Holiday update!

We interrupt this vacation to welcome 2 new characters to the pages of Dr. Grumpy:

Garlic and Onion!

 

 

 

These are a pair of 7 year-old brother-sister litter mates who have never been separated. Their previous owner was unable to keep them and took them to a rescue, and now they've joined us. We only went to look at one, but taking them both was part of the deal, and how could we resist?

We have no real idea what they are, besides totally awesome dogs.

Mello is doing fine with them.

Remember, if you're looking for a great family friend this holiday, contact a rescue or humane society near you.

Holiday treats

Craig decided to make cookies this weekend. They were a little, um, difficult, to get off the baking sheet:

Does anyone else think the broken spatula is giving me the finger?


And that's a wrap for 2016, gang. I'm shutting down for the holidays, and will be back in 3 weeks. See you on January 9th!

Thank you all for sticking with me, making comments, and keeping this fun for the last 8 years. Looking forward to 2017!

Dr. Grumpy's gift guide

With the end of the year coming, we all know what that means: hanging out with friends, eating enormous amounts of food, and watching football. Those bowl games are right around the corner.

Of course, these are your friends coming over, so you want the best for game day: Beer, chips, and uh, I guess more beer.

But are your friends the discerning type who insist on high quality? The kind of connoisseurs who prefer Keystone beer to Budweiser? The epicurean master foodies who, after 4-5 cans of shitty reasonably priced brews will know the difference between Tostitos, Doritos, and the generic store-brand?

If so, then you need to serve them something truly special!

For only $56 you can get a delectable box of St. Erik's chips, made by the Swedish brewery.

Yeah, I said $56 bucks.

Featuring ingredients like truffle seaweed, Ammarnäs potatoes, Matsutake mushrooms, crown dill, and Leksand onions, these are the chips that are guaranteed to turn your beer-swilling gathering of buddies into an Edwardian soirée that will be talked about for years.

In case I didn't mention it, what you see above is exactly what you get: each $56 box contains only 5 chips, one in each flavor.

Yep. You read that correctly.

So this works out to $11.20 per chip. Plan accordingly as to how many boxes you'll need.

Dr. Grumpy's gift guide

Home decor is such a personal issue. Taste is variable, and what one person likes may be hideous to another.

Fortunately, some things are universal. We all want a comfortable home, a nice hot shower, a decent meal, and, of course, a wall portrait of an older woman using an asthma inhaler:

What's that? Your friend's abode is sadly lacking in this respect? Well, now you know what to get them. For only $28 this lovely accent can be ordered from Amazon, and their life will be complete.

Dr. Grumpy's gift guide

Did a loved one pass this year, leaving you with an urn above the fireplace? That seems so trite. There has to be something better to aspire to for all eternity.

How about reincarnating them as a coffee mug?

"Auntie Em? Is that you?"

For only a few hundred bucks this place will convert the dearly departed into a serving bowl, or candle holder, or jewelry, or dinnerware... The possibilities are endless!

Think of the looks you'll get when you reach into a cabinet and say "I'm taking grandma out for coffee" (and laugh maniacally) or ask a guest "can you pass Aunt Zelda's mashed potatoes?"

No word on the site if they make dental implants or toilets, but it never hurts to ask.

Gift guide

Life is full of tough decisions, especially when you have $85 to blow. What should you spend it on?

Like most people, you're probably thinking "if only there was a decent rock in a leather half-pouch I can get for only $85, but I can't find one."

Fortunately, Nordstrom has heard your cries, and is now selling exactly that: a solid rock, found somewhere in the Los Angeles area, and lovingly sewn into a leather case.

 

"You're shitting me, right?"

Order it here. The possibilities are endless! You (or the lucky recipient) can use this $85-rock-in-a-half-leather-case as a paperweight, doorstop, or artistic commentary on sado-masochism's relationship to classical philosophy's effects on the fabric of human relationships.

And, best of all, when someone asks "What did you get for Christmakuh?" You can say...

Breaking news

Keeping you up to date on the world around you, we at the Grumpy Neurological Emporium news division strive to bring you the most important stories.



Dateline: Florida.

A car with 4 days of parking tickets all over the windshield was found to have a dead body inside, slumped over the steering wheel. The unfortunate man had apparently died of natural causes shortly after getting into his vehicle.

The city of Fort Lauderdale has kindly agreed to dismiss the accumulated parking fines due to "extenuating circumstances."



Dateline: Oregon


Craig Buckner, after being arrested on drug charges (he'd fallen asleep while waiting outside a courtroom on other charges and was drug tested - I swear)  was worried about his pet parrot's well-being. This is understandable, as the bird (imaginatively named "Bird") had been left outside the building in a tree.

Mr. Buckner was allowed to retrieve Bird the bird, but then Bird refused to be separated from him when they took the mugshot. After a few attempts officers decided to wing it, and snapped the picture anyway:

(Photo: Multnomah County Sheriff's Office via AP)

 
Dateline: Florida (again)

Unidentified burglars climbed over a backyard fence at night, hoping to break into a house. Due to them failing to scope out the area in advance, they landed on top of the owner's beehive, knocking it over.

The occupants were buzzing mad about beeing woken up, and chased away the evildoers.

