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Things I Learn From My Patients
Started by docB
How long was that pregnancy - just the two months??.
Maybe he is the babydaddy but they weren't in a relationship until 2 months ago. You know, the classic love story.
Just came across this in the morning paper:
If your BKA operation is postponed, feel free to self-amputate your diabetes-related gangrenous toe using a kitchen knife, scissors and a pair of heavy duty toenail clippers.
Ps - credit where it's due, I wouldn't have the pain tolerance to self-amputate my toe unless it was trapped/life threatening/no help available through normal channels!
If your BKA operation is postponed, feel free to self-amputate your diabetes-related gangrenous toe using a kitchen knife, scissors and a pair of heavy duty toenail clippers.
- I think I'll lean towards the latter assessment: "lucky" - if he done such a good job of it, I don't see why he'd need to see multiple surgeons in the aftermath!
Ps - credit where it's due, I wouldn't have the pain tolerance to self-amputate my toe unless it was trapped/life threatening/no help available through normal channels!
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When you and your wife of 30 years are driving home from dinner and she says it's dangerous for you to keep your pistol in the center console it is a good idea to grab said .357, put the barrel under your chin, say "aww hell it aint even loaded", and pull the trigger. It is ONLY a good idea if, in fact, the pistol is not loaded. If so, the bullet will cause damage breaking your maxilla, blowing out your orbit, rupturing your globe, and exiting just south of your eyebrow. Also, make sure to do this to the side of your face which is home to your non-blind eye.
Rule 1: all guns are loaded.
Amen
or if you can draw the cat emoji. then it's totally acceptable
Apparently this is a thing.
"At the Upstate New York Poison Center, we have had a sevenfold increase in calls related to loperamide use and misuse over the last four years."
http://www.npr.org/sections/health-...high-from-this-drug-for-diarrhea-can-be-fatal
When checking to see if a nail gun is empty on a construction site when you are about to go to lunch, do not point the nail gun at your pubic region and pull the trigger. This can lead to having a nail embedded in your suprapubic region and down into your bladder. If you have done this, you can expect to be the man of the hour with EM attendings, residents, med students flocking into your room to look at your nether regions. This will also cause the Urology service (attendings, residents and anyone rotating through their service at that time) to run gleefully down to the ER after receiving the page regarding a "nail through the penis" to see if this is really true. Urology will quickly lose interest once it's determined that, no, the nail did not, in fact, penetrate the penis and missed all the vital structures. The med students will think it's cool and talk about you for a few days.
That seems like a pretty misleading page to uro if the nail simply went through the suprapubic region and into the bladder.
Well, the bladder IS part of the tract. However, if it did say "through the penis", yeah, you're right.
#1 If you're a chronic drinker with an WBC is 12.000 discharge yourself AMA so you can get some drink then two days latter you can show up with pancreatitis and a WBC of 45.000 😱
As a bonus go into SVT, a dash of V Fib and get intubated , the ER crew will love you.
#2 When asked for previous conditions or surgeries say none. When I inspect you can discover a large surgical scar across the abdomen and ask you what type of surgery is it from act flabbergasted and say you don't remember.
As a bonus go into SVT, a dash of V Fib and get intubated , the ER crew will love you.
#2 When asked for previous conditions or surgeries say none. When I inspect you can discover a large surgical scar across the abdomen and ask you what type of surgery is it from act flabbergasted and say you don't remember.
If you are a third year chemistry student in the inorganic lab, reacting ammonium with a mixture of metal salts in the presence of a homogeneous catalyst, you should not ignore the technician who says "do not look in the end of that burette!"
You should not ignore him the second time he says do not look in the end of that burette.
The third time you ignore him, the burette will choose that moment to eject a hot, foaming, blue, toxic mixture of ammonia, ammonium, copper sulphate, and some other inorganic salts straight into your face.
You will end up thrashing on the floor screaming as you try to get the ammonia-mixture out your nose and make a very interesting scene: you will admit later that you thought you were going to die.
The technician, seeing you thrashing around on the floor, covered in "blue" and screaming will immediately drag you to the emergency shower while other technicians call an ambulance. They will strip you to your underwear and continue pouring water on you: they too will later admit that they thought you were going to die.
