Jack Iwashyna🫁
@iwashyna
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Not paying for Twitter. I work @JohnsHopkins as @JHU_BDPs to help patients + their loved ones heal from critical illness
Baltimore, MD
Joined July 2013
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9 Oversimplifications that I Think are Mostly True--an intro the
#HealthServicesResearch
Aphorism 1: U.S. healthcare is not consistently great at care or health
Aphorism 2: U.S. healthcare is best in the world at getting money from others
Aphorism 3: It’s not really a system
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I did not know the man, yet this brings a lump in my throat each time I pass it
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In the years I since I have taken the
#NoManels
pledge, this is the first time I've ever had to send this email
But I took the pledge, I raised the issue up front, and now I am honor-bound to follow through
A global pandemic is no time for old-boys-clubs + exclusionary science
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It has now come to intensivists volunteering to do unpaid overnight shifts in the ICU to make sure patients have enough staff to care for them
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Bicarb was just described by this brilliant nurse as “the Spanx of medicine”
“It holds everything together for a little bit, but when it wears off, **BOOM**”
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I can’t believe I have reason to write this, but…
If your mental models of healthcare workers are all immunocompetent young adults with neither dependents nor medically vulnerable friends or relatives…
You’re doing your mental models wrong
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Never be the smartest person in the room
If you are:
(a) find a better room;
(b) check the calibration of your self-regard.
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Our ICUs are full and Costco is out of decent toilet paper and I am just going to sit in my car and hyperventilate
Nothing to see here
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Speaking as a medical intensive care physician, this is ludicrous.
BREAKING: Charging doc against Minneapolis police officer who kept his knee on George Floyd’s neck says autopsy revealed: “No physical findings that support a diagnosis of traumatic asphyxia or strangulation”...combination of force & health problems contributed to death. (CNN)
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My teen is COVID+ this week. I have been taking care of her wearing a KN-95, and we have a HEPA filter running in the house
I am still negative on day 6. I texted her to let her know and her response is too good not to share
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My humble
#COVID19
opinion
Stop wasting money on wishful-thinking drugs
Double or Triple your ICU Nurse + RT's wage, so they can give as much time as they need w/o sacrificing their family as heavily
Watch our patients get better
That's it. That's the tweet.
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I am hugely proud of some of big papers I have written
But most of my best science is solid incremental work in mid-tier specialty journals relentlessly-but-slowly accumulating small new facts about the world
That relentless, rigorous, incremental, empirical work IS my legacy
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@MattWhite_95
@Sciencing_Bi
@browofjustice
Agreed
Wes Ely,
@ICU_Recovery
and
@jcjackson68
at Vanderbilt are the world’s experts at clinical recovery of post-critical illness cognitive impairment—please DM me if I can help connect you
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I have been promoted to full professor of internal medicine, with tenure.
Thanks to all for their support.
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If they believe
#BlackLivesMatter
, large academic medical centers need to accept more
#COVID19
patients in transfer
Business-as-usual during this crisis is choosing to let Black + brown patients die disproportionately
I wrote in
@nytopinion
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Illness is not metaphor
Illness is not judgment
Illness is not a test of character
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One of the tenets of medical professionalism, as I understand it, is that our commitment to excellence is the same for every patient
Regardless of race or religion
Regardless of background
Regardless of choices they have made in the past
Regardless of vaccination status
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July 2022
This is going to be fun
I look forward to new learning + discovery with
@JHUPCCMFellows
@OslerResidency
@HopkinsPCCM
@JohnsHopkinsDOM
@HopkinsMedicine
under the leadership of
@NadiaHanselMD
and
@JHU_HBHI
@JHSPH_HPM
@JohnsHopkinsSPH
under the leadership of
@DR_KMP
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1st rule of being a doctor: it’s not about you, it’s about the patient
1st rule of being a mentor: it’s not about you, it’s about the mentee
1st rule of being a father: it’s not about you, it’s about the child
1st rule of being an author: it’s not about you, it’s about the reader
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With no disrespect, I think this response is like thinking the way to do more surgeries is to build more scalpels
The shortage of tools is acute, but not nearly as acute as the shortage of experts to wield them
Ventilators are just easier to count
#COVID19
#HumanCapital
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Better late than never
Google will not make contributions from its political action committee this cycle to any member of Congress who voted against certifying the results of the presidential election, following the deadly Capitol riot.
