SPread Sheet IN THIS ISSUE

Standardized Patient Program Newsletter
educating, informing, entertaining, inspiring
SPread Sheet
IN THIS ISSUE
IT’S OPEN!
FEATURES
SESSIONS PENDING
3
0UR SYMPATHIES
3
SPOTLIGHT ON . . .
Cathy MacDonald
5
SPIN AND AROUND
5
SYMPTOMS . . .
Cheyne-Stokes
HUMERUS
PROSE
6
6
ARTICLES
UPDATE ON DEPARTMENT OF
MEDICAL EDUCATION
4
PATIENT SAFETY MEDICATION
CARD LAUNCHED
7
SOLVING (A FEW MORE OF)
PROBLEMS
10
LIFE’S LITTLE
Contributors to this issue include:
Dr. Andrew MacDiarmid
George Kolomayo
Volume 2, Issue 1, June 2008
The University of Manitoba Faculty of Medicine and Winnipeg Regional Health Authority opened the new multidisciplinary Clinical
Learning and Simulation Facility, developed in partnership with the
Winnipeg Regional Health Authority and Manitoba departments of
Health and Science, Technology, Energy & Mines on April 11.
The Faculty of Medicine, in collaboration with WRHA, will operate
the new $4.6-million, 11,000 square foot state-of-the-art facility,
one of Canada’s most comprehensive clinical learning and simulation
centres.
“The Clinical Learning and Simulation Facility will transform how
Manitoba’s health professions are prepared to deal with real patients
and medical emergencies. Realistic simulation training on robotic
mannequins will strengthen communication and clinical skills of students and ensure more confident, experienced practitioners,” said
Dr. J. Dean Sandham, Dean of Medicine, University of Manitoba.
Dr. Brian Postl, President and CEO of the Winnipeg Health Region
said the new centre is a huge step forward in terms of both education and patient safety. “This will allow students to practice the
skills they need to develop before actually using them on patients.
It is the way of the future.”
Funding for the Clinical Learning and Simulation Facility (CLSF)
includes $1 million each from the WRHA, Province of Manitoba and
Faculty of Medicine; and $1.6 million from donors, students and
alumni.
“The provincial government’s $1 million contribution for this innovative facility was provided through the Manitoba Research and Innovation Fund,” said Jim Rondeau, minister of Science, Technology,
Energy and Mines. “Over the years the fund has provided more
than $50 million for research and development and research infrastructure, in areas such as health, manufacturing, aerospace, new
media and alternative energy.”
(continued on page 2)
TRANSPOSITIONS
This feature is to let readers know about forthcoming format changes to the SPread Sheet.
The feature formerly known as SIMULATING PHYSICALLY from now on will be simply entitled: SYMPTOMS, to reflect a wider range of simulations, since findings in an exam or teaching
session can be physical and / or emotional. It can be found on page 5 of this issue.
Questions or comments? Call 480-1307, extension 1.
SPread Sheet Volume 2, Issue 1, June 2008
Contact the SPread Sheet:
T151—770 Bannatyne Ave.
Winnipeg, MB, Canada
R3E 0W3
Phone:
(204) 480-1307
Fax:
(204) 977-5682
E-mail:
[email protected]
Home Page:
http://www.umanitoba.ca/
faculties/medicine/
education/ed_dev/
spp.html
NEWSLETTER EDITOR
Tim Webster
SP PROGRAM STAFF
Lezlie Brooks,
SP Coordinator
Holly Harris,
SP Coordinator
Tim Webster,
SP Coordinator
Cathy McDonald,
Office Assistant
Copyright © 2008
University of Manitoba
Permission to reproduce
and/or distribute any of
the material contained
herein must be obtained
from the Standardized
Patient Program.
ISSN 1715-5452
Page 2
IT’S OPEN! (continued from page 2)
The CLSF promotes simulation education and training using lifelike robotic mannequins for students and postgraduate students in
Medicine, School of Medical Rehabilitation, Pharmacy and Nursing;
clinicians, physicians and faculty members; and WRHA health teams
and emergency medical service personnel.
Four rooms are equipped with robotic headboards and elevated observation rooms which allow
instructors to emulate various medical scenarios or
traumas –such as power failure or code blue.
“The Clinical Learning and Simulation Facility
exemplifies how the University of Manitoba and its
partners and supporters work together. The facility
The CLSF in action.
is at the forefront of medical simulation technology
Photo by Tamara Bodi.
and will ultimately provide the exposure to students of real-life medical scenarios to ensure the highest quality of
patient care for all Manitobans,” said Dr. Emőke Szathmáry, president and vice-chancellor of the University of Manitoba.