Local hospitals have been asked to bee on the lookout for anyone coming in with an unusual number of stings.

Dr. Grumpy's gift guide

This time of year festive is everything. We all want to look festive, act festive, and be so sickeningly festive that total strangers will give us money to go away.

Of course, all this festivity comes to naught if your anus doesn't smell equally festive, too.

Fortunately, Tesco (the same company that brought you horsemeat burgers and bolognese sauce) is, for a limited time only, selling...

Mulled spice scented toilet paper!

Yes, now you can smell holiday-fresh EVERYWHERE (and I mean everywhere). But you better hurry, because this cosmetic necessity is only available until December 23.


BUT WAIT! THERE'S MORE! If having an invigoratingly holiday-smelling rectum isn't enough for you, you can now get mulled spice scented toilet bleach! Just in case Santa needs to use the john and puts his head below the rim to make sure you're on his nice list.

And (I SWEAR!) this toilet bleach is not only scented, but the site says it's safe for use by vegetarians and vegans.

Dr. Grumpy's gift guide

Nikolaos of Myra was born in 270 A.D. in the area now called Turkey.

And today I suspect a lot of seismic activity in the middle east is caused by him spinning rapidly in his grave. Because this is the man who, over roughly 1500 years, became Santa Claus in Western culture, appearing in shopping malls, used car lots, TV specials, Viagra commercials, movies, condom ads, and heaven knows what else.

I think Nikolaos would be pretty horrified by the whole spectacle of what he's become.

Even more horrifying, at least to me, are the Santa-themed business suits that are promoted as things you can wear to important meetings this time of year. I suppose this is a measure of job security. The only men likely to wear these outfits are the ones who know they can't be fired and those who want to be.

What am I talking about? Not the generic St. Nick suit that abounds on fat bearded guys working in department stores this time of year, but these hideous ensembles of jacket, slacks, and a tie:

"Hey, ladies, want to check out my sack?"

"The sneakers are for running, since this outfit is a chick magnet."

These are not, I must stress, pajamas. For PJ's they might be sort of cute. But no, someone designed and is selling them as standard business attire for this time of year.

So here's a perfect gift for the guy who... (let me get back to you on that). 

Longevity

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

Mrs. Time: "No, actually a lot of longevity. My mother would have lived to 100, I mean, if she'd made it another 24 years."

Here we go!

As we near the end of another trip around the sun, it's again time for the annual...

Dr. Grumpy's Gift Guide!


I'm going to kick off this year with something truly meaningful. After all, in cultures around the world, motherhood is revered.

So what would be an ideal gift for your growing child to always remember mom by? Something meaningful, lasting, powerful...

I know! What could be more appropriate than jewelry made from your very own breast milk?

Featuring an array of bracelets, rings, and pendants, you can now remind your child, or yourself, or the guy who knocked you up, of all the sacrifices you made for them during your "nursing journey" (that's what the site calls breastfeeding, I swear).

Cookies not included.

Heading out for the holiday

Back on Monday!

Have a good one, and try not to get killed in a Walmart Friday morning at 2:45 a.m. in a fight over the last "Fondle Me Elmo" doll.

Weekend reading

Trapped by the dropping temperatures and unexpected snow this weekend, I got caught up on some medical reading. I thought I'd share some of it with you:


The driving abilities of patients with Alzheimer's Disease worsen as the disease progresses. In addition, people with Alzheimer's Disease were more likely to have trouble with driving and other complex tasks than age-matched controls without cognitive problems (Journal of Alzheimer's Disease, May 11, 2016).


Patients who suffered a massive stroke requiring neurosurgical decompression, and survived the whole thing, were more likely to be dependent on others for long-term care than those who didn't make it (New England Journal of Medicine, September 7, 2016).

Beware of the Dragon

Seen in a chart:

Special

Tracy: "Hello?"

Annie: "Hi, this is Annie at Dr. Grumpy's office. I was trying to set up the MRI for you..."

Tracee: "What time should I be there?"

Annie: "Well, we were looking for old studies to do a comparison. They had a few past MRI's for someone with the same last name and birthday, but the first names were all slightly different."

Tracey: "Oh, they're all me."

Annie: "All you?"

Traysee: "Yeah, I like to spell it different whenever I feel like it."

Annie: "Okay..."

Tracie: "That way it's special."

Annie: "Indeed it is."

Roads

I was a neurology resident, doing a rotation at a large county hospital. Like most county hospitals, it served a predominantly indigent population.

I was in my 2nd year of residency, 3 years out from medical school and in my late 20's.

She was the same age. I'd been consulted because she couldn't afford her epilepsy medication and had a seizure. She was also pregnant with her 4th child. So she was in the OB ward of the county hospital.

I had a job, an apartment a few miles away, a 4-year-old car in the parking lot, and a girlfriend (now Mrs. Grumpy).

She was homeless. None of her kids had the same fathers. She bounced between different shelters and whichever guy would take her and her kids in for a few days.

I'd showered that morning. She and her kids smelled awful, and obviously hadn't bathed recently.

I was in a generic shirt, tie, and pants from Target, with the required white coat. She and her kids were in tattered clothes from a donation center.

As I talked to her, scribbling her history down on my note pad, I suddenly realized I knew her.

