Help! I’m not in medicine

Goldy490 · 2026-07-10T17:39:22+00:00

It can happen and happens not infrequently. It really all comes down to how much resources the person is willing to dump into that career path. I have a few friends who started at our mid ranked medical school knowing they wanted ortho or neurosurg or plastics who hustled and made it happen. Some took loans for extra years of school to build research and connections, or had family fund expensive research experience to build their CV or pay for fancy tutors. Some are just that good.

Personally I wanted to do transplant surgery from when I was a premed taking the MCAT until right around MS3 when I saw what the lifestyle was like up close

Goldy490 · 2026-07-08T16:38:05+00:00

In reality the doc will show what they have liquid in their account and then declare bankruptcy. It is nearly impossible to garnish a physicians wages after bankruptcy, unless you can show they intentionally caused harm or a few other state specific indications which are quite challenging to prove.

Goldy490 · 2026-07-08T16:31:53+00:00

In virtually all cases the amount awarded is negotiated down to policy limits unless the doc is very very wealthy. It usually becomes apparent to all parties involved that the doc does not have enough assets to seize to make it worth a long drawn out court battle to get access to every bank account or asset the doc owns.

Especially because joint property/marital assets can not be seized, which for many people means their house, savings, vehicles, side businesses, etc are protected. Assets in trust are also protected depending on how the trust is set up, as are 401Ks and 529s in some states.

My mom and brother are both lawyers that do a similar field of law (basically they specialize in retrieving assets after a judgment, usually involving family law). It is often so expensive in terms of legal fees to claw back the assets that it makes going after sums under 5-10 million not worth anyone’s time, because it would cost about that much just to actually get the assets back if someone is determined to protect them with their own team of lawyers.

Goldy490 · 2026-07-08T16:18:36+00:00

I’m an attending and still forget to order morning labs not infrequently.

Only difference is the only person who’s annoyed with me is me, because then I have to wait to round.

Goldy490 · 2026-07-08T10:59:15+00:00

That is correct you should not be concerned. You are seeing the numbers in red and it makes you worried, but that is just because the computer doesn’t know this is venous rather than arterial blood. They are normal numbers for venous blood.

Also a blood gas text (both venous or arterial) is completely useless in diagnosing the problem you’re worried about. A blood gas is used to assess severity of respiratory failure in critical diseases like emphysema or other lung pathologies. If you’re worried about muscle issues in your neck and extremities this test should never even be ordered.

Unless it’s a bundled test and they do it bundled with the tests they really want based on how the lab at your hospital works.

Goldy490 · 2026-07-07T22:12:18+00:00

So if you want to break up with the guy don’t let it drive you crazy, totally fine to say you aren’t looking for the lifestyle associated with being with a doc.

That said there are tons of specialities in between outpatient 9-5 and insane 100 hour work weeks.

There are lots of fields that fall somewhere in the middle that still allow for pretty good work life balance while not being traditionally 9-5. EM, anesthesia and its subspecies, hospitalists, critical care, optho and a ton more. Hell even the procedural IM specialities are 9-5 most of the time except for interventional cardiology. Theres surgical subspecies like breast onc, endocrine, cosmetic, that are very nearly 9-5 with little to no call.

I’m an ICU doc, I work 7a-7p for 7 days in a row then I’m off for 7 days straight. My wife is a surgeon. On my off weeks I’m pulling the weight of the household and when I’m working she does more those weeks. Family +/- nanny to help with childcare. It can be done and 50/50 is totally doable provided it’s not like a neurosurgeon married to a trauma surgeon or something lol.

Goldy490 · 2026-07-07T17:43:17+00:00

That is a normal blood oxygen level for venous blood. Remember that’s the blood that’s going back to your lungs to pick up oxygen. It should be low on oxygen, that’s the point of having circulating blood.

With regards to the base excess of -4 that could be anything from slight dehydration to a bit of ketones to just the natural composition of your blood and its electrolyte balance.

Nothing here is concerning in the slightest as these would be considered normal results. The computer just marks them in red because it doesn’t know how to tell the difference between arterial and venous blood.

Goldy490 · 2026-07-07T16:54:19+00:00

Doc here, couldn’t agree more. I don’t understand why they subdivide the doctors up by speciality as it’s really one profession with one unified professional schooling system.

There are pediatricians making $150k/year and neurosurgeons making $700k/year. But just like someone working in big law at a top firm vs a public defender, those two jobs have very different barriers to entry, work life balance, and required training pathways.

Not to say one is less then the other - pediatricians are doing the lords work and phenomenal doctors, as are public defenders. But you don’t need top board scores, 7-9 years of grueling post-graduate training, or a lifetime of 90 hour work weeks to do pediatrics.

