Wednesday, November 26, 2014

Tuesday afternoon

Mary: "Dr. Grumpy's office, this is Mary."

Mrs. Concern: "Yes, I need to make an appointment for my husband."

Mary: "Okay, we can see him next Tuesday at..."

Mrs. Concern: "That's not acceptable. We need to be seen urgently, this afternoon. We're flying to visit our children in the morning. It's Thanksgiving this week."

Mary: "Yes, ma'am, but we're entirely booked today and Wednesday, and closed the rest of the week. But next Tuesday we have..."

Mrs. Concern: "We can't wait until then. He's had a stroke."

Mary: "When was his stroke?"

Mrs. Concern: "Sometime during the night. He's had trouble using his left side today, and his speech is slurred. And now my back hurts, because with him like this I had to do all the packing for both of us."

Mary: "Ma'am, you need to take him to the emergency room. I know Dr. Grumpy is going to tell you to do that. Immediately."

Mrs. Concern: "Nonsense. They'll just do some expensive tests and put him in the hospital. We have a flight in the morning, and can't miss that. We're going to visit our children. I just want to have Dr. Grumpy check him over before we leave."

Mary: "You really need to take him to an emergency room."

Mrs. Concern: "Our internist's office told us the same thing. I can't say I like the attitude you people in 'modern medicine' have these days."

Mary: "I'm sorry but..."

Mrs. Concern: "I hope you realize you're ruining our Thanksgiving."

Tuesday, November 25, 2014


This is from a letter an insurance company sent to one of my patients about having an MRI:

So, let's translate this:

1. It's okay with us if you have an MRI.

2. We may pay for it. Then again, we may not. We won't decide until AFTER you actually have it done.

3. If, after we get a bill, we decide not to pay for it, you will have to pay for it.

4. If we do decide to pay for it, you'll still likely have to pay part of the bill. How much this will be will depend on what we decide. We'll let you know after you've already had the test.

5. Once you get the test, you have absolutely no say in the matter. We, on the other hand, can change our mind at any time.

Monday, November 24, 2014

Sunday morning, 3:48 a.m.

Dr. Grumpy: "This is Dr. Grumpy, returning a page."

Mrs. Wokemeup: "Hi, I'm a patient of Dr. Cortex. He has me on Ataxizon 500mg twice a day. Anyway, for the last week I've had a lot of balance problems. He did labs on Thursday, and said my Ataxizon level was way too high."

Dr. Grumpy: "Okay."

Mrs. Wokemeup: "So he told me to lower the dose to 400mg twice a day. But my balance is still terrible, and I don't know what to do."

Dr. Grumpy: "So you're on 400mg twice a day of Ataxizon right now?"

Mrs. Wokemeup: "No, I take 500mg twice a day."

Dr. Grumpy: "Wait... I thought you said Dr. Cortex told you to decrease the dose because it was affecting your balance?"

Mrs. Wokemeup: "He did. But I wasn't sure if I should. I thought I'd see what someone else thought."

Saturday, November 22, 2014

Home moments

Discovering your kids are playing Star Wars... and have dressed the dog up to be Luke Skywalker.

Friday, November 21, 2014


Dr. Grumpy: "Why are you taking Lithium? Are you bipolar?"

Ms. Valence: "No, I'm Puerto Rican."

Thursday, November 20, 2014

Crystal ball

Mary: "Dr. Grumpy's office, this is Mary."

Ms. Seance: "I need to get an appointment right away! I have a brain tumor!"

Mary: "Okay, we have an opening Thursday, at..."

Ms. Seance: "It's an emergency! I have a brain tumor!"

Mary: "Where did you have your MRI? I can try to get that report for the doctor."

Ms. Seance: "I haven't had any tests. Look, this is serious! I have a brain tumor!"

Mary: "Huh? You haven't had any tests? Then how do you know...?"

Ms. Seance: "My medium told me!"

Mary: "A medium told you..."

Ms. Seance: "Yes! And she's never wrong! The spirits told her that I have a brain tumor!"

