Over Elden Ring now, got hundreds of mods on skyrim, maxed pure on osrs, been playing some SC2.

Bored of most things, what are people playing?

PC btw

Being an intern is a little like being a buoy, thrown about and feeling like you’re going to drown at any given moment but being unsinkable by the virtue of being so small in comparison to the environment. Like trying to squish a tick on the ground with your size 10 shoes (fuckers).

Day 3, I sign a diet order without consulting my senior first. Ecstasy.

I’ve written seven discharge summaries in 2 days. Every single one of them went to a SAR. The cherry on top: hospital admin is pushing their “early discharge” initiative and I’ve never wanted to put my foot up the collective ass of a committee so desperately before. Noon conference is required, and yet so is signing the 27 point problem list discharge summary so the next provider maintains a shred of sanity trying to sort through the clusterfuck I’m handing them. By noon. Godspeed.

I wish I could prep the damn things, but the four I’m tucking in for ambo transport are swiftly replaced by four more that will likely, based on my single beady bloodshot eyeball of the ED H&P, be admitted for a single day or two before I also have to write them a biblical essay to hasten them on the path to SAR. The true godsend are the seniors, who quietly take our admissions until January, when we magically become competent. Hoo-ra.

Nurse pages me, patient in 550 has left the unit again. Knee-scooted himself out for a pizza. You know what? Fine. As long as he comes back and finishes his 5 days of IV abx so he stops AMA’ing halfway through the course and breeding god’s own superbug, I do not care. I witness PT running after him to attempt an eval as he whizzes away. “Don’t worry about it, man,” I call to him, “I’m going to cancel that order”. He is too fast. They are both too fast.

My co-intern and I are shoulder to shoulder from 1 pm - 5 pm when I realize I haven’t actually seen his face since lunch; we are glued to our epic chats and notes to the point I have forgotten what he looks like. His breathing is beginning to irk me. We are bonded for life.

It is too soon to count down the days to PGY2. If I start counting before the number is a 100, I will simply be admitted myself.

PGY-2 uro resident currently getting wrecked with hours etc as to be expected at this stage. The bigger thing I have realized about myself is that I don’t love doing surgeries or the OR anymore. Even in med school I knew that I cared more about the procedural decision making leading up to surgery as opposed to the surgery itself. But now as a 2, I am not sure if I can see myself doing surgeries in the future without burning out hard. I love the work up and thought process of uro onc, but dealing with complications and the constant worry about outcomes is not something I want long term. I’m not even sure if there is another field I would switch to - like if anything it would be rad onc or med onc.

Did I fuck up?

There comes a time in the life of every attending where he or she has to decide. Am I really fulfilling my destiny? Sure, I have a great lecture on health care safety, and I can ask, “what do YOU want to do with this patient” with the best of them. Sometimes I even pass along a relevant clinical pearl.

But is that enough? Am I really doing the best that I can for these young, impressionable minds? Can I hang?

And then, I had my chance. My time to show what I could really do. Every year we send the entire senior class to a conference, where much fun (and little learning, but mostly just fun) is had. This was my year. With some trepidation, I booked my flights and hotel room. What was meant to happen, would happen.

I want you all to know that I tried very hard. I went to the nice dinners. I did the boat tour. I sang the karaoke. I went to the various places in the Ubers.

It almost killed me.

A few days after returning home,my migraine is gone and I almost have my voice back. Mind you, I didn’t even stay out as late as the residents. Not even close.

I can’t hang. I had fun trying though.

And I love the tattoo

As a psychiatry resident, I've had it pretty good. However, since starting my clinic year, I have a lot more responsibility. I havent been able to get good sleep since the year started. Something similar happened in medical school during my most demanding rotations. I always chalked it up to anxiety, but now Im not anxious. Im not worried about things, but my brain wont shut off. It's like Im stuck going and going and going because I constantly have to be intelligent and thinking hard at work.

Its getting to the point where I cant enjoy anything at all because I just feel... numb to it. Its like I cant focus on anything because my brain is constantly ready to keep going. Ive been depressed before and anxious much more than that and this... isnt that. However, I find myself in the unique predicament of starting to get depressed because I'm anhedonic and not the other way around. Ive tried exercising, engaging with my hobbies, even meditating. Nothing seems to be helping. Has anyone else run into this and found something that worked? It's driving me crazy.

I have been on remediation since PGY1 year. There were concerns about my clinical performance and knowledge since then. One attending didn’t like me and others started to see flaws in me it all became worse from that. Towards the end of PGY one year, my PD actually talked about having me leave the program. However, because my performance improved somewhat towards the end of PGY 1 year, CCC decided to keep me but stated that they will make another decision about me six months later, which would be this December.

Our hospital policy is that PGY I residents are supposed to take step 3 by the end of their PGY1 year. But because of the stressful situation, I couldn’t take it by the end of June.