Each of the 17 multipurpose, universal access examination rooms
can accommodate a WRHA standard-sized hospital bed or stretcher
and is equipped with a diagnostic headwall of blood pressure cuffs,
otoscope, thermometer, medical gas columns, heart-rate monitors
and intravenous carts.
Students will practice medical diagnosis and treatment on five
new life-like robotic mannequins--two adults, a birthing mother, an
infant and a child. Each is anatomically correct and can breathe, and
has a pulse and reflexes.
To teach procedures such as endoscopes, high-tech haptic simulation technology integrates touch with visual and audio responses
to mimic the look and feel of actual medical procedures and surgery.
“It’s exciting to see new technology put to use in such a great
learning environment” said Health Minister Theresa Oswald, “This is
going to improve the learning experience and make sure these students are ready to give the best patient care possible when they
graduate.”
(continued on page 3)
SUBMISSIONS, PLEASE
The SPread Sheet is your newsletter; if you have any articles, photos, opinions, thoughts,
trivia, anecdotes, pictures, or jokes to contribute for the next issue, please do so by August
31, 2008. Contact information is provided in the sidebar on page 2. We reserve the right to
edit any and all submissions for length and content in collaboration with the contributor.
Submissions that are not included in one issue may be included in subsequent issues.
Questions or comments? Call 480-1307, extension 1.
Page 3
SPread Sheet Volume 2, Issue 1, June 2008
IT’S OPEN! (continued from page 2)
The Clinical Learning and Simulation Facility offers high-tech evaluation and assessment
techniques with two way mirrors in each of the multipurpose exam rooms. Central to the
simulation teaching style is debriefing after the event. All examination rooms are equipped
with hi-fi video cameras, microphones, real-time playback capability and storage of digital
images to track progress individually as a student or as a health team, and allow for detailed
review later as a teaching and improvement tool.
The Clinical Learning & Simulation Facility will be supported by the new Mindermar Professorship in Human
Simulation, created through a $1-million gift from the
Rady Family Foundation, Mindel Olenick and Marjorie
and Morley Blankstein.
The Mindermar Professorship in Human Simulation
will provide leadership in the area of medical education
through human simulation. A Faculty of Medicineappointed professor will be involved in the development,
evaluation and research of educational programs utilizing human simulators and standardized patients.
“Teaching using simulation is the most important advance in medical education in the last century,” said Dr.
Sandham, Dean of Medicine. “With any advance in the
methods of teaching, the first task is to teach the teachers. The Mindermar Professorship in Human Simulation
will enable the Faculty of Medicine to do that.”
Above: Ribbon cutting ceremony (or surgical tubing
cutting ceremony, if you will) at CLSF opening event.
From left: University of Manitoba President and ViceChancellor Dr. Emőke Szathmáry; the Honourable
Jim Rondeau, Manitoba Minister of Science, Technology, Energy and Mines; Kam Birdi, senior stick of the
Manitoba Medical Students Association; the Honourable Theresa Oswald, Manitoba Minister of Health;
President and CEO of the Winnipeg Health Region Dr.
Brian Postl; and University of Manitoba Dean of Medicine Dr. J. Dean Sandham. Photo by Tamara Bodi.
Source: U of M e-memo April 16, 2008
http://myuminfo.umanitoba.ca/index.asp?sec=2&too=100&eve=8&dat=4/11/2008&npa=15657
SESSIONS
PENDING
Because of the new CLSF, we have received a few requests from external organizations for
SPs during June, July and August. These have been singular projects with very short notice,
so we appreciate the flexibility of SPs as we recruit for these projects.
There are no upcoming examination or teaching sessions scheduled for the rest of June or
for July and August, but Coordinators will be filling roles for the fall sessions during these
months.
A prompt response to phone and e-mail messages from the SPP Office is the best way to
confirm your continuing involvement.
More details will follow in the September issue of the SPread Sheet.
OUR
SYMPATHIES
We extend sincerest condolences to the family of SP Ron Clay on his sudden passing May
26, 2008. The obituary is available for viewing at:
http://www.passagesmb.com/obituary_details.cfm?ObitID=136214
Questions or comments? Call 480-1307, extension 1.
