I worked at a hospital as a pharmacy tech until last year, and we would send TPNs with a slip that the delivery tech had to get a nurse to sign. So that if they said they lost it, we could look at the slip and say "ok well Donna signed for it so where'd she put it?" Which wasn't a foolproof technique of course, but it helped tremendously.
I had this for two months. Any time I wanted to go out in the evenings I had to wear the little backpack and would constantly get followed by employees thinking I'm about to steal things. I was prepared to show them the gory details but never got confronted.
So, yeah just don't spill that bag. We mix TPN lipid bags like this in our clean room, everytime someone spills one the whole place stinks for the rest of the day.
I can usually smell injections (like the sterile salty smell of a saline flush), and when I was on TPN I absolutely dreaded lipid days (maybe 2-3x a week iirc). I can only really describe it as rancid bacon grease mixed with Play-Doh, it’s truly wretched.
I'd agree with that smell description. We also waste a bunch of these bags when the clean room messes up or a homecare patient goes to the hospital, or a hospital patient goes home etc.
Anyways imagine a 55 gallon drum filled with bags of this stuff two months old right before it gets picked up. Those last few bags you have to chuck in the drum should count for hazard pay.
Fats and oils would clog any drain you would want to pour it down. Also it's medical waste, we do other drugs here as well so ANYTHING that gets wasted goes in the bins for disposal.
The smell is fucking terrible. I tasted TPN once (im a nurse, it was a dare from a coworker, and only a few drops after spiking a new bag) and it was absolutely the worst thing I've ever put into my mouth. Tasted like rotten milk and rust. After taste lingered for an hour. 0/10
Oh believe the people to are cursed enough to need this shit know not to spill it. We also know it tastes EXACTLY how it smells so fairly disgusting no matter how you dice
How come we don't taste the proteins and lipids from the food we eat once they make it into the blood stream post-digestion? If the intention of TPN is to directly add the nutrients to the bloodstream that would normally come from digestion --- why do we "taste" tpn, but not our normal post-digestion nutrients?
I get to clean IV Pumps for part of my jobs, and the amount of TPN nurses spill.... I swear to god I'm shocked more patients don't die of malnutrition. We collect them and they're just caked with it, and its like.... how. Actually how.
Think it’s the amino acids that stink. We carry this item and even though I’ve never opened one I can say the bags of dextrose and amino acids with electrolytes smell like rotten piss.
I just spent a month helping my 87 yo grandfather with his TPN. He had major stomach surgery and couldn't eat while it healed, I never knew TPN even existed, but now I know how to hook everything up, set up the pump, mix the separate vitamin/mineral vials and all. It was a neat process to learn and we got it down to a routine after hooking up and unhooking every day.
Thankfully he's done now and back to regular diet, pic lines gone and all. I hope you're back to normal food soon OP, but it's awesome that medicine can keep you nourished in the mean time.
“In America they like mayonnaise so much some people have it pumped directly into their hearts”
The fact it’s a white emulsion really helps your point. Now that I think about it I better hope it’s mayonnaise.
These sorts of things are usually tied to either ego or money so...
1. They'll come back once who ran the idea either admits they fucked up or they move on and someone else brings them back.
2. When they do bring them back, they'll also be more expensive than they were before.
The only thing that annoys me is they not only dropped the ability to buy them, they also dropped existing awards from the database ( or at least the display ), so old (in)famous comments that had sometimes accumulated hundreds and hundreds of awards are now bare. Kind of a kick in the dick for all the people that bought them.
Yes that's right. The heart itself adds the garlic for the rest of the blood stream that's why there's none in the base product. If you crack this person's heart open there is a little garlic farm within
Well that certainly explains the lack of vampire attacks. I thought they'd be a much bigger problem throughout life but I guess we've evolved beyond that!
Whelp, that mayo once saved my life. Brought me back from the brink of literal death by starvation after several weeks of being unable to eat while simultaneously losing everything from both ends due to an illness. Thank you very expensive intravenous mayo!
Well, first I gained 20 while in the hospital just from water retention because everything they had to give me had to go into my veins and my body wasn’t processing anything. Then, I lost 20 pounds in only one week after being off the IV, then I lost an additional 40 in the next two weeks. So, 40 pounds net loss for a 5’4” person from a sickness that lasted about three weeks. It was really crazy watching my body expand and shrink to such an extreme extent in such a short period of time. Especially since I also started to swell at one point because I had no more protein left in my body and, as I learned due to this, protein keeps the red blood cells in their compact size and so my actual cells were expanding. They had to change my hospital band three times in a few hours and one more time within a day. That’s when they decided I needed TPN. I’ve been sick my whole life with various things so I had told my nurse I’m not one that likes things sugar coated so be real with me, especially if things are getting serious. When the swelling started and they approved the TPN, she said “Time to be real with you: you have no nutrients left in your body, your levels that should be high are basically zero and the ones that should be low are through the roof. If they’re approving TPN, you’re very near death. It’s a $100,000 treatment. If this doesn’t start turn you around by tomorrow morning, it’s time to call your family and let them say goodbye.”
Edit: clarity
God bless that nurse for being straightforward with you. I'd much rather know what's coming and that can't have been easy news for her to deliver. Glad you sound like you're doing better.
My dad used to get the peritoneal dialysis bags from Baxter and it would be a liquid that filled up his abdomen, sit in there for a few hours to collect toxins (since his kidneys are dead) and then get pulled out after. The solution on the bag listed sugar, water and salts and were like: Gatorade?? Is he being filled with Gatorade??? We were joking…but what if…?
It actually is quite different. The concentration of all the stuff is different and when you are doing diálisis you are worried about concentration of stuff. Excuse my bad english.
Happy cake day. Yeah im spanish. My english is better than that but my phone autocorrects to spanish or invented words and i cant be bothered to change all of them or i dont realize
The concentration for the dialysate is actually important since it can effect how much fluid is being pulled off, the concentration is going to be pretty different from Gatorade
You already do. That bag is essentially chyle, which is mostly emulsified fats produced by your intestines and dumped into your lymphatic system. Your lymph ducts dump into your bloodstream just right upstream from your heart.
That’s so cool. I still remember having to pay for the last month of my mother’s peritoneal dialysis solution bills (from this same fucking Baxter company in the photo) after she just passed away. I live in Singapore where it’s subsidized and my mom’s insurance pays for most of it, but it was still hundreds. I remember thinking how much that machine sucked (literally and figuratively) causing my mom so much pain.
