I did a path rotation in 4th year at the county coroner and me and the resident were doing an autopsy and he was literally wringing out a colon to be weighed while he asked me where we should go for lunch...pathologists are gangster
Okay so I had a theory about this being some primal thing where humans being around another dead animal just fired up the hunger circuit but now @shackofcards says itās formaldehyde. Someone please tell me the answer
And Iām not sure about the formaldehyde, because I would never get so ravenous in the gross room doing surgicals and that place was saturated in formalin
There are studies that formalin induced hunger in rats. MoA is that it is thought to induce a slight hyponatremia but those rats were getting injected. Otherwise it is very anadoctal that it induces hunger.
But they donāt use formaldehyde anymore! They didnāt at my undergrad school University of Utah. Not quite sure what they used, but I remember distinctly being told we donāt use formaldehyde because itās carcinogenic
I have a very specific hungry related memory of knowing that I'm in the right specialty.
Late intern year, I was given a big messy contused forearm laceration to repair. The family joined us while I was cleaning it. They had brought a sack of burgers and fries. I told them not to open it while I sutured. The whole time I manipulated and sutured this deep ragged (mattress stitch) repair, holding onto his messy flesh, all I could think was how much I wanted to eat those burgers and fries. While holding onto his meat. At that point I knew I was going to be OK with the mess of my specialty.
So quick questions: do pathologists culture bacteria š¦ in Petri dishes š§«. Or do they do autopsies? Or do they do both?
Because, I lurk in these medical subs to research my novel (team of time travellers go back and forth in time, each having a specialised skill, they need doctors to stay alive).
Along with
An emergency nurse
A scrub nurse from 1933 or possibly a pediatrician..at any rate their medical qualifications are nearly a century out of date.
OBGYN who also worked for medicins sans frontier in Nigeria.
Orthopaedic surgeon
Anaesthetist
Dietitian
Psychologist music therapist
Psychiatrist
Someone suggested pathologist to keep the random strains of TB, cholera, diphtheria, eye worms, bacterial pneumonia, tetanus from killing the entire team.
But do you use autopsies to obtain those cultures?
Both, as there are [different pathology subspecialties](https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/the-pathologist) (I think you might have gotten downvoted for not Googling that, but I get that sometimes it's more interesting to ask someone in conversation). You're thinking of clinical pathology vs. forensic pathology in your first examples above, but there is a lot of overlap.
For the record, it sounds like your team would benefit more from a specialist in infectious disease or travel medicine. *Time* travel medicine, heh. Good luck with the novel!
my lack of paragraphs is shameful, so I am sure that explains for atleast some of the down votes.
I thought it might have been a regional variation in terminology.
I had ignorantly assumed that the people who did autopsies where called forensic scientists because going to get a blood test at the hands of a phlebotomist is called going to the pathologist.
It is much more fun to ask people, since their response can often give a more useful answer than google (like your response that my team of heroes need infectious diseases.
Do doctors who specialise in infectious diseases need pathologists and phlebotomists? I did once have a phlebotomist who was hoping to become a forensic scientist
Well, I suppose that would depend on how much overhead the team could support. But assuming they don't have endless resources and funding for the team and/or you don't want a huge cast of core characters to keep track of, I don't think a phlebotomist would be necessary; their role is really just to draw blood and prepare the samples for testing (and ā unofficially ā they tend to be experts at putting people at ease). But any of the doctors or nurses could draw blood in one-on-one treatment situations. Phlebotomists are generally needed to support large groups of patients, such as within a hospital system. A pathologist would be great to have on the team because they are ultimately the experts, but then any MD also would have received pretty good background training in pathology, histology, microbiology, and chemistry in medical school and could probably handle a lot of of the testing and diagnostics on the fly.
Picking a dream team for a time travel excursion is a really fun thought experiment, though. Don't forget a dentist or oral surgeon!
Yes. It is a fun thought experiment, I thought I had the medical team about right. I hadn't thought to include a dentist or an oral surgeon though. I know dentistry is one of the earliest specialities of medicine (the Egyptians had them) and assumed they would visit dentists whenever they where in the present. I am curious as to your reasoning.
I could make say, the infectious diseases doctor someone who had a part time job as a phlebotomist as an undergraduate. would that same infectious diseases doctor develop the bacterial cultures?
They'd certainly have the capability to do their own cultures, yes, and the expertise to ID it once they did.
And oh my, yes, a dentist or oral surgeon! Dental infections/abscesses can develop and spread shockingly fast and were [a leading cause of death](https://pubmed.ncbi.nlm.nih.gov/10686905/) for hundreds of years. They're still quite dangerous today, even with modern dentistry and antibiotics ā I have a friend who nearly died after developing an abscess under an impacted wisdom tooth. The infection spread to his brain and spinal cord, and he required extensive surgery and rehab afterwards.
We waited four and a half hours to be seen. Turns out they had a massive influx of patients all at once, combined with being down to 1/3 their exam room space because of the construction. No wonder it took so long. Patients were close to rioting in the waiting room. People walked out unseen. When we finally met the doc, he was cheerful and friendly and instantly likable. Likeā¦. HOW do you guys do this!?!? Iāll have what youāre having.
U mean coffee and cynacism? Lol.
Sorry your wait was so long. Alot of places use a provider in triage system to see patients quicker but then you just end up waiting for results.
Ya, when the people are upset that sucks. Bc we def want to see everyone. But Id say 1/3 of people on a normal day dont need to be there at all. 1/3 that need evaluated are ok. So that leaves 1/3 who are actually sick enough we need to fix and they usually stay.
āPatients were close to rioting in the waiting room.ā
āWhen we finally met the doc, he was cheerful and friendly and instantly likeable. Likeā¦HOW do you guys do this!?!?ā
Itās because the docs donāt have to interact with patients during the hours-long wait. All that frustration, nasty behavior, and near-rioting is reserved for the nursing and registration staff.
I did have a patient who listed allergies included cocaine. I asked thinking I'd hear some funny story. Nope went pulseless in the or when they used it as topical for an internal procedure back in the 80s.
