Patient quote of the day

"I understand, but I don't understand. Do you understand?"

Mary's desk, March 27, 2013

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

Mrs. Khwarizmi: "Yeah, I'm driving all over, and can't find your office."

Mary: "Okay, we're in Medical Office Tower 6."

Mrs. Khwarizmi: "Yes! That's where I am! But there isn't one marked 6!"

Mary: "We're the building farthest to the east. There's a sign in front that says 'MOT 6'."

Mrs. Khwarizmi: "I must be in the wrong place. The only sign I see just says 'motvi'."

Mary: "Motvi? Wait... Okay, you ARE in the right place. The 'MOT' sign uses Roman numerals."

Mrs. Khwarizmi: "Roman numerals? Damnit, doesn't anyone speak English anymore?"

WTF?

Doing a survey last night, one allegedly for neurologists, and this question came up:

Beyond shingles I really had no comment.

Memories...

My former call partner, Dr. Darth, had an office manager (Suzee). He eventually fired her and promoted his secretary (Floozee, who he was banging on the side) to office manager.

So when Suzee needed to see a neurologist a few months later, she made an appointment with me.

Unfortunately, she came in on a week when Dr. Darth was out of town, and I was covering for him.

So as Suzee sat in my lobby, leafing through "So You're Trapped in a Doctor's Waiting Room" magazine, Floozee came in with a bunch of MRI reports for me to review in Dr. Darth's absence.

The magazine and MRI reports were quickly forgotten.

They both had pepper spray. Mary had to call hospital security to get them out before anyone got hurt.

Perseveration

Mrs. Map: "Sorry I'm late, I had trouble finding your office. My iPhone gave me weird directions."

Dr. Grumpy: "That's okay. What bring you in to see me?"

Mrs. Map: "Well I..."

Siri: "Please turn right on 24th street, then continue west."

Dr. Grumpy: "Was that your phone?"

Mrs. Map: "Um, yeah, I guess she's still trying to get me to your office."

Siri: "Please turn right on 24th street, then continue west."

Dr. Grumpy: "Siri! She found it!"

Mrs. Map: "I don't know how to turn it off."

Siri: "Please turn right on 24th street, then continue west."

I reached over and turned off the phone.

Mrs. Map: "Wow! That bitch drives me nuts!"

Weekend reruns

It's been 3 years since I ran this post. And I still believe every word.


Nurses...

Are AWESOME.

I'm a doctor. We get all the glory. And credit. And guess what? We only deserve part of it.

I started out in medicine in the mid-80's, volunteering at an ER. And the biggest shock to me was learning how much of what happens in a hospital is nurse territory. Us doctors will see you from 5-30 minutes a day (30 is A LOT), depending on how sick you are. And the rest is the nurses.

They come in all shapes, colors, and sexes. Yes, there are a few idiots out there, that I take shots at in this blog. And there are idiot doctors, too. Idiots are in all fields, but the majority of nurses are damn good.

They're the ones making sure you get your pills, checking that your vital signs aren't dropping (and doing what they can to save your ass initially if they are, of which calling a doctor is only one part). They make sure you don't fall down and break something. If you start barfing, us doctors will run out of the room and the nurses will rush in. They change your wound dressings and start your IV line. They'll bring you a warm blanket. And clean disgusting things off you. Even if you're drunk. Or delerious. Or mean. And through all of this they try be friendly and positive. Even though you aren't their only sick patient.

I respect nurses A LOT. I learned early on that they're key to being a good doctor. You piss off the nursing staff, and you'll have a miserable career at that hospital. Respect and treat them well, and you'll never regret it. They're as important to being a good doctor as your medical degree. Maybe more.

If you come out of medical school with a chip on your shoulder against nurses, you better lose it fast. Because they will make or break your training, and often know more than you do. Be nice and they'll teach you. A good neuro nurse is often a better inpatient neurologist than some doctors I've met.

