Emily Fridenmaker
@emily_fri
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Wife | Mom | Appalachian | MD | Pulmonary & Critical Care
WV
Joined October 2010
Goodnight RTs.And goodnight EKGs. Goodnight X-rays.And goodnight trauma bays. Goodnight charts.And goodnight bronch cart. Goodnight vents.Goodnight PEEP.And goodnight to the CRRT machine, alarming “BEEP” . Goodnight nurses.Goodnight patient care.Goodnight medicine, everywhere
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We portray COVID outcomes as binary—alive or not alive. “Survivor” should not be equated to “fine now.” There’s a lot that comes with surviving COVID—often in the form of oxygen or even a long term ventilator (and those are just the pulmonary complications).
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LESLIE KNOPE WOULD HAVE HAD AN ENTIRE BINDER DEDICATED TO VACCINE DISTRIBUTION BY FEBRUARY 2020.
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One time when I was a med student a cardiologist was going over EKGs with us. He asked me who I trusted most in the world. I thought this was a weird question, but I answered “My husband.”. He, caught off guard, said “No, it’s yourself. Always look at the EKG yourself.”. 🥴.
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Patients who were admitted for a week with sepsis requiring abscess drainage, a fib, and a kidney injury don’t need 12 pages of “heart healthy eating tips” in their discharge paperwork. They need to be able to see their instructions, meds, and appointments simply and clearly.
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Why do we always have to try and prove that working 30 hours in a row harms patients? Is it not enough that it harms the doctors?.
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Fighting football traffic and crowds of unmasked people trying to get home after my shift covering an ICU full of COVID patients and I am just So. Angry.
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Anybody else remember asking their parents about that weird hole in their arm?
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This may be a minor thing in the grand scheme right now, but it’s like nails on a chalkboard to hear @realDonaldTrump refer to “Dr. Fauci and Deborah” instead of referring to her as Dr. Birx.
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Doctors: Afraid to recommend a bandaid for a cut on Twitter because it might constitute medical advice. Quacks: LET ME CURE YOUR CANCER WITH KALE AND YOUR DEPRESSION WITH OIL.
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Patient: GI bleed. GI: Recommend call IR.IR: Recommend call surgery.Surgery: Recommend call GI
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Today I’m going to cover some basics of asthma. 🫁. Most of this content comes from this year’s GINA report.
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I have never seen so many hospitalized flu patients in NOVEMBER. I have also never seen this much secondary bacterial PNA—soooo much staph.
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I am 32. I am sitting at a table trying to study for a test without falling asleep. I'm all for being a life long learner, but I don't want to do it this way anymore.
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Remember how we all used to just knowingly go to work with colds and sit right next to everybody else?.
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Phases of time off:. 1. Recovery - all you can do is lay on the couch, nap, etc. 2. Picking Up the Pieces - laundry, groceries, unpaid bills, unanswered emails, etc. 3. Real Rest - you actually feel good enough to do stuff that you like that makes you feel rested.
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One of my favorite MICU nurses has cared for our COVID moms this year. I found out today that she pumped for one mom while the mom was intubated because prior to intubation/delivery, mom had told her that she wanted to breastfeed. I want to give her forty daisies.
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I used to wonder why I had to know all that biochemistry and basic molecular biology to be a doctor and now I understand that it was so I would be able to police anti-science misinformation on social media.
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If you knew what was happening inside our ICU today you would not line up along the main road in town (where every HCW from two major hospital systems has to drive in order to get home) to protest vaccines and tout the superiority of your immune system.
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How you gotta look when you’re furious but you’re also a girl.
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How I teach my residents to present in the ICU:. - one liner (NOT including full PMH).- overnight events.- pertinent vitals/exam.- Is/Os, drips, vent settings.- pertinent labs/studies.- assessment and plan (I do problem based).- FASTHUGSBID.
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Husband: *painstakingly goes around getting every faucet turned on just the right amount*. 6 y/o shortly after: The faucets were dripping so I turned them all off!.
