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Questions I'm frequently
asked about my book and life in the ER
Q: How did you get so many ER stories?
A: Good question. I used to assume that all experienced
ER physicians had a repertoire of a few hundred good stories, but I eventually
realized that I had far more than my share. How did I get so "lucky"?
I've spent more than a few sleepless hours wondering about this, and here's
what I've come up with:
Many of the nurses with whom I worked swore that I attracted unusual patients
with unusual problems. I used to believe that such a supposition
was statistically unsupportable. To make a long story short, my faith
in statistics is now seriously eroded.
Most of my time in the ER was spent working the night shift. Whenever
I'd work other shifts, I was struck by how normal the patients were.
If I had to write a book of daytime ER stories, it would be so thin it
wouldn't be worth printing. After midnight, though, I'd often be
inundated with one strange case after another.
Although some people wish to believe otherwise, there are regional differences
in behavior. I have worked in emergency rooms in both rural and urban
settings, and the patients in those areas are demonstrably different.
However, it has been my experience that most of the oddball cases come
from the suburbs. Some suburbs are filled with so many wacky people
it is a wonder that the government doesn't spike their water with Haldol
or some other antipsychotic drug. As luck would have it, I spent
most of my career working in areas that had a high percentage of unusual
people who did unusual things, thus giving me a lot to write about.
I seem to possess a genuine ability to extract latent oddity that other
ER docs might gloss over. For example, a patient with a finger cut
casually remarked that he was a cover model for Cosmopolitan magazine.
Most physicians would probably think, "Yeah, right," and just sew up the
cut. But not me. I pursued the matter and learned he claimed
to have a date later on that day with Jackie Onassis, and that Michael
Jackson wanted to kill him. In less than a minute I'd gone from a
straightforward ER case to something so odd it could be the top story in
the National Enquirer.
While most of the stories in my book were ones that I experienced, several
were contributed by my colleagues—for which I am eternally grateful.
Q: Why have some of the contributors to your book insisted upon anonymity?
A: Probably because they’re afraid of retaliation by their employers, who
don’t like to have light shed upon some of the things that occur in hospitals.
I think that hospital administrators are primarily afraid of how the public
might react if they knew how much of their money is being wasted on cases that
are really nothing more than shams. I also think that administrators are
attempting to impose an overzealous and lofty standard of professionalism. One
need only look at the termination of ER nurse Darva Conger (of Who Wants to
Marry a Multimillionaire? fame) to realize that healthcare workers can be
whimsically dismissed for engaging in extracurricular activities that are
entirely legal but, for one reason or another, rub some administrator the wrong
Q: What do you think of the television show ER? Is
A: I don't watch it very often.
It's more realistic than medical shows of the past, but it has a long way
to go to achieve true realism. Achieving medical realism on a TV
show, I realize, is a challenge. However, there is much they could
do to capture more of the essence of life in a real ER. Their writers
seem to be stuck in a rut, and I'm bored by their minor variations on the
Q: What about the new* show, City of Angels?
A: From what little I’ve seen of it, I’ve been put off by the fact that
it seems to be filled with too much intensity, rage, and stereotyping. In short,
it’s a wildly inaccurate depiction of what really goes on in hospitals.
(*It was new when I originally posted this, but it was canceled years
Q: What do you think of Grey's Anatomy?
A: First, I think the name itself is a double-entendre with a simultaneous
allusion to Gray's Anatomy (the venerable medical text) and to the
anatomy of the show's protagonist, Dr. Meredith Grey, whose attractive body ends
up in bed with a surprising number of men, thanks to her perennial angst and
penchant for booze. As the series evolved over the first few years, the focus
shifted from Dr. Grey to other cast members with more pulchritude, most notably
Dr. Isobel "Izzie" Stevens (Katherine Heigl).
From what I've read, the producers of Grey's Anatomy attribute its
success to its medical realism. While a few aspects of the show are indeed
realistic, it is primarily just a soap opera with a medical theme. I think its
writers are running out of good ideas, because lately some of the content has
been decidedly less realistic than typical soap operas. In fact, I have
repeatedly wondered if the show's medical advisers are being held hostage
somewhere because Grey's Anatomy is so incredibly unrealistic that
it grates on my sensibilities as a doctor. I am not alone. Dr. Orin Guidry,
President of the American Society of Anesthesiologists,
sent a letter to Peter Horton, Co-Executive Producer and Director of
Grey’s Anatomy, complaining about the number of factual errors in the show.
I could literally write a book describing everything about the show that is
unrealistic. The producers and writers of Grey's Anatomy obviously
believe that this unrealistic material is more intriguing than what happens in
the real world. I disagree. If the writers of Grey's Anatomy read my
Emergency Room Stories and
Love & Lust in the ER (the latter is a free download), they would find
lots of "it really happened" fodder that is more captivating than their fiction
(note to the producers of Grey's Anatomy: Don't try taking my story ideas
without compensation). As I proved in my books, stories can be real and yet
spellbinding. Truth is stranger than fiction any day.
Q: Do you believe that the television shows have overglamorized what it’s
like to work in an emergency room?
A: Definitely. 98% of what we do in the ER is fairly dull and repetitious,
and 2% is exciting. Naturally, they show the glamorous 2%.
Q: Is it ethical to write stories about patients?
A: Apparently so, given that I'm hardly the first doctor to do
this. Clearly, it would be unethical to mention a patient's true
name—which I never do.
Q: Are you worried that any of the patients you mentioned in
your book will recognize themselves, get mad, and try to kill you?
A: I'm not very worried, for the simple reason that most of the
patients whom I depicted in an unfavorable (but accurate) light are people
who likely do not spend much time reading books.
Q: What inspired you to become an author?
A: I like to write. In the case of the ER stories, I noticed
that there aren't many other books available written by ER physicians,
and even those books are somewhat constrained in their range of stories.
I decided to inject an ounce of realism into the literary world.
Q: I want to be an ER doctor—and not just any ER doc, either.
I want my colleagues to think that I'm topnotch and a real star.
A: Certainly. First, you must understand that the competency
of an ER physician is often viewed as being proportional to the speed with
which he can move patient charts into the discharge bin. You know,
treat 'em and street 'em. However, the primary stumbling block to
achieving this goal is that patients often present with more than one problem.
You won't be getting any bonus points or gold stars for attending to these
other problems. In medical school you will be taught that you should
listen to your patients. This is utter nonsense. If you listen
to your patients you might actually discover an important medical problem
which needs therapy. However, dealing with this problem will slow
you down, and you will not be a star. You have to ask
yourself what is more important: being
a hotshot ER doc or not sending scores of people to an early grave?