10 years earlier we'd been in the same year in high school. We took PE, economics, typing, social studies, and chemistry together. We weren't close friends, but knew each other and said "hi" in the halls and local stores when we crossed paths. I suddenly had a vivid memory of her running to third base when I hit a single in a softball game.

I didn't mention it, and if she recognized me she didn't say so. I don't think she did. Her chart was huge, and I was just another in an endless stream of residents she dealt with on her frequent admissions. I restarted her seizure med and folic acid and she was discharged later that day. I went to another rotation the next week and never saw her again.

To this day I think of her. We came from the same upper-middle class backgrounds. We went to high school in American suburbia. Her parents were as successful in their area as were mine. Not wealthy, but comfortable, with expectations for their kids of college and a job and self-sufficiency.

I wondered how she got there. In 10 years we'd landed in very different lives. Had she made bad choices? Drugs? Alcohol? Had she just encountered terrible shit luck that all of us dread happening to us? A marriage gone bad? Domestic violence? A financial catastrophe beyond her control? I remembered seeing her and her parents posing for a picture at graduation. Did they know where she'd landed?

Sometimes, while trying to sleep, I think of her sitting there. I wonder if she's still on the streets. If she got her shit together and was able to move out of poverty. If she's even still alive. I'll probably never know.

Maybe she did something stupid, the kind of thing where all of us living in comfort can say "that would never happen to me, I'd never do something like that." Or maybe the circumstances were entirely beyond her control, the kind of financial clusterfuck nightmare that all of us dread destroying everything we have and work for.

I'll never know the answer. But the encounter always reminds me how much of life can be terrifying random chance, no matter how much we'd like to believe otherwise.

Appreciation

Seen in a chart:

Saturday, 12:23 p.m.

 

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

Mr. Sativa: "Hi, um, you saw me for headaches last year, and referred me to a headache specialist, and I kind of have an emergency, and I can't reach him."

Dr. Grumpy: "Okay... What's up?"

Mr. Sativa: "Well, that doctor suggested marijuana, and it works fine, but this morning my dog Mojo ate it all, and now he's really sleepy. I mean, he's breathing, but I can't wake him up. What should I do?"

Dr. Grumpy: "I'd call your vet. I don't treat dogs."

Mr. Sativa: "Oh, I hadn't thought of that."

Dr. Grumpy: "Okay, good luck and..."

Mr. Sativa: "With a stoned dog, um, should I play music or something?"

(pause)

Dr. Grumpy: "I'd go with Dark Side of the Moon."

Mr. Sativa: "Cool! Thanks, doc. I'll call the vet now."

Helpful

Trying to figure out why a lady was coming to see me, I called the other doctor's office and asked them to fax over the most recent chart note.

This is all I got:

Memories...

"What should I call you for?"


This is a common question I get from nurses before I leave their station. They understandably want to know what things are important to me in a given patient's care. Exam changes, abnormal test results, medication problems, etc. I'm fine with answering them, too. It's part of treating someone.

In the early 90's I was an intern, covering the cardiology and general medicine floors. One evening I was meeting with the other interns at a nurses station, getting the nightly check-out. This consisted of them each handing me a crumpled sheet of paper listing patient summaries for me to refer to if called. The lists were folded into a big wad and crammed into my white coat pocket. As I stood up to go see someone in ER, a nurse came over and asked what I wanted to be called on. I absently mumbled "any concerning changes" and stepped into an elevator.

The night ticked on. Several admissions, some calls to discuss labs and medications, the usual smorgasbord of pages. Somewhere after midnight there was a break in the action, and I went to the call room to try and sleep.

I dozed for maybe an hour before the nurse I'd spoken to earlier paged me.


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

Nurse Smokey: "Hi, I'm calling you about Mr. Gomer, in room 564. Are you familiar with him?"

Intern Grumpy: "Hang on..." I switched on the light, grabbed the wad of papers out of my pocket (I still had my coat on) and began flipping through them for room 564.

Nurse Smokey: "No worries, I'll wait."

Intern Grumpy: "Okay, I have him. It says he was admitted for a heart attack 2 days ago, and is scheduled for an angiogram tomorrow."

Nurse Smokey: "Yes, but he has other issues. He also has a history of lung cancer, for which he had surgery and radiation 2 years ago. It recently recurred, and he's now on chemotherapy. There's also him having COPD from being a smoker, and last month he was here for a pulmonary embolism and is on heparin. He needs a left knee replacement, but that's on hold for now due to his other medical issues. Do you need a list of his medications and allergies?"

Intern Grumpy: "No, I have that here... What's going on with him that you're calling?"

Nurse Smokey: "He's on fire."

Intern Grumpy: "WHAT?!!!"

Nurse Smokey: "He's on fire. He's on oxygen, and apparently his wife snuck in some cigarettes and matches and..."


The phone fell to the floor. I ran out of the call room into the stairwell and dropped down 2 flights to the 5th floor. As I flew past the station, Nurse Smokey was still on the phone with my empty call room, calmly saying "Hello? Dr. Grumpy? Can you hear me?"

