Let me tell you a story about how my wife was almost killed 3 feet from a nurses station for lack one of the simplest pieces of equipment in the hospital. Many of you know that she almost died of cancer, but she was thisclose to never starting her fight. Buckle up. Long one. 1/x Shortly after her dx of melanoma was made, she was in Louisville to go to meet with the team (with her sis who was covering while i worked). She had been having pretty bad back pain but late the night before her clinic appointment, I got a frantic call from SIL. 2/

Seeing all over that Bob Saget’s autopsy report suggests he was murdered. Certainly, he had a terrible injury. Many seem to think the injuries to the frontal bone and superior orbits seem to indicate that he was struck multiple times. Almost certainly not, and here is why 1/x The visible trauma externally was to the right sided occipital bone There was an abrasion and underlying bleeding as well as a linear fracture of the occipital bone.There were also fractures to the temporal bone and the frontal bone extending into the superior orbits. 2/

Short 🧵
Observations from the midwestern front:
1. Holy crap.errybody got it.
2.timing the last week or so means my sickest patients are likely delta residuals.
3. Some triple vaxxed with cases, but vast minority.
4. More babies, kids and teens since the beginning.

1/ 5. Seeing lots more teens and adults with fever and flu-ish body aches very early in disease than prior. More “I feel terribles” than people sucking wind.
6. Less real deal holy-shit pneumonia
7. Inpatient COVID census down a fair bit from peak here.

2/

Wanna hear a story? On Christmas Eve, 1944, my Paw-Paw was on a ship on the way to fight the Battle of the Bulge. It was torpedoed about 2 mi off the coast of France.He wrote this and read it to is my senior year of HS a few years before he died. It weighed on him. Please read.1/ Dedicated to Men of the 66th Infantry by Frank A. Sample

It was the night before Christmas in Nineteen and Fourty-Four

When twelve hundred soldiers or maybe more were loaded on a ship to go to the fore.

Most of the them 18 19 20 21 all of them their mother’s loving sons 2/

🧵 8 years ago today, my wife who was SO sick and so much pain with stage 4 melanoma with many bony mets received her first dose of the drug that was to become Keytruda. She was the last enrollee worldwide in the phase 2 trial.
1/ She had been given an effective death sentence. There was nothing left.She had failed traditional therapy and was in bed 23 hours a day, and dozed on the couch in a haze of narcotics the other hour. It was so painful to watch, and in the 6th and 9th grade my kids were reeling. 2/

🧵 on masks, vaccines and gathering in the age of COVID. There is so much confusion in the general public and even docs in the face of changing guidelines and all the misinformation out there, balanced with our desire for normalcy. I get asked often, so here is how I do it. 1/ I fully admit, it may not be perfect, but I have assessed the risks to myself and my family, and I am comfortable with this plan. We are all triple vaxxed and i have had a mild case of COVID. 2/

🧵 Hi. I’m an ER doctor. I’m vaccinated, but 10 months out with a high level of daily exposure to an airborne disease. I can’t get most patients to keep a mask on when I’m out of the room,or wear it properly when I’m in. I now have Covid. Mild for now. 1/ And hopefully, gonna stay that way. I am very optimistic that I will stay well, thanks to the vaccine. My body is already at war with this stupid bug, beating it back. If I had gotten this last year, I would have been very scared. I’m middle aged, and smoked for 25 years. 2/

I see a shocking amount of vaguely weak elderly folks with decreased appetite but nothing else particularly wrong in the ER. Holding a hand and asking the right questions with empathy will often elicit tales of the overwhelming sadness of loss or fear of their own end. Short 🧵 It is easy for us to spot the anxious or depressed youth, the histrionic middle aged person, the substance use disorders. But so often the mental health issues in our elderly are brushed aside, written off as a result of the chronically “dirty” urine that is asymptomatic… 2/

Imagine being privileged enough to have been born into a situation that allowed for a stable income with no food insecurity, free of the scourge of addiction, being provided a good education and arguing that paying people 7.25 an hour is enough. 1/ Imagine sitting there in your nice house and thinking that you’re there SOLELY because of your smarts, your grit. And thinking that the child that was born to a heroin addicted mother in a trailer in rural America, or in section 8 housing in the inner city should just 2/

Found online:
Huge numbers of our population believe in a complete alternate reality. Alternate facts as it were.

But just as intensely as I believe they are deluded, they think I am the one who is deluded. So how can I be confident in my perception? Here's a tip:

1/x I have found that in times of political confusion, particularly when emotions are running high and creating tunnel vision, THE PRESENCE OF NAZIS can be an extremely helpful indicator.

If I am attending a local demonstration or event and I see Nazis…neo-Nazis, casual Nazis, 2/x

Thread:
Dearest trolls of the interwebs. . If you post online on your page or in a comments section and tell people the vaccine:
1. Will alter your genetic code
2. Can cause infertility
3. Is more dangerous than COVID

1/ 4. Will not help because , flu, or something, without the basic understanding of antigenic drift/shift and how that affects the search for the vaccine.
5. That this technology was just invented and cannot be trusted.

2/

College 2020. My daughter went to school, moved into sorority house. Next day, many girls go to frat party (not my kid). Within 4-5 days she has to quarantine back here. Within 3-4 more days, her whole house is on quarantine. 1/ She is banned from campus due to contacts. We move her into an apt off campus with 3 other negative friends. Finally she gets to go back to campus for her ONE in person class. Day 1 AFTER class, a kid walks up to the prof and tells him that she has been feeling poorly. 2/

Thread-
it is unfortunate that easy to say slogans can wipe out an entire movement. “Defund the police” does not mean “eliminate the police”, but unfortunately, it can be used as a weapon against reform since the vast majority Americans don’t read beyond slogans and headlines. I wish it was “re-think the police”, “re-imagine the police” or something like that.
I see police’s problems much like the problems nationwide in emergency medicine since EMTALA made emergency departments nationwide the dumping ground for all of society’s ills.

Ladies and gentlemen of the Twitterverse. I am an emergency physician. COVID has not hit where I live yet, but it is coming. Because of people needlessly hoarding N-95 masks, my ER has 2 boxes, with no estimate as to refill date. I will be literally covered in virus. 1/ We are the only ER in a small city. The virus is highly transmissible. If my partners and I go down, we will be unable to care for patients for 2 weeks. There is no backup. There is no plan to be made to replace us if more than 1 go down at a time. 2/

1/
I’ve been to war, twice. Iraq in ‘09 and Afghanistan in 2011. I am just a fucking ER doc. But it was there, in the deserts far,far from home, that I made my bones as a newly board certified ER doc. It is around that time, I think that I lost my capacity to feel joy. 2/
Being in war is a strange place. As an ER doc, I wasn’t out kicking doors or taking small arms fire. I was back in base at the level 1 trauma center, waiting for the wounded to pour in. As far as safety went, I was about as safe as you can get there.