Sunday, July 31, 2011

Weekend reruns

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

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

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

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

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

Which is "intercourse".

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

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

Here are some of the questions:



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

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



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

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



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

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



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

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



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

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



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

Saturday, July 30, 2011

Overheard at home

Marie: "See? Here's a picture. I told you it looked like this."

Craig: "Well figgle my newtons!"

Marie: "What does that mean?"

Craig: "I don't know."

Friday, July 29, 2011

Bad ways to meet girls

Whatever happened to the good old "What's your sign?" or "Do you come here often?"

Apparently this guy needed to try his own method.

Then why did you come here?

Mrs. Tech: "The headache is over the entire right side of my head, I get horrible nausea, and I can't stand light or noise."

Dr. Grumpy: "That's a migraine."

Mrs. Tech: "No, it's absolutely NOT a migraine! You should know better!"

Dr. Grumpy: "Why are you so sure it's not a migraine?"

Mrs. Tech: "The iPhone app says so."

Thursday, July 28, 2011

Driver's Ed

Dr. Grumpy: "Anything else I can do for you?"

Mr. Bozo: "Yes, I need you to write a letter to the state, to get my 13 year old son a driver's license."

Dr. Grumpy: "The state driving age is 16, and your son isn't my patient."

Mr. Bozo: "I know, but you're treating my back pain, and when it really hurts I'm not comfortable driving. My son is the only one who's available."

Dr. Grumpy: "But he's not old enough to drive."

Mr. Bozo: "He drives those motor cart things all the time at the fun park. He does fine. Can't you just send the state a letter to get him a license?"

Dr. Grumpy: "I can't do that."

Mr. Bozo: "Why can't you be reasonable?"

Checkmate!

I found this in a hospital chart today.

(click to enlarge)


Wednesday, July 27, 2011

Neurology, 2011

Dr. Grumpy has lost his neurology mojo over time.

Actually, I shouldn't say I've lost it, as much as it's been worn down by red tape.

Yesterday I turned away a good hospital case, and told them to find someone else.

The patient was insured. The patient was interesting. Not some run of the mill chronic back pain case.

28 year old guy admitted for abdominal pain and weight loss. Large mass found (possibly lymphoma). Within 2 days of admission he developed 2 separate cranial nerve palsies, on opposite sides.

Now, I know you residents and medical students are out there, holding up your hands and yelling "Oooh! Oooh! Mr. Kotter! He could have meningeal lymphomatosis with cranial nerve palsies! He needs an MRI and spinal tap."

Hell, you think I didn't know that? Like I said, these are the interesting cases that make the job fun.

So why did I tell them to find another neurologist?

Here's why:

The patient had seen another neurologist (who didn't come to my hospital) about a week before. He'd had an MRI done as an outpatient. He'd had a spinal tap done as an outpatient.

And yet, no one, including the patient and his family, had ANY FREAKIN' IDEA about which neurologist he saw (beyond "his office was on the west side"), or where the MRI was done, or where the spinal fluid had been sent for tests.

I don't care that someone else had already done the key parts of the work-up. I'm not looking to stand up as the great Grumpy, solver of the unsolvable. Any competent neurologist would know what to do.

And getting results is reasonably easy IF you know where to fax a release.

But in order to get the answer here I'd have had to try to track down a neurologist, an MRI facility, and a laboratory. And there are no shortage of any in Grumpyville.

And from personal experience (particularly involving tracking down labs) I knew it could easily take an hour or more of phone time to do this. I've found that when you want something specific, delegating it to an order in a chart ("please get outside labs from Planet Phlebotomy") will often get you nowhere, or some results you didn't want. So I'd likely be doing the calling, and getting transferred between departments, and then cut off, and having to call back... you get the idea.

When you have a full-time office practice, and a family of 5, adding an extra hour or two to the day isn't something you want to do. Especially when you're going to get paid the same amount for the consult no matter how much work you put into trying to track the results down.

And so I quietly told them to call another neurologist.

I still like what I do. But the realities of time, money, and frustration can dull the scientific curiosity of anyone. Even me.

