Predictive humor

I was giving post-call checkout to Dr. Brain last night. The list was REALLY LONG.

Dr. Grumpy: "And that's it. Sorry about the list, it was insanely busy."

Dr. Brain: "Okay. Not your fault, but holy crap this is a lot of patients" (chuckles) "oh well, maybe some will die overnight."


3 of them did!

Sunday Reruns

So following the time-honored tradition of my Bible (Chapter 20- Execute Forms at Dawn) I'm sitting here doing miscellaneous paperwork.

For those of you who have never had to deal with employer health forms, they are a freaking nightmare. A remarkable collection of stupid questions, redundancy, and more redundancy.

Today I'm completing job forms for one of my epilepsy patients, who works in sales. Questions from his employer include:

Is Mr. Shakes capable of working in sales during a seizure? (depends on what he's selling)

Would a seizure at work impair Mr. Shakes' job performance? (No! Who could resist an unconscious salesman who just wet himself?)

Will Mr. Shakes need to leave work to attend doctor appointments? (Of course not, I'll just swing by in the Grumpymobile)

If Mr. Shakes has a seizure, will it be necessary for him to leave work? (No, just leave him lying in the aisle)

Between seizures, is it safe for Mr. Shakes to operate a golf cart for clients? (NO! Wait till he's having a seizure, THEN let him operate it)

We have a great deal for you! CLEAR!

I found this in a pile of scratch paper this morning. Obviously, I missed out on whatever fantabulous deal it was.

In medical language "coding" generally doesn't refer to someone who's in a good state of health. So if the customer is coding, having to pay full price on a book is the least of his worries.

Yes, medical coders, I know what it's really referring to. But it still give me a laugh.

I had no idea it ever was

Patient quote:

"Doctor, I've had so many of my friends die from brain cancer that it isn't funny anymore."

Chaucer, M.D.

There's a new hospitalist in Grumpyville, who's either a medieval time traveler or frustrated Renaissance Faire participant. In the last week I've seen these statements on his charts (and yes, he really does use the royal "we" when speaking):


"We shant deny neurology the pleasure of this consult."

"We beseeched the patient to stop using heroin, yet still she scorns our advice."

"Cardiology has been waiting in the wings, and we shall summon them forthwith."

AAN LOTR NOLA

This week is the AAN (American Academy of Neurology) annual meeting in New Orleans.

For neurologists, this is THE event. To outsiders, it is the largest collection of neurogeeks in the world.

This is where the majority of the participants registered with NCC-1701 as their password. Where you'll find people who don't know their kids' names, but can lovingly identify every structure on an axial slice of the pons. And where you'll find the last 5 people on Earth who wear bow ties to work.

I wasn't invited (they're angry at me for revealing our darkest secret), but I do have a spy there, sending me pictures with a camera cleverly disguised as a phone.

Agent SMOD took this picture in the exhibit hall:

It's a company that makes gadgets to measure nerve thickness at the back of the eye. So they have giant round screens surrounding the booth showing huge eyes. Big Brother is watching you spill coffee on the sales reps.

These things only reaffirm that neurology was the right specialty choice for me. Because my first thought was how much it reminded me of this image:

What would Frodo, do?

Or perhaps this one:

I'm sorry, Dave. We're out of Diet Coke.

(If you don't recognize the movies, ask a neurologist. If you can't find one, they'll be back from New Orleans next week).

Thank you, ladies!

Today is Administrative Assistant's Day (formerly Secretary's Day) and this is dedicated to my awesome staff, Annie and Mary.

Mary's Desk

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

Mr. Azz: "Yeah, I need to see Dr. Grumpy urgently today."

Mary: "Sir, you had a 10:00 appointment this morning, and didn't show up..."

Mr. Azz: "I know that. Obviously, I wasn't able to make it. But I still need to get in today."

Mary: Well, the rest of our slots are booked today. We can see you tomorrow at..."

Mr. Azz: "Maybe you didn't hear me. I said I want to be seen TODAY! So give me an appointment!"

Mary: "Sir, you had an appointment today, and you missed it. We don't have another. The best I can do is tomorrow."

Mr. Azz: "Screw this. Tell the doctor he's fired. I'm going to find a practice that helps people who need it."

Irony

This Saturday in Grumpyville was a fundraising walk for breast cancer research, so while I hauled the kids to various Boy Scout/Girl Scout/Junior Terrorist activities I frequently passed groups of women walking along the course.

In mid-afternoon I noticed one in particular.

She was standing in the middle of a busy street, with her back to oncoming traffic, talking on a cell phone.

And she was wearing a pink T-shirt that said "Early Detection Saves Lives!"

