"Things I learn" & "Medicine Sucks" discussion thread

[Bishop 341B]

If you're a nurse passing by another nurse who is having a b*tch of a time placing an IV in a patient, don't mention that she's the best around at it... this does NOT reassure the patient.

My wife is a phlebotomist and works at a blood donation center...so she performs quite a few sticks a day (she actually became known for being able to hit the 'impossible' veins). Following a c-section, she started suffering from fairly massive PPH leading to emergency surgery, many transfusions and a special trip to the cath lab for embolization and a nice long stay in the ICU.
Due to the trauma, and the fact that the nurses had shredded all of the good IV spots trying to start lines while she was crashing, by the time she hit the ICU, nobody could seem to get a line started.

After having 3 people try and all failing, she finally chimed in and talked the 4th person through starting her line...while still loopy from blood loss and dilaudid. After that, every time they needed to draw blood or start a new line, they would ask her to help.

I really should have her sign up here...she has some great stories. You would think that the whole "voluntary" aspect of it would weed out the weirdos. Strangely that is not the case.

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[CajunMedic]

Murphy's law, if a patient says they want to go the ED and you say no, they will die and their brother will be a lawyer. Once you get some experience as a medic you can often Jedi Mind Trick them into a refusal. "You should definitaly get that checked out, it is up to you how you want to do that. We can bring you to the ED, you can get a ride with x family member here, or you can go see your PMD. But (if true) you will probably been seen in about the same amount of time however you get there." It also helps when you work in a area where people get charged for the ambulance ride, cuz you can throw in the "we're happy to take you but it'd be much cheaper for you to get a ride with your friend here."

Note the patient still signs a refusal, and you have at no time refused to take them. But often if they are reasonable and it's something super minor you get get them to refuse.

And at most EDs if the patient comes in with true crap complaint the nurse who meets the ambulance will have the patient walk over and sit in triage. They don't get to cut the line just because they have had toe pain for a year.

One of the best things about my department is our Physician Directed Referral program. If its obviously not in need of an ambulance transport, we can call a Med Control doc and ask if they would like them to be transported or follow up with PCP or After Hours clinic. 99.9 percent of the time, the doc says not to transport them.

 

[PennySaved]

Learned from a patient last week.....

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.

Eww.

 

[Kittenmommy]

Hey folks,
I've gotta say, I love this thread. It's taken me awhile but I've read the whole thing and I think I have some contributions. (More all the time!) I'm a patient transporter, so not necessarily 100% in the ED, but I've learned some interesting things nonetheless.

You wouldn't be the same Kitsune I knew on GAFF, would you?

 

[Kitsune]

Possibly... What does GAFF stand for?

Depakote- I have kind of a lot of exp. with dementia pts, both in my family and at the hospital. It didn't really *bother* me, and I was friendly the whole while, but I figured if I could vent anywhere, this would be the place. I just read over my post and should probably add that he had 'singing-frog' dementia, as in he behaved totally normally and was completely 'with-it' in front of his nurse and his wife, but when we went anywhere (and conveniently, the wife chose not to go with him) things would decline rapidly. It was this that made me suspect some of it was less than genuine, but I couldn't accurately gauge how much.

New lesson:
The Law of Inverse Mass. This states that the smaller/slimmer/slighter you as a provider are, the larger/girthier/heavier your patients are likely to be.
This law coincides with the Law of Distance- The heavier/more difficult patients will undoubtedly have to be transported further and to more awkward floors/units/rooms/beds.

 

[Kittenmommy]

Possibly... What does GAFF stand for?

If you were the same Kitsune, you probably wouldn't have to ask.

It stands (or, stood for, as it's now defunct) GodAwful Fan Fiction (read them and weep!).

 

[Kitsune]

ah, then nope.

 

[Kittenmommy]

ah, then nope.

I guess "Kitsune" is a pretty popular username on the 'net!

 

[Depakote]

Depakote- I have kind of a lot of exp. with dementia pts, both in my family and at the hospital. It didn't really *bother* me, and I was friendly the whole while, but I figured if I could vent anywhere, this would be the place. I just read over my post and should probably add that he had 'singing-frog' dementia, as in he behaved totally normally and was completely 'with-it' in front of his nurse and his wife, but when we went anywhere (and conveniently, the wife chose not to go with him) things would decline rapidly. It was this that made me suspect some of it was less than genuine, but I couldn't accurately gauge how much.

gotcha. Mine was a bit of an off-the-cuff response... I managed to forget that everyone needs to vent somewhere.

