Parimal

Critical Care @ AIIMS-Delhi

[Lee Roach @leevalueroach]

In 2021 I told my wife she reminded me of a deep value turnaround on the pink sheets and she asked me to elaborate and I did. I should not have elaborated.

I said she was undervalued by the market and she said “what market” and I said the dating market and she said “I am married to you” and I said “exactly, that’s what I’m saying, you’ve been taken private at a discount,” and the temperature of the room dropped 11 degrees.

I tried to recover. I said she had hidden assets that nobody else had noticed and she said “what hidden assets” and I said her sense of humor and she said “I am not laughing” and I said “that’s because the market hasn’t priced it in yet.” She put her fork down.

I kept going. I said her downside was protected because she had real intrinsic value and she said “are you saying I would be worth something if you sold me for parts” and I said “no but technically yes.” She stood up. I told her this was actually a bull thesis.

I told her I was long her. I told her I was so long her that I would never sell, even if the multiple compressed, even if there was a quarter of bad earnings, even if she had a temporary impairment. The word “impairment” did something to her face that I had never seen before and will never see again.

I told her she was a generational opportunity. I told her she was a name nobody else was covering. I told her she was a special situation. She said “I’m leaving” and I said “this is the bottom, this is where conviction is forged,” and she said “no this is where I leave” and I said “I am averaging down,” and she said “on what” and I said “on us,” and she left. She took the dog.

The dog gave me a look on the way out that I have spent four years trying to interpret. The look said one of two things. It either said “you brought this on yourself” or it said “I was always more her dog than yours.” I think it said both.

I have, in the four years since, told the story of this conversation to exactly two people. The first was a man at a bar who stopped me halfway through and said “I think I understand why she left” and I said “I know, the analogy didn’t fully land” and he said “no, sir, I don’t think you do know,” and he paid for his drink and left.

The second was my therapist, who listened to the whole thing without speaking, and then asked me how I felt, and I said “honestly? I still think the thesis was right. I think the timing was wrong. I think I was early.” She put her pen down. She has never put her pen down before. She picked the pen back up. She wrote one word.

I will never know what the word was. I asked. She said it was for her records. The session ended four minutes early. I paid the full $300. I drove home in silence. I thought about the conversation the whole way. I think the problem was that I said “impairment.” I think if I had said “transitory headwinds” the marriage would still be intact.

I am not joking. I have thought about this every single day for four years. Transitory headwinds. That was the word. I had the word the whole time. I did not use the word. That is the only regret I have. Not the analogy. The vocabulary.

[Congress Kerala @INCKerala]

Rajesh Exports without any experience is eligible for PLI subsidies from Central Govt.

Ola Electric, which sells the most substandard 'firey' Electric Scooters, got 367 Cr in PLI subsidies from Central Govt.

Ather Energy which has built most high quality Electric Scooters in India, is not eligible for PLI scheme.

Every scheme is designed to favour Modi and his chamchas. That's all it is. And you wonder why businesses are not investing in India.

[Parimal @Haywired2]

@JaiTDP That's it! That's the end of tdp! That's the tweet!!

[Pawan Kumar Rai @prai2303]

Our social team made this, and I cannot stop thinking about Kerala and Goa.

These are the states we associate with fish diets and active lifestyles.

So why are they topping the cholesterol chart?

What am I missing here?

[Ankit Kedia @Ankittskedia]

Once you visit small countries like Sri Lanka, Thailand, or Vietnam, or cities like Dubai for the first time and then come back to Indian streets, you realize how much you’ve been scammed by your municipality, local MLA, MP, and the whole system.

[Neil Borate @ActusDei]

😅 A gem by @1shankarsharma.

[Subramoney.com @pvsubramanyam]

Went to a friend's house in Mumbai. Each flat there is worth at least Rs. 4 crores (a new one in that locality will cost Rs. 6 crores). The watchman was missing....and I just saw him coming in. I had time so I chatted. He was a BRAHMIN from Bihar. No that is not the tweet. He had gone to relive himself -AT A NEARBY garden which had a loo. This building did not have a loo for him, he had a broken plastic chair (some had me down cushions kept it company), and a much used 2 litre bisleri bottle. He got it filled from a nearby garden. 12 hour shifts, and a grand salary (what he got from the agency) was Rs. 17000.
What is WRONG with us?

[DD News @DDNewslive]

A key finding from AIIMS New Delhi research highlights that increased screen time in children under one year of age is associated with a higher risk of autism by the age of three.

The study suggests that greater screen exposure may increase the likelihood of autism-related concerns. Experts recommend keeping children below 18 months away from screens.

