Is this thing still on?
I just logged in for the first time in two years and I’m wondering if any of my PA mutuals are still out there......
he wasn't even looking at me and he found me
PUT YOUR BEARD IN MY MOUTH
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cherry valley forever
styofa doing anything
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wallacepolsom

titsay

JVL

Kaledo Art
Alisa U Zemlji Chuda

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Misplaced Lens Cap
RMH

祝日 / Permanent Vacation

Andulka
Aqua Utopia|海の底で記憶を紡ぐ
we're not kids anymore.
Sweet Seals For You, Always

Product Placement
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@digiti-minimi
Is this thing still on?
I just logged in for the first time in two years and I’m wondering if any of my PA mutuals are still out there......
End of the Year 2018
Hey tumblr! Long time no see. Heard you’re not cool anymore because you don’t have porn.
I’ve been gone for a while but I figured I’d come back to the blogosphere to do my traditional end-of-the-year post.
My 2018 resolution was to set healthy boundaries with my family members, who have unfortunately been pretty problematic as of late. Happy to say that I managed to stick to my guns with that. It’s been a little tough, but overall it’s been worth it.
This is the longest I’ve ever been at the same job (over 4 years). As far as being a PA goes, I’ve really settled into a comfortable routine. I have a great level of autonomy, and feel comfortable independently handling the majority of the patients I see. I’ve also started taking students, and it’s been interesting to be on the flip-side of things. Seems like it was just yesterday that I was shadowing a PA in the ER for the first time; but that was back in 2010!
What else? I visited some new places in 2018! I went to: Nevada, Arizona, and Utah; Georgia and South Carolina; Louisiana; !!!!!!SPAIN!!!!!! (top of my bucket list since I was a young teen, and my first time in Europe) and Portugal.
Japan had been on our bucket list for 2018, but we decided to move it to 2019 so we could go for cherry blossom season. We booked a two-week trip to Tokyo in April! Really looking forward to that. We’ll also do a big trip in November for my 30th. Haven't decided yet on the location... thinking about maybe a European river cruise. We’ll see!
Honestly, I’ve never been the kind of person to talk like this, but lately I feel so incredibly blessed by everything in my life. This year was one of the first times in my life that I consistently exercised (mostly doing yoga, which has been a lifesaver for me) and also started a meditation practice, which has helped dramatically with anxiety, along with some self-guided cognitive behavioral therapy. I also returned to pescatarianism. Overall, just trying to be more thoughtful of the ways I use my mind and body. It’s been a really transformative year and I can feel a difference just in the way I think about things in my life, and especially how I think about myself. I am truly grateful.
I have a loving and supportive partner who accepts me as I am, but also makes me want to be the best version of myself. We have so much fun together; it doesn’t matter if we’re in some beautiful foreign location or sitting at home playing WoW together. He’s enriched my life in so many ways, especially through his children. I never anticipated having a partner with kids-- as a matter of fact, I previously thought it could be a dealbreaker. But wow, have they taught me a lot about love, patience, and selflessness. Not to mention the simple fact that they provide a whole new arena of FUN that was missing from my life previously! Although they also continually remind me that I somehow became old and uncool at some point. But I’ve learned a lot about meme culture at least?
Anyway, I foresee a lot of happiness in 2019. My resolution for 2019 is financially motivated... since I started paying off my loans in 2015, I’ve paid off nearly 50% of them. I’m going to be even more aggressive about loans in 2019. While I won’t be able to pay them off completely, I think I should be able to get them down to about 20% of my original loan amount. Then I will be slated for a 2020 payoff! Can’t wait!!!
Hope all is well for anybody who is still listening out in PAblr world. Have a happy new year!
In today’s episode of “Totally Ridiculous Chief Complaints Coming in by EMS”...
I had a 5-year-old recently who came in because she had a laceration across the bridge of her nose after getting whacked in the face with the handlebar of a bike.
Facial lacs on kiddos are difficult because they can see the tools and the needles coming at them. It’s not like you can distract with the TV or an iPhone.
So for this one, I had her sit with LET on the lac for a while and then came back in.
We engaged in some chatter and distraction for a bit while I got ready. I always set up the lac tray where they can’t see it. The last thing a kid needs to see is you pulling up the lidocaine through a huge blunt needle.
