Family dinner table

Today some WWII veterans came to Wingnut Elementary School to talk to the kids.

Dr. Grumpy: "How'd the meeting with the veterans go, Frank?"

Frank: "Fine. But I'm not sure they were really soldiers."

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

Frank: "They were really old. The ones that you see on the news are young."

Dr. Grumpy: "Well, they were soldiers, and young, once."

Frank: "Well, they're old now. It's not a bad thing though, because, I mean, you look old, too."

Today's criminal tip

When getting drunk after pulling a smash & grab at the liquor store, I suggest you go home before starting the party.

Not like this guy.

Thank you, Fran, for sending this in!

Idiocy

Last night I was doing an online marketing survey, which featured this question:

Will your prescribing of Sarcasma increase, decrease, or stay the same based on your meeting with the sales rep?

[] Yes.

[] No.

Got yarn?

My 1:00 today came in with his wife.

She had a strange sweater on. It had the collar and both arms, but only partially (like by 3 inches) covered her shirt below the neck.

As I spoke to her husband, she took out yarn and needles.

She began knitting, working on adding to the semi-sweater she was wearing.

Tuesday night, 11:37 p.m.

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

Mr. Wokemeup: "Yeah, I was wondering if you got a fax from my pharmacy. They said they sent it about an hour ago."

Dr. Grumpy: "I have no idea. It would be at my office. Are you out of pills?"

Mr. Wokemeup: "No, I'm good for another 3 days. I was just wondering if they faxed it like they said they would."

Face it. You're a crappy forger.

While I try not to post too many bizarre news articles at a time, some things just demand to be shared with my readers. Especially when one involves a fake medical note.

Like this talented lady.

I bet they're taking her to Nurse K's ER, too...

Thank you, Lee, for sending this in!

Quit smoking. OR ELSE!

While I strongly discourage smoking, and try to get my patients to quit, I leave it at that.

Some doctors just take things a little too far.

Nice try

Craig: "Dad, I don't think I can go to school today."

Dr. Grumpy: "What's wrong?"

Craig: "There was this girl who fell off the swings last week, and got knocked out. They took her to the hospital, and said she had a concussion."

Dr. Grumpy: "So what's the problem?"

Craig: "She's back, and I sat next to her yesterday. Today my head hurts, so I must have caught it from her."

Mary's desk, March 28, 2011

Guy walks in, stands at front desk.

Mary: "Hi, can I help you?"

Mr. Lost: "Yes. I'm looking for Susan Stemi."

Mary: "Hmm, I don't see her on our schedule, or Dr. Pissy's... Where is her appointment at?"

Mr. Lost: "She doesn't have an appointment. She's a patient here."

Mary: "Well, she's not here, and..."

Mr. Lost: "Your phone operator said she was here, room 647, on the cardiac floor. Isn't this the 6th floor?"

Mary: "Yes, but, sir, you must be looking for a hospital room. Local Hospital is about 2 blocks down the street. You need to go east on 23rd avenue and..."

Mr. Lost: "WAIT! When did you move her to another floor?"

Mary: "We didn't. She's on the 6th floor of the hospital down the street. This is the 6th floor of an office building."

Mr. Lost: "Then why did your operators lie to me?!!! After I find her I'm going to complain to a supervisor!"

(walks out)

Devotion to duty

This weekend I got dragged kicking and screaming called in to see a hospital consult. It was a lady who'd had her appendix out, and had a bad headache afterward.

Dr. Grumpy: "Have you had headache problems in the past?"

Miss Shiny: "No... Hey! Are you Dr. Grumpy, from downtown Grumpyville?"

Dr. Grumpy: "Yes, that's me. Have you seen me before?"

Miss Shiny: "No, but I work for Big Pharma, Inc. One of my partners is a drug rep who calls on your office. My territory is over on the east side."

Dr. Grumpy: "Oh, okay. Anyway do you normally get headaches?"

Miss Shiny: "Have you considered prescribing our product, Noshakesatall, for your Parkinson's disease patients?" (reaches in purse, pulls out a sales brochure) "If you look at this graph, Noshakesatall shows superior efficacy and duration of action in treating Parkinson's, and..."