In room 564 I found Mr. Gomer, miraculously uninjured except for some minor burns and missing eyebrows. He was almost completely covered in ashes and fire extinguisher foam (which a terrified student nurse was still randomly spraying at anything that moved, including me). Another nurse was pulling off the charred oxygen mask and melted tubing, while a respiratory tech made sure all the oxygen valves to the room were closed.

This was a good reason to call the doctor, if not the fire department. Skipping his past medical history, under the circumstances, might have been a good idea, too.

Shantih. Shantih. Shantih.

Craig had to make a quiz for the younger Boy Scouts, and tested it out on his sister.

Since they aren't in the same literature classes, he didn't think her answer was funny.

But I did.

Sheeee's back!

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

Mrs. Sequel: "This is Mrs. Sequel, I need to make a follow-up appointment with Dr. Grumpy."

Mary: "Okay... Wait... it looks like you sent us a release 3 months ago, saying you'd decided to see a different neurologist because Dr. Grumpy didn't help you at all."

Mrs. Sequel: "Well, the other neurologist didn't help me, either. So I thought I'd give Dr. Grumpy another try."

Mary: "I'm sorry, once someone leaves the practice we don't let them come back. That's just office policy."

Mrs. Sequel: "Well, I never said I was leaving the practice, I just wanted to change doctors."

Mary: "You'll have to stay with that doctor, or find another. You can't come back here."

Mrs. Sequel: "I never saw another doctor. After I sent the release I changed my mind."

Mary: "But you just said the other doctor hadn't helped you!"

Mrs. Sequel: "I never said any such thing. You're imaging that."

Mary: "I'm sorry, but you'll have to seek care elsewhere."

Mrs. Sequel "Why, you have some nerve!"

click

Weekday update

During election season it's easy to forget that their are other major news stories going on. So, as a public service, I'm taking a break from medical blogging to update you on what's going on in the world.


DATELINE: MAINE

Police in Portland were called to investigate a traffic disturbance, namely one caused by a man dressed as a tree standing in the middle of the road.

CBS WGME

Mr. Tree (my colleague Officer Cynical identified him as a Dendriticus idioticus) was asked to stop obstructing traffic. When he refused to do so he was placed under arrest.

An unidentified friend of his told officers the green fellow was "studying traffic patterns." I suppose it's possible he was trying not to be seen.

I highly recommend the original story here. It features a video of Mr. Tree being arrested while officers try to figure out which branches to put the cuffs on.


DATELINE: FLORIDA

A 28-year old man was leaving the Dancer's Royale strip club. Friends noticed he was intoxicated and asked him not to drive home, but he refused.

He got into his truck and was heading out of the lot when he somehow fell out of the driver's seat onto the road, and was run over by his own vehicle. He then fled the scene but his identity was quickly discovered as he'd left his driver's license behind.

The truck continued on its way down the road before crashing into a nearby home.

WFTV9, Florida

An occupant of the home suffered non-life-threatening injuries.

Original story here.



DATELINE: WISCONSIN

Christina Ferguson, 32, was upset by a meeting of Donald Trump supporters that she passed and decided to, in the spirit of having a blood alcohol level of 0.218, vandalize their cars.

Unbeknownst to her, the meeting had nothing to do with Mr. Trump, but rather was a meeting of the local non-profit Tomorrow River Valley Conservation Club.

Armed with a family-size jar of low-sodium, creamy-style Jif peanut butter, Ms. Ferguson proceeded to smear the innocent TRVC club's cars with peanut butter, writing obscenities and drawing penises on them.

Ms. Ferguson initially denied involvement, but investigating officers noted she was holding a jar of peanut butter and "licking her fingers repeatedly" when they confronted her.

Chief deputy Dan Kontos told reporters, “Fortunately it wasn’t chunky peanut butter, so vehicles didn’t get scratched."

Story here.

Artisanal overload

Time to hit the mailbag for more bullshit "artisanal" crap you guys have sent in.



Here's an offer for an artisanal vacation to Portland, Oregon. I have no idea how an entire trip can be artisanal. Is the plane rustic? (that doesn't sound safe, does it?). Is the rental car handcrafted? (yes, by giant sheet-steel-bending robots). You also get to "blend your own tea." Hell, I can do that with a large mug and a Keurig - at home.

Sara Lee, the McD's of grocery store bread, now has:

Not to be outdone, a mass-produced frozen pizza crust is now, what else,

But why stop at grocery store pizza crust? If you make over 10 million tortillas a year around the globe, doesn't that qualify them as artisanal? And what's "artisan style" anyway? What a person would make if they were made of metal and could manufacture 3000 tortillas an hour?
 

 

Then there's this. Although the word "artisanal" isn't in here, it's like they were using a thesaurus to find any other cheesy phrase in its place. And over what? FISH. How do you "handcraft" a fish?

After a hard day handcrafting fish, you're probably going to want to blow off steam at the gym. And where better to go than...

Regardless of what they're making, even artisans need to invest money for retirement. And where better to do that than in an artisanal mutual fund?

Details

Seen in a hospital chart:

Drug rep

Rikki Foneysmile: "So, Dr. Grumpy, please remember Locraft for all your patients with Phingluie-Maglawnaf Syndrome."

Dr. Grumpy: "Okay. Where do I sign for samples?"

Rikki Foneysmile: "Right here, in the box on the lower left... Great! Here's 5 boxes, and some co-pay coupons..."

