Okay, I polished off a few more journals to help keep up-to-date this afternoon, and have learned that:
People who use excessive amounts of salt have increased risks of stroke and heart disease (WOW! I've never heard that one before!). British Medical Journal, November 24, 2009.
Excedrin Migraine is effective for some patients with migraines (when compared to placebo), but not for others. Paper presented at the 14th Congress of the International Headache Society.
People who have severe migraines on workdays are more likely to miss work due to migraines, than people who don't have migraines during those times. Another paper presented at the 14th Congress of the International Headache Society.
Sunday, January 31, 2010
Dr. Grumpy's Rules, #1024
No good will EVER come out of returning a Sunday morning message that begins with:
"Yeah, I have an appointment with Dr. Grumpy this morning, and your office building is all locked up."
"Yeah, I have an appointment with Dr. Grumpy this morning, and your office building is all locked up."
Saturday, January 30, 2010
Breaking Medical News
I was relaxing in the hot tub today, catching up on cutting edge medical literature.
I learned that:
Patients on sedating drugs have a higher risk of falling than those not taking sedatives.
Patients with imbalance from inner ear problems are more likely to fall than those without balance problems.
(Archives of Internal Medicine, May 25, 2009)
I also learned:
People with a stroke, and poor blood flow to the area of brain involved, are more likely to have another stroke then people with normal blood flow to that area.
(Brain, April, 2009)
I learned that:
Patients on sedating drugs have a higher risk of falling than those not taking sedatives.
Patients with imbalance from inner ear problems are more likely to fall than those without balance problems.
(Archives of Internal Medicine, May 25, 2009)
I also learned:
People with a stroke, and poor blood flow to the area of brain involved, are more likely to have another stroke then people with normal blood flow to that area.
(Brain, April, 2009)
My readers write
This photo was submitted by reader Francine, who says she took it in a hospital ER.
For all the advice painted on the top and bottom of the machine, I have to say I don't see anything remotely healthy in there.
(click to enlarge)
And thank you Francine for sending this in!
For all the advice painted on the top and bottom of the machine, I have to say I don't see anything remotely healthy in there.
(click to enlarge)
And thank you Francine for sending this in!
Friday, January 29, 2010
Friday afternoon insanity
Dr. Grumpy: "Let me fill out an MRI form... Are you claustrophobic?"
Ms. Bright: "No. My period started yesterday."
Ms. Bright: "No. My period started yesterday."
Mystery solved
Last night I was at a dinner meeting for a research company. These things are always held at some swanky overpriced steakhouse.
Dr. Duffel is a local neurologist who drags around the biggest damn purse in the world. It's HUGE, and goes everywhere with her. For years many of us have wondered what's in it: a complete set of every neurology journal ever written? Jimmy Hoffa? the Bermuda Triangle?
So last night she came in late to the dinner, and sat down next to me. She put el monstro humungo purse on the floor next to me, so I had to move over a bit.
The meeting dragged on. One slide after another. The occasional cell phone ringing. The speaker droning. Food courses.
At some point I wandered out to stretch and empty myself of biologically-filtered Diet Coke. When I came back and sat down I stepped in a puddle on the floor. I figured someone must have spilled water or something while I was out of the room, and refocused my attention on the speaker.
A minute later a waitress came by to refill my Diet Coke, and stumbled over the giant purse.
And the purse started barking.
The waitress screamed and leaped back, dropping the pitcher on the purse, which only got it snarling at her.
Dr. Duffel jumped up, grabbed her cell phone (which hadn't rung), mumbled "I have to answer this outside" and dragged her growling purse out of the room. I'm pretty sure it wasn't her ringtone.
She never came back.
I rinsed off my shoes when I got home.
Dr. Duffel is a local neurologist who drags around the biggest damn purse in the world. It's HUGE, and goes everywhere with her. For years many of us have wondered what's in it: a complete set of every neurology journal ever written? Jimmy Hoffa? the Bermuda Triangle?
So last night she came in late to the dinner, and sat down next to me. She put el monstro humungo purse on the floor next to me, so I had to move over a bit.
The meeting dragged on. One slide after another. The occasional cell phone ringing. The speaker droning. Food courses.
At some point I wandered out to stretch and empty myself of biologically-filtered Diet Coke. When I came back and sat down I stepped in a puddle on the floor. I figured someone must have spilled water or something while I was out of the room, and refocused my attention on the speaker.
A minute later a waitress came by to refill my Diet Coke, and stumbled over the giant purse.
And the purse started barking.
The waitress screamed and leaped back, dropping the pitcher on the purse, which only got it snarling at her.
Dr. Duffel jumped up, grabbed her cell phone (which hadn't rung), mumbled "I have to answer this outside" and dragged her growling purse out of the room. I'm pretty sure it wasn't her ringtone.
She never came back.
I rinsed off my shoes when I got home.
Thursday, January 28, 2010
Whatever
Mrs. Sad: "Some days I feel like I have no one to talk to."
Dr. Grumpy: "What do you do when that happens?"
Mrs. Sad: "You mean when I have no one to talk to?"
Dr. Grumpy: "Yes"
Mrs. Sad: "I talk to someone about it."
Dr. Grumpy: "What do you do when that happens?"
Mrs. Sad: "You mean when I have no one to talk to?"
Dr. Grumpy: "Yes"
Mrs. Sad: "I talk to someone about it."
Plumbing FAIL!
"I know I have bleeding somewhere in my colon, because every time I urinate bright red blood comes out."
(yeah, I'm sure someone will write in that maybe the patient has a fistula, but trust me, that ain't the case)
(yeah, I'm sure someone will write in that maybe the patient has a fistula, but trust me, that ain't the case)
Things that make me grumpy
YOU!
Yes, you. You make me grumpy. Pissed off. Wanting to leap across my desk at you, if you were to ever come back here again, which you won't.
You were here last week for a disability evaluation. You looked miserable. Your friend pushed you up here in a wheelchair, and you used a cane to get from the chair into my office.
You were very polite. You told me how nice I was. You said that I "wasn't like the other insurance company docs" you'd been sent to. You even brought Mary some chocolate-covered berries for working you in so quickly.
I could see you were trying to butter us up. I'm not that stupid. But you did seem legitimately suffering, and were quite patient while I reviewed the boatload of test results your company had sent me.
I've been doing this long enough that I could see you were exaggerating some things, but you did seem to have some real limitations.
Anyway, I didn't complete your disability report over the weekend. Sorry, but I was on call. I put it off until this week, and boy, am I glad I did.
A DVD from your insurance company showed up in my mail yesterday. I've been watching it.
It's kind of interesting. It actually shows you leaving my medical building last week, after the appointment. I guess you were in too much pain to see the camera guy following you around, huh?
It was kind of neat how you stood up and began walking as soon as you got to the parking garage. I kind of expected you to yell "Hallelujah! It's a miracle!" like they do on TV, but you didn't. You just folded up the wheelchair, handed the cane to your friend, and walked over to your car.
You'd told me that you hadn't been able to drive for a year, so it was kind of surprising watching you get behind the wheel. I guess with your miraculous recovery you had an itching to try out the old motoring skills, huh?
I then watched a boring clip of you going over to Local Grocery. No biggie. But I loved it when you drove to Home Depot. You told me you couldn't lift more then 5 pounds at a time. I haven't bought paint in a few years, but those big metal cans, I'm pretty sure, weigh more than that. And you were carrying one in each hand.
After you got home there's a few hours missing. Maybe you were inside recovering from the horrible pain you'd suffered heroically buying salad dressing and paint. But when you emerged carrying a ladder, and began painting your front porch, I just lost it.
So, as you requested, I've now completed the forms listing my findings and what I think the extent of your disability is. And I personally faxed them to your company. And called to make sure they got them.
Have a nice day.
Yes, you. You make me grumpy. Pissed off. Wanting to leap across my desk at you, if you were to ever come back here again, which you won't.
You were here last week for a disability evaluation. You looked miserable. Your friend pushed you up here in a wheelchair, and you used a cane to get from the chair into my office.
You were very polite. You told me how nice I was. You said that I "wasn't like the other insurance company docs" you'd been sent to. You even brought Mary some chocolate-covered berries for working you in so quickly.
I could see you were trying to butter us up. I'm not that stupid. But you did seem legitimately suffering, and were quite patient while I reviewed the boatload of test results your company had sent me.
I've been doing this long enough that I could see you were exaggerating some things, but you did seem to have some real limitations.
Anyway, I didn't complete your disability report over the weekend. Sorry, but I was on call. I put it off until this week, and boy, am I glad I did.
A DVD from your insurance company showed up in my mail yesterday. I've been watching it.
It's kind of interesting. It actually shows you leaving my medical building last week, after the appointment. I guess you were in too much pain to see the camera guy following you around, huh?
It was kind of neat how you stood up and began walking as soon as you got to the parking garage. I kind of expected you to yell "Hallelujah! It's a miracle!" like they do on TV, but you didn't. You just folded up the wheelchair, handed the cane to your friend, and walked over to your car.
You'd told me that you hadn't been able to drive for a year, so it was kind of surprising watching you get behind the wheel. I guess with your miraculous recovery you had an itching to try out the old motoring skills, huh?
I then watched a boring clip of you going over to Local Grocery. No biggie. But I loved it when you drove to Home Depot. You told me you couldn't lift more then 5 pounds at a time. I haven't bought paint in a few years, but those big metal cans, I'm pretty sure, weigh more than that. And you were carrying one in each hand.
After you got home there's a few hours missing. Maybe you were inside recovering from the horrible pain you'd suffered heroically buying salad dressing and paint. But when you emerged carrying a ladder, and began painting your front porch, I just lost it.
So, as you requested, I've now completed the forms listing my findings and what I think the extent of your disability is. And I personally faxed them to your company. And called to make sure they got them.
Have a nice day.
Wednesday, January 27, 2010
WTF were they thinking?
As an Apple fan going back over 25 years, I have to wonder WHAT THE HELL WERE YOU THINKING? "iPAD" WAS THE BEST FUCKING NAME YOUR BILLION DOLLAR MARKETING DIVISION COULD COME UP WITH?
What the hell, Steve? What about iTop? or iScreen ("i scream, you scream, we all scream for iScreen")? or iANYTHINGELSEBUTIPAD?
Even Failblog got into the joke today.
What the hell, Steve? What about iTop? or iScreen ("i scream, you scream, we all scream for iScreen")? or iANYTHINGELSEBUTIPAD?
Even Failblog got into the joke today.
Mary's Desk, January 27, 2010
Dr. Grumpy: "Have you sent those reports over to Dr. Freek yet?"
Mary: "I've been trying, but they're not going through. And it's been busy today."
Dr. Grumpy: "A lot of calls?"
Mary: "Yeah, but most are hang-ups or a fax or something."
Dr. Grumpy: "Why aren't the reports going through to Dr. Freek?"
Mary: "I have no idea. They just aren't. Are you sure about the fax number you gave me?"
Dr. Grumpy: "I think so, let me see it... Yeah, that looks familiar, I think it's his number."
Mary: "Okay, I'll keep trying... HEY!"
Dr. Grumpy: "What?"
Mary: "You dipshit! That's OUR phone number you told me to fax it to."
(long pause)
Dr. Grumpy: "Well, you didn't catch it either."
Mary: "You wrote it down! Not me!"
(another pause)
Dr. Grumpy: "Well, at least now we know why you're getting so many hang-ups today."
