1/ 🧵 Mentor-Mentee topic: MEANWHILES
Mentees often tell me they feel stuck in time with no progress in achieving their goals. This is a Meanwhile. As humans, we want to get through meanwhiles, but they are important times of growth. Don’t rush meanwhiles!

Some thoughts…
2/ When I was in college, a mentor taught me about the 3 major types of meanwhiles.

1. Uneventful Occurrence.
2. Unknowing.
3. Not Yet.

Don’t let fear drive you past the riches of these meanwhiles!

Let’s break them down…
3/ Meanwhiles of Uneventful Occurrence:
Tedium is not just OK. It’s necessary. Ordinary times are preparation for fruit to come. Let the grace of your routine establish sustainable balance in your life…one day at a time…in this we grow.
4/ Meanwhiles of Unknowing:
These are times spent in inactivity because of not knowing what to do. The digital age breeds impatience. Do not give in to anxiety here, because wisdom is accrued during this meanwhile by learning to live in the moment without future-casting.
5/ Meanwhiles of Not Yet:
It can be frustrating & tense when we know what we want to do but can't yet do it. These are the unspectacular times during which we are formed. These are perhaps the hardest of all the meanwhiles. We're all fired up to act, but are forced to wait...
6/ Meanwhiles are like a garden. After planting seeds, you see dirt for a long time, yet there’s a LOT of activity going on. When green sprouts show, a foundation of roots has been established to allow the plant to endure harsh weather & grow in stature. Patience, Grasshopper!
My mentor told me: “Meanwhiles are not lost days. They are priceless times of hidden growth. When our meanwhile is done, something remarkable happens. Life becomes extraordinary when we allow the ordinary times of life to accrue through the meanwhiles!
I’m adding another 💭 about the #mentor-#mentee relationship for my 🧵. This👇from @SapnaKmd on how much I as a mentor gain and learn from those I am #mentoring.

#MedTwitter #AcademicTwitter #ScienceTwitter #nursetwitter #medstudenttwitter #TipsForNewDocs

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More from @WesElyMD

12 May
1/ Steroids in #COVID19?🧵

N=428. In 1 study we go from
1. statistically significant ⬆️ Deaths w steroids
2. to no difference by adjusting
3. to statistically significant ⬇️ Deaths by subgroup phenotyping of inflammation…

All in the same study? Let’s unpack this...
2/ Chen et al built on a 2014 @LancetRM study by Dr. Calfee of 1,022 pts, showing that sick people on a ventilator w ARDS (think #COVID19) are of 2 types, 1 of which is Hyperinflammatory (storm of inflammation) who might benefit from drugs like steroids.

3/ First Chen tried to overcome the biases associated with their observational data & showed that some observational methods (eg, multivariable regression including baseline SOI) can give the exact wrong answer (HR 1.97) because it does not include temporal biases.
Read 7 tweets
11 May
1/ #COVID19’s “Long Loneliness” was exacerbated by our flawed decision to separate pts from family at just the time they needed each other most. @doctor_oxford has captured the sorrow & pleads for us to come to our senses.
#medtwitter #PalliativeCare
2/ @doctor_oxford ✍🏻: “NHS did its best, but too many were isolated when they needed connxn most, leaving a legacy of deep trauma.” No doubt we dropped them “into Hades.” It was done w benevolent intent but in fear. PPE works & we must adjust visitation humanely.

3/ One daughter who lost her dad said, “Even when they told us they were going to withdraw Dad’s life support, no one from the hospital offered us the chance to come in or suggested a video call or a phone call.” This is flat out wrong at every level & we know it.
Read 4 tweets
10 May
1/ Typewriters & Stethoscopes:

Ann Patchett wrote a tantalizing @NewYorker piece on, among other things, tools of the trade. Reflecting on her cherished Hermes 3000 typewriter, my 🧠 wandered to the stethoscope. She ✍🏻


@ParnassusBooks1 @MedBookClub1
2/ “I didn’t need the glasses or silver, things that represented who I thought I’d become but never did, & I didn’t need dolls, which represented who I’d been & no longer was. The typewriter, on the other hand, represented both the person I had wanted to be & the person I am...” Image
3/ “Finding the typewriter was like finding the axe I’d used to chop the wood to build the house I lived in. It had been my essential tool. After all it had given me, didn’t it deserve something better than to sit on a shelf?”

#docswhoread #nurseswhoread
Read 11 tweets
10 May
1/ 🧵 What is “Brain Fog” in #COVID19: discussion, papers & pts
 Brain Fog is a non-medical term but it works since it’s what pts describe. Whether in a ward, ICU on a vent, or months later as a #LongHauler w #LongCOVID, they are “in a fog.”


2/ Medically this is #Delirium acutely and #Dementia chronically + various forms of neuropsychological impairment coupled with #depression and #PTSD.
Our paper: go.nature.com/3nU9ZYm
3/ Scientifically, it’s millions of neurons sick, dying or dead. This is depersonalizing & devastating. Fig A shows MRI 3 mos after ICU in pt w/out delirium vs B shows ICU pt w #Delirium. Duration of delirium predicted loss of 🧠 tissue.

Our MRI study - bit.ly/3uxAqFQ
Read 13 tweets
6 May
1/ #Sleep & #Dementia: @NatureComms
Study of ~8,000 people followed for 25 years! Look at the figures. Sleeping <7 hrs per night chronically increases risk of dementia by 30%.  Get your sleep!


#MedTwitter #MedEd #Geriatrics
2/ Sleep and Dementia Risk: @nytimes

@PamBelluck wrote a great article on this NatureComm paper showing heightened risk of #dementia for “short-sleepers,” defined as <7 hrs of sleep a night.


#Aging #Delirium
3/ What’s the Mechanism?

Our brain’s “trash” clearance (like the body’s Lymphatic system but by brain’s “glial” cells & called Glymphatics) kicks into ⬆️ gear in sleep. So less sleep is like your waste management system going on strike. Kapische??

REF: bit.ly/3eQxtte
Read 5 tweets
3 May
1/ 🧵A picture is worth 1,000 words 👁 #COVID19:

This 🎥 shows a clear example of what can happen to a person’s body w #COVID. His wife asked me to show it on twitter & urges everyone to get #vaccinate

(w/ consent of pt & wife)

#MedTwitter #NurseTwitter #CriticalCare
2/ You’ll notice his eyes are swollen shut. (Written perm to show). This is not fluid. It’s AIR from inside his chest leaking out his lungs 🫁 through muscles & skin to his neck & into his face. He is AWAKE & communicating but had ICU #delirium earlier.

#MedStudentTwitter #Nurse
3/ Look at his chest CT. See the “L” lungs w #Covid pneumonia/#ARDS & also AIR leaking out under his skin. Now go back to 1st tweet & watch 🎥 again. This is called “barotrauma” & happens when the 🫁s get too stiff and pop. Difficult situation. We’re hoping he can heal!

Read 5 tweets

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