If you\’re in healthcare, this is probably your worst winter ever. Between the COVIDs, scarce resources, shutdowns, homeschooling, bureaucracy, hoaxers, and checking the in-laws\’ rashes online, you must feel cooked.

You\’re frustrated. Your patients die calling COVID a hoax. People refuse to wear masks. So many loved parents die alone. Bureaucrats don\’t prioritize people\’s lives. Even some of our own sold their soul for fame or money.

You\’re tired of being strong. You care for others\’ families, while your own must fend for themselves. You\’re tired of fighting COVID, ignorance, administrators, even your relatives over the Thanksgiving virtual table. You\’re tired of the mask burning your face, filthy gloves, people shrinking when you hug them. You\’re tired of being treated like a pariah whenever you stop to get coffee at the gas station. You\’re tired of your scrubs shrinking since the gym\’s closed and you live on junk food.

You miss your parents. But they\’re old, frail, and COVID-prone, so you avoid them. So much so that Dad asked if that new Ancestry test taught you something he should know about, and Mom apologized for mentioning your ex that last time you visited.

You love your kids. You\’d die a thousand deaths for them, but homeschooling? Oregon Trail and core math? Having them home every hour of every day? They don\’t know you need to sleep after your nightshift.  And you just can\’t watch Frozen three times a day.

Your spouse?  Things weren\’t that bad when you both worked and the kids went to school. Family time was sacred but limited. Now, you struggle to bite your tongue and stick those fists in your pockets. No more date nights to rekindle a flailing relationship, no more vacations to break the monotony, no more nights out with your buddies to blow up steam.

How can you survive this winter holding on to your temper, family, and job?

Look out for #1.

That\’s you. To care for others, you must care for yourself first.  Like the in-flight safety videos say: \”Put on your own mask before you help others.\” You won\’t save anyone if you run out of oxygen. To care for those who need you, you must keep afloat. You\’re everybody\’s keeper. If you get sick, they might too. If you go crazy, your family will suffer. If you fall apart, who\’ll care for your elderly parents?

That\’s not selfish. That\’s smart. To protect those who need you, you must stay healthy and sane.

How? These are my tips.

1. Set rules for others and for yourself. Your sleep should be sacred. So should whatever time off you can schedule.
2. Enlist help. There are so many grateful folks who want to help the healthcare workers. Your neighbors may be glad to walk your dog, run some errands, or grab a gallon of milk.
3. Prioritize yourself. Pay someone to plow, buy groceries online, hire a housekeeper to save time for the things that really matter.
4. Schedule time for yourself. To exercise, meditate, pray, journal –  whatever helps fill your well.
5. Shut off the TV. Whether you\’re Democrat or Republican, you won\’t enjoy the news. Watch Hallmark, the nature channel, or the food channel. Watching food is fun, and it won\’t make you fat.
6. Go outdoors. There\’s magic in nature and sunlight, whatever\’s left of it. Hike, snowshoe, and allow your lungs to breathe real air instead of the reconditioned germs they allow you in the hospital.
7. Say no. That\’s a survival technique. Say no to parties, to hugging strangers, to doing things you shouldn\’t, in order to protect other\’s feelings. Let them take care of their feelings. You take care of yourself.
8. Cut yourself some slack. You aren\’t perfect. Nobody is. You\’ll make mistakes, gain a few pounds, step on some toes, maybe even lose it at times. So what? Just do the best you can.
9. Read a book. Remember those things made of paper? You turn a page and land in a new world? These three always make me happy: The art of Racing in the Rain, Holes, and Because of Winn Dixie. What works for you? Please share.
10. Be careful with alcohol and substance use. They may feel good at the moment, but you\’ll be worse off in the long run.
11. Watch old movies that make you laugh. My favorites: A fish called Wanda, Hopscotch, and Naked Gun. And MASH. It\’s on HULU. How about you?
12. Take a break from social media. Picking fights with random strangers won\’t help your mental health. Sadly, not everyone posts sunrises and puppies. Cut off those who hurt you.
13. Get a cat. They have nine lives; That\’s why they are masters of survival. They ignore all unpleasantness, from dogs to COVID, and they\’ll show you how to do it too. And they\’re the best nap helpers.
14. Communicate. Ask your coworkers how they handle the stress. They may teach you something, but even if they don\’t, sharing the burden will help you both.
15. Seek help before you lose it. Check out the CDC resources below.
16. Pat yourself on the back. You\’re a darn hero! In recycled PPE instead of shining armor you saved fair maidens of all genders, ages, and persuasions. With a vaccine in sight, there\’s a light at the end of the tunnel.

Wishing you all health, joy, and happiness. See you all on the other side.

Rada

Rada Jones is an ER doc. She lives in Upstate NY with her husband Steve, Paxil, his deaf cat, and a tsunami named Guinness who loves brushing her teeth.

Rada authored three ER thrillers, Overdose, Mercy and Poison, and “Stay Away From My ER,” a collection of medical essays

Free confidential resources: 

• National Suicide Prevention:  1-800-273-TALK (1-800-273-8255
•  Lifeline Crisis Chat, free, will connect you to a counselor in your area.
• Domestic Violence Hotline: 1-800-799-7233 and TTY 1-800-787-3224

If you\’re in healthcare, this is probably your worst winter ever. Between the COVIDs, scarce resources, shutdowns, homeschooling, bureaucracy, hoaxers, and checking the in-laws\’ rashes online, you must feel cooked.

You\’re frustrated. Your patients die calling COVID a hoax. People refuse to wear masks. So many loved parents die alone. Bureaucrats don\’t prioritize people\’s lives. Even some of our own sold their soul for fame or money.

You\’re tired of being strong. You care for others\’ families, while your own must fend for themselves. You\’re tired of fighting COVID, ignorance, administrators, even your relatives over the Thanksgiving virtual table. You\’re tired of the mask burning your face, filthy gloves, people shrinking when you hug them. You\’re tired of being treated like a pariah whenever you stop to get coffee at the gas station. You\’re tired of your scrubs shrinking since the gym\’s closed and you live on junk food.

You miss your parents. But they\’re old, frail, and COVID-prone, so you avoid them. So much so that Dad asked if that new Ancestry test taught you something he should know about, and Mom apologized for mentioning your ex that last time you visited.

You love your kids. You\’d die a thousand deaths for them, but homeschooling? Oregon Trail and core math? Having them home every hour of every day? They don\’t know you need to sleep after your nightshift.  And you just can\’t watch Frozen three times a day.

Your spouse?  Things weren\’t that bad when you both worked and the kids went to school. Family time was sacred but limited. Now, you struggle to bite your tongue and stick those fists in your pockets. No more date nights to rekindle a flailing relationship, no more vacations to break the monotony, no more nights out with your buddies to blow up steam.