Mary: "Go back to your office! I'll tell you when you're allowed to come back out!"
Mary: "I've been trying, but they're not going through. And it's been busy today."
Dr. Grumpy: "A lot of calls?"
Mary: "Yeah, but most are hang-ups or a fax or something."
Dr. Grumpy: "Why aren't the reports going through to Dr. Freek?"
Mary: "I have no idea. They just aren't. Are you sure about the fax number you gave me?"
Dr. Grumpy: "I think so, let me see it... Yeah, that looks familiar, I think it's his number."
Mary: "Okay, I'll keep trying... HEY!"
Dr. Grumpy: "What?"
Mary: "You dipshit! That's OUR phone number you told me to fax it to."
(long pause)
Dr. Grumpy: "Well, you didn't catch it either."
Mary: "You wrote it down! Not me!"
(another pause)
Dr. Grumpy: "Well, at least now we know why you're getting so many hang-ups today."
Mary: "Go back to your office! I'll tell you when you're allowed to come back out!"
Go Away!
I wandered up front to see my least-favorite drug rep, Rikki Phoneysmile, standing there.
Rikki: "Hi, Dr. Grumpy! Do you need any samples of Fukitol today?"
Dr. Grumpy: "Actually, yes, I'm all out."
Rikki: "I don't have any right now! Sorry!"
Rikki: "Hi, Dr. Grumpy! Do you need any samples of Fukitol today?"
Dr. Grumpy: "Actually, yes, I'm all out."
Rikki: "I don't have any right now! Sorry!"
A Little Help Here, Please
Come on, somebody say something stupid! I've got a blog to write, damnit!
Geez. So far nothing blogworthy today. This sucks.
Geez. So far nothing blogworthy today. This sucks.
Tuesday, January 26, 2010
The hits keep coming, folks
Mrs. Hyve: "I'm allergic to all medications. I'm even allergic to Benadryl."
Dr. Grumpy: "What happens?"
Mrs. Hyve: "All medications give me a rash, so to safely take any pill, I have to take another pill first, to prevent the rash from happening."
Dr. Grumpy: "What do you take to keep the rash from occurring?"
Mrs. Hyve: "Benadryl."
Dr. Grumpy: "What happens?"
Mrs. Hyve: "All medications give me a rash, so to safely take any pill, I have to take another pill first, to prevent the rash from happening."
Dr. Grumpy: "What do you take to keep the rash from occurring?"
Mrs. Hyve: "Benadryl."
Medication fun
Dr. Grumpy: "Are you still taking Ambien?"
Mr. Insomnia: "No, it stopped working, so my doctor switched me to Zolpidem, and that's much better."
(For my non-medical readers: Ambien and Zolpidem are the same medication)
Mr. Insomnia: "No, it stopped working, so my doctor switched me to Zolpidem, and that's much better."
(For my non-medical readers: Ambien and Zolpidem are the same medication)
I'm Living in "Airplane"
This morning I ordered a few bottles of Botox.
Miss Waytoohappy: "Okay, Dr. Grumpy, that's 4 bottles of Botox, and we'll get this shipped out today! Would you like a confirmation number?"
Dr. Grumpy: "Sure, what is it?"
Miss Waytoohappy: "It's a number we give you that allows you to reference this order if there are any problems or questions."
Miss Waytoohappy: "Okay, Dr. Grumpy, that's 4 bottles of Botox, and we'll get this shipped out today! Would you like a confirmation number?"
Dr. Grumpy: "Sure, what is it?"
Miss Waytoohappy: "It's a number we give you that allows you to reference this order if there are any problems or questions."
Strange things to find in the playroom, part 2
(for Part 1, click here)
Last night the boys borrowed Marie's Cinderella castle set, but told her they didn't need the dolls.
An hour later I wandered by and noticed this.
(click to enlarge)
Last night the boys borrowed Marie's Cinderella castle set, but told her they didn't need the dolls.
An hour later I wandered by and noticed this.
(click to enlarge)
Monday, January 25, 2010
Irrefutable logic
Dr. Grumpy: "You look kind of unsteady today."
Mr. Woodstock: "Yeah, I smoked a few joints out in my car before coming up here."
Dr. Grumpy: "Why did you do that?"
Mr. Woodstock: "I was really nervous about coming in today."
Dr. Grumpy: "Why were you nervous? You've been here before."
Mr. Woodstock: "Oh, not about that. I've been drinking scotch all morning, and didn't want you to notice I was drunk when I came in. I've never been drunk to a doctor visit before, so I smoked some weed to calm down, because I didn't want you to think I'd been drinking."
Mr. Woodstock: "Yeah, I smoked a few joints out in my car before coming up here."
Dr. Grumpy: "Why did you do that?"
Mr. Woodstock: "I was really nervous about coming in today."
Dr. Grumpy: "Why were you nervous? You've been here before."
Mr. Woodstock: "Oh, not about that. I've been drinking scotch all morning, and didn't want you to notice I was drunk when I came in. I've never been drunk to a doctor visit before, so I smoked some weed to calm down, because I didn't want you to think I'd been drinking."
Do you enjoy wasting time?
Look, lady, I don't treat Glermfronger's disease*.
I've never treated it. I mean, I know some neurologists do, but most of us don't. It requires some additional training that I don't have.
In fact, when you called last week, both Annie and Mary told you I don't, and tried to give you some names of docs who do. You insisted on making the appointment with me anyway, saying you had "other neurological issues", too.
So, now that you're here, you tell me that you really don't have other issues, and you just made the appointment to discuss your Glermfronger's. And guess what? I still don't treat it. You coming into my office didn't magically give me the ability to treat it, like you apparently thought it would.
And handing me an insurance auth from your family doc saying "refer to neurology for Glermfronger's disease" doesn't miraculously make me treat it, either. So stop repeatedly showing it to me.
Oh, I get it, if it's on your insurance auth it MUST be true.
And now you tell me that there actually is a neurologist on your insurance who does treat it, but she's 5 miles from your house, and I'm only 3 miles. So you thought you'd lie to get in here, hoping to save some driving.
Well, you've now wasted a 1 hour slot for both of us, and your crappy insurance won't pay me for it, and someone else who needed to come in today is waiting for another day because of your selfishness and stupidity.
People like you make me wish I had a trap door under that chair.
*Not a real disease, but I'm using it for anonymity.
I've never treated it. I mean, I know some neurologists do, but most of us don't. It requires some additional training that I don't have.
In fact, when you called last week, both Annie and Mary told you I don't, and tried to give you some names of docs who do. You insisted on making the appointment with me anyway, saying you had "other neurological issues", too.
So, now that you're here, you tell me that you really don't have other issues, and you just made the appointment to discuss your Glermfronger's. And guess what? I still don't treat it. You coming into my office didn't magically give me the ability to treat it, like you apparently thought it would.
And handing me an insurance auth from your family doc saying "refer to neurology for Glermfronger's disease" doesn't miraculously make me treat it, either. So stop repeatedly showing it to me.
Oh, I get it, if it's on your insurance auth it MUST be true.
And now you tell me that there actually is a neurologist on your insurance who does treat it, but she's 5 miles from your house, and I'm only 3 miles. So you thought you'd lie to get in here, hoping to save some driving.
Well, you've now wasted a 1 hour slot for both of us, and your crappy insurance won't pay me for it, and someone else who needed to come in today is waiting for another day because of your selfishness and stupidity.
People like you make me wish I had a trap door under that chair.
*Not a real disease, but I'm using it for anonymity.
Attention Dr. Pissy!
Since I was on call this weekend, I appreciate you picking up the next week's soda supply for the office.
However, you have erroneously purchased Local Grocery Generic Brand CAFFEINE FREE Diet Soda.
You are never allowed to do the office shopping again. Ever. And I'm reporting you to your wife.
And if the staff uses up all the Provigil samples this week trying to function, it's your fault.
However, you have erroneously purchased Local Grocery Generic Brand CAFFEINE FREE Diet Soda.
You are never allowed to do the office shopping again. Ever. And I'm reporting you to your wife.
And if the staff uses up all the Provigil samples this week trying to function, it's your fault.
Sunday, January 24, 2010
Dénouement
Aw, gee, they're towing Dr. Prik's car away.
What kind of asshole would have called security to report the expired placard?
That's a shame.
What kind of asshole would have called security to report the expired placard?
That's a shame.
Sunday Morning, 4:05 a.m.
Bleary-eyed, I stumble into the doctor's lounge. I'm on call. I have a migraine, though the medication is starting to take effect. I'm sleep deprived. I forgot to grab a Diet Coke on the way out of the house. I need caffeine, calories, and fluids.
It's been picked clean. No bagels, bread, or muffins. Shelves empty. Refrigerator empty. Coffee machine broken and overflowing into the sink.
After a careful search I found:
3 packets of melba toast.
1 packet of fat-free, calorie-free, taste-free cream cheese.
And an 8 oz. can of caffeine-free diet RC cola that was lying between the refrigerator and the sink. It was covered with dust bunnies and warm from the fridge motor. The hospital hasn't carried RC in years.
This sucks.
It's been picked clean. No bagels, bread, or muffins. Shelves empty. Refrigerator empty. Coffee machine broken and overflowing into the sink.
After a careful search I found:
3 packets of melba toast.
1 packet of fat-free, calorie-free, taste-free cream cheese.
And an 8 oz. can of caffeine-free diet RC cola that was lying between the refrigerator and the sink. It was covered with dust bunnies and warm from the fridge motor. The hospital hasn't carried RC in years.
This sucks.
Saturday, January 23, 2010
On Call, Again. Live the Adventure
Dr. Grumpy: "This is Dr. Grumpy, returning a page."
Mr. Cabbage: "Yeah, I see Dr. Nerve for my back problems, but for the last 2 hours I've had this heavy chest pain, too."
Dr. Grumpy: "Sir, you need to go to ER for that. NOW!"
Mr. Cabbage: "I don't want to. Can't you give me a pain pill or something?"
Dr. Grumpy: "NO! I'm a neurologist, sir. And chest pain is scary. You need to get it checked out ASAP. Do you have a cardiologist?"
Mr. Cabbage: "Yeah, but I already called him. He told me to go to ER, too."
Dr. Grumpy: "Then why are you calling me?"
Mr. Cabbage: "I hate going to ER, so I thought I'd call some of my other docs for ideas.
Dr. Grumpy: "You need to go to ER."
Mr. Cabbage: "My internist said that, too."
Dr. Grumpy: "Look. This could be serious. If you don't go, that's your business. But ER is the best advice I can give you."
Mr. Cabbage: "You're no help at all. I'll call some of my other docs. Thanks for wasting my time."
(click)
Mr. Cabbage: "Yeah, I see Dr. Nerve for my back problems, but for the last 2 hours I've had this heavy chest pain, too."
Dr. Grumpy: "Sir, you need to go to ER for that. NOW!"
Mr. Cabbage: "I don't want to. Can't you give me a pain pill or something?"
Dr. Grumpy: "NO! I'm a neurologist, sir. And chest pain is scary. You need to get it checked out ASAP. Do you have a cardiologist?"
Mr. Cabbage: "Yeah, but I already called him. He told me to go to ER, too."
Dr. Grumpy: "Then why are you calling me?"
Mr. Cabbage: "I hate going to ER, so I thought I'd call some of my other docs for ideas.
Dr. Grumpy: "You need to go to ER."
Mr. Cabbage: "My internist said that, too."