I remember a guy named Steve, who was an intern with me a long time ago. He had his head up his ass about being a doctor, and saw nurses as lesser scum. We were only a few months out of med school, and as we were writing chart notes one morning a nurse came over and asked if he'd go listen to his patient's heart. With icy contempt, and not even looking up from the chart, he said "I don't have to listen to his heart, because I looked at his EKG." They ain't the same thing, dude. If he'd listened he might have noticed that the patient had developed a loud murmer in the last 24 hours. When the attending caught it a few hours later, Steve got his ass chewed out. If he'd taken the nurse's advice, and listened, he wouldn't have gotten reprimanded by the residency board.

I talk about my Bible a great deal in this blog. Here's a quote from it: "Working with a good nurse is one of the great joys of being a doctor. I cannot understand physicians who adopt an adversarial relationship with nurses. They are depriving themselves of an education in hospital wisdom."

Those doctors are also depriving themselves of friends. On a shitty day on call, sometimes all it takes is a sympathetic nurse to temporarily add you to her patient list, steal you a Diet Coke from the fridge, and let you cry on her shoulder for 5 minutes. It doesn't make the day any less busy, but helps you absorb the punishment better.

What got me started on this?

While I was rounding this weekend, a grateful patient's family brought the ICU nurses a box of donuts, and so the staff was picking through them. One said "Oh, this kind is my favorite, it has cream filling."

And some pig in one of the rooms yelled "Hey, babe, I got my own kind of cream-filled dessert in here! Come have a taste!"

You say that to a waitress, and you'd likely get your ass kicked out of the restaurant.

You say that to a co-worker, and you'd be fired and/or sued for harassment.

You say that to a lady in a bar, and you'll likely get a black eye.

And what did the nurse do? In spite of the fact that the guy was obviously a detestable jackass, she went in his room, turned off his beeping IV pump, and calmly told him that he would not talk to her that way.

And I admire the hell out of that.

Nursing is a damn tough job. And the people who do it are tougher. And somehow still remain saints.

While this post isn't about them, there are a lot of other unsung heroes who are part of the hospital team- pharmacists, social workers, nursing assistants, EMT's, respiratory therapists, X-ray techs, lab techs, physical/occupational/speech therapists, housekeeping staff. And many more.

Hospital rounds, Thursday night, 7:10 p.m.

Dr. Grumpy: "What were you doing just before you blacked out?"

Mrs. Climax: "Having a MAJOR orgasm."

Reasons Mary drinks

Lady walks into office, signs in

Mary: "Hi... ma'am, your appointment was yesterday. We have you marked down as a no-show."

Mrs. Hansen: "I'm sorry, I had a family emergency. Can't you just see me today?"

Mary: "No, we're completely booked up."

Mrs. Hansen: "But I had an emergency!"

Mary: "I understand, that can happen. We can see you this Friday at 1:00 or..."

Mrs. Hansen: "Why are you doing this to me?"

Mary: "Excuse me?"

Mrs. Hansen: "I don't appreciate that you're treating me like a leper."

Mary: "Ma'am, I'm not..."

Mrs. Hansen: "This is so unfair! I had an emergency that wasn't my fault, and for that you're punishing me."

(pause)

Mary: "Do you want the appointment on Friday afternoon or not?"

Mrs. Hansen (scrolls through phone): "No, I'm meeting a friend at the casino."

Advice for grads (new and old)

A few years ago I signed up for an account with one of those "suggest-a-doctor" sites as a way to get business.

Shortly afterwards I began getting emails that "a patient has sent you an appointment request." Figuring it was a prospective patient, I checked them. My plan was that I'd forward the info to Mary to call and schedule them.

To my horror (I guess I'm naive) people who used the site had absolutely no interest in actually coming to the office. They just wanted medical questions answered online. For free (of course).

Examples of typical questions I received included:


"I've been dizzy on and off for years. I've had lots of tests and seen many doctors, but none of them can find the cause. Can you tell me what's wrong?"

"I can't afford my medications. Can you please put samples with my name on them out in your front office? 3 months worth would be good."

"I don't have time to go to a surgeon, so can you tell me if I need back surgery? MRI images attached."

"I live in Farfaraway, but am willing to travel to Grumpyville if you can cure me. I'll do this only if you offer a money-back guarantee, and cover my plane fare."

"I think my husband is more sick from taking his pills than he is without them, but he will only stop if a doctor tells him too. Can you call him and tell him to stop?"


