Marketing Moments

I'm doing a marketing study tonight over the internet, and got this question:

"What percentage of your untreated epilepsy patients are untreated?"

Skool Nerse Time

Mrs. Grumpy is a veteran school nurse. This year, she's starting at a new (to her) elementary school.

So she spent this morning sorting through all the medical cards parents have turned in.

Under allergies, some listed for kids at her school include:

"unwashed lettuse"
"sugar, fake sugar, and artificial sugar sweets"
"byprodukts"
"rubber bands or glue and/or whatever stuff like that"
"no Aspirin, but Aspirin is okay"
"that drug that killed Michael Jackson" (hell, this district doesn't even supply Tylenol)
"band-aids"
"metal cans"
"ear thermometers"
"that bad kind of paper I read about"


On the line marked "Other medical concerns you'd like us made aware of":

"Don't let him eat Legos again this year, PLEASE!"

"Can I get a copy of the district's swine floo plan?"

"I don't like her getting junk food. Can you make sure she doesn't bring any for lunch" (who's packing her lunches? Not the nurse, you bozo)

"He doesn't like beer or coffee" (on a 2nd grader)

"Please don't make him swallow goldfish. I saw that on TV once."

If he faints in PE, no blood transfusions"

Sunday Morning, 5:51 a.m.

I suddenly sit bolt upright in bed. My 3rd year of medical school starts the Tuesday after Labor day, and I'm not even ready. A horrible feeling of dread comes over me.

It's a 2 day drive from my parents' house to my medical school. My roommate Enzyme is likely already back there, and wants to kill me (I've got the stereo with me). After I get there I have to buy one of those short white coats that the medical students are required to wear on rounds, and a boatload of clinical textbooks. The school bookstore isn't open on Sundays and holidays. So I'll have to leave here by Thursday at the latest.

I'm not even packed with all the clothes and crap I need for my 3rd year. I don't even own a tie. My car needs an oil change before the 1500 mile drive. I have no idea where the stethoscope I bought last month is.

I jump out of bed in a panic and cold sweat, and call to my Mom if she knows where my suitcase is. Mrs. Grumpy yells "What the hell are you doing?!?"

Suddenly I'm wide awake. The only drive I have to face is the 2 miles to my office on Monday. This isn't my parents' house. I've been an attending physician for 11 years. I've just woken up the dogs. Snowball starts barking his stupid head off, waking up the kids.

No more deep fried ice cream before bedtime for me.

Early Saturday Morning, 12:47 a.m.

I'm deep asleep. My cell phone chimes. A voice message has been left.

Loud music and people talking in background.

"Hello? This is Suzy Kyoo. I see Dr. Grumpy for migraines and I'm out with my girlfriends and some asshole stepped on my foot and the nail polish came off my big toe and the nail is really brown and gross when I looked at it and I showed it to the bartender and he said he thinks it's like some sort of fungus or something nasty like that and I'm not sure if it's safe to paint over it again and I once saw this TV ad for pills or a spray or lotion or something like that to treat toenail fungus and I've got a date on Saturday night and I don't want to scare the guy off with this disgusting toenail and I was wondering if Dr. Grumpy could call in some of the toenail stuff I saw advertised on TV for me and hey Cindy can you get me another daiquiri I'll pay you back Monday at work oh I love this song I'm gonna go dance to it hang on let me get off the phone."

More Forms

I love crap like this, and I get a lot of it.

Here's a form that I need to sign, then fax back to a drug company to get medication samples.

Notice how, in the same paragraph that says I'm supposed to sign and fax, it also says that a signature stamp isn't allowed.

It's a freakin' fax! How would they know?

(click to enlarge)

Screw You, Dr. Rude

Whenever another doc calls and tells Mary to interrupt me, I take the call. I do this because I assume there's an urgent patient matter they need to discuss with me.

Likewise, I'll usually take a few minutes between patients to talk to new docs who call looking for business. When I started in 1998 I went to every medical plaza I could find to hand out cards and ask for work, and still appreciate those docs who were willing to meet with me.

So today I'm with a new patient and Mary comes back to flag me down. She says Dr. Rude is on the phone (I've never heard of him) and told her he urgently needs to talk to me about a case.

So I apologize to the patient sitting in my office and pick up the phone. "This is Dr. Grumpy."

Dr. Rude: "Hi, I'm Dr. Rude. I'm a new specialist in your area, and have just opened my office. I wanted to make you aware that my practice is accepting new patients, and I'd appreciate any referrals you might send my way".

I thanked him and hung up. With a patient across the desk from me, I'm not going to start yelling at another doc.

Piss on you, Dr. Rude. I'm not sending you any damn patients. Having me interrupted by lying to Mary about the reason for your sales call is just wrong. You may be a good doc, but manners mean a lot, too.

I Hope He Didn't Have Anything Serious

Timely communication between doctors is (at least in my opinion) important for good patient care.

So yesterday, this letter from a local kidney specialist showed up on my fax machine. I can't put the whole thing up, but this is the key paragraph.

Besides what it says below, the letter itself was marked as having been dictated on July 4, 2009 (which was both a holiday and a Saturday) and was promptly transcribed on August 18, 2009, then quickly faxed to me on August 27, 2009.





I guess it's also notable that it doesn't mention which January is being referred to.

Medical Resources

Sir, I certainly understand you wanting to find out more about your Parkinson's disease and it's treatments. In fact, I encourage it.

I am, I swear, a board-certified neurologist with over 10 years of combat experience at this desk. While you are welcome to get information from whatever sources you choose, I'm concerned that you're basing your decisions on opinions rendered from non-medical people who may not even have neurological illness. Specifically:

1. The stockboy at Local Grocery who thinks his aunt in Buffalo has Parkinson's disease.

2. The lady you met in line at the movie theater who's hands were shaking a little and told you medications were the work of the devil.

3. The retiree handing out ravioli samples at Costco who told you her last customer had a tremor like yours.

4. bigdavesparkinsonsdiseaseandroofingmaterialsinformation.com

5. The guy who flipped you off in traffic and yelled that you should stop whatever medications you're taking.


These are just suggestions, though. You can do whatever the hell you want.

No Thanks, I'm Trying to Cut Down

Mrs. Oldbird, I'm truly sorry that the medication trial for your husband's Alzheimer's disease caused him to have diarrhea. That is, unfortunately, a known side effect of the drug. I'm glad he got better after we stopped it.

