Answering service fun

Mrs. Soma is well known to our call rotation. When Dr. Brain isn't on, she routinely tries to get a remarkable variety of pain relievers from the rest of us. She's been shut down many times in the past, but is remarkably optimistic (or forgetful) and keeps trying.

So it was no surprise when Dr. Brain's answering service relayed a message that she was looking for Vicodin. I called her back, and said no. She asked if there was another doctor she could talk to (she always does). I said no and hung up.

Ten minutes later I get called by the answering service again:

Dr. Grumpy: "This is Dr. Grumpy."

Ms. Supervisor: "Yes, I'm the service supervisor. Mrs. Soma called back, and says she needs Vicodin."

Dr. Grumpy: "I told her no."

Ms. Supervisor: "But she called back and asked again."

Dr. Grumpy: "The answer is still no."

Ms. Supervisor: "She sounds awful!"

Dr. Grumpy: "She always does. She's been doing this for over 10 years."

Ms. Supervisor: "Well, I"m tired of her calling my operators. We have a lot of calls to answer."

Dr. Grumpy: "Okay. Tell her that."

Ms. Supervisor: "Can't you just give her one Vicodin to shut her up?"

Dr. Grumpy: "Wha...? NO! I can't believe you just asked me that."

Ms. Supervisor: "She's just driving us nuts."

Dr. Grumpy: "Sorry."

Ms. Supervisor: "Happy new year."

More things that make me grumpy

When Dr. Cortex is out of town, I cover his patients.

I try to work within my patient's means as much as possible. If they have crappy (or no) insurance, I try to use the cheapest generic medication possible.

Dr. Cortex, however, uses a lot of brand-new, pricey Wonderdrugs, mainly because he has samples to give out. The problem here is that he also sees A LOT of Medicaid-subplan indigent patients, and once the patient runs out of samples there is NO FREAKING WAY the plan will pay for the prescription.

Normally, this is a problem between he and his patients. Except when he's out of town. Like now.

So Mr. Ictal runs out of expensive Wonderdrug samples for his epilepsy. Dr. Cortex's nurse calls in a script to Local Pharmacy. Local Pharmacy finds out Wonderdrug isn't covered by his Medicaid plan, and tells Mr. Ictal it'll be $400.

So Mr. Ictal calls Dr. Cortex's office. And his staff closed the office to take a 4-day New Year's weekend (which they weren't supposed to, but figured the boss was in Brazil, so who cares?). And so the answering service routes him to me (my office is closed for the 4-day weekend, too).

Wonderdrug won't be covered without a doctor begging, pleading, and filling out a 30 page form. I call the Medicaid subplan to at least beg. But I'm not contracted with that subplan myself, so they won't even talk to me.

The pharmacy (understandably) can't afford to take the loss on a $400/month pill that they know won't get reimbursed. And Mr. Ictal can't afford this at all. And he has 1 sample pill left, and it's pretty damn dangerous for epilepsy patients to stop their meds cold turkey. And he has no idea what he's taken in the past. And I really hate to change meds on a patient I know nothing about. And his chart is locked up in Dr. Cortex's office until next week.

I feel bad for Mr. Ictal. This insanity (mostly) isn't his fault.

What did I do?

Fortunately, I live close to my (closed) office. So I drove down there this morning to meet Mr. Cortex, and gave him enough samples of Wonderdrug so he won't run out before Dr. Cortex can get back and decide what to do. But this is me (and at least I had samples). In all honesty, most other docs wouldn't care, and say they can't help him. Or would tell him to put the pills on a credit card. Or say it's the pharmacy's issue and to call them. Or to go to an ER (I have no idea why he should go to ER for this, but it's amazing how many docs send patients there for stupid shit like this).

The bottom line here is that you should try to work within your patients' means as best you can. It prevents crap like this from happening, and your call partners will be grateful.

Stupid questions

Dr. Grumpy: "Here are the names of 3 hand surgeons I recommend."

Mr. Carpal: "Are they good docs? I don't want to see a bad one."

My inner voice: "No, you dipshit. They're all dangerously incompetent. WTF would I knowingly refer you to a bad one?"

You VILL do ze physical therapy!!!

This note is from Local Physical Therapy, and hot off the fax just now.

With therapists like this, who need enemies?

(click to enlarge)

Is she a cephalopod?

Getting ready for the day, and reading another doctor's note on a patient coming in this morning:

"Her pain can involve 1 to 4 limbs at a time, but never more than that."

Mary's Desk, December 29, 2009

Mary: "Okay, I have you down for a follow-up appointment in 3 months, on March 22nd at 9:30."

Mr. Organizer: "Let me write that in my daily planner, hang on... wait, is that a weekend? I can't find it on my calender."

Mary: "Um, no, it's a Monday, like you asked for."

Mr. Organizer: "You must be wrong, that date isn't in my planner."

Mary: "March 22?"

Mr. Organizer: "Oh, I thought you said March 72nd."

Somebody put something in my drink

Sometimes finding the humor is the best we can do.

This morning I saw a new dementia patient, Mr. Bukubux.

He's an older gentleman, who hasn't quite been himself for a while, but his family couldn't put a finger on what was different... Until recently.

He and his wife are members of Headupthebutt Country Club, and have an annual holiday party for their friends. At these shindigs he's always the bartender, which he enjoys doing and is good at.

At this year's party, however, several guests complained to Mrs. Bukubux about their drinks. He'd forgotten various people's favorites, though that was a minor issue.

More concerning was that he was mixing them incorrectly, combining ingredients at random, depending on which bottles happened to be near him at the time.

One lady ordered a scotch & soda. Mr. Bukubox handed her a coffee mug containing milk and red wine, with a lemon floating in it.

Another man asked for a martini. He was handed apple juice with a Ritz cracker bobbing in it.

More things that make my grumpy

A December phenomenon that drives me nuts.

I'm sorry that your regular neurologist is closed/on vacation/dead until after New Years, and that you don't like the doctor covering for them.

But I'm not some sort of neurological urgent care. Showing up at my office without any old records because of some acute issue you need addressed, and planning to return to your previous doc as soon as they get back, doesn't fly here.

I mean, I have my own patients to take care of, and it's not like you're planning to stay with my practice. You make it pretty clear that you're just coming for me to patch things up until Dr. Wondrous returns/detoxes/is resurrected next week. There's a doctor on call for him. SO CALL THEM, NOT ME!

And I'm really pissed off at your internist for participating in this. He tells you to come see me until Dr. Wondrous comes back, because he doesn't know what to do, and he doesn't know Dr. On-Call, and so he sends me a note that says something like "please manage meds until regular doc returns" or "patient has had neck pain since 1972, please do something about it in Dr. Wondrous absence". These notes are especially grating when written by an internist who never refers to me anyway.

Of course, I have none of your past records, and Dr. Wondrous staff is gone, too, and you have no freaking idea what you've tried before, or if it worked, or what tests you've had done.

This is why we have call groups people. I'm sorry if you don't like the person who covers for your regular neurologist. Tell them when they come back. But I am not providing temporary coverage for them.

Job Counseling

In the early 80's, when I was in high school, we had to take these career guidance tests. You answered a bunch of questions, and a computer (like a TRS-80: anyone else out there have one? I had the top-of-the-line model, with a whopping 16K of RAM) would tell you what career was best suited to your personality.

My test results suggested a career in farming and agriculture was best for me. (Oddly, so did my Dad's tests in the 1950's. And he's a lawyer now).

In October I put a resume up on a medical site, looking for research work in addition to my regular practice.

Today I got an email from the site's "job assistant", saying that I'm qualified for an exciting career as a Certified Nursing Assistant, and should register for classes NOW.

Memo to Patients

LOOK! Just because you people waited until the END OF THE FREAKING YEAR to see if you met your insurance deductible, does NOT make it an emergency here for Annie and I.

I don't care that you now need the test (which I ordered 6 months ago) urgently because your insurance is changing, or because you finally met your deductible, or you just looked at a calender for the first time in 6 months and had forgotten December is the last month of the year, OR WHATEVER.

These are not tests you can generally get Bozo Insurance, Inc. to authorize and schedule in under a week, let alone a few days.