Tuesday, July 26, 2011

Do not try this at home

No matter how easy surgery looks on your favorite TV show, it should only be done by trained professionals.

Also, it is not recommended that you try to staunch blood loss with a lit cigarette.

Like this guy.

Thank you, Lee!

Helpful

Dr. Grumpy: "Do have your MRI report here?"

Mr. Lumbar: "No, but it said I have disks in my back."

Dr. Grumpy: "Everyone does. Did it say anything more specific?"

Mr. Lumbar: "Um, it mentioned bones, too."

Fun with drugs

Wild times with hallucinogens.

Monday, July 25, 2011

Sunday night. 11:35 p.m.

"I know the waiters there spit in my food, because they don't like people who just eat salads. I told the waiter that I had special powder I'd sprinkle in my salad to show traces of saliva, so he better not try it. But now I'm afraid to go anywhere else, because the food servers throughout the country are conspiring against me. They've hired a chemist to find ways to make it so that their spit doesn't show up with my special powder, and my powder doesn't work now. I know they're still secretly spitting in all my food, so I need to hire someone to make me a new powder that will detect their invisible saliva. Does Dr. Grumpy do this sort of thing? Please call me back in the morning."

Sunday, July 24, 2011

Memories...

The brain that would not die...

In 2005 I took care of a patient with Jakob-Creutzfeld disease (or Creutzfeld-Jakob, depending on where you trained). This an uncommon, rapidly progressive, neurological disease.

My patient's family got in touch with a research program at the NIH, where they were collecting brains from these patients for further studies. So after he died later that year, his brain was sent off to their research center.

To this day, once a year, around the time he died, I get a letter from the NIH, asking how the patient is doing.

I used to write back pointing out that THEY had his brain, and to ask him. Now I just toss them.

Saturday, July 23, 2011

Today, on the Travel Channel

One of my friends was recently on a trip to China, and sent back a few pics.

This one shows the location of a party school. I suspect there's a big difference between the American and Chinese definitions of "party school".

(click to enlarge)





In his hotel room, among the usual amenities, was a box of condoms. Obviously, these people take their birth control seriously.

(click to enlarge)





This last one, which I'm not going to comment on (that's your job) he says was taken in a generic shopping mall, in a store that featured local crafts.

(maybe you shouldn't click to enlarge)


Friday, July 22, 2011

The joy of Wikipedia

It was pointed out to me that the entry for IRNA, the Iranian government's news agency, lists their website as having started in 1981.



This is very impressive. In 1981 I was in high school. My computer at the time was a TRS-80 (top-of-the-line model, with 16K of RAM!) and in spite of all that technical saavy I'd never heard of webpages. I didn't learn about such things until the mid-90's, during my residency.

Friday afternoon whatever

Dr. Grumpy: "What kind of exercise are you doing?"

Miss Fit: "Yogurt."

Dr. Grumpy: "You're on a yogurt diet?"

Miss Fit: "No, yogurt. The exercise thing, where you hold different positions and stretch."

Dr. Grumpy: "You mean yoga."

Miss Fit: "Whatever."

Urgent matters

Last night I saw a hospital consult, with the following admission note:

"On Saturday, while packing his car, he suddenly felt lightheaded, followed by right-sided weakness and slurred speech. He didn't seek medical attention at the time. In fact, he and his wife drove to Connecticut that day for a short vacation. All symptoms have since persisted, and upon returning to Grumpyville this afternoon they went home, unpacked, and then came to ER for evaluation."

Thursday, July 21, 2011

Balancing act

Medicine is never an easy field. People accuse doctors of not doing enough, or doing too much.

There are no easy answers. We're caught between doing what's best, without putting the patient through too much, and doing what's needed to protect ourselves from legal action.

Let's take Mrs. Summer. She's a nice 78 year-old lady I saw in the office last week.

Earlier this month she hurt her back. So she saw her internist, who correctly diagnosed her with a muscle strain. He gave her a muscle relaxant and Tylenol #3.