I really do take your word that it gave him the runs. You didn't need to bring in a pickle jar full of his week-old liquid shit to show me. And I really don't want to know what you did to collect it. And I don't need to keep it here to run tests on it. And, if you even THINK about loosening the lid, so help me I'm going to leap over my desk and throw you out the window.

We All Live in a Yellow CME...

I get ads in the mail for CME (Continuing Medical Education) courses. They're generally boring-looking brochures, listing courses like "Stroke Update- 2009" or "Epilepsy Review". They're held at places like "Headupyourbutt University Medical Center" or "Insanely Expensive Resort & Spa". So I toss them in the paper recycling bin.

Yesterday, however, a remarkable one came in the mail for a music themed neurology CME! Featuring hits of the 60's, 70's, 80's and 90's!

I'm still not going to the meeting, but you guys at Case Western get a big Dr. Grumpy "A+" for creativity.

Check it out! Test your classic rock trivia!

(click images to enlarge)

Time to Start Aricept Myself

Look, lady, maybe your husband is demented. Maybe he's had a stroke, and forgotten how to do this particular household activity. Maybe he's just being a guy (I have some experience in that field).

BUT, when I ask you why you brought the old fellow to see me, a neurologist, you're gonna have to give me more information than a note saying "He doesn't know how to make the bed".

Using only that as a criteria, the majority of guys, myself included, will need to start seeing a neurologist. So will most of the pediatric population.

And there ain't enough female neurologists to see us all.

Any Other Bright Ideas, Doc?

Alzheimer's is never fun, but sometimes you have to see the humor in it.

Because patients forget to do routine things, family members often try to compensate by leaving large signs around the house as cues: "remember to brush your teeth", "remember to take your pills", "remember to drink a glass of water", etc.

So today I was asking a family how this method was going with Grandpa. He lives in a condo by himself, near his son, and the family checks on him frequently.

Grandpa saw the signs all over, and for unclear reasons (there are never clear reasons with these people) assumed they were meant for his dog.

And, since his dog obviously wasn't obeying the signs, he had to do something about it.

So one day the son wandered over to find Grandpa vigorously brushing the dog's teeth.

Upon further investigation, he found that, in the week since he'd put up the signs, the dog had been receiving Alzheimer's pills (no, I don't think they helped at all), and sleeping pills (no wonder he was so easy to catch). He'd also moved the "drink water" sign from the refrigerator door to the floor next to the dog's bowl.

This also explained why the dog was wearing a pair of clean underwear, since they'd put up a note reminding Grandpa to change those daily, too.

The signs have come down, and the family is looking into care homes.

The dog has been adopted by the son's family, and is much happier (though his breath isn't as minty-fresh).

The underwear has been washed, with bleach.

Signs of a Bad Economy

This gives new meaning to chips & dip.

Basically, a lady who traded oral sex for Fritos. For the news story, Click here.

TPA Commentary

When I put up the TPA post (see below) the last thing that ever occurred to me was that it would spark discussions in families about advance directives and TPA.

But, from reading your comments, obviously it has done so.

I consider this a good thing. Hopefully you'll never be in the situation below, but I think it's good to have talked about it in advance, so those who may have to make decisions for you know what you would want.

Dr. Grumpy.

TPA- A Play

Before telling this story, I’m going to have to lay some background for my non-medical readers.

The most obscene word in English, in my opinion, has 3 letters and is an acronym. It’s TPA (stands for Tissue Plasminogen Activator).

This drug gets a lot of press as a clotbuster. It has the potential to break down clots and reverse a stroke. That potential, though, has a dark side. By breaking down clots it can also cause catastrophic bleeding into the brain.

So as a result I'm not a fan of this drug. I use it very judiciously, and with a solid understanding by the family and patient of what they are getting into. It can lead to great rewards- and serious complications.

Compounding this is the fact that the drug MUST be given within 3 hours of a defined stroke onset, or the risk of bleeding really goes up. So if I'm told that the symptoms started at 1:45, then a clock immediately starts running, and if the drug isn’t given by 4:45, then it ain’t gonna be. So in that 3 hour window I need to get to ER, confer with the ER doc, assess the patient, get a CT scan and labs, explain the situation and drug (and it’s dangers) to the family/patient, and get their understanding and approval (or refusal) to give it.

So those 3 hours become a very frantic, fast-paced blur. It’s even worse if the patient gets to ER 1 hour after this started, so then I only have 2 hours to work with.

And with that background, I now present “TPA- A Play”, which was performed this weekend at Local Hospital.


Our play opens in ER, where our hero, Dr. Grumpy, has just arrived. The patient is an elderly gentleman with abrupt onset of speech difficulties and right-sided weakness at noon. He got to ER at 1:30, our hero was called at 1:45, and arrived in ER at 2:00. He’s hurriedly examined the patient and met with the wife, and discussed the risks & benefits of TPA.

(Curtain rises)

2:15 p.m. Dr. Grumpy: "What are your thoughts about this treatment, or any other questions?"

Mrs. Smith: "Let me call our children."

Mrs. Smith then whips out a cell phone, frantically calling people all over the country, leaving messages on their voice mail, then calling back to see if they've picked up their voice mail yet. Dr. Grumpy wanders back to nurses' station to review labs.

2:22 p.m. Nurse says wife wants Dr. Grumpy to come discuss this with the patient again. Because of the stroke Mr. Smith is unable to speak or understand speech, but Dr. Grumpy attempts to do so anyway. He reminds Mrs. Smith of the urgency of the situation. She continues to make phone calls. Dr. Grumpy goes back to nurses' station.

2:28 p.m. Mrs. Smith reaches a daughter, and tries to explain situation to her. Then gives cell phone to Dr. Grumpy to explain to daughter.

2:29 p.m. Daughter becomes hysterical and asks to talk to her mother again.

2:31 p.m. Mrs. Smith hands phone to Mr. Smith, and tells him to explain his symptoms to the daughter. The unfortunate stroke patient can’t speak, just stares at phone, saying nothing. Dr. Grumpy leaves the room to keep from breaking down, again reminds wife of urgency.