Dr. Shefali Gulati, Professor, Department of Pediatrics, #AIIMS

#ChildHealth #ScreenTime #ParentingTips #AutismAwareness @aiims_newdelhi

[Prashant Nair @_prashantnair]

😊

[Parimal @Haywired2]

Dope!!

[Mushtaq Bilal, PhD @MushtaqBilalPhD]

> be Alexandra Elbakyan
> be born in Kazakhstan in 1988
> start coding at 12
> hack your internet provider at 14
> hack MIT Press at 16 to download neuroscience books you can't afford
> get a CS degree from Satbayev University
> intern in neuroscience at Georgia Tech
> speak at Harvard on brain-computer interfaces
> notice researchers can't read the papers they need
> notice academic publishers charging $30 a paper
> notice peer reviewers worked for free
> notice editors worked for free
> notice universities funded the research with billions of dollars of public money
> build Sci-Hub in 2011
> upload nearly every paywalled research paper ever published
> give it away for free
> get sued by Elsevier
> get hit with a $15 million judgment
> don't give a flying f*ck
> keep Sci-Hub up
> get domain after domain seized
> register a new one
> keep Sci-Hub up
> get investigated by the US Department of Justice
> don't give a flying f*ck
> get accused of working for Russian intelligence
> don't give a flying f*ck
> have the FBI subpoena your iCloud
> get named one of Nature's ten people who mattered in science
> get a parasitoid wasp named after you
> get a deep-sea snail named after you
> get the Electronic Frontier Foundation Award for Access to Scientific Knowledge
> become a legend

[Mushtaq Bilal, PhD @MushtaqBilalPhD]

The growing inaccessibility of science that you can understand by paying €27.99

[Fiachra (Fiki) 马骏 @FiachraRM]

Be Mark Zuckerberg:

> learn Mandarin
> give speeches in Mandarin in China
> put Xi Jinping’s book on your desk
> get employees to read Xi Jinping’s book
> ask Xi Jinping to name your baby
> get rejected
> host Chinese internet officials at Facebook
> try to bring Facebook back to China
> get rejected
> explore China-friendly censorship tools
> get rejected
> quietly test a China-only app
> get rejected
> buy an AI company with Chinese roots
> get rejected by China again

[NEJM @NEJM]

For critically ill adults undergoing tracheal intubation, the use of etomidate to induce anesthesia may increase the risk of death. Whether the use of ketamine reduces this risk is uncertain. Research findings from the RSI trial are summarized in a new Quick Take video. https://t.co/Jnq5vIUQfJ

[Medical Notes @A25ma22]

New TB Guidelines (2025)

[Mamas A. Mamas @mmamas1973]

@DrMarthaGulati - if you are not educating your patients online, someone else is.

Misinformation means simplicity beats nuanced truth and can lead to harms

[Parimal @Haywired2]

so true!

[Dr. Vrinda Kabra @KabraVrinda]

Purchasing a pay-once lifetime Goodnotes 5 subscription in 2023 right before they launched Goodnotes 6 (which needs yearly renewal) was possibly the best real estate financial investment of my life.

[Parimal @Haywired2]

@drmohansai These studies would have had many confounders like periarrest cases where only fentanyl is given sometimes since it would have been a crash intubation by a ward resident

[Anuja Jaisswal @AnujaJaiswalTOI]

The appointmen tof M Srinivas as a member of #NITIAayog has set off transition at #AIIMSDelhi with an interim director likely to be named before govt appoints a full-time head. With his move, there is no immediate clarity on who will take charge. Officials said the selection of a full-time #director could take several months, and in the interim, the institute is likely to be led by the senior-most faculty member, in line with past practice. @MoHFW_INDIA @NITIAayog @JPNadda @aiims_newdelhi @timesofindia

[Parimal @Haywired2]

by reducing respiratory rate and FiO₂ rather than escalating hemodynamic therapy. The key ICU pearl is that the Pv–aCO₂ gap reflects flow only when PaCO₂ is stable. A high gap with high ScvO₂ and stable lactate should prompt you to think physiology or artifact

[Parimal @Haywired2]

A 58 year old man with septic shock due to pneumonia is on day 2 in ICU. At baseline he has MAP 68 on low dose noradrenaline, HR 102, adequate urine output, lactate 2.1 mmol/L. ABG shows PaCO₂ 42 mmHg with ScvO₂ 72 percent, and VBG shows PvCO₂ 48 mmHg (1)

[Parimal @Haywired2]

espite preserved or even improved systemic flow. Acting on this number alone leads to overtreatment, fluid overload, pulmonary edema, and harm. The correct approach is to interpret the gap in context, recognize confounders like hyperventilation and hyperoxia, and correct them (6)