Alex Pretti: a physician’s open letter defending his legacy

Physician
January 25, 2026

To those who would speak too quickly, to those shaping narratives without knowing the weight of the work, and to those of us still standing, I write this as a physician, as a colleague in medicine, and as someone who understands, intimately, what it means to stand at the threshold between life and death. Not as an idea, not as rhetoric, but as responsibility.

I am not a nurse. I am …

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Alex Pretti: a physician’s open letter defending his legacy

Methamphetamine-induced lung injury: the hidden diagnosis in South Texas

Conditions
January 21, 2026

Methamphetamine has become an unavoidable presence in South Texas medicine. It shows up in our EDs, clinics, and ICUs, usually framed as a cardiotoxic, neurotoxic, or psychiatric problem. But over the past few years, a different pattern has kept surfacing in my practice: “pneumonia” cases that don’t behave like pneumonia, young lungs that look like ARDS, and hypoxic patients whose imaging and labs do not match the story, until someone …

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Methamphetamine-induced lung injury: the hidden diagnosis in South Texas

A school nurse’s story of trauma and nurse burnout

Conditions
January 11, 2026

School had just started for the new school year. It was hot and humid. I had just retired from ICU nursing and behavioral health, a 46-year career and never skipping a beat. After several months of retirement, I couldn’t sit still. I was bored and had that nagging feeling that I wasn’t done yet with my career. Maybe that nagging feeling was guilt. Like you can’t quit. You can’t stop. …

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A school nurse’s story of trauma and nurse burnout

The haunting trauma of nursing

Conditions
December 3, 2025

We put on that strong face. Resilience. We learn to handle anything. But our outside appearance can fool you as our inner turmoil plays havoc emotionally.

I learned quickly that nursing was not all about holding hands with a sick child in the emergency room or fluffing up a pillow for a dying grandma. My initiation into the dark side of nursing began in the emergency department. I was fresh out …

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The haunting trauma of nursing

A nurse’s view on the broken health care system

Conditions
October 31, 2025

We ran as fast as we could. I glanced up occasionally at the nurse straddling my patient, her blonde waves obscuring her face as she furiously attempted to restart a non-beating heart. We pushed the hospital bed down hallways and around corners, narrowly missing people-filled stretchers lining the Emergency Department. I stood in the back while the experts took over. If she was ready to leave this world, I wanted …

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A nurse’s view on the broken health care system

A nurse’s story of hospital bullying

Conditions
October 23, 2025

An 18-year-old was admitted to our ICU with a questionable diagnosis. The drug screen did not reveal what he had taken. Our ICU intensivist speculated he ingested bath salts. Bath salts came to the U.S. around the 2010s. It was cheap and, even better, considered a “legal high” as it was not detectable in drug tests. Josh came to the emergency room psychotic, paranoid, and hallucinating, with hypertension and SVT. …

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A nurse’s story of hospital bullying

Inside the final hours of a failed lung transplant

Conditions
August 21, 2025

This story has been fictionalized.

Dorothy Klein. MRN 508291987. DOB 12/22/1962. Patient A-. Unit A-. Unit number W038306745014-K.

OK. Next.

Dorothy Klein. MRN 508291987. DOB 12/22/1962. Patient A-. Unit A-. Unit number W038306928906-K.

We finish checking the emergency release blood and wait. We know that whatever was coming up isn’t going to be pretty. A lung transplant gone bad, uncontrolled hemorrhaging, 14 hours on the table. So much blood transfused, an exploratory laparotomy was …

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Inside the final hours of a failed lung transplant

Living through injury: one family’s journey to the other side

Conditions
June 10, 2025

For a while, I enjoyed telling Dave’s story. In the beginning, I found it therapeutic. It was just as unbelievable to me as it was to the person I was telling it to. Somewhere along the line, telling the story of Dave’s accident and the health care nightmare that followed became more matter of fact. Then, it became heavy.