2:35 p.m. 4 minute attempt to get Mr. Smith to talk to daughter on cell phone ends, with no decision. Highlight was when Mrs. Smith turned up the volume on the cell phone, figuring that might help patient understand daughter better. The look on Mr. Smith's face makes it apparent he's suddenly regretting his choice of spouse.

2:38 p.m. ER volunteer says wife wants Dr. Grumpy to come back and explain to patient for 2nd time what is going on. He good-naturedly attempts to do so. Mrs. Smith repeats everything Dr. Grumpy says, screaming loudly into patients ear, hoping that will help. Dr. Grumpy has a fleeting image of Garrett Morris doing "News for the Deaf" on SNL in 1975. Again reminds wife of urgency.

2:41 p.m. Parents of screaming child in room next door ask Mrs. Smith to stop yelling at Mr. Smith, as it's upsetting their child. She goes into their room to argue with them.

2:43 p.m. Mrs. Smith starts making more phone calls. Dr. Grumpy reminds her of urgency.

2:44 p.m. Dr. Grumpy goes back to nurses' station, asks staff to play the “Jeopardy!” theme over the loudspeaker.

2:46 p.m. Mrs. Smith somehow decides that the reason she can only reach voice mails is because the cell phone reception inside the hospital is poor.

2:47 p.m. Dr. Grumpy goes back to see if Mrs. Smith has made a decision. Discovers she’s absent from room.

2:49 p.m. Dr. Grumpy and nurses stand at window, incredulously watching Mrs. Smith walk across the street and get in line at a Starbucks, still frantically dialing phone numbers.

2:55 p.m. Mrs. Smith gets a coffee and starts coming back to ER. She walks in front of an oncoming ambulance, which slams on it's brakes and swerves to avoid flattening her. Mrs. Smith goes over and pounds on the driver's side window to cuss out the driver, arguing with him in the middle of the street.

2:58 p.m. Mrs. Smith attempts to enter ER again through ambulance entrance, which only opens for a paramedic or hospital ID. She frantically knocks and waves at the paramedic who she just finished cussing out. They get into another argument about which of them needs to pay better attention.

3:01 p.m. Mrs. Smith finally finds way back to patient room, asks nurses to call Dr. Grumpy.

3:03 p.m. Mrs. Smith says she's made a decision. She wants to do whatever Dr. Grumpy thinks she should do. Dr. Grumpy informs her that he is not going to do anything, as the TPA window has closed. Mrs. Smith asks Dr. Grumpy where she can get some sugar for her coffee.


(Curtain falls).

Public Service Announcement

Dear owners of the Fuk-Yu Dragon,

Mrs. Grumpy and I enjoyed our meal there tonight, as always. I'm glad we got to meet for dinner while I was on call.

Generally speaking, however, if you want to attract loyal customers (as opposed to sending them screaming down the street to dine at the Jade Wong instead) you should NOT repeatedly play certain background music. I'm referring, of course, to tonight's choice of "Air Supply's Greatest Hits of the 80's", played again and again and again overhead.

Thank you.

(For those of you who are now thinking "Hey! I remember Air Supply! I wonder where they are now?" the answer is that they've been playing hotels in Macao, China for years. Click here if you don't believe me).

I'll Just Use the Sink, Thanks

I'm on call this weekend (for those of you who don't know how much I just LOVE being on call, click here).

Since I was last on call, the hospital has installed these signs in the bathrooms (sorry for the bad picture, it's a cheap cell phone camera).




Given the IQ's of some of the folks I deal with, and how they tend to take everything quite literally. I would NOT want to be on the hospital janitorial staff these days.

WTF? Friday Patient Freakshow

Dr. Grumpy: "Did you have any other questions, Mrs. Brown?"

Mrs. Brown: "Yes, Doctor, just one. Is it normal for me to be able to stick a Q-tip this far up my nose?" (whips out a Q-tip, shoves it up nose until it disappears)

Dr. Grumpy: AAAAAAAAAAAAAAUUUUUUUUGGGGGGHHHHHHHHH!!!!!!!!!!!!!!!!!

Patient Quote of the Day

"My last Doctor was from India. Or maybe it was Indiana. Anyway, it was one of those foreign places."

Expect the Unexpected

I'm a veteran of the neurology wars. I've done front-line service in ER. I've done trench warfare in hospitals and even at my office desk. After 10 years of this I feel like I can handle most situations in my field, or at least know where to transfer the patient if I can't.

But there are some things you are never prepared for. Like showering buck naked in the pitch dark at 4:00 a.m. (so you don't wake up the family). And suddenly having a zillion megawatt flashlight shined in your eyes. And an 8 year old girl in Little Mermaid pajamas, Spongebob slippers, and a fireman's hat suddenly yell "DADDY! YOU UNDER ARREST!"

Nothing prepares you for that. Ever.

Tell it Like it Is

I've got a junkie over in the ICU, who overdosed on a bunch of stuff yesterday. She was on a ventilator (a breathing machine) this morning, but they were going to see if she improved enough today to get her off it.

So I called over there a minute ago to talk to her nurse:

Dr. Grumpy: "How'd she do this morning?"

Nurse Icu: "She's more awake, and we got her off the ventilator, but may have to put her back on again."

Dr. Grumpy: "Why? Is she still having trouble breathing?"

Nurse Icu: "No, she's just a bitch."

WOW! That is SO Useful!

Okay, Grumpyites. My friendly neighborhood Lidoderm (a skin patch for pain after shingles) drug rep was by last week.

Drug reps aren't allowed to take us to ball games anymore (I'm okay with that). In fact, this year they've actually been banned from bringing us even cheap pens and post-it notes.

BUT they are still allowed to bring us oddball stuff which falls under "patient education". Like this thing:




What is it? An art deco cactus garden? A model of Bikini Bottom (the home of Spongebob Squarepants)?


Nope. It's a model of the nerve endings of your skin, showing how painful post-shingles pain can be. When you turn it on, notice how the nerves glow red (it's pain, get it)?





And HERE! When you push down on the Lidoderm patch (get it? you're applying it to the skin?) they now glow soothingly blue (ah, that feels better). Thank you, Craig, for the hand cameo.



Isn't this useful! Isn't this revolutionary! Isn't this a great use of your medication money!

The kids and I have now taken out the batteries, and this weekend will study the feasibility of turning it into a new home for Ed, my office fish.