NONE of these people were established patients of mine. As best I can tell, of the 200+ messages I received over time, fewer than 5% were within 100 miles of my office. Some were from overseas.

Besides the obvious money issues here (I have a family to support. I am not free.) is the legal one. This basically amounts to treating a patient without actually seeing or examining them. I worry enough about getting sued by patients that I do see, and don't want to add ones I don't to the list.

I finally deleted the account last year.

So here's today's advice from Dr. Grumpy: Don't even bother with these sites. Unless the idea of practicing free, legally dangerous, medicine appeals to you.

Ouch

My 2:00 patient had a large, straight, red mark on her forehead.

Mrs. Amana: "Sorry I'm a little late. I burned my forehead."

Dr. Grumpy: "I see that. What happened?"

Mrs. Amana: "Well, I was ironing some shirts, and needed to do my hair. So to save time I put my head on the ironing board, and started doing my hair, too. Then my phone rang, and I turned my head to answer it and..."

Why do I bother?

Dr. Test is down the street from me. He sends me infrequent referrals.

I consistently send him notes about visits, listing what, if any, tests I'm ordering. Within an hour of one being faxed I always get a return fax from his office, listing the tests that I just said I'm ordering, and asking me to send the results to him when they become available.

I don't know why, but I find this thoroughly irritating. I'm actually quite obsessive about sending letters and tests to referring physicians, and after years of doing so it annoys me that this one still asks. Of course, there's also the (likely) possibility that the letters go to a trained chimpanzee who reads the last paragraph, fills out the results-request form, and faxes it back without the doctor ever seeing it.

Last week, on a quiet morning due to some last-minute cancellations, I sent his office a fax on a non-existent patient saying I was ordering a "serum profactor 7-CoA." To the best of my knowledge there is no such test.

Within 15 minutes we got a note back saying "Mr. Non Existent isn't a patient in our practice. Please send us a copy of his serum profactor 7-CoA result as soon as it becomes available."

I amuse myself.

Patient quote of the day

"I'm looking through a fishbowl, but without fish. This is because my left toenails are all pale, which explains my neck problems."

(no, folks, the patient doesn't have a left cortical lesion. Or dementia)

Mary's Desk, March, 2013

Guy comes in, stands at counter, obviously angry.

Mary: "Can I help you, sir?"

Angry Guy: "Yes! I demand to speak to the doctor!"

Mary: "Okay, he's with a patient right now. What is this about?"

Angry Guy: "My wife saw him yesterday, and she says he told her she was fat!"

Mary: "WHAT? Sir, I've worked for Dr. Grumpy for 10 years, and he's never said anything like that to a patient."

Angry Guy: "Are you calling my wife a liar?"

Mary: "No, but I know Dr. Grumpy, and he isn't like that!"

Angry Guy: "Well, you're wrong! She even brought his card home!" (waves card in air)

Mary: "Uh, that card is for Dr. Frazzle. He's the neurologist down on the 2nd floor."

Long pause

Mr. Angry: "Well, all you neurologists are the same, and your doctor should still know better!"

(storms out, slams door)

Deja Vu

Filling out an insurance company's drug authorization form yesterday, I discovered this:

History rerun

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.

Sunday afternoon

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

Dr. Hospital: "Yeah, I need you to re-consult on Joe deMentia, who you saw last week."

Dr. Grumpy: "The guy with Alzheimer's disease? What's up?"

Dr. Hospital: "He has memory problems."

Dr. Grumpy: "Correct. I diagnosed him with Alzheimer's disease."

Dr. Hospital: "Well, he still has it. Can you come back and do something about it?"

"I've been through my MacBook on a drive with..."

Great radiology reports

From a thoracic spine MRI:

"Degenerative changes are seen at T3, T4, and TSH."

Mary's desk

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

Mrs. Crabby: "I need to make an appointment to see the doctor."

Mary: "Have you been here before?"

Mrs. Crabby: "No."

Mary: "Okay, so you'll be a new patient. We can see you on Thursday at..."

Mrs. Crabby: "No, I'm not a new patient."

Mary: "But you just said..."

Mrs. Crabby: "I've already seen another neurologist, and didn't like her. I just want someone else to tell me what they think."

