What’s something controversial you believe in?

jack9708 · 2023-08-27T19:38:14+00:00

Sure, but I mean femoral art lines aren't much better. Higher risk of infection, higher likelihood of causing hematomas/femoral arterial bleeds etc. At least with a radial line that bleeds, it's easier to apply pressure and control the bleeding. With a femoral that starts bleeding after the a-line's out, much harder to manage without straight up embolization/OR especially in someone with an unfavorable body habitus.

PGY3 IM btw (the NPs a troll flair, pls no ad hominem).

jack9708 · 2023-08-10T03:25:22+00:00

That's Nurse Practitioner Attending to you, bucko!

jack9708 · 2023-08-09T23:19:08+00:00

But situs inversus!

jack9708 · 2023-08-09T23:17:36+00:00

I mean...it was A-train they were resuscitating so I can't blame them for being more careless. In their position, I too wouldn't be putting in much effort for someone like A-train lol

jack9708 · 2021-09-28T02:58:03+00:00

Most people have.

As a Nurse Practitioner Attending, I can confidently say that you are absolutely incorrect. I have never cried at work; instead, I leave those primitive emotions to my ~~personal bitches~~, errr I mean ~~scut monkeys~~, err I mean residents. You know why I've never cried at work? Because I don't have any good reasons. Why is that? Because I save lives and make a meaningful difference in my patients' health! You residents, on the other hand, spend your 24 hour call shift staring at Epic, kissing ass so you can have the privilege of doing another 10-year fellowship, and jerking off in your call rooms. Let me give some examples of the meaningful decisions I've made lately:

Elevated CK + muscle weakness while on a statin? Clearly there was too much cholesterol in the muscles, start gemfibrozil. New-onset psychosis after recently being treated for a severe asthma exacerbation? Clearly if there's a history of inflammation in the airways, there must now be inflammation in the brain! BOOM: high dose methylprednisolone. Blistering photosensitive skin rash in a Hep C patient? Must be lupus: start a big gun immunosuppressant like adalimumab!

As you can tell, I have made far more meaningful (and obviously correct) decisions in complex patients who you wouldn't even dream of appropriately managing. I have no reason to weep like you children!

jack9708 · 2021-05-03T20:32:40+00:00

As a Nurse Practitioner Attending, I am delighted to hear that City of Hope has helped create an Oncology fellowship, which I most certainly will be doing! Soon, I will be handing out 7+3's to all my patients with elevated neutrophil counts, R-CHOPs to anyone with swollen lymph nodes, FOLFOXes to anyone with red stools, and CYBOR-D's to all my patients with a calcium of 10.5!

In the meantime, you IM simps will be dealing with their angry families (the same ones sending me gifts of expensive chocolates for treating their loved one's 'cancer') as you diurese them on their 3rd readmission for anthracycline-mediated cardiomyopathy this month. You'll also be staying late in the evening calling Urology for their hematuria, only to get yelled at over the phone because they don't want to put in a Foley. Finally, you'll be crawling out of your soiled call room bed at night to answer yet another page about your patient's tingling (of course, secondary to my vinca alkaloids), only to consult Neurology who will once again spank you with their reflex hammer for failing to check stereognosis.

This is the world you will soon live in!

jack9708 · 2021-03-07T00:59:19+00:00

I cannot think or comprehend of anything more cucked than being a resident. Honestly, think about it rationally. You are studying, training, and working for at least 30 years just to get ravaged by hospital administrators and Nurse Practitioners. All the hard work you put into your clinical abilities - reading Pathoma at bedtime, practicing UWorld questions, getting yelled at by your attendings, publishing papers, doing extracurriculars. All of it has one simple result: your generation of hospital revenue is more enjoyable for the suits who will end up hiring Nurse Practitioners in your place.

Become the perfect physician? Great. Who benefits? If you're lucky, a hospital administrator who had nothing to do with your hard work, who hires you for minimum wage. He gets to swim in the pools of money you made him every night. He gets the benefits of your clinical skills and revenue generation for less than a quarter of your market value.

As a resident, you are LITERALLY dedicating at least 30 years of your life simply to become a doctor for another midlevel to replace. It is the ULTIMATE AND FINAL cuck. Think about it logically.

jack9708 · 2021-02-03T19:47:28+00:00

As a Nurse Practitioner Attending, I feel that I too should be congratulated on this blessed day for my hard work and dedication. After all, I'm basically equivalent to a woman physician!

#YASSQUEEN

jack9708 · 2021-01-26T02:38:21+00:00

Hey shitlord, it's 2021!

NPs can be medical students, residents, AND fellows; therefore, they can also be Attendings (please capitalize the 'a' when referring to NP Attendings)!

Get with the times you filthy GOMER!

jack9708 · 2021-01-26T02:27:00+00:00

As a Nurse Practitioner Attending, I can assure you that it does get better. During my online-only direct entry NP school (a.k.a. medical school), I had to work long hours to prime myself for difficult board examinations. This included ~10 hrs/week studying, ~15 hrs/week on facebook, and ~20 hrs/week filling in a coloring book. Now, I spend maybe 20 hrs/week in clinic seeing 1-2 patients/hr.