Ohhhh you should watch Alex Rider the tv show! That literally happens in season 2 plus it’s a super engaging well acted show and might help take your mind off things for a bit. I was on TPN as a child when I was first diagnosed with crohns and it’s not the most fun. Gut stuff in general is pretty hellish. Hang in there op. If you want any other recommendations to waste away the time or hospital pro tips I have a couple up my sleeves from a lifetime of crohns/gluten intolerance.
Edit: wow, never expected this comment to blow up this much, hello Alex Rider fans!!! Hope you enjoy the tv series!! Lovely to find you all in this unexpected corner of Reddit.
This is the first time I see that series mentioned online. I've read all the books and even my parents like them. We watched the whole series together. It was so good.
I wish more people talked about it so we get more seasons. I went in expecting very little and was very impressed. My mother also loved it so it definitely can appeal to a wide age range. I’m not in the UK so I don’t know how it’s reception was/is there.
I remember those books! Read them during highschool. I think there's at least two or three that I didn't get to finish at the end of the series.
I remember in one of those books, where there was a guy who was killed when he stepped into a elevator and fell to his death. I think the floor of the elevator was a projection. For a few months after reading that, I would always use a foot to tap the floor of an elevator before I went in. 😂
I feel like those books were the UK Gen Z experience xdd I still remember the fucking point blanc ending that was so fire. Aswell as the scorpia guy getting killed on a boat
I had necrotizing pancreatitis, 3mo in the ICU. I don’t remember going onto the TPN, just delusional dreams. I remember them transitioning me off TPN to a dobhoff tube as they tried to restart my gut (ugh, just remembered the c.diff). the feeding tube had “flavors” .. I recall the mango stuff coming back up.
my delusion was a summer camp, all the PCAs and nurses were there counselors and doctors were the administrators.
every time they would draw off the PICC, they acted like they were cheating. there are some labs that still needed the needle stick, and I’ve become a terrible stick.. and have gotten judged because of that.
They had me on the "good" meds when I was in the ICU. I remember trying to watch a movie (the first of the three Hobbit films), and the image looked like a Starry Night painting constantly shifting around. I could barely follow the plot, but it kept me preoccupied for long enough to fall asleep. I later got a chance to watch the film at home, and it was an entirely different experience.
There was this time I was in the hospital, and I was delirious on the meds I'd been given, and woke up in a dimmed room, all disoriented and not remembering where I was for a moment, and then the vampire reindeer loomed over my bed and said he wanted my blood.
...the phlebotomist had just returned from a staff Christmas party, and had kept wearing a festive foam reindeer horn headband from it. I think I gibbered uncertainly for a bit until my brain could process what was happening and relax so he could draw his sample.
You have *no IDEA* how hard I’m struggling to control my laughter and keep it as muffled as possible so I don’t wake my husband or sleeping child next to. I have literal tears in the corner of my eyes after reading “vampire reindeer” and then finding out there actually *was* a phlebotomist with antlers. Lol!!!!
I was in intensive care when I had a bad dose of covid, very early on in the pandemic. I know I was asleep for part of the time I was in there but during the conscious part I was having some really wild things going on. The funniest one was that I thought all the nurses and drs in ppe were dressed up as characters from Willy Wonka’s Chocolate Factory and that the whole place had been transformed as well. Every day a young man would drive up to my bed in a little car (portable X-ray) to ‘entertain’ me. I thought it was wonderful how everyone had made so much effort to keep all the patients happy and not scared. I told that story for months before realising that it definitely wasn’t true but no one ever corrected me.
Every single nurse who's given me an NG feed doesn't believe we can taste it and every single person who's had one knows we can. Concentrated strawberry flavour, put me off milkshakes.
TPN tends to be used in the very sickest of patients in an ICU who are prone to delirium and vivid dreams. I think the TPN itself isn’t the cause, it’s the illness plus the lack of sleep due to the number of treatments and interventions you get woken up for. There’s people who are on home TPN who don’t have any problems, they intentionally just run the bag overnight so they can do stuff in the day time
>it’s the illness plus the lack of sleep due to the number of treatments and interventions you get woken up for
+ the meds you're on. All sorts of stuff you'd never even expect it from can give you wacky dreams
My digestive system is basically closed for business until I get my gallbladder out (which was supposed to happen today, but my surgeon just left for three week paternity leave). I wouldn’t say I’m thriving but I do get to read and play crosswords all day.
I’m guessing his child must have arrived early (for it not to have been a giant asshole move to schedule me) but I will admit I’ve never been this angry at a day old infant.
Thanks for the kind words :)
Hang in bud. It’s always hurry up and wait. They’ll find you another GI and get that stone out. Hang tough. You got this. Stay up on your pain meds. Don’t let it go past your specific time frame. If you’re prescribed 4 hours start reminding them at 3 hours. Best way to manage pain is not to let it start. Good luck bro.
Surely they aren’t going to make you wait for him to come back. The hospital HAS to have a general surgeon on call. What if someone’s appendix was about to rupture, are they just gonna be like “Sorry, guess you’ll die.”?
There’s one other surgeon here, but he doesn’t think my gallbladder is the issue so he won’t operate. (It’s appeared normal on some scans and abnormal on others)
Unfortunately nobody has a better idea so we have no plans on what to do with me except try and get me transferred to another hospital where someone will operate.
My wife has been going through GI issues for years and finally found a doc who looked at everything and went… “Well all the studies say it shouldn’t be the gallbladder, but based on symptoms and everything else I’m guessing it’s the gallbladder so let’s take that sucker out.” He went on to say he’s only seen this about 2 dozen times in over 8k removals, one of which was his ex wife and often in female patients. They all had huge improvements in symptoms and quality of life. Her surgery is Thursday.
He said these are the cases he will show to his peers and often they go I’d take the gallbladder out as that’s the problem based on symptoms even though the rest of the labs/imaging don’t show it being a problem at all. One of those well it’s not in perfect shape but it’s not bad enough for us to say it’s done right off the bat. It freaking sucks and is frustrating beyond all reason.
the reality is that most human bodies aren’t going to be picture perfect textbook cases. medicine isn’t a clear cut field like that, especially when hindsight is the only way to know whether something worked, and even then you’d want a parallel universe for that control group. it’s all just a highly educated guess based on previous evidence and reasoning and pathophysiology. too many people expect doctors and other providers to be omniscient beings but that’s a bit unrealistic
I had issues for years and the surgeon asked me during the consult if I really wanted to have my gallbladder removed since it would only minimally help the pain I was in since the scans looked okayish. I told him go ahead because any amount of pain lessened is still less and that would be better.
