🌈 Alana Kinrich, MD
@AlanaKinrich
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“Some entitled little shit ER doc,” home cook, sometimes dancer, cat person, lover of swishy skirts and warm sweaters. She/her. 🏳️🌈 tweets≠employer
Bay Area, CA
Joined February 2009
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Life update!
@theodore_gordon
made the beautiful box from walnut and maple. The diamond is a family heirloom that my nana passed down to my mother when I was born, and it’s so special to me that my mom decided to give it to me now.
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If you come to the ER with a titanium cock ring that you cannot get off, our ring cutters are not sharp/strong enough to cut it. Which will result in us having to call the fire department to get their diamond saw, and this is a very undesired experience for everyone involved.
Please do not buy stainless steel or titanium rings. They seem cool until you can't get them off.
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On my flight the woman next to me boarded with no mask, while in air opened a brand new 3M aura N95 and wore it most of the flight, then took it off before landing and got off without a mask. I have so many questions.
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In residency, one of my frequent patients was found dead in a snow bank. She made a complete neurologic recovery and signed out AMA from the ICU. Later that winter, it happened again—cold/dead, warmed, complete neurologic recovery.
You’re not dead until you’re warm and dead.
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This week I learned that PAPR hoods are actually way easier and more comfortable than N95 mask + face shield. You can’t hear so well, but you do get the comedic effect of having to mime at each other while yelling. And blessedly, nothing touches your face.
#COVID19
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Today I learned that organ recipients can acquire food allergies from their organ donors, and I am *floored.* Can you imagine getting a new liver and now you have an anaphylactic peanut allergy?? That’s wild. Immune systems are so fascinating.
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@sallyt
In a conversation about fertility options with my ob/gyn, she used the phrase “if there’s sperm in your life…“ and I thought that was just most hilarious and wonderful way to say it.
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Please, please—have a hinge mechanism on your metal cock rings. Or use a non-metal ring in the first place.
I know this from (professional) experience.
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I did follow up on a patient admitted for covid. While he was inpatient, his strongyloides test came back positive. Now he’s getting appropriately treated with ivermectin.
I found one, guys! A covid patient who actually warrants ivermectin treatment!!
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Yes also this! Unbreakable and with a flared base for anal play, please. There are so many good toys out there. Please don’t use household items that are not intended for this purpose.
On a semi-related note don’t put light bulbs up your backside it’s extremely dangerous.
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One of my favorite cases in residency: young healthy woman was at a hookah bar with her friends when she started feeling very unwell. Sudden onset chest pain, palpitations, shortness of breath. She stood up to get some air, walked a short distance, and then passed out.
1/
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@gaysocialworker
Great question! There was enough room to put a little shiv under the ring. The next problem was that the entire thing got very hot, so we kept having to douse the ring and penis in ice water.
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Don’t check a urinalysis without symptoms of a UTI—but I would argue that, particularly in elderly women, altered mental status and delirium are absolutely symptoms of a UTI.
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The passenger seat of my car is a surgical mask graveyard.
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Actual triage note: “Tested + for COVID at home, does not have any symptoms just wants to be seen because she has COVID.”
How did we get here? What failure in messaging/education is happening?
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Me: Hi, I’m Dr. Kinrich, one of the Emergency Room doctors. I understand you’re not feeling well today, how can I help you?
Patient: What are you, 12??
Haha. It never gets old. Evidently, neither do I.
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Two docs in my group are married. Watching them sign out to each other...
Him: psych pt pending transport, chest pain needs 2nd troponin, etc.
Her: kid needs to practice violin, grocery list is on the fridge, please do laundry.
It’s kind of adorable.
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Hypoxic patient in respiratory distress who doesn’t “believe in any of this.”
Took all my low power not to say “Sir, you may not believe in COVID, but it certainly believes in you.“
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Helped an elderly woman with constipation have a BM. Afterwards she grasped my hands, looked deeply into my eyes, and told me “It has never felt so good to shit.”
Highlight of my shift!
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If you recently had surgery and you have concerns, please call your surgeon. If you need to go to the emergency room, please go to the hospital where your surgery was done. Or at least within the same hospital system. Please.
