@CardioNPi
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just an NP who worked in cardiology, now retired
California
Joined January 2009
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Cardio NP retweeted
Bill Gurley might be the best public speaker I’ve ever heard. This is 10/10 on the persuasion scale. And a masterclass in using PPT.
Oh…and he’s 💯 correct on the main point of his talk
All-In Summit: Bill Gurley
(0:00) Bill Gurley takes the stage at the All-In Summit
(1:29) Bill's Presentation: Searching for Feynman
Links to additional resources mentioned in talk and used in research:
p3.institute/searching_for_f…
@bgurley
Variants of this have been going on for 40+ years. In the 1980s a former colleague told me that it was fairly common that affluent families would buy falsified nursing degrees in the Philippines for their women who would then be able to come to US to work and take boards.
Federal investigators uncovered a massive fake nursing diploma operation that ran through Haitian immigrant networks in South Florida, selling credentials to people who never completed the required nursing coursework or clinical training.
Investigators say the broader scheme involved roughly 15,000 fraudulent nursing diplomas and $250 MILLION.
Many buyers then took nursing board exams, obtained licenses and went to work in healthcare facilities across America.
Forget the money for a second. How many patients were treated by people who never actually completed nursing school?
November 2000: I'm a newish NP trying to leave clinic b/c I got notified my mother is imminently dying. Clinic mgr asks me to see add on pt who got triaged to urgent walk in clinic rather than ED at the VA.
Pt is 65 yo M w new onset dizziness, NO medical care in 20+ years. BP 200/110 manually. Arrives in w/c b/c couldn't walk d/t dizziness. No other neuro abnormalities, but tells me that while sitting in waiting room he had transient swallowing difficulties (w saliva). Present to collab MD who wants to tx HTN and send him home. I insist that I think he's having a stroke and say needs to be seen in ED. She reluctantly agrees. My note is brief but document findings as above and transport to ED w impression of r/o stroke.
I leave and fly to see my mother. She died the next morning (had been on hospice). So I got no f/u until after I returned to work another 10d later.
Unfortunately pt seen in ED and dx w new HTN and started on meds and d/c'd w/o imaging or Neuro eval.
Next day he re-presents to ED w ongoing dizziness. Gets admitted this time and dx is new onset DM and they think his dizziness is d/t vol depletion.
He has persistent dizziness despite hydration and tx of newly dx'd DM. Finally they get Neuro consult who note my initial impression and recommend MRI.
MRI confirms posterior circulation stroke. Don't recall the exact anatomy but they did try neurovasc intervention which didn't help a lot. Perhaps d/t delayed dx.
So yes, posterior strokes can present w only dizziness.
That’s why I am the stroke neurologist and that’s why you’re not. That’s why I blocked you early on, because you remind me of the sort of persons who would encourage diagnostic nihilism that ultimately result in the maiming of patients.
Don’t give up. Do your job! I’ll do mine to ensure that the 10 to 25% of AVS patients who present to the ED with new onset symptoms who are indeed having a stroke, isn’t missed because a clinical Dunning Kruger who actually DOESN’T see patients at bedside, and hasn’t for decades, preach the harmful rhetoric of diagnostic nihilism.
Cardio NP retweeted
Ask yourself how an illegal immigrant who has no right to be here can be arrested in NYC in June for sexually assaulting a minor and yet somehow end up free to rape another underage girl in Maryland just months later?
That a systemic choice that is causing massive daily harm.
BREAKING: DHS confirms to @FoxNews that a rideshare driver arrested in Montgomery County, MD for allegedly kidnapping & raping an underage girl during a ride is an illegal alien from the African country of Guinea who was caught & released at the AZ border by the Biden admin in 2023. He also has a prior rap sheet of sexually assaulting a minor in NYC from earlier this year.
DHS says Abdoulaye Dia of Lanham crossed the border illegally into Lukevilke, AZ on December 21, 2023 (one of the days my team and I were there doing live shots showing masses of African men crossing illegally), but was released into the U.S. by Border Patrol.
Dia was arrested by NYPD on June 10th for sexual abuse by forcible compulsion, forcible touching – sexual/intimate parts of another person, injure child less than 17, and sexual abuse without consent.
He’s now been arrested by police in Maryland for allegedly kidnapping and raping an underage teen girl during an Empower rideshare in which he was the driver. Police say he took her to a parking lot and raped her in his vehicle, and they believe there are more victims.
Cardio NP retweeted
EXCLUSIVE: Chinese criminal gangs with links to the CCP have built an illegal cannabis empire in Siskiyou County, California. They're generating $2 billion a year in revenues and criminal growers are now 20% of the entire population.
Gavin Newsom is doing nothing to stop them.
Proud achievement of the day:
Replacing the wipers on my RAV all by myself!
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before you say big deal.. it was. Broke a metacarpal last year that then triggered a cascade of PsA sx in bilateral hands w trigger finger, dactylitis in 3 fingers, partial saggital band rupture and required steroid injections in both hands.
Cardio NP retweeted
California is moving forward with a ban on former ICE officers from law enforcement positions as well as a ban on the use of shock gloves in the state. The state has become a perpetual motion machine of unconstitutional measures, burning millions on performative legislation...