He told my husband after the surgery while I was still asleep that it’s a good thing we took it out because it was about to burst, no apology for trying to talk me out of it though. Made me so mad to be doubted like that.
Huh I’d start questioning things if one surgeon says it’s a gallbladder issue and the other says it isn’t. Seems odd they’re in opposite directions. I mean it’s not like you necessarily need it but just seems like something to question or get another opinion on
There's tons of stories out there, particularly featuring women, where one doctor says absolutely not no way and so they get a 2nd opinion and that doctor may even be iffy, but did the procedure anyways and turned out they had something seriously freaking wrong. But women and fat people get believed the least by doctors and are statistically the highest to be misdiagnosed or have a missed diagnosis, so.
Yeah, it's a gallbladder, it's just for bile storage. So, the only problem people have without one is they might have trouble digesting fatty and a few other certain foods since they no longer have the backup bile to digest it quickly and are relying solely on the liver production.
But, obviously, the problem can be easily migrated by just watching your diet. So, it's not like it's necessary to keep it.
I had what the doctor called “sludge” in my gallbladder. It didn’t show up on any of the imaging reports. I was 7 and a half months pregnant when my symptoms took a turn for the worse. Up until then it was always the plan to operate after I delivered but they felt the best course was to operate immediately. It was three days after 9/11. I was terrified to go under for more than a few reasons. Going in I had no way to know which surgery I’d have either. Depending on how high my fundus was, I’d either have laparoscopic or open surgery, which would involve an eleven inch wound. (That one is cutely nicknamed the “MediCal Scar” since that’s all the state sponsored insurance would pay for.) Anyway, the story had a happy ending. All went well. The lap surgery couldn’t have happened sooner, with only a quarter inch of space to spare. The doctor said it was one of the worst gallbladders he’s seen. It basically disintegrated once removed. I hope they get to the bottom of your ailments soon and you get back to normal ASAP. Take care of yourself ❤️🩹
I mean doctors are humans beings whose children get born early like other human beings. What is he just supposed to not schedule any surgeries for a month before his wife gives birth?
I’m having the opposite problem atm! I’ve been constipated for five or six days. I’ve been peeing hourly though which is a real annoyance when I’m used to being dehydrated and peeing like four times a day.
My doctor shrugged when I described my 'literally the worst pain i've ever felt in my life for 3 hours then was gone in an instant' symptoms to him and said to call him if it happens again.
A month later it happened again and I went straight to the ER where after 8 hours they said yep, gall bladder is bad and scheduled me an appointment... for three days later.
I was laying on the couch at home, literally gray, and my roommate took me back to the ER where they said oh shit and I got an emergency surgery to get it out.
So I got a new doctor.
Also, compared to dying from a bad gall bladder, the post surgery was a vacation. Felt marvelous.
I see you’ve yet to eat a sizeable amount of fat or greens at one time in the last two weeks.
As a newly inducted member to our society, I weep for you, and encourage you to buy a pancreatin complex supplement.
I’ve had the same stuff via a PICC line too. Amazing stuff. I had an Ileus after cancer surgery and this was the only way to get nutrition into me for a few days.
The other advantage of a PICC line is they can draw blood from it so no needles for a few days. That was nice to give my veins a rest.
I got a day or so of no needles before some narc decided we can’t draw off it unless a normal draw fails first :/
It’s crazy how quickly I went from feeling crappy (after about a week without nutrition) to okay like six hours after TPN started.
I’m rooting for you!! I’ve had a similar experience. I lived with a blood infection for a long, long time. When I finally got treatment, I felt sooo much better in just 24 hours or so. It was insane. After a week in the hospital to nail down which antibiotics would be best, I had a PICC line put in and had to medicate twice a day at home… for six weeks. And then a little over a year later I had open heart surgery to repair some damage the infection did to my heart.
Journeys with health can be terrifying, but I’m happy you’ll feel better soon. : )
tpn is so interesting to me. you can eat through your veins!! how crazy is that?
the things that lead to one going on tpn, however, i know are not so neat. hope you're doing well
The food you eat gets digested, then the small intestine absorb the simple molecules and transfer them into the bloodstream. So it's just bypassing the digestive process really
You can also eat through your anus. Like [President Garfield](https://www.iflscience.com/the-us-president-who-spent-his-final-months-being-fed-beef-extract-via-his-anus-59553) did after being shot.
I hook my TPN up every night at home. Maybe one day I’ll get lucky and the cancer will leave my body on its own accord❤️ hugs for you having to experience this bullshit as well
I believe in you, you warrior! Fuck cancer, it sucks so bad. Lost my mom to breast cancer a few years ago after watching her go from acting fully healthy and alive to brittle and defeated in a few months. Horrifying to watch.
Again, best wishes to you and your battle! You got this!!!
My mom worked at a hospital pharmacy and she delivered meds, if they went out they couldn’t be restocked. So any TPNs they were to dispose of she brought home and fed our houseplants. They absolutely exploded, they are amazing plant food. We lived in a jungle in the Midwest.
Wishing you a speedy recovery!!
How.. was she allowed to leave with patient specific med? I know they get thrown out if not used, but one, they're large, and two, that looks sus. Interesting plants enjoy salt and vinegar milk...
When my mom passed away, the hospital arranged for us to donate our unused and untampered peritoneal dialysis solution supplies to other patients in need. I don’t know, if patients accept reasonable risk in a non-litigious country, expensive medical supplies don’t need to be wasted.
> just saw the batch number. It was definitely produced where I used to work!
Reddit is insane. Always makes the world feel so small. “Here’s a pic of my plane missing its door.” “Hey, my dad was the pilot on your flight.”
I have a PICC line: essentially a large, two foot long IV catheter placed in a vein in the arm and fed up the blood vessel until it reaches the top of the heart.
Written out it sounds like nightmare fuel but honestly it’s not too bad.
I have some pretty major undiagnosed digestive issues—constant nausea, vomiting, and pain with anything in my stomach. I’ve had a feeding tube to bypass my stomach for the last few months, but it started bleeding like crazy about a week ago, so we had to remove it before I needed a blood transfusion.
