Ash, MD
@AshMD_1
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Following
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Physician. Posts ≠ medical advice. Patient related images/videos are shared with consent. Insta & Tiktok: @ashmd_1 Youtube: @ashmd_10
Joined December 2021
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Thank you so much for 10K followers guys, I appreciate you all!
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Me when I was a kid: my dream is to be a doctor
Me living the dream 20 years later:
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The medical student: comes across a difficult topic, tries to read about it but doesn't understand it, so asks the attending to explain it to them
Attending: Why don't you read about it and give us all a talk about it tomorrow
The med student:
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The dermatology residents when they're rounding on their 2 inpatients and run into residents from other specialties doing 30 hour shifts.
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Getting accepted into medical school vs actually being in medical school
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Ortho asking for the patient to be admitted to medicine because they have a blood pressure of 146/93.
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Me during the week: ugh I can't wait for the weekend to enjoy my hobbies and have some fun
Also me throughout the entire weekend:
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Me: Hey I have a med student with me today, is it ok if he quickly listens to your heart, he has never heard a murmur before
The med student:
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No one:
Doctors trying to have lunch on their 3 minute break when they're on call:
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A dermatology resident heading to clinic alongside a surgery resident who is on their way to do their third 26 hour shift that week
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When the cardiologist repositions your stethoscope and asks you if you can hear the murmur now
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Me pretending to listen to a murmur that I absolutely cannot hear after the cardiologist repositioned my stethoscope by 0.1 inches
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Me to the patient: yes it is ok to take NSAIDs in moderation if you really need to and you have no other alternatives
The nephrologist outside the patient's room, waiting to talk to them once I am done:
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The dermatology team when they're rounding on their 2 inpatients and run into residents from other specialties doing 30 hour shifts.
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Me to the patient I am seeing with the medical student: I have this young, brilliant, future doctor rounding with me today.
The medical student:
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When a group of healthcare workers hang out together and they try to go 5 minutes without talking about work
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When a doctor goes in to the ED as a patient, and no one asks them what they do for a living during the first 17 seconds
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When you finish rounding for 11 hours on internal medicine and then the attending goes, ok, now who is ready for some teaching time!
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When you start working in healthcare and ask someone when your lunch break is
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Pre-med students explaining to their college friends their master plan to get into medical school, match into residency, then into fellowship, complete an advanced fellowship, get an academic job & then get promoted to a professor so that they could have a chill life afterwards
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Me when I leave internal medicine rounds to go to the restroom, see three patients, discuss a discharge with a nurse, get coffee and them come back to find the team still discussing the same patient they were discussing before I left
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Patient: My goodness, there is no way you're a doctor, you look like a baby!
Me:
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Me on my first day of medical school: Getting into medical school has been a life long dream of mine, I am endlessly grateful to be here.
Medical school:
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When the medical student asks a quick question on internal medicine rounds
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When you put in a consult note for a patient and the primary team doesn't write that they appreciate your recommendations in their note the next day
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When you ask a doctor what causes a certain disease and they say "well it is probably multifactorial"
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Me at the end of every e-mail or note: Please do not hesitate to reach out to me with any questions or concerns.
Me when anyone reaches out to me with a question or concern:
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Them: Find a job you love, and you will never have to work a day in your life.
Me at the end of each workday at the job that I love:
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Healthcare workers when they spend 12 minutes buying groceries and 10 minutes doing chores after a call shift before they go to sleep to wake up and do another call shift
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Surgery note: “patient had half their body removed last week, but they were able to walk and poop”, ready for discharge.
Medicine note: The patient coughed 3 times when I was talking to them, the cough makes me suspicious they have one of the following 17 conditions.
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When your attending listens to your presentation like this you just know they're not going to agree with a single word you said
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Surgery note: The patient had half their body removed last week, but they were able to walk and poop, ready for discharge.