And the auth department at Bozo Insurance, Inc. is running half-staffed right now so their people can go on vacation, or get their tests done, or whatever. So auths are slow right now.

A lack of preparation on your part does not constitute an emergency on ours.

And don't give me the line about how you had no idea the end of the year was coming, either.

Yours truly,

Dr. Grumpy.

Dear Mrs. Thoughtthatcounts,

I just wanted to write and thank you for the tray of homemade chocolate brownies that you brought my office last week.

I'm well aware of your fondness for improvising new recipes, and the staff and I appreciate you telling us which brownies had jalapeños in them, which had bacon, and which had both.

As always, you've outdone yourself. Many of us here thought you'd never be able to top your 2007 tray of chili-pepper-and-white-chocolate-cookies, but we underestimated you and your fondness for spicy foods.

As you can imagine, your unique brownies didn't last long in our breakroom, and quickly disappeared.

You work so hard in the kitchen around the holidays, perhaps next year you should take a break and just rest. You've earned it.

Yours truly,

Ibee Grumpy, M.D.

My readers write

I'd like to thank my reader Brian, who submitted this story. For my non-medical readers, NPO is medspeak meaning "no food, water, or pills orally". Advair is a drug that's INHALED.


Hi Dr. Grumpy! I'm a pharmacist at an academic medical center. Tonight I received a phone call from a surgical resident.

Dr. Surgistud: "My patient is NPO for surgery and is on Synthroid. Is there an IV formulation and what is the conversion?"

Brian, RPh: "Yes, it's 50% of the oral dose."

Dr. Surgistud: "OK, great. And also - the patient is on Advair. I need to change him to Levalbuterol and Atrovent, right?"

Brian, RPh: "Um... no. Those are different drugs. Why do you want to change the Advair?"

Resident: "Because the patient is NPO."

Hope you got a good laugh out of that... all of my colleagues did!

Loose playlists sink ships... or something like that

Ya know, given the ease with which a guy was apparently able to walk on a plane with a bunch of explosives last week, some of the other measures seem somewhat out of place.

For example, when I was accused of contributing to terrorism a few months back.

So this morning I'm updating my iTunes software. A friend had told me about this a while back, but I'd never looked for it before today (hell, who actually reads the consents that come with software updates?). But, there it was.

I direct you to item #10 of the iTunes update agreement.

(click to enlarge)




I really love the last line. "You also agree that you will not use these products for any purposes prohibited by United States law, including, without limitation, the development, design, manufacture, or productions of missiles, or nuclear, chemical, or biological weapons."

I freely admit that my taste in music doesn't suit everyone (Mrs. Grumpy hates it), but I think the most that could be said is that my iPod constitutes a weapon of mass good taste destruction.

December 26, 2009

Dr. Grumpy: "FRANK, CRAIG, MARIE GET IN HERE NOW!!!!!!!!!!!!!!"

(shifting feet, poor eye contact)

Dr. Grumpy: "Why on Earth are you all jumping on the trampoline, in cold weather, NAKED????"

"I told you we'd get in trouble!" "Well, it was your idea!" "Wuz not."

Dr. Grumpy: "ANSWER ME."

(quick glances back and forth)

"Um, they all fell off."

Dr. Grumpy: "I'm not stupid."

"No, really, we were jumping hard and the bouncing made them..."

Dr. Grumpy: "I said I'm not stupid."

"We were out on the trampoline and wanted to play dodge ball."

Dr. Grumpy: "So why were you all naked?"

"Because we didn't want to go find a ball, so we used our clothes to throw at each other."

Dr. Grumpy: "Do you have any idea how cold it is outside?"

"Yeah, um, but not until we were naked. Then it seemed pretty cold."

Dr. Grumpy: "Frank, where are your clothes?"

"Because Marie is a bad loser. After she lost, she threw my clothes over the fence."

Traditions of Christmas

The morning after Christmas I got dragged in to the hospital to see a guy for headaches.

He kept referring to he and his wife as having "a traditional Christmas", which apparently landed him in the hospital. "Traditional" obviously varies from person to person. Here is how Mr. Traditional and his wife spent their traditional Christmas (and it took A LOT of coaxing to get the whole story out).

They woke up on Christmas morning. Then:

They had a traditional cup of coffee. Then:

They had a traditional exchange of gifts. Then:

They had several traditional shots of scotch. Then:

They smoked a few traditional joints. Then:

They did a few traditional lines of cocaine. Then:

She gave him a traditional under-the-mistletoe blowjob. Then:

When he blew his traditional load he had sudden onset of the-worst-headache-of-his-life (not a tradition).

He was taken to ER, where he had a traditional head CT, MRI, and MRA (having to drag in an MRI tech on Christmas).

So then he had a traditional spinal tap. Which was equivocal, because he wouldn't hold still.

So then the angiogram team got called in on Christmas.

So then he had a traditional 4-vessel cerebral angiogram, complicated by bleeding and a BIG hematoma at the groin puncture site (yeah, your wife's gonna love that thing next to your yule log, dude).

The admitting doc then felt a second traditional spinal tap was needed.

And that's how Mr. Traditional spent his Christmas.

When I met him (and his charming wife) this morning he asked me if I'd ever seen a case like this before.

I gave him my traditional answer. You guys can guess.

More Dragonisms

Okay, for Christmas I thought I'd give you guys some Dragonisms.

(What is a Dragonism?)


Dr. Grumpy said: "She's had bilateral breast augmentations."
The computer typed: "She's had bilateral breast amputations."


Dr. Grumpy said: "Since the stroke he's taken Plavix."
The computer typed: "Since the stroke he's taken buttocks."


Dr. Grumpy said: "Flexeril helps her back pain."
The computer typed: "Sex oral helps her back pain."


Dr. Grumpy said: "The ophthalmologist is treating his corneal abrasion."
The computer typed: "The ophthalmologist is treating his toenail infection."


Dr. Grumpy said: "I'll see her back for the tests."
The computer typed: "I'll see her back for the tits."


Dr. Grumpy said: "He has circumoral paresthesias"
The computer typed: "He has immoral paresthesias"


Dr. Grumpy said: "When the neck pain worsened, she went to a chiropractor."
The computer typed: "When the neck pain worsened, she went to a car repair."


Dr. Grumpy said: "She has Ambien to help her sleep."
The computer said: "She has Indians to help her sleep."


Dr. Grumpy said: "After the fall he had a right knee arthroscopy."
The computer said: "After the fall he had a right knee atrocity."


Dr. Grumpy said: "She has migraines with phonophobia."
The computer said: "She has migraines with porno phobia"

Holiday Reruns

(For those of you who missed it the first time around, the following was my post for Christmas, 2008)

The following message was left on my office voicemail last night (December 24th) at around 8:30 p.m., by a pharmacist who was obviously less than enthusiastic about having to work on Christmas eve.

"Hello, I'm calling from Local Pharmacy about a refill for Dr. Grumpy. It's on patient Mrs. Smith, for her Cartia. The idiot's at her nursing home didn't realize she was all out until 5 minutes ago, and then were stupid enough to think they could just waltz down here
and get more. But no, there were no refills.

"So if someone could please call me to refill this, this bunch of bozos at the care home want it tonight. And I'll be here, tonight, on Christmas Eve, at Local Pharmacy, all damn night. so you can reach me whenever you call. My name is Joy. Thank you."

December 24, 2009. Tis the season

Oh, 2 tomatoes, and some paper plates? No problem. Let me get my car keys.

Crap, Local Grocery is mobbed. Hey, bitch! Don't flip me off! I wasn't even looking at that parking space. Chill.

Merry Christmas, Mr. Salvation Army dude. My only cash is $3, but I'll gladly put it in your kettle.

What a fucking mob scene. Hey! Don't push me! I didn't even want the last shopping cart! I'm just here for some damn tomatoes, lady. Merry Christmas.

Hi, it's me. I have the tomatoes. What brand of paper plates do you want? No, it looks like they're out of those. Okay, I'll get Chinet. Says they're made from recycled paper. Hope it's not toilet paper.