I sat next to her on the bed. I always start with minimal force. The earliest memory I have is being pappoosed in the ER while a doctor sutured my lip. Kind of ironic how my career turned out, considering that it is certainly a traumatic memory.
“Remember how I put that magic medicine on your nose? How does it feel?”
“Better.”
“Cool! Hey, how high can you count?”
“I can count to twenty.”
“Holy moly!!! Can you close your eyes for me as tight as you can and count to twenty?”
While she was doing that, I quickly used a TB syringe/needle (tiny needle, perfect for small lacs in sensitive places) to ensure that the entire lac was numb. LET is great, but the last thing I needed is for her to feel pain when I was in the middle of suturing her. She didn’t flinch and finished counting to twenty.
“That was so good! Do you know the alphabet song? Do you think you can close your eyes again and sing it for me?”
Four simple interrupted sutures later, and not a tear shed... we were done. The stressed out parents were relieved and I felt like a champ. There’s a certain kind of satisfaction I get from handling a peds encounter without any tears or stress. A happy kiddo and grateful parents are a welcome reward during a difficult day in the ER.
When you are selecting an antibiotic: do not use a mallet when a small hammer will do the job.
Antibiotic resistance is serious business.
The Rest is Silence
Trigger warning: pregnancy, miscarriage, and medical procedures
Keep reading
I appreciate your empathy for this patient, but I hope anyone who reads this who has either been through a D&C in the past, or may need one in the future, understands that it is not the horrific procedure outlined in this post. I observed many D&Cs on my OBGYN rotation and never had this kind of reaction. Sometimes, like in this case, a woman has had a miscarriage but continues to have painful prolonged bleeding— and this procedure is a relief and a blessing to have done. Women who are this far along also have vacuum aspiration abortions, which is a similar process.
Working in the ER and seeing countless miscarriages has taught me that a woman’s response to an abortion, either spontaneous or induced, is completely variable. And you’re entitled to your own opinion of course, but to call a fairly routine procedure that MANY women have to go through “horrific”… eh, it doesn’t sit right with me. Our job is to support the patient through whatever emotion they are having and to minimize any stress in regards to the actual procedure.
Thanks for the input - I 1000% support the need for this procedure and understand that it is routine. This post was written from my perspective seeing something that I wasn’t quite prepared to see. To be honest, I didn’t think I would be as affected as I was and that’s a big reason why I wrote this post.
I’d also add that in the moment, I was horrified. I can’t change that reaction. Like you, I’ve learned about D&C/ vacuum aspiration in a theoretical sense. I knew the indications for use and the basics of the procedure. I understood its benefit for patients and their health. However, it is a completely different experience to see it. While it isn’t inherently a horrific procedure, it is certainly jarring.
I can see how my post could discourage women from getting a suction D&C for whatever reason and that was definitely not the intent. It was a very necessary procedure to do for our patient. Our patient was informed of the process in the least stressful way and was ultimately very grateful for the closure and relief of pain. It definitely wasn’t my intent to say that the procedure is bad, unnecessary, or immoral. It’s not at all. But I had big issues wrestling with my own emotions, particularly because literally 6 hours earlier I watched a patient give birth. I was just on a roller coaster of “firsts” and this was a way to process.
Definitely not faulting you at all for your reaction or needing to process it. The original post gave me some weird pro-lifey vibes but I’ve been following you for a while and I know that wasn’t your intent, just offering a second point of view for anyone who may have been reading. No hard feelings!
The Rest is Silence
Trigger warning: pregnancy, miscarriage, and medical procedures
Keep reading
I appreciate your empathy for this patient, but I hope anyone who reads this who has either been through a D&C in the past, or may need one in the future, understands that it is not the horrific procedure outlined in this post. I observed many D&Cs on my OBGYN rotation and never had this kind of reaction. Sometimes, like in this case, a woman has had a miscarriage but continues to have painful prolonged bleeding— and this procedure is a relief and a blessing to have done. Women who are this far along also have vacuum aspiration abortions, which is a similar process.
Working in the ER and seeing countless miscarriages has taught me that a woman’s response to an abortion, either spontaneous or induced, is completely variable. And you’re entitled to your own opinion of course, but to call a fairly routine procedure that MANY women have to go through “horrific”... eh, it doesn’t sit right with me. Our job is to support the patient through whatever emotion they are having and to minimize any stress in regards to the actual procedure.