Again, you have my apologies.

 

[bros]

With me, the doctor was like "Oh CRAP i've been trying to reach you all day. Meet me at xxxxx Medical Center."

The problem turned out to be a combination of dehydration, seizure aftereffects, and a high amount of medication in my blood.

I still felt like crap for a week or so after.

And during that ER visit, they discovered a PVC that still persists today.

They have no idea what caused it. Probably the seizure did something

About this one, I got the records from that ER visit that day. Now I know why they were so attentive.

EMERGENCY DEPT COURSE AND TREATMENT: Called to see patient because of h/o head injury with dizziness and vomiting. Patient has high probability of imminent or life threatening deterioration in condition.

Another page:
Emergency Dept Medical Decision Making: Initial considerations based on the presenting problem included, but were not limited to: Contusion, concussion, fracture, hemorrhage, associated injuries

After the eval in the ED: my clinical impression is
1. Closed Head Injury w/o LOC
2. High Carbamamazepine level
3. H/O SEIZURE DISORDER, PREMATURITY, AND BASELINE ATAXIA

I wonder what baseline ataxia is

 

[Katydid]

If you're a 15 year old boy, drink until you are paralytic, then steal your father's car to drive to the drug dealers. When your father reports you to the Mounties and you spot them behind you with the lights and sirens going, speed up and swallow all your drugs (only a little clonazepam as it happens) so you can be high in lock-up. Then tell the cops you have taken a drug overdose when they catch you.
But wait, the night is still young! When you arrive in emerg refuse to tell anyone what you've taken so they have to draw blood and do a full tox screen. Be sure to call the doctor on duty a crack ***** and a f---ing b-tch at the top of your lungs for spoiling your high. Then spit the activated charcoal on the nurses while complaining loudly about the bad taste. This will not, of course, result in four point restraints and a threat to use an NG tube to administer the rest of the dose. Please remember to mock the doctor for not knowing the street names of the drugs you claim to have taken (which were made up by you and your friends because you live in the extreme back woods and don't know the real names). Also shout all the swear words you know because no one will give you a cigarette or any of the good drugs.
We were so happy when this little fellow left the ED. This was in a 10 bed hospital in a rural area and he was seriously disturbing the demented little old ladies in the acute care beds. Fun times,
M

Every now and then, I'm perfectly willing to advocate the administration of a sound beating.

This is one of those times.

 

[StMarc]

If you're a 15 year old boy...

TL, DR version:

It is possible to diagnose congenital aeroatterosis* as young as 15.

M

*Yes, I made that up and it's ungrammatical as Hell. But if there's not a word for it, there needs to be one.

 

[da8s0859q]

Every now and then, I'm perfectly willing to advocate the administration of a sound beating.

This is one of those times.

Beat the jerk senseless.

I learned you shouldn't try bypass the regulator on your bbq while trying to cremate the family dog in your garage. You'll give your kids two things to cry about that day.

Wow.

 

[Katydid]

I learned you shouldn't try bypass the regulator on your bbq while trying to cremate the family dog in your garage. You'll give your kids two things to cry about that day.

What the HELL?

I'm sorry, now I'm just stuck with a slow blink, wondering WTF that dude was thinking.

 

[Kittenmommy]

This is a different take on the "things I've learned from" idea. We bought our house eight years ago, from a guy who is a doctor. And here are some things I've learned.

Things I Learned From My The Arrogant Jerk Doctor Who Used To Own Our House:

1. If you're a doctor, you know how to do anything. No, really!

2. Yeah, you can install you own stove! No problem! It's just like surgery, amirite?

3. Wiring your new stove directly into the wall is totes safe and is absolutely not in violation of any code anywhere!

4. What? The broiler comes on when the oven is turned on, and the oven comes on when the broiler is turned on? You're a doctor, so you couldn't possibly have messed up anything. They must've messed up the instructions! The new homeonwers had to call in Sears to fix it? Not your problem! You're a Doctor and you can do ANYTHING!

5. If you have a glass top stove, be sure to let your kids bang pots and pans on it. That giant crack they made won't do any harm!

6. Installing a dishwasher is easy! You can do it yourself with no problem!

7. No, the dishwasher is totally supposed to come out from under the counter when you run a load of dishes! You know this because of your learnings as a Doctor!