No, Mr. Salvation Army. I gave you my last $3 on the way in. Remember? Merry Christmas.

Hello? No, just leaving. Lettuce? Yeah, hang on. I can go back. Looks like some guy in a Santa hat is yelling at the Salvation Army guy for blocking the door, but security is leading Santa away now. Shit, somebody took my parking space as soon as I pulled out. Let me find another one.

Sorry, Mr. McDonald's manager. I didn't realize this space was for McD's customers only. It's not marked that way. I'll move my car, don't worry. Merry Christmas.

Mr. Salvation Army, it's me again. I had to come back. You have my $3 already.

Lettuce... hey, stockperson, whatever sex you are, where's the lettuce? You only have 3 heads left? Wow. I had no idea there'd be such a rush on iceberg for Christmas. Well, this one looks like it's been dropped the least.

It's a self-checkout. Look, I don't recognize you as one of my Alzheimer's patients, but you obviously are not grasping how to work this thing. So go over to the cashier and check-out the old fashioned way. I think she's one of my dementia patients, so I'm sure you'll have a lot to talk about while you hold up that line.

What the fuck! It's not taking my credit card! All I want is one fucking head of bruised iceberg lettuce!

WhatdoyoumeanthefuckingcreditcardsystemhascrashedbecauseeveryotherlastminuteloserinAmericaistryingtousetheircreditcardrightnow?

How long will that take?

NO! I DON'T HAVE ANY FUCKING CASH! I GAVE MY LAST 3 DOLLARS TO THE FUCKING SALVATION ARMY GUY! IF I HAD ANY CASH DO YOU THINK I'D BE WASTING MY TIME TRYING TO PUT A SINGLE $1.29 HEAD OF LETTUCE ON A FUCKING CREDIT CARD?!!

Well, fine. I'll go over to the ATM across the parking lot. Look at that line and NO, YOU BELL-RINGING ASSHOLE! YOU ALREADY HAVE MY $3! IF I HADN'T PUT IT IN YOUR FUCKING KETTLE I'D HAVE BEEN HOME BY NOW!

This is the line for the ATM? There are 5 freaking ATM's here? Oh, great, the other 4 are all out of cash due to the Christmas rush. Fine, I'll wait.

Hello? No, I'm in line at an ATM. I need to get cash to buy lettuce and... Because I gave it to the Salvation Army guy, that's why! Look, it's taking longer than I thought!

NO, MR. SALVATION ARMY! I just got this $20 out of the ATM after waiting for 15 minutes, because I gave you my last $3 and now the credit card machine is broken, and if you approach me again I'm going to shove that fucking bell up your ass.

YOU SOLD MY FUCKING BRUISED HEAD OF LETTUCE TO SOMEBODY ELSE? ARE THERE ANY LEFT? NO? CALL THE FUCKING MANAGER!!!

Fine I'll take this bag of salad instead, but it better be for the original $1.29. Merry Christmas.

Don't even think about it, Mr. Bell Ringing Salvation Army Guy.

When I got home Mrs. Grumpy told me she'd just found an extra head of lettuce in the refrigerator. She'd forgotten she'd bought one yesterday and put it in the produce drawer.

Merry Christmas to all, and to all a good night.

Healthy Living

Okay, my office is closed today, but I'm working at home, doing some marketing reviews online.

One company had me watch a television commercial in development for a new Parkinson's Disease treatment, which featured patients explaining how the disease interfered with their ability to do things they enjoyed.

One of them, I swear, was a lady explaining how, because of her Parkinson's Disease, she'd had to stop smoking, and showed a "before" clip of her trying to light a cigarette with her hand shaking all over.

Then she went on about how with new drug ParkieMiracle her coordination had improved so that SHE'D BEEN ABLE TO START SMOKING AGAIN, and showed her happily puffing away.

This ad agency really needs to be fired, or find some better examples.

More Gift Ideas

Last one for the year, for you last minute shoppers.

I'll generally ignore a few small holes in my undies, but when they become too far gone I just go to Costco and buy a bunch.

Apparently, though, this idea is too simple for others...

Augh!!!!!!!!

This message was left on the office voicemail over lunch hour:

"Hi. I have a gray pill, with 10 on one side and nothing on the other. I have no idea what it is, but I got it at Medco. It's for my husband and we only have 3 left. Call me right away."

Dear Dr. Dumpster,

I appreciate you sending Mr. Etoh to my practice.

We had an appointment scheduled for him, but after further review of your notes I cancelled it, as I feel seeing him at this time won't be possible.

It was very helpful that you sent his MRI reports, and the EMG findings, and the list of medications he'd tried in the past.

But most helpful was the handwritten note (and I recognize your handwriting) on the last page of the fax, which simply stated "December 14, 2009. Mr. Etoh came to appointment inebriated and punched receptionist. Police notified, patient fired from practice. Told to see a neurologist, given Dr. Grumpy's name."

Anyway, it looks like I'm not currently accepting his insurance, whatever it is (even if it's cash), and have referred him to my former colleagues at Humungous Neurology, Inc.

Wishing you a Merry Christmukah,

Ibee Grumpy, M.D.

Hey! This sausage tastes like... uh, chicken?

More fun at drug rep lunches:


Mr. Pharmastud: "I brought pepperoni and sausage pizzas, I hope you like them. I don't like the other kind myself."

Dr. Grumpy: "What other kind?"

Mr. Pharmastud: "The ones with only veggies. Veterinarian style."

Dr. Grumpy: "You mean vegetarian."

Mr. Pharmastud: "Um, yeah".

More Gift Ideas

What's more exciting than Formula 1, Indy Car, and Nascar racing?

Why elderly-patient-in-a-wheelchair-on-Aricept racing, of course! Rev that wheelchair, squeal those tires, and rocket down the hall to the day room for some serious pottery lessons!

(click to enlarge)

Whatever

Dr. Grumpy: "Who's your regular internist?"

Mrs Belfry: "Dr. Elderly. He specializes in generic patients."

Dr. Grumpy: "Generic patients?"

Mrs: Belfry "You know. Old people."

Dr. Grumpy: "You mean geriatrics?"

Mrs. Belfry: "Whatever. Same thing."

Tuesday Morning, 1:47 a.m.

"Hello, um, we worked together, in 1995, I think you were in residency at the time. Anyway, I hate to bother you, but I really need some Vicodin or something called in, because I have really bad neck pain, and back then I mentioned it to you. I'm not a junkie because I used to have a nursing license and learned all about these drugs, and why you shouldn't abuse them, so if you could please call some Vicodin in to Local Pharmacy I really need it."

This is a yes or no question

Dr. Grumpy: "Did the new medication cause any side effects?"

Mrs. Pain: "No, none at all. But I got a rash from it, and it made me sleepy."

Thank you for sharing

A company I consult for was trying to set up a time for me to review data. The person at their office stopped returning my emails and calls for a week, then emailed me this morning to apologize.

Could he have just said "Sorry, I was out sick"? Of course. Did he. Hell no!

Instead he felt the need to send this:

"Sorry Dr. Grumpy, I haven't been feeling well, and was out of the office. I'm having terrible rectal problems, and am scheduled for an anuscopy tomorrow. I'm not looking forward to it, either."

Hey! This is like a ride!

And what a ride it is.

I'm shocked to look at the calender.

Today is 1 year since my first post.

Now, 365 days and 615 posts later, here I am.

I started writing this just to bitch. I had no idea so many others would enjoy it.

In 1 year I've gone from 1 daily reader (me) and zero blogger followers to 2800 daily readers and 231 Blogger followers.

And all I can say is THANK YOU, to all of you. Your comments and emails and idea/story contributions have made this more fun than I EVER dreamed it would be.

I'll keep writing as long as it's fun and the patients give me reasons too. Which will likely be a long time.

Dr. Grumpy.

Things that make me grumpy

I had a consult for Parkinson's disease over at Local Rehab hospital today. So I dragged my butt out of bed on Sunday and drove over there.

Parkinson's patients, unless they live in the boondocks, generally have a neurologist. Most PCP's don't want to manage this (nor should they). So when I see a Parkie in the hospital I always ask them who their regular neurologist is.

