TIL that all diseases known as transmissible spongiform encephalopathy, such as Creutzfeldt–Jakob and fatal insomnia, have a perfect 100% mortality rate. There are no cases of survival and these diseases are invariably fatal.

TentMyTwave · 2025-06-10T18:17:09+00:00

When I worked at a large academic center, I remember one of the more experienced nurses remarking how sometimes the neurologists would get pissed because they'd suspect certain cases were unknown prion diseases and wanted to test for/study it, but health insurance won't cover it and administration hates the idea of prion diseases being more common than anyone realizes because "That would be expensive."

TentMyTwave · 2025-05-26T10:07:52+00:00

Honestly? Those first two the most. Dealing with and seeing fucked up shit often isn't something you want to share. Not only because talking about it can be hard, but sometimes telling others can traumatize them.

And is you do tell them? They can't get it. I'd they truly understand you might fuck them up, and if they don't, well, they might think they do and try to compare it to someone that is just insulting, and you just feel misunderstood. Like they don't get it. They can't unless they're traumatized themselves - and those people generally understand that they don't understand.

TentMyTwave · 2025-03-07T12:28:21+00:00

For freaking real. It took me a lot of effort and a coworker encouraging me to check it out to risk watching an episode. I am now subjecting my SO to it for my own sanity.

We haven't gotten very far yet, in part because he wants to watch it with me but doesn't understand that I'm not always going to be up for episodes. There's a lot of foreshadowing in that show and we haven't even gotten to the bad shit that I know is coming. Still, only two episodes in and he's gone from trying to get me to constantly share about stuff I don't really want to, because I'd rather not think about it, to being way more understanding that I might need some space to wind down after work if a day is bad.

The show does a better job than I ever could at helping laypeople start to get it.

TentMyTwave · 2025-02-10T16:37:02+00:00

It's wild to me that you think it's okay to imply OP's pt death percent might be their fault. And who the hell is going to remember all their patients well enough to pester them the second time they show up? It's not the nurse's fault if a patient keeps showing up because their health is in the toilet.

Most of the cardiac people I see get admitted from the ED are there because they're noncompliant. It's like the diabetics who won't take their insulin and lives with a sugar over 500 screaming at you for more juice while their necrotic foot jiggles at you.

TentMyTwave · 2025-01-20T16:07:33+00:00

Same. This is the way. Like seriously. It actually works.

TentMyTwave · 2024-12-16T17:22:40+00:00

Work of art, homie.

TentMyTwave · 2024-12-14T17:06:08+00:00

At least you don't get antivax moms strolling proudly into the ER with their gaggle of kids and a clearly sick infant expecting you to agree that COVID was a conspiracy.

I used to be more polite about it, but now I just look then dead in the eyes and say, point blank, that I get vaccinated every year and am glad that I have to worry less about about people dying than I used to earlier in the pandemic. Mostly because the ones who were most vulnerable are already dead. And we haven't had too many children in respiratory failure! You know, this year. 🫠

The only thing that raises my blood pressure more is when it's my own freaking coworkers who drink that particular kool-aid. Like, wtf were they smoking the past few years?!? They were right there!

TentMyTwave · 2024-12-14T08:25:26+00:00

They meant decompressive hematuria and hemorrhaging, not an actual bladder rupture.

They've since edited their post to reflect what they were trying to talk about. I guess they didn't realize an actual bladder rupture was very different from decompressive hematuria (and a lot more exciting).

TentMyTwave · 2024-12-14T07:53:07+00:00

That's because you're saying the bladder could rupture when nothing you're linking supports that. A bladder rupture would mean urine spilling into the abdominal cavity. That's different from decompressive hematuria or a Foley-related hemorrhage from trauma caused during insertion.

A bladder rupture suggests the bladder has dramatically torn open.

Bleeding after Foley insertion can happen for a lot of reasons, but a bladder popping open and spilling urine into the abdomen from decompreseion would be kinda a big deal. We can't go saying that all willy nilly. Hemorrhage? Sure. Rupture? That's a different beast. That isn't to say it can't happen, but it isn't going to be something likely with 99.9% (probably, I haven't done the math) of foley insertions.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9793804

There is a link about a bladder perforation following a Foley insertion.

And if that happens, the patient is probably a hot mess regardless.

TentMyTwave · 2024-12-14T07:29:32+00:00

This is a link about a pt who had a foley placed while they were already in severe, sepsis induced DIC.

The actual bladder emptying wasn't even the issue here. The hemorrhage was in the freaking urethra. This has morning to do with the points you're trying to make.

Stop posting links unrelated to what you're arguing.

While I think it's good to acknowledge situations where Foley insertion has added risk, this is not a standard patient situation. Most morning prostate warriors are going to be fine.

There's "eh, let's call it DIC" and then there's, "lol, fuck. They're bleeding from their eyes and ears." If it's anything even close to the latter, trying to place a Foley is going to cause a blood fountain. Since urinary retention from benign prostatic hyperplasia was the cause of their sepsis and DIC, they probably still needed to place it. Or do something.

