Susan Wilcox, MD

Ok, I have to say something, especially as I keep getting pulled into in these posts. COVID-19 causes ARDS. I keep hearing the refrain that it is not ARDS because “the compliance is normal.”

This has to be satire, right?

@DougMann7 Can you please provide a link to this German protocol? I was pretty well-versed in the global COVID protocols, and I never saw anything this drastic. Also, what compliance value are you reporting as normal? I'd love the citation.

@MiscSusan The German ARDS protocol, which calls for the use of mechanical ventilators was applied to all cases of COVID where O2 sats were dropping. However, normal lung compliance was seen with the 2 main presentations of COVID hospital patients, who needed more O2, not mech ventilation

Ok, I have to say something, especially as I keep getting pulled into in these posts. COVID-19 causes ARDS. I keep hearing the refrain that it is not ARDS because “the compliance is normal.”

@kareem_carr Plus - the fact that she was attacked for giving the answer that was written and answered by a man only further proves that it’s the packaging, and not the content, that people objected to. That was the point of the post. Not that she was the first to come up with the answer.

@kareem_carr That’s exactly the point. Why would these non-experts feel comfortable lambasting her? Because of who she was, not because of what she knew. (Plus, I never saw anything about her claiming to be the 1st. She just answered the question. So the fact she wasn’t 1st is irrelevant.)

I know folks love these "the experts don't know anything" stories, but this isn't one of those cases. The Monty Hall problem was *created* and solved by statistician Steve Selvin in 1975, 15 years before vos Savant published her solution.

In 1945, six women pulled off a computing miracle. They programmed the world’s first computer—with no manuals, no training. Then, a SINGLE assumption erased them from tech history for decades. The story of how ONE photo nearly deleted computing’s female founders: 🧵

@EM_RESUS @IM_Crit_ Yeah, I like how it highlights the “pseudonormalization” of the ABG, or normalization with spectacular patient effort, as with in this terrific teaching case above👆🏻

@MiscSusan @IM_Crit_ Love this! I think we all do this on at least on a subconscious level, but to explicitly state it as an actual mathematical calculation is brilliant.

ICU Snapshots: - How is this new patient in room 6 doing? I have not seen him yet - Blood gases look ok. Po2 96, Pco2 35 - OK, I will see him in 5’ 5’ later: I saw the (non-invasive) vent screen before entering the room

@SalaryDr @KunalBSukhija I’m curious- in your program, how are residents being given more responsibility than APPs? This may warrant further discussion with someone, as residents should be supervised and have a focus on education.

@KunalBSukhija Couldn’t agree more. Especially when you consider residents are expected to hold more responsibility than the APP.

Ignoring what hospitals could afford, or would be willing to pay, what would be a fair salary for a resident? I think most would say $100k (nice even round number) & step up for most. Assuming 80hr weeks this is $25/hr and is above minimum wage.

@SalaryDr When I started as an intern in 2004, we made $45,000 in Boston. That was still really tight and difficult to live. I just calculated that to be ~76,000 in 2025, so that is a baseline number - just inflation. Since it was so tight then, I don’t think your 100,000 is off.

The more certain someone is, the less they’ve seen. Wisdom doesn’t deal in absolutes—it holds contradiction, nuance, and the humility to be wrong.

PAC use in medical ICUs is a dying art form. Don’t always need them, but you still should be able to work with them in select situations. Even if you’re experienced, get all you can out of the data! It’s not about any 1 #. And context is everything.

@AmiBhattMD Amazing thread Dr. Bhatt! Thank you for sharing.

The first pacemaker was primitive. It failed. Again and again. But trial and error is how innovation works. Every failure taught researchers something new. Today, millions of people rely on pacemakers—because two doctors dared to take a risk, and one woman refused to give up.

In 1958, this man’s heart kept stopping—20 times a day. Doctors had no solution. Then his wife demanded an experimental surgery that had only been tested on dogs. What happened next changed medicine forever. 🧵

@IM_Crit_ Thank you so much. Few things frustrate me more. These “max” doses are usually arbitrary institutional policies and not based on any evidence. Drives me insane - especially when patients are allowed to be profoundly hypotensive because they are “maxed” to some arbitrary limit.

ICU Facts: There is no way you can work in a 🇺🇸 ICU without hearing the expression "the patient is maxed out on pressors". This means that the pt is on the maximal dose of pressors (usually norepi) allowed by the institutional protocol Even though the “maximum dose” of pressors

From SCCM Congress 2025:

Still reading this myth that ventilators killed people with severe Covid. It's like going outside on a rainy day and blaming umbrellas for the rainfall

The rules are extremely strict because the risk of rejection is extremely high. This is not a new policy. You can’t get a heart transplant without your vaccination because the patient will need to be on anti-rejection drugs for the rest of their life that make them immunosuppressed. If the patient then gets Covid & dies, then the patient dies & the heart is wasted. This isn’t political.

*Every single* cure for a disease ultimately flowed from basic exploratory research. Stopping basic research is like stopping the mountain rains and expecting rivers of cures to still flow. Examples: 1) studying saliva of Gila monster -> GLP1's 2) studying funghi -> first statins 3) mRNA biology -> gene therapy for spinal atrophy 4) studying bacterial genetics -> CRISPR gene therapies 5) studies of nuclear magnetic resonance -> MRI scans this list can go on and on. Not only in biology but all aspects of technology.... e.g. 6) curvature of spacetime -> GPS 7) quantum mechanics -> semiconductors 8) electromagnetism -> fiber optics -> internet ...

@NotoriousS1Q3T3 Obviously. We studied them extensively in numerous contexts. Immunology, infectious disease, internal medicine, pediatrics, public heath… they are one of the most important advances in medicine, so they come up over and over again in medical school in all different ways!

Physicians, medical students, and other allied health professionals in patient care roles: Please like, comment, hand-raise, etc. if you learned about vaccines (and their incredible effectiveness and strong safety profile) in medical school. I’m trying to see something here. ✋🏻

@VipsMDMEd Inhaled epoprostenol for ARDS or other severe hypoxemia.

What’s a medication you use off-label more frequently than for the labeled indication?

@RepGregMurphy @GmOrr9000 What’s your definition of full time? Full time clinical? Research? Teaching? Admin? Given that it varies wildly from specialty to specialty, academic to private, by locale, with other factors… this post is nonsense for a whole host of reasons. (Also, I paid for my own tuition)

@GmOrr9000 It should be mandated that unless disabled, each medical school graduate should have to practice medicine FULL TIME for 15 years (minimum) or have to refund the Federal Government for the cost of tuition.

#1 reason for MD shortage is Med schools admitting students who aren’t going to practice. Only 60% of med students today plan on practicing clinical medicine. Med Schools need to focus on admitting students who want take care of patients, not just get their MD.