Mary: "Okay. Well, we can see you Thursday, at 2:30. What insurance do you have?"

Ms. Seance: "CrappyCare, Inc."

Mary: "I'm sorry, we're not contracted with CrappyCare."

Ms. Seance: "But my medium said you are!"

Mary: "We've never been with CrappyCare. Let me give you some phone numbers..."

Ms. Seance: "This is my medium! She's never wrong! You must be!"

Wednesday, November 19, 2014

Elevator talk

It's 5:15 a.m. The first group of docs is drifting in for the day. I grabbed a Diet Coke and got in the hospital elevator. The doors were closing when one of the hospitalists, trying not to spill his coffee, called for me to hold it. So I hit the "open" button.

Dr. Med: "Morning, Ibee. Thanks for getting that."

Dr. Grumpy: "No problem, Jack. Where you starting?"

Dr. Med: "Ummm, I guess 8 would be best. Can you push that? Thanks."

Dr. Grumpy: "Sure. Hey, are you going to send Mrs. Stroke home today? Her dopplers looked fine."

Dr. Med: "Yeah. She's on Plavix, and I'll have her follow-up with you in 2-3 weeks."

Dr. Grumpy: "Sounds good."

Dr. Med: "Recently I've been getting headaches, but only when I'm masturbating. Should I be concerned about that?"

Next time I'm not going to hold the door.

Tuesday, November 18, 2014

Run that by me again

Seen in another doctor's note:

Monday, November 17, 2014

Lunch with Dr. Pissy

Having lunch with a rep selling migraine pills:

Drug rep: "Doctors, did you know that menstrual migraine affects up to 30% of women?"

Dr. Pissy: "And at least ten times that many men."

Pissy's nurse kicked him under the table.

Sunday, November 16, 2014

Weekend reruns

Dr. Grumpy: "You look kind of unsteady today."

Mr. Woodstock: "Yeah, I smoked a few joints out in my car before coming up here."

Dr. Grumpy: "Why did you do that?"

Mr. Woodstock: "I was really nervous about coming in today."

Dr. Grumpy: "Why were you nervous? You've been here before."

Mr. Woodstock: "Oh, not about that. I've been drinking scotch all morning, and didn't want you to notice I was drunk when I came in. I've never been drunk to a doctor visit before, so I smoked some weed to calm down, because I didn't want you to think I'd been drinking."

Friday, November 14, 2014

Land of confusion

Dr. Grumpy: "Are your symptoms any better or worse?"

Mr. Vague: "I'm not sure. Maybe I don't understand what you're asking?"

Dr. Grumpy: "Well, last time you were here we were talking about your leg pain. Does it hurt more or less since then? Or is it about the same?"

Mr. Vague: "That's a really hard question. I'm not sure what you want me to say."

Dr. Grumpy: "Just tell me how your leg feels."

Mr. Vague: "Are there any easier questions? Like what I'm allergic too, or the name of my dog?

No, folks, he wasn't cognitively impaired.

Thursday, November 13, 2014

Happy pills

Dr. Action Potential has made no secret of her battles with anxiety and depression, and the fact that she takes Lexapro.


Absolutely not. I commend her for speaking out on it. Personally, if my doctor has a problem, I'd want them to be getting care for it.

Why do psychiatric disorders get "blacklisted" as a human condition? Insurance companies don't want to pay for them. Employers don't want to give time off for them. Relatives often don't believe in them ("Oh, she just needs to get over it. She's fine.").

The lady who has a heart attack and requires coronary artery bypass surgery gets time off from work, medications and doctors covered by her insurance, and cardiac rehab to help her recover. But the guy who has severe, nearly suicidal, depression? He may get a few days off work by calling in sick ("I have a cold.") He likely won't find help from a psychiatrist because his insurance doesn't cover them, and if he can't afford to pay cash he's SOL. If his boss learns what's really wrong with him he'll probably get fired.

