Do not place all your worth on success or failure.
Instead, focus on the fundamental mindset of continuous growth and bringing your best to every opportunity.
Success will come.
Sometimes you will still lose, but that is ok because you will have grown.
#MedTwitter
My toughest
#COVID
loss this week was a fully vaccinated+boosted pt my age (with young kids) who was immunosuppressed due to organ transplant.
We did CPR for 30 mins. It was hard to stop.
#MedTwitter
Pt came in with COVID pneumonia. Got intubated for respiratory distress. On the ventilator for over two weeks. Died today after transitioning to comfort.
Some family members: “But did she REALLY die OF COVID?”
Me:…
#MedTwitter
Good news: We have some open ICU beds tonight.
Bad news: Just pronounced my 5th patient in the last 48 hours.
All of them died with no family at bedside.
Stay safe out there.
#COVID19
I learned today that our hospital has a “No one Dies Alone” program.
Volunteers who come in and sit by the bedside as patients pass. 🙏🏼💪🏼
#MedTwitter
#NODA
Dear everyone working in large tertiary care hospitals...
👉Please do not assume that just because we work in a small hospital that we do not know what we are doing.
We all trained in the same places and have more experience with sick patient than you might think.
#MedTwitter
Problem: Critically ill patient with multiple family members scattered around the US all needing an update.
Solution: scheduled a zoom call and gave everyone an update simultaneously from the bedside.
This needs to be the new standard.
#MedTwitter
Me - asked a terminal elderly female patient in the ICU what her greatest priority was for today.
Patient - I miss my son. I want to see him in person.
Me - ....ok team let’s make this happen!
Son is at the bedside holding her hand.
#MedTwitter
#PalliativeCare
Never in my 20+ years have I had to place a dialysis catheter for emergent dialysis in the ED for an ICU patient boarded there (>72 hours) due to lack of beds…until today.
#MedTwitter
Immigrant from South Korea.
Naturalized citizen.
West Point grad.
Med school
@Georgetown
.
Now Chair of Medicine
@USUhealthsci
‘America’s Medical School’
I assimilated just fine.
Expectation should be ZERO
#COVID
deaths in children.
One death is too many.
i.e. - Stop saying the death rate in children is "low".
#DeltaVariant
#MedTwitter
Another case of “mild” URI symptoms for three days. +COVID
Admitted for altered MS.
CT head shows b/l PCA infarcts. Brain edema.
Coded this morning and passed away.
#MedTwitter
Just intubated another
#COVID19
pt in the ICU.
FaceTime with family right before intubation.
On max BIPAP, he says...
“I’m proud of you son.”
😢
Hoping he can tell him in person soon.
Currently working in a
#COVID
hospital. Caring for 15 sick ICU patients.
Someone: “How are you so calm?”
Me: “Well, the hospital is not under rocket attack so...”
Someone: “...oh.”
COL (ret.) and Dr. David Barillo was a mentor, colleague, and friend to many, devoted to the care of combat casualties, and lead burn surgeon who flew hundreds home after catastrophic injury during combat operations.
Last night he died from COVID19.
#RIP
#heartbroken
Some things do not need to be said...But for the love of humanity. Please...
👉Do not lie about your vaccine status.
👉Do not lie about your COVID test result.
Me during ICU rounds: “pt will undergo *terminal* extubation”
Another ICU doc: “*compassionate* extubation is a better term”
Me: “…wow. You are right…”
#ICU
#PalliativeCare
#CME
I had a vigorous discussion today about my loyalties as a US military officer.
“Don’t you have to obey the orders of your commander and chief no matter what?”
I told him to read this. 👇🏼👇🏼👇🏼
This long weekend, I will be covering a sleepy MD hospital ICU that has a usual average census of 8 or so during normal times. I go there because I like being a solo ICU doc sometimes.
I just found out that the ICU census is up to 36. 😳
Crazy times.
#Omicron
#MedTwitter
Shout out to all the Nurses, RTs, PharmDs, SW, and other hospital staff who just keep showing up to work under extreme conditions.
I see you.
#gratitude
#Omicron
#MedTwitter
Every hospital leader and/or adminstrator should go into a COVID positive room at least once. Preferably during a ‘aerosol producing procedure’.
Then decide what the appropriate PPE should be for their employees.
#InThisTogether
#AllHandsOnDeck
#COVID19Response
Hospitals are enforcing gags on physicians. Doctors aren’t allowed to talk about what policies are being implemented. Leaves free license for administrators to do what they want (and treat employees as they please), while we stay silent. The public should be asking questions.
When someone says “masks don’t work” around HCWs who have been directly caring for COVID patients (with appropriate masks) for the last 18 months…without getting COVID…it’s a just a bit silly.
ICU Update - (community hosp)
We are now out of
#COVID19
ICU beds...
Combination of “no more ICU nurses” and “no more negative pressure rooms”
We can take more pts, but will sacrifice HCW safety and non-ICU nurses will care for ICU pts.
How are you doing in your ICU?
Last night, I admitted a pt from the ED with non-ketotic hyperglycemia. No other complaints, symptoms, only a new O2 requirement.
👇🏼👇🏼👇🏼👇🏼👇🏼
POSITIVE - SARS-CoV-2
Had appropriate PPE on.
Some did not.
Do not let your guard down
#MedTwitter
.
Assume everyone is a PUI.
Back in the ICU this week in a small community hospital in MD.
Just got sign out.
ICU full (mostly COVID), COVID ward full, 7 COVID+ in ED waiting for a bed…
It’s going to be a long week.🤦🏻
#MedTwitter
Back in the ICU for the next few nights at a small community hospital where I work part time.
Partial list of my sign out tonight...
This surge is no joke. Numbers much worse than the spring.
Be careful out there.
#covid19
Studies suggest loss of smell better predicts the disease better than fever and cough.
Probably the only question you have to ask if you are screening.
Best quote so far while (finally) reading
@Atul_Gawande
’s
#BeingMortal
.
“A family meeting is a procedure, and it requires no less skill than performing an operation.”
Yup.
#MedTwitter
If you have any doubt about the impact of
#Omicron
on our healthcare system, just talk to anyone in your area who works in urgent care or hospital.
It’s bad and it will get worse before it gets better.
#DontLookUp
#MedTwitter
COVID ICU day
#7
Although our sleepy ICU has been busy, things are still manageable here at the moment.
I wanted to take this opportunity to share with you some key take-away observations from my first week.
May not have time to do this when I return in a few weeks.
Dear Healthcare Leader (at every level),
The longer this drags on, the tougher it is going to get and the more people will need you.
People have asked, what can I do to maintain morale through this difficult time?
1/
@Millennial__MD
Didn’t get into my first choice.
Best thing that could have happened...
The program I ended up in was awesome. My rejection was fuel for the next 20 years. Still is.
Now I am Chair of the Dept affiliated with the program I got rejected from.
#charliemike
#itwillbeok
People doing all the right things seldom get thanked.
This ICU doctor appreciates you. 🙏🏼
Stay vigilant and protect the vulnerable.
We will get through this.
#omicron
#InThisTogether
I wonder if “anti-mask” will bleed into “anti-vaccine” when one becomes available.
Need to ensure public health messaging is coordinated and consistent to benefit the greatest number of people.
#InThisTogether
I just saw this thread by
@MarkHoofnagle
and feel compelled to respond to clarify some things.
Disclaimers: I am not an ID expert. I am a Medical Intensivist in the Military. These are not the official views of the DoD. Just my personal opinions. No financial COIs.
1/
US Pentagon has funded a blood filter for a dialysis machine that removes the
#SARSCoV2
coronavirus from the blood - FDA has approved it for emergency use. It has been used to treat nearly 300 patients.
#COVID19
Going full court press on a sick pt in his 90’s.
Why? 🤔
Because although that’s his chronological age, his physiologic age is more like 60.
Treat the patient, not the age.
#CriticalCare
#MedTwitter
Elderly patient this morning on non-COVID ward rounds, discussing taking precautions during this pandemic:
“I don’t live in fear, I live in awareness.”
Me: Good for you ma’am.
#COVID19
Pt with “mild” cold-like symptoms two weeks ago. +COVID
Got prescribed Paxlovid but not able to fill.
Today woke up with acute shortness of breath.
CT chest shows Saddle Pulmonary Embolus.
#Omicron
#MedTwitter
I had close to 30 ICU admissions over 5 night shifts.
👉🏼80%
#COVID
.
And this was BEFORE Thanksgiving.
We are in trouble.
Hang in there
#MedTwitter
.
#StayStrong
MICU Day 3 observation:
Intubated another
#COVID19
patient.
As we (fellow, RT, and I) are donning PAPR, which take a while...
Me: “What would happen if he coded right now”
RT: (doesn’t skip a beat) “I’d go in there without any of this stuff.”
#sacrifice
#InThisTogether
Starting the new year with most of the hospitals in the area with overrun EDs and full ICUs in contingency or crisis standards…while we are still on an exponential upward trajectory in cases is not good.
We are in for a very rough few weeks.
#StaySafe
#MedTwitter
A couple of lessons for
#MedTwitter
✅Don’t be a hero (or do what I did).
✅US and CT scan can MISS gallstones!
How common this is??
#GITwitter
#Surgery
/End
I am shocked at how many pts in the ICU with multiple (I mean MULTIPLE) co-morbidities are unvaccinated.
Having targeted these high risk groups alone would have made a difference.
#VaccineHesitancy
#MedTwitter
Back in the community ICU for a long stretch.
Just got sign out.
We are overfull. Boarding pts in the PACU.
And we haven’t begun the post-Christmas surge.
Winter is definitely here.
#COVID19
I have a
#CriticalCare
#MedTwitter
confession to make.
The femoral vein is my preferred central line site.
*Especially when it’s emergent.
Don’t hate me
#IDtwitter
. 🤷🏻
We need to do a better job sharing what we are seeing in the COVID wards and ICUs with the general public.
Just reporting positive cases and hospitalizations does not appear to be enough to get everyone on the same page.
How do we do this responsibly?
#COVID19
Among the most tragic moments I have experienced recently is consoling a family member who was responsible for spreading COVID-19 in their family, ultimately resulting in the death of their eldest.
#MedTwitter
✅ UNMET NEED
#1
– Need a reliable way to detect REAL pain.
It was clear that I was automatically labeled as a drug seeker.
I don’t blame anyone for this, but we need to be able to differentiate real from “fake” pain.
Anyone in
#MedTech
or
#MedTwitter
looking at this?
7/
During his inaugural address in 2019, Zelensky told lawmakers: “I do not want my picture in your offices: the President is not an icon, an idol or a portrait. Hang your kids' photos instead, and look at them each time you are making a decision.”
“We have enough surge capacity to handle more COVID patients”...should not be comforting.
Many are not fully comprehending what happens to mortality when we tap into that “reserve surge capacity” (or when we exceed it)
Have we not learned from Italy or NYC?
#COVID19
Regarding finding motivation for doing research, a mentor once told me.
"Find something that pisses you off...and work on solving that."
You know what pisses me off?
👉 Preventable
#COVID19
deaths in the ICU.😡
Guess that is what I will work on...