8. Oh... it's not supposed to do that? Sorry, your bad! The new homeowners had to get Whirlpool to come and fix it? Er... oops?

9. Your kid whacking the top of the stove created a crack that spidered after eight years and produced shards of glass that are hazardous to the new homeowners' pets? Oops! But you are a DOK-TOR and you know stuff, so you should've been right when you told the new homeowners that that crack was totes OK! Oh yeah, and be sure to let your kids express their artistic sides by drawing all over the walls everywhere with green magic marker, 'cause you're moving out anyway. New homeowners love scrubbing the walls with Clorox Clean-Up to get that stuff off!

10. Oh... Best Buy will not install the new homeowners' new stove because the old one was miswired so badly that the guys pulled the old stove out, took one look and said "We're not touching that!" while backing away slowly? Ooops! But you're a DOK-TOR and YOU CAN DO ANYTHING! Never mind those silly silly electricians and their silly silly codes and not burning the whole damn house down and silly stuff like that!

New Glass Cooktop: $550. What? I could get an entire new stove for that! Forget it!

Oh, OK. So:

New Stove: $600

New Outlet Wired By A Professional Electrician: $177

House Not Burning Down By The Grace Of God In The Meantime: Priceless.

The Moral Of The Story: Everyone has his/her own area of expertise. If you are beyond yours, call in professional help.

Also, do not allow your children to act like rabid wolverines. But that's another rant entirely.

PS. I wouldn't have posted this, but we unfortunately had to deal with this guy several times during and after closing, and my God, was he ever a horrible, arrogant jerk. Oh, and he's a doctor, did I mention that? Because he did, about twenty times in every single sentence.

 

[theangeljean]

Hmm. Some people have an over-inflated sense of their own abilities. Some people are just too cheap to do things right. And some people with both of these attributes become doctors. Kittenmommy, I know from your other post that you're not one of the haters ... I just hope other people won't let this guy spoil it for the rest of us!

Anyway, things I learned in the ED: apparently it is normal in some places to present for a sore throat and runny nose. At 4pm on a work day. This was two young men who appeared to be together, with identical symptoms except one had caught it off the other. I was mystified as to what they wanted, as they didn't even request a medical certificate for time off work. Basically sent them home with instructions to rest, wash their hands, drink lots of water and take Vitamin C.

 

[Kittenmommy]

Hmm. Some people have an over-inflated sense of their own abilities. Some people are just too cheap to do things right. And some people with both of these attributes become doctors. Kittenmommy, I know from your other post that you're not one of the haters ... I just hope other people won't let this guy spoil it for the rest of us!

No, I'm not a hater, and I know not all doctors are like him. Oh God, that guy was such a piece of work you wouldn't even believe it! Some of the neighbors told us that that entire family was freaking nuts, and I believe it.

Oh, I just remembered another one; I can't believe I forgot this:

11. When you move out, don't clean your master bathroom at all, and be sure to leave lots of little "surprises" around. The new homeowners will be thrilled to reach up to clean the top of the bathroom cabinet and find a used hypodermic needle without a needle cap or anything! That's totally safe, and it couldn't possibly have hurt anyone. And besides, people love surprises!

Yeah. Seriously. Thank God I was wearing rubber gloves when I reached up there (it's very high, and there's no way I could've seen it beforehand unless I were Spiderwoman and climbed up the walls or something). That was definitely a "What is this I don't even..." kind of moment. What/who was he injecting? Some things probably aren't meant to be known.

Anyway, things I learned in the ED: apparently it is normal in some places to present for a sore throat and runny nose. At 4pm on a work day. This was two young men who appeared to be together, with identical symptoms except one had caught it off the other. I was mystified as to what they wanted, as they didn't even request a medical certificate for time off work. Basically sent them home with instructions to rest, wash their hands, drink lots of water and take Vitamin C.

I don't know, maybe they were worried they had swine flu or something? That's just odd.

 

[Katydid]

Hmm. Some people have an over-inflated sense of their own abilities. Some people are just too cheap to do things right. And some people with both of these attributes become doctors. Kittenmommy, I know from your other post that you're not one of the haters ... I just hope other people won't let this guy spoil it for the rest of us!

