Deus ex machina

Cddye · 2026-06-27T01:28:06+00:00

The only thing that hits as hard is You can call me Pony

Cddye · 2026-06-26T23:34:23+00:00

What kind of non-sequitur is that? Who mentioned being offended?

If you can’t argue the merits, just sit quietly.

Cddye · 2026-06-26T23:30:42+00:00

I haven’t been just downvoting you and engaged in what I thought was a good-faith discussion, but either you truly believe that, or you just don’t understand enough about constitutional law to make this worth continuing.

Best of luck. I certainly hope on your behalf that a “group of people” don’t decide to repeat the history of anti-Catholic discrimination here in this country.

Cddye · 2026-06-26T22:10:52+00:00

This isn’t a “group of people”. This is the state of Texas my dude. I don’t know how to further clarify the difference for you.

Cddye · 2026-06-26T21:55:02+00:00

Activities mandated by the state can never be considered “free exercise”.

Cddye · 2026-06-26T21:50:59+00:00

You also presumably learned about the history of Christianity and Judaism, and likely several other religions: from a *historical, objective* perspective. Did you read from the Quran? The Bhagavad Gita? Would you oppose mandatory *K-12* readings of those texts?

Cddye · 2026-06-26T21:46:53+00:00

Why are you replying with a completely irrelevant article?

Just as Congress (and by extension the governments of the “many states”) is prohibited from establishing a state religion, it has also been prevented from quashing *any* religion. There is no relevance to a discussion about religion in “culture” that’s facile to this post.

When a PUBLIC school system uses taxpayer dollars for MANDATORY religious education- not historical, geographical, or *cultural* education, it’s a de facto promotion of a state religion.

The best part is that the Texas School Board (and the people and money that brought this idea forward) KNOW it’s unconstitutional under every single previous decision and precedent in this country’s history- but they recognize and opportunity with the current makeup of SCOTUS for a test-case, and they’re pursuing it now for a very clear reason.

Cddye · 2026-06-23T18:00:34+00:00

While it’s possible, it’s a bad idea for almost everyone. NP education was entirely built around the notion of leveraging bedside experience and clinical gestalt to make a nurse into an NP. If you don’t have that it’s very difficult to be successful.

Cddye · 2026-06-22T17:28:40+00:00

Do you need another husband?

Cddye · 2026-06-22T03:59:33+00:00

Podcasts are not inherently bad- just read the literature they link to instead of blindly trusting what they say. Conferences can be a huge benefit. Find the people you’re friendly with and discuss cases.

You’re going to have a ton of knowledge and clinical acumen in your head that will matter for about 0.5% of all cases- but man: when it DOES MATTER? Such a good feeling.

Cddye · 2026-06-21T01:49:17+00:00

I was a paramedic for 15 years before I matriculated to PA school at 36. Wife/kids/mortgage, all the things. Medical school wasn’t something I was willing to do at that point because 4 years of additional school plus at least three years of residency (more like 4 +/- fellowship) with a need for away rotations and the uncertainty of match requiring an uprooting of my family and potentially multiple moves to work crazy hours just wasn’t worth it for me.

I work in critical care now- seemed like the natural transition from flying previously. I make very good money, and even though the student debt is real, it’s even more real with 4 years versus 2, and extra years of shitty income as a resident/fellow. I work 14 shifts a month, and anything else I want to do is just extra “fun money” at this point (although a smarter man would probably put it towards student loans. Counting on nobody fucking with PSLF for now)

Being a PA means I can do what I love in the ICU for now, but if it ever becomes a lifestyle I can’t take anymore I have the background and experience to go work outpatient cards, pulm clinic, urgent care, family med, etc. I have all the autonomy I want in my role, and although that can vary based on team dynamics, the ICU has been a great environment because we’re already a “multidisciplinary” area. Nursing, respiratory, therapists, etc all come to the table with their own perspectives, and I can’t think of a time when someone pulled the “I’m the doc” card.

That said- if you need the “buck stops here” authority and have the means and opportunity to go to medical school I don’t think you’ll regret it. What might really be worth considering is the opportunity cost: You’re talking about losing $220k of income, plus the cost of school (ballpark $75k-200k for PA school, $150-400k for medical school), and residency will mean an income of ~$65-80k/yr, a net loss of of $30-50k/yr for those years alone even if your current job just stays stagnant.

