Things I Learn From My Patients

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

  1. Unzbuzzled

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    This sounds much more interesting than my current project at the VA. Gonna have a chat with my attending.

    We had a patient with a CC of angina who declared he never had any surgical procedures done, but chest xray revealed a stent. He claimed he didn't know about it being done, and I actually believe him.
     
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  3. Aquar1us

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    ok i looked it up and thiocyanate and oxalate are too irritating for this
    however i found a paper on corrosion and this sentence in it:
    'Thiosulfate and chloride clearly have a synergistic effect in inducing localized corrosion.'
    also i have found that acid has a synergistic effect both with chloride and thiosulfate
    so salt, sodium thiosulfate and (some) citric acid would do it
    BUT
    do not think things have finally become sensible
    for I have saved the maddest for last
    if a (small) metal object were scratched in many laces with a file and immersed in acid (an EDTA compound would accelerate this), the nascent hydrogen would diffuse into the scratches and combine into molecules inside the metal, forming tiny bubbles with huge pressure. you can guess what has been recorded to happen next...
     
  4. dudeliness

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    You work in a VA hospital? Were you on the HPSP or something for school? I just signed on in the AF. What's it like working in a VA hospital I wonder?
     
  5. Perrotfish

    Perrotfish Has an MD in Horribleness
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    Military physicians do not cover VA hospitals. They are covered by civilian docs. How much do you know about the contract you just signed? Did you leam about GMO tours? The military match?
     
  6. nd92

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    There are some dual VA-military hospitals - at least there used to be. I know Nellis AFB (NV) used to be one, I am not sure if it still is.
     
  7. dudeliness

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    Apparently I know less than I should :smuggrin:

    Seriously, it is a bit surprising to learn that military docs don't work in VA hospitals, although I guess that does make sense since there aren't oodles of active duty docs...
     
  8. Missorleans

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    hope you weren't betting on doing your residency in a VA hospital. I thought that was an option, and was considering applying for HPSP, but my army HPSP bf informs me it is not an option. So he has only like 6 programs to choose from, only 3 of which are somewhere I would not hate living :(
     
  9. MikeWilliamson

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    Dept of Veterans' Affairs is not part of DoD.

    I learned from the VA that even though my lung damage happened in the Middle East, and my Flight Surgeon provided a letter stating sand and dust as the reason, it is a "pre-existing condition" as I'd previously been to the VA for an upper respiratory infection.
     
  10. SteinmetzMD

    SteinmetzMD Hello, old sport!

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    This is great :laugh:
     
  11. Unzbuzzled

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    Yeah I work at the FHCC in North Chicago, which is right next to chicago med. I'm just a student research fellow there for the summer, and I don't have any military experience. But it is right next to the Great Lakes Navy base, so all the recruiters are always trying to get us to join the Navy to pay back our loans haha.

    Interestingly, my mentor at the VA was a ship's doctor during the Gulf War, and they made him the lone medical officer on his ship before he even finished his internal medicine residency. Imagine being the only doctor on a ship, heading to war, without ever really being in charge of your own patients before. I don't know if that's how they do things now, but I can imagine it was a real steep learning curve at the time. Yikes!
     
  12. deuist

    deuist Stealthfully Sarcastic
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    Yep, still is.
     
  13. 3bamboo

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    yes, a garder snake can fit in your urethra.
     
  14. suberogator

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    Yeowch!
     
  15. Dr Peper

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    Not ER, but still a highly informational case where I was "lucky" enough to be an observer.

    When you are a male going in for a simple, outpatient procedure involving your upper thigh, please empty your bladder completely and fully before being wheeled into the procedure room. Otherwise, this might happen....



    Patient is brought in and prepped. Has opted for a light, conscious sedation with plenty of lidocaine. He is hooked to an IV at a high flow rate and given versed and fentanyl premedication. For some reason, the surgeon is delayed (discussing another case with a resident or something...) Anyway, just after the surgeon comes in, the patient asks for a foley.

    You all know where this is going. But it's the details that make it sooooo much better.

    Patient is asked how bad he needs to go. He says something non-committal. Surgeon says a foley is not indicated at this time. Procedure begins.

    Procedure goes on for a half-hour or so, then the patient again asks for a foley. Nurse grabs a urinal and tried to get a response. However, the patient explains that he has a case of urinary retention and, being a second year med student, insists he knows a little bit about what he's talking about. Apparently some part of this goes over everyone's heads, because they leave the urinal nearby but do nothing more at that point.

