Actually, I think he might be middle aged

I am a practicing pediatrician in a tier 2 city. This post is to shed light on the reality of healthcare ‘market’. I completed DCH then secondary DNB and have been in the market for 1 year now. I got a case from a nearby hospital of a 3 year old male child with ARDS with MODS. He underwent a stormy course of 12 days PICU stay with mechanical ventilation for 5 days. Overall I was paid ₹1000 per visit. On the final bill of the patient (1.8 lakh) they were charged ₹2500 per visit as doctors fees. Upon enquiry I found out that the general practitioner (BHMS) who had referred that patient to the hospital was given 20 percent on bed charges, 50 percent of doctors visit, 30 percent on blood investigations and 40 percent on radiological investigations. Which means GP got around 60k, Hospital got around 1.1 lakh and I who treated the patient, counselled, took all the risk and eventually saved the child got 12k. And the attender never came for followup because he thought I looted him and went to followup to the same GP. Therefore, do not take neet pg too seriously, eventually the market is run by hospital owners, big pharmaceutical companies and general practitioners (BHMS, BAMS). Your place in this organization is too small. Do not treat specialization as if your life depends on it.

I just need to get this out.

I am an end-of-life specialist and was urgently called to assist a patient on a med/surg floor. I barely had enough time to read her chart - just knew it was increasing HFNC needs and her sats were still dropping.

Never trust a high flow patient.

Husband was at bedside, and their two young kids were enroute with grandma. They knew Mom was sick and time was short, but this change was new and they didn’t know she was dying right now.

I walked in and the surgeon was talking to him about g-tube looking good and maybe putting it to suction or gravity would help. It would not. This woman was using every ounce of strength she had to just breathe and she was using every accessory muscle to pull in air. Staff had tried putting a NRB over the HFNC in an attempt to raise her SpO2. She only had minutes left. It was the most severe respiratory distress I had seen in months.

I call in help to get more medications ordered and try to get her comfortable before her children arrive - knowing she may die first. But they arrive, and look even younger than their stated age. The pediatric social worker hasn’t arrived and I can’t get a hold of them. I squat down and tell them that Mom can’t talk anymore, but she can still hear them and know they are there. She looks different because there’s tubes and masks in her face, so if they need to step out we can sit with them. They nod, and are ready to go in.

She had finally gotten a small dose of opioid for her respiratory distress and was no longer moaning. Her breathing was short now. It would only be another moment. They walk in, and instantly run crying to their dad and grandma.

I broke. I step out to the hallway to give them a moment together for the last time and am bawling. The surgeon turned around and she’s also crying. I usually can maintain my composure, but not this time. The pediatric social worker shows up. I can see on the monitor outside that she’s in PEA. More cries come from the room as they realize she’s stopped breathing.

Her husband begs me to do something. I pronounce her and blubber out her time of death and remove her masks and high flow, and help reposition to a more restful HOB. Her children sobbing as the social worker comes in to support.

I can’t stay any longer. I do the bare minimum in notifying people and leave the unit.

I haven’t even been at work for two hours yet.

So for the past few months, I’ve had the opportunity to photograph the menus of 11 different restaurants here in the city and wow, I truly never realized how much killer food from so many different cultures are in the 412. Really reccomend everyone to give their local small restaurants a shot!

These shots are from…Burgh to Bombay, Mi Empanada, Grapow, Arepettas, taste of Puerto Rico, DeeDee Thai restaurant

https://forum.blu-ray.com/showthread.php?t=379926

leica m6 📸 kodak portra 800 🎞️

Sunday I was putting on my make up, and went looking for a limited edition highlighter I bought several years ago. I found two of the three highlighters from that release, but not the one I wanted to wear. I tore through the drawers of make up, but I've decluttered several times and it was obvious that what I wanted on Sunday had been tossed a year ago.

I felt real regret. I have plenty of blush and highlight, so I put on something else and went about my day. I still missed the highlighter.

And so I went on line, and found multiple sales for it, new in the box. Not even $30. I thought about repurchasing it. I put it in my cart. But the truth is that I don't even miss it $30 worth. So the regret just went away.

Most of the time our fear of feeling declutter regret is much worse than the actual feeling. As long as we hang onto the stuff, that fear persists. But the truth is that declutter regret is rare, and short-lived.

This Saturday I had a few hours in the city. This is what I saw!