Dr. Grumpy: "Look. This could be serious. If you don't go, that's your business. But ER is the best advice I can give you."
Mr. Cabbage: "You're no help at all. I'll call some of my other docs. Thanks for wasting my time."
(click)
Things that make me grumpy
This morning I went to the hospital to round. As I was walking in, I ran into Dr. Prik, who'd parked in a handicapped space near the hospital entrance. He had a handicapped placard hanging from his rear view mirror.
He looked fine, but being a neurologist I know that many people who legitimately need handicapped spaces can look fine at first glance.
Dr. Grumpy: "You doing okay?"
Dr. Prik: "Yeah, fine. How about you?"
Dr. Grumpy: "Oh, I just saw the handicapped thing."
Dr. Prik: "Yeah. That was from when my wife broke her ankle a few years ago."
Dr. Grumpy: "I remember that."
Dr. Prik: "She's fine now. I just hold onto it. I hate having to walk too far to the building when I'm on call."
So, Dr. Prik, you hereby win the "Golden Asshole Physician Award" for your jackass sense of entitlement, and for your contributions to making the rest of us look like scum.
Also, you win the "Phailed Physically Phit" award for showing another reason as to why people are fat. Because YOU'D rather not burn a few extra calories, and at the same time ensure that someone who needs a decent space won't get one.
He looked fine, but being a neurologist I know that many people who legitimately need handicapped spaces can look fine at first glance.
Dr. Grumpy: "You doing okay?"
Dr. Prik: "Yeah, fine. How about you?"
Dr. Grumpy: "Oh, I just saw the handicapped thing."
Dr. Prik: "Yeah. That was from when my wife broke her ankle a few years ago."
Dr. Grumpy: "I remember that."
Dr. Prik: "She's fine now. I just hold onto it. I hate having to walk too far to the building when I'm on call."
So, Dr. Prik, you hereby win the "Golden Asshole Physician Award" for your jackass sense of entitlement, and for your contributions to making the rest of us look like scum.
Also, you win the "Phailed Physically Phit" award for showing another reason as to why people are fat. Because YOU'D rather not burn a few extra calories, and at the same time ensure that someone who needs a decent space won't get one.
Friday, January 22, 2010
Mary's Desk, January 22, 2010
Mary: "Good morning, Dr. Grumpy's office. This is Mary."
Mr. Pancake: "Hi! This is Bill Pancake. I have an appointment with Dr. Grumpy this afternoon."
Mary: "Um, yes, at 2:15."
Mr. Pancake: "Well, I'm right across the street having breakfast, so I want to come in now."
Mary: "Let me see... I'm sorry, we're completely swamped this morning, and can't do that."
Mr. Pancake: "Well you're not very accomodating."
Mary: "I'm sorry, it's just very busy today. Normally we would."
Mr. Pancake: "That's rude! I'm already here! I don't want to have to go all the way back home."
Mary: "I thought you lived in the apartment building across the street, within walking distance?"
Mr. Pancake: "What does that have to do with it?"
Mr. Pancake: "Hi! This is Bill Pancake. I have an appointment with Dr. Grumpy this afternoon."
Mary: "Um, yes, at 2:15."
Mr. Pancake: "Well, I'm right across the street having breakfast, so I want to come in now."
Mary: "Let me see... I'm sorry, we're completely swamped this morning, and can't do that."
Mr. Pancake: "Well you're not very accomodating."
Mary: "I'm sorry, it's just very busy today. Normally we would."
Mr. Pancake: "That's rude! I'm already here! I don't want to have to go all the way back home."
Mary: "I thought you lived in the apartment building across the street, within walking distance?"
Mr. Pancake: "What does that have to do with it?"
Bwahahahahahaha!
The rivalry between doctorhood's medical and surgical branches goes back to Hippocrates, and has led to some friendly (and not-so-friendly) ribbing over time.
There's a surgeon upstairs in my building, who I've treated for migraines for a few years. Yesterday he had a severe headache, which was different from his usual ones. I was worried something bad had happened, so I admitted him to the hospital, and ordered a bunch of tests.
At around 9:00 last night I got paged by the radiologist with the MRI results.
Dr. Grumpy: "What have you got?"
Dr. Radar: "I'm looking at Dr. Surgeon's head MRI. It's very abnormal."
Dr. Grumpy: "Crap. What's up?"
Dr. Radar: "He has a large intracranial soft tissue mass, which is almost never seen in surgeons."
I was laughing so hard I had to get off the phone (the study was fine, folks).
There's a surgeon upstairs in my building, who I've treated for migraines for a few years. Yesterday he had a severe headache, which was different from his usual ones. I was worried something bad had happened, so I admitted him to the hospital, and ordered a bunch of tests.
At around 9:00 last night I got paged by the radiologist with the MRI results.
Dr. Grumpy: "What have you got?"
Dr. Radar: "I'm looking at Dr. Surgeon's head MRI. It's very abnormal."
Dr. Grumpy: "Crap. What's up?"
Dr. Radar: "He has a large intracranial soft tissue mass, which is almost never seen in surgeons."
I was laughing so hard I had to get off the phone (the study was fine, folks).
Thursday, January 21, 2010
More hairs fall out
Dr. Grumpy: "What can I do for you?"
Mr. Tremor: "My hands shake."
Dr. Grumpy: "How long has this been going on?"
Mr. Tremor: "Since they started shaking."
Mr. Tremor: "My hands shake."
Dr. Grumpy: "How long has this been going on?"
Mr. Tremor: "Since they started shaking."
Skool Nerse Time
This is Mrs. Grumpy.
I'm sorry so many of you kids out there suffered injuries during the Martin Luther King holiday, and have required repeated trips to my office since then. I'm sure Reverend King would be flattered to know that you understand his life as "he was that guy who did something and then got killed."
Anyway, since your impression of MLK day (or Veteran's Day, or President's Day, or Columbus Day) is that it was created solely for you to spend it lying on the couch, eating Fruit Loops, and watching Nick, it's amazing to me how many of you suffered sprains. Apparently getting off the couch is trickier than it looks.
So I wanted to publish this guide for your future reference.
1. If you come to the school nurse about a serious injury of some sort to your writing hand or thumbs, DO NOT come in and write me out a detailed note on how you can't use your writing hand. Also, claiming you can't use your thumbs, and then texting your bff while sitting there, doesn't score points (And I get to confiscate your phone, since it's not supposed to be on during school).
2. If you come in more than once for a limb sprain, please try to remember where it was the first time you came in. Switching joints and limbs doesn't give you a lot of credibility. And asking "which one was hurting me last time?" is only going to get you sent back to class.
3. I know when the math quizzes are. Don't think I don't. Your teachers and I do talk.
4. Stop asking for ACE wraps (I know your parents want them). The school hasn't been able to afford them since 1995. Here is what I have: Band-aids and Kleenex. If you're looking for someone to make a miracle cast out of popsicle sticks, duct tape, and Jell-O you can either watch MacGyver or call a Boy Scout.
5. Walking around with a mouthful of hot chocolate to raise your temperature isn't going to get you anywhere. A temperature of > 110° F (43° C) is generally not compatible with life, let alone playing your Nintendo while I'm taking it.
Now get back to class.
I'm sorry so many of you kids out there suffered injuries during the Martin Luther King holiday, and have required repeated trips to my office since then. I'm sure Reverend King would be flattered to know that you understand his life as "he was that guy who did something and then got killed."
Anyway, since your impression of MLK day (or Veteran's Day, or President's Day, or Columbus Day) is that it was created solely for you to spend it lying on the couch, eating Fruit Loops, and watching Nick, it's amazing to me how many of you suffered sprains. Apparently getting off the couch is trickier than it looks.
So I wanted to publish this guide for your future reference.
1. If you come to the school nurse about a serious injury of some sort to your writing hand or thumbs, DO NOT come in and write me out a detailed note on how you can't use your writing hand. Also, claiming you can't use your thumbs, and then texting your bff while sitting there, doesn't score points (And I get to confiscate your phone, since it's not supposed to be on during school).
2. If you come in more than once for a limb sprain, please try to remember where it was the first time you came in. Switching joints and limbs doesn't give you a lot of credibility. And asking "which one was hurting me last time?" is only going to get you sent back to class.
3. I know when the math quizzes are. Don't think I don't. Your teachers and I do talk.
4. Stop asking for ACE wraps (I know your parents want them). The school hasn't been able to afford them since 1995. Here is what I have: Band-aids and Kleenex. If you're looking for someone to make a miracle cast out of popsicle sticks, duct tape, and Jell-O you can either watch MacGyver or call a Boy Scout.
5. Walking around with a mouthful of hot chocolate to raise your temperature isn't going to get you anywhere. A temperature of > 110° F (43° C) is generally not compatible with life, let alone playing your Nintendo while I'm taking it.
Now get back to class.
Wednesday, January 20, 2010
Circus is sounding really good now, too
Dr. Grumpy: "Are you allergic to any medications?"
Mrs. Wrinkled: "I don't know. I might. Should I be?"
Mrs. Wrinkled: "I don't know. I might. Should I be?"
Mary, I'm running away to join the circus
"Doctor Grumpy, at our last visit you said my wife had Parkinson's disease, and started her on Sinemet for it. And since then her tremor has stopped and her walking is much better. So all her symptoms have gone away on their own. At this point I think you were wrong, and she doesn't really have Parkinson's disease at all."
Maybe you should try Nicorette?
Dr. Grumpy: "Do you smoke?"
Mr. Church: "Yes, but Jesus is helping me quit."
Dr. Grumpy: "How long have you been trying to quit?"
Mr. Church: "7 years."
Mr. Church: "Yes, but Jesus is helping me quit."
Dr. Grumpy: "How long have you been trying to quit?"
Mr. Church: "7 years."
More Helpful Notes
I sent one of my patients, Mr. Huge, over to a neurosurgeon last week.
Yesterday Mr. Huge returned, so I was wondering what the surgeon thought. I called over and asked them to fax his note. They said they'd get right on it.
5 minutes later, this helpful item showed up on our fax machine. This was all I got. One page.
Except for changing the names, I haven't altered it in any way.
(click to enlarge)
Yesterday Mr. Huge returned, so I was wondering what the surgeon thought. I called over and asked them to fax his note. They said they'd get right on it.
5 minutes later, this helpful item showed up on our fax machine. This was all I got. One page.
Except for changing the names, I haven't altered it in any way.
(click to enlarge)
Tuesday, January 19, 2010
Afternoon rounds
Dr. Grumpy: "Does anyone else in your family have a tremor?"
Mr. Pointless: "Nope. But my mom choked to death on fried scallops."
Mr. Pointless: "Nope. But my mom choked to death on fried scallops."
Fun with patients
Mr. Math: "Doc, I'm concerned about my liver on all these pills."
Dr. Grumpy: "What dose are you up to now?"
Mr. Math: "Um, I've got the 25mg pills, and I'm taking 4 of them, twice a day."
Dr. Grumpy: "That's a standard dose, you should be okay."
Mr. Math: "I dunno. I read some scary stuff online about taking so many pills, and I'd like to change."
Dr. Grumpy: "How about if I change you to the 100mg pills, and you take one twice each day?"
Mr. Math: "Oh, that's fine. Thank you for working with me on this."
Dr. Grumpy: "What dose are you up to now?"
Mr. Math: "Um, I've got the 25mg pills, and I'm taking 4 of them, twice a day."
Dr. Grumpy: "That's a standard dose, you should be okay."