Can you be more specific? T-Bone? Rib Eye? Strip?

I stopped by the office today to get the mail and change Ed.

A patient for Monday had faxed over some of his records, which included this note:

'My migraines feel like someone is pushing a steak through my head."

Jesus. Now in uniform.

Gee, why do I think drugs are involved?

Questions

Medical marketing surveys usually ask, at the end, if I have any recommendations to improve them. But last night I took one that had the question on every freakin' page!

So I was faced with things like this:

(click to enlarge)



I mean, it's a pretty basic question, not some bizarre doublespeak. So let's try to think of ways to improve it:

"Oh great and exalted one, in which medical specialties do you practice?"

"Look, asshole, what kind of doctor are you?"

"Even if you're really a yak herder, what are you pretending to be?"

"Does this medical specialty make my butt look fat?"

"You're still practicing? After 15 years you still aren't good at it?"

Master Yoda: "Which medical specialties practice do you?"

The nerve!

Dr. Grumpy: "I haven't seen you in a few years."

Ms. Glunk: "Well, I didn't need to come back until now."

Dr. Grumpy: "At your last visit you were having neck pain..."

Ms. Glunk: "Right, and it got better, because I wished it away."

Dr. Grumpy: "So what brings you back?"

Ms. Glunk: "My ex-husband unwished it."

Marriage: The good, the bad, and the artistic

A while back I wrote about the strange things that show up on my patient info forms about marital status.

We've recently had a few more, which I thought I'd share with you.

First we have the cutesy "smiley face"





Of course, you don't have to be married to have the happy face.





I can only assume that in both of the above cases the spouse/boyfriend doesn't have a nose.


This one is devoted to whatever he is, whether it's single, married, or other.





On the opposite side, we have this guy





And, finally, this lady.

Blowing cows to smithereens

While it has nothing to do with stupid criminals, this is still one of the stranger news stories I've encountered.

Thank you, Leigh!

Annie's desk

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

Mr. Gardner: "Yeah, I saw Dr. Grumpy last week for my arm problems."

Annie: "What's up?"

Mr. Gardner: "My accountant is out of town. Does Dr. Grumpy recommend cash value or term life insurance policies?"

Patient quote of the day

"I hope you realize that your capabilities as a physician thus far appear to be entirely suboptimal."

Smooth jazz

Dr. Grumpy: "How's your jazz band doing?"

Mr. Armstrong: "So-so. Our last gig was at a dump."

Dr. Grumpy: "Sorry. One of the cheap college bars?"

Mr. Armstrong: "No, the dedication for the new city landfill."

Weekend reruns

I had a busy day at the office, so didn't get a chance to return calls until I got home. I had to call a 20-something patient to give her (normal) MRI results. Here was the conversation:

Miss Suzy Singlefemale: "Hello?"

Dr. Grumpy: "Hi Suzy, This is Ibee Grumpy."

Miss Singlefemale: "Oh! I am SO glad you called. I've been meaning to call you back, but I've been sick for 2 days, and have been running errands, but I didn't want you to think I was blowing you off. I had the most INCREDIBLE time with you on Saturday night!"

I was speechless. Finally I said:

Dr. Grumpy: "Uh, I just called to discuss your MRI results."

LONG pause.

Miss Singlefemale: "Is this Dr. Grumpy? Oh, I thought you were someone else. How
are you this evening?"

April 14, 1912

"There was peace and the world had an even tenor to its way. Nothing was revealed in the morning the trend of which was not known the night before. It seems to me that the disaster about to occur was the event that not only made the world rub it's eyes and awake, but woke it with a start - keeping it moving at a rapidly accelerating pace ever since, with less and less peace, satisfaction and happiness. To my mind the world of today awoke April 15th, 1912."

-Jack B. Thayer, Titanic Survivor


Today is 100 years since the Titanic struck an iceberg and sank (yes, I know the sinking was on the 15th, but I'm going to mark the 14th, since that's when the collision occurred and started the chain of events).

I've done annual posts on lesser-known aspects of the disaster, and obviously had quite a bit of time to think about what would be appropriate for today. I hope you enjoy this, as I've tried to connect it with something we still have 100 years later.

The Titanic's story has formed the basis for movies, computer games, TV shows, novelty ice cubes, and books. Even a few musicals (such as the Las Vegas Jubilee comedy-musical-topless show about the sinking), and, most bizarrely, a childrens' inflatable slide.

Lost in all of this is a tragedy in which over 1500 people died. I think any of us would be horrified to see "Holocaust- The Musical!" or "September 11 - a laugh-a-minute review!" and it always irks me that the Titanic's needless loss of human life is often treated as on object of amusement.