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Husband: Did you know Mommy touched a lung the other day? . 4 y/o: That. doesn’t sound safe.
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Me: He has a fever and he said his head hurts. Ped: Are you in medicine?. Me: I’m a critical care fellow. Ped: This *points to my post-Tylenol kid spinning on the stool* is not what meningitis looks like.
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Good critical care is 10% performing dramatic interventions, 90% being aggressively persistent with the seemingly mundane details. - Fluid balance.- Weaning sedation.- Weaning the vent.- BMs.- Deescalation of lines and tubes.- Deescalation of abx/other meds.
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I have had two attendings who write procedure notes in order to help the trainee get the work done and it’s probably not a coincidence that one trained the other. They are also why I try to write them for my residents when I can, too. Kind doctors make kind doctors.
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We got preapproved, and I’ve been stressed out trying to weigh options and make decisions about which house to buy. I asked my 5yo for help. He told me he didn’t need a big yard if it meant he didn’t have to wait so long for me to get home from work every day. 🥹.
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Vents are still difficult for me. There’s lots of physics and numbers and my brain just does not naturally work like that. I’ve been working through vent details lately, and I thought I’d share some basics. Corrections very welcome—I’m still training my brain in this stuff.
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Has anybody tried giving burnout lectures to the healthcare system decision makers about how to cause less burnout rather than lecturing the burnt out on how to be less burnt out.
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Today I walked in a room and just asked a new patient questions without looking at their chart first. Like a maniac. Like a reckless and free maniac.
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I let myself comment on a mask/vaccination Facebook post from people I went to high school with and why do I do this to myself.
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The reason women often talk fast is because we know we have a limited amount of time to get our thoughts out before someone interrupts us.
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My residents came up with a handy guide for determining what type of Appalachian place you’re in: . • Town = has a dollar store .• City = has a Wal-Mart.• Sprawling metropolis = has a Target.
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Today I’m remembering the time I was up to my elbows in an emergency and called the evening pharmacist and basically just said “I need protamine for [this patient]!” and hung up and before I knew it she was in the room with it and clinical pharmacists are SO NECESSARY.
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Our American health insurance system is terrible. Health insurance tied to employment is extra terrible. Health insurance tied to employment that doesn't even kick in until a month after you've started is triple terrible.
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“How was your day?”. The patients were sick. The management was fun. The families were heartbreaking. The procedures were good. The volume was exhausting. I loved my team. I missed my family. My legs are sore. My brain is tired. My heart is full. I think. “It was good.”.
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Medical professionals staying home if they feel sick is obviously the right answer. but can you tell me what that actually looks like? . If every trainee with cold symptoms stayed home for the duration of their illness, I don’t know if we would have enough workers. Right?.
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Playing clinic with a 5 y/o: . 5: What’s wrong today?. Me: I can’t get warm and I keep shivering. 5: Um, here’s some hot chocolate. I’ll have some, too. Me: Do you think I might have a fever?. 5: What? Oh…I’m a heart attack doctor. You’ll have to go to the fever doctor.
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I feel like I am losing family because of COVID, and it’s not because they died. 😢.
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Working in the ICU really makes you appreciate being able to just walk around euvolemic, without even needing lasix or fluids.
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I recently gave a COPD boot camp lecture and wanted to share some of the high points. 🫁. #tipsfornewdoctors.
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I started a palliative rotation today, and it seems I’ve found where they keep all the best people in the hospital. My attending also directed me to this poet and beautiful poem as my assignment for the day.
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I didn’t understand what was in the mystery chest tube box for most of my residency.
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Resident sign out: 65M with h/o SSS and MRSA bact, pacer wire with veg, s/p TEE. Last cx still + on Wed. On Vanc, awaiting hardware change. Levo down from 0.3 to 0.1, on 3L NC. Fellow: Guy with MRSA bacteremia, pacer infected, on vanc, pressors down. Attdg: Septic. Better.