Mr. Math: "I dunno. I read some scary stuff online about taking so many pills, and I'd like to change."
Dr. Grumpy: "How about if I change you to the 100mg pills, and you take one twice each day?"
Mr. Math: "Oh, that's fine. Thank you for working with me on this."
Sucker!
Dr. Grumpy is always looking for junkies. I try not to deny pain meds to those who need them, but at the same time I hate people who abuse them. They make it harder for those who need them to get them.
Every doctor has been taken by a junkie at some point.
A few years ago one of the ER docs called me. He had an old lady at the hospital, who was visiting from out of town, and had a flare-up of her Trigeminal Neuralgia (a condition with awful facial pain). He asked if I could work her in that day, so I told Mary to put her on the schedule.
She came over from ER. She was very sweet, in her mid-late 70's. Fully dressed in a Salvation Army uniform (even with a little hat with the red badge). She had a long history of Trigeminal Neuralgia, which hadn't bothered her in several months. It was late November, and she was a ranking member of the Salvation Army who'd come to town to help organize the annual holiday bell-ringing campaign.
She gave a good history for Trigeminal Neuralgia. I put in a call to her regular neurologist, but the office was closed for lunch. She'd left her Neurontin and Percocet back home, and needed refills, so I wrote her for some and sent her on her way.
I went on with my afternoon. After about an hour Mary nabbed me between patients. While straightening up the lobby she'd noticed sweet old lady had left the Neurontin script sitting on top of the water cooler. I figured it was an accident, and she'd call looking for it.
Then her "regular neurologist" called. They'd never heard of this patient.
Ten minutes later the ER doc called me. He'd just gotten a call from a police department in another state. They were looking for my patient. She'd stolen a Salvation Army uniform several weeks earlier, and was traveling around, using it to collect as many narcotics as she could. She'd take some, and sell the others, and keep on the move. They'd found she'd filled a script in my city, and were calling local ER's to alert them.
I have no idea whatever happened to her. On one hand, I felt sorry for this old lady who's life was reduced to being a traveling fugitive junkie. On the other hand, I was pissed for having gotten taken, and certainly she was giving the Salvation Army (for all the jokes about bell-ringing, they're a good organization) a bad name.
And, in some strange way, I had to respect her ingenuity and skill as the opponent she was. And laugh at how I'd been beaten by my own view that a sweet little old lady, especially one in a Salvation Army uniform, couldn't possibly be a junkie.
Junkie's and other low-lifes are a common source of amusement on medical blogs. But in reality they're far from funny. For an excellent look at this forgotten, but more realistic side, I recommend this post by my colleague Phathead.
Every doctor has been taken by a junkie at some point.
A few years ago one of the ER docs called me. He had an old lady at the hospital, who was visiting from out of town, and had a flare-up of her Trigeminal Neuralgia (a condition with awful facial pain). He asked if I could work her in that day, so I told Mary to put her on the schedule.
She came over from ER. She was very sweet, in her mid-late 70's. Fully dressed in a Salvation Army uniform (even with a little hat with the red badge). She had a long history of Trigeminal Neuralgia, which hadn't bothered her in several months. It was late November, and she was a ranking member of the Salvation Army who'd come to town to help organize the annual holiday bell-ringing campaign.
She gave a good history for Trigeminal Neuralgia. I put in a call to her regular neurologist, but the office was closed for lunch. She'd left her Neurontin and Percocet back home, and needed refills, so I wrote her for some and sent her on her way.
I went on with my afternoon. After about an hour Mary nabbed me between patients. While straightening up the lobby she'd noticed sweet old lady had left the Neurontin script sitting on top of the water cooler. I figured it was an accident, and she'd call looking for it.
Then her "regular neurologist" called. They'd never heard of this patient.
Ten minutes later the ER doc called me. He'd just gotten a call from a police department in another state. They were looking for my patient. She'd stolen a Salvation Army uniform several weeks earlier, and was traveling around, using it to collect as many narcotics as she could. She'd take some, and sell the others, and keep on the move. They'd found she'd filled a script in my city, and were calling local ER's to alert them.
I have no idea whatever happened to her. On one hand, I felt sorry for this old lady who's life was reduced to being a traveling fugitive junkie. On the other hand, I was pissed for having gotten taken, and certainly she was giving the Salvation Army (for all the jokes about bell-ringing, they're a good organization) a bad name.
And, in some strange way, I had to respect her ingenuity and skill as the opponent she was. And laugh at how I'd been beaten by my own view that a sweet little old lady, especially one in a Salvation Army uniform, couldn't possibly be a junkie.
Junkie's and other low-lifes are a common source of amusement on medical blogs. But in reality they're far from funny. For an excellent look at this forgotten, but more realistic side, I recommend this post by my colleague Phathead.
Monday, January 18, 2010
YOU! YES! YOU!
Let's look at this:
1. YOU are the one who lives 140 miles from here.
2. YOU are the one who refuses to move your demented mother into a home closer to you, in spite of the fact that she has no connections here at all.
3. YOU are the one who frantically called last Friday demanding an immediate appointment for Mom's behavioral changes.
4. YOU are the one who went apeshit because you called at 3:30 p.m. on a Friday and I didn't want to keep my office open until 6:00 so you could drive here, pick her up, and bring her to see me.
5. YOU are the one who refused my suggestion of admitting her to the hospital last Friday to work this up.
6. YOU are the one who demanded an appointment for today, so I agreed to work Mom in over lunch.
So don't come in and chew me out for making you spend 2 hours driving here and bring your Mom to see me! And don't chew Mary out and tell her that I did this only to get your Mom's $15 co-pay!
And, when YOU just decided you don't want any more tests done or medications started on Mom, don't freaking yell at me for wasting your time on this visit!
1. YOU are the one who lives 140 miles from here.
2. YOU are the one who refuses to move your demented mother into a home closer to you, in spite of the fact that she has no connections here at all.
3. YOU are the one who frantically called last Friday demanding an immediate appointment for Mom's behavioral changes.
4. YOU are the one who went apeshit because you called at 3:30 p.m. on a Friday and I didn't want to keep my office open until 6:00 so you could drive here, pick her up, and bring her to see me.
5. YOU are the one who refused my suggestion of admitting her to the hospital last Friday to work this up.
6. YOU are the one who demanded an appointment for today, so I agreed to work Mom in over lunch.
So don't come in and chew me out for making you spend 2 hours driving here and bring your Mom to see me! And don't chew Mary out and tell her that I did this only to get your Mom's $15 co-pay!
And, when YOU just decided you don't want any more tests done or medications started on Mom, don't freaking yell at me for wasting your time on this visit!
Another bright part of my day
Dr. Grumpy: "Do you still see Dr. Internist?"
Mr. Beeph: "Yeah, I'm due for my special exam."
Dr. Grumpy: "Special exam?"
Mr. Beeph: "You know, where he uh, puts his finger in the, um, hole I poop out of."
Mr. Beeph: "Yeah, I'm due for my special exam."
Dr. Grumpy: "Special exam?"
Mr. Beeph: "You know, where he uh, puts his finger in the, um, hole I poop out of."
Monday Morning
Dr. Grumpy: "This is Dr. Grumpy, returning a page."
Mrs. Confused: "Yes, I have an appointment for this morning, but that must be wrong."
Dr. Grumpy: "No, I remember from the schedule. It's at 9:00."
Mrs. Confused: "But it's a national holiday. The post-office is closed."
Dr. Grumpy: "Yes, but I'm open."
Mrs. Confused: "You must be wrong. So if you're office is closed, I'd like to reschedule."
Dr. Grumpy: "We're open! Most doctors are."
Mrs. Confused: "But the post office is closed!"
Dr. Grumpy: "Ma'am, I'm not the post office."
Mrs. Confused: "Okay. I'll be in then."
Five minutes passed. Then the phone rang. It was Mrs. Confused again, so I answered it.
Dr. Grumpy: "This is Dr. Grumpy."
Mrs. Confused: "Doctor, I'm just not comfortable with this. I'd like to reschedule, just in case your office is closed today."
Dr. Grumpy: (heavy sigh) "Okay, I'll have Mary call you later."
Mrs. Confused: "Will she be in today if you're closed?"
Dr. Grumpy: "Have a nice day." (hangs up, watches hairs leap off his head like lemmings)
Mrs. Confused: "Yes, I have an appointment for this morning, but that must be wrong."
Dr. Grumpy: "No, I remember from the schedule. It's at 9:00."
Mrs. Confused: "But it's a national holiday. The post-office is closed."
Dr. Grumpy: "Yes, but I'm open."
Mrs. Confused: "You must be wrong. So if you're office is closed, I'd like to reschedule."
Dr. Grumpy: "We're open! Most doctors are."
Mrs. Confused: "But the post office is closed!"
Dr. Grumpy: "Ma'am, I'm not the post office."
Mrs. Confused: "Okay. I'll be in then."
Five minutes passed. Then the phone rang. It was Mrs. Confused again, so I answered it.
Dr. Grumpy: "This is Dr. Grumpy."
Mrs. Confused: "Doctor, I'm just not comfortable with this. I'd like to reschedule, just in case your office is closed today."
Dr. Grumpy: (heavy sigh) "Okay, I'll have Mary call you later."
Mrs. Confused: "Will she be in today if you're closed?"
Dr. Grumpy: "Have a nice day." (hangs up, watches hairs leap off his head like lemmings)
Sunday, January 17, 2010
Sunday Funday
So I had a hospital consult this lovely Sunday. The patient was an EXTREMELY drunk lady.
Dr. Grumpy: "How much do you drink?"
Mrs. Smashed: "Oh maybe 3, sometimes 4 a day."
Dr. Grumpy: " 3 or 4 what? Beers? Bottles of wine? Six-packs?"
Mrs. Smashed: "You're getting warmer."
Dr. Grumpy: "How much do you drink?"
Mrs. Smashed: "Oh maybe 3, sometimes 4 a day."
Dr. Grumpy: " 3 or 4 what? Beers? Bottles of wine? Six-packs?"
Mrs. Smashed: "You're getting warmer."
Saturday, January 16, 2010
Elevator Stories
My favorite drug rep and I were talking about my elevator encounter from a few days ago, and she sent me this story:
In my old job I made hospital calls to talk to cardiology nurses. One day I was in the elevator, and this short, squat, unattractive guy in scrubs got in with me.
Dr. Scrubs: "You must be a rep. What company do you work for?"
Ms. Nicerep: "Notsobig Pharma, we make cardiac surgical devices. What field are you in?"
Dr. Scrubs: "Plastic surgery is my game. Here's my card. Why don't you come by my office? I could do something about that nose and breasts of yours."
Ms. Nicerep: (GASP!): "Umm, no thanks, I'm happy with how I am..... But if that's your marketing schpiel, you might want to get some work done yourself!"
Then I got off the elevator.
In my old job I made hospital calls to talk to cardiology nurses. One day I was in the elevator, and this short, squat, unattractive guy in scrubs got in with me.
Dr. Scrubs: "You must be a rep. What company do you work for?"
Ms. Nicerep: "Notsobig Pharma, we make cardiac surgical devices. What field are you in?"
Dr. Scrubs: "Plastic surgery is my game. Here's my card. Why don't you come by my office? I could do something about that nose and breasts of yours."
Ms. Nicerep: (GASP!): "Umm, no thanks, I'm happy with how I am..... But if that's your marketing schpiel, you might want to get some work done yourself!"