How can you survive this winter holding on to your temper, family, and job?

Look out for #1.

That\’s you. To care for others, you must care for yourself first.  Like the in-flight safety videos say: \”Put on your own mask before you help others.\” You won\’t save anyone if you run out of oxygen. To care for those who need you, you must keep afloat. You\’re everybody\’s keeper. If you get sick, they might too. If you go crazy, your family will suffer. If you fall apart, who\’ll care for your elderly parents?

That\’s not selfish. That\’s smart. To protect those who need you, you must stay healthy and sane.

How? These are my tips.

1. Set rules for others and for yourself. Your sleep should be sacred. So should whatever time off you can schedule.
2. Enlist help. There are so many grateful folks who want to help the healthcare workers. Your neighbors may be glad to walk your dog, run some errands, or grab a gallon of milk.
3. Prioritize yourself. Pay someone to plow, buy groceries online, hire a housekeeper to save time for the things that really matter.
4. Schedule time for yourself. To exercise, meditate, pray, journal –  whatever helps fill your well.
5. Shut off the TV. Whether you\’re Democrat or Republican, you won\’t enjoy the news. Watch Hallmark, the nature channel, or the food channel. Watching food is fun, and it won\’t make you fat.
6. Go outdoors. There\’s magic in nature and sunlight, whatever\’s left of it. Hike, snowshoe, and allow your lungs to breathe real air instead of the reconditioned germs they allow you in the hospital.
7. Say no. That\’s a survival technique. Say no to parties, to hugging strangers, to doing things you shouldn\’t, in order to protect other\’s feelings. Let them take care of their feelings. You take care of yourself.
8. Cut yourself some slack. You aren\’t perfect. Nobody is. You\’ll make mistakes, gain a few pounds, step on some toes, maybe even lose it at times. So what? Just do the best you can.
9. Read a book. Remember those things made of paper? You turn a page and land in a new world? These three always make me happy: The art of Racing in the Rain, Holes, and Because of Winn Dixie. What works for you? Please share.
10. Be careful with alcohol and substance use. They may feel good at the moment, but you\’ll be worse off in the long run.
11. Watch old movies that make you laugh. My favorites: A fish called Wanda, Hopscotch, and Naked Gun. And MASH. It\’s on HULU. How about you?
12. Take a break from social media. Picking fights with random strangers won\’t help your mental health. Sadly, not everyone posts sunrises and puppies. Cut off those who hurt you.
13. Get a cat. They have nine lives; That\’s why they are masters of survival. They ignore all unpleasantness, from dogs to COVID, and they\’ll show you how to do it too. And they\’re the best nap helpers.
14. Communicate. Ask your coworkers how they handle the stress. They may teach you something, but even if they don\’t, sharing the burden will help you both.
15. Seek help before you lose it. Check out the CDC resources below.
16. Pat yourself on the back. You\’re a darn hero! In recycled PPE instead of shining armor you saved fair maidens of all genders, ages, and persuasions. With a vaccine in sight, there\’s a light at the end of the tunnel.

Wishing you all health, joy, and happiness. See you all on the other side.

Rada

Rada Jones is an ER doc. She lives in Upstate NY with her husband Steve, Paxil, his deaf cat, and a tsunami named Guinness who loves brushing her teeth.

Rada authored three ER thrillers, Overdose, Mercy and Poison, and “Stay Away From My ER,” a collection of medical essays

Free confidential resources: 

• National Suicide Prevention:  1-800-273-TALK (1-800-273-8255
•  Lifeline Crisis Chat, free, will connect you to a counselor in your area.
• Domestic Violence Hotline: 1-800-799-7233 and TTY 1-800-787-3224

I’m a doctor. And, like most medical professionals, I\’m a bad patient.

Two years after my last appointment, I got a CTJ, \”Come to Jesus\” from my doctor.

I called his office for a form. I needed proof that I don’t have tertiary syphilis. For my Thai visa.

Why tertiary syphilis, as opposed to HIV, cholera, lepers or bubonic plague? I don’t know. That’s the power of bureaucracies. They don’t have to make sense. They make the rules.

My doctor wasn’t happy. “Come get seen or get lost,” he said. Or something to that effect. Politely wrapped.

I went.

Good news: I didn\’t have tertiary syphilis.

Bad news: I didn\’t have a colonoscopy either. At 57, I\’m seven years late. No recent mammogram either. As for the PAP smear…

Whatever you think, I’m not totally negligent. I brush my teeth. I floss. I pay attention to what I eat. Too much, maybe. I work out. I don\’t smoke. Anything.

But I live and work in a small community in the North Country.  I know every doctor, including the vets. I work daily with the OBGYNs and the GIs Nice people. Down to earth, outdoorsy, mostly easy-going. I love seeing them in the ER, though they seldom feel the same way. We commiserate about the weather. We bash the administrators\’ latest move. We’re friends on Facebook. I know the names of their dogs, the size of their wives, and how many cocktails they had before posting.

I like them, but a colonoscopy? That’s a level of carnal knowledge I’m not up for.

I don’t know about you, but I find it easier to show my privates to people I don’t know than to my friends. Having them examine my insides – and my outsides – is not my idea of fun. Not like it’s life and death, people! Yes, I see them in the ER. I examine them. I even intubated a few. But they didn’t have a choice! They were dying!

My doctor got it. He didn’t care.

“You need preventive care. You’re way past due for colon cancer screening. And pap smear.”

\”But I’ve never had a bad pap smear! And my social life is not worth mentioning!\”

He nodded, smiled and referred me across the lake, in the next state, for GYN. He got me Cologard.

What\’s Cologard? It\’s a test for colon cancer that doesn’t require a colonoscopy. You provide a sample (of you know what) in the comfort of your own home, then send it for DNA testing.

I can do that, I thought.

Yesterday was Christmas in July. The mailman brought me a Doximity plaque proclaiming me “The most entertaining author,” and a cardboard box of Cologard with multiple interrelated plastic parts and 80 pages of bilingual instructions.

Did you ever buy furniture from Ikea? It’s DIY. Comes in boxes. The instructions are more entertaining than straightforward. My success rate is 1:3. Three assemblies to get one right. Cologard must use the same writers.

Instructions started with Step 6: Label your samples.

That’s jumping the gun a little, I thought. But I didn’t let that deter me.

Next brochure: How to return your kit. Four pages later I got enlightened: Weekend pooping is a no-no. The package needs to be sent immediately and tested within 48  hours.

Further explorations brought me to another unputdownable 60-page brochure. Indications, contraindications, warning, precautions, test interpretation, risks and more. The style was crisp, the images graphic, the protagonist daring.

