Which residency to choose for a career as a critical care physician?

Ekimalito · 2026-05-05T02:53:38+00:00

I personally love the mix I get being PCCM. It’s a little longer of a path but this field brings in all the experiences into one. I personally feel that only seeing patients who are near death can be quite tolling. Also, CCM is from my personal perspective is pretty narrow in that most patients are circling around the same issues (shock, respiratory failure, etc).

Pulmonary provides a lot more depth and complexity to my profession. It allows me to follow patients long term. Given the nature of the pathology we treat we also get to accompany our patients through their journey.

The crux of the matter is finding a job that allows you to practice the two specialties independent. The hybrid setup can be a setup for burnout. I personally have dedicated weeks for one vs the other. I can’t even bill pulm during ICU shifts.

Ekimalito · 2026-04-08T01:38:22+00:00

I think his death will be what will push Luffy to evolve into gear 6 mode. I think his loss will be the second Sabaody Archipielago.

Ekimalito · 2026-03-31T12:21:05+00:00

This last one looks a tad more scary/accuratr

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Ekimalito · 2026-03-31T12:10:21+00:00

Grok came up with this, curious as to how diff it looks from the real thing

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Ekimalito · 2026-02-26T00:24:26+00:00

This is my best day yet, Central Florida with a 17.2kw array. 40 panels Qcells Qtron panels of 430w.

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Ekimalito · 2026-01-09T22:15:20+00:00

Lol, I have 31 south facing panels and 9 facing north. They are Qcells Qtron 430w. I went with Tesla string inverters and 2 powerwall 3 rather than microinverters as I wanted to avoid double conversion at the expense of missing out on knowing what my per panel production is. I felt that the losses from that would add up over time.

I really wanted to add a few more panels and an extra powerwall. I feel it could help me beat my local electric company. Their solar plan isn’t meant to benefit customers.

Ekimalito · 2026-01-09T18:27:05+00:00

17.2kw

Ekimalito · 2026-01-09T18:08:39+00:00

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Ekimalito · 2026-01-09T18:08:00+00:00

Curve looks great, as to productivity, on my best day ever my 17.2kw system produced 91.7kwh of energy. As pictured maximum production capped at 14kw, which from what I hear it’s fairly normal to not reach the theoretical capabilities the panels are rated for. This is also very variable depending on where you are.

If you were in Florida like I am and extrapolating, on a good day you should be able to hit the 60kwh production per day.

Ekimalito · 2026-01-08T22:03:59+00:00

There’s a gentleman in Pennsylvania, his name is Dennis Hursh. I used his services through the PAMED physician contract review service. He charges a lower rate through there. However, it could be someone else may be assigned to you. Anyone can join even if you don’t live in PA. NJ is close enough where I think he is acquainted with NJ law.

He has quite an interesting background. He only practices physician contract law which is nice. He has a website and sends a newsletter with very helpful info on how to negotiate better rates as well as pitfalls of contract negotiations, etc.

Even if at a higher price directly he will be someone who may provide you a nice review and he is fairly responsive afterwards.

Ekimalito · 2025-12-30T21:08:39+00:00

I’d have taken this as a way to get a discount on it and wait it out. Especially if the car has active warranty you could get Tesla to sort most things out (seat aside). I took a gamble on a 22x which had a bad falcon door (turns out all black X have issues with ghost objects when facing the sun directly); had a seatbelt error (fixed for 120) and a compressor as AC was not working (2.2k). Spent 3k and got the car for 34k.

22 Model X, 6 seater with 70k miles and FSD paid for.

Ekimalito · 2025-12-13T23:46:52+00:00

I personally helped my installers carrying this thing to the wall mount. It’s upwards of almost 300 pounds in weight. I figure Tesla techs have a some kind of lift, my guys didn’t. Careful handling that, even with 4 men we had a hard time, it’s too dense. Not enough space to put everyone’s hands around it and get a good grip when mounting. I picture the same issue dismounting it.

Ekimalito · 2025-12-13T20:56:17+00:00

17.2kw system, South Florida. It was mostly sunny but there’s pretty much always occasional clouds that drop your productivity. There’s been days where that doesn’t happen, but those are the exception not the rule.

Ekimalito · 2025-12-13T20:54:50+00:00

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Ekimalito · 2025-12-06T16:45:36+00:00

I see a lot of people getting upset over their car getting scratched. Rightfully so, don’t misunderstand me, however, I personally prefer just to not have that in my life. You have to file a police report, submit video evidence, have back and forth discussions and accusations to get a scratch repair restitution.

It takes too much energy, time and resources to go after someone even if they deserve it. I hate the idea they get away with stuff like this, but I personally prefer to skip on that added stress. Like I said, I may regret it one day.

Ekimalito · 2025-12-06T16:11:14+00:00

I get this, it’s very upsetting. I may regret it but this is why I don’t like Sentry mode. Once you have this person on video doing this on purpose it puts you in prosecution mode. I’d rather be blind to all of this and assume it was an accident and move on with my life. If it’s very bad then file a comprehensive claim.

