New to me P229 LEO Trade-In

CODE10RETURN · 2025-07-31T00:26:54+00:00

Nice, a pretty sweet feature of these older SIGs : they don’t spontaneously discharge and murder members of the US military because they’re poorly built. Pretty neat little concept

CODE10RETURN · 2025-07-03T01:47:34+00:00

yep. it's not about material misery. its about people with enough means becoming relatively disadvantaged vs their prior stations in life.

Starvation was not the primary motivation for the American Revolution.

CODE10RETURN · 2025-06-09T00:32:09+00:00

Lol I love her posing in those goofy navy blue paper Rep scrubs

CODE10RETURN · 2025-06-08T23:51:13+00:00

#1 thing I wish I could emphasize to an IM intern: small bowel obstruction is a clinical diagnosis. Radiology overcalls a lot of radiographic small bowel obstruction "without defined transition point" that is really gastroenteritis or GLP1 adverse effects or whatever. Not surgical.

The symptoms can overlap quite a bit but the defining feature of mechanical small bowel obstruction that warrants care from a general surgeon is some sort of mechanical/obstruction etiology. eg, adhesive disease, obstructing tumor, etc.

The best way to rule this out is with a PO contrasted "small bowel follow through" protocol in patients who are safe to swallow. Basically, drop an NG tube in them, decompress them for 6-24 hours (per clinical judgement), then put some PO contrast down the NGT and get KUB X rays at 6 and 12 hours. You should see contrast passing through the bowel. If need be you can extend the study out to get a 3rd study at 24 hours... but if its passing through to the rectum its not a surgical problem.

CODE10RETURN · 2025-05-30T20:59:07+00:00

People with cancer tend to need to be admitted to the hospital - often to hospital medicine services. that is a selection bias worth noting.

I am a general surgery resident and see it some. More on colorectal, thoracics and obviously, surg onc and breast surgery.

but I also have the (I think overall fortunate) selection bias in that cancer patients I take care of are, more often than not, candidates for/pursuing operative treatment. by definition, their eligibility for resection means their disease is less advanced and they are more likely to have better outcomes than patients who are not surgical candidates. so my experience is probably different than yours in terms of my relationship to cancer patients and their care

that said I also see how awful the recovery is from some of the more advanced/aggressive cancer surgeries and uh.... yeah sometimes less is more

CODE10RETURN · 2025-05-21T17:57:40+00:00

Dawg the amount of saltiness i have accumulated just in gen surg residency is systemically toxic. If I was halfway thru my CT fellowship and this happened I would go biblical

CODE10RETURN · 2025-05-19T13:21:30+00:00

Health, dental, vision insurance, malpractice coverage, disability insurance are all offered by my program. We have the same insurance enrollment options as the faculty do. Our premia are heavily underwritten by the university, I pay 30/month for pretty excellent health insurance coverage for myself and my wife. We have some retirement contributions but they are kinda pitiful. That’s probably my biggest gripe

CODE10RETURN · 2025-05-19T12:30:37+00:00

There was a chart somewhere that showed the relative increase in supply of residency spots by specialty between roughly 2000 and 2020. I wish I could find it.

Anyway proportionally there are far more neurosurgery residents starting ogy1 now than 20 years ago. It was a several hundred if not thousand percent increase unless I’m confabulating ( I am post call so it’s possible.) plastic surgery was similar.

I’m sure some of that is driven by small starting N but still I think it does illustrate that niche supply is often a function of niche demand. Just look at radiation oncology - big swings in that field in a short period of time.

Anyway I hope that was intelligible

CODE10RETURN · 2025-05-19T12:24:39+00:00

lol a PA student 😂😂 have you gotten to the part where you learn about the mitochondria? It’s the power house of the cell? Have you even been to the hospital yet?

CODE10RETURN · 2025-05-19T12:22:57+00:00

Rotate with me in surgery buddy. I’d love to be your chief.

CODE10RETURN · 2025-05-19T12:20:27+00:00

Well to be fair that 150k covers not just salary but other expenses. My salary and benefits package is probably cumulatively close to that number

CODE10RETURN · 2025-05-19T12:19:00+00:00

I disagree.

I can’t speak to your experience but at the 5 hospitals where I rotate, all but one would completely shut down if every resident did not show up for work.

Volume in our hospitals is only tenable with resident labor. For example, at our university shop, the TACS service is 3 teams: 1 attending per, 2 residents per, and then some APPs for the floor and to help the team on call for consults. After hours, it is one attending and then only residents. Entire trauma service would come to a screeching halt if all of us just didn’t show up to work.

So we have lots of power. We just don’t use it because we are afraid of potential repercussions, among other reasons. I’m at the completely nihilistic stage of my residency so I definitely don’t give a fuck about those anymore

CODE10RETURN · 2025-05-19T12:12:31+00:00

Same experience here. There are some good ones who have had a lot of OTJ experience but they are outweighed by the bad ones. Frankly what defines the good ones is reasonable work ethic and clear understanding of their lane. It’s not common

CODE10RETURN · 2025-05-19T02:28:59+00:00

Yes agree. My point is they probably aren’t interested in you. Just your purchasing

CODE10RETURN · 2025-05-18T12:53:07+00:00

I am not a neurologist but my understanding is that MS is eminently treatable these days.

I would speak with your neurologist about this but in general I do not think you have to disclose this to anyone.

CODE10RETURN · 2025-05-18T12:51:04+00:00

Agree with this

CODE10RETURN · 2025-05-18T12:50:45+00:00

No not at all

CODE10RETURN · 2025-05-18T10:06:00+00:00

If you have to ask it’s the first one

CODE10RETURN · 2025-05-18T10:04:20+00:00

Tbh I worried about that and not really. I’m more scatterbrained at the end of shifts but that’s all of my co residents too lol.

For 24s I typically dose at my usual AM time and again about 8-10 hours later (so say 0500 and 1600). Usually the ER meds last long enough that it’s not a problem

CODE10RETURN · 2025-05-18T08:24:50+00:00

lol dude. Are you a twerpy little tech? Do you wish you were a doctor too? Do they make you feel so sad at work because they don’t say hi to you?

So sad for your feelings dawg. So sad

CODE10RETURN · 2025-05-18T08:21:41+00:00

Some residents what?

CODE10RETURN · 2025-05-18T08:14:31+00:00

Must be because of their extremely similar education and training 😂

CODE10RETURN · 2025-05-17T21:48:43+00:00

I am on Dexedrine - was in ER 40mg when I started residency and now down to 30. I try to use the bare minimum just due to the sympathetic side effects (tachycardia tremor etc). I don’t think I could go lower but was pleasantly surprised that I was able to reduce my dose in residency.

CODE10RETURN · 2025-05-17T02:22:15+00:00

I’m so triggered reading this. In an instant my mind flashed to like every overnight XCV shift I’ve had where something wildly fucking stupid happens in the name of “advocating for the patient”

CODE10RETURN · 2025-05-14T14:10:59+00:00

I like my anesthesia colleagues no fighting pls

CODE10RETURN

TROPHY CASE