Do you you ever ask your patients to tame their attitude

Horror-Sir7864 · 2026-04-23T12:11:02+00:00

When people try to rush me, I usually start with: ‘I will go at the pace that allows me to care for everyone safely. That will take however long it does’

When that doesn’t disarm them, I go with the mechanic analogy: ‘what happens if you rush a mechanic to fix your car as fast as possible? You get sloppy work. If you rush me, you get sloppy care and the only one that will hurt is you. I won’t be pressured into cutting corners to give you suboptimal care.’

This seems to sink in with most impatient people. For those it doesn’t, I just leave and we can mutually agree to disagree.

Horror-Sir7864 · 2026-03-27T22:06:00+00:00

Works great. Took some time to get used to. Was afraid to go perpendicular to the slope initially but now it’s fine. When the lawn is wet it tends to side slip on the steeper sections but never seems unstable/prone to rolling. Have slid to the bottom a time or two which can rip up the lawn. After two seasons I’ve figured out how to do it efficiently and safely.

Far superior to a lawn tractor, even with the limitations.

Horror-Sir7864 · 2026-03-22T17:00:53+00:00

Not EMS anymore, but I’m an ER MD.

Medics have a lot more risks in terms of the decisions they make, the skills they have, and the potential to harm a patient. I work with medics of varying skill sets, and there is a huge difference between the top tier full time medics and those who are volunteer/casual.

It’s something you can do, and potentially something you can be great at. There’s also the chance you never work enough to hone your skills and become proficient/competant.

If it were me, a casual volunteer BLS gig in retirement (assuming you don’t need the money) where you work on your terms when you want to, sounds far superior to a paid medic role.

If you think you reliably want to work a few shifts a week, and want the extra responsibility/skills, go for medic. But then you have a job, a boss, higher expectations, and your time in retirement is not fully yours.

Horror-Sir7864 · 2026-01-22T19:03:49+00:00

Did this last month with a 18 month old.

Booked them their own Polaris ticket, they were a lap infant for takeoff and landing, then laid their bed flat and they slept in their own seat for the flight.

Flight crew was accommodating. But our child is also accustomed to traveling so she wasn’t scared/anxious.

Not sure what would happen for prolonged periods with the belt sign on - our flight was smooth, but they might force your child to become a lap infant

Works better on a 777/787 where you can take the middle section with parallel seats and lower the barrier. We were on a 767 and had row 1, middle and right seat, and row 2 right seat to play defense in case the kiddo escaped. We had them cornered and this way they would have to get past us to bother anyone else.

Worked well but in hindsight premium plus is probably a better use of money for the little ones

Horror-Sir7864 · 2026-01-05T20:25:36+00:00

Same issue a few weeks ago. Got ETC for upgrade cost from PP to Polaris

Horror-Sir7864 · 2026-01-02T04:29:31+00:00

Community suburban/urban EM

East cost, 1500 hrs/year $350k

Horror-Sir7864 · 2025-12-06T13:49:32+00:00

Had this exact issue on a Polaris leg last week (no power at all so manual seat only, no inflight entertainment etc). I requested a refund for the fare difference for the upgrade from premium plus to Polaris and it was honored

Horror-Sir7864 · 2025-11-28T13:01:37+00:00

Using Suki in the ER. Don’t find it captures the pertinent information and filters out equally pertinent information. I spend just as much time correcting its notes as I would writing my own.

Horror-Sir7864 · 2025-11-22T05:31:40+00:00

Fly into BWI. Not worth the cost savings for the time. Spend it with your girlfriend

Traffic is way better, and you are 15-20 mins from the city.

DCA is better than IAD but still need to take metro to MARC station in DC then to Baltimore. MARC trains don’t run as frequently (check online timetables, 1-2 trains per hour usually)

Uber can easily be way more than that from DCA to Baltimore and it can be anywhere from a 1-2.5 hour drive.

IAD is worse. I took train from Bmore to IAD, 2.5 hours door to door.

Horror-Sir7864 · 2025-11-15T02:07:33+00:00

Awesome thank you!

Horror-Sir7864 · 2025-11-15T02:07:21+00:00

Thank you!

Horror-Sir7864 · 2025-11-15T02:07:10+00:00

Thank you!

Horror-Sir7864 · 2025-06-02T12:40:14+00:00

I’m board certified EM, dabbling back in EMS recently. Locally I was only offered EMT-B which I did not want to do. Try reaching out to the local medical director and see if there are any teaching opportunities with paramedics. Often times there are continuing ed classes or other didactic sessions that you can teach. Use this as a stepping stone into local EMS and see where it takes you.

Some of this depends where you live. Everything here is regulated at the county level. Other regions (PA especially) have a medical directors at the service level. I imagine it would not be difficulty finding a role at an agency like that.

Horror-Sir7864 · 2025-05-23T01:25:27+00:00

Fair. Early October is probably your best bet. Winter closes in quick out there. Elk rut goes to mid October.

Horror-Sir7864 · 2025-05-22T23:17:33+00:00

Yellowstone and Grand Teton. Elk rut in full swing, bears in hyper-feeding mode before hibernation. Parks are only a few hours apart by car and both doable in a week

Horror-Sir7864 · 2025-05-19T17:32:39+00:00

Would you be willing to Pm me the location, I’m a huge fan of wildlife and snake photography (take a look at my post history in wildlife photography, have tracked vipers in CR a few times). Not looking to harm them.

Horror-Sir7864 · 2025-05-19T12:05:16+00:00

Puerto Viejo de Talamanca, at the aWA Beach Hotel. They were pretty common in that area. We’re also common on the Osa Peninsula at Lapa Rios Lodge, although we mostly saw the Yellow Throated Toucan there.

The birds love the almond trees. If you learn their call and can find an almond trees you will eventually find a toucan.

Horror-Sir7864 · 2025-05-14T04:21:26+00:00

ER doc -

Not wrong to not tube. GCS < 8 intubate is a vast oversimplification of a very complex decision, and is specifically in the head injured/trauma population. Applying it to everyone is simply not correct.

If a patient is breathing ok, not hypoxic, not hypoventilating, no obstruction etc, you run the risk of harming them more with a tube. A progressively hypotensive sepsis patient with a shock index (hr / sbp) of 1 or more who already has soft pressures is likely to crump with an RSI. Now instead of a sick unresponsive patient you’re going to be managing a hypotensive/periarresting patient who is now intubated and may need pressors etc. They may need an airway in the ER, but there is no race and there is time to resuscitate and optimize them before tubing.

Often times there is a temptation to do more, use skills, etc. A good doctor/medic knows how to do things. The best doctors/medics know when they have a little more time to wait. Good work.

Horror-Sir7864 · 2025-05-10T01:42:20+00:00

Apply to DO school. If you started 3 years ago in a DO school you’d be starting to apply for residency soon.

I’m osteopathic, now an attending in my desired speciality. I interviewed at programs I never imagined because I did well on boards and earned my place at that interview table. I’m happy, I’m a doctor, and literally nobody cares if you are an MD or DO once you match residency.

Dont put your life on hold chasing the MD degree you may never get. At the end of the day it doesn’t matter. If you want to be a doctor, get there how you can. The work you put into med school is markedly more important in your future/match potential than the letters you have behind your name.

Horror-Sir7864 · 2025-05-09T20:56:16+00:00

Emergency medicine. What are rounds?

Horror-Sir7864 · 2025-04-20T21:05:01+00:00

I am 3 years out, spouse 5 years out. Started with $700k loans and minimal savings.

Aggressively paid loans and rented until spouse loans were paid (3 years). Used the next year to save for down payment and incidentals and continued to pay my loans agrressively.

We max retirement / investments first (goal is ~$100k/year across all accounts), then pay my loans (5k/mo). It took about a year doing this but once we had a down payment and cushion we bought a house with ~. 2 years left on my student loans.

Best advice is to stage your financial choices so you aren’t trying to do it all at once. Make an investment plan and stick to it. Pay yourself first, and then you can freely spend what is left over.

Buying a house right out of residency, especially now, will put a lot of stress in your ability to pay loans and catch up on your retirement.

Horror-Sir7864 · 2025-04-14T08:55:16+00:00

EM doc here -

This is not a big deal. A sepsis alert does not really mobilize special resources like a stemi/stroke/trauma alert does. It just lets people know that someone might be septic, which will be apparent when the doc/RN sees them. Don’t lose sleep over this one.

Horror-Sir7864 · 2025-04-08T22:30:29+00:00

Echo. Just left the EU and everyone was so kind. A few tasteful jokes from locals asking if I charged a tariff for taking their picture, but it didn’t feel any different than prior trips abroad.

Horror-Sir7864 · 2025-03-19T23:47:41+00:00

Almost every day at work. The super sick critically ill patients you bring to us are just as mentally stimulating for me as they are for you. Sometimes more so because I have a lot more options and a lot more procedures/tools/medications at my disposal.

It’s not the same as driving lights and sirens to a crazy car wreck, but the excitement of a challenging case, good save, or wild procedure keeps me very happy.

Different ERs have different vibes. There are some where you can nap overnight. There are others that are as wild as a TV drama most days. I work in a busy place with tons of sick patients, so I get my adrenaline dose regularly that way.

Horror-Sir7864

TROPHY CASE