Twelve pages into it, I got to Step 1: Check the expiration date, then to Step 2: Prepare to collect a stool sample. How to assemble your Cologard kit and avoid pooping next to it. Or something to that effect.

I pulled the heavy zipper bag out of the box to remove the contents. It wouldn’t come. I pulled harder. Nope. I turned it upside down and shook it. It was stuck.

I tore it off the box. Then I saw it, right there.  Leave the plastic bag and the white tray inside the box.

I pushed it back to cover the tear and I engrossed myself in lecture. Half an hour later, I\’m an expert in Cologard. I can\’t wait to test my new expertise, once the weekend is over.

The pap-smear, you say? Seriously? I hope he forgets about it!

But that got me thinking. Am I foolish to avoid preventive care? I wouldn’t let my patients do that. Am I risking my health? My life maybe? Why?

Is it because I’m a doctor? Do I secretly believe that my medical knowledge will keep me safe? That I\’ll know it if my body goes rogue?

Or is it just the opposite? Do I know enough about medicine, including how little we really know, to lose respect for the science?

There’s so much we don’t know. Then, half of what we do know is wrong. We just don\’t know which half.  From blood-letting to smoking and coffee, the only constant in medicine is change. This here is just the latest.

Or is it the NNS, the number needed to screen, that makes me hopeless and fatalistic? 25,000 to prevent one death from melanoma. 1374 (every five years) for colon cancer, 2451 for mammograms. They cost money and time. They have risks. Many risks. False positives, exposing you to more studies. Colon perforation. Infection. Bleeding. Sedation gone bad. More.

Is that why I’m a bad patient? Maybe. But I’m not an exception. Most medical professionals are bad patients.

We should take better care of ourselves. We should sleep more. Drink less. Avoid stress. Get our colonoscopies and our mammograms. Ask for help when we need it. We\’d live better and longer.

But we don’t. Why?

I hope I remember that next time my patients are difficult and noncompliant.

In the meantime, I\’ll go look for some essential oils. Anybody knows how to grow aloe?

Rada Jones MD is an  Emergency Doc in Upstate NY, where winters are long, people are sturdy, and geese speak mostly  French. She lives with her husband, Steve, and his black deaf cat Paxil. Her ER thriller, OVERDOSE, is on  Amazon, Audible and Apple books. MERCY, Book 2, is on preorder. 

If you’re sexy, fit and nimble,  if you can part your thighs and bend your knees, if you can see your private parts without a mirror, ignore this. Move on. This is not for you.

This is for those with flailing sex-drive and failing abilities whose sex life is a challenge, but they\’d like to make their partners happy and have some fun. Maybe your parents or grandparents. This must be an awful thought, but I\’m pretty sure they did it before, or you wouldn\’t be here.

Sex in the elderly is not a need. It\’s a privilege.

Most days you just hope for a good bowel movement.  You walked out of bed, you peed without a tube in your urethra, you pooped without an enema! Wow!

Towards the end of your life, the day you even think about sex is a good day. You have a spring in your step and tickle in your nether parts, reminding you of the good old days. You feel naughty. But your partner…They may or may not be into it.

You\’re not quite sure how to ask. There used to be signals: that special smile; that slow touch; the tongue maybe? You didn\’t use to have dentures, then.

It\’s hard, whether you\’ve been together forever or just since your granddaughter hooked you up on Tinder. You spoon while you sleep. You switch plates at dinner. Sometimes you take his meds. Your intimacy is not sexual.

Today, you feel the stir. You\’re not sure how to go there. Wouldn\’t that be fun?

Maybe.

There are challenges.

Artificial hips and fused backs hinder your mobility and limit position choices. Avoid low chairs. They make hips come out. Nothing spoils the mood like an ambulance trip.

Atrophic vaginas lack flexibility, so lubrication is essential. Lubricants come flavored in endless choices. Naked strawberry. Pina Colada. Cinnamon roll. I\’m looking for one in bacon. They say bacon makes everything better. You need lube, love, and lots of patience.

The penis needs blood to engorge. Lots of it. Your heart needs to stand up to the challenge, besides just keeping you alive. Sex may be the only demanding physical activity you\’ve engaged on since fighting for that TV on Black Friday. Sex is risky for your heart, your brain, your aorta. Your body works just as hard as if you were shoveling snow, but you\’re having too much fun to notice the warnings.

I\’m an ER doc, so I\’ve seen plenty of heart attacks and strokes caused by sex. A few deaths. They were all men. Their lovers were distraught.

So were their wives, when they all met at the bedside. I saw that twice. Neither man made it.

Be careful. Speak to your doctor. Ask them if your heart is strong enough for sex.

Viagra works. It made a difference in my patients\’ sex lives. It gave them hope and joy. It also gave them HIV and Hep C. Viagra doesn\’t work well with alcohol. You may want to forgo the wine and stick with roses and candles. Viagra interferes with nitroglycerin, our go-to drug for the heart. Tell your doctor if you took it.

Regardless, sex is fun, sex is joy, sex is love. If you\’re not doing it, you’re missing out.

If you\’re lucky, you have an interested partner. Still, coordinating is a challenge. Maybe it\’s not their day.

In comes oral sex. The blow job is the refuge of the intercourse destitute. Whether you had surgery, you hate being touched down there or it’s just not your day. Oral sex can be your friend.

How bad can it be? It won\’t make you fat. Like celery and grapefruit, it\’s negative calories. It will help soothe a relationship that needs more than you can deliver. Look at it as a gift. Share sex like you’d share a special dinner: You can choose your entree, but you have to agree on a time and place.

A few technicalities:

• Soap is cheap. Skin folds are tricky. Wash them twice.
• Dentures: Remove them if they don’t fit well.
• Breathing is a challenge. If you\’re oxygen dependent, secure your oxygen first!
• Sex is exercise. Getting in shape will improve your health, your endurance, and your fun.
• Use condoms if it\’s just a random night. HIV, HSV, HCV, and gonorrhea don\’t care about age.
• It\’s not kosher. I checked.

Still, oral sex may not be your thing. You\’re not that adventurous. You have a gag reflex. Your morals don\’t agree.

Modern technology is there for you. You can cater to each other’s needs without the physical demands. Vibrators conquer challenges that hypertension, diabetes, and strokes make unmanageable. Electricity is cheap. 

Caveats:

1. Be careful with batteries. If they catch fire, they spoil the mood.
2. Avoid vacuum cleaners. Too much suction.
3. Avoid vegetables, even healthy ones. If they break inside, they go bad.
4. Same with glass. Stick with plastic.

Bottom line:  Sex in the elderly is not for the faint of heart, but its a way to stay together even as everything else falls apart: joints, friendships, retirement accounts.

