
tannertan36
almost home
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ojovivo
KIROKAZE
cherry valley forever
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i don't do bad sauce passes
Monterey Bay Aquarium
d e v o n
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JBB: An Artblog!
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Xuebing Du
Alisa U Zemlji Chuda

JVL
I'd rather be in outer space đ¸

â

@theartofmadeline
Not today Justin

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@mostlyunfiltered
Rapid Primary Survey
When it comes to primary surveys in trauma situations, my skills will never be to the same standard as the emergentologist. However, in those times when I have had to do it, this checklist has worked for me. I am missing a few points that probably could be included for comprehensiveness but in general it covers all the necessary points.
AIRWAY
Secure.
Suspect cervical injury? C-spine collar.
Talking. Breathing.
Head tilt/jaw thrust > Airway > Endotracheal tube.
BREATHING
Look: Tracheal midline. Mental status. Color. Respiratory rate. Work of breathing.
Listen: Breath sounds. Obstruction? Symmetry?
Feel: Trachea. Chest crepitus. Deformity.
CIRCULATION
Level of consciousness. Heart sounds. Blood pressure. Heart rate/respiratory rate. Cool extremities. Urine output.
Abdominal pain.
ABC. Maintain pressure. 2 large bore IV. Transfuse if severe.
DISABILITY/DEFORMITY
GCS. Neurovascular status. Squeeze pelvis. Check long bones. Look for the blood.Â
FASTÂ (Focused Assessment Sonography in Trauma)
We know that media vita in morte sumus or, âin the midst of life we are in deathâ. We begin dying the day we are born, after all. But because of advances in medical science, the majority of Americans will spend the later years of their life actively dying. [...] There are many ways for a corpse to be disturbing. [...] But the decubitus ulcer presents a unique psychological horror. [...] Without some movement, the patient will literally begin to decompose while he or she is still living, eaten alive by their own necrotic tissue. [...] You can almost gaze through such a wound into our dystopian future.
Caitlin Doughty, Smoke Gets In Your Eyes
Time warps for a young surgeon with metastatic lung cancer
[bonus street jokes on Facebook]
There is a cult of ignorance in the United States, and there always has been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "my ignorance is just as good as your knowledge."
Isaac Asimov, Column in Newsweek (21 January 1980)
new year, new goals
the last 12ish months have been rough. medschool has a habit of taking all of the neuroses, all of the bad habits, and all of the insecurities a person struggles with and magnifies it to near-untenable proportions. it brings the selfish and petty out of lots of people, forces you into unpleasant situations, and challenges you to figure out what's actually important to you. and in my case, if everything makes you angry, what shit are you willing to deal with and what shit should you avoid so you don't pop a carotid. I'm not alone on this, eh? That feeling where someone's talking to you and s/he's just unbelievable[-y arrogant and misguided and selfish and ignorant] and you just want to stab yourself in the neck with a pencil and bleed all over them to a) put yourself out of your misery and b) shock them into being human beings instead of academic cocksuckers? jesus, I am bitter. Â Â
and stay home. and be a child. and find happiness.
so I took a sabbatical from people, tried growing up, started prioritising, and re-evaluated what fucks to give. which, I have discovered, is even less than the fucks I thought I gave (more on that in another post). so when 2015 came along, and I once again found myself in bed under three duvets--because my family is super frugal slash super Asian slash poor and turns off the heat at 2100 each night to save on the energy bill--at still-an-hour-and-a-half-left-'til-midnight-o'clock, I decided 2015 was going to be different.
granted, this is not the first time I vowed a year to be different.
it's a slow start.
jan 1, 2015. supercharged. downhill from there.
to mark the beginning of 2015 and my conviction to make it less suck, I chopped off my hair. well, my mum chopped off my hair (re: poor). while it's superficial, but there's just something about chopping off a foot of hair that makes you think damn, shit's getting serious now. of course, I immediately began to panic when I realised I could no longer use my hair try to cover up my period-zits (always futile, but still comforting to have the option). and when you no longer have hair, 'whoops, didn't see you because whoops no peripheral vision' is less plausible an excuse for not talking to people you might sort-of kind-of not-really recognise from the wards. but I have since been informed that 'it suits you' and 'it makes you look less intimidating' (not sure I like the latter), so lining, silver.Â
anyway, I read this article on forbes.com about things people do to decrease stress. And because I have been swimming in a shit ton of stress since September, I am going to adapt some of these so that maybe I won't find myself battling medschool and a systemic candidiasis or a shingles outbreak.
my TO DO list:Â
Say No and don't feel guilty about it.