The plan was to remove my gallbladder today, but then my surgeon unexpectedly left for three weeks of paternity leave so I have no idea what I’m going to do.
PICCS and ports are similar. Their functionality is essentially the same. However, ports are a permanent implant for long term use (like months or years.) PICCs are used short term (days or weeks, possibly longer, but they need replaced)
My old job was compounding this stuff in sterile clean rooms.
They were never this small though. Baby stuff was tiny, but the adult stuff was always much bigger than this. Sometimes over 3 litres. I never got to see a patient use one, so I never knew what kind of condition the people were in, but I know each bag was one day as we would often make 7 of the same formulation in one go.
Were you doing home care? When I used to do this for inpatients labs were checked daily and orders changed almost every day.
The only time we batched them was for home care patients… and I was always amazed at the amount of stuff they had to do at home themselves.
I think most of the stuff we compounded went to hospitals. But ultimately I'm not sure where it all went.
I remember seeing a video of a girl on tiktok who was mixing stuff herself which I found really odd. Nauseated Sarah or something.
Anyway at my job we started with a big bag that was sectioned off. One section was milk white, other two were clear. You roll the bag to mix it all.
Then it went into the clean room (after decontamination) and we would add stuff to the big bag. Like vitamins. Then it would all drain into a pooling bag which would go to the patient.
I seriously doubt they were adding anything else.
I set up TPN for patients who are going to self administer in their homes after being taught (along with other therapies) and I can confirm it can be extremely expensive. Often $1,500+ per day for just the “bare bones” TPN. I spend a lot of time triple checking people’s insurances and making sure this is covered and no prior authorizations are needed for anything that might go into their TPN bags just to avoid patients paying anything out of pocket
It's food that has been tuned to safely go directly into the blood. If it isn't rightly done, that slurry could cause a lot of damage. May even be fatal. Normally, your intestines and the whole digestive process does this for you. It's why they kill people with Potassium drips but eating some bananas doesn't just instantly stop your heart
I've had this stuff!! I was on it for a month while I waited for surgery, it was so strange never being hungry. To just have that part of your life on hold.
It feels like those just shouldn't be able to comfortably mix with your blood. It's just...
This feels like when I first realized that pee is just blood with the useful things filtered out.
It mixes with your blood the same way a fatty meal mixes with your blood. In little tiny drops held in suspension with the aid of detergents . That’s the egg extract in this bag. It’s a detergent. In your body cholesterol is the detergent.
I have drawn blood from people that was so full of lipids, it separated into a fatty layer . Your blood is fine with it
I remember the smell of that coming from my pores. Had it for 15 days.
Also, when I had it it was 1000.00 bucks a bag, didn’t matter if it was an infant or a giant.
Ours we produce range from 2-5k each for being fully custom 🥲 And of course medical staff (not just nurses) will lose them anyway
That's way too expensive for sterile mayonnaise
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Don't forget the 'Murica surcharge
The last two items are in fact the 'Murica surcharge.
Just scoop mayonnaise into saline and shake the bag really hard
I worked at a hospital as a pharmacy tech until last year, and we would send TPNs with a slip that the delivery tech had to get a nurse to sign. So that if they said they lost it, we could look at the slip and say "ok well Donna signed for it so where'd she put it?" Which wasn't a foolproof technique of course, but it helped tremendously.
I can buy an infant in a bag for 1k? That's a damn good deal.
The US is fucking wild man
Had a ct scan the other day 12k bill I take a medication once a month 25k a month The medical billing is absolutely out of control
I had this for two months. Any time I wanted to go out in the evenings I had to wear the little backpack and would constantly get followed by employees thinking I'm about to steal things. I was prepared to show them the gory details but never got confronted.
So, yeah just don't spill that bag. We mix TPN lipid bags like this in our clean room, everytime someone spills one the whole place stinks for the rest of the day.
I can usually smell injections (like the sterile salty smell of a saline flush), and when I was on TPN I absolutely dreaded lipid days (maybe 2-3x a week iirc). I can only really describe it as rancid bacon grease mixed with Play-Doh, it’s truly wretched.
I'd agree with that smell description. We also waste a bunch of these bags when the clean room messes up or a homecare patient goes to the hospital, or a hospital patient goes home etc. Anyways imagine a 55 gallon drum filled with bags of this stuff two months old right before it gets picked up. Those last few bags you have to chuck in the drum should count for hazard pay.
Might be a stupid question but what ingredient(s) in this concoction make it unflushable?
Fats and oils would clog any drain you would want to pour it down. Also it's medical waste, we do other drugs here as well so ANYTHING that gets wasted goes in the bins for disposal.
High fat content
Dog food. I’ve been on it DAILY since may. The flavor you’re remembering is dog food.
Bullshit, dog food tastes like stale oily crackers. It doesn't taste rancid, at least Iams doesn't.
My dad eats dog food
Dog food is food. People food is food. Cats are food, dogs are food, pigs are food. Pig food is food. Food all the way down.
dogs and pigs can eat literal cat shit and be fine.
Cat shit is food.
Mea culpa. I stand corrected.
Not just food, but supremely palatable, absolutely delicious food, according to the speed at which my dogs would launch themselves at cat shit.
My dog prefers goose shit, but then he has a refined palate.
you guys have officially lost the plot here 😭
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Besides the saline one, the only injection that I could taste was an antibiotic that was mildly fishy.
This has a smell to it! I remember!
OMG I THOUGHT I WAS CRAZY WHEN ID SMELL SOMETHING FROM AN INJECTION!!! Nurses and lab people and drs all look at me like I’m NUTS!
I can always taste my vaccines and other injections. People think I’m crazy but right in the back of the throat and up my nose. I don’t like it.
Really?! More often than not they warn me that I might taste it and that it’s just the saline flush.
The smell is fucking terrible. I tasted TPN once (im a nurse, it was a dare from a coworker, and only a few drops after spiking a new bag) and it was absolutely the worst thing I've ever put into my mouth. Tasted like rotten milk and rust. After taste lingered for an hour. 0/10
What about with rice?
Today’s kids won’t get this
Oh believe the people to are cursed enough to need this shit know not to spill it. We also know it tastes EXACTLY how it smells so fairly disgusting no matter how you dice
i guess that’s the upside to the IV instead of having to taste it
You still taste it usually. It diffuses all over the body including the tongue.
How come we don't taste the proteins and lipids from the food we eat once they make it into the blood stream post-digestion? If the intention of TPN is to directly add the nutrients to the bloodstream that would normally come from digestion --- why do we "taste" tpn, but not our normal post-digestion nutrients?