Sex is just another way to love each other and meet each others’ needs. Getting them what they need, whether you need it or not is like you’d get them their cereal even if you live gluten-free.

Sex in the elderly is both a challenge and an opportunity. Like walking with a walker, it\’s clumsy, but it gets you there.

Until the stairs.

Rada Jones, her husband Steve, and his deaf black cat Paxil live in Upstate NY.  Her first ER Thriller, OVERDOSE  is on Amazon. More at RadaJonesMD.com,  instagram RadaJonesMD and twitter@JonesRada. 

BBC: “Jemima Layzell, a 13-year-old girl who died from a brain aneurysm has helped…eight different people, including five children, through organ donation…no other donor had helped as many people. Jemima collapsed during preparations for her mum\’s 38th birthday party and died four days later… Her heart, small bowel, and pancreas were transplanted into three different people while two people received her kidneys. Her liver was split and transplanted into a further two people, and both of her lungs were transplanted into one patient. Normally, a donation results in 2.6 transplants.”

As I got older, I stopped worrying about looking good – it never worked anyhow. Now it’s too late.  I started thinking more about my spare parts. They aren’t pretty, and they don’t smell good, (I learned that in Surgery,) but they keep me alive. My kidneys relieve me of my half-gallon of morning coffee, my liver lets me enjoy a glass of wine (or two), and thanks to my corneas and my many reading glasses, I can read, write, and look forward to “Game of Thrones.”

Like the matching gears of a well-oiled machine, your organs are essential to your life. Except for two: Your gallbladder – her life-goal is to make you crave French Fries and donuts, then shrink your clothes when you aren’t watching. And your appendix. He was invented to wake up grumpy surgeons and get you irradiated with CTs. But I digress.

Your organs let you enjoy life. Thanks to their good behavior, you can breathe well enough to make it to your grandkids’ soccer game, you can have a beer without drowning your lungs and you can enjoy a burger without turning yellow.

Some are not so lucky.

My patient L., a woman in her thirties, died slowly. She came back week after week, so I can drain the fluid from her abdomen to help her breathe, after alcohol had killed her liver.

After his heart attack, G.’s heart started failing. He was 58. His heart didn\’t have the strength to pump the blood out of his soggy lungs. They filled with fluid. His breathing suffered. He barely walked to the bathroom. He couldn\’t lay flat, so he slept in a recliner on the good days when he was home. Those days got fewer and fewer.

M, a beautiful woman in her twenties, was pregnant. Her kidneys had been iffy for a while. Her pregnancy didn’t help. A second pregnancy put her on the transplant list. There were no matches but her mother. She got rejected because her tests weren’t good enough. M. waited and waited on the transplant list, wondering what would happen to her kids.

Let’s talk transplant. That’s getting refurbished with other people’s spare parts. Like fixing a car, except we’re talking new lungs instead of new breaks. Taking parts from the dead to fix the live ones? No brainer! Well, it’s a brainer. Transplants are difficult. Transplants are expensive. Transplants are restrictive.

Organs are scarce. As per UNOS, on March 9^th2019, there were 113710 people waiting for an organ. Mostly kidneys, followed by livers and hearts. The waiting times vary widely. The average wait for an eight-year-old needing a kidney was 920 days. Every day, twenty people die waiting. Every 10 minutes, another person is added to the waiting list. Still, people take their organs with them, when they die.

Does God need your organs? Apparently not. As per organdonor.gov, most religions allow organ donation “Organ, eye, and tissue donation is considered an act of charity and love, and transplants are morally and ethically acceptable to the Vatican. (Pope John Paul II, Evangelium Vitae, no. 86)”.

In the US, you need the donor’s consent to use their organs, no matter how dead they are. Even though God may need their soul, but probably doesn\’t need their heart.

In Europe, twenty-four countries operate under presumed consent. Unless you opt out, your organs are available for somebody who needs them more. Spain is #1, with 35.1 donors per million population, compared to 26 per million in the US.

In China, the organs of executed prisoners are available for transplant. Since their consent is questionable, this practice is widely condemned. I’m a pragmatist. A dead person does not need a liver. Consent? Have they consented to be executed? If you don’t need consent to kill people, do you need consent to take their liver? Is the societal good enough to compensate for the harm of the individual? Is there harm done by removing a dead person’s liver? What if that person’s liver results in cash for the Chinese government? Some say that death row prisoners get executed on command, to provide an organ for an approved match. This is a can of worms I’m not competent to handle. Others have. Ethicists, philosophers, politicians.

Selling human organs is illegal in most of the world. Not so in Iran and the Philippines. Forbes: Selling Your Organs: Should it be Legal? Do You Own Yourself? \”there is evidence that the financial incentive works. Organ sales are permitted in the Philippines as long as the donor recipients are natives. A Filipina organ recipient says: “Nobody would donate a kidney without getting paid.” Iran uses a hybrid system… vendors sell their organs to the government, which acts as an intermediary. It pays them and gives them free health insurance for one year. Donor recipients must be Iranian and they are required to work to pay for the cost of their organs. The system has virtually wiped out the waiting lists.”

This opens the door to organ trafficking. People whose kids are starving may sell parts of themselves in order to feed them, supplying the black market.

How does one find human organs though? How much do they cost? I googled “Human organs for sale.” eBay responded: “Organs For Sale Sold Direct – eBay – Fantastic Prices on Organs for Sale.” I clicked. “Nord C2 Organ Keyboard synthesizer in excellent condition.” No good. I tried again. I came up with: “Kidney for Sale by Owner: Human Organs, Transplant. Preowned.” $4.48. Cheap, I thought, but it was just a paperback.

According to Havocscope.com, Global Black-Market information, the asking price for a lung in Europe is $312.650 (you’d think they’d quote it in Euros and round a bit.) The average price paid for a kidney is $150K. Out of that, $5K goes to the kidney provider. The rest is shared between the middlemen.

Aljazeera: “The illicit kidney trade… has exploded as brokers use social media to find donors. This gaping hole between demand and the legal supply of kidneys is being filled by …the world\’s biggest black market for organs, which crisscrosses India, Nepal, Bangladesh, Pakistan, Sri Lanka, and Iran.”

 The black market is, by definition, unregulated. Many donors found themselves penniless, without a kidney and without recourse. As always, the poor, the uninformed, the vulnerable.

In our society, you can’t pay for organs. You can pay for insurance, for hospitalization, for cancer treatment. You pay for food. Not for organ donation. That’s done for love. How many people do you love enough to give them a kidney? The lack of a legal market leads to functional organs being discarded, to sick people dying while waiting for them, and to a thriving black market praying on the vulnerable.