Marketing Errors

Avinza is a once-daily form of Morphine. A few years ago they ran this ad, to show a typical patient who may need once-daily narcotics.

I hope she's supposed to be a waitress. Because I'd hate to think they're encouraging a typical patient on sedating and addictive pain medication to start downing daiquiris, and a whole tray of them at that.

They pulled this ad rather quickly. I can't imagine why.

(Click to enlarge)

Unforgettable Weddings

I have a lady with Trigeminal Neuralgia. This causes episodes of sudden, severe, facial pain, which can be quite disabling when they occur.

Her daughter's wedding was this past weekend, and the patient had been asked to stand up front as the couple wed. She's been anxious about it for months, terrified that if she has an attack of pain during the ceremony she'll start crying, and make a scene.

So to prevent pain she decided to a take a handful of Percocet just before the ceremony. About halfway through the wedding she suddenly began vomiting uncontrollably, then passed out on the alter.

I'm glad she didn't make a scene.

One Good Stroke Deserves Another...

There's an irregular heart rhythm called V-tach (short for ventricular tachycardia). Sometimes it's harmless and transient, but at other times can lead to more life-threatening heart rhythms. Therefore, when it shows up on the cardiac-telemetry monitor, it needs to be checked out FAST.

So this morning, around 5:00 a.m., I was on hospital rounds, reviewing a chart on the cardiac floor. I'd been asked to see the gentleman in room 31 (Reverend Jones, of Local Church), for a small stroke he'd had.

Suddenly the monitor tech paged overhead: "Room 31 is in V-tach! Check patient STAT!!!".

About 5 nearby nurses jumped up and ran into the room, throwing the door open, flipping the lights on, racing to the bed.

Reverend Jones was, uh, playing with certain things. Without sheets over him, either.

He explained that he "just wanted to see if my man-parts still work after the stroke".

I decided to just see him this afternoon, after his MRI is done. He's had enough embarrassment for the morning.

In Memoriam

This week marked the passing of a dear friend and associate.





This is my Panasonic electronic pencil sharpener. I have no idea what the model number was, if it had one.

I don't know when it was bought. I first remember seeing it in my Dad's law firm when I worked there in the summer of 1982 (I ran the copy machine for $2/hour).

At some point it got relocated to our house, and I took it with me to college, then medical school. It's since sat patiently on my desk, heroically and faithfully performing it's services when called to do so. It's been with me for at least 20 years, and likely more.

This week, it passed into the great machine heaven, done in by having to sharpen 6 dozen pencils in preparation for the new school year. It tried valiantly, but just couldn't handle it.

Besides the Grumpy family, it leaves behind many friends, including a stapler, tape dispenser, and desk lamp.

Services will be held in the next few weeks, as Frank requested an autopsy be performed to see what's inside an electric pencil sharpener.

Thanks, But I Did That This Morning

Took the Grumpy tribe bowling today. I went to the counter to pay for shoes and a lane.

The guy rings me up and says "Sir, would you like a ball wash?"

It may be part of his job, but I couldn't say that with a straight face.

Checking Out

Mrs. Grumpy sent me over to Local Grocery for some tomatoes today. She also wanted me to pick up Danimals, those drinkable yogurt things for kids.

So I'm at the check-out and Mr. Cashier starts chatting.

Mr. Cashier: "Dude, you can't send these Danimals to school with your kids. They need to be refrigerated".

Dr. Grumpy: "My kids have them at home for snacks."

Mr. Cashier: "Good. They need to be refrigerated, ya know."

Dr. Grumpy: (getting out my wallet) "I'll put this on my debit card."

Mr. Cashier: "Okay. Maybe, instead, you should get snacks that don't need to be refrigerated, and that way your kids could have them at home or school".

Dr. Grumpy: (frantically trying to get out of there) "I'll just bag these myself, don't worry about it"

Mr. Cashier: "Or you could make your own protein shakes for kids, like with Ensure or ice cream or Slim-Fast? Or you could buy protein powder at health food stores? Or... Hey, you want your receipt? Where you going, Mister?"

Today's Mail

Included a letter, with this address:

"Grumpy Neuro Logical Neurological Neurology Office
Attn: Mr. Dr. Grumpy Mister, M.D."


I feel so special now.

No, Thank You

Mr. Gagmewithaspoon, while I understand that the abscess on your scrotum, which you saw a dermatologist for this morning, is of great concern to you, it is not why you are seeing me, your friendly neurologist.

So when I asked you how your carpal tunnel syndrome is doing, there was no reason to drop your pants. Especially since the door to my office was open, as I hadn't expected you to do something like that. Neither did the rest of my staff, though you may have unintentionally helped their diet plan.

So kindly pull them up, put your inflatable donut cushion on the chair, and tell me how your carpal tunnel syndrome is doing.

Wii Fit Boxing

While exercising last night with the Wii Fit, I realized the boxing could be improved by allowing you to put a face on the punching bag. Like Dr. Dipshit. Or Mrs. Idiot. Or evil drug rep Rikki.

On the other hand, if I did this I'd likely die from exhaustion, or break the TV.

You Don't Say!

I always ask patients if they've changed any of their other docs since I last saw them. I think it's important they get my letter, so we all know what each other is doing. Good communication is good for patients, and in this age people change docs often.

So I asked that question of a lady in her 50's today.

She said: "I'm seeing a new Gynecologist. I don't remember her name. She specializes in women."


Best kind, I guess.

Dear Dr. Dipshit

You sent a fax over to my office this morning that only said "PLEASE CALL ME ASAP TO DISCUSS MUTUAL PATIENT IMA DINGDONG!!! I'M AT 867-5309!!!".

I can only assume you did this because you are incapable of actually dialing a phone by yourself. Obviously, if someone at your end could look up my fax number, they could have found my phone number, too.

Mary brought it back to me about 3 minutes after it printed, and interrupted me while I was with a patient because it looked urgent.

I don't mind being interrupted, because a patient emergency should always take priority. So I called 867-5309.

The call was immediately transferred to your answering service, who told me your office was closed and offered to page another doctor on call, who likely had no idea why you were trying to reach me urgently. I begged the operator to see if your office had a backline she could connect me to, and she kindly did.