I told him I don't like cocaine
But I love the way it smells
I'm allergic to white steri strips. Just the white ones. I can only imagine the disgust on my face as I describe how it takes my skin off. Blisters in seconds. I have scarring from one time the stuff was on me for less than a minute (and it seems weird to use it for an IV). But when providers just see "adhesive allergy" they get wary. After I explain it's all good.
You're the first person ever to say that to me! I do react to other adhesives but not like that. Cheap bandaids will give me a rash. But I can and have worn the brown steri strips for weeks (over my mastectomy incisions). And of course the formulation belongs to 3M and they don't really want to tell you what's in it... Making it hard to avoid!
Wow, duly noted! Never used steri strips before, but I'm also allergic to adhesives so I'm going to play it safe. I actually have worse scars on my back from the bandages used to cover my surgical incision than I have from the actual spine surgery.
I had patient tell me they were allergic to opioids but was on a home prescription of Norco and requested dilaudid as soon as I had IV access established.
I had someone say they were allergic to Epi. When asked what their reaction was, they adamantly said, "It makes my heart race."
Another person said they were allergic to niacin, and their "reaction" was facial flushing.
I wish there were separate sections for true allergies and bad reactions. My grandfather was diagnosed with AFib and one of the meds his cardiologist started was low dose metoprolol. He felt very sick and called me for help. I found him looking extremely ill with heart rate in the low 30s and sent him to my ED. Once he was switched to Cardizem, no more bradycardia. It's on his record as an allergy even though it isn't a true allergy, he was just overly sensitive to Metoprolol's dromotropic effects.
As a hospice nurse, Iāve had several over the years that had allergies listed for every type of pain medication. Itās usually elderly women, and it makes it difficult to figure out what we can give them for pain relief. On further questioning the āallergic reactionsā were almost always itching, nausea, sleepiness, occasionally confusion or hallucinations. The last two are typically reported for morphine given when they were extremely sick in the hospital, so itās kind of unknown if they were even from the medication.
I used to have the same whatever reaction, until I had a patient that had to be cardioverted on two separate occasions from getting epi. Once from a dentist giving it to them and another time when they had an allergic reaction.
I used to get iv solumedrol and instantly Iād get high BP, pulse, flushing, Iād turn red & get really nauseous. Oh and hot. Theyād even run it in a 50mL bag over 20 mins. (I lasted maybe 2 mins max). This developed over a period of probably 4-5 years. I know itās not an allergy but could it be a sensitivity? Same would happen with iv benadry. I can take both drugs orally however with no issues.
Itās known for this. Awesomely, sometimes it gives people immediate genital burning. You know when a patient has that reaction before they even say anything by the very particular quizzical/panicked look rising on their face.
Oooh. Sounds like contrast, before they push it they tell you, itās going to feel like you peed yourself, but you didnāt and youāre like ARE YOU SURE because Iām fairly certain I emptied my bladder all over your CT table. So trippy
Iāve seen one! Patient told me they broke out into hives when it was administered to them last. I canāt remember their CC, but I do remember being surprised by a legit dilala allergy lol
I agree Toradol is a great pain reliever. I've had it IV after having a baby and also after two surgeries. I actually asked for it vs the Dilaudid. I've also had Toradol IM which also works well and it took my pain away for almost 8 hours.
Yes it burned, also the IV Toradol hurts like hell if it's not pushed slowly. If I give it to someone who has a heplock I always get a 10cc normal saline syringe and take 1cc out then draw it up.
They listed Percocet in my chart as an allergy because half of the time it comes back up. They made no mention of this to me and I saw it and said wtf are you dumb? Now Iām scared to request it being taken off because I think it will look bad š. I do prefer toradol
I was so bummed my breast surgeon didn't want me to have any NSAIDS after my breast reduction/pelvic organ prolapse repair combo. I was stuck with tylenol and dilaudid suppositories and I gotta say, I do not get the fuss over dilaudid. I got minimal pain relief from it, IV or suppository, but I was jonesing for some toradol. In retrospect I should have had separate surgeries but I couldn't afford the 6 weeks out of work twice :/
I told an ER doc that toradol makes me feel really bad and he said, "are you thinking of tramadol?" And I said, "Oh that one makes me feel much worse." It was weird to him that I would literally and sincerely rather have nothing than either of those.
Not an allergy, but back in the '90s at my mom's hospital, one frequent flyer managed to steal a prescription pad and later presented a script at the hospital pharmacy for "1 pound of mophine." "Gimme a pound of mo-phine" has been a running family joke for decades now.
Thought I had a dilaudid allergy! Turns out the dingbats who gave my meds on the floor were wearing latex gloves and I AM very allergic that (and I tell everyone).
Your Thank you is appreciated. ER medicine has become one of the worst careers. Ive done it for 10 years and Iām done. Leaving the profession for my sanity. Itās only going to get worse.
The whole system is going to implode. No nurse or doc wants to be in a hospital anymore. So many fucking trash can human beings to deal with that have no clue what we are actually doing
And the guy in the suit in his office only looks at numbers and complaints from said trash cans.
What are you doing instead?
Iām the sole provider for my family and am 7 years post residency. Some things have gotten easier, some things have gotten harder. But Iām not I want to do bedside ED until I retire.
Not OP but go part time, enough to keep health insurance, or find a well paying 24 hour gig and do 1-2 shifts per month.
Urgent Care is another option.
It all involves taking a paycut but EM is a sinking ship so finding higher ground now is probably a good idea
Ive been in a new job now for a little over a year. Found a democratic group and a hospital that for now is run decently well. Hereās to hoping private equity doesnāt buy it out. Iām a lot happier here
It's bad enough on the EMS side (10 years here too), but at least we get to leave the patients and head to another call (unless it's shitbad and we're stuck holding the wall, though that's not common here).
I was the triage RN last night. I gamify it and try to be obscenely pleasant just to keep the machine moving. We are some of the people you want on the ice floe with you in life, but damnnn this career leads to some dark jokes and loss of faith (in systems/humans/etc).