Happy whatever

I'd like to thank my reader Kelly for sending this in. She writes:

"Petersen therapy is across the street from our office. They send us faxes with seasonal trivia and asking us to refer patients. This one came on Thursday. The fax date stamp (March 24, 2011) is at the top."

click to enlarge



Thank you, Kelly!

Note- for my non-North American readers, Thanksgiving is celebrated in the Fall.

Attention patients!

If you have a wart on your leg (or anywhere) PLEASE refrain from picking it off while talking to your neurologist.

The fact that you take Coumadin doesn't help.

Normally I don't charge for the Kleenex on my desk. But at the rate you're going through them I might have to start.

On the other hand, it's cheaper than a carpet cleaning service.

The Horror!

Local Hospital has elevator doors with lights that flash green when they're opening and red when closing.

I'm done with afternoon rounds. I get in the elevator to leave.

The elevator stops on the 6th floor and a lady and her little kid get on.

Little Kid: "Mommy, why do the elevator doors have those green and red lights?"

Mom: "So blind people know which way the doors are moving, honey."

Just shoot me. She was pregnant, too.

Current 20 something

Has her name:

1. On her necklace

2. On her right hand ring

3. Tattooed on her left forearm.

4. Tattooed on her right ankle

5. And on a left toe ring

I have to wonder if this is so she doesn't forget it.

Jupiter is lovely this time of year

Dr. Grumpy: "Are you allergic to anything?"

Mrs. Flake: "Oxygen. I can't be anywhere near the stuff. I can't breathe it at all. Just being around it makes me horribly sick. I can only go places where there isn't any, so I don't accidentally inhale it."

Things that make me grumpy

All right, this just pisses me off. Here's a doctor who's been suspended for re-using prostate biopsy supplies on patients. NOT re-sterilized. Just using the damn things until they get "too bloody" to keep using. And we all know how clean that area is.

Wanna get angry, too? Here's the link. (Thank you, Andrew, for sending this in).

Stories like this aren't new. Since we invented money some people have always tried to find ways to rip others off.

But in health care it somehow seems worse. Nurses have done it, too. And pharmacists.

Why the hell would anyone do this? Especially after all the damn training we go through?

I'd like to think they're just stupid. It doesn't make it better, but it's somehow easier to accept than the more likely option: greed.

If the doctor keeps re-using the biopsy equipment, it's good for his overhead. He has to buy fewer supplies to do the same number of billable procedures. He may even be charging the insurance for a new kit each time he uses the old one.

The pharmacist knew what he was doing. Just greedy.

The nurse is a little less clear. Maybe she's just lazy. But who knows? Maybe she took the fall for a greedy hospital that secretly condoned such a practice. Maybe they were paying under-the-table bonuses to staff who found illicit ways to save money.

Regardless, ANY doctor, nurse, pharmacist, or other health care person, who does ANYTHING for personal gain at the expense of a patient, should never be allowed to do this job again. These people come to us for care, and screwing them over for your profit line is absolutely unforgivable.

To me, this is worse than fraudulant billing (example: charging for taking off a mole when you really didn't). They're both wrong, but when you intentionally put it a patient in harm's way just to make a buck, you should be banned from medicine forever (provided you haven't already been locked up).

In medicine the prime directive is "do no harm". This is a balanced statement, because obviously we DO harm: Surgeons cut people open. Chemotherapy can make you horribly ill. I do procedures with needles. The issue is that in these cases we're doing harm with the overall end result being (hopefully) for the better.

But when you cross to the dark side, and knowingly hurt a person to make some extra dollars, you should be hung out to dry.

And if you're in this field, and disagree with that, then get out of it now.

Medical students: I'm a PGY-18. And some fires never go out. And I hope they never do.

The Time-Traveler's Neurologist

This message was left on Mary's voice mail at 10:35 this morning:

"Hi! This is Mrs. Clock. I need someone to call me back at home. I'll be at the house until 10:15 this morning, and it's 10:30 now, so if you can call me back before I leave 15 minutes ago that would be great."

Ibee Idiot, M.D.