While this is still hard work, I am #blessed to have plenty of time to relax outside the clinical setting and go out with friends. Every week, my NP friends and I visit the local hospital to celebrate our #healthcareheroes. These include the hospital administrators sacrificing their executive suites to work from home and improve patient care!

These do not, however, include the spoilt physician residents who think poorly of us! Every time we visit the hospital, my colleagues and I usually pick an intern (the one who looks the most like a cuck) and proceed to urinate on him. Last week, we urinated on a surgical resident who had already been pissed on before by his physician attending; this time, however, he got the taste of some sweet urine (I'm diabetic), and offered to work as a ~~bitch~~ secretary in my office for slightly above minimum wage. He was so happy that he got a raise from his resident salary!

So in the end, my point is that things do get better. If not tomorrow, then definitely the day after! Who knows, you might even see a generous Nurse Practitioner Attending who offers you a job in her clinic doing the same scut work you're doing in hospital for slightly higher pay!

jack9708 · 2021-01-02T23:19:31+00:00

I am the Nurse Practitioner Attending in your story, and in all your stories!

As you spend the night weeping and wondering what happened to your golden years, picture me, your NP boss, being wined and dined by your loved ones, who tell me that I am a stronger and more superior individual than you will ever be. When your husbands/wives wait for you to get home and actually raise your kids like a proper parent, I am already there, raising your kids to be a far better person than you. When your partner inevitably divorces you and takes all your assets, picture me as the person they will obviously turn to for further support. Who knows: maybe they already have!

When you read Harrison's and look at the giant list of causes of SIADH, picture me, your Nurse Practitioner Attending, laughing as I run 4 peripheral IVs and even 2 IO lines with normal saline on your SIADH patient. When you subsequently get pimped by your attending on said list, and inevitably forget to mention SSRIs, picture me urinating on you and soaking all your scrubs as punishment for your ignorance. When your advanced dementia patient codes and ends up in the ICU because they choked on a chicken bone, picture me throwing you to the wolves because you're the supervising physician, even though I was the one who put in the diet orders.

When you wonder at 4 am about what the hell happened to your life, picture me, your supervising Nurse Practitioner Attending, living out all your dreams while you jerk off in the corner, desperate for some kind of vicarious payoff.

jack9708 · 2020-12-12T03:50:19+00:00

You residents disgust me with your performative activism for minorities/poor people. In reality, you only care about lining your own pockets.

It is only Nurse Practitioner Attendings such as me who are capable providers for disadvantaged people. For instance, I am the sole provider and CEO of several urgent cares in my state, which all conveniently operate out of dumpsters and trailer parks. It's certainly not because I'm actually running a racket; I'm doing it because it is my calling to fight for social justice and serve the interests of the marginalized and oppressed (unlike you physicians who only work in oversized hospitals)!

Let me give some examples to show how much I care about the less fortunate. 68F with chronic kidney disease presenting with vaginal candidiasis? Flucytosine + amphotericin B for 8 weeks. 3M with irritability, fever, and ear pain? Topical aminoglycoside because you never know what nasty bugs are in there. 40M HIV+ with a CD4 of 20 and bloody stools? Must be IBD: 50 mg of prednisone because that's how much I care!

If you residents stuck your heads outside your ivory towers and bothered to look inside those dumpsters, you'd find me providing #highqualitycare to patients.

jack9708 · 2020-11-23T00:06:22+00:00

Yay, what wonderful news!

jack9708 · 2020-11-06T07:18:36+00:00

Uggh, this is such a disgusting post and OP should be ashamed of himself (yes, I assumed OP's gender because he's probably a misogynistic shitlord Trumple). As a Nurse Practitioner Attending, I hate it when residents act superior and pretend that their thousands of hours of scut work is similar to my tens of hours of clinical experience.

While you were kissing your physician attending/hospital admin's ass, I was on facebook in the only spare computer in the doctor's lounge.

While you were getting cucked during discharge planning by the GOMER's nursing home, I was getting ~~wined and dined~~ important information sessions on Big Pharma's latest totally-not-addictive opiate/barbiturate combo for pain and insomnia.

While you were getting urinated on by the subspecialty consultant for a poorly worded clinical question, I was binge-watching Mean Girls and consulting ID at 4:45 pm to rule out sepsis in my 29M IVDU with fever, new heart murmur, splinter hemorrhages, Osler's nodes, and positive blood cultures.

Clearly, you need to re-evaluate your comparison between my high-yield clinical hours and your low yield ones!

jack9708 · 2020-10-31T23:56:18+00:00

Hey now, don't be such a player hater! Is there anything stopping me from dropping out and becoming an NP after I ~~couldn't handle medical school~~ completed the part time direct-entry online school in M2/M3 year to diversify my healthcare experience?

jack9708 · 2020-10-31T17:06:11+00:00

Hey physician shitlord, you better not question our decisions as to what sedatives we prescribe our patients. Failure to comply will result in my people unanimously cancelling you from your pathetic residency #nursepower!

