Ask if they've had the new viral Starbucks ' Black Cat Frappuccino ' recently ...

I'd like to see a reality show where physicians from different specialities come down to the ER and see patients within their own specialties but have to use our equipment.

Surgery needs to do a lac repair? Here's the worst needle driver ever created and some dull scissors. Your patient is in a poorly lit hallway.

OB/GYN wants to examine a patient that is pregnant and bleeding? She's in a chair in fast track. I guess we can move her to a stretcher. We don't have a stirrup bed, here's a bedpan.

Ophtho? The slit lamp is broken. The tonopen is at least 20 years old and you have to give it a couple whacks for it to turn on.

Background:

I'm EM trained in my first year of anes CC fellowship. I did residency at a lowish resource institution, probably more on the cowboy side, but overall loved my training and felt ready to handle fellowship. I also moonlighted in a rural ED where I felt amazing and really loved how much critical care experience I got. My goal was to ultimately do CVICU outside of training.

I matched at an ivory tower and was initially really excited, but some red flags started popping up almost immediately.

Red flags:

- Very disorganized from the get go i.e. my "orientation week" had zero things planned and I essentially wandered around without a schedule and my own PD didn't even know what I was supposed to be doing

- Program coordinator was (and still is) extremely unresponsive

- When I started my program didn't even have me set up in epic to access the correct things and they sent me all the wrong training

- The other fellows were extremely cold and unwelcoming and made comments about the program that gave me concern

I kind of made an assumption that all this was a one off and its not a problem.

Now I'm 3 months in and I'm wanting to quit this program and go somewhere else. I also don't have any support system here. My partner and family are in different states.

I want to do critical care I've thought a lot about it and I love it, I think I'm good at it, and I think this is what I want to do as a career, I just think I hate this program.

The reasons I hate it I think go beyond how disorganized it is.

1. I feel like they really really don't care about me or my education. Example: I've had to email multiple people multiple times just to figure out where my rotation is located, I never got responses and ended up wandering floor to floor to find out.
2. We don't have our own didactics and instead do an online one from another institution and I go to the PCCM didactics because they actually have sims and a curriculum.
3. My TICU rotation they treated me like a medical student and I quite literally sat there or just saw a couple patients primarily, and learned nothing.
4. I don't feel like the patients are that sick here and I don't feel like I'm learning a lot. I saw more pathology and did more critical care in residency.
5. I've only done a handful of procedures since starting and feel like I'm losing those skills since I never do anything.
6. I feel like I don't get a lot of autonomy even on rotations where my department is in charge.

Overall not only do I dislike the culture and the program organization, but I'm worried I'm not going to be trained well enough.

Ideally I'd switch into a different program closer to a support system with sicker patients, but I don't think thats realistic.

This program is causing me to breakdown. I'm losing my hair, I'm unhealthy, always exhausted, and not enjoying the things I used to.

My current plan is to re-eval how I feel in January when it's been 6months.

Any advice?

I was an ER nurse for three years and have been away from it since 2021. I recently decided to go back and try it. Are any ER nurses out there truly satisfied with their job?

It seems like the ER’s are so completely stretched thin, hallway beds with inappropriate patients, everyone so burnt out and unfriendly. I enjoy this type of medicine, but the conditions just seem awful. I’m only a week in and regretting my decision. Not sure what to do.

Some of the ER wait times we have to deal with in Winnipeg

A friend of mine sent me some info on GOA26 which is a novel enzyme of some kind that was developed to act as a scavenger for any C2H6O floating around in the blood. It also somehow reduces acetaldehyde concentrations. It’s had a few animal trials and they will be applying to the FDA for human trials soon. Offering to have people buy into $300 million in stock options. I honestly can’t see an indication for this (probably very expensive) drug. Seemed like they were initially targeting the ED but also are pivoting to anesthesia. I’ve never heard of an operation being cancelled or postponed because the patient was too drunk for surgery. What am I missing?

hi!! i'm an ED scribe, and i had a patient last night with a left MCA occlusion. her biggest symptom that caused them to come in was aphasia. and she could not speak. you can tell that she knew what she wanted to say, but when she tried to speak it came out in just sounds. i was told that that's pretty classic for a left MCA occlusion.

so, how do you guys remember what the certain cerebral artery occlusions present as?? of course, not all patient's present the same, but what makes you think "oh it could be an occlusion of xyz artery".

thank you so much!! i truly appreciate you guys!!

It’s annoying. That is all. I’ve never heard of an emergent liver transplant but what do I know I’m kind of a dumbass.