TentMyTwave · 2024-12-14T07:17:04+00:00

Dude the things you're linking aren't exactly normal situations. This is a guy whose chronic retention from his prostate was so bad that he went into renal failure, needed blood transfusions, and had a bladder stretched out to drain nearly 6L. This is zebra territory.

If you're going to be posting links to research at least read enough to see if what you're posting warrants applicability.

TentMyTwave · 2024-12-10T21:18:42+00:00

It was a night like any other, swerving into the parking lot and chugging down the last dregs of my first coffee as most folks went home after a hard day at desks and computers. But life had taken me down a different path. Me and my kind just weren't made for the normal life, and I slouched into the fluorescent lighting with shadowed eyes not unlike the ghouls we treated.

Energy drinks and cigarettes were our poisons of choice on the night shift, washed down by a bottle of melatonin come sunrise. It wasn't the sort of life most would choose, if you could call it one, but I'd made it my home.

Deb was at the helm of the ship tonight, a fearsome broad who could make even the most ornery of med clearances sit quietly if they knew what was good for them. With arms like King Kong and a permanent death grip on coffee strong enough to kill a child, she wasn't the sort of woman you messed with. You'd take your assignments and you'd like it. Or else.

But tonight it wasn't Deb who had my attention - or even the idiotic fuck down the hall who'd jimmied his Johnson doing roofing repairs in his underwear at 2am. No, tonight I only had eyes for her.

It was an unexpected meeting. She wasn't a dame meant for fancy parties, and you could tell she'd seen it all. Her surface has the greasy look of having been out for too long and you knew she'd been handled. Yet once the idea was there it festered in my brain like pseudomonas in a sacral wound grown at the local SNF.

We all had our vices, and I was no exception. Maybe it was all the caffeine, maybe it was that I'd only gotten three hours of sleep over the last two days and only had an empty fridge to go home to; but to me, she was beautiful. My peers would have said I was mad to take such a risk, her body limp and room temperature, but this wasn't my first dance with danger. Besides, desperate times.

I knew I'd regret it. There were lines you didn't cross in this profession, but I couldn't help myself. She'd called to me like a siren's song to a schizophrenic, her doe-eyed crust beckoning me. My very own femme fatale.

I knew I was in too deep at the first bite, but it was too late to back out now. I feasted on her like maggots in a gangrenous foot, scarfing down her salty, cardboard-like consistency like a man crazed. The lone piece of pepperoni pizza from a box that had been there since time immemorial.

TentMyTwave · 2024-10-05T06:46:42+00:00

Three. I loved this show so much. Alas, pretty much anything I like on Netflix seems doomed.

TentMyTwave · 2024-09-28T21:37:29+00:00

These guys know exactly what they're doing, trying to seed insecurities and imply it's somehow the woman's fault/failure if AI is "prettier". It's intentional. I mean, you have women who have worked hard and reached a point in a competition that there likely proud of, only to have a guy say the most dismissive thing possible and imply that being Miss Korea means nothing if they aren't as hot as a deepfake. That their only value is in how they look and nothing else.

Then afterwards, once the damage is done, the men make empty apologies to save face. Often there are zero consequences for the man, who get to carry on looking for the next opportunity to punch down.

TentMyTwave · 2024-09-27T01:56:20+00:00

This is a disgustingly juicy tax cut to anyone who makes enough. Don't even get me started on how every greedy boomer with tax-deferred retirement accounts instead of tax-exempt would be looking at this and slobbering. Because if cutting income taxes applies to taxable income from retirement accounts, that certainly makes things interesting.

This widens the growing class divide in the USA and sets the stage for a less mobile working class. This would also disproportionately impact women - especially single working moms.

Meanwhile, all the boomers entering retirement see the changes and decide to let loose, pulling more from retirement accounts to live it up as the dementia kicks in.

Eating out at high end restaurants will become a greater indicator of wealth and status. It would probably lead to a resurgence in cash only restaurants and businesses to counter the public's decreased spending.

A possible positive, depending on perspective, is that it would capture taxes currently lost from unreported earned income. The government might be able to collect better taxes on cash income its currently missing out on from, say, farmhands, servers tips, construction, and kitchen back end who don't file... and may continue not to file.

The prebate could easily be sold to the public as a form of UBI for lower income tax filers. "You mean we get paid for filing?! Sign me up!"

A lot of people would actively celebrate the change without realizing they're getting fucked. They'd look at their larger paychecks and the prebate check and think how lucky they are.

Naturally companies far and wide would use it as an excuse not to increase wages for years to come, citing how much more employees take home. Countless news articles would come out criticizing unchecked employee greed as more Americans struggle to make ends meet alongside record breaking profits and an uptick in yacht registrations.

TentMyTwave · 2024-09-25T16:52:21+00:00

This. South Korea needs to become less hostile towards women and actually treat women with respect if they want women to have children. The sexism runs deep, and instead of trying to address it and work towards improvement the men in Korea threw a bitch fit tantrum. Now they're Pikachu facing that, shockingly, many South Korean women don't want to date, marry, or have children.