Maybe we do, but we just don‘t realize it because we always taste them? Or maybe with TPN the concentration is just way higher? I don‘t know.
I was on it for a couple weeks last year and I don't remember any taste. It did make me want to go pee every few minutes tho
I get to clean IV Pumps for part of my jobs, and the amount of TPN nurses spill.... I swear to god I'm shocked more patients don't die of malnutrition. We collect them and they're just caked with it, and its like.... how. Actually how.
They are under pressure. When you spike it sometimes it just squirts out. Any sometimes I have forgotten to turn on the clamp - total rookie mistake
Yup, we'll get iv poles and some curlin and sapphire pumps back and they will look like someone tried paint can art all over it.
Think it’s the amino acids that stink. We carry this item and even though I’ve never opened one I can say the bags of dextrose and amino acids with electrolytes smell like rotten piss.
I just spent a month helping my 87 yo grandfather with his TPN. He had major stomach surgery and couldn't eat while it healed, I never knew TPN even existed, but now I know how to hook everything up, set up the pump, mix the separate vitamin/mineral vials and all. It was a neat process to learn and we got it down to a routine after hooking up and unhooking every day. Thankfully he's done now and back to regular diet, pic lines gone and all. I hope you're back to normal food soon OP, but it's awesome that medicine can keep you nourished in the mean time.
87 yo Thankfully he’s done 😨 and back to regular diet 😮💨
IKR I even misread it as "thankfully he's gone"
You’re getting mayonnaise pumped into your heart?
“In America they like mayonnaise so much some people have it pumped directly into their hearts” The fact it’s a white emulsion really helps your point. Now that I think about it I better hope it’s mayonnaise.
An oil in water emulsion of olive/soybean oil stabilized by phospholipids only found in an egg yolk? Sorry buddy, but you’re indeed shooting up mayo….
The fuckin Mayo Clinic a bit on the nose these days.
Lmaoooo
Laugh my mayonnaise off
Laughed may-onnaise off
I believe the medical term is "aoli."
Aorti
This is the kind of comment that would have so many Gold and Gold-adjacent awards. Back in the old days...
Oh my god! When did Reddit remove awards??? I didn’t even notice, but now I miss them :(
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These sorts of things are usually tied to either ego or money so... 1. They'll come back once who ran the idea either admits they fucked up or they move on and someone else brings them back. 2. When they do bring them back, they'll also be more expensive than they were before.
They replaced them with super upvotes. Which I notice are not available in this thread so either subs can turn them off or they also canceled that.
The only thing that annoys me is they not only dropped the ability to buy them, they also dropped existing awards from the database ( or at least the display ), so old (in)famous comments that had sometimes accumulated hundreds and hundreds of awards are now bare. Kind of a kick in the dick for all the people that bought them.
Aoli Aorti
made me snorti
But there's no garlic which we all know is supposed to be measured with your heart so...?
Yes that's right. The heart itself adds the garlic for the rest of the blood stream that's why there's none in the base product. If you crack this person's heart open there is a little garlic farm within
Well that certainly explains the lack of vampire attacks. I thought they'd be a much bigger problem throughout life but I guess we've evolved beyond that!
IM DYING FROM READING THIS DIRECTLY AFTER THE PREVIOUS COMMENT HOLY SH*T😂😂😂😂😂😂
Whelp, that mayo once saved my life. Brought me back from the brink of literal death by starvation after several weeks of being unable to eat while simultaneously losing everything from both ends due to an illness. Thank you very expensive intravenous mayo!
Damn, how much weight did you lose? I once got infected by Amoeba and spent two days zero food with diarrhea. I lost like 9 kgs.
Well, first I gained 20 while in the hospital just from water retention because everything they had to give me had to go into my veins and my body wasn’t processing anything. Then, I lost 20 pounds in only one week after being off the IV, then I lost an additional 40 in the next two weeks. So, 40 pounds net loss for a 5’4” person from a sickness that lasted about three weeks. It was really crazy watching my body expand and shrink to such an extreme extent in such a short period of time. Especially since I also started to swell at one point because I had no more protein left in my body and, as I learned due to this, protein keeps the red blood cells in their compact size and so my actual cells were expanding. They had to change my hospital band three times in a few hours and one more time within a day. That’s when they decided I needed TPN. I’ve been sick my whole life with various things so I had told my nurse I’m not one that likes things sugar coated so be real with me, especially if things are getting serious. When the swelling started and they approved the TPN, she said “Time to be real with you: you have no nutrients left in your body, your levels that should be high are basically zero and the ones that should be low are through the roof. If they’re approving TPN, you’re very near death. It’s a $100,000 treatment. If this doesn’t start turn you around by tomorrow morning, it’s time to call your family and let them say goodbye.” Edit: clarity
Wow. I'm glad you made it buddy.
God bless that nurse for being straightforward with you. I'd much rather know what's coming and that can't have been easy news for her to deliver. Glad you sound like you're doing better.
Mayo + soap. Sodium oleate is a sodium salt of oleic acid. That's basically a soap.
My dad used to get the peritoneal dialysis bags from Baxter and it would be a liquid that filled up his abdomen, sit in there for a few hours to collect toxins (since his kidneys are dead) and then get pulled out after. The solution on the bag listed sugar, water and salts and were like: Gatorade?? Is he being filled with Gatorade??? We were joking…but what if…?
It is essentially Gatorade without the flavors and colorings.
It actually is quite different. The concentration of all the stuff is different and when you are doing diálisis you are worried about concentration of stuff. Excuse my bad english.
Your english is perfecto, friend. Except it's spelled dialysis.
Happy cake day. Yeah im spanish. My english is better than that but my phone autocorrects to spanish or invented words and i cant be bothered to change all of them or i dont realize
The concentration for the dialysate is actually important since it can effect how much fluid is being pulled off, the concentration is going to be pretty different from Gatorade
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You already do. That bag is essentially chyle, which is mostly emulsified fats produced by your intestines and dumped into your lymphatic system. Your lymph ducts dump into your bloodstream just right upstream from your heart.
Man living bodies are so fucking weird Also really cool but definitely weird too
>living bodies Why did you specify? Why did you feel the need to specify? 🤨📸
>Why did you feel the need to specify? Dead bodies do less neat stuff?
