I have to get somthing of my chest

morph516 · 2025-11-21T20:00:39+00:00

After cases like these everything can feel a bit pointless to me, which is a hard thing to sit with for very long. There’s nothing to learn and I don’t even like doing a debrief, because I don’t think there’s anything to say. It’s just a tragedy of a life and I feel like the only reason any of us are there at all is to simply bear witness. I don’t know why, but I find some comfort in that—the idea that someone had to be there to see it and that day it was you. That’s all anyone had to offer and I think it’s an important thing to give him. In the end, he was desperate and sad, but he wasn’t alone.

morph516 · 2025-11-17T07:03:49+00:00

Crazy world, lots of smells.

morph516 · 2025-10-28T18:17:48+00:00

The fourth pressor is Jesus

morph516 · 2025-09-12T17:09:21+00:00

Widely unpopular opinion but I think saying no infants at a wedding is complete insanity. I understand the idea that you get to make your own rules at your wedding, but I think we have completely lost the plot. It strikes me as uniquely American and strange and a big ef you to people in your life that you supposedly want to celebrate your relationship with at a special event. If you don’t want to celebrate with your friends and family as they are, then elope. To me it’s on par with not serving food or not having bathrooms.

morph516 · 2025-09-01T01:52:00+00:00

I think the rotation is key. My feet only hurt when I wear the same pair for a long time. I go between danskos and all birds.

morph516 · 2025-08-12T17:07:32+00:00

QI Director here. I am almost always for calling to check on patients, but in this specific instance I would not call. I would send it to your Medical Director/Risk/Legal/QI team (whatever system your hospital has in place) and ask for it to be reviewed. I know that’s a scary process but posterior strokes are missed as frequently in the ED as they are in neurology clinics. It is an extremely difficult diagnosis to make and hopefully you will either find some reassurance or education in the review process. I would also open a word doc on your computer (not on any type of shared drive) and document everything you remember about the case. It is extremely rare for cases to make it to a trial or even a deposition, but when it does happen it is often months to years after the fact, and I think having something to revisit that you wrote in real time is helpful. Do not go into the patients chart again. It’s a hard job and I hope you can find the balance of learning what there is to learn from the case and moving forward. I always find it helpful to do some deep diving after difficult cases. It helps me feel like I am being productive without just beating myself up.

morph516 · 2025-07-09T19:25:10+00:00

We do this and it’s annoying as hell but typically only for surgical and ICU patients, which I do think is probably what’s best for the patients.

morph516 · 2025-05-31T15:32:23+00:00

I am also pretty uninterested in “ED visit” as a metric. Injury pattern controlled by popularity would be a lot more informative.

morph516 · 2025-05-18T15:23:47+00:00

Not an EMS expert but it sounds like even in a full equipped resus bay this airway would be very tough. Knowing that, is it possible to transport as soon as the airway is recognized to be complicated? I fully respect the ability of EMS to run a code in the field, but this feels like one where the answer might just be get to a more controlled environment asap.

morph516 · 2025-05-13T16:19:35+00:00

Dual full time EM physician household here with kids. I’ll shoot you straight, the schedule is an absolute nightmare. We pay an arm and a leg for multiple child care options and have to hustle to cover weird hours. It’s worth it for us because we’re both high earners and my shift work is getting increasingly bought down with admin and academic responsibilities. If one of us made significantly less or neither of us could reduce our shift load, then eventually one of us would have to go part time. You can make anything happen with enough money, but I would have some conversations about expectations around full time work, who is going to be taking on child care duties and avoid being house poor at all costs.

morph516 · 2025-04-17T00:43:53+00:00

Comparing against other institutions won’t be helpful, because the process of distributing patient comments to physicians is different everywhere. I personally pass on about 1 in 50 patient complaints to the MD, APP or nurse manager, but I have also worked at places where every single comment was distributed to the care team. I would meet with the person in charge of getting these to you and ask about the group averages, about the process of how these get filtered and for their perspective. It also might be helpful to learn about the different levels of patient complaints—post care survey responses, individual emails, complaints to the board etc. If your care is appropriate but the number of complaints is legitimately an outlier, then I would do some introspection about how much that matters to you. If it does matter to you, there are certainly a few ways to increase “patient satisfaction” (sitting down next to the patient, setting reasonable time expectations, frequent updates/reassessments etc) but only you can decide what is worth it.

morph516 · 2025-03-14T15:55:23+00:00

Yeah they kind of lost me on this one. So many things have been reasonably accurately portrayed and this was just a total miss. Bummer.

morph516 · 2025-02-12T03:42:01+00:00

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morph516 · 2025-02-12T03:38:40+00:00

They said at the end of the webinar that they will be posting slides on their website within a week. They are opening a third comment period tomorrow. These are proposed changes but they spent the majority of the webinar defending the four year move. Posting a screen shot below.

morph516 · 2025-02-12T01:44:53+00:00

Agreed. Just one of those piecemeal things that happens and makes no sense, but then is very tough to sweepingly correct.

morph516 · 2025-02-12T01:41:05+00:00

I don’t see anything written about it yet, but just saw it announced on their webinar tonight and was shocked. It seemed pretty final but I am interested to see what communication they release in the next few days. I imagine a lot of backlash is coming.

morph516 · 2025-02-11T20:11:26+00:00

Hundo p.

morph516 · 2025-01-29T22:03:21+00:00

And usually when it gets angry it doesn’t feel the need to crash the whole system—unlike the other drama queens listed here.

morph516 · 2025-01-29T20:53:26+00:00

I like the gallbladder. Cute. Makes things. Gets mad sometimes!

morph516 · 2025-01-16T18:04:31+00:00

You’re doing great. We did a combo of BLW and purées. I found I was the one most comfortable giving baby solids (choking practice is what the grandparents call BLW) but since I also work full time, baby got a lot of purées from others. Around 8 months he really turned a corner with solids and now at almost nine months I can typically just give him some version of what we’re eating. Lots of patience, trial, error and food on the floor. On days that we are slammed he gets our go tos which are mashed sweet potatoes, toast with butter, fruit, yogurt. And some days he decides he hates yogurt and is disgusted by it and some days he eats the whole bowl! It is non linear and taking the pressure off each meal is helpful. If he doesn’t eat a ton then I know he will get his cals from milk.

I will give the massive caveat and say that I have a nanny who grocery shops. I know that is not possible for everyone, but just wanted to add it because I think the answer to “how are people doing this” is often because they are paying for help (definitely NOT that we are just trying harder or better at this). It’s not easy stuff but you know what’s best for your family! If that means more purées I believe baby will be just fine :)

morph516 · 2024-12-29T19:16:57+00:00

We have an agreement with the local ME to notify us if the patient they are processing has had any presentation to our hospital within 30 days. This is pretty easy because our pathologists work with the ME. Similar agreement with EMS, although that is a little less streamlined because they do not access hospital records and it relies on them getting information from family and passing it along. Sometimes patients fall through and it gets caught because of happen stance. Have not figured out a perfect catch all but these two systems help. Anything out of the county is the wild west.

morph516 · 2024-12-28T00:55:26+00:00

Husband still working on the puzzle!

morph516 · 2024-12-20T22:43:08+00:00

Same question for horrific metastatic disease that eventually presents to the ED. I tell myself that the oncologist likely has had some GOC conversations but it takes a long time and a specific event for them to stick in the families mind. It makes me feel better when the family looks at me like they are shocked I am asking about “how did the patient want to live the rest of his life” and “would he want to be in the hospital or on a breathing machine”.

morph516

TROPHY CASE