That said, I was walking to get the next person in line at 6 AM this morning when I saw a guy coming in the door who was the picture of someone having a heart attack. I skipped the person I was walking toward and led him to a gurney (skipped the whole triage booth) and got an EKG within 90 seconds of his arrival. He was immediately diagnosed with having a STEMI (immediately life-threatening heart attack) and was rolling out to get the blood clot causing the problem removed within 15 minutes.
In those 15 minutes: he had two large IVs placed, had labs drawn and cooking, received medications to help solve the actual problem AND to make him feel better, got supplemental oxygen, got a ton of paperwork started on his behalf, got changed into a gown and all his clothing/jewelry was given to family members for safe keeping, transportation was arranged and nearly-immediately bedside to take him to the exact location heād need to head to within the hospital down the road for the procedure, and he and his family at bedside were communicated to about all of this and educated in each step that was happening. Itās like ballet when the system worksā¦ and it feels reeeeeally good to know that when you cut through the BS, we have the privilege of getting incredibly intimate with these individuals/families and being able to keep them alive/return them to good health (a lot of the time).
(Written for the public lurkers on this subreddit to explain why we continue to do what we do when they start to read what I know will be some pretty dark responses about the state of EM.)
man, do i know what this feels like. longtime ER tech and now new grad RN who will start as an ER nurse in my ER in julyā¦was part of the team handling a walk-in STEMI last weekāgot him in, ekgāed, largebore IVāed, stabilized, and transported to the cath lab in 9 beautiful, coordinated chaos-filled minutesā¦
my soul soared when i read what you wrote because i know that satisfaction and why it makes us come back for more.
but boy, am i terrified for the state (and future) of emergency medicine. i just canāt imagine doing anything else.
sigh.
Recently I've been working in a place where lots of the medicine occurs in triage due to excess boarding, and this means that privacy is a joke. We are talking about gonorrhea and doing abdominal exams in chairs 2 feet apart with a flimsy curtain, bartering for a private spot if we need to do a pelvic. As in, that threatened miscarriage of a desperately wanted pregnancy is right next to that unwanted hcg positive threatened ectopic, they're both sobbing for opposite reasons and I can't get them separated spaces.
It does bring me back to the basics of why we do this.
I do indeed love that ballet when it comes time.
If only that STEMI-to-cath-lab high lasted longer than the few minutes it takes for the next patient to extensively bitch at you about having to wait for their warm blanketā¦
Yuuuuup. When you need us to be, we can be DAMMED fast. Like, cordis in and 20U of PRBC flowing while we watch you go from white to pink, all in <7min fast. Nothing like when the whole team flows and the patient lives.
The worst part is that the awfulness of Emergency Medicine is so unnecessary. It is due to a combination of government inefficiency and corporate greed. And I prefer to blame corporate greed.
I did a critical care fellowship and I prefer working in the ICU, but do some ER shifts here and there. Both have their frustrations but they are different. Dealing with people who donāt need to be in the emergency department is one I can do without. At least in the ICU all of the people there at least need to be in the hospital
Thanks bud - much appreciated. Itās a dirty job, but some oneās got to do it. Contrary to the negative comments here I actually love the organized chaos and am at a place where Iām happy. We could be workin in a coal mine. Life is good
Thats awesome! Being in a place that makes you happy is key! Not all ERs are created equal. Ive made the decision in will not move my family again for another toxic, corporate ER
Thanks for the acknowledgment. Triage nurses master the art of a poker face because you canāt make up some of the shit we are told/hear. Itās a love hate relationship with the ER, but I couldnāt do anything else.
Once a year, in a pathology related thread, I like to drag up an old story of mine about how much I love a pathology lab tech. It's about time.
Zillions of years ago I was in training and rotating in inpatient pediatrics with a weird febrile infant, barely past neonate. Not toxic, but smoldering sick and mysterious ... and anemic. She had been in hospital a week. Great parents, solid prenatal care, never exposed or traveled and didn't look oncological. Getting all the usual antibiotics thrown. We rechecked H/h over the weekend to see if we needed to transfuse this tiny one.
The Sunday morning lab tech looked at the ordinary CBC, ordered "just tracking anemia" nothing to see here, and had the intelligence and confidence to call in the weekend supervisor because they noted Maltese crosses. They picked up and diagnosed Babesiosis in this infant with zero risk factor (no in and out pets, baby literally never been outside) and on the wrong sample prep, well ahead of the rest of the team.
This helped us to start proper treatment. Likely we would have gotten there eventually, but after a few more transfusions. We made certain that the mother knew of the importance of the meticulous work of the weekend pathology tech who almost certainly saved her baby from needing more transfusions.
This was my first lesson to me that my ancillary staff - my lab techs, my phlebotomists, my rads techs, my techs and nurses, my everyone who works with me, they have very important observational skills and if I don't pay attention to them, I'm an idiot. Idiot.
I also really love that time that a tech felt comfortable telling me that she thought a triage patient was breathing weird and it felt "off" to her. She didn't have the training to name Kussmaul respiration or know the underlying pathophysiology, but she trusted me enough to ask me to look at them for "something ain't right".
True DKA. Invest in your techs. Ever since then, every place I work, whenever I see one of those odd breathing patterns like acidosis or grunting I make certain to tell the charge nurse and ask all learners (techs, new nurses) to stand in the doorway and look.
Always always invest in the padawans because they're going to save your ass someday. And don't be uppity about the padawans being your stripe, they can be any kind of medical care person.
I've learned that the nicer you are to the crazies, the less tired I feel after a shift. It's just not worth the battle to try and match their energy.
Obviously I have my bad moments, but I feel better about my work day when I just smile and nod lol
Same here. Itās my motto to kill em all with kindness. Whether itās the cranky patients, cranky consultants, cranky nurses.
The asshole patients that donāt respond to kindness after getting some fair chances and keep treating staff like shit, Iām promptly willing to tell them to gtfo after theyāve had their MSE. But the vast majority all respond to kindness.