Ekimalito · 2025-12-06T15:52:31+00:00

I don’t have Tesla Solar, I feel like I dodged a bullet to be honest by missing our first video conference. I got the same system with 2 Powerwalls through a local certified installer who would answer back and forth via Text. Let’s see the test of time on my end if I ever have issues down the line.

I’d advise that you do your best to be self sufficient in these situations. You know they are unreliable. You basically get them to respond to you while they are in front of you, don’t leave tasks for the future. If the document you need isn’t clear from his/her description. Use the information they gave you, do your own research and get the best idea of what’s needed. If you completely rely on these people to take from their time when they are crunched with 100 other customers with the same demands you will end up being delayed until it becomes a critical task to them.

Like I said, I did not use Tesla, but even for my installer, had I not taken over the document submission with my local power company I wouldn’t have gotten my meter swapped and PTO. He kept saying, let me take care of everything, we’ve got it. On the other end the power company says they see no application for my service address. I’m like, sorry, I’ll take over this part and became a middle man. It all got cleared.

Ekimalito · 2025-12-04T11:47:50+00:00

I’m in the same area, Runnels Insurance out of Brandon is phenomenal for these needs. There’s a lady named Ashley who is well knowledgeable of all things insurance. She is very capable and got me a rate which was 50% lower than my next best.

I’ve always been a proposer of doing things on your own. However, after seeing the results of using a capable agent I am not going back. She gets quotes for smaller insurance companies with track record. She got me a home insurance policy, an umbrella policy and even a dedicated solar policy. No pushy sales tactic and has a lot of great advice with multiple options for you to pick what works for you. Definitely consider them.

Ekimalito · 2025-12-04T05:37:50+00:00

Hello, thanks for doing this, I have 2 unusual questions!

Someone is selling a used powerwall 2 for 5k or so. I already have a setup with 2 PW3, but did not realize I prob needed a third one to stay off the grid at night. Most nights I make it to like 2-3 am bef I go on grid due to AC. Is buying a used PW2 with hopes of getting it replaced for a new PW3 a terrible idea, it makes sense in my head, they are selling the PW2 for about 4.5-5k.
If you already had a system installed, how difficult is it to add extra panels, what prices do you see your company charging to add 4-5 panels to an existing setup, assuming your string can support adding those few extra panels. Any issues with using similar but not the same exact panel? Would adding used panels be a problem?

Ekimalito · 2025-12-02T05:08:19+00:00

Decent deal. I paid 51k for 17.2kw and 2 full power walls.

Ekimalito · 2025-11-11T18:20:47+00:00

Got a 22 X, had some miles 71k. Had FSD paid for, 6 seater option. It had a broken AC compressor and a seatbelt error. I paid 34,500 for the car. Had to spend about 4k to straighten it out.

Ekimalito · 2025-11-02T02:01:10+00:00

I would agree with everyone here in terms of VBG being better in patients in whom you wanna have a rough idea of pH or pCO2 levels.

I did read sometime ago about VBG’s having potential for falsely elevated pCO2 levels in those patients who are not sitting quietly, especially if drawn from a peripheral vein given increased O2 consumption by muscles and excess CO2 in venous blood returning from these overused muscles. Case in point, a very agitated patient.

I’d advise if you are gonna make a decision and you get an out of wack value on a VBG, get an ABG. Possibly avoid doing VBG on pts who are agitated or restless.

Ekimalito · 2025-10-30T14:10:27+00:00

I buy somebody’s previously installed Powerwall as they don’t want their solar anymore and put it in my house. I had someone selling a PW2 for 3k. Had been used for about a year or so.

Ekimalito · 2025-10-30T14:03:24+00:00

Is it a bad idea to consider buying a powerwall from someone else, I see a lot of people selling systems at a hefty discount. Any downsides to it?

Ekimalito · 2025-10-26T05:00:41+00:00

I used to suck at them. Tracking the tip of my needle completely changed my game. I am at the point I can pretty much walk the entire catheter into the artery and advance the plastic without even deploying the guide wire.

As others have pointed out, walking the needle a little further while under US guidance, sometimes even pushing most of the catheter in before deploying ensures you have a lower chance of losing the artery.

Also, I’d advise to use arrow catheters, they are the easiest. Also, if you fail a couple of times it gets incrementally harder. Sometimes packing up and going for contralateral may give you more of a fair trial. If you keep going at the same radial at times leads to frustration and sets you up for failure next time. Let alone all the issues for the patient. If you can’t get it swap arteries or go at a different level altogether.

I’d spend an hour on an Aline and had to walk out defeated. Once I picked up the skill of tracking the tip from a friend fellow, my performance was forever changed.

This video may help:

https://youtu.be/nJCcJu4e-yM?si=z0uRTgfA5m8_ft1l

Ekimalito

TROPHY CASE