The paramedics who arrive to find you unconscious, wrapped in towels on the floor, gasping for breath and occasionally coughing a frothy blood which keeps collecting in your oxygen mask, and a face that even Freddy Kruger would have called ugly: even they may later admit that they thought you were going to die. Okay, no they didn't, but they thought you were a mess.
When you get to A&E (ER), have your nasal passages lavaged, and are about to get transferred, abruptly wake up and continue screaming/thrashing around because your face is sore and you can't breathe properly - you'd have thought the pulmonary oedema might have hinted that screaming is a bad idea - but nah, Shriek away good sir! Everybody here loves it!
I was the chemist who got called down from the labs upstairs to advise on the blue stuff: my advice was to "wash it off" [with water] - they haven't called me down again.
The moral of the story? Don't alkalise your face and respiratory tract - you won't like it.
Ps - Just to clarify, I'm pretty sure it's not common practice to get lab technicians down to A&E for advice: I really don't know what they were wanting me to say! "You should wash it off?", "Don't rub it on your face?","Audition for the Blue Man Group?", "Hah! Looks like a Smurf!?". There really isn't much I can advise you on the matter! You're already doing the "get it out his nasal passage" part!
You should not ignore him the second time he says do not look in the end of that burette.
The third time you ignore him, the burette will choose that moment to eject a hot, foaming, blue, toxic mixture of ammonia, ammonium, copper sulphate, and some other inorganic salts straight into your face.
You will end up thrashing on the floor screaming as you try to get the ammonia-mixture out your nose and make a very interesting scene: you will admit later that you thought you were going to die.
The technician, seeing you thrashing around on the floor, covered in "blue" and screaming will immediately drag you to the emergency shower while other technicians call an ambulance. They will strip you to your underwear and continue pouring water on you: they too will later admit that they thought you were going to die.
The paramedics who arrive to find you unconscious, wrapped in towels on the floor, gasping for breath and occasionally coughing a frothy blood which keeps collecting in your oxygen mask, and a face that even Freddy Kruger would have called ugly: even they may later admit that they thought you were going to die. Okay, no they didn't, but they thought you were a mess.
When you get to A&E (ER), have your nasal passages lavaged, and are about to get transferred, abruptly wake up and continue screaming/thrashing around because your face is sore and you can't breathe properly - you'd have thought the pulmonary oedema might have hinted that screaming is a bad idea - but nah, Shriek away good sir! Everybody here loves it!
I was the chemist who got called down from the labs upstairs to advise on the blue stuff: my advice was to "wash it off" [with water] - they haven't called me down again.
The moral of the story? Don't alkalise your face and respiratory tract - you won't like it.
Ps - Just to clarify, I'm pretty sure it's not common practice to get lab technicians down to A&E for advice: I really don't know what they were wanting me to say! "You should wash it off?", "Don't rub it on your face?","Audition for the Blue Man Group?", "Hah! Looks like a Smurf!?". There really isn't much I can advise you on the matter! You're already doing the "get it out his nasal passage" part!
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When you have hx of cocaine abuse and come in for cp stating you got a "dinner plate" from a friend; make sure their friend didn't dump coke in there as the cops were following them only to be called later and asked "did you eat that dinner plate?".....smh they think we believe this stuff?
And remove your contact lenses and don your glasses *before* cutting the peppers. Your 'morning after' eyes will thank you.
Not ER: The bilateral knee pain you've been experiencing that just won't resolve has absolutely nothing to do with the fact that you ran a marathon 2 weeks ago, a half marathon 3 days ago and did "tempo work" for the last 2 days preparing for a marathon next month --- no, really, I don't need XRays and your insurance likely won't pay for an MRI of both of your knees since, given the negative PE I just did, it's likely an overuse injury and you need to chill on the couch for a while...really....yes, I'm really sure the orthopod will tell you the same thing...No, there's no specialist who will likely give you a different answer or order the MRI --- unless you want to pay for it.....I didn't think so....
Long time lurker here. I'm not a medical student, never have been, never will be, but I worked for many years as a medical librarian, and before that as a unit clerk on several different units including a trauma unit. On one of the fairly rare quiet days several of our attendings were hanging out sharing stories including this one:
Young male in his 20s is a patient on the trauma unit, and ends up needing his chest cracked. Amazingly he not only survives, but is conscious and extubated several days later.
Attending (who has just finished explaining what was done and why to patient): Do you have any questions?
Patient: When can I start having sex again?