A few hours after she took the medications she became confused and sleepy. Her family called Dr. Internist, who said to stop them immediately.

She was absolutely fine the next morning, but her daughter is a nurse at the hospital, and wanted me to have a look at her for the episode. So she called Mary, and they came in last week.

The odds are that all she had was confusion due to Tylenol #3. So do nothing. It's most likely and least expensive.

BUT maybe she had a TIA. If I don't correctly diagnose that, and she has a big stroke, than they could sue me. So let's order a brain MRI, head & neck MRA, and echocardiogram. That's a few thousand dollars in tests.

Or maybe she had a seizure, and needs to be started on seizure medications. So lets order an EEG, too. Another $500.

Perhaps it was a metabolic event, with her blood sugar getting too low. So I'll order some labs. That'll be another $500-$1000 depending on how much I order.

This is the dilemma your doctor faces each day, many times over. None of us come to work saying "Oh boy! I can't wait to drive up the cost of health care today!" But we're faced with finding an (at times) impossible balance.

We don't get a 2nd chance, either. If we guess wrong we run the risk of getting sued. Another doctor is always willing to make a living as an expert witness and testify that we are incompetent.

And yet, with this sword of Damocles hanging over our heads, I and thousands of other doctors do this every day. And try to do the best we can, within the limits of human fallibility.

Wednesday, July 20, 2011

High speed chase

Look, people. If you're planning on being a crook, you need a decent getaway vehicle to outrun the cops.

You should NOT pick something that they can catch on foot.

Thank you, Jok!

Guess again

Dr. Grumpy: "Have you ever had surgery?"

Mr. Hollow: "Yeah, they took out my internal organs."

Dr. Grumpy: "Which ones?"

Mr. Hollow: "Um, I don't know. All of them?"

Maybe I should dress better

Yesterday a drug company hired me to do a lunchtime talk at an office down the street. It wasn't one I'd ever been to before.

I showed up at the appointed time, and politely waited at the front desk. After a few minutes a lady noticed me, and before I could speak, she said "Oh, glad you're here. Go through the door, and down the hall. It's the 3rd room on the right."

So I obligingly headed that way. I found myself in a room with a few business machines, and no people. An odd place to do a lunch talk, but some offices have very limited space. So I got out my speaker's notes and quietly glanced them over while I waited.

A few people walked by and looked at me, but didn't say anything. Finally the lady who sent me in came back.

Office Lady: "Uh, you can start whenever."

Dr. Grumpy: "But there's no one here yet to give my talk to."

Office Lady: "Talk? What do you mean?"

Dr. Grumpy: "I'm Dr. Grumpy, here to give a talk on Fukitol..."

Office Lady: "Oh, I thought you came to fix the copier."

Tuesday, July 19, 2011

Today's criminal tip

Okay, when committing a robbery, there are some things you shouldn't leave at the scene.

Like your diploma...

Life in line

I had to return something to the store last night, and was in line behind a lady carrying a large cardboard box with a picture of a table on it.

Counter Girl: "Can I help you?"

Mrs. Mesa: "Yeah, I bought this table that you have to put together, and I didn't like the way it looked when I assembled it. So I'm bringing it back."

Counter Girl: "Okay, do you have your receipt?"

Mrs. Mesa: "Right here." (hands over receipt)

Counter Girl: "Okay, and the table."

Mrs. Mesa: "Here you go." (hands over box)

Counter Girl: "Uh, this box is empty."

Mrs. Mesa: "Yeah. I put the table together, so it doesn't fit in the box anymore."

Counter Girl: "So where's the table?"

Mrs. Mesa: It's in my car. Do I need to bring it in?"

Counter Girl: "Yes, if you're returning it."

Mrs. Mesa: "Okay. But you should have that posted somewhere."

Monday, July 18, 2011

That doesn't sound good

Mr. Reaper: "Everyone in my family who's died, died of stuff."

Dr. Grumpy: "Like what?"

Mr. Reaper: "Bad stuff. I mean, the kind people die from."