I'd finished an appointment yesterday afternoon, and was walking the patient up front.


Mrs. Crotchety: "You seem like a nice doctor, and smart too. I've seen 2 different neurologists before, both times when I was in Local Hospital. They were both incompetent idiots."

Dr. Grumpy: "Thank you. I'll get those records to review, and Mary will help set up this test."


I walked back to my office, and logged into the hospital computer system. The patient had seen neurologists there in 2005 and 2007.

And both times it was me.

Adventures with the Boy Scouts

Craig spent Saturday at a Scouts' activity, trying to earn his Craftsman badge. They were doing woodworking, clay, and other assorted stuff.

One of the projects was to make a roughly 4" tall ring-holder out of clay.

Without further comment, I'm now posting front & side views of the ring-holder my son made with the Boy Scouts.

Breaking news! Stop the presses!

When Dr. Grumpy was a teenager he had...

(head down, whispers)

zits.

Yes, that horrible scourge of adolescence. I had zits.

The pimples, as always, popped up at the worst time. Like the big honker on my nose just before a date. Or asking Suzy Weintraub out. Or other (by teenage standards) major-league events.

And yes, it was depressing. It made me feel ugly. And so (like many other teenagers) I invested my hard earned money in whatever product promised results. Because what girl would want to go out with a guy with a zit the size of Sheboygan on his forehead?

And, although you were ashamed to talk to other kids about zits, EVERY teenager obviously felt the same way. Hence, the enormous success of Zitzaway! and other skin care products aimed at adolescents. Hell, zits even had their own page in the unofficial puberty bible "What's Happening to Me?"

So, obviously, zits are a longstanding, well-known, part of adolescence, impacting emotions and confidence. Right?

Of course, actually having gone through puberty, or having kids doing so, just isn't good enough. Someone actually had to STUDY THIS!

And they found that (SURPRISE!) having zits in adolescence can effect the way you feel about yourself!

Really. Here's the article.

Weekend reruns

Due to the usual crazy amount of kid stuff, I'm re-running this from about 2 years ago.


Being a neurologist means sometimes being LOUD. In residency, no matter how quiet and soft-spoken you may be, you learn how to SHOUT, yet still be polite.

Is this because we deal with little old deaf people? A little. But the main reason is because we are frequently consulted to wake the dead (or at least try) and evaluate the comatose. In order to do so you need to make sure that this person definitely isn't responding. So you learn to be able to shout into their ears in the gigadecibel range, to see if they can actually hear you.

And you yell simple commands, trying to break through a wall of brain damage, drugs, and loud ICU machines to see if there's anyone in there. "MR. JONES! CAN YOU WIGGLE YOUR TOES FOR ME?" or "MRS. SMITH! CAN YOU SHOW ME TWO FINGERS?"

If you don't believe me, just ask any ICU nurse. They often carry their own earplugs for when they see a neurologist going into a patient's room.

This morning I got called in to evaluate a guy with brain damage named Mr. Dick.

So I did my usual shouting routine to try to wake him.

"MR. DICK! CAN YOU HEAR ME? CAN YOU HOLD UP TWO FINGERS?"

No response.

"MR. TOES! CAN YOU WIGGLE YOUR DICK FOR ME?"

Mercifully, the patient didn't respond. The nurses' station, however, broke down in hysterical laughing. So did the patient 2 doors down. I'm sure I turned bright red when I realized what I'd said.

Leave me alone. It's 5:00 a.m., and I haven't had a Diet Coke yet.

Kids

Mary told me a drug rep I like was up front, so I went to sign for samples and say hi.

Mrs. Rep: "Sign here... How have you been?"

Dr. Grumpy: "Fine. I thought your kids were on Spring Break this week?"

Mrs. Rep: "They are."

Dr. Grumpy: "Oh, I thought you'd said you were taking this week off to spend time with them."

Mrs. Rep: "I did, but they drove me nuts. This morning I couldn't take it anymore. I called in sick for my husband, and told him I was going to work. He can deal with them."

Thursday

Mr. Vegas: "My wife is a nurse, and wanted me to see you. She says she knows you."

Dr. Grumpy: "Oh, where does she work?"

