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“Difficult NGT due to large sinus. Possible exposed carotid artery. NO NGT TO BE PLACED.” 2 wks of silliness ensue. CVL. TPN. GI and IR consults for PEG. Txfr to ICU. On detailed review it was all chart mythology. NGT placed (on first attempt) for nutrition and enteral meds.

Post-call I was on my way home and was exhausted, dreading having to walk up 2 flights to let the dog out. I had a great idea. Pulled out my phone to call the dog and tell him to come down so I could let him out.

One of the greatest drivers of job dissatisfaction in ACS is the need to do low acuity elective cases off hours because otherwise pts won’t get timely care. Debriding wounds at 0230 is good for the hospital system but bad for the providers.

Anybody know if I can get The Mythmakers by John Hendrix locally in StL?

During training (when I could) I shifted to more lifting/less cardio. Residency is like constant catabolic cardio. Lifted heavy to keep muscle and try and convince my physiology to be at least a bit anabolic…(but exercise and residency was hit and miss after kids).

No ICU beds. ED is boarding in the halls. Multiple OSH pt waiting for beds. Reasons ICU pt can’t leave: no iHD today ( x2), no ride home (5h away) x1, can’t go to floor with trach (on trach collar for days) x1. 4 ICU pt with no icu issues while sick pt can’t get here.

Got flagged for using “copied text” in an op note. It was text from a dot phrase in Epic, but I didn’t want to use it all so had copied the relevant part. No go. Amended note, dropped whole dot phase in, deleted everything I didn’t want. That’s ok!

Many people vastly overestimate the utility of a noncon head CT…

This is a perfect graph. No notes.

In the OR today (Friday) at 4 pm the med student didn’t have a firm grasp of the details of the case they are scheduled to scrub Mon! I asked them to scrub out and go read-up! Look, you need to be ready for the next case. I hope they made good use of the time.

pancreatitis, next question

Having babies plus surgery residency has completely desensitized me. Unless blue drapes are involved I can’t get worked up about “germs”. I mean I eat in the icu break room which populated by 50% ESBL and 50% VRE.

Ok, help out the new interns. What’s the best pen?! To any General Surgery Residency at WashU Medicine intern who drops the favorite pen in the comments, I’ll have some in the house staff office for you. This is credit for all of the pens I steal over the next few years.

No more danishes. From now on: freedom fritters!

AI is going to take over medicine. ChatGPT 4o

Sending an email is not leadership. It’s at best administration. Show up. Be present. Listen. Troubleshoot in the moment. Make decisions. And be willing to take a big bite of the shit sandwich if that’s what you are putting on the table.

Wait so this is OK?

It’s verboten to debate the meaning of “well-regulated militia”. But we can parse the hell out of “under the jurisdiction of”.

Underlying the fear of AGI is the fact that the only intelligence we know is derived from a biological imperative to reproduce. Literally we are fancy machines to copy DNA. But there is no reason a priori that other intelligence will have any of those properties.

I think at least 10% of the content on social media revolves around the fact the “divided by” symbol can be ambiguous in an equation.