Life is terminal
Just “nuts” is an acceptable diagnosis
Crazy people get sick too
“99% of the time a monkey can delivery a baby, we are there for the other 1%”. (I never asked this OB attending why the c-section rate is not 1% then)
A patient needs to have normal lab values before they die
aboxic- when all lab values are not in the normal ranges
Uboxic – when they are all in the normal range
(the box refers to the old SMA machines that had a printout with boxes)
Don’t trust anyone they are all out to kill your patient
“Never let the sun set on undrained pus.”
The patient who thinks she has hypothyroidism doesnt. — Me (the mild ones are asymptomatic and the severe ones rarely complain about anything).
“Dyspareunia is better than no pareunia”.
From the ER days of late 70’s “Are you stoned or just stupid!” Dale Foster Rush Medical Center. You Kill ’em, we fill em! Cook County ER. in ’81 saw hundred gunshot wounds a month. If you can’t dazzle ’em with brilliance, then baffle them with bullshit. I did use this one ” What is the first thing you do in a code? Take your own pulse!” House of God
Sick people complain about one thing. Healthy people complain about everything.
A patient was once asked how he liked hospital food. His response, “It will make a turd.”
Osler, pneumonia is the old man’s friend..
If you can’t explain an abnormal lab value,stop drawing the test.”
The art of medicine is to do as much of nothing as possible”.
The art of medicine is to do as much of nothing as possible”.
“If you can’t make a diagnosis, make a decision.” (a sage attending in my internship) ”If it were not for the great variability among individuals, medicine might as well be a science and not an art.” Sir William Osler
God punishes those who operate upon the pancreas. H. Stone, M.D.
Air must go in and out. Blood must go around. Pus, poop, piss and babies must come out. K.Sheahan, M.D.
If it looks like a duck, sounds like a duck and walks like a duck, it’s probably a duck.
If you don’t want to find a fever, don’t take a temp. Half the attendings I ever had.
I never met a man with a broken jaw who didn’t deserve it.
Physician speaking about incapable physician – “He knows not, and he knows not that he knows not.”
1) Don’t drive a red sportscar 2) Don’t have sex with animals 3) Never let a
1) Don’t drive a red sportscar 2) Don’t have sex with animals 3) Never let a rad
radiologist make the diagnosis for you
Key to a long happy life: “Keep yo’ mou’ shut an yo’ bowel open an’ believe in Jesus” – Erasmus B. Aiken (not his real name) ; )
“If you can’t cure it by cutting on it, it can’t be cured”. “I hate the color red”. “Ooooooo!! It (the tumor) is a lot bigger here (the O.R.) than it was when I saw him in clinic”. “Wait a minute. If this is his pancreas, then what the hell is this?” “I can teach a monkey HOW to operate, but I can’t teach the monkey WHEN to operate”. “You can’t polish a stool”. “If a–holes could fly, this place would be an airport”.
“Don’t touch the patient–state first what you see; cultivate your powers of observation. “–Osler
All bleeding stops eventually.
Sometimes it’s better to be lucky than good.
It’s better to do the correct procedure with poor technique than the wrong procedure with perfect technique.
And one of my personal favorites:
You can’t refract better than a 20/200 brain.
Try to coordinate intervention with spontaneous resolution
Eyes first and most, hands last and least” Osler. ”Pass me those guessing tubes” Grahame Henson, General Surgeon, referring to a stethescope. Double blind study–a pair of orthopods looking at an EKG. If the bleeding gets to her knees, it is moderate, if it gets to her ankles, it is severe. Me Circumcision: The unkindest cut.Anon. In a cut-down, the first strand of tissue that looks like a vein, -isn’t. Me.
he surgeons always like these:
“Cold steel is the best deal”
“A Chance to cut is a chance to cure.”
and…. “All bleeding eventually stops….”
The eye cannot see what the brain does not understand.
Internists “know all about everything but can’t cure anything !” Surgeons: “don’t know much about anything but can cure everything !”
“Do what is practical, not what is possible.”
“Meconium happens.” ”John Brown is professor of stool, and for that he has gone long to school. If you can take shit and make money from it, Then you are nobody’s fool.”
“If it’s dry, wet it. If it’s wet, dry it.”- diagnostic mantra attributed to dermatologists by all those doctors disdainful or envious of them.
