u/catamorphism

@iamwearingpants got it, but you can always look up any song, including covers, on https://themountaingoats.fandom.com/wiki/The\_Mountain\_Goats\_Wiki — it will take you to a list of live shows and then you can follow the link to each show to see if there’s a recording of it online!

Six days!

Also In the Shadow of the Western Hills, Maybe Sprout Wings

Sudden Oak Death, Black Pear Tree, Proverbs 6:27, High Doses #2, Song for My Stepfather

https://themountaingoats.fandom.com/wiki/Going\_to\_Georgia

Agree with Done Bleeding and Ox Baker Triumphant. I’d add Sail Babylon Springs and The Legend of Chavo Guerrero (“Now your ashes are scattered on the wind”)

I agree. I don’t know how the job market is right now (I last worked in 2020), but I worked out of Marin and it seemed the only way people could afford to work as IFT EMTs, especially part-time, was to live with their parents. Also, I have the impression these companies prefer not to hire full-time employees so they won’t have to pay benefits, and then on top of it all you have to pay for an expensive Covered California health insurance plan. I was an adult who needed health insurance, but I wanted the work experience so I made it work by dipping into savings.

If you’re young enough to live with your parents and be on their health insurance (and you like them enough for that), maybe go for it, but that’s not an option for you, you may want to consider moving to a different area. Unless you accept an incredibly long commute, just paying for housing in even the outskirts of the Bay Area on an EMT salary is impossible (and even if you don’t mind the commute, there’s the price of gas to consider.)

I’ll be there in an N95!

I’ve worked for Norcal Ambulance in the past and they were a decent employer. They are hiring, at least if their web site is anything to go on. In 2019, getting hired for IFT basically meant showing up and having a pulse (I had no experience either). Dropping off a resume in person doesn’t seem like something people do in the 2020s. For Norcal specifically, if you want to meet people, you could take one of their continuing ed classes (offered under the name American Health Education).

I haven't found any other music that quite scratches the Mountain Goats itch, and I've tried. But I recommend The Weakerthans, Jason Isbell, John Vanderslice, Mary Chapin Carpenter, Mal Blum, Wye Oak, Phoebe Bridgers, and The Hold Steady.

I go to the Berkeley location of Bay Psychiatric. I would recommend them if they accept your insurance. They have a San Mateo location, but I haven’t been there.

I also work in tech and I’m more than twice your age. If you want to go to med school, do it now. It won’t get easier with time, both due to the golden handcuffs effect and with age. I don’t think you will start liking tech more as time goes on, which I say both based on my own experience and on the fact that LLMs are eradicating both worker power and whatever pleasure it was once possible to get from the act of writing software and the relationships we form with our colleagues.

If you are committed, you can work full-time and take 1-2 classes. You have to be intentional about organizing your time.

At age 22 (assuming you don’t have anyone depending on you financially), you’ll never have a better opportunity to learn that the only thing money does for you, past when you can cover basic needs, is make you want more money. Being around other students and not just tech workers will help you see that you don’t really need the things your coworkers think they need.

At least at every show I’ve been to (and I’ve been to 40), you don’t need to plan a group in advance. Just show up 3-4 hours early and you’ll make friends while waiting in line.

Many providers treat people with bipolar with ketamine. It depends on the individual, but the research shows it to be a safe and effective treatment for bipolar depression. It’s important to work with a qualified professional, but I hope no one reads this and gets the idea that they shouldn’t even try to get ketamine treatment because they have a bipolar diagnosis. As with any other antidepressant, most providers will want to prescribe a mood stabilizer alongside it.

From another comment I wrote in this subreddit:

Jawad MY, Qasim S, Ni M, Guo Z, Di Vincenzo JD, d'Andrea G, Tabassum A, Mckenzie A, Badulescu S, Grande I, McIntyre RS. The Role of Ketamine in the Treatment of Bipolar Depression: A Scoping Review. Brain Sci. 2023 Jun 4;13(6):909. doi: 10.3390/brainsci13060909. PMID: 37371387; PMCID: PMC10296406.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10296406/

“Overall, ketamine treatment appeared to be tolerable with minimal risk for manic/hypomanic switching and showed some effectiveness across parameters of depression and suicidality.”

Santucci MC, Ansari M, Nikayin S, Radhakrishnan R, Rhee TG, Wilkinson ST. Efficacy and Safety of Ketamine/Esketamine in Bipolar Depression in a Clinical Setting. J Clin Psychiatry. 2024 Oct 2;85(4):24m15376. doi: 10.4088/JCP.24m15376. PMID: 39361411.

https://www.psychiatrist.com/jcp/efficacy-safety-ketamine-esketamine-bipolar-depression-clinical-setting/

“In a small sample of patients with bipolar depression treated with ketamine/esketamine, no evidence of mania/hypomania was seen during the acute phase of treatment.”