And this lady told me it was Dr. Osa, who works across the street from the rehab hospital and goes there to round. He's been following her for 5 years.

So I went back to her chart, and reviewed the records. She was recently hospitalized for hip surgery, and during the hospital stay Dr. Osa saw her EVERY FREAKING DAY and, as a consultant his name was printed at the top of every damn page of her hospital stay. But Dr. Fruitcake, who's following her in rehab, somehow didn't notice that minor detail.

So I went back and asked the patient. Did you tell Dr. Fruitcake you see Dr. Osa? "Of course I did, but she never payed attention. She just said she'd have a neurologist come see me."

So I asked the charge nurse. Did Dr. Fruitcake even look at the hospital records? "Of course. I handed them to her myself. She gave them back to me and said to put them in the chart. She told me that she never wastes time looking at hospital records because she has a busy life."

I changed the consult to Dr. Osa, and called him myself. He'll be in later today.

I drove home, an hour wasted.

Dr. Fruitcake, READ THE FUCKING CHART. If you don't have time to take proper care of patients then get out of medicine.

More Gift Ideas

Santa Claus.

The embodiment of holiday cheer. One of December's most endearing legends. A great way (at least to try) to keep your kids in line year round ("you're gonna get coal if you don't stop that!").

So what could be more appropriate, joyful, or holiday-esque than this?

(click to enlarge)

Winter Vacation, Day 1, 7:09 a.m.

And it was clean last night. Yes, that's part of the Christmakuh tree.

December, 1974

I hadn't been in a hospital since I was born, and of course I don't remember that.

But my asthma was not getting better that week (I was on Marax- you RPh people remember that?) and so, after repeated visits to his office, my pediatrician admitted me to Local Hospital.

My most vivid memory is watching "The Year Without a Santa Claus" on TV ("I'll have a blue Christmas without you...). It was the only thing I remember being on. Maybe that's why, ever since then, I've been oddly partial to the "I'm Mr. White/Green Christmas" musical numbers.

Yes, kids, back then you had to PLAN your holiday-TV-special-watching. It wasn't as simple as just, say, finding which of the 182 channels were showing it on any given night, or popping the DVD in whenever you wanted. A motivation to learn to read was so you could look through TV Guide and make a list of when and what channel each of the key specials was on. Because if you missed them, too bad. They wouldn't be back until next year. So, no matter where you were, you found a way to watch them.

I also had to learn to pee in a urinal. But, I digress.

I thought I was a good patient. I really did. I don't remember pressing the call button much. My breathing got better. I went home the next day.

And now let's fast-forward to the mid-90's.

Studly, white-coated, intern Dr. Grumpy, fresh out of med-school, is now doing his training at the very same hospital where he spent that night long ago. And one day, while waiting for an admission to come out of the MRI, he wanders down to medical records, looking for that long ago chart from 1974.

Down 2 flights of stairs, in a dimly lit basement, they still had it. It was on microfiche (remember that, people?). I sat down and perused the notes out of curiousity. Reading off asthma drugs long withdrawn from the market.

And then I came to the nurse's notes.

And my nurse that night had written "Patient won't stop whining."

WTF! You bitch!

Me? Whine?

I didn't whine! I was sick, damn it! And my IV hurt! And the hospital food sucked! And the TV reception could have been better! And you put the urinal where I couldn't reach it! And you kept waking me up for that breathing treatment! And I needed another blanket because you kept my room pretty freaking cold! And you had coffee-breath!

I put the chart away. I was curious. I called the pediatric floor to ask if she still worked there.

She'd retired the month before I started my internship.

You got lucky, lady.

Skool Nerse Time

This is Mrs. Grumpy.

Attention little school twits:

If you're going to fake illness/trauma/death to get out early on the last day before Winter Break, here are some tips for next year (since today's attempts failed).

1. Know where your freaking appendix is. Pointing to the left hip is not going to score points. Moving your finger around and trying to get me to say "warmer" or "colder" will not work. I am not stupid.

2. If you come in weekly claiming to have appendicitis, don't even bother to do it today.

3. After I send you back to class, calling your mother (or, better yet, 911) from your cell phone to complain that you're being mistreated and ignored by the school nurse does not help your cause. There is a reason my office is right across from the Principal's, and my door is always open. Everyone can witness what is going on in here. In fact, you aren't supposed to be using your phone during school hours. Now that you did (and for a bullshit reason) it will be confiscated if you bring it back in January. And I don't care whose greatest hits you have on it.

4. If you don't want me showing your Mom my list of all the times you bring your lazy butt in here for a stomach ache (which I write next to what classes and tests you had at those times) then don't tell her to come talk to me about how I'm not caring for you properly.

5. The "fibulia bone" is NOT in your arm (in fact, it doesn't exist, but I assume you can't spell either). So don't tell me you broke it, and hold your arm. Coming in claiming that your left arm is hurting, and favoring your right arm, doesn't help. Neither does limping when you come in for arm pain.

See you in 2 weeks.

The Return of Wrong Way Wooten

Mr. Compass: "Sorry I'm late. Mapquest told me to take a right on 3rd street to get here."

Dr. Grumpy: "You are supposed to take a right on 3rd street to get here."

Mr. Compass: "Yeah, but I took a left. That's why I was late."

Next year, put it in an envelope

Before we met, Mrs. Grumpy was a cancer nurse, specializing in chemotherapy. She worked at the infusion suite of Local Cancer Center.

As you've heard me complain, in December all medical practices get trays of food and/or flowers from different ancillary businesses, thanking them for their support in the past year.

So one busy mid-December morning a delivery guy dropped off a HUGE floral arrangement on the front counter. Since it was busy, and the flowers were pretty, the staff just left them there.

Oncology clinics are never cheerful places, but that morning there seemed to be a larger-than-usual number of patients and their families crying in the lobby. But nobody mentioned anything to the staff, so work went on as usual.

Sometime in the early afternoon a secretary took the flowers back to the break room, so the rest of the staff could enjoy them.

At that point they realized the side of the display that had been facing the lobby had a large note that said:

"Thank you for your referrals over the past year. From the staff at Local Mortuary."

More Gift Ideas

The item has been around for at least 2 years, and always shows up in December. A gift for that truly desperate person in your life.

(click to enlarge)




I've seen various models of it. Another catalog (which Frank colored in, so I couldn't use the picture) had one that actually (I swear!) was powered by AA batteries and said: "It vibrates soothingly, just like a real man!"

I suppose this is true, provided your idea of a "real man" is headless, legless, one-armed, half-torsoed, and "vibrates soothingly".

But if your idea of a "real man" involves vibration and batteries, maybe you should be looking in a different sort of catalog.

Say that again?

From another neurologist's note:

"Clinically, the patient has clinical features of dermatomyositis as noted in clinic today. His clinical exam and lab reports support the clinical diagnosis. So, on a clinical basis, I think he has it."

Chocolates from hell update

The lady who brought the half-eaten chocolates below just came in.

She's blaming it on her teenagers, who were in charge of wrapping gifts, and confessed to her this morning they'd sampled some, then re-closed and wrapped the box.

She is (understandably) mortified.

She's given us a new box, and taken that horror away.

So we're having chocolates and caramel corn for lunch today. With a side of cookies.

Okay, this is just WRONG!

Yesterday one of my patients dropped off a box of chocolates.

This morning the staff unwrapped the paper and opened it.

This is what greeted them.




No more free drug samples for you, lady.

Alzheimer's Disease and the Holidays

We don't decorate for any holiday at my office. This isn't some sort of "Bah! Humbug!" thing as much as we're just too busy to put them up and take them down.

Decor here is fairly spartan. A few generic pictures. On a counter, like most doctors, I have various anatomy models that I use to explain things to patients.

So yesterday afternoon, as I was walking a demented lady back to my exam room, she stopped and looked at them for a minute.

Then she turned to her son and said "Look, Steven, they have Christmas decorations up over here."

Smooth Move, Dr. G.

Tonight Mrs. Grumpy had me stop at Local Deli to pick up dinner.

The glass doors in front are heavily darkened. You can see if there's someone on the other side (so you don't whack them) but they're too dark to make out any details about them.

As I'm leaving with my Bag-O-Dinner, I was starting to push the door open. At the same time a child suddenly appeared on the other side of the door, starting to come in. He jumped back as I pushed the door open, and I almost hit him with it.

I stuck my head out and said, "Oh, sorry, kiddo, I..." and stopped.

It was a midget.

Better late then never

Dr. Grumpy: "Mr. Gregorian, it looks like I saw you once,... back in 2003, and started you on daily Aspirin... and then we never heard from you again. So what brings you in today?"

Mr. Gregorian: "Just following up. You told me to come back in 6 years to check in."

Dr. Grumpy: "Um, it looks like I told you to come back in 6 weeks."

Mr. Gregorian: "Whatever. Anyway, I'm here now."

Mrs. Grumpy is going to kill me

English is an odd language. Being a native speaker, it seems pretty easy to me. But I'm generally lousy at other languages. I took 2 years of Spanish in high school and 4 in college, and I still can't speak it worth crap.

As you guys know, I moonlight doing medical market research interviews. Some are over the internet, some are in person, and some are by phone.

Some of the phone meetings have been outsourced overseas, so occasionally I find myself chatting with someone who speaks English, but with a non-American accent. Occasionally it's someone to whom English is a second language, though usually they're still quite good at it. And that's the situation I found myself in yesterday morning.

The study was on my interactions with drug reps, given by a lady with a mild, nonspecific, accent, but her English was still quite good and understandable. Unfortunately, it was also very old-style, and oddly formal, with phrases and words that aren't used much among modern English speakers. Understandable words, just a little odd.

Most of them were minor, but one was an issue. She used the old word for personal interaction.

Which is "intercourse".

Yes, I know it can mean ANY kind of personal interaction, and the technical phrase for sex is "sexual intercourse". But it's been shortened over time, to where now intercourse just means you're doing the wild thing.

And I'm a veteran of crazy patients, and having to keep a straight face. And I freaking lost it here, (thank heavens for the phone mute button) and at one point had to run to the john to keep from peeing myself (I told her I was going for a Diet Coke).

Here are some of the questions:



"How many times a day do you have intercourse with drug reps?"

My inner voice: It's variable, depending on the time left after I have intercourse with patients.



"If a drug rep provides lunch for your office, are you more likely to have intercourse with them?"

My inner voice: My standards aren't that high. If she's hot, I don't care if she brings prime rib or Taco Bell.



"Do any of your staff members also have intercourse with drug reps?"

My inner voice: Oh yeah, we have a non-stop orgy here. Nowadays I just wear a silk robe to work.



"During intercourse, did the rep provide you with insurance formulary information?"

My inner voice: If she did, I was too preoccupied to notice.



"Following intercourse, did the rep provide you with medication samples?"

My inner voice: No, but we shared a cigarette.



Wait until Mary and Annie find out I had intercourse with a marketing person yesterday. Of course, then I'll be having intercourse with them, too.

More Gift Ideas

My biggest problem with Christmas parties is not knowing what to wear (okay, it's really not a problem at all, because I never get invited to any parties).

But, if you're wondering what to buy your manly man for this holiday season, one of the catalogs had this awesome suggestion.

Let's face it, NOTHING says "seething cauldron of testosterone boiling under the surface" like pink and green giraffes. So get that special stud something that screams "I'M A HOT SEX MACHINE!"

(click to enlarge and induce emesis)

Christmas is coming, the staff are getting fat

(Not to mention Dr. Grumpy)

December, at least for me, is the worst month in my practice. The schedule is usually half-empty as people try to postpone things to after the holidays ("maybe my right arm will start working before the new year"). Patients have a million things come up at the last minute and can't come in. Most irritatingly, my epilepsy patients always get so damn busy that they forget to take their pills, and then have a seizure, and then get angry at me because they can't drive for a month and go Christmas shopping. Like it's MY fault!

But the biggest office issue this time of year is food. The holidays offer a perfect storm.

Like many medical practices, my staff and I depend on drug reps to help supply our nutritive needs. We average 2-3 drug company lunches (occasionally breakfasts) per week, and with the leftovers get 5 days out of it. Sometimes even enough to take home.

But in December, that starts to vanish. Many reps take vacations, or have mandatory time-off. A lot of them find they've gone over-budget for the year, and so to balance it out they cut lunches in December. So we're left with the prospect (gasp!) of foraging for ourselves!

The converging issue that makes this worse is what does come to the office. Every MRI place, lab, physical therapist, pharmacist, and grateful patient sends us trays of stuff. And not healthy stuff, either. Cookies, cakes, pastries, candies, cupcakes, donuts, chocolate covered anything, and other stuff. By the boatload.

So we eat this shit instead. And with fewer patients, we have more time to hang out in the back and chat and eat. And since we are all trying to save money for holiday gifts, we don't want to go get something healthy (like at McD's or Taco Bell).

(There are other options- a diabetes specialist down the hall from me puts all the sweets out in his lobby for the patients. Really.)

So our lunches become a selection of cookies, a few chocolates, and maybe a piece of pie (hey! it's apple pie! Isn't that healthy?).

And it's in this condition that I have to face my evil arch-enemy, the Wii Fit Trainer, who just delights in telling me how much my weight has gone up.

Fortunately I have the new Wii Fit Plus. And so far I've been killed repeatedly by giant wrecking balls on the obstacle course. It's so depressing I'm going to go have a cookie.

Tearing My Hair Out

Dr. Grumpy: "At your last visit you started Inderal for the migraines. Has it helped?"

Mr. Hedhertz: "Nope."

Dr. Grumpy: "Any side effects?"

Mr. Hedhertz: "Nope."

Dr. Grumpy: "What dose did you build up to?"

Mr. Hedhertz: "Um, actually I forgot to get it filled."

Why use your brain when you can buy an EMR and look like an idiot?

This is from a patient note that another doc faxed to my office this morning. The only things I've whited out listed the patient's pharmacies.


(click to enlarge)

Early Monday at Grumpy's House-of-Brains

When Mary makes reminder calls for the next day she notes on the schedule as to whether she confirmed the appointment with the patient, or a family member, or left them a voice mail, or whatever.

So looking over today's schedule, I saw the following entry:

"1:00 - Suzy Jones, referred for hearing problems. Phone kept ringing, no one answered."

At 5:00 on a Monday morning it gave me the giggles.

Dear Mrs. Nosybich,

Sorry about our little dispute at the school last week. Normally I don't take the kids in the morning, but Mrs. Grumpy had an early meeting that day.

It must be nice having a child that is naturally compliant with your orders. Frank, however, is not like your daughter, and will fight us to the death about wearing a jacket. Getting him to wear a sweatshirt over his clothes took an act of Congress and delicate negotiations. While it's not perfect, it was a halfway compromise.

So far he hasn't frozen to death or caught pneumonia/swine flu/AIDS/cooties/halitosis, or any of the other disorders that you seem to think are floating through the air specifically targeting unjacketed children.

But I'm glad you were concerned enough about someone else's kid to take the time out of your busy day, walk over to me, and make a scene in front of all the other parents about how you've been watching the "horrible neglect" practiced by my wife and I. I appreciate you running down a list of communicable airborne illnesses that you got from Google, and closing your argument by threatening to report us to Child Protective Services if you ever see my kid without a jacket again.

I think it's great that you want to pay such close attention to the failings of us lesser parents. Reminded me of the Charlie Brown cartoon where Lucy took it upon herself to write New Year's Resolution lists for everyone else.

I really like the way you punctuated your tirade by slamming your daughter's car door, HARD, to make sure we were all paying attention. We definitely all were (except your daughter, who looked too terrified to speak) because me, 3 teachers, and 20 other parents immediately began trying to tell you that you'd just slammed one of her backpack straps in the door. But you were clearly more concerned with my crappy parenting skills to notice.

Fortunately, your child had the presence of mind to let go of the other strap after she'd been pulled down and dragged about 3 feet as your drove away. And I have to admire the teacher who boldly leaped in front of your car to make you slam on the brakes, at the risk of her own health.