SPread Sheet Volume 2, Issue 1, June 2008
Page 4
IT’S AN OPEN HOUSE
You are cordially invited to the:
Clinical Learning and Simulation Facility (CLSF)
Open House for Standardized Patients
Thursday, October 16, 2008
University of Manitoba, Brodie Centre
727 McDermot Avenue, Basement Level (000)
There are two times available to drop in: 2—4PM or 6:30—8:30PM.
R.S.V.P. by calling 480-1307 or e-mailing: [email protected]
Hope to see you there!
UPDATE ON DEPARTMENT OF MEDICAL EDUCATION
By Dr. Andrew MacDiarmid, Acting Head, Department of Medical Education
When I took on the Acting Headship some of my Internal Medicine colleagues said, “Congratulations! I didn’t know there was a department of
medical education!” It heightened my desire to raise the profile of the
department at every opportunity. These opportunities are not lacking.
In April, the Clinical Learning and Simulation Facility had its grand opening and came under the department’s umbrella. Many of you have
toured the facility and already have ideas for using it to improve medical
education and patient safety. The day included professional development sessions with simulation as the subject.
Earlier this year, we helped organize similar sessions on International Medical Graduates
and Professionalism. These sessions, the New Faculty series, our regular journal club and
many other events have been led by Joanne Hamilton, our Faculty Developer.
Of course faculty and staff in UGME, PGME, CME, Med Rehab, and many in the clinical and
basic sciences departments have known about us for years. They may have used the Standardized Patient program to teach or examine students or residents. They will know Lezlie
Brooks, Holly Harris and Tim Webster, our SP coordinators. Recently they were joined by
Cathy MacDonald, the SP program office assistant (see page 5 for her profile—Editor).
Other friends in the faculty may have used the TIPS program for training their faculty and
residents in teaching skills, or consulted with Ingrid Toews who handles our communication
skills program or our office manager Kathy Harlos.
Many positions in the CLSF and the department are yet to be filled. We look forward to
welcoming new members to the team and continue effectively serving our faculty’s educational mission.
For more information, please visit our webpage at:
http://umanitoba.ca/faculties/medicine/education/ed_dev/index.html
or e-mail: [email protected].
Source: MedLines, Faculty of Medicine e-news, May 29, 2008
Questions or comments? Call 480-1307, extension 1.
Page 5
SPread Sheet Volume 2, Issue 1, June 2008
SPOTLIGHT
ON
...
Cathy MacDonald has been the Office Assistant for the Standardized Patient
Program since January 28, 2008. She comes to us with several years of experience from the Faculty of Dentistry.
“During my first week I was surprised when an SP came in to our office. She
and I immediately recognized each other, from my last position. That was a
nice welcome to the program and I’ve enjoyed meeting the other SPs whenever I have the opportunity to do so.”
On another occasion, she recognized the name of an SP, again from her last position. She
remembered him as “one of my most pleasant clients/patients,” and when she left him a
phone message regarding some paperwork he recognized her voice!
Her first real encounter with standardized patients was observing an Occupational Therapy
training session with SPC Tim Webster. “I was really impressed with the high quality of the
training, and it helped me comprehend what the SP Program was all about.”
Cathy provides clerical and administrative support for the three SPCs, like mailings and
payroll, but she now also serves as a receptionist for the new CLSF, where she manages
bookings and scheduling.
Born and raised in Winnipeg, Cathy and her husband Garry share a blended family. Cathy
has two sons, Garry has a daughter and son (daughter-in-law) and three grandchildren.
Her favourite holiday is Christmas, so she’ll really be in her element for our Annual gather
in December. When she’s on her own time and relaxing, she’ll probably be found next to the
campfire, enjoying the quiet times at her trailer park.
Cathy wanted to be sure to mention “how much I am enjoying my job, everyone in our
department, and all the SPs.” Welcome to the team, Cathy!
SPIN
AND AROUND
•
“Welcome!” to new SPs Sarah Brereton,
Brian Davisson, Daniel Dell’agnese,
Taylor Doerr, John MacDonald, and
Colleen Medd
•
“Welcome back!” to:
1) SP Leah Frost, who came back from
Thailand at the end of April
2) SP Sarah Kessleman, who returns to
our program after studying at McGill
3) SP Marilyn Rudge, who returns after
9-month trip to Norway
•
“Safe travel!” to SPCs Lezlie Brooks and
Holly Harris, who are traveling to San Antonio, Texas for the 7th Annual Conference
of the Association of Standardized Patient
Educators (ASPE), June 29-July 2.
•
We are still compiling a catalogue of photos
of all the SPs and Recruits in the program.