Legalizing organ markets would actually save money in healthcare. ABS-CBN news: “Kidney transplant patients… enjoy a better quality of life… It is also cheaper…The cost of kidney dialysis in the US averages about $44,000 per year per patient…Separate studies conducted by the UMMC and the Washington University School of Medicine in St. Louis indicate that the \”break-even\” cost of kidney transplants is shrinking. The Washington University School of Medicine study stated that, given reduced transplantation and post-transplantation costs, society could pay each donor $90,000 and easily break even.”

No can do.  Selling organs is not ethical. Is selling antibiotics, vaccines, epinephrine, ethical? It’s legal! How is selling organs different? It’s legal to bury – or cremate – your heart, liver, corneas, after you crushed your brain in a motorcycle accident or overdosed on Fentanyl. Is it ethical?  What if there’s a mother watching her kid die, in need of a heart? How about the husband hoping a kidney for the mother of his two kids? How about the parents waiting for a match for their toddler? What if this was your kid?…your mom?… your wife?

How about recycling myself, I thought. I looked it up. My chances are mixed – kidneys and lungs look good, but my heart\’s too old. Thankfully, she doesn’t know it.  If I want to recycle, I’d better die soon, and die healthy.

In a world where we recycle beer bottles, we make old clothes into quilts and remake the same movies, how about ultimate recycling? How about recycling yourself? I don’t know about you, but I love looking at houses for sale. I’m obsessed with traveling. I dream of alternative lives. Who would I be if I was born in Peru, petting llamas? In Portugal, fishing for octopus in clay pots? In Egypt, drinking mint tea instead of wine?

What if my heart got to live again, beating inside the bony chest of a teenager for his first kiss? Inside a mother holding her child? Inside a bride? Would it add to the joy of the universe? Would my spirit soar? Maybe not.

But even if I won’t be there to enjoy it, the recipient would. So would her family, her friends, her dog. So would my husband and my son. They’d know that somewhere in the world, my heart still beats, and loves them still. They may feel less alone.

Are you in? If so, what should you do?

1. Tell your family. They need to hear it from you, not from some stranger asking them for your heart before it even got to stop.
2. Start here. They\’ll redirect you to your state site. Like fish, guests and French baguettes, organs go stale in a hurry. The closer the recipient, the better the results.
3. Live well. Be happy. Be generous and kind. Live as if death can\’t touch you.

But if the day comes…If that car comes too fast…if that floor is too slippery…if tomorrow never comes…Won\’t it be good to have your heart love again in somebody’s chest? See the world through somebody’s eyes? Piss somebody else’s beer?

Rada Jones, MD is an Emergency Doc in Upstate NY, where she lives with her husband Steve and his deaf black cat Paxil. Her ER thriller, OVERDOSE, is now on Amazon.

1. You don’t like to be told what to do. Especially not by arrogant doctors who act as if they know better, just because they’ve been through a little training!
2. Your child hates shots. As her parent, your main job is to keep her comfortable.
3. Dr. Google told you about side effects: fever, pain, irritability. “The pro-vaccine mafia is quick to sweep all cases of vaccine-related injury and death under the rug as extremely rare anomalies, but many a parent of a vaccine-injured child will be the first to tell you that, if she could do it all over again, she wouldn\’t have let her kid get jabbed,\” the anti-vaxxers say.
4. Once, you got the flu after you got the flu vaccine. Vaccines don\’t work.
5. Vaccines weaken immunity. An often quoted anti-vaxxer, Tetyana Obukhanych Ph.D. states: “in the debate over vaccine safety, we have lost sight of a bigger problem: how vaccination campaigns wipe out our herd immunity and endanger the very young.” Her Amazon sales pitch ends: “Disclaimer: The information in this book is not intended as medical advice. Readers assume sole responsibility for choosing for themselves and their children disease prevention options that are compatible with their convictions.” No medical advice here. Just philosophy.
6. Taking your kid to the doctor takes time. Plus they\’re always late, taking care of sick kids or something.  You don’t have time for this.
7. Vaccines cost money. Not yours, the insurance\’s. You still have to pay for the gas!
8. Jenny McCarthy and other celebrities, including a famous – now infamous – doctor, whose license was withdrawn for fraud, say that vaccines can lead to autism. The entire medical community disagrees, but you trust her, not the doctors.
9. Doctors are just looking to make money out of your child.
10. Vaccine companies can\’t be sued if your child is harmed. The National Childhood Vaccine Injury Act of 1986 exempts drug companies from liability, in an effort to avoid vaccine shortage. It also establishes alternative ways to compensate those who have been harmed. As Natural News says, “Is this really a risk you want to take with your child?” (Not be able to sue if they die?)
11. As per the same website, \”vaccines can cause lifelong, incurable diseases… If your child develops permanent nerve damage, she could require lifelong care… If you choose to vaccinate, are you prepared to reorient your life in the event of autism or brain damage?\” Easier to just let them die.
12. You always wanted a boy. This one is a girl.
13. Vaccines kill children. Your anti-vaxx resources told you that \”Gardasil, the HPV vaccine, has injured and killed tens of thousands of adolescents and teenagers.\” While you\’re looking for the mass graves, how about checking what CDC has to say?
14. You know better than anyone what’s best for your child. You don\’t need to take her to a doctor. She shares your DNA. You don’t need an education or even information. It’s in your DNA.
15. Gandhi was against vaccines. He disapproved of using cows to produce the smallpox vaccine. He also disapproved of eating cows. He didn\’t care for steaks. Not even burgers. He was a Hindu and a fruitarian. Are you?
16. Vaccines contain toxic stuff. As a matter of fact, vaccines are mostly water and antigen, plus preservatives to keep them from going bad. You wouldn\’t inject rotten stuff into your kids, would you? They\’re similar to those in your packaged bread, soda, mayo, and mascara.
17. Your kid looks like your ex. And you hate your ex.
18. Vaccines will overwhelm your baby\’s immune system. Newsflash: Your baby doesn’t really have one. Yet. That’s what vaccines are doing. Building up her immune system to help her fight disease.
19. The immunocompromised – young babies, cancer kids, pregnant women – they\’re not your problem. They’d better take care of themselves.
20. Childhood diseases have been mostly eradicated. Why vaccinate for something that doesn’t even exist? Good point! That\’s why we no longer vaccinate for smallpox. Because it’s extinct. Why? Because of the vaccine. We vaccinate for other diseases. Measles, mumps, pertussis. They\’ve been resurging since people refuse to vaccinate.
21. God says NO. Like some in the Middle East, you think that vaccinating your kids is against God\’s will. In Pakistan and Afghanistan, many thought that the Polio vaccine was intended to prevent their kids from reproducing, so they listened to God and killed the healthcare workers.
22. Your anti-vaxxer friends told you: Natural exposure to disease is the best vaccine. “Truth be told, the only way to truly develop vibrant, lifelong immunity, is to live your life as you normally would, without injecting dead viruses and chemical adjuvants into your muscle tissue. Natural exposure to whatever diseases are lurking in the world is the only way for the body to develop permanent antibodies that will forever protect against disease.” Remember Darwin?  Survival of the fittest? Good luck.
23. Your child is special. Unlike all the others.
24. The earth is overpopulated anyhow.