Then I got off the elevator.
Friday, January 15, 2010
Friday afternoon quiz
You woke up this morning with severe back pain, completely paralyzed from the waist down. You immediately:
A. Call 911.
B. Call a friend to take you to the hospital 2 blocks from your home.
C. Drag yourself to your car and drive yourself down the freeway to a hospital over 1 hour from your home because you saw a TV ad last night on how it delivers "Premium Quality Healthcare"
D. When you discovered you couldn't drive because your legs were paralyzed, you grabbed a broomstick you had in your garage and used it to operate the pedals as you sped down the freeway at 75 mph.
E. Both answers C & D.
If you answered E, it was a pleasure meeting you this afternoon in the neurosurgical recovery room, sir. I hope they can get those wood splinters from the broomstick out of your hand.
A. Call 911.
B. Call a friend to take you to the hospital 2 blocks from your home.
C. Drag yourself to your car and drive yourself down the freeway to a hospital over 1 hour from your home because you saw a TV ad last night on how it delivers "Premium Quality Healthcare"
D. When you discovered you couldn't drive because your legs were paralyzed, you grabbed a broomstick you had in your garage and used it to operate the pedals as you sped down the freeway at 75 mph.
E. Both answers C & D.
If you answered E, it was a pleasure meeting you this afternoon in the neurosurgical recovery room, sir. I hope they can get those wood splinters from the broomstick out of your hand.
But did he dress like a pimp?
Seeing a new patient this morning
Dr. Grumpy: "So what brings you in today, sir?"
Mr. Mouth: "My previous neurologist was an asshole."
Dr. Grumpy: "So what brings you in today, sir?"
Mr. Mouth: "My previous neurologist was an asshole."
End of the day
After rounds last night I got in the hospital elevator on my way to the parking lot. The only other person in it was a sweet-looking elderly lady, with a pleasant smile.
The doors closed, and she looked at me.
Mrs. Olde: "Excuse me, sir, but are you a doctor?"
Dr. Grumpy: "Umm, yes..."
Mrs. Olde: "Oh. Because that shirt makes you look like a pimp."
The doors closed, and she looked at me.
Mrs. Olde: "Excuse me, sir, but are you a doctor?"
Dr. Grumpy: "Umm, yes..."
Mrs. Olde: "Oh. Because that shirt makes you look like a pimp."
Thursday, January 14, 2010
Drug Rep Lunch Quote
"Dr. Grumpy, if you look at this data, you'll notice that as pain relief improves, the patients hurt less".
Mary's Desk, January 14, 2010
A lot of patients have Mary's email. They use it to schedule and confirm appointments.
So my 8:30 was running a few minutes late today. Using her cell phone, she sent Mary an email that she was running late because she spilled soda on her pants. Whatever.
A few minutes later, while driving down the freeway, she took a picture of the stain and emailed it to Mary.
I couldn't make this stuff up if I tried.
So my 8:30 was running a few minutes late today. Using her cell phone, she sent Mary an email that she was running late because she spilled soda on her pants. Whatever.
A few minutes later, while driving down the freeway, she took a picture of the stain and emailed it to Mary.
I couldn't make this stuff up if I tried.
Wednesday, January 13, 2010
Shining Lights of Education
The twins (Craig and Marie) routinely beat the crap out of each other. This is such a normal occurrence at our house that we just ignore it unless at least one liter of blood is spilled.
So after I got home from work today, the phone rang.
Dr. Grumpy: "Hello?"
Mrs. Playground: "Is this the father of Marie Grumpy?"
Dr. Grumpy: "Yes."
Mrs. Playground: "I'm the playground supervisor at Wingnut Elementary School, and I have to notify you that Marie was involved in a playground fight today, with a boy at school."
Dr. Grumpy (glancing out the window at the twins gouging each others eyes out on the trampoline): "Is she in trouble?"
Mrs. Playground: "Yes, she has to miss recess tomorrow. She and the boy suffered some minor scrapes, so I need to notify the parents of both children."
Dr. Grumpy: "Okay, thank you."
I hung up the phone, looked at Mrs. Grumpy, and began counting. "5-4-3-2..." As soon as I got to "1", the phone rang. I bit my tongue, hard.
Dr. Grumpy: "Hello?"
Mrs. Playground: "Is this the father of Craig Grumpy?"
Dr. Grumpy: "Yes."
Mrs. Playground: "I'm the playground supervisor at Wingnut Elementary School, and I have to notify you that Craig was involved in a playground fight today, with a girl at school..."
I can see why she's the "playground supervisor", whatever the hell that means.
So after I got home from work today, the phone rang.
Dr. Grumpy: "Hello?"
Mrs. Playground: "Is this the father of Marie Grumpy?"
Dr. Grumpy: "Yes."
Mrs. Playground: "I'm the playground supervisor at Wingnut Elementary School, and I have to notify you that Marie was involved in a playground fight today, with a boy at school."
Dr. Grumpy (glancing out the window at the twins gouging each others eyes out on the trampoline): "Is she in trouble?"
Mrs. Playground: "Yes, she has to miss recess tomorrow. She and the boy suffered some minor scrapes, so I need to notify the parents of both children."
Dr. Grumpy: "Okay, thank you."
I hung up the phone, looked at Mrs. Grumpy, and began counting. "5-4-3-2..." As soon as I got to "1", the phone rang. I bit my tongue, hard.
Dr. Grumpy: "Hello?"
Mrs. Playground: "Is this the father of Craig Grumpy?"
Dr. Grumpy: "Yes."
Mrs. Playground: "I'm the playground supervisor at Wingnut Elementary School, and I have to notify you that Craig was involved in a playground fight today, with a girl at school..."
I can see why she's the "playground supervisor", whatever the hell that means.
Going in circles
Dr. Grumpy: "Do you have high blood pressure?"
Mr. Brainless: "No."
Dr. Grumpy: "Do you take any medications?"
Mr. Brainless: "Zestril."
Dr. Grumpy: "What do you take that for?"
Mr. Brainless: "My high blood pressure."
Dr. Grumpy: "I thought you said you don't have high blood pressure?"
Mr. Brainless: "I don't if I take the Zestril."
Mr. Brainless: "No."
Dr. Grumpy: "Do you take any medications?"
Mr. Brainless: "Zestril."
Dr. Grumpy: "What do you take that for?"
Mr. Brainless: "My high blood pressure."
Dr. Grumpy: "I thought you said you don't have high blood pressure?"
Mr. Brainless: "I don't if I take the Zestril."
Things that make me grumpy
If I'm still prescribing medications for a patient, I want to see them once a year (give or take a month). I'll see them more than that if needed, obviously, but for a stable patient I think once a year is reasonable if I'm still the one writing their scripts. Dr. Darth, a neurologist downstairs from me, makes everyone come in every 8 weeks, and Dr. Ivyleague across the street requires monthly visits. But I think that's just digging for a co-pay.
Mrs. Bagge is an elderly lady who I see for benign tremor. I see her once a year, and refill her Inderal, and she goes on her way. But she always bitches and complains about her $25 HMO co-pay to see me once a year. I'm not that desperate for the $25, but if I'm taking the legal liability of writing her pills, I want to see and examine her once a year.
She was due for a return visit in early November, 2009, so I had Mary call her. Mrs. Bagge said she'd just had surgery on her bunions, and couldn't get in then. So, to be nice, I wrote her for another month.
So in early December, her next refill came up. This time Mrs. Bagge had family in town through the holidays, and so asked if I'd give her until January. I don't want to be Scrooge, so I said fine.
Last week another refill came up. Mary called her, and Mrs. Bagge wanted to make an appointment, but she needed an insurance authorization from her internist to see me. So Mary called Dr. Internist (twice) to ask for one, and said she'd call Mrs. Bagge to schedule the appointment as soon as we got it.
In the meantime she was out of Inderal. I told Annie to give her 15 days worth of pills, and no more until she was seen. Annie argued with me that Mrs. Bagge is on a fixed income, and we shouldn't put her in the position of having to make 2 medication co-pays for one month of pills. Since we were in the process of getting the auth for her to see me, and I'm a soft touch, and (most importantly) because I never argue with Annie, I said fine. Give her a whole month.
So yesterday afternoon her insurance auth showed up for her visit, and Mary called her.
Mrs. Bagge refused to make the appointment. She said she was tired of dealing with my greedy office, and accused us of harassing her with phone calls and holding her Inderal hostage. She then sent over a request to fax her records to Dr. Darth, because she has an appointment with him next week.
Good riddance.
Mrs. Bagge is an elderly lady who I see for benign tremor. I see her once a year, and refill her Inderal, and she goes on her way. But she always bitches and complains about her $25 HMO co-pay to see me once a year. I'm not that desperate for the $25, but if I'm taking the legal liability of writing her pills, I want to see and examine her once a year.
She was due for a return visit in early November, 2009, so I had Mary call her. Mrs. Bagge said she'd just had surgery on her bunions, and couldn't get in then. So, to be nice, I wrote her for another month.
So in early December, her next refill came up. This time Mrs. Bagge had family in town through the holidays, and so asked if I'd give her until January. I don't want to be Scrooge, so I said fine.
Last week another refill came up. Mary called her, and Mrs. Bagge wanted to make an appointment, but she needed an insurance authorization from her internist to see me. So Mary called Dr. Internist (twice) to ask for one, and said she'd call Mrs. Bagge to schedule the appointment as soon as we got it.
In the meantime she was out of Inderal. I told Annie to give her 15 days worth of pills, and no more until she was seen. Annie argued with me that Mrs. Bagge is on a fixed income, and we shouldn't put her in the position of having to make 2 medication co-pays for one month of pills. Since we were in the process of getting the auth for her to see me, and I'm a soft touch, and (most importantly) because I never argue with Annie, I said fine. Give her a whole month.
So yesterday afternoon her insurance auth showed up for her visit, and Mary called her.
Mrs. Bagge refused to make the appointment. She said she was tired of dealing with my greedy office, and accused us of harassing her with phone calls and holding her Inderal hostage. She then sent over a request to fax her records to Dr. Darth, because she has an appointment with him next week.
Good riddance.
Tuesday, January 12, 2010
The hip bone's connected to the...
Mrs. Anatomy: "The pain goes down the front of my thigh to the clavicle."
Dr. Grumpy: "Clavicle?"
Mrs. Anatomy: "Yeah, the clavicle, in the front of your knee."
Dr. Grumpy: "You mean knee cap? Patella?"
Mrs. Anatomy: "Yeah, there too."
Dr. Grumpy: "Clavicle?"
Mrs. Anatomy: "Yeah, the clavicle, in the front of your knee."
Dr. Grumpy: "You mean knee cap? Patella?"
Mrs. Anatomy: "Yeah, there too."
Missed the "calling with results" lecture, did we?
Dr. Grumpy: "This is Dr. Grumpy, returning a page."
Nurse Newgrad: "Hi, I'm the nurse taking care of Mr. Seizure, in room 8, and his Dilantin level is abnormal."
Dr. Grumpy: "What is it?"
Nurse Newgrad: "Oh, I don't know. I just heard it was abnormal. Do you want me to look it up?"
Nurse Newgrad: "Hi, I'm the nurse taking care of Mr. Seizure, in room 8, and his Dilantin level is abnormal."
Dr. Grumpy: "What is it?"
Nurse Newgrad: "Oh, I don't know. I just heard it was abnormal. Do you want me to look it up?"
