Things I Learn From My Patients

Discussion in 'Emergency Medicine' started by docB, May 2, 2003.

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  1. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

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    If you are out sailing in the ocean, and you cut off half your thumb (and watch it flip through the air and splash into the water), finish your sailing trip, pack your stump in rock salt, and wait two days to be seen. Oh, and say a prayer of thanks that your hand hasn't fallen off yet.
     
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  3. lytesnsyrens

    lytesnsyrens The Phoenix... 10+ Year Member

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    or speaker wires. That really isn't a good idea.
     
  4. lytesnsyrens

    lytesnsyrens The Phoenix... 10+ Year Member

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    oh yes, also if you have "seasonal allergies" or pink eye you should call them. its not like we have anything else to do at 3 am. I mean, Cops doesn't come on till 4 am so come on down!
     
  5. tonem

    tonem Senior Member 10+ Year Member

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    ....the vagina is not the best place to store those pieces of broken glass you were collecting.


    I have also learned to engage my brain before I open my mouth.

    The other night was wicked busy (I've been in New England too long). The waiting room was packed, the department was half full of "boarders" waiting for a bed upstairs. Two fresh DOA's were still occupying beds in the trauma room (curtains drawn of course--very symbolic) while a trauma resuscitaion was being worked on across the hall (very noisily I might add). In the next bed, separated by a curtain, was a patient with 3 months of knee pain that decided saturday night was a good time to get it checked out. When I came in to see her she started screaming what the hell took you so long, I've been here for four hours!!! My first reaction was to say...ask the guy in the next bed but I took a big breath and patiently explained for the 100th time that we're just a tad bit busy tonight.

    I wonder what she would have done if she'd known she was so close to two dead guys.
     
  6. Nater44

    Nater44 Senior Member 7+ Year Member

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    I had a man come in the other night convinced he had an inner ear infection "I just know it's infected," was his mantra. Apparently, a few years back a hot rivet got lodged in his ear cannel while he was welding (10 years ago) I think the rivet passed through his ear and fried his brain.

    All the while a homie from the hood who just got back from afganistan fighting the taliban was bleeding out from a stab wound he just received at his coming home party.

    Mr. Ear Infection, who after weeks of "not feeling right" must be seen right away on a friday night in the busiest ED in the county! (Diagnosis: excess wax in his ear)

    Meanwhile, the homie spends months dodging hostile enemy gunfire and comes back without a scratch...then gets stabbed in his own backyard. He survived, but another 10 minutes and he would have bled out.
     
  7. EMIMG

    EMIMG Senior Member 7+ Year Member

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    Don't be suprised to have your name changed on your medical records to protect you in the event that you come in for gunshot wounds and are carrying over $11,000 (Yes, eleven THOUSAND dollars) in cash.
     
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  8. docB

    docB Chronically painful Moderator Emeritus Lifetime Donor 10+ Year Member

    I had a developmentally delayed woman on her third ER visit in 24 hours who as I was discharging her (again) piped up with "You know, my back is pretty tight. Could you massage it out for me?" I almost cracked up, the nurse did crack up and left the room. I informed the patient that since it was after midnight our masseuse had already gone for the night.
     
  9. Scrubbs

    Scrubbs Chisellers beware! 7+ Year Member

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    If you don't like the fact that you're getting discharged after a Dilantin load post-seizure, be sure to cause a seen in the middle of the ED by screaming that you can't hear anything and flopping on the floor like a fish, since you "have no balance". Then... start screaming that you're going to sue everyone, since obviously they are a bunch of racist mo-fo's. And when you finally WALK out, be sure to go to the corner and call 911 - since you weren't treated correctly... of course the EMT's are going to take you to a different hospital... since they generally function as a taxi service, right? I mean, why would they take you right back to where you started?
     
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  10. ERMudPhud

    ERMudPhud Back for a visit 10+ Year Member

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    A recurring theme recently...

    If your buddy has sustained major trauma, GSW, spinal cord injury, epidural hematoma, etc... Don't call an ambulance instead load him in the back or your car or even better pick-up truck and drive aimlessly around town, potentially going right past 2,3 even 4 trauma centers in order to eventually show up at my ambulance bay. Since I have no neurosurgeons and my trauma surgeon is as much as 30 minutes out if your buddy is still alive its guaranteed to make my life interesting at least.
     
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  11. docB

    docB Chronically painful Moderator Emeritus Lifetime Donor 10+ Year Member

    Didn't someone do a study at some point and find that the home boy ambulance service actually had better save rates than EMS? They thought it was because the response time was 5 seconds instead of 5 minutes even though no care was rendered.
     
