Friday, 29 April 2016

Another tragic brain death

Anyone who's followed this blog for any length of time knows the tragedy that was (and still is) the Jahi McMath case.  For the three of you who have never heard of Ms. McMath, she was a 13-year old girl from California who underwent a complex upper airway procedure (including a UPPP and tonsillectomy) over 2 years ago.  She bled profusely postoperatively and went into a prolonged cardiac arrest, leading to brain death.  A total of six different physicians confirmed the diagnosis, and she was declared dead.  Despite the fact that a death certificate was produced, her mother refused to accept her daughter's death and fought (successfully) to have Jahi transferred to a facility in New Jersey where brain death can be refused on religious grounds.  And there she still remains ("still" having two very distinct, but very appropriate, meanings here).

It's happening again.

This time the victim is little Israel Stinson, an adorable 2-year old boy, also (probably not coincidentally) from California.  According to his mother Jonee Fonseca, Israel had a "minor" asthma attack on April 1, so she took him to the Mercy General Hospital, where he was stabilised and transferred to University of California Davis Medical Center.  Unfortunately once he was there, he had another attack and stopped breathing.  He was without oxygen for 40 minutes while they attempted to revive him.  Once the dust settled, he was moved to yet another hospital for further treatment on April 12.

Details are rather scarce, so getting an accurate timeline is somewhat difficult.  It seems that doctors at the third hospital performed some sort of brain death study, and when the results came back as unfavourable (ie brain dead), they apparently notified Jonee of their intention of performing a confirmatory study.  His mother didn't like that idea ("I know what comes next after that, and I’m just not ready to talk about burying my baby," she said) , so she posted this note in his room:

In case you can't read it, it says,
"Dear Dr's (sic) and physicians of Kaiser and whomever else this may concern,
This letter puts you on notice that we will be filing a temporary restraining order with the courts this week.  I am in need of more time before any further tests are performed and am requesting an outside physician intervene and give a second prognosis.  If you perform any tests on my son Israel Elijah Stinson that jeopardize his well being you will be fully responsible and liable for everything and any injuries. - Jonee Fonseca" 
The doctors supposedly performed the tests anyway, which confirmed he was brain dead.  The nature of the tests and whether they were done before or after this note was written is unknown.  Regardless, Jonee was informed that because he was dead, the hospital intended to take Israel off life support within a day or two, after the family was given enough time to say their goodbyes.

Jonee did not accept this.

"How would you feel if someone said, ‘Your son is dead, we’re not doing anything for him,'" she said.  She enlisted the assistance of Alexandra Snyder and her Life Legal Defense Foundation (LLDF).  If that name sounds familiar, they are the same group that provided documents that assisted Nailah Winkfield in getting Jahi McMath out of California and transferred to New Jersey.  Jonee and her team of lawyers have successfully stopped the hospital from turning the machines off, though time seems to be running out.  Last week they were given until today to get an outside specialist's opinion, though yesterday that was extended until Monday May 2.

Alexandra Synder had this to say about brain death: "I absolutely believe this is the parent’s choice. It’s not for the state of California, it’s not for the doctors to make this declaration as long as this child’s heart is beating,"  Sound familiar?  It should.  It sounds startlingly similar to something that Jahi's lawyer Chris Dolan said: "It is our position that no doctor determination can end a life without parental consent".  

In plain English, these lawyers are claiming that doctors shouldn't be the ones to make a medical diagnosis - parents should.  Jonee said essentially the same thing:
"I don’t feel that its anybody’s right to say just because we’re not getting response from the brain right now, that we have to bury him.  That’s crazy to me."
and
"Who is a doctor to go against God?"
Out of respect for a dead toddler, I'm trying my best to avoid my usual snark and sarcasm here, so I will leave those statements alone for now.  For now.  NOTE: I will not ask commenters to do the same.

Meanwhile several videos have been released showing Israel twitching in response to being tickled.  The family seems to think this means he isn't brain dead.  It doesn't.

