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  Good job Brazil and Serbia. Perhaps the US of A can learn something.

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  Since Collins thinks Manchin has solid independent cred, it’s a good time to remind people that Joe Manchin’s daughter ran up the price of epinephrine autoinjectors (Epipens) around 300% for no reason beyond pure profit. She is responsible for the preventable death of many children and adults. Joe Manchin facilitated this, and protected her in Congress. Fuck Joe Manchin and his yacht.

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  “Why are all of these evil billionaires…” Well, let’s start with the billionaire part. Would someone who hasn’t a phenomenal asshole just keep accumulating wealth after the first couple hundred million? They don’t need it. They can’t use it. A human with empathy and a desire to do good would be spending it lifting others out of suffering.

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  One closing thought tonight: did you know you couldn’t access Fox’s studios if you weren’t vaccinated against COVID during the shitshow? Yeah. All of those fucking weaseldicks were jabbed. They just lied to everyone because it makes money. Guess everyone forgot about it.

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  Harry Potter was awesome when I was a kid. The story is epic. The messaging overall good. So what. Rowling is a hateful scumbag out there hurting people for shits and giggles when she could be spending her well-earned fortune on saving lives or bettering the world. My kids may read it of their own accord, but we’ll be buying Dragonriders of Pern, Lirael, Redwall, and others first. No need to support hate.

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  “Ah nah, he’s not a pedo. That’s just people trying to make a dime or get fame off of him” From the same people who: “Bro had meth in his system seven years ago. He’s just seeking drugs. I didn’t order anything in triage. Eye roll” Anyway. I’m judgemental as fuck at times, but if you can’t get your head out of your ass enough to see a predator, you deserve to get eaten. Also, don’t be shitty to people.

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  Watched some videos from drone strikes on Russia tonight. Airport footage (no strike there) — parents carrying tired toddlers, little kiddos in parkas walking, zombie-faced adults — this is all too familiar. They’re humans. This whole war thing is awful. Russian leaders can go play hide and go fuck yourself, but the citizens walking through that airport suffer. The citizens of Ukraine suffer. It’s all bad. War is bad. Anyway, fuck Trump for prolonging it.

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  Following up on my previous post: Pretty much yes to most comments. Anxiety in the emergency department setting should be viewed as a symptom, or physical manifestation, of an underlying disease state. It is not an emergency diagnosis. The cause needs to be investigated, and life-threatening conditions ruled out. For example, recently someone came to my ER with high heart rate as a complaint. They admitted chronic meth use, and feeling anxious. Guess what? Hyperthyroidism was the problem. 1/…

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  Guys, if you’re in #emergencymedicine please do not even put anxiety on your differential until you have done a very thorough medical workup AND the patient has reported feeling anxious. It is a diagnosis of exclusion. “Anxiety” is the diagnosis on the chart the day before the patient dies from their blood clot, arrhythmia, thyroid storm, sepsis, hemorrhagic shock, or overdose. It is a bullshit diagnosis unless you have a clear patient-reported history of anxiety.

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  They’re holding a man in solitary confinement solely because he stood up in his Air Force blues and called for the impeachment of the President.

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  Just so EVERYONE understands this: Moderna has a flu shot. It works. It works well. It is safe. It is safe in people with compromised immune systems (like cancer patients!). Trump’s nutjob at FDA, Robert F. Kennedy Jr., appears to have ordered FDA to refuse to even accept the application to review the shot for approval. RFK wants to kill your grandma. Fuck RFK.

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  For anyone wondering: inserting a nasogastric tube is sufficiently painful for many people that I typically administer IV fentanyl and give a nebulized lidocaine treatment before placing them. I doubt ICE’s folks are considering analgesia. https://www.theguardian.com/us-news/2026/jul/28/trump-administration-forced-treatment-ice-hunger-striker

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  Lol. Leading a party that is experiencing a historically unpopular moment, with an absurdly unpopular president, going into midterms with a shaky economy, and he thinks putting tariffs back in place is the winner. Are y’all tired of winning yet? I’m not sure we can take more of this “winning”.