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  12. FoughtFyr

    FoughtFyr SDN Lifetime Donor Lifetime Donor 10+ Year Member

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    There was a study out of UCLA that compared ALS service v. private auto and found little difference in outcome. That said, the data was all over the place in terms of hypothetical "why?". Long response times and long scene times were (if I remember right) at the top of the list. I'll find the citation and post it here this w/e.

    - H
     
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  13. grouptherapy

    grouptherapy super pork 7+ Year Member

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    foughtfyr-a superstudent now/fellow in 5/research director in 7/chairman in 10
     
  14. FoughtFyr

    FoughtFyr SDN Lifetime Donor Lifetime Donor 10+ Year Member

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    Ouch...

    When'd I peeve you off GT?

    - H

    {O.k., sorry, I misread your msg. as sarcasm. It has been a long day in a county ED. Too many bitter, angry patients today.:( }
     
  15. Scrubbs

    Scrubbs Chisellers beware! 7+ Year Member

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    A wise upper year told me once that working in the ED is about not letting them "take all of your coins..." Basically, each shift you start with a bag of coins... the grateful, nice, polite patients add to your till, while the bitter, angry, malingering ones steal your coins. Object of each shift? Walk out in the black!

    Keep smiling FoughtFyr! :D
     
  16. EMRaiden

    EMRaiden Senior Member 10+ Year Member

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    If you feel "down" call 911 and come on in at 5 am... especially if you have been seen in EDs over 100 times this year, been blacklisted at EVERY single psyciatric hospital in the area and even the probate judge refuses to listen to your whining and commit you any more... when discharged walk to the EMS station up the road and ask to be taken to another hospital for eval, then when they walk you back down the street act shocked and leave.
     
  17. docB

    docB Chronically painful Moderator Emeritus Lifetime Donor 10+ Year Member

    Here's one to cheer up FoughtFyr:
    If you call EMS because your husband has collapsed on the floor it might be a good idea to mention that he did this 2 days prior. Should you let this minor point slip your mind try not to attack various members of the responding agency because they are not saving his life.

    As a side note, at the time I was a rookie EMT/FF so guess who got to bag this dude. Unfortunately (for me) he was kind of sprawled out on the floor and had a good case of rigor going. I squished him into the bag as best as I could but I broke the zipper trying to keep him squeezed in. Various profane words were uttered and I suggested several alternative courses of action including, but not limited to, the jaws of life, the Hurst saw, the backfire drip torch, the Halligan bar and sneaking away from the scene. The Capt. came up with a better solution which was to tie the DB's arms and legs together with backboard straps and telling the Chief that the previous shift had lost the straps at the ER.
     
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  18. FoughtFyr

    FoughtFyr SDN Lifetime Donor Lifetime Donor 10+ Year Member

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    Hey DocB,

    Here is the citation and abstact:

    Arch Surg. 1996 Feb;131(2):133-8

    Paramedic vs private transportation of trauma patients. Effect on outcome.

    Demetriades D, Chan L, Cornwell E, Belzberg H, Berne TV, Asensio J, Chan D, Eckstein M, Alo K.

    Department of Surgery, Los Angeles Medical Center, Los Angeles, USA.

    BACKGROUND: Prehospital emergency medical services (EMS) play a major role in any trauma system. However, there is very little information regarding the role of prehospital emergency care in trauma. To investigate this issue, we compared the outcome of severely injured patients transported by paramedics (EMS group) with the outcome of those transported by friends, relatives, bystanders, or police (non-EMS group). DESIGN: We compared 4856 EMS patients with 926 non-EMS patients. General linear model analysis was performed to test the hypothesis that hospital mortality is the same in EMS and non-EMS cases, controlling for the following confounding factors, which are not affected by mode of transportation: age, gender, mechanism of injury, cause of injury, Injury Severity Score (ISS), and severe head injury. Crude, specific, and adjusted mortality rates and relative risks were also derived for the EMS and non-EMS groups. SETTING: Large, urban, academic level I trauma center. PATIENTS: All patients meeting the criteria for major trauma. RESULTS: The two groups were similar with regard to mechanism of injury and the need for surgery or intensive care unit admission. The crude mortality rate was 9.3% in the EMS group and 4.0% in the non-EMS group (relative risk, 2.32; P < .001). After adjustment for ISS, the relative risk was 1.60 (P = .002). Subgroup analysis showed that among patients with ISS greater than 15, those in the EMS group had a mortality rate twice that of those in the non-EMS group (28.8% vs 14.1%). After controlling for confounding factors, the adjusted mortality among patients with ISS greater than 15 was 28.2% for the EMS group and 17.9% for the non-EMS group (P < .001). CONCLUSIONS: Patients with severe trauma transported by private means in this setting have better survival than those transported via the EMS system. Large prospective studies are needed to identify the factors responsible for this difference.
     