Attending (after picking his jaw off the floor, says first thing he can think of): If you feel up to it, go for it!
The attending figured that if the kid was feeling well enough to even think of sex, only three days after a chest cracking, he was most likely going to make a full recovery. Which I understood the kid did.
So if this is supposed to be in a lesson learned from a patient format, I suppose it would be Lesson: The patient who feels well enough to think about sex is more likely to survive whatever has put him in the hospital than the one who doesn't.
Young male in his 20s is a patient on the trauma unit, and ends up needing his chest cracked. Amazingly he not only survives, but is conscious and extubated several days later.
Attending (who has just finished explaining what was done and why to patient): Do you have any questions?
Patient: When can I start having sex again?
Attending (after picking his jaw off the floor, says first thing he can think of): If you feel up to it, go for it!
The attending figured that if the kid was feeling well enough to even think of sex, only three days after a chest cracking, he was most likely going to make a full recovery. Which I understood the kid did.
So if this is supposed to be in a lesson learned from a patient format, I suppose it would be Lesson: The patient who feels well enough to think about sex is more likely to survive whatever has put him in the hospital than the one who doesn't.
Today, I learned you can snort weed.
Why you would choose to do this, on the other hand, is unanswerable.
Why you would choose to do this, on the other hand, is unanswerable.
"Whatever you were doing that ended in you igniting the hairs surrounding your anus is not good idea."
Sage advice from the A&E Dept: what amazes me is the doctor apparently said this with an entirely straight face... (second hand account from a technician colleague who witnessed said patient and his... um... condition.
Can anybody explain to me the fascination with the human anus? You'd think after we developed all this cool tech and medical advancements and started blasting people to the moon... that surely the human anus would have lost its exploratory appeal?
Sage advice from the A&E Dept: what amazes me is the doctor apparently said this with an entirely straight face... (second hand account from a technician colleague who witnessed said patient and his... um... condition.
Can anybody explain to me the fascination with the human anus? You'd think after we developed all this cool tech and medical advancements and started blasting people to the moon... that surely the human anus would have lost its exploratory appeal?
It's a hole on the bottom of the body that you use every day but can't see without a mirror. It's easier to see the moon.
But what about my other orifices? I use them every days as well and struggle to see all of them as well 😛
Somebody had better call the creator and submit a bug report 😉
##Bug description: Anal Obsession
##How to reproduce this bug: Leave somebody alone in a room with an insertable object
##Status: Awkward for all involved
##Notes: Been informed that candles are moderately x-ray opaque: further study required. Information suggests that I will not be volunteering for said study
I'll see your cannabis snorting and raise you a list of interesting things a diagnosed schizophrenic former acquaintance of mine has injected in some rather misguided attempts to get high (at least there's one saving grace, he couldn't hit a vein to save his life) ...
4 syringes worth of lemon juice (after he miscalculated the amount needed to inject an acid trip)
Vegemite (into the back of his hand; followed by a subcutaneous injection of Panadol in his foot, because injecting Vegemite hurts, apparently)
Cannabis resin scrapings from a pipe
Bong water
An attempted injection of fly spray (thankfully aborted by a friend showing up right time, right place)
And a gram of speed (into his eye)
Well he didn't actually go directly into his eye, somehow he managed to poke the needle of the syringe down the side of the eyeball, near the Caruncula I think it's called. End result still looked like something out of a horror movie once the eye started bulging out of its socket.
Aye, but not everyone 'needs for speed' to make it happen.End result still looked like something out of a horror movie once the eye started bulging out of its socket.
PS: Love your siggy. Especially the second line 🙂
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I am afraid I was caught socmob-ing on Friday evening - but it gave me a wonderful glimpse into the life of the A&E/ER department... a very terrifying, awe-inspiring, vomit-inducing, wondrous glimpse.... and being a Friday evening at about 1130pm, I think I may have arrived during rush-hour...
Ignoring the exact details of my socmob-when-these-two-dudes story (it's really boring; and minor as far as A&E trips go*), I learned the following:
1) Inserting a 2" wood screw into your urethra (male) is not a viable contraceptive method.
2) Trying to run out the department, naked, gets you tackled by the police officers watching over you.
3) Some people will try and claim that they are expert surgeons, and that they don't need no f****** doctor to sew them up, they can do it themselves and have done it before (the nearby nurse will then amuse herself by saying you must have done a wonderful job since you didn't even leave any scars!).