Medicine note: The patient coughed 3 times when I was talking to them, the cough makes me suspicious they have one of the following 17 conditions. Will
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When the hospital tells you you're experiencing burn out because you're not sleeping enough or spending enough time away from work
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Attending: Now if you position your stethoscope over the left lower lung lobe and listen carefully, you will be able to appreciate some really fine crackles
Me with my stethoscope positioned over the colon, alternating between hearing nothing and bowel sounds:
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When you are a PGY 7 still making minimum wage and you go out with your college friends who have had successful careers for years
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When your co-resident is driving you home after your third 24 hour shift that week, and goes "I don't know man, I should've gone into law school" as he starts speeding
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Them: It all gets pretty straightforward once you've finished intern year
My life since I've finished intern year:
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The 2 shocks every doctor goes through in life are becoming an adult and realizing what an average adult is like, then becoming a doctor and realizing what the average doctor is like.
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When you prescribe a patient diuretics, and their peripheral edema resolves but the ascites does not respond
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Me to patient: you need to have a good sitting posture when you do your desk job so as to not develop back pain
Also me sitting down to finish 13 notes at the end of the day:
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Doctor: Ok I am going to gently touch your neck to feel for any enlarged lymph nodes.
Also doctors:
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Me when I cite a paper I previously wrote while writing a new manuscript, and describe it as a well conducted study
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Me: I am sorry I can't join you this weekend guys, I have some premade commitments
The commitments:
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Wellness module: Recent research shows that getting adequate sleep and spending time away from work can decrease rates of burn out
Me:
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Emergency physicians preparing their team for an overnight shift
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On call today but I hope all my friends here get to spend the holiday with their loved ones
Happy Thanksgiving everyone!
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Me walking in the hospital after consulting both cardiology and nephrology on 6 different patients on the same day
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ICU attendings going "but who knows what could be truly going on with this patient" after spending 20 minutes explaining the detailed pathophysiology of what's going on with them
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When you're behind on 4 research projects & doing ICU nights after a stretch of multiple inpatient blocks, & the division director of the specialty you want to go into is enthusiastically telling you about the research project they're starting but need someone to help with.
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Designer: So what kind of look are you looking for?
Pedro pascal: Have you ever done a zoom interview?
Designer: Say no more.
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When cardiology and nephrology make the same recommendations while co-managing a patient
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Me after showing up to internal medicine rounds a few minutes late: Sorry guys, did I miss anything?
The medical student who just started their internal medicine rotation:
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When you're finishing residency and someone asks you if you're planning to go into fellowship
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When the dermatologist reads how I worded the skin exam findings in my note
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When you're a resident and someone approaches you with a new "learning opportunity".
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Patient in the hospital: gets all their medical issues managed, their discharge orders are released, but they cough 2 times as they're about to leave the hospital
No one:
The internal medicine team:
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Me 2 hours into a 24 hours shift: Oh It's actually been quiet so far today, looks like this shift is going to be pretty manageable
The shift:
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In the intrinsic pathway of coagulation factor XII activation culminates in factor IXa, which along with factor VIIIa activates factor X which along with factor Va activates thrombin which cleaves fibrinogen into fibrin. Now for the extrinsic pathway: ...
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Just another day of me staring at myself in the mirror and debating whether I should get my hair cut to be able to get ready for work faster when I am on call
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When a radiologist steps out of their workroom after spending 8 hours reading CT scans
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When you realize tomorrow is Monday, but we've already had a Monday last week
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When the attending asks what you should know about the patient before starting them on a new medication
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Albumin transporting anything it is supposed to transport , as soon as a drug that binds albumin enters the blood stream
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when you call a consult team about a patient they've already signed off
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Me: Ugh I feel so tired today, I can barely walk
Someone: Hey there are donuts in the breakroom, you should get some bef-
Me:
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When you finally finish your fellowship and you gain the ability to respond with "Oh this is not really my specialty, you should discuss it with your primary care provider" to every question that you don't know the answer to
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Patient tells me they have abdominal pain > me: here are 17 differentials, and the 23 steps of how we’re going to work this up and manage it.
Me when I get abdominal pain > meh it is probably nothing.
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Me: tries to log into epic from home, from the same computer I used to log into it 7 times today and 698 times this year
Epic:
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Finishing a 28 hour call shift then getting an email that today is the deadline for you to complete all the wellness modules you've been putting off
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Them: A 30 minute power nap can boost your energy for hours
Me after a 30 minute power nap:
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Oral contraceptive pills increase the risk of development of Gallstones. This is secondary to an estrogen medicated increase in cholesterol production by the liver which can later precipitate in the gall bladder forming cholesterol stones & a progesterone related decrease in 1/
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