Lastly, all of us with an interest in the story owe a debt to the late Walter Lord. Without his research and compelling writing it would likely have been forgotten along with many other turn-of-the-century shipping disasters.
 

And on with the post.









The Sundowner


The Sundowner (a comical name for those of us in medical profession) is a 58 foot (18m) motor yacht at the Ramsgate Maritime Museum in England. She was, coincidentally, built in 1912, the same year the Titanic sank. She's a fairly nondescript boat, and certainly nothing like the huge ocean liner. One man was to link the 2 ships, both times with remarkable heroism.





Charles Herbert Lightoller


Charles Lightoller was born in Lancashire in 1874. His mother died shortly after his birth from delivery complications, and his father (who owned a cotton mill) abandoned him and left the country a few years later. Both his siblings died in childhood.

When he was 13 Charles signed on to an at-sea apprenticeship, and between 1887 and 1899 went on journeys that led him to being shipwrecked & rescued once, fighting an at-sea fire that threatened his ship, catching malaria, prospecting for gold in the 1898 Klondike gold rush, becoming a cowboy in Alberta, riding railroads as a hobo across Canada, and working as a cattle wrangler on a livestock freighter back to England. He was 23 years old, had circled the world twice, and was penniless upon returning home.

He worked his way up to a Master's certificate, and in 1900 joined the White Star Line, gradually rising in the ranks. He married and had 5 children (2 girls and 3 boys - all served in WWII, with 2 sons killed in the fighting).

In 1912 he was named 1st officer of the brand-new Titanic, though shortly before the voyage a new chief officer was brought aboard, knocking Lightoller down a notch to 2nd officer.

He was off-duty when the ship struck the iceberg, but once alerted quickly went to work. He supervised lowering the port-side lifeboats, never trying to get in one himself. After all the boats were gone and the ship about to go under, he felt he could do no more, and dived into a wave that was breaking over the now-submerged officers' quarters.

As tons of seawater poured down the Titanic's ventilators, he was sucked under, and pinned against one's grating. If it had broken he'd have been sucked deep inside the dying ship and never found, and the suction was so powerful he couldn't break free and swim to the surface.

He'd been trapped underwater for 15-20 seconds when a boiler ruptured deep in the dying ship, sending up a blast of hot air that broke the suction and launched him to the surface.

Reaching the air he was in 28°F (-2° C) water, in which a person couldn't survive more than 15 minutes. He was near lifeboat B, which had overturned, and had about 30 men clinging to it. He swam over and crawled aboard.

Without oars they were unable to move away from the sinking ship, and may have been sucked down with her. But when the first smokestack collapsed into the water (and likely killed many beneath it) the wave pushed their overturned boat safely away.

The upside-down boat was swamped and unstable, and the men clinging to it were in danger of being thrown off in the swells. Lightoller quickly arranged them standing on its bottom in parallel lines, and ordered them to lean right or left to counteract the waves. When the Carpathia came in the morning they were the last boat to be picked up. Lightoller himself was the last survivor of the disaster to be brought aboard, and the highest-ranking officer to live.

He testified at both the British and American hearings, and many of his recommendations to prevent similar disasters from occurring were agreed to by the major maritime nations. Several of them stand to this day (lifeboat drills, enough lifeboats for all aboard, continuous radio communication by all vessels for distress signals, and ship-to-ship notification of icebergs).

He served his country in WWI, receiving decorations and commanding 2 ships. He was sunk (and rescued) again during the war, and later rammed and sank a German U-Boat.

After the war he returned to the White Star Line, but discovered that his association with Titanic had blacklisted him from advancing. He became discouraged and left the sea, taking jobs as an innkeeper and chicken farmer, and writing his autobiography.

But his heart never left the sea, and in 1929 he and his wife bought the little Sundowner and sailed her around Europe.

In 1940 came Great Britain's darkest hour.

Hitler's seemingly invincible armies were swarming across Europe, and a large portion of Britain's armies were trapped at Dunkirk by the invaders. Their options were to surrender or die fighting.

Churchill's government requisitioned every ship and boat available to evacuate them home, and at age 66 the now-retired Lightoller and his oldest son volunteered to take the little Sundowner across the English Channel to help.

Without any armament they set out, dodging strafing Luftwaffe planes. Halfway across they came across another boat that had broken down and caught fire, and rescued her crew. Then Lightoller sailed on. Upon arriving at Dunkirk he took the Sundowner alongside another ship, which quickly off-loaded soldiers to his, then went back for more. He headed back to England with 130 men crammed in his vessel (built to carry perhaps 20 at most). Badly overloaded, the Sundowner was barely maneuverable, but with his experienced hand on the wheel she avoided further airplane machine guns and the wakes of larger ships that threatened to overturn his.