The lady who answered your backline obviously didn't give a shit. I told her I was Dr. Grumpy, and I was returning YOUR fax about Mrs. Dingdong. She told me the office was closed, and I should leave a message with the answering service. When I repeated that YOU HAD FAXED ME, she said you were having coffee with a drug rep, and didn't want to interrupt you (I guess it's better for a doctor to be interrupted when with a patient, huh?).

I told her that the fax said it was an emergency, so she sighed heavily (I know she rolled her eyes, even without a video link), whined, and said, "okay, let me go see if he's done".

I was then placed on hold for 2 minutes and 38 seconds (while I'm with a patient at my end) before another of your staff came on, said you were still with the drug rep, and asked me which patient it was on, what their date-of-birth was, and why was I calling in the first place? Could it wait until your office opened?

Sorry I hung up at that point, but I didn't want to scream and swear at some poor staff member that you'd stuck between us. Obviously, you and I have a different definition of "emergency".

And you can call me back if you need me. Or better yet, just have the patient call me, since apparently no one at your end believes in patient care.


(Friday morning update: Nope. I never heard back from him.)

No! Not that!

From my first patient of the day:

Dr. Grumpy: "What kind of neck surgery did you have?"

Mr. Neckpain: "It was a bone graft. They put a cadaver in my neck. I mean a bone graft from a cadaver, not the whole cadaver."

The Dog Ate My Homework, but the Cat.....

Too awesome not to share. Here's a guy caught with kiddie porn on his computer, who tried to convince the police that HIS CAT downloaded it!

Check it out!

Phone Phun

Today ended with me doing an evening telephone and internet conference with 15 other neurologists across the country to review data on a drug that's in development.

The meeting took place after we were all home. So you'd hear the occasional sounds of home life. A kid yelling, a dog barking, somebody laughing in the background, etc.

Usually these things go fairly smoothly. Tonight's, however, had 2 noteworthy interruptions:

Interruption #1:

The "click" of a receiver being picked up, and suddenly a young female voice cuts off the moderator:

Young female: "Daddy! My boyfriend is supposed to call tonight! Why are you on the phone?"

Neurologist X: "Britney! Get off the phone NOW! I'm in a meeting!"

Young female: "Daddy! This isn't just any boy! This is TREVOR!!!!!!!!!!!!" (click)



Interruption #2

The Moderator was asking a few questions. He was interrupted when a neurologist with a thick Brooklyn accent apparently had an interruption at home, and loudly said:

"What? Tell him to fuck off! I'm on the phone!"


Good night, and have a pleasant tomorrow.

Dr. Grumpy's Guide to Life, Chapter 2

(As a public service I've written the following, for you to print off and use before shopping for school supplies).

Okay, so this is the 2nd edition of my helpful newsletter (If you missed the last edition on surviving your child's birthday party, click here).

Today's issue will focus on what I discovered to be a horribly traumatic life-altering experience: Back-to-School week at OfficeStaplesMaxDepot. There's one right across the street from my office, so I go there regularly for supplies. It's quiet, the employees are generally helpful, and I know my way around it pretty well.

I naively thought this would be easy.

So on to the lesson:

1. Do NOT volunteer for this job (flip a coin, or arm wrestle, or have a duel to decide instead).

Silly me. When Mrs. Grumpy was wondering when she'd have time to get the school supplies, I volunteered. I figured "How hard can it be? Hell, it's just some pencils and a bottle of glue". DUMBASS!!! The list is HUGE, and features items from the mundane (No. 2 pencils), to the specific (Expo dry erase markers, wide tip, in blue, green, yellow, and black) to the odd (1 Pringles can with lid, original flavor, empty). It took me 2 freakin' hours!

2. Be prepared. Normally there are 5-10 other quiet business-type people there. NOT THIS WEEK! Holy Crap! An African street bazaar is an orderly affair compared to this! Deranged parents running on caffeine! Kids running amuck! Store clerks running for their lives! And all the crazed parents are trying to read off a list, push a cart, yell at kids, and scream into a cell phone at the same time. Bring a water bottle, food, a map, a cattle prod, and a flashlight. A card with your blood type, hospital preference, and next of kin is also a good idea.

3. Do not leave your cart unattended. People will steal your shit out of it. I AM NOT MAKING THIS UP! I had my cart 2/3 full with the crap on my list, when I left it at the end of an aisle to go find notebooks (spiral, wide-ruled, 100 pages each, single subject, 1 red, 1 blue, 1 green). When I returned 3 minutes later about half the stuff I'd already put in it was GONE! I watched a few minutes later as it happened to others. Apparently, when you walk away from your cart, people think it means they can raid it for supplies they haven't had a chance to pick up yet. "Hey, this guy has those index cards (2 sizes, lined and unlined, 100 each) that my kid needs. Cool. I'll scratch that off my list".

If another parent asks you what school your kid goes to, or who their teacher is, DO NOT ANSWER. Ignore them. Pretend you're deaf, or that you don't speak English. They are not making conversation. They are casing your cart, and if they find out your kid is in the same class as their kid, they'll wait until you aren't looking to take your stuff (or just switch carts).

Best part was when I went to ask an employee for help finding something (Flair Correction Pens, in 4 colors). When I got back to my cart the box of 12 ultra-fine tip Sharpies I left in it had been opened, and someone had taken one of them. They'd even doodled on the shopping list I left in my cart to make sure they were taking a pen that worked.

Oddly, you can leave valuables in your cart. Your wallet, purse, and gold jewelry will be perfectly safe if left unattended, but the $2.69 box of high-lighters (12 markers, large tip, in 3 colors) will vanish.

My recommendation: bring a child to guard your cart, preferably one with an iron bladder and who's old enough to use a Taser or firearm if needed. If your kids don't meet this requirement, stop by Home Depot and hire one of the day laborers who hangs out in front looking for work.

4. Do not look for certain numbers of things. The people who make these lists have no idea how things are sold, so it lists things as "1 Expo dry erase marker, chisel-tip, red). Great. They don't sell red ones individually, just in boxes of 4. Or the Flair Correction Pens don't come in only 4 colors, but they do come in 8. Just buy it. If you aren't certain what item the teacher wants, just buy everything in sight and return the rejects later.

Alternatively, if the teacher only wants 1 of an item, such as, say, an ultra-fine tip Sharpie (which only come in boxes of 12), you can always look for an unattended cart with a box of them in it, and take one. If paper is handy, try doodling on it to make sure you are stealing one that works.

