I’ve intubated in parking lots.
Declared death in living rooms.
Led trauma teams on the worst nights of people’s lives.
But the most lives I ever helped save?
That happened at the library. 🧵🪡 When I served as a state’s Chief Physician in Public Health, I learned something you don’t hear in medical school:
The most powerful tool for saving lives isn’t always a hospital.
It’s access. To warmth. To Wi-Fi. To community.
And libraries provide all three.

My grandfather wasn’t the “kindly old man” type.
He was gruff. Sharp. A little paranoid. Easily irritated.
We didn’t joke about it—we just assumed it was the natural progression of a man who worked hard and had been smacked around by life.
It wasn’t. Looking back—after years of medical training—I realized what no one around him ever named:
He had dementia.
Not Alzheimer’s. Not memory loss.
Binswanger’s disease.
Subcortical vascular dementia.
And we missed it entirely.

The half-baked “EBM” curriculums of the past 20 years—spearheaded by statisticians still mad about their orgo grades—tried to force stats into medicine without understanding medicine. The result? A profession paralyzed by uncertainty and allergic to action. We trained clinicians not to think, but to wait. Wait for the meta-analysis. Wait for the multicenter RCT. Wait for a forest plot to bless a move they’ve already watched work a hundred times. In short: we made medicine a spectator sport.

You ask me why I’m slow to act when the patient’s crashing, why I walk instead of run.
You say “Shouldn’t we be doing more?”
Here’s what I’ve learned, and why I don’t reach for the epinephrine first.

A thread for young docs: 1.Calm is contagious.
If you look like the room is on fire, everyone else will think it is too.
Even when your hands are trembling, your face shouldn’t be.
Let others borrow your stillness.

When I was a new attending, I worked in a tiny rural ER in the middle of nowhere, Pennsylvania. 24-hour shifts—mostly quiet, sometimes brutal. No CT. No backup. Just me, a few nurses, and whatever rolled in. On my first day, I floated a transvenous pacer and lysed a massive PE. Another patient had hypokalemic paralysis—something I’d only read about. A woman walked in carrying a black trash bag. Inside? The rabid fox that bit her. She’d strangled it to death.

She needed antibiotics (ceFOXitin?)

She was 22 years old—healthy, active, no medical problems. She came in septic, crashing fast. Blood pressure in the gutter, fever sky-high. I thought it might be toxic shock.

But days later, we learned the real cause. And it’s something people are doing every day. 🧵👇 A few hours before she got sick, she’d gotten an IV vitamin drip—one of those mobile IV services that come to your house. Wellness influencers love them. But they’re unregulated, and if even one step isn’t sterile, bacteria go straight into your bloodstream.

Dad took his 12-year-old for a cold plunge. A bit of bonding thru wellness. The kid had just warmed up in the hot tub. He jumped in, gasped, and went under

By the time they pulled him out, his heart had stopped. I coded him for over an hour before I told his dad he was dead.🧵👇 Cold plunges are everywhere—biohackers, athletes, influencers swear by them. But sudden cold exposure can kill. Cold shock triggers a massive sympathetic surge, spiking heart rate, blood pressure, and risking fatal arrhythmias.

Emergency medicine is a lifestyle, not just a job.

You’ll see the sickest patients, the worst luck, and the darkest corners of humanity—& still be expected to smile, move fast, and get it right every time. A thread on what they don’t tell you about EM. 🧵 No one trains you for what it really means to be an emergency physician.

You will make life-or-death calls in seconds. You will miss things. You will doubt yourself. And you will still have to walk into the next room and be perfect.