Mary: "Yes, but if you've never seen Dr. Grumpy before, he'll need to take a history, and review tests you've had, and examine you."

Mrs. Crabby: "The other neurologist did all that. He can just read her notes, and decide. It won't take him more than 5 minutes."

Mary: "Ma'am, if you've never been here before he needs to take his own history and all."

Mrs. Crabby: "That's ridiculous. He can have 10 minutes of my time, no more. I'm very busy."

Mary: "I can ask him, but I'm pretty sure he'll say no."

Mrs. Crabby: "Don't bother. I'll find someone who can accommodate me."

Click

And I feel fine

Unless you lived under a rock, you were probably aware the world was supposed to end twice in 2011 (May 21, then October 21, per Harold Camping) and once in 2012 (December 21, per Mayan "scholars"). Exactly why they're so fond of the 21st remains one of those mysteries (I'm assuming because it's 1/2 of 42).

This is nothing new. Since the beginning of time, people have predicted the end of the world, thus far without success. The number of failed predictions is huge, and too long to list. People hoping for an apocalypse make Cubs fans look pessimistic.

William Miller (1782-1849) was another unsuccessful doomsday seer at 0-3. An American preacher, he initially predicted the world would end between March 21, 1843 and March 21, 1844 (again with the 21st!).

When the second date passed without incident he re-scheduled the apocalypse to April 18, 1844. Then, after nothing happened, postponed it to October 22, 1844. The last failed prediction so rocked his church that it became known as "The Great Disappointment" (why they were disappointed is beyond me).

Miller himself felt the errors were from incorrect translation of the Bible's chronology. He believed the end of the world was imminent, and continued to do so until it ended for him in December, 1849 at age 67.

There have been, and will continue to be, many others.

Now I, Dr. Grumpy, will tell you how, and roughly when, the world will end.

As the sun converts hydrogen to helium, it's luminosity will slowly increase over time. The rise in solar radiation will reach a critical point somewhere between 500 and 900 million years from now, reducing the carbon dioxide in Earth's atmosphere below the level at which plants can survive. As the plants die out, the amount of oxygen in the atmosphere will decrease, and all animals will be lost, too.

About 1 billion years after all life is gone, the surface temperature will increase to where liquid water can no longer exist, and the oceans will gradually vaporize into the atmosphere. Some will also collapse into the planet's mantle, due to venting of the mid-ocean geologic ridges.

What's left of the Earth, which will likely be similar to our neighbor Venus, will continue to orbit for another 3-4 billion years. At that point the Sun will reach the red giant stage of its life, and start to expand. Its increased size will take it beyond the orbits of Mercury and Venus, incinerating them.

The now widely-expanded solar atmosphere will gradually pull the Earth's orbit inward, until it too becomes ashes scattered through the outer layers of an aging star.

Eventually the Sun will throw off the outer layers, becoming a planetary nebula with a white dwarf star at the center.

The ejected layers will travel through space for another few billion years, eventually being taken up by a cloud of dust that's slowly condensing into a new solar system - just as ours formed 5 billion years ago - and again become part of a new star and its planets. Just as we're made of the base parts of a long dead solar system, so we will become another.

And that's how the world will end. And begin, again

My dogs couldn't care less about the end of the world. And I will take that cue from them.

The heat is on

You've just driven your Pontiac through the side of somebody's trailer home.

Now, the cops are after you.

To make matters worse, you aren't wearing shoes or (for unclear reasons) pants.

You also have a suspended driver's license.

And (of course) you're drunk.

There's only one thing to do: Steal the nearest vehicle from its owner and try to escape.

More great survey moments

Yeah, I'd have to agree the answer can "affect your relationship" with someone.

"Survey at Bernie's"

Thank you, Laurie!

Sales call

Dr. Grumpy: "All right, I'd like you to try this medication" (hands over script) "and I'll see you back in a month to see how it works."

Mr. Pulp: (waves script) "Doc, you call this paper? Let me give you my card. My printing company can give you real quality paper for your script pad, not this cheap crap."

1980's PSA, remade at my house

THIS IS MY DOG

THIS IS MY DOG, ON A HOT TUB

ANY QUESTIONS?

I think they're trying to tell me something