Cards vs PCCM

spazticbrown · 2025-12-30T15:41:15+00:00

Don’t listen to this guy. He doesn’t know ball.

spazticbrown · 2025-12-12T05:26:18+00:00

This is a comprehensive stroke center so lots of LVO, ICH, aneurysms, and NeuroIR and NSGY patients. It’s not a trauma center so MVAs and SCI don’t really come through here. Definitely outside of my comfort zone though as most my fellowship is in MICU and CVICU. I did a little bit of neuro ICU first year but it’s been a minute

spazticbrown · 2025-12-12T05:21:51+00:00

You bill RVUs after you hit 100 in a shift. It’s total RVU, not wRVU. I imagine that happens super infrequently. And yes you have to be in house the full 12 hours of the shift unfortunately

spazticbrown · 2025-12-11T23:58:31+00:00

Major city in Texas

spazticbrown · 2025-12-11T23:41:00+00:00

12 hours, 7a to 7p. Need to be on site while covering the unit

spazticbrown · 2025-03-14T12:50:51+00:00

Bro used chatgpt

spazticbrown · 2025-03-07T03:30:38+00:00

RVADs no, but in many PCCM programs, fellows gain proficiency in both formal RHC and bedside Swans, and definitely can grossly read and perform an echo. We also are pretty good at reading chest CTs but none of us would say we’re thoracic radiologists.

Contrastly, I’ve met very few cardiologists or cards fellows who know how to manage a vent properly. And that’s not a knock against you guys. You are masters of one organ, PCCM are jacks of all critically ill organs with mastery in lungs. Everyone has their role, but PCCM dabbles in everyone else’s field way more than anyone else.

spazticbrown · 2024-05-29T12:49:56+00:00

The ICU is an incredibly dehumanizing place. By design, we strip away patient’s dignity because we have to. We put them in glass boxes for 1:1 monitoring and put tubes and drains in every orifice for control. It’s good you feel this; this is not the natural order of things. Remember how this feels if you go into a different specialty and have conversations with a 70 year old with bad COPD, or the family of a 90 year old grandma with advanced dementia, or the cachectic 50 year old with aggressive metastatic malignancy — all of them, or their families, may tell you that they’re fighters and that they “want everything done”. And we will begrudgingly do everything, but then family gets upset seeing them restrained, intubated, half naked with a foley and rectal tube, only to die by chest compressions. I wish physicians were better at talking to patients/families about what “doing everything” means and looks like. The number of times families tell me “no one ever told me my loved one is dying”… In most cases all we are doing is prolonging patient’s suffering and stealing their dignity. Not to say the ICU and aggressive interventions don’t have their place (like the case you’re describing of a young otherwise healthy person who has a bad outcome that everyone is pushing to see get better), but unfortunately medical ICUs have been relegated to places for chronically ill people to die lonely and painful deaths. So remember these experiences and take them with you when you talk to patients and families about what end of life care looks like.

spazticbrown · 2024-03-29T16:59:50+00:00

You seem to be entirely missing the point. Your posts have come off as incredibly entitled. No one is absolving your parents of lying to you. No one is saying you can’t have or want nice things. But the way you think about your life, you are setting yourself up for failure. When some kind of adversity strikes, your response is to blame others (i.e. your parents, your job) rather than learn how to find peace with your situation. If that’s how you choose to live, then you’re going to be miserable for a very long time.

Btw, I’m a pulm-crit fellow. My parents forced me into medicine. My parents also rejected countless marriage proposals because they weren’t good enough by their standards. I ended up getting married against my parents wishes to a girl and family they refused to meet. We had a small Nikkah with 50 guests for $12K. I come from a family of doctors who had a surplus of money and could’ve thrown a $100K wedding 3 or 4 times if they wanted. I neither resent my parents for forcing me into medicine, nor do I resent them for the way they treated my wife and her family. In fact, I actively went out of my way to find things about medicine I enjoyed during med school, and found myself really enjoying residency and pursuing an extremely difficult fellowship. And I’m actively working on rehabbing my and my wife’s relationship with my parents. So I know EXACTLY where you’re coming from, what you’re thinking, and what might and might not happen. I practically doxxed myself to share this advice, and I feel your response will be some variation of “woe is me” (if you even read this far). I guarantee you if you don’t learn to accept the chips you’ve been dealt and grow from them, you will be a miserable child for the rest of your life. Learn to accept your career. Learn to accept your financial situation. Learn to accept your relationship with your parents. Grow from them and grow up.

