Melissa Red Hoffman, MD, ND, FACS

The grief after violent death (homicide, suicide, accident, war, disaster) is unique and often very isolating. My hope is this talk will help survivors feel less alone and will help others support survivors while they work to make meaning out of the worst day of their lives.

@rafaellugomd @MaryBowdenMD I agree with idea, but do you have any suggestions on how to operationalize this? A 2nd opinion would require some sort of credentials which would then grant necessary access to the EMR. Credentials process, which may feel lengthy or burdensome, is essential for patient safety.

As a physician, I fully support patients' rights to seek trusted expertise and second opinions it's fundamental to good care. However, allowing any out-of-state (or even out-of-system) licensed MD to directly consult or influence inpatient management creates real liability risks for everyone involved. The external doc may not have full access to the EMR, hospital protocols, or real-time labs/imaging, leading to recommendations that can't be safely implemented. Undisclosed issues (e.g., prior board actions, malpractice history not visible across states) could expose the hospital/team to vicarious liability or credentialing gaps. If the external opinion leads to conflict or adverse outcome, it risks finger-pointing in litigation Why didn't you follow Dr. X's advice? Or Why did you allow unprivileged input?' A balanced approach might be: if the hospital truly lacks the needed subspecialty expertise, facilitate transfer to the institution/physician the patient prefers (with appropriate transport/insurance coordination). That preserves patient choice without bypassing established privileging and safety systems. What safeguards do you envision in the Second Opinion Act to address these practical/medicolegal hurdles? Appreciate your advocacy patients deserve more options.

You think you have a right to a second opinion—but in most hospitals, that "right" is strictly limited to their own staff. It’s time for legislation that ensures patients can consult with the doctors they trust, regardless of hospital "privileges." As long as a physician's license is in good standing, their expertise should be available to you when you need it most. What do you think? Should you have the right to a second opinion from any licensed doctor?

@TXOwallet @NoFilterSkin Me too! Have had some wild compliments while wearing it.

LADIES : what’s the one perfume that got you the most compliments ? I’m talking people stop to ask what you’re wearing

@Rick_Pescatore Thanks. This is fascinating. So much to read about mitochondrial dysfunction and microcirculation in the chronic disease literature, but I haven’t been exposed to these ideas before!

Article link: journals.lww.com/em-news/fullte…

The biggest progress we’ve made in years in cardiac arrest was derailed by trolls in an EMCrit comments section. The frequency with which idiot politics influences patient care should make you weep. I wrote about it in this month’s @EMNews!

@udarnik @DrPlantel Agree - not all physicians are good and ethical people. My point was the vast majority of docs who commit to so many years of post-graduate training (residency and fellowship) are well intentioned & part of those intentions are shaped by close contact with colleagues and mentors

@RedMDND @DrPlantel But "for the most part" leaves room for a large minority of bad apples.

Why do some people who never finish residency become the loudest medical grifters? It’s amazing how quickly ego rushes in when training and accountability are missing….

Hopeful. Just started.

@theoliverxp @EO_Nutrition Also look at pyridostigmine- acts as a acetylcholinesterase inhibitor (as opposed to nicotine which acts as a receptor agonist). But pyridostigmine affects both nicotinic and muscarinic ACh receptors (and the muscarinic are what affects the autonomic system).

@EO_Nutrition What about a sensitive nervous system that can’t handle the sympathetic surge from nicotine? Is there an alternative, or do you just keep the dose so low it’s tolerable?

I don’t know you would fix the receptor sites if blocked or damaged, but you can’t make Acetylcholine without Acetyl-CoA and you can’t make Acetyl-CoA without Thiamine.

@silverpebble Your posts never fail to make me smile so I am sending a hug your way❤️

My mental health declined pretty badly last week & I still feel as though I'm at the bottom of a well in the dark, but some of you asked for more photos like the hunt-the-tiny-owl one I made recently & I so wanted to try to make an advent calendar for you so here's a start: some lovely things that fell off trees & this time a tiny deer stag🦌to find. As ever making my photos is creative medicine for my brain-it changes my brain biochemistry & makes me feel slightly more alive. If you like this photo, find the stag, maybe enjoyed the process & would like more photos like this maybe let me know below...