Your kid will be okay, I swear. She has a small cut on one hand, and a tear in her jacket where it got dragged (maybe you should get her a new one).

I felt so awful about it too. You made me feel very guilty when, after you checked your kid and released the backpack strap from the car door, you turned to me and yelled, "Now look what you made me do!" before getting in your car and driving away.

Happy holidays.

Christmakuh

(I have no idea who wrote this, or where it started. It gets circulated by email so much I'm sure many of you have seen it. But it's still entertaining)

Subject: Holiday News Release

THE NORTH POLE (Reuters) Continuing the economic trend towards monopolies, it was announced today at a press conference that Christmas and Hanukkah will merge. An industry source said that the deal had been in the works for about 1,300 years.

While details were not available at press time, it is believed that the overhead cost of having 12 days of Christmas and 8 days of Hanukkah was becoming prohibitive for both sides. By combining forces the world will be able to enjoy consistent quality service during the 15 Days of Christmukah, as the new holiday is being called.

Massive layoffs are expected, with lords-a-leaping and maids a-milking being the hardest hit.

As part of the agreement, the letters on the dreidl, currently in Hebrew, will be replaced by Latin, thus becoming unintelligible to a wider audience. Also, instead of translating into "A great miracle happened there," the message on the dreidl will be the more generic "Miraculous stuff happens." In exchange, Jews will be allowed to use Santa Claus and his vast merchandising resources for buying and delivering of their gifts.

One of the sticking points holding up the agreement for at least 300 years was the question of whether Jewish children could leave milk and cookies for Santa after having eaten meat for dinner. A breakthrough came last year, when Oreos were finally declared to be kosher. All sides appeared happy about this development except for Santa's dentist.

A spokesman for Christmakuh, Inc., declined to say whether takeovers of Kwanza, Solstice, or Festivus might not be in the works as well. He pointed out that were it not for their independent existences, the merger between Christmas and Hanukkah might be seen as unfair cornering of the holiday market. Fortunately for all concerned, he said, the other holidays will help to maintain the competitive balance.

He then closed the press conference by leading all present in a rousing rendition of "Oy, Come All Ye Faithful."

More Gift Ideas

Hitting the snooze button too many times? Or are you a 4-wheel drive aficionado that thinks every household appliance should be an all-terrain-vehicle? Or both?

Now, you can truly have it all! An alarm clock that not only wakes you up, but leaps off your night table, forcing you to chase it!

(click to enlarge)





I know this would work at my house, but only once. The alarm might not wake me up, but Blackdog frantically barking at it rolling across the floor would, and then I'd have to get up to clean the puddle where terrified Snowball pissed on the carpet when he thought it was coming to get him. And I wouldn't need to hit the snooze button because in the next minute psycho Cooper would tear it to pieces. And $39.95 seems like a lot of money to me for a 1-time-use appliance.

Suzy Frazzled, M.S.W.

The phones have been ringing busily today, and so a few calls went to voice mail. Annie had me listen to this one. She was laughing so hard she ran to the bathroom so she wouldn't wet herself.

"Hi, this is Suzy Frazzled. I'm a social worker involved in the medical case of Kathy Smith. I'm calling to see if you have any records on her. You probably don't, because none of the other doctors on the list she gave me have ever heard of her, either, and I'm on my last damn nerve dealing with her. Anyway, she's blaming every freaking illness she has, like Fibromyalgia, Restless Leg Syndrome, asthma, arthritis, back pain, irritible bowel syndrome, fatigue, fungal bladder infections, and a bunch of other junk, all on a freaking piece of cotton that was left in her ear 2 years ago after she had a glob of wax taken out. She thinks she's won the freaking lottery, apparently. What? No Bob, I don't have that info here. I've been working on Mrs. Smith all damn morning. How come you don't get these? The boss gives me all this shit, and it's not fair. Where the hell do these people come from and why do they always end up on my freaking desk? Why can't I get normal cases? Oh, sorry, hello? Anyway, please call me back and let me know if you've ever heard of this lady and have a happy holidays."

Spelling Errrorz

Hot off the fax machine this morning! A bunch of notes on a lady, and referral form that says:

"Send patient to a neurologist ASAP. I think she has a stork."


If it's NOT a spelling error, the patient needs either a vet or an OB.

The First Night

The official Grumpy family Christmakuh tree is up, and I want to wish my Jewish readers a very happy Hanukkah.



For those of you unfamiliar with Tom Lehrer's remarkable work, I suggest you learn more. He is one of the very best musical comedians EVER, with, oddly enough, advanced degrees in science and mathematics. Other brilliant works include The Elements, Pollution, Smut, The Hunting Song, I Hold Your Hand in Mine, and many others. For those who (like me) grew up watching The Electric Company on PBS, he wrote a number of those catchy tunes, such as L-Y and Silent E.

Okay, You Can

Dr. Grumpy: "After you hit your head, how long were you unconscious?"

Mr. Dingdong: "1 minute and 14.37 seconds."

Dr. Grumpy "That's pretty precise."

Mr. Dingdong: "I used a stopwatch".

Attention Junkies!

I hate all of you who have impaired my ability to buy enough Sudafed to keep me and my family snot-free during cold season.

Rot in hell, with a cold. And no medications are available for it. Or Kleenex. You can just chap your nose for all eternity with your shirt sleeves. Or worse.

Dear CVS Caremark,

If your specialty pharmacy mail-order branch is handling my patients' potentially dangerous injectable drugs, it would give me (not to mention them) A LOT more confidence if you knew how to spell your own job title.

(click to enlarge)




Yerz trooly,

Dokter Grumpy.

I Bet He Ain't As Comfortable

Dr. Grumpy: "Is there anything that makes your back pain better?"

Mrs. Lumbar: "Well, my husband has a set of exercise balls, not the huge ones, but the small ones you roll across your muscles, and the pressure from those helps. So I'm able to get comfortable and sleep, but only if I spend the night lying across his balls".

Dear Mr. I.M.A. "Rich" Azzholl, III

I'm sorry about the way things went at your appointment yesterday. I guess you and I just didn't have great chemistry.

I can understand you being frustrated with me. Obviously, a man of your means is used to people kissing his ass constantly. But here at Grumpy Neurology, it doesn't buy you much. Let's face it, Medicare pays me the same amount to put up with you as it pays me to put up with Mr. Nice Butpoor. If you were paying me $1000/hour to listen to your stories about the yacht club I might be more inclined to do so. But I'm only going to get Medicare's flat $115 for you, and my billing company gets 10% of that, and I have to pay Mary, Annie, my rent, the Diet Coke bill, and my malpractice insurance out of the rest.

Anyway, we were obviously off to a bad start when you told Mary that your regular doctor (who you pay cash to) dresses up for you. And this was before you even had a look at me. You also were not happy that, when you asked Mary what kind of refreshments we offer for waiting patients, she pointed to the water cooler.

I SO enjoyed being grilled over my credentials. I really am a doctor, I swear, not some homeless person who decided to rent an office, hire some staff, and buy some cheap office furniture just for the hell of it. You were clearly not impressed that I went through public schooling most of my life. Of course I've heard of your alma mater, but it was so much more fun to watch the horrified expression on your face when I pretended I hadn't, and then asked you if it was in Arkansas. The devil made me do, what else can I say?

I think we reached the low point during the appointment when, after I'd spent 30 minutes taking your windy history, and another 20 minutes examining you, your heavily plasticized wife (who may be putting arsenic in your prunes- watch out) asked me "So when will the doctor come in to talk to us?" That made me feel real special.

So when I heard you tell Mary that you didn't want to schedule a follow-up with me, and wanted to discuss matters with your internist, I knew this translated to "I'm never coming back here and am complaining to my internist about you". And guess what? I don't care.

Be careful the automatic door doesn't hit... oh, sorry, guess I should have warned you sooner.

More Gift Ideas

For those of you still looking for that perfect gift, here's another great idea!

Dogs give you unconditional love, but is that really good enough for you? Wouldn't it be important to know just how many breeds are represented in your mutt? Or is your "purebred" really that? And maybe you'd love your poodle less if you discovered he had a trace of beagle in his lineage?

Wonder no more!