Wilkowska A and Cubała WJ (2023) Short-term ketamine use in bipolar depression: a review of the evidence for short-term treatment management. Front. Psychiatry 14:1322752. doi: 10.3389/fpsyt.2023.1322752

https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1322752/full

“…according to a very recent systematic review (12) eight included studies suggest that ketamine is a safe and effective add-on treatment for bipolar disorder with an overall pooled response rate of 48%. The reported antisuicidal effect of ketamine is explicitly significant for bipolar depression where suicide risk is particularly high.”

Alessandro Cuomo, Simone Pardossi, Giovanni Barillà , Pietro Carmellini, Bernardo Firenzuoli, Francesca Tarantino, Rebecca Tinturini, Andrea Fagiolini,
Symptom modulation and tolerability of intravenous ketamine in treatment-resistant bipolar depression: A retrospective study,
Journal of Affective Disorders,
Volume 376,
2025,
Pages 76-83,
ISSN 0165-0327,
https://doi.org/10.1016/j.jad.2025.01.059.

https://www.sciencedirect.com/science/article/abs/pii/S016503272500076X

“No ketamine-treated patient experienced a manic switch during the observation period. A statistically significant decrease (i.e., improvement) in MADRS global score and scores on the Internal Tension, Reduced Sleep, and Suicidal Ideation items was observed from the second week, with no evidence of worsening of the above symptoms. Patient-reported adverse events were generally mild to moderate.”

“Our results confirm the potential ability of ketamine to provide rapid symptom relief in patients with treatment-resistant bipolar depression, with a generally acceptable safety profile and a low risk of inducing or exacerbating manic symptoms or symptoms of internal tension, sleep disturbance, or suicidal ideation, which instead improved.”

Bahji, Anees, Zarate, Carlos A, Jr, Vazquez, Gustavo H, Ketamine for Bipolar Depression: A Systematic Review, International Journal of Neuropsychopharmacology, 2021, Pages 1461-1457,

https://academic.oup.com/ijnp/article/24/7/535/626101

“Regarding the side effect profiles, most studies indicate that ketamine is reasonably well tolerated for bipolar depression treatment. Two significant concerns involve the risk of dissociation and induction of mania or hypomania. However, in our review, most trials and most participants did not experience either of these adverse events.”

Fancy F, Haikazian S, Johnson DE, Chen-Li DCJ, Levinta A, Husain MI, Mansur RB, Rosenblat JD. Ketamine for bipolar depression: an updated systematic review. Ther Adv Psychopharmacol. 2023 Sep 26;13:20451253231202723. doi: 10.1177/20451253231202723. PMID: 37771417; PMCID: PMC10524067.

https://pubmed.ncbi.nlm.nih.gov/37771417/

“While there is a growing body of research supporting the use of ketamine as an antidepressant for MDD, some researchers have been hesitant to include bipolar-depressed patients in these studies due to concerns about the risk of treatment-emergent affective switching and the risk of dissociation. Despite these concerns, this review demonstrates that recent research supports a relatively low risk of manic switching and dissociation with ketamine treatment. The majority of studies suggest that IV ketamine is a generally well-tolerated treatment for BD.”

Wilkowska A, Wiglusz MS, Arciszewska-Leszczuk A, Gałuszko-Węgielnik M, Cubała WJ. Anhedonia in bipolar depression treated with ketamine. Bipolar Disord. 2024 Jun;26(4):356-363. doi: 10.1111/bdi.13409. Epub 2024 Feb 4. PMID: 38311367.

https://pubmed.ncbi.nlm.nih.gov/38311367/

“Add-on ketamine seems to be a good choice for the treatment of anhedonia in treatment resistant bipolar depression. It also showed a good effect in reducing symptoms of anxiety in this group of patients.”

Queissner R, Fellendorf F and Reininghaus EZ (2026) Ketamine as an NMDA-modulating therapy in bipolar disorder: rationale and evidence. Front. Psychiatry 17:1777402. doi: 10.3389/fpsyt.2026.1777402

https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2026.1777402/full

“Importantly, across all ketamine studies involving bipolar cohorts, the incidence of treatment-emergent mania or hypomania was low. Only isolated cases of transient mood elevation were observed, typically resolving spontaneously or within hours. These findings support the notion that ketamine’s rapid antidepressant mechanism is distinct from conventional monoaminergic antidepressants, which are more prone to trigger manic switching.”

Liu TH, Wu JY, Huang PY, Cheng WL, Lai CC. Risk of manic switch and suicidal outcomes in bipolar depression treated with esketamine: A one-year retrospective cohort study of 2126 patients. Eur Neuropsychopharmacol. 2025 Oct;99:3-12. doi: 10.1016/j.euroneuro.2025.07.006. Epub 2025 Aug 6. PMID: 40774133.

https://pubmed.ncbi.nlm.nih.gov/40774133/

“Our real-world study suggests that esketamine, when used alongside mood stabilizers, is a safe and potentially effective treatment for bipolar depression, demonstrating sustained anti-suicidal benefits without an increased risk of manic switch across both short- and long-term follow-up and across different patient subgroups.”

