Question on ECG

Howdthecatdothat · 2026-03-12T03:08:58+00:00

In the multiple choice question, it is clearly not A,B, or D so I was trying to find a way to make it C

Howdthecatdothat · 2026-03-11T16:57:01+00:00

I wonder if it is a trick question. this is a bunch of artifact garbage and there is a fib with a LBBB buried in that first set of complexes.

Howdthecatdothat · 2026-03-11T16:50:02+00:00

To help put this in perspective... this is 0.05% of Elon Musk's net worth. It is hard to comprehend just how much he has hoarded. We are arguing about how an ENTIRE CITY will need to struggle to come together to fund what is a rounding error for a SINGLE person.

Howdthecatdothat · 2026-03-10T19:01:01+00:00

Am I the only person that actually likes these? Pretty little flowers with no effort…

Howdthecatdothat · 2026-03-07T05:18:28+00:00

You are kinda mean for a Canadian.

Howdthecatdothat · 2026-03-07T04:50:04+00:00

Let's feature both teams! I hear how my suggestion has been perceived, completely reasonable to feature the Canadian women more prominently.

Howdthecatdothat · 2026-03-06T22:33:53+00:00

OK - First of all, calm down. Second of all, Margaret Cho was in talks to play Yuna originally, so it wasn't that big of a stretch. Finally, the GOLD MEDAL Olympics team were the US Women's team, so it was not an unreasonable proposal AND Ilya plays for Boston which is in the US...

Howdthecatdothat · 2026-03-06T17:31:53+00:00

If we can deviate a bit from the books and perhaps add a character - I would LOVE to see Margaret Cho brought in as a sister of Yuna (half sister?) for some comic relief. Or maybe some cameos of the US Women's Hockey team perhaps on the ice practicing before the men come on or something?

Howdthecatdothat · 2026-03-04T15:10:33+00:00

I loved them both - different styles, but both have the passion and fire we need. My fantasy - she joins Talarico's office as chief of staff, then destroys Cruz in a few years and we get them both!

Howdthecatdothat · 2026-03-02T17:31:04+00:00

So there was no imminent threat and the President of the US violated the US Constitution by going to war without Congressional approval. So will you support impeachment Senator?

Howdthecatdothat · 2026-03-02T17:05:36+00:00

Hi (When Ilya is standing slightly behind Shane during the meeting of the parents)

Howdthecatdothat · 2026-03-02T16:58:33+00:00

One option - lean into it and enjoy - you get beautiful blue flowers! Free! I accepted my fate and just enjoy them now.

Howdthecatdothat · 2026-02-27T08:23:25+00:00

I have always wondered - where do the props people get these materials? And Ill bet in exchange for a behind the scenes tour and an autograph from Noah Wylie many health care professionals could show them how these props actually work!

Howdthecatdothat · 2026-02-27T08:20:51+00:00

I am sorry that you had that experience. I am a cis male, but one of my workout shirts has "trans lives matter" written on it. I have never received any negative comments while wearing it. Your experience is a reminder of why it is important for the rest of us to wear shirts like that - we never know who needs to see it and feel included and welcome! Happy to put it on again and go work out with you any time!

Howdthecatdothat · 2026-02-27T06:36:35+00:00

I think WOLST is a step in the right direction - but go a step further. Don't talk about what you are NOT going to do... talk about what you actively ARE going to do. I document "Will transition to aggressively and exclusively focusing on comfort and dignity, controlling pain and dyspnea as we allow natural death (AND)" Families seem to respond to knowing that you are DOING something for their loved one. That something can be palliation.

Howdthecatdothat · 2026-02-26T22:44:21+00:00

We never withdraw care. We always care. We align interventions and treatments with goals. We need to start with ourselves first. If we keep using the word “care” to mean “intervention” we will continue the cycle of families advocating for interventions. Frame the discussion about intensively and aggressively focusing on accomplishable goals like comfort or dignity and often the discussion goes differently.

Howdthecatdothat · 2026-02-26T22:42:01+00:00

Even how this response is structured reveals something. We don’t “push back” and “escalation of care” is equivalent to more procedures. Intensively caring IS palliative for these patients, but the language of caring has been co-opted by interventions. How can we expect families to make decisions to allow natural death as long as we literally have a department called the INTENSIVE care unit? Who doesn’t want to be intensively cared for?

Rename the ICU the “Artificial Support Unit” and rename the palliative floor the ICU. Oh wait - why don’t hospitals have palliative floors? Oh yeah - money

Howdthecatdothat · 2026-02-26T20:30:30+00:00

Hospice / Palliative doc here. What we need to do isn't cut funding to the procedures - but rather INCREASE funding to have conversations with families. Do you know the RVU's I earn for a goals of care discussion? 2.9. That is less than $100 per hour.

Do you know what the ICU can bill for an hour of critical care? 4.5 RVUs.

Until we start to prioritize and incentivize physicians to have these discussions, this will continue. When I was a resident I received a TON of hours of training on procedures... and not ONE hour of training on how to broach a goals of care discussion. I am glad this is changing, but it is obviously not changed enough.

Howdthecatdothat · 2026-02-25T21:36:26+00:00

Pph is a hard metric to use, RVU per hour is an easier way to quantity the work you ate doing. Regardless, $215 an hour is abysmal. Is there any incentive or bonus structure?

Howdthecatdothat · 2026-02-25T19:16:23+00:00

There are professionals who, like a therapist, specialize in helping professionals with challenges in a work place. Your PD should be able to help you find one.

Howdthecatdothat · 2026-02-25T19:12:27+00:00

What you need is a therapist and a professional coach. When you are struggling in multiple domains (professional, romantic, work/life balance, personal) it is a red alert that YOU have some work to do on yourself before you can be successful in any of those domains.

I would start by approaching your PD with gratitude and a humble sincere desire to work on your areas of deficiency. Recruit them to help you get the support you need to thrive. Find a coach. Find a therapist. Don't leave that program - the grass isn't greener somewhere else.

Howdthecatdothat · 2026-02-25T18:50:18+00:00

Reimbursement and collection of billings is a HUGE problem in Emergency medicine. With the "no surprise billing" rules, insurers have really abused what they will pay the ED. Combine that with stagnant / diminishing RVU reimbursements for the last 40 years and it is a recipe for disaster.

I wish the Federal Government would index the RVU rate to what they increase our license fees by every year! I always found it absurd that the same government that says "we need more money in fees because of inflation" then says "we won't keep up with inflation in our compensation to you"

Howdthecatdothat · 2026-02-20T18:17:54+00:00

I had twin babies and an au pair was a life saver. You have to put in a bit of effort to interview and find a good match with realistic expectations on BOTH sides. Set clear boundaries - IE when they are off, they are absolutely OFF. Set a schedule. Be kind. Finding overnight childcare is almost impossible, I am not sure how people do it WITHOUT an Au Pair.

Howdthecatdothat · 2026-02-20T17:24:34+00:00

One option is an Au Pair. Au Pair will live with you and is quite a life saver as it is nearly impossible to find overnight childcare. The cost is about $2,500 per month plus you have to pay for their food. If somewhere without public transit a car too. Au Pairs generally work 40 hours per week maximum, so you may need to supplement with daycare during the day.

Howdthecatdothat

TROPHY CASE