As expected, LLDF is trying their damndest to get Israel transferred to a facility in New Jersey, looking for a doctor and facility to accept and care for him.  As of this writing, they have found neither.  The pro-life vultures are however, continuing to demonstrate that they don't understand what brain death is.  Writing at LiveActionNews.com, self-described "evangelical pro-life attorney" Kristi Burton Brown had this to say about Israel:
"It is unthinkable that a hospital would act so quickly to pull a child off of life support without an adequate opportunity to recover. At Israel’s age, the brain still has much development and growth to work through."
I'm not sure how Ms. Burton Brown could think that a full 4 weeks is inadequate time for one to recover, ignoring the fact that recovery from brain death is physically impossible.  I have to remember though that 1) Kristi is a lawyer, not a doctor, so she most likely doesn't understand, and 2) as an evangelical pro-lifer, she has no interest in understanding.

This is the second brain death dispute case out of California just this month.  The other was a 17-year old boy who led police on a high-speed chase at 3 AM (with alcohol reportedly involved) before crashing into a pole.  He was declared brain dead, his family fought it, but he succumbed to his injuries a few days later.  Despite the circumstances surrounding the crash, his family is, predictably, talking about suing the hospital.

As I predicted waaaaaaaaaaaay back in January of 2014, Jahi's case seems to have set a precedent where family members of brain dead Californians believe they can refute the irreversible diagnosis of brain death and keep their loved ones "alive".  This belief benefits absolutely no one.  NO ONE.  

Except the lawyers.

As was (and still is) the case with Jahi, the people who will lose the most here are Israel's parents, in more ways than one.  A beautiful little boy was devastatingly lost, and just like with Jahi, various people are sadly enabling them to prolong their own agony.

Monday, 25 April 2016

Letters

As much as I may not want to admit it to myself or to you good people, I'm human.  Yes, I realise that may come as a shock to many of you who see me solely as a snarky robotic technician who just fixes holes, but I do actually have feelings, and I even pay attention to them.  Sometimes.  It's rare, but occasionally I even let those feelings show.

This is one of those times.

I get a fair number of letters from readers.  Well, emails actually.  This isn't 1882 - who the hell writes letters these days?  Some of them include medical questions, some are personal questions, some folks relate medical stories of their own, and some are hate mail, though I sadly haven't gotten any of that in a while.  I do love hate mail.

Every now and then, however, I get an email that tugs at my calcified, nearly immobile heartstrings.  Incidentally, I must have missed that day of anatomy when we were taught about tugging on heartstrings.  I have no idea why the chorda tendineae would have anything to do with sappy crap, but that probably has to do more with the fact that I have a Y chromosome, and men aren't supposed to understand "emotions" or something, which leads me back to my point.

Unfortunately for that stupid stereotype (is there any other kind?), I do understand emotions.  Quite well, in fact.  It probably has something to do with having a daughter who gets blubbery and cries during nearly every movie.  Seriously, you should have seen her at the end of E.T.  Total waterworks.

Anyway, Freddy (not his real name™) emailed me some time back out of the blue.  He's a teenager (15 years old) from the US and apparently has been reading this stupid blog for a while.  I don't know what made him decide to contact me, but I'm glad he did.  For some reason his email hit me just in that right damned spot.
Hi I'm Freddy (not my real name™), I live in {redacted} and my dad was the trauma program director at a hospital in {redacted}.  Dad joined the military when he was older.  He died serving in Iraq in 2008, when I was 8.  Dad said he joined to help save the soldiers over there.   
My mom followed your blog for a while then introduced me to it, and I love your stories.  And also your humor reminds me a lot of my dad, so it's nice to read your stories.  I'm interested in medicine, and reading your stories shows the types of stuff that happens in a trauma bay, and since my dad isn't alive to tell me what happens, I'm happy to hear them from you.  Thank you for the hilarious stories.  I can't wait to read more of them!   
Freddy P (still not my real name™)
What?  No, I am NOT crying!  There's just an eyelash or some sand or something in my eye!  Hang on, I just need a tissue or five.