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And if your guidance to institutions does not begin with “protect your team”, well, you are doing that wrong, too
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My child + I picked up
#free
#anonymous
#Narcan
today at a
@cvspharmacy
, courtesy of State of Michigan
Did you get some for your house?
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My first
@medrxivpreprint
10.1101/2020.04.15.20066688 has posted:
An amazing collaboration w
@ProfAmyCohn
@HalliePrescott
@DeenaKCosta
and many others
Explainer coming soon
Is HHFNC really more aerosolizing than 6L NC or spontaneous breathing?
Nope
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This tweet has gotten much support, which is amazing
It has also gotten a small number of responses that seem to be arguing “let critically ill patients suffer/die to make some point”, and that gets a hard pass
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My brother just shared with me a home-brew regimen being circulated among well educated folks that includes not only the clearly wrong HCQ and Ivermect!in, but also 4000 mg of Tylenol + 3200 mg of ibuprofen a day (might be 4000 mg, written as q4h but 4x/day)
Oh goodness
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Look, I don’t want to be a corporate shill, but this is like the best news ever
Today, we shared positive pre-clinical data demonstrating our ability to combine 6 mRNAs against 3 different respiratory viruses in 1 vaccine: COVID-19 booster + Flu booster + RSV booster.
#mRNA
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If you are another clinician or caring professional who is feeling that way—I feel you + want to give you a hug + help you get back to being your best self
If u r not, may I strongly suggest u re-examine your moral compass + read more deeply about nonviolent organizing tactics?
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Co-sign
There is no way understanding the Krebs cycle is more relevant to excellent clinical care than understanding redlining. Fight me.
Every healthcare professional should be required to know and understand why redlined neighborhoods from the 1930s correspond to areas with the worst racial health inequities today.
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Meanwhile, in NEJM, an interesting exchange about what constitutes racial bias, as it relates, for example, to pulse oximetry
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(And if you try to use this emergency to pit physicians against nurses or other clinicians, I block unapologetically)
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Hey, I love all the love Michigan is getting right now, but let's be clear who really deserves the love
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As
@SCCM
@atscommunity
+ others finalize their 2019 programs, now is a good time to renew your commitments.
FWIW, this how I accept invitations. Usually warmly received by organizers.
No
#manels
, no
#allmalepanels
Science + professionalism thrive on diverse views
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My physician colleagues who are looking for a thing to do right now...
The prestige of our profession is being used to excuse police brutality. You can help fight that directly by explaining in your own words why the autopsy quote below makes no sense
Please consider doing so
BREAKING: Charging doc against Minneapolis police officer who kept his knee on George Floyd’s neck says autopsy revealed: “No physical findings that support a diagnosis of traumatic asphyxia or strangulation”...combination of force & health problems contributed to death. (CNN)
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I wrote something about trying to be a clinician in these
#COVID19
times for a new
@mcsweeneys
series
Sad? Inspiring? Rage-Fueled? What Kind of Story From the Medical Front Lines of the COVID-19 Crisis Do You Want? - McSweeney’s Internet Tendency
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.
@nytimes
: “President Trump has been given the steroid dexamethasone, the president’s physician, Dr. Sean P. Conley, said on Sunday”
This is HUGELY important. In the
#RECOVERYtrial
() Dex did NOT help and MAY HAVE KILLED people not on oxygen
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Please get vaccinated
It is not perfect. Nothing is. It IS really good
(ICU service day 6…)
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6:30 a.m. texts are one of the joys of mentoring surgeons in research
[forgive the censoring]
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The initial logic behind using a single
#ventilator
to support
#multiple
#patients
is compelling, and speaks to our most basic urge to rescue.