  19. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

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    Which journal was this in?
     
  20. FoughtFyr

    FoughtFyr SDN Lifetime Donor Lifetime Donor 10+ Year Member

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    Sorry, long night...

    Arch Surg. 1996 Feb;131(2):133-8.

    BTW - the entire paper is not as convincing (IMHO) as the abstract. There were considerable methodolgy questions with the "normalizing" via ISS. When I was doing EMS consulting work I didn't find their results very useful; nor do I "buy into" their results. I only posted the cite as docB had mentioned the paper.

    Just my $0.02 (actual cash value $0.005)

    - H
     
  21. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

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    If you are a female that masturbates so furiously your "clit is bleeding, not my vagina", try some lube next time.
     
  22. Savvydiva

    Savvydiva Junior Member

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    This thread is absolutely frickin hilarious! I am just a pre-M, but I work in a small, yet busy ER. It's amazing, I used to work at a level one trauma center, but now I actually get to sit back and enjoy the stupidity, ESPECIALLY since I work thirds.

    If you are in the ER 'seeking', please don't start off your lie-infested story to the Doc with..."See what had happened was..."

    Please, by all means bring your child into the ER in the middle of the night for a HIGH fever (which the triage RN record's as 99.0), stay for 30 minutes and then request a doctor's excuse because you have to be at work in 3 hours.

    Please, please, please bother the admissions people about why the wait is so long (for your 'sinus infection')...afterall, you've been here for hours and that guy clutching his chest JUST walked in!

    Whatever you do...never, ever, EVER only have "only ONE drink" before driving, serious consequences could result.

    If you have a severe case of diarrhea, the BEST cure would be two laxatives...that way you can just get rid of all of it and be done with it. :rolleyes:

    Do go into triage and tell the RN you are here for a sore throat, and then happen to add on that you have a 'irregular period'...we are really stupid and we don't realize that you just want a pregnancy test.

    If you think the bartender has served you too much to drink, by all means call EMS to take you to the hospital at 2am to get a 'blood alcohol' level checked so you can report him/her.

    By all means, please curse out the admissions staff, that will DEFINITELY get you seen quicker. When you finally do get to the back, why don't you curse out your nurse and ask why it took so long. THEN, when the doctor gives you a dx that you think is wrong, just go running through the ER yelling, "That's why I hate this damn hospital! I ain't never coming back!" Be sure to be on your best behavior when you return two days later...they won't recognize you! ;)
     
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  23. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

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    Make friends in the ED by telling the doctors that they are discriminating - discriminating against the homeless. Say how your friend, who had the exact same cellulitis, got Percocet for his, despite your being in the department one month before, saying that "40 Percocet" was what you needed - no more, no less. Say how you needed to get out in a reasonable amount of time, to go to your lawyer (who "went to your law school here!"), who will discuss your upcoming 3rd appeal for Social Security. Of course, you will add to your attraction by saying 1. that you had moved into a smaller place (someone burned down your big tent, so now you're in a smaller one) and 2. you can't work with your cellulitis - your job being standing on the median with a sign saying "Homeless and hungry. God Bless You" (but NOT "Will work for (food, sex, housing, or any other remuneration)").
     
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  24. soluentgreen

    soluentgreen Junior Member 7+ Year Member

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    More from the South Bronx:

    1.) If you are a psych patient in need of hospitalization do not argue your point against staying by ripping the surgical lamp off the ceiling and threatening to electrocute yourself with the loose wires. We called the NYPD. The NYPD called the SWAT team. The SWAT team had to take down the guy using a tazer gun.

    2.) Do not leave you methadone dose on the kitchen counter in a kids sippie cup where your 2 year old son can easily reach for it and chug down your days dose.....:hardy:
     
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  25. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

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    A new attending here told me about this story - he said just that - that ESU had to come in and tazer the guy.
     
  26. emedpa

    emedpa GlobalDoc 10+ Year Member

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    Taking an Away team....
    BASED ON A CASE TODAY...
    don't allow someone with a known poorly controlled seizure disorder to perform oral sex on you...
    enough said...
     