If you answered the latter, you obviously don't have "The Right Stuff."
To achieve your goal of moving on to the next patient as rapidly as
possible, you must not make the mistake of performing a complete examination.
Years ago, I knew an ER resident who was viewed as being a star.
How did she achieve this? By omitting totally superfluous components
of the exam. For example, one patient presented to the ER with a
gunshot wound to his leg. Little Miss Star did not check distal neurovascular
function, since she knew that checking pulses, strength, and sensation
are trivial matters and would only slow her down, thus tarnishing her stellar
reputation. Instead, Little Miss Star scribbled on the chart that
the patient had a "left leg gunshot wound." This was both the history
and the physical exam . . . and the diagnosis. See how brilliant
she is? Yes, it takes years of training to achieve such acumen.
Mere mortals, like us, would probably spend from now until eternity figuring
out that the patient had a gunshot wound in his left leg. The pen
with which she reached such a penetrating observation is now on display
in the National Archives.
The bottom line is this: speed is paramount, and thoroughness
is irrelevant. We live in a culture which glorifies speed and those
who achieve it. Patients are simply obstacles in your path, and the
sooner you learn to give them short shrift, the better your reputation
will be. The patients, or your reputation? It is not a difficult
decision. The history books, Hollywood, and the Nobel Prize Committee
are waiting for your answer. Do not disappoint them.
second-year medical student wrote to me asking for advice on how he could
impress his ER attendings (supervising physicians) enough to obtain an ER
residency position. In my response to him, I forwarded the above
paragraph, then continued.) Obviously, I was being facetious (although one ER doc literally interpreted my tongue-in-cheek comments . . . leading me to wonder if he's manifesting incipient Alzheimer's disease). However, like most humor, it is based on truth. Little Miss Star really exists, and her amazingly
superficial exams truly did impress her attendings. The impetus to "treat 'em and street 'em" is often joked about, but it's SOP (standard operating procedure) for many ER docs. I could give you hundreds of other examples of patients being given short shrift, from an ER doc who failed to detect a severed digital nerve because he thought all was A-OK because the patient could move his fingers, to my brother who was almost paralyzed from a vitamin B-12 deficiency which four docs, two of whom evidently didn't think that physical exams are a worthwhile expenditure of time,
misdiagnosed as carpal tunnel disease. That was a nightmare for our family, so I'm a bit touchy about this subject of glaringly superficial exams, and it grinds me that the docs who habitually engage in such practices can be revered instead of reviled. Notwithstanding my personal feelings, the fact remains that speed in emergency medicine is glorified, often even when it is at the expense of accuracy and thoroughness. I don't live in a dream world, and I know that because of time constraints it isn't always feasible to not cut corners in a busy ER. Yet I've seen too many cases in which ER docs are
superficial even when time is not an issue. I've heard a couple docs attempt to justify this practice by saying it's the only way for them to keep "in the groove" for speed -- presumably, if they ever did a complete exam, they fear they'd somehow forget how to cut corners. It may be too much to expect a rat navigating a maze to possess a repertoire of behaviors to adapt to changing circumstances, but is it really too much to ask a physician to do this? I don't think so, but a distressingly large number of docs think speed trumps all in the ER. Hence, if you wish to impress your
attendings, find out what yardstick they're using. If it's "speed is #1," you have a tough choice:
do you give them what they want (and thereby give patients the short end of the stick), or do you forgo speed for the sake of speed? Do that, and you probably won't become an ER doc -- and thereby won't become someone who might work to change our wacky system in the future. Tough choice? You bet. I'd continue this exegesis, but I haven't had enough coffee today.
Q: What was one of the most bizarre injuries you've seen?
A: A 20-year-old woman presented with a perfectly circular cut
around one of her nipples. Initially, she professed to have no knowledge
of how the injury occurred, which I felt was a bit less likely than impossible.
Eventually she admitted that she had inserted her nipple into the end of
her vacuum cleaner hose so as to make the nipple swell up. She did
this because she was on her way to the beach. As everyone knows,
engorged nipples are one of the requisite accouterments to the augmentation
of intersexual appeal. Without it, a day at the beach just wouldn't
be the same.
Q: Would a vacuum cleaner really make nipples larger?
A: I've been too busy lately to spend much time enlarging my
nipples, so I can't give you a definite answer. The maximal vacuum
produced by different vacuum cleaners varies widely, but I doubt that any
standard vacuum cleaner would have enough suction to induce much enlargement.
However, I do know that vacuum pumps can create a vacuum sufficient to
produce a substantial enlargement. In fact, one company makes vacuum
chambers specifically for this purpose. For those who are especially
adventurous, they also offer a vacuum chamber for enlarging the entire
breast. First, the good news: it actually works. Now
the bad news: the effect is temporary. You'll probably outlast
Cinderella and make it past midnight, but 95% of your gains will have dissipated
by the next day. We live in a cruel world.
Science of Sex, I discuss some techniques that produce permanent
breast enlargement without surgery.
Q: Where did you learn all this stuff?
A: One of the benefits of being an ER physician is that you get
to meet a wide variety of people, some of whom engage in occupations in
which the enlargement of certain body parts is critical to their success.
Perhaps not surprisingly, these folks tend to be rather outgoing, and their
loquacity has given me information that I could never find in any medical
Q: What was the strangest thing you've ever heard about as
an ER doctor?
A: Given that a significant percentage of ER cases would merit
being termed "bizarre" in anyone's vocabulary, asking me which is the strangest
case is like asking Bill Clinton who was his favorite extramarital sexual
partner—with so many to choose from, how can you tell? It's a tough
choice, but here is one that stands little chance of being published in
the Reader's Digest:
Carl returned from a week-long business trip late Friday night.
As he was wont to do, he stopped by a bar on his way home and got totally
blitzed. He staggered home and collapsed next to his wife in bed,
quickly falling asleep. When Carl awoke in the morning he felt extremely
nauseated and he ran into his bathroom and vomited a few times. Initially,
he assumed that the nausea was merely the result of his alcoholic binge
the prior night. However, when Carl returned to his bedroom he was
overcome by the fetid smell which permeated the air. He massaged
his wife's shoulder to wake her up so he could discuss this with her, but
she wouldn't wake up. She was dead, and had been decaying in bed
for a few days.
Q: How about something less likely to cause nightmares?