Monday morning hospital rounds

I love it when I see contradictory stuff like this in a chart:

(click to enlarge)

Sunday, July 17, 2011

Sunday Reruns

Mrs. Grumpy had a meeting tonight, so I had to feed the kids. Fortunately for me, a Big Pharma, Inc. drug rep brought lunch today to the office, and there were a lot of leftovers.

So as I was leaving this afternoon I grabbed a big bag out of the cabinet (with the Big Pharma, Inc. logo on it), tossed the leftovers in it, and headed out.

As I was passing a cardiologist's office on my way to the elevator, a pretty female rep I'd never seen before, wearing a Big Pharma, Inc. name tag, came out of his office. We made eye contact, and I nodded, smiled, and continued on my way.

Only to be stopped after another few steps by her saying loudly, "Oh MY GOD! What are you doing?"

I turned around to find Ms. Prettyrep looking at me, horrified, with her jaw agape. "Excuse me?" I said.

Ms. Prettyrep: "Are you taking food from a doctor's office?"

Dr. Grumpy: "Um, yeah, is that okay?"

Ms. Prettyrep: "NO! It's rude! It's unacceptable and inappropriate! And look at the way you're dressed!" (I tend to be on the casual side) "No name tag! What are the corporate people teaching you new reps, anyway?"

Before I could answer she went on: "I'm sorry. I suppose this isn't your fault. The training people must be slacking off." She offered me her hand. "You must be new. I'm Stacey, from the cardiology marketing division".

I shook her hand. "I'm Dr. Grumpy, from the neurology division down the hall."

Stacey from the cardiology marketing division looked even more horrified now then she had a minute ago. After a few stuttering attempts at saying something she answered her cell phone (which hadn't rung), mumbled "nice to meet you" and ran into the stairwell.

Saturday, July 16, 2011

Random Saturday pictures

Thank you to everyone who sent in odd shots from everyday life.


Our first entry is a business that either needs a better speller, or has a strange inventory.





Next, we have a company that really needs a better acronym.





And finally, a reader whose car has a commentary on Driver 1's condition.


Friday, July 15, 2011

Minor details

Last month a local ER went to a Dragon-based dictation system that enters stuff in the chart as you type/talk, and you CANNOT undo anything. You can only dictate an addendum.

So I'm reading a note yesterday on a nice little old lady:

"When I went back into the room the patient was clearly intoxicated and verbally abusive. Her husband took off his belt and tried to hit me with it. Security was called and the husband was physically restrained, though he bit a guard in the process. The patient was put in 4-point leathers and given Haldol when she attempted to punch a nurse. Sorry, please ignore that, it's the wrong chart. Please rewrite it as: her head CT was normal, and I think she has benign positional vertigo. She and her husband were satisfied with this, and I gave her a prescription for Antivert. She'll follow-up with Dr. Grumpy next week in his office."

Thursday, July 14, 2011

Attention patients:

Calling Mary "asshole bitch" for asking for your co-pay (or pretty much any reason) will not get you anything but the door.

Also, telling me "if you don't waive my co-pay I'll fire you", is not going to be taken as a threat.

Annie's desk, July 13, 2011

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

Ms. Whiney: "Yeah, I'm trying to get a lift chair, and the notes Dr. Grumpy furnished aren't getting it covered."

Annie: "Let me look at your chart... I don't see you having a neurological reason to have a lift chair."

Ms. Whiney: "I don't care. I want one. What's this line on the form that says 'neuromuscular disease'? Do I have one of those? Or can he at least check it off?"

Annie: "No."

Ms. Whiney: "I have migraines. Does that count as a neuromuscular disease?"

Annie: "No."

Ms. Whiney: "How about my bunions?"

Annie: "Goodbye."

Wednesday, July 13, 2011

Ways you don't want your body found

No matter what you did in life, it will always be overshadowed if they find you like this.

Thank you, M!

Let's hope she was adopted

Dr. Grumpy: "Have you had any surgeries?"

Mrs. Olde: "I had a hysterectomy, but I don't remember when. Susan, do you remember?"

