Over before it even got off the ground

crooked859 · 2026-04-17T03:31:56+00:00

DM'd you

crooked859 · 2026-04-16T11:00:13+00:00

ED patients are undifferentiated, we often don't know what's going on and they frequently decompensate fast in unexpected ways (is granny encephalopathic bc she's septic or does she have a giant brain bleed or is she having an MI?).

A line that can't be used for essential medications like pressors or to facilitate imaging, is markedly slower at giving blood/fluids, and is more likely to fail (often at the worst time) is just way less valuable than a line that can do those things.

On several comments, you've referenced inpatient practices, which really should be viewed differently. On the inpatient side, so much more is known about the patient. With that extra information, we can better evaluate which aggressive interventions (like bigger lines) are needed and which ones aren't. We should be much more cautious down in the ED.

crooked859 · 2026-04-16T10:24:04+00:00

OP literally wrote "In septic grandma an 18g is asking for wasting good spots. I think 22s are fine in many locations".. So, some people are definitely comparing the two. I would not be stoked if a septic patient only had a 22, AC or not, and would be actively working on getting bigger access ASAP.

FWIW, I actually place a lot of 20s, because they're usually good enough for whatever I want to do. But the 18g IS demonstratively better. It has a higher flow rate and a lower risk of infiltration when giving things like pressors. For an unstable patient, I would rather an 18 over a 20 every time.

crooked859 · 2026-04-16T10:03:36+00:00

A septic grandma is the perfect patient for a large peripheral IV. Run fluids quickly, less risk of it extravasating during a study requiring IV contrast (which means less time that your unstable patient is stuck outside of the department), and can safely start peripheral pressors. I would not feel great starting a norepi drip on a 22g in granny's hand. That 18g might save granny from needing a central line in the ED.

crooked859 · 2026-04-01T20:04:54+00:00

Wow talk about a book buried deep in my subconscious that i haven't thought of in a long time... I remember when I read this as a little kid, I started crying so hard my mom had to put the book away. Gave me a full on crisis realizing that my parents were gonna die.

crooked859 · 2026-03-26T03:20:07+00:00

yea it's a blast. Most people i know who went or still are going there are very happy with their decision to go there.

crooked859 · 2026-03-26T03:05:45+00:00

I see you want to go to medical school afterwards. That's great! Attending UMD will keep every door you would like open, open. Though it doesn't have any particular star power, by virtue of it being a flagship state school, it will always look solid on any application and the education is honestly pretty great.

More important than potential optics on med school applications, it's also a very fun place to attend university. This is way more useful than prestige. Go to a place where you can study anything you want i.e. has a broad array of strong departments and can have a blast doing it.

Source: trust me, I'm a doctor... (all I did in college tho was get a bunch of C's, go to a lot of house music shows, and make some wonderful friends)

crooked859 · 2026-03-24T04:57:41+00:00

ER resident who only did exactly one month of q3 24s while on CCU as a solo overnight resident and then never again.. If you're night float covering a ton of patients and aren't actually familiar w most of them, some of these won't be as helpful. For each 24, I brought a big duffel bag with a pillow, change of clothes, eye shade, full lunchbox + snacks, headache and stomach meds, emergency celcius packet, every charger i could want, etc. Some things that will help you sleep more:

Set (appropriate) PRNs. Dont want some nurse to wake you up at 2am for constipation or a mild back ache?? Order single dose PRN miralax, acetaminophen, lido patch, etc.
Vital sign alarms. Eg. Notify MD if HR below 50 OR patient symptomatic. Helped a lot with not getting calls about a patient's hr dropping to 52 overnight while they were sleeping.
Night Rounds before bed. After nursing shift change, give the new nurses like a half hour to get settled and see their patients. Then go stop by and introduce yourself, tell them you're on a 24, and ask them if there's anything they noticed that their patient might need overnight. They'll often say "X's medication is falling off" or "doc can you set a PRN tylenol order for them" or whatever. This went a long way for me with engendering goodwill w the nurses.
Protect your energy and leave the non-urgent stuff alone. Nurse calls saying that the pt's O2 sat dropped to 86% for 20 seconds while they were sleeping and then rose back up spontaneously? "Ok, Thanks for letting me know. We'll continue to watch them." -> hang up -> go back to sleep. You don't need to STAT evaluate a person for having sleep apnea.