A: OK, I'll give you a heart attack story . . . but not just
any heart attack story. In reading other books of this genre, I've
learned that many authors are overly impressed with heart attack cases,
believing them to be the sine qua non of a good book of ER stories.
In my opinion, there are only so many interesting ways in which a coronary
artery can clot off. After I've read, "He's in v-fib, Jimbo!
I'll shock him with 200 Joules! Everybody clear!" in one story, I
need an intravenous infusion of caffeine to keep awake through the next
one. Consequently, the only heart attack stories which made it into
my book were ones that have some unusual twist to them. I won't bother
repeating the stories in the other parts of this book (which are far more
interesting than this one), but I will mention one that should intrigue
readers with a medical background. I had a young police officer as
a patient who suffered an MI (myocardial infarction, or heart attack) when
he was shot in the chest while wearing Kevlar body armor. The
bullet didn't penetrate the vest, but the impact hammered the anterior
(front) wall of his heart with enough force to severely damage it.
He survived, but he had the heart of an 88-year-old cardiac cripple.
It's like aging 60 years in a split-second.
TRUE Emergency Room Stories
by Kevin Pezzi, M.D.
Now available as a
free e-book download
What really goes on in emergency rooms? If you're a fan
of the television show ER, you might think that you know. Not so,
asserts Kevin Pezzi, M.D., an ER doctor and author of True Emergency Room Stories. Pezzi says the show ER only
scratches the surface; the truth is far more interesting — and bizarre.
So bizarre, in fact, that the cases could shock even an experienced ER
physician. "I'm now a firm believer in the saying that truth is stranger
than fiction," he says. "I don't think that anyone could dream up such
Pezzi's book is packed with nothing but unusual stories. There are no
"the patient's in v-tach, shock 'em with 200 J and give 'em 100 mg of
lidocaine, stat" type of cases. While such cases are a mainstay of the
show ER, Dr. Pezzi believes that they quickly become repetitious.
Instead, he presents an amazing collection of true stories. The book
begins with a story of how he may have saved Michael Jackson's life by
averting an assassination attempt by a person who claimed to be a
Cosmopolitan cover model, and ends with an interesting tale of how he was
propositioned on a beach by a relative of a recent ER patient. In
between, he recounts stories of unusual murders and other crimes, truly odd
reasons for dialing 911, unfathomable reasons for visiting the ER, and people
with an extraordinary affinity for their pets. Then there's a shocking
end to a pregnancy, a twisted tale of revenge that would be a spellbinding
plot for a movie, and the story of a man who attempted to remove his liver at
In this book, you'll accompany Dr. Pezzi as he meets the world's unluckiest
man and woman, deals with people who have strange requests, and attends to a
bride whose genetic disorder wasn't discovered until her wedding night.
There is also the story of the man who didn't know that he had been shot in
the head, and the case of the pit bull who picked on the wrong person.
True Emergency Room Stories has something for
everyone. Besides the strange cases, readers will be captivated by
dozens of incredible, tragic, humorous, steamy, heartwarming,
thought-provoking, and poignant tales.
Q: Have you ever done anything in the ER that you regret?
A: Yes. I had a teenager whose face had been severely mangled
in an accident. Despite the numerous cuts, I could tell that she
was stunningly attractive, and I felt it was my duty to do everything I
could to restore as much of that beauty as possible. I regret that
I did the surgery myself, instead of calling in a plastic surgeon.
While I think I'm more skilled than an average ER physician in such repairs,
I've since been haunted by the knowledge that the plastic surgeon may very
well have done a better job. On the other hand, I had another young
lady with a similar injury be so grateful to me for her virtually perfect
result that she gave me all sorts of free stuff. As it turned out,
the merchandise didn't belong to her, but that's another story.
Q: Any other regrets?
A: Now that you mention it, yes. A young woman once told
me that something happened to her when she had been with a friend of her
father. After she said this, she clammed up. I had no idea
of what the problem may have been until a few years later when I read several
news reports about one of the unusual customs of a particular religion:
namely, fathers lending their daughters to their male friends as sexual
concubines. I was shocked that such a practice could continue in
this country, but it happens every day. How could any father—let
alone one who professes to be devoutly religious—allow that to happen to
his daughter? I don't know. In any event, I regret not being
worldly enough to consider the possibility that she was being sexually
Q: Any more regrets?
A: Yes, not shooting a certain resident under my tutelage.
I used to work as an attending ER physician in a teaching hospital, where
one of my responsibilities was teaching residents in the ER. One
day, one of the residents was suturing a patient's laceration without using
any sterile field. Instead, he was just dragging the suture across
the stretcher—which is hardly sterile. When I admonished him for
this, he told me that it "didn't matter." On the contrary, it did
matter, and he was the first physician educated since the Germ Theory of
Disease was accepted as fact in the 1880s to asseverate that the introduction
of germs into wounds was inconsequential. While he should have learned
sterile technique in medical school, I was not upset merely because his
position was ludicrously untenable. What bothered me is that this
Texas dude had the gall to tell me that he was just going to keep on doing
what he'd been doing. Thus, he was not merely ignorant, he was stupid.
To save untold thousands of future patients from being victimized by this
idiot, I should have pulled out my pistol and erased everything north of
Q: Do you have any nominations for the Darwin Awards?
A: Naturally, but first a brief word of introduction for the
uninitiated. Charles Darwin was the originator of the modern concept
of evolution, which holds that individuals with the most adaptive traits
are the most likely to survive and pass their genes on to subsequent generations.
In a nutshell, it's survival of the fittest. Darwin, who dropped
out of medical school, apparently gave little thought as to how his theory
of evolution may have applied to his personal life. Darwin married
his first cousin and had ten children, three of whom died in infancy.
The Darwin Awards are an extrapolation of Darwin's theory that superior
individuals are the most apt to survive, and inferior individuals are the
least apt to survive. As such, the Darwin Awards are essentially
Emmys for idiocy. In other words, people who are too stupid to live
usually have abbreviated life spans. Other than frolicking in the
sack with his cousin, Darwin was a politically correct man a century before
anyone gave serious thought as to how to euphemize thought control.
Consequently, Darwin did not conceive of the Darwin Awards. Credit
for that must go to the person who realized that natural laws never seem
to lose their relevance.
Without further ado, here are a few nominations for the Darwin Awards:
Q: Do you still work in the ER?
