#pa-c

[populationpensive]

This is just one of many articles (see below) about how the American scientific community is suffering from the Trump administration. I URGE YOU to spread the word amongst your friends, family, and co-workers. The average person does not remotely understand how this funding is impactful. How it make health advancements for those in need.

Educate the people around you. While we can all have product conversations about governmental budget reform, yes, even with NIH funds, a slash and burn policy will only harm us all in the end.

[populationpensive]

"...but I'm not moving that fast and he is DAWDLING. Disgusting. No work ethic these days."

This post is everything.

A code status is what you want the hospital to do if your heart or breathing stops, and we've got two basic options: full code which means we do EVERYTHING and Do Not Resuscitate or DNR which means we do less than everything. There's like little add-ons like intubated or not intubated, or blood products or no blood products, but that's basic gist of it. Do you want us to try everything we can to save your life or if your heart stops, is that it? And then we take that information and put it in your chart and make it very prominent in case we need to find it quickly in an emergency. Jane Doe, 72 years old, DNR. John Whatsisname, 49 years old, full code. Like that.

Anyway I'd like to propose a third code status that we'll call "DNR!!!" This is when you not only don't want heroic measures to extend your life, you are so excited to die. I thought of this recently when getting report on a patient, and the day nurse talking to me was like, "Alice Smith, 80 years old, DNR and she will tell you that herself." And I was like, "I don't think code status is gonna come up organically," and the nurse was like, "It won't, but she'll tell you anyway." And then I introduced myself to the patient, and like three minutes in as we're talking about pain meds, she goes, "and by the way, when I'm dead, I'm DEAD. Don't be bringing me back! Every woman in my family has lived past 90, and I'm here to break that tradition! NO one needs to live that long, and I certainly don't, and frankly it's indecent for me to have made it this far. God willing the reaper will come for me any day now. I would never take actions to make him come sooner, but I'm not moving that fast and he is DAWDLING. Disgusting. No work ethic these days. And don't bother with a grave, just chuck me out the window and let the birds at me."

And I'm like "so is that a no to the tylenol"

And she was like "oh no, I'd love some tylenol and a warm blanket too. Now look at me. I've done everything I could possibly want to do in this world and quite a few things I didn't want to do, and personally I don't think I should have to keep doing things. I'd also love a cranberry juice."

Anyway. DNR!! I'm sorry to say she made it through the night completely unscathed.

[zero-signal]

[populationpensive]

Followers

I am following 118 people on tumblr.

The vast majority of these people (verifiable, ACTUAL people) haven't updated in 3+ years and it makes me sad. :-(

[populationpensive]

I don't know about you guys, but this is what I see and why studying science helped me rediscover my own faith.

Two neurons sensing each other and trying to connect

Credit: @rockatscientist

[shathesha]

A sign stood at the door. Closed indefinitely, it said, but the neighbor knew it would be closed forever

[losttranslator]

on en parle de la fois où arthur oublie l'anniversaire de guenièvre donc c'est lancelot qui prépare tout et ils font genre que c'est arthur qui a planifié et lancelot offre des cafards à guenièvre pour faire passer arthur pour une grosse merde?

pcq en soit arthur EST une grosse merde dans cet épisode mais la préoccupation première de lancelot c'est de la lui mettre dans l'os plutôt que de faire en sorte que guenièvre passe un bon anniversaire. et en plus il fait l'innocent ce bâtard. "bah je comprends pas, des petits cafards tous mignons" sqsdssd connaaaaaaaaaaaard

[maochira]

Ways of being a father. (Kengan dads & child!reader)

I wrote this almost a year ago, originally with Blue Lock characters assigned. But I thought a lot about assigning Kengan characters so here we go! The quotes are all translated from Alligatoah's song Nicht adoptiert. Also! The song may originally be about being born into a family and not being adopted, but reader can very much be seen as an adopted child in this if that's what you prefer!

gn!child!reader (reader is implied to be different ages in different parts)

If you're listening to this, you're alive, congratulations / I always knew you'd become more than a broken condom

Let's be honest, you weren't planned. Being a father initially wasn't part of his life plan, but then you happened. But he wouldn't replace you for anything in this world.

-Adam, Raian, Lihito, Kanoh, Ohma

Cause I don't believe in marriage you were born a bastard

-Ohma, Raian, Adam, Hatsumi

Sure, we love you, but there's a reason for that, kid / Nature arranges it like this so we won't kill you

Sometimes being a father can be frustrating and exhausting. But no matter how annoying you might get, his fatherly instinct always wins. In no way would he ever intentionally do harm to you.

