Taken in its entirety from @suuperstar, because i needed to see it today and will need to look back at it again in the future

"Sometimes you have to be strong for yourself. You have to know that you're a good person and a good friend. What's meant to be will end up good, and what's not, won't. 

Love is worth fighting for, but sometimes you can't be the only one fighting. At times, people need to fight for you. If they don't, you just have to move on and realize what you gave them was more than what they were willing to give you. 

Hopefully, people realize great things when they come around and don't lose something real. 

Always fight, until you can't fight anymore, and then be fought for." 

Still having problems at work. more to come on that later, when i can motivate myself to setting something about it down. It sucks not being able to trust your own department

Spent 2 hours admitting a septic patient, trying to stabilize their rapidly failing heart rate, respiratory function and overall multiple complications in someone who was DNR

30 minutes after completing the admission, I am called down to pronounce the same patient.

Dammit.

Mr. Biochem: "What did my labs show?"

Dr. J: "Well, your homocysteine level was high, and..."

Mr. Biochem: "That's impossible! I'm not gay!

Dr J: ...

Overnight, one of my patients went encephalopathic.

When you have liver disease, you dont break down certain metabolites as well as a normal person, and toxins like ammonia build up in your body. These can get carried through your bloodstream into your brain and make you act crazy and irrational. Liver patients, or rather patients with liver disease can decompensate quickly and for a variety of reasons.

So.

One of my patients became encephalopathic and during the night when nursing staff wasnt watching, slipped out of her room, walked clear across the hospital and climbed into bed with another patient. When he awoke, he was understandably disturbed at the stranger in his bed. He was even more disturbed when she promptly shat upon his sheets, got up and returned to her room.

And that is why you always read nursing notes.

I dont know why I never put anything personal on here anymore. It's not like I am trying to do anymore about protecting my identity. Maybe it's just that life has been so busy that sitting in front of a computer for another hour just to sit down and complain that i have too much to do doesnt seem worth it. Easier to go swimming, or yoga, or something active with my limited free time.

Residency has been bad the last couple months. Mostly because I have been made the whipping boy in this hospitalists versus residents atmosphere. Someone not get their scheduled med? Josh's fault. Pt septic on wrong antibiotic? Probably Josh. Someone three counties over broke a hip and died from fat embolus? Get Josh's lawyer on the line.

It's not really that bad, but the snowball effect sure makes it seem that way. So in my final year of residency when everything is supposed to be sunshine, lollipops, and unicorn farts, what am I doing?

getting in early, writing all my notes, and then looking for procedures to do so I can minimize the amount of time I have to spend around all these toxic personalities until 5pm when I can go home. The upside it that it means even better pt care since I can hide in pts rooms to avoid the hospitalists...they will never find me there. I have already managed to do about 4 paracentesis and 3 central lines in 2 weeks. maybe i will throw a thora or two in for the hell of it.

I walk into the ER and notice a young couple at opposite sides of the room, neither one looking at the other, eyes downcast, the man occasionally reaching for his genitalia, the woman nursing a black eye. Seems like a fairly straightforward case and I find myself wondering why I got the call from the ED doc to admit to medicine.

Turns out the couple had been celebrating an occasion, lets say an anniversary just for the hell of it. At the fancy restaurant, the woman decided to slip under the table to give her beau an appetizer before the main course, as it were.

Of note, her past medical history is significant for seizures which have been well controlled on anti-convulsant medication. Of more significance, she opted not to take her medication this evening as she knew she was planning to have alcohol and was worried about possible interactions.

So there she is, fellating her companion when all of a sudden she begins to seize.

Kindly reread the above sentence.

The man, on the receiving end of a ooh, ooh, OW reaction, does some quick thinking and calculations and realizes that he is poorly positioned to be involved in her seizure. After trying once or twice to forcibly remove her head, he does the only thing he can think of to save his member and punches her right in the face. At which point he then goes to obtain assistance for his significant other with what had to be an elaborately concocted cover story.

End tally:

1 male with a lacerated member

1 female with post ictal confusion, remembering only that she went to a restaurant and is somehow now in an emergency room with a black eye

So, my questions to the modern gentleman

1.Does this qualify as the only acceptable excuse for hitting a woman?

2. What are your odds of the male counterpart of this dynamic duo suffering PTSD-no honey, lets just cuddle tonight, no BJ's necessary

"I started feeling the pain right after I ate lunch. So I think it was the sandwich."

"You had a significant heart attack. The fact that you were eating a sandwich just prior is a coincidence."

"Well, I think the sandwich caused it."

"You have a completely blocked vessel leading to your left ventricle."

"It's the sandwich."

"The sandwich is not blocking your vessel."

"What if I didn't chew it completely?"

"Food doesn't get swallowed into your blood vessels. There's medication we can give you to help your heart, but I need you to understand, this is a problem that's been building over the course of years."

"I did not have a problem until I ate the sandwich."

"You didn't have any symptoms, but the blockage was building. Your heart was not in good shape-- and now, post-event, it's in worse shape. Which is why we need to start you on medication."

"I don't care what you say, it was caused by the sandwich."

"That's fine if you think it was caused by the sandwich. Even if it was, it doesn't change what we have to do going forward. You need to change your diet--"

"Of course. No more sandwiches."

"Well, it's more than that."

"No-- it's the sandwich."

"Fine. No more sandwiches. Your heart attack was caused by a sandwich. And I'm writing you a prescription for three anti-sandwich pills that will help counter the effects of past sandwiches."

"But if I don't eat anymore sandwiches, I shouldn't take the pills?"

"No, you need to take the pills either way."

...

"Then how is this helping with the sandwich problem?"

Dr. J: "This is Dr. J, returning a page."

John: "Hi, this is John Anydude. You saw my girlfriend a few weeks ago for a left arm injury? She had a lot of trouble using her arm? I was with her at the appointment?"

Dr. J: "What can I do for you?"

John: "Well, she's getting a lot better, like you said she would and, um, I..."

Dr. J: "Yes?"

Mike: "Is there anything that might, like slow down her recovery? Not a lot, 'cause she's my girlfriend and all, but maybe just make it take longer?"

Dr. J: "Um, we're trying to get her better."

John: "Yeah, but she can use the arm for almost everything now, and when it was really weak she had me come in the shower to shampoo her hair for her, and that sort of got things going if you know what I mean..."

Dr J: I see you've lost almost 15 pounds since your last visit-- that's great! You're sticking to the diet we talked about?

Eaty McEaterson: Yep. But, doctor, I don't think this is healthy for me."

Dr J: What do you mean? Your blood pressure is lower, eating healthier and losing weight is going to be good for your heart failure and diabetes, it'll help your back pain, you're really doing great, I'm very proud of you."

Pt:But my foot's been hurting, and I think its because of the weight loss."

Dr J: ???

Pt:It used to be cushioned with all of this fat. Now that I'm losing weight, there's less cushioning, and when I walk, it's really the foot that's feeling the weight, without that cushion. I feel it all over. The fat made things soft. Now everything hurts

Dr J: That makes no medical sense, let me take a look and maybe I can get some xrays if you have a sprain or fracture or something

Pt: But now there is less fat to absorb the radiation and I am at a higher risk for cancer

Dr J: *curls up into little ball and cries*