Dr. Grumpy: "Thank you. Have a great weekend."

Rikki Foneysmile; "You, too. By the way, I know what you're doing."

Dr. Grumpy: "Huh?"

Rikki Foneysmile: "I know what's really going on."

Dr. Grumpy: "With what?"

Rikki Foneysmile: "You're using my samples to start people on Locraft, then switching them to the generic form."

Dr. Grumpy: "I..."

Rikki Foneysmile: "I just want you to know that I know what you're doing."


She turned around and left.

Refills

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

Mrs. Pill: "I need a refill on my Plortchzap."

Annie: "Sure... Actually it looks like you should have 3 refills left on it."

Mrs. Pill: "That's what the bottle says, but I wasn't sure what 'three refills' meant."

Air time

Recently I went to a research meeting in another city.

The guy next to me was watching a movie on his iPad.

About halfway through the flight, he dug into his backpack and pulled out a bunch of yellow Splenda packets.

And proceeded to tear them open and pour the contents in his mouth, one by one.

"Thanks, but I brought my own lunch."

Never tried that

"It hurts like, um, doc, you know what it feels like when you're out hiking barefoot and you accidentally step on some rusty barbed wire somebody left lying around? You've done that?"

Pruf reeding

My reader Liz was doing some continuing education in ethics, when she saw this example of how a typo can change things:

Thank you, Liz!

Personalized medicine

Monday

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

Dr. Cowboy: "Hi, this is Dr. Cowboy down the street. I have a guy, a really great guy here. I'd like to set him up to see Dr. Grumpy. He has good insurance."

Mary: "Okay, how do you spell his name?"

Dr. Cowboy: "Shit, I have no idea. Let me call you back when I have the chart."


Wednesday:


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

Dr. Cowboy: "Hi, this is Dr. Cowboy again. I have a great guy here, I talked to you about him the other day. Anyway, I've got his name here, so I can set that up now. He has good insurance."

Mary: "Okay. What insurance is it? I just want to make sure it's one we take."

Dr. Cowboy: "Sure, I agree, it's... Shit, I don't have that here, just his name. It's one of the big companies, let me call you back when I have that in front of me."


Friday:


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

Dr. Cowboy: "Hi, this is Dr. Cowboy. I talked to you about this guy. He's a great guy, and his insurance, which is good insurance, is Major Illness, Inc."

Mary: "Great! We take that. And what day would he like to come in? We have openings on..."

Dr. Cowboy: "Shit, I'm not sure. I better ask him first. I'll call him later today and get back to you, or have him call you, and we'll get something set-up."



Monday (again):


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

Dr. Cowboy: "Hey, it's Dr. Cowboy. Okay, I spoke to him late of Friday, and he says he can come in on Tuesday or Wednesday, preferably in the..." (mumbling in background) "Really?"

Pause

Mary: "Hello?"

Dr. Cowboy: "Shit, never mind. My nurse just said he died over the weekend. He was a good guy, too. Had great insurance."

Weekend on call

Seen in a chart:

Rimshot

Dr. Grumpy: "How are you doing? That was a pretty bad concussion."

Mr. Cantu: "I'm not myself at all."

Dr. Grumpy: "What do you mean?"

Mr. Cantu: "I have to ask my wife for help with everything."

Mrs. Cantu: "If that's the main issue, then you've had a concussion since we got married."

Let's hear it!

Turing test

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

Voice: "Hello, I'm calling from Major Illness Insurance to verify your office information."

Mary: "Okay."

Voice: "Is this Dr. Grumpy's office?"

Mary: "Yes."

Voice: "And is this the correct phone number to call Dr. Grumpy at?"

Mary: "Yes."

Voice: "What is the correct number for your office?"

Mary: "Uh, this one. You just called me on it."

Voice: "Please verify."

Mary: "867-5309"

Voice: "Correct, thank you. Do the doctor and staff speak English?"

Mary: "Yes."

Voice: " Any other languages?"

Mary: "No."

Voice: "Does Dr. Grumpy see patients?"

Mary: "Of course."

Voice: "Is that yes or no?"

Mary: "Yes."

Voice: "What kind of doctor is Dr. Grumpy."

Mary: "He's a neurologist."

Voice: "Does he specialize in neurology?"

Mary: "Yes."

Voice: "Does he see neurology patients?"


This went on for another 10 minutes.

Relax

Seen in a chart:

The power of zero

To give you some background, Duchenne's Disease is a form of muscular dystrophy. I don't see it at all because there's an MDA clinic across the street from my office, so I refer cases there.

Anyway, last night I was doing an online study, and it asked me how many Duchenne's patients I've seen in the last year. I said zero.

So the next question...

Wait a minute...

Keep in mind that the Grumpy/Pissy Medical Emporium is on the 6th floor of our office building.


Mary: "If you could just fill out these forms... And let me copy your insurance card..."

Mrs. Parker: "Where's the restroom? I need to use that first."

Mary: "Sure. If you go back past the elevators it's on your right."

Mrs. Parker: "I didn't take the elevator."

Mary: "Oh, okay, then the bathroom is across the hall from the staircase."

Mrs. Parker: "I didn't take the stairs, either. I just walked here."