Blehhhhhhh.
Dealing with some personal life stuff, which always tanks my productivity at work. I’m working all weekend. Boyfriend is out of town so I don’t have comfort and snuggles waiting for me when I get off work. Honestly all I can think about right now is getting in my bathtub with a sheet mask and a glass of wine. But I have another 8 hours to go, and the charts just keep coming.
Coming in via ambulance, of course.
When day shifters talk about the things they’re able to do during during daylight hours:
Emergency Room Night Shift Gothic
Gothic of the Medical Student
You enter through the front as per usual. 20 pairs of eyes in the waiting room see into your soul. They demand retribution. There is nowhere to run.
The ER doc tells you to see the patient in room 4. There is no room 4. There has never been a room 4.
There is one patient here who has been here for 16 hours. They have not left their room once. They have many secrets.
The ER doc is telling you about the political climate of the 1980s. You’re not sure if you need to study this later.
You hear someone call your name from the nurse’s station. When you ask they respond that they do not know your name.
“I come here once a week. They always send me home.” Says the frequent flier. You don’t know how to respond.
There is one nurse who has been on during every one of your shifts. When you mention this, they say they haven’t been in for a week.
You don’t know where your preceptor went. The nurses watch but do not approach. You are lost and alone.
There is another student in the ED. They only stare as you pass, eyes empty. The depth of your mutual understanding goes beyond words.
You cannot remember what happened between 2 AM and 5 AM. No one does. It is lost to universe.
A patient refuses to leave until she’s admitted. She says its not rocket science. You wonder if you should tell her a rocket scientist still can’t admit her.
You go in to help with a procedure. It is already complete. No one know when it happened.
Someone asks you what medication a patient needs. You can’t remember any medications. You don’t know who you are anymore.
The nocturnist asks you about the political climate of the 1980s. You have answers.
You are sent into remove a foreign body from an orifice. There is no foreign body. There is only fear.
You hear a scream in the distance. It’s too far away to be in the ER. You are told to check it out anyways.
There is blood on the floor. There are no external injuries or trauma patients. There is no trail.
“An MI.” You say. The ER doc accepts this answer. It never mattered what the question was.
You see a provider with brightly colored hair. You do not know what they do. You never see them again.
There is a smell that starts to waft around 1 AM. You ask the charge nurse about it. They say it will pass and nothing more.
There is no one in the doctor’s lounge. The coffee machine turns itself on. It knows.
During hand off, the new ED doc mentions the political climate of the 1980s. You don’t know what year it is anymore.
PERFECTION.
HA omfg. This. 1000% this.
/r/opiates
If any of my fellow medical people want to feel some rage, head on over to the /r/opiates subreddit and start browsing.
Quality content includes:
-“Pill porn,” pictures of their monthly narcotic prescriptions after getting them filled.
-Complaining about how the opiate crisis has “ruined things for everybody” and all you ever get in the ER is ibuprofen 800 mg.
-Complaining about strict pharmacy rules and regulations.
-Posting pictures of street heroin and prescription Adderall side by side— prescribers, didn’t you know that the intended use of Adderall is to keep your heroin addict patients awake?
-Suggesting that one should befriend cancer patients as a way to get easy access to opiates.
-Talking about what a great “nod” they got from fentanyl and versed during a procedure (followed up by another user commenting “I always love Dilaudid 2 mg IV when I’m in the hospital.”)
-Pictures of pills stolen from grandparents’ medicine cabinets.
-Pictures of syringes full of heroin about to be shot into someone’s arm, in honor of a fellow user... who just overdosed and died.
-“I just got Narcanned by EMS, how soon can I shoot up again?”
And so on, and so forth.
I understand that addiction is an illness, but when I encounter addicts at work every single day and often find myself being manipulated by them, finding this content really made my blood boil. It was like every bad thing I’ve ever thought about opiate users....... was not only true, but they’re also POSTING ABOUT IT OPENLY ONLINE!
There are also many posts about how their first step toward addiction was being prescribed narcotics by a medical provider, so that was a sobering thought.
On the plus side, I learned a lot of cool new drug slang (never knew “boofing” was a thing...)