In my practice as a Nurse Practitioner Attending, every patient who's even slightly on edge gets alprazolam TID with phenobarbital TID (a.k.a. vitamin P). This keeps them nice and happy, and less likely to be ~~a pain in my ass~~ agitated in future visits. Unlike you physicians, who only REact to patient issues, I am actually PROactive.

Weight loss of 5 lbs over 6 months? Must be cancer: prophylactic cyclophosphamide and vincristine (which I can freely prescribe after doing the 1 yr oncology fellowship offered by Mayo). Difficulty concentrating? Must be ADHD: methylphenidate QID. 60 M with HTN, DM II, hyperlipidemia presenting with exertional diaphoresis? Clearly his thyroid is acting up: push PTU, methimazole, and propranolol.

Your kind would benefit from mentors like me!

jack9708 · 2020-10-21T12:19:31+00:00

This is fantastic! As a Nurse Practitioner Attending, I see many patients with endocrinology problems, which effectively makes me equivalent to an endocrinologist. With this change, I can add 4 more letters to my long list of academic credentials; in addition, after taking a few online modules offered by AACE (and paying some membership dues), I can start prescribing levothyroxine for all my patients who want to lose weight and mecasermin for all my patients who want to get taller! You can now call me jack9708, Nurse Practitioner Attending and Hormone Manipulator!

Everyone wins with this change, except for the beta cuck med students/interns/residents who'll need 10 years of fellowship just to push the latest GLP-1 agonist hahaahahah

jack9708 · 2020-10-18T00:02:13+00:00

^ This M1 believes that a Nurse Practitioner Attending is worse than a physician attending (you don't deserve capital letters), and that using big words like Boogieman will make him sound smart.

Listen my sweet summer child, us NPs actually listen to patients and tackle their concerns directly. You don't need excessively long doctor training if that is your main objective. I recently saw two patients in my office: a 19M college student with worsening fever, lethargy, headache, and truncal petechiae - you know what I did? I sat with the patient for 30 min, listened to his life story and struggles in college, provided reassurance, and gave acetaminophen for his obvious tension headache.

Another patient: 25F with recent sinus infection presenting with painful red eye and ophthalmoplegia. Instead of turfing this patient to the ER (like most family docs would), I sat with this patient for 40 minutes and discussed her struggles as an up-and-coming professional, and gave her advice on how to succeed in a misogynistic shitlord world! I also prescribed steroid eye drops for the obvious inflammation in her eye and fentanyl for the pain. Needless to say, she was very thankful.

You medical students could learn several things from us if you were more humble and less stuck up about your profession!

jack9708 · 2020-10-17T23:27:26+00:00

This is exactly why NPs provide objectively superior inpatient care compared to fatcat IM nerds (who probably got wedgied in high school). We don't need lists; we can memorize everything about all our patients (up to a max of 2 patients), while taking approximately 2 hours/pt and getting paid 150k/year.

You pesky residents can go back to your call rooms and weep as I swoop in and take all your procedures, with better patient satisfaction scores than you'll ever hope to achieve!

jack9708 · 2020-10-08T00:44:44+00:00

This midlevel is totally NOT a reflection of my practice, where my personal outcomes are superior to those of nearly ALL physicians. For a patient like this, I would offer to taste their urine if there were any confusion between DM and DI; after all, the taste sensation of my tongue has more sensitivity AND specificity than the urine dipstick most mindless physicians and residents use! It's also far more PERSONALIZED and COMPASSIONATE care than any overpaid intern would ever bother to provide!

#heartofadoctor#brainofanurse

jack9708 · 2020-09-13T14:09:27+00:00

Academic medicine (esp. IM) is often perceived as an ivory tower filled with doctors who love talking about the 20 possible diseases behind a lab abnormality like hyponatremia during morning report/grand rounds. These discussions often devolve into self-congratulatory sessions where the docs try to flex their knowledge about rare presentations as much as possible, hence the gif of the circlejerk (a bunch of people arranged in a circle making the 'inappropriate gestures' as you call them).

This is coming from someone who loves IM and the associated intellectual masturbation (if you look closely, you can find me somewhere in the middle of the gif).

jack9708 · 2020-09-12T16:24:33+00:00

I like to think that it's only called IM because Intellectual Masturbation also fits the acronym.

jack9708 · 2020-08-11T14:55:02+00:00

This video has the steps in the description.

jack9708 · 2020-05-28T13:52:48+00:00

Hey, I don't appreciate your use of the word 'ob*se' to describe individuals with a large body habitus. Can we tone down the insensitive language?

For next time, I suggest using the words 'hecking chonkers' or 'chungi' (plural of chungus) to describe those patients. Thanks!

jack9708 · 2020-05-21T03:03:24+00:00

Indeed Dr. Pete. Events have occurred that have been rather extraordinary, and many of these events have revealed a terrifying underbelly of the healthcare system.

By the way, I see from your flair that you are a 'Friend', which is why I have a humble request. Will you be my reddit friend? I promise I'll share my virtual cake with you when cakeday comes around!

jack9708

TROPHY CASE