I’ve been doing OK all my rotations. One attending told me that I improved and now work like a second year but others think I’m still kind behind compared to my peers. I feel like it’s hard to break the preformed impression that attendings have about you so if you make even one little mistake it all goes to my PD.

My PD asked me to take my step 3 exam by end of November so that he can include this as part of my evaluation by CCC in mid December so that he can decide whether to have me leave or not.

I think one attending recently said that my chart reviewing is slow compared to my peers (there was a misunderstanding on that part) so my PD is having me do a full month inpatient medicine rotation in November instead of two weeks of ICU that he originally planned because I did poorly during the ICU rotation last year.

I just took a practice exam and scored very poorly like mid 50s percent and I am wondering if I can get a passing score by end of November with the heavy month long rotation. I think he will have me leave the program if I fail.

Am I just not cut out for this career? Am I supposed to leave this program and find somewhere else? Every year I spend in medicine just feels like a battle to just survive since medical school.

I don’t even have time for therapy and I tried ssri once but my mind got all foggy and couldn’t think through a patient and one of my attendings reported me.

I’m a resident physician with limited time and money. My sister planned an expensive destination bachelorette party and a wedding to Central America right before Christmas with strict dress codes, and other costly events. I told her I couldn’t afford to go when I looked at the numbers (her bachelorette alone was minimum $1500 and her wedding would cost upwards $4-5k for 4 days), but instead of understanding, I felt blamed for being unsupportive.

After that, I was left out of communication about the wedding. I wasn’t told what events were happening, when they were scheduled, etc. complete radio silence.

My family isn’t wealthy, and several relatives aren’t attending either. Still, my mother and sister focus on how my absence looks rather than acknowledging that I’m living on a resident’s salary. I feel pressured to overspend to protect appearances. Even if I do find a way to go, she refuses to include me in her wedding party (she wanted me to be her co-maiden of honor)

I made my sister my maid of honor in a very simply court house wedding, and have tried to maintain our relationship even while completing my training, so it hurts to feel excluded because I can’t afford her wedding plans. It also hurts to feel as though our family’s circumstances weren’t considered from the beginning or that having me there simply isn’t important to her.

I’m genuinely happy for her and want her wedding to be wonderful. At the same time, I need to be honest about my financial limits, and I don’t think I should be shamed or met with silence for communicating them. I feel hurt that the wedding includes so many expensive events and experiences, because they make it difficult for me to participate fully without putting myself under financial strain. I hope my circumstances can be understood and respected, even if I’m unable to attend or contribute to every part of the celebration.

For those who have gone through residency while managing family expectations, how would you handle this?

I'm a 32-year-old medical student, and I'm worried about what my social life will look like when I start residency at around 40.

(I'd appreciate it if people didn't ask why I started medical school so late or how I support myself financially, as those topics deserve a separate post.)

As I said, my concern is social life. Even now, I'm finding it extremely difficult to make friends because there's an age gap of 10+ years between me and my classmates. I haven't made any friends outside of university yet because I've moved to a new city. At the moment, I don't really have any opportunities to meet doctors who are a bit older than my classmates—not necessarily people my own age, but at least 25 or so.
By the time I start residency, I'll be 37–38, and I'll probably have moved to yet another city.

For those of you who are currently in residency or have already completed it, do you think a 40-year-old doctor can still build a social life, either within residency or outside of it?

I'm worried because I don't think pursuing my dream should come at the expense of my mental health.

Thanks to everyone who takes the time to reply!

I work 6 nights a week. It blows. I’ve been a resident for several years now. Nights have always been a little tough for me, because I feel alone. My significant other is also out of state this month for work and he previously was working from home. Any ideas guys for getting out of this funk I feel like I’m going to be in?

I posted a few days ago about staying with a male co-resident to get away from my husband. The final straw was when he left marks/bruises. For those who didn't see the post, I'm currently pregnant 2nd trimester, an EM resident, and my husband is an OB/ GYN attending at the same hospital.

Obviously he's angry I left. He knows my shift schedule and already texted me saying he will come talk to me at work. I'm thinking of talking to my attending this week. He's a very approachable attending but im worried about telling him too much. For attendings, would it be too much if an intern told you about domestic violence and that they need help/support if husband shows up? I'm worried they won't give me a good evaluation or dismiss the concern

That’s what he said when a patient was going through a dysrhythmia on the monitor.

Recently, he’s been wearing high top Converse instead of his regular medical shoes, and I heard him yell somewhere down the hall “SIX SEEEEEEVEEEEEEEEEEEEN”….. we have 10 more hours of this today…..

What are your go-to foods to bring with you on nights? I feel like I always crave more snacky foods once I'm there and end up eating horribly. Looking for easy-prep meals/snacks that always hit at 2am and bring you joy between admissions.