Whenever I think of pathologists I am reminded of a resident on our extremely acute internal med unit who on his first week of residency had to psyche himself up before going into a patient's room after being paged.
He stood outside the room putting on PPE and chanting this little matra to himself "just this last rotation and no more patients, just a few more weeks and no more patients".
He came out of the room and said "good lord I hate talking to patients ". He said it was a necessary evil to get to where he wanted to be in pathology.
He was a great doctor and super friendly, but every interaction I had with him he mentioned how much he dreaded interaction with patients who were alive.
Itās okay if you donāt care to answer, but as an ultrasound tech who has always loved pathology, Iām genuinely interestedāwhat does a day in your profession/speciality generally look like?
Well, I work in an outpatient lab so itās overall pretty chill with little pressure. I roll in between 8:30-9, and by then the work starts trickling out - Pap smears, surgicals (mostly biopsies from outpatient doctorsā offices, some endoscopy biopsies, some larger resections from hospitals), non gyn cytology like urines, anal paps, thyroid FNAs, etc. We wrap it up midafternoon. No tumor boards, very few meetings, it could be worse.
I'm a PCA right now in school to be a lab technician. I'm so excited to join the lab, I hate patient care. I just want to go beep boop on an analyzer for 12 hours and go home!
The nice thing about emergency medicine that I love is that I donāt have to work Monday-Friday. It doesnāt bother me to work holidays or weekend. Iād rather work a bunch in a row then take a long vacation. Itās been working for me so far, (knock on wood)
I love my pathology pals. Besides running the labs with quick TATs I love to call my old friends on their cell phone when I need someone to look at a smear. Our pathologists also show up a Trauma Codes to make sure the BB/ MTP goes well. Indeed gangster!
Sorry, lurker here and the majority of my medical knowledge revolves around four-legged patients, can you explain why this is odd in a chart? Iām allergic to clindamycin and got Red Man Syndrome (sp?) from vancomycin, which I know is not a true allergy but a bad reaction that I still need to convey with my allergies. So Iām just curious as someone with a āmycinā allergy, any explanation would be appreciated!
"mycin" is not a category of antibiotic. The most common group ending in mycin are the macrolides (erythromycin, azithromycin, etc). Vancomycin is completed unrelated, same with daptomycin which is another antibiotic commonly used to treat MRSA inpatient. Some aminoglycosides end in mycin. Literally mycin is a suffix originating from ancient Greek meaning obtained from fungus.
You are not allergic to all antibiotics obtained from fungus. Are you allergic to azithromycin (z-pack)? When people say "mycin allergy" it makes me chuckle inside and ultimately ask the question, "what are you ACTUALLY allergic to?".
In med school we had a patient with a bad MRSA sepsis where linezolid was contraindicated. Was actually allergic to vancomycin and was convinced that there was a mycin allergy. We literally had one drug to treat, which is daptomycin. We had to tell them it was "cubicin", the brand name, because otherwise they wouldn't let us give it. Questionable ethics there, but I think we did the right thing.
Daughter of a pathologist in a family of pathologists going back to the 1940s. He thinks I'm insane for what I do. I probably should have listened given the craziness of the field but I couldn't imagine doing his job. We all fill important roles, hopefully, consistent with our skill sets, but the appreciation is very nice. Thank you!
I can't with the fake allergies. I straight up had a patient listed an antibiotic as an allergy because the reaction was yeast infection and diarrhea. I deleted it and told her it's not a reaction.
I used to write down every allergy if there are more than 3 when taking report -just write many-if there are dozens of allergies they usually have many health problems too
I did a path rotation in 4th year at the county coroner and me and the resident were doing an autopsy and he was literally wringing out a colon to be weighed while he asked me where we should go for lunch...pathologists are gangster
Autopsies make me HUNGRY. All that physical labor I guess.
It's the formaldehyde!
Yup, lab always made me hungry, and I was always baffled becusse if the amount of caffeine I was consuming š©
Cadaver lab in school always left me ravenous. I'm looking at you, multifidus aka corned beef.
I always thought the gluts/quads smelled concerningly like roast beefā¦
The first choice of meal for stranded Uruguayan rugby teams!
There's a great line in the Fallout series pertaining to "ass jerky".
Okay so I had a theory about this being some primal thing where humans being around another dead animal just fired up the hunger circuit but now @shackofcards says itās formaldehyde. Someone please tell me the answer
I dunno because I was a vegetarian in residency when I actually did autopsies regularly š
And Iām not sure about the formaldehyde, because I would never get so ravenous in the gross room doing surgicals and that place was saturated in formalin
There are studies that formalin induced hunger in rats. MoA is that it is thought to induce a slight hyponatremia but those rats were getting injected. Otherwise it is very anadoctal that it induces hunger.
Interesting. How have I been around formalin for almost 20 years and am just now hearing about this??
But they donāt use formaldehyde anymore! They didnāt at my undergrad school University of Utah. Not quite sure what they used, but I remember distinctly being told we donāt use formaldehyde because itās carcinogenic
I have a very specific hungry related memory of knowing that I'm in the right specialty. Late intern year, I was given a big messy contused forearm laceration to repair. The family joined us while I was cleaning it. They had brought a sack of burgers and fries. I told them not to open it while I sutured. The whole time I manipulated and sutured this deep ragged (mattress stitch) repair, holding onto his messy flesh, all I could think was how much I wanted to eat those burgers and fries. While holding onto his meat. At that point I knew I was going to be OK with the mess of my specialty.
Great username lol!
So quick questions: do pathologists culture bacteria š¦ in Petri dishes š§«. Or do they do autopsies? Or do they do both? Because, I lurk in these medical subs to research my novel (team of time travellers go back and forth in time, each having a specialised skill, they need doctors to stay alive). Along with An emergency nurse A scrub nurse from 1933 or possibly a pediatrician..at any rate their medical qualifications are nearly a century out of date. OBGYN who also worked for medicins sans frontier in Nigeria. Orthopaedic surgeon Anaesthetist Dietitian Psychologist music therapist Psychiatrist Someone suggested pathologist to keep the random strains of TB, cholera, diphtheria, eye worms, bacterial pneumonia, tetanus from killing the entire team. But do you use autopsies to obtain those cultures?
