WesElyMD Profile picture
Apr 25 11 tweets 3 min read
1/🧵 I DARE YOU 👍

When we’re busy, relationships become I-It & should be “I-Thou”

How can we fix it?

I asked him 4 Questions:

What’s your favorite song, hobby, food, pet’s name?

Do this for 1 WEEK. How does it change the way you SEE & CARE for others?

Read on…(pic w perm)
2/ Hecame to our ICU service over night after his spinal fusion.

He would only be w us a short time & would then be gone. So why dive deeply into his history??

Because he’s an ENTIRE PERSON.

So every minute with him is a gift. What did I learn?
3/ His favorite 🎶 is anything by the Eagles. Hobby is cars. Food is Thai. Pet is a “white golden” named Hondo!
4/ I added one more. “How did you meet your wife?”

It was the jewel question on this day!!
5/ His answer, “We met at the Pentagon. I’m in the air force, and I was in the Pentagon doing my last assignment, and a plane hit the building on NINE ELEVEN. I carried people out. The next two days we practiced “SHOW OF FORCE” tactics…
6/ “Doc, SHOW OF FORCE meant that we wanted to prove that the terrorists wouldn’t get the better of us. So we came together to recover and rebuild. It’s how I learned the mindset I’d use to fight this cancer down. I want to share my experience, strength & hope w others!”
7/ I just took over caring for another patient who’s been in ICU for 3 weeks on a vent. I found out his dogs are Abby and Mack. His favorite song is 8 Days a Week by Beatles. He rebuilds cars – fave is “70 Chavelle. He love pepperoni pizza.
Guess What?
8/ I’m IN. I can SEE him now. I’m fighting for HIM. I want him to get back to this scene:
Working on his Chavelle, with Abby and Mack watching, while they all listen to “Ooh I need your luvin’” and eating pizza!
9/ Don’t you see? We are all just people. But sometimes we look straight past what makes us each unique. That creates a scenario where I can treat you as LESS. Less valuable. Less dignified. Less IMPORTANT to fight for. Don’t let it happen on your watch.
10/ I’m not pointing fingers here. I’m guilty. Complicit. I make this mistake. But then when I use my tools, my own personal challenge, I can fix things for the person sitting in front of me. Each person if of inestimable worth.
I have learned that if I take 2 minutes to ask about each person’s favorite food, music, pets & hobbies (bonus questions about relationship back stories take longer but are AMAZING), it makes me a better #HEALER + prevents #BURNOUT.

The Ely 4 Questions Challenge – try it!

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More from @WesElyMD

Apr 26
1/🧵 Does Alcohol shrink the brain?
Yes, all liquor can hurt our brains if we drink too much. The disease of Alcoholism, which is NOT the fault of the person afflicted, causes brain injury slowly over time.
A picture is worth 1,000 words. Look below at a diseased brain… Image
2/ Gray on this CT scan indicates actual brain tissue.

Do you see the black areas pointed out here by RED arrows?

These are called sulci (grooves).

This <40 year old person has VERY large grooves that show the amount of brain tissue as we would see in someone >80 w dementia. Image
3/ Normally brain grooves are small in young people. See example👇.

When someone gets dementia, s/he can lose actual brain tissue (less gray) and the area fills in with fluid (BLACK - sulci).

SO this is atrophy & manifest in life as memory problems & executive dysfunction. Image
Read 6 tweets
Apr 7
1/🧵 You have a COVID ICU patient on benzos who doesn’t respond to needle injection of local anesthetic do to sedatives.
What depth of sedation do you consider this? (it was a CME question just now)
2/ The answer is GENERAL ANESTHESIA, which of course makes sense.

If a person is so deep that he/she doesn’t respond to getting stuck by a needle and the pain of lidocaine injection, that is general!

Why am I writing about this?
3/ Anyone working in the ICU this past few years of #COVID #PANDEMIC is seeing this depth of sedation on a regular basis.

We had almost gotten rid of this by 2019. Then COVID undid progress.

People now think this is normal for some reason.

It is NOT normal.

It is not OK.
Read 9 tweets
Apr 7
1/🧵 A personal story of misjudgment as a physician.
Years ago, when I was a young doctor, I had a patient in the ICU on a ventilator who was doing so poorly, day after day, that I was certain he was going to die.

I confidently told the family he was going to die.
2/ The family members all gathered and were extremely distraught. They listened and trusted me.
But I was wrong.

#PalliativeCare #EndofLife
3/ For many years to come, I received Christmas cards from this man.

It was extremely humbling.
Until I learned, this happened many other times in my life as an ICU doctor.

Sometimes I was off by just 2 weeks, sometimes 2 months, and other times by 2 years.
Read 8 tweets
Apr 6
1/🧵 #LongCovid is REAL & up to 23,000,000 ARE (not “may be”👇) suffering.

Yesterday, @POTUS announced expanded funding.

Becerra told reporters Tuesday. "Millions of Americans may be ⁉️struggling with lingering health effects…”

2/ As part of its efforts, the White House said in a statement that Biden will push to accelerate a $1.5 billion study started last year by the National Institutes of Health to follow 40,000 individuals with and without long Covid to try to better understand the condition.
3/ Biden also proposed spending an additional $25 million on a $50 million study started last year by the Centers for Disease Control and Prevention to understand the risk factors, mechanisms of action and characteristics of long Covid, the White House said.
Read 4 tweets
Apr 5
1/🧵 Race & Medicine - #COVID

Dark-skinned people who get #COVID, or any disease lowering O2 levels, are more likely vs whites to suffer undetected hypoxemia (missed ⬇️ O2 levels).

Pulse oximeters are affected by skin color & read falsely high in Blacks.

Does it matter?
2/ It matters because undetected hypoxemia tripled the odds of DEATH 💀
This study of >128k measurements from 26,000 pts confirmed these inaccuracies that we’ve known about for 30 years.

Black, Asian & Am Indians were all included. #Disparity
3/ It’s not lost on me that this study comes at a time when we’re trying to get RID of false distinctions of race in medicine.

MYTHS generated by #racism about Blacks having different lung or kidney function are bogus.

But the Pulse Ox must addressed: bit.ly/3uZIrEG
Read 8 tweets
Mar 29
1/🧵Serious question:
Is it ok to CLAMP OFF blood vessels to a human brain to stop cell function & get organs for transplant?

A new procedure does this to ensure no blood reaches a person’s 🧠 as surgeons take organs from freshly ‘dead’ bodies. Discuss.

2/ We all want to relieve the suffering when people are dying of failing kidneys, lungs, hearts.

Transplant can be a great solution.

As a transplant physician myself, I directed lung transplantation at #Vanderbilt.

I worry this new approach is a breech of the dead donor rule.
3/ The “dead donor rule” (DDR) says donors must be determined dead according to established legal/medical criteria PRIOR to procurement of vital organs.

What if there are doubts?

Like ongoing neuronal activity?

Can we take it upon ourselves to stop blood flow?

My letter:👇
Read 15 tweets

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