It's after midnight during a raging blizzard. Most folks with brains
are nestled into a cozy bed, but not Derek. Attending to one of those
pressing tasks which often face unemployed people at 2 a.m., Derek was
walking down the middle of a five-lane road while wearing dark clothes.
You can guess what happened to him.
Josh was sucking on the end of an ink pen while listening to music (and
you think your life is boring??). Ink came out of the pen and
coated the inside of his mouth a nice Bic® blue. As Josh inspected
the inside of his mouth by looking into a mirror, he panicked because he
had a date later in the evening and he doubted that his Smurf-tinged mouth
would harmonize with his macho image. Ah, such an ill-starred inconcinnity!
He tried rinsing his mouth with water, but Bic® ink is not very soluble
in water. He tried sloshing around a mixture of detergent and water,
but even that didn't work. He knew that gasoline dissolved ink, because
he'd previously used it to dissolve ink stains on his clothes. Gasoline
is toxic, and he knew that, but he had no intention of swallowing it.
Nah, he'd just swish it around and spit it out. Guess what?
It worked! Josh was so relieved that he sat down to have a cigarette,
apparently forgetting that gas vapor is explosive.
Ed had a number of hobbies, which ranged from gardening to making pipe
bombs. Other than an occasional insect bite, he never got into much
trouble with the former hobby. His affinity for explosives was another
matter. After making a bomb one day, Ed was miffed that the darn
thing wouldn't explode. He didn't want to waste the expensive gunpowder
in the bomb, so he decided to salvage it by cutting the pipe open to pour
out the powder. As he was doing this, he discovered that his bomb
wasn't a dud after all.
A man with an affinity for kitchen utensils presented to the ER after he
underestimated the depth of his blender in comparison to the length of
his penis. He either had incredibly quick reflexes, or his withdrawal
was expedited by the pain of being whacked by a blade tine spinning at
22,000 rpm, because his injuries were surprisingly minor. He justified
this activity by saying that he didn't have a girlfriend—and apparently
no Vaseline, either. Although I was not particularly interested in
hearing more, he explained that the sensory delights of the swirling peaches
was simply irresistible.
A: I am many things, but I'm not insane.
Q: I'm an ER resident, and I'll soon be graduating and starting
to work at a new hospital. I've noticed that the relationship between
ER doctors and the hospital administration is often strained. Any
tips on how I can best harmonize with them?
A: Of course. For starters, you might want to avoid writing
an exposé such as this. The hospital brass takes a pretty
dim view of anything that might interfere with their cash cow. For
example, one of the patients I mentioned elsewhere in this book was injured
when she fell through a glass table at the home of the town's richest man,
who was a longtime benefactor of the hospital. The woman was rather
inebriated, as you might imagine. She was married, too, but her husband
wasn't with her. Does the word "scandal" come to mind?
Within a few seconds of her hitting the door, she was in what could
be best described as a catfight with one of the nurses. I knew that
I'd have to be the one to take care of her injury, and I didn't want an
angry patient to work on, so I intervened. I think I was a bit too
nice, because the patient was fondling my genitals less than an hour later.
I'll leave the remaining details for you to explore as you read that story
or, should you choose to skip it, to your imagination.
When the administration found out that I was going to write about this
(even though I didn't include any names), they threw a conniption fit.
Hospital administrators are not ardent supporters of the First Amendment,
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Q: Why is there sometimes an adversarial relationship between
doctors and nurses?
A: Apart from the potential personality conflicts which can develop
in any workplace setting, I think that there are a few primary causes of
this tension, such as:
Some physicians still think they are either God, or God's Right Hand Man,
and everyone else is a member of an inferior species. This delusion
is far less common than it once was, but a few physicians find that by
clinging to this fantasy they can maintain their self-esteem at an unjustifiable
high. While some doctors do help people, many doctors just pass out
pills to people that they would be better off avoiding.
Some nurses have an overblown sense of how much they know. I have
had the pleasure of working with some truly excellent and knowledgeable
nurses, but I've also worked with nurses who like to think that they know
more than the doctors. I have yet to meet a nurse who could do something
as basic as a complete interpretation of a 12-lead EKG (not just spotting
an obvious MI), so I'm not sure what objective basis they have for thinking
that they know more than doctors. In my opinion, the greatest value
of a good nurse is his or her clinical judgement and experience, not their
ability to match wits with a doctor on a test of medical knowledge.
(Warning: don't read this section if you are
convinced there are no differences in the way men and women think.) Most doctors are men and most nurses are women. I’m
certainly not the first person to think that men and women have very different
ways of viewing the world. I used to think I could treat women that I worked
with the same way I treated co-workers who were men, but my boss didn’t
agree. He took me into his office and, in a very avuncular way, informed me
that he had learned through the School of Hard Knocks how to best harmonize
with nurses. Basically, he told me to treat them with kid gloves—to baby
them, in other words. He said that women are often fueled more by their
emotions than they are by logic.
My first reaction was that this was a very condescending
and sexist attitude, but I eventually learned that there is some merit in his
message. If you’re already taking umbrage at its apparent offensiveness, you’re
just proving the point that your emotions reign over your logic. It’s
politically incorrect, but it is true, and it is one of the delicious
distinctions that make men and women different. Our brains are
different, our emotions are different, and our neurochemistry is
different. Frankly, the emotional softness of women is one of the things that
men find appealing—and vexing, too. In the workplace, this dichotomy of
mindsets creates friction between the sexes. Men can’t understand why women
cannot see things with more logic and less emotion, especially in view of the
fact that emotion is often a comparatively superfluous ingredient in the
success of running a life-and-death business such as an emergency room.
Let’s briefly consider the case I presented in
the book in which one of the nurses I worked with almost had a nervous breakdown
after I calmly mentioned to her that she should do her own patient assessments
and not rely upon the diagnosis rendered by a security guard. Not
surprisingly, the security guard’s diagnosis was dead wrong. What was
surprising to me was that this nurse—who was actually a bright person and
was otherwise a decidedly above-average nurse—would blindly accept the
conclusion of the guard without doing her own assessment. And this was no
minor error, either: the patient in question had suffered a cardiac arrest,
and every second in which the nurse was behaving as if this was no big deal
just brought the patient that much closer to death or permanent brain injury.
As luck would have it, I happened to be near the hall that
connected the ER to the waiting room, where the patient had collapsed.
Nurse: (seeing me approaching) It’s a seizure.
Dr. Pezzi: (thinking, yeah, and I’ve got Nikki
Cox begging me for a date, too) Does she have a pulse?
