Medical

The Future of Emergency Medicine

/ Nate / 4 Comments

So let’s say you’re having a bad day: you have bad enough abdominal pain that you decide it’s time to go to the ER.

Unfortunately, it’s not The Pitt: it’s my ER! Sucks to be you.

Bad fluorescent lights and plasticky chairs, a waiting room at capacity filled with vomiting children, and a wait that feels longer than you were prepared for. You get triaged and your vitals are taken. If you’re lucky, you wait three hours. You’re brought back to a room. A nurse asks you a bunch of dumb questions about whether you have guns in the home and whether you’ve recently traveled to Zambia. And then, someone walks in to see you.

Here’s the question: who is that person?

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A Highly Interchangeable Modular Part

/ Nate / 2 Comments

I wrote before about how emergency medicine is, in my opinion, a dying field. Maybe it’s already dead. Emergency departments and their physicians have lost the war on multiple fronts: declining reimbursement from payers, declining interest from medical students, pay cuts, increasing liability, encroachment from midlevel providers, and a lack of offramps. To spare your attention span, here are some bullet points – facts, not opinions.

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Following the Money…?

/ Nate / 5 Comments

I have a really good job for an ER doctor.

I think it’s important to state that up front, because after eight years of post-medical school training (four residency, two toxicology fellowship) and twelve years of delayed income growth, I’m finally a grown-up making grown-up doctor money. Here is a chart I made showing how far behind my friends I am!

My emergency department administration is remarkably supportive and helped me launch a toxicology consultation service. So I split my time between working ER shifts and doing tox consults. It’s great, especially insofar as it means I work fewer ER shifts.

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Academic Publishing is a Massive Corrupt Scam

/ Nate / 2 Comments

I would like to first point out, before we even get started: after my last post, I had a minor Zoom-based showdown with the HR department about some professionalism modules I was refusing to complete and I got in pretty big trouble. In case you are interested, I stood my ground like the dumpster-inhabiting dipshit I am and ended up NOT HAVING TO DO THE MODULES. F**K YEAH.

Anyway.

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CataclysEM

/ Nate / 6 Comments

I want you to picture a dumpster. A bad one, full of rotting fast food, like a McDonalds-parking-lot-at-3am dumpster. One that no one bothers to lock or protect from animals because even the racoons will stay away from the fermenting, rancid waste.

Got a mental picture? Now place that dumpster aboard a Viking funeral of a ship, ablaze, sailing toward an enormous waterfall with nothing but jagged rocks below.

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The COVIDpocalypse is Here and I’m Coping By Writing Again

/ Nate / 4 Comments

I would like to blame my prolonged absence again on COVID-19. To be fair, it does dominate about 95% of my work life and probably 50% of my personal life, but honestly, I’ve just gotten lazy.

The last time I published here was March 5, where I started with “it seems like we are inevitably headed for a massive, global pandemic.” For once on this blog, I get to say I WAS RIGHT ABOUT SOMETHING IN RESIDENCY! No attending or dad can correct this.

As of this writing, my area’s daily hospitalization rates look like a Space-X rocket launch. We’re out of ICU beds, regular beds, gurney, cots, sleeping bags, and patience. The worst is somehow yet to come. I am coping with this impending doom by playing with my dog and, finally, writing again.

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Coronavirus FAQ

/ Nate / 1 Comment

Well, from listening to the news it seems like we are inevitably headed for a massive, global pandemic. Millions of people will die. Soon thereafter, the zombies will rise, coughing and sneezing coronavirus loogies on the few healthy people left.

COVID-19(/the coronavirus/SARS-nCoV-2019/whatever) is likely to be, if it isn’t already, a pandemic. Hundreds of thousands, if not millions, of people are probably going to get sick. Some will die. As an ER doctor, I am almost certain to catch the disease. Seriously. Continue reading →

Third Year Sucks Less

/ Nate / 4 Comments

Yes, it has been very long. This is because my life outside of residency lately has been consumed with raising a small weapon of mass destruction named Otis.

This is Otis when I got him:

This is Otis now:

As you can see, he is a) much bigger and b) a Systematic Toy Destroyer. A well-meaning resident gifted me a plush toy for him; Otis ripped it in half in about thirty seconds.

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EM Senior

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Another July has come, and with it an upgrade in my rank and nominally in my salary. I make a whole $2.75 an hour now!

In the third and fourth years of this program, I’m considered a “senior” resident. Senior residents have some additional responsibilities over those of juniors: we are supposed to keep an eye on the entire emergency department, make sure everyone is pulling their weight, lead resuscitations, and teach novice learners. Continue reading →

Not My Hill

/ Nate / 3 Comments

The journey through second year of residency is an interesting one. As I’ve mentioned before, we are tasked with two major, new responsibilities: performing most procedures and seeing a much greater volume of patients. We’ve all gone through a substantial adjustment period. It’s been hard.

One of these journeys is toward two, or greater, patients per hour. I hit this milestone rather infrequently. In fact, it is about as likely for me to achieve this as I am to win a game of Oregon Trail. It is far more likely that I will die of dysentery, or make it no further than Fort Collins before my oxen quit on me. Continue reading →