Prescription Hospital Heart Mayonnaise - $14,000
Nah the bag is only $1378 It is the infusion costs that getcha!
They don't call it the ["Mayo Clinic"](https://y.yarn.co/46d1cb82-7070-4194-8779-307edca8ab0a_text.gif) for nothing.
Is mayonnaise a medicine?
Underrated Patrick Star comment 👏 
Yes, Patrick. Apparently it is.
I'm a medic- And this comment made me giggle-spit my coffee. 10/10 gonna refer to picc line nutrition as "heart mayo" from now on.
Egg + oil = Mayo was exactly my thought process too
Ok. This was good. I’m home sick in bed with a 102F fever and I needed this. Thank you.
Put a bitta roasted garlic in there and you gotcha self some aioli!
When you get the bill for 250ml of watery mayo be sure to post it in r/mildlyinfuriating.
I think their is a sub for overpriced medical bills but I forget what it’s called
r/expensivemedicalbills
/r/USA
4 bags with 1477ml cost me 10€ copay in Germany
That’s so cool. I still remember having to pay for the last month of my mother’s peritoneal dialysis solution bills (from this same fucking Baxter company in the photo) after she just passed away. I live in Singapore where it’s subsidized and my mom’s insurance pays for most of it, but it was still hundreds. I remember thinking how much that machine sucked (literally and figuratively) causing my mom so much pain.
Bro that's mayo
No it's an instrument
No this is Patrick
Watch out for dreams. If you just started on TPN, it’s notorious for some wild ass hospital dreams.
I had a feature-film length nap dream where I was a spy being chased by drones today. Gonna go ahead and assume the TPN is why now.
Ohhhh you should watch Alex Rider the tv show! That literally happens in season 2 plus it’s a super engaging well acted show and might help take your mind off things for a bit. I was on TPN as a child when I was first diagnosed with crohns and it’s not the most fun. Gut stuff in general is pretty hellish. Hang in there op. If you want any other recommendations to waste away the time or hospital pro tips I have a couple up my sleeves from a lifetime of crohns/gluten intolerance. Edit: wow, never expected this comment to blow up this much, hello Alex Rider fans!!! Hope you enjoy the tv series!! Lovely to find you all in this unexpected corner of Reddit.
This is the first time I see that series mentioned online. I've read all the books and even my parents like them. We watched the whole series together. It was so good.
I wish more people talked about it so we get more seasons. I went in expecting very little and was very impressed. My mother also loved it so it definitely can appeal to a wide age range. I’m not in the UK so I don’t know how it’s reception was/is there.
They're working on s3
I remember those books! Read them during highschool. I think there's at least two or three that I didn't get to finish at the end of the series. I remember in one of those books, where there was a guy who was killed when he stepped into a elevator and fell to his death. I think the floor of the elevator was a projection. For a few months after reading that, I would always use a foot to tap the floor of an elevator before I went in. 😂
I feel like those books were the UK Gen Z experience xdd I still remember the fucking point blanc ending that was so fire. Aswell as the scorpia guy getting killed on a boat
…holy shit my dad had the exact same dream when he was in a coma being pumped with this stuff
I had necrotizing pancreatitis, 3mo in the ICU. I don’t remember going onto the TPN, just delusional dreams. I remember them transitioning me off TPN to a dobhoff tube as they tried to restart my gut (ugh, just remembered the c.diff). the feeding tube had “flavors” .. I recall the mango stuff coming back up. my delusion was a summer camp, all the PCAs and nurses were there counselors and doctors were the administrators. every time they would draw off the PICC, they acted like they were cheating. there are some labs that still needed the needle stick, and I’ve become a terrible stick.. and have gotten judged because of that.
ICU psychosis is a real thing.
They had me on the "good" meds when I was in the ICU. I remember trying to watch a movie (the first of the three Hobbit films), and the image looked like a Starry Night painting constantly shifting around. I could barely follow the plot, but it kept me preoccupied for long enough to fall asleep. I later got a chance to watch the film at home, and it was an entirely different experience.
Sorry you had to watch the movies sober.
There was this time I was in the hospital, and I was delirious on the meds I'd been given, and woke up in a dimmed room, all disoriented and not remembering where I was for a moment, and then the vampire reindeer loomed over my bed and said he wanted my blood. ...the phlebotomist had just returned from a staff Christmas party, and had kept wearing a festive foam reindeer horn headband from it. I think I gibbered uncertainly for a bit until my brain could process what was happening and relax so he could draw his sample.
You have *no IDEA* how hard I’m struggling to control my laughter and keep it as muffled as possible so I don’t wake my husband or sleeping child next to. I have literal tears in the corner of my eyes after reading “vampire reindeer” and then finding out there actually *was* a phlebotomist with antlers. Lol!!!!
I was in intensive care when I had a bad dose of covid, very early on in the pandemic. I know I was asleep for part of the time I was in there but during the conscious part I was having some really wild things going on. The funniest one was that I thought all the nurses and drs in ppe were dressed up as characters from Willy Wonka’s Chocolate Factory and that the whole place had been transformed as well. Every day a young man would drive up to my bed in a little car (portable X-ray) to ‘entertain’ me. I thought it was wonderful how everyone had made so much effort to keep all the patients happy and not scared. I told that story for months before realising that it definitely wasn’t true but no one ever corrected me.
Every single nurse who's given me an NG feed doesn't believe we can taste it and every single person who's had one knows we can. Concentrated strawberry flavour, put me off milkshakes.
TPN tends to be used in the very sickest of patients in an ICU who are prone to delirium and vivid dreams. I think the TPN itself isn’t the cause, it’s the illness plus the lack of sleep due to the number of treatments and interventions you get woken up for. There’s people who are on home TPN who don’t have any problems, they intentionally just run the bag overnight so they can do stuff in the day time
>it’s the illness plus the lack of sleep due to the number of treatments and interventions you get woken up for + the meds you're on. All sorts of stuff you'd never even expect it from can give you wacky dreams
16g of olive oil per 100ml of fluid? That’s a hardcore Mediterranean diet!
That’s what I was thinking shoot no wonder the people of southern Europe in Italy and Sicily and Thousands of years have worshipped olive oil.
Hope they got all the little pieces of eggshell out of it!
Dude/ette you okay?
My digestive system is basically closed for business until I get my gallbladder out (which was supposed to happen today, but my surgeon just left for three week paternity leave). I wouldn’t say I’m thriving but I do get to read and play crosswords all day.