In all seriousness, it is truly an honour to share my stories, and even more of an honour that there are people like Freddy (and the rest of you crazy people who are still willing to share my tiny corner of the Internet) who appreciate what I have to say.  I have the utmost respect for people who willingly put their lives on the line in order to help others.  Freddy's loss is heartbreaking, especially when you consider that his father wasn't even a fighter - he was a healer.

Maybe this won't affect you the same way that it affected me, but the only way I see that possible is if you are this guy.

Thank you very much for the email, Freddy.  Thanks to your mother for sharing this with you.  And thanks to you both (and everyone else) for staying with me.  I hope you continue to share and enjoy my stories, and I hope they continue to give you two even a tiny bit of solace.

Since Freddy is underage, he and his mother both gave consent to publish his email.

ADDENDUM:
Freddy and his mother are still following along with us here.  I got this email from Freddy's mother Jane (not her real name™) earlier today:
This was beautiful.
Thank you,
Jane, "Freddy's" mom
What? No, I am NOT crying again!

Monday, 18 April 2016

Consultant

I'm neither a primary doctor nor a general practitioner.  I don't pretend to be one, I don't want to be one, and I can't imagine being one.  To me, seeing the same people over and over again for the same problems over and over that may or may not be getting better over and over sounds worse than having hot pokers stuck in my eye over and over.  Thankfully people who enjoy that particular flavour of torture exist, and I respect the hell out of them for it.  I just couldn't do it - I think I'd rather sell used cars for a living.

As a result, I'm a consultant.  Very few people refer themselves to a surgeon, so the aforementioned torture victims I mean primary doctors do that for me.  If they find a breast lump during a routine visit, they refer her to me.  If they're having abdominal pain and an ultrasound shows gallstones, they are sent to me.  If a patient goes to the emergency room/A&E and has appendicitis, they call me.  The system mostly goes very smoothly, and the calls I get are mostly appropriate.

Mostly.

Every now and then, however, something slips through, mistakes happen, calls are made . . . something happens that makes me wonder how certain doctors had the mental capacity to graduate from primary school, let alone medical school.

Charlie (not his real name™) was a very nice 18-year-old kid who was sent to me by his primary doctor due to right groin pain.  He'd been having the pain for several days, localised to the right groin, and worse when he would bear down (read: poop).  It seemed a fairly straightforward presentation, and his doctor felt it was likely a hernia (though I'm quite certain he never examined him for reasons that will become crystal clear later), so he sent him for a CT scan which confirmed a small left inguinal hernia.

Those of you who are reading carefully have already discovered the problem.  What, you haven't found it yet?  Stay with me.  I'll get you there.

When Charlie came to see me, he was clearly in pain, clutching his right groin.  I looked over the radiologist's reading of the CT scan ("small left inguinal hernia) as Charlie said "It hurts over here, Doc", pointing to his right groin.

Right groin.  Left hernia.

I looked at the CT scan itself which definitely showed a left-sided hernia, and my Inner Pessimist started yelling at me.  "He's at the wrong doctor, stupid!"  Trying my best to ignore Inner Pessimist (though I suspected he was absolutely correct), I decided to do something silly: examine the patient.

Charlie pulled his pants down gingerly, taking care to avoid his scrotum.  I did the usual Turn Your Head And Cough routine, and while there was definitely a hernia on the left (which was tiny and completely painless), there definitely was not one on the right.  His right testicle, on the other hand, was exquisitely tender, mainly on the back side.

"I told you!" my Inner Pessimist started laughing.

"Are you sexually active?" I asked him.  He turned sheepishly to his father before muttering "yes" under his breath.  "More than one partner?" I continued.  The beet red colour he turned and the silence that ensued was exactly the affirmative I expected.