Mr. Vegas: "I have no idea. We just met last weekend."

Secrets of the Jedi Masters

Today I am going to reveal one of the deep, dark secrets of neurology. A secret so carefully hidden that this post could result in my excommunication from the neurobrotherhood.

Most doctors, in some way, are snobs. Some are money snobs (a malady not limited to medicine), others about where they went to med school, still others about their clientele, others about research.

And what are neurologists snobs about?

We are snobs about...

(looks around furtively and whispers)

Reflex hammers.

Yes, reflex hammers. The little rubber triangular thing your internist uses to tap on your knees.

But we're NEUROLOGISTS, damnit! We did 3 years of training to learn how to properly use a reflex hammer! Plus, while your internist will only tap on your knees, we have a bunch of other reflexes we check.

I mean, we have to do SOMETHING to make it worth your higher co-pay to see a specialist. Would Harry Potter carry around just any old wand? No! Reflex hammers are to neurologists as lightsabers are to Jedi.

This is what your internist likely uses:





It's called a Taylor hammer. Or Tomahawk. They give you one in med school. No self-respecting neurologist would EVER be seen holding one. It's like a toy to us, and we are specially trained to look down our noses at them with a "you call THAT a reflex hammer!" look.

Someone once pointed out to me that this was one of the very first types of reflex hammer specially designed for this purpose. My answer to that is that the Wright brother's plane was the first one built, but I don't see anyone catching one to Chicago these days, either.

The only thing (in the eyes of a neurologist) lower than a Taylor hammer is this bizarre contraption:




Yes, it's a sad attempt to combine a Taylor hammer and a tuning fork (another item commonly used by neurologists). In the Bible they called things like this "abominations unto the Lord" (or, in our case, abominations unto Charcot).

It's like a sofa-bed: when you combine 2 things, you often get something that isn't quite as good as either one alone. When I was in med school I thought these things looked cool and practical (it took up less pocket space in that stupid looking short white coat). Now that I'm a neurologist, I realize how worthless they are. If you ever have a neurologist use one on you, ask them how many box tops they had to exchange for their medical degree.

The only thing worse than either of the above is using the head of your stethoscope to check reflexes. Might as well put on a shirt that says "Beware! Greenhorn on rounds!"

Next up, and maybe a notch or 2 above the Taylor hammer:

This is a Buck hammer.



The Buck is a few notches above the Taylor. It means that you're somewhat serious about checking reflexes. It's often carried by neurologists on hospital rounds, because it's convenient to toss in your bag.

A word of warning- the top piece on most Buck's unscrews to reveal a sharp pin. This is a throwback to the pre-AIDS era when you could freely jab multiple patients with the same sharp object and not worry about spreading disease. If your doctor pulls one out of his hammer and tries to jab you with it, RUN AWAY. You don't know where it's been.

A few rungs up, and we get the Trömner hammer (or Troemner, depending on where you trained).



Now THIS is a good hammer. It's what I carry in my hospital bag. The picture alone can't convey what it feels like to hold one. Although it looks somewhat like a Buck hammer, in reality it's larger and heavier. It has a solid, reassuring, feel to it, like if the patient suddenly lunges, you can beat the crap out of him with it. No other reflex hammer gives you that sense of security.

For my pharmacy readers, my faithful Trömner actually was a gift from a Naprosyn rep. Which says more about me than I want to admit.

This is a Berliner hammer. I've never used this type.



It looks, somewhat reassuringly, like an axe (to keep the Haldol deprived at bay until the orderlies arrive).

Now we come to the royalty of reflex testing, the Queen Square hammer.



As simple as it looks, this is THE HAMMER for the serious neurologist. It's what I (and most) keep in our offices. It's nicely weighted and allows you to swing it easily from several directions to test reflexes in different limbs, without having to reposition yourself or the patient too much. It's not as solid as the Trömner, but if the patient attacks you can stun them with it (it breaks after 1 solid hit, don't ask how I know this) as you draw your other hammer.

But neurologists sometimes have to round at the hospital, and the Queen Square, with it's long stalk, doesn't conveniently fit in a black bag. So, if you don't like the Trömner or Buck, there's the Babinski hammer.



This is basically the smaller handle of a Buck hammer with the Queen Square head. The head usually tilts to the side and the handle telescopes to a smaller size so you can put it in your bag.

It has the bizarre history of having been introduced to the U.S. by neurologist Abraham Rabiner, who received his personally from the great Dr. Babinski himself. This was as a peace offering after the 2 of them had physically beaten the shit out of each other (REALLY!) during a debate over a neurophysiology question at a Vienna black-tie dinner (Hey, we neuro Jedi take this shit seriously).

There are a handful of other hammer types out there (Krauss, Wintrich, Ebstein, and Wintle to name a few), mostly variants of the above. Some of them, like Ebstein and Wintrich, are of mostly historical interest and no longer used.

That's reflex hammers in a nutshell. Now you have something to talk about when you want to see a neurologist, or pretend to be a neurologist, or want to score points on your neurology rotation, or end up on Jeopardy saying "I'll take 'Reflex Hammers' for $500, Alex."

And know, ye of lesser hammers, why those of us who wield a Trömner or Queen Square look down on you as unwashed heathens. And appropriately so.

Entomological Neurology, Inc.

Dr. Grumpy: "Any seizures since your last visit?"

Mrs. Thorax: "No, that issue is fine. But my big toe is killing me. A spider bit it this morning."

Dr. Grumpy: "What kind?"

Mrs. Thorax: "I don't know. What do you think?" (whips out tupperware with big ugly spider crawling around in it).

Tips for bank robbers

Okay. If you're planning on robbing a bank, please keep the following in mind:

If the teller asks you to show an ID so you can complete the robbery, you SHOULD NOT do it.

Take this guy, for example.

That's helpful

Mr. Vague: "My dad had Alzheimer's disease. Or maybe it was Parkinson's disease. It was some kind of disease. Do you know which one I'm talking about?"

Miracles of modern technology

Dear Dr. Hitech,

I think it's great that you recently felt the need to shell out a fortune for FUBARMED, the new computerized chart system that runs your office.

Apparently FUBARMED has a feature that lets you list me, or any other doctor, as a "consultant" in a patient's chart. I assume the idea here is to improve physician communication.

It seems like an absolutely great idea. You order an MRI, or labs, and your computer automatically faxes the results to my office, too.

In theory, that sounds nice.

But FUBARMED has no fucking clue what different doctors care about.

So it faxes me EVERY DAMN THING. Mrs. Patient (who I'm seeing for migraines) gets a pap smear? I get the results. She calls you with a runny nose? The phone note shows up on my fax machine (along with your delightful response "what color is her mucus?"). She needs a refill on her cholesterol medication? FUBARMED faxes me a notification, then a copy of your approval.

As far as I can tell, this great program of yours is functioning primarily to waste my time, paper, and fax machine toner.

Hoping to see one come over soon that says "Patient doesn't like Dr. Grumpy, wants you to take him off the consultant list."

Yours truly,

Ibee Grumpy, M.D.

Sunday Funday

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

Mrs. Frantic: "Help! You see my mom for Alzheimer's disease, and she's completely out of control. She's walking around the house all day and night, and yelling constantly!"

Dr. Grumpy: "At her visit last week I gave you a script for Calmherdown for this problem."

Mrs. Frantic: "Yeah! It's in the medicine cabinet!"

Dr. Grumpy: "Did it help?"

Mrs. Frantic: "Oh, was I supposed to give it to her? I thought it was for me, to sleep through this!"

Weekend reading

While catching up on journals yesterday I learned that:

Some people's headaches will get better with Ibuprofen. Others won't. (Neurology Reviews, November, 2010, page 4).

Alzheimer's patients who are unable to care for their own needs are more likely to be placed in a nursing home than those who are still able to do so. (Neurology Reviews, November, 2010, page 10).

Parkinson's patients who are OLDER at time of disease onset won't live as long as people who are younger (Neurology Reviews, October, 2010, page 5).

March 12, 1944

It happened during World War II. But it isn't a war story.

It's about a basketball game. But it's not a sports story.

It involved medical students. But it's not a medical story.