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I’m finding it very hard to continue to have empathy for unvaccinated people who are coming to the ED sick with COVID. None of the patients I have seen recently have a medical reason they couldn’t get vaccinated. They just chose not to. It’s hard to not get frustrated.
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Oh hello, I’m just over here crying over people offering their N95 masks to their nearest frontline healthcare workers. Totally normal.
A friend is going out of town and giving me 125 tomorrow. I haven’t seen that many in weeks.
#COVID19
#coronavirus
#GetMePPE
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Made a headband with buttons to hold my mask! Hopefully will save my ears a bit. Also, hair will go into a bun for shift.
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I just had a toddler patient reach out to me, crawl into my lap, and give me a big long hug. It was the best. Do I really have to see other patients today? I just want toddler snuggles.
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Sometimes, very healthy people in the ED are *indignant* that they got sick. “But I only eat organic, I exercise every day, I do yoga, I take vitamins, what was I supposed to do better?” Feels a little bit like toxic individualism mixed with willful ignorance. Thoughts?
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I am having a really, really hard day. One of the very saddest I have had in a long time. Kind words, animal pictures, and uplifting gifs would be much appreciated.
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My thoughts on the “Annoy an X doctor in one tweet”
Funny to make fun of doctors/the system (see:
@DGlaucomflecken
for a master class)
Not funny to make fun of patients seeking care, for any reason. Even if you are annoyed. Don’t punch down.
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Some takeaways:
- CO poisoning is a sneaky one. Can be non-specific and look like other things. High index of suspicion.
- Vital signs are vital, as always.
- Prehospital team members are amazing, and they might be more aware of environmental factors than the ED staff.
9/
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Dude, what the fuck? I shared my own experience as a patient/volunteer. I asked for information if my experience was generally common. (It was.) And this dude comes to comment that I’m a bad doctor? Fuck that.
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One of my joys in the ED is picking up young women with potentially embarrassing pelvic complaints. I’m more than happy to normalize symptoms, talk about sexuality, find your retained tampon, whatever. And patients tend to appreciate my age/sex too. Win-win.
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As always, your friendly neighborhood poison control/toxicologists are always happy to help. Call 800-222-1222 if you ever need them.
Also, maybe avoid indoor hookah bars. Or smoking in general.
10/10
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I get really upset when EM docs are unapologetically bigoted, especially against the disadvantaged patients that we take care of more than anyone else. If you don’t care for helping people in pain or sickness or with nowhere else to turn, GTFO of emergency medicine.
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@cocuzzo_kaitlyn
She was “homeless by choice”—her words. After the second time I believe she was deemed not to have capacity. Sent to a board and care against her will.
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This week’s winner for funniest chief concern that turned out to be COVID: “I’ve been eating out my girlfriend a lot, and I think I choked on something.”
1. Good job
2. What exactly would you have choked on?
3. No, that’s COVID sore throat
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Today in our urgent care area I saw 26 patients in 7.5 hours. Not all of them had viral symptoms, but of the ones I swabbed: 10 had influenza A, 1 COVID, and no RSV. Weird.
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40-something patient today asked me how old I was.
Me: 34
Her: And you’re a doctor???
Me: Yes... I’ve been a doctor for many years.
Her: Wow, congrats
I get that training is long, but how old does the general public think you need to be to be a doctor?
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Recent patient was very sick, hypotensive, dry on exam. Worried about septic shock, I gave LR 30 ml/kg. BP better. Later found Na 159. Admitting doc was upset I gave a high Na IVF, and not D5W.
IM friends, please understand EM has to make decisions without all the information.
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A general rule of thumb: your INR and hemoglobin should not be the same number.
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I recently took care of a 10 year old with type 1 diabetes who just had to ask his phone “Siri, what’s my number?” and it told him his current real time glucose. Guys, technology is so amazing.
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I just went to a fancy coffee shop, the kind where my two drinks came to about $12. The tip options on the screen were 20%, 30%, and 35%. Is this… the new expectation? I would normally tip $1/drink… but 35% on expensive coffees feels a bit much?