I explained to him that his pain was not due to a hernia on the opposite side (heh), but rather to epididymitis, an infection of the epididymis which stores sperm and sits just behind the testicle.  It's usually caused by chlamydia or gonorrhoea and is easily treated with a few doses of antibiotics.  A 2-minute exam (and asking the right questions, of course) is all it would have taken his primary doctor to save Charlie a CT scan and an unnecessary trip to a general surgeon, who has no business diagnosing an infectious urological infection anyway.  I sent Charlie back to his primary doctor to get the appropriate antibiotics.

If you think that's bad, it gets worse.

Two days later (while this little episode was still fresh in my mind but I hadn't yet had a chance to write it down for you fine people), I was called at 8 AM (at least it wasn't 2 AM) by one of the hospital's gynaecologists.  I get these calls with some frequency, usually due to a pregnant woman with suspected gallstones or appendicitis or some kind of surgical misadventure in the operating theatre where they need help.  Those can be very difficult cases to diagnose, and even more difficult to manage.

But not this time.  I wish it had been something that simple.  The conversation went a little something like this:

GYN: Hi, yeah, um, we have this lady here."
Me (under my breath): Well I hope you have a lady, because if you're seeing a man then something is askew in the universe.
GYN: What?  Oh, well she has a big labial abscess and is in diabetic ketoacidosis."
Me: . . .
GYN: . . .
Me: I'm waiting for the punchline.
GYN: What?

The woman was acutely and severely ill due to a raging infection in one of her Girl Parts.  In case you forgot, I don't do Girl Parts.  Fortunately for me there are specialists who manage these exact types of Girl Part Problems, namely gynaecologists.  Which she was.

Hence my confusion.

It sounded like an isolated gynaecological problem (apart from the diabetic ketoacidosis, which is a medical problem that I also don't treat), so I waited for her to tell me what exactly I could do to help.  She seemed entirely shocked that I expected her, a gynaecologist, to deal with a gynaecological problem.  She expected me to do . . . something.  However, being the conscientious bastard I am (and because I was already in the hospital seeing another patient), I went to see her to make sure they weren't missing anything.

And . . . they weren't.  It was an isolated abscess involving the entire left labia majora, but nothing else.  I went back and told the gynaecologist that this was a gynaecological problem and that she, a gynaecologist, should take care of it.  Right now.  Reluctantly, she agreed to do her job and took her to the operating theatre where she encountered and drained a large labial abscess (which everyone, including the janitor, I suspect) already knew about.

It shouldn't take a general surgeon to diagnose or manage these problems, just like my skills should not have been required to diagnose shingles.  And just like I shouldn't expect a nephrologist to remind me how to take out a gall bladder.  There are certain things that are easy to miss, difficult to diagnose, or complicated to treat, and I'm always happy to lend my expertise.

These two cases were none of those things.

Tuesday, 12 April 2016

Behaving badly

Usually when I have a stupid patient story, I like for it to be mine.  Though I have posted numerous submissions from readers, I prefer the stupid patients to be my own so that I have first-hand knowledge of the events and can elaborate on (read: embellish) them.  But oh do I have a good one today.  It's definitely a stupid patient story, but fortunately it isn't mine.

Wait, "fortunately"?  You just said that you prefer the stupid patients to be yours, but you're glad this one isn't?  What?  Be consistent, Doc!

I'll explain.

I've written before about doctors behaving badly, and boy did they ever.  In case you missed that little escapade, a man (identified only as "DB") undergoing a colonoscopy had used a small voice recorder in order to record the verbal instructions he was given before his procedure (in case he forgot them later).  He accidentally left it running and ended up recording the entire procedure.  While he was asleep his anaesthesiologist made several nasty and very personal remarks towards him, including insinuating that he was gay, saying she wanted to punch him in the face, and calling him a wimp and a retard.  She also falsified his medical record in the process (recording that he had haemorrhoids when he did not) just for good measure.