“shit… 1) you cannot shine shit. 2) Shit flows downhill 3) the intern is at the bottom of the hill” ”Surgery is like sex, it should be done with appropriate lighting and adequate exposure” ”Surgery is like sex, unless the two if you have done it together often, only one person at a time should be moving ” ”Never yell st a nurse for calling you in the middle of the night for something stupid. Thenk her for the 3AM wakeup call for the normal potassium then tell her Mrs Johnson needs an enema. It is rough on the patients at first, but eventually she will learn not to call” ”Treat everyone like crap, if you try to be nice you skip important things” ”A rectal tube is a hollow structure with an asshole at both ends… The one it goes into and the one who chose to place it there” Thank you,
“Never say ‘oops’ in the operating room. Say ‘there now.’ That way everyone will think you meant to do that.”
A referring physician who is more eager to operate than the surgeon is has the reckless courage of the non-combatant.
the solution to polllution is dilution –
“medical illustrators are optimists”
You surgeons are all alike. You won’t be satisfied until the whole world is bleeding.
In business, “the customer is always right” In medicine, “the patient is almost never right”,… although it rarely profits one to point that out
The first laws of surgery from one of our visiting attendings: “Eat now, sleep now, pull no tubes after 4 o’clock, and fix the blame early.” The three biggest lies from the OR (from attending to resident): “This will never leave the room. I’ll stand behind you at M&M. It was dry when we left.” From attendings looking over my shoulder in the OR: “Were you any better before the stroke? Looks like surgery, only slower. We always used to say we could teach a monkey to operate, but after watching you, we’re not so sure.” ”Folly that succeeds is folly nonetheless.” From Tom Jewell who was an attending at USNH San Diego and USNH Portsmouth. ”There are only two diagnoses we never make–the ones we don’t think about and the ones we don’t know.” Joe Mullen–head of the surgery program at USNH Portsmouth in the 70’s. ”Come on, Hal, move hands! That’s not Gina Lollobrigada’s face down there!” Captain Jim Guzik whenever he wanted me to get in gear. ”Death or discharge–what are you going to do with that patient?” –from the residents over me whenever they wanted to trim the service. ”In disorders of surgical hemostasis, the clotting factor most often lacking is silk.” From John Collins, former chief of surgery at Stanford. ”Hemostasis, asepsis, gentleness.” The pre-operative mantra of Glover Copher at Barnes Hospital, sometimes referred to as the HAG of surgery. (If I recall this correctly from an editorial by Bernie Jaffe.)
There are more diagnoses missed by not looking than by not knowing. If you don’t have the diagnosis when you have taken the history you are unlikely to get it from the examination. And – comment by a patient – Don’t give me one of those genetic medicines. I don’t think they work as well as the real ones; but maybe it’s just the gazebo effect!
the patient is too short for her weight”—She was so big, she got on the scale and it said “One at a time please!”
The art of medicine consists of amusing the patient while nature cures the disease.” … Voltaire
“By medicine life may be prolonged, yet death will seize the doctor too.” -Shakespeare
“He’s the best physician that knows the worthlessness of the most medicines.” -Ben Franklin
My grandfather used to always say “Laughter is the best medicine.” Maybe that’s why so many of us died of TB. -Deep Thoughts, by Jack Handy
“Medicine, the only profession that labors incessantly to destroy the reason for its existence” -James Bryce
“Expensive medicines are always good: if not for the patient, at least for the druggist” -unknown
Sometimes the best medicine is a tincture of time. -unknown
Fingers, toes, penis, toes” in reference to where not to inject epinephrine. – unknown
“Don’t shit where you eat”. Advise from my med school surgery attending in reference to my dating student nurses. In other words, treat them with respect and dignity.
“I closed the wound, God healed it.”
If the lips are Blue, the Brain is Too!
“Be kind, for everyone you meet is fighting a hard battle.” Philo of Alexandria
From an attending during my internal medicine rotation regarding determining a pt’s alcohol use: “Whatever the patient says double it. Whatever the wife says half it”.
You can’t treat stupidity no matter how hard you try!
If you think a patient needs a trach, do it.
Sum Quod Eris, Latin Tombstone Inscription, I am what you will be..
Tombstone Inscription from somewhere in the Bronx, which my Uncle Louie told me, said the following, “My Doctor Put Me Here.”
“They won’t remember what you said. They won’t remember what you did. They will remember how you made them feel.”
What’s the 1st rule of the operating room? Everybody gets naked!
How’d this happen? I was minding my my own business when out of nowhere two dudes just came up and SHOT me!
How’d that get up there? I was walking around the house naked and fell on it.