I\’ll offer you a compromise: Don’t vaccinate all your kids. Only vaccinate the ones you want to keep.

As for all of you who can\’t immunize your kids for medical reasons, take care and stay safe!

Rada Jones MD is an Emergency Doc in Upstate NY, where winters are long, people are sturdy, and geese speak mostly French. Her ER thriller Overdose is now on Amazon.

Humor is a shield in the ER. It helps us cope, so we laugh a lot. At each other, at ourselves, at the weirdness. Check these out. They are all real complaints of real ER patients.

1. \”I have Bavarian cysts.\”
2. \”My doctor said that I may have a blood clog in my leg.\”
3. \”I have a stiff neck. My doctor said it could be Smiling Mighty Jesus.\” Either that or spinal meningitis.
4. \”My lips are chapped.\” 
5. Attacked by an ostrich.
6. \”I can\’t get the apple out of my vagina. The orange came out fine last night.\” It had to be surgically removed.
7. \”The left side of my brain isn\’t working. It gets better when I eat beets.\”
8. Superman got hit by a car. He came in naked, wearing only a cape and socks. Why? \”The FBI implanted something in my brain and now I can\’t fly!\”
9. \”I got attacked by a squirrel.\”
10. \”I was cleaning my butt with my electric toothbrush and it got sucked in, the whole way.”
11. \”Ghosts are sexually assaulting me.\”
12. Got attacked by a yak while cleaning the yak pen. 
13. \”I was sexually assaulted by the mushrooms I ate. They melted my brain.\”
14. \”Ghosts are touching my cat.\”
15. The patient thinks she\’s a cat and will only eat cat food. She refused milk.
16. Got attacked by vampires.
17. \”I\’m Jesus Christ. I was told to come see you.\” At 3AM, Christmas day.
18. \”I woke up lookin like Forest Whitaker.” 19 years old white girl
19. \”I\’m coughing. I think I\’ve got ammonia.\”
20. \”My vulva is swollen.\” That one, in your throat, is your uvula. Your vulva is lower.
21. \”Im a robot, and my sister put me together wrong. Watch…\” Shakes her arms to demonstrate.
22. \”My pussy be drippin...\”
23. The patient got blown over by the wind at the waffle house. 
24. \”My stuffed animals keep saying, \”kill me, bitch.\”
25. \”Every time I ejaculate I smell like bleach.\”
26. \”She tastes funny down there,\” states the boyfriend of the patient coming for a vaginal discharge.
27. \”I had sex and he went into where I pee. Now it hurts to pee.\”
28. Two years old fell into grave. Grandfather\’s.
29. “The thing that hangs down in the back of my throat is upside down, and now I can’t spit.” That\’s your uvula. That\’s how it hangs.
30. \”I cut my arm off and I threw it in the trash.\” Would have been funny if it wasn\’t true.
31. Patient one: bleeding from groin trauma.  Patient two: epileptic seizure and choking. Do the math. 
32. \”My surgeon said I could have a hematomato.\” 
33. \”I have a bleeding hemorrhoid.\” He pulls his shirt to reveal an abscess on his side.
34. Glass rod shattered inside the penis
35. \”I had a vasectomy last week and my ovaries hurt.\”
36. \”I’m feeling homicidal after seeing a midget, a unicorn, a leprechaun, and a dog playing cards...\”
37. \”Just want to make sure that my dealer gave me the good meth.”
38. \”Do you pierce baby\’s ears?\”
39. A sack of flour got spilled outside a grocery store. The whole town came in to be tested for anthrax.
40. \”I \’m being controlled like an avatar and I woke up with a moist butt hole.\”
41. \”I have a worm in my tentacle.\” Pointing to a testicular vein.
42. \”Got Gorilla glue in my hair.\”
43. \”I sat on a cocaine-dusted gerbil. He crawled into my butt. He\’s trying to claw his way back out but he\’s lost and I\’m bleeding.\”
44. \”I drank cleaner fluid and my throat hurts.\”
45. \”When I was younger, I wore special shoes.\” So did Forrest Gump.
46. \”I got food stuck in my sarcophagus.\”
47. “Google said I could die from hypothermia, so I wanna make sure I am
    not too cold.” 98F.
48. \”I need Dilaudid for my finger. I burned it with a French fry.\”
49. \”I have acid reflex.\” 
50. \”I\’m allergic to tazers.\”
51. The patient called an ambulance because she dreamed she had a stroke.
52. \”I\’m tired of my thighs touching.\”
53. Patient stapled scrotum back together after his spouse lacerated it.
54. \”I\’m bleeding from a paper cut.\”
55. \”My son\’s penis is too small.\”
56. During Bird Flu season: \”I walked in a room serving fried chicken. I think I caught the bird flu.\”
57. The patient was brought from jail for drinking from his colostomy bag
58. \”I have purple stuff coming out my lady pocket.\” 83yo female and her husband ran out of KY jelly. They improvised with Smucker\’s grape.
59. \”\”I ripped my nipple with my piercing in the shower.\”
60. Got hit in the face with a catfish.
61. \”I have a low sperm count.\” A young man coming by ambulance.
62. \”I think someone peed in my beer.\”
63. \”My BF said I taste funny.\” She had trichomonas.
64. \”I have a problem with my prostitute.\”
65. Elderly woman getting ready for a rectal: “My husband’s usually the one doing this!” “Grandma!” Patient: “I mean getting sick and coming to the ER.” 
66. I’ve got clogs coming out my Eucharist!
67. Vacuum cleaner stuck on penis.
68. \”I accidentally swallowed half a bottle of Clorox bleach.\” Accidentally? Half a bottle?
69. \”My penis shrinks when I sneeze.\”
70. \”My child swallowed bath water.\”
71. \”I don\’t last as long in bed as I used to.\”
72. \”I have a condom lost in my vagina.\”
73. \”My poop doesn\’t float.\”
