Night 6 of 7 done. This stretch has been crazy stressful with tons of critical care and even finding myself joining security in physically restraining an intoxicated patient for 20 minutes Tonight, I got paged to the ICU for *CODE LATTE* I love my team 😊

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Ooh, that's a helpful new EPIC icon

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Temporary blindness Another rare disease has been reported in Australian Natalie Adler, who lives in Melbourne. A young girl suffers from temporary blindness. It is expressed in the fact that the patient periodically cannot open her eyes due to severe spasms of the eye muscles. An interesting fact: the girl's phenomenon is observed cyclically and repeats once every three days. Natalie says that this happened to her for the first time after she suffered severe sinusitis with complications of a staphylococcal nature. Since doctors can't help her heal yet, she plans all her activities in such a way that she can do everything that is most important before the next spasm.

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Hutchinson's disease Progeria, or Hutchinson's disease, is one of the most famous rare diseases. Due to congenital genetic abnormalities, a young child's body begins to age at a tremendous rate. At the same time, his psychological development remains, as it should be, at the childish level. The child's appearance becomes characteristic of the disease when he turns 2 or 3 years old. He is diagnosed with severe stunting, loss of skin elasticity, lack of hair and secondary sexual characteristics. Veins appear on the thin and pale skin. Progeria is 2 times more common in boys than in girls. Approximately 80 people with this pathology are officially registered worldwide. Death from progeria occurs at the age of 10-13 years, but there are cases when patients live up to 27-30 years. A kind of record was set in Japan when a person lived to be 45 years old and died of progressive heart failure.

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Morgellon's disease In 2002, American doctors officially registered the rare Morgellon's disease for the first time. When it develops, the patient feels as if nasty small insects are running around under his skin. On the one hand, the clinical manifestations of the disease strongly resemble the classic psychosis observed in some forms of schizophrenia. However, on the other hand, during an objective examination, lesions did appear on the skin of patients, and the muscles cramped. The vast majority of patients reported that some kind of "worms" or strange "fibers" penetrated into the depths of their skin. Previously, researchers thought that rare mutagenic fungi that can survive in any situation could cause the pathology. Over time, the fungal nature of Morgellons disease was not confirmed, and in 2012, the opinion was finally confirmed among doctors that the phenomenon has a psychogenic origin.

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I'll start with a short block of posts about unusual diseases. ENCEPHALITIS OF THE LETHARGIC VARIETY This disease first appeared in the early 19th century and was classified as incurable. Those affected had hallucinations, after which they were practically trapped in their own bodies. Outwardly, it seemed that the patients were asleep, but these people were conscious and unable to move. Most died at this stage, and the survivors suffered from nightmarish behavioral problems for the rest of their lives. From that moment on, the disease no longer manifested itself.

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Write down the most unusual disease that you have encountered in your life.

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Medical facts ⚕️ 11. Heart surgery, which was performed in 1970, went down in history as the bloodiest. And in the literal sense. It took 1080 liters of blood for a patient suffering from hemophilia (blood clotting)!!! 12. In the Middle Ages, a doctor had to have a doll with him in addition to medical instruments. On it, the patients showed exactly what hurt them if the painful symptoms were felt below the chin, since if the doctor began to feel the patient, then with a high degree of probability he could end up in prison. And the patient herself would simply burn with shame.

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Medical facts ⚕️ 9. More than two million babies were saved by a simple Australian named James Harrison. He has a very rare blood type, the antibodies in which help newborns with severe anemia survive. For the sake of saving children, this man donated blood more than one thousand times!!! 10. Interesting fact! In case of amnesia (memory loss), the patient does not forget swearing in his native language. This helps doctors determine the nationality of the victim.