5. Hold your place in the check-out line AT ALL COSTS. Reserve it as soon as you walk in the store BEFORE shopping. Use a child (preferably your own) if possible. Other options include day laborers from Home Depot, mannequins, dogs, and aggressive Venus Fly Traps.

6. When in doubt, ask the bleary-eyed, terrified employees for help. If nothing else, it is fun to watch them try to convince you that they don't speak English as they run outside for a cigarette.

Good luck!

Heard In My Office

My secretary Mary was chatting with a patient while she scheduled a follow-up appointment. I was around the corner, reading through some MRI reports.

Mary: "So, are you going anywhere this Summer?"

Mrs. Sympathy: "No. I'm stuck here, waiting for my mother to die. Today would be good."

And then she picked up her purse and left.

Priorities

Just before closing yesterday, my 9:00 for this morning canceled his appointment. It happens.

So early this morning Miss Headache calls: "I'm having a HORRIBLE migraine! My treatment isn't working anymore! I need to see Dr. Grumpy urgently!!!!!!!"

Trying to be helpful, I called her back myself (Mary wasn't in yet).

Dr. Grumpy: "Hi, Miss Headache. We have an opening for 9:00 this morning, can you come in then?"

Miss Headache: "9:00? No, I've got a hair and nail appointment. Do you have anything next week?"

Ed! Don't Jump!

Ed* is my office mascot, and has been since 2001. While he changes incarnations every few years, his name remains Ed. He is a Betta, and carries out his office responsibilities with great enthusiasm.

So it came as a shock to start my day this morning to find that Ed had attempted suicide sometime during the night, and was flopping around on the floor next to his bowl. He's since been returned to his home, and suicide precautions have been taken by lowering the water level.

I dissolved some Prozac in his bowl, and called for an emergent visit from the aquatic psychiatrist.


*Not his real name. Ed comes from a family with a long tradition of service in the health care industry, and has requested anonymity due to concerns his parents will learn he's working for a lowly neurologist, instead of a surgical subspecialty.

More School Follies

The kids didn't have homework after the first day, but Mrs. Grumpy and I sure did. 7 zillion pages of forms about medications, notifications, field trips, what should they do if one of them pees his pants (really!) allergies to medications, allergies to foods, allergies to medical foods, and this gem:

"Please complete this form only if you are unable to understand English, and require forms written in another language."


The only language on the form was English.

That's Uplifting

Dear Mr. Goldman,

We are sorry about your wife's death last year. She was a kind woman.

However, asking my staff if they'd like to see a picture of you together, and then showing the girls one of you standing by her gravestone, is somewhat misleading about the picture's contents.

And Another One!

I just got a note faxed from an ophthalmologist:

"He has normal vision other than his vision is not quite right."

Okay...............

I was reading a note from another doctor this morning. It featured this line:

"She's had a great deal of stress, as her husband was recently widowed."

This is Not Encouraging

Dropped the twins off for the first day of school.

Marquee in front said "WELCOME BACK! WE ARE EXITED TOO BE STARTING!"


I can only hope this was a joke.

Thus Endeth the Summer

Summer, at least for me, has never been determined by the date of seasons beginning and ending. It's based solely on the first and last day of school. It was this way when I was a kid, and is this way now that I have them.

So today was the last day of Summer. And what better way to wrap it up, on a HOT day, then to go ice skating?

I have never ice skated in my life. Or roller skated. Or skied. As a kid, I wasn't coordinated enough. As an adult, my freakishly large feet give me a convenient excuse not to. No place carries my size in a rental. I bowl in my sneakers, because no bowling alley seems to carry sizes above 14.

So we went ice skating. My kids are good at it from going to various birthday parties at the ice rink. Mrs. Grumpy grew up in cold country, and so knows how to do it. I just sit on the sidelines. I have no interest in going, but use my humungous feet as an excuse.

So today, when Mrs. Grumpy asked me if I'd go, I said no. I can't, after all, because they don't carry my size. But to make her feel better I went over to the counter and asked the guy what his biggest size was. And he said my size.

I was trapped.

I consoled myself by watching my kids go around, and thought "how hard can this be?" So I laced on the skates. Took one step on the ice. And went down on my ass.

While my kids were laughing, I hobbled back onto land and got a training walker from the counter. And took that out on the ice. Now I know what my patients feel like. Even pushing this thing around I still went down several times. Fortunately, I was saved by them clearing the ice for the Zamboni. So I took the opportunity to return the skates.

What is it that fascinates people about the Zamboni? Is this an American thing, or do other countries have it, too? It's been satirized in "Peanuts". At skating parties here the birthday kid gets to ride on it. The whole crowd today cleared the ice, watched it raptly, and cheered when it was done. At basketball, football, and baseball they do all kinds of stuff to keep people in their seats during a break in play. Half-dressed cheerleaders. Marching bands. Half-court shot contests. Cartoon hot dog races. Mascots. And people still get up and go to the snack bar. BUT NOT AT HOCKEY! The crowd stays in their seats to watch the Zamboni drive around in circles and cheer!

By this time the twins had wandered over to another rink, where they had a giant pile of snow. I went over to see what they were up to. As I learned, being the only adult in this area made me the mutual snowball target of about 40 kids. I fought valiantly, but went down in flames. While I was lying in the ice the little bastards came over and put snow down the back of my shirt.

The ice capades ended with them playing YMCA. I'm old enough to remember that song first coming out. I never would have believed that more than 30 years later it would be even more popular than ever. Kids who aren't old enough to walk know how to dance to it.

The only injury I suffered all day was when I twisted my ankle getting out of the minivan at home. It's killing me.

And so the Summer ends.

This Sums It Up

School starts Monday.

Staples used to run this commercial. I don't know if they still do.

They ran it before I even had kids. And now that I have 3 of them in various elementary school grades, the commercial just means SO MUCH MORE.

It's a WORD, Okay People?

(Please note, the following post is NOT meant to convey any viewpoint about abortion. Any comments trying to fight-out or inflame pro-life vs. pro-choice opinions will not be published).

I use the word "abort" in my dictations: "Her migraines are aborted by Imitrex" or "He was seen in ER, where the seizure was aborted by Ativan" or "The MRI was aborted due to his claustrophobia".