74. \”I have lickulitis. I need that pill flagall.\” Must be oral transmission!
75. \”My diabolic blood pressure is too high.\” Diastolic of 150? Diabolic all right. 
76. \”I have diabetes type 3. The one you fix by eating a candy bar. Type two is the one with a pump. Type one is the one that gets shots.\”
77. \”I just don’t feel like myself.\”
78. \”A raccoon fell into the baby stroller at midnight while we were fishing.\” Are you here for the raccoon?
79. \”I got beat up by a ghost.\”
80. Female patient: \”I googled it. I’m worried that this could be prostate cancer!\”
81. “My pussy hurts.” Triage nurse: “We don’t treat animals here.”  
82. \”Hey doc, I have Driver Triculitis.\” Occupational medicine referral? 
83. \”I have end-stage fibromyalgia.\” 
84. \”I brushed my teeth with my hair remover.\”
85. \”I got attacked by an owl.\” 
86. \”Aliens froze my urethra. Now I can\’t pee.\”
87. \”I walked through meth and it absorbed through a wound on my foot.\”
88. \”I think I have Fluumonia.\” She had both.
89. \”I can\’t read.\” 
90. \”I have no ambition.\” That sounded funny until the cardiac enzymes came back positive. 
91. \”I’m vomicking out of both ends.\” That\’s efficient!
92. \”I have sick as hell anemia.\” Sickle cell too.
93. \”The doctor took my castrator out.\” He\’d just had a prostatectomy.
94. Glass Christmas ornament in the butt. In July.
95. \”I have fireballs in my Eucharist!\” Religious psychosis? Nope. Bleeding from her uterine fibroids.
96. \”I was impregnated by my ex-husband, who is a warlock through the internet.\” Not clear if the impregnation or the training happened online.
97. \”I got hit in the head by a cow.\” Ended up with a detached retina.
98. \”My house smells like carbon monoxide.\” CO has no smell.
99. \”I’m here because I’ve been walking all day and my feet hurt.\” I\’m here in spite of that.
100. \”I knocked my joint out and now can\’t find it.\”
101. \”My labia got tangled in my underwear.\” It required a procedure to set it free.
102. \”I got hit in the head with a frozen burrito.\” It flew off the assembly line and smacked her
103. \”Her cummer is stuck.\” She had a seizure during sex. 
104. \”My acid reflux came out my ears after I ate.\” Anatomy be damned! 
105. \”I need an ambulance. I dropped a jar of peanut butter on my toe and I think it’s bruised.\”
106. \”I fell as I was running from an ostrich.\” Ill-tempered birds!
107. Live bat found in family home and attic. Didn\’t hit anyone or bite them. The family of 6, including those who were not home, insisted on getting rabies IgG.
108. \”I kissed a girl, not my girlfriend. Now my cum tastes different.\”
109. \”I\’m bleeding from my mouth after oral sex.\”
110. Fractured penis. Male subject 120 lbs, partner pushing 400. She was on top. It broke as she was bouncing.
111. Injected testicles with industrial grade silicone with a manual bicycle tire pump. Can you say big balls? 
112. \”I swallowed my wife\’s hearing aids.\” They\’re so expensive that he had to poop in a bucket for a week, in an effort to recover them.
113. “I think I have ovarian cancer.” A man who googled his symptoms.
114. \”I have an enlarged Prostrate. 
115. \”I have a pinched nerve, right above my testicles.\” 
116. \”I have anxiety brought on a silent retreat. It was too quiet.\” She was there for two days.
117. \”Pussy discharge.\” Foul smelling discharge with pus coming from her \”vaginia.\”
118. \”I got raped by my dildo.\”
119. Lotion bottle stuck up his ass to get out of jail. Now his colon is silky soft and his poop smells like cocoa butter.
120. \”I was playing with magnets. Now they stuck together. I can’t get them off my junk.”
121. \”I have sperm dripping from my vagina.\”
122. \”I\’ve had trouble breathing since birth.\” Age 68.
123. Got nuts stuck in a lawn chair,
124. Iguana bite. It took off half her finger.
125. \”I pulled a worm off my butt.\”
126. Got scalped, after a horse bit off her hair bun. (70 y/o)
127. Gored by a buffalo while loading his buffalo herd onto a truck and they stampeded. He drove himself in with significant injuries.
128. Possible inhalation of potato chips.
129. Got into a fight with a raccoon. 
130. Fell on 8lb sledge hammer and it got stuck in the butt. He drove to ER. 
131. \”I got run over by a pig.\” Works at a slaughterhouse and got trampled by a 350 lb pig.
132. “I’m pretty sure I’m a dead man walking.”
133. Girlfriend shoved a knife up patient\’s rectum, blade first, as he was tied to the bed.  He earned a colostomy.
134. \”I think I broke my penis. It’s crooked.\” He was right.
135. Confused patient: \”I have smoke in my attic!\”
136. \”A squirrel urinated in my eye.\” How?!?
137. A baby turkey pecked me in the corner of my eye.\”
138. \”I\’m starting to see Satan.\”
139. \”I\’m turning blue.\” It was dye from her jeans.
140. Got bit by zebra.
141. \”I have a dead kitten hanging from my lip.\” She kissed it, it bit her, she choked it.
142. \”I\’m worried I got HIV.  I got monkey poo in my face.\”
143. \”I ate sushi two years ago. Now there’s a parasite crawling out of my skin.\”
144. \”I got apesex and pain.\” Bad way to spell abscess.
145. The patient requested transport to ED for Valtrex when his girlfriend told him she had herpes. The second unit brought her. She\’d been assaulted.
146. \”I went to take a shower. My wife had put a zucchini on the bathroom chair. I sat down to dry my feet\”…The last zucchini standing.
147. \”I ate the wrong vagina.\”
148. \”Been sick for twenty years, worse tonight.\”  