Monday, January 11, 2010
Thanks for clearing that up.
Dr. Grumpy: "What kind of doctor did you see after that?"
Mr. Dimbulb: "The one my family doc said I should go to. I think she was a cardiologist or rheumatologist or something like that. You know, one of those 'ologist' docs. What do they do, anyway?"
Mr. Dimbulb: "The one my family doc said I should go to. I think she was a cardiologist or rheumatologist or something like that. You know, one of those 'ologist' docs. What do they do, anyway?"
Scoreboard: Arizona: 51. Green Bay: 45. Patient: 0
(While football is primarily a North American sport, I'm sure my international readers will agree that idiotically extreme sports fans are universal, though the sport varies).
Dr. Grumpy: "When did this all start?"
Mr. Touchdown: "Mmm. I think Dad's right arm stopped working in the 2nd quarter."
Dr. Grumpy: "Any idea what time?"
Mr. Touchdown: "I dunno. It was the 2nd quarter. Yeah, that was it. Because normally Dad makes a sandwich at halftime, but today he just stayed on the couch and stared at the TV. He was real quiet, even though it was a good game. Normally he really gets into them."
Dr. Grumpy: Well, it looks like it's too late to give him TPA, the clot-busting drug. We can only give it within a few hours of when things start and..."
Mr. Touchdown: "Look! I would've gotten him in here sooner, but the game went into overtime! That's not my fault! Can't you give it anyway? What's the worst that could happen?"
Dr. Grumpy: "He could bleed into his brain and die."
Mr. Touchdown: "Well, with Green Bay out of the playoffs, Dad wouldn't really care."
Dr. Grumpy: "When did this all start?"
Mr. Touchdown: "Mmm. I think Dad's right arm stopped working in the 2nd quarter."
Dr. Grumpy: "Any idea what time?"
Mr. Touchdown: "I dunno. It was the 2nd quarter. Yeah, that was it. Because normally Dad makes a sandwich at halftime, but today he just stayed on the couch and stared at the TV. He was real quiet, even though it was a good game. Normally he really gets into them."
Dr. Grumpy: Well, it looks like it's too late to give him TPA, the clot-busting drug. We can only give it within a few hours of when things start and..."
Mr. Touchdown: "Look! I would've gotten him in here sooner, but the game went into overtime! That's not my fault! Can't you give it anyway? What's the worst that could happen?"
Dr. Grumpy: "He could bleed into his brain and die."
Mr. Touchdown: "Well, with Green Bay out of the playoffs, Dad wouldn't really care."
Sunday, January 10, 2010
Today's Quiz
You woke up last night with chest pain and your heart racing. You called 911. In the emergency room you were found to have a heart attack. You then had a 10 minute episode of right-sided weakness and inability to speak, but are better now.
So this morning you:
A. Thank your internist, who dragged his butt out of bed on a Sunday to come see you in the hospital.
B. Thank the cardiologist, who dragged her butt out of bed on a Sunday to come see you in the hospital.
C. Thank the neurologist (me), who dragged his butt out of bed on a Sunday to come see you in the hospital.
D. Tell the internist, cardiologist, and neurologist to all go away and come back to your hospital room tomorrow, because you don't want to miss any of the football pre-game, game, or post-game coverage.
(If you answered "D", It was nice to meet you this morning, sir. And I think you're an asshole).
So this morning you:
A. Thank your internist, who dragged his butt out of bed on a Sunday to come see you in the hospital.
B. Thank the cardiologist, who dragged her butt out of bed on a Sunday to come see you in the hospital.
C. Thank the neurologist (me), who dragged his butt out of bed on a Sunday to come see you in the hospital.
D. Tell the internist, cardiologist, and neurologist to all go away and come back to your hospital room tomorrow, because you don't want to miss any of the football pre-game, game, or post-game coverage.
(If you answered "D", It was nice to meet you this morning, sir. And I think you're an asshole).
Everything I ever learned about surviving being on-call came from "Meet the Robinsons"
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
(Oh yeah, and eat when you can/sleep when you can, from the Science Marches on Department).
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
(Oh yeah, and eat when you can/sleep when you can, from the Science Marches on Department).
Saturday, January 9, 2010
On Call Follies
There is nothing more fun than standing at the bedside in ICU, with a teenage patient who was found passed out somewhere. The patient has a blood alcohol level of 0.374 and piss that tests positive for marijuana, opiods, cocaine, and a host of other illicit substances.
And the parents, Mr. & Mrs. DeNyel, are arguing with me about the lab results.
"My kid doesn't do those things!"
"Someone must have put it in her drink!"
"Your lab must have gotten her specimens mixed up!"
People, I've heard it all. Wake up and smell the crack.
The best part is when they find out her pregnancy test was positive, and go fucking NUTS! Our daughter is a good girl!
Comically, this pisses them off even more then the drug issues and possible brain damage. Apparently, because my hospital did the revealing labs, it's OUR fault that we've brought shame and disgrace on her family for generations to come.
And they keep insisting that she "doesn't do those things". Sorry gang, its, 2010, and her name ain't Mary.
And the parents, Mr. & Mrs. DeNyel, are arguing with me about the lab results.
"My kid doesn't do those things!"
"Someone must have put it in her drink!"
"Your lab must have gotten her specimens mixed up!"
People, I've heard it all. Wake up and smell the crack.
The best part is when they find out her pregnancy test was positive, and go fucking NUTS! Our daughter is a good girl!
Comically, this pisses them off even more then the drug issues and possible brain damage. Apparently, because my hospital did the revealing labs, it's OUR fault that we've brought shame and disgrace on her family for generations to come.
And they keep insisting that she "doesn't do those things". Sorry gang, its, 2010, and her name ain't Mary.
Nice Picture
Hospital nurses (at least where I work) carry around notebooks listing their patients' medications and dosings, called MARS (I have no idea what it stands for). After each shift the MARS sheets are scanned into the patient's chart, so the next shift can keep track of what was given and when.
Since each nurse has her own notebook, they tend to be personalized. Most have pictures of kids, family, friends, pets, maybe a cute saying, or a religious symbol, whatever.
Tonight I'm on call, and got dragged in. As I was dictating a note, I absently glanced over a few MARS notebooks lying near me. Some cute kids and pets looked back at me. One picture of a nurse at her graduation.
One of the books had only one picture on the cover. I recognized it as a blurry shot of the nurse who owned it. The odd part was that the picture showed her in street clothes, looking very upset, with a black eye, her wrists handcuffed behind her back, and getting put into the back seat of a police car.
Since each nurse has her own notebook, they tend to be personalized. Most have pictures of kids, family, friends, pets, maybe a cute saying, or a religious symbol, whatever.
Tonight I'm on call, and got dragged in. As I was dictating a note, I absently glanced over a few MARS notebooks lying near me. Some cute kids and pets looked back at me. One picture of a nurse at her graduation.
One of the books had only one picture on the cover. I recognized it as a blurry shot of the nurse who owned it. The odd part was that the picture showed her in street clothes, looking very upset, with a black eye, her wrists handcuffed behind her back, and getting put into the back seat of a police car.
Friday, January 8, 2010
Mary's Desk, January 8, 2010
Mary: "Dr. Grumpy's office, this is Mary."
Mr. Armpain: "My pain is awful today, and I want to go over my MRI results! I need to come in urgently! Please! Can Dr. Grumpy work me in somewhere?"
Mary: "Umm, well, I can squeeze you in over lunch hour today."
Mr. Armpain: "No, that won't work. I'm meeting some friends. Do you have anything on Monday?"
Mr. Armpain: "My pain is awful today, and I want to go over my MRI results! I need to come in urgently! Please! Can Dr. Grumpy work me in somewhere?"
Mary: "Umm, well, I can squeeze you in over lunch hour today."
Mr. Armpain: "No, that won't work. I'm meeting some friends. Do you have anything on Monday?"
To bleed is human...
Look, Mrs. Protime, we all bleed. Maybe you have a paper cut. Maybe you picked your nose more aggressively then usual. Maybe you chewed one of your toenails too close. I don't care.
And I really don't mind that you used some of my Kleenex on the wound. It's there for whatever reason.
But for crying out loud, did you have to put your hemorrhagic tissue BACK ON TOP OF THE BOX OF KLEENEX?!!!
I could (sort of, maybe) understand you setting it there if I didn't have a wastebasket in the room. But I do.
In fact, if you'd pay some freaking attention to something other then your neck pain, you might have noticed the trash can WAS RIGHT UNDER THE DAMN BOX!!!
Have a nice day.
And I really don't mind that you used some of my Kleenex on the wound. It's there for whatever reason.
But for crying out loud, did you have to put your hemorrhagic tissue BACK ON TOP OF THE BOX OF KLEENEX?!!!
I could (sort of, maybe) understand you setting it there if I didn't have a wastebasket in the room. But I do.
In fact, if you'd pay some freaking attention to something other then your neck pain, you might have noticed the trash can WAS RIGHT UNDER THE DAMN BOX!!!
Have a nice day.
Thursday, January 7, 2010
More from Mr. Lumbar
"Doc, maybe this sounds weird, but when I feel weak, I don't feel very strong. And the opposite is true, too. On days when I'm feeling stronger, I seem less weak."
Thursday patient quote
Mr. Lumbar: "I have Percocet, but I use it sparingly. I don't like narcotics, so I don't want to get used to taking them."
Dr. Grumpy: "Do you take anything regularly for the pain?"
Mr. Lumbar: "Vicodin, 3 or 4 times a day."
Dr. Grumpy: "Do you take anything regularly for the pain?"
Mr. Lumbar: "Vicodin, 3 or 4 times a day."
Thursday morning, 2:05 a.m.
My cell phone wakes me. I recognize the number. Not a good sign.
Dr. Grumpy: "This is Dr. Grumpy."
Mr. Clueless: "Yeah, my wife took her pills at bedtime tonight."
Dr. Grumpy: "She's supposed to."
Mrs. Notas-Clueless (in background): "I told you not to bother him!"
Mr. Clueless: "Well, we normally go to bed at 11:00. So tonight we went to bed at 11:15. Was it still safe to take them?"
Dr. Grumpy: "Yes."
Mrs. Notas-Clueless (in background): "I told you so!"
Dr. Grumpy: "She's been doing this for years. Why are you calling now?"
Mr. Clueless: "I'd never read the bottle before, and just happened to notice it said that when I woke up to pee."
Dr. Grumpy: "This is Dr. Grumpy."
Mr. Clueless: "Yeah, my wife took her pills at bedtime tonight."
Dr. Grumpy: "She's supposed to."
Mrs. Notas-Clueless (in background): "I told you not to bother him!"
Mr. Clueless: "Well, we normally go to bed at 11:00. So tonight we went to bed at 11:15. Was it still safe to take them?"
Dr. Grumpy: "Yes."
Mrs. Notas-Clueless (in background): "I told you so!"
Dr. Grumpy: "She's been doing this for years. Why are you calling now?"
Mr. Clueless: "I'd never read the bottle before, and just happened to notice it said that when I woke up to pee."
Wednesday, January 6, 2010
Wednesday Afternoon Freakshow
Dr. Grumpy: "Do you have any other medical issues?'
Mrs. Rudeandcreepy: "I have special powers."
Dr. Grumpy: "Excuse me?"
Mrs. Rudeandcreepy: "I have special psychic powers. I can read minds. I'm very good at it."
My inner voice: "Lady, if you were that good at reading minds, you'd have walked out of here 5 minutes ago."