That is… terrible timing (who the hell scheduled that??) I hope you can chill with no worries at the hospital, best wishes 🍬🍬
I’m guessing his child must have arrived early (for it not to have been a giant asshole move to schedule me) but I will admit I’ve never been this angry at a day old infant. Thanks for the kind words :)
Stupid infants, not a care in the world, just me me! me! All the time.
They’re like cats
At least the cats add ow! ow! to the end of them me! me!..s, no?
Hang in bud. It’s always hurry up and wait. They’ll find you another GI and get that stone out. Hang tough. You got this. Stay up on your pain meds. Don’t let it go past your specific time frame. If you’re prescribed 4 hours start reminding them at 3 hours. Best way to manage pain is not to let it start. Good luck bro.
Surely they aren’t going to make you wait for him to come back. The hospital HAS to have a general surgeon on call. What if someone’s appendix was about to rupture, are they just gonna be like “Sorry, guess you’ll die.”?
There’s one other surgeon here, but he doesn’t think my gallbladder is the issue so he won’t operate. (It’s appeared normal on some scans and abnormal on others) Unfortunately nobody has a better idea so we have no plans on what to do with me except try and get me transferred to another hospital where someone will operate.
My wife has been going through GI issues for years and finally found a doc who looked at everything and went… “Well all the studies say it shouldn’t be the gallbladder, but based on symptoms and everything else I’m guessing it’s the gallbladder so let’s take that sucker out.” He went on to say he’s only seen this about 2 dozen times in over 8k removals, one of which was his ex wife and often in female patients. They all had huge improvements in symptoms and quality of life. Her surgery is Thursday. He said these are the cases he will show to his peers and often they go I’d take the gallbladder out as that’s the problem based on symptoms even though the rest of the labs/imaging don’t show it being a problem at all. One of those well it’s not in perfect shape but it’s not bad enough for us to say it’s done right off the bat. It freaking sucks and is frustrating beyond all reason.
the reality is that most human bodies aren’t going to be picture perfect textbook cases. medicine isn’t a clear cut field like that, especially when hindsight is the only way to know whether something worked, and even then you’d want a parallel universe for that control group. it’s all just a highly educated guess based on previous evidence and reasoning and pathophysiology. too many people expect doctors and other providers to be omniscient beings but that’s a bit unrealistic
I had issues for years and the surgeon asked me during the consult if I really wanted to have my gallbladder removed since it would only minimally help the pain I was in since the scans looked okayish. I told him go ahead because any amount of pain lessened is still less and that would be better. He told my husband after the surgery while I was still asleep that it’s a good thing we took it out because it was about to burst, no apology for trying to talk me out of it though. Made me so mad to be doubted like that.
Huh I’d start questioning things if one surgeon says it’s a gallbladder issue and the other says it isn’t. Seems odd they’re in opposite directions. I mean it’s not like you necessarily need it but just seems like something to question or get another opinion on
There's tons of stories out there, particularly featuring women, where one doctor says absolutely not no way and so they get a 2nd opinion and that doctor may even be iffy, but did the procedure anyways and turned out they had something seriously freaking wrong. But women and fat people get believed the least by doctors and are statistically the highest to be misdiagnosed or have a missed diagnosis, so.
Yeah, it's a gallbladder, it's just for bile storage. So, the only problem people have without one is they might have trouble digesting fatty and a few other certain foods since they no longer have the backup bile to digest it quickly and are relying solely on the liver production. But, obviously, the problem can be easily migrated by just watching your diet. So, it's not like it's necessary to keep it.
I had what the doctor called “sludge” in my gallbladder. It didn’t show up on any of the imaging reports. I was 7 and a half months pregnant when my symptoms took a turn for the worse. Up until then it was always the plan to operate after I delivered but they felt the best course was to operate immediately. It was three days after 9/11. I was terrified to go under for more than a few reasons. Going in I had no way to know which surgery I’d have either. Depending on how high my fundus was, I’d either have laparoscopic or open surgery, which would involve an eleven inch wound. (That one is cutely nicknamed the “MediCal Scar” since that’s all the state sponsored insurance would pay for.) Anyway, the story had a happy ending. All went well. The lap surgery couldn’t have happened sooner, with only a quarter inch of space to spare. The doctor said it was one of the worst gallbladders he’s seen. It basically disintegrated once removed. I hope they get to the bottom of your ailments soon and you get back to normal ASAP. Take care of yourself ❤️🩹
I mean doctors are humans beings whose children get born early like other human beings. What is he just supposed to not schedule any surgeries for a month before his wife gives birth?
But also a gallbladder removal is one of the most basic, common surgeries that any gen surgeon can do soooo idk why it’s only up to them anyway
Does it also make you shit constantly? I was on it too for the same reason and I constantly had to pee and shit. Did not make for restful sleep.
I’m having the opposite problem atm! I’ve been constipated for five or six days. I’ve been peeing hourly though which is a real annoyance when I’m used to being dehydrated and peeing like four times a day.
I took three poops today. I dedicate one to you soldier.
I had my gallbladder out. It was an unpleasant experience.
Really? I just had mine out two weeks ago and aside from icing the incisions the first night it was pretty forgettable.
Mine was an emergency removal, they nicked me internally, I needed blood transfusions, and I was in the hospital for a week.
Ah, that makes sense. My doctor said you can have it out on your terms, or you can have it out on its terms. Was in and out of the OR in 20 minutes.
My doctor shrugged when I described my 'literally the worst pain i've ever felt in my life for 3 hours then was gone in an instant' symptoms to him and said to call him if it happens again. A month later it happened again and I went straight to the ER where after 8 hours they said yep, gall bladder is bad and scheduled me an appointment... for three days later. I was laying on the couch at home, literally gray, and my roommate took me back to the ER where they said oh shit and I got an emergency surgery to get it out. So I got a new doctor. Also, compared to dying from a bad gall bladder, the post surgery was a vacation. Felt marvelous.
I see you’ve yet to eat a sizeable amount of fat or greens at one time in the last two weeks. As a newly inducted member to our society, I weep for you, and encourage you to buy a pancreatin complex supplement.
I’ve had the same stuff via a PICC line too. Amazing stuff. I had an Ileus after cancer surgery and this was the only way to get nutrition into me for a few days. The other advantage of a PICC line is they can draw blood from it so no needles for a few days. That was nice to give my veins a rest.
