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Claire Keane
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YOU ARE THE REASON
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PUT YOUR BEARD IN MY MOUTH
@theartofmadeline
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@cranquis
"My equilibrium hurts" (True Story, Kiddos!)
Patient: my shoulder and neck hurts and the pain goes all the way into my equilibrium
Cranquis: You mean, it makes you dizzy?
Patient: no, YOU KNOW, my equilibrium, it hurts
Cranquis: I'm not sure what...
Patient: (pointing at occipital area) RIGHT HERE. it hurts
Cranquis:
Patient:
Cranquis: Your... brainstem?
Patient: oh right I guess it's called the medulla, not equilibrium, sorry
Glad to see your blog's still up and with the same House gif format it had when I followed you back as a first year medical student! I've been working in the ER (mostly UCC or life-saving/patient transfer cases, shifts in the ER itself a bit of a rarity for me, I enjoy the work others don't seem to like, ha!) now! Your stories come to mind a lot, especially the "oh and" last minute reveals that are more serious than what came before, fff.
Congrats on making it this far in your medical journey! Always great to hear that I'm riding "shoulder-devil" for an old PMTH co-worker, LOL.
Blog is still up. Laptop with over 500 House MD gifs crashed a few years ago, which was a devastating blow for the easily-amused internet-perusing medical community.
As you know from your own experience, the stories keep coming - you can't see patients without encountering bemusement, horror and outright hilarity. But I'll admit, the multi-factor trauma of the Covid pandemic, as experienced within the US health care system, really muted my "joyous-snark" perspective on medicine. Like, I still enjoy being a physician - but I'm no longer enthusiastic about encouraging high school/pre-med students to pursue medical careers in the US health care system. Because the system, it sucketh the life out of ye.
Which sucketh. Because Dr. Cranquis, despite wearing a cranky internet persona, is IRL stil a doc who loves making patients feel at ease and keeping his colleagues chuckling. I still see things happen at work and think "THIS would make a great True Story Kiddos! post" -- and then I get home and leave every memory of work behind me... ANYWAYS - don't know how I wandered down that avenue in this reply. Just haven't replied to a Cranquis-Mail (tm) in a while, I guess, and caught an acute case of the feels once again.
So, keep on keepin' on, my colleague!
You coming to my Urgent Care with multiple urgent symptoms and complex conditions, needing tests and therapies which our Urgent Care doesn't provide - but refusing to be evaluated at the ER - is like ME going to McDonald's and demanding a Crunchwrap.
-Dr. Cranquis is hangry, I think.
This is what you call an…impaction.
Me waiting for any former classmates of our new "US Surgeon General" to bring the receipts for why Casey Means had to quit during her 2nd year of ENT residency...
You know that feeling when you ok Tylenol for a 99 temp for your tubed patient who just came down from 3 pressors and you thought oh yeah maybe the Amikacin is putting in work cool then nursing comes back to you 30 mins later and says now it’s 104?
It's amikacin does it ever really put in work
Ok excuse me fox but it was Amikacin linezolid doxycycline azithromycin metronidazole iso penicillin anaphylaxis carbapenem anaphylaxis and vanc anaphylaxis and aztreonam drug fever so maybe show some grace.
But also let’s all laugh out loud how Amikacin got switched to Gentamycin the next morning because “vibes were off”.
Also he’s still spiking fevers.
Okay all that side what is going ON with the antibiotic situation there also clearly the aminoglycoside isn't putting in work anyway so I'm justified in roasting it. Silly little 30s inhibitor it doesn't even have doxy's wide spectrum to its name
Additionally, I see pen anaphylaxis penem anaphylaxis and aztreonam intolerance but I don't see that you've tried a cephalosporin.........
Extubated and downgraded thanks to Aminoglycoside supremacy AND we didn’t have to fuck around and find out (anaphylaxis)
Oh please gent is hardly even as good as a placebo at this point in the current antibiographic state... if you're attributing the patient's improvement to something maybe thank their hardworking lymphocytes and macrophages
Also, my my. I see you assuming that the patient could've had an allergic reaction to cephalosporins just because they had an allergic reaction to penicillins and penems. All while cephalosporins are out there having side chains you've never even dreamed of.