    Then two things happen at once. The surgeon asks for the urinal to be moved further from the surgical field, and the nurses switch shifts. In the confusion, somehow the urinal gets lost and the incoming nurse has no idea that the patient has complained of urinary retention while simultaneously claiming to know a little bit about said condition.

    New nurse goes to assess the patient and finds him more responsive and oriented than she had anticipated. Patient asks her for a foley, as she is a new face and might say yes. Nurse says "the chance of UTI are very high," as rationale for denying the request. Someone else mentions "He's asked that twice already."

    Apparently the new nurse diagnoses the patient with excessive nervousness or tension. She prepares a little bit more versed and fentanyl and tells the patient he's going to get a "little bit more medicine." Patient says "Okay."

    The amount she gives is a tad more than was strictly needed. As a result, around two minutes later, the patient becomes incredibly and abruptly disinhibited as his urethral sphincter relaxes and releases a vast amount of pressurized renal filtrate. In the ensuing controlled chaos, the surgical site and surgeon get splashed. Also, the urinal can't be easily found, which results in a large amount of renal filtrate being absorbed by towels, sterile drapes, and running onto the floor. The chaos results in the patient giggling uncontrollably as if he's been given a large dose of opiates (...oh, wait... he has).

    The surgeon has to leave the room to scrub up again. As he leaves, he barks orders to everyone in view. By the time he returns, the mess is cleaned up, all the sterile dressings have been changed, the patient is out cold, and there is a foley in place to prevent any of this from happening again. The rest of the procedure goes by swiftly and smoothly, with virtually no talking between anyone in the room. The surgeon is obviously frustrated, and he has enough clout that no one wants to risk annoying him more.





    The lesson? Empty your bladder before your procedure, otherwise you may wake up and find yourself in recovery, with a foley in place, and more dope onboard than you ever anticipated.

    ...Oh, and a surgeon who doesn't want to speak with you for extended periods of time.

    ...And... you may be the joke of the ward for the next couple days.
     
  16. Kittenmommy

    Kittenmommy Owned By Cats
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    OK, you know what? He should have peed first, yes. But the real stupid here (IMO) comes from everyone in the OR who ignored his multiple requests for the catheter and ignored him when he said he's a med student and knew what he was talking about. Seriously, they're supposed to be medical professionals... what did they expect would happen at that point? :rolleyes:

    PS. And it sucks that they're making a joke out of the patient when all this could have been avoided if they'd just paid attention and done their damn jobs.
     
    #3315 Kittenmommy, May 11, 2013
    Last edited: May 11, 2013
  17. Spinach Dip

    Spinach Dip Delicious with nachos
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    I just finished reading this whole thread and it is AWESOME.


    I haven't shadowed in the ER yet, but my mom was an ER nurse for a while, and this is her favorite story:

    If you are a teenage boy experimenting with fireworks, do not empty the gunpowder from a dozen fireworks and try to mix it in your mother's blender. But if you do decide to do that, don't hold the lid down with your other hand and stand right over it. This will result in the traumatic amputation of several fingers, burned and skinned forearms, glass shrapnel in your face, and a couple of badly scratched corneas as a start. You will spend months in rehab and never be able to use your left hand again.
     
    #3316 Spinach Dip, May 11, 2013
    Last edited: May 11, 2013
  18. greatnt249

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    You know it's about to go down when the patient asks FOR a Foley. Can honestly say I've never had anyone actually request one.
     
  19. StevieStud

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    Not to defend their actions, but all too often such requests are a byproduct of low dose narcotics so they tend to get ignored if nobody believes the request to be valid

    I was told I requested my tire to be blown up.... which might have been related the flat I had the week before.
     
  20. Kittenmommy

    Kittenmommy Owned By Cats
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    OK, yeah. But it still sucks that they made him into a joke on the floor when it was seriously their own fault.
     
  21. Unzbuzzled

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    It's nothing personal- sometimes a joke can lighten the mood in the department. I'm sure those who were there found it pretty humorous, and there's nothing to be embarrassed about from the patient's perspective. Sometimes you gotta squeeze every laugh you can out of the humorous situations because it dilutes out some of the bad energy when things get tough. As long as everyone is being a good sport, I think it's ok.
     