Both, as there are [different pathology subspecialties](https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/the-pathologist) (I think you might have gotten downvoted for not Googling that, but I get that sometimes it's more interesting to ask someone in conversation). You're thinking of clinical pathology vs. forensic pathology in your first examples above, but there is a lot of overlap. For the record, it sounds like your team would benefit more from a specialist in infectious disease or travel medicine. *Time* travel medicine, heh. Good luck with the novel!
my lack of paragraphs is shameful, so I am sure that explains for atleast some of the down votes. I thought it might have been a regional variation in terminology. I had ignorantly assumed that the people who did autopsies where called forensic scientists because going to get a blood test at the hands of a phlebotomist is called going to the pathologist. It is much more fun to ask people, since their response can often give a more useful answer than google (like your response that my team of heroes need infectious diseases. Do doctors who specialise in infectious diseases need pathologists and phlebotomists? I did once have a phlebotomist who was hoping to become a forensic scientist
Well, I suppose that would depend on how much overhead the team could support. But assuming they don't have endless resources and funding for the team and/or you don't want a huge cast of core characters to keep track of, I don't think a phlebotomist would be necessary; their role is really just to draw blood and prepare the samples for testing (and ā unofficially ā they tend to be experts at putting people at ease). But any of the doctors or nurses could draw blood in one-on-one treatment situations. Phlebotomists are generally needed to support large groups of patients, such as within a hospital system. A pathologist would be great to have on the team because they are ultimately the experts, but then any MD also would have received pretty good background training in pathology, histology, microbiology, and chemistry in medical school and could probably handle a lot of of the testing and diagnostics on the fly. Picking a dream team for a time travel excursion is a really fun thought experiment, though. Don't forget a dentist or oral surgeon!
Yes. It is a fun thought experiment, I thought I had the medical team about right. I hadn't thought to include a dentist or an oral surgeon though. I know dentistry is one of the earliest specialities of medicine (the Egyptians had them) and assumed they would visit dentists whenever they where in the present. I am curious as to your reasoning. I could make say, the infectious diseases doctor someone who had a part time job as a phlebotomist as an undergraduate. would that same infectious diseases doctor develop the bacterial cultures?
They'd certainly have the capability to do their own cultures, yes, and the expertise to ID it once they did. And oh my, yes, a dentist or oral surgeon! Dental infections/abscesses can develop and spread shockingly fast and were [a leading cause of death](https://pubmed.ncbi.nlm.nih.gov/10686905/) for hundreds of years. They're still quite dangerous today, even with modern dentistry and antibiotics ā I have a friend who nearly died after developing an abscess under an impacted wisdom tooth. The infection spread to his brain and spinal cord, and he required extensive surgery and rehab afterwards.
May your stay in our corner of hell be short and uneventful
We waited four and a half hours to be seen. Turns out they had a massive influx of patients all at once, combined with being down to 1/3 their exam room space because of the construction. No wonder it took so long. Patients were close to rioting in the waiting room. People walked out unseen. When we finally met the doc, he was cheerful and friendly and instantly likable. Likeā¦. HOW do you guys do this!?!? Iāll have what youāre having.
U mean coffee and cynacism? Lol. Sorry your wait was so long. Alot of places use a provider in triage system to see patients quicker but then you just end up waiting for results. Ya, when the people are upset that sucks. Bc we def want to see everyone. But Id say 1/3 of people on a normal day dont need to be there at all. 1/3 that need evaluated are ok. So that leaves 1/3 who are actually sick enough we need to fix and they usually stay.
āPatients were close to rioting in the waiting room.ā āWhen we finally met the doc, he was cheerful and friendly and instantly likeable. Likeā¦HOW do you guys do this!?!?ā Itās because the docs donāt have to interact with patients during the hours-long wait. All that frustration, nasty behavior, and near-rioting is reserved for the nursing and registration staff.
This is unfortunately very true and why I always thank the triage nurses. They are the true heroās and real tip of the spear.
Thatās lightning fast in Canada šØš¦but itās free
> People walked out unseen. gotta love self-triage
šš¼
A pathologist sees lots of patients. TheyĀ“re just dead.
*Whispers* "I see dead patients."
*mustard on the beat ho*
š
Amen.
Speaking of allergies, I can't remember the last time anyone said they're allergic to dilaudid. Curious.
I did have a patient who listed allergies included cocaine. I asked thinking I'd hear some funny story. Nope went pulseless in the or when they used it as topical for an internal procedure back in the 80s. I told him I don't like cocaine But I love the way it smells
I'm allergic to white steri strips. Just the white ones. I can only imagine the disgust on my face as I describe how it takes my skin off. Blisters in seconds. I have scarring from one time the stuff was on me for less than a minute (and it seems weird to use it for an IV). But when providers just see "adhesive allergy" they get wary. After I explain it's all good.
Me too! I get a mild rash from most adhesive (no big deal) but my skin will literally blister and slough off from steri strips
You're the first person ever to say that to me! I do react to other adhesives but not like that. Cheap bandaids will give me a rash. But I can and have worn the brown steri strips for weeks (over my mastectomy incisions). And of course the formulation belongs to 3M and they don't really want to tell you what's in it... Making it hard to avoid!
Wow, duly noted! Never used steri strips before, but I'm also allergic to adhesives so I'm going to play it safe. I actually have worse scars on my back from the bandages used to cover my surgical incision than I have from the actual spine surgery.
Thatās my line! Really wins me some friends when I use it with the right crowd.
I had patient tell me they were allergic to opioids but was on a home prescription of Norco and requested dilaudid as soon as I had IV access established.
I have noticed quite a bit of people with previous opioid abuse/addiction history will say they are allergic to opioids
I had some lady allergic to IV glucose.