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Tell your med students to stay home when the weather is bad. Being an essential employee isn’t a skill you learn. It doesn’t need to be practiced. They’ll have plenty of time to be necessary when they’ve got the pager and the pay. No need to endanger everyone’s life at once.
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A necessary part of medical training is building resiliency and assertiveness, and learning to be tough, for lack of a better word. But that’s not the difficult part. The difficult part is trying to retain your gentleness, despite all the hard edges that training creates.
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Our nurses leave us to travel, making more money elsewhere (and good for them). Other nurses travel here to work because we are short staffed, making more money here as a traveler. Make it make sense.
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What percentage of your tired is actually just future tired over things you’re dreading?.
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Hey new interns, we really are glad you’re here. We don’t think you’re dumb, you’re not too slow, you are not a bother to us, and you’re not asking too many questions. We think you’re going to be good at this. We’re excited to teach you some stuff. Love,. The Seniors.
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Do NOT write COPD in that chart unless you’ve seen the PFTs with your own eyeballs.
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Every morning report—. Attdg: Who does the patient live with?. Seniors/interns: *crickets*. Students: He lives with his ex-wife who is actually his first wife, and he moved in about 4 months ago when his second wife cheated on him while she was in Vegas. He also has a chihuahua.
Third year of med school: old enough to be in the hospital, but too young to be helpful.
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🎶Merry Christmas to me,.I'm board certified in pulmonology🎶. 🫁🎁.
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You get THREE Christmas movies for the rest of forever. What are they?
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When you’re watching your attendings intelligently disagree with each other but the source of the disagreement is a little over your head.
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An ER doc from home arrested on his shift last night. He is very sick. He walked me through my 1st subclavian as a resident. He was always looking for critical care learning opportunities for me when I was around in the hospital on his night shifts. He is such a light there.
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UptoDate just showed me this in a pop up. Did we know this already, COPD twitter?
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*whispers* it’s ok if you occasionally have to stop somewhere on your way home and you’re wearing scrubs.
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If you’re talking to a patient about a potential cancer diagnosis, you HAVE to say the word cancer. Not tumor, not malignancy, not mass, not leukemia, not lymphoma. Cancer. Don’t dance around it. #tipsfornewdocs.
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I almost quit med school as an MS2. Stopped studying. Suddenly bombed a bunch of tests as a result. Didn’t even register for Step 1. After a long talk with my husband, I had a change of heart on the last day to register. Med school sucks. Don’t let anyone tell you otherwise.
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I am five minutes later than I had planned because as I was about to walk out the door my little boy came and took my hand and excitedly said “Mom come look at this lady bug we can lay here and watch it together!” and I have found that very few things can’t wait five minutes.
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So how long do I have to exercise regularly before I’m in shape enough to exercise regularly.
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If you are caring for a pregnant patient with COVID, please ask them about their breastfeeding preferences on admission and document it, so we know what they would like us to do if they end up intubated and delivering.
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Conditions that I truly worried that I had while in med school: . - Optic neuritis + MS.- Vertebral artery dissection.- Lupus.- Peripartum cardiomyopathy .- Shingles.- Ovarian cancer. Studying diseases in a basement with little human contact is not good for a person.
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In 25 years our current trainees will be the seasoned attendings who still keep a small stash of N95s in their office drawer, just in case.
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Husband: Are you ok?. Me: Yeah. Well. I mean I’m just grumpy because I weigh 20lbs more than I would like to. 6yo: Why?! It’s ok! You can have as many pounds as you want!.
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Sometimes the little extras make the difference in getting the line or not getting the line. This not a how to. These are some tips and tricks that people have taught me over the last 2-3 years, and that I teach to residents. All additions, corrections, and comments welcome!
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I would be the worst debater ever because I would just answer the question that I was asked and then stop talking when my time was up.
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There’s so much heaviness in standing over a person just before you intubate them, knowing that these will be their last waking moments. I want to say something comforting and substantial, but everything I can think of feels trite and small.
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Signed my attending contract today, on the first day of my last year of training and that all feels significant. 🥳.