Anyway, things I learned in the ED: apparently it is normal in some places to present for a sore throat and runny nose. At 4pm on a work day. This was two young men who appeared to be together, with identical symptoms except one had caught it off the other. I was mystified as to what they wanted, as they didn't even request a medical certificate for time off work. Basically sent them home with instructions to rest, wash their hands, drink lots of water and take Vitamin C.

Seriously? The came to the ED for that?

Dude. I knew when I woke up this morning that I definitely, for-sure, had a sinus infection. Classic symptoms, or at least, classic symptoms for every sinus infection I've ever had. Swollen-face feeling, stuffed up nose, Technicolor snot, sore throat, yeah, been there, done that.

Know what I did? Took some Benadryl, and will be calling the local health department tomorrow (we no longer have health insurance) to see what I can do about getting this treated. Oh yeah, and I took some ibuprofen. Srsly.

Who the hell goes to the ED for a sore throat and runny nose? Other than these guys? I don't get it.

 

[dmitrinyr]

Who the hell goes to the ED for a sore throat and runny nose? Other than these guys? I don't get it.

Oh.... you would be surprised. It's not uncommon to see a handful of people with flu-like symptoms that are otherwise healthy-looking for ONE doc in ONE 12 hr shift. Especially given all of the hoopla over H1N1.

 

[Katydid]

Oh.... you would be surprised. It's not uncommon to see a handful of people with flu-like symptoms that are otherwise healthy-looking for ONE doc in ONE 12 hr shift. Especially given all of the hoopla over H1N1.

Yeah, I'm beginning to think that I'd be shocked at who, exactly, shows up at the ED. For minor stuff.

Probably because I'm one of those people that will fight to NOT go to the ED. "No, no, I'm FINE, FINE, dammit, FINE! I'm not going to the ER!" Every sniffle is not a huge cause for concern, and my God, if I flipped out over every sniffle, I'd be a big bag of neuroses, because I have allergies, and dust is one of those that just sets me off....and we're moving, and disturbing it.

Blargh. Some people just need to be chlorinated right out of the gene pool.

 

[Apollyon]

Anyway, things I learned in the ED: apparently it is normal in some places to present for a sore throat and runny nose. At 4pm on a work day. This was two young men who appeared to be together, with identical symptoms except one had caught it off the other. I was mystified as to what they wanted, as they didn't even request a medical certificate for time off work. Basically sent them home with instructions to rest, wash their hands, drink lots of water and take Vitamin C.

Two guys together, not related, "caught it from each other". Uneducated about AIDS, concerned for same.

Not sure how to ask, and the provider being "mystified" does not help.

 

[Apollyon]

I'm not a medical student of any type just yet, I'm on the transplant waiting list, and considering pharmacy tech or something similar as a career change. I just don't think a correction facility is a good place for someone that has to take immunodepressants for the rest of their life.

That's a great attitude, brother, and on HD and you have a job? See, that's where we get a little bitter - the only HD patients we see are the train wrecks (including those that are their own damn faults - like those that have a big ol' GD steak and a gallon of beer after HD that day), and the normal ones never cross our threshold.

BTW, "immunosuppresants". But, all the prayers and hope in the world for a new bean!

 

[Makati2008]

I agree. The majority of us(I was on HD from 15 until senior year in high school) don't seem to hold full time jobs. It was amazing that I saw so many people that recieved their kidney let it die due to not finding a real job before medicare lapsed(saw this as a HD patient as well as a PA student rounding)....

I hope for the best for you, and I would definitely try to get a hospital job(or one with good benifits.) due to the $$$ in the drugs you will be taking.

E.J. PA-C/OMS-0

 

[Kittenmommy]

Not my patient, but I ran across this gem of an abstract the other day:



And for anyone that wants more details: http://www.ncbi.nlm.nih.gov/pubmed/8420252

That case is being discussed on Stupid Free Drama right here, if you're interested. Lots of the folks in that thread are chemists/scientists and we even have a pharmacist and a medical student in there, so it's a very interesting read. Not your typical SF_D foolishness.

Bonus lulz: This thread got a mention over there.

 

[eeyore spice]

That case is being discussed on Stupid Free Drama right here, if you're interested. Lots of the folks in that thread are chemists/scientists and we even have a pharmacist and a medical student in there, so it's a very interesting read. Not your typical SF_D foolishness.

OH SNAP I thought you might be the same kittenmommy! Is there an actual pharmacist 'round those parts or are you thinking of me?