Mrs. Olde's daughter: "I'm not sure, Mom. Was it before or after I was born?"

July 13



His name was Girard. He had back pain. That's all I remember about him.

On July 13, many years ago, he was the very first patient I ever saw on my own.

Working without a net for the first time is terrifying. I'd survived 4 years of medical school, 4 years of residency, and 1 year of fellowship to get there. This is the goal I wanted. And when it finally came it scared the crap out of me.

There was fear in medical school, starting classes and later starting clinicals, and even more in residency. But in both those cases there was always a back-up system- more senior people who actually knew what they were doing. There was also a herd-based support system: You were with plenty of other people, all sharing the same challenges.

But here, after 9 years of training, it was just me and Girard. Even though his case was simple, it's pretty damn scary to realize that YOU are the attending, and if you screw up there's no one else to blame.

I remember another patient that day started the visit by saying "I came to Humungous Neurology because I heard you guys are the most experienced." My inner voice said "you probably don't want to know this is my first day."

Throughout medical school you saw the attending physicians as omniscient giants. Suddenly you're one of them, and realize that they don't know everything. And you aren't a giant.

Like everything else, after a while it becomes routine. But trying to remember that first day still helps to keep you on your toes.

I don't remember how many patients I saw that first day. A handful compared to what I see now. One of them is still with me. I think I told her a few years later she was on my first day. I even got a hospital consult, a lady who'd obviously had a stroke. I got lost in the hospital trying to find her room, then sat in the MRI control room to see images, terrified at the thought that if they were normal I'd have no idea what was going on.

I've now spent an estimated 4,420 days of seeing patients in one place or another, with a lot more to go. But the first one was the scariest. And hopefully always will be.

To all who are starting this July, good luck.

I'd like to thank ER's Mom, who's recent post got me thinking about this.

Tuesday, July 12, 2011

Public Service Announcement

Attention kids: It is NOT safe to pet an alligator.

Especially if it is a stranger telling you to do so.

You're not supposed to talk to them, so WHY THE HELL would you listen when one tells you to play with a gator?

Thank you, Lee!

Lost in translation

While doing an online research survey this morning, I encountered this question, which bizarrely switches between Portuguese and English in the same sentence:

(click to enlarge)

Monday, July 11, 2011

Huh?

Dr. Grumpy: "Any major illnesses in your family?"

Mr. Mendel: "My first cousin was adopted, so I have no idea what my aunt had."

Rhyme and verse

Some days I think the staff at Local Hospital tries to invent new ways to torment me. This message was left on my voice mail last night:

"Dr. Grumpy, this is Local Hospital.

We have a consult for you
In room 722
Call me at extension 16742

First name Mel, last name Bell
He fell, and doesn't feel well
Requesting physician is Dr. Patel
When you call back, his nurse is Nell."


For doing this to me, you people can go to hell.

Sunday, July 10, 2011

Dude, am I driving?

Another fine moment in alcohol use.

Memories...

In medical school I (briefly) joined a local singles group.

The only event I remember going to was a dinner party at someone's apartment.

Me and another guy (even more geeky than me, and he was quite drunk, which didn't help) were both interested in the same girl (I think she was the only pretty one there. Possibly the only female there at all).

Anyway, I won, and she ended up leaving with me to go get a drink afterwards.

A week later I discovered the geeky guy was an Internal Medicine attending. At my medical school.

And I was assigned to him for a week.

He, fortunately, either didn't remember me (he'd been pretty drunk) or was pretending not to remember me (didn't want to admit losing the girl to a med student).

Saturday, July 9, 2011

Things that go BOOM!

Instead of a regular post...

With this year's July 4th fireworks behind us, here are some of the odder explosive-related news stories I've been sent.

1. A guy who tried modifying them in his kitchen.

2. A school with an explosive way of starting classes.

3. A gentlemen who, in lieu of regular fireworks, lit a military-grade explosive (not for the squeamish).

Friday, July 8, 2011

Pick-up lines from a pizza

I'd like to thank Webhill for sending in this picture from a pizza place.