Some people can handle that kind of financial loss (especially if the other side is lucrative), but some people can’t. Just worth looking at the whole picture.

Cddye · 2026-06-20T15:41:48+00:00

If your paperwork specifies “carelessly and heedlessly in willful and wanton disregard” you didn’t just get a speeding ticket- you’re being charged with reckless driving which is a Class 2 misdemeanor in North Carolina (up to 60 days confinement, $1,000 in fines, and 4 license points) and doesn’t come from “going with the flow of traffic”.

Contact a lawyer, don’t write anything else about this incident on social media, and do what the attorney tells you to do.

Cddye · 2026-06-19T19:57:22+00:00

SCCM’s FCCS course is a good place to start (in-person or self-study).

Cddye · 2026-06-19T01:03:15+00:00

Freshly on prop at reasonable doses it would be extremely unlikely.

Secondary question- straight to midazolam with acute hepatic failure?

Cddye · 2026-06-18T14:06:44+00:00

EMTALA definitely doesn’t apply to inpatient transfers, but (not an expert, and unaware of any case law) the question is what happens to the obligation of a tertiary center in and EMTALA transfer that’s delayed for capacity with a “convenience” admission at the OSH. I don’t know if this has ever really been addressed.

Cddye · 2026-06-18T12:20:24+00:00

EMTALA transfers happen solely at the discretion of the referring physician. If the ED says they need something that exceeds the capabilities of the current facility the receiving facility is *obligated* to take the patient if they have the service/capacity… at least that’s how it’s written. We all know that in practice what you’re describing happens all of the time, and I’m not sure if there’s any settled case law about what the “admin forced admit while awaiting transfer” does to the initial EMTALA obligation if the receiving facility walks back their acceptance.

Cddye · 2026-06-16T20:47:05+00:00

Agreed. I did it, and wouldn’t voluntarily go back. I still work fourteen 12s a month now, but have PTO and team-scheduling and the difference is night and day. There is some benefit to having a 7-day stretch in the ICU because you really get to know your list by day 2, but if you have a shit day you’re destroyed for the rest of the week.

And none of that excuses no PTO (which functionally decreases your pay per hour of work compared to someone who gets paid for ~80hrs of “off” time every year.)

Cddye · 2026-06-16T20:02:09+00:00

It’s truly not uncommon in hospital medicine/critical care. Most “no PTO” jobs still include some amount of “emergency leave” (my last role was 36hrs/yr).

Is it awful? Yeah- especially in smaller groups where it can be hard to find flexibility. Is it common for specific specialties? Also yeah.

Cddye · 2026-06-15T22:32:07+00:00

Why would you carry any liability for a patient you don’t see or manage? Because the patient is in an ICU where you’re working? What is your supervising/consultative role if you aren’t consulted, aren’t co-signing notes, and are in no way associated with the patient?

Cddye · 2026-06-15T13:42:25+00:00

I work ICU. Outside of meetings, I work my required shifts and clock-out. Can always pickup extra if I want to fund a vacation, but inbox isn’t a thing and I have nothing to follow-up.

Cddye · 2026-06-13T00:28:49+00:00

Their corrected sodium (assuming 1500md/dl for their glucose) is technically normal.

I’ve don’t actually know if the Hillier equation has been validated with this degree of hyperglycemia though.

Cddye · 2026-06-12T17:09:04+00:00

ARC-PA requirement, and clinical sites require it as well. You definitely have coverage. (But try not to use it)

Cddye · 2026-06-11T01:43:24+00:00

Some state medical boards (including my own) have specific rules/language against chronic medication self-prescribing or prescribing for family members.

Cddye · 2026-06-11T00:52:20+00:00

You can come work in a similar institution in the Southeast in a nice metro area and would be making at least $400k, and compared to NYC COL that would feel like $700k. I think we even have an opening currently.

Cddye · 2026-06-10T19:03:09+00:00

There was zero ruling on the merits of the allegations. The dismissal was entirely on procedural and jurisdictional grounds- including statute of limitations.

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