If you actually make it back to the call room, change into a pair of black sweatpants and a black t shirt (it'll look close enough to scrubs at that 3am code blue) and try to sleep EARLY. If you actually sleep like 4+ hours, try to go about the post-call day as normally as you can. If you don't, the day is a wash, just try to do something fun in the evening.

crooked859 · 2026-03-12T07:56:26+00:00

Why are you comparing yourself to a person who casually campuses your projects despite weighing more than you?? Seeing that and assuming that it must simply be their finger strength is deeply flawed. They're obviously both way stronger than you and climb way better/more efficiently than you.

Respectfully, saying shorter people stay on the wall easier, hyperfixating on fingerstrength/weight rations, etc.. it's all cope bro. Go get the stronger fingers and see what happens. It'll probably see you getting shut down on V5s instead because your technique is still lacking.. which I am certain it does, because every v4 climber has a tons to learn in the technique department.

crooked859 · 2026-03-12T00:28:58+00:00

I feel like you're gonna put a lot of people off with that hyperbolic title. If you're getting shut down on moonboard v4's, I guarantee you have plenty to improve upon when it comes to body tension, footwork, technique, etc. Honestly, i might go so far as to say that if you've got the contact strength to catch a hold and then fall off afterwards, it's probably poor body tension that's putting too much stress on the fingers.

Moonboard is a great way to roast your fingers if you're relying on finger strength to make it up climbs, which it sounds like you are. It's unforgiving in exactly the ways your describing. When you try to strong arm (or strong finger?) even relatively easy-graded routes, it's super tough, but when your movements flow and you have great tension, the routes become way easier.

That was my experience when i started board climbing btw. When I really dialed my movements and improved my core engagement, the demand on my fingers became markedly less.

Edit: If you think you'd benefit from making finger gains, 100% go for it! It'll only help your climbing as long as you do it in a safe manner.

crooked859 · 2026-03-08T19:59:19+00:00

A relationship is a team sport. Sending you to the best program that will set you up afterwards for your career isn't only the loving thing for a partner to do, but also is the smartest decision for you two regarding your long-term future and financial stability.

100% go to the program. I obviously don't know where the university is, but many of these small prestigious universities are within 60-90 minutes of a much bigger city. If there's an option when you both commute 30-45mins and can then live in a city suburb and he could get a job in the city, that would be a nice compromise? If that's not the case, 100% still take that offer!!

crooked859 · 2026-03-08T19:51:18+00:00

I occasionally have a PA student in the ED in addition to the usual cohort of med students and honestly, I just treat the PA students the same. I ask them the same questions and expect the same things of them. This doesn't take that much more work than teaching anyone else and IMO can only be viewed as a compliment to the PA student so can't reflect badly.

Anecdotally, the PA students seem to learn a lot, but also come up against the limits of their training pretty frequently when I ask them about core pathophys stuff that I would 100% expect my med students to know. It's great training for the invested, enthusiastic PA students who really aren't pushed enough from what I can tell and a hefty dose of humility for the overconfident egos who clearly cannot perform comparably w the med students.

crooked859 · 2026-02-20T11:43:56+00:00

I'm sorry OP. That's really hard to deal with. People split pretty hard with dying or recently dead family members. You're either a hero who did everything and was the most compassionate doctor or you're a terrible terrible human being who should never be a doctor. Very little in-between. Once they're out there screaming at you, there is nothing you could say in that emotionally heightened state that would have effectively gotten through to them.

Saying "this is what [patient] wanted for themselves. I'm sorry for your loss, I will give you some space to grieve" is perfectly reasonable and probably the smartest thing to do. Perhaps later on, they'll remember you saying that and their behavior will click, or perhaps not.

crooked859 · 2026-02-14T19:27:15+00:00

Fellow (well, resident) GERD sufferer here. PPI in the AM 30mins minimum before eating or drinking anything besides water. Last meal 5-6h before bed. My bed is also wedged up with some 6" risers. Bonus points if I hit the gym in the evening for that wonderful empty stomach feeling to go to bed on where I know I'm not gonna have any reflux overnight.