Despite the fact that his procedure went well and there was no real medical malpractice, DB sued her and was awarded $500,000, and rightfully so.  Her behaviour was atrocious, unprofessional, and has no business happening in a healthcare setting.  Ever.

Well, it happened again.  Sort of.  This time the patient is 44-year-old Ethel Easter (her real name) from Texas.  Her surgeon was recorded making disparaging remarks about her while she was asleep.  Sort of.  Only this time, Ethel is the bad guy.

Wait, what?  He said bad things about her, and SHE is the bad guy?

I'll explain.  Again.

First, a little background.  According to news reports (including dramatic news coverage with dramatic sound bites and dramatic interviews of dramatic Ethel), Ethel went to see the unnamed surgeon for a hiatal hernia, which she said made her "terminally ill" (no, it didn't).  She was told she would have to wait two months for the surgery (totally believable), but because she was having pain after eating, she didn't want to wait and apparently threatened to call a lawyer and lodge a complaint against the surgeon (100% believable, though she denied this - more on this later).  According to Ethel, the surgeon yelled at her, "Who do you think you are?  You're gonna wait like everybody else" (yeah, sure he did).

Ethel reportedly lost trust in the surgeon and was so shaken by the interaction that she did the right thing and chose another doctor to entrust with her life.  Right?  RIGHT?  HAHAHAHA no, of course she didn't.  No, instead she did what any reasonable person would do in this situation - she went ahead with the surgery and hid a voice recorder in her hair because, according to her, "I was afraid that if I didn't make it nobody would know why, and I wanted them to know it was because he didn't care about me as a person."

Wait wait wait.  Just . . . wait.  Let's pause here a moment so I can make my first completely unbiased (not really) evaluation of Ethel, shall we?
  • Hiatal hernias are common, often asymptomatic, and are always treated medically first unless there is a surgical emergency (which hers clearly was not).  I'm assuming that her GP treated her with the appropriate H-2 blocker and/or PPI, which failed.  They are not fatal unless they strangulate, which is rare.
  • She was so uncomfortable with and unnerved by the surgeon and was so worried that she would die under his care that she figured, Hey, I'll just record him.
  • The surgeon wrote in her permanent medical record (a legal document, mind), that their interaction raised "red flags" about her attitude.  Therefore he was obviously concerned about how she treated him from the start.
Oh, I like her already.  But just you wait, it gets worse.  Much worse.

On the recording just after Ethel went off to sleep, the surgeon mentioned their first consultation and said "She’s a handful.  She had some choice words for us in the clinic when we didn’t book her case in two weeks.   She said, ‘I’m going to call a lawyer and file a complaint'".  Ethel, of course, denies ever saying that.  The anaesthesiologist (presumably) replied, "That doesn’t seem like the thing to say to the person who’s going to do your surgery."  No, it certainly isn't.  Don't piss off the person who is responsible for your life.

Now is this inappropriate talk for an operating theatre?  No, not even one iota.  This is normal shop talk, and we talk like this all the time.  And the rest of the banter on the recording is just that - banter.  For example: a female in the room makes a comment about her belly button.  Someone calls her "Precious", which she believes (with no verification whatsoever) is a reference to the 2009 movie about an obese black girl but could just as easily be a reference to the One Ring from Lord of the Rings or just an ordinary term of endearment.  The surgeon says "I feel sorry for her husband," which I would too (this is really the only thing said that I would consider over the line, but only just).  Something is said about touching her, but based on the limited information available, it doesn't sound remotely sexual (which she claims it is, of course).

To top it all off with some nice cherry-flavoured bullshit, Ethel also claims that the doctor "jeopardized my life" by giving her a dose of Ancef.  "It’s just by the grace of God that I’m even alive right now.  It was an unnecessary risk that he took with me," she said.  Ancef is an antibiotic in the beta-lactam class, which includes penicillin (to which Ethel has a mild-moderate allergy, not a serious one).  More on that in a bit.