4) Fireworks: not for hands.
5) Fireworks: not for faces (separate person).
6) If you're so drunk that you fell over and somehow ended up with a protruding tib/fib fracture, the best course of action is is to complain (extremely loudly) about the shoe you lost during your escapade.
7) If you put your back out so much that you can barely stand let alone walk, just from "getting it on" with your boyfriend, maybe you shouldn't have told the Paramedics that while your husband is standing right next to you.
8) You should proudly exclaim that you fractured your ding-a-ling while "f****** a f****** hot lass". We were all wondering.
9) If you must vomit, be sure to wait and do it when the nurse comes to speak with you: for bonus points, be sure to vomit over the nurse.
--EDIT-- Forgot one!
10) Yelling "Suck my magnificent boabey!" (a Scottish word for one's schlong) will earn many, many bemused smiles, especially when nobody can really pinpoint the exact owner of said magnificent boabey.
*was socmob-ing home from visiting a friend at 11pm, on my pushbike and after an altercation with these two-dudes in a car, I ended careening into a bush. The bush won.
Ignoring the exact details of my socmob-when-these-two-dudes story (it's really boring; and minor as far as A&E trips go*), I learned the following:
1) Inserting a 2" wood screw into your urethra (male) is not a viable contraceptive method.
2) Trying to run out the department, naked, gets you tackled by the police officers watching over you.
3) Some people will try and claim that they are expert surgeons, and that they don't need no f****** doctor to sew them up, they can do it themselves and have done it before (the nearby nurse will then amuse herself by saying you must have done a wonderful job since you didn't even leave any scars!).
4) Fireworks: not for hands.
5) Fireworks: not for faces (separate person).
6) If you're so drunk that you fell over and somehow ended up with a protruding tib/fib fracture, the best course of action is is to complain (extremely loudly) about the shoe you lost during your escapade.
7) If you put your back out so much that you can barely stand let alone walk, just from "getting it on" with your boyfriend, maybe you shouldn't have told the Paramedics that while your husband is standing right next to you.
8) You should proudly exclaim that you fractured your ding-a-ling while "f****** a f****** hot lass". We were all wondering.
9) If you must vomit, be sure to wait and do it when the nurse comes to speak with you: for bonus points, be sure to vomit over the nurse.
--EDIT-- Forgot one!
10) Yelling "Suck my magnificent boabey!" (a Scottish word for one's schlong) will earn many, many bemused smiles, especially when nobody can really pinpoint the exact owner of said magnificent boabey.
*was socmob-ing home from visiting a friend at 11pm, on my pushbike and after an altercation with these two-dudes in a car, I ended careening into a bush. The bush won.
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UC: Pt. c/o ear pain --- I go into the exam room and note that the right earlobe is black; Upon interview I learn that the patient had decided to lance a boil on the earlobe by heating a needle in a gas burner on the stove to "sterilize" it and then jam it into the boil. When I asked him "why?" -- he had seen it in the movies and thought it was okay to do..... in the spirit of patient education, I remonstrated with him that if we had just experienced the end of civilization as we know it, it may be a viable option but not when you're in downtown Dallas and can throw a rock and hit physician's office/UC/ER....I thought about keeping my mouth shut and allowing Darwinian selection to occur but was feeling merciful that day.....
Great thread everyone! 🙂 My tip for today:
If you are using a radial arm saw to cut a piece of wood down for a project, do not cross your arms to pull the blade forwards. Especially don't cross your arms in such a way as to make it so you cannot see the hand holding the piece of wood in place - especially when you know better. Because you will run the blade into your hand. You will then start screaming for help in such a way as to make your wife and daughter (who were both home at the time, about to can tomatos) know that *something* has gone very wrong, and the former will run downstairs while the latter accidentally trips over one of the cats, who also came running. Your wife will grab some shop towels, get you upstairs and out the door as fast as can be, and tell her daughter to stay home. After doing this, please especially do not continually yell, "stupid, stupid, stupid! Why did I do that I know better!" (and mixed variations thereof) at the top of your not-inconsiderable volumn during the entire 15-20 minute drive to the hospital in rush-hour traffic; your wife will not appreciate it.