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  27. soluentgreen

    soluentgreen Junior Member 7+ Year Member

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  28. FoughtFyr

    FoughtFyr SDN Lifetime Donor Lifetime Donor 10+ Year Member

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    Emergency Services Unit -
    NYPD Special Unit (SWATequse)

    - H
     
  29. heldicus

    heldicus Senior Member 7+ Year Member

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    Loving this thread...here's my addition:

    If you are brought into the ED following an overdose, be sure to escape from the hospital (and your police escort) after being transfered to ICU. Then, in approximately 12 hours, OD AGAIN, come right back to the ED, and enjoy your complimentary leather restraints.
     
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  30. xdismalx

    xdismalx Junior Member 7+ Year Member

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    if you are going to drink entirely too much msuhroom tea, please don't proceed to, for lack of better terms, finger your own rectum while ejaculating all over yourself. And if for some reason you do, try to remember when you wake up. It could make for a rather embarrassing moment, i.e. "Son, you too too many mushrooms. Oh you don't remember what you did? Ok, Here's a moist towel..."
     
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  31. grouptherapy

    grouptherapy super pork 7+ Year Member

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    it would be funny if you told him you had to amputate his ischemic finger
     
  32. DSM

    DSM 7+ Year Member

    If you are going to commit suicide by all means drink liquid potpouri. At least your breath will be fresh and fruity as you are doubled over with SEVERE abdominal cramps. Yes, that is the way I want to go out, in excruciating pain.

    Yes, we know you only had 2 beers. Was that 2 quarts, 2 six packs, 2 cases.........?

    If you call for an ambulance for that non traumatic back pain that you have been having for 2 years at 2 am, then please have all of your family with perfectly running cars block the driveway so that we have to park WAY down the street.

    If you want to see me more often, Do take your insulin and don't eat. We are sure to meet.

    The larger you are, the smaller the bathroom will be that you die in.

    If you are having chest pain ( I believe I saw this one earlier)
    Don't go to the bathroom. period.

    If you are having your 6th baby, do not wait until the contractions are 10 minutes apart.
     
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  33. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

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    And every patient starts at 250, and gains 50lbs for every floor higher.
     
  34. DSM

    DSM 7+ Year Member

    Amen and preach on!! I know my uterus is lying at the bottom of some morbidly obese patients steps. Whoever said that being overweight can only hurt the patient, never had to lift them up or carry them up/down a flight (or 2,3,4, etc........) of stairs.
     
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  35. docB

    docB Chronically painful Moderator Emeritus Lifetime Donor 10+ Year Member

    My patients must get a hold of some special beer because 2 of them can give you a BAL of 310.

    If you're a gangbanger who gets shot in the leg in a business disagreement with a colleague and you come to the ER acting tough and thumping your chest about how they messed with the wrong guy don't squeall like a little girl and say that it hurt more than getting shot when I irrigate your wound. (Why are all gang dudes so scared of needles?)

    If you come to the ER (by EMS of course) with 2 days of priapism which you've had before and I aspirate and inject your penis with phenylephrine and it starts to go down don't sit in your bed and stroke yourself until it gets hard again (not making this up).

    If you're a cop who wants a complete list of injuries on a minor assault victim (5 minutes after they hit the door and I have'nt even seen them yet) for you're report so you can leave the ER ASAP don't stand at the foot of the bed and shout questions at me while I'm trying to intubate someone else.
     
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  36. jonb12997

    jonb12997 I'm a doctor!! 10+ Year Member

    Never be in a small bathroom when a cop decides to pepper spray a drunk 300 lb 50 year old man that does NOT want to put on a hospital gown. You WILL get it in your eyes and it WILL hurt like heck. :rolleyes:
     
  37. emedpa

    emedpa GlobalDoc 10+ Year Member

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    Taking an Away team....
    if you are a gang banger who has been shot in the neck and been fortunate enough not to
    have bled out ,wait a few days until pus starts to drip out both sides of the wound before you come in for evaluation.....then when you are intubated to secure your tenuous airway don't pull the tube......
     
  38. DSM

    DSM 7+ Year Member

    Got a call to a residence with a complaint of a male who had "knots in his stomach" I'm trying to think what it could be...hernia, aneurysm....whatever. My partner and I pull up to the house. FIFTEEN people are standing outside the door on the steps.
    I had to ask....where is my patient. The mom points at her son and said he had "knots pop up on his stomach" I looked at this thin 15 year old male,
    "Let me see the knots."


    A perfect six pack was his knots.

