NY has a progressive rate starting at 4% for $8200 and going up to 8.82% over $1 million. It ranks among the highest bottom rates and top rates and in addition to that, we also have one of the highest sales taxes, some of the highest property taxes, etc in the country. The state also pushes a lot its costs, like much of the cost of Medicaid, to the county level, where the expenses aren't seen in the state's budget expenditures.

California spent $145 billion last year for 34 million people ($4265 per capita). New York spent $135 billion for 19 million ($7105 per capita).

NY has been strangling business and people economically for years, but as long as NYC was humming along, nobody important cares. We haven't had a governor from outside the Hudson Valley Corridor in more than a century, NYC (one man in particular) straight up controls the Assembly and the Senate has been a farce for quite some time. There's a governor that is simultaneously telling people that they can GTFO of the state if they don't believe the same things he does while also begging businesses to come into NY by granting them a decade of complete tax exemption if they open near a college, even if it screws existing businesses and forces them to close or leave the state.

Frankly, I'm not sure NY does ANYTHING right... the only reason I stay is family, but things are getting bad enough that I may just have to leave anyway.

Mine has slowly morphed away from a book/media store as well. It started with focusing on the coffee shop, encouraging people to hang out and have coffee while they read a book - a book they aren't going to buy, but may very well drip their coffee into. I don't even like the smell of coffee, but I'll be damned if I'm going to pay full retail for a used book unless it's something I have to have right away. That's if they even have it now that they've cut down the selection of books to focus on toys and other crap. So, why drive 60 miles round trip to go to the "book" store and have a crappy experience when I can buy it from amazon for under MSRP and get it shipped in 2 days for free?

I think somewhere, they lost the idea that the core of the business is selling books and other media. The books became a draw to get people in the door to buy coffee and now it just seems to be "throw anything out on the floor that might make money." In general, the Nook was a nod back to that, but the pricing simply isn't that favorable compared to a paper book and combined with the Nook's forced limitations, they left me no compelling reason to buy one or their ebooks.

Back in 1998, my dad had a brain aneurysm (his second, the first was a ruptured brain aneurysm when he was a teenager that he survived without any impairment othe than an aneurysm clip on his left carotid arterty) that required a coil embolization (a new technique at the time, he was the 7th patient they had done at this hospital). After placing the coils, a clot broke free resulting in a stroke. He was recovering well and was almost fully functional, when two weeks later when he developed hydrocephalus, so they placed a ventriculostomy to relieve the pressure. Two days after that while doing a CT to check the placement of the catheter, they found an infection in his brain stem (later to also note that he had developed a left ear infection), which required a craniotomy. That resulted in him being in a coma and on a ventilator.

The only directive he had ever given me was that he didn't want to live on a machine... That ventilator weighed heavily on me. The doctors told me that he had three days to come out of his coma or he probably never would. In an effort to try to get any type of response out of him, they would twist his nipples so hard that they bled. My sister's 14th birthday was on day 5 of the affair and I decided that there was a difference between living on a machine and recovering from a serious incident for a few days. If he didn't come out of the coma, I would pull him off the ventilator on day 7 - just in case he hung on, I didn't want him to die on my sister's birthday.
He woke up on day 3 and ended up on the ventilator for about a week. It was that incident that finalized his brain damage, Essentially, he was a 41 year old that lost the entire top half of the right side of his brain. He wasn't moving his left side at all, he wasn't able to talk well, his short term memory was totally gone, he couldn't even sit up without falling over and could barely swallow a pureed and thickened diet. After 2.5 months of trying to get him stable enough to leave, he went to rehab where he stayed for another 2.5 months.

After rehab, he came home to live with me... and he regained almost all of his mental faculties. He could walk with assistance, having regained most of the major muscle control in his left leg, but his primary long term deficits were the loss of his left arm and the neglect of the left side of his field of vision. The kicker? He remembers every word that was said to him while he was in a coma. The doctors can't believe that the person they see corresponds to the brain imaging that they're looking at... while they expect that amount of plasticity in a younger individual, it's extremely rare in an adult. Needless to say, he was pretty happy with his life, though he faced the usual depression and whatnot that comes with such a significant change in his lifestyle.