That was my dad. Surprisingly enough, he wound up only needing to have stitches. He hit his hand right bwteen the middle and ring fingers; missed the tendons, missed the bone. We're pretty sure he used up his allotment of luck for the year doing that. That was the only time (that I know of) he hurt himself in his workshop.
If you are using a radial arm saw to cut a piece of wood down for a project, do not cross your arms to pull the blade forwards. Especially don't cross your arms in such a way as to make it so you cannot see the hand holding the piece of wood in place - especially when you know better. Because you will run the blade into your hand. You will then start screaming for help in such a way as to make your wife and daughter (who were both home at the time, about to can tomatos) know that *something* has gone very wrong, and the former will run downstairs while the latter accidentally trips over one of the cats, who also came running. Your wife will grab some shop towels, get you upstairs and out the door as fast as can be, and tell her daughter to stay home. After doing this, please especially do not continually yell, "stupid, stupid, stupid! Why did I do that I know better!" (and mixed variations thereof) at the top of your not-inconsiderable volumn during the entire 15-20 minute drive to the hospital in rush-hour traffic; your wife will not appreciate it.
That was my dad. Surprisingly enough, he wound up only needing to have stitches. He hit his hand right bwteen the middle and ring fingers; missed the tendons, missed the bone. We're pretty sure he used up his allotment of luck for the year doing that. That was the only time (that I know of) he hurt himself in his workshop.
Earlier this week I learned* that, Mr Trump being president is not the kind of "Accident and Emergency" dealt with by the A&E Department.
Patient was also high as a kite and had heart issues - but they kept that bit a surprise! Well... Surprise! You heart is aspiring to sound like Gene Krupa, and your kidneys are on their last legs. Wtf you been snortin' mate?
*from a colleague who dealt with it; passed on with her permission.
Patient was also high as a kite and had heart issues - but they kept that bit a surprise! Well... Surprise! You heart is aspiring to sound like Gene Krupa, and your kidneys are on their last legs. Wtf you been snortin' mate?
*from a colleague who dealt with it; passed on with her permission.
When teaching your young Cub Scout how to whittle, do not use your trusty razor sharp combat knife which served you faithfully in deployments all over the known Planet Earth to demonstrate proper whittling technique. Especially do not do this in shorts, outside, on the porch, sitting in your favorite chair with your legs crossed, lest you demonstrate to your CubScout that it is possible to slice into your flesh so thinly that it rolls up like a wood shaving from a planar and teach him a whole new vocabulary along the way.....lots and lots of bleeding but no sutures required....
Youch! That's nasty!
I have done something similar with my finger before with a microtome: quite a short roll of skin though; not much blood mind you! (lots of serous* exudate, but very, very little blood) - for all those would-be knife-users, remember to twist your torso round so that your legs are BOTH at one side of where you are working - that way you're not going to accidentally slice into your femoral artery with your knife when you slip!
Had the pleasure of witnessing a Wilderness Survival instructor do that a few years back: one of two arterial bleeds I've had the pleasure of witnessing first-hand! (I'm a scientist, if I'm witness to a lot of arterial bleeding then I'm clearly doing it wrong 😉 - though some of the researchers I've met would argue the exact opposite.)
I'm also afraid to mention that I am no longer in a medical setting - last week was my final week in the labs: but that didn't stop the door hitting me on the way out!
And that brings me to the lesson of the week...
I learned that if a sudden gust of wind blows a heavy fire-door shut, you should not under any circumstances put your hand out to try and stop the door from smacking into you. Instead, you should try to dodge through it - that way the door will catch you between the door and the jamb! It turns out wind-powered doors can and will quite happily crack four of your ribs!
It's very important that if you witness this, you should laugh your *** off at the person getting caught in the door: what you, the witness and fellow lab-assistant haven't realised is that because your partner finishes up tomorrow, that you will be the one carrying all their stuff out to the car for them since they can't lift anything heavy! They will thank you with beer, so it may have been worth it.
What an interesting two-last-days that turned out to be! Did you know if you cough and reflexively double over while looking through a (binocular) microscope you can poke BOTH your eyes at the SAME time?
*The word of the day is serosanguinous!
Ahh another year, another cornucopia of patients (this thread should be split into years , it's getting hard to navigate by now)
#1 You only give your CHF father - the patient - ACE inhibitors when his heart get enlarged . You will then promptly be questioned if you have x-ray vision or kryptonian relatives.