@jeremyjudkins_ I’ll think of Don today. Wishing him safe passage to the great beyond. And wishing your heart some peace. Caregiving is the hardest job. Some of the content on grief.com is very helpful🙏❤️

At the hospital on Thanksgiving. I am thankful for 16 years of memories. This is likely the last full day my husband, Don will be alive. We have made the decision to proceed with comfort related care beginning tomorrow. Some of you know he had a stroke in 2019. It slowly progressed and got worse. It’s been a struggle to juggle my life, happiness, and also be his caregiver. He recently fell in his memory care facility a few days ago and it has quickly progressed from ER to hospital admission to ICU after a code blue. I was told he went without oxygen to his brain for 20 minutes. I don’t know how to process this right now but the best I can do is be with him on Thanksgiving. It was his favorite holiday. He called it “Fat Boy Christmas.” I don’t know if he can hear me but I have told him I will be okay and he can pass peacefully. I will play the Macy’s Thanksgiving parade for him. Perhaps it will bring back some really good happy memories. Please enjoy this video of Don singing. He was an amazing singer and sang until the very end. He never forgot the lyrics to his favorite songs. His brother passed away around the time this video was recorded and it made him realize life was too short. We fast tracked our life together and the rest was history. I moved to Florida to be with him and we had an amazing life together full of love and happy memories I will cherish forever. I love you Don. ♥️♥️♥️

@mikejwhelan @phillytuesday @suethompson91 Home hospice still requires an extremely heavy lift from the caregiver. That being said, it can be helpful for symptom management, for emotional support and for help navigating the world at end of life. Other thought- is a PACE Program an option? Can google it❤️❤️❤️

@mikejwhelan @phillytuesday @suethompson91 Few thoughts from a hospice medical director… while one hospice company may not feel she qualifies, it may be worth reaching out to another one or two. The Medicare guidelines are not always as clear as one thinks. However, the reality is (and you may already know this Michael

Home and Hurting Tonight I’m lying here in bed with a truth I can’t outrun anymore: I came dangerously close to the edge today. Not because of one dramatic moment, but because 500 days of being the only person holding this entire world together finally crushed me. After last week’s procedure, I did what I always do I came home and went right back into caregiving like nothing had happened. No rest. No recovery. No breathing room. I lifted Rebecca, steadied her, cleaned her, answered her questions, tried to calm her episodes. Tried to be strong enough for both of us. And today, my body finally said no more. I felt myself swaying, losing strength, slipping into that frightening place where you wonder if this is the moment your life gives out. But the thing that scared me more than collapsing was the same brutal thought that haunts me every day: What happens to Rebecca if I don't make it home? Not in some abstract sense literally. Who walks through our door? Who gets her out of bed? Who speaks for her when her mind freezes? The answer, today, was almost no one. A neighbor a stepped in so I could get to the ER. Not family. Not a support system. Not the medical world. Just someone down the street kind enough to answer the door. In the hospital, hooked up to IVs, exhausted and shaking, I finally said the words I’ve been swallowing for months: I can’t keep doing this alone. I’m breaking. And if I fall, Rebecca falls harder. I asked for Social Services. Filed a “caregiver crisis” report. Begged for Palliative Care because the truth is, I’m out of reserves. Out of backup. Out of the illusion that I can somehow hold this together forever. And I’ll be honest I don’t have much faith in our medical system or our insurance. I don’t trust that affordable help will suddenly appear. I don’t trust that someone will step in when we’re drowning. Everything feels like a fight, a battle you’re expected to win without any armor. Rebecca is being tteated for advanced Parkinson’s and who knows what else along with episodes of catatonic psychosis. She’s slipping faster, disappearing in front of my eyes. Her world is shrinking, and I’m the only person guarding the doorway. That’s why I reached out to my sister my brother and Rebecca’s sister. We need a blunt, unflinching conversation: If I die who takes care of Rebecca? If the answer is “no one,” then we need to stop pretending. I haven’t responded to all the messages I don’t have the strength. But I read them. And they mattered. On a day when I felt myself disappearing, your words were the only proof I hadn’t vanished completely. Tonight I’m just a man in a dark room trying to figure out how to keep the woman he loves alive when he can barely stay standing himself. I survived today. But something inside me cracked wide open. And I can’t hide it anymore.