Nurse: I don’t know, I didn’t check. The guard said
she had a seizure. He said she twitched.
Dr. Pezzi: (checking for a pulse and breathing) She’s
not breathing, and she doesn’t have a pulse. Let’s start CPR.
I grabbed the defibrillator, used its "quick
look" paddles* to read her cardiac rhythm (ventricular fibrillation), then
I shocked her and restored a normal rhythm. She was given some additional
treatment in the ER, then transferred to the CCU. Afterward, I mentioned to
this nurse (who was a friend of mine) that she should do her own assessments
and not rely upon the conclusions of a guard or other nonprofessional. I also
mentioned that a patient may jerk if he passed out because his heart stopped
beating. This is sometimes misinterpreted as a seizure by some people (and I
thought, ahem, lay people).
* Most defibrillators do more
than just deliver shocks. The same paddles that carry the jolt of electricity to
the patient can also be used to pick up the electrical activity of the heart (as
does an EKG machine) and display it on a monitor built into the defibrillator.
I thought my interaction with the nurse in this case was
rather straightforward. I passed along the above tidbit and asked her to do
her own assessments. Big deal, right? The nurse didn’t think so. She went on
a crying jag for hours, pouted for the next few weeks, then quit working in
Sheesh! If she were a medical student or resident and
had made a comparable mistake, one of her supervisors would have ripped her
apart. Rather than placidly discussing it as I did, most of them would have
peppered their diatribe with incandescent invective. Doctors often become
incensed when they think patients have received substandard treatment, and
they usually aren’t shy in relaying their opinions. Contrary to what most
nurses think, doctors in general are much harder on their colleagues than they
are on nurses. The worst upbraiding I’ve ever seen directed at a nurse by a
physician was a mere slap on the wrist compared with the lashing that docs
sometimes unload upon one another. I know of cases in which physicians,
probably overwrought with compunction, thought this was too much to bear so
they committed suicide. The most dramatic case was when a resident walked over
to a hospital window and jumped out, splattering himself on the sidewalk
several stories below. A less tragic but still newsworthy case occurred when
Doc A, after a heated discussion with Doc B, chased him for over an hour on
the freeway to continue the argument in Doc B’s driveway.
So why all the acrimony? The answer is obvious: people’s
lives are at stake. With so much on the line, it is understandable that
tempers will occasionally flare. Physicians are typically very anal,
perfectionistic people, and nurses sometimes mistake this perfectionism as
arrogance, especially when a doc lets a nurse know that he isn’t satisfied
with something the nurse was doing. Yes, there are doctors who are truly
arrogant, but this is more common in the old-timers. In all my years in
medicine, I’ve seen only a handful of docs who deserved to be called
arrogant. However, nurses bandy about the term "arrogant" so often
that I think they’re taught a definition of it in nursing school that isn’t
in the dictionary. All the whining and moaning by nurses about this subject
has done nothing except create an unwarranted stereotype.
As is the case with most stereotypes, there is some
collateral damage that accompanies the rhetoric. Seeking to minimize the risk
of their being labeled "arrogant" or abrasive, docs often turn their
intensity back a couple of notches. Is that good? Not in my book. How much
more laid back can we be without being mute and turning the farm over to the
nurses? When I spoke to the nurse mentioned above, I did so as if she were a
beloved sister, yet she came unglued. I suppose the only way I could have
gotten along with her was to sycophantically tell her she was right even when
she was wrong just so that she could maintain her self-image at an
unjustifiable high, or I could have just ignored her error altogether.
However, if it was your mother who was the patient, I think you’d
implicitly expect the doc to not let such a potentially devastating error
slide by as if it were less important than a batch of bad fries at McDonald’s.
Some physicians resent this need to curry favor with nurses
by treating them as if their actions were beyond reproach. In my own career, I
became so disgusted by this petulant "treat me with kid gloves or I’ll
scream" attitude that I eventually gave up and ignored all kinds of
errors. I’m not proud of how I abandoned my standard of perfectionism, but I’m
certainly not the first person in the world to relinquish my standards just to
keep on getting a paycheck.
Collectively, nurses have done a great job convincing the
public that nurses care more about patients than doctors do. That’s just a
lot of hogwash, but I see nurses patting themselves on the back all the time
as they relish in this self-serving deception. Sure, nurses talk the talk, but
do they walk the walk? If they’re so caring, then why are they giving docs
such a hard time about delivering the perfect care that patients deserve?
Fortunately, not all nurses are this way. Some of them are
dedicated, bright, caring, and diligent people who do a wonderful job and are
a pleasure to work with. I’ve worked in emergency rooms in which the
majority of the nurses were topnotch, yet I’ve also worked in places in
which most of them were bad apples. In those latter facilities it could be
that the bad attitude of a few spread like a cancer to infect the others.
Some of the battles that I fought with nurses were
unimaginable. There was one nurse, for instance, who evidently had no
conception of a sterile field. He would routinely touch something in the
sterile tray that was holding the instruments I was using to suture a patient’s
cut. I reminded him umpteen times that he couldn’t touch anything that was
sterile with his unwashed, ungloved hands, and he’d just argue with me—in
front of the patient, nonetheless—that what he was doing was OK.
How can such an idiot be allowed to work in an ER, or even
a dog kennel for that matter? The answer is simple: doctors do not run most
emergency rooms. Nurses are fond of saying that they run the ER, and the docs
just work there. In most hospitals, that’s true. The ER director is usually
a nurse who is employed by the hospital, and the ER docs are usually a group
of independent contractors who have virtually no say in hiring or firing
decisions. I think this is ridiculous. In general, it’s a good idea for
those who have the ultimate responsibility to be given the tools and power
they need to get the job done right. Physicians are under a lot of pressure—from
patients, state medical boards, hospital committees, lawyers, and ultimately
from themselves—to ensure that every patient receives optimal treatment. I
think physicians resent being subjected to this pressure without having
control over some of the variables. For example, one of the nurses I worked
with for three years had Alzheimer’s disease. The nurse in charge of the ER,
Sally, wouldn’t fire her because she’d been there a long time (no
kidding!) and needed the paycheck. So who cares if she is one of the gang and
needs money—who doesn’t?
This is obviously an extreme example that illustrates how the decisions of
some women are based more upon emotion than logic. Would most women who are
head nurses make a similar mistake? Certainly not. However, after having
worked with both sexes, I believe that women are more likely than men to let
emotions cloud their thinking. To get back to the original point of this
discussion, I think this different way of viewing the world contributes to an
adversarial relationship because neither sex can entirely understand what the
other is thinking.