(click to enlarge)


Concern

Mrs. Regan-Goneril: "Hello?"

Dr. Grumpy: "Hi, Mrs. Regan-Goneril, this is Dr. Grumpy, the neurologist taking care of your mom. We met last night at the hospital. I wanted to update you on her condition, as things have changed in the last few hours, and..."

Mrs. Regan-Goneril: "I'm at the salon. Just tell me in one word what is wrong with my mother, because I'm busy and they haven't even done my nails yet."

Thursday, July 7, 2011

"Hey! Let's get drunk, steal a gator, and go 4-wheeling!"

I just don't understand people.

Wednesday night, 11:28 p.m.

My cell phone rings. It's the hospital ID.

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

Voice: "Please hold for Dr. Brain."

(pause)

Dr. Brain: "Hello? Ibee?"

Dr. Grumpy: "What are you doing? I thought you were in the hospital for knee surgery."

Dr. Brain: "I am, but I have a question. Are you taking care of the confused guy in room 23, who keeps screaming?"

Dr. Grumpy: "Um, yeah, why?"

Dr. Brain: "I need you to call in a sedative for him. I'm in room 24, and he's keeping me up. Let me get you his nurse."

Wednesday, July 6, 2011

Random memories of Monday

For Independence Day the Grumpys went to a local fair with rides and music and places to let your kids burn off energy while waiting for the fireworks to start.

We stopped at Local Grocery to buy tickets and pick up some tomatoes. Inside a couple in the floral section was fighting LOUDLY.

What was the dispute?

She was insisting that July 4th is one of those holidays where you're supposed to buy your wife/girlfriend flowers.

Now, I can understand this if it happened to also be her birthday. Or their anniversary. But it was pretty clear from their screaming that it was neither.

I didn't get it, either.

__________________________________


At the fair several sponsoring businesses had set up booths to advertise their stuff. One was from Local Cancer Treatment Center, where a lady handed out pamphlets and told people about their new treatment and research protocols.

During the entire time she never stopped smoking.


__________________________________


One booth was handing out prizes to kids who scored a bullseye. Winners had their choice of candy, a little stuffed animal, an airplane toy, or sunscreen.

They definitely weren't going to run out of sunscreen.

Dear Ms. Patient,

I'm sorry to hear you've fired me, and that you're irate you owe me $200.

You've been here 3 times in the last 6 weeks for various issues. Each time, as per office procedure, Mary asked if your insurance or address had changed, and each time you said no.

Last week we learned that not only HAD your insurance changed, but it was to a plan I don't take.

When my billing service called you about this, your reaction was "well, if my last insurance covered him, my new one should." Wrong.

And you just left Mary a scathing voicemail claiming that it's OUR fault for just taking your word on the insurance, instead of demanding that we see a copy of your card at every visit. Silly us, we assumed you'd tell us if it changed. That's why we ask each time.

I also loved the part about you threatening to turn me into the state board and "giving you bad reviews on all the internet rating sites" if I didn't forgive the $200.

This is no different than shoplifting. If you stole $200 worth of merchandise from a store, they'd press criminal charges. I can't do that, but I can turn you over to collections. I don't care if you're stupid, pretending to be stupid, or just malicious, but this is what I do for a living. You were more than happy to accept my treatments, and signed a bill after each visit.

Have a nice day.

Tuesday, July 5, 2011

Mary, give this man an appointment

My office has 3 overhead fluorescent light fixtures. When I came in today the one over my desk had burned out.

No biggie. I called maintenance, and they sent Mr. Repairman over.

He comes into my office, and looks at all 3 light fixtures. After a minute he points to the dark one over my desk and says "Doc, is this the one that isn't working?"

Show him the BaRF!

Medicine is full of rating scales. This is a new one to me.

It's used to ask kids how nauseous they are. And it is, I swear, called the Baxter Retching Faces (or BaRF) scale.


Monday, July 4, 2011

July 4th history lesson

Covert operations, while recently famous due to the hunt for Bin Ladin, have been an integral part of militaries since the dawn of time. The technology changes, but the people don't. Out of many remarkable ones, probably the most successful operation of this type (in my opinion) was the British commandos who knowingly went on the one-way Operation Chariot (which is rarely mentioned in schoolbooks today).

But, since it's July 4th, I'm going to write about an American most of you have probably never heard of. Although he certainly wasn't the first American to carry out a dangerous mission, he did what many thought was impossible.

During the American Civil War the new technology of iron warships was being repeatedly put to the combat test- with stalemate results. Although metal ships could easily destroy wooden ones, clashes between ironclads typically resulted in a lot of smoke and noise, but both opponents survived. Sinking a solid ironclad remained a challenge.

In 1864 a single, dangerous, Confederate warship, the Albemarle, was guarding the North Carolina Sounds from Union forces. She was small by today's standards, and had been built in a cornfield because of a lack of shipyards. But in her iron hull she had 2 powerful cannons, and had proven herself in combat. Her existence was a thorn in the side for Union forces, who didn't have an available ironclad that could travel far enough to reach her. Her location, and potential to get out and cause trouble, prevented more extensive military plans from being carried out.





Even when young, William Barker Cushing was a chronically ill man, with recurrent respiratory infections and headaches. He was, nevetheless, admitted to the U.S. Naval Academy- only to be expelled in his 2nd year for pranks. But when the Civil War started 3 weeks later officers were needed, and he was reinstated. In spite of his multiple health problems he proved himself to be a relentless warrior, and at age 19 was given command of 2 ships that had been taken as prizes.

He excelled in daring missions, leading a raid into a confederate harbor to burn ships, and later several missions behind enemy lines to destroy military supplies. He was promoted rapidly, and was even brought to meet President Lincoln to give him a personal appraisal of the war. A few weeks later Cushing's brother was killed in the fighting at Gettysburg.

In 1864 he led a covert raid to capture a Confederate general, Louis Hebert. The raid was almost successful- but Hebert had traveled to Wilmington on business the day before. Cushing took other prisoners, and left a signed note on Hebert's desk saying "I deeply regret that you were not here when I called."

Cushing thought about the Albemarle hiding upriver, and how to stop the seemingly invincible ironclad. He finally came up with the idea of a surprise attack using a small boat and explosives.

It seemed like a suicide mission, and hadn't been done before. But the Albemarle was a problem that had to be dealt with, and Cushing had shown a remarkable ability to do the impossible. His commanding officer recorded that he personally felt Cushing's idea was "a forlorn hope... I have no great confidence in his success" but, since a failed mission would cost the Union only 2 boats and a small group of men, was willing to proceed.

Cushing went from ship-to-ship in the blockading Union squadron, asking for volunteers. He told them of the dangers: traveling up the Roanoke river, trying to slip by confederate outposts and sentries, and sinking an ironclad.

On October 27 he and his handpicked crew had a champagne dinner to celebrate the coming success of their mission (or their last meal) before leaving. They sailed at 11:00 p.m. on a small wooden steam-powered boat, with an explosive charge mounted on a long pole in front.

It was a dark night, with rain. Cushing and his men managed to slip past several Confederate stations before the Albemarle's night watch saw him and rang the alarm He was too close at that point for the ironclad's cannons to be used, but her crew, and shore troops, opened up a withering fire.

Cushing continued on, only to discover the Albemarle was surrounded by a floating log boom, linked by heavy ropes. It was too far away from the ship for his explosive to work. By this time one of Cushing's men had been wounded by enemy fire, and Cushing himself, while unharmed, had his clothes shot through in 3 places.

He turned his boat away - and for a few minutes the Confederates thought he'd been driven off. But Cushing just wanted to build up speed. After traveling 100 yards downriver he turned around, and throttled to full speed. He and his men knew there was no way to get back over the boom once they crossed it.

The heavy fire continued. Cushing was shot in the left hand, and the back of his jacket and sole of one shoe had been shot off. But he didn't flinch. His boat struck the logs and went over, driving the explosive charge into the Albemarle. The force of the blast "blew a hole you could drive a wagon through" and the ironclad rapidly settled into the mud as her crew jumped to shore.