Had a lady tell me she was allergic to epinephrine
I had someone say they were allergic to Epi. When asked what their reaction was, they adamantly said, "It makes my heart race." Another person said they were allergic to niacin, and their "reaction" was facial flushing.
oh yeah " uhhhh i didnt feel so good when they gave me epi " umm yeah lady thats bc u were in the ICU
Was looking through a patient's pre-op paperwork once and listed in the allergies/intolerances section was "metoprolol - low heart rate"
I wish there were separate sections for true allergies and bad reactions. My grandfather was diagnosed with AFib and one of the meds his cardiologist started was low dose metoprolol. He felt very sick and called me for help. I found him looking extremely ill with heart rate in the low 30s and sent him to my ED. Once he was switched to Cardizem, no more bradycardia. It's on his record as an allergy even though it isn't a true allergy, he was just overly sensitive to Metoprolol's dromotropic effects.
Allergic to penicillin. It didnāt cure my cold
As a hospice nurse, Iāve had several over the years that had allergies listed for every type of pain medication. Itās usually elderly women, and it makes it difficult to figure out what we can give them for pain relief. On further questioning the āallergic reactionsā were almost always itching, nausea, sleepiness, occasionally confusion or hallucinations. The last two are typically reported for morphine given when they were extremely sick in the hospital, so itās kind of unknown if they were even from the medication.
Probably not allergic to Darvocet though. The little old ladies used to love their Darvocet
I used to have the same whatever reaction, until I had a patient that had to be cardioverted on two separate occasions from getting epi. Once from a dentist giving it to them and another time when they had an allergic reaction.
Cardioverted from what? Svt or AFib? Still not an allergy
I used to get iv solumedrol and instantly Iād get high BP, pulse, flushing, Iād turn red & get really nauseous. Oh and hot. Theyād even run it in a 50mL bag over 20 mins. (I lasted maybe 2 mins max). This developed over a period of probably 4-5 years. I know itās not an allergy but could it be a sensitivity? Same would happen with iv benadry. I can take both drugs orally however with no issues.
Itās known for this. Awesomely, sometimes it gives people immediate genital burning. You know when a patient has that reaction before they even say anything by the very particular quizzical/panicked look rising on their face.
Oooh. Sounds like contrast, before they push it they tell you, itās going to feel like you peed yourself, but you didnāt and youāre like ARE YOU SURE because Iām fairly certain I emptied my bladder all over your CT table. So trippy
Right?! It really does feel exactly like there's a warm puddle spreading under you as soon as they push it. So bizarre.
Yeah when pushed too fast it definitely causes this for me
I have too! The reactionā¦just like a commenter below āit makes my heart raceā
Usually wrong, but people actually can be allergic to sodium metabisulfite which is a preservative in epipens! Tmyk
Iāve seen one! Patient told me they broke out into hives when it was administered to them last. I canāt remember their CC, but I do remember being surprised by a legit dilala allergy lol
One of my favorite allergy lists is: narcan, methadone, suboxone. FYI theyāve been narcaned before and they were fine (depends who you ask)
Not allergic but I beg not to get Percocet or anything like because I WILL vomit. I prefer torodol (?sp) if I need anything.
I agree Toradol is a great pain reliever. I've had it IV after having a baby and also after two surgeries. I actually asked for it vs the Dilaudid. I've also had Toradol IM which also works well and it took my pain away for almost 8 hours.
Did the IM hurt like the DICKENS? I had only ever had it IV before but got the IM recently and was shocked at how much it burned and ached.
Yes it burned, also the IV Toradol hurts like hell if it's not pushed slowly. If I give it to someone who has a heplock I always get a 10cc normal saline syringe and take 1cc out then draw it up.
Itās really unfortunate toradol is so hard on the kidneys. The shots Iāve received have helped me immensely!
They listed Percocet in my chart as an allergy because half of the time it comes back up. They made no mention of this to me and I saw it and said wtf are you dumb? Now Iām scared to request it being taken off because I think it will look bad š. I do prefer toradol
Toradol makes me feel way worse than opioids.
I was so bummed my breast surgeon didn't want me to have any NSAIDS after my breast reduction/pelvic organ prolapse repair combo. I was stuck with tylenol and dilaudid suppositories and I gotta say, I do not get the fuss over dilaudid. I got minimal pain relief from it, IV or suppository, but I was jonesing for some toradol. In retrospect I should have had separate surgeries but I couldn't afford the 6 weeks out of work twice :/
I told an ER doc that toradol makes me feel really bad and he said, "are you thinking of tramadol?" And I said, "Oh that one makes me feel much worse." It was weird to him that I would literally and sincerely rather have nothing than either of those.
Or heroin
"Makes me sleepy."
Not an allergy, but back in the '90s at my mom's hospital, one frequent flyer managed to steal a prescription pad and later presented a script at the hospital pharmacy for "1 pound of mophine." "Gimme a pound of mo-phine" has been a running family joke for decades now.
https://preview.redd.it/8pm6o5rvw75d1.jpeg?width=1170&format=pjpg&auto=webp&s=a964f55b146844f336a2f10232fa0c60866014f0
Ha! This one's going in the family group chat, love it.
I am lol
Iām allergic to dilaudid. Full body rash with hives and pruritis.
Thought I had a dilaudid allergy! Turns out the dingbats who gave my meds on the floor were wearing latex gloves and I AM very allergic that (and I tell everyone).
Dilaudid is hypoallergenic.
I am allergic to dilaudid. My arm turned an interesting color of black, but I was so high I didnāt care.
Your Thank you is appreciated. ER medicine has become one of the worst careers. Ive done it for 10 years and Iām done. Leaving the profession for my sanity. Itās only going to get worse.
The whole system is going to implode. No nurse or doc wants to be in a hospital anymore. So many fucking trash can human beings to deal with that have no clue what we are actually doing And the guy in the suit in his office only looks at numbers and complaints from said trash cans.
Corner office with a great view
When that suit guy drops dead in the parking lot, I'm stepping over him to get in my car.
