#pleasedotheneedful

[pleasedotheneedful]

waiting awkwardly at bedside during a very long rapid response for afib/RVR

nursing: here, try blowing into this straw

resident: I don't think it's gonna do anything, he's in afib--

me: sshhhhh it gives the patient something to focus on

...

resident: ohh, I guess that's one of those attending insights huh?

[pleasedotheneedful]

Medicine will sign off. Thank you for the interesting consult.

- a consult that was absolutely not interesting

closing statement on a 60-something who fell over and broke his hip when the wind blew his bicycle over. takes no meds, has virtually no chronic medical conditions. dude is healthier than the patients half his age in the hospital. he was "optimized for surgery" when he got up in the morning.

[pleasedotheneedful]

what's new in pdtn land

became a dad last month

had to fight tooth and nail to get 8 weeks of unpaid leave for child care though, because I have < 1 year in service and HR/admin in my hospital system is a fucking disaster. my wife has similar rules about her maternity leave but her admin waived them without any pushback. she works for a different hospital system and gets 12 weeks fully paid. guess who's more likely to retain their physician?

2. had my teaching titles/roles stripped back in January, rather suddenly. I admittedly let myself get into an unhealthy cycle over the winter and wasn't doing a lot of teaching, but I'm surprised they took me off the schedule entirely for a year. I'm not sure how I'm supposed to get better without actually getting reps on service. I talked to the PD about it, who acquiesced but when the new teaching schedule came out I wasn't on it. yet we share the same vision for the program and its residents.

3. moved into a new house to accommodate #1, which unfortunately meant moving out of the city. the housing market is total insanity still, houses were impossible to find without an HOA and even then, flying off the market within 48 hours.

4. given #1 and #2, I have limited prospects on staying at my current job. the pay is good and the day-to-day work on non-teaching is pretty manageable. but it's not what I want out of my career long-term. I'm toying with the idea of going part time or PRN here, and putting that time into being a mercenary. locums pays well and requires fewer hours--there aren't any benefits but since I'm on my wife's plan that doesn't matter to me. so I can use that time to be at home more, and expand on my private practice hybrid concept. the locums gigs also offer me a chance to get a diversity of references instead of being tied to one employer. if I'm not back on teaching with some frequency by next January, I'll probably scale down to PRN by the subsequent summer or walk.

[doctorspork]

@pleasedotheneedful replied to your post “Day 1 in the MICU with the new interns. Here we go!”

I'm so grateful I didn't have any ICU time as an intern (at my current program)

Honestly I didn’t mind it as an intern. The schedule sucks but I loved the work and it made me want to do critical care. I haven’t been back in 2 years, and these interns are brand-new, so it’s a challenge but they’re doing great so far!

[doctorspork]

@pleasedotheneedful replied to your post: shoutout to the incredibly pleasant surgeon who...

“nah I read your note” YESSSSSSSSSS

it’s always a nice surprise when surgeons actually read

[randommomentsdevida]

pleasedotheneedful replied to your post “Got my in service score back... I improved by 11%!”

niceeee mine went up like 6%... crushed it on neuro and apparently still suck at rheum

lol I killed neuro and nephro. I sucked at ID ;_;

But yea, was really surprised how much I improved considering I tried to get out of the test ASAP LOL

[randommomentsdevida]

captainmdphd replied to your post “It’s been a while. Mostly because I’ve been so angry at my program...”

Three months of q4 in one year is way harsh. Most useless remnant in medicine, IMO. Stay strong. Y'all don't have MICU fellows?

I’ve already done 3 months of q4 call as a PGY1.. and two months of nights.. I’m fucking done. 

And no, we basically are the pseudo-MICU fellows. The PD is maxing out our ICU months. 1 day + 1 night as interns (which doesn’t count as ICU for some stupid reason), 3 as PGY2, and 2 more as PGY3, which I imagine won’t hold because when I’m a PGY3, the new PGY2s won’t know what the F they’re doing. 

pleasedotheneedful replied to your post “It’s been a while. Mostly because I’ve been so angry at my program...”

yikes, two kinds of program leaders out there. sounds a little like my old program.

Yea.... I hate this place. Malignant AF

cranquis replied to your post “It’s been a while. Mostly because I’ve been so angry at my program...”

wow. WOW. what idiocy.

RIGHT????!

[medical-gal]

drift-crazy-rushian

Eehhhh I’m always on the fence. I mean an MRI? If she’s otherwise cooperative and not fighting it? Sure. Is her urine clean? What is her baseline functionality/quality of life? I’d be more apt to work it up a little more aggressively if she was fully functioning with minimal deficit at baseline. But also more importantly, what does she want? Advanced directives? Family know what she would want?

pleasedotheneedful

If pt will cooperate and everyone is on board I would be ok with MRI. this gave me a flashback to a patient who was admitted on a saturday with stroke symptoms but no CT findings so they just hung out in the ICU for seizures with a low-priority neuro consult placed. neuro saw her on monday, repeat CT showed a big ischemic stroke. EM resident got their shit pushed in.

cranquis

like other comment said, first and foremost, what advance directives exist? what can family convey about her goals for quality of life?  

  I live in the city where no radiologist would give me MRI stat for 90something year old lady. I had to promise a free lunch whn I wanted an early MRI in a young female when I suspected RES. 

And no advance directives from the patients. However the fam doesnt want to do any excessive procedures. The quality of life before was that she was able to move from the bed with the help of others, was able to walk for a short time. Now she is lying and not communicating. she isnt in any pain. Atleast doesnt seems like it. 

My working diagnosis is brain infarct. we shall see how she will do tomorrow.