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Cake day: August 7th, 2023

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  • In the mental health field in particular, it’s not unusual to list various not-a-diagnosis problems, stress factors, life circumstances type things, in the diagnosis list (see also: social determinants of health). E.g., a lot of my patients are homeless, and I also work with a lot of forensic patients, so their diagnosis lists often includes “homeless” or “legal problem”. Which, obviously, aren’t actual diagnoses, but it’s often the best way to communicate to other members of the care team or future caregivers what the major factors are influencing a patient’s health. For many people, “low income” is a major source of stress which drives or exacerbates their mental health problems, so it does make sense to include if the therapist thinks it’s a factor.

    Now, why it’s the only item listed is another question entirely. It could be a quirk of whatever system they use for patients to view their records; with the electronic medical record system my employer uses, on some screens it only shows the first item in the diagnosis list, so if I put in “homeless” first then that’s all I would see on some pages. The system isn’t smart enough to know what’s an actual diagnosis or not, so it relies on humans to put in the data correctly.




  • Except China is doing exactly that, and it has been known for years, with multiple US federal agencies taking various steps to counteract it. E.g.:

    https://www.brookings.edu/articles/chinas-role-in-the-fentanyl-crisis/

    https://www.npr.org/2024/04/16/1244964595/fentanyl-china-precursor-overdose

    China, specifically the CCP, has an obvious interest in weakening the US, and has demonstrated that they have no qualms with injuring people to achieve their ends (for further reading, look up Hong Kong, the Uygher people, and Tibet). (And no, before you think it, I’m not saying that getting poor white Americans addicted to opioids is equivalent to genocide of Uyghers.) We have a massive opioid crisis in the US, and it has been fueled in the last few years by fentanyl. Virtually all of the illicit opioids available here now contain fentanyl or are comprised entirely of fentanyl, and it’s routinely found contaminating other drugs.

    It’s a problem that is recognized by both parties. To say “China is flooding the country with illegal drugs” is, yes a gross oversimplification of the problem, but it’s a simple narrative the Republicans can use to try to convince their voter base that tariffs are somehow a sensible course of action. If their voter base was wont to grasp and meaningfully contemplate complex geopolitical issues, they’d never have voted Republican in the first place.


  • So, not exactly what you’re asking, but: I worked for 4 years as a psych tech before becoming a nurse, then switched to ED when I graduated. It took a solid 6 months in ED to start feeling like I had any idea what I was doing and not feel like I was in a panic every single day, then another 6 months before I started feeling actually somewhat comfortable. Part of this is because I was a new nurse, and part of it was because ED has a steep learning curve (the orientation period was 5 months iirc). I suspect it would have been an easier transition to ED if I had already had some experience as a nurse on something like a med-surg or cardiac unit. I switched back to psych as a RN and it really only took a few weeks before I was “standing on my feet” as it were, but I already had a good deal of psych experience from being a tech and I wasn’t a new-grad nurse anymore.

    What do you mean by dedication? As in time/effort to acquire the necessary skills/knowledge, or emotional fortitude? Definitely oncology and hospice require a lot of the latter, as you and death will become familiar company. ED sees a fair amount of death and it tends to be constant demands, constant action, with days where you wont have a chance to catch your breath. Psych can be soul-sucking at times and tends to be at higher risk of violence from patients, but there’s also a lot less dying or cleaning up of blood and feces. How much dedication a specialty might take will depend in large part on what your strengths are and what you can tolerate or are willing to put up with. I hated ED because of the constant pressure and never knowing what will come through the door next, but I love psych despite often having to work with people with aggression problems and having been hit a few times.

    Are you thinking of changing specialties? What’s your motivation? What do you want to do now, and do you have something particular in mind? I suspect the ease of transition will mostly depend on what experience you already have and how much skill/knowledge overlap there is with the new specialty.







  • For all his faults and evils, Vance is not a narcissist who pathologically seeks the approval of those he sees as high status, which is what has compelled Trump to try so hard to be buddies with dictators. Vance is more cunning than Trump and would need to have a profit motive beyond just an ego stroking before putting his position at risk (even if the risk is evidently slight, but his relatively low popularity / lack of cult following makes me think/hope he’d have a harder time getting away with stuff than Trump). I suspect most dictators don’t have much to offer Vance in the way of profit that he couldn’t just as easily secure for himself as president without the personal risks of selling out the country to foreign adversaries, and the most salacious scandal we’ve heard about him has to do with a couch rather than Epstein so the kompromat is probably minimal or nil.

    Don’t get me wrong, a President Vance would be awful in a lot of ways, and arguably worse than Trump in some ways. It’s just that I don’t imagine him as being quite as much of a national security risk. But, again, maybe it’s just naive hope. 🤷






  • Some people are genuinely apathetic or feel like it doesn’t directly impact their life, but a lot of people fall for the propaganda of “both sides are the same” and that it makes no difference either way, and a lot of people are intentionally disenfranchised by various voter suppression efforts by Republicans. Then there’s the electoral college nonsense which leaves the populace of 43 states with essentially no say in who the president is, leading some to wonder why they should bother, not being mindful that their vote may carry weight for the federal legislature and state/local elections. And many people are just too busy surviving to worry about anything else.

    For my part, voting straight Democrat in a heavily Republican-leaning state, my vote literally means nothing at all because my state will inevitably give all of its electoral college votes to Trump, and will elect nothing but Republicans to the federal legislature and for almost all state/local offices. But I voted on the first day of early voting, and I will vote in every election, because we have to show support for change if we ever want there to be change. There are enough left-leaning people in my state for it to be a swing state (hell, we had a Democrat for governor 2003-2011, and he was popular), but so many see their votes as meaningless simply because their fellow left-leaners also aren’t voting…





  • CPR. Doing 2-3 chest compressions, seconds apart, and then some mouth to mouth, followed by 2-3 more chest compressions. Or the needle into the heart thing. Or the shock a flatline thing. All of it. It’s just all wrong.

    On Andromeda? I believe it was, a villain used the stereotypical twist the head to break the neck and they fall over dead bit. The character proceeded to be not dead and did the stereotypical express their love while dying in the protagonist’s arms bit, talking and moving their neck as if it wasn’t broken. And then died.