby’s life. That’s tragic in terms of the climate of inter-parental hostility and depression that the baby grows up in. That affective climate between parents is the real cradle that holds the baby. And for the majority of families that cradle is unsafe for babies.

So far I believe we’re going to find that respect and affection are essential to all relationships working and contempt destroys them. It may differ from culture to culture how to communicate respect, and how to communicate affection, and how not to do it, but I think we’ll find that those are universal things.

Bob Levenson and I were very surprised when, in 1983, we found that we could actually predict, with over 90 percent accuracy, what was going to happen to a relationship over a three-year period just by examining their physiology and behavior during a conflict discussion, and later just from an interview about how the couple viewed their past. 90% accuracy!

That was surprising to us. It seemed that people either started in a mean-spirited way, a critical way, started talking about a disagreement, started talking about a problem as just a symptom of their partner’s inadequate character, which made their partner defensive and escalated the conflict, and people started getting mean and insulting to one another. That predicted the relationship was going to fall apart. 96% of the time the way the conflict discussion started in the first 3 minutes determined how it would go for the rest of the discussion. And four years later it was like no time had passed, their interaction style was almost identical. Also 69% of the time they were talking about the same issues, which we realized then were “perpetual issues” that they would never solve. These were basic personality differences that never went away. She was more extroverted or she was more of an explorer or he was more punctual or frugal.

Some couples were caught by the web of these perpetual issues and made each other miserable, they were “grid locked” like bumper-to-bumper traffic with these issues, while other couples had similar issues but coped with them and had a “dialogue” that even contained laughter and affection. It seemed that relationships last to the extent that you select someone whose annoying personality traits don’t send you into emotional orbit. Once again conventional wisdom was wrong. The big issue wasn’t helping couples resolve their conflicts, but moving them from gridlock to dialogue. And the secret of how to do that turned out to be having each person talk about their dream within the conflict and bringing Viktor Frankl’s existential logotherapy into the marital boxing ring. Once people talked about what they wished for and hoped for in this gridlock conflict and the narrative of why this was so important to them, in 86% of the cases they would move from gridlock to dialogue. Again a new door opened. Not all marital conflicts are the same. You can’t teach people a set of skills and just apply them to every issue. Some issues are deeper, they have more meaning. And then it turned out that the very issues that cause the most pain and alienation can also be the greatest sources of intimacy and connection.

Another surprise: we followed couples for as long as 20 years, and we found that there was another kind of couple that didn’t really show up on the radar; they looked fine, they weren’t mean, they didn’t escalate the conflict — but about 16 to 22 years after the wedding they started divorcing. They were often the pillars of their community. They seemed very calm and in control of their lives, and then suddenly they break up. Everyone is shocked and horrified. But we could look back at our early tapes and see the warning signs we had never seen before. Those people were people who just didn’t have very much positive connection. There wasn’t very much affection — and also especially humor — between them.

…These sorts of emotionally disconnected relationships were another important dimension of failed relationships. We learned through them that the quality of the friendship and intimacy affects the nature of conflict in a very big way.

One of the major things we found is that honoring your partner’s dreams is absolutely critical. A lot of times people have incompatible dreams — or they don’t want to honor their partner’s dreams, or they don’t want to yield power, they don’t want to share power. So that explains a lot of times why they don’t really belong together.

Psycho-physiology is an important part of this research. It’s something that Bob Levenson brought to the search initially, and then I got trained in psycho-physiology as well. And the reason we’re interested in what was happening in the body is that there’s an intimate connection between what’s happening to the autonomic nervous system and what happening in the brain, and how well people can take in information — how well they can just process information — for example, just being able to listen to your partner — that is much harder when your heart rate is above the intrinsic rate of the heart, which is around a hundred to a hundred and five beats a minute for most people with a healthy heart.

At that point we know, from Loren Rowling’s work, that people start secreting adrenalin, and then they get into a state of diffuse physiological arousal (or DPA) , so their heart is beating faster, it’s contracting harder, the arteries start getting constricted, blood is drawn away from the periphery into the trunk, the blood supply shuts down to the gut and the kidney, and all kinds of other things are happening — people are sweating, and things are happening in the brain that create a tunnel vision, one in which they perceive everything as a threat and they react as if they have been put in great danger by this conversation.

Because men are different. Men have a lot of trouble when they reach a state of vigilance, when they think there’s real danger, they have a lot of trouble calming down. and there’s probably an evolutionary history to that. Because it functioned very well for our hominid ancestors, anthropologists think, for men to stay physiologically aroused and vigilant, in cooperative hunting and protecting the tribe, which was a role that males had very early in our evolutionary history. Whereas women had the opposite sort of role, in terms of survival of the species, those women reproduced more effectively who had the milk-let-down reflex, which only happens when oxytocin is secreted in the brain, it only happens when women — as any woman knows who’s been breast-feeding, you have to be able to calm down and relax. But oxytocin is also the hormone of affiliation. So women have developed this sort of social order, caring for one another, helping one another, and affiliating, that also allows them to really calm down and have the milk let-down reflex. And so — it’s one of nature’s jokes. Women can calm down, men can’t; they stay aroused and vigilant.

Physiology becomes really critical in this whole thing. A provocative finding from Alyson Shapiro’s recent dissertation is that if we take a look at how a couple argues when the woman is in the sixth month of pregnancy, we can predict over half the variation in the baby, the three-month-old baby’s vagal tone, which is the ability of the vagus nerve, the major nerve of the parasympathetic branch of the autonomic nervous system, which is responsible for establishing calm and focusing attention. That vagus nerve in the baby is eventually going to be working well if the parents, during pregnancy, are fighting with each other constructively. That takes us into fetal development, a whole new realm of inquiry.

You have to study gay and Lesbian couples who are committed to each other as well as heterosexual couples who are committed to each other, and try and match things as much as you can, like how long they’ve been together, and the quality of their relationship. And we’ve done that, and we find that there are two gender differences that really hold up.

One is that if a man presents an issue, to either a man he’s in love with or a woman he’s in love with, the man is angrier presenting the issue. And we find that when a woman receives an issue, either from a woman she loves or a man she loves, she is much more sad than a man would be receiving that same issue. It’s about anger and sadness. Why? Remember, Bowlby taught us that attachment and loss and grief are part of the same system. So women are finely tuned to attaching and connecting and to sadness and loss and grief, while men are attuned to defend, stay vigilant, attack, to anger. My friend Levenson did an acoustic startle study (that’s where you shoot of a blank pistol behind someone’s head when they least expect it). Men had a bigger heart rate reactivity and took longer to recover, which we would expect, but what even more interesting is that when you asked people what they were feeling, women were scared and men were angry.

So that’s probably why those two differences have held up. Physiologically people find over and over again in heterosexual relationships — and this hasn’t been studied yet in gay and Lesbian relationships — that men have a lower flash point for increasing heart-rate arousal, and it takes them longer to recover. And not only that, but when men are trying to recover, and calm down, they can’t do it very well because they keep naturally rehearsing thoughts of righteous indignation and feeling like an innocent victim. They maintain their own vigilance and arousal with these thoughts, mostly of getting even, whereas women really can distract themselves and calm down physiologically from being angered or being upset about something. If women could affiliate and secrete oxytocin when they felt afraid, they’s even calm down faster, probably.

How it feels to drown, get decapitated, get electrocuted, and more

From Anna Gosline’s “Death special: How does it feel to die?” (New Scientist: 13 October 2007):

Death comes in many guises, but one way or another it is usually a lack of oxygen to the brain that delivers the coup de grâce. Whether as a result of a heart attack, drowning or suffocation, for example, people ultimately die because their neurons are deprived of oxygen, leading to cessation of electrical activity in the brain – the modern definition of biological death.

If the flow of freshly oxygenated blood to the brain is stopped, through whatever mechanism, people tend to have about 10 seconds before losing consciousness. They may take many more minutes to die, though, with the exact mode of death affecting the subtleties of the final experience.

Drowning

Typically, when a victim realises that they cannot keep their head above water they tend to panic, leading to the classic “surface struggle”. They gasp for air at the surface and hold their breath as they bob beneath, says Tipton. Struggling to breathe, they can’t call for help. Their bodies are upright, arms weakly grasping, as if trying to climb a non-existent ladder from the sea. Studies with New York lifeguards in the 1950s and 1960s found that this stage lasts just 20 to 60 seconds.

When victims eventually submerge, they hold their breath for as long as possible, typically 30 to 90 seconds. After that, they inhale some water, splutter, cough and inhale more. Water in the lungs blocks gas exchange in delicate tissues, while inhaling water also triggers the airway to seal shut – a reflex called a laryngospasm. “There is a feeling of tearing and a burning sensation in the chest as water goes down into the airway. Then that sort of slips into a feeling of calmness and tranquility,” says Tipton, describing reports from survivors.

That calmness represents the beginnings of the loss of consciousness from oxygen deprivation, which eventually results in the heart stopping and brain death.

Heart attack

The most common symptom is, of course, chest pain: a tightness, pressure or squeezing, often described as an “elephant on my chest”, which may be lasting or come and go. This is the heart muscle struggling and dying from oxygen deprivation. Pain can radiate to the jaw, throat, back, belly and arms. Other signs and symptoms include shortness of breath, nausea and cold sweats.

Most victims delay before seeking assistance, waiting an average of 2 to 6 hours. Women are the worst, probably because they are more likely to experience less well-known symptoms, such as breathlessness, back or jaw pain, or nausea, says JoAnn Manson, an epidemiologist at Harvard Medical School.

Even small heart attacks can play havoc with the electrical impulses that control heart muscle contraction, effectively stopping it. In about 10 seconds the person loses consciousness, and minutes later they are dead.

Bleeding to death

People can bleed to death in seconds if the aorta, the major blood vessel leading from the heart, is completely severed, for example, after a severe fall or car accident.

Death could creep up much more slowly if a smaller vein or artery is nicked – even taking hours. Such victims would experience several stages of haemorrhagic shock. The average adult has 5 litres of blood. Losses of around 750 millilitres generally cause few symptoms. Anyone losing 1.5 litres – either through an external wound or internal bleeding – feels weak, thirsty and anxious, and would be breathing fast. By 2 litres, people experience dizziness, confusion and then eventual unconsciousness.

Fire

Long the fate of witches and heretics, burning to death is torture. Hot smoke and flames singe eyebrows and hair and burn the throat and airways, making it hard to breathe. Burns inflict immediate and intense pain through stimulation of the nociceptors – the pain nerves in the skin. To make matters worse, burns also trigger a rapid inflammatory response, which boosts sensitivity to pain in the injured tissues and surrounding areas.

Most people who die in fires do not in fact die from burns. The most common cause of death is inhaling toxic gases – carbon monoxide, carbon dioxide and even hydrogen cyanide – together with the suffocating lack of oxygen. One study of fire deaths in Norway from 1996 found that almost 75 per cent of the 286 people autopsied had died from carbon monoxide poisoning.

Depending on the size of the fire and how close you are to it, concentrations of carbon monoxide could start to cause headache and drowsiness in minutes, eventually leading to unconsciousness. According to the US National Fire Protection Association, 40 per cent of the victims of fatal home fires are knocked out by fumes before they can even wake up.

Decaptitation

Beheading, if somewhat gruesome, can be one of the quickest and least painful ways to die – so long as the executioner is skilled, his blade sharp, and the condemned sits still.

Quick it may be, but consciousness is nevertheless believed to continue after the spinal chord is severed. A study in rats in 1991 found that it takes 2.7 seconds for the brain to consume the oxygen from the blood in the head; the equivalent figure for humans has been calculated at 7 seconds.

It took the axeman three attempts to sever the head of Mary Queen of Scots in 1587. He had to finish the job with a knife.

Decades earlier in 1541, Margaret Pole, the Countess of Salisbury, was executed at the Tower of London. She was dragged to the block, but refused to lay her head down. The inexperienced axe man made a gash in her shoulder rather than her neck. According to some reports, she leapt from the block and was chased by the executioner, who struck 11 times before she died.

Electrocution

In accidental electrocutions, usually involving low, household current, the most common cause of death is arrhythmia, stopping the heart dead. Unconsciousness ensues after the standard 10 seconds, says Richard Trohman, a cardiologist at Rush University in Chicago. One study of electrocution deaths in Montreal, Canada found that 92 per cent had probably died from arrhythmia.

Higher currents can produce nearly immediate unconsciousness.

Fall from a height

A high fall is certainly among the speediest ways to die: terminal velocity (no pun intended) is about 200 kilometres per hour, achieved from a height of about 145 metres or more. A study of deadly falls in Hamburg, Germany, found that 75 per cent of victims died in the first few seconds or minutes after landing.

The exact cause of death varies, depending on the landing surface and the person’s posture. People are especially unlikely to arrive at the hospital alive if they land on their head – more common for shorter (under 10 metres) and higher (over 25 metres) falls. A 1981 analysis of 100 suicidal jumps from the Golden Gate Bridge in San Francisco – height: 75 metres, velocity on impact with the water: 120 kilometres per hour – found numerous causes of instantaneous death including massive lung bruising, collapsed lungs, exploded hearts or damage to major blood vessels and lungs through broken ribs.

Survivors of great falls often report the sensation of time slowing down. The natural reaction is to struggle to maintain a feet-first landing, resulting in fractures to the leg bones, lower spinal column and life-threatening broken pelvises. The impact travelling up through the body can also burst the aorta and heart chambers. Yet this is probably still the safest way to land, despite the force being concentrated in a small area: the feet and legs form a “crumple zone” which provides some protection to the major internal organs.

Some experienced climbers or skydivers who have survived a fall report feeling focused, alert and driven to ensure they landed in the best way possible: relaxed, legs bent and, where possible, ready to roll.

Hanging

Suicides and old-fashioned “short drop” executions cause death by strangulation; the rope puts pressure on the windpipe and the arteries to the brain. This can cause unconsciousness in 10 seconds, but it takes longer if the noose is incorrectly sited. Witnesses of public hangings often reported victims “dancing” in pain at the end of the rope, struggling violently as they asphyxiated. Death only ensues after many minutes, as shown by the numerous people being resuscitated after being cut down – even after 15 minutes.

When public executions were outlawed in Britain in 1868, hangmen looked for a less performance-oriented approach. They eventually adopted the “long-drop” method, using a lengthier rope so the victim reached a speed that broke their necks. It had to be tailored to the victim’s weight, however, as too great a force could rip the head clean off, a professionally embarrassing outcome for the hangman.

Despite the public boasting of several prominent executioners in late 19th-century Britain, a 1992 analysis of the remains of 34 prisoners found that in only about half of cases was the cause of death wholly or partly due to spinal trauma. Just one-fifth showed the classic “hangman’s fracture” between the second and third cervical vertebrae. The others died in part from asphyxiation.

Lethal injection

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Michael Spence, an anthropologist at the University of Western Ontario in London, Canada, has found similar results in US victims. He concluded, however, that even if asphyxiation played a role, the trauma of the drop would have rapidly rendered all of them unconscious. “What the hangmen were looking for was quick cessation of activity,” he says. “And they knew enough about their craft to ensure that happened. The thing they feared most was decapitation.”
Lethal injection

US-government approved, but is it really painless?

Lethal injection was designed in Oklahoma in 1977 as a humane alternative to the electric chair. The state medical examiner and chair of anaesthesiology settled on a series of three drug injections. First comes the anaesthetic thiopental to speed away any feelings of pain, followed by a paralytic agent called pancuronium to stop breathing. Finally potassium chloride is injected, which stops the heart almost instantly.

Each drug is supposed to be administered in a lethal dose, a redundancy to ensure speedy and humane death. However, eyewitnesses have reported inmates convulsing, heaving and attempting to sit up during the procedure, suggesting the cocktail is not always completely effective.

Explosive decompression

In real life there has been just one fatal space depressurisation accident. This occurred on the Russian Soyuz-11 mission in 1971, when a seal leaked upon re-entry into the Earth’s atmosphere; upon landing all three flight crew were found dead from asphyxiation.

Most of our knowledge of depressurisation comes from animal experiments and the experiences of pilots in accidents at very high altitudes. When the external air pressure suddenly drops, the air in the lungs expands, tearing the fragile gas exchange tissues. This is especially damaging if the victim neglects to exhale prior to decompression or tries to hold their breath. Oxygen begins to escape from the blood and lungs.

Experiments on dogs in the 1950s showed that 30 to 40 seconds after the pressure drops, their bodies began to swell as the water in tissues vaporised, though the tight seal of their skin prevented them from “bursting”. The heart rate rises initially, then plummets. Bubbles of water vapour form in the blood and travel through the circulatory system, obstructing blood flow. After about a minute, blood effectively stops circulating.

Human survivors of rapid decompression accidents include pilots whose planes lost pressure, or in one case a NASA technician who accidentally depressurised his flight suit inside a vacuum chamber. They often report an initial pain, like being hit in the chest, and may remember feeling air escape from their lungs and the inability to inhale. Time to the loss of consciousness was generally less than 15 seconds.

Syrian-style torture via family connections

From D. Ghirlandaio’s “Comment to Stephen Griffin’s ‘Torture and the Ticking Time Bomb'” (10 October 2006):

The Syrians had a technique for the ticking bomb scenario. Give the man who knows where the bomb is a cell phone. “Call your mother.” At the mother’s house, a man picks up the phone.

The end of days in Slab City

From Charlie LeDuff’s “Parked in a Desert, Waiting Out the Winter of Life” (The New York Times: 17 December 2004):

Directions to purgatory are as follows: from Los Angeles drive east past Palm Springs into the bowels of the Mojave Desert. Turn south at the stench of the Salton Sea. Proceed down Highway 111 to the town of Niland, a broken-down place of limited possibilities.

Turn left on Main Street and head down the road to the railroad tracks where the law sometimes waits, as though the tracks were an international boundary.

“Where you going?” asked the deputy, Frank Lopez, on a recent night, even though the road leads to just one place. The Slabs.

Bored stiff, the deputy spun a ghost story about drugged-out crazies, a cult in a blue bus, a child molester, a man who sleeps with rattlesnakes, a mobster on the lam, and old people, flocks of old people who have traded in their picket fences for a mobile home and a life on the drift. …

Five miles down is the sign, “Welcome to Slab City,” marking the entrance of this former World War II military base. The only suggestion of life this night was the flickering of campfires. …

Pastor Hyatt, at 69, has inherited the burden of living. His wife, Audrey, died this year after suffering a stroke here in the desert wasteland. The memory of her scent is everywhere.

“Ah, he’s lonely, and it’s tough to see it,” said Rusty, 73, who sat at the pastor’s fire, warming himself. Rusty looked and smelled like a bum — the price paid, he said, for freedom. “Nobody particularly wants to die out here in the desert, but the living’s free.”

Slab City is not so sinister as it is a strange, forlorn quarter of America. It is a town that is not really a town, a former training grounds with nothing left but the concrete slabs where the barracks stood. Gen. George S. Patton trained troops here. Pilots of the Enola Gay practiced their atomic mission, dropping dummy bombs into the sea.

The land belongs to the state, but the state, like the law, does not bother, and so the Slabs have become a place to park free. More than 3,000 elderly people settle in for the winter, in a pattern that dates back at least 20 years. They are mostly single, divorced or widowed — a whole generation on the road, independent, alone. In this place, to be 55 years old is to be young.

There are no amenities; no potable water, no electricity, no sewerage. Groceries can be picked up in town at the grubby market whose managers do not seem to mind that hundreds of people fill their jugs from the water tap. Mail is routed to a post office box — Niland, CA 92257. Gasoline is bought in distant towns like Brawley; prescriptions and liquor are bought in Mexico. Sewage is held in storage tanks or holes in the ground.

The north side of Main Street is Poverty Flats. The south side, the suburbs, where the relatively well-to-do motorhomies have their dinner dances and clubhouse trailers.

Cole Robertson lives in the Flats with his wife, Mabel. Mr. Robertson, 72, is a retired construction worker from East Texas who cuts an intimidating figure, sitting shirtless, with one rheumy eye, a watermelon physique and a cotton fields vocabulary. An argument with a neighbor last year ended with one of the Robertsons’ trailers in flames. That is how law is dispensed in the Flats, vigilante style. One man was dragged to death a few years ago, another shot in the kneecap last year. Occasionally, the deputies do come around, usually in the day to exercise a warrant or to remove children who have not been seen in school for months. But normally, justice comes at the end of a matchstick in the Flats.

“There ain’t no rules,” Mr. Robertson said. He told of his neighbors, an aging man who lives with his voices in the rundown bus, a geriatric transvestite, a no-good who strapped his kid to a tree and left him in the sun.

A few years ago, a man tried making scrap metal from an unexploded aluminum shell he found at the bombing range in the nearby Chocolate Mountains. He succeeded but at the cost of his own life. His legs had to be picked from a tree.

It was in this anarchy, eight years ago, that Pastor Hyatt stumbled upon his life’s purpose. He discovered the Slabs quite by accident. He and Audrey had packed up their whole life, sold the house in Lebanon, Ore., left their jobs at the titanium plant where he was a shift foreman, said goodbye to their children and to their obligations and struck out on the road.

He was not always a good man, he admits that. He had a temper and hard fists. But he came across a band of rolling revivalists that first year on the road, and followed them to Minnesota. He was ordained by the World Wide Ministries without ever studying at seminary and seems a little embarrassed by this.

Stuck near Niland, the pastor inquired about a place to camp in an R.V. for the evening. A stranger told him about the Slabs, five miles down the road.

Upon seeing the privation and sadness and isolation, the preacher and his wife believed that the Creator had given them a second life. They built the Slab City Christian Center out of modular housing and began to preach and feed October through April, when the weather is clement and the Slabs come to life.

When people were found dead in their trailers, the pastor and his wife were there with a Psalm. They gave children rides to the hospital. The Hyatts paid for the work from their life savings. But Audrey was felled by a stroke in February and passed in May.

When she died, the pastor’s self-assurance faltered and he found that he had become one of the lost, emotionally stranded with one foot in hell and the other on an ice cube. …

Rusty, the doubter who cleans his shirt once a week in a bucket. Rusty, who tells about a prepubescent military career. Rusty, whose smell and language come from the stables. Rusty, who came in on a bus and says he ran a militia out of this camp for 12 years in case the Mexicans invaded from the south or the F.B.I. from the east.

“Everybody can’t fit in to the middle-class life,” said Rusty, who wore a military shirt and cap, military boots and long fingernails as thick as seashells. Suffice it to say, Rusty does not want people to know him and does not disclose his last name.

The evening was cold and dark, the air thick with the smells of burning salt oak as Slab City went to sleep. A Frank Sinatra record played somewhere across the salt flats. The thunder of bombs clapped on the far side of the Chocolate Mountains. Rusty smoked by himself in his broken-down camper with the flat wheels and camouflage netting. A lamp burned in the pastor’s trailer.

Rusty talked about a daughter who did not want anything to do with him; a wife he reckoned was working a truck stop somewhere between California and Texas. But Rusty is human. He dreams of a rich woman from the south side of the Slabs. They wear makeup, those girls over there in the R.V.’s. They use toilets instead of buckets. They have class. It’s never going to happen, he says. “I’d love to have company, but I can’t dance anymore,” he said. “I got old legs, but I’m a good conversationalist. But those women over there, they’re stuck up. Middle-class stuck up.”

The senior citizens on the south side of town travel in a sort of lonely-hearts club tailgate. They are alone, having suffered a late-life divorce or the death of a longtime partner. Their vehicles are big, expensive Coachmen and Fleetwoods and Ramblers and the like. They work as a sort of neighborhood watch, and the denizens of the Flats do not cross the imaginary line.

The majority of the society is women. They come to the Slabs because it is free and close to Mexico, where liquor and prescription medicine can be bought cheap. They are educated, savvy about life and competent mechanics.

Donna Lee Cole is a member of Loners on Wheels, a rolling singles club with chapters across the United States. Mrs. Cole says there are at least 10,000 people who belong to this subsociety of aged hobos, people who drive around in search of nothing except tomorrow. They tend to be women, she said, because women live longer than men. …

“We women aren’t looking for a man,” she explained. “The divorcees walked away from a bad situation and don’t want another one. The widows draw Blue Cross and their husband’s Social Security and would lose it if they married a new man. So you don’t bother. You’re just looking for some company.”

Besides, Mrs. Cole says, look at the quality of men, no offense. “They’re bald and paunchy and toothless. I’m old, but I’m not dead.” …

The lonely-hearts clubs have happy hour and social mixers, dances twice a week and trips to town for steak dinners. Still, the Elvis generation goes to bed early and goes to bed alone.

“I was married 46 years,” says Tina Faye at the afternoon mixer at the L.O.W. slab. At 80, Mrs. Faye strikes an exotic figure, lean, rouged, coiffed, with a voice as thick as apricot nectar.

“My man told me to go on if I was to outlive him. So I took to the road. But I feel him sitting there right next to me. I can’t let him go.”

The mood is a bit sad until Ruth Halford, a 74-year-old-widow with a silver permanent, pipes up. “I’m not sad about anything. I don’t owe nobody nothing. I scratch my plans in the dirt. I’m not looking for anybody. The only person I’m in love with is me. Right, girls?”

This is maddening to the eligible bachelor, like a dog chasing a pork chop on a string. A waste of a perfectly beautiful woman.

“Those girls, they get to being independent and they don’t need men,” said John Clairmont, 77, a retired truck driver. “You can never get them to come home with you.” …

The pastor talked about random things from his life with his wife. The snowstorms and eggs in a rooming house. The smell of her hair. Ceramic snowmen she collected. Her face lighted by the dashboard lights. Recipes the children do not ask for. Grandchildren who, chances are, will not remember her name. Death in the desert in some nameless place without longitude or shade.

“That’s the tragedy of old age,” the pastor said as his eyes welled once again. “I’m alone. I’m derelict without her.”

Rusty stared at his feet.

What would it be like to feel no pain?

From CNN’s “World without pain is hell, parent says“:

Roberto is one of 17 people in the United States with “congenital insensitivity to pain with anhidrosis,” referred to as CIPA by the few people who know about it. …

Other abnormalities quickly surfaced. Roberto was severely susceptible to heatstroke on hot summer days. His parents soon noticed he did not sweat.

“You can’t carry Roberto because he sucks your heat from your body. You’re hot, sweaty. His body can’t sweat like yours so he’s just absorbing all of your heat,” Stingley-Salazar said.

His family was shocked when Roberto started teething. He gnawed on his own tongue, lips and fingers to the point of mutilation. …

Axelrod has studied this family of “no-pain” diseases for more than 35 years. These genetic disorders affect the autonomic nervous system — which controls blood pressure, heart rate, sweating, the sensory nerve system and the ability to feel pain and temperature. …

CIPA is the most severe and fatal type of the seven types of hereditary sensory and autonomic neuropathy, or HSAN. Overheating kills more than half of all children with CIPA before age 3, Stingley-Salazar said.

According to Axelrod, levels of pain vary.

“For some children it’s a mild degree such as breaking a leg, they’ll get up and walk on the leg. They feel that something is uncomfortable but they keep on moving,” she said. “For other children, the pain loss is so severe that they can injure themselves repetitively and actually mutilate themselves because they don’t know when to stop.”

All HSAN disorders are recessive genetic disorders — both parents have to carry the genetic mutation in order to pass it on to a child. But there is less than a 1-in-4 chance that the child will develop it. …

A more common HSAN condition is familial dysautonomia, or FD. There are about 500 cases of FD in the United States, Axelrod said.

The first sign of FD is a child’s inability to suck properly followed by delayed milestones — these children walk and speak later.

Often, FD patients endure severely dry eyes because they are unable to produce tears.

Also, part of this sensory disorder is difficulty “telling where they are in space,” Axelrod said.

The minor effect is constantly bumping into things. The major effect is that 80 percent of these kids suffer curvature of the spine because they have no concept of posture.