Let my family know I love them every day.
Stop thinking about 'what if' scenarios.
Go offline and read a book/paint a mug/do something. Â
1 cup of coffee, 1 visit to the gym, 8 hours of sleep, q24.Â
If you can't let it go, lock it away because grudges can be motivating only if they aren't time- and energy-consuming.
Prioritise happiness.
Give less fucks.Â
Write more (I suck, I know).
my spirit animal for 2015.
how I prepare for Step 1 vs. how my classmates prepare for Step 1
Classmate: You just have to keep doing questions.
Me: I know.
Classmate: And take practice tests.
Me: I am.
Classmate: So what's not working?
Me: I know what I have to do, it's just that my head is stuck so far up my ass that I keep getting distracted by all the shitty scenery.
*pause*
Me: haaaaahah. Pun.
Classmate: Well, you're never going to feel prepared for the test. I didn't feel prepared.
Me: Yeah, but you are the Beyonce to my Britney Spears, circa 2007 after she shaved her head and then gained 50-pounds or something. It's not the same level of not feeling prepared.
Classmate: I remember why we should hang out more.
A crop of books by disillusioned physicians reveals a corrosive doctor-patient relationship at the heart of our health-care crisis. Â
The deceptive salary of doctors.
Source:Â http://www.bestmedicaldegrees.com/salary-of-doctors/
Unfortunately, anything that is tight-fitting and shows a little bit of cleavage is likely to be interpreted as an animalistic attempt at sexual flirtation, with zombified men becoming aroused and dragging themselves into London-town from as far as High Wycombe using their own cocks like dowsing rods to hone in on the areole every time I, or any other well-endowed woman, slips into a saucy v-neck top......Women with large breasts are never described as elegant. They are curvy, and sexy, and bubbly. They are not taken seriously. They are cheap and sexually accommodating. They are âeasy.â We are forced into a position of having to apologise for our breasts, making a concerted effort to conceal them so we are not considered complicit in our own sexual objectification.
Vagenda. More at: http://vagendamagazine.com/2014/11/memo-to-both-men-and-women-my-big-tits-do-not-belong-to-you/#sthash.b8B35Kc7.dpuf
Male privilege is âI have a boyfriendâ being the only thing that can actually stop someone from hitting on you because they respect another male-bodied person more than they respect your rejection/lack of interest.
Source: http://lunalunamag.com/2013/09/05/stop-boyfriend/
How would you talk a male diabetic out of smoking? Dude, you'll get impotence. Buuuut that's not really respectful enough, like, dude I just met you let me talk about your penis. So instead, I go: let me explain to you how smoking and diabetes affect the body. I explain things, and then I say, what you may not know is that smoking causes constriction of blood vessels and prevents the flow of blood through your circulation. So you may not be able to have an erection or have sex when you're in your 40s. See that's much better. And then when you see these diabetics with amputated feet, that's another opportunity to scare them. I would rather always talk to patients over their heads than under their heads. Just like I'd rather be talked to over my head than under. Give them a little bit of credit.
ED doc, on pt interactions
Unsolicited Advice re: using feedback and doctoring
not everyone who shits on you is your enemy,Â
not everyone who gets you out of shit is your friend,Â
and when you're in deep shit, it's best to keep your mouth shut!Â
During clinical year, learn how to be a doctor and decide what kind of doctor you want to be.
everyone is teaching you something
learn to judge yourselfÂ
patients are medical students
pick a realistic reading plan and do itÂ
learn some version of "There but for the grace of God go I" and say it often
people do what makes sense to them
it is a privilege to be a physician
you get to decide what kind of doctor you want to be
As you walk around the wards, beg, borrow, and steal everyone else's best stuff.Â
- ED doc, on getting started with clinical year
sand art by Kseniya Simonova, winner of Ukraine's Got Talent
I went to a Narcotics Anonymous meeting
I could feel the eyes.
