Paul Chestovich MD MBA FACS FCCM

Husband, dad of three girls, trauma/burn surgeon. Writer. Weightlifter, history buff, and science nerd. Mushrooms are gross. Tweets are mine.

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

@olsonplanner How much does the mortgage amount play into this?

Say income is 500k. Home price $1M comparing a 50% down mortgage of $500k vs standard 20% down and $800k loan.

Clearly the pmt ⬇️ with ⬇️loan, but the tax deduction is better with ⬆️loan, and more $ can be invested.

Thoughts?

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

@talishammas If an agent passed on a query and that agent is attending a pitch event, is it worthwhile to try and pitch them anyways?

Corollary question: If I want to query an agent and that agent is attending a pitch event, is it better to hold on the query and see if pitch is successful?

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

@D25610 @AdamPlantinga This makes me so hungry.

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

@DrWojakMD Actually it is the opposite. Brain death declaration rules out all recoverable conditions. Brain death by definition means the complete brain is gone and will never recover.

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

@anish_koka @DrDiGiorgio To answer the question, typically the unit secretary will notify the OPO. This is part of CMS guidelines and should occur <1hr after pt arrival with certain triggers. They follow along but only engage if patient could meets criteria such as declared brain dead.

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

This is correct and how it should be. Organ donation is one of the most misunderstood subjects in healthcare. The pressure is to resuscitate the patient and honor their wishes which is traced back to the principles of beneficience and autonomy in medical ethics.

[Anish Koka, MD @anish_koka]

Neurosurgeon @DrDiGiorgio on organ procurement: he feels zero pressure to produce donors. The hospital—not the care team—contacts procurement; he's never made that call himself. A firm wall separates the treating clinicians from the procurement team, and he doesn't even know who's a registered donor while treating them.

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

This is misleading and not true. Hospitals with transplant programs are often also stroke and trauma centers. Brain Death is a rigorous clinical diagnosis clearly documenting complete lack of brain function, which is also codified in state laws.

[Jojo Braun @TerribleJyon]

@MaryBowdenMD @TexasChildrens Multiple studies confirm that hospitals with organ extraction programs declare "brain death" at something like 5x the rate of hospitals without organ programs

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

Declaration of brain death and organ donation are codified in state laws of each individual state in the US. And patients can specify if they wish to be an organ donor after their death as specified in the Uniform Anatomical Gift Act. This man knows nothing.

[Toby Rogers @uTobian]

You have a brain aneurism and the paramedics take you to the hospital. The hospital is now staring at a person who may not be conscious, cannot speak, and cannot give informed consent... that is worth a million dollars if the person is declared "brain dead" and is an organ donor.

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

@nickmmark @CritCareTime A-lines still standard in my book for sick pts, on vent or pressors.

One of my pet peeves is the a-line technique which deliberately backwalls the artery and is then rewired into lumen. Terrible technique IMHO.

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

I was pretty dumb and naive as a third year student so this tracks.

[Pitt Crave @PittCrave]

Noah Wyle compares his medical knowledge to that of a third year

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

@oliviamemerick 2nd question. Is it wise to work on a sequel to a novel before the primary novel has sold?

Would an agent even consider a book 2 without book 1?

Or better to work on a completely new standalone story.

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

@oliviamemerick Another comps question. What if the very best comps (based on genre and content) are >10 yrs old? Is it better to use them despite their age or pick something newer that is not is close?

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

Feel free to consult ChatGPT to remove an appendix or gallbladder or save a gunshot victim.

[Suneel Dhand MD @DrSuneelDhand]

ChatGPT is far better than 95% of doctors

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

@fuqekgs I can identify with this comment. I have dozens of unbuilt Lego sets, don’t have the time to assemble them. My wife really loves that about me.

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

@SCHostetler Appreciate the historical context, but in most modern situations, ‘doctor’ usually means of the medical variety.

If someone says “is there a doctor on the plane” they’re generally not interested in someone who got a PhD in Art History.

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

@perrigame You would not be the first patient to make a joke like this when undergoing a physical exam.

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

@generalorthomd @SeeFisch Tell me you’re an orthopedic surgeon without telling me you’re an orthopedic surgeon 😜

[Ron Barbosa MD FACS @rbarbosa91]

With everyone talking about *that* survival curve, I thought I would redraw the same survival graph, but for one of the common conditions we treat in trauma surgery (tension pneumothorax).

It may not be as fancy as pancreatic cancer treatment, but it remains quite effective. 🧐

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

@heather_wohl I would be willing, depending on genre. I’m down with mystery, thriller, horror, literary. Send me a message if interested.

[Paul Chestovich MD MBA FACS FCCM @PChestovichMD]

@DrDiGiorgio I find the epic chat very useful, especially for non-urgent requests. It means I don’t need to interrupt what I’m in the middle of for little things that can wait until later.