I'm having flashbacks of internal medicine rotations, when two specialists would start countering each others' recommendations in their daily progress notes.
Today an elderly patient's daughter asked if I could guarantee that the blood I might need to give to the patient (in case the patient is actively bleeding out during the surgery, which had a pretty high chance of happening) is from a donor who hadn't been vaccinated against COVID.
Not gonna lie, I needed a moment to recover from that
There's been hesitation prior to patients getting bone marrow transplants that didn't exist before.
Typically you get all your childhood vaccines given to you again with new bone marrow.
When patients decline (still a tiny minority), some services then have to say well, we can't offer this too you, because the risk of dying is high and the resource is so finite. But it's the reality now.
I just can't.
We are practicing medicine in a country of cromagnons.
I get so pissed off when I ask what parents' thoughts are on vaccines and if they have any questions, and the parents just smugly ask me if I get my kid vaccinated, like it's going to lead to some big "Gotcha!" moment
Yes, I vaccinate my kid
Yes, even flu and COVID
Hell, if I had it my way, she'd get an early MMR right now even though she'd have to get the shot again when she is 12 months old - that's an extra shot and I'd be first in line for her to get it
Don't try to 'gotcha' me, we have the same vet and animals don't have HIPAA - I know you vaccinate your livestock because our vet was doing a farm call vaccinating your herd when my dog was stung in the muzzle by a bee and acted like the world was ending and we had to wait until he was done to bring her in (she was fine, she'd just never felt pain in her life before being stung by the bee, the psychic damage she incurred was severe but luckily no lasting physical harm occurred)
I cannot begin to fathom why you'd protect your cows' health but not your kids' health
But I don't throw that in your face because my mama raised me right
If you want to risk your kids' health by not vaccinating, own it and own the consequences
Don't be a coward and try to pull my fully vaccinated kid into it
So good, as always. LOL!
And let’s remind everyone one that the Internet Archive duplicated all of its data to locations outside the US when Trump was elected the first time.
and if one doesn't need one's information to be US specific but does need it in English, the public health information sites run by the World Health Organization and relevant agencies in Canada, Australia, and the UK should all have it
Resources for contraception, gender-affirming care, STIs and HIV flicker in and out of existence or vanish completely
Research and basic information on subjects ranging from tuberculosis surveillance to adolescent health disappeared from federal health agenc
Research and basic information on subjects ranging from tuberculosis surveillance to adolescent health disappeared from federal health agenc
Great.
Let me tell you how fucking insidious this is.
This morning, i heard on the public health reddit that the HIV page at cdc.gov had been scrubbed. Sure enough, the landing page was there, but all links to information about programs, treatment, data were gone.
Then we started to hear that all CDC was going to be removing data. Whole data sets. I started looking, and the Social Vulnerability Index, which identifies geographic areas that are vulnerable to climate, economic, or health-related disasters, it was gone.
The Behavioral Risk Factor Surveillance System, which is a national survey that helps identify things like smoking prevalence, healthcare access, are people meeting nutrtion guidelines, was gone. I had just downloaded that dataset and the documentation on Tuesday to run some stats on colorectal cancer screening in my state. It was now gone.
My colleagues at the health department started messaging each other. Were they also having troubles finding data? People on reddit were frantically trying to download datasets, comparing what they already had. For fuck's sake, the Census website and data was going down. The goddamn Census.
There are some heroes, like the good people at the r/DataHoarders subreddit who had heard rumblings earlier this week and had started scrapping the entire CDC website. The End of Term Archive had already been archiving federal websites and data for months, and are getting those datasets up on GitHub.
But this is unprecedented. This is fascism. This is an authoritarian regime removing public data from access to make sure theres nothing out there that can conflict with their message.
This is not normal.
If you live in the US and have the capability, call your reps and ask them what they're doing about this data scrubbing, ESPECIALLY if they're Democrats. Hold their feet to the fire.
i am without words.
Co-signed, E. Cranquis, MD
Blogging this tweet because this explains SO MUCH about the mindset of pretty much all the folks I’ve known who’re against single-payer, it’s not even funny…
This….
This never occurred to me. Not once. That Americans are against Health Care because they think it actually costs tens of thousands of dollars for a broken arm, hundreds of thousands for a complicated birth, millions for cancer treatment.