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It’s early in your career but your superiors already see leadership potential in you. They put you on the Peer Review committee as soon as a spot opens up, it’s the first rung on the leadership ladder they want you climb. Peer Review is where the doctors police the doctors. A patient has a bad outcome? Peer Review determines if the care was appropriate. The hospital gets a complaint? Peer Review gets tasked to investigate. Half of cases are automatically triggered by the monitoring system (inpatient deaths, rapid readmission to the hospital, complications above the expected rate for a surgeon, etc) while half are generated by complaints from families, nurses, and other doctors. You agree to the assignment. At first it’s fun. You’re good at learning by watching others and you learn a lot. You see others’ mistakes and it helps you make a system to avoid them yourself. You get a little frustrated seeing the same providers with the same behavioral issues, but that’s how it goes, right? The committee chair is great about taking action where they can and you generally trust their process. Although, it is slow, and you don’t really know why. One month, the chair gives you a case a little early. “I can’t do this one, there’s a history here and I’m already biased. Please look at it as soon as you can, but take your time.” The request is odd. Your stomach turns when you get the envelope. It’s a busy day so you don’t open it until late in the evening. It’s a complaint from a nurse about one of the doctors. You know the name well because many of this doctor’s cases have come to Peer Review recently. “A patient was failing and needed immediate intervention. We called *doctor* who told us to make the patient comfort care and close their door. The patient was adamant they did not want comfort care and wanted ICU transfer for their issues. *Doctor* again told us not to treat the patient or respect their wishes. On a third call with 3 nurses present *Doctor* agreed to let us contact the ICU doctor and the patient was transferred to the ICU.” You honestly can’t believe what you’ve read. It’s unfathomable. One of the nurses listed in the complaint, a friend, is working right then and you immediately go to her. She confirms the story told in the complaint. Worse, she says the rumor is this has happened before with this doctor and is considered acceptable culture on that unit. It is an oncology unit. Your mind is numb. This happens at faraway places, places where the people are different and mean and harsh, not at your hospital, not in your town. You call the main nurse who filed the complaint. You talk for over an hour. You write everything down. When you’re done it’s very late, but you don’t care, you call the chair of the committee. “Why is this person still practicing? Why hasn’t administration been notified to terminate their privileges immediately? Have we notified the police yet?” You ask. Silence. Finally, “So it is real?” You don’t know it, but this is the start of a years long legal battle. The doctor is the most loved doctor in town. Mysteriously, he commands a legion of patients and community supporters who will battle relentlessly for him. In the process, your committee uncovers cases that still make your skin crawl years later. Inappropriate testing and billing. Chemo for cancers that aren’t real - chemo that kills some of the patients. Unnecessary hospitalizations. High dose narcotic prescriptions that are not documented and appear to be cash pay. And worst, euthanasia, to the point that some of the cases look like murder. For the next two years you get grief in the community about the firing. “I can’t believe you fired them.” “This place really doesn’t care about its patients.” “The administration fired them because they didn’t want to pay their worth.” You hear it all, but there is no doubt in your mind the doc had to go, the evidence against them is overwhelming. Worse, you can’t correct the record. There is a lawsuit and you’ve been instructed not to say anything otherwise you will become a defendant. The doc sues everyone they can and succeeds at controlling the narrative…for a while. Years later the legal proceedings start, everything gets made public. Opinion shifts, slowly at first, then all at once. The doctor bullies as best they can and the public believes the lies, for a little bit. But the legal system is strange. They say it wasn’t the FBI, SWAT teams, or police that got Al Capone in jail for his heinous crimes, it was the IRS that booked him for tax evasion. Similarly, your villain is knee-capped by the Center for Medicare Services for false billing. When the government announces the charges, the doctor’s impenetrable, god-like aura vanishes. The king has no clothes. But it doesn’t reduce the static. After years of brushing off comments about the doctor’s unjust firing, you now catch shade for not stopping the issue soon enough. The community loses faith in your organization the same way you did when you opened that damned envelope years earlier and you have to deal with new reputational shame. You get “promoted” to the next committee and are encouraged to run for an officer position. The chair of Peer becomes the vice-president of the physician group, but then they get sick. Their heart is having issues. They miss work frequently. Ultimately, they need surgery to fix it. They are young, too young for these issues. You realize their illness came from the stress of the litigation. For years, they shielded you and your group from all of the lawsuits. They were named as a defendant, deposed, and brought on stand, but you never were. They took it to the heart to protect you. You’re good a learning by watching others. You quit your committee. You get off of the leadership track. You go into the woods more, where people won’t criticize you for things they don’t know. How many of these monsters exist among us? A question that can’t be answered. But once you know a monster exists, it’s reasonable to assume there are more, right? You once asked a police officer why they get such a bad rep. He told you that police officers are just people, and people can be good, bad, and every shade in between. It just takes one bad one to tarnish the lot. If your job has any power (police, doctor, lawyer, politician, billionaire, etc), you’ll get flamed, right or wrong, for any grievance. It’s fair to be skeptical, monsters do exist. But know there is a group of people out there, most of us actually, trying to do the right thing, even when it’s hard, even when it scars your heart.

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Medicine in non-urban settings is more and more becoming a spoke-and-hub model. You have a core group of boots-on-the-ground generalists physically present at the point of care, augmented by tele-specialists out of academic centers or 3rd party groups. My hospital now uses telemdedicine for ICU, neurology, and more specialties to come. The generalist (me) is now needing to learn more hands-on skills, too. I'm not complaining, I love learning. So far patients have had mixed feelings. They like having top of the line doctors involved but are understandably skeptical of their physical ailments getting diagnosed by a phantom intelligence hundreds of miles away. I suspect the same will be true with AI's. Why is this happening? 1) The tech now exists to make it possible 2) It's hard to attract talent out of cities 2b) If you can attract talent, they may be the only specialist around. It's not sustainable to expect them to be available 24/7

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Specialists who prioritize lucrative elective procedures over critical, underpaid care are perpetuating a broken system. When plastic surgeons avoid complex wound management or orthopedic surgeons dodge diabetic foot infections, they’re not just following perverse financial incentives, they’re abandoning patients in pain. You may have the skills to make half a million PLUS a year, but you’ve got the moral obligation to use them where they actually matter, not just where the money glows brightest.

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It is SO much harder to treat you when you lie to me. I'm not the cops. I don't care what you do in your free time. There is nothing you can tell me that will surprise me. If you didn't take the antibiotics, don't tell me you did. If you rip whippets nightly, I need to know because it may be why you're B12 deficient and can't walk. If there's a baggie of meth in your rectum, please tell me! I will retrieve it (yes, I have done this). I'm here to help you. Do AIs fix this? Will people be more likely to be honest to an AI? Or will it be worse? Will the AI not have the ingrained skepticism of a seasoned physician and just lead the patient into misdiagnosis hell?

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Shot...chaser In American healthcare https://www.aafp.org/pubs/afp/issues/2025/0600/mbtn-clostridioides-difficile-infection.html

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Medical facts ⚕️ 5. Coffee is considered a very harmful drink. That's what King Gustav III of Sweden thought. He decided to conduct an experiment. The governor ordered tea for one prisoner and coffee for the other, and assigned two doctors to monitor them. The king assumed that the prisoner who drinks coffee would be the first to die, but... one doctor died first, followed after a while by the second doctor, then the king himself was fatally wounded. And the prisoners died many years after the king's death. Moreover, the one who was given tea died first. 6. In England, during the reign of Queen Victoria, alternative medicine was very popular. Hydrotherapy has become the most widespread. Specialists came up with a rocking tub that could be rocked by the patient himself. This exercise caused the healing effect of sea waves.

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