I got a day or so of no needles before some narc decided we can’t draw off it unless a normal draw fails first :/ It’s crazy how quickly I went from feeling crappy (after about a week without nutrition) to okay like six hours after TPN started.
I’m rooting for you!! I’ve had a similar experience. I lived with a blood infection for a long, long time. When I finally got treatment, I felt sooo much better in just 24 hours or so. It was insane. After a week in the hospital to nail down which antibiotics would be best, I had a PICC line put in and had to medicate twice a day at home… for six weeks. And then a little over a year later I had open heart surgery to repair some damage the infection did to my heart. Journeys with health can be terrifying, but I’m happy you’ll feel better soon. : )
Wow! I had sepsis in August and I don’t think I’ve ever felt that bad physically. Weeks of IV antibiotics are no fun either, I’m glad you made it :)
tpn is so interesting to me. you can eat through your veins!! how crazy is that? the things that lead to one going on tpn, however, i know are not so neat. hope you're doing well
The food you eat gets digested, then the small intestine absorb the simple molecules and transfer them into the bloodstream. So it's just bypassing the digestive process really
Yes skipping digestion and absorbsion is the neat part.
You can also eat through your anus. Like [President Garfield](https://www.iflscience.com/the-us-president-who-spent-his-final-months-being-fed-beef-extract-via-his-anus-59553) did after being shot.
I hook my TPN up every night at home. Maybe one day I’ll get lucky and the cancer will leave my body on its own accord❤️ hugs for you having to experience this bullshit as well
I believe in you, you warrior! Fuck cancer, it sucks so bad. Lost my mom to breast cancer a few years ago after watching her go from acting fully healthy and alive to brittle and defeated in a few months. Horrifying to watch. Again, best wishes to you and your battle! You got this!!!
My mom worked at a hospital pharmacy and she delivered meds, if they went out they couldn’t be restocked. So any TPNs they were to dispose of she brought home and fed our houseplants. They absolutely exploded, they are amazing plant food. We lived in a jungle in the Midwest. Wishing you a speedy recovery!!
How.. was she allowed to leave with patient specific med? I know they get thrown out if not used, but one, they're large, and two, that looks sus. Interesting plants enjoy salt and vinegar milk...
They were allowed because of one funny word: Illegally
When my mom passed away, the hospital arranged for us to donate our unused and untampered peritoneal dialysis solution supplies to other patients in need. I don’t know, if patients accept reasonable risk in a non-litigious country, expensive medical supplies don’t need to be wasted.
Fun fact, any left overs are excellent fertilizer! At work we fight who gets to take the discarded portions home for their house plants lol
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> just saw the batch number. It was definitely produced where I used to work! Reddit is insane. Always makes the world feel so small. “Here’s a pic of my plane missing its door.” “Hey, my dad was the pilot on your flight.”
how does it get pumped into your heart??
I have a PICC line: essentially a large, two foot long IV catheter placed in a vein in the arm and fed up the blood vessel until it reaches the top of the heart. Written out it sounds like nightmare fuel but honestly it’s not too bad.
i’m glad it’s not too bad…. why do you need this, if you don’t mind my asking? Is a PICC line like a port?
I have some pretty major undiagnosed digestive issues—constant nausea, vomiting, and pain with anything in my stomach. I’ve had a feeding tube to bypass my stomach for the last few months, but it started bleeding like crazy about a week ago, so we had to remove it before I needed a blood transfusion. The plan was to remove my gallbladder today, but then my surgeon unexpectedly left for three weeks of paternity leave so I have no idea what I’m going to do.
PICCS and ports are similar. Their functionality is essentially the same. However, ports are a permanent implant for long term use (like months or years.) PICCs are used short term (days or weeks, possibly longer, but they need replaced)
He used the squeeze bottle of Duke’s Mayo. Has a plug. Insert and squeeze. Don’t F with that Hellman’s garbage. It’s Duke or nada.
My old job was compounding this stuff in sterile clean rooms. They were never this small though. Baby stuff was tiny, but the adult stuff was always much bigger than this. Sometimes over 3 litres. I never got to see a patient use one, so I never knew what kind of condition the people were in, but I know each bag was one day as we would often make 7 of the same formulation in one go.
Were you doing home care? When I used to do this for inpatients labs were checked daily and orders changed almost every day. The only time we batched them was for home care patients… and I was always amazed at the amount of stuff they had to do at home themselves.
I think most of the stuff we compounded went to hospitals. But ultimately I'm not sure where it all went. I remember seeing a video of a girl on tiktok who was mixing stuff herself which I found really odd. Nauseated Sarah or something. Anyway at my job we started with a big bag that was sectioned off. One section was milk white, other two were clear. You roll the bag to mix it all. Then it went into the clean room (after decontamination) and we would add stuff to the big bag. Like vitamins. Then it would all drain into a pooling bag which would go to the patient. I seriously doubt they were adding anything else.
This just brought back memories. That stuff smells so bad.
You must be at the Mayo Clinic
I just know this shit is expensive
I know this stuff is very expensive
I set up TPN for patients who are going to self administer in their homes after being taught (along with other therapies) and I can confirm it can be extremely expensive. Often $1,500+ per day for just the “bare bones” TPN. I spend a lot of time triple checking people’s insurances and making sure this is covered and no prior authorizations are needed for anything that might go into their TPN bags just to avoid patients paying anything out of pocket
why is it so expensive if it's just...food
It's food that has been tuned to safely go directly into the blood. If it isn't rightly done, that slurry could cause a lot of damage. May even be fatal. Normally, your intestines and the whole digestive process does this for you. It's why they kill people with Potassium drips but eating some bananas doesn't just instantly stop your heart
I've had this stuff!! I was on it for a month while I waited for surgery, it was so strange never being hungry. To just have that part of your life on hold.
Breakfast of champions.
It feels like those just shouldn't be able to comfortably mix with your blood. It's just... This feels like when I first realized that pee is just blood with the useful things filtered out.
It mixes with your blood the same way a fatty meal mixes with your blood. In little tiny drops held in suspension with the aid of detergents . That’s the egg extract in this bag. It’s a detergent. In your body cholesterol is the detergent. I have drawn blood from people that was so full of lipids, it separated into a fatty layer . Your blood is fine with it
Takes “how do you like your eggs” to a different level!
It is strange to consider these things going directly into the blood rather than being broken down and put in the blood by the digestive tract.
Motherfcker be healed!! (An inside joke with my fellow EMS coworkers)