Doktur must rite good

This ad was recently posted on a site for freelance writing jobs:

Spelling: it isn't brain surgery. I hope.

Thank you, Donna!

Friday whatever

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

Mr. Lasix: "Yeah, my Dad is a diuretic."

Dr. Grumpy: "You mean diabetic?"

Mr. Lasix: "Whatever."

Damn, you caught us

Dr. Grumpy: "It looks like the hematologist wants to do a bone marrow biopsy to find out..."

Mr. Gammopathy: "I'm not doing that bullshit."

Dr. Grumpy: "May I ask why?"

Mr. Gammopathy: "I know the games you people play. What you really do is inject my healthy marrow with lymphoma cells, thereby tying me into the medical-military-industrial complex that the government is running."

Post-Christmas rerun

In 2008, the following message was left on my office voicemail around 8:30 p.m. Christmas Eve:

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

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

Merry Christmas to all!

Weekend on call

Dr. Grumpy: "So you haven't been taking your seizure medication at all?"

Mr. Stoner: "I don't need to! See, my friend gives me marijuana, and if I smoke it several times a day than I don't have seizures. Hey, can you give me some while I'm here? He's not answering his phone."

Dr. Grumpy: "Local Hospital doesn't keep marijuana in the pharmacy and..."

Mr. Stoner: "Well, I'm not going to take any of your pills!"


Several hours later, at the nursing station...


Dr. Grumpy: "All right, here's some orders on the new admission. Hey, has Mr. Stoner had his EEG yet?"

Nurse: "He left AMA*. Didn't anyone tell you?"

Dr. Grumpy: "No. When did this happen?"

Nurse: "After you told him the hospital wasn't going to give him marijuana. He snuck out of his room and went down to ER, trying to find a patient there who could sell him some. When security came after him he ran out of the building and didn't come back."


*Against Medical Advice, for the non-medical readers. Basically walking out.

Skool Nerse Page

This is Mrs. Grumpy, announcing that I now have my own page on the site, compiled from my posts.

You can find it down in the right sidebar, or click here.

Guest post from Officer Cynical

While the insanity of our world takes over headlines, the legacy of one man has been largely ignored. Daniel Inouye died on Monday, December 17th.

Inouye served as congressman and senator from Hawaii since the date of its statehood in 1959 until his death. He was also a Medal of Honor winner during WWII. The following is the citation for that award:  

________________________________________

The President of the United States of America, authorized by Act of Congress, March 3, 1863, has awarded in the name of The Congress the Medal of Honor to

SECOND LIEUTENANT DANIEL K. INOUYE
UNITED STATES ARMY

for conspicuous gallantry and intrepidity at the risk of his life above and beyond the call of duty:

Second Lieutenant Daniel K. Inouye distinguished himself by extraordinary heroism in action on 21 April 1945, in the vicinity of San Terenzo, Italy. While attacking a defended ridge guarding an important road junction, Second Lieutenant Inouye skillfully directed his platoon through a hail of automatic weapon and small arms fire, in a swift enveloping movement that resulted in the capture of an artillery and mortar post and brought his men to within 40 yards of the hostile force. Emplaced in bunkers and rock formations, the enemy halted the advance with crossfire from three machine guns. With complete disregard for his personal safety, Second Lieutenant Inouye crawled up the treacherous slope to within five yards of the nearest machine gun and hurled two grenades, destroying the emplacement. Before the enemy could retaliate, he stood up and neutralized a second machine gun nest. Although wounded by a sniper's bullet, he continued to engage other hostile positions at close range until an exploding grenade shattered his right arm. Despite the intense pain, he refused evacuation and continued to direct his platoon until enemy resistance was broken and his men were again deployed in defensive positions. In the attack, 25 enemy soldiers were killed and eight others captured. By his gallant, aggressive tactics and by his indomitable leadership, Second Lieutenant Inouye enabled his platoon to advance through formidable resistance, and was instrumental in the capture of the ridge. Second Lieutenant Inouye's extraordinary heroism and devotion to duty are in keeping with the highest traditions of military service and reflect great credit on him, his unit, and the United States Army. 

______________________________________________________

More remarkable (to me) is Inouye's own description of those events. The Atlantic published the following - Inouye's personal account of his Medal of Honor-winning actions in the town of San Terenzo, Italy, in 1945.

Inouye's unit was charging three German machine guns.

