There are deer frolicking and literally chasing turkeys around in our yard right now.

Our log so far this spring. The tufted titmouse is our favorite, but the cowbirds have our favorite call. The boys think it sounds like a robot but I hear a rock plopping into water.

I have had a very long few weeks, with lots of work. Today it was cool and rainy and I got to unplug, start about a hundred seeds, thin out all my growing seedlings, and visit all my perennials as they’re waking up. Here’s a couple of my little apple trees. 😌

“Those who serve in the front lines of rescue must learn —and teach others— to slow down, evaluate with a clear clinical eye, and determine whether the carnage they are creating in the hope of victory is destroying any possibility of achieving the good they are attempting to do.”

When I was a resident I always felt like the sepsis police were out to get us. Did you check a lactate, did you see the sepsis alert, did you document why you didn’t do 30ml/kg, etc. Now though I feel like it’s the CLABSI police.

WV is a small, so it’s common that I’ll have mutual friends with patients and see things about them shared online when they’re sick, or have passed. At least twice recently I’ve seen outpourings of praise for what wonderful people they were. It’s a good reminder of the humanity of our patients.

In general I don't like protocol or algorithm driven care. This feels like many patients will unnecessarily get PA catheters which are not without complications.

Our hospital is doing a new initiative where if you suspect someone has shock and it could be cardiogenic, you call a shock call and the swan must be placed within 90 minutes. If a candidate for MCS by the numbers, you escalate to cardiology and CTS. Do you guys do this at your hospitals?

Today I learned that Mercury’s day is longer than its year. 🤯

Seeds feel like magic. Something so small grows into a tree?!

I know sitting and working in the unit is a popular strategy for ultimate availability, but I do my best doctoring when I can have some time by myself to think.

Today’s organ donation question—would you have qualms giving premortem heparin for a DCD? What about if there’s a head bleed, or GIB, etc?

We moved our fellows from 4 week blocks to 2 week blocks (which I loved as a fellow). The residents now frequently mention that 4 weeks of ICU is too much. Is this the case elsewhere too? I have only ever seen 4 week blocks for residents and have always accepted that as usual.

The sun is nervous As a kite That can’t quite keep Its own string tight. Some days are fair, And some are raw. The timid earth Decides to thaw. From March, by John Updike

Re: organ donation. Is there literature on what percentage of patients who start the process of DCD progress to death within the allotted time frame?

This little guy and his lady are back for the third year building their nest in our birdhouses and they make me so happy. Our indoor cats love supervising the nest build, too.

"This miserable political moment will end when especially Christian politicians forsake cruelty for compassion and realize that we shall know Christians in politics not by their stridency and ideology, but by their integrity and love, inc. their love for, as Talarico put it, “all of our neighbors.'”

I think @davidfrenchjag.bsky.social and I would disagree on many lower-level policies, but I completely agree with his point that having Christian politicians espouse actual Christian values is sorely what the US needs now as a way out of our division. www.nytimes.com/2026/03/08/o...

Things are starting to wake up 🌱

I think we are making PE more complicated than it needs to be.

Last night we went to visit my new niece. Today I got to sit in a few hours of faculty development on teaching. This evening I started two trays of seeds while my kid played on the swingset and my husband baked focaccia and the cats meowed through the screen at the birds.

Fresh blog: STRATIFY trial for PE Peripheral tPA infusion is EQUALLY EFFECTIVE as compared to ultrasound-assisted thrombolysis Catheter-directed thrombolysis for PE is dead We can get the same benefits with peripheral tPA infusions (w/o procedural costs & complications)... #1/2 #EMIMCC

Given the literature on vent mechanics and cuff leaks as poor extubation success predictors for allcomers, should routine measurement of these things be built into pre-extubation workflows for RTs? Or should they be optional, and done only when requested/felt to be necessary? #emimcc

My two brothers have had 3 babies in under a year. We just had to postpone the first birthday party for his sister’s birth. I am swimming in bay nieces and nephews and it’s the best thing ever.

PERT activation worksheet 😁 trying to design a one-page sheet to collect info & guide the process this is what I've got so far, please provide constructive feedback #EMIMCC

I got this in preparation for Sturgill Simpson’s physical only album release and I am so happy. We used to record ourselves on tape at my grandma’s and this one records, too.

WV governor announced a data center coming to the eastern panhandle. It will sit on 540 acres and create…125 jobs. 0.23 jobs created per acre by this monstrosity. Not to mention how bad it is for the environment, the economy, and literally for our brains and souls as humans. So sad to see this.

Why do I have to pretend that I'm going to print something in order to save it as a PDF. Why do I have to engage in a little ruse.

This one hits hard.

So NJ lawmakers wrote a bill to rein in ICE. And this is what they called it. www.nytimes.com/2026/02/21/n...

Adding to my To Read list

The daffodils are getting started so it must be time to order one million seeds. 🌱

I adored The Martian and Project Hail Mary but I am struggling to get through Artemis. The main character isn't likable, and I have no reason to root for her at this point.

If this country was truly “pro-life,” we would have Medicare for All, a Green New Deal, gun reform, universal child care, and a living wage. The right-wing agenda isn’t about “life.” It’s about control.

We ordered Thai food and watched Mickey 17 and the latest Deadpool and it was the best Valentine’s Day.

Perfect Andy valentine from the KY Democratic Party.

💕💕💕

A frequent point of contention in my work life: paper vs digital. Paper lists for rounding, clinic intake forms, asthma action plans, etc. All MUCH more effective and useful than digital, but systems INSIST on everything being digital and it drives me nuts because it just doesn't work.

I need to go to a conference this year. I don't fly. CHEST and ATS are far away from WV. Any favorite conferences within CCM, pulm, or medical education I should look into? #emimcc

The people I work with make fun of me for my obsession with the patient's bowel reg and last BM, but people can literally die from complications of constipation and it is an avoidable problem!

Applications for our APP CCM fellowship open next week! One year, starting in September. Core ICU rotations include MICU, CICU, CVICU, SICU, STICU, NSICU. #emimcc www.camcmedicine.edu/departments/...

Listening to it now and I am SO EXCITED.

Grammy winner for best country song!!

This

Shrinking 😭

Watching The Martian because I’ve been listening to the audiobook. Boromir is part of the meeting named Project Elrond and he helps explain why it’s called that. 🤯

January cozy

Poisonous plants Horror fiction Ecology German Cell and molecular

“Ask any doctor who worked with him and they will tell you: he protected. He taught. He defended women colleagues. He bought coffee for broken interns. He made the ICU more human. That is what great nurses do. They don’t just carry out orders. They carry the unit.” -A physician friend of Pretti