Mrs. Rudeandcreepy: "I have special powers."
Dr. Grumpy: "Excuse me?"
Mrs. Rudeandcreepy: "I have special psychic powers. I can read minds. I'm very good at it."
My inner voice: "Lady, if you were that good at reading minds, you'd have walked out of here 5 minutes ago."
Things that make me grumpy
Wallpapering.
I like most of my drug reps. I've said that before. But some of them drive me nuts. (If you are one of my reps who reads this, don't worry, It's none of you).
Drug reps often bring "patient education materials". Most of these are just trash, and I either refuse or toss them. They consist of thinly veiled ads in booklets that have a smattering of info about a disease and lots of big glossy "ask your doctor because you'll feel SO MUCH better on our product" ads.
Sometimes they actually bring in a very useful booklet, with info about the disease and fairly neutral information about treatments, with only a drug company logo on the back cover. I screen these, but if they're good ones I appreciate them and often give them to patients.
Any info that patients get in my office should come through me, NOT directly from a drug rep. So I don't allow booklets of ANY kind to be out in the lobby without me screening them first.
Most reps are fine with this. But a few aren't. And they engage in a thoroughly annoying practice called wallpapering. And it REALLY pisses me off.
Wallpapering is when they put pamphlets out in my lobby that are blatant "You should take Flatula, instead of Obecalp, because our drug is SO much better for you. Ask your doctor. NOW!" They are just ads, often hard sell. Sometimes with a big coupon for a free trial. My patients don't need that crap. And neither do I. And putting them out in the lobby makes it look like I've endorsed this product.
So I don't allow this, and if my staff sees it they tell them to stop. So some wallpaperers have taken it a step further. They actually keep track of when the front office staff are most likely to be in back for a coffee break, or know when the lunch hour is (when nobody is up front). So they come in then, quickly wallpaper the lobby with booklets, and then run off.
Sometimes we notice this when we get back. But they're good at putting them behind a plant, or under a magazine, or some other place where they won't be noticed from the front desk. So once or twice a week I do a sweep through the lobby looking for these things.
And we know exactly who the reps are who do it. I mean, you guys come by pushing this stuff regularly, and leave your cards, so we know who sells what. And when we ask them about it, they always deny it, "Huh! How did the Fukitol booklet get inserted between the pages of every National Geographic issue in your lobby?"
We ain't that stupid. If you have to leave these somewhere, just save us the trouble and use the recycling bin.
I like most of my drug reps. I've said that before. But some of them drive me nuts. (If you are one of my reps who reads this, don't worry, It's none of you).
Drug reps often bring "patient education materials". Most of these are just trash, and I either refuse or toss them. They consist of thinly veiled ads in booklets that have a smattering of info about a disease and lots of big glossy "ask your doctor because you'll feel SO MUCH better on our product" ads.
Sometimes they actually bring in a very useful booklet, with info about the disease and fairly neutral information about treatments, with only a drug company logo on the back cover. I screen these, but if they're good ones I appreciate them and often give them to patients.
Any info that patients get in my office should come through me, NOT directly from a drug rep. So I don't allow booklets of ANY kind to be out in the lobby without me screening them first.
Most reps are fine with this. But a few aren't. And they engage in a thoroughly annoying practice called wallpapering. And it REALLY pisses me off.
Wallpapering is when they put pamphlets out in my lobby that are blatant "You should take Flatula, instead of Obecalp, because our drug is SO much better for you. Ask your doctor. NOW!" They are just ads, often hard sell. Sometimes with a big coupon for a free trial. My patients don't need that crap. And neither do I. And putting them out in the lobby makes it look like I've endorsed this product.
So I don't allow this, and if my staff sees it they tell them to stop. So some wallpaperers have taken it a step further. They actually keep track of when the front office staff are most likely to be in back for a coffee break, or know when the lunch hour is (when nobody is up front). So they come in then, quickly wallpaper the lobby with booklets, and then run off.
Sometimes we notice this when we get back. But they're good at putting them behind a plant, or under a magazine, or some other place where they won't be noticed from the front desk. So once or twice a week I do a sweep through the lobby looking for these things.
And we know exactly who the reps are who do it. I mean, you guys come by pushing this stuff regularly, and leave your cards, so we know who sells what. And when we ask them about it, they always deny it, "Huh! How did the Fukitol booklet get inserted between the pages of every National Geographic issue in your lobby?"
We ain't that stupid. If you have to leave these somewhere, just save us the trouble and use the recycling bin.
Tuesday, January 5, 2010
That's kind of personal
One of my MS patients is trying to have kids, and is seeing a fertility specialist.
I get notes all the time from other docs asking me for neurological clearance to do some procedure (colonoscopy, hysterectomy, face lift, whatever) on my patients. So I write out an "okay from neurology view to do whatever you want with them, have fun" note.
The request on my MS patient, though, could have been worded better. It said:
"Cindy is going to do a procedure that may result in her becoming pregnant. Please write a note that it is okay for her to do this."
Sheesh! If I have to write a clearance note every time one of my patients does something "that may result in her becoming pregnant" I'm going to have a really sore hand (from writing the notes, I mean) and will likely run out of pens when a patient goes on her honeymoon.
I get notes all the time from other docs asking me for neurological clearance to do some procedure (colonoscopy, hysterectomy, face lift, whatever) on my patients. So I write out an "okay from neurology view to do whatever you want with them, have fun" note.
The request on my MS patient, though, could have been worded better. It said:
"Cindy is going to do a procedure that may result in her becoming pregnant. Please write a note that it is okay for her to do this."
Sheesh! If I have to write a clearance note every time one of my patients does something "that may result in her becoming pregnant" I'm going to have a really sore hand (from writing the notes, I mean) and will likely run out of pens when a patient goes on her honeymoon.
Whatever
Mr. Behind: "At the hospital they told me I had a hemorrhoidic stroke."
Dr. Grumpy: "You mean hemorrhagic stroke?"
Mr. Behind: "Something like that."
Dr. Grumpy: "You mean hemorrhagic stroke?"
Mr. Behind: "Something like that."
Scrubs Catalog- Part 3
This picture from the scrubs catalog supposedly shows a NEUROLOGIST! I swear. Read his white coat.
Mrs. Grumpy pointed out, and I agree with her, that any medical person can clearly see this isn't a neurologist:
1. He's handsome and studly. We aren't. We are the geeks of medicine. Most people see a neurologist coming, and immediately react with, "Hey is that really a doctor? Hide the children! Call security!"
2. He's clean shaven. Most male neurologists have mastered the perpetual 5:00 shadow look.
3. He's wearing a stethoscope, for Pete's sake. Most of us have one, but it's somewhere in the black bag of pins, hammers, tuning forks, ophthalmoscopes, and other crap we carry around.
4. His shoulders are at equal heights. Usually one is lower from years of carrying the black bag full of crap (see #3, above) everywhere.
5. His tie is done properly. Many male neurologists don't wear them because we've forgotten how to tie them. Those who do wear them usually have botched knots, partially undone, and hanging to one side.
6. Aside from the tie, he's nicely dressed (granted, he could be pantless under the white coat). Except for the neuros at major academic centers (and I think those places dress their docs), most male neurologists have absolutely NO fashion sense. We may understand the complexities of the brain, but have no fucking clue what colors match. And Mrs. Grumpy will tell you it shows. I'm often greeted home at night with "OMG! You wore THAT to work?!!"
Mrs. Grumpy pointed out, and I agree with her, that any medical person can clearly see this isn't a neurologist:
1. He's handsome and studly. We aren't. We are the geeks of medicine. Most people see a neurologist coming, and immediately react with, "Hey is that really a doctor? Hide the children! Call security!"
2. He's clean shaven. Most male neurologists have mastered the perpetual 5:00 shadow look.
3. He's wearing a stethoscope, for Pete's sake. Most of us have one, but it's somewhere in the black bag of pins, hammers, tuning forks, ophthalmoscopes, and other crap we carry around.
4. His shoulders are at equal heights. Usually one is lower from years of carrying the black bag full of crap (see #3, above) everywhere.
5. His tie is done properly. Many male neurologists don't wear them because we've forgotten how to tie them. Those who do wear them usually have botched knots, partially undone, and hanging to one side.
6. Aside from the tie, he's nicely dressed (granted, he could be pantless under the white coat). Except for the neuros at major academic centers (and I think those places dress their docs), most male neurologists have absolutely NO fashion sense. We may understand the complexities of the brain, but have no fucking clue what colors match. And Mrs. Grumpy will tell you it shows. I'm often greeted home at night with "OMG! You wore THAT to work?!!"
Monday, January 4, 2010
Scrubs Catalog- Part 2
Here's a scrubs catalog picture of a nurse, happily demonstrating the inside pockets of her white coat.
How do we know she's not a real nurse?
1. The coat is spotless.
2. Very few nurses wear these white coats anymore.
3. Only people in training carry books in their pockets. A real nurse's pockets have tape, scissors, hemostats, pens, a granola bar, a "buy 500 get 1 free" Starbucks punchcard, and a hospital ID.
Another point: Although I don't know what Nurse K looks like, this could be a picture of her, taken at the critical moment when she's tired of putting up with a drunk patient's shit and is smilingly drawing her Taser.
How do we know she's not a real nurse?
1. The coat is spotless.
2. Very few nurses wear these white coats anymore.
3. Only people in training carry books in their pockets. A real nurse's pockets have tape, scissors, hemostats, pens, a granola bar, a "buy 500 get 1 free" Starbucks punchcard, and a hospital ID.
Another point: Although I don't know what Nurse K looks like, this could be a picture of her, taken at the critical moment when she's tired of putting up with a drunk patient's shit and is smilingly drawing her Taser.
OMG!
Miss Boobshow, when I asked you to take off your jacket so I could check your blood pressure, I didn't expect you to whip it off so quickly.
Likewise, I'd have appreciated it if you'd told me in advance that you weren't wearing a shirt, bra, or anything else under it. I would have tried it through the sleeve if I'd known.
The older gentleman that was passing in the office hallway on his way to Dr. Pissy's exam room, however, was very grateful for your actions. He just had cataract surgery last month, and is glad it went so well.
Nice dragon tattoo.
Likewise, I'd have appreciated it if you'd told me in advance that you weren't wearing a shirt, bra, or anything else under it. I would have tried it through the sleeve if I'd known.
The older gentleman that was passing in the office hallway on his way to Dr. Pissy's exam room, however, was very grateful for your actions. He just had cataract surgery last month, and is glad it went so well.
Nice dragon tattoo.
Scrubs Catalog- Part 1
Over the weekend I received a catalog from a scrubs company.
Clothing catalogs are always an oddity, at least to me. Let's face it. The people in them appear creepily happy. In most cases they show people relaxing, so they should be happy. But in the scrubs catalog this is what they wear to work. If you look that happy at work, then your Prozac dose is way too high.
But I digress.
In my area there are 5 Dr. Kumar's, all from India or Sri Lanka. They're all good guys. And none of them look anything like this Dr. Kumar.
BUT, in the very same catalog, just a few pages later, we find Beachboy McStud again, but now he's Dr. Ruckman (which, I know, is almost an anagram of Kumar).
Mrs. Grumpy commented that she'd rather see what he looks like with the scrub top off. And regardless of his name, if he's been marked down to $7.99 she'll take five.