Believe it or not, but I'm not anti-nurse, nor are most
doctors. Physicians are generally appreciative of the work performed by
nurses and we give respect when it's due. Personally, I can think of
several nurses that I hold in such high esteem that I think their faces should
be chiseled into Mount Rushmore alongside those of Presidents Washington,
Jefferson, Roosevelt, and Lincoln.
Q: Where in the hospital do you have sex with the nurses?
A: It's funny how often I'm asked that question during radio
interviews, given that I never mentioned this in my book. Had I ever
done it, I surely would have mentioned it—as they say, sex sells.
The myth of nurses as being hot, young nymphomaniacs is just that:
Oh, but there are exceptions. In fairness to the woman whose reputation
I am about to trash, the following information was provided to me courtesy
of a resident who was either a very lucky man, or someone with a real knack
for shameless self-aggrandizement. It's tough to fool an ER doc,
but it's possible.
On to the vicious rumors. This Internal Medicine resident, who
I'll call Pablo, claimed that he and scads of other doctors had intercourse
with this CCU nurse, unfettered by any pretext of love. She was,
he claimed, just out to snag a doctor as a husband, and they were just
after The Big O.
I almost gave ol' Pablo a knuckle sandwich when he referred to her as
"a whore." Even if she did have premarital sex, that did not necessarily
make her into a prostitute. Besides, I had a crush on her and, to
tell the truth, I still do. Lisa was without question the most beautiful
woman I've ever seen, and from my interactions with her (she'd often moonlight
in the ER) she was always a lady. I had an overwhelming urge to ask
her out, but I'm shy. No, really, I am.
Anyway, to hear Pablo tell the rest of his sordid tale, Lisa never found
a doctor to marry so she gave up trying, married a fellow CCU nurse, Chuck,
and moved away. Broke my heart.
One of the perks of being an ER attending is that we get to grade residents
whenever they do their stint in the ER. After the thrashing I gave
Pablo, I'd bet he's now repairing potholes on a road crew somewhere in
Nicaragua. He should have known that it's not wise to disparage the
woman a man loves.
Q: Do doctors really know more about sex?
A: This is like asking if a plumber really knows more about your
water pipes or faucet—of course he knows more. However, when people
ask this question I don't think they're referring to the relatively boring
science of reproduction. Instead, I believe they are asking if doctors
know more juicy tips about enhancing sexual performance and pleasure.
In that regard, most physicians are as lost as the next guy. Eager
for vicarious pleasure wherever I can find it, I have devoted years of
diligent research to this topic, which is covered in Chapter 11 of my book
Fascinating Health Secrets, and in far more detail in
The Science of Sex: Enhancing Sexual
Pleasure, Performance, Attraction, and Desire. One of my
colleagues, a gynecologist (and you'd think he'd already be an expert in such
matters, wouldn't you?), was absolutely mesmerized by that material.
Q: Did you ever date a nurse?
A: OK, now you get me to fess up! Hmmm, let me think .
. . three nurses, I believe. 'Nuff said.
Q: Come on, Doc, can't you give us any juicy details?
A: OK, you talked me into it. So as not to steal the thunder
from my chapter on sex, I won't give any of the more licentious stories
here, but I will mention one that I couldn't seem to fit in elsewhere.
Years ago, as I was at the home of a nurse whom I was dating, we were talking
while sitting on her couch. She was either incredibly attracted to
me, or she found my conversation less than riveting, because she said,
totally out of the blue, "Oh, Kevin, shut up and make love to me."
Now there's a comment that only a woman can get away with.
Q: But you didn't marry her, did you?
A: Pass up a woman with that eloquence? What, are you kidding?
Tempting as it may have been, I somehow drew upon heretofore untapped reserves
of personal fortitude and tore myself away from her. The problem
was not her lack of a silver tongue, as you might imagine. Instead,
it was something that's a bit less easy to overlook. Early on in
our relationship she warned me that once she began to love me she would
pull away and turn cold as ice. Piffle, I thought, no one could be
that warped. Well, I was wrong, and I was forced to renounce my claim
to fame as a budding psychoanalytic guru.
Q: Did you ever really date a patient?
A: Given that I am a summa cum laude graduate of the William
Jefferson Clinton School of Speech Obfuscation, you may wish to carefully
parse the following answer: I have never had sex with a patient.
And, to set the record straight, I have never had sex with "that woman,
Q: Did you ever date anyone who read your books?
A: How the heck did you find out? Well, now that the cat
is out of the bag, I might as well fill you in on the details. A
woman who read my first book (Fascinating Health Secrets) wrote
to me saying how much she liked the book. After a year or so, we
met and . . . well, I knew that she'd really read my book, especially parts
of Chapter 11. I was impressed.
Q: So, are you married?
A: Nope. I'm in a hurry to get married, but she was in
such a rush to get married that it spooked even me. Hard to believe,
I know, but it's true.
Several people have asked me why I'm not married. Here's my answer:
During my years of training, I incorrectly assumed that I would easily
find a compatible mate once I entered the real world and began some semblance
of a normal life. Boy, was I wrong! I knew and dated some perfectly
normal and desirable people in high school, college, and medical school.
However, as the years went by there was less and less time to truly interact
with people in general and my girlfriends in particular. Our dates
degenerated into sessions in which they would be in the same room as me
when I studied. How exciting! Eventually, I broke up with them
because I felt that our relationships existed only because my partners
had an unusually high degree of tolerance for being ignored. It was
not that I didn't want to give them more attention—I simply didn't have
the time. To this day I have no idea why they stuck with me for years.
After I resumed dating following my training, it did not take me long
to realize something that I should have been able to deduce long ago—namely,
that there are not many 28-year-old "good catches" remaining single.
You really have to wonder about someone with an expressed intention to
commit to someone and eventually marry, if she is still single a decade
after high school! If she has a good reason for this, such as being
highly devoted to her work, there is a slightly better chance that she will be normal. Even then, the chance is slim. Of all the women
I have dated after residency, only two were normal by my definition.
The others possessed a variety of insurmountable character flaws.
Two of them would almost force alcoholic drinks upon me as soon as I would
walk in the door, even if I came over in the afternoon. One of them
did it trying to get me in bed. Isn't this the stereotype of what
men are supposed to do? The other one did it for reasons that
I still can't discern; perhaps she was an alcoholic and simply wished to
recruit me to her way of life. Thanks, I'll pass. A couple
of the others wanted to sleep with me, but were reluctant to kiss or hug.