He unloaded the soldiers and was ready to return for more, but with the worsening conditions only faster ships were being sent. The little Sundowner spent the rest of the war doing coastal patrol, and in 1945 she returned to being a pleasure boat. Lightoller and his wife spent the rest of their years sailing her.

Lightoller died in December 1952, a victim of another man-made disaster, the Great London Smog.

His wife continued sailing Sundowner, leading a repeat procession of boats back to Dunkirk in 1965 for the 25th anniversary of the evacuation. After her death the boat had several owners before being purchased by the Ramsgate Maritime museum, and has since led the memorial procession back to Dunkirk twice more (1990 and 2000).

Today this connection to the past is still with us. While the wreckage of the once magnificent Titanic reminds us of her 1500 dead and the lessons taught by the tragedy, the little Sundowner reminds us of courage in the face of adversity- perhaps our most noble capacity.

How to rob a bank

Lesson 1: Be intimidating.

Do they pay you by the word?

Last night I was looking through a hospital chart, and discovered this in another neurologist's note.

"The patient has had an electrical dysfunction of the cortex, resulting in abnormal neuronal discharges. The resultant signal propagation caused generalized tonic-clonic muscular activity."


Dr. Grumpy's translation: "He had a seizure."

Medical humor

Knock knock
Who's there?
HIPAA
HIPAA who?
I can't tell you that.

Thank you, Webhill!

The country club life

Dr. Grumpy: "When did the symptoms start?"

Mrs. Howell: "We were at a party, on our friend's yacht. It's a big yacht, not like the little ones poor people have, and I went to lay down, when..."

Great Moments in Crime

"Gee, how did you guys catch me so fast?"

Thank you, Ed!

Reasons I'm going to hell

Before leaving last night I looked at today's schedule. One of the new patient's listed was familiar, and I searched my charts. It was a lady I'd fired 7 years ago for various reasons. She'd been referred back to me by her new internist, Dr. McCheese, who likely hadn't been told of my history with her. Mary had missed the problem.

So I talked to Mary. She'd forgotten I'd fired the lady, and said she hadn't spoken to the patient. Dr. McCheese's office had scheduled the appointment.

Dr. McCheese doesn't normally refer to me, so I really didn't care about making him angry. I called his office and reached the lady who'd made the referral.

Dr. Grumpy: "I'm not going to accept this case. She can't come back here."

Office Lady: "Well that's just freakin' GREAT! I mean, we don't refer to you anyway, and you were our last hope. We already tried all 5 good neurologists in town, but none of them wanted to touch her either. So we thought we'd send her to you."

You have no idea how special I felt. There are about 80 neurologists in my town, not including the one who died on Monday, and I didn't know that only 5 of them were competent.

Dr. Grumpy: "Sorry. I'm not taking her."

Office Lady: "So now what am I supposed to do?"

I thought about telling her to go stuff herself, but an even better idea came to mind.

Dr. Grumpy: "Why don't you refer her to Dr. Justdiedmonday?"

Office Lady: "I hadn't thought of that. He isn't on our list either. Do you think he'd see her?"

Dr. Grumpy. "It can't hurt to ask. I heard he has some schedule openings this week."

Office Lady: "Thank you! I appreciate your help. I'll call his office right now."

Dr. Grumpy: "Have a good night."

Mary, bring me a gavel

Dr. Grumpy: "So when did this start?"

Mrs. Tia: "Well, we were at dinner, and I'd just started some chocolate pudding, when suddenly I had trouble talking and..."

Ms. Daughter: "Mom, you were having tapioca pudding."

Mrs. Tia: "No, it was chocolate. I hate tapioca pudding."

Ms. Daughter: "No, I'm the one who hates tapioca. It makes me sick that you order it."

Mrs. Tia: "I wouldn't have ordered it because I can't stand it. That's why I got chocolate."

Ms. Daughter: "Maybe you should consider a restaurant with better desserts."

Mrs. Tia: "Maybe you should think about why Robert left you."

Ms. Daughter: "I didn't bring you here to fight with you."

Mrs. Tia: "Could have fooled me."

Ms. Daughter: "I hate all kinds of pudding, anyway."

Priorities

Dr. Grumpy: "How did this start?"

Mr. Walton: "We were in line at Walmart, returning a toaster. It was a real POS, know what I mean, Doc? It burned everything. Anyway, Ma began telling me that her left arm and leg were weak, and so I helped hold her up. After we returned the toaster I carried her out to the truck, and drove her to the hospital."