Because they’ve never known anything different. The idea that a broken arm is only a couple hundred bucks; a complicated birth a couple thousand; cancer treatment only tens of thousands; all easily covered by existing tax structures.
This explains a lot. And it’s a good example of what I was talking about in my post on scarcity being used to prop up ableism – always question the idea that a resource is genuinely scarce. Even if it seems obvious that it is, quite often that’s the result of careful manipulation and misconceptions that you’re not even aware of.
And never think you’re too smart to be fooled by that kind of thing, it doesn’t work like that. Similarly, don’t think people who are fooled by something are stupid. Nobody can have all the information about everything, and nobody has the time and energy to investigate and put together conscious conclusions about every piece of information they’re given. It doesn’t take being stupid, or even just gullible, to believe something like this.
I currently live in a country without free medical care and still, it’s enormously cheap compared to the USA. An American expat wrote a piece for our English language paper about how she paid more for parking at the hospital than giving birth to her baby that’s pretty interesting:
https://grapevine.is/mag/articles/2016/01/06/healthcare-in-iceland-vs-the-us-weve-got-it-so-good/
Yesterday I had to go to the hospital cause I injured my eye, I’m frankly dreading what the bill is going to be, but what made me balk was being told in the pharmacy that my insurance was denied for the antibiotic eye drops and it’d be over $100 out of pocket. So I didn’t get my eyedrops.
I’ve had these same drops before living in the UK. They cost me seven GBP.
It’s the exact same drug, same steroid, same strain of antibiotic. But somehow the US gets away with charging $100 for a generic non brand version of a drug which is easy to create and widely used. It’s downright robbery, but also a form of eugenics through poverty and class warfare. You keep the poor poor by making sure basic necessities remain unattainable and then you make it seem like the norm so no one fights it.
The rest of the world is not like this.
Eat the rich. Resist.
When I was travelling in Germany once, I seriously hurt my ankle. In a few hours, it had swollen to twice its size, and I went to a little ER in a tiny town. I spoke no German and only one nurse spoke English. They ran an X-ray and an MRI to determine what had happened (turned out I had bruised my peroneus brevis muscle and pulled the tendon), gave me a ton of very regulated meds for the pain and swelling, including some supports so I could walk…and my poor little 22-year-old ass was sat there, knowing all of this would cost thousands, if not tens of thousands, back in the US. I was shaking.
I’m in the exam room, post diagnosis and with pill bottles in hand, and in walks the one nurse I’ve been able to speak to the entire time. She pats my hand and tells me (and this is verbatim—I will never forget this conversation as long as I live), “I’m so sorry. We had to run those tests, and they are expensive. You don’t have insurance so you will have to cover the full cost.”
I start crying.
She continues, softly, as if telling me someone has died, “It’s going to be three hundred.”
I start sobbing, certain I’ve misheard, certain that I would be absolutely fucked, broke and going into debt in a foreign country. “Thousand?” I clarify.
Her entire demeanor changed, and she looked at me as if I had sprouted four extra heads. “No,” she says, “euros.”
That moment radicalised me.
My family got charged several thousand dollars for a late-night trip to the ER when I was a kid after an oops at home resulted in a large cut that needed almost 40 sutures. We lived in the US at the time.
Now we live in Canada. Last year my leg got rolled over by one of the front tires on a pickup truck. I spent 3 weeks in hospital, had 3 surgeries, one of which included skin grafting to cover the half of my leg that was degloved in my accident. I had IV antibiotics 4 times a day, I had physiotherapy daily, I was on a lot of meds for pain and having complex wound dressings changed every day. After all that, I had a home care nurse visit me every 1-2 days for 6 weeks to help with my wound care. The greatest expense to us as a family for the amazing care I received was my parents and husband using the parkade next to the hospital, which was like $13 a day. If we’d lived in the US, that injury absolutely could have bankrupted us.
This information needs to be part of the US med school curriculum.