My compatriot and I had girded our loins and strode with purposeful steps towards the main entrance, somehow managing at once a sense of assuredness while we clearly had no idea what we were doing or where we were supposed to be. A friendly woman who was walking up behind us must have sensed the confusion, because she shouted out, âwhere you girls lookinâ to go?â and then very helpfully directed us to the right entrance. For a minute I was relievedâshe seems like a nice person, perhaps this wonât be so badâand then I walked in.
I was definitely hypersensitive, but walking into that room struck a high-strung chord of social anxiety that reverberated cacophonously over my baseline key of introversion and self-imposed solitude. The one I usually manage to keep silent and under control with a generous dollop of avoidance of all situations involving a population of n>3 andâwhen absolutely necessaryâaplomb. Large groups disturb me, and I start suffocating under a stimulus overload by all of the bodies and voices and unique-yet-all-really-the-same identities asserting themselves in a space that grows smaller and smaller the longer I spend in it. And the group that gathered at â[NA meeting]â was definitely of an n>3. So as we walked into the room, I felt the eyes of everyone swivel towards us, picking apart the fact that weâwith our skin and clothes and youth and BMIsâwere strange folk who did not belong.
The fluorescent lights flickered off a wide expanse of linoleum floor in the center of the room, ringed by plastic chairs organised into four concentric rectangles. It was a stage, and we made sure to skirt far along the periphery as we searched for two seats together, in some inconspicuous place. We stiffly sat ourselves down, and I tried to surreptitiously scan the room and the faces while making sure not to linger too long or to make eye contact. I found myself starting to slouch, as if poor posture would somehow help me fade into the background, to observe without betraying myself. Excepting the two of us and save perhaps four other individuals (all white and all male), everyone was black, obese, hovered around the age of 35-55yo, knew what THC was before hitting 12yo, familiar and belonged.
Someone (the leader/director/chair/committee member?) called the meeting to order with several general announcements of conference, activities, and planned events. An almost empty basket with loose bits of cash was passed around the room, for fellowship funds of some sort. Off to the corner was a table of liquid refreshments like coffee or juice. It was the town meeting assembly of my imagination. Another person went to the center of the room, held up what looked like a chain of key tags or chips, and began to call for individuals who were newcomers, folks who had reached hallmarks in their abstinence, or people who had perhaps fallen back into old ways and were just returning to try anew. He was often met with silence, but occasionally a bark of some number wrenched from some voice in some corner of the room, and then a smattering of weak applause. I knew nothing and did not know what to expect, but everything just seemed so much more tired and sad and forced than I had imagined. The bodies looked small, worn, chronically ill and collapsed onto themselves. The visages were closed and gazes deadened. The voices sounded ancient and exhausted. I felt myself dissecting the details, these strangers for whom I felt nothing but separation and hypervigilance, and was faintly aware that I was disappointed.
Then the stories started, and each story shared seemed to breathe a bit of life into the room. There was a 17yo white boy in a loose tank top and heavy-rimmed glasses slouching on the opposite side of the room. The glasses hid his eyes, but I imagined I could feel a sort of sullen, defiant gaze. His outward appearance belied just how much he belonged. From a face that still hadnât lost all its baby fat came a lethargic, occasionally inarticulate voice speaking a story I couldnât understand: of triple C and spending nights out on the streets getting high and jail, of doing all of that and then doing all of that again, just because he was bored, because all of his âgoodâ friends were still in school. I felt a morbid fascination and complete disconnect towards this kid. As much as I can empathise with patients, [struggle to] understand motivations and those messy human parts, I just could not empathise with this boy and his choice. It was as if trying to understand what he was saying intellectually was so difficult, it made impossible any other connection. I wondered if he actually thought he could do it now, when it seemed like he had failed to quit so many times before. I wondered if any of the other members of the audience thought the same, that this was such a typical sad story, doomed to repeat itself like so many others. Oddly, this sensation of an inability to integrate, almost like a disturbed internal equilibrium or processing, was specifically to this one boy and his story.
When he ended, there was a loud round of applause, and many people stood up to both literally and figuratively welcome him [back] into the fellowship, with open arms and hearts. Strangers embraced easily and with great purpose, as if trying to imbue strength and will by touch. This repeated itself many times throughout the night, people sharing their individual lives and circumstances, yet all sort of sounding the same in the end. It was sad, but I suppose in a way it was profound. It was a microcosm of hope and human struggle.
I forgot the eyes.Â