A long thread, to outline challenges that must be solved for it to work in
#COVID19
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“I wish it need not have happened in my time,” said Frodo.
“So do I,” said Gandalf, “and so do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given us”
(Sent at request of my son, to all HCW tonight)
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.
@LungDocDoug
on service last week asked house staff each day to tell the team one thing about each patient as a human being outside the ICU--to aggressively re-humanize every patient every day
I thought
@RanaAwdish
might enjoy this
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#ICUreadings
A single article that overviews all of CT of the lung? Yes! and does so with helpful pictures showing what the hell these ridiculous radiology metaphoric "signs" are supposed to look like in the world and the lung. bravo.
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I have done 24 days of ICU service since the epidemic hit here.
I have never been offered testing.
I have no idea if it is safe for me to be around my family.
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Of all the many pieces of undeserved good luck in my life, I think the biggest was my wife falling in love with me
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I had to relearn again today that bringing data to a discussion about feelings is bringing a knife to a gun fight
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Paid underemployed middle teen child to bake for team this morning so I could sleep in rather than drive to donut shop
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These two paragraph has by
@Jbrekkie
capture so much of modern hospital care so much better than anything I have yet written
2 pages later she writes “we had tried to choose living over dying and it turned out to be a horrible mistake”
Echoes of
@RanaAwdish
+
@WesElyMD
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My family’s immigration “papers” after World War 2 from Ukraine, when the United States welcomed them as stateless refugees fleeing both the Russian Army and Nazis
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This is a tremendous honor, only possible due to the incredible colleagues, teammates, + mentees w/ whom I have the privilege to work -- in a fantastic environment
@UMIntMed
@VA_CCMR
@umisr
@UM_IHPI
@ncspMICHIGAN
For more information re: Dr. Tucker:
Congratulations
@iwashyna
on being named Alpheus W. Tucker MD Collegiate Professor Internal Medicine award. Couldn’t imagine someone more deserving.
#GoBlue
@UM_IHPI
@umichmedicine
@UM_PCCM
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3 papers on
#sepsis
that came up a lot this week on my service
#ICUreadings
1/ When to give
#antibiotics
in the ICU? it's about BOTH the probability of infection AND the cost of being wrong
@HalliePrescott
in
@AnnalsATS
:
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Fresh
@AnnalsofIM
@anicalaw
@garyweissman
+ I, on behalf the Pulmonary Critical Care Anti-Racism Working Group break down the physiology of why one can speak even if one cannot breathe
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(I wonder if this will get me in trouble)
I wrote a piece in
@AnnalsATS
. I'm not sure how to summarize it as a tweetorial or VisualAbstract, but it's only 4 pages, so here you go
How do we know when someone is
#acutely
#dying
, what should we do then?
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I love that many of you engaged with this clinically. It was intended to be a heavy-handed metaphor
After 42 years of deeply gender-unbalanced medical conferences, simply saying “henceforth we will try to be equal” does not result in a balanced scientific discussion or equality
Imagine you get a patient in the ICU
Cared for by an out-of-date standard for the last 42 days, they have gotten fluid resuscitated, every single day, day after day
If the plan is to now restore them to balance,should you?
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I shall quote this on rounds in the ICU this morning.
#TipsForNewDocs
, Never say "there's nothing more we can do." We can always treat pain, continue discussion, offer comfort/empathy. Always.
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The personal library of retired John Hopkins University Humanities professor Richard A. Macksey, housed in his home.
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This is an incredible reframing that needs to be heard deeply
#LongCovid
is likely the largest mass disabling event in modern history. Ignoring it will not make it go away, but it *will* worsen all outcomes.