What Ethel happens not to mention in any of her interviews is that the surgery was uncomplicated and apparently a success, because I'm 100% certain that she would have screamed otherwise from the rooftops, and saying that her surgery went well would have definitively undermined her "Oh woe is me" credibility.

Now that we have more details about what was said, I'll give a few more thoughts.
  • Did the surgeon actually yell at her?  I highly doubt it.  I have no doubt he said something like, "You'll just have to wait like everyone else", but I'd bet my life savings he didn't yell.  Regardless, is that insensitive or unprofessional?  Absolutely not.  She was not critically ill and there was no surgical emergency, so the surgeon was simply telling her that she was no different than his other patients and her case would not be more or less important.  That's called being fair.
  • The surgeon did not put her life at risk by giving her Ancef.  There is only a 10% cross-reactivity between cephalosporins and penicillin (if that), and true penicillin allergies are rare.  She had a mild reaction to something after the surgery (which could have been any of the medications she was given) which was treated in an emergency room.
  • The mild disparaging remarks about her body are par for the course in the OR.  I've written about it before, and yes it's true - we absolutely do make comments about your body when you're asleep (most but not all of them innocuous).  You know who else does that?  EVERYONE.  Put microphones on people sitting at a café, and I guarantee with 100% certainty that you will hear much harsher comments made about the people walking by.  I'm guilty of that too, as are you.  If you deny it, you're lying.  Is it unprofessional?  Maybe.  Are we going to stop?  Nope.  Are you?  Nope.
  • Ethel was (and is) looking for a payday.  It is perfectly clear that her first interaction with the surgeon didn't go her way, she was angry that she wasn't given priority over the doctor's other patients, and she wanted to catch him in a "Gotcha!" moment.  She failed at that but is publicising this episode anyway simply to gather support for a lawsuit.  She is dramatising this in a ridiculously histrionic fashion, saying that her hernia was "terminal" (NO IT WAS NOT) and that the mild allergic reaction put her life in jeopardy (NO IT DID NOT).  
  • She had a successful and uncomplicated surgery, but I'd also be willing to bet that she was hoping for some kind of complication.  I admit this is (obviously) pure supposition, but while I'm betting my life savings anyway, I may as well add this one in too.
  • If I hadn't already bet my life savings twice already, I would bet it again that she will sue the surgeon, the anaesthesiologist, the hospital system, and/or everyone else in the room.
Perhaps I'm looking at this from a biased point of view.  Maybe Ethel was truly scarred by what she heard.  I suppose it's within the real of possibility that she only had angelic, pure motive for hiding the recorder in her hair.

I doubt it.

Monday, 4 April 2016

Jail

I've never been to jail.  I've never been arrested.  I've never been detained or questioned by the police.  The closest I've ever been was a citation for speeding nearly 20 years ago, and that's the closest I ever intend to getting incarcerated.  It just doesn't sound like much fun.  My perception of prison is limited to how it is portrayed on television and in movies, but despite the fact that Andy Dufresne came out clean on the other side, I can't imagine having a good time there.

Despite that, the threat of prison time isn't the main reason why I live my life the way I do.  Mainly it's because I think being a good person is better than being an asshole.  But I suppose if I were an asshole, I wouldn't think that way and wouldn't really care.  It's a bit of a Catch-22.

After my recent experience with Terrence (not his real name™), I have to assume (or at least hope) that assholes who don't give a shit about being good citizens have some fear of prison, though it obviously isn't enough to keep them in line.

I don't really consider myself a judgmental person, but sometimes I just get a feeling on people.  When Terrence first rolled through the door just after midnight, my first (admittedly judgmental) thought was "This is not a good guy."  I can't say exactly why I thought this - perhaps it was the look of utter nonchalance in his eyes, perhaps it was the way he refused to make eye contact with anyone.  Perhaps it was the way that he was cursing at the medics and nurses who were trying to take care of him.  But maybe it was his shiny new stainless steel bracelets attaching his wrist to the stretcher.

