Ghetto Medical Terminology

Working in a "distressed urban area" like I did until recently has its unique challenges. People who ignore lights and sirens on the ambulance, people calling for foolish reasons (that's a whole other post), and language barriers. Usually when people say language barrier they mean that people are trying to communicate but they each speak different languages. But in the Great White North, I mean my patients use strange medical phrases and a lovely "language" known as Ebonics. Phrases that new EMTs have never heard of. Phrases that, frankly, boggle the mind.

So, here are the phrases you need to learn to work in EMS in an urban area.

Ammalance: Personally my favorite word. This is how your properly say "That giant box on wheels with the flashy lights that comes when we calls 911". You'll notice that the word Ammalance has no "b" in it. I have actually trained everyone I know to pronounce the word this way. Ammalance, that's what I work on.

Fell out: Ah, the most common. And one of my favorites. Fall out means passed out, lost consciousness or had a syncopal episode. It does not mean they fell out of a car, out of a tree or off a building. And this isn't a slang phrase as best I know. This is honestly the only term some of my patients know to express this idea. I've had people deny passing out but a little further questioning reveals that they definitely "fell out"

I got the sugar: Pretty common and pretty simple to understand. This means that they have diabetes. A little more probing with reveal how compliant they are with meds, how often the check there blood sugar, what type of diabetes, etc. If they say this, taking a blood sugar is never a bad idea.

Worser: I hate this 'word'. It’s like fingernails on a chalkboard, Paris Hilton on the radio or a cheese grater vigorously rubbed against your nipples. Just painful. Worser means the pain is increasing. Frequently it really means that the pain started 4 days ago, the concept of primary care doctor is completely unknown to the patient and right now there's nothing good on TV so they'll call 911 for a ride to the ER. 90% of the time "worser" means low levels of pain and a whinny person.

My ______ is painin' me: The National Grammer Chancellor started sobbing inconsolably when he heard this. This phrase means that a particular area or organ is causing pain/distress/discomfort/annoyance. However, very few people who say this are well versed in basic anatomy. So it's possible that your "heart" is painin' you/you're having a "heart attack" but that the pain is actually in your abdomen. Kidney pain may be felt in your epigastric area and a headache can occur in the groin. You should not just write down what they say on you run report. Ask them to point to the pain and go from there.

10/10 pain or Pains a TEN!!!: Some asshat decided we needed a way to measure pain, a self-reported number. So we have a 0-10 scale, 0 being no pain and 10 being "the worst pain you can possibly imagine".

Let me paint a picture of true 10/10 pain....you're walking down the street, minding your own business, drinking a glass of wholesome milk, when Sumdude shoots you in the knee for no reason. You stagger a little on what remains of your knee and end up wandering into the street, where you are promptly hit by a bus going 40 miles per hour. So now you have 6 broken ribs, broken clavicle, dislocated shoulder, bruised kidney, lacerated liver and spleen, multiple random bruises and lacerations plus the gunshot to the knee. And miraculously your spine is totally intact and you are totally awake and alert and aware of your surroundings. You plead with god for unconsciousness or, failing that, death because the pain is so bad. Then when I roll up in the ammalance, my partner accidentally drops the backboard on your face breaking your nose. You got that mental picture??? Great, that is 10/10 pain. Pain as bad as you can imagine. Pain that makes death seem like a damn fine idea.

I had a 14 year old girl who "may" have mildly twisted her ankle try tell me she had 10/10 pain. After I watched her walk to the hallway and get her shoes for her trip to the ER. The most mild of limps was questionably present. I lost my cool a little bit. A 'discussion' ensued between me and the patient. We ended up calling it 8/10 pain. And when the first thing you say when I walk in the door, while smoking a cigarette, is "Pains a TEN!", that makes me 95% sure that your complaint is BS.

I take peanut butter balls: Um, okay we all like peanut butter balls but I don't know what would make you think they are a medication. Oh wait. You take them for your seizures? Ahhhh, is it possible the doctor meant Phenobarbital?? An old school medication for seizures?? Yes, I did hear this once. You kids will her it less and less since Phenobarbital is being slowly replaced by a variety of better medications with less side effects and less funny names. But yeah, that man with the "shakes" takes peanut butter balls

Part Duex will follow soon.

GWN

Tips on Overdosing - A Guide for the Do It Yourselfer

EMT's are not quite as dumb as you think we are, so here are some tips on doing and calling in your own OD. Following these tips will make the call more interesting for EMS and more fun for you, so please pay attention and follow along.