@tashabloombaby @katiamek Do you have a brand you can recommend

@katiamek Beef organ capsules taken with vitamin c. Only thing that has helped me

Any help from anyone with severe me ? My ferritin is 21. I can’t do infusions because no doctor considers it out of normal here. Will it increase with supplementing? Immunologist said I should see a hematologist but I’ve already had in the past and again - gaslighting. #mecfs

@matt_vanswol Beautiful book. I read it in my young 20s, looking for answers about my dad’s murder. It kept me close to God. I haven’t read it in 30 years but it continues to get good reviews. a.co/d/dVve2OY

Lately, my 5-year-old has been asking a lot about God. We’ve only been going to church since March, and I can see him struggling to understand. The other day, he asked his mom if God sent Hurricane Helene to punish us for being bad. ...that one got me He asked me again last night why God lets bad things happen and if he's mad at us. I told him no. That sometimes bad things happen so we can learn how to love each other better. But honestly, I’m not sure who needed to hear that more... him, or me. I think I had been holding onto the same question, just with more anger and resentment... ...and yesterday, I finally let it go

All Trauma/Surgical Critical Care/Acute Care Surgery fellows interesting in upping your ACS robotics game. Applications now open for the 2025-2026 AAST ROBO-TRACS program! Deadline October 30th. Will include monthly webinars and a hands-on training day at @IntuitiveSurg lab in Atlanta. @traumadoctors @traumadoctorsam Apply: aast.org/education/robo…

@LiangRhea LOVE this!!!

By chance, I've packed a leotard that matches the artwork in my hotel room. That's never happened before! 💜🩰🤣

@Rach4Patriarchy @StefanMolyneux This has really made me think- been on both sides of this equation. Agree that it is at least as hurtful. Also a very similar mindf-ck because in both situations the partner somehow convinces you the problem is all in your head.

@StefanMolyneux True. And possibly even more hurtful.

Consistently refusing sex in a relationship is a form of cheating.

Rest in peace, Patricia Routledge 🙏🏻 In memory of her, I encourage everyone to read these words of hers from February last year. Whether young or old, you're bound to get something out of it. ***** "I’ll be turning 95 this coming Monday. In my younger years, I was often filled with worry — worry that I wasn’t quite good enough, that no one would cast me again, that I wouldn’t live up to my mother’s hopes. But these days begin in peace, and end in gratitude. My life didn’t quite take shape until my forties. I had worked steadily — on provincial stages, in radio plays, in West End productions — but I often felt adrift, as though I was searching for a home within myself that I hadn’t quite found. At 50, I accepted a television role that many would later associate me with — Hyacinth Bucket, of Keeping Up Appearances. I thought it would be a small part in a little series. I never imagined that it would take me into people’s living rooms and hearts around the world. And truthfully, that role taught me to accept my own quirks. It healed something in me. At 60, I began learning Italian — not for work, but so I could sing opera in its native language. I also learned how to live alone without feeling lonely. I read poetry aloud each evening, not to perfect my diction, but to quiet my soul. At 70, I returned to the Shakespearean stage — something I once believed I had aged out of. But this time, I had nothing to prove. I stood on those boards with stillness, and audiences felt that. I was no longer performing. I was simply being. At 80, I took up watercolour painting. I painted flowers from my garden, old hats from my youth, and faces I remembered from the London Underground. Each painting was a quiet memory made visible. Now, at 95, I write letters by hand. I’m learning to bake rye bread. I still breathe deeply every morning. I still adore laughter — though I no longer try to make anyone laugh. I love the quiet more than ever. I’m writing this to tell you something simple: Growing older is not the closing act. It can be the most exquisite chapter — if you let yourself bloom again. Let these years ahead be your TREASURE YEARS. You don’t need to be famous. You don’t need to be flawless. You only need to show up — fully — for the life that is still yours. With love and gentleness, Patricia Routledge ***** Once more, rest in peace. 🤍

Take a listen to the podcast, first published in 2020. podcasts.apple.com/us/podcast/dr-…

Thinking of Dr. Balfour Mount, the father of Palliative Care, who died last week. I was so lucky to interview him twice for my podcast and to correspond with him over the past few years. What an incredible legacy! This is a photo of Bal and Dame Cicely Saunders!

@danaparish @PhillyPhile215 I ❤️ you Dana (and Melissa). I literally had sent her mom the link to chronic a few hours ago but didn’t think to reach out to you directly. Thank you.

@PhillyPhile215 @RedMDND So sorry. There’s no in-patient facility for Lyme that I can rec but it sounds like she needs to be in hospital. In terms of a Lyme doc, if $ is no object, Dr. Richard Horowitz or Dr. Elena Frid are two ideas. Feel free to drop my name. ILADS.org can rec further.

#chronicillness folks: I have a dear friend who is dying from malnutrition secondary to #LymeDisease. If money were not an issue, is there any place in US you would suggest she go for treatment. She needs careful refeeding as well as treatment for Lyme and ??? Thank you❤️🙏