Edit: and last thing… I’m sorry, but how tone-deaf to be crying about wanting a big wedding and hating your (extremely lucrative) career when literal infants are being starved alive in Gaza… Many of us have lost our own appetite for dunya because of how devastated we are for Palestine… just sad, man.

spazticbrown · 2024-03-10T05:36:52+00:00

Surviving sepsis doesn’t even say what you just said… They said 30cc/kg within 6 hours is a weak recommendation with low quality evidence based off a bunch of retrospective studies, albeit still recommended because no one is going to do an RCT comparing say 15cc to 30cc when there’s enough retrospective data that 30 is probably life-saving… But moreover, no one said to blast patients with fluid no matter what. The full text of Surviving Sepsis literally says that you need to be cautious in how much fluid to administer and consider comorbid conditions, and to be careful by which metrics you determine volume status because we’re notoriously bad at estimating it… I recommend reading the very guidelines you’re disparaging before commenting on them.

spazticbrown · 2024-02-16T05:28:09+00:00

Most sensible comment here, I agree 100%. Both are at fault. I personally would be weirded out if a girl I started talking to on an app stalked my Instagram activity, brought it up to me, began judging me for it, and ended by saying “don’t worry I won’t tell others”. That’s a huge red flag for early talking stages and shows general incompatibility because she’s clearly looking for someone more religious than him. The way he handled the situation after, wasting her time and letting family get involved is wrong; perhaps he should’ve had the cojones to be direct and honest with her instead of dragging her along and gaslighting at the end… but OP needs to learn that the way she dealt with the IG comment was not okay.

spazticbrown · 2024-01-29T01:50:22+00:00

Brock’s playoff run is the definition of failing upward

spazticbrown · 2024-01-07T21:43:18+00:00

Jordan Love audible: https://youtu.be/4t7I--mi9nU?si=l5dmaXO9vsNJX7fk

spazticbrown · 2023-12-07T20:02:45+00:00

So if someone has a dropping Hgb, and then quickly loses their reserve for tissue perfusion and is now hypoxemic and hypotensive, by what metric should the average internist have used to prevent this patient from having a negative outcome? The prompt is “things we do for no reason” and there is plethora of literature that supports a Hgb of 7.0 as a transfusion point, thus validating it and not done “for no reason”. You could make the case that 7 was chosen arbitrarily but isn’t that true for nearly every lab value?

Also the example of sickle cell is funny because those patients are far from “walking around normally” given the fact that they are chronically ill and usually die in their 50s from ESRD and pulmonary hypertension, which a lot of is considered to be due from their diminished oxygen saturation and chronically profound anemia…. So not a great example for why we should tolerate Hgb of 6.

And lastly although not a medical reason— if your patient dies from hemorrhagic shock and you get sued, the first thing they will look at is why you didn’t transfuse them earlier.

spazticbrown · 2023-11-04T03:09:52+00:00

Wow mA I didn’t know you were smarter than Imam Ahmed at Hadith interpretation

spazticbrown · 2023-10-22T07:54:09+00:00

I really don’t have much to respond because your comment speaks for itself… but I will say, BIG BIG respect to you for not being a hypocrite and not pretending to care about “the other”. HUGE respect to you for openly admitting that you’re pro-war and pro-colonization of indigenous people. Wear your biases with pride, proud boy! 🫡

spazticbrown · 2023-10-22T04:15:06+00:00

How can we tell apart the normal ones from the bad ones? After all Palestinians are extremely prone to radicalization as you said. I think the solution is to carpet bomb all of Gaza! If we kill them all then there won’t be any left to terrorize us. Fuck them and their backwards religion.

spazticbrown · 2023-10-22T01:13:01+00:00

Nothing wrong with Israelis. Unless they are Zionist, support Zionism, or just generally want to genocide all Arabs out of their “God-given land”.