1. If you are going to make a heroic effort in your current condition to move your normally barely ambulatory body to your living room, unlock your door, and position yourself on the sofa, so we can see your barely alive self slumped on your couch, please remember to unlock both your main front door and your screen/glass door or we most definitely will break the door down to get to you. Also, please buy a door with a stronger handle. If I tug on the door because I think it's just stuck and the handle breaks and I cut my hand, I might lose focus on your plight for a moment.

2. If you forget to unlock the screen/glass door, please do not move your nearly lifeless body suddenly to the door to unlock it when you hear me asking for tools to break in. It kinda blows the illusion you're going for.

3. If you do choose to hop up and unlock the door you forgot to unlock because you do not want us to break it, please do not return to the sofa and resume the exact nearly lifeless position you were just in. Maybe fall on the floor or something. Just a suggestion.

4. If you plan to vomit for our benefit upon our arrival, at least swallow some empty capsules or sugar pills, so we see something in your vomitus. If you OD'd 15 minutes ago, trust me, particles would still be in your stomach.

5. Vomiting should not take the much effort if you just OD'd. If it doesn't come easy, don't force it. Again. You're really trying to make me believe.

6. If you want me to believe you really did OD on prescription meds, pick one that would match up with the effects you are play acting. If the pills and the symptoms don't match, I'm not gonna buy it. Again, you really have to work a little to keep the illusion going for me.

7. If you tell me you OD'd on one of your prescription meds, toss them in the toilet or something and present me with the empty bottle. If you tell me you took XXX drug, and I open your prescription bottle and count 28 pills, and the label says there were 30 in the bottle ... again with the illusion. It just faded a little.

8. Please specify WHICH top drawer you are talking about when I ask where you keep all your meds. I am planning to go get them and bring them with me to the hospital. I will be opening the drawer to do this. If I open the wrong top drawer and find your porn stash, I could be traumatized for minutes, hours or days. It's not nice to traumatize the person who is trying so very hard to save your life. You OD'd remember? I'm here to help.

9. Oxygen doesn't fix everything. Even though I will swear it does, it doesn't. So when you improve DRAMATICALLY in the ambulance on 2 liters of O2 and nothing else, you are once again messing with the illusion.

10. Precipitous drops in vigor and acute onset blindness are not symptoms of many drugs. Hardly any actually. So if you're pink and chatty and happy in the amalance, don't expect me, the nurses or the ED doc to believe you have suddenly become so lethargic that you literally cannot lift a finger, and that you have suddenly gone blind as we pass thru the ED doors. Not even the phlebotomy student is buying this.

11. I absolutely will tell the ED doc that your are full of shit if you push me far enough. And yes, in case you're wondering. You pushed me far enough.

Try again another day. With these tips in hand, you might be more successful.

12. One last tip. If you print these tips out, do not have them within sight when I show up. I actually enjoy well acted plays, and I'd like to play along as long as you can keep me interested.

You are incorrect sir ...

I do NOT hate all Mexicans. I do not even hate you. I am however a little miffed that it is 4AM, you have admitted to the use of illicit substances, and you are being such a baby that I cannot touch your sprained ankle without eliciting a stream of profanity from you, and yet you are now sitting in the back of the very expensive ambulance, receiving care for which you will not pay, on your way to the hospital, to receive services for which you will not pay, and you choose to accuse me of being racist because the splint I put on your ankle is uncomfortable. Should I take a look at your gang tattoos and summon your homeboys to see what a tough guy you really are?

WSS

Man, do we suck

The title kind of says it all doesn't it?

WSS and I have totally dropped the ball. We have both had hilarious patients, great posts, sad patients and entertaining stories to tell recently and neither of us has posted.

We suck. And not it the happy, fun way.

But all is not lost. I have 2 posts that are partly written that I will make sure to get up within the next week. And I'm sure WSS can crank something out too.

So, stay tuned, we're still here and we still have funny stories.

GWN

Of yeah, as a favor to Ambulance Driver we just wanted to pass this along.

Cycles and More still sucks.