'"I remember being shot in my abdomen, first, on the right side. The bullet came out in the middle of my back, and it felt like someone had slugged me. There was no intense pain or anything like that. I fell backwards and then kept on going until my messenger right in the back of me ... said, 'By the way, you're bleeding.' So I stuck my hand in there and, sure enough, it was warm and moist. I took out my hand. It was all bloody but, since it wasn't bleeding profusely, I just kept on going."

Continuing forward with a bag of grenades, he cocked his hand and was ready to throw another when a German grenade hit him in the arm, leaving his right arm dangling by a thread.

'"I saw a fellow pointing it at me and I felt the blast and I recall going for my grenade, prying it out of my right hand and throwing it with my left. My arm was dangling by a couple shreds, so when I lifted it up, it was hanging like that. Just shredded. So I knew it was gone. First I was looking all over for the grenade, I thought it fell. And then I looked at my hand and I said, 'Oh, my Lord. It's there.' I had pulled the pin, and my hand was back ready to toss it, so I knew it was armed. The fingers somehow froze over the grenade, so I had to pry it out."

With his left hand, Inouye tossed the grenade at the German who had shot him, hitting him. Then he blacked out. Later, when he was cited for his bravery, he learned that he had grabbed a tommy gun in his left hand, charged toward one of the machine guns, knocked it out, and then got shot again. He was given so much morphine that doctors later amputated his arm without anesthetic, concerned that any more would drive his blood pressure too low."

 ________________________________

I try to remember that, while a few nutjobs are out killing kids and cops and firefighters, real heroes walk among us.

Today's featured gift #1

Today wraps up the 2012 Grumpy gift guide, with the following 2 items. I hope you've enjoyed it! If you see anything out there that catches your eye, please send it in and I'll consider it for next year.


 This gadget is advertised for training dogs.

Looking at it I can't help but think that if someone tied a rope around my, uh, boy parts down there, I'd be pretty "calm and orderly," too.

Today's featured gift #2

Now this one I kind of like. Because a leading problem of the modern workplace is the dreaded lunchroom thief. This drove Mrs. Grumpy nuts, as no matter how brightly she wrote her name on an item, it would still disappear before she had a chance to touch it.

But now, you can get this awesome lunchbox:

This great lunchbox is just perfect for any workplace, or the ax murderer on your list. Mary and I use hers to hide body parts after I've finally snapped at a patient on their 5th consecutive visit who hasn't yet started the medication I prescribed, but is still complaining that they aren't any better.

Mary's desk, December 19, 2012

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

Mrs. Dilly: "Yeah, I have an appointment in an hour, and I'm going to have to cancel it. I'm in the Emergency Room."

Mary: "Are you okay?"

Mrs. Dilly: "Yeah, I was all blocked up down there. I think I ate too much cheese."

Mary: "I'm sorry. Just call us back whenever..."

Mrs. Dilly: "They just gave me my third enema. I've never seen so much shit in my life. Do you have anything open on Friday afternoon?"

Skool Nerse time

Attention parents:

Calling in to say your kids will be absent on Thursday and Friday, because it's the end of the world, is absolutely the lamest excuse for a long weekend I've ever heard.

If you really believe that, you're going to have a boatload of catch-up Christmas shopping to do this weekend.

Gee, why didn't I think of that?

Joe: "Local Hospital computer help, this is Joe."

Dr. Grumpy: "Hi, I went to read an EEG, and the reading room is, um, gone. I mean, completely vanished, and they're building an orthopedic supply closet where it used to be."

Joe: "Is this a problem?"

Dr. Grumpy: "Well, yeah. A lot depends on my ability to read EEG's on the hospital patients. If I don't have the results, then I can't make treatment decisions."

Joe: "Look, we spent a lot of time setting things up so you guys can read EEG's from home, WHICH YOU ASKED FOR, so why can't you just drive home, read them, then come back and round?"

Today's featured gift

Do you enjoy mini-golf? Do you love bathroom humor? Have you ever wanted to show the office golf asshat where he can put his ball? Then this is ideal for you!

Yes, with this remarkably tasteless gadget, you can pretend to whack a golf ball into someone's ass and listen to them fart. You can repeat this action until the joke is old (1-2 times) and then give it to that co-worker you hate in the office gift exchange.

Proud parenting moments

At my parent's 50th anniversary party, which was held at an incredibly swanky restaurant:

Grandma Grumpy: "Marie, are you enjoying your dinner?"

Marie: "Yes. I like this place. It's fancy. It doesn't have gum under the tables."