Fellow medical peeps - FYI
#medtwitter
#cardiologytwitter
Verified U.S. clinicians can get free GPT-6 Astra (Pro) access today via ChatGPT for Clinicians.
Sign up: chatgpt.com/plans/clinicians…
Cardio NP retweeted
Since they were too busy giggling to hear their names, let's look at the faces and stories of the names being honored while AOC and Mamdani were cutting up.
Andrew La Corte was a 61-year-old trader for Carr Futures.
Carol Ann La Plante was last seen going to early Mass before going to work at Marsh & McLennan in the North Tower.
Jeffrey G. La Touche was a banquet captain at the Windows on the World restaurant, located on the 106th and 107th floors of the World Trade Center's North Tower.
Kathryn Laborie was a flight attendant with United Airlines.
Gavin Newsom's California:
Sanctuary state for illegals
Restrictive gun laws to limit ownership by law abiding citizens.
Illegal alien gets car and driver's license and drives for Door Dash, starts stalking server at a restaurant. Acquires gun somehow and kills woman he was stalking.
kcra.com/article/sacramento-…
Cardio NP retweeted
It’s the 25th anniversary of 9/11 and the New York Times is literally doing the Norm Macdonald meme
Cardio NP retweeted
It is not that people are finally waking up to Gavin Newsom’s California.
Highest gas prices in the country. Worst homeless crisis in America. Drug tourism. Sanctuary state. A high-speed rail that eats billions and goes nowhere. Highest taxes. Waste. Fraud. Abuse.
He looks TERRIBLE because of all of that. I have watched it first hand. I live here.
That is not what this is about.
This is about people finally waking up to what kind of MAN he is.
I already know the first reply.
But, but, but, but… Trump.
Every.
Single.
Time.
Not because the comparison holds. Because a certain kind of reader cannot talk about a Democrat without dragging Donald Trump into the room. Every. Single. Time.
Clinton cheated. Trump cheated. Powerful men cheat. I am not pretending otherwise. If your whole argument is “but Trump,” you are not answering what Newsom did to Alex Tourk. You are diagnosing yourself with TDS.
A lot of men have had affairs.
Most men have not done THIS.
For something like ten months, Gavin Newsom, then the mayor of San Francisco, was sleeping with Ruby Rippey.
Wife of Alex Tourk.
New mother.
Alcoholic trying to stay sober.
She worked for him.
He put her outside his office.
Tourk was not a guy he waved at in a hallway. He was his deputy chief of staff. Then his campaign manager. His BEST FRIEND. The man in the next office. The man Newsom saw EVERY SINGLE DAY.
Fist bump. Hey bro. How about that Niners game.
Looked him in the eye.
Meetings. Cars. City Hall. Same as always.
WHILE HE WAS SLEEPING WITH HIS BEST FRIEND’S WIFE.
That is the part that should make your skin crawl.
Not the sex.
The mornings after.
The handshake.
The smile.
In July, Rippey finally wrote it down in Vanity Fair.
She does not write it as a romance.
She takes a pile of the blame, which is more than Newsom has ever given this story. She also names the thing he will never name. Power does not need to coerce. It only needs to exist.
Newsom’s version in the memoir is small and flattering. “The stupidest and also briefest of affairs.” She was the last to leave a party. Then, in his telling, he “came clean” to Tourk.
Rippey says that last bit is the detail that stays with her. It reads like he stole credit for a confession she had already made.
There is no mystery about whether it happened. He admitted it in 2007. On camera. City Hall.
“Everything you’ve heard and read is true.”
What he wanted in the book was a softer version. Shorter. Cleaner. Him as the guy who told the truth.
She says it was her.
Before it started, at a Mexican restaurant, sitting there with her husband, he looked at a woman who had just had a baby and told her she looked good, that she'd lost all the pregnancy weight.
Awkward laugh around the table. She writes that she suddenly wanted her husband’s margarita.
Then it starts. Again and again and again. Russian Hill penthouse. A back room in North Beach. A hotel in Los Angeles. She comes to him. They drink. There is sex. She says the sex is not even the point. The point is the hit. The text. The look across the marble hallway at City Hall.
It is not long after Newsom starts “dating” her that she “coincidentally” develops a cocaine habit.
She writes that cocaine did not do much on its own. After a bottle or two of wine it let her drink twice as much, twice as long.
One night she is in his king-size bed watching him on all fours, scrubbing red wine out of his precious carpet that she had spilt. He is furious.
That is when the moral awakening arrives. We really can’t do this anymore. YOU can’t be doing this to Alex.
Not in the office.
Not in the car.
Not on the mornings he looked his BEST FRIEND in the eye and asked about the game.
When she stained his precious rug. The rug he cared about more than his best friend’s wife.
She had a one-year-old at home.
Newsom’s presidential odds are not falling because California is a mess. They are falling because almost no man could do that to his best friend for TEN MONTHS... and then write it down as brief and stupid.
And because the women who read Rippey can see exactly how he handled her.
That is not a policy disagreement.
That is the record of a man who can look you in the eye and lie to you again and again and again while he tells you he cares about you.
Americans are catching up.
That is why the odds are dropping.
That is why his own party is backing away.
That is why he does not get the White House.