-Ohma, Kanoh, Kazuo

It looks like you're family / Looks like it's just us now / We've got to get through it now, blood's thicker than beer / [Sorry, you ain't adopted]

-Adam, Kanoh, Hatsumi

I have no idea how to take care of children / But don't worry, I'll find a tutorial

He went into fatherhood completely without knowing what to expect. It all came a bit out of sudden for him, and he was too anxious to prepare himself properly. But when he held you in his arms for the first time, he knew he'd figure it out just fine.

-Lihito, Inaba

The good thing is, I don't even have to share any knowledge with you / You can just read the wiki entry

-Saw Paing, Lihito, Kanoh

I won't always be there for you, I have to party hard too / Did I say "party"? I mean "work"

Being a father doesn't mean that's the only part of his life now. He'll try to be there for you whenever possible, but there will be moments when he gets lost in other things.

-Saw Paing, Lihito, Sekibayashi

Joking aside, the ego-pig in me is happy that you are coming / Cause then I can play with Lego blocks

A part of him is still a child as well. And hey, being a father means he gets to play with toys again - that's something he can look forward to.

-Cosmo, Saw Paing, Inaba

Cause even though I'm putting effort and thinking about how / I can take the pressure off and still get you into bookstores / Something I do will lead to trauma, c'est la vie / I'll be the star of your psychotherapy, have fun

As careful as he is with you, he knows at some point he'll do something wrong. He's perfectly aware of how he won't always be the perfect father, but he's still trying his best.

-Raian, Kazuo, Wakatsuki, Suekichi

You're programmed for me, I'm programmed for you / Now we're sittin' here, I say now we're sittin' here / Sorry, you ain't adopted

He didn't choose to have you as his child, and you didn't choose him to have as your father. But still, you're perfectly made to be this role for each other.

-all of them.

You may not become president or student representative / Reality will throw your dreams in the chick shredder / I know what I'm talkin' about, life ain't no show

You won't achieve the greatest things in the world, and that's okay. You don't have to do that to make your father proud. He knows exactly what it's like to fail, and that's why he will always encourage you to reach your dreams, no matter how big or small they may be.

-Gaolang, Kazuo, Suekichi, Setsuna

You'll see my burdens, I've given them to you / If you think your genes are bad, they're Papa's genes / But you're my update, you can fix the bugs

You may not be a carbon copy of your father, but the similarities are undeniable - both the good and the bad.

-Ohma, Setsuna, Kanoh, Raian

In the beginning it's ambition like in a chess duel / You will emulate me until you outshine me / The balance of power is on my side - currently / But your chance is good, because Papa's withering parallel like a leaf

Being his child also means being his rival - in a fun way. If there's something to compete in, there will be playful competition. Board games, soccer in the backyard and running random races when you're just walking somewhere together - things like that.

-Raian, Koga, Saw Paing, Lihito

This has to come out now 'cause later I won't be the same / When you're around I'm sure I'll write some corny shit / No more tasteless jokes, no more Hitler comparisons

He was more of an immature person before, but he knows after your birth he has to become more serious as a father - at least that's what society expects from him.

-Lihito, Raian, Naoya

I stand in front of the mirror and see a caricature / But I train every day for my father figure / I practice "La-Le-Lu" on the keyboard / And I subject myself to a motherfucking radio censorship / And I learn all the movie clichés, after birth / You'll get a wristwatch with your name engraved on it

At first, knowing he'll be a father soon felt so unreal to him. But the closer the day gets, the more the realization sets in. But that realization makes him nervous, so he's putting extra effort into learning how to be the best father he can be. And even though he doesn't want to be "like the other dads", he finds himself following every cliché possible.

-Kazuo, Sekibayashi, Adam, Suekichi

Even though being strict clashes with my liberal nature / I'll pretend I'm interested in your Spanish exam

He doesn't care how much of a good or bad student you are, but he knows you'll have to pass school somehow. As much as he doesn't care about your grades, he pretends as if he does to keep you encouraged. But of course you'll get praise for your hard work when you get good grades.

-Ohma, Kazuo, Lihito

I'll be mad at you for every adolescent booze story / But don't be afraid of me just because I fuck your mother

-Raian, Lihito, Adam

I'm just an old cynic who writes frustration poems / But I swear I'll give it all to you till the end of my chapter

He'd do anything and everything for you. He will always make sure you feel safe and loved, no matter what age you're at. Even when you become an adult, he will always be your father and protect you as good as he can.

-all of them.

If you enjoyed this, please remember to reblog with tags! That's the best and easiest way to support me and my writing!

[fallsflowersandmoss]

Tsuchinshan comet

[keewy10]

Je peux tout vous expliquer…

@tmk-987 Voilivoilou c pour toi 😌

Enjoy ! 🤗

[nikki-le-terrible]

I don't know. I made this. I was afraid to post it on youtube and on discord so idk I hope it'll sink into tumblr's madness

[populationpensive]

I realize that this was first posted in 2021. However, the comments and the question in general is a great one for discussion.

