7% NaCl (Salty)

How to be a terrible person: Lesson 1:

Wrong. Screening may detect a dissection, but millions of people live with stable aortic dissections. Thoracic aortic rupture is a sudden onset surgical emergency that has a very high mortality rate, even with immediate access to care.

@RandomEvent95 There are eight shelves of this at Barnes and Noble these days.

@TwoRulesOfWar Take note on how to write best selling novels that instantly get movie deals.

@SpaceborneMedic You can. It’ll be tight for a while, but my wife went to graduate school during the immediate aftermath of the housing crash and things were very tight then and I was making shit money as a flight nurse . Easier to do before kids though.

@TwoRulesOfWar Who can afford grad school in this economy?

For what it’s worth, you could have a ruptured aortic aneurysm standing in the ER with thoracic surgeon next to you and still might not make it.

@BriannaWu You’re a real piece of shit. You know that, right?

The worst kept secret in Washington was that Lindsey Graham was gay. I’m sorry if that’s news to y’all, but this is just something that is known. And I think it’s sad that he died alone fucking prostitutes who literally hated him and mocked him, which is why everyone knew. I’m not reveling in anyone’s death. I genuinely think that’s sad. I think most closeted gay men of Lindsay Graham’s generation are tragedies.

She won’t because this job changes tou. It has to, bu it’s very nature, but I promise. She’s going to be fine. Healthcare is the highest highest and the lowest lows often in the same day. You can help somebody feel better and save a life, and utterly fail to do so twenty minutes later. You’ll do CPR on a kid and get them back and they’ll go onto a full and happy life at 9 am and at 11 am you’re pulling a remote control out of an unmentionable place. What she will never, ever worry about, is the question about whether what she does does matters- because it does; and it will matter deeply to the people under her care. She’s going to do great. It takes a very special type of person to do ER- a combination of cynical, hardass and deeply compassionate at the same time. Tell her to stay flexible, drink water and remember to not take it personally- and give her our best. Is older Emergency Types are waiting to pass the crown- but not u til they’re ready.

@TwoRulesOfWar @brent_maz My daughter starts in an ER tomorrow. I worry that she won't be the same person in six months.

@lyndonbajohnson “Californians”

Saw a guy struggling to start his car going into HEB. Still there 40 minutes later on the way out. Nobody'd give him a jump. Gave him a jump. What the fuck has happened to Texas that a dead battery doesn't materialize 40 Bubbas with jumper cables who live for this situation? -OS

Oh, this one hits. Rest in peace, Dr. Grant. (Sam Neill absolutely owned the role and so many others.)

@SpaceborneMedic You’ve come so far. so fast. One of these days, you’re going to go to graduate school, and I am going to be very excited to watch that journey and I will help any way I can.

@TwoRulesOfWar I've witnessed this exact scenario

Losers don’t get a say who gets executed. That’s history 101.

Yeah! Who cares if he wrote the majority of the Federalist Papers, the defining arguments for our constitution? He was clearly a midwit globalist and not a *true libertarian* (tm) despite that not being a thing at that point in history or his own writing to the contrary.

@bronzebarbarian MBIC, if you have a ruptured thoracic aortic aneurysm, *you* don’t tell the surgeon you’re done. He tells *you* you’re done.

@TwoRulesOfWar Because I'm just going to tell the surgeon I'm done and walk away.

@mdusahk They’re the surgical specialty specifically trained to open your chest, cross clamp the aorta and repair the hole before you die. If they get to your fast enough, they can do it, but you need a whole lotta luck and factors falling your way for it to work out.

@TwoRulesOfWar What does a thoracic surgeon good for if you have a ruptured aortic aneurysm?

@UKnowwho222 Yeah, those are bad shit. I’ve seen people in the intensive care unit being monitored specifically for pulmonary embolisms get saddles and die in a matter of minutes.

@TwoRulesOfWar Same thing for a saddle embolus.

That’s a wild generalization.

@olamide3039 It’s true. There are some parts of your brain where if you lose perfusion, you actually do OK. (M2 and M3 segments of the MCA, etc.). There were other parts where if you have an aneurysm rupture you’re basically making an appointment with Jesus. (basilar artery)

@TwoRulesOfWar People often assume every tragedy is caused by a delay. Reality is that some medical emergencies are catastrophic from the moment they happen.

@BoSoxFanAimee A dissection is very different than a rupture. A dissection isn’t good, but it generally maintains the integrity of the vasculature space. A ruptured aneurysm does not and in the aorta that gives you seconds to live.

@TwoRulesOfWar Jaime Dimon survived an aortic dissection.

@PeteMye23798979 @CyborgPeds That’s my whole career. ‘Ho hum’ to ‘OH SHIT’ in seconds. I can be eating a sandwich one minute and five dilated have my hand inside someone’s chest.

@TwoRulesOfWar @CyborgPeds Not many things go from ho hum to oh shit, oh fuck in less time than it took to say that.

A friend of mine told me before my first deployment: ‘Don’t worry about dying. The bullet or rocket that is going to kill you has already been fired – and there’s not a thing you can do about it, so don’t worry about it.. Be smart, Be safe, make good decisions and you’ll be home before you know it.’

@TwoRulesOfWar I find death to be one of the most random things in the world and people just don't get that

This is a fundamental misunderstanding of heroism. Those heroes aren’t heroes because of their powers. They are heroes in spite of their powers. Harry wanted to protect his friends and break his family curse. The avengers had multiple reasons to do what they did but all overcame personal challenges and ended up bound by loyalty to each other- even to death. Aragorn was willing to sacrifice himself to save even the humble hobbits, fighting a horde of orcs alone to save Sam and Frodo on Amon Hen. He also led a sacrificial attack that may lead to his death on the Black Gate to buy Sam and Frodo time to destroy the ring. (A day may come when the world of men comes crashing down, but is not this day! An hour of wolves and shattered shields but it is not this day!) Heroes aren’t defined by powers. They’re defined by who they are and what they believe in- and what they’re willing to sacrifice for who they love.

1999 was the peak of human existence.