From the "No shit, Sherlock" research department

The mere anticipation of an interaction with a woman can impair men's cognitive performance.

Archives of sexual behavior, (2012) 41:1051-1056 

Abstract

Recent research suggests that heterosexual men's (but not heterosexual women's) cognitive performance is impaired after an interaction with someone of the opposite sex (Karremans et al., 2009). These findings have been interpreted in terms of the cognitive costs of trying to make a good impression during the interaction. In everyday life, people frequently engage in pseudo-interactions with women (e.g., through the phone or the internet) or anticipate interacting with a woman later on. The goal of the present research was to investigate if men's cognitive performance decreased in these types of situations, in which men have little to no opportunity to impress her and, moreover, have little to no information about the mate value of their interaction partner. Two studies demonstrated that men's (but not women's) cognitive performance declined if they were led to believe that they interacted with a woman via a computer (Study 1) or even if they merely anticipated an interaction with a woman (Study 2). Together, these results suggest that an actual interaction is not a necessary prerequisite for the cognitive impairment effect to occur. Moreover, these effects occur even if men do not get information about the woman's attractiveness. This latter finding is discussed in terms of error management theory


Thank you, Vince!

Today's featured gift

Before moving on to the post, I'd like to say something:


HAPPY 50th ANNIVERSARY MOM AND DAD!

And now back to our regular program.

 
Is your favorite cook tired of drab colors? Do they want to spice things up? Well, you should give them Esslack: edible spray paint for food!

Think of the possibilities: gold chicken, blue steak, or fire-red asparagus! Make your holiday dinner look like something out of Willy Wonka (the 1971 version).

Foodies in the 'hood can give up using plain, inedible Krylon and do some serious food tagging to let everyone know that particular Big Mac is YOURS.

Your kids already believe you're trying to poison them. So why not have fun with it?

Today

I want to offer my thoughts, prayers, and condolences to all affected by the terrible events of today.

Today's featured gift

Have a friend who likes tasteless historical knick-knacks? Consider this:

Now they can own a bobblehead doll of the man who murdered America's 16th, and probably greatest, President. Ideal for those who enjoy, um, I guess, this sort of thing.

As best I can determine bobbleheads of Lee Harvey Oswald, Charles Guiteau, and Leon Czolgosz are not currently available.

Wednesday night, 7:45 p.m.

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

Mrs. Down: "Hi, are you covering for Dr. Nerve?"

Dr. Grumpy: "Yes, what can I do for you?"

Mrs. Down: "I'm emotionally uncomfortable."

Dr. Grumpy: "About what?"

Mrs. Down: "I'm worried I may run out of gas on the way to the drugstore."

Mary's desk, December 11, 2012

Wild-eyed guy breathing rapidly throws open the door, runs in, stands at counter.

Guy: "HEY! CAN YOU GUYS BREAK A $100 BILL?!!!"

Mary: "Uh, no, sorry. We only have a few $5's and $1's for change."

Guy: "SHIT!"

(runs out, door slams behind him)

Today's featured gift

Have a friend who REALLY loves Christmas music?

Yes, now even in private moments you can enjoy the gentle melodies of holiday tunes, and imagine you're being bombarded with them in Wall-to-Wall-Mart. The more TP you use, the more it plays. So even if you're having explosive diarrhea you'll never run out of musical entertainment (as long as you don't run out of paper or batteries).

At present it is not available in Hanukkah/Kwanzaa/Festivus forms, or with music that can be played year round (such as the Mama's & Papa's "Go Where You Wanna Go").

$5

Recently there was a news story about Dr. Russell Dohner, of Illinois. He charges all patients a flat fee of $5/visit. He doesn't take insurance.

This led to several online threads featuring comments such as "Finally! A doctor who cares!"

Apparently, this means that doctors like me, who charge more than practically nothing, are evil and don't care.

I respect Dr. Dohner, and am not putting him down. I think highly of what he does. I actually like what I do, and if I were independently wealthy and could see patients for free, I probably would.

It isn't until almost the end that the article notes Dr. Dohner is supported by his family's farming business, and NOT his medical practice. By that time most readers have moved on to the football scores and "Dancing with the Stars" results, and therefore are left with the impression that any doctor can do this for $5 a head.

Bullshit.

I do care.

But that doesn't mean I don't have my own responsibilities: like office rent. And paying Annie & Mary. And a mortgage. A wife. 3 kids. If I can't support those things, then I'm not going to be able to keep my office open to care for people.

Regardless of what people may think, just because I charge for my services doesn't mean I don't care.