Lessons learned:

1. Avoid animals and birds from austriches to zebras. Even pussies.
2. Sex is risky. Even with oneself.
3. With a name like Smucker\’s, it\’s got to be good.

Thank you to all my Facebook friends and my ER friends for their contributions.

Rada Jones MD is an Emergency doctor in Upstate NY, where she lives with her husband Steve and his black deaf cat Paxil. She authored three ER thrillers, OVERDOSE, MERCY, and POISON.

1. Murphy’s Law as it applies to the ER: If something can go bad, it will do so in a hurry. If it can’t possibly go bad, it will still find a way.
2. Clock’s First Rule: All the patients will crash at the same time. Usually when the computer system goes down.
3. Clock’s Second Rule: The sickest patients will come just before the shift change.
4. Haste’s Theorem: The healthier the patient is, the more they insist on being seen first. Sick patients are not in a hurry. Lefty’s Corollary: The patient who doesn’t ask “When is the doctor coming?” is probably dead.
5. McDonald’s Law: The patient who needs sedation will stop at McDonald’s on his way to the hospital.
6. Sweet’s Exception: Unless they are diabetics. Then they didn’t eat for three days, but they did get their insulin.
7. Sandwich’s Principle: All vomiting patients request a sandwich.
8. Mass’s Law: Whenever a non-ambulatory patient needs to be moved, he will weigh at least 300 pounds.
9. Law’s First Rule: Every drunk patient has a lawyer on speed dial.
10. Law’s Second Rule: Alcoholics will start withdrawing before becoming legally sober.
11. Law’s Third Rule: Every lawyer in the ED will be your patient.
12. Law’s Rule on Charting: The ONE case you documented poorly will turn bad and get you sued.
13. Urin’s First Law: The consultant you paged an hour ago will only call back when you go to the bathroom.
14. Urin’s Second Law: All babies will pee as soon as you remove their diaper. On you.
15. Urin’s Third Law: Whenever you need urine, the patient has just peed.
16. Cutter’s Law of Time: The surgeon who performed the surgery is never the one on-call.
17. Cutter’s Law of Space: The surgery was never done at your hospital.
18. Timer’s Law: Whenever you manage to go see a patient, they just went to radiology.
19. Gyn’s Principle: The pelvic stretcher is always inhabited by a large non-ambulatory male.
20. The Law of Detrimental Location: The trauma victim was just sitting there minding his own business.
21. Bleeder’s Law of Priority: The most important lab will be the first one to clot and the last to result.
22. Bleeder’s Law of Excruciating Challenge: The likelihood that the labs will clot again is directly proportional to the difficulty of getting them.
23. Bleeder’s Inevitability Principle: You can’t stop the bleeding even if the INR clotted on its way to the lab.
24. Home’s Placement Law: Patients will need placement only after case management has left.
25. Hitchcock’s Theorem: The likelihood of a patient having a long QT is directly proportional to the degree of psychosis.
26. Middlesex’s Law on Gender: If you are female, you are a nurse. If you’re male, you are a doctor.
27. Prick’s Principle: The fear of needles is directly proportional to the number of tattoos.
28. Segway’s First Risk Theorem: The likelihood of medical errors increases exponentially in VIPs.
29. Segway’s Second Risk Theorem: The nicer the patient, the worse the disease. Segway’s Corollary: All nice patients will have cancer, a stroke or at least a broken hip.
30. Segway’s Pregnancy Conundrum: Sitting on the toilet or swimming in the pool may get you pregnant.
31. Pain’s First Principle: Patients with high pain tolerance are allergic to Motrin and Tylenol.
32. Pain’s Second Principle: 95.8 percent of Fibromyalgia flares occur on Mondays.
33. Pain’s Rule of Furniture: Chronic back pain patients love to move refrigerators.
34. DeBeer’s Law of Correlation: The likelihood of a patient being suicidal correlates directly with the blood alcohol level.
35. Fahrenheit’s Law: Parents of unvaccinated kids don’t own thermometers.
36. Poor’s First Law: Smoking is inversely correlated with the ability to afford your antibiotics.
37. Poor’s Second Law: The number of tattoos is inversely correlated with being able to afford dental care. Poor’s Corollary: Beware the tooth to tattoo ratio.
38. Hope’s Law: Being on Chantix negates smoking.
39. Love’s First Law: The patient asking for your phone number is in the ER for an STD.
40. Love’s Second Law: The patient who hugged you before he left has scabies.
41. Love’s Third Law: The patient who shook your hand is positive for C Diff.
42. Pooper’s Rule: Patients with three weeks of diarrhea become constipated as soon as they step in the ER.
43. Cheeto’s Rule: Abdominal pain gets better with Cheetos.
44. Sucker’s Law: When you separate fighting dogs, you’ll be the one who gets the shots.
45. Mattu’s Law: If the patient is so diaphoretic that you can’t stick his EKG leads, just activate the Cath Lab. They’re having a STEMI.
46. L’Hospitel’s Law: Patients who need admission have pets at home they need to care for. L’Hospitel’s Reciprocal: Patients who don’t need admission have families that can no longer care for them.
47. Tester’s First Law: Whenever you need a CTA, the patient’s GFR is bad. Tester’s Reciprocal: Whenever the GFR is bad, you need a CTA.
48. Tester’s Second Law: D-dimers are positive only if the patient can’t get a CTA. Tester’s Corollary: Then, they are positive every time, and the VQ scan is out of substrate.
49. Luck’s Theorems: The likelihood of the computer crashing is directly proportional to the number of patients in the department. Multiply by five if it’s Monday night. Add 10 if it’s a full moon. If you’re red-haired and have at least one stepparent, divide by 0.25.
50. Schift’s First Law: JACHO only comes during your shift.
51. Schift’s Second Law: The other doctor has fewer patients.
52. Lavoisier’s Principle on Medication Errors: They always got too much. If they got too little, it would be easy to fix.
53. Lavoisier’s Theorem: Tylenol allergy is a risk factor for fibromyalgia, IBS, and anxiety.
54. Lavoisier’s Rule of Anticoagulation: Every patient who has a sloped porch must be on Coumadin.
55. Lavoisier’s Dictum: When the patient comes to the ER, the med list stays home.
56. Child’s Principle: Toddlers can’t swallow pills. Unless they are grandma’s. Then they’ll swallow the whole bottle.
57. Child’s Law of Location: Bleach must be stored under the sink in a Coke bottle.
58. Snow’s Method: The best way to unclog a snowblower is sticking your hand in it.
59. Needy’s First Rule: Your patient will need you as soon as you leave the room.
60. Needy’s Second Rule: Your consultant always needs the one test you didn’t order.
61. Margarita’s Law: The ER goes to shambles as soon as the pizza arrives. Margarita’s Corollary: Never order pizza in the ED. Margarita’s Conclusion: To eat hot pizza you need to retire.
62. Bell’s Rules: Patients who are hard of hearing don’t have their hearing aids. If they do, the battery is dead. If it’s not, the family will take them home, together with their watch, their jewelry, and their glasses
63. Bell’s Axiom: If the patient doesn’t speak English, the translation phone is not working. In the unlikely event that the phone is working, the patient will speak the only language that the phone does not.
64. Sage’s First Advice: Skip the CT if the patient with abdominal pain is eating McDonald\’s.
65. Sage’s Second Advice: Whenever a patient tells you: “You took care of my mom,” don’t ask how she is. She’s dead.
66. Sage’s Third Advice: The family member looking like the patient’s mother is his wife. Don’t ask.
67. Sage’s Unavoidable Error: You should have called the other consultant first.
68. Sage’s Chest Pain Rule: Every patient with chest pain, elevated troponin, and cardiac risk factors has GERD. Just ask your cardiologist.

Rada Jones MD is an Emergency Physician. Her ER thriller, OVERDOSE, is now on Amazon.