When I asked them about this, they said that kissing and hugging were something
special that they would do only if they were very close to someone.
Isn't this putting the cart before the horse?
Q: On your web site you answer questions submitted by people.
Is there any question you haven't answered?
A: Just one. A man wrote to me asking what drugs he could
give to a woman to knock her out so that he could have sex with her and
she'd have no memory of the event. He claimed that he was an author
and was merely doing research for a book he was writing. Yeah, right.
What really spooked me about this guy was that he was so eager for me to
give him very detailed information, such as the exact dose to use and what
he could do if he gave too much and the woman had an adverse outcome, such
as lapsing into a coma. This kind of thing is not only sick, but
wholly unnecessary. Since when is it so difficult to find a sexual
partner? My eloquent brother, Ray, once quipped, "Kevin, women want
it more than you do." In any event, I didn't answer his question
because I was afraid that the knowledge might be used to victimize some
woman. Even if he were an author, I was afraid of the consequences
of disseminating this information.
I received a somewhat similar question from another person that I decided
to answer for no other reason than I happened to be in an unusually voluble
mood that day. He asked me if . . . ah, why paraphrase it?
I'll let him stick his foot in his own mouth.
Q: One of my buddies claims that he heard the government is
working on an electronic device that can make people do things they wouldn't
ordinarily do by suppressing the area of the brain involved in self-restraint.
Have you heard of this and, if so, can you tell me how to make one?
Would it be possible to use this device on women?
A: Thank you for restoring my faith in humanity. When I
was a teenager it was de rigueur to procure the sexual favors of a woman
by plying her with a chemical that would achieve the same effect, most
typically Boone's Farm Strawberry Hill wine. It is heartening to
learn that people are finally taking the moral high ground on this issue
and are in search of healthier ways of achieving mind control. By
the way, if you had any idea of how often I've had sex in the past decade
you would not be asking me for tips on seduction—it's like asking a homeless
person for the latest hot tips about stocks on Wall Street. But if
Dear Abby can dispense advice about romance, I suppose I can spout off
on this subject.
To begin with, the notion of using an electronic device to influence
behavior is not as wacky as it may sound. There are many drugs (both
prescription and nonprescription) that can influence thought to varying
degrees, and even certain foods and spices can modify cognition and perception.
Nevertheless, these effects are notoriously nonselective, so sending Janine
Turner a gift-wrapped container of nutmeg or ginger will not make your
lifelong fantasies come true. In the future, drugs with far more
specific actions will be developed. Until then, you might want to
try a dating service.
Drugs which influence thought achieve their effects by altering neurotransmission,
the process of communication between nerve cells. While it is possible
to use electricity to influence thought, this effect is very nonselective—unless
you can somehow finagle a way to directly apply electrodes to the surface
of her brain without your date noticing it. But hey, television remote
controls were once a pipe dream, and now they're practically an appendage
on the right arm of every man. To the best of my knowledge, though,
no one knows how to substantially alter thought using an inductive (non-contact)
device. Otherwise, the authors from electronics hobbyist magazines
would be tripping over the cords of their soldering irons in their haste
to build such a gizmo.
Lest you go away with a heavy heart, thinking that scientists have neglected
your love life, I can brighten your day by filling you in on some useful
tips. First, a caveat: you try any of this stuff on my cousins,
and I'm coming after you.
Tip #1: Buy a bottle of Realm® cologne. I won't cover
this topic in detail here since I tell you more than you ever wanted to
know elsewhere on my web site, but
I will mention that Realm® contains a pheromone which can have a favorable
effect on people around you. Just hope they attribute this bliss
to you, instead of the decor of your surroundings. If you're studying
for a doctoral degree in biochemistry, or if you're desperate for some
action this weekend, you may also want to bone up on the pragmatic aspects
of how the
influence your success in dating. In my web site I discuss some clever
ways of how you can exploit this information to outwit Mother Nature.
Tip #2: Behavioral scientists, probably bored silly by years of
watching rats navigate through mazes, have recently broadened their studies.
Their latest and greatest coup is the discovery that the sexual pump can
be primed, so to speak, by scaring the bejesus out of your prospective
partner. To be effective, however, this activity must be socially
acceptable, such as a ride on a roller coaster. Showing her your
extensive collection of Soldier of Fortune magazines probably won't
work unless you're lucky enough to be dating Carol Howe.
Q: Any other strange requests?
A: Yes. I received a call from a woman who
my first ER book and thought she
might be interested in me. Coincidentally, I'd seen her on television.
She was a guest on America's most notoriously trashy talk show (I'd just
moved into a new house, and before I installed an antenna this was the
only station I could receive). She said that she had worn a wig on
the show to disguise her appearance. Who could blame her? Anyone
who appears on that show is almost a de facto inductee into the Hall of
Fame for Freaks. She went on to say that she was bisexual, and
she wanted to know if that bothered me. She also explained that her
sexual predilections hadn't dissuaded the host of the show who, she claimed,
invited her out for drinks in a very transparent effort to seduce her.
So the rumors about him are apparently true.
Q: As an emergency nurse, it seems to me that we are seeing
more psychiatric patients in the ER than we did many years ago. Is
the prevalence of mental illness increasing? If so, why?
A: I think that mental illness is indeed more prevalent than
it was in the past. While there are many reasons for this increase,
I'll mention a few of the factors which seem to have been glossed over:
- In the United States and other countries, many mentally ill people were
once prevented from reproducing by measures that would now be generally
considered draconian, such as sterilization and sequestration.
While not all mental illnesses are inheritable, some do have a genetic
component. Consequently, when mentally ill people reproduce they
are more likely, on average, to have children with mental illness.
- Recently, some tantalizing research suggests that certain mental illnesses
may be ultimately caused by various prior, or long-standing but smoldering,
infections of the brain. Infections are more likely to be transmitted
when people have impaired immunity, when the population density increases,
or when there is increasing contact between population groups that were
once isolated. All of these factors are now operative, thus making
people more likely to acquire an infection and its possible sequelae, such
as mental illness.