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Ugh. Somehow my tweet from last night about having a lot of COVID+ patients got found by a bunch of COVID deniers. I don’t mind talking to people who disagree with me. But if you make fun of my 🏳️🌈 or my pronouns, I will assume you are a bigot and block you immediately.
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Is there anything more beautiful than a fully stocked N95 drawer?
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This is profoundly, disgustingly unacceptable. Not just unprofessional, but illegal. How dare they. I’m livid.
If anyone knows these people or is in a position to help, please do. I’d be glad to assist in any way I can.
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I saw an elderly patient who had a German last name. He had a number tattooed on his arm—the same type of numbers that I saw on many of my friends’ grandparents and older members of our synagogue. I asked if he was Jewish. 1/
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My entire shift today was COVID. Even patients who I didn’t think had COVID, who were getting tested because they were being admitted, had COVID. Damn. I work in a region that has been relatively spared. This is my first shift that really felt like that.
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This isn’t even parody any more. It’s just… real life. I’ve actually said almost every one of these things. (How is he this good?)
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Late at night, already past my shift end time, seeing my last patient. His adult daughter is very knowledgeable and using medical terms. I incorrectly assumed she was a nurse. She’s a physician. Tried to apologize, made it more awkward. I hate this stupid internalized bias.
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On a 0-10 pain scale, an elderly gentleman just rated his pain 0.6. But the nurse needs a whole number for documentation. So now they’re discussing whether she could round up to 1. It’s very cute.
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Sometimes late at night, looking down long empty hospital halls, there is only one thing to do…
…tombé, pas de bourrée, glissade, grand jeté!
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My DVT soapbox: flying in a plane is not a risk factor for a DVT! Sitting in a chair for 4 hours doesn’t change your risk, whether you’re flying to Chicago or watching Lord of the Rings!
“Prolonged immobilization” is like being bedridden for days, not your trip to Mexico.
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I’ve been nauseous all morning despite drinking water. Welcome to today’s brain game: COVID, pregnant, or hungover?
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I recently gave ketamine to kid who needed an ortho reduction. Told him to choose where he wants to visit. He decided to take a hot air balloon all over the world. And then that’s exactly where his trip took him! He told the nurse all about how awesome it was. I love peds EM.
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My job at work today is to see all of the people who probably have COVID with normal vitals, and to tell them that by policy we are not doing their COVID swabs in the ED, and referring them to outpatient testing and home isolation. Everyone is unhappy about it, myself included.
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As an EM PGY3, I precepted an IM PGY2 in the ED. She saw a patient with pelvic pain and said she didn’t need my help with the exam, then gave me an extremely detailed report of findings I would never have noticed. I was clearly surprised. Turns out she was an obgyn in India.
New attending on rounds with IMG residents who were attendings in their countries
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I literally forgot to listen to his heart and lungs. I was too busy hearing his story and trying not to cry.
Can always go back in and auscultate, and I will. But I think I listened to the more important thing today. 6/6
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I’m frustrated with a lot of tweets I’m seeing that say surgical masks suck, or confer no protection to Covid. Yes, well fitting N95/KN94 masks are more effective. But surgical masks aren’t useless, and I wish people wouldn’t disparage them. It doesn’t help with harm reduction.
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Cheating is cheating, and it’s not okay. But honestly? I really wish we could have better conversations about ethical non-monogamy and open relationships. They’re real. They can work. And if people don’t know they’re an option, they can suffer needlessly.
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Mom found out while pt was in ED. She took a deep breath. “Sex is not wrong or dirty. It’s magical and important. I thought your first time might be different, but I’m not angry. You have done nothing wrong or to be ashamed of.”
I can only hope to Mom that well some day. 2/2
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I hadn’t even thought of carbon monoxide poisoning. But it all fit: hookah bar, SOB, tachy, dizzy, headache, syncope, a bit slow to respond, getting better as she sat in the ED. Ran an ABG with co-oximetry, and of course her CO level was super high.
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I recently tried to transfer to UCSF a patient who needed admission for a transplant-related issue. There were no beds available, so the patient got admitted to my non-transplant-center while they waited. Ganhdi is mistaken or lying that her hospital isn’t overwhelmed.