Anyway, I realize this is a potentially controversial post, and is mostly just intended for me to vent. I do try my best to be sympathetic and understanding with my patients struggling with addiction, but I definitely have issues with compassion fatigue. If anyone is familiar with addiction medicine and has any quality resources for ER providers that you think may be helpful, by all means, send it my way.
Can’t Please ‘em All
Recently I got a patient complaint that was so obviously made up, but somehow STILL got forwarded to me from my medical director as if it were somehow legitimate.
The patient claimed that I made statements such as:
“There’s nothing wrong with you, this is all in your head.”
“You’re a nurse so you should know better than to be here right now” — BUT ALSO — “You need to listen to me because I’m a PA and you’re only a nurse.”
“You’re wasting my time.”
She stated that I “forcibly ripped the IV” out of her arm (side note: discontinuing IVs hasn’t been in my job description since I was a CNA) and told her to “get out of my ER and never come back.”
She also claimed that she spoke directly to her PCP who told her that she would be getting admitted and there was a bed waiting for her upstairs, when in reality, I called her PCP in the middle of the night despite the patient’s COMPLETELY NEGATIVE WORKUP and he said “this patient is texting me on my personal number at 3AM, this is inappropriate, and she can be discharged.”
And finally, her email implied that I had ultimately missed some kind of dangerous diagnosis by discharging her home— when in reality, I was able to review her PCP’s note from her ER followup, where he agreed with the plan of discharge (obviously) and the patient was fine.
I went above and beyond with this patient encounter, sitting down and explaining all of the diagnostic testing, explaining why it was appropriate for her to follow up in the outpatient setting, and offering a variety of different treatment options to help with her symptoms.
And then I get a nastygram from my boss outlining a situation that is clearly confabulated, completely outside of my character, and outside of....... any reasonable person’s view of reality.
Ridiculous. Especially since she was a fellow medical professional.
Where I get me a man like this???
check the morgue on the fifth of july
yo when he lands a solid punch on one tho
Oh, look. Job security.
Well, that can’t be good.
Better find someone to go put it back in again. I nominate the anaesthetists…
Maybe that’s short for tracheostomy tube came out? 🤔
Well, that can’t be good.
Disrespected
Today, I was disrespected harder than I’ve ever been in my entire life. I try to believe the best in people all the time. So when somebody for no reason is a bigot towards me, perhaps I shouldn’t be shocked. I think my trusting heart is just not used to being so utterly insulted.
As you all know, I have overcome a lot of s*** trying to get into physician assistant school, to achieve graduate status and officially get into surgery and save lives. I don’t have everything handed to me, I’ve had to scrape and scratch in order to get to where I am today. Every dollar has either been from my mother working three jobs to help me, or hours spent working to get scholarships to fund my education. I even have to rely on food stamps to eat.
None the less, today I was speaking with a doctor. He’s about my age, and we were chatting. I was telling him about my high ambitions, and how I want to be a PA. He said to me plainly,
“So… you’re not going to med school. You aren’t even having a residency?”
I replied with, “ actually it’s two years accelerated Medical school and yeah there is a residency. I’m super proud of getting to where I am today to someday be able to work in surgery. Considering all of the obstacles I faced. You seem to only be interested in if I’m a doctor?”
He said , “oh.. Just trying to figure out what thought you said your "high ambitions” were…..“
And made it clear he did not want to associate with a girl who was putting herself through PA school.
Honestly so glad his Harvard Ass is fucking gone.
Okay so this guy sounds like a douchebag, but can we as PAs please stop referring to PA school as “accelerated medical school”? It’s not. And it’s not “four years of medical school crammed into two years” as I often hear. And clinical year is certainly not a residency (another thing I hear PAs say), although there are elective residencies that exist. This is the kind of stuff that makes some physicians think PAs just want to do what docs do without putting in the effort.
You’re going to be a PA. You’re going to go to PA school. Not medical school. You don’t have to prove that you’re just as good as some doctor with a superiority complex. It’s a different career— own it.
Trust me, I get the frustration of having your dream career belittled, and it’s something I’ve certainly vented about before. But you’re gonna have a hard time if you’re trying to measure up to docs, especially in surgery, which is a field where you’re going to have less autonomy than some other specialties. Let that shit roll off your back.