I care enough to call in your seizure medication to a pharmacy at 2:00 a.m. because you're out of pills, even though you knew you needed a refill for at least a week.

I care enough to call you from my family vacation to go over your MRI results, because I didn't think they should wait until I got home, or that you should get bad news from a covering doctor who doesn't know you.

I care enough to come in early and see you at 7:00 a.m. because you can't get time off work, but really do need to be seen.

I care enough to spend time arguing with some pinhead at your insurance company about why you need an MRI, when they don't think you do.

I care enough to rush in to the hospital to see you on my weekend off, rather than let a hospitalist who doesn't know you from Adam try to figure this out.

I care enough to call a drug rep and beg for samples of your medication because you lost your job and can't afford it.

I care enough not to order unnecessary EMG's and EEG's on you, even though doing them would improve my revenue.

I care enough to face worsening reimbursements and rising expenses every day, when many colleagues have given up and gone into another field.

I care enough to try and give you hope, even when I'm not sure there is any.

I care enough to help you find another neurologist who will take good care of you, because your crappy insurance won't let you see me anymore.

I care enough to step out of my kid's music recital and take your call, because I know you're scared.

I care enough to take the time and explain why the drug you saw advertised on TV isn't a good idea in your case, rather than just writing a script to shut you up.

I care enough to stay in a job that has deprived me a of decent night's sleep, family time, and likely shortened my overall lifespan, in spite of the fact that my financial goal nowadays is just to break even.

I care enough to refer you to a neurological subspecialist who can take better care of you than I can, even though in doing so I'll lose you as a patient.

I care enough to call your spouse at 9:00 p.m. to reassure them that you'll be all right.

I care enough not to force you to have a test you can't afford, even though you can sue me for malpractice if I miss something.

I care enough not to dismiss you from my practice, in spite of your insanely annoying personality, because I know that you really do need my help.

I care enough to still be doing this job, even though every day a little bit of my idealism dies.

I care enough to be a doctor. I hope I always will.

It's time!

Amazon weirdness

Today's featured gift

Picnics are SUCH a hassle. You have to sit on the ground, and balance a plate, and eat- ALL AT THE SAME TIME. Let's face it, unless you're remarkably dexterous, you'll starve. Or make a mess. Or both.

But now, there's Picnic Pants!

Now you can attend picnics unafraid of spillage or being unable to find a table! You walk around with what looks like a large gray scrotum, or crotch-cape, or whatever, secure in the knowledge that merely by sitting cross-legged you'll have a convenient place to set your lunch.

History rerun: December 6, 1917

It was World War I.

Gigantic convoys of ships carrying weapons, food, and troops went constantly to Europe, bringing supplies to the Allies. They left from several major Canadian and American ports.

On this day one of them went horribly wrong. And outside of where it happened, it's mostly forgotten.

A large convoy was gathering in Halifax harbor for the trans-Atlantic journey. One ship was a freighter heavily loaded with explosives, the S.S. Mont-Blanc.

At 8:40 that morning, due to a series of mutual errors, she collided with the freighter S.S. Imo.

The Mont-Blanc immediately caught fire. Her crew tried to put it out, but due to its rapid spread were unable to. Scuttling attempts were unsuccessful, and the crew were forced to abandon ship. Someone rang a fire alarm, and several firefighting teams quickly responded to the docks. But with the ship in the harbor, there was little they could to but watch it burn. None of them knew about its cargo.

At 9:04 a.m. the disaster happened.

The ammunition cargo on the Mont-Blanc exploded with the force of 3 kilotons of TNT (roughly 1/5 the strength of the Hiroshima atomic bomb). To this day it remains the largest accidental explosion in human history, and until the 1945 nuclear tests was the biggest man-made explosion ever. Windows were shattered 10 miles away. Objects fell from shelves 80 miles away. The explosion was heard over 200 miles away.

A mushroom cloud and fireball rose over a mile into the air, and a tsunami wave of water, 60 feet high, was sent surging into Halifax. The steamship Imo was picked up and thrown ashore like a toy. Many people (including the firemen) who'd gathered ashore to watch, or were trying to get to the Mont-Blanc to help, simply vanished.

Fire spread through the city. Since it was winter, many homes had furnaces and heating stoves alight, and the shock wave blew them over, spreading heating oil and coal on the ground. Red hot shards of the ship's metal rained everywhere in the city, starting fires in buildings not directly affected by the explosion. A half-ton section of the Mont-Blanc's anchor was thrown over 2 miles into the city, and is now part of a monument. To this day St. Paul's Church has a piece of wreckage embedded in the building.

