Thread by @nathan_culley

I've been a first responder for ~6 years, most spent riding an ambulance. I figured going into it that I'd have some unique takeaways from the experience, but I didn't anticipate this understanding of how hard life can be for the less intelligent.

https://twitter.com/_NathanCulley_/status/1521538003684007937

People self-segregate along various factors--geography, SES, etc., but also intelligence. I think this leads many to believe the range of typical intelligence is narrower than it really is (i.e. "smart people" aren't that much smarter, dumb people aren't that much dumber).

(side note: I wonder if, due to Berkson's paradox, this leads people to believe intelligence is less correlated with success than it actually is. *Among their social group*, smarts may be less or even negatively correlated with achievement) en.wikipedia.org/wiki/Berkson%2…

Many jobs (most customer service jobs, I imagine) allow brief contact w/ people outside your range. More than most, though, first responders are forced to constantly interact with those outside their range (mainly below it, as explained here)

https://twitter.com/_NathanCulley_/status/1521538435244253184

First responders' interactions with them are deeper as well. These people struggle with basic instructions and questions, and often turn around and get angry at you when communication breaks down. Forget about big words and compound sentences.

You see them in their homes, too, where you can see how much of their lives are built around systems that compensate for intelligence. Strict routines, intentionally constrained options, etc. Hard to explain, but you know it when you see it. Social svcs often heavily involved.

A typical patient: Get called for a 60 y/o male having difficulty breathing. Arrive to find patient in a chair with mildly labored breathing. I ask, "what's going on today?"
"I'm having trouble breathing."
"Okay, how long has that been going on?"

"Oh, I've had COPD for years."
"But when did *this* trouble breathing start?"
"A few months ago, I guess."
"And you haven't sought treatment after a few months of this?"
"No, I went to the hospital last week."
"So when did you get out of the hospital?"
"A couple days ago."

"And you didn't feel better after the hospital?"
"Oh, I felt fine when I went home."
"So you felt fine after the hospital, & you've started feeling bad again since then?"
"No, I said I've been feeling bad for a few months." He is visibly frustrated by my inability to understand.

".......after you got out of the hospital, you got worse though, right?"
"Yeah."
"When was that?"
"About noon today when I sat down to watch TV."
"Okay, around noon." I mark "12:00" in my report and mutter "holy shit dude" under my breath.

I ask him if he has any other medical history. He says he has CHF and diabetes. I ask if he has high blood pressure, and he says no, I take a pill for that.

"What pill is it?" "I don't know." "Do you take any other medications?" "Oh, a bunch." "Do you know what any of them are?" "No, they're over on the counter; you can look at them."

There is a pill organizer with about 10 pills in each daily AM slot and the same in the PM slots. There are no bottles or labels anywhere.

The patient is wearing home oxygen. I ask how much he wears, and he says normally 2 liters, but he had his wife, who is also present, turn it up to 4 when he started having trouble breathing. He says it didn't help.

I look at the oxygen tubing. He is sitting on top of it. I suggest that this is why he's having trouble breathing and that we can try fixing his problem here. We stand him up and sit him back down with his O2 tubing free and clear. A few minutes later he says it's much better.

"Great. Would you like to go to the hospital?" He says no, but his wife interrupts and insists that he go, "just to get checked out." He relents and says yes. Which hospital? The farthest one, of course. That's where his doctor is, Dr. McWhatsit. You know him, right?

We load him into the ambulance and head to the hospital. His wife follows us, flying behind us through red lights and stop signs, because like much of the population she apparently believes this is fine as long as she throws her flashers on. (it is not)

We arrive at St. Farthest Hospital, where he will be monitored for a few hours and sent home with an inhaler prescription and a thick packet of discharge instructions that neither he nor his wife will be capable of understanding, much less following. Another life saved. Fin.

You see his type everywhere, along with people who call 911 at 2 AM for minor months-long problems that have or for complete non-emergencies, and truly don't seem to see what the problem is with that. They have a problem; we're here to fix it. What's the big deal?

It's aggravating to deal with, of course, but as the original thread that started this pointed out, it's mostly just tragic. Nobody asks to be born stupid. But it's uncomfortable to grapple with the topic, so it gets ignored, and everybody pays the consequences.

Life has gotten easier over the years, but baseline complexity of daily life has gone up while protective social scaffolding has been dismantled. It's easy to say dumb people should just drown, but it's not their fault the waterline rose. Who's to say it won't rise over you too?