Let's call him SGT Smith

So I went to Great Big Hospital to pick up a patient who had recovered from an acute MI and was going home to the long term care facility where he had been living for the past several years . I stopped by the nurses station to begin the requisite paperwork while my intrepid partner went to the patient room to introduce himself, grab a set of vitals, see if the patient could get on the cot by himself, and check for things like a foley, IV, monitor, etc that might need to be discontinued before we left. He came back in a few with a set of vitals and didn't say much else. I finished the paperwork and went down to the room where a CNA was attempting to dress our patient in a hospital gown, since the patient apparently favored nudity. The patient was literally kicking and screaming at the nurse and telling her how expensive the clothes were and that they were the property of the USMC and that she shouldn't be so careless with them and that he was fine to stay just the way he was. He became more and more combative and abusive as time went on, but due to perserverance and some cool CNA ninja moves, our intrepid aide finally managed to get our patient somewhat dressed. He was still more than a little immodest, but at least she'd tried.

I asked her if our patient was normally this combative and she said he wasn't. I told her I was uncomfortable taking him in our ambulance unless everyone was clear that I might need to use restraints, and/or they gave him a sedative before we left. So I went to talk to the nurse and she seemed confused as the patient had never been that way with her. As soon as she and I walked back into the room, the patient saw the nurse, and turned into a very calm man, smiling and making borderline suggestive comments, and there was actually a spark and a gleam in his eye. 3 minutes ago, he was angry and combative and now he's on the prowl with the admittedly quite attractive nurse.

The patient's history suggested that his altered mental status worsened significantly after his MI, so now I knew that I had a normally calm, but confused patient and something about the CNA and the gown had set him off. My partner and I loaded him to our stretcher and cocooned him a bit in the sheets just in case and set off through the hallways of Great Big Hospital. As we walked, our patient was making random observations and comments which I initially ignored, but then began to listen to. A lot of what he was saying made no sense until it hit me. Our patient, Mr. Smith (not his real name of course) was actually a former Marine Corps infantryman and right this very minute in his mind, we were in a combat zone. His unit had just been hit hard by enemy fire and he and all of his buddies were wounded badly. The reason he was so upset was that someone (presumably a Medic) had snatched him away from his buddies to treat his wounds and he was concerned about the rest of his unit. As soon as I figured this out, and started to tailor my conversation to suit his reality, he started to calm down quite a bit.

By the time I had him in the back of our ambulance, I had the whole story, and I had assured SGT Smith, that me and my partner were indeed military medics and we were assigned to take him to a facility where he could be properly treated and more importantly the remainder of the medics in our group had been sent to take care of the rest of his sqad. He relaxed more and then asked me where I was taking him to get fixed up. He was concerned that the drive to Philadelphia might be a very long one and he wasn't sure he could make it. I asked him if he had ever been to Georgia (not really, but it's a southern state and it works for the story) and he lit up like a kid at christmas and said "Son, I was BORN in Georgia." I asked him where and he said "Eatonton , I was born in Eatonton Georgia." And I said, well SGT Smith, I'm taking you to a military hospital in Warner Robins. Then with a sly grin, SGT Smith said "are you SURE you can't take me to Eatonton?"

No sir, I said, I have my orders and you know how the Corps is about orders. We're going to Warner Robins and that's the end of it. He laughed and said, "Son, I knew you couldn't, but I had to try. You just carry out your orders and I'm sure I'll be fine". With that, my formerly confused, angry, combative patient closed his eyes and napped for the rest of our 20 minute ride to his nursing home.

When we got there and unloaded him, he recognized the nurses and aides on his ward, and seemed quite content to be there. Now whether he knew he was in the nursing home, or thought they all worked in a military hospital in Warner Robins, GA, I'll never know, but at least he was calm and peaceful and no one had to drug or restrain him.

Some days I love my job.

WSS

Sometimes ...

Sometimes this job just sucks hot rocks. It's not actually the job that sucks, but who you are called on to help. We're supposed to be working on "them", not "us". If you pray, please pray. One of our own got hurt tonight.

Mothers Day

On Mother's Day, I was able to be a part of the unofficial Dive Rescue Team which was able to save 10 tiny ducklings from a sewer drain.

One of our other squads saw a mother duck acting very strangely near a sewer grate, and so they stopped to take a look. The found 10 of her little ones had fallen through a sewer grate.

We were called in as back up because...um....because that's where Dispatch told us to go. We were bringing some backup supplies. One of the EMTs from the first squad on scene was nominated to get into the sewer to get the ducks. He said the smell didn't bother him because it reminded him of the air at Really Terrible Nursing Home.