The city within 1 mile of the entire explosion (326 acres) was utterly destroyed. Buildings, docks, warehouses, homes, and people- all gone in a few seconds. Large fires swept quickly through many city blocks, fueled by winter stores of coal and heating oil. An inferno grew quickly.

Many of Halifax's rescue workers were injured or killed by the explosion, and so the city's ability to react was already impaired. Firefighters from nearby communities came to help- only to find that fire hose and nozzle sizes weren't standardized, and they couldn't connect to the Halifax hydrants. In spite of this, they and surviving local crews worked valiantly to put out the fires, and began rescue efforts of the many trapped under collapsed buildings.

But it was a northern Winter, and darkness came early, along with bitter cold. Rescue workers struggled through the night, chasing voices and moving frozen debris by hand.

The dawn brought light- and a heavy snowstorm. It became the largest blizzard of that decade, dropping 16 inches of snow in a few hours. It put out the last of the fires, but also impaired efforts to reach those who were trapped. Many survivors stuck under debris died from exposure while awaiting rescue.

This view overlooking Halifax harbor was taken after the snowstorm. This had previously been a busy neighborhood and business district.

All told, roughly 2,000 people died- 600 of them under 15 years of age. Another 6,000 were seriously injured, with 9,000 total wounded. 31,000 more were either homeless or had only minimal shelter. Many of the wounded were blinded by flying glass, and care for them eventually led to new treatments for eye trauma.

Although there were many heroes that awful day, one man stands out. His name was Vince Coleman, and he was a railway dispatcher ashore. When he learned of the burning ammunition ship, he realized that a loaded passenger train would be at the waterfront depot in a few minutes. Instead of saving himself, he ran to the telegraph key and quickly tapped out "Stop trains. Munitions ship on fire. Approaching Pier 6. Goodbye." He was killed a few seconds later in the explosion, and is credited with saving at least 300 lives.

Local hospitals overflowed with the dying and wounded, and anyone with medical training was pressed into work. The overtaxed Canadians were assisted by medical crews from American and British warships that had gathered for the convoy. An old ocean liner was turned into a hospital ship overnight. Other medical responders arrived, sent from all over Nova Scotia to assist.

Word of the disaster reached America in a few hours, and the state of Massachusetts rapidly organized a relief effort. All available trains in Boston were frantically loaded with food, medical supplies, shelter materials, and volunteer rescuers and medical personnel. The first train left Boston the night of the explosion, chugging through the same blizzard that was impairing relief efforts, and arriving roughly 30 hours later. It was followed by many other trains from all over Eastern Canada and America. The supplies and workers they brought are credited with keeping the death toll from going higher.

It's been 95 years since the tragedy, and the American assistance hasn't been forgotten. To this day Nova Scotia annually chooses it's finest Christmas tree and sends it as a gift to the city of Boston. This is the tree that stands in Boston Common every holiday season, remembering assistance in a time of need.

Modern English

The introduction of a medical letter is important. It sets down basic patient data and gives you an idea of their chief complaint. When you screw something that simple up, you just know it's going downhill from there:

I get all kinds of letters from other doctors. Most are understandable (although the computer template ones often give me no clue what they're thinking, if they're thinking at all).

I get some, however, that are full of garbled phrases. I have no idea if this is due to bad language skills, lack of good transcription (yes, Dragonphiles, YOU!), crappy proofreading, or all of the above.


Here we have this sentence (from another neurologist no less) which defies all structural rules of the English language:




Or this:




You see all kinds of odd stuff:

 Some of which makes no sense whatsoever:

At times the salutation at the top isn't particularly flattering:

Lastly we have this doctor, who's apparently so embarrassed by his shitty notes that his name isn't even on them:


 

Thanks to all who sent these in!

Mary, call tomorrow's 3:30 and cancel him

A packet of records showed up on a new patient who has a pending appointment with me. It included this note from his previous neurologist:

"He's quite insistent on being allowed to get his drivers license back. When I refused to comply, he pulled out a gun and threatened me with it. Fortunately, his wife quickly took it from him and told me it wasn't loaded."

Weekend reruns: What does a neurologist do?

Every day a neurologist has to deal with many serious medical questions. Annie and I constantly exchange email concerning critical patient problems and other important issues.

Here, for example, is a conversation excerpt on a patient who called in for urgent medical advice.