  22. Spinach Dip

    Spinach Dip Delicious with nachos
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    I learned today that if you are an average-looking non-patient male and talking on your phone while standing in the middle of a hallway, if a nurse comes up behind you and politely asks you to move aside, there are two possible answers to this request:

    1. Politely move aside.

    2. Step six inches to the right while pretending you didn't hear anything. When the nurse asks again 3 seconds later, turn towards her violently while yelling "WHAT? Bit..." and raising your empty hand as if to give her the finger. Then, upon seeing that she is wheeling a hospital bed containing a cute 19-year old girl with neurologic problems, finish your sentence with "WHAT? Bit... oh, hello there!" And swipe that empty hand through your greasy hair while smiling at the young patient. She will be totally turned on by that.



    I met both of these people today.
     
  23. Warrior011

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    Here's 3 more stories for you from a 4th year medical student (5 year course here in Ireland).

    When you're in end stage renal failure and have been told by the dieticians not to use the Lo-Salt (low sodium salt) as it still contains too much sodium, by all means should you use the full sodium salt instead and end up in the ED. (I don't know what happened afterwards in this case, my GF a 3rd year student saw the patient in the OPD).

    The second story happened at a tram stop in the hospital grounds, two males in their early 20s came to the tram stop from the ED, one of them was on crutches and the other was wearing a hospital gown and had his jeans cut open as far as the groin. The guy on the crutches stopped, held the crutches in the air in a X-shape while shouting "I am the X-men!!!!". The guy in the hospital gown then decided to come across to the other side of the tracks (where I was) and started shouting at people that he was selling pain pills for €20 a tablet saying "I've taken some, they're great!!", he had no takers so shouted "all the more for me" and got on the next tram.

    3rd: When taking medications for SLE, it's perfectly ok to decide to stop taking your medications in preference for herbal teas. It's not like you can get massive lower limb oedema (nephrotic syndrome) and end up in the ED or anything....

    EDIT - 1 more from my GF.

    When you are an ED doctor and the timid young medical student comes to you asking for a good history to take, by all means smile your evil smile and mention that she should try "cubicle 7". Do not be suprised when a few minutes later the medical student comes running out to the nurses' station yelling for a doctor. This will result in all the doctors not budging from their seat and staring at the student. When all the medical student can do is repeat her request for a doctor, this will result in all 4 or 5 of them running in after her into cublicle 7. But hey, at least she'll never forget to use lorazepam for seizures.
     
    #3322 Warrior011, May 27, 2013
    Last edited: May 27, 2013
  24. docB

    docB Chronically painful
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    If you are a teenage male with sagging pants and you seem to always have your hand in your crotch clutching your genitals don't be surprised when your offer of a friendly handshake with your physician is declined.
     
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  25. Sabate

    Sabate Wingnut
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    Quite a gem of a thread here. I've got my own from working in rural EMS in Oregon:

    After coming out of an A-fib episode in the back of an ambulance, please explain to the EMTs how you've dealt with this before by "taking some bong rips and shot-gunning a beer." The fact that you're a 50-something biker covered in gang/MC tats will be one of many reasons we decline to come party with you after you get home.
     
  26. Ceke2002

    Ceke2002 Purveyor of Strange
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    Can't remember if I've posted this one yet or not...

    When an ED is dealing with a shot gun wound to the head, a catastrophic MVA with multiple victims and a Doctor is just about to deliver news to a family that their 17 year old son won't be coming home, by all means keep wandering outside to smoke and sneak a drink of beer all while hootin' and hollerin' about the damn slack arse Doctors who've made you wait several hours because your foot or elbow, or something just happens to really hurt.

    Know what else hurts? My hands around your throat. :mad:

    (I was a patient in the same ED at the time, it took me all my strength not to go this person)

    ~~~~~~~~~~

    If you're Schizophrenic by all means entertain the ED staff by doing renditions of show tunes up and down the department. I've never seen so many Doctors and Nurses struggling to keep a straight face. :laugh:
     
  27. Ceke2002

    Ceke2002 Purveyor of Strange
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    Somehow I thought this picture was appropriate for this thread...

    [​IMG]
     
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  28. Spinach Dip

    Spinach Dip Delicious with nachos
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    Today I learned that "You've gotta help me-I've had four heart surgeries in the past year and I just figured out it might be genetic and I have three sisters who all refuse to talk to me but they might have the same thing so can you get a doctor to call them and convince them to get themselves tested" is not exactly a priority one emergency, and it is unlikely to get you seen before the 8-yo with projectile vomiting, the grandma who sounds like she is in the process of hacking up a lung, or even the HS baseball player who dislocated his ankle sliding into second base.
     