Mary: "Okay... then... uh..."

Mrs. Parker: "I'll go look for it, and be right back."

Spell check

Nortriptyline is an old antidepressant, now used primarily for pain and migraines.

I recently put it in a note, and the spell-check feature kept trying to change it:

I have no idea.

Laces

I get a fair number of emails from people asking me for advice on careers in medicine. I don't answer them often, because realistically I can't make those decisions for someone else. A career in this insane field, not to mention all its different branches, is a pretty personal choice.

A medical student, though, recently wrote and asked what one piece of advice I'd give anyone already in med school (besides "cut your losses and get the hell out"), so I thought about it.

Here it is:

Learn to tie shoes.

Yes, you read that correctly. That's my sage advice, for whatever it's worth, to all of you in training.

Now, I figure you already know how to tie your own shoes (although in the age of Velcro straps I could be wrong). What I'm talking about is tying someone elses shoes. This is a 180° reversed perspective of tying your own, and takes a little bit of getting used to, and not making them too tight.

During my 4th year of medical school I had a rotation where I was assigned to a family practice doc, just for his morning rounds at the hospital. I don't remember his name. He was in his mid-50's, and was always neatly dressed with a tan blazer. I'd meet him outside the doctor's lounge every morning and we'd see his hospital patients.

What always impressed me is how he knew his patients. Not just their medical stuff, but he'd often make comments like "she bakes the best sweet potato pie" or "he paints great landscapes." And his patients clearly adored him, too.

Anyway, the time we rounded was usually when breakfast was being brought around. Most docs I'd met would just ignore it, and have the food set aside until they were done talking to them.

But not this guy. He'd take the trays and help sit the patient up to have them. He'd ask what they liked in their coffee (though usually he already knew!). He'd open those little cardboard milk cartons (they can be tricky) and pour it in cups or on cereal. He peeled and cut up bananas for them.

And, if we happened to go in while they were getting ready to go home, he'd help them tie their shoes.

Although some may find this silly, I found it was a pretty important lesson. Letting your patients know you care about them goes beyond looking in ears and reviewing labs. It wasn't an act, this guy obviously just wanted to help them.

I typically don't round during meals, but I do tie shoes. Checking feet for atrophy, sensation, and reflexes are a big part of being a neurologist, so you end up with barefoot patients sitting on your exam table.

Younger people generally don't want help, but older people or those with physical limitations appreciate it. Helping them put on socks and tie their shoes may not seem like a lot... But it is. It's letting someone know you care about them, no matter how grody their toenails are.

Pro tip: always keep a shoe-horn handy.

No matter how far you go in medicine and life, never think that you're above helping another person put their shoes and socks on. You aren’t. And someday you may be in their position.

Ding!

 

Dr. Grumpy: "Okay, so at the last visit..."

Mrs. Bickerson: "Doc, what's with the box of clothes by your briefcase?"

Dr. Grumpy: "Oh, my kids cleaned out clothes that don't fit them anymore, so I'm dropping those off at the charity store on the way home."

Mrs. Bickerson: "That's a good idea. We have some old chairs I've been meaning to donate."

Mr. Bickerson: "No, we're not getting rid of them. I can use them. They just need to be re-done. Why can't we donate the old vacuum in the back closet?"

Mrs. Bickerson: "What do you mean? It still works."

Mr. Bickerson: "It's not like you ever use it. It's taking up space."

Mrs. Bickerson: "What, like one square foot in a room you never go in?"

Mr. Bickerson: "We don't need it."

Mrs. Bickerson: 'What about that fucking dune buggy you got on Craig's List that takes up the whole shed and that you've never driven? It's bigger than a tank."

Mr. Bickerson: "Really? How about the stupid exercise machine you don't use? Let's get rid of that."

Mrs. Bickerson: "Oh, it is SO on now. Let's talk about that collection of racing photos piled behind the couch..."

The calls

Actual message left on Mary's voicemail at 3:43 p.m. yesterday:


“Hi, I saw Dr. Grumpy about 10 years ago for something or another. Anyway, my wife may have had a stroke, or migraine, one of those things, this morning. I’d like him to order an MRI on her for today. We’re flying out tonight to Europe, so need it before then."

Futility

Monday afternoon, 4:35 p.m.


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

Ms. Daughter: "Hi, this is Mrs. Substantia's daughter, and her Parkinson's disease is really bad this afternoon!"

Annie: "What's going on?"

Ms. Daughter: "Her tremor is out of control! She's shaking everywhere, and can barely walk!"

Annie: "Has she missed any medication doses?"

Ms. Daughter: "No! She got her morning pills right on time!"

Annie: "What about her 2:00 p.m. afternoon pills?"

Ms. Daughter: "I haven't given her those yet. Should I?"

Holiday reruns

Here's this memory from 2010:


The twins (Craig and Marie) routinely beat the crap out of each other. This is such a normal occurrence at our house that we just ignore it unless at least one liter of blood is spilled.

So after I got home from work today, the phone rang.

Dr. Grumpy: "Hello?"

Mrs. Playground: "Is this the father of Marie Grumpy?"

Dr. Grumpy: "Yes."

Mrs. Playground: "I'm the playground supervisor at Wingnut Elementary School, and I have to notify you that Marie was involved in a playground fight today, with a boy at school."