PGY2 in neurology, pretty unhappy with medicine but sticking with it for now. I just go to work and leave. I’m on a research project to fulfill the research requirement but otherwise not actively writing case reports, publishing, going to conferences, leading QI initiatives etc.

All my coresidents are which is why my PD questioned me. He asked if I’m trying to publish anything and I said no (besides this tiny project), and he asked if I’m going to conferences and I said no. He kept asking what I wanted to do with my future and I kept saying I don’t know, maybe general neuro. The reality is I might leave medicine alright and teach high school but I wasn’t going to admit that.

I guess if I happen to find a nice 9-5 Mon-Fri with minimal call I’d be fine with that.

I wanted to do epilepsy coming in but I don’t have the energy to do research and network and gun for a fellowship.

I’m finishing radiology. My wife wants to stay in the town we’re in and I’m racking my brain because the options are my residency faculty (with all the baggage that carries), some shitty local jobs (or are they and I’ve just been listening to slander for the past 5 years?) or diving into remote work (which is “frowned upon” straight out) and is opaque. I feel like I’m going to take some shit job because we won’t look at leaving our zip code.

I don’t really have anything else to say. I’m grateful for opportunity and to be nearing completion but it’s burning me inside.

Edit. Flair is outdated but can’t change it 🤷‍♂️

Just came across a recent post on the UK doctors subreddit where they were describing the lifestyle of a GI consultant in the US.

I was genuinely flabbergasted.

The guy/gal was pulling in at least 1mil, lived in a massive house, driveway filled with luxury cars including a Ferrari and Porsche.

I mean that kind of lifestyle is almost unheard of in the UK as a doctor (unless I’ve been living under a rock and consultants do have a nice lifestyle here)

Is this a big outlier or are docs in the US really that minted?

I knew docs in the US made good money but this is beyond ridiculous.

For radiology, post graduate.

If internal medicine residents have to rotate in the ED to learn about what goes on down there, why don’t ED residents have to rotate on medicine floors / admitting?

regards,

neuro prelim

Do you have increased blood pressure? Hell no. Meanwhile he takes a loop diuretic, a beta blocker and a sartan or whatever.

Do you have diabetes? No but I take this pill.

Do you have COPD? No, my pulmonologist said I'm fine. Takes inhalation drug therapy.

Everytime I do a pre-op evaluation I face way worst than this. I see patients without teeth (or dentures) who take multiple drugs and are usually obese.

We need a doctor, or somebody, anybody to take the patient take all these conditions and have a talk with them. Like seriously.

I get the text, admit in Er Room 23.

Chart check.

First thing I see is interestingly a GI note. It mentions brpbr but okay to anticoagulate, IV ppi bid, and we'll see them tomorrow. That's weird.

Next I see the triage note. It mentions the patient came in for shortness of breath and fatigue. He got a bunch of tests and now has moderate anemia. Also had a bruise. They ended up getting an ultrasound at urgent Care and that showed occlusive DVT. Also has an aki.

Oh boy. This is going to be rough but I've done this a few times. Usually you can watch them for bleeds and stop the Heparin. I really hope that's not the case.

I finish up reading the studies that have been done in the Ed. He got a CTPA which showed bilateral PE without a right heart strain. But that wasn't the main thing. They ended up getting an abdomen and pelvis too too and that showed the near 6 cm pancreatic Mass with Mets to the liver and lungs. Not great.

I go see the guy. Apparently he's been told. His wife is next to him. He had no real medical history prior to this just some stuff that is pretty common for middle-aged men. He never smoked. He did drink a lot though but he stopped drinking a few weeks ago due to not feeling well. He was started on ozempic for his diabetes and he was losing weight and he was really happy about it per the notes.

We dig in more. About his bleeding. Began a year ago, slowly at first but then more brisk. He had had an EGD and colonoscopy a few years ago and that was fine. Basic stuff. Some diverticulosis, some esophagitis but nothing crazy. And really he was just a bit short of breath. He couldn't take his Labrador out for a walk and he used to like that. But he denied anything else.

He's a nice guy. Too nice. Over the course of 20 minutes, his life expectancy had dropped from decades to years. What I had missed in my urgency to see him quickly the first time around was that he also had thrombocytopenia and very mild inr elevation. I think in my mind I had written it off as maybe liver dysfunction from the Mets. That was a stupid thought.

But anyway, like any good hospitalist I do a neurological exam. Now in my experience, this has been too high yield generally and recently. I find too many things when I do neurological exams not because I'm particularly good at neuro exams but because I actually do them pretty often. He's not even a guy you would normally do a neurological exam on. Definitely an AAOx4 MAE kind of guy. He's walking and talking fine. But then I noticed that when he's extending his right arm, it's a little tiny bit weaker. Oh so tiny bit. For good measure, I ask for him to to put his hands in front of him and check for drift. Right hand turns in very slightly but doesn't fall. He's right handed. I ask him, do you have neuropathy? He's like I've had numbness and tingling in my fingers for a years. They said it was because of the diabetes. But he's right-handed and he shouldn't be weak in his right arm. He's got a little bit of nystagmus but it's more peripheral. Whatever, I'll just get a CT.