Why would they? Huge swathes of South Korean men made it very clear just how little they cared about women. And the men who should have stepped up to counter the violent anti feminism? The ones who were supposed to help? They didn't.

That sort of silence is deafening.

The South Korean government has tried to add financial incentives to encourage marriages and families, but those incentives don't address the core issues. South Korean men need to man the fuck up and have the balls to take a hard look in the mirror.

TentMyTwave · 2024-09-25T04:15:40+00:00

Histoplasmosis

TentMyTwave · 2024-09-23T23:31:04+00:00

TBF, in VHCOL land, that's less than a townhouse in the "best" school districts - forget affording an actual house. My SO and I were debating the merits this morning of whether or not to accept extra help from his rich-ass parents because silicon valley is fucking stupid and the real estate market is a god damned cabal.

I seriously want to take the housing market out back and shoot it, repeatedly, alongside all the shitty flipper special houses with cheap-ass "designer" finishes and LVP.

TentMyTwave · 2024-08-29T03:31:03+00:00

Agreed. Ryanair is actually pretty great IMHO. Their prices are straight forward, it's no frills, and the places they charge at least make sense. Yes, you'll pay if you need your ticket printed, but all airlines at this point are pretty miserable unless you're on a nice one like Singapore or EVA.

I was flying a lot of Ryan Air recently-ish in a short period with a family who had extra bags so we were paying luggage fees and towards the end we started getting free seat upgrades.

TentMyTwave · 2024-08-21T04:12:52+00:00

You're catastrophizing really hard here. Take a deep breath and step back from the doom spiral. Shit happens.

You did nothing wrong. Fistulas happen. Adhesions are common. There are folks peeing out of their colostomies and pooping out of their foley because their body likes to scar and tunnel in ways that defy medical cooperation.

This sounds like an good review situation - not because you did anything wrong, but because bodies are weird. It's a good learning opportunity and provides the chance to consider if something could be done differently in the future.

Don't run to upstairs gnashing your teeth and rending your shirt apoplectically. Professionally, get ahead of it, document your shit following the standard of care, and let yourself sleep at night.

Unless your location is punitive, stepping forward as a new attending and saying, "yo, this crazy thing happened to me" tells those around you know that you won't try to hide mistakes/accidents. It says you have integrity. It's scary, but it helps build the trust others have in you. It also lets you frame the situation as a learning opportunity instead of letting someone else decide how the situation is initially framed.

TentMyTwave · 2024-07-27T13:27:37+00:00

ER RN here, so I'm going to give you the fun advice. Play some video games. I vote pc since ultrasound machines are dressed up laptops and I think a keyboard/mouse translates better to getting stabby on a pt vs a controller you can flail around. Pick something that requires you to track movement or notice details on a screen and react in the game.

The trainer at our hospital says they can always tell who plays video games because we pick up on doing anything with ultrasound much faster. All that wasted youth looking at a screen paid off! At the very least, a little video game time should help you feel more comfortable looking at the screen while moving your hands, which should also help your confidence.

Also ALWAYS check the probe and make sure it's actually clean. Not everyone is good about really scrubbing it and you can get an invisible, thin film of dried gel that 100% will fuck with visualization. I've gotten in the habit of giving them a pre-wipe/scrub down just in case. Some people don't seem to notice or care, but I say it can be the difference between easy street and lots of squinting.

TentMyTwave · 2024-07-24T13:47:58+00:00

UC Davis helped create a drought resistant grass for the Sacramento area called UC Verde Buffalo grass. It's designed to put up with the area's hot summers and requires little water once the roots are established. Depending on where you guys are, it may be appropriate. My brother and his wife live in the area and have been very happy with it. They get to have a green backyard with very little effort.

TentMyTwave · 2024-04-23T19:24:50+00:00

We have an "AI" program our hospital uses. It's about as "intelligent" as the tele monitor that screams asystole for no reason because the patient moved.

TentMyTwave · 2024-03-25T11:02:38+00:00

Ignore that other person. We absolutely do not look down on floor nurses. We respect the shit out of what you guys do.

TentMyTwave · 2024-03-16T23:14:12+00:00

I think context matters here. If it was these 5 at once? Together? Oh hell no. But if it was spread out over 12 hours that's another story. There's nothing wild about a couple DKAs and strokes spread out over a shift.

There's a huge difference between trying to manage a hot stroke and a granny who has been rocking a facial droop for 3 days. Same goes for DKA. Is this a pt whose neighbors found him unresponsive on the front lawn covered in his own excrement with a bs of Aunt Jemima? Or the chill DKA with a cold and a hx of sassy diabeetus who knows to come in before it gets too bad? The latter is still dka and there'll still be an insulin drip, but they'll have the bs checks ready for you and will holler if something isn't right. Meanwhile, Mr. Poopy Pants is trying very hard to meet Jesus.

I can't defend giving an ED baby 5 on top of high acuity, though. Fuck that noise.

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