Dr. Monica Ganhdi has been outspoken, at several stages, about where she thought the pandemic would be headed.
@mehdirhasan
asks her if it’s time for her to stop making such broad forecasts. WATCH:
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Put her on O2 face mask and she quickly felt much better. CO toxicity with syncope can actually be an indication for hyperbarics, so we called the regional hyperbaric center but they felt she was okay without. Patient’s symptoms resolved, vitals normalized.
8/
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I just did all of this—waved all contingencies, physician with a steady job, very little debt, and offered $400K over asking. Sellers asked for $200K more. Bay Area housing is completely unaffordable. It’s not the avocado toast.
I just offered 50K over asking and waived all my contingencies as a physician with a steady job and no debt and still got outbid. So I’m gonna go out on a limb and just say maybe soy chai lattes are not the reason millennials can’t buy a house.
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@SavannaRae42
@oliviagatwood
I try to find kind ways to say this to my patients. Not “I don’t believe your pain is real” or “it’s all in your head,” but “our emotions have a lot to do with how are bodies feel; can we get you better taken care of in that way?”
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Today I had a sweet elderly demented patient cough right in my face
...who later turned out to be positive for COVID-19
...three days before I’m supposed to get a COVID vaccine.
Nope. Don’t like that.
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Fauci reassures children that Santa is immune to COVID and he tells a reporter that he wants to join the gays at brunch. I just love him. 🎅🏼🏳️🌈
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@amy1weber
Right?? I kind of thought anyone who would bother to obtain a good N95 would also have some idea of the relative risks of when to wear it…
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@jmugele
I usually answer that the worst/craziest thing I’ve seen is that with massive amounts of wealth, our country has utterly failed to take care of people at every stage of healthcare, causing systemic disparities and bankruptcy. They quiet down after that answer.
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I live in a pretty non-religious area. Today a patient told me, “Whatever your spirituality may or may not be, blessings on you and the work that you do. I appreciate it.”
Honestly, that felt really nice.
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I’m happy to be a lifelong learner. I look things up on shift. I listen to medical podcasts on my drive to work. I follow up on my admits.
But I am so SO glad I no longer need to study during my evenings/free time. Wow. It feels great.
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The age difference between my last two patients tonight is greater than 102 years. Emergency medicine is really fun and kind of hard to believe sometimes.
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Made this lovely person a birthday cake, and I’m incredibly proud of it. 💗
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A bit ago I saw a pt with shortness of breath, low grade fever, hypoxia. Admitted for r/o COVID. Follow up: tested negative! CT chest and echo normal. Huh. ABG shows... methemoglobinemia! Presumed from dapsone. Even in a pandemic, keep a broad differential.
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Luckily patient was feeling a bit better after fluids and meds. As she was waiting to go to CT, I told one of my paramedic friends about this patient and her somewhat confusing presentation. His first question: what was her CO level? 😳
6/
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Just thinking about one time in residency when we literally had a priest trying to do an exorcism in the resuscitation room, and the charge nurse had to kick him out because he was interfering with medical care. That was wild.
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Thanks to COVID vaccinations, today I was able to hug my parents for the first time since January 2020. I pet my dog, cooked with my mom, and sang my dad happy birthday. It’s such a deep and quiet joy. I’m so grateful.
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He also, incidentally, said he was happy I was a woman and young, because young people and women make better doctors.
And now I’m in the staff bathroom bawling my eyes out because I’m just so overwhelmed with love and gratitude for him. 5/
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Every time I have a tweet that goes viral and people quote tweet it in mean or nasty ways, it gives me some small satisfaction to see that mostly they get zero interaction—0 likes, 0 comments. Also, a personal boundary: make fun of my 🌈 or pronouns and I will block you.
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I think one of the most difficult things we do in emergency medicine is reassure people when their symptoms are not concerning for emergency causes, and don’t need further work up in the ER. It’s gratifying to offer reassurance, but it’s very very difficult to do well.