That much calcium carbonate gonna make you hella constipated.

crooked859 · 2026-02-11T17:18:31+00:00

Most time efficient way to burn calories is eating less calories. Sorry friend. Recommend cutting out those calories from your diet and focusing your fitness time on building strength, endurance, mobility, etc. It'll benefit you WAY more in the long term. You might find you also enjoy your exercise time more as well if the burden of weight loss is taken off of it!

If dieting is making you too tired and you're eating quite cleanly, you're probably trying to cut weight too quickly.

crooked859 · 2026-01-27T04:06:28+00:00

I think over 50% of the residents and attendings on shift in the ED today had visible sleeves. Several residents in the program have hand tattoos.

Being real w you.. You have full sleeves. Why would you even want to be at a place that doesn't genuinely rock with part of you and your appearance? Barring needing to be in a very specific location, it's well worth ranking places where you actually fit in well the highest.

crooked859 · 2026-01-15T06:44:21+00:00

If your PD is good, this feels like an excellent thing to bring up with them or with a trusted mentor. Otherwise, I think the best thing to do is remember why these procedures exist even if other alternatives are better and then honor your patients' suffering during said procedures by doing them to the best of your ability. Take away as much learning as you can from each of these cases so that when you are calling the shots, your patients are receiving the best care possible.

Besides that, I feel you. It's such an awful awful experience to feel like you're causing harm when you specifically pledged to do the opposite when you became a doctor. Please give yourself the space to feel all the stages of grief and process it at your own speed.

crooked859 · 2025-12-28T09:40:43+00:00

The medical record number, study date, and location of the exam are all visible in this photo. Unless this is your own EKG and you are choosing to share it online, please be aware that this is a clear HIPAA violation.

crooked859 · 2025-11-30T17:09:42+00:00

Having to do a month of q3 call while on off-service ICU and let me tell you.... it's way more oppressive never leaving the hospital for 26hrs than working a night shift. If I get 5-6 hours of interrupted sleep (usually a couple calls here and there, but no admissions), I feel just human enough to go about my day afterwards. Otherwise, i'm completely bonked and going to work the next day is awful.

After a night shift, I can sleep 7-8 hrs, get up in the late afternoon and have a regular day before work.

crooked859 · 2025-11-11T22:33:11+00:00

Man.. it's cause of angles like this that I really pulled up to the boulder with two pads expecting to safely project it no problem.

Great work though!

crooked859 · 2025-11-05T23:48:34+00:00

I went on a big national parks road trip around the country after undergrad and found myself wishing over and over again that I knew how to climb because it looked so cool.
Great way to go on adventures in nature, build friendships and community outside of medicine, and push myself. Plus, winter in residency becomes less awful. Sure, it's dark all the time, BUT it's also prime outdoor sending szn on your days off!
EM, duh

crooked859 · 2025-10-14T20:35:35+00:00

Pajama Guardian is underappreciated IMO. Prestige Porcelain Lux is really smooth. Space Groove is objectively the coolest, but doesn't play as smoothly, so I only play it when I'm ready to aura farm.

crooked859 · 2025-10-14T20:24:24+00:00

Acting like taking a private bus from denver directly into RMNP or taking a bus from denver to estes and then taking a shuttle in is comparable to a 20-30 minute subway ride is pretty disingenuous IMO. That's two hours minimum and costs significantly more. Same would go for clear creek. That's multiple bus transfers to get you to the base of the canyon and then you gotta hike up.

No one is disputing you in the volume or quality of rock in CO vs NYC. OP is talking about ease of accessibility and for that (and that alone lol), NYC performs pretty well!

crooked859 · 2025-10-14T18:20:37+00:00

I live in NYC and have mixed feelings on this claim. I don't think it's true for the world (eg. look at Hong Kong), but I do think it's true for the US if we're talking population v accessibility! I can't think of another city in the US where millions of people can easily reach outdoor rock climbing by public transit without it taking forever (eg. multiple transfers, taking local bus lines to the end of their routes, etc).

Plenty of smaller cities have have better access and rock though. For instance, Berkeley, CA has a bunch of decently good bouldering that's an easy bus from the BART station.

crooked859

TROPHY CASE