Michelle Irwin Tough

Pulm/CC nurse practitioner navigating the art and science of medicine. Working night shift magic. Right brained. In awe of how much I don't know. #FOAMed fan!

[Michelle Irwin Tough @latenightNP]

Grateful to the @NashvilleScene for featuring some of the healthcare workers on the COVID frontlines including my team of NPs heading up our COVID ICU. We’ve been there since March and we’re tired in every way, but we keeping going!

[Nashville Scene @NashvilleScene]

"I truly wish people could see what it’s like in a COVID ICU every day," says acute care nurse practitioner Christy Noblit. "It’s just — it’s terrifying for these patients."

https://t.co/2jg0OXCo1N

[Michelle Irwin Tough @latenightNP]

Medical conferences look a little different in 2020: couch, blanket, pjs, coffee, autumnal candle. The opening session for #CHEST2020 was excellent. I could listen to Dr. Fauci talk for hours. Excited for the next few days!

[Michelle Irwin Tough @latenightNP]

Yes. This. Succinctly puts into words what I’ve learned working in a COVID ICU.

[Esther Choo, MD MPH @choo_ek]

The outcomes from COVID are not live vs die. There is a world of suffering, morbidity, and disability in between.

[Prof. Feynman @ProfFeynman]

If you cannot explain something in simple terms you don't understand it yourself. It is the mark of a genius to be able to explain a complicated topic in a simple way. 🧠

[Michelle Irwin Tough @latenightNP]

Couldn’t stop the tears with this one 😭

[Michelle Irwin Tough @latenightNP]

This is true wisdom. 🥞🥞🥞

[Esther Choo, MD MPH @choo_ek]

I don’t know who needs to hear this, but cold + rain are nature’s way of saying get yourself to pancakes.

[Michelle Irwin Tough @latenightNP]

I’ve worked in a hospital for a decade. It’s always felt like home. Coming in today with a loved one who is a patient, and it feels totally different, unfamiliar, even scary.

[Michelle Irwin Tough @latenightNP]

🙌🏼

[Sam Ghali, M.D. @EM_RESUS]

I don’t know who needs to hear this but FFP does NOT normalize INR. The lowest you can get an INR down to with FFP is ~1.6. So stop giving it to reverse patients with INRs ≤ this value. It doesn’t work.

[Michelle Irwin Tough @latenightNP]

This whole thread. Yes.

[Sam Ghali, M.D. @EM_RESUS]

I recently had a patient who presented in profound acute renal failure with a BUN of >200, creatinine of 13.5, and critical pH of 6.7, on the brink of death...

[thread]

[Michelle Irwin Tough @latenightNP]

As a full time night shifter for the past 3+ years, this is gold!

[CORE IM @COREIMpodcast]

Some of our fav residents were on nights and well...

#Bingo! 🤣

[Michelle Irwin Tough @latenightNP]

I’ve seen this several times today, and it still makes me LOL 😂

[Mark Lisseman @marklisseman]

Is that diagram… accurate??

[Michelle Irwin Tough @latenightNP]

Beautiful.

[Panagis Galiatsatos, MD, MHS @panagis21]

During MICU rounds, a pt died while on comfort measures.
When we went by the room, our resident asked if we could still “present her”.
Then, our team talked about what they learned from the pt during our care for her: job, jokes, fav TV show 😊
Humanity in the ICU.
@OnlyintheICU

[Michelle Irwin Tough @latenightNP]

This thread. Nurses, you are doing important work. The small things sometimes are the biggest and best things.

[Kate Bowler @KatecBowler]

The insane difference a good #nurse makes.

Reason #1: He intuits that you do not want to small talk about your horrible horrible illness. He wonders if you are invested in Game of Thrones. You are. He has some thoughts about House Stark, would you like to hear them? You do.

[Michelle Irwin Tough @latenightNP]

Finished my first month at my new job. It’s humbling, different, and lonely at times, kind of like most new beginnings! My mantra of sorts: Embrace humility, be teachable, stay deeply curious. It’ll get better. It will.

[Michelle Irwin Tough @latenightNP]

Starting a new job t’moro at the hospital where I trained. Nervous. Excited. Always learning, but haven’t been an official “trainee” in a few years. Advice on being the best trainee possible?

[Michelle Irwin Tough @latenightNP]

This absolutely blows my mind. The human body and what it can do...wow.

[NEJM @NEJM]

Image Challenge: This image is a cast of what anatomical structure? Submit your answer: https://t.co/KfTyrPPL8e

[Michelle Irwin Tough @latenightNP]

#latertweet from #IkigaiMedEd : “Education saves more lives than clinicians... If you are a good educator, you will save more lives.” @ffolliet This will stick with me for a long time.

[Michelle Irwin Tough @latenightNP]

What an amazing three days hanging out in a castle with a brilliant and creative group of medical educators for #ikigaimeded Super inspiring, tons of ideas, heading back to ATL with lots to process! Thank you @Med_Utopia crew!

[Michelle Irwin Tough @latenightNP]

@jtheheist I think you’d love this!

[Michelle Irwin Tough @latenightNP]

Curriculum development workshop to kick off Day 3 of #ikigaimeded Yeah, Bloom’s Taxonomy!