His internist will try to help with some Cymbalta or Wellbutrin, but doesn't have the knowledge on what to do if those fail. Nor does she have the time to spend with him at his appointments because, as a primary doc, she's got a packed schedule.

So let's go back to your doctor being on Lexapro (or whatever) for their mental health. Does this bother you? Why? If your doctor was a diabetic wouldn't you hope they're taking their insulin like they're supposed to? Or blood pressure medication? A doctor who takes care of their own health issues is (hopefully) going to be around longer and capable of practicing better than one with out-of-control blood sugars or hypertension.

Yet, many people who learn their doctor was being treated for a psychiatric condition would probably run like hell from them. Why? If, like treating any other condition, it makes them better able to function, what's the problem? Wouldn't you want that?

Apparently not. Even though doctors battle the same demons as everyone else, AND are in a profession with one of the highest rates of depression and suicide, no one wants to hear that their physician may be on "crazy meds."

Insulin, Sotalol, Coumadin, Xarelto, Amiodarone, Herceptin, Tysabri, Cellcept, and many other potent meds for serious medical conditions - no one cares if their doc takes them. But Prozac? Hell, maybe you shouldn't be in practice.

So here's my confession: I'm on Zoloft (sertraline). I've taken it for 20 years. Don't like that? Think that means I suck as a doctor? I don't give a shit.

I've battled depression since I was a teenager (yes, for the doubting assholes out there, it's a real disease). I also have OCD. Not the personality type, but the actual disorder. Left unchecked, a circuit fires repeatedly in my head causing me to do pointless activities endlessly- checking light switches, counting to certain numbers repeatedly, walking in & out (and in & out) of a room. Those of you who don't face this have no fucking clue how awful it feels to know your repetitive actions are insane BUT YOU CAN'T STOP DOING THEM no matter how hard you try. Imagine being my wife dealing with that.

So, I take Zoloft. It's not a miracle drug for everyone, but in my case it works quite well. It keeps my wife from killing me for flipping the lights, or shower, or whatever, on & off too many times. It lets me focus on figuring out what's wrong with you, or playing basketball with my daughter. Got a problem with that? Go find another neurologist.

We might treat you for a mental illness, and wouldn't hold it against you, so why would you hold it against us? Or a lawyer, or decorator, or veterinarian, or politician (there's a lot you CAN hold against politicians, but this shouldn't be one of them), or plumber, or nurse, or accountant..., or anyone else for that matter?

I also take Lipitor for my cholesterol. Does that bother you? I doubt it. But I bet Zoloft would make you think twice about coming to see me. Why?

Your doctor, like me and Action Potential, is just another person, made up of the same organic chemical soup as you. We're going to have the same issues that you face (given the nature of this job, possibly more). And if we're willing to be treated for that, I personally think that's good. It let's us concentrate on taking care of you.

Which is, after all, why you came to us.

Your doctor can't help you unless they take care of themself first. No matter what their health problem is.

Wednesday, November 12, 2014

Mary's Desk

Mary: "Okay, so we have you down for next Tuesday, at 4:15."

Mr. Argue: "I'll be there. This is so exciting! I've always been stuck seeing general neurologists, and I'm so thrilled to finally be seeing someone at the famous Binswanger's Clinic."

Mary: "Um... we're not part of the Binswanger's clinic."

Mr. Argue: "Of course you are. The person who gave me your name said so."

Mary: "No... The Binswanger Clinic is in south Grumpyville, about 5 miles from here."

Mr. Argue: "But I want to be seen by a Binswanger neurologist!"

Mary: "Okay, but Dr. Grumpy isn't part of that institution. We're happy to see you here, but we don't have any affiliation with them."


Mr. Argue: "Then cancel my appointment. I'm tired of settling for neurologist wannabes."

Tuesday, November 11, 2014

Veterans Day, 2014

Corporal Chester Nez, U.S.M.C.

Buried under headlines full of election-year vitriol, fighting in the middle east, conflict in Ukraine, ebola, comments by a basketball team owner, nuts with guns killing police officers and civilians, religious nuts with bombs killing anyone they can, and other cheery items... were 2 obituaries. Odds are that they didn't even make it into your local paper, or newsfeed, and even if they did you probably skipped them.

On June 4, a 93 year-old man died in Albuquerque of kidney failure. He was born in 1921 in Chi Chil Tah, New Mexico. Never heard of it? Join the club. It's an unincorporated area of land on an Indian reservation in western New Mexico. He could have been anyone's father, or grandfather, or great-grandfather, from that remarkable Greatest Generation.

But Chester Nez was so much more.

He was the last living member of a group of 29 men who were critical to the Allied victory in WW2.

They were the original Navajo Code Talkers.

You've likely heard the story to some degree. American forces needed an unbreakable code to fight their way across the Pacific. There was a successful one already in use, but it required a long time to transmit, receive, and decode at the opposite ends. And time, in the rapidly changing situation of combat, is one thing you don't have.

The U.S. had used Choctaw and Cherokee code talkers, with great success, in WWI (you probably didn't know that, either. Maybe I'll tell that story another time). In the buildup to WW2, however, the Germans were aware of this and sent anthropologists to the U.S. to learn as much about the native languages as they could. As a result they were used only on a small scale in Europe, with Comanche and Meskwaki talkers serving at Normandy and in Africa, respectively. Seminole talkers served in both Europe and the Pacific.

Navajo is a complex language. As of 1942 it hadn't even been set on paper, and was only known through oral teaching. It has a different grammar structure from other North American native tongues, and is indecipherable for those not familiar with it.

Philip Johnston, who'd been raised on the reservation in a family of missionaries, was one of the rare non-native speakers. In 1942 he approached the army with the idea, and they began quietly recruiting Navajo men. In tests under simulated battle conditions they found the talkers could relay an operational message in 30 seconds - compared to roughly 30 minutes using the standard encode-and-decode system. The cipher they finally developed was an odd combination of phonetic alphabet, straight words, and approximations (for when there wasn't a Navajo equivalent for English). Bombers became buzzards. Submarines were iron fish. Tanks were tortoises.

Codebooks to teach the new system were developed, but carefully watched and never left classrooms. Testing by U.S. codebreakers unfamiliar with Navajo showed that, to a non-speaker, it was unintelligible gibberish.

The Navajos were rapidly deployed. At Iwo Jima, home of one of the world's most iconic photographs, 6 code talkers operated continuously for 48 hours. They called in fire support, updated positions, relayed new orders, and allowed the commanders to quickly adjust to changes ashore. Major Howard Connor, commanding the Marines' signal division, later said that, without the Navajos, the island wouldn't have been taken.

It remains, to this day, the only spoken code that was never broken.

Not that the Japanese didn't try... Early in the war, at Corregidor, they captured Joe Kieyoomia, a Navajo serving in the army. Joe subsequently survived the Bataan Death March. He was viciously beaten by the Japanese, who thought his facial features meant he was of Japanese descent, and therefore a traitor. Eventually he was put in a concentration camp outside Nagasaki with other soldiers.

When the Japanese suspected the code was an Indian tongue, they tried to have Joe translate for them. He recognized the words, but since he didn't know the arranged structure and phonetics he couldn't understand it. As a result they tortured him even more viciously, then made him stand naked in snow. His feet froze to the ground, and when they shoved him back to his cell, the soles tore. Somehow surviving that... he went on to live through the atomic bombing, too. He died in New Mexico in 1997, and you probably didn't see his obituary, either.

Edmond Harjo, the last surviving Seminole code talker, died this year, too, on March 31, 2014. He was 96. He served in more territory than most, sending and receiving messages at both D-Day and Iwo Jima.

And the man I started the article with, Chester Nez, returned after the war and eventually became a painter at the Veterans' Hospital in Albuquerque. When he died on June 4, 2014 he was the last survivor of the original Navajo code talkers, who served with such great distinction far from home.
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