Blood Pressure is Overrated, Anyway

This note was faxed to my office from the patient's family doc this morning.

(click to enlarge)

You Saw It Here First!

My reader Kaitlin notified me yesterday that Dave Barry's column for Sunday, December 6, also featured the nose-shaped soap dispenser that I presented on December 5.

I wish to point out that Dr. Grumpy beat him to press with this important breaking news by several hours, and his column was not leaked to me in advance (unless you consider the catalog being sent to my home to be a leak).

I also am not now, nor have I ever been, Mr. Barry

And I ain't gonna pose in the buff for you guys, either.

Skool Nerse Time

This is Mrs. Grumpy. He didn't want to hear me bitch about my day at the school, and told me to tell you guys. So here.

School nursing brings you an amazing collection of hypochondriacs, and it gets worse with winter break coming and they get restless. So today, besides the usual collection of snotty noses, stomach aches, and "I can't do PE because..." I had this.

Kid #1: "Somethings wrong with my eyes. I can't read the board today."

Me: "Don't you wear glasses?"

Kid#1: "Yeah, but I left them at home."


AND


Kid #2: "I've had this bump on my little finger since I was five, and it looks the same."

Me: "You're ten now. So why are you here?"

Kid#2: "I wanna know what it is."


I also want to thank the 2 teachers (neither of whom was a sub) who sent these kids to my office during regular class time for these complaints.

Whatever

Dr. Grumpy: "Do you have any other medical issues?"

Mrs Barph: "I vomit every afternoon at 3:05 p.m. This started in 1987 and I haven't missed a day since."

I Bet the Cops Love You

Dr. Grumpy: "Sir, why did you call 911?"

Mr. Bozo: "I forgot my doctor's phone number, and thought maybe they would know it, and could call him for me to make an appointment. I need to see him."

More Fun Junkie Quotes

These guys just make a weekend on call so entertaining.


"I've been using crack since I was 18, and I'm 27 now. I mean, that's almost 7 years I've been doing this stuff. I've spent 2 years in jail for it. I've been in and out of every rehab program in town. I've never had a real job, and still live with my parents. It's time for me to turn my life around, and I'm going to start by being honest and telling my parents about my habit. I've been able to hide it from them, but It's time they know I've got a problem."


Dude, if your parents haven't figured that out yet, they're probably on it, too. Also, your math sucks.

Lifestyle Changes

Yesterday I admitted a lady in her 50's who had a stroke. So I'm rounding on her this morning.

Mrs. LDL: "Doctor, I'm changing my whole life right now! I'm going to start being healthy. For many years I've always had a cheese omelet for breakfast. So, today, when they took patient breakfast orders, I realized I had to start doing things differently."

Dr. Grumpy: "Good for you! What did you order?"

Mrs. LDL: "A vegetable omelet, with cheese."

Tis The Catalog Season

With the pentuplet of seasonal holidays approaching (Hanukkah, Festivus, Christmas, Kwanzaa, and Solstice), my home mailbox is full of catalogs selling all kinds of things that these people apparently feel my family and friends can't live without.

Since so many of my patients call my office asking if we have any gift ideas (NO! I HAVE ABSOLUTELY NO FREAKING IDEA WHY THEY CALL ME!!!) I figure many of you are dying to do the same (Dr. Grumpy merchandise is always nice).

So I've personally combed through these many catalogs to help you, my loyal readers, find some of the most useful gifts out there, and will present them over the next few weeks.

Today I'm going to kick off the list with this tasteful item:



Yes, it's a shower soap dispenser (comes with green gel soap! Wow!) that dispenses soap out of it's nostrils. I suppose next year they'll have one that makes a sneezing noise when you squeeze it.

I'd order one for that special coworker who continuously complains about allergies and leaves wadded-up Kleenex all over the office.

Public Service Announcement

Attention ladies:

It is NOT, generally speaking, normal for you to be woken at night by your guy shaking the bed violently, turning blue, and peeing on the sheets. If he does this, and hasn't done it before, he needs medical attention.

You also should not allow this to go on for several nights in a row, and then call his mother to see if she can help you wash all the bedsheets, and (when she asks you why), let her be the one to make the CORRECT decision that he should go to ER.

It is also not cool that you sent him in by himself, so you could stay home and catch up on washing sheets. Your description of the events is usually helpful to those of us in the "med-biz".

Thank you.

Live! From ER! It's Dr. Grumpy!

I'm on call.

While rounding, I was paged overhead to come down to ER for a stroke that had just arrived. Guy who can't move his right side.

So I'm sitting here in ER, watching him from the nurses' station, waiting for my turn to go in. Nurses are hooking him up to stuff, techs in there drawing blood, an EMT going over info with another nurse.

In the middle of this all the patient is lying there, calmly texting with his left hand.

Starting and Ending With a Survey

Well, just as my day began with a strange marketing survey question, apparently it's going to end that way. I'm doing one tonight over the internet, and this question came up:

"When managing a male or female MS patient who wishes to become pregnant, what action do you typically take with their current MS medication?"

You Must Live REALLY Far Away

"I only get migraines when there's a full moon. In my neighborhood I think that's around once a week we have one."

Okay, Let Me Get A Blindfold

I did an online marketing study this morning, in which I was looking at various ad concepts to see which parts of the ads interest, and don't interest, doctors.

So at one point I came to these instructions:

"On the following screen, we'd like to know which parts of the picture did not get your attention. Please click only on those parts of the image that you don't look at."

Homecoming

I pull into the driveway, and walk down to the mail box to get the bills & junk. The neighbor family is out putting up some Christmas lights. Mr. Neighbor comes over to chat for a minute.

Suddenly, my front door flies open. Frank comes out, screaming at the top of his lungs.

Frank: "DAAAAD!!! THE FRONT HALL TOILET BACKED UP ON ME 'CAUSE I USED TOO MUCH PAPER AND NOW THERE'S POOP ON THE FLOOR AND SOME STILL IN THE TOILET AND PAPER EVERYWHERE AND IT SMELLS BAD AND THE TOILET KEEPS RUNNING AND..."

Dr. Grumpy: "Frank, calm down. Why didn't you tell Mom as soon as this happened?"

Frank: "I did. She told me to wait and tell you as soon as you got home."


Mr. Neighbor doubled over laughing. Perhaps for the first time he was glad to have teenagers.

Just Say No

Things are tough all over. Occasionally I get patients asking me if I'll forgive their appointment co-pay. Usually I can't, because most insurance contracts forbid it, and because I'm trying to stay afloat, too.

So today I had a lady tell me she can't afford her $25 visit co-pay, and could I PLEASE write it off? She used the "I need the money more than you do" line.

I know she has legitimate financial hardships, but I refused.

Why?

Do I need the $25 that badly?

I did it because she smokes 2 packs a day. And ADAMANTLY refuses to quit.

Let's look at this:

The average price of a pack of cigarettes in the U.S. right now is $5. This varies by brand & your state taxes, and whether you buy them by the pack or case. But roughly $5 a pack.

So for her, that's $10/day. Or $300/month. Or $3600/year.

I told her that. If she quits smoking, that would be like her getting a $3600 annual raise, without any additional taxes. Ignore the health benefits, just look at the money alone.

All that money for making one life change. That would help her financial situation A LOT. It's a hell of a lot more money than making a $25 co-pay once or twice a year.

She got pissed off and left. Told me that I "don't understand".

She's right. I don't.

For an excellent post on drug co-pays from the pharmacy view, check out this one from The Angry Pharmacist.

Now THAT'S Exciting!!!

From a fax on my machine this morning:


"Our company is looking for males over age 25 who do their own shopping. We're doing a very exciting market research study on the following topic:

PACKAGED SALAD

We think you'll find the discussion to be exciting and enjoyable, and will reimburse you for your time. Please contact us today, as spots will go fast!"

Edgar Allan Poe

Generally, I try not to copy things from other blogs.

But sometimes I MUST make an exception when I see something so good, so clever, that I want to share it and say LOOK AT THIS! IT'S FREAKING AWESOME!!!

And when I do that, I make sure I properly credit it.