 

[Kittenmommy]

OH SNAP I thought you might be the same kittenmommy!

*bows*

Is there an actual pharmacist 'round those parts or are you thinking of me?

I don't recognize your username, so I'm not sure if I confused you for a fully grown pharmacist (LOL) or if there's another pharmacist in that thread.

 

[theangeljean]

Drat.

I was an intern, okay?

Actually, 'caught it off each other' was my words, not theirs ... basically one had symptoms for a few days and one had a day's worth. But still, good thinking. And yes, I did consider that there was something about them ... just my mind-reading skills weren't up to scratch.

Now that I'm in the 'not exactly things I learned in the ED' thread, here's something I learned from the other thread:

Not to bring this into the ED.
(the resolution on this is decent, so worth enlarging.)The close up (image size compressed to approx 20kb)
The bigger view (image size compressed to approx 20kb)

You might be able to work out from the second picture that it's not my elbow in the first picture, it is my fingernail. The shadow just below the shard is the shadow of the camera lens from the flash, because I had to hold the camera so darn close to the little box.

The story: my husband changed some halogen lightbulbs for me. And afterwards his right index finger stung. That thing was embedded right in the middle of the finger pad (the clear bit inwards). I could feel it with my fingernails but not grasp it, so I was fairly sure it was glass. Ditto with a pair of tweezers.

So there was no local anaesthetic in the house, and no hypodermic needles. For some odd reason (okay, hypothetical suture practice) I had a sterile suture with a J curve needle. It was in date (not expired). It was sharp enough that he didn't feel a thing.

Take this to the ED?
"I've got this in my eye" okay, come to the ED.
"I've got this in my finger" ... err ... no.

 

[Kittenmommy]

If you are a 75 yo with a history of brain tumors, seizures, hemiplegia and DVTs for which you take rat poison don't climb up ladders. Jeeze this is so common and stupid. What is wrong with these people?

OMG why would you take rat poison?? Are you sure he wasn't suicidal??

 

[deleted77919]

…

 

[Kittenmommy]

Warfarin is used as an anticoagulant in people. It's also used as a common rat poison in the US.

Ahhh, I see. I know that it can cause cardiac arrest in pets who accidentally eat some.

 

[howelljolly]

Ahhh, I see. I know that it can cause cardiac arrest in pets who accidentally eat some.

after they bleed out of their eyeballs and get hypovolemic

 

[howelljolly]

Warfarin is used as an anticoagulant in people. It's also used as a common rat poison in the US.

(Ok, so rat poisons are usually so called "super-warfarin," so it's not exactly the same thing, but same idea, depletes vitamin K dependent coagulation factors)

From what I know, most commercially available anti-pest agents are generally based on human medications. They don't generally use organophosphates. I was looking at some stuff to get rid of ants, and I think it was just Ivermectin or something.

 

[Pharmavixen]

If you are a 75 yo with a history of brain tumors, seizures, hemiplegia and DVTs for which you take rat poison don't climb up ladders. Jeeze this is so common and stupid. What is wrong with these people?

This was one of my neighbours. Didn't want to pay one of the numerous neighbourhood kids saving for college $15/hr to clean the leaves out of his gutters, so at +75 y.o. climbed up on the roof of his million-dollar home himself.

On the bright side, he doesn't have to worry about cleaning his gutters anymore.

 

[Stryker One]

This was one of my neighbours. Didn't want to pay one of the numerous neighbourhood kids saving for college $15/hr to clean the leaves out of his gutters, so at +75 y.o. climbed up on the roof of his million-dollar home himself.

On the bright side, he doesn't have to worry about cleaning his gutters anymore.

I assume that means he's dead, right?

 

[njac]

who lets grandpa on the ladder anyway? One afternoon we had 3 different 60-75 y/o guys who fell off ladders. I think 2 of the 3 didn't make it.

 

[beanbean]

My father(73) who had been having some issues with vertigo fell down the stairs, knocked himself out and ended up as a trauma alert while I was at work. He was on his way outside to climb a ladder to trim some trees!

We had the "no ladders" talk many times prior. Odd that taking a header down the stairs may have saved him from worse.

 

[howelljolly]

Having a "seizure" in the waiting area may get you seen a bit quicker.
AND
Thinking you have "bugs and parasites" crawling under your skin explains why you have scratched off your eyebrows.
BUT
You seriously need to calm down and stop yelling "What kind of hospital is this?!?" after I tell you we do not have dermatologist staffing in the ED.