Clothing catalogs are always an oddity, at least to me. Let's face it. The people in them appear creepily happy. In most cases they show people relaxing, so they should be happy. But in the scrubs catalog this is what they wear to work. If you look that happy at work, then your Prozac dose is way too high.
But I digress.
In my area there are 5 Dr. Kumar's, all from India or Sri Lanka. They're all good guys. And none of them look anything like this Dr. Kumar.
BUT, in the very same catalog, just a few pages later, we find Beachboy McStud again, but now he's Dr. Ruckman (which, I know, is almost an anagram of Kumar).
Mrs. Grumpy commented that she'd rather see what he looks like with the scrub top off. And regardless of his name, if he's been marked down to $7.99 she'll take five.
Sunday, January 3, 2010
Sunday morning, 8:45 a.m.
"Yeah, I'm a patient of Dr. Cortex, and his answering service told me to call you. I have migraines and am all out of pills and need something strong, like Demerol or Percocet or one of those other drugs, the really strong ones. I need some pain relief fast, because I have football tickets, and want to enjoy the game, and if I don't get some pain meds the tickets will be wasted and it will be all your fault and I'm going to complain to the medical board and bill you for the money lost on the tickets."
Sunday morning, 6:55 a.m.
"Hello? Is someone there? I was referred to Dr. Grumpy, and need to make an appointment for my husband. He had a stroke, the neurological kind, and it was in his brain, like on the right side, or maybe the left, or somewhere else. But he had one, and it was somewhere in his body, and he needs to see Dr. Grumpy. Do you have Sunday appointments? My chiropractor does, so I thought other doctors might, so maybe we could get in today. Thank you."
Saturday, January 2, 2010
ABSOLUTELY FREE! Impress your neighbors! Be the first on your block!
Following a link kindly sent to me by Sunflower, R.N., I discovered this amazing gadget FOR FREE!
Are you tired of trying to keep up with your neighbors? Is your 1988 Chevy looking pretty pissy every time they drive by in their Rolls Royce? Are your kids still playing Odyssey or Atari 5200 while the children next door have a Wii? Are you sick of looking at their satellite dish antenna while you only have rabbit ears on your TV?
Well, its time to blow them out of the water, FOR FREE! Yes FREE!
For a limited time only the U.S. Government is giving away AN AIRCRAFT CARRIER! FREE! THIS IS NOT A JOKE!
U.S.S. John F. Kennedy
Yes, imagine the look on your neighbor's smug face as you bring this 82,000 ton, 1,052 foot long bad boy up the street, crushing his Rolls, house, and lawn in the process. Your kids will be the envy of the block, as other children will want to come over and play on their new "toy". Sure beats that concrete pipe and see-saw, huh?
Worried about that teenage punk down the block with a spray can? Well, the ship comes with Sea Sparrow missiles and a Phalanx computer defense system. Just let him try to tag it.
And remember, this smokin' deal is FREE! Originally built for hundreds of millions of dollars, it can now be yours for nothing (and you don't even have to tell the neighbors what you paid for it)! To build your own aircraft carrier can cost upwards of $6 billion! SO CALL NOW!
This amazing offer is not available in stores or on Craig's list. To receive this once-in-a-lifetime giveaway, see below.
Are you tired of trying to keep up with your neighbors? Is your 1988 Chevy looking pretty pissy every time they drive by in their Rolls Royce? Are your kids still playing Odyssey or Atari 5200 while the children next door have a Wii? Are you sick of looking at their satellite dish antenna while you only have rabbit ears on your TV?
Well, its time to blow them out of the water, FOR FREE! Yes FREE!
For a limited time only the U.S. Government is giving away AN AIRCRAFT CARRIER! FREE! THIS IS NOT A JOKE!
U.S.S. John F. Kennedy
Yes, imagine the look on your neighbor's smug face as you bring this 82,000 ton, 1,052 foot long bad boy up the street, crushing his Rolls, house, and lawn in the process. Your kids will be the envy of the block, as other children will want to come over and play on their new "toy". Sure beats that concrete pipe and see-saw, huh?
Worried about that teenage punk down the block with a spray can? Well, the ship comes with Sea Sparrow missiles and a Phalanx computer defense system. Just let him try to tag it.
And remember, this smokin' deal is FREE! Originally built for hundreds of millions of dollars, it can now be yours for nothing (and you don't even have to tell the neighbors what you paid for it)! To build your own aircraft carrier can cost upwards of $6 billion! SO CALL NOW!
This amazing offer is not available in stores or on Craig's list. To receive this once-in-a-lifetime giveaway, see below.
WASHINGTON (NNS) -- The Department of the Navy has advertised the availability of ex-John F. Kennedy (CV 67), located at the Navy's Inactive Ships Maintenance Office, Philadelphia, Pa. for donation as a museum/memorial under the authority of Title 10 U.S.C. Section § 7306.
Eligible recipients may include any State, Commonwealth, or possession of the United States or any municipal corporation or political subdivision thereof; the District of Columbia; or any organization incorporated as a nonprofit entity (under Section 501 of the Internal Revenue Code).
According to the Federal Register notice, the deadline for submission of Phase I documentation, a Letter of Intent and an Executive Summary, is Jan. 22, 2010.
For organizations meeting the minimum requirements of Phase I, a letter will be sent notifying each organization to proceed to Phase II of the application process. Responses to Phase II of the process will be due one year from the date of the notification letter to proceed to Phase II. Should Navy receive no interest within two years for donation of the ship, the Navy may remove the vessel from donation consideration and proceed with disposal.
Bad Workout Endings
We keep several sports bottles full of water on one shelf of the fridge, and just grab then whenever needed.
So this morning I had my usual weekend confrontation with the hated Wii Fit Trainer (he started out by saying "I stayed up too late last night" WTF? He's a digital picture!).
After a vicious hour of Wii Fit torture I walked over to the fridge, grabbed a water bottle, sat down, and took a big swig. And began coughing violently.
Mrs. Grumpy ran in to say she'd forgotten to warn me that the big blue sports bottle was where she'd put left over au jus from roast beef last week.
So this morning I had my usual weekend confrontation with the hated Wii Fit Trainer (he started out by saying "I stayed up too late last night" WTF? He's a digital picture!).
After a vicious hour of Wii Fit torture I walked over to the fridge, grabbed a water bottle, sat down, and took a big swig. And began coughing violently.
Mrs. Grumpy ran in to say she'd forgotten to warn me that the big blue sports bottle was where she'd put left over au jus from roast beef last week.
Holy Ice, Batman!
(The iceberg pictured above is suspected to be the one that sank the Titanic. It was photographed near the sinking the following day, with metal scrapes and a line of red ship's paint on it).
Today I'm going to write about something non-medical, and indulge my interest in maritime history. I'm going to tell you a very strange story. And it's entirely true.
To set the background: In 1941-1943, the Axis U-boats dominated the Atlantic, and the Allies were looking for an answer. The airplane was an effective anti-submarine weapon, but the logistics of using planes in the Atlantic were daunting. Aircraft carriers were urgently needed in the Pacific and Mediterranean. Land based planes' range was limited, and could only cover portions of the Atlantic. So there existed a "black gap" in mid-ocean, where the U-boats could roam at will.
So the naval staff of Britain came up with a remarkable idea, which was named Project Habakkuk: to build a gigantic aircraft carrier out of ice. And, as crazy as it sounds, it may have worked.
Normal ice shatters, and melts. A British engineer, Geoffrey Pyke, developed a mixture of ice and wood pulp called Pykrete. The new material was surprisingly resistant to blunt force. As temperatures rose, the wood pulp formed a fuzzy coating over the ice, insulating it from further melting. Experiments on Pykrete were conducted in top secret, in a refrigerated meat locker beneath Smithfield meat market in London. Frozen animal carcasses were used to hide the research areas.
The size of these ships would have been remarkable. The initial design was for a floating airfield 5000 feet (1524 m) long, 2000 feet (610 m) wide, and 100 feet (30 m) high. Later designs were shortened to 2000 feet long. They would have a displacement of 1-2 million tons. By comparison, the huge aircraft carriers in use today by the U.S. Navy are just under 1100 feet long and weigh 101,000 tons.
They could handle the biggest planes of the era, and carry enough food and fuel to resupply them for months. They had externally mounted power plants capable of propelling them at 6 knots, and would act as floating airfields in the North Atlantic. They were cheaper, and could be built much faster, then a conventional carrier, and had an estimated lifespan of 6-18 months (likely longer, as it turned out).
To see if the idea would work, a 60 foot scale model was built at Patricia Lake, in Canada, over the winter of 1942-1943. To preserve secrecy, the Pykrete blocks were made at Lake Louise, and moved to Patricia for assembly. And it worked quite well. In Summer the wood pulp covered the ice and slowed the rate of melting. Auxiliary cooling equipment was developed that could be carried outside the hull.
Churchill thought quite highly of the idea. The ships would be built in Canada, and to this end the Canadians began assembling enough ice and wood pulp to begin construction.
More and more technical problems, however, came up, and by the time they were sorted out the tide had started to turn against the Axis. The Liberty ships were being built faster than U-boats could sink them. The Allies had developed small, relatively cheap, escort aircraft carriers, which were now providing air coverage to Atlantic convoys. Long range patrol bombers had improved. And so one of the most remarkable ideas in naval history was quietly shelved.
The model built at Patricia Lake took 3 years to melt, showing that Pykrete was quite durable. It was allowed to sink into the lake.
And there, at the bottom of Patricia Lake in Alberta, Canada, lie the remains of Habakkuk. The test ship's frame, with a small motor and refrigeration plant, are now visited by scuba divers. Jasper National Park receives many visitors every year, most unaware that at the bottom of a small, serene, lake is all that's left of this remarkable idea.
And that's my story. I hope you guys enjoyed it, as I know it's a bit different from my usual. For those of you who share my interest in maritime history, I've previously written about the steamship Portland.
Friday, January 1, 2010
The bells, the bells, they torment me
2010 is less then 24 hours old in my time zone, and I have the day off.
And in the background there is constant ringing.
Not of bells or some other relaxing device, but of my cell phone.
All of them messages of this sort:
"Hello? I see Dr. Grumpy for (neurological problem) and take (drug du jour). It's a new year, and so I need a new script (called/faxed/telepathically sent) to my mail-order pharmacy because I (have new insurance/can afford them on my medical FLEX account/am now out of the medicare 'doughnut hole'). Please call them in for me ASAP!!!
Just chill, people. My office will be open on Monday. Call then. Your pharmacy won't be shipping before then, anyway.
And in the background there is constant ringing.
Not of bells or some other relaxing device, but of my cell phone.
All of them messages of this sort:
"Hello? I see Dr. Grumpy for (neurological problem) and take (drug du jour). It's a new year, and so I need a new script (called/faxed/telepathically sent) to my mail-order pharmacy because I (have new insurance/can afford them on my medical FLEX account/am now out of the medicare 'doughnut hole'). Please call them in for me ASAP!!!
Just chill, people. My office will be open on Monday. Call then. Your pharmacy won't be shipping before then, anyway.
Happy New Year!
Wishing you a very happy New Year, from the dogs of Grumpy Neurology, Inc.
(click to enlarge)
Zoom (Annie)
Spaz and Fizzy (Mary)
And last, but not least, Cooper, Snowball, and Blackdog (Dr. Grumpy)
(click to enlarge)
Zoom (Annie)
Spaz and Fizzy (Mary)
And last, but not least, Cooper, Snowball, and Blackdog (Dr. Grumpy)