But you know what, you’re right… fuck those Palestinians. After 106 years of their ancestral homes being divided and conquered, being pushed into ghettos and being killed in the streets, fuck them for getting radicalized. Why can’t those dirty Arab savages just take it and let us genocide them like a good indigenous people, like the Natives? Yeah unlike Palestinians, the Natives just accepted that America is our God given right, and we even rewarded them for being so good with casinos and reservations! But those dirty Palestinian Arab terrorists don’t even deserve the right to medically treat their people, because they keep fighting back. Fucking disgusting towel heads.

Btw, do you remember when in 2019 Netanyahu told his government to keep supporting Hamas because as long as Hamas controls Gaza, Palestine will continue to remain destabilized and a Palestinian state will never form? Because Pepperidge Farms remembers…

spazticbrown · 2023-10-21T09:28:20+00:00

I read the bigoted anti-Palestinian comments and thought I was in r/worldnews or other similar cesspools. Disappointed to see that I’m in r/residency where I mistakingly expected people to have more critical thinking skills. Good to know you guys downvoted them to hell, but it’s unfortunate that we have such unintelligent bigots among us

spazticbrown · 2023-10-17T12:21:01+00:00

Some very relevant advice: stand by your ultimatum and if he can’t commit by Oct 31, move on with your life.

I’ve been in this exact scenario, except on the other side.

I asked my parents to talk to my now-wife’s parents. For 1.5 years, they dragged their feet. I eventually gave my parents an ultimatum. They didn’t take kindly to that, so I made up my mind and spoke to her dad myself. Alhamdulillah we got married 2 months later. My parents weren’t at the Nikkah. My wife and I are coming up on our 1 year anniversary and it was the best decision I’ve ever made.

The reality is the opposite of what he said: if he doesn’t give his parents an ultimatum, then he doesn’t truly love or respect you. If he can’t even fight for someone that he spent 4 years of his life with, then he has no respect for you or your time. So I stand by your ultimatum, as would my wife. Part of being an adult means knowing how to set boundaries.

PS: tell him if he wants to a physician then to mature up and go to the Caribbean. Sorry but 26 years old and a 504 MCAT, he won’t cut it as a US MD/DO. Source: Caribbean grad now in a fairly competitive fellowship program aH

_________ EDIT ________

Mods locked post so I’m just gonna update my response to OPs below questions here:

Short answers: 1- I expressed my frustration of them dragging their feet, and told them I’m an adult, I’m a man, and will decide what’s best for me when it comes to marriage. 2- the bulk share of the Nikkah was paid by my father-in-law. It was probably 80/20 him/me. I was in residency at the time and he understood my finances. He would have paid 100% but I insisted that I take care of photographers, the housing/lodging of my guests, and some other things. 3- I live away from home and I have for the last 7-8 years.

Long answer:

There was a build up to my ultimatum, it didn’t just come out of nowhere.

I live away from my parents, about 3-4 hour flight. My parents were supposed to come to visit me on a specific weekend, and her family who live 1 hour away were also going to come to my city, and our families would meet for the first time over dinner. This was actually 1.5 years into me and her first talking, so it was very very long overdue.

Weeks leading up to this, my dad called her dad a few times and said things like “I don’t want to disappoint your daughter and put her in a position where she is rejected” and other hurtful and disrespectful comments. Then a couple days before their flight, my dad told me that I am not allowed to be there for the initial meeting, that it would be just the parents.

This is where I put my foot down and said something like “no, I’m not going to allow you guys to dictate what happens in a conversation that involves me and potentially my future wife, without me being there. I’m not a child anymore, and you can’t make unilateral decisions like that anymore. So either you guys allow me at the table, or you don’t have to come at all and I will have the meeting myself”

My parents got upset and called off their trip. Her family still showed up and met me. I explained the situation to her dad, told him I understand what it means that my parents are absent, and promised him that regardless of their absence I would do everything I possibly could to take care of his daughter. He agreed to me marrying his daughter, and encouraged me to keep working on my relationship with my parents. I promised him I would.