It was 1944.

The Duke University Blue Devils had won the Southern Conference basketball championship. Surprisingly, though, the official university team wasn't even the best one on campus.

The military had set up wartime training programs at Duke, and brought in young men from all over the country. Many were good college players in their own right, but their schools had closed down athletic programs due to the war. So when they came to Duke they formed intramural teams.

The medical school team was considered, by far, the best (possibly the last time in human history that will be said). The players had all been stars at their previous schools. Although they never played each other, it was generally thought that the medical school team was better than the Blue Devils themselves.

It had also been a good year for another local basketball team, the Eagles of the North Carolina College for Negroes. Their coach ran an aggressive high-speed game, and they'd only lost once all season. But that was how it ended. Neither of the basketball tournaments (NCAA and NIT) allowed black colleges to participate.

The details on how it started are lost to history, but somewhere, somehow, the idea came to have the invincible Duke medical students meet the NCCN team on the basketball court.

In 1944 North Carolina this was unthinkable. It was actually a crime, and color lines were enforced. A few months earlier a black American soldier had been killed by a white bus driver for not moving to the back of a city bus fast enough (the driver was found not guilty).

Coach John McLendon of the Eagles liked the idea, and contacted his counterpart at the medical school. The white team was shocked. Such a thing was unheard of, illegal, and seemed to be just asking for trouble. But eventually their pride won, and they agreed to the game. As medical student player David Hubbell said, "We thought we could whup 'em."

The game would have to be played at the NCCN gym, because there was no way to get black students onto the Duke campus without drawing attention. They'd have a referee, but no spectators would be allowed. They'd play on a Sunday morning, when most of the town (and hopefully police) would be in bed or church. The doors to the gym would be locked as soon as all the players were inside, to keep anyone from seeing what was happening. Neither school administration was aware.

The medical students drove to NCCN with a winding route, to keep from being followed. They wore hats, and had their jackets pulled up partly over their heads to keep their skin color hidden.

Inside, the Eagles were very nervous. Aubrey Stanley (who was 16 years old at the time) later said "I had never played against a white person before, and I was a little shaky."

The game got off to a nervous start, with both sides making mistakes and missing easy shots. But they soon got into their routine. Duke went to their strong half-court game, and the Eagles played their speed attack. Stanley recalled "About midway through the first half, I suddenly realized, 'Hey we can beat these guys. They aren't supermen, they're just like us.' "

The second half was a blow-out, with the Eagles scoring almost every time they had the ball. Duke wasn't accustomed to their aggressive, high-speed, full-court game, the likes of which wouldn't be seen in the NBA for another 20-30 years.

The final score was NCCN 88, Duke Medical 44. Not even close.

And then, after the 2 teams had rested, the unthinkable happened: They played again, this time a mixed game, shirts vs. skins. Black and white on the same teams. A serious violation of state law.

A few NCCN students walking by the gym heard noise inside, looked in the windows, and saw this unthinkable match-up. Nobody called the police. It was amazing to watch.

Neither game ever happened by official records. There was no scorecard. Only the player's memories.

Jack Burgess was a Duke player. He was from Montana, and a few days after the game wrote to his family "we played basketball against a Negro college team... and we sure had fun and I especially had a good time, for most of the fellows playing with me were Southerners. When the evening was over, most of them had changed their views quite a lot."

In being able to tell this remarkable story, I (and all of us) owe a great deal of thanks to writer Scott Ellsworth. Without his determined research in chasing it down, it would have been lost to history.

Skool Nerse Time

This is Mrs. Grumpy.

Dear Principal Skinner,

I think it's an interesting project idea to have each 4th grade class develop their own identity. Like flags, secret codes, and secret claps. I understand this is a 2 week project, this week with students developing their own "countries" and next week sharing their ideas with other classes.

But I think you could have ended your talk better than with the line "Next week you'll visit other classrooms to share your clap with them."

And you wondered why the teachers in back began snickering.

Mary, bring me a Diet Coke. With rum.

Dr. Grumpy: "Anything going on at home?"

Mrs. Bright: "Just a lot of stress. My husband told me this morning he has a computer virus. I hope my daughter doesn't get it, because she's already missed 5 school days out sick this quarter."