Yeah, they need to make patients sign some kinda form stating that they understand that the ED attending is and Emergency Physician... oddly enough.

I'm still irritated by to mother who screamed and yelled, and carried on when she found out that our community hospital ED didn't have its own pediatric gastroenterologist, or critical care paramedic unit.

 

[Depakote]

who lets grandpa on the ladder anyway? One afternoon we had 3 different 60-75 y/o guys who fell off ladders. I think 2 of the 3 didn't make it.

Come to think of it... one call I was on 2/3 of the traumas I saw were old dudes falling off ladders.

We should do a study.

Ladder associated morbidity and mortality in the geriatric male population.

 

[njac]

Come to think of it... one call I was on 2/3 of the traumas I saw were old dudes falling off ladders.

We should do a study.

Ladder associated morbidity and mortality in the geriatric male population.

small sample size definitely wouldn't be a limitation...

 

[beanbean]

It would show a male:female ratio of about 100:1...just like snakebites.

 

[da8s0859q]

It would show a male:female ratio of about 100:1...just like snakebites.

You never see a woman say, "Hey, hold my beer and watch this!"

 

[jbar]

You never see a woman say, "Hey, hold my beer and watch this!"

You also don't see many husbands badgering their wives to clean out the gutters on a Sunday. Not to be sexist, but I think often both genders conspire to create these situations.

 

[Pharmavixen]

I assume that means he's dead, right?

No, though I see it looks like that, the way I wrote it. He's in chronic care.

I wouldn't blame the wives - my dad (74 y.o. retired carpenter) has been told by all of us not to go on the roof after he fell off a couple years ago, narrowly escaping serious injury by falling off at a low part onto soft turf. We're pretty sure he sneaks up there when nobody's around.

It's totally a guy thing.

 

[Mrs Butterworth]

Guy comes in after a nasty abscess on the buttocks get's I/D a few days prior. He present back to the ED and complains that the abscess has not healed even though he didn't fill the abx he was given because he "didn't have the money" yet admits to smoking crack earlier in the day. After this guy offered up a horrific social history of swapping sexual favors with both men and women for drugs....he throws a fit, screams, and declares "THIS IS SO DEGRADING" when I pack the abscess

Oh, and then asks "does smoking crack interfere with healing?"

Better is out here bactrim is 4$ or free at participating pharmacies (see list). Check to make sure they can read the first address and number. D/C.

I say this and still get this response.

I'm amused that your druggie found that degrading. Hell, my mother told me not to eat dirt and medicine is a holy calling, she'd die if she saw what I play with now.

Learning point:
Pelvic pain -> appy
Pelvic discharge -> appy
Suprapubic tenderness -> appy
Painful intercourse -> appy
Just finished period several days ago -> appy
Please don't consent to a pelvic exam when it's an appy. Please demand a ct, because everyone wants to CT a tampon. Well we bartered. I get my pelvic and if nothing's there.. she'll get her ct.

I did get her/my tampon and stellar cultures.

1) Why are you complaining I gave you antibiotics because of your pelvic pain/white goo pile when the sniffler I'll see next adamantly can't leave with out them?

2) lol. And yes, although it is still possible for you to have appendicitis as well. Take your antibiotics. If you get worse come back in. I expect you'll feel better soon.

You will not get to me today! For today I did a holy tampon extraction!
I will not think of the man who had sex with you and your tampon. I will not!

 

[da8s0859q]

You will not get to me today! For today I did a holy tampon extraction!
I will not think of the man who had sex with you and your tampon. I will not!

You just did!

 

[beanbean]

Now you did it. You made me think of him too.

 

[Hamhock]

Now you did it. You made me think of him too.

Yeah, me too! Damn it!

...but, based on the style/thought process in the post, I still say:
Welcome Mrs. Butterworth!

HH

 

[Kittenmommy]

You will not get to me today! For today I did a holy tampon extraction! I will not think of the man who had sex with you and your tampon. I will not!

I've been using tampons for almost thirty years now, and I still can't figure out how a woman could accidentally leave one inside her. I just... I mean... what is this, I don't even

 

[traumasurg]

In ems even the psych patient that calls because her head is falling off will tell on you when you give her a c-collar and tell her if she wears it her head will not fall off.

 

[howelljolly]