- People are now exposed to considerably more artificial light than they
were in the past. This is especially disruptive to our circadian
rhythms when light exposure occurs in the evening and night. At those
times, even low levels of light interferes with the secretion of melatonin,
the sleep regulating hormone. People sleep less than they have in
the past, and their sleep is often of a lesser quality. While this
sleep deficit is not the primary cause of mental illness, it may uncover
latent oddity in people who have a suitable predisposition. Also,
the suppression of melatonin by light may explain why there seems to be
an increase in abnormal behavior around full moon periods. In case
you haven't had your fill of trivia for the day, I'll unfurl another tidbit
that may give you something to think about the next time you step on a
bathroom scale. Cutting back on sleep reduces your basal metabolic
rate (BMR). In other words, your metabolism slows down, you burn
fewer calories, and you gain more weight.
Q: If you were the Surgeon General, what would be your first priority?
A: Thank you for asking, George W. Assuming that I had
a cooperative Congress, I'd require tobacco companies to only use heavy
smokers as models. The people they're using nowadays look like people
whose worst vice is using sweetened granola.
In my first opus (Fascinating Health Secrets)
I suggested that people might smoke less if they were apprised of risks
which really mattered to them, such as becoming an impotent old prune.
The prospect of lung cancer and an early death isn't a sufficient deterrent
for most people, but if a guy can't get it up . . . well, where is that
nicotine patch, anyway?
While my suggestions may have appeared to be tongue-in-cheek to some
readers, some Canadian officials apparently liked my ideas and proposed
similar warnings for cigarettes sold in their country.
Q: What advice would you give someone who wanted to be an ER
A: Start taking your Haldol more regularly.
Q: What is Haldol?
A: A drug used to control psychotic behavior.
People who are obsessed with becoming an ER physician are never dissuaded
by such an apparently flip exhortation. These folks are usually teenagers
or college students whose knowledge of this job was distilled from the
glorified depiction of life in the ER issued at weekly intervals by that
Grand Dispenser of Truth otherwise known as Hollywood. I feel morally
obliged to dispel their illusions, but young people, I've found, prefer
to keep their blinders on and ignore any facts that don't mesh with their
idealized notions. I suppose I can't fault them, since I was probably
even more idealistic when I was young.
Teenagers usually send gushing e-mail messages to me, wiling me with
something like, "I want to be just like you. Can you tell me how?"
OK, but don't ever say that I didn't warn you. The recipe for
becoming an ER doc is fairly simple:
1. Get extraordinarily good grades in college and get a high score
on the MCAT exam so that you will be accepted into medical school.
2. Do extremely well in medical school to give you a reasonable chance
of being accepted into an ER residency program. It seems like everybody
and his brother wants to be an ER physician these days, so the competition
for the limited number of ER residency positions is fierce.
3. After seven years of working 110 hours per week during medical school
and residency, you're now an ER doctor. If you haven't blown your
brains out yet (you'd be surprised how many physicians do just that), take
yourself out for an ice cream cone to celebrate.
Q: Why are family members usually not allowed to witness a code?
A: I think that most physicians are hesitant to have family members
witness a code. In my opinion, the most salient reasons are:
- It is difficult to know in advance whether or not the observer will interfere
with the code. If that person becomes such a distraction that removal
from the room is warranted, this requires the attention of the typically
limited staff, whose attention would be better focused on the patient.
- Some observers may be psychologically traumatized by witnessing some aspects
of the code. Again, judging this prospectively is virtually impossible.
- As an ER doc who used to work at a teaching hospital, I've seen a number
of codes run by a variety of people, and I have yet to witness a code that
has been executed perfectly. Practitioners usually fulfill most of the
major ACLS dictates, yet flub some of the seemingly minor points that can
nevertheless have a major impact upon the outcome of the code. I
am not advocating the exclusion of family members to conceal these errors,
but it is indisputable that mistakes (even trifling ones) may foster subsequent
malpractice litigation. Moreover, the family members may be eternally
haunted by the thought that their loved one may have lived were it not
for the mistake.
Q: Some folklorists claim that some of the ER stories circulating on the
Internet are nothing more than urban legends. What’s your opinion on this?
A: Some of them are probably just urban legends, but I know that some of the
cases that have been branded as urban legends are indeed true. I think the
impetus for characterizing certain cases as urban legends is attributable to the
fact that most folklorists are pointy-headed academics who have very little idea
of the types of wacky cases that are actually seen in emergency rooms. With smug
condescension and a paucity of facts, folklorists reflexively assume that some
cases did not occur because they resemble an urban legend, or something that
fits their mold for what they’d like to think is an urban legend. Similarity
to a prior event does not necessarily mean that the event in question did not
occur. When these stories are disseminated, people often change the story from
one iteration to the next. However, that's just human nature (and this tendency
has been scientifically documented in a variety of situations). No matter how
the story is twisted, warped, colored, and revised as it is retold, this cannot
erase the reality of the original event. As an ER doctor who has seen some of
these hard-to-believe cases, I can assure you that some very strange events do
in fact occur. Some of the things I've seen in the ER have stunned me, and that
was one of the reasons I wrote this book.
Q: (I'll paraphrase this, since the question came from
a reader with whom I've had a long-running dialogue.) Aside
from the murders allegedly committed by Dr. Michael Swango, do you think
that there are other physicians who are intentionally killing patients?
A: I think it is far more likely that some nurses around the
country are deciding who lives and who dies, offing this one or that one
at their discretion. I've heard several nurses talk about giving
an injection of HIV-laden blood to patients they hated. Since nurses
are usually the ones who draw blood specimens and give injections/start
IV's/etc., they have plenty of opportunity to do this if they are so inclined.
AIDS patients visit hospitals so frequently that nurses are guaranteed
an essentially limitless supply of infected blood to inject into patients
they detest. Furthermore, the long latency of HIV infection makes this the perfect
crime: by the time the infection is apparent, linking it to its source is
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You will have sex about 10,000 times during
Doesn't it make sense to read a book that can maximize
your enjoyment, and the enjoyment you give to your partner?
Cast away your preconceptions of sex books as
being a rehash of things you already know and hence a waste of time. By
reading this book, you will learn
many things that Dr. Ruth and other sexologists
have never considered.
The Science of Sex
Enhancing Sexual Pleasure,
Performance, Attraction, and Desire
by Kevin Pezzi, MD
Available in printed
and Adobe Acrobat e-book versions (will display on any computer)
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Are you skilled at marketing
and looking to make more money?
If so, I want to speak with you. I have several
hundred inventions (a
few of which are pictured
on my web site), but not enough time to market very many of them. I am
looking to partner with marketing professionals who possess the skills
required to introduce new products into the marketplace. In return, I
offer you a substantial percentage of the income generated.
Contact me via this page:
If you want a beautiful garage that is easy to
keep organized, see the GarageScapes web site: