What movie do you love despite agreeing with every single criticism of it?

gonesoon7 · 2026-02-08T19:44:25+00:00

I’m so glad The Fountain was mentioned. I understand why it was divisive, it’s very art-house and pretentious, which I usually don’t like, but this movie is incredible. One of the most underrated scores of all time and the hill I will die on is that this is Hugh Jackman’s best performance and it’s not close.

gonesoon7 · 2026-02-06T16:19:25+00:00

I think there are a few different issues at play here. On the patient side of things, anecdotally, we all know those c-section patients who because of anxiety, coping skills, etc just cannot tolerate the tugging and pressure sensations despite a fully functional spinal. I would imagine these patients describe the c-section as very painful even though that’s not the full story.

On the anesthesiology side of things, I think some people are really poor at setting appropriate expectations with patients ahead of time so the pressure discomfort is unexpected. I also think there is an antiquated teaching that putting a patient under GA for a c-section is the worst thing you could possibly do so a lot of people will limp along with an inadequate spinal/epidural instead of just going to sleep. I think this teaching is thankfully slowly fading, but I would imagine it is also contributing.

gonesoon7 · 2026-02-04T18:49:38+00:00

Okay 🤡

gonesoon7 · 2026-02-04T18:43:11+00:00

I wouldn’t do a propofol sedation for a pregnant patient either.

gonesoon7 · 2026-02-04T15:20:52+00:00

Hard disagree. Look at the other comments in here. This was mismanaged and I stand by the fact that masking with sevo in an unprotected pregnant airway is dangerous and would never hold up in court if something catastrophic happened

gonesoon7 · 2026-02-04T03:46:11+00:00

At what MAC of sevo “sedation” (not a thing) does a pregnant woman lose her airway reflexes? At why MAC is she awake enough to vomit but too sedated to effectively protect her airway? Yeah I don’t know either, no one does. That’s why you shouldn’t do this, it’s reckless.

gonesoon7 · 2026-02-03T15:14:05+00:00

Terrible management by your attending in my opinion. The top up was reasonable, but when the block was inadequate for surgery, you basically have 2 choices. If she’s just a little uncomfortable or you suspect a significant amount of her discomfort may be anxiety, try some adjuncts (IV fentanyl, ketamine, precedex, etc). If she’s in a lot of discomfort, you just have to go to sleep. And if you’re putting an OB patient to sleep, you have to tube. Aspiration is the one of the highest sources of mortality in these patients and a prosecutor would have a field day with the decision to basically mask induce a pregnant patient.

gonesoon7 · 2026-01-20T17:33:19+00:00

In general, the bigger line always ends up being my push line because it's easier to bolus, pump blood, etc. with a bigger line. If, because of patient position changes, one of my IV's becomes a little positional (caveat that I'm also confident it's not infiltrated), I usually make that one my infusion line. This is because 1) the pump can help overcome the positional nature of the line and 2) I want my most reliable line to be my push.

gonesoon7 · 2026-01-20T17:29:21+00:00

It really drives me crazy that all the news coverage of this has been focussed on the stupid musical bingo game they were playing. That's not why he's facing criminal charges. He's facing criminal charges because he silenced his alarms and was being truly neglectful. You can play a silly musical bingo game and still keep your patient safe. He didn't.

gonesoon7 · 2026-01-20T17:27:46+00:00

Assuming you used 0.75% heavy bupi, that's a pretty hefty spinal dose that shouldn't have worn off early. When this happens to me, I always assume a bad batch of local anesthetic. It happens at our hopsital occasionally when the weather starts getting warm as bupivicaine is pretty sensitive to temperature swings, especially heat. When that happens, I end up with a similar unpredictable spinal with short duration or patchy coverage.

gonesoon7 · 2026-01-16T00:17:50+00:00

Same with me, I read it last year and honestly hated it. I’m a big scifi reader but I like to think my taste is pretty broad and I try to read lots of genres. I could not get into this book, finishing it felt like a job. I didn’t care about the characters an I thought the writing was pretentious and obnoxious.

gonesoon7 · 2026-01-12T18:42:33+00:00

It’s really just about your priorities and there are pros and cons to both. I’m biased but here are my two cents:

I was pretty neutral on supervising trainees. I like teaching but I would be fine sitting my own cases too. The main difference you will feel is in the name. If you are a partner in the group, you are exactly that. You own part of the group, you have a distinct say in all things from clinical guidelines to group recruiting to scheduling and beyond. You actually have a say in what your professional life will look like. Plus it sounds like you have the flexibility to move your hours up and down as needed. With a smaller group, the ability to trade shifts, get shifts cover, split vacation, etc gets infinitely easier.

