during my MS-3 surgery rotation, i got pulled into a cardiothoracic surgery case. the division, and this attending in particular had...a reputation, and most of us would do anything to get out of working with them. but this time, i couldn't get away.
it was a laparoscopic case involving one lung. my job was to hold the camera--not a particularly difficult job, but one that's really important, and one that's not easy if you've not done it before.
as things were getting set up, the attending was talking to me about how we were going to insert the endotracheal tube further than normal, to intentionally intubate one lung, allowing us to work on the other. brilliant. i'd never thought of that.
we got started, and i was doing a relatively good job holding the camera. but something didn't seem right. i decided to say something.
"i think the tube's in the wrong place."
she responded angrily. "we just talked about this."
"yes, i know. you said we would be ventilating only one lung. but it looks like we are ventilating both."
things were adjusted. no harm was done. no apology was made. no gratitude was expressed. no words were said.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
when i was in residency, i had an idea for a different practice model. one that would allow me to spend more time with patients, and would let me operate outside the bounds of the typical healthcare system, giving my patients the attention they deserved.
i spent two years working on a business model that i thought would work. i examined similar practices from across the country, took the best parts of them, and implemented them into a practice model that i thought would be great.
but things didn’t go as i had planned. the grand opening was less than grand. i think i saw 2 or 3 patients the first month, which was great for studying for boards, but not so great for paying bills or keeping a practice afloat.
“colic” isn’t a thing. “gripe water” is also not a thing.
except they kind of are. they're multiple things, really.
come with me on this journey. (THREAD)
in 1954, dr. morris wessel published a paper called “paroxysmal fussing in infancy, sometimes called 'colic’” it’s about (as you probably surmised) babies who cry a lot.
the researchers examined the records of 98 babies and separated them into 2 groups: “fussy” and “contented.” how? by using a definition that dr. wessel just made up: babies who cried more at least 3 hours a day, at least 3 days a week, for at least 3 weeks were defined as "fussy"
The story of teething begins, as all good medical stories begin, with Hippocrates, who wrote in the 4th Century BCE that “teething children suffer from itching of the gums, fever, convulsions, diarrhoea, especially when they cut their eye teeth.”
(a thread)
It wasn’t until the late-19th century that a precise mechanism was elucidated. J. W. White explained, “The nervous perturbation occasioned by the eruption of teeth increases the susceptibility and lessens the resistive power of the child.” (There, that sounds science-y enough.)
Just a few hundred years after Hippocrates wrote of the perils of teething, Soranus of Ephesus developed one of the earliest recorded treatments for teething:
1) Kill a bunny (or don’t, but it seems the humane thing to do) 2) Cut out its brain 3) Rub it on your kid’s gums
we shouldn't be here. the management of this pandemic has been a complete disaster from the start. efforts to get this pandemic under control have not been only ignored, but undermined by our president. we shut down for weeks, and we have very little to show for it.
we still lack adequate ppe. we don't have a coherent testing strategy, and the tests we are doing often take a week or more. we still lack hospital beds and icu beds and staffing required to handle what's here or coming. that's what the shutdown was for.
we flattened the curve so that we could address those things, and yet here we still are, months later. people are tired of it, and i get it. i'm really damn tired, too. i want this to be over. but we can't just *decide* it's over, which seems to be what's happening.
In the words of Kenny Rogers, "If you're gonna wear a mask, boy, you gotta learn to wear it right." (Thread intended for HCWs, but important for anyone)
Point #1: If you're wearing a mask, its job is not to protect you. The point of the mask is to protect other people from you.
Because a significant percentage of people infected with SARS-CoV-2 don’t have any symptoms, and those that do are contagious before symptoms develop, we have to assume everyone has it, including ourselves. Your mask is intended to protect others from you in case you're infected.
Masks may provide a slight benefit in protecting the person wearing them, but they are dangerous if not used correctly. It’s helpful to think of things as “clean” and “dirty.” As you breathe--or get breathed on, the mask collects and concentrates viral particles.
Biotech companies distributing rapid IgG/IgM test kits for SARS-CoV-2 🦠that provide results in as little as 10 minutes from a simple finger stick.
What could go wrong?
Well... 😬
These are being produced and released without sufficient testing or FDA approval. We don't have great data on how accurate the results are, and any data that we do have likely comes from the companies that are trying to sell them...
I'm not *saying* they'd intentionally fudge the numbers or present only their best data, but I'd be less than surprised.
These tests are different from the COVID-19 testing you've heard of so far. They don't look for RNA from the virus, but for antibodies in your blood.