Insurance Company Follies

I'd like to thank Kalie, who sent in this letter she saw from an insurance company.


(click to enlarge)

Mary's Desk, March 9, 2011

Guy walks in, stands at counter.

Mr. Tardy: "I have an appointment today with Dr. Grumpy."

Mary: "Sir, your appointment was at 10:00, over an hour ago. We have you listed as a no-show."

Mr. Tardy: "I spoke to you this morning, and you said to be here by 10:00, and I told you I'd try."

Mary: "Yes, but you're here at 11:15. I can reschedule you for later this week..."

Mr. Tardy: "Why can't you see me today? Traffic was bad."

Mary: "I understand that, but we're booked solid, and..."

Mr. Tardy: "When I called earlier you didn't even mention that traffic would be a mess today."

Mary: "Sir, I didn't know, but I did tell you to allow extra time."

Mr. Tardy: "This is bullshit. You don't have the courtesy to warn me about traffic conditions, and now you tell me it's MY fault that I'm late. I'm going elsewhere."

Today's fashion tip

If you're getting a haircut, and suddenly find yourself in need of a weapon, I can understand that the scissors being used by the stylist may be the closest thing at hand.

HOWEVER, after you're done stabbing someone with them, it's always important to complete your haircut.

Otherwise you run the risk of having a seriously bad hair day when the police take your mug shot.

Like this guy.

Thank you, Kathryn!

Timing is everything

Dr. Grumpy: "Hi, I'm Dr. Grumpy."

Patient: "Hello, I'm Lisa Pine."

Dr. Grumpy: "Are you related to Dr. Pine, the oncologist?"

Patient: "No, but I see a lot of his patients."

Dr. Grumpy: "Oh, are you also a doctor?"

Patient: "No, I'm a mortician."

Mickey? Can you hear me now?

This headline is on the cover of this week's Neurology Today:

(click to enlarge)




Tinnitus is subjective, and I'm not sure I understand the article's explanation for measuring this. How do you know if a rat hears a ringing in his ears? How do you ask the rat if the ringing does (or doesn't) stop? How do you know if the ringing bothers the rat? How do you know this, Sam I am?

But, then again, I'm not a researcher. Not in a lab, or with a hat, or on a cab, or with a rat.

Pointless link

Normally I don't link to the Onion. I like their stuff, but figure they get enough readers without me. Besides, it's not like they even know I exist.

But, from both a medical and human viewpoint, this article is too damn funny not to share.

Actually, it sounds like one of my patients.

Patient quote of the day

"It looked awful! I had bruising around all of my eyes and noses!"

Monday morning, 3:59 a.m.

"Hi! I need to make an appointment to see Dr. Grumpy! My brain is constantly sizzling and the government put a tattoo on my forehead to make people think I'm crazy and the FBI keeps breaking into my house every night to rearrange my shoes and poison me! I need the doctor's help so I can go to the news and tell them this! People need to know that government agents are secretly spraying acid into their ears to eat their brains away and that it will make everything smell like bacon!"

Attention drunk drivers!

If you need a ride home desperately enough to steal (and operate) someone else's car, YOU SHOULD not take one that stands out in a crowd.

Like this guy.

Thank you, Carol!

Stupid dog

It's all Cooper's fault.

Last night we had a lot of rain, which he hates. So he was up pacing and growling, jumping on and off our bed, and randomly barking (he hasn't figured out yet that barking at rain won't make it leave).

At some point Mrs. Grumpy decided to take him to the other end of the house to try and calm him down, and fell asleep on the couch.

As the night progressed the storm scared Craig, who came to our room. When he discovered my wife was missing, he climbed into the bed and fell asleep.

Then Marie woke up. When she realized her partner-in-crime was missing, she came to our room. She found him, and got into bed, too.

Frank got up to pee, and noticed the twins were gone. So he came to our room, discovered the situation, and jumped into the bed.

After the storm ended Cooper and Snowball came down to the bedroom, and jumped up with the rest of us.