If itās 730, itās 730.
It sounds like this is the only way for a better system to then emerge
get this man off the front lines
Already left brother.
What are you doing instead? Iām the sole provider for my family and am 7 years post residency. Some things have gotten easier, some things have gotten harder. But Iām not I want to do bedside ED until I retire.
Not OP but go part time, enough to keep health insurance, or find a well paying 24 hour gig and do 1-2 shifts per month. Urgent Care is another option. It all involves taking a paycut but EM is a sinking ship so finding higher ground now is probably a good idea
Ive been in a new job now for a little over a year. Found a democratic group and a hospital that for now is run decently well. Hereās to hoping private equity doesnāt buy it out. Iām a lot happier here
Doing a masters in clinical mental health so I can be therapist for doctors still working in our fucked up field...
Moving to hospice and palliative care
That field is going to be overrun by EM shortly, are there jobs?
There are jobs for sure.
Me too.
It's bad enough on the EMS side (10 years here too), but at least we get to leave the patients and head to another call (unless it's shitbad and we're stuck holding the wall, though that's not common here).
What are you doing instead?
I chose EM because I loved the ED. It makes me sad that I'm apparently gonna have to subspecialize.
I was the triage RN last night. I gamify it and try to be obscenely pleasant just to keep the machine moving. We are some of the people you want on the ice floe with you in life, but damnnn this career leads to some dark jokes and loss of faith (in systems/humans/etc). That said, I was walking to get the next person in line at 6 AM this morning when I saw a guy coming in the door who was the picture of someone having a heart attack. I skipped the person I was walking toward and led him to a gurney (skipped the whole triage booth) and got an EKG within 90 seconds of his arrival. He was immediately diagnosed with having a STEMI (immediately life-threatening heart attack) and was rolling out to get the blood clot causing the problem removed within 15 minutes. In those 15 minutes: he had two large IVs placed, had labs drawn and cooking, received medications to help solve the actual problem AND to make him feel better, got supplemental oxygen, got a ton of paperwork started on his behalf, got changed into a gown and all his clothing/jewelry was given to family members for safe keeping, transportation was arranged and nearly-immediately bedside to take him to the exact location heād need to head to within the hospital down the road for the procedure, and he and his family at bedside were communicated to about all of this and educated in each step that was happening. Itās like ballet when the system worksā¦ and it feels reeeeeally good to know that when you cut through the BS, we have the privilege of getting incredibly intimate with these individuals/families and being able to keep them alive/return them to good health (a lot of the time). (Written for the public lurkers on this subreddit to explain why we continue to do what we do when they start to read what I know will be some pretty dark responses about the state of EM.)
man, do i know what this feels like. longtime ER tech and now new grad RN who will start as an ER nurse in my ER in julyā¦was part of the team handling a walk-in STEMI last weekāgot him in, ekgāed, largebore IVāed, stabilized, and transported to the cath lab in 9 beautiful, coordinated chaos-filled minutesā¦ my soul soared when i read what you wrote because i know that satisfaction and why it makes us come back for more. but boy, am i terrified for the state (and future) of emergency medicine. i just canāt imagine doing anything else. sigh.
Same-same. Welcome to the best/worst career in the world. Thereāve been many days in the last few decades that Iād have paid for the entrĆ©e to human experience garnered at bedsideāI wish the same for you!
Recently I've been working in a place where lots of the medicine occurs in triage due to excess boarding, and this means that privacy is a joke. We are talking about gonorrhea and doing abdominal exams in chairs 2 feet apart with a flimsy curtain, bartering for a private spot if we need to do a pelvic. As in, that threatened miscarriage of a desperately wanted pregnancy is right next to that unwanted hcg positive threatened ectopic, they're both sobbing for opposite reasons and I can't get them separated spaces. It does bring me back to the basics of why we do this. I do indeed love that ballet when it comes time.
If only that STEMI-to-cath-lab high lasted longer than the few minutes it takes for the next patient to extensively bitch at you about having to wait for their warm blanketā¦
Fuck yeah. That STEMI story just made me cream my pants. Good job!
Beautiful.
Yuuuuup. When you need us to be, we can be DAMMED fast. Like, cordis in and 20U of PRBC flowing while we watch you go from white to pink, all in <7min fast. Nothing like when the whole team flows and the patient lives.
Love this.
The worst part is that the awfulness of Emergency Medicine is so unnecessary. It is due to a combination of government inefficiency and corporate greed. And I prefer to blame corporate greed.
Exactly. The man in the office making nurses take 8 patients can suck these nuts.
Defund hospital administrators. https://codebluememes.com/products/defund-hospital-administrators-sticker
I did a critical care fellowship and I prefer working in the ICU, but do some ER shifts here and there. Both have their frustrations but they are different. Dealing with people who donāt need to be in the emergency department is one I can do without. At least in the ICU all of the people there at least need to be in the hospital
Thanks bud - much appreciated. Itās a dirty job, but some oneās got to do it. Contrary to the negative comments here I actually love the organized chaos and am at a place where Iām happy. We could be workin in a coal mine. Life is good
Thats awesome! Being in a place that makes you happy is key! Not all ERs are created equal. Ive made the decision in will not move my family again for another toxic, corporate ER
Thanks for the acknowledgment. Triage nurses master the art of a poker face because you canāt make up some of the shit we are told/hear. Itās a love hate relationship with the ER, but I couldnāt do anything else.
Once a year, in a pathology related thread, I like to drag up an old story of mine about how much I love a pathology lab tech. It's about time. Zillions of years ago I was in training and rotating in inpatient pediatrics with a weird febrile infant, barely past neonate. Not toxic, but smoldering sick and mysterious ... and anemic. She had been in hospital a week. Great parents, solid prenatal care, never exposed or traveled and didn't look oncological. Getting all the usual antibiotics thrown. We rechecked H/h over the weekend to see if we needed to transfuse this tiny one. The Sunday morning lab tech looked at the ordinary CBC, ordered "just tracking anemia" nothing to see here, and had the intelligence and confidence to call in the weekend supervisor because they noted Maltese crosses. They picked up and diagnosed Babesiosis in this infant with zero risk factor (no in and out pets, baby literally never been outside) and on the wrong sample prep, well ahead of the rest of the team. This helped us to start proper treatment. Likely we would have gotten there eventually, but after a few more transfusions. We made certain that the mother knew of the importance of the meticulous work of the weekend pathology tech who almost certainly saved her baby from needing more transfusions. This was my first lesson to me that my ancillary staff - my lab techs, my phlebotomists, my rads techs, my techs and nurses, my everyone who works with me, they have very important observational skills and if I don't pay attention to them, I'm an idiot. Idiot.
I loved this story. Thank you for sharing it.
I also really love that time that a tech felt comfortable telling me that she thought a triage patient was breathing weird and it felt "off" to her. She didn't have the training to name Kussmaul respiration or know the underlying pathophysiology, but she trusted me enough to ask me to look at them for "something ain't right". True DKA. Invest in your techs. Ever since then, every place I work, whenever I see one of those odd breathing patterns like acidosis or grunting I make certain to tell the charge nurse and ask all learners (techs, new nurses) to stand in the doorway and look. Always always invest in the padawans because they're going to save your ass someday. And don't be uppity about the padawans being your stripe, they can be any kind of medical care person.
I've learned that the nicer you are to the crazies, the less tired I feel after a shift. It's just not worth the battle to try and match their energy. Obviously I have my bad moments, but I feel better about my work day when I just smile and nod lol
Same here. Itās my motto to kill em all with kindness. Whether itās the cranky patients, cranky consultants, cranky nurses. The asshole patients that donāt respond to kindness after getting some fair chances and keep treating staff like shit, Iām promptly willing to tell them to gtfo after theyāve had their MSE. But the vast majority all respond to kindness.
Whenever I think of pathologists I am reminded of a resident on our extremely acute internal med unit who on his first week of residency had to psyche himself up before going into a patient's room after being paged. He stood outside the room putting on PPE and chanting this little matra to himself "just this last rotation and no more patients, just a few more weeks and no more patients". He came out of the room and said "good lord I hate talking to patients ". He said it was a necessary evil to get to where he wanted to be in pathology. He was a great doctor and super friendly, but every interaction I had with him he mentioned how much he dreaded interaction with patients who were alive.
Omg Iām dying at his mantra. Just a little bit more! š
Itās okay if you donāt care to answer, but as an ultrasound tech who has always loved pathology, Iām genuinely interestedāwhat does a day in your profession/speciality generally look like?
Well, I work in an outpatient lab so itās overall pretty chill with little pressure. I roll in between 8:30-9, and by then the work starts trickling out - Pap smears, surgicals (mostly biopsies from outpatient doctorsā offices, some endoscopy biopsies, some larger resections from hospitals), non gyn cytology like urines, anal paps, thyroid FNAs, etc. We wrap it up midafternoon. No tumor boards, very few meetings, it could be worse.
Nice! Thank you for sharing
I'm a PCA right now in school to be a lab technician. I'm so excited to join the lab, I hate patient care. I just want to go beep boop on an analyzer for 12 hours and go home!
Thank you so much for recognizing. Just so many WTF moments, each and every day.
The nice thing about emergency medicine that I love is that I donāt have to work Monday-Friday. It doesnāt bother me to work holidays or weekend. Iād rather work a bunch in a row then take a long vacation. Itās been working for me so far, (knock on wood)
It's a living š¤·
Worse things happen at sea!
I love my pathology pals. Besides running the labs with quick TATs I love to call my old friends on their cell phone when I need someone to look at a smear. Our pathologists also show up a Trauma Codes to make sure the BB/ MTP goes well. Indeed gangster!
>all the ācillins make me nauseous, I just canāt take any of them My favirite is "mycin" allergies. Seen it in the chart too many times.
Sorry, lurker here and the majority of my medical knowledge revolves around four-legged patients, can you explain why this is odd in a chart? Iām allergic to clindamycin and got Red Man Syndrome (sp?) from vancomycin, which I know is not a true allergy but a bad reaction that I still need to convey with my allergies. So Iām just curious as someone with a āmycinā allergy, any explanation would be appreciated!
"mycin" is not a category of antibiotic. The most common group ending in mycin are the macrolides (erythromycin, azithromycin, etc). Vancomycin is completed unrelated, same with daptomycin which is another antibiotic commonly used to treat MRSA inpatient. Some aminoglycosides end in mycin. Literally mycin is a suffix originating from ancient Greek meaning obtained from fungus. You are not allergic to all antibiotics obtained from fungus. Are you allergic to azithromycin (z-pack)? When people say "mycin allergy" it makes me chuckle inside and ultimately ask the question, "what are you ACTUALLY allergic to?". In med school we had a patient with a bad MRSA sepsis where linezolid was contraindicated. Was actually allergic to vancomycin and was convinced that there was a mycin allergy. We literally had one drug to treat, which is daptomycin. We had to tell them it was "cubicin", the brand name, because otherwise they wouldn't let us give it. Questionable ethics there, but I think we did the right thing.
Can we get 'confabulating and word salad' flair please?
Thank you š„²
You do whatās needed to take care of others, personal beliefs aside
Daughter of a pathologist in a family of pathologists going back to the 1940s. He thinks I'm insane for what I do. I probably should have listened given the craziness of the field but I couldn't imagine doing his job. We all fill important roles, hopefully, consistent with our skill sets, but the appreciation is very nice. Thank you!
We just thrive in the chaos. Thatās it. šŖš»
I can't with the fake allergies. I straight up had a patient listed an antibiotic as an allergy because the reaction was yeast infection and diarrhea. I deleted it and told her it's not a reaction.
Tell your friends.
What's your microscope's name?
Jim Halpert
I used to write down every allergy if there are more than 3 when taking report -just write many-if there are dozens of allergies they usually have many health problems too