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  A woman is suing Fargo ND police for falsely imprisoning her for SIX MONTHS based on a bad facial recognition hit. She’d never set foot in ND, and the photo the cops fed into the recognition database didn’t look anything like her. She lost her home, car, and possessions while incarcerated. She’s suing for $10 million. To me, that honestly seems reasonable. Fuck those cops. Losing six months, everything you own, and having a felony arrest wrongly show up in AI shit for decades is a problem.

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  “My loaded shotgun with the safety off, left propped against a tree, went rogue and shot me in the back”. You see how fucking stupid that sounds? No you absolute coop scraps, you were NEGLIGENT and left something in an unsafe state, and it PREDICTABLY caused a problem. That’s a liability, a testament to shitty judgement, and an indictment of your safety practices. Get wrecked hosers.

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  ICYMI: The July 7 JAMA has a great paper by Rodriguez, Fuerst, and Schrote, in which they evaluate the management of spontaneous abortion (miscarriage) before and after *Dobbs*. In short, after *Dobbs*, women are being told to suffer through it without medication more often, and when they are prescribed medication, they are given a less effective treatment than before. https://jamanetwork.com/journals/jama/article-abstract/2849131 1/2

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  Blowing up water tanks in Iran is an unconscionable act. It may disrupt military targets, but it absolutely will kill civilians. Cowardly fucking nonsense by a country too chickenshit to put boots on the ground and too stupid to just say fuck it and leave.

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  The guy who killed a grandma when his Tesla tore into her house supposedly had the accelerator pedal to the metal, “overriding” the car. Tesla is suggesting he was accelerating intentionally. That’s one possibility. Another is that he was furiously trying to slam on the brakes to override unsafe driving by the car, but hit the wrong pedal. This is a common mistake people make.

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  Guys, guys! I was out of touch enough today I had no idea the Orange memory care escapee was going to give a speech, and missed it entirely. So much win.

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  For anyone wondering: you can, in fact, run while wearing a 3M Aura N-95 respirator. It feels awful for a minute or two while you get used to the restrictive feeling, and you dump sweat like whoa out of your face, but it works. I was doing it here last week when you could see the smoke particulates in the air at night with a headlamp. For smoke particulates, a vented N-95 makes it less sweaty and gross, I just don’t have any at the moment because they aren’t safe for clinical use.

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  Congratulations to Pete Hegseth for offering men gender affirming therapy. Real surprise move, but the first step is always the most important.

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  ICE and GEO group say that there are currently no active tuberculosis cases at the Aurora facility where there was one a week or two ago. This means that person was hospitalized, moved, or deported. One of those is reasonable. The other two means contact tracing and treatment is difficult or impossible. It is a statement that says ICE and GEO group intentionally are making it impossible to control a deadly and highly contagious pathogen.

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  Lol. Hegseth wants to test military members testosterone levels. Bro is gonna uncover the rampant illegal use of steroids across the service. Good job.

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  ICE is killing more people because ICE is probably being told to be more aggressive. The fascists want more violence and instability going into the fall so they can play the security card. It didn’t work in 2020 and it won’t work this time either.

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  All I’m saying is that Trump talked to Graham before he died. Sure, correlation isn’t always causation, but…

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  Israel is gonna go through some things when we get control of our country back. https://www.theguardian.com/world/2026/jul/11/ro-khanna-congressman-detained-israel-settlers-west-bank

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  Once again, ICE appears to have shot a driver from the side of their vehicle for no particularly good reason. https://www.theguardian.com/us-news/2026/jul/10/texas-man-ice-immigration

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  Why is that all of these evil fuckheads keep naming their shit after things from Tolkein epics? Y’all motherfuckers are the orcs. Aragorn would be hunting you for sport.

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  RE: https://mstdn.social/@JugglingWithEggs/116890822377662966 This 100%. If a country won’t let a ship dock because the passengers are gay, you and I should say fuck that place, and boycott the country.

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  Why do Republicans win? They win because they treat this as a team sport, and just like in college football, they don’t let rape allegations derail the game. That doesn’t make Democrats wrong for demanding rapists stay the fuck out of their party. It just makes Republicans shit people, and Democrats principled losers.