What’s the 1st rule of medicine? Never assume.
Leprosy All my skin is fallin’ offa me I’m not half the man I used to be! Oh how did I . . . get leprosy?
Syphilis It just started with a little kiss Now it even hurts to take a piss Oh how did I . . . get syphilis?
How her **** got sick I don’t know, she wouldn’t say Now my dripping d*ck Won’t get thick like yesterday
Yesterday, my ***** was always coming out to play Now it needs 3 weeks to hide away Oh how I wish it was yesterday
the solution to pollution is dilution. Old surgical quote for infection.
“Shit don’t float, son”….chief of surgery to the interns at Highland Gen Hospital, Oakland, 1977 ”The enemy of good is perfect”
An adage bestowed unto me by a very astute Occ Hlth director regarding her experience with patients: ”If they’re cryin’, they’re lyin'” These words still ring true in my practice to this day.
I would go diving in that family’s gene pool.
a chance to cut is a chance to cure a chance to heal with cold hard steel
about good judgment above: Intelligence is the ability to learn from the mistakes of others
and House of God references: list the commandments of the House of God First concern on admission is placement Your job is to buff and turf There is no body cavity that cannot be reached with a 14 gauge needle and a good strong arm If you don’t take a temperature, you cannot find a fever Gomers go to ground GOMER= Get Out of My Emergency Room
three lines fro same surgeon, same case, in short order. 1)Suck for me suck for me the sight of blood makes me ill 2)You must anticipate me, anticipate me 3)Don’t anticipate me, I don’t know what i’m going to do next, you can’t possibly know what I’m going to do next.
another surgeon Too long followed by too short.
If you’re going to get in trouble, do it in a crowd. Dan Rightmire,MD Springfield, IL.,1989 If it don’t fit, you gotta quit the pit. (apologies to Johnny Cochran, JD) If the contractions quit, start the pit. All pregnancies are ectopics until proven otherwise. All post -menopausal bleeding is cancer until proven otherwise. Don’t cut what you can’t see…Gen’l Surgeon at St. Francis, Evanston mid 80’s.
It is more important to know what kind of patient has a disease than what kind of disease a patient has
Former Chairman Dept of Dermatology Univ. of Missouri Philip C. Anderson (now deceased) had many favorite sayings. Among the best:
1. “It can’t hurt to know everything.” This was his answer when residents bellyached about how much studying was required in his program, or when he pulled some obscure fact about a disease from his encyclopedic memory.
2. “If the rash is scaly, then scrape it for KOH prep.” It’s surprising how often some scaly rash will turn out to be occult tinea if it’s looked for.
3. “You know, most women are crazy.” (self explanatory…)
Ortho sayings: There are only 2 kinds of bleeding you need to worry about: 1. Bleeding you can hear 2. Your own
Cut down to bone, then stay there
Lap sponges are specially formulated to turn red when saturated with blood – an attending subtlety telling me to get a clean one
I heard the line as, ‘You trust your mother, too, but you still cut the deck when she deals.’
See one, do one, teach one.
And since I put a picture of Yogi on the post, a couple of my favorites are: About a restaurant, No one goes there anymore, it’s too crowded. I’d give my right arm to be ambidextrous. Sleep when you can, eat when there is time, and Don’t fuck with the pancreas.
Tumor is the rumor. Tissue is the issue. Cancer is the answer.
when it comes to surgery, “I’m only as fast as my slowest assistant”.
“Life is painful, but thankfully short.”
“you learn from the bodies you leave behind””It amazes me how often the wrong way of doing things works as well as my own.” ‘Nobody likes her; she’s one of the popular girls.'”90% of baseball is mental. The other half is pysical” ”When you come to a fork in the road, take it.” ”You should always go to other people’s funerals. Otherwise, they won’t come to yours.” 1. Line up in a circle. 2. Pair off in threes 3. Line up alphabetically by height. The first step in breaking the rules, is knowing the rules.” “Fully half of all wisdom lies in swallowing the smoke of fools.” “When it becomes obvious that you are riding a dead horse, dismount”.
‘When you eliminate the impossible, that which remains, however improbable, is the truth.'”Better never then late”A chance to cut is a chance to cure”when in doubt, cut it out. ” A fart caught crosswise in the poop tube.” Running a test for no particular reason is like picking your nose in public; if you get a positive result, you don’t know what to do with it. Dyspareunia is better than no pareunia. “lack of preparation on your part does not constitute a emergency on my part”
House: “It’s never lupus.”