Fast forward to this year... he had mastoiditis in the same ear as that infection back in 1998 and took two courses of antibiotics to get rid of it. Five months later, he went blind and started exhibiting stroke symptoms. I took him to the hospital and he was diagnosed with an abscess in his occiptal lobe (visual cortex) that penetrated the ventricles, causing ventriculits. To do imaging and a lumbar puncture, they ended up needing to sedate him and he ended up on a ventilator. Broad spectrum antibiotics (flagyl, vancomycin, and ceftriaxone) were started that night. A week in, he was, once again, no longer responding to pain.

Once again, I was stuck with confronting my father being on a ventilator and essentially in a coma. Once again, the doctors came through telling me that the odds of survival weren't very good and that, given the previous brain damage to the other side of his brain, now that both sides were involved and with little reserve brain left, he almost certainly wouldn't recover.... but there was still a chance that, if I stopped treatment, he could survive, though it wasn't likely. I decided that my dad would want the only option that gave him any chance of an outcome worse than death, so I convinced neurosurgery to try a ventriculostomy again... and two days later, he started following commands again and another three days later, he was taken off the ventilator, breathing on his own and talking, though there was some aphasia.

Seventeen days in, my dad left the ICU and went to a floor bed, where he continued his course of IV anitbiotics. He was improving on almost a day to day basis and a month later, he was probably 75% back to normal... he had even regained his vision. We started talking discharge and plans for follow up, but there was still the problem of the antibiotics and when to stop them. Infectious Disease recommended an 8 week course since nothing from the LP or ventriculostomy ever cultured but we could tell the anitbiotics were working.

With two days left to go, the vancomycin attacked his kidneys and he went into acute renal failure. He left the floor and went back to the ICU, where he spent a week on dialysis (three treatments). His kidneys recovered even to be able to maintain themselves without dialysis but his urea and sodium levels were all over the place... Once again, my dad was confused, lethargic and unable to follow commands. Every once in a while, everything would align and he would be somewhat normal.

Then one day, I came in and his face was droopy, the left half of his tongue was numb and rolling over on itself, plus he was gnawing on it (fortunately, he has no teeth). A positive blood test and imaging showed that, once again, the infection was back. Ten days into this course of antibiotics, we placed another ventricular catheter so that we could stop antibiotics and sample his spinal fluid (as well as to check for hydrocephalus since his ventricles appeared loculated) a week later. The CSF was negative for infection but in the meantime, I started to see signs of mental improvement. Ten days later, my dad was medically cleared to leave the hospital and go to rehab... well, then the next day, his sodium level spiked again.
That was a weke ago now. The last two days, he's been fully awake and alert and communicating pretty well. There's still some aphasia and the nurses neglected his oral care, so he had a buildup of yeast, mucous and blood in his mouth. He's moving everything that I expect him to move and he's able to see and make out objects, though I don't know if it's good enough to read yet. I tell the family that he's not out of the woods yet but we can touch the grass.

Now, my dad is a remarkable case... definitely one for doctors to study. Chances are that it was the massive stroke 14 years ago that allowed him to survive the ventriculitis by allowing the ventricles room to expand rather than to crush the brain from the inside out. I'm sure he's going to have some residual effects from the latest trauma going forward, but he's happy to be alive right now.

Fully accepting that my dad always seems to be an exception to the odds, I think it's important to keep in mind that we don't always know as much as we'd like to think we do. My dad's been read his last rites (I'm an atheist, but it's not my job to denounce his beliefs on his death bed for my "benefit") three times and we've been told that he has either little or no chance of survival probably a dozen times by different doctors through the three brain incidents in his life. It's amazing what we can manage to survive, even thriving after everyone but you has already decided its time to give up.

Most people aren't going to be like my dad... but having been the one, as his health care proxy and power of attorney, that has to make the decisions for him, please, please tell your next of kin what you want, even if it is just some general guidelines. Assign someone to be your proxy that you can trust to make the decisions you would want to make yourself. It's very easy as a proxy to exercise your desirss instead of the desires of the person you're actually making the decisions for. Nobody wants to talk about death... even after the second aneurysm and stroke, my dad still refused to give me any guidance about what to do in the event of another hospitalization or even what he would want for a funeral (which will happen some day). I know it's an uncomfortable subject, but it's a lot harder for your loved one to make the decisions you would want, if you refuse to talk to them about it.