Not all of the Coordinators know what each
and every SP and Applicant looks like, and
a catalogue will help us to fill roles more
easily. Please forward an 8” x 10” picture
of yourself – preferably in black or white –
to the SP office at your earliest convenience if you haven’t already done so. You
can send your pictures electronically to:
[email protected]
or mail them by regular post to:
Attn: Tim Webster, SPC
SP Program Wall of Fame
T151B-770 Bannatyne Avenue
Winnipeg, MB R3E 0W3
Questions or comments? Call 480-1307, extension 1.
SPread Sheet Volume 2, Issue 1, June 2008
Page 6
SYMPTOMS . . . Cheyne-Stokes
This feature is the continuation of a series on how to accurately simulate various degrees
of coma and unresponsiveness. The next installment will focus on simulating blindness.
***
Cheyne-Stokes respirations refers to the abnormal breathing pattern of an unconscious or
unresponsive patient lying on a bed or examining table. The condition was named after John
Cheyne and William Stokes, the physicians who first described it in the 19th century. 1 The
abnormality is a periodic and continuous change in the depth AND frequency of breathing.
After breathing easily and naturally on the examining table, the SP learning to simulate
this breathing pattern should gradually begin to breathe more and more deeply, until breathing quite heavily.
Then the SP should begin to breathe more and more shallowly until there are barely discernable breathing movements, until finally there is no breathing whatsoever for 5—10 seconds.
The pattern begins again with the barely discernable movements and the breathing slowly
increases until quite heavy again—and so the cycle continues.
SPs who breathe heavily for long periods of time tend to get dizzy. In this pattern, however, the constant alternation between over– and under-breathing prevents dizziness, and
allows the SP to tolerate the 5—10 seconds of no breathing quite well.
In some cases, the cycle will continue almost automatically once the SP has become used
to it. This allows the SP to concentrate on other signs appropriate for an unresponsive or unconscious patient.
Reference:
1. Wikkipedia (http://en.wikipedia.org/wiki/Cheyne-Stokes_respiration)
1(a) J. Cheyne: A case of apoplexy in which the fleshy part of the heart was converted into
fat. Dublin Hospital Reports, 1818, 2: 216-223. Reprinted in F. A. Willius & T. E. Keys:
Cardiac Classics, 1941, pp. 317-320
1 (b) William Stokes: Fatty degeneration of the heart. In his: The Diseases of the Heart
and Aorta. Dublin, 1854, pp. 320-327.
Adapted from Training Standardized Patients to Have Physical Findings,
by Howard S. Barrows, M.D., Southern Illinois University, School of Medicine,
Springfield Illinois, 1999, pp. 7 & 8
HUMERUS
PROSE
Comedian George Carlin died on Sunday, June 22, 2008 at age 71. Most of his routines
are not re-printable for our family-friendly format, but in honour of his passing, here are a
couple of his comments about the medical profession:
“Isn't it a bit unnerving that doctors call what they do "practice"?”
“Somewhere is the world’s worst doctor –
and someone has an appointment with him tomorrow!”
Questions or comments? Call 480-1307, extension 1.
SPread Sheet Volume 2, Issue 1, June 2008
Page 7
HOLD THE DATE
The University of Manitoba Faculty of Medicine will be holding a gala celebration to mark
its 125th Anniversary Saturday, November 1, 2008 at the Delta Hotel. Help us celebrate!
PATIENT SAFETY MEDICATION CARD LAUNCHED by George Kolomayo
In late May, a local video / communications company used some of our SPs for a promotional video that was shot in the new CLSF. The following is a press release that accompanied the media launch on June 2, 2008—Editor.
***
New tool supports greater involvement by Manitobans in their own healthcare –
greater awareness leads to enhanced patient safety
Manitobans have a powerful new tool that can help them manage their own health care by
knowing which medications they take and helping them share that information with their
health care providers. The Manitoba Institute for Patient Safety today launched the free It’s
Safe to Ask Medication Card as the latest way to support Manitobans and their health care
providers in the provision of safe patient care throughout the province.
Studies have shown that approximately 50% of Canadian patients have at least one medication error upon admission to hospital and about 40% of these errors have the potential to
cause moderate to severe harm.
Few Manitobans keep an accurate list of their prescribed and over-the-counter medications, making it more difficult for healthcare providers to get a complete picture of the medications that their patients are taking.
“Patients can play an important and valued role in their own safety by knowing as much as
possible about their medications and sharing that information with pharmacists, doctors and
nurses,” said Laurie Thompson, Executive Director of the Manitoba Institute for Patient
Safety. “The Institute is urging all Manitobans who take medicines to fill out the card and
(continued on page 8)
Questions or comments? Call 480-1307, extension 1.