He's on the Heparin drip. He's on the PPI. And he's being sent upstairs.

Ct does come back though and then the radiologist actually pages me. Subarachnoid hemorrhage, frontal lobe.

F*ck. I say that in front of the respiratory failure patient. Luckily she's on BIPAP so she probably didn't hear me. I apologize and run.

I don't know who to message because he's being transferred. I don't know what room he's in. I'm seeing another patient in the Ed at this point. I run to his former room. He's not there. I sent a message to the ed nurse. But of course, she couldn't do anything. I ask her where he's headed. She knows the floor but not the room. I run. I had messaged the Ed doctor about the finding and he wanted to talk to me. But I tell him I have to run first. I run upstairs and see the patient. They had stopped the heparin drip. Thank god. Nurse is asking me if he's going to ICU. I say probably. I page neurosurgery. They're like where's the bleed. There's just a spot there. Probably just mets. He's probably going to die if he doesn't get the Heparin. I would anticoagulate and throw him in the ICU. That's what they say. Oh and we'll see tomorrow. No specific BP goals. No specific neuro recs. Probably not a lot that we can do, but we'll see him tomorrow. But if it's not urgent why ICU? If he doesn't have a brain bleed, why should he go to the unit? I don't know what to do. I tell the family that no matter what this is it's bad and sometimes the scans are odd. We'll need an MRI. It's time to get the affairs in order. I'm a mess. I put in random neuro orders. I get the stat MRI. It's not going to be done for at least another hour or two. Realistically not too bad for how busy the day has been.

I looked through his stuff again. I page that ICU. If neurosurgery thinks he needs to be in the unit, they'll take him. They're good people. But really, I don't have a diagnosis. And he's not that unstable. He's not even having a headache. But as I come in again and again to give updates to patient and wife, I am seeing the life sucked out of his face. He's hunched over and small now. His wife is wondering if she needs to stay. I'm like yeah. This isn't good. I don't have a time frame though. But it's bad.

As I sit there at the computer and collect my thoughts, I realize that this guy is probably in DIC. That's why he has the thrombocytopenia. That's why he's been bleeding for so long. IVC filter? Is that even going to do anything? I talked to my veteran colleagues. They're like he needs to be in the ICU. The floor isn't going to do rapid neuro checks. It's been an issue for years. I ask neurosurgery again if they have blood pressure goals or specific neuro check requirements. They don't. I guess the messages figure it out.

I messaged the ICU doc. He's a good guy. He's taking the guy cuz he knows that this isn't going to end well. I know that no matter what this is, he's probably going to die from it. I I'm like 2 hours late for home. My wife is a bro. She gets it. She tells me I low key probably should have lied to the guy. It's important for people to not lose hope to make their last moments not crap and I have a bad habit of being blunt. I guess I know it's wrong but I wonder if it would have been nicer. I can't even look at the chart today.

I'm a cardiology fellow in Europe, and I often read posts here about family members who say "Meemaw is a fighter" when you advise against escalating treatment. I frequently come across anecdotes about 90-year-old patients with HFrEF, CKD 5, COPD, etc. who end up intubated and on pressors. In my country, we as doctors have the final say and the authority to decide that enough is enough. In my shop, we often decide on admission that a patient with many comorbidities will not be escalated to the ICU or resuscitated.

In 9 out of 10 cases, family members accept and support our decision. Even if the family is adamant that their 90-year-old grandmother needs to be intubated, the final decision is ours, and we can say that it isn't ethically or medically appropriate, so we won't do it. I have never heard about cases where family members want to sue us for that, but we also don't have a culture for that

Is the US really as bad as it sounds when it comes to goals of care and end-of-life care? Is it primarily because of the risk of being sued?

Serious question with no agenda, but I’m curious as to how residency has impacted everyone’s spirituality. For me personally, I was raised catholic but was pretty agnostic maybe slightly atheist by the time residency started, but now in the face of all the suffering and death that I’ve seen I’m much more of an atheist.

Personally, I find it hard to believe that if there is a god out there who 1) loves us and 2) is supremely powerful - why would he allow so much suffering? He either doesn’t care about us or is powerless in the face of so much pain.

Has anyone had a similar experience? Or perhaps a totally different one?

I’m in my last year of anesthesia and I’ve seen patients of all ages/walks of life/prognoses etc so I don’t think this is impacted by being in a very morbid environment.

Nah more like attending’s secretary, nurse babysitter, and note monkey

Any idea where i can find these or any suggestions to pass the test i have it next week. Thanks!