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Once my brother had vertigo and I explained how his ear crystals were probably out of alignment and how to do special movements to put the crystals back in. He was 100% convinced that I was joking. Still uses “re-aligning ear crystals” as his sarcastic explanation of what I do.
Humans are so complicated but the best we could come up with for balance is ear stones
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Our social system is completely unprepared for the number of boomers who are going to need expensive in-home or nursing-home-type care, when they have insufficient savings to pay, and yet live in $2 million homes.
(Speaking for Bay Area and high cost of living areas)
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I’m really worried about the regular patients we’re not seeing in the ED, because they’re too scared of
#COVID19
to come in. Leads to things like perforated appy, grossly infected ulcers, terrible fluid overload, septic shock, or cardiac arrest of unclear cause.
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Colleague told me that they saw a patient in the ER with Covid. But luckily, I had gotten him vaccinated during a prior ER visit a few weeks ago. Mild symptoms, oxygen normal, able to go home. What an amazing feeling.
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I think about this scene all the time. So grateful for nurses and pharmacists who save prescribers from dumb mistakes.
A doctor misspoke today & asked for 100 mg of midaz instead of 100 mcg of Fentanyl & after I clarified the correct order, all I could think of was nurse Roberts from Scrubs.
“Your intern ordered 100 mg of morphine. I thought I’d check with you before I killed a man.”
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Top 3 worst places I’ve run a code blue:
3. Bathroom
2. MRI trailer
1. Ophthalmology office b/c those chairs do not lay flat and are bolted to the ground and no you can’t get a stretcher in and the patient has no line and what PMHx does he even have and why is the ED so far away
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@ShariDunawayMD
We have one who works for the police department, but she visits the ED regularly for snuggles and kisses. 🖤
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@ShabbirSafdar
Thank you! I don’t post cases in anything close to real time, for patient confidentiality. This case happened many years ago. But it’s fun sometimes to remember some of the good ones, and think my way through what happened then.
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I asked my attending for help. Without standing up, he rolled his wheely desk chair across the ED, put a spinal needle in the patient’s back with one fluid motion, pulled the stylet, and clear CSF started flowing. Nodded at me, and wheeled his chair back to the desk. I was agog.
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Man, there are a whole lot of doctors* who do not practice emergency medicine who are telling me how to practice emergency medicine on the Internet today.
*may or may not be actual physicians, though some certainly seem to be
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One of the ED nurses is slowly chanting ommmmmm to an agitated patient as he cleans him. It’s really helping. Then the patient joined in!
Ommmmmmm... ommmmmm...
Sounds like a yoga class in here. 🕉
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Somebody pilfered my calla lilies! 😱
I hope they got a nice Easter bouquet. Sigh.
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Leaving for work at 6:15am today, my sleepy boyfriend paid me a great EM compliment: “I’m really impressed at your ability not to have a circadian rhythm.”
It’s a professional asset, for sure.
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Listening to a talk on OB emergencies. Perimortem c-section at minute 4 of CPR, for goal of getting baby out at minute 5? Yeah, sure. I can definitely do major abdominal surgery that I’ve never done before in 60 seconds while my patient is dying. 😳
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I’m a patient today. Someone in the next room is in pain, and I overhear “We already gave you a dose of toradol, but let’s do a second dose? A double dose of toradol is 60mg.”
And in my sleepy post-propofol state, I just want to yell “there’s an analgesic ceiling!”
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Because of her syncope, she fell and hit her head hard on the ground. Was unconscious for maybe a minute. Awake by the time EMS got there. Started vomiting en route. In the ED she was tachycardic, tachypnic, afebrile, normal oxygenation. Slow to answer questions, but A&O x3.
2/
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I had a patient today who looked me in the eyes and pleaded “Please help! Something is wrong!” My heart dropped because I believed her and I was afraid I wouldn’t figure it out in the ED. But I tried.
And then she eloped with her IV intact.
Gotta say, that one hurt.
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I had a teenage patient who was having a panic attack. She’d had sex with an older guy at school, and then he broke up with her. She was heartbroken. Now his friends were spreading nasty rumors. She was terrified her mom would find out. 1/2
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