My ISP expressly bans servers in their TOS, yet I've been running web/ftp/mail/ssh since my 24/7 connected dialup days at another ISP in the 90s and I've run various other servers for different uses over the years like anl IRC server where my friends and I would play networked AD&D games after I wrote some bots for various tools like dice rolling. I have a dynamic IP that changes every 12-24 months with the most frequent changes occuring about 6 years ago when it changed 3 times in one year.

My ISP has never complained and none of it has ever been an issue... and in return, I've gotten a ton of experience, albeit not full blown enterprise level experience, of how to manage and run such services myself, including, for their day, a pretty massive number of incoming hits from freshmeat and slashdot when I mentioned some software I had written a decade ago (sure, the numbers were small compared to what goes on at enterprise servers, but I got to learn about throttling and whatnot to keep my then meager 384kbps uplink usable in such a situation). On top of that, there was learning about how to build/maintain NFS, LDAP, keeping filesystems backed up over the network, syncing my development box with my server with rsync, writing scripts to do things like automatically update my IP if/when it changes or to insert iptable rules for people trying to break into ssh/ftp, etc.

Yeah, I could have just paid for hosting somewhere, but I would have learned a lot less... The hobby sites were mostly for fun but I had just as much fun learning how to handle the administrator side of it all. Chances are, those of us posting at slashdot are kinda nerdy like that and if we don't do it as a profession, we still might to want to learn such things as a hobby, at which point, doing it yourself is the best way. I also ran my own pre-LFS self-compiled/configured distro before eventually switching to gentoo to semi-automate it.

In 14 years of driving it, I can't say I remember a time where I ever got the wrong function while using the single stalk in my truck. There are times when I've gone to turn off the high beam and pulled too far, triggering the beam flash, but I've never turned my wipers on only to trigger the turn signal. There are times, usually when it is really cold, that the multifunction switch doesn't want to work at all, but never does it trigger wrong for me.

But maybe I'm lucky and I got the only multifunction switch that isn't hard to mistrigger or maybe you're unlucky or there's something wrong with your technique. Every function except the wipers is a one finger thing for me, the wipers are three - my thumb, index and middle fingers as I roll it.

My 98 Ranger has a multifunction switch that really isn't that hard to master. Up/Down is the turn signal, forward is high beam, backward flashes the high beam, twist the knob for wiper control (off or about 6 speed settings) and push the end in for washer fluid. It took all of about 30 seconds to master.

I've driven other vehicle where it can be difficult to figure out how to turn on the headlights, there is no obvious way to turn on/off the wipers or the off/speed is on different stalks, the HVAC system can't actually be turned off, that have a non-obvious ignition lock that prevents you from removing the keys, letc.

My dad had a stroke that damaged his right frontal lobe and part of the temporal and parietal lobes 14 years ago at 40 years old. In terms of knowledge and cognition, there was little effect, however, it did affect motor control (he has left hemi-paresis) and his sense of tough (he tends to be hypersensitive to anything on his left side, usaully registering pain with any type of contact, even just brushing his arm with something soft like a feather), speech (he saw a therapist for 8 months afterward and is pretty normal now), ability to swallow (which has since recovered), his left field of vision (if he concentrates, he can see things, but he generally ignores things there in casual vision, note that there are two different pathways for vision in the brain too), short term memory and some new long term memory (though recall of old memories is still pretty good), emotions and personality. His senses of taste and smell seemed to have changed too. Lately, he's been having problems with sleep as well (though whether or not that is caused by a new malfunction in the brain or something else isn't known right now). He also tends to be less creative in thought about learning new things, preferring step by step instructions (but that's probably because the right brain is more creative while the left is more literal and analytical).

Around 1991, I was in a group that traded D&D stuff online... and to avoid the 25 cent per message fee, one of us would sacrifice one of the logins on our account and bounce messages to it. People would take turns logging into the same account to read the bounced messages or to bounce new ones. Eventually, Prodigy would catch on, close that login and we'd move on to another one. Somewhere in a folder stored in my attic are hundreds of fanfolded pages of dot matrix printouts from that era.