#2 If you have C Diff. , HCV , pneumonia and dementia loudly demand that you be released so you can go home and have cake , end your demand by violently passing gas and ****ting yourself.
#3 Never take your large metal pendant off for a chest x-ray no matter what . That way your doctor can admire your film and recommend to IM the diagnosis of duchebag pneumonia.
#1 You only give your CHF father - the patient - ACE inhibitors when his heart get enlarged . You will then promptly be questioned if you have x-ray vision or kryptonian relatives.
#2 If you have C Diff. , HCV , pneumonia and dementia loudly demand that you be released so you can go home and have cake , end your demand by violently passing gas and ****ting yourself.
#3 Never take your large metal pendant off for a chest x-ray no matter what . That way your doctor can admire your film and recommend to IM the diagnosis of duchebag pneumonia.
One should avoid masturbation for at least sometime after a circumcision 😵
That is... more immaturely hilarious than it should have been
But less than it could have been... I see that you refrained from describing this Code Brown in detail, even as it was C Diff upgraded ...it'd gag a maggot. (Ok, maybe only Pseudomonas would)'Duchebag pneumonia'... I'm dying 😀
In other news, curiosity item - why scrubs are anything from green to blue (collectively called 'cyan'):
(This info is from multiple sources, but most of it is repeated here)
• Harry Sherman pioneered green in in 1914 because in the brightly lit operating room, it reflects less light than white and causes less eye strain.
• Surgical instruments (shiny steel) lie down on the sterile field and blaze with reflected white from the ceiling. When everything is green, subconsciously it emphasises the sterility of them to everyone in the OR. (although that’s the drape and not the scrubs)
• Cyan is considered a restful and soothing color, it causes less anxiety to patients (opposite to what red would be). (Green was changed to blue to be even more restful)
• Shifting one's sight to cyan after staring at red for long periods of time does not cause cyan after-images, as shifting from red to white will do. (or rather, the afterimages blend in)
• Looking back at the red of a patient('s insides), the visual system is now refreshed by looking at a complementary color and can see red and pink nuances gooder than before.
• Cyan is complementary to red, so red blood on a cyan gown looks black or gray rather than red, and is not as vivid.
• When laundering blood from white scrubs, it too leaves greenish 'afterimage' stains; on cyan they blend in.
So it seems, it's all based on cyan being somehow the 'anti-red' 😱 😕
• Surgical instruments (shiny steel) lie down on the sterile field and blaze with reflected white from the ceiling. When everything is green, subconsciously it emphasises the sterility of them to everyone in the OR. (although that’s the drape and not the scrubs)
• Cyan is considered a restful and soothing color, it causes less anxiety to patients (opposite to what red would be). (Green was changed to blue to be even more restful)
• Shifting one's sight to cyan after staring at red for long periods of time does not cause cyan after-images, as shifting from red to white will do. (or rather, the afterimages blend in)
• Looking back at the red of a patient('s insides), the visual system is now refreshed by looking at a complementary color and can see red and pink nuances gooder than before.
• Cyan is complementary to red, so red blood on a cyan gown looks black or gray rather than red, and is not as vivid.
• When laundering blood from white scrubs, it too leaves greenish 'afterimage' stains; on cyan they blend in.
So it seems, it's all based on cyan being somehow the 'anti-red' 😱 😕
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I caught that, too, and forgot to quote it!So, I'm guessing this wasn't written by an English major!
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What ever happened to @docB? Anyone know? Was a great poster, alway had sober, thoughtful advice, but hasn't been on here in 3 years.
If you are a 32 year old man with pharyngitis the best way to treat it is to show up at the ER at 2:40 in the morning . When asked what have you done to treat it say without batting an eye "nothing" and rate your pain 6/10. This will cause the attending to come over and ask you how did you make it to age 32.
After the end of the shift I will be able to laugh for hours thinking about your monolithic stupidity.
After the end of the shift I will be able to laugh for hours thinking about your monolithic stupidity.
Dude - in a word -" 'murica".
You find singular something that is legion and quotidian he in the ol' US of A.
Repeat x20 times daily during cold/flu season.
Don't try Advil then get indignant when I send you home with Advil for pain.
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While I understand that they derive from different sources, I enjoy the use of both " 'murica" and "quotidian" in the same response.