SPread Sheet Volume 2, Issue 1, June 2008
Page 8
PATIENT SAFETY MEDICATION CARD LAUNCHED (continued from page 7)
carry it in their wallets, purses or pockets to all healthcare appointments and when they go to
the hospital.”
Filling in the card provides vital details about the individual’s medications. Among other
information, the card has places for Manitobans to write down the names, strengths, quantities, and frequencies that they take their medications, along with the reason they take it and
who prescribed it.
Having a personal, up-to-date Medication Card, listing over-the-counter and prescription
medications will:
• reduce the possibility of medication errors and contribute to improved patient safety,
• record information to increase patients’ understanding of their medications and their
health condition,
• enable providers to know patients’ current medications and ensure that these medications are started or stopped correctly,
• provide critical information for emergency responders in times of emergency,
• improve communication between healthcare providers and patients about medications,
• and allow for increased patient involvement in their health care.
“We have been anxiously awaiting the release of the It's Safe To Ask Medication Card as it
will be a valuable tool when collecting an accurate home medication list," said Kristi Chorney,
Brandon Regional Health Authority Quality/Risk Coordinator. “We believe it will further help
build upon the successes we have had in medication reconciliation efforts over the past 18
months. Since implementing Safer Healthcare Now processes, our rate of potential harm to
patients (known as unintentional changes to a patient’s medications) has been cut in half.”
Two hundred thousand medication cards will be printed initially and distributed across the
province. They will be available to:
• community pharmacies,
• 48 healthcare teams in Manitoba involved in medication reconciliation, a best practice
model of preventing medication errors (Safer Healthcare Now!),
• physicians’ offices,
• community health agencies, and
• senior resource councils.
Manitobans can also print a medication card or save it to their computer by visiting
www.safetoask.ca.
The www.safetoask.ca site will feature:
• a Safe Use of Medications sheet for the public,
• two short informational videos, one to help Manitobans better understand why it is important to list and carry their medications and the other to help guide them in filling out
the card,
• implementation tips for providers and organizations, along with a video on medication
reconciliation for healthcare providers,
• a supporting article, and
• links to supporting materials in other jurisdictions.
(continued on page 9)
Questions or comments? Call 480-1307, extension 1.
SPread Sheet Volume 2, Issue 1, June 2008
Page 9
PATIENT SAFETY MEDICATION CARD LAUNCHED (continued from page 8)
The Government of Manitoba is the lead
sponsor of the initiative, providing $50,000 in
funding towards printing, distribution and
promotion of the It’s Safe To Ask Medication
Card. The Canadian Patient Safety Institute
and Industrial Alliance Insurance and Financial Services Inc. are also sponsors.
“We’re very excited and proud to sponsor
the It’s Safe to Ask Medication Card,” said
the Honourable Kerri Irvin-Ross, Minister of
Healthy Living. “We all need to feel confident
taking an active role in our own treatment.
Better understanding of our own situation
can help ensure a speedy recovery, and reduce fears or apprehension at the same
time.”
The Manitoba College of Family Physicians,
College of Licensed Practical Nurses of Manitoba, College of Registered Nurses of Manitoba, College of Registered Psychiatric Nurses
of Manitoba and the Manitoba Pharmaceutical
Association will send sample medication
cards to their members, and encourage them
to promote the use of the medication card.
The Manitoba Society of Pharmacists has
printed 10,000 copies and will distribute
them upon request to pharmacies across
Manitoba.
The Medication Card is also designed to fit
into the Emergency Response Information Kit
(ERIK) that is widely used in homes across
Manitoba to alert emergency responders to
important information in times of emergency.
The kit, developed by a team headed by the
Boni-Vital Council for Seniors, is commonly
found on the front of Manitobans’ refrigerators. The Paramedic Association of Manitoba
supports this new initiative, as it will continue
to provide essential information to paramedics during times of emergency.
“We know from the experiences of Manitobans using our ERIK kits that having important medical information available to emer-
gency responders and healthcare professionals has saved lives,” said Karen Irvine, Resource Coordinator for the Boni-Vital Council
for Seniors. “That's why we have been so
pleased to have the opportunity to partner
with the Manitoba Institute for Patient Safety
to ensure that the new It's Safe To Ask Medication Card works with our ERIK kits!”