Jucha D, Klimas M, Wiśniewska D, Winiarska M, Szczupak M, Kobak J, Krupa-Nurcek S. Pharmacotherapeutic Options in Drug-Resistant Bipolar Depression: From Molecular Mechanisms to Rational Polypharmacotherapy. Biomedicines. 2026 May 23;14(6):1185. doi: 10.3390/biomedicines14061185. PMID: 42351613; PMCID: PMC13296849.

https://pubmed.ncbi.nlm.nih.gov/42351613/

“Crucially, given the risks of antidepressant therapy, no patient experienced a phase shift to a manic episode (switch) throughout the entire observation period, and no premature withdrawals were noted in the study.”

Bennett R, Yavorsky C and Bravo G (2022) Ketamine for Bipolar Depression: Biochemical, Psychotherapeutic, and Psychedelic Approaches. Front. Psychiatry 13:867484. doi: 10.3389/fpsyt.2022.867484

https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.867484/full

Sipan Haikazian, Roger S. McIntyre, Shakila Meshkat, Kevin Kratiuk, Cristian-Daniel Llach, Diana K. Orsini, Sara D. Di Luch, Joshua D. Rosenblat,
Real world effectiveness of maintenance ketamine infusions for treatment-resistant depression in major depressive disorder and bipolar disorder,
Psychiatry Research,
Volume 352,
2025,
116691,
ISSN 0165-1781,
https://doi.org/10.1016/j.psychres.2025.116691.

https://www.sciencedirect.com/science/article/pii/S0165178125003397?via%3Dihub

Of course, some of these studies are preliminary or use small sample sizes, as noted in the meta-analyses. This is important for researchers studying this topic, but a patient deciding whether to undergo this treatment doesn’t need absolute certainty; they need reasons to think the benefits are greater than the risks.

I was on 300mg Lamictal when I started ketamine and I did notice results immediately, both within the session and in an ongoing way. My psychiatrist reduced my Lamictal dosage to 200 mg, then 100 mg, and I definitely notice stronger effects during the sessions, but the ongoing effects are more or less the same.

I'm not a doctor. Ketamine increases blood pressure. This reverses itself when the ketamine leaves your system. High blood pressure can increase the risk of stroke. If I were in your situation, I would ask my neurologist again and say I was concerned about the temporary increase in blood pressure and whether this would put me at risk for another stroke. If they said "no, it's no big deal", I would want to understand why they thought so (for example, is it because the increase in blood pressure is just for a brief period of time? Or because of the specific details of why/how the previous stroke happened? Etc.) I wouldn't trust a mail-order ketamine company to screen out all patients who shouldn't use ketamine.

I worked as an IFT EMT for a little under two years and none of the things you said about it are consistent with my experience. Shifts were 8 hours, night shifts weren’t required, the work environment was pretty relaxing. I liked night shifts because there were no supervisors around when we were at the station between calls. I worked part-time by choice and it’s easier to get a part-time job since like all private companies, profit-hungry private ambulance companies don’t like to pay out benefits. But some of my co-workers did work full-time. I’d still be doing that job now if it paid a living wage.

If you’re talking about working as an EMT in the 911 system, that’s generally not possible in major cities unless you have prior experience, which usually means IFT.

It obviously depends on your location and what company you work for but these are questions you can ask during the interview process.

Your attitude sounds pretty entitled, but others have covered that already. I just wanted to correct the misinformation.

I’m interested, please DM me the link! Thanks!

I haven’t been told I couldn’t drink after my appointments, just to not drink in the 48 hours before.

What you said about “No Children” reminds me of this intro that JD gave to “Outer Scorpion Squadron”:

“Interviewers have a job to do, and their job is to ask you a set of questions that are pretty rote about, you know, 'So, the new album is about thus-and-such, tell me about that.' And I took a real sadistic glee in answering all their questions honestly. 'So the new album is about, uh, life at home with your stepfather, tell me about that.' And I would say: Well, once I saw him beat my mother with a vacuum cleaner. Right? See what happens? Nobody says shit. It's just so terrifying. Whereas if you lived in that house, after a certain point of remove, there's some humor in even the worst thing that happened. It's like, it's sort of, it is how you cope with those situations. You learn to find it all funny at some level. And to take that terrible brutal glee in seeing how long people are willing to listen to you talk about it before they say, 'Well, you're just doing this to see how I react.' I'm not just doing this to see how you react.”

It’s from this recording: https://www.nyctaper.com/2011/03/the-mountain-goats-march-28-2011-bowery-ballroom-flac-and-mp3/

If you can’t answer this question for yourself by having an honest and open conversation with him, then maybe you’re the one who isn’t ready for dating.

I didn’t read it, but this book was randomly placed in the bedroom in an AirBnB I recently stayed in (the one on the right seems more relevant to your question, though the one on the left may be fun as well).

https://preview.redd.it/6rl00ryuweoh1.jpeg?width=3024&format=pjpg&auto=webp&s=2cac0073a017f29fef354944af44309e338fba2d

This explains it pretty well: https://apnews.com/article/peptide-injections-rfk-maha-4d48e78a5d65658b4d6eac87818352e3

Basically, chemicals that may occur in the body but are sold by right-wing wellness grifters in probably contaminated and dangerous forms.