This is probably a weird question, but I don't really know anyone who works in the medical field to ask directly. I've been considering a career change to respiratory therapy, but I knew there were several different areas in the healthcare field so I took a class at my local CC that involved "discovering different healthcare careers" and had us talk to and shadow many different occupations. I had 2 different professionals through this class tell me studying Respiratory Therapy wouldn't be worth it because they were being phased out because others within healthcare already know how to do the job they do. Do you know if this is true or not? I was really excited about pursuing this, but I don't want to spend time and money pursuing a degree if it is being "phased out." I haven't been able to find anything about this through just looking it up online, if anything my research indicates Respiratory Therapists are needed and in demand right now, so I'm a little confused.
Hi! Well I think that's a great question, but I am as "in the dark" as you are about this, since I don't work in a hospital setting with respiratory therapists.
I'm going to assume you're in the United States? You can send me another anon ask if not, so I can clarify the country in question for anyone who might have info on the topic.
Ok, let's punt this question out to the readers -- anybody have insights on the current and future demand for respiratory therapists in US healthcare?
As a critical care provider, I have NEVER heard of phasing out respiratory therapy. Our hospital is SHORT many RTs.
The fact of the matter is that y'all know those vents better than I do. I cannot do my job for all 10 of my patients if I have to sit and fuck with a vent for 20 minutes.
While I "know how to work the vent" in that I will want more Vt, change of a mode, etc, YOU as the RT know the technicalities of your vents. We (PAs - and honestly crit care docs as well) do not get trained that way. Period.
So, go be an RT if your heart desires. We need more, amazing RTs in this world. *shout out to Mama Poppi who is the BEST RT in the world*
Insights!
Thanks, @populationpensive :)
This is probably a weird question, but I don't really know anyone who works in the medical field to ask directly. I've been considering a career change to respiratory therapy, but I knew there were several different areas in the healthcare field so I took a class at my local CC that involved "discovering different healthcare careers" and had us talk to and shadow many different occupations. I had 2 different professionals through this class tell me studying Respiratory Therapy wouldn't be worth it because they were being phased out because others within healthcare already know how to do the job they do. Do you know if this is true or not? I was really excited about pursuing this, but I don't want to spend time and money pursuing a degree if it is being "phased out." I haven't been able to find anything about this through just looking it up online, if anything my research indicates Respiratory Therapists are needed and in demand right now, so I'm a little confused.
Hi! Well I think that's a great question, but I am as "in the dark" as you are about this, since I don't work in a hospital setting with respiratory therapists.
I'm going to assume you're in the United States? You can send me another anon ask if not, so I can clarify the country in question for anyone who might have info on the topic.
Ok, let's punt this question out to the readers -- anybody have insights on the current and future demand for respiratory therapists in US healthcare?
Behind the Medic: Well that sucks.
Office printer repair guy: The paper gets jammed if you don't fluff the pages first by fanning them a bit.
Cranquis: Yeah, I always do that when reloading the paper.
Nurse Naive: OH YES, DR CRANQUIS IS A PROFESSIONAL FLUFFER!
Cranquis:
Nurse: WHY? WHAT DID I SAY?
This may seem like a meme, but it is real. It's formatted like this to get people's attention and be memorable, in the hopes that maybe it saves some lives.
Edit 1: If any of you are unsure that this is real, check out the notes of folks talking about it.
Transcript:
[transcript of sign]
Are you currently struggling with … MEDICAL BILLS?
… Perhaps you should try … FAPping!
Financial Aid Policy
Did you know that most hospitals and some doctor’s offices are what is known as a 501r, or “medical non-profit”?
This means they are legally required to have a “financial aid policy” or “charity care policy”
What is means, is that they are LEGALLY REQUIRED under United States Law to provide FREE OR DISCOUNTED healthcare, and also to FORGIVE EXISTING MEDICAL DEBT to individuals with financial difficulty.
Basically, every household making und $100K a year is eligible for a reduction in their medical costs.
Billing departments often try to push people to get on a “payment plan” if someone asks, but don’t accept it!
Ask if they have a Charity Care or Financial Aid policy “Based On Income.”
If it looks like you might not qualify?
Apply anyway. They try to scare people away with scary processes.
YOU QUALIFY. EVEN IF YOU ARE ALREADY IN COLLECTIONS.
[/end sign] (Credit to Moonlit-wings for the transcription.)
https://www.dea.gov/everyday-takeback-day
A list of free drop-box locations across the United States where you can dispose of unwanted/expired medications.