  29. zidanetribal

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    So entitled. I would've made sure he became a patient that day...
     
  30. Unzbuzzled

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    I just realized this thread is still going strong after a decade! Keep 'em coming!
     
  31. TravelingRunner

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    Things I have learned from the professors of life in the ED:

    1. The ED staff are really there to engage in [insert perverted fantasy here] with you. When I said I didn't want to see you pleasuring yourself, I really meant "Please continue while I try to get this EKG done." When I said don't grab my butt/boobs/crotch, I really meant "Grab them as soon as they are back in range." And when our friendly RN reminded you that assault on ER workers is a felony in our state, she was just kidding. Like we all were last week, and the week before, and the week before that... ...Gotta love our FF perverts.

    2. When faking a seizure, it adds authenticity when you answer "Yes" when I say, "Are you having a seizure?"

    3. If you are an ambulatory patient (yes, I saw you walk in here) who refuses to get out of bed because you are looking to score pain meds for your "10/10 pain," it will help your case with all the ER staff when you repeatedly wet the bed and demand that I change the sheets immediately. When I offered to escort you to the bathroom, to bring the bedside commode, or a bedpan, I didn't mean it; changing wet sheets is fun for me. After your third bedchange in 30 minutes, which was always accompanied by loud yelling about my incompetence and the lousy service at this ER, don't be offended when I put you on chux pads.

    4. If you accompany your coding relative/friend in the ambulance and come running into the ED with the EMS folks, please loudly announce that YOU are "a doctor" and will be taking control of this code now. Never mind that no one has ever seen you before. Never mind that you just ordered a CNA to push "that medicine" (atropine). And please get in our attending's face while he is actually trying to save your relative/friend; I'm sure it will improve the outcome.

    5. Virginity is something that apparently regenerates, according to our G4P3 patient (and many like her). "But I can't be pregnant! I'm a virgin!" "Ma'am, the tests are positive." "Again??"
     
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  32. huskyjackal

    huskyjackal morbidly fascinated

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    I apologize, I am only on page 56 of this thread but I have the utmost respect for those of you in this field and who have the patience and courage to work with everyone that comes through those doors (and EMTs on the field).

    This is a response to the "they put what in their butt?" line of posts I've read.. a quick doodle in Photoshop as those posts have made me laugh until the wee hours of the morning as I couldn't stop reading. Thank you all!
    [​IMG]

    [feel free to save and use however you'd like, maybe I can clean it up and make it look a little better in time or add different objects, make a GIF that rotates through all sorts of things]
     
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  33. Rendar5

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  34. Deekle

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    Should say..."woops doc, I slipped in the shower" haha
     
  35. Kintatsu

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    That would make an excellent t-shirt.

    That said, I've been lurking on this thread since before it was made anonymous to non-members, and was linked here from TVTropes (the "Too Dumb to Live" page, specifically). I'll be going for forensic autopsy in the fall. Three lessons from the ages of seven, 12, and 18, respectively:

    1) When your aunt's dog has already displayed massive amounts of territorial aggression, and is tied up between you and the swing-set, don't bother taking the long way around. Instead, try to sneak past him while your aunt plays tug-o'-war to distract him. There is absolutely no way he will notice and tackle you to the ground. However, kudos for managing to place your arm in his mouth to distract him from your neck, and laying limp, thus minimizing damage. (Two stitches)

    2) When you see that your grandfather's trailer ramp takes two strong, full-grown men to lift into "closed" position, feel free to unlatch it unassisted and unsupervised 15 minutes later. This will in no way result in it falling on you, pinning you to the ground and breaking your clavicle. Do be grateful that your younger brother is absurdly strong for his age under normal circumstances, and can get you enough clearance to crawl most of the way out. (Immobilization harness)

    3) Turns out, wet microwave turntables are slippery, especially the glass ones. It also turns out, it's a bad idea to try to catch them against the counter. On the plus side, glass shards are too sharp to hurt when they cut you. (Three butterflies and a dab of glue)
     
    #3334 Kintatsu, Jul 13, 2013
    Last edited: Jul 13, 2013
  36. loveoforganic2

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    A 3rd year friend's 1st trauma case on her 1st day of trauma call on her 1st day of rotations was an arrow wound to the abdomen. I don't know the back story, but I have a feeling it involves something that would belong here. Oh New Orleans...
     