Yeah, it was probably that last one.

The police officer to whom the handcuffs belonged trailed closely behind, and the medics looked almost as displeased as he was as they gave their report.

Medic: Hey there Doc, this is Terrence, 21 years old, healthy.  He and his 4 friends were involved in a car accident.  They hit another car, and then they all got out and ran.
Police (scowling): Yeah, 7 blocks,
Medic (annoyed): Anyway, no loss of consciousness . . .
Police: Obviously.
Medic: (really annoyed): ANYWAY, he has no complaints other than some pain in his lip where he has a laceration.
Police (eyes shifting): That was, uh, from the accident.

According to the officer, the accident was relatively low speed, not enough to cause major damage to either car.  Then the 5 guys inside all got out and ran in different directions.  Terrence was reportedly the driver, and he was definitely (obviously) the slowest of the group.  He was surprisingly unwilling to give us any details of the accident.

Shocking.

Regardless, I examined him from head to toe, and the only thing that hurt was a 1.5 cm laceration of his lower lip.  No other bruises, lacerations, abrasions, or deformities.  Nothing hurt when I examined it.  I turned to the officer, who was still huffing and puffing a bit, and asked him if Terrence would be leaving with him tonight.

"You're damned right!  This asshole made me run 7 blocks!"

The ability to run 7 blocks rules out the vast majority of serious injuries, so luckily Terrence had done a lot of my job for me.  A few X-rays and sutures later and Terrence was ready to leave.  Or so I thought.

All of a sudden his chest hurt.  Supposedly.

This is a classic move that prisoners often use to get out, at least temporarily.  They know that chest pain is not something that will be taken lightly, and they use this knowledge to their full advantage.

Now at this point I had two options - 1) assume that Terrence was acting like the asshole that he obviously is and was faking his symptoms because he knew exactly what was about to happen to him, or 2) act like a professional trauma surgeon and make sure he didn't have any injuries.  I reluctantly chose option 2.  A CT scan of his chest, abdomen, and pelvis was . . . ready?  Completely normal.  The nurse automatically did an EKG (despite Terrence referring to female dogs repeatedly) which was, shockingly, also normal. 

Twenty minutes later Terrence was remarkably pain free, able to walk, and was out the door with his new best friend and a free ride to jail. 

I like to think that the lip laceration actually was from the car accident.  But after witnessing Terrence's behaviour, I somehow doubt it, nor would I be disappointed by it.  Even I have to look the other way every now and then. 

Friday, 1 April 2016

April 1

Oh happy day, happy day!  Yes it's April 1 again, my favourite day of the year again.  It's the only day of the year when you can literally get away with anything as long as you scream "April fools!" directly afterwards.  Want to tell off your boss?  "Fuck you, boss!  I hate you, I hate this job, I hate fucking everything so I fucking quit!"
. . .
"Hahaha!  April fools!  No but seriously, you're a big giant douchebag.  April fools!  I hope you die by falling into a giant pit of broken glass, king cobras, and arsenic.  Haha!  April fools!"

Anyway, I happened to post a lovely picture of a chiropractor doing an adjustment on a duck (no April fools) to Twitter earlier today:

In case you can't see it due to the mouthful of coffee you just spit all over your screen, that is actually a picture of an actual chiropractor actually doing a chiropractic adjustment on an actual duck.  I'll repeat for those of you still cleaning your screens: A CHIROPRACTIC ADJUSTMENT. ON. A. DUCK.

Seriously folks, the picture just captions itself. 

The response has been, ah, rather amusing, to say the least.  So in the spirit of today, here are my favourite captions and responses.

It was a close race, but here are the runners up:

And the winner:
Happy April Fools Day!

COVID-19 Mythbusting (clean)

Due to popular demand (well, two polite requests, actually), I have decided to create a clean version of my post about COVID-19 myths . If...