So here are two pictures of the GWN Dive Rescue Team in action. I'm not in either of these pictures. And Mom was soon reunited with her ducklings.

Enjoy.

Great White North

So how did THAT happen?

I'm soliciting guesses from the general public as to how exactly I managed to write THREE run reports in one shift for the same patient.  I'll give you a hint.  It wasn't actually a patient as much as it was a deceased individual.

WSS

To all the nurses out there ...

Nurses ... please pay attention.  If you have a patient in ICU who is aged and has recently undergone surgery, especially C-Spine Surgery, and they are about to be transferred by ambulance to a rehab center ... PLEASE GIVE THEM THEIR PAIN MEDS BEFORE WE GET THERE.  

Seriously, if you give them their pain meds on the way out the door, even ON OUR COT ALREADY, the pain meds will kick in about the time the patient gets to the rehab center, but they will endure us lifting and moving them onto the cot, lifting them into the ambulance, DRIVING them around town on streets that are under construction, unloading them from the ambulance, and lifting them onto the bed at the rehab center.  All of these are very uncomfortable activities for a patient who is in a great amount of pain.

Laying on the bed on the other end of the trip isn't so bad, so don't be so worried that she will be uncomfortable when she gets there, but rather please consider the trip and give them those pain meds a half hour before we arrive.

Your patients will thank you, and the EMT who has to sit in the back of the ambulance and listen to the patient moan in pain that YOU could have prevented will thank you.

... WSS

Nursing Home Fail

"Um, she fell" said the CNA.

 

Sigh.  I already knew that.  That's why you called me.  At 2am.  But CNA's are borderline retarded on a good day, so maybe another try will help get me a little information.

 

"Okay, and..."

 

"Um, lemme get the nurse."

 

Fail.  Double fail.  There's an 80 y/o lady moaning and writhing in pain in a wheelchair, its 2am.  Of course she fell.  I knew that before I left the station to come here.  When did it happen?  Wheres she hurt?  Why is she in a wheelchair?  Why is she moaning in pain?  Mental status, medical history?  But no, you don't know anything.  And worse than that, Sandy (not her real name) looks like she's actually injured, seriously injured.  And she is definitely in pain.

 

"Sandy, what happened to you tonight?  Where are you hurting?" I ask, kneeling down in front of the wheelchair.

 

"oh sweet Jesus, oh my leg hurts.  My leg hurts really bad.  Oh, please help me." Sandy yells.

 

Airway check, breathing check, good skin color so we'll give circulation a tentative check.  Quick impression: elderly black lady, in distress, holding her left thigh, left foot/leg rotated outwards 90 degrees, left leg possibly shortened.  Clearly in severe pain and major distress.  No other obvious injuries.  Her right foot is hooked around the left ankle providing the only stabilization she has in the wheelchair.  The "nurse" shows up.  I'll let Cute Medic Partner start a more detailed assessment, I want answers from the nurse.

 

"What happened and whats she doing in a wheel chair?" I ask, not really bothering to hide my anger.

"Oh, well she fell and we pick her up.  Bed alarm went off at 12:30" says the vacant eyed LPN who's English is barely understandable.

90 minutes.  90 minutes since the alarm saying she fell til now.  90 minutes where she has been screaming in genuine pain either on the floor, or worse in your wheelchair.  90 minutes of not calling, and then requesting we come non-emergent.  This goes above and beyond usual nursing home failures.  WAY beyond.  

"How did she fall, and where is the paperwork?"

She hands me the paperwork and I start running through it looking for important stuff, meds, allergies, code status, etc.  But as always with shitty homes, the paperwork has a face sheet, the blurry photocopy of a photocopy of a photocopied med list from last month, and medicare paperwork promising Sandy can have her room back.  The very last thing I could possibly care about is insurance and medicare paperwork.  Its not relevant to me and even if it was relevant, I'd want some actual medical information about Sandy first.  

I turn back to my partner and look at Sandy and try to decided how to get her out of the wheel chair.  If she had been lying on the floor, I could have used about 4 different techniques to get her up with only moderate amounts of pain.  Now, we have to lift her up by hers shoulders and thighs.  Its the only way and its really gonna hurt.

"Sandy, we're gonna have to lift you out of this chair they put you in.  I'm not gonna lie, its gonna hurt alot.  But we'll be as quick as we can."