  37. deuist

    deuist Stealthfully Sarcastic
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    That light bulb picture is awesome. I might just print it up to hang at work.
     
  38. Perrotfish

    Perrotfish Has an MD in Horribleness
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    Mardi Gras Indians?
     
  39. Deekle

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    Haha. First case I saw in the ED was an 8 y/o with a broadhead arrow in the butt. His dad thought it was ok to toss his hunting bag right behind the kid's bean bag chair.
     
  40. Chip N Sawbones

    Chip N Sawbones Ship's Carpenter
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    "Well I was making a left turn running a red traffic light on my way to the drive-thru to get a daiquiri when some dude pulls out a crossbow and..."

    I'll be starting at Tulane in a few weeks. I think I'm going to like it there.
     
  41. Perrin

    Perrin sittin in the morning sun
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    Me: Sir, what brings you to the ED tonight?
    Pt: Well, I've been having some problems with my urine.
    Me: What kind of problems? Blood? Pain? Frequency?
    Pt: Nah, I think my prostate is getting too big?
    Me: What makes you think it's your prostate?
    Pt: Oh, I check it every day and it feels bigger.

    Me: ...slowly nods head... O...K.. sir...

    :scared:
     
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  42. Spinach Dip

    Spinach Dip Delicious with nachos
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    Recently, I learned that an inability to crap is a medical emergency to some people.

    I also learned that if you make enough of a scene, the nurses will be happy to give you an enema. But no, they don't care about your notions of propriety. Drop your freaking pants already if you want some relief.

    After that relief comes, you will wait an hour to talk to the doctor. He will speak with you for 2 minutes before sprinting back to his doughnut.

    The bill, since you have no insurance, will be well over 1 grand. Hopefully next time you will buy an enema from walgreens and administer it to yourself--you'll get the same result at [sup]1[/sup]/[sub]200th[/sub] the cost!
     
  43. deuist

    deuist Stealthfully Sarcastic
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    And if you're a real a-hole, I give GoLytely.
     
  44. acceptmeplease

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    Back in my ER tech days, I was basically the foley and EKG ***ch. I was putting a foley in a lethargic man with hep c who, upon further investigation, had a Woody the Woodpecker tattoo on his penis. When leaving the room, his sister informed me that the needle which gave him "his tattoo" was the same one who inoculated him with hep c.

    Is that something you share at Sunday dinner with the fam?

    Also. I can't tell you how many breast implants I've seen on 90+ year old women... Even had a nurse in her 20s walk in and say to a patient, "hmm. Those are nicer than mine."
     
  45. Unzbuzzled

    2+ Year Member

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    Well it probably makes the heart exam easier because at least they'll be up and out of the way. I'm not sure you can ever get used to using the back of your forearm to move 90-year-old boob out of the way to get mitral sounds.
     
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  46. acceptmeplease

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    I never get used to the amount of yeast women foster under those things.
     
  47. Aoirann

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    Think of it like this. At least he didn't come in with a prostate the size of your fist screaming to everyone one that will hear him that that it's not a problem and will sue you if you get near him with a glove. He's being proactive with his problems... Though in a kinda gross way about it.
     
  48. greatnt249

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    Still a totally inappropriate use of EMERGENCY resources, much like the guy I had come in last night complaining of foot pain, only to discover 5 seconds later a measly plantar wart was the culprit.
     
  49. njac

    njac Senior Member
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    I thought about this the other day while I was at a Korean spa, getting exfoliated in places I didn't imagine could need it.

    If everyone did that once a month, the ED would be a much better smelling place.

    Just saying.
     
  50. Perrin

    Perrin sittin in the morning sun
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    I had that a few months ago. He thought he had a foreign body in his foot due to the pain in his foot that started 3 days ago. I asked if he had stepped on anything barefoot that may have caused this. "Yeah, I stepped on a piece of wood 6 years ago." Sir, I don't think a splinter has been hanging around for 6 years waiting for the right moment to strike. Turned out to be a few plantar warts. When I showed him, he said, "Huh, I guess I should have looked at my foot first." Ya think :rolleyes:
     
  51. TravelingRunner

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    It is completely normal to have an ant colony living in your fat rolls. No, it doesn't tickle (I thought it would...).
     
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