I woke up early this morning with my left arm and leg, and most of my body, hanging off the bed because I'd been pushed off. And I was freezing cold because the kids had taken all the covers.

Mrs. Grumpy got a good night's sleep on the couch.

Stupid dog.

But wait! There's more!

Ok, it's time for more of your submissions showing the insane overuse of the word "artisan" and it's derivatives these days.

Before we get started, I should note that many of you have recently sent in excerpts from the J. Crew catalog using the words to describe their clothing, fabrics, and (for all I know) toilet paper. There were just too many of those to choose from.


First, I'd like to thank Doris for submitting a special banner for me to use here.




And we're off!

For those of you who find your nose is easily offended by generic pseudo-pheromone smells, there's now artisan cologne:



Need something artisanal for your artisanal home? Maybe you should visit:







If you can't afford the premium charged by companies for using the word "artisan" (usually it seems to be a 50% or more mark-up) you can get discounted artisanal products with on-line coupons.






After the cheese, maybe you'd like some chocolate.





If you've had too much cheese and chocolate, you might need to see a dentist.






And while YOU may get to enjoy artisanal products, let's not forget about your best friend.




At this point, I think it's time for all this artisanal overuse to STOP!

Attention patients!

When I ask if you're taking Coumadin, PLEASE remember that you are BEFORE I start putting needles in you for an EMG, not suddenly saying "Oh, wait, I think I am taking Coumadin" as blood goes flying everywhere.

Thank you.

Dear Sam's Club,

Thank you for the letter I received yesterday, notifying me that the Christmas cookie trays we bought last year, for office and family parties, have been recalled due to "undeclared food coloring ingredients".


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From what I can see on your website, it was a nationwide recall. So I'm sharing the letter with my readers, in case they still have some Christmas cookies lying around.

Your letter requests that I return the cookies to my local Sam's Club. After carefully questioning family members and employees as to their current whereabouts, I am unable to bring them back to your store at this time.

If it's absolutely critical that you get the cookies back, I suggest you contact the Grumpyville Sewage Treatment Facility. I think they give tours on Mondays.

Yours truly,

Ibee Grumpy, M.D.

P.S. Mary says you can have them (and some PB M&M's) back by doing liposuction on me.

BUSTED!!!

The following message was left on Mary's voicemail at 10:08 this morning:

"Hi, this is Karen Java. I have a 10:00 appointment with Dr. Grumpy, and I'm running late. Traffic is horrible (whispered: grande, please, with whip cream), and I think there's an accident or something (whispered: and a blueberry scone, too). Anyway, it's bumper-to-bumper, so I may be a few minutes late (whispered: Thank you, I have a gift card, here). Sorry. I'll be there as soon as I can."

Wedded bliss

Dr. Grumpy: "Ma'am, have you noticed if you wear one shoe down more than the other?"

Mrs. Marcos: "I'm not sure."

Mr. Marcos: "You can't tell. Doc, you should see her closet. I don't think she's ever worn the same pair twice."

Drug interactions

I'd like to thank Effenormous Pharmacy for this fax. They sent it yesterday, warning me that a drug I'd prescribed (Drug A) had a potential interaction with one from the patient's internist, Dr. Tutone (Drug B).

Except for the names and phone numbers, I haven't changed anything.

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And thank you Dr. Pissy for volunteering his handwriting!

I guess that would be Dr. Grumpy then

Guy walks in, stands at front desk.

Mary: "Are you here to see Dr. Pissy or Dr. Grumpy?"

Mr. Guy: "Sure! Which one works here?"

Mary: "They both do."

Mr. Guy: "Yeah, I'll see that one."

Taking requests

Mrs. Znot: "I brought my head MRI films. It was done yesterday, and I want you to show me something."

(hands me a DVD)

Dr. Grumpy: (loading disk in computer): "Sure. What are you wondering about?"

Mrs. Znot (pulls out plastic baggie with disgusting little green slimy object): "This."

Dr. Grumpy: "Uh... That's..."

Mrs. Znot: "It's a huge booger..."

Dr. Grumpy: "Yes, I can see that."

Mrs. Znot: "... and I blew it out of my nose about an hour after the MRI, so can you show it to me in the pictures?"