Subaqua Sternal Rubs

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1. Tonight I learned yet another helpful life lesson from one of my patients. If you're on the street corner selling coke and you see the cops coming to bust you don't eat all your coke. Having been taught this valuable lesson I will now know better than to do this and wind up going to the ER in handcuffs, seizing uncontrollably, aspirating my vomit and doing all of this with a white powder moustache looking like and ad for "Got Coke?"

2. Stay away from people named "Some Guy" or "This One Dude", because they for whatever reason, just punch someone in the face or hit them with a crowbar and run off. If I see them on the street, I cross the street to get away from them.

Corollary: If the two dudes live in YOUR city, don't sit out on your front porch reading the bible and minding your own business at 2 AM unless you are praying to be shot.

3. Never, ever leave flashlights, shampoo bottles, beer bottles or any long, circular object on the floor because someday you will fall on it and it will somehow, work its way up your rectum.

4. Always wait until finishing your woodwork with the skillsaw prior to using your meth.

5. Don't road surf on the top of a moving stickshift car driven by your younger sibling with a learner's permit.

6. Never leave your last refill of percocet in plain sight after your docs office closes if one of these 3 friends is coming over for dinner: 1. some dude, 2. my friend, 3. that bitch.

7. Well another professor of life came through last night and bestowed some wisdom on me which I'll share. No matter how annoyed you are at being incarcerated dont slash open your scrotum and shove razor blades up your urethra. Now I know, who among us hasn't thought wistfully of doing that but it turns out that it's not a good idea.

8. If you are prone to dystonic reactions and are stealing your roomates meds. Make sure you can tell valium from haldol. Take a look at the two in the PDR. It is amazing how similar they are.

9. Latex paint, despite being thick and creamy, does not coat your stomach and provide the same relief as pepto bismol.

10. If you are a 70 year old man with COPD, and you want to clean the toilet really well, go ahead and mix the ammonia and bleach. Most of us learned not to do this before the onset of pubescence, but give it a try regardless! Later, after the paramedic has successfully conducted a RSI intubation in the ambulance, make sure your family speaks up for you in the ED. They are there to advocate for you on the most pressing and salient issues. Have them go right up to the ED attending, and demand that, if they don't find the patient's missing dentures right now, the doc and paramedics are buying him a new set. Hint: they should demand this while standing in front of the ventilator (the patient's only earthly connection with an oxygen satuaration >70%).

11. If you are going to get into a fight, and have a prosthetic eye, make sure you take it out first…..and, for safe keeping, shove it up your vagina…..the, realize that you cannot get it out and go to the ED for removal.

12. If you have taken 7 home pregnancy tests that are all positive, and you come into the emergency department…chances are that test too will come back positive.

13. If you're walking the dog and an unleashed pit bull suddenly attacks your dog, DO NOT get on your hands and knees and try to break it up. the pit bull will bite the tip of your nose off and possibly eat it, too.

14. When the IV drug user with no veins comes in with cellulitis and gets a central line, tell the nurses to not let them "go out for a smoke". Patient took off (obviously), brought back in to the E.D. 1 hr later in full arrest by girlfriend after shooting up on the street into central line with "the really good stuff".

15. If you are given a prescription for narcotics wait until the presciption is filled before you try to sell them… Patient gets perscription for vicodin and trys to sell them over the phone (loudly) in the E.D. lobby…"They gave me 30 vicodin…how about $250? OK, meet me here in 20 minutes". Patient overheard by staff who took written perscription from patient and ripped it up in his presence…..

16. No matter how badly constipated you are, a vodka enema is not a good idea.

17. Drinking Pine Sol diluted in a 5 gallon bucket, shared with 5 friends, is not a good way to get drunk.

18. 18 year old kids absolutely need new Audis– especially the kind with the DVD player built into the dashboard so that they can watch "The Fast and The Furious" while driving along a windy road at say, 3am. the best thing to say (if you are an 18 year old driver of such a car) is "hey, watch my car handle this turn" as you careen into a tree. (unrestrained driver had not one but TWO spiral femur fractures in the same leg. his foot was pointed backwards). Tree survived with minor scratches.

19. If your dentures do not stick to your gums, probably not a good idea to superglue them on!

20. Mosquito bites itch. A lot. Really, really bad. So much in fact that, what the heck, you may as well go on in to the Emergency Department.

21. When your 15-year-old daughter gives precipitous delivery to a bleating, underweight infant 30 minutes after presenting to triage with "gas pains", you should run around the department loudly yelling, "I don't know what y'all did or who that baby is, but my lil' girl warn't pregnant when she come in here"

22. Injecting a mixture of wine, Klonopin, and Lidocaine into your veins may seem like a cool idea at the time when you're wasted, but can leave a nasty phlebitis a few days later.

23. If you are in police custody and are brought to the ED for evaluation, do not go to the bathroom then try to escape through the ceiling, because the styrofoam ceiling will probably collapse at some point and the PD standing outside the bathroom door might notice your bare behind, scantiliy covered by the hospital gown, hanging out of the ceiling.

24. That broken hand you deliberately smashed with a hammer will get you ONE PRESCRIPTION FOR VICODIN, NO REFILLS. Do not go home and remove the cast and try to return to the ER two hours later to get more. We are busy, but we will remember you.

25. If you're a 13 year old girl with a long arm, fiberglass cast on it's totally OK to go swimming at the beach (she didn't even try the usless bag with duct tape trick). When your dripping, sand filled cast starts to itch be sure to use a bent coat hanger to pull out all the cast padding. Since that won't work (I swear I'm not making this up) go ahead and pour salt down the cast on the assumption that it will soak up the water. Once your arm is a red, macerated mess come on down to the ED.
Aside from the stupidity of this course of action this girl also had a weird affect so I asked if she was developmentally delayed. This thoroughly annoyed the girl and her mother but the dad said, "Well I can see why you might think that but no."

26. When your 97-year old mother trips and falls on the floor and doesn't say anything or really seem to move at all, you should definetly wait 5-6 days before calling EMS. If she starts to feel cold (even though she hasn't said that she's cold), just cover her with blankets and surround her with space heaters. She's probably just sleeping and will get up when she's good and ready. Nevermind the smell and the roaches.

27. 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

29. If you're 71 years old, have arthritis and emphysema and several drinks under your belt already, it's dark outside and raining like stink, now is NOT the best time to go up on the roof and try to fix a leak.

30. If you're trying to fake a generalized seizure, turning that ringing cell phone in your pocket off is gonna be conspicuous no matter how much you try to incorporate it into your clonic movements. Also, always fake the seizure before and/or after the EEG, not DURING.

31. When you come into the ED after trying to OD on your phenobarb and are being forced to chug charcoal, you should definitely complain (in a howling voice loud enogh for the whole ED to hear and with your face covered in charcoal) that no one has offered you a glass of wine.

32. After you fall and hit your head on the ice while trying to dig your car out of a snow bank by all means get angry and wedge your snowbrush on the gas peddle while you dig out the rear tires and then act amazed when you get run over by your own car.

33. Using a blow-torch to work on your car (near the fuel tank, of course–geniuses, every one of 'em!) is pretty much guaranteed to win you a tour of the Burn Unit, followed by a free trip to the morgue.

34. If your family/doctor/government whatever has taken away your drivers license because you have frequent seizures and refuse to take your pheno, please use a riding lawn-mower as your primary means of transportation. Chances are, you won't seize, hit a telephone pole, burn your leg and scalp on the mower as you fall off of it, and cause a power outage in your surrounding area.

35. If you're a chronic alcoholic forced to drink Scope because none of the liquor stores in the vicinity will sell you anything, it probably isn't a good idea to go for a drunken walk in the middle of a busy road after dark. But at least your breath will be minty fresh for the paramedic who has to try and intubate you.

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