Dr. Grumpy (glancing out the window at the twins gouging each others eyes out on the trampoline): "Is she in trouble?"

Mrs. Playground: "Yes, she has to miss recess tomorrow. She and the boy suffered some minor scrapes, so I need to notify the parents of both children."

Dr. Grumpy: "Okay, thank you."


I hung up the phone, looked at Mrs. Grumpy, and began counting. "5-4-3-2..." As soon as I got to "1", the phone rang. I bit my tongue, hard.


Dr. Grumpy: "Hello?"

Mrs. Playground: "Is this the father of Craig Grumpy?"

Dr. Grumpy: "Yes."

Mrs. Playground: "I'm the playground supervisor at Wingnut Elementary School, and I have to notify you that Craig was involved in a playground fight today, with a girl at school..."

Patient quote of the day

"Barfing is much worse than diarrhea, though I think the caveat depends on the exit velocity."

Differential

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

Dr. Hack: "Yeah, this is Mike Hack, I'm an internist on the east side, and I'm not happy about what you told my patient."

Dr. Grumpy: "The guy with Myasthenia Gravis?"

Dr. Hack: "Yeah. I'd told him he had a stroke, and you have the balls to tell him something else?"

Dr. Grumpy: "But... he didn't have a stroke. His MRI was normal."

Dr. Hack: "Look, he had slurred speech. Any idiot can look up slurred speech and find out that it can be caused be a stroke. Except, apparently, a neurologist."

Dr. Grumpy: "A lot of things besides stroke can cause slurred speech. His brain MRI was normal, his Myasthenia antibodies were elevated, and he responded to Mestinon."

Dr. Hack: "Yeah, whatever fancy bullshit testing you people use nowadays. I've never referred to you before, and I sure won't do it again."

Click

Gifts

On Friday a grateful patient brought in a little basket of goodies for the office.

Which included this tea bag:

Too tired to write

Why don't you guys post comments about insanity at your jobs?

Memories...

 

It was a cheap chicken pot pie. The frozen kind, that your mom makes you eat when you're growing up.

I was a college student, living in a small condo near BSU with 3 other guys, in the mid-1980's

The place was old, and (like most college-based condos) not in the best repair.

One night, I made the fateful decision to have a chicken pot pie for dinner (this is college, man, you eat what you can afford).

I put it in the oven (a real oven, we didn't have a microwave), turned it on, set the timer, and went back to my room to read. As I left the kitchen I heard a loud mechanical "clunk," though didn't think anything of it at the time. The dump was full of weird noises.

When I wandered back 30 minutes later, I discovered the oven had somehow activated its self-cleaning mode - meaning it locks the oven door and heats itself up to something on the Kelvin scale to incinerate anything inside. Including my dinner.

The whole condo at this point began smelling like a chicken pot pie. I turned off the oven, only to discover that it had broken. Even with the cleaning cycle stopped. The door was locked and couldn't be opened.

I walked over to McD's that night for dinner.

The chicken pie was now a fixture of the condo. There was no way to get the oven door open without tearing it apart. The landlord didn't really care about fixing it since the place was falling apart, and the 3 of us didn't have the money to fix it ourselves. So we left it there.

As the semester progressed the kitchen would occasionally develop a weird smell from the culture medium residing in the oven. When this happened (every few weeks) we'd turn the oven on for a while to bake the culture into oblivion for another month or so. We'd turn it off again when it began to smell like chicken & mold pot pie. For all I know the oven had become a primordial soup experiment, and some new life form was evolving.

When I moved out 6 months later the pie was still in there. For all I know it still is.

So, if you're a college student living in a run-down condo with a locked oven that smells like a chicken pot pie when turned on... I'm sorry.

Seen in a chart

- Thank you, B!

Friday reruns

Last week

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

Mrs. Freek: "Yeah, this is Ima Freek, I need to make a follow-up appointment with you. I saw Dr. Grumpy 8 years ago, and need to come back."

Mary: "Okay, hang on... You're not in our system. Are you sure you were here?"

Mrs. Freek: "Of course. I remember your lobby, with all the golf posters, and the golf clubs on the walls."

Mary: "Oh, that's not us. That's Dr. Darth down the street. Let me give you his number."

Mrs. Freek: "No, that's okay, I'm fine seeing a different doc. Can I come in next week?"

Mary: "Sure. Tuesday at 3:00. See you then."



This week


Mrs. Freek: "Hi, I'm here for my appointment. What happened to your lobby?"

Mary: "Nothing. It's been this way for years."

Mrs. Freek: "What did you guys do with all the golf stuff?"

Mary: "We never had that. I told you, that's Dr. Darth down the street."

Mrs. Freek: "Wait a minute... You mean the golf-club doctor isn't here?"

Mary: "No. I told you that on the phone. You said you wanted to come in, anyway."

Mrs. Freek: "I can't believe you misrepresent yourself as part of another office!"

Mary: "Ma'am, I explained that..."

Mrs. Freek: "I'm leaving! This is criminal!"

(storms out, comes back a minute later)

Mrs. Freek: "Hey, I left my cell phone at home. Can you call Dr. Darth to see if he has an opening this afternoon?"