“Very often patients and family members
feel anxious or overwhelmed in times of
emergencies so it may be difficult for them to
recall important medical details,” said Eric
Glass, Chair of the Paramedic Association of
Manitoba. “The new It's Safe To Ask Medication Card not only serves as an excellent tool
for patients to record and carry information
about their prescribed and over-the-counter
medications to medical appointments, it can
also help speak for them in times of emergencies in their home when they tuck the
Med Card into the ERIK kit on the fridge.”
“Health care providers won’t be able to
make the best decisions about a patient’s
healthcare, without knowing important information about what medicines they are taking” said the Executive Director of the Manitoba Institute for Patient Safety. “We are
asking every Manitoban who takes medications to list them and keep the list up-todate. Know your medications and show your
card every time you see a doctor, nurse,
pharmacist or are in a situation where your
health is being discussed. Know and Show it could help save your life!”
All partners in this initiative want to encourage dialogue about these important areas of patient safety. People need to know
that “It’s Safe to Ask” about their medications.
Source: Media Release, June 2, 2008
http://safetoask.ca/wp-content/
uploads/2008/05/final-medcard-newsrelease-02jun08.pdf
Questions or comments? Call 480-1307, extension 1.
SPread Sheet Volume 2, Issue 1, June 2008
SOLVING (A
FEW MORE OF) LIFE’S LITTLE
Page 10
PROBLEMS
Just to show that you don’t ALWAYS get a silly answer when you ask a silly question . . .
Whose idea was it to put an "S" in the word "lisp"? Because . . . okay, got me there, but
the word “lisp” is onomatopoeic; it’s sounds like what it names, like the word “splash.” It
comes from the Old English, “awlyspian.” 1
If people evolved from apes, why are there still apes? Because . . . and I know full well I
say this at the risk of offending SOMEONE . . . maybe we didn’t. But if we did, the simultaneous existence of humans and apes finds a possible explanation in the theory of allopatric
speciation, an evolutionary process in which one species divides into two because members of
the original population become separated. Both groups diverge from each other, in separate
environments, going their own evolutionary ways, accumulating different gene mutations, being subjected to different selective pressures, experiencing different historical events, finally
becoming incapable of interbreeding should they ever meet again. 2
How do all those dead bugs get into those closed light fixtures? Because . . . Many insects are attracted to the light and warmth of the fixtures. While they’re trying to get closer
to the light they sometimes find tiny little holes around the light fixtures that they can
squeeze into. Insects aren’t the most intelligent creatures and they don’t remember how to
get out, so they eventually starve to death or burn themselves on the light bulbs. Even a
“sealed light fixture” has tiny holes. Sometimes insects will lay their eggs near one of these
tiny holes and the larvae will hatch and crawl towards the light for warmth. When they finally
grow to full size they can’t get out and quickly starve to death. It’s also possible that the
eggs were laid inside the light at the factory before it was assembled, so even an air-tight fixture can have dead bugs inside of it.3
How come you never hear father-in-law jokes? They exist (see sidebar), so the question should properly be: “How come you don’t hear father-in-law jokes as often as mother-inlaw jokes?” People are more likely to retain, recall, and retell jokes
A young man had just prothat centre on a common experience. Does that mean that the
posed to a young woman
common stereotype of mothers-in-law is accurate? No, but statisti- and was being interviewed
cally, women tend to be more relational than men – generally. That by his prospective father-inlaw.
means that when a child gets married, the mother of that child is
more likely to keep in regular contact with the new family unit than
“Do you think you are
the father. The more often that contact occurs, the greater the
earning enough to support a
family?” the older man
common experience and the jokes go from there.
asked the suitor.
Is there ever a day that mattresses are not on sale? No.
“Yes, sir", he replied, “I'm
sure I am.”
If at first you don't succeed, shouldn’t you try doing it like your
wife told you to do it in the first place? Modern, empowered women
“Think carefully now,” said
know that there are really only three ways to get something done:
her father warningly. “There
are twelve of us!”
1. Do it yourself
2. Hire someone.
Source: http://
3. Forbid your kids to do it. 4
www.targetitmarketing.c
om/jokes/pg6.htm
References:
1. Douglas Harper, Online Etymology Dictionary http://www.etymonline.com
3. Ask a Guru http://www.thealmightyguru.com/AskAGuru/2003-12.html
2. PBS Evolution Library: Allopatric Speciation
http://www.pbs.org/wgbh/evolution/library/05/2/l_052_03.html
4. Mona Crane http://quotes4all.net/quotations/mona%20crane/quotes.html
Questions or comments? Call 480-1307, extension 1.