After about a year, I bailed for the local BBS scene and ended up running one of my own. In 1994, a friend "got me" a shell account with FTP at a local college that I ended up attending later on (look, you can download porn from australia, for free!). Once I got to college, I was more focused on doing stuff on the internet. The web was still in its infancy and we were still using tools like archie and veronica, USENET and email were awesome compared to FIDONet, etc. By 1996, I stopped calling the local BBSes and left my linux box connected to my dialup ISP 24/7 despite the rules not to.

I met my best friend way back in 1993 on a BBS... we had gone to the same school our entire life and never knew each other. We both ended up running BBSs in the same small town. I also reconnected with another friend around that same time. It ended up being a pretty small world with a few more friends mixed in, even though we were mostly all in different neighboring towns and never would have met if not for that era. It's the one thing I probably miss the most about the internet in comparison today, a lack of geographical community.

This was at a major medical university and its hospital. I specifically asked for as much physical documentation as I could, which is why I got the CDs of the CT/MRI. I don't know if their fancy EMR system tracks revision history on patient records. I also took pretty thorough notes while I was there and confronted both the Nurse Manager of the ER and the head of Emergency Medicine. I sent a letter to the CEO as well as the QA department describing in detail what happened and asking what they intend to do to correct the problems in the future. I have yet to hear back from either, though it has only been a month.

Fortunately, I mostly know what I'm doing and my mom (divorced from my dad) works in another hospital, so what I don't know myself, she generally does. Most doctors end up asking me if I'm a doctor... Most patients don't have that type of family advocacy for them.

On a side note, going back to the original brain aneurysm in 1998, my dad's lawyer met me at the hospital to arrange Power of Attorney papers before my dad's surgery. I mentioned the incompetence we had seen and he told me to never mention words like sue, lawsuit or malpractice in a hospital setting. If the staff overhears you, they go into CYA mode and will do everything by the book, even to a fault, and do absolutely nothing extraordinary, even if it could help.

He decides himself. I open up the rather large absentee ballot for him on the kitchen table and explain the rows and columns to him to make sure he doesn't overvote and realizes that some races have 2 or 3 candidates he can vote for (say, school board where there may be 2 vacancies and 4 people running), especially because of the left side neglect in his field of vision. More often than not, he chooses to undervote or not vote at all and I respect his wishes. For as long as I can remember, my dad has always been the "they're all corrupt, why bother?" type voter and he only registered to vote in the first place because he had a government job where they got Election Day off if they voted.

I never said the neurosurgeon was the one that wanted the organs, just that doctors can and do make mistakes.

That MRI and CT series is from a night back about a month ago. About 2pm, my dad started complaining of a general headache. I gave him a tylenol #3 and an hour later, he asked for another because it still hadn't gone away. By 7pm, we were at the hospital ER, where he was complaining about acute localized pain in addition to the general headache and I informed them of his previous medical history of aneurysms, strokes, etc, which even occured at that hospital. Three hours later, I tried to talk to the triage nurse to see if they would be seeing my dad anytime soon and, despite sitting at a desk just doing paperwork, she got up and walked away from me. A half hour later, I left and drove 40 miles to another hospital, where within a half hour, they gave him a CT and decided to ship him back to the first hospital. Meanwhile, he was given valium and dilaudid for the agitation and pain.

Back at the first hospital, the CT was ruled inconslusive because of the embolization coils, so they decided to do a CT with contrast, giving him a double dose of pretty heavy duty radiation. An hour and change later (maybe 4am), a resident from neurosurgery came down to tell us that they didn't think there was any bleeding, but it was inconclusive... he recommended an MRI but said we could do it on an outpatient basis rather than waiting. Now, your typical family may have just up and left being overtired and frustrated, but I knew better so we stayed. The MRI took an additional 6 hours before he got it. Meabwhile, they were giving him regular shots of dilaudid and it was doing nothing for the pain. Knowing that the first CT was inconclusive, they shouldn't have ordered a second CT, but an MRI/MRA instead and yet the proper diagnostic test was delayed for another quarter of a day, all while he could have been bleeding inside the brain. It's not like he's going to show symptoms with left hemiparesis.

Ultimately, he was cleared and sent home with directions to follow up with his primary and no medication despite the fact that he was still in severe pain. His primary looked in his ear and noticed the typical milky fluid indicator of an ear infection and dianosed him with mastoiditis and prescribed antiobiotics (it took 3 courses, but has finally cleared up).

So that's 4 big mistakes over one issue, all by different doctors... 1) they didn't order any type of diagnostics for a possible aneurysm/stroke patient, leaving him to languish in the waiting room for 3.5 hours and ultimately forcing us to go to another hospital to seek care 2) They did a duplicative test involving lots of extra radiation rather than ordering the right test to begin with 3) a resident was about to send him home despite him still having agonizing head pain and not giving him the proper diagnostic test and 4) nobody bothered to check his ears despite the pain being localized above the left ear. oh and 5) nobody bothered to order saline for him despite the other hospital putting an IV in him and him constantly complaining of thirst until he had already been at the hospital for hours. They denied all oral food and water in case he had to go to surgery even though they obviously weren't doing any rushing to see if he had to be rushed to surgery so he went 22 hours without eating. oh 6) he's on a number of medicines, which I gave them a list of, including keppra and a bunch of stuff for diabetes and they allowed him to go 24 hours without any of that.

So, yeah, doctors make mistakes... especially in the confusion of an ER, where it's most likely a patient is going to be declared brain dead and have their organis harvested.

He wasn't declared brain dead... though the only stimulus he responded to during the first couple days of being in a coma was literally twisting his nipples until they bled. Had THAT not showed a response, he probably would have been. Maybe a less rigorous doctor doesn't even take it that far (and he was lucky enough to have a world famous neurosurgeon). On day #3, the day they told me was pretty much the point of no return, I came in and asked him to show me two fingers... he finally gave me a gesture, though it was just with one hand. I've gotta say, I don't think I was ever so happy to be flipped off in my life. I ran to the nurse's station to inform them and I kinda got a nonchalant "yeah, we know." Nice of them to inform me.

At the end of the day, doctors can and do make mistakes... and the patient's family is going to weigh the doctor's opinion heavily. Some won't allow it to overcome their internal biases, some have no biases and will just blindly do what the doctor says whether it is really in their loved one's best interests or not. In the end, we circle back to the question posed here... just how do we know when you are really dead for certain?

This is my dad, 14 years after coil embolization to repair a brain aneurysm, a stroke resulting from a clot breaking free after the surgery and further complicated by hydrocephalus and an infection in his brain stem when he was 41 years old. As you can see, a substantial portion of his brain is dead. He has left side hemiparesis and initially had massive problems with short term memory loss, swallowing, cognitive function, lack of inhibition, etc during the first year. Today, he's almost normal, though he sometimes gets a little forgetful and he needs help walking (he never regained much of his left hand). Most of the damage was done because it took 2.5 months to get him stabilized enough to go to rehab. After the surgery for the infection in his brain stem, he was in a coma and on a ventilator. I was told that he had 3 days to come out of it or he probably wasn't going to... and, respecting his wish to never be left to live on machines, I had made the decision of when I was going to pull the plug (I was going to wait a week so he didn't accidentally hang on and die on my sister's birthday).

The younger the brain, the more plasticity it has and the more capable of recovering from severe brain damage it is. You might not be the exact same as you are now, but my dad certainly has a decent quality of life today. "He" is definitely still very much there, though sometimes he gets frustrated because he can't do everything he used to do, particularly in way he used to do it. He hates that he's dependent on others... but he finds plenty of enjoyment in life, looks forward to the time he gets to spend with his grandkids, etc. After years of resistance and despite being a grade school dropout, he's finally decided he wants to start learning about computers and stuff.

Massive brain damage isn't the end of the world, though it can certainly be difficult. I understand that it's quite scary to think about and a lot of people would rather be dead than face those challenges. That said, the younger you are, depending on just how severe the brain damage is, you can still have a positive life afterward and you still can even be you. Not every case is an absolute case of permanent vegetative state or "losing the soul."