Nico Gagelmann Profile picture
Jun 20 12 tweets 3 min read Twitter logo Read on Twitter
10 rules for life of a young doctor.

How to deal with death and suffering.

A short 🧵

#MedTwitter Image
#1 Embrace empathy.

Understand that every patient is unique and has a story worth hearing.

Listen.

Connect with your patient on a deeper level than just a "health provider".

Provide comfort and support.

It's necessary to reflect upon their pain.
#2 Caring for others requires caring for yourself.

Take time for activities that replenish your energy and help you decompress. You don't help anyone with your insecurity and own problems you have with this world. Your well-being and confidence is crucial for quality care.
#3 Seek guidance.

Don't hesitate to reach out to experienced colleagues, mentors, or friends. Discussing your emotions and concerns can help you process difficult experiences, change perspective and find coping mechanisms. Remember, you're never alone in this world.
#4 Acknowledge limitations.

You can't always save everyone, and that's okay. Understand that medicine has ends, and you're doing the best you can with the knowledge and resources available. Focus on compassionate care rather than projecting your own anxiety.
#5 Death is the end of all things and gives meaning to all things.

Death scares the shit out of me, and that's ok because that makes me value every moment I have on this world.

Use every minute you have with your patients to give them and yourself meaning in the Today & Now.
#6 Be truthful.

Dialogue is vital for prognosis and end-of-life care. Be honest, compassionate, and listen actively. Let them share their fears, hopes, and questions.

Remember, know your own insecurity and give yourself space to evolve and become better in this.
#7 Be less impressed and get more involved.

Cultivate mindfulness techniques to help you stay present amidst emotional intensity. Whatever it is you do to achieve that, mindfulness can ground you, make you realize what's relevant, enhance your ability to reflect and understand.
#8 Facts don't equal truth, nor do opinions.

Do not hide behind facts. Life is so much more than a parameter or an image. The truth of suffering and death requires to be open for higher truths and differentiation.

Never become a narrow minded snob of realism.
#9 YNWA.

Surround yourself with a strong support system of colleagues who understand the challenges you face. Share your experiences, exchange advice, and offer each other support. Together, you can navigate the complexities of medicine and find solace in one another.
#10 You CHOSE to be here.

Remember why you chose this path of medicine. Even in the face of suffering and death, the impact you have on patients' lives is profound. Celebrate moments, and make a difference in this Here and Now, one patient, one life at a time. Your life.
In the end, cherish the golden rule: treat others as you would like to be treated. The insecurities of others can be probably also found within yourself.

Thanks for reading and happy to read your own reflections and techniques. Sorry for the messed up publication of the 🧵🙏

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More from @NicoGagelmann

Jun 6
😱Emergencies in hematology😱

Hyperleukocytosis and leukostasis

A short 🧵 #MedTwitter

1/12 Image
Intro:
-Hyperleukocytosis (HLC) often defined as WBC of 100×10^9/L or more
BUT
-symptoms of leukostasis (LS) can occur at lower counts
-HLC👉microvascular obstruction👉tissue hypoxia+ infarction👉LS
-most common in acute leukemia, esp AML (5%-20%)
-children>adults
2/12 Image
Pathophysiology I:
-2 main theories, probably both play a role
-first theory
--LS due to increased blood viscosity by large population of leukemic blasts👉less deformable than mature leukocytes👉plugs in microcirculation 👉WORSENED by RBC transfusions or use diuretics❗️
3/12 Image
Read 13 tweets
Jun 4
😱Emergencies in hematology😱

Hypercalcemia of malignancy (HoM)

A short 🧵 #MedTwitter

1/17 Image
What causes hypercalcemia?
Before you think malignancies, think Chimpanzees:
Calcium supplementation
HCT
Iatrogenic
Myeloma, milk-alkali syndrome, medics
Parathyroid hyperplasia/adenoma
Alcohol
Neoplasm
Zollinger Ellison
Excessive vitamin D
Excessive vitamin A
Sarcoidosis
2/17 Image
Now to HoM:
-Ca2+⬆️common in advanced cancer (-30% of patients)
-most common in myeloma, non-small cell 🫁 cancer, renal cell, breast, non-Hodgkin lymphoma, leukemia
-adverse prognostic factor
BUT
-effective therapy, both for hypercalcemia + cancer, improves outcomes
3/17 Image
Read 18 tweets
Jun 2
😱Emergencies in hematology😱

Malignant spinal cord compression (MSCC)

A short 🧵 #MedTwitter

1/11 Image
Intro:
-true oncological emergency❗️
-up to 6% of cancer patients
-annual incidence of hospitalizations secondary to MSCC among patients with advanced cancer ~3.5%
-multiple myeloma and non-Hodgkin lymphoma with highest cancer-specific incidence
-prognosis poor
2/11 Image
Definition of MSCC:
-any radiologic evidence of indentation of the thecal sac or spinal cord compression, whether or not there are neurologic signs and symptoms associated with compression
-grading using the "epidural spinal cord compression (ESCC) scale" (Bilsky scale)
3/11 Image
Read 12 tweets
May 30
😱Challenges in medicine😱

Thrombotic microangiopathy (TMA)

A short 🧵#MedTwitter
1/16 Image
Intro:
TMA syndromes are extraordinarily diverse❗️
They may be
-hereditary or acquired
-occur in children and adults
-onset can be sudden or gradual
BUT
despite their diversity, they are united by common, defining clinical and pathological features
2/16
A short history of everything TMA
3/16 Image
Read 17 tweets
May 28
Calling all early career people!

Relations between us are often poisoned by fights for the best spotlight, position and papers.

Here are 10 things we should say to one another more often.

A 🧵 Image
1️⃣ "You're not alone." Remember, everyone goes through ups and downs in research. Reach out to your peers, share your struggles, and lean on each other. Together, we can overcome challenges and celebrate successes.
2️⃣ "You belong here." Doubting your abilities is common, especially when starting out. Remember, you earned your place through hard work and dedication. Believe in yourself and trust in your unique contributions.
Read 11 tweets
May 18
😱Hematological emergencies😱

Disseminated intravascular coagulation (DIC)

A short🧵#MedTwitter
1/20 Image
Intro DIC:
-systemic activation of coagulation
👉resulting in microvascular thrombosis & haemorrhage
-devastating condition, poor prognosis
-clinic variable, depends on ⚖️of clot formation in microvasculature & consumption of coagulation factors, inhibitors, platelets
2/20
History I:
-Dupuy in 1834: described effect of IV injection of brain material in animals👉almost immediately died and at autopsy widespread clots in the circulation, 👉due to what we would now call tissue factor–dependent systemic activation of coagulation
3/20 Image
Read 21 tweets

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