Maybe it's because I'm a literature buff, and took too many of those classes in college. Edgar Allan Poe is featured in most of them, and his most famous work is The Raven.

So on reading other blogs today, I found this excellent post written by Maha. She's an ER nurse who writes Call Bells Make Me Nervous. Check her site out. And Maha, please forgive me, but I just had to share your remarkable piece of writing.

So, without further ado, I present Maha's satire on The Raven. It's called The Drunkard.

Had Edgar Allan Poe Been an Emergency Nurse…

The Drunkard

by Maha

Once upon a midnight dreary, while my back ached, weak and weary,
Over many a quaint and curious patient at the triage door.
While I nodded, nearly napping, suddenly there came a tapping,
As of someone rudely rapping, rapping at my triage door.
"'Tis no drunkard," I muttered, "tapping at my triage door--
A well man and nothing more."

Ah, distinctly I remember the bloody night before November,
And each and every staff member had brought a patient to the floor.
Eagerly I wished the morrow, vainly I had sought to borrow,
From my books of assessments thorough –to avoid the cookies from days of yore
And drink my latte from so long before.

But the stinkin’ sad uncertain shuffling of a drunkard’s gait that’s struggling
Thrilled me – filled me with supreme annoyance, never felt before.
So that now to still the beating of my heart, I stood repeating
“Tis no drunkard entreating entrance at my triage door –
Some late UTI-er entreating entrance at my triage door;
This is it, give Toradol galore”.

Towards the patient I finally headed, hope for sleep completely shredded,
“What,” barked I, “please don’t have a complaint I’ll deplore,
But the fact is I was napping and so intently you were tapping,
And so rudely you came slurring, ranting at my triage door”.
And without regard or thinking, he barfed upon my triage door,
Chunky vomit and lots more.

Then, of course, the air grew denser, thanks to the obscene Spencer,
A man now pickled, whose foot-falls dragged in the department’s floor.
“Wretch,” I cried, “why did God bring thee – by the devil he hath sent thee
Respite – respite and Valium please for thy abnormal CIWA score
Why, oh why this loud decree of your drunken presence on my door?!”
Screamed the drunkard, “I barfed some more”.

"Spencer!" said I, "this stench is evil!--Spencer this is the needle’s bevel,
Whether taxi sent, or whether ill-fate tossed thee here ashore,
Desolate, yet all undaunted, in this department un-enchanted,
In this hallway by Horror haunted--tell me truly, I implore--
Is there--is there calm from Gravol?--tell me--tell me, I implore!"
Quoth the drunkard, "I need lots more."

"Spencer!" said I, “more upheavals? - Spencer still, if man or devil!
By the score of twenty and eleven – by the Valium we both adore –
Tell this nurse with sorrow laden, who to call? Perhaps thy maiden?
Please, oh please, I beg thee, use the bucket on the floor.”
Quoth the drunkard, "Nevermore."

"Be that word our sign of parting, man or fiend!" I shrieked, upstarting.
"Get thee out of the department and save my night from being abhorred!
Leave no chunks of vomit as a token for my tolerance thou hast broken!
Leave here with this train token! – Quit the bed and leave the main floor!
Take thy stench as you depart, and take thy form from out the door!”
The drunkard started to loudly snore.

And the drunkard, unremitting, still is snoring, still is snoring
On the pallid stretcher mere inches from the door;
And his socks have all the seeming of a mold that is steaming
And the lamp-light o’er him streaming throws his shadow on the floor;
And my break retreating into shadows that was planned for four,
Shall be taken – nevermore!

How Hard Is This To Understand?

Okay. Your epilepsy has been stable for over 20 years. In fact, I only see you once a year for it, and refill your Tegretol while we chat about sports, weather, whatever.

Your medication dose hasn't changed since the 80's, back before I even went to med school.

I write you a new script once a year, that you fax to your mail-order pharmacy.

Normally I see you in January, but you had to move up your appointment since you'll be out of town next month. So you asked me to date your next Tegretol script for January 1, 2010, and you won't send it in until then. Fine. I did just that.

So, after I've given you a post-dated script DON'T FAX IT TO YOUR FREAKING PHARMACY WITHIN AN HOUR OF LEAVING MY OFFICE!!!

Now I've got the pharmacist calling, wondering if I'm demented and don't know the date (not an unreasonable thought). I'm pretty sure he doesn't think you have some sort of special time-traveling fax machine at home.

So don't do it again. Put the script on your refrigerator and don't cash it in until January 1, 2010 LIKE YOU TOLD ME YOU WOULD and we'll all be happy.

Thank you.

Memories...

The peanut post got me thinking...

When I was doing my internal medicine residency, another doc in my class was a girl named Christine. She was just doing a 1 year internship before going on to radiology.

She was a good person, and a good doc. But she was a HORRIBLE black cloud. Bad luck just followed her and her patients, in spite of the fact that she took damn good care of them.

She just had remarkably shitty luck. When she was on call, her service would always max out with admissions, and they were all really sick. Codes would occur. Her patients seemed to die more often then anyone else's. And, again, this was just bad luck. She was a good doc, just always seemed to get the sickest patients.

After the first 6 months of this, she was so burned out that she needed a vacation, and booked a cruise.

On the first night of her cruise, the guy sitting next to her at dinner collapsed and died from a peanut allergy.

How To Irritate Your Neurologist

Dr. Grumpy: "Any allergies?"

Mr. Cereal: "Nuts... Hey, do you know it's safe for me to eat Honey-Nut Cheerios?"

Dr. Grumpy: "Umm..."

Mr. Cereal: "I mean, I know it says 'nut' in the name, but I wasn't sure if they really have nuts in them, or if they just say that".

Dr. Grumpy: "Have you read the ingredient list on the side of the box?"

Mr. Cereal: "No, why?"


Obviously, I'm allergic to nuts, too, of a sort...

Tuesday Morning Patient Quote

"Sometimes, when I really hurt, I stop breathing. I mean, like, for hours, literally. It hurts so bad I just stop breathing. After my car accident I went 2 weeks without breathing."

This is the Dawning of the Age of Extavia

(I am not a marketing person. I don't have the personality, or the mindset, or the training. So this story only barely makes sense to me. I'm sure the marketing or business people out there will tell me this is perfectly logical).

Extavia!

Isn't that a great name?

I have to wonder how much they paid the person who thought it up. It has a cool ring and the letters "X" and "V" (according to my friends who do sales, these, along with "Z", are considered "power letters", and putting them in words is supposed to connote something impressive).

With a name like that you'd think the drug was new, powerful, groundbreaking.

Extavia! NEW! For Multiple Sclerosis!

Released to the neurology world recently with hoopla, ads, drug rep lunches, etc.

Would you believe that Extavia is over 15 years old, and is being used to launch a drug that isn't even on the market yet?

Here's the story: Betaseron (Beta Interferon 1b) has been on the U.S market since the early 90's. It was the first drug ever approved for MS, and certainly is a decent drug. I prescribe my share of it. It's manufactured by Bayer.

Novartis, another pharmaceutical company, is developing a new MS drug, which it hopes to bring to market in the next 6-18 months.

But Novartis has no MS drug currently out there (though they do have 3 big neurological ones under patent). So they decided that, to get a foot in the MS marketing door now, they should hire a bunch of new reps (though they already have a fairly well-trained neurology sales force), and train them to market MS drugs. This is hard to do when you don't have one.

So they bought a license from Bayer to sell Betaseron, too, to get their reps some practice. But, since they didn't want to market plain old, early-90's Betaseron, they renamed it Extavia! New name! New marketing! Same drug! Same dosing! Same everything except the name (actually, I think the price is slightly lower)!

And, of course, Betaseron is still on the market. In fact, Bayer is making all the Extavia, too. So Bayer is likely going to clean up on the deal, since they get paid regardless of which gets prescribed.

I suspect Novartis will not make money on this, and is using Extavia as a loss leader, hoping to make the money back when the new drug comes out in a year or two.

On the one hand, I think it's good that they're hiring a new sales force to sell Extavia and future drug. Certainly, jobs are good for the economic recovery.

But on the other hand, it still seems kind of silly to me. Like I said, though, I'm not a marketing person.