At least twice a year, most recently yesterday, I get an angry letter or phone call from some patient who is reading my notes on them and becomes incensed over this. They see the word and automatically assume it means they HAD an abortion (No, sir, that is biologically impossible") or that my use of the word is expressing a political viewpoint ("I'm devoutly pro-life! How dare you use that word in a note about me!").

Usually I just explain to them what it means, and send them to a dictionary. It's amazing how many people are stunned to find out it has some other meaning then THAT ONE, and are fine once they realize this.

In spite of this, in the last 10 years I've had 3 patients change neurologists over this issue. Whatever.

Part of being a doctor is respecting your cultural, religious, and political beliefs. That's why I never discuss mine. Words in my notes are just that. Words.

My 11:00

Hot pink shirt, electric green shorts, bright red shoes, orange purse, purple umbrella, who the fuck dressed this woman?

It's a Guy Thing

I was at the hospital early this morning to see a 70-something gentleman who had a stroke yesterday. He told me this great story, which I'm repeating (to the best of my memory) verbatim. Because I can't write them better than this:


"I drove over to Local Grocery, because my wife had been nagging me all damn day that we needed bread and celery.

"Anyway, Doc, when I got there and tried to get out of my car I found I couldn't move my left arm or leg at all. They were completely paralyzed. So by turning I was able to use my right arm to pull a shopping cart over, and then I used that to support me to get into the store.

"At first I thought I should get help or something, but when I got inside I saw they had those motorized electric shopping cart scooter deals, so I got into one and was able to work it okay with my right hand, though I knocked over a display or two. And all these damn store employees kept asking me if I was okay, like it's any of their damn business.

"Anyway, so I got the bread and celery, and got out to my car, and drove here to the ER. That was a bitch, because my cars a manual, so I had to work the clutch and brake both with my right foot, and that ain't as easy as you probably think it is.

"Then, after I got here, I called my wife and had to wait outside in your parking lot for her to come pick up her damn bread and celery. Then I came inside to the ER."

Blinded By the Light

While I was at work today, Mrs. Grumpy decided to replace the 60W light bulbs (some had burned out) over our bathroom vanity with fluorescent 60W equivalent bulbs.

I walked in there tonight and flipped on the lights.

Holy crap! The new bulbs are beyond bright. Like the light from the top of the Luxor Hotel has been moved into my john. I felt like I was peeing inside a tanning bed. I was frantically looking for Coppertone in the cabinet over the toilet.

While washing my hands I realized that the worst part of this incredible luminescence is the way it shows how many gray hairs I have (of the few left at all). I went out to complain to Mrs. Grumpy, who said she didn't care.

She went in there an hour later, and after seeing her own gray hairs illuminated so clearly, immediately drove back to Home Depot to get significantly lower wattage bulbs.

It's Midnight

Look, lady, I can, in some vague way, understand how you forgot to call for a refill on your seizure medication until you were all out. We all screw up here and there.

And I can even understand you frantically calling me at midnight to get a refill. I guess I'd rather have you do this then get called at midnight by an ER doc because you seized and wrecked a car and hurt somebody.

HOWEVER, I DO NOT have your chart in front of me at midnight. When you wake me up I'm lucky to remember my own name. So telling me you need your refill at "the same pharmacy as last time" doesn't help. Neither does your insistence that "I think it's a Walgreen's, you know, one on the west side". We live in a big city here. There are Walgreen's on every other street corner.

And when you finally find a phone number, don't ask me if it's a 24 hour store, or where the nearest 24 hour place is, or what your co-pay is. I just call in the scripts. I am not the Shell Answer Man.

What Sort of Doc Do You Think I Am?

Lady, the long plastic thing hanging by my exam table is a freakin' shoehorn. It's 2 feet long to help my Parkinson's patients use it without having to lean too far over.

IT IS NOT SOME SORT OF VAGINAL SPECULUM.

And no, I ain't gonna do that, either, to help save you a co-pay. I do what I do for a reason, in case you missed Monday's post on it.

You want that kind of exam, call ER's Mom.

Beggars as Choosers

You people are in the damn Medicare donut hole, and I understand that. You call my office looking for free samples, and I try to help. Your internist has a "no samples" policy, but I try to be nice and help you guys save some dollars when you are in the Medicare donut hole, because I know how damn expensive your pills are, and I am trying to help. That's why I became a doctor.

I called my drug rep, and he was actually quite nice, and dropped off a case of your damn pills. It was easy, because his company accidentally sent him a case of samples labeled in Spanish that was meant for a neighborhood across town. So he was happy to contribute it to your care, instead of having to fill out the paperwork to send it back to his company.

They are the same damn pills. You can see them through the plastic. The same pill name and pictures are on the same damn box. You can see that for yourself.

I am trying to help you. So don't stand in my damn lobby and yell at me and Mary because you don't want "pills for Mexicans". You want free pills? Here they are. I wrote the instructions out in English, for crying out loud.

You are the losers who stomped out because I didn't have pills with English packaging, and now you're calling back. Sorry, but now that you've gone home and realized how much it costs to buy the same pills, it's too late to have a change of heart. I'm going to give them to a decent, non-bigoted person. And don't whine to me about how you may not have enough money to buy them. You had your chance at a damn month of free pills, and stomped out with attitude.

What a Drag!

This is too good not to post.

A criminal gang of cross-dressing gay bar performers, who stole over $30,000 in dresses and other feminine things to wear in their shows!

Check it out!

Catch-22, HMO Style

Reading the faxes from overnight.

Idiotic HMO, Inc., sent over a note saying that they were refusing to pay for a patient's MRI because "This does not meet our criteria for lumbar spine MRI's. The patient must undergo a minimum of 8 weeks of physical therapy, without benefit, before an MRI will be authorized."

Farther down on the same page, under guidelines for physical therapy, it says "Idiotic HMO, Inc., will not cover more then 6 weeks of physical therapy per calender year."

No, Not THAT Bible

We all have a book that is our "Bible". After an insane day like yesterday, I go home and read mine (and no, I don't read it in the john).

So what is Dr. Grumpy's bible? Some neurological work by Charcot? A medicine tome by Osler? Nope.

My staff has learned that when I refer to "The Bible" I mean a small book (I've given them all copies) called "Kill as Few Patients as Possible" by Oscar London, M.D. It's a remarkable collection of 57 essays on "how to be the world's greatest doctor". It's a scream. I first read it in 1992 in medical school, and it's since been kept at arm's reach. Any aspiring physician (or anyone who needs a good laugh) should get it.