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#ICUreadings
Starting in the unit for 14 days tomorrow. The fellows + I are going to try to do 1 new paper a day to catch up, just a conversation with more senior trainees + attendings, with space for lots of assumed knowledge
Here's our prelim list if you want to read along...
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#ThriveICU
If you provide ECMO / proton beam therapy
but not physiotherapy
then "lack of resources" is a management choice about priorities
NOT an excuse
#ccc47
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I really want to write a paper on ARDS recovery titled "It will leave you breathless, or with a nasty scar"
It would be a homage to Roy Brower
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Since apparently sometimes I'm unclear.
Yes, I do sometimes tweet personal things from this account.
My tweeting about
#MeToo
and gender inequality are core professional + pedagogic commitments, and would in no way decrease if I were to confine my statements to "academics".
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We can admit the US healthcare system is number 1 in expense but pretty mediocre otherwise, right?
Or do we still have to pretend?
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#MedTwitter
: I think we are bad at admitting we have normal human emotions
So I propose
#FeelingsFriday
, wherein we try to do so, in public, cuz it has been a long year
Share a popular song lyric (no deep cut Shakespeare here, nothing heroic) that reliably chokes you up
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Nurse
@Jomcpeake22
wins
@ATSCritCare
International Early Career Achievement Award -- first nurse ever to be recognized with an
@ATSCritCare
achievement award -- for her pathbreaking work on recovery after ICU, including
#LongCOVID
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Dear mentees,
Please use page breaks, not many sequential returns, to separate tables and figures into separate pages
Signed,
Your slightly obsessive mentor
(but details of presentation matter...he muttered to himself)
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I absolutely understand the idea of “with” not “for” COVID.
Just explain why hospitals are coincidentally bursting at the seams right now with very high absolute numbers of patients if this is true?
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One of the unexpected joys of science, for me, has been the deep friendships I have developed with colleagues around the world through shared meaningful work to make lives better and learn new things
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FYI, the
@umichmedicine
nurses in 6D have started calling
#covid19
proning “tummy time” and I love it
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“That’s why they are calling us ‘heroes’. That’s what you call someone you are going to force to betray themselves”
@RanaAwdish
#ATS2022
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With this document, the US offered a new life to my grandparents + father in 1949, when they were semi-literate Ukranian war refugees living in a camp in Germany
The US has been indescribably good to my family. Surely paying that forward to others in need is America at our best
"Herewith we affirm under oath:
My name is Fedor Iwashyna
I have no papers to prove my identity as I have the nationality of Ukraine and I couldn't get my papers. ...
We have the following children:
1./ Sergiy Iwashyna ...
2./ Basil Iwashyna, born 28.11.39 at Wlad.Wolynsk"
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I am a child of an immigrant
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I hereby nominate this as the official tree of 2021
Knocked over, burnt, it still somehow turned itself around and started growing straight up again. Less robust than it once was, but moving in the right direction
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Yes, dear mentees, I really would prefer you use the oxford comma.
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Sometimes -- and today was one such time for me -- being an ICU physician lets one truly witness the sacred
I am not sure I have ever seen a family as effectively blend love, truth, and bravery as beautifully as I just saw
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My 16 yo son: “I am very precise when I talk. It would be better if I were accurate, but at least I am precise.”
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Louder for the folks in the back:
1/ nurses are the scarcest resource in this epidemic
2/ nurses are quite specialized and not interchangeable—ICU skills take time to develop
#NoNursesNoICU
(HT
@juliaflynch
@DeenaKCosta
)
Agree! what is also sad is
@juliaflynch
@neva9257
@erin__ice
+ I wrote about lack of attention to RNs in media + guidelines during
#COVID19
(with data!) and guess what? Can’t seem to find a journal interested in publishing it. Shouldn’t be disappointed but I am...
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I definitely had several plans for things to get done this morning, but all are on hold because sleeping kitten on shoulder
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