Their boat trapped, Cushing and his crew abandoned it. Only Cushing would return to safety, the others all surrendering or drowning. But they had done what no ship had been able to: sink an ironclad.

Cushing swam downriver that night, and spent the next day evading Confederate patrols in a swamp. That evening he stole a rowboat and paddled back out to the waiting Union fleet. With the news of the Albemarle's loss the Union forces moved rapidly, and successfully, upriver.

Cushing's star was bright, but brief. After the Civil War he began having debilitating attacks of hip pain, and his headaches and respiratory problems worsened. He married and had children. In spite of his health issues he tried to remain in active service. At age 30 he became the youngest man in U.S. history (up to that time) to become a Commander.

His pain worsened, and spread. The medical science at the time didn't find a cause for his worsening (now suspected to be either Tuberculosisis or metastatic cancer). On Thanksgiving 1874 it was incapacitating, and he became delirious. He died 3 weeks later, and was buried at the U.S. Naval Academy Cemetery.

He was 32.

New page announcement

Due to several requests, I've compiled all the Grumpy vacation adventures into a single page, joining my history and artisanal pages. You can find it down in the right sidebar. Enjoy!

Some have written wondering when the 2011 vacation will be. Don't worry, it's coming (sighs, looks at credit card bill).

Sunday, July 3, 2011

Sunday reruns

Dr. Unka is in my office complex. When he refers a patient to me, he often walks them upstairs to my office and waits with them up front (while his own waiting room backs up) until Mary has scheduled the patient. He often asks that I drop everything I'm doing to come meet his new referral, instead of just having them call us to make an appointment.

So today Mary called me to say Dr. Unka was up front, and wanted me to come meet a new patient. So I excused myself from my current patient and went up front, to see him standing there with a familiar, somewhat irritated-looking, older lady.

Dr. Unka: "Ibee, I'd like you to meet Mrs. Ancient. I'm referring her for memory loss."

Dr. Grumpy: "Uh, Mrs. Ancient was here 3 weeks ago for that."

Mrs. Ancient (glaring at Dr. Unka): "I told you! Why didn't you listen to me?"

Dr. Unka: "She was?"

Mrs. Ancient: "Yes!"

Dr. Grumpy: "Yes, I sent you a note."

Dr. Unka: "You did?"

Mrs. Ancient: "Yes! He did! It was even in my chart at your office! I pointed it out to you!"

Dr. Unka: "You did? Um, I mean, then have her make a follow-up." (leaves).

Saturday, July 2, 2011

Random pictures

All right, due to me being tired and it being a holiday weekend, I'm going to put up some random shots I've been sent.

To show that the hated autocorrect feature is everywhere, this picture shows how a computer interpreted the phrase "IP-joint" (it stands for interphalangeal joint)

(click to enlarge)





Next, we have this page that was sent as an urgent-lab-results-please-call-nurse-ASAP to a doctor (for those of you not in medicine, this result is normal).






And finally, a neurologist who was trapped in an airport took this picture of brain-shaped chocolates for sale. I can only assume that (amongst other advantages) they have a lower risk of causing Jakob-Creutzfeld Disease than eating a real brain.


Friday, July 1, 2011

I stand corrected

Dr. Grumpy: "Hi, I'm Dr. Grumpy. Have a seat... What can I do for you?"

Mrs. Newpatient: "You wrote me a script for physical therapy, and I lost it. When I finally found it last month the therapy place said it was too old, and that I needed a new one."

Dr. Grumpy: "Hang on, ma'am... "(frantically searching computer) "um, I've never seen you before, let alone ordered therapy for you. We don't have anyone by your name or birthday in the system."

Mrs. Newpatient: "That's not true! I have your script right here!"

And she pulls out a discolored, dog-eared, wrinkled, physical therapy order from freakin' 1994, written, by me, on the order forms from the hospital I did my residency at.
 
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