Pinocchio

One of my patients was at the lab to have her blood drawn, and the lab called me to say that she could barely walk and kept falling. I had them send her to ER, and then went to see her.


Dr. Grumpy: "Your head CT was okay, but the seizure medication blood level was WAY too high. Have you been taking it correctly?"

Mrs. Ataxia: "Um... Well, this morning I took a triple dose."

Dr. Grumpy: "Why on Earth did you do that?"

Mrs. Ataxia: "Because I was going to get my blood level drawn, and didn't want you to think I hadn't been taking it."

Dr. Grumpy: "Had you been taking it?"

Mrs. Ataxia: "Yes."

Dr. Grumpy: "Really?"

Mrs. Ataxia: "Uh... maybe... here and there."

Dr. Grumpy: "Overdoing it just before you get the labs drawn won't make up for that."

Mrs. Ataxia: "Sometimes it works at the dentist's."

Skool Nerse Time

Another exciting school year will be starting soon, and somehow I got sucked into becoming a band booster. This thrilling job involves me handling questions from other parents about band, upcoming band camp, musical instrument rentals, over-the-counter medications, do you know a good plumber, next week's weather forecast, and why are you calling me because the judge said it's my ex who has to pay for this stuff.

In a week of calls, this one was my favorite:


My iPhone rings.

Nurse Grumpy: "Hello, this is band booster Grumpy."

Mrs. Clueless: "I just found out my daughter, Marsha, has to bring her musical instrument to band camp?"

Nurse Grumpy: "Uh, that's correct."

Mrs. Clueless: "Why didn't anyone tell me this? You need to make these things clear!"

Nurse Grumpy: "Well, it is band camp."

Mrs. Clueless: "On that whole list of things to bring to camp, no where did it say 'musical instrument.' "

Nurse Grumpy: "She does need to bring it."

Mrs. Clueless: "What kind of instrument should she bring, anyway?"

Nurse Grumpy: "Um, whatever she plays. What does she play?"

Mrs. Clueless: "YOU'RE THE BAND BOOSTER! Isn't it your job to know that?"

Nurse Grumpy: "Okay... so you don't know what Marsha plays?"

Mrs. Clueless: "It's something she blows in. Where can I get one of those?"

Nurse Grumpy: "That covers a lot... What does it look like?"

Mrs. Clueless: "I don't know. It makes a lot of noise, so she has to practice with her door closed. I've never seen it. Can I rent one?"

Nurse Grumpy: "You don't have one?"

Mrs. Clueless: "Well, she has the screechy thing in her room. You mean I have get another one for her to take to band camp?"

Nurse Grumpy: "No. She can take the one she already has."

Mrs. Clueless: "Doesn't make that clear, either. This info sheet is useless."

Nurse Grumpy: "Just have her bring the instrument, whatever it is, that she has at home, to band camp."

Mrs. Clueless: "You people are really disorganized and unhelpful."

Fone Fun

The home phone rings.


Dr. Grumpy: “Hello?”

Accent Guy: “Hello, I am calling from Bank of Grumpyville technical support, and I need some information about…”

Dr. Grumpy: “I didn’t call technical support.”

Accent Guy: “Well, I am returning a call about a trouble ticket. I need your BofG…”

Dr. Grumpy: “Nurse Grumpy, did you call BofG technical support?”

Nurse Grumpy: “No.”

Dr. Grumpy: “Sorry, you must have a wrong number.”

Accent Guy: “Well, what we do is Windows technical support, so I guess there’s an issue with your Windows log-in for BofG. Can I have your computer…”

Dr. Grumpy: “No one here uses Windows.”

Accent Guy: “I’m sorry, did I say Windows? I meant it’s a Mac issue and I need your…”

 
As much as I felt like stringing him on for fun, I hung up.

Seen in a chart

"Are you shitting me?"

Thank you, ERM!

Another fun weekend

With all respect to Bob Seger.


On the long and lonesome highway
To the hospital
You can listen to your iPhone
Ringing with another call
You think about the differential
Of the case you saw the night before

But your thoughts will soon be wandering
The way they always do
When you've been awake for 27 hours
With consults still left to do
And you're sick of swilling coffee
You just wish the call was through

Here I am
Out on call again
There I am
On a rounding rampage
Here I go
Playin' doc again
There I go
Return the page

When you walk into the doctor's lounge
Strung out from Diet Coke
And the only food that's left in there
Is just a friggin' joke
So you take a half-eaten, stale, bagel
And try hard not to choke

They call to check the orders
"Hi, doctor this is Jan
In your note on Mr. Stroke
Did you want an MRI or CT scan?"
And at 2:00 a.m. you're there
Eating popcorn from a bedpan

Here I am
Out on call again
There I am
On a rounding rampage
Here I go
Playin' doc again
There I go
Return the page

Racing through the ER
The CT is 2 more halls away
And you've only got an hour left
To start the tPA
As the sweat pours out your body
"Please don't hemorrhage," you pray.

Later in the evening
As you lie awake in bed
With your cell phone like a live grenade
Lyin' near your head
You take another ER call
About a guy whose brain has bled

Here I am
Out on call again
There I am
Trapped in its cage
Here I go
Playin' doc again
There I go
Return the page.

Seen in a chart