(Disclosure- I do not know who Dr. London is, I am not selling copies of this, and I have no financial interest in any booksellers whatsoever).

So, Dr. London, if you are reading this, I just want you to know that I think you are awesome. And I continue to try to practice by your rules.

What a Day

The afternoon ended with me ordering an MRI on a 30-something guy.

I'm filling out the MRI form, and automatically checked "No" on the question "Is patient pregnant?"

The guy leans over and says, "Hey, you need to change that."

Dr. Grumpy: "Uhhh, are you pregnant, sir?"

Mr. Bozo: "No, but my wife is. Wouldn't that also affect an MRI that I'm having?"


That's enough insanity for one day. I'm giving up and going home.

Drug Rep Fun

Okay, gang, I've just finished lunch with a drug rep. He represents a narcotic drug, so as a result he can't give me samples for patients to try. The guy is originally from Germany, and the accent, for whatever reason, always adds an extra layer of formality to these meetings.

Under these circumstances most companies give out coupons for the patients to redeem for a week or so of pills, so I asked this guy if his company would be giving us those.

He gave me this horrified look and angrily said (in his German accent) "At my company ve do not believe in prostituting our drugs!"

Okayyyyyyyyyyy.....................

More Weirdities

Today just seems to be shaping up as weirdness in the medical world.

While I'm not trying to take sides online in the animal rights vs. medical research issue, this article today caught my attention.

A group of animal rights activist in Switzerland have targeted the CEO of Novartis pharmaceuticals by (among other things) stealing his mother's ashes!

Medical Research

The West Virginia branch of our Science Marches On Department has brought the following enormously important medical research to my attention.

(click to enlarge)



FOLLOW-UP COMMENT: The Texas branch of our Science Marches on Department, upon reviewing this article, had several questions which I thought were worth printing:

"(a) Does it matter what you read? Sci-fi, romance, action-adventure, military history, self-help, etc? More work in this field is needed.

(b) Since this was done in Israel, does it make a difference if you read left-to-right or right-to-left?

(c) Is this why they call Jews the People of the Book?

(d) Do you get the impression that the Primary Investigator did this research because his wife complained about his reading on the john and gave him some old wives' tale about how it's bad for you?

(e) I know (from personal experience) that Haifa isn't the most exciting city in the world, but how bored do you have to be to come up with this?"

Good Causes For All Things

On the way home from the Grumpy Neurology Emporium tonight I passed a sign: "This is National Stop-at-a-Red-Light Week. Remember to stop at red lights this week."

I'm not making this up (you can google it if you don't believe me).

I had no idea we were in need of this. Are there weeks for other traffic laws (Slam-on-the-Gas on Yellow Week, or Swerve-to-Avoid-Pedestrians week)?

And if I try to remember to stop at red lights this week, do I still have to do it next week?

Attention Other Specialists

I am a neurologist. This means I deal with brains and nerves. I do this for a reason, just like you have your reasons for doing whatever you do.

This means that I do NOT want you to send me any of the following:

From GI docs: vivid bright color endoscopic pictures of a mutual patient's hemorrhoids, the inside of his rectum, or a bleeding ulcer in his duodenum. I will take your word that he has problems, and you don't need to send graphic evidence. Sending it by fax, however, has helped Mary stay on her diet.

From OB/GYN's: close-up photos of herpes sores on a mutual patient's hoohah, shots of her cervix at 28 weeks, and slides from her pap smear.

From any surgeon: A DVD of you taking out Mr. Smith's gallbladder or fixing his inguinal hernia. I treat his migraines. You stay on your side of the body and I'll stay on mine.


I don't send you people samples of spinal fluid, EEG clippings, or a DVD of abnormal reflexes. So stop it.

Bad Ways to Wake Up

My cell phone beeps at 3:47 a.m. on a Monday morning. It's the coroner's office, urgently needing records on one of my patients.

Sunday in the Pool

I'm sitting on the pool steps today, watching the kids swim. Marie comes over and starts fanning water onto my submerged torso and legs. After a few minutes of this, I asked her what she was doing.

"I'm getting the barnacles off. On Spongebob, Mr. Krabs said old people have barnacles grow on them."

This parenting thing can be SO flattering at times.

Does Anyone Else Think This is Wierd? Or is it Just Me?

Mrs. Grumpy went to a funeral last week, and just returned yesterday.

I've never heard of this (and neither had she) but the family had hired a professional photographer! I am not making this up. As each group of guests came in they were asked to have their picture taken standing by the casket (mercifully closed) and widowed spouse ("say 'cheese' everyone!").

After everyone was there, the photographer filmed the whole ceremony, including burial. You could sign up to have a free CD of the funeral soundtrack sent to you, or (for only $9.95) also get a DVD with video so you can always revisit the excitement.

This was all part of the package that was offered by the mortuary.

I have nothing against photographers. They work at weddings, parties, Bar Mitzvahs, etc. But I've never heard of similar stuff being done at funerals.

Am I out of touch? Is this normal these days? Does anyone else think this is strange?

"When will my labs be back?"

Labs fall into 3 groups:

1. Regular tests (done at the lab, back within a few hours).

2. Local send-outs (done in the city, but we "send-out" the sample to another hospital. Can take a few days).

3. Major League send-outs (only a few places in the country, or even the world, may do these. Several weeks to get back).


So yesterday afternoon, around 4:00, I was trying to track down some results in category #3. The hospital lab kept switching me from person to person, and each time I had to tell them my story, the patient's name, etc.

Finally I reached a supervisor, who said: "Oh, those are rare labs. We had to send them quite a ways. I'm going to have to connect you to Israel."

I was quite surprised, but patiently held the line. After about 10 seconds it began ringing, and a male voice answered.

Male voice: "Lab, can I help you?"

Dr. Grumpy: "Um, I'm looking for some send-out results from about a month ago on Mr. John Smith..... Hey, what time is it there anyway?"

Male voice (surprised): "Uh, about 4 in the afternoon."

Dr. Grumpy: "Oh..... I thought I was being connected to Israel."

Male voice: "I'm Israel Nunez. I work in send-outs. What's the patient's birthday?"


At least he got me my lab results.