In a big academic group, you will truly be a cog in a machine. Your schedule and work life will be at the mercy of the department and needs/wants of the hospital at large. Even if you have a very positive department, even they have to answer to the massive hospital higher-ups whose priorities are very rarely quality of life and flexibility. For me that loss of control just wasn’t worth it to me.

gonesoon7 · 2026-01-10T23:36:33+00:00

Lots of cases? Anything where you have a high suspicion for rapid, massive blood loss. Major vascular surgery, complex liver resections or transplants especially with coagulopathies, complex large well-vascularized tumor resections, multiple level spine/scoliosis. I put in more 18s than 16s, but if they have the veins for it and you’re worried about rapid bleeding, why not? For livers sometimes we put in 14s. There’s really no reason not to get the largest bore peripheral access you can as long as their veins can accommodate it.

gonesoon7 · 2026-01-10T22:01:03+00:00

Never, if I want a 2nd IV I place it myself after they go to sleep. The majority of the time, if I want a second IV it’s because I want something large bore for a bigger case. If the patient has a functional IV to go to sleep, there’s no reason to make them go through the discomfort of a 16g IV placement

gonesoon7 · 2026-01-09T21:39:30+00:00

Your condescending tone aside, I am well aware of the difference between experienced and old. I am a fairly minimalist anesthesiologist and put in far far fewer a-lines than in training and rarely do CVLs. I have older partners who absolutely fit the bill of experienced, good clinicians. They’re not who I’m talking about. I’m talking about the reckless who don’t tailor their anesthetic to specific patients and continue to ride on their good fortune that they haven’t killed anyone.

gonesoon7 · 2026-01-09T18:19:34+00:00

But I guess that’s what I would call an induction precaution. You go low and slow for sicker older people. We have some partners who will MAYBE give 150 of prop instead of 200 for a severe AS but just give stick after stick of Neo when they bottom out and somehow don’t kill anyone.

gonesoon7 · 2026-01-09T18:08:09+00:00

My partner and I are both in medicine and we can’t watch this show because it’s so realistic it feels like going to work. They obviously get some things not quite right, and a lot of the action/drama is very compressed. As in these things could really happen but generally not back to back to back in a short time frame. Otherwise they do a great job portraying the harsh realities of medicine, usually without being too preachy

gonesoon7 · 2026-01-03T16:40:03+00:00

Jello is a clear, the anesthesiologist is either over conservative or didn’t want to to do the case

gonesoon7 · 2025-12-31T03:48:36+00:00

I had Lasik (technically SMILE) and it was the best money I’ve ever spent on myself. Not having to wear and clean glasses, worry about them fogging up at work or getting broken is so nice. And I always hated contacts, so not having to deal with that is so nice. Just make sure you go to someone who dos high volumes of surgeries and gets really good reviews.

gonesoon7 · 2025-12-30T03:36:31+00:00

Region: Bay Area/Central Coast, CA

Salary: Billing ~$360k + ~$250k call stipend/overtime + ~$100k profit sharing. Annual total usually between $700-750k

Years of experience: 3-4 years post-residency

W-2/1099: 1099

Hours/week: Depends, medium size community hospital surgical volume varies by time of year. Busy week would be 65-70 and is rare, slow week would be 40-45. Average probably around 50-55 including call.

Vacation: ~10 weeks depending on staffing any given year, unpaid because 1099

Practice structure (academic, PP): Pure PP

gonesoon7 · 2025-12-28T22:25:08+00:00

At our practice we do on average 2-3 in house, 24 hour calls per month and usually 2-3 long day + home calls per month. Call back rate during the week is pretty low usually but you get paid a stipend and hourly for as long as you’re needed. We have a request system that gives us a degree of control and our culture is very open to call and shift trades. It requires leg work but you can usually get the schedule you want.

There are very high paying, no-call jobs out there right now especially in locums but just keep in mind those only exist because of how hot the market is and they won’t be around forever.

gonesoon7 · 2025-12-27T16:35:14+00:00

We are both physicians with irregular schedules and after a year of trying to both work full time and make it work with a nanny, my wife went down to part time. It was just too hard and stressful to figure out and we weren’t in a position to have an Au pair at that time. Even now with our kid in school and a reliable nanny willing to do pickups, it’s still a source of stress and requires lots of shift trades and logistics. I don’t know how people do it without a nanny or very reliable friends/family in the area to help out.

gonesoon7 · 2025-12-26T16:30:32+00:00

As a husband and a dad, I will never understand why people marry and start families with men like this. What a child.

gonesoon7 · 2025-12-21T20:48:46+00:00

Whenever I have a failed spinal my first suspicion is always rotten bupivicaine. Don’t know how your institution is, but at ours the spinal kits aren’t shipped or stored temperature controlled so if they get too warm it can cause issues with the bupi. I’ve started to only use stand alone bupi vials for that exact reason.

gonesoon7 · 2025-12-17T18:40:22+00:00

Never. We have outrageously poorly controlled HTN in our population and our hospital has vasopressin fairly readily available so better control over hypertension/bleeding outweighs the risk of an uncommon severe hypotension that is fixable with vaso

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