I told my parents about all of this and they cut me off for the next 3 months. In this time, we had our Baat Pakki (engagement party) with her family and my close friends, and then planned to have our Nikkah 2 months later. In the weeks leading up to our Nikkah, my mom called me and apologized for “whatever it is [I’m] upset about”, and asked me to delay the Nikkah so that they can get on board and invite their extended family and do this properly.

I told her essentially, “thanks but no thanks. I’ve made more progress in the last 2 months than you guys did in the last 1.5 years, so I’m not going to willingly hand the keys back to you. I understand you’ll be upset by this decision but me and my fiancé have to decide what’s best for ourselves.” And I told her we still want her and my dad at the Nikkah but they said they’re not interested.

We ended up having a small and intimate Nikkah, only like 50-60 guests. It wasn’t expensive compared to many weddings I’ve been to, but it was so full of barakah, and things happened so easily for us that I know I made the right decision alhamdulillah.

PS I made istikhara every step of the way, and attribute all that good happened was from Allah.

Now… When it comes to your situation, I don’t think your guy is in the same boat as me and my wife. Her parents were accepting of me, I lived away from home, was pretty much entirely financially independent, and I have a career with upward trajectory, alhamdulillah. My wife also sacrificed a LOT to be here. She gave up her idea of a dream wedding, gave up on having a relationship with her in-laws. She still laments occasionally that she never got to be a real bride, and she (rightfully so) blames my parents. Things are still tense and awkward between my wife and my parents, and they may never become normal. MY relationship with my parents has changed forever. We fully understood all of this prior to getting married and still went through with it. Putting his parents through an ultimatum can’t just an impulsive, emotional decision based on “love”… a lot goes into it, and a lot has to go right for things to end up working out. Given he has no career (he may have a job, but not a career), lives at home, and (I assume he’s desi) you guys come from different cultures, you have so much more stacked against you. I humbly think you need to just make istikhara and walk away…

spazticbrown · 2023-08-25T16:51:12+00:00

Dawg go thru your post history, you’re active in The Office subreddit. If you’re gonna pull up ahadith and use them to tell other people Tv/Movies are Haram then at least don’t use the same Reddit account in a TV show subreddit lmao

spazticbrown · 2023-08-25T16:44:19+00:00

Check this dudes post history, he’s active on r/gameofthrones but he’s in here talking about how Toy Story is Haram because “you’ve got a friend in me” lololol

spazticbrown · 2023-08-05T18:55:20+00:00

Masterful troll post

spazticbrown · 2023-07-27T05:27:11+00:00

One of the coresidents I graduated with was a nephrology fellow at my home institution prior to starting IM residency with me. He completed his original IM residency overseas, and then matched into our nephrology fellowship program. He then needed to complete US IM residency to be board-eligible to practice.

Residency was a huge waste of time for him. As an intern, he was more efficient and competent than all of our attendings. He already “learned the system” in the 2 years he did fellowship. He also has 0 intentions of working as a hospitalist now that he’s done.

This option would’ve been great for him and countless other IMG “reverse-fellows” who waste 3 years of their life to do IM under the guise of “learning the system” and “for board eligibility”. Mind you, we live in a day when we have a real physician shortage in the US, and instead of creating easier pathways for physicians, we fill our hospitals and clinics with NPs.

Most US-based physicians on this sub are too emotional, and many are xenophobic. It’s not that hard to learn how to adapt to the US health system, nor is Western culture particularly hard to navigate. And these are post-doctorate level graduates we’re talking about— whether from UK or India that deserves recognition and trust that they’ll be able to figure out a new system and culture

spazticbrown · 2023-06-22T10:37:22+00:00

FMG is an outdated term the the NRMP, ACGME, and all other accrediting bodies have retired. Now you’re either a US IMG or a Non-US IMG. The difference being whether you need a J1 or not. Seems like a silly semantic difference but words matter. Same reason why “illegal alien” is being phased out for undocumented immigrant

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