So we lift and she screams and its horrible.  My partner looks like she about to kill someone, but we stabilize the hip was best we can with heavy blankets and cot straps.  Then the Russian "supervisor" shows up with more useless paperwork.  I do see buried at the very bottom is important info like her last History and Physical and code status (Full Code, of course).

Best part is once we get her lying down flat and no longer putting pressure on the broken hip, we see her left leg is 1-2 inches shorter than her right leg.  and the whole thing is very obviously rotated 90 degrees outwards.  So, Sandy is in for some heavy duty orthopaedic work.

On the way out we've already decided that she needs pain relief in the field.  So the medic partner starts hooking up chest leads for an EKG while I prep the IV supplies and get the blood pressure and pulse ox hooked up.  

"Wait, whats she allergic too?  They didn't mention any allergies and its listed as No Known Drug Allergies in the paperwork."  I ask noticing an allergy alert band on her right arm.

We both search for the paper work.  Its either listed as blank or NKDA everywhere.  So why the alert band?  In the very back of the paperwork is a form saying she is having her routine annual TB skin test and it was started yesterday.  Further exam reveals a circled area of skin on the inside of her right arm.

"You've got to be kidding.  They used an allergy alert band to mark the TB skin test??" my partner asks.  "Tell me even these people aren't that stupid"

"Well, best I can figure, yeah that's exactly what they did.  They are that stupid"

So she starts an IV while I get printouts of the EKG and other vitals signs.  And like a helpful EMT-B, I have the narcotics box pulled out, still sealed, and sitting on the bench next to her before she is finished taping the IV down.

"Alright, lets go, I'll give her this while we get going"

So I start the drive, going 20 mph at the most, weaving back and forth to try to avoid the biggest potholes.  We finally make it to the ER all the way across town and get her inside.  4 mgs of Morphine have definitely helped, but she's still obviously in major pain.

While we give the report to the ER nurses they look at us like we're pulling a joke when we point out the allergy band and the 90 minutes sitting on the deformed, probably broken hip in a wheelchair before we arrived.

"No, I couldn't make up that sort of abuse if I tried" says my partner.

We wish Sandy good luck, and I go start cleaning up the back of the rig and the cot while Medic Partner finishes paperwork.  Then we get a nurse to watch her waste the extra Morphine into a bio container and its time to clear.  We still need to fuel and we might have a chance to get 2 hours sleep if we're lucky.  We weren't that lucky but we did get to talk to Awesome Dispatcher about the nursing homes massive screw up when we went to get more narcotics.

Just another day in paradise....

GWN

Media Frenzy = Mass Hysteria

Ok ... seriously.  Enough with the swine flu thing.  Even though most Americans can't spell it (top search on google = swine flue), most of us think we have it.  

However there may be a tiny bit of confusion related to how one contracts this illness.  Yes, you can get it if an ill person coughs or sneezes on you, and you do not wash your hands, and you stick your fingers in your mouth.  Yes, you can get it if an ill person uses a telephone and you come along behind them and use the same phone and then do things to help the little germies work their way inside your body.  Yes, you should probably avoid unnecessary travel to remote villages in Mexico where pig farming is a primary source of income and avoid contact with persons who have fever, chills, sweats, coughs, sneezing and so on.  (I also avoid contact with people who spontaneously burst into song, but that's just me.)

However, please, please do all my friends who work in ER's the world over a huge favor, and listen to this.  

If you have NO symptoms, and you feel fine, please do not walk into your local ER and demand a test for swine flu because you have recently had contact with your relatives who live in Mexico ... BY TELEPHONE.  

Seriously.  I know it's hard to believe.  But no ... you just can't get it that way.  For real.  I mean it.  Stop making those faces.  That's not how you get it.  Really.  Now take off the yellow mask and go home.

It's gonna be a wild one when ...

WSS says ...

When you and your new partner are tending to one patient, and two more wander over and decide that your current location is the new triage area, and PD says to you, "Ok, we have a group of people standing in a circle around your next patient so he doesn't get stepped on ANY MORE" ... it's about to get interesting.

I'll explain more later.  But suffice it to say ... it did get interesting.

Great White North

Once upon a time, which was actually yesterday, I had a strange patient. A nice little Asian lady, who practically ran when she saw me. Which made me a little confused.

We were called, with lights and sirens, to an intersection in the really ghetto area just north of one of our stations for....wait for it....a nosebleed. So I flipped on the flashy-flashy's and started heading in that direction. While we drove, I reminded my very new partner about how to best deal with epistaxis. And we mused about why we'd been called to an intersection rather than a specific address. But much more bizarre things have happened in the ghetto of the Great White North. I was also secretly keeping my eyes open for any sign of an assault since face punching can cause nose bleeding.