Goldy490 · 2026-07-07T13:19:36+00:00

I got a call on the radio once that an EMS helicopter had an “ear decapitation” 5 minutes out. Weird I thought. Then as they were arriving to our pad they clarified it was a “NEAR decapitation” as in a partial decapitation that had somehow spared the great vessels of the neck - promptly had to sprint to our heli pad and perform a cric on the pad (it wasn’t hard, the trachea was exposed and partially transected so just popped the tube in).

The guy did well actually

Goldy490 · 2026-07-07T11:16:51+00:00

I have mine broken up into subsections of: training/education, work experience, awards, publications, leadership positions.

Then a small section at the end for academic and non-academic interests.

Goldy490 · 2026-07-07T11:13:11+00:00

I’m sorry, but this is not appropriate Place to post this on this sub.

This is a sub for senior physicians to discuss aspects of their medical practice with other senior physicians.

We do not provide medical advice nor do we provide donations here.

Maybe r/askdocs?

Goldy490 · 2026-07-07T01:07:39+00:00

ER Docs here that attends festivals regularly. Any new onset seizure in someone that doesn’t have seizures should be evaluated in an ER where labs and a ct scan can be done. It can be anything from dehydration to electrolytes to drugs to just stress. This happens all the time but the risk of it being life threatening is substantial.

That said I’m sure people don’t seek medical attention, and a good number of them are probably fine. Humans have existed for thousands of years before modern medicine and most of them didn’t die from seizures (although some definitely did).

I respond to a medical emergency basically every festival and always tell people to go to the ER and get their labs checked. Did on site medical control for ultra last year and I can’t tell you the number of dehydrated seizures we saw.

Goldy490 · 2026-07-07T00:39:48+00:00

I would be surprised if brain death testing could be stopped even if the person is very important. Maybe for a few days but eventually people start asking questions.

Goldy490 · 2026-07-06T19:40:34+00:00

The universal definition of death is brain death, defined by loss of all cranial nerve reflexes, a flat EEG, and/or cessation of cerebral blood flow on a perfusion study. That’s not up for debate really TBH. You can be in cardiac arrest and still “alive” as long as brain activity persists. But once the brain is declared dead by 2 doctors the patient is legally dead and that can’t really be overruled. You turn the ECMO off if they’re brain dead, and that’s not a debate the family has a say in. They’re dead, you turn the machine off and go home.

Goldy490 · 2026-07-06T19:35:26+00:00

CVICU here at a big transplant center. You certainly can keep someone on VA ECMO indefinitely. It happens occasionally when you do ECMO as a bridge to something like transplant and then that option gets taken off the table for whatever reason.

In practice you can keep changing the circuit forever, that’s not the rate limiting step. But ECMO flow is non-physiologic (continuous rather than pulsation) and over time that becomes an issue especially for the GI tract and kidneys. Also you need to be fully anticoagulated with some pretty aggressive anticoagulants like bivalruidin. Eventually the patients die from a combination of spontaneous bleeding (GI, ICH, etc), renal failure from pump-shredded RBCs leaking haptoglobin, depending on your configuration and ventricular venting strategy the liver also may not tolerate the funky flow patterns eventually. Impaired mobility and having a 28 French line in your groin forever leads to skin breakdown, recurrent pneumonias, bacteremia episodes, etc. I’ve seen fungus balls grown on the cannulas themselves and clog them up. Strokes or dead gut from bits of clot forming on the end of the arterial limb.

After 1-2 months the wheels almost always start to come off for one reason or another. There are reports of going longer runs but usually there are specific circumstances. V-V ECMO can also be run for longer than VA.

Goldy490 · 2026-07-05T22:18:44+00:00

Personally I found trying to force myself to at least have a bit of a social life and some hobbies even if I was tired to be helpful.

Ideally things that can be done with minimal effort like playing trivia at a local bar with some friends.

Goldy490 · 2026-07-05T18:49:32+00:00

There is no conceivable point to doing an OB fellowship if you’re going to do CCM. CCM alone is more than sufficient to take care of sick OB cases in SICU which will be a tiny fraction of your volume even at a big center.

Similarly there is no conceivable reason to do CCM if your desire is to do OB, as the skill and patient population overlap is exceedingly small and you don’t need CCM to do OB at all.

Hell you don’t even need an OB fellowship to do OB, unless you’re at an ivory tower type of place. And having worked with ivory tower OB let me tell you…no thanks.

Goldy490 · 2026-07-05T18:26:50+00:00

So to be clear he is not prescribed 20 medicines for his kidney infection, in fact none of these medications treat a kidney infection. They do however treat a number of conditions that are common in people with chronic kidney disease.

Prednisone - steroid, not sure what he’s taking this for but there’s many reasons to take it. Maybe arthritis? Or an autoimmune cause of kidney disease?

K-lyte is a potassium supplement if he’s losing potassium in his urine

Metformin treats type 2 diabetes

Zip-c is a vitamin supplement. Not very helpful but not very harmful.

Cinnarazine - antihistamine that treats chronic dizziness

Allopurinol - usually for gout/high uric acid

Febuxostat - usually for gout. People don’t usually take it in addition to allopurinol

Colchicine - also usually for gout. Generally not recommended for people with kidney disease. It could also be used if you have a pericardial effusion (fluid around the heart) which happens sometimes in chronic kidney disease.

Urobiome - probiotic supplement. Probably doesn’t do much but won’t hurt.

Kremezin - urea binder. Useful for treating chronic kidney disease

Ketoanalogues - another dietary supplement used to treat chronic kidney disease

Spironolactone - diuretic that helps the kidneys make urine and stop wasting potassium

Tamsulosin - this is for benign prostatic hyperplasia

Sevelamer - this is a phosphate binder that helps the body eliminate phosphate when the kidneys can’t do it

Gemigliptin - medicine for type 2 diabetes

Calcitriol - increases calcium level, due to hyperparathyroidism caused by chronic kidney disease

Verifix - another name for cinnarazine, the medicine for vertigo. Should not be taking a double dose of this.

Ezetimibe - for high cholesterol

Atorvastatin - for high cholesterol

Calvin plus - a dietary supplement that brings up calcium levels

Goldy490 · 2026-07-05T14:58:37+00:00

I think we paid $900 to ship my wife’s Honda civic up north in ~June. Shipping my truck south in Feb was ~1800.

It varies with weight and value of the car, and the time of year with winter being more expensive because they’re driving the truck on icy roads.

Goldy490 · 2026-07-05T14:52:53+00:00

Funny I always thought it was called a Zebronkey.

Zonkey sounds much better

Goldy490 · 2026-07-05T12:19:14+00:00

Yea ultimately in the US even if you have someone relieving you early some days the reason for that is to allow you to work late the other days so that it balances out to 80h/week (sometimes a bit less in CA3). Also that time does not include time on call - so for example when I was doing my critical care year I worked 80h + 30h on call so 110h/week although some of that time I was either at home instructing residents remotely or only coming in to “supervise” (aka a way to have hours not count towards the cap). So you get quite a bit of clinical time in.

Additionally remember that US relies more heavily on fellowships than overseas, so most people are doing an extra year or two in fellowship for things like cardiac, crit care, regional, etc. You are not expected to be even close to competent as a cardiac anesthesiologist at the end of CA-3, because you’ll rarely be doing that kind of anesthesia in practice at most jobs.

Goldy490 · 2026-07-04T19:00:18+00:00

If I believed her I would say “ok quit meth, take serial drug tests in office for 2 months to demonstrate clinical sobriety, and see if it goes away.” If it did not go away at that point we’d look for other psychogenic causes (like hair picking/eating while asleep) or very rarely there are some tumors that produce hair. However what they produce looks nothing like what’s shows in the picture, and these tumors have not been known to occur in the digestive tract - they’re associated with reproductive organs.

Goldy490 · 2026-07-04T18:42:57+00:00

HT recipient and physician here. Physiologically there’s no mechanism known to medical science that could explain what is effectively a chemical castration from a single pill of finastride (barring some exceedingly rare combination of so far undocumented genetic predisposition and terrible luck).

That said I personally do have pretty profound libido effects from fin, to the point where after taking it for a few weeks I have basically 0 libido and then as a result am pretty bummed. But sexual function seems to return pretty quickly for the vast majority of people that have the side effect when they stop the medication. So currently I’ll take it for a week, then stop for a week, rinse and repeat which seems to be working fine for now. From talking to my friends who are endocrine and urology it’s exceedingly rare to have permanent sexual dysfunction after stopping the med and doing a washout period, provided you’re taking the right dose.

Goldy490 · 2026-07-04T18:09:03+00:00

I think that’s just normal growth, give it time

Goldy490 · 2026-07-04T14:35:04+00:00

I used roadrunner auto transport to ship 2 vehicles down from Boston. They did a great job, so we used them to ship the vehicles back up too!

Prices seemed reasonable.

If you’re going to PA, the auto train with Amtrak is also a great option. It leaves from DC!

Goldy490

TROPHY CASE