What I didn’t tell most is that Dave’s injury took more than …

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Living through injury: one family’s journey to the other side

A retired ICU nurse’s brunch conversation sparks a life-changing moment

Conditions
April 3, 2025

We were a team. Always had been. Always would be. We defended each other, protected each other—from management, from nurse bullies, from the cruel ICU doctors who thought they ruled the world. Back in the day, we had our own kind of “therapy sessions”—long talks over coffee, unloading the weight of twelve-hour shifts, of lives saved and lost, of the battles fought in the trenches of critical care. But life …

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A retired ICU nurse’s brunch conversation sparks a life-changing moment

When every second counts: the evolving challenges of pediatric transport

Physician
February 21, 2025

The most difficult transport I have ever encountered was during my pediatric critical care fellowship. I traveled to an outside hospital with a fully equipped pediatric critical care transport team, including a critical care nurse, respiratory therapist, and myself—a third-year pediatric critical care fellow—to pick up a toddler ejected from a vehicle during a high-speed collision. Upon arrival, we found a child who had undergone an open laparotomy, open clamshell …

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When every second counts: the evolving challenges of pediatric transport

The power of names: Superstition in the neonatal intensive care unit

Physician
January 17, 2025

An excerpt from Yankee Doctor in the Bible Belt: A Memoir.

We work in high-pressure environments, where Dr. Death is often lurking. We can be superstitious. We can protect ourselves with a sense of humor. We can use words as a smokescreen to protect our sanity. See below.

I was a resident working in the NICU. The shifts were long—sometimes as long as thirty hours in …

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The power of names: Superstition in the neonatal intensive care unit

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Faster sepsis diagnosis in emergency departments [PODCAST]

Podcast
December 6, 2024
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

We sit down with pulmonary and critical care physicians Tonya Jagneaux and Hollis O’Neal to explore the complex challenges emergency departments face when diagnosing and treating sepsis. With overcrowded EDs, rising patient volumes, …

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Faster sepsis diagnosis in emergency departments [PODCAST]

How family presence in hospitals can be a lifeline for patients in crisis

Education
November 25, 2024

During my time as a medical student shadowing in the intensive care unit, I met Ms. Stacey, hospitalized with a severe intestinal infection. As I entered her room, I saw her frail form lying amidst a web of tubes and monitors. Her prolonged hospital stay had visibly drained her, leaving her dependent on the vigilant care of both the medical staff and a quiet, devoted man sitting beside her bed—her …

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How family presence in hospitals can be a lifeline for patients in crisis

From darkness to empathy: How one ICU patient transformed my perspective

Physician
October 24, 2024

My first ICU rotation of intern year was filled with great darkness. It was dark outside as I walked from my car into the hospital each morning before sunrise, and it was again dark when I walked to my car at the end of the day. Less than one hour into my first day in the ICU, a patient’s weak and ineffectual heart stopped beating, and CPR was swiftly initiated. …

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From darkness to empathy: How one ICU patient transformed my perspective

The shocking fall of a respected ICU nurse

Conditions
October 1, 2024

In the ICU, there was an experienced nurse. She was full of information and knew the policies and procedures inside and out. She was proficient in her role as an ICU nurse.

But she was flawed. Something was wrong.

Each day, she came to work wearing a gold bracelet, which she made sure everyone knew was valued at $15,000. She wore two-carat diamond rings. She would arrive, showing off her fancy pocketbook …

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The shocking fall of a respected ICU nurse

The dual demands of a PICU physician

Physician
September 18, 2024

A physician in the pediatric intensive care unit (PICU) requires vast medical knowledge along with emotional resilience. I always thought I had a strong sense of compassion for my patients and their families until I had my own baby 1.5 years ago. It completely shifted my perspective. I started to understand parental grief and fear on a personal level, which reshaped my approach to work.

Before having a baby, I was …

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The dual demands of a PICU physician

5 lessons for a better life: observations from a front row seat for the highs and lows

Physician
June 8, 2024

Recently, I had the privilege of being shadowed by a medical student who is interested in becoming a pediatric critical care medicine physician like I am. On the day she came to observe me, we were navigating a busy and heartbreaking time in the pediatric intensive care unit (PICU). I was curious how the experience would affect her and her decision, but I figured it was as good of a …

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5 lessons for a better life: observations from a front row seat for the highs and lows

Pain management for Black patients and painful realities

Conditions
May 23, 2024

This piece is inspired by my recent patient encounter. Within the past week, I received a call from the ER to admit a 29-year-old African-American female whom, for the sake of this essay, I will call Keisha. Keisha presented with severe lower abdominal pain and was found to be in hypertensive crisis. Her systolic blood pressure consistently was in the upper 200s. It turned out that the young lady suffered …

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Pain management for Black patients and painful realities

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