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Amazing how when you go to the dentist they will stab your gums over and over with little knives and then blame the bleeding on your inadequate flossing.
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Please just give everyone who is on long term oxygen therapy a portable concentrator. It’s ridiculous to expect people to be able to get out and about with the tanks.
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I can’t figure out why we give tPA so liberally for stroke but everyone is afraid to give it for massive PE.
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Medicine takes a lot from a person and doesn’t leave much of you to go around. That can be hard to navigate sometimes.
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Toddler had been asking me to see lungs (he knows you use them to breathe) and we have been looking at chest X-rays and watching videos this week. He knows trachea, bronchi, and alveoli and can pick out the heart/lungs on XR. WHY DID NO ONE TELL ME HAVING A KID WOULD BE SO FUN.
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When I’m an attending I want to free students and residents from feeling like they have to know everything all the time. We can look up labs, we can look up PFTs from 1975, and we can look up the dang hyponatremia algorithm on UpToDate. I’m happy if you’re happy and learning.
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Laying on the couch post 24hr call and my toddler just came over with a toy syringe and “injected” it into the middle of my forehead saying,. “It’s a brain shot, Mommy. It’ll make you feel better.”.
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“The woman on the treadmill next to me is coding” means something very different to me than it does here, apparently.
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Delta is changing everything, particularly for families with kids who are too young to be vaccinated. I am so tired, and I just want this to be over.
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I am very tired. Please don’t make me have to explain why COVID is not a conspiracy, why plandemic is nonsense, why you should still be distancing and staying home, and that no one WANTS the economy to be driven into the ground. I just don’t have it in me right now.
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I would give it in a boat.And I would give it with a goat.And I would give it in the rain.And in the dark and on a train .And in a car and in a tree.It is so safe, so safe you see!. I would give it here and there.I would give it anywhere!. #getvaccinated
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Interesting that at the beginning of the pandemic, there was that (inappropriate) meme or whatever going around about OBGYNs having to intubate. But a year and a half in now, the actual problem is intensivists having to deliver babies in the medical ICU.
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So if they invoked the 25th would that be a contrecoup?.
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There are still 30 and 40 year olds dying of COVID, in case you were wondering.
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Our palliative care pharmacist taught me about methadone & buprenorphine & micro dosing & X waivers & all the things I never learned in residency & I wish you could’ve seen the way she LIT UP talking about it. I also told her she should join twitter because y’all would love her.
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I have to tell you a story about my sweet 6 year old. Tonight as I was putting him to bed he didn’t seem like himself. He is always wide open, always goofy, always grinning, and always talking up a storm.
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Hey students and interns, let me tell you a secret. You know how your seniors and fellows seem to know stuff about the admissions you do together?. When we give you a headstart to work on taking your history, we’re reading UpToDate. 😬.
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If this is true and I’m just now learning about it I am going to be mad.
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@SarahJaneguru Clearly none of your nursing was actually in a hospital. Patients are awake and writing messages on the vent literally all the time. Some even get up and walk around. Sincerely,.Actual ICU Doctors.
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“The patients you’re seeing in clinic, we saw in the hospital. The patients you’re seeing on the floor, we had in the ICU. The patients you have in the ICU were dead when I trained.”.
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I have a text group with my COVID+ family called COVID Crew where I check on them BID and they report their symptoms and vitals to me and we discuss frequent ambulation for VTE prevention and as you can see I am a really fun relative.
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Tonight is my last. - night shift.- weekend shift.- MICU shift.- shift attached to a pager. of fellowship! 🎉.
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Today I told my 6 y/o to have a banana. His eyes got big and he said, “I don’t think you want me eating too many bananas!”. He ran upstairs and got this Periodic Table book, then brought it down and read me that second paragraph. 🍌
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Bacillus cereus came up clinically during rounds today and every doctor or doctor to be in the room went “THE RICE ONE?!”.
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My non-med husband asked me why software in medicine was so far behind in an era where most software is so good and so intuitive. Any ideas?.
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