    I asked, 'what brought on these "knots".' He did a perfect example of a crunch and said his stomach hurt everytime he did that.

    (Well, don't do that anymore!)

    It was all I could do to keep a straight face. Mom was adament about the boy going in by ambulance and not in one of those 7 finely tuned automobiles in the driveway.

    As delicately as I could, I explained that Medicaid would not pay for the ride because, THERE WAS NOTHING WRONG WITH THE BOY!!!

    Dad decided quickly to abort the ambulance ride!!

    Don't you love it!!
     
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  39. beanbean

    beanbean 1K Member 10+ Year Member

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    If you and your two friends decide to have a little party one December evening in your 3rd floor attic apartment and one of those friends is occupying the bathroom; it is not a good idea to climb out on the roof of the house in the middle of an ice storm to take a leak. This could result in falling off the roof with your weiner hanging out. If this does occur, be sure to ask the cop[ if you will be arrested. He will tell you that he can't arrest people just for being stupid. The EMS crew will try very hard not to laugh as we backboard you and give you a lift to the ED with a Fx ankle and your weiner still hanging out. ( I wasn't going to put it back in!)
     
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  40. ERMudPhud

    ERMudPhud Back for a visit 10+ Year Member

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    The best way to let the nurse know that your IV has run out and blood is starting to back up into the line is to pull out your cell phone, call the hospital operator, and ask to be put through to the ER
     
  41. tonem

    tonem Senior Member 10+ Year Member

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    Just ask Elvis
     
  42. Febrifuge

    Febrifuge Grizzled Old Newcomer 7+ Year Member

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    If you're drunk enough, taking a whiz in a plastic shopping bag while restrained to a cart makes perfect sense. Not only that, but if I offer you a urinal so you can finish your little project properly, you might even be just a touch... offended. Who am I to criticize your technique? Do I tell Picasso how to paint?
     
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  43. ERMudPhud

    ERMudPhud Back for a visit 10+ Year Member

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    You can hook the nasal cannula to the faucet in your room and use it to take a shower.
     
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  44. Febrifuge

    Febrifuge Grizzled Old Newcomer 7+ Year Member

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    Okay, that one is genuinely informative. And it would have surprised me, until very recently.
     
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  45. Robz

    Robz La Vie Boheme 7+ Year Member

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    Drinking Texas Tea
    Now that is ingenious. I might have to try that :)

    Ahhhh. I remember putting in my first nasal trumpet in a patient that was faking an overdose. She didn't appriciate getting it and I got a suprise as she really wasn't passed out. (guess she liked sternal rubs :rolleyes: ) The ER staff thought it was funny to see my reaction with their frequent flyer patient.
     
  46. lattimer13

    lattimer13 good boy! 10+ Year Member

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    wow:eek:
     
  47. docB

    docB Chronically painful Moderator Emeritus Lifetime Donor 10+ Year Member

    I had this guy once, BIBA found down, GCS of 3, didn't move a bit with all my attempts at stimulation. The attending knew the guy so in a loud voice he said "Well, he's pretty out of it. Give him 4 of narcan." Now the guy didn't open his eyes but he suddenly said "Don't you give me none o' that ----. I's 'lergic."
     
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  48. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

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    If your name has been called 3 times in the waiting room, the entranceway, and outside the entrance to the ED...when there have only been 3 other people there...and you don't respond, even though you are sitting right there...don't complain about the wait.
     
  49. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

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    And the dishonorable mention:

    If you have the family member on the telephone that is the power of attorney, and you have the POA sold on the DNR, do NOT let your attending, who only needs to be the second MD to confirm that the POA understands, somehow - SOMEHOW - ever IN SOME WAY let it happen that the family gets the IDEA about the DNI, and that they do INDEED want CPR, defibrillation, and meds, but simply no tube. This is despite the fact that the patient is 88, bilateral AKA with only 10cm of leg left on either side, very advanced Alzheimer's (blank stare, responds only to very painful stimuli, PEG tube in place), and has a pneumonia that would allow him to expire peacefully, and that was only noticed by staff walking by the room and hearing the patient gurgling.

    First and goal on the one...and we end up with 3 points.
     
  50. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

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    And, for entertainment for the ED, give this statement about your boyfriend (if you are a guy): "He's being a drama queen. Notwithstanding his sexuality, or mine, for that matter, he's just being a bitch!"
     
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  51. mikecwru

    mikecwru M.D. = Massive Debt 7+ Year Member

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    Windex, Hairspray, Acetone, Ajax are not as delicious as they sound.

    mike
     

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