I have colleagues in other specialities that essentially utilize the second option. The attending might see new patients, etc. Depending on the speciality, the attending may want to see certain types of patients, at least initially.

I work with ~20 different physicians who staff the unit on a weekly basis. So, I work with one doctor a week. They come from a variery of practice backgrounds: EM, surgery, anesthesia, internal medicine. Given that I work in critical care and at a tertiary care facility, the distribution of labor is a bit different. I've found most scenarios to go like this:

Doctors that are new to our institution or who haven't worked with me before tend to initially micromanage or check in more.

Once I have worked with a doctor enough that they feel confident in my competence and my ability to recognize limitations, they tend to give more autonomy.

We share 10-14 patients. We round together, though sometimes I start treatments/order meds prior to rounding if they are not things I know the attending is going to really care about (method of replacing electrolytes, limiting polypharmacy, etc.)

We round, I present the plan of care, and the physician is in agreement 99% of the time. If they want something else ordered or considered, rounds is a nice time for collaborative discussion. I continually learn a lot every day I work because of this.

I write my own notes, do my own procedures, admit patients independently (tho the doctor is the admitted provider), and talk to families myself. Some staff docs are more involved at bedside than others. It just depends who I work with.

Many of the staff physicians I work with have administrative and teaching obligations that force them to be out of the ICU for chunks of the day. Each doctor has their own preference about what they want to know about; however, most of them want a text/page for:

FYI for new admits

New oxygen requirements (either changed method of delivery or increasing FiO2)

New or increasing pressor requirements

A status change requiring urgent imaging.

Placement of lines (art lines, CVC, HD, etc)

Need for an unexpected operative procedure

Our staff generally serve a supervisory/teaching role. They will sometimes write notes but mostly they are co-signing resident notes. And again, how much autonomy they grant the APPs like myself is dependent on many factors.

Who has advice?

My future job is very APP friendly. So much so that all attendings are paired with a dedicated APP. As someone coming straight from fellowship, I am not familiar with having help. From talking to the other attendings in the practice, there seem to be two approaches when working with APPs.

The first approach has the APP practicing similar to a resident or first year fellow. We share a patient list and tag team visits. I handle half the patients and then have the APP staff with me for all patients they see. I feel like this approach would suck the most for me in having to bounce back and forth between the APP’s patients and my own. I also lead to feel to the tendency for micromanagement on my part and lack of appropriate autonomy on behalf of the APP. It also seems this would result in us collectively seeing fewer patients.

The second approach has the APP practicing independently. We each have a separate patient lists. This approach makes me a little nervous because I have a really hard time delegating and allowing anyone else to make decisions about my patients. I have a hard time letting go of control. There are a couple of categories of patients that I’m not willing to share. All new patients, restaging visits, and at least every other cycle of patients on neoadjuvant chemo would have to run through me. This approach would probably be the best use of time for both of us.

Any advice on working with APPs? Better approaches? 

Any APPs out there want to tell me what they wish the docs they work with knew? 

[cheolcam]

Seus últimos posts do joshua me fizeram pensar que TALVEZ ele goste de levar tapa na cara e ser enforcado enquanto fica por baixo..... mas é só oq eu acho mesmo 🚬

anon, vc me deixou pensativa...

no caso eu sempre achei que ele fosse dom (o shua hard!dom acaba comigo) só que eu tô vendo ele como muito switch agora, sabe? imagina comigo, você sentada no colo dele, rebolando lentinho com as mãos dele na sua cintura, todo molinho. ele fecha os olhos quando a sua mão fecha no pescoço dele, colocando uma pressão, o rosto dele fica mais vermelho ainda quando a sua mão entra em contato com a bochecha dele, e ele abre os olhos e te olha assim 🥺

mas tudo que vai, volta... e pode ter certeza que ele retribui na mesma moeda (ou até pior, dependendo do dia)

abri o twt antes de ver essa ask e fui presenteada com mais provas do freakshua

[clhook]

Je sais pas trop comment articuler ma pensée donc je ne développerai pas mais les livres collector les reliés le jaspage sur les livres qui sortent en mille exemplaires différents pour faire acheter les gens les influenceurs littéraires qui vont à des événements complètement hors sol comme des bals littéraires bah ça me rend folledingue et il faut que ça s'arrête

[leclercskiesahead]

Zandvoort circuit preview with C2

will these videos ever be normal

[populationpensive]

This happened to me recently and it is

TRULY

a vibe

And then to get harassed that my password must contain a lower case letter, an upper case letter, the name of my first pet, some odd character, my social security number, and then not resemble any other password I've ever had....

...it is all too much, man.

NEW PASSWORD DAY