So we roll up and stroll over to the city bus when a woman with a bloody nose standing at the door. No one mentioned a bus, but I'm flexible.

"So, happened here ma'am?" I ask as I look at the mostly dried blood on her hands and upper lip.

"I just want to go home. Please, I live right around the block. My daughters waiting for me, please." says a very anxious Asian lady in her 40's.

"Well, my partners gonna take a quick look at your nose and help get you cleaned up. Is that alright?"

I go over to talk to the bus driver. She says the woman was sleeping, woke up with the nosebleed, asked her frantically to call 911 and then tried to leave once we were on the way. Only hearing the sirens in the distance made her decide to wait an extra minute for us to arrive. Apparently the woman was a semi-regular on the route, but never acted strangely before.

The nice lady, who's name I never managed to get, was adamant the needed to leave. So I ran though a very quick mental status check. Since she was alert and oriented, I asked her to wait a moment while I got a refusal form. But this 2 minute and 37 second encounter was already taking way too long for her and she started speed-walking down the street.

New Partner had to run down the street just to get her to sign the refusal form. All we managed to determine was the nosebleed was non-traumatic, she had a history of hypertension,she didn't take her meds today, she needed to go to her daughters house and she was oriented appropriately. Her English was fine, so I don't think it was a communication problem, but her anxiety level had been though the roof as soon as we rolled up. The bus driver and I exchanged unit numbers for each others reports and we drove around the corner to go write up the report.

I still don't know the patients name or why she was so intent on leaving. My best guess is that the anxiety and hypertension combined with the lack of meds caused her nosebleed. And that she realized there was some time-sensitive reason that she needed to be at her daughters house right away. Maybe she was supposed to watch one of the daughters small people (children).

But New Partner learned how to write up refusals and we got to go back to the station and wait for the next call.

Just another day in paradise.

GWN
(Great White North)

From the top ...

WSS says ...

(That's Warm Sunny South, as opposed to GWN or Great White North)

I thought I'd get the ball rolling by just mentioning a few things I've learned in my very brief career in EMS thus far.  In no particular order, I have learned.

• If you are 15 and weigh 90 pounds you should not drink so much.  Or at all.
• Texting while driving is a really bad idea.  Cars roll over and if you're LUCKY your cell phone gets destroyed.  If you're not so lucky other things get kinda broken.
• Rearranging furniture that is much heavier than you are ... at 3AM ... bad idea.
• If you stop and think "yanno, I should move my hand before I cut open this box" ... move your hand.  You'll thank me.
• Whether you're 30 days old or 89 years and 11 months old it is in your best interest for the people in the ER to do what they need to do to make you better.  It would be good if your parents or caretakers understood that.
• Jumping out of moving cars is a bad idea.  Young or old, sober or intoxicated ... for kicks or for some reason you seriously can't remember ... it's not going to end well.
• The people in the ambulance and the ER are going to do everything in their power to make you better.  However they will WANT to do it more if you're nice to them.
• No matter how much you are convinced that you live on a military installation, if you do not have proper ID and authorization to enter, the powers that be are not going to appreciate your multiple attempts to enter.
• Sometimes bad things happen to good people.  It sucks.
• Sumdood* is alive and well the world over.
• Polite goes a long way, no matter which direction its coming from.
• We cannot choose our genetics, but we can make a LOT of choices regarding our health.  Making good choices does not guarantee perpetual good health, but making bad choices WILL catch up to you one day.  Don't act so surprised when it does.  All of those health studies include you too.
• Everyone should learn CPR.  Everyone.  Everywhere.
• You should wash your hands more often.  Seriously.  Yes, you.  I mean it.  With soap.  Often.
• Golf Carts can be dangerous.
• "Pull to the right for sirens and lights" applies to you.  I don't care if you're driving a (insert important person's car here).  LET US THROUGH, GENIUS BOY, NEXT TIME IT MIGHT BE YOUR DUMB A** WE'RE TRYING TO SAVE.
• Older people are still people.  They've seen a lot.  They're worth listening to.  You might learn something, hotshot.
• And finally ... I've learned ... that I have a LOT to learn.

* Credit for identifying the phenomenon known as "Sumdood" goes to Ambulance Driver.