Dr. Grumpy: "Okay, what time would you say this all started?"

Mr. Walton: "We were in line about another 20 minutes after she first said something."

Dr. Grumpy: "Why didn't you bring her in or call 911 right away?"

Mr. Walton: "We'd already been waiting for 20 minutes and I didn't want to go back."

Weekend reruns

From December, 2008:


Okay, so at this time of year we get tons of cookies, candies, fattening stuff in general, dumped at the office.

A few weeks ago a local physical therapy place that specializes in hands dropped off a bunch of hand-shaped frosted sugar cookies.

Our staff was pigging out. I kept asking them to set one aside for me and put it next to my coffee in the break room, but they ignored me, as the cookies gradually decreased in number.

Finally I said "Somebody put a cookie near my coffee, or I'll have you all shot!" Then I went in to see my next patient.

When I wandered back to the break room 20 minutes later, they had saved me this cookie.

Driving safety quiz

Which of the following is a bad idea:

A. Driving while texting.

B. Driving with a kid in an unsecured child seat

C. Driving while talking on your phone.

D. Driving without wearing a seatbelt.

E. Driving on a suspended license.

F. Driving with an infant on your lap.

G. Driving with an older kid who isn't wearing a seatbelt.

H. Doing all of the above at the same freakin' time!


Thank you, David!

Artisanal: now with artisanally dangerous additives

 

Thank you, Sheila!

Oh yeah, that one

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

Mr. Vague: "My sister has that one disease, it makes you sick. You know which one I mean?"

Bad idea #1

There are worse things than driving drunk. Butt not many.

Thank you, Webhill!

Bad idea #2

I hope they didn't get to the "Hot Wax Undercarriage" treatment.

Thank you, Bob!

Great ad placement

Thank you, Rachel!

Mary's desk, April 4, 2012

New patient signs in up front.

Mary: "Hi, I need to get a copy of your insurance card."

Mrs. Paranoid: "I don't carry my card with me. Someone might steal it."

Mary: "Okay, but we need your information to bill your insurance."

Mrs. Paranoid: "I have Medicare."

Mary: "Okay, then can I get your Social Security number so we can bill them?"

Mrs. Paranoid: "I can't give you that. How do I know you won't still my identity, or sell it to someone who will?"

Mary: "We need some way of billing your insurance for the visit. Otherwise you'll have to pay cash today."

Mrs. Paranoid: "This is ridiculous that you treat people this way."

Leaves.

Wait...

Mr. Sugar: "I have diabetes, but it's controlled with diet. I don't take anything for it."

Dr. Grumpy: "Okay. Are you on medication for anything?"

Mr. Sugar: "I take Metformin, Actos, and Insulin."

Time for another advertising quiz

This picture:




A. Some flick about a romance between a doctor and football player.

B. Boy, Dell is really going avant-garde in their new commercials.

C. She makes porn movies of herself & drunk quarterbacks on her laptop, and sells them online.

D. Um... L'Oréal ad? She really needs something for better hair control. Or is she a medusa?

E. Is a computer-guided system to help the center guy at the bottom scrape dog shit off his shoe.

F. Why is her white coat billowing up like that? Is it starched? Is she gassy? Hey, does she even have pants on?

G. An ad for an ultrasound needle-guidance system.

"Uh, no, officer, that's my, um, girlfriend"

I think this would make a great ad for Honda. "The new Civic: more back seat room than Toyota."

Thank you, Kimm!

Patient quote of the weekend

"I've been having headaches, you know, and like, stuff that I get with them, you know, all that stuff that happens with my headaches, like, you know, it hurts, and I don't feel good and stuff, you know, and like, can you do stuff about this? You know, like, pills or stuff or something?"

And, as usual, this call came in at around 3:00 a.m.

Random Sunday pictures

Time to hit the email bag for shots you guys have sent me.


First, this screenshot shows the dangers of having your site truncated by browser software:






Next we have this snack bar:



I think I'll just have the plain cheese pizza, hold the toppings.



And here's a fine example of (probably artisanal) coffee:



It might be really good, but if I were at a coffee place and a guy said to me "Hey! Would you like to taste mysore nuggets?" I'd probably run. Fast.



Next is a beer that believes in truth in advertising:






Here's an ad for a resort's play facility:



They apparently have a higher opinion of 6-week-old human motor skills than I do.



This is from an interview with a Best Buy executive, describing company plans. I don't understand this, which is why I guess I'm not an MBA. In fact, it sounds like a story from the Onion.





To show yet another irritating overuse of the word "artisan" we have this mass-produced vinyl barbecue cover:





And finally, since it is April 1, here's one of my favorite pranks ever: