That wraps it up

Shutting down for the next 3 weeks. See you in 2020!

For those who didn't see it

Toxic

Phone rings.

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

Mrs. Latrodectus: "Hello, I need to make an appointment with Dr. Grumpy."

Mary: "Let me put you on hold for a sec, I'm scheduling another patient right now."


Mary finishes scheduling the other patient in < 1 minute, goes back to Mrs. Lactrodectus, finds she hung up.

Phone rings.


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

Mrs. Latrodectus: "How DARE you put me on hold. I'm a VERY busy woman!"

Mary: "Sorry, but there's always a lot going on here. Okay... We have an opening next Wednesday afternoon... what are you going to be seeing Dr. Grumpy for?"

Mrs. Latrodectus: "Excuse me? Are you the doctor?"

Mary: "No, I'm his secretary."

Mrs. Latrodectus: "Well, I don't have to tell underlings why I'm coming in. Unless he's willing to get on the phone right now, I have no plans to discuss this on this call."

Mary: "The only reason I ask is because there are several disorders he doesn't handle, and so I don't want to waste your time, or his, if you come in and he doesn't see your condition."

Mrs. Latrodectus: "I'm a very busy woman and don't have time for this nonsense. Why don't you just tell me all the things he doesn't treat and I'll decide if this is worthwhile."

Mary: "I'm not going to do that. Do you want to make an appointment or not?"

Mrs. Lactrodectus: "You have some nerve!"

Click.

Seen in a chart

Day at the Races

Early last Friday morning Mr. Party, a heavy-drinking patient of Dr. Smith (an internist downstairs in my building) wasn't feeling well. He'd quit drinking 2 days before, and decided to go to his doctor's office and wait for it to open.

While standing in the hall, Mr. Party was passed by a drug rep (yes, this one) coming to bring breakfast to me and Pissy's office. She markets anti-seizure medications, and her company has been promoting a campaign to make its reps more aware of the special needs of epilepsy patients.

Anyway, just as she was walking by Mr. Party, he suddenly collapsed and had a generalized seizure, wetting himself and lacerating his forehead on the doorknob as he fell. She then showed her newfound awareness of the special needs of seizure patients by running screaming through the building yelling "Help! Someone call 911!" repeatedly. The whole time she had a cell phone in her hand (Richard Dreyfuss did something similar in "Down & Out in Beverly Hills" for those who remember the flick).

Her meeting with me forgotten, she ran out to her car and decided to, um, I'm really not sure. As she was getting into it she suddenly realized she had a phone in her hand and called 911 herself. She then sat there for 15 minutes, trying to work up the courage to go back and look for her sample case and the tray of bagels she'd dropped in the excitement.

In the meantime, Dr. Smith had arrived at work to be greeted by one of his patients lying unconscious in a pool of blood and urine in front of his office door. At about the same time the police, firemen, and paramedics all arrived. They'd been summoned by the somewhat nonspecific nature of people in the building calling 911 when they heard the rep yelling, but not knowing what was going on.

Mr. Party was admitted to the hospital and is suspected of having had an alcohol-withdrawal seizure.

Dr. Smith waited until they loaded Mr. Party into the ambulance, then called building maintenance to shampoo the carpet in front of his office.

The drug rep found her sample case and bagels, and rescheduled her meeting with Pissy and I to later in the morning. During it she mentioned that she's considering a career change.

Midnight. Not a sound from the pavement.

Dr. Grumpy: "So that was 2 weeks ago that you were in the hospital... How have you been doing?"

Mr. Percheron: "I'm fine, I mean, I don't remember much about that day, but everything else has come back. What was that called?"

Dr. Grumpy: "Transient Global Amnesia. It's uncommon, and fortunately generally benign. You'll probably never remember the day it happened, but that's not a big deal."

Mr. Percheron: "Maybe you can help me with this?" (hands me a folded paper).

Dr. Grumpy: "What is it?"

Mr. Percheron: "It's from the hospital. They sent me a satisfaction questionnaire about my stay. But I don't remember anything about it."

"That's not my specialty."

Seen in a chart:

Research

I think we'd all agree that going through alcohol withdrawal is a bad thing.

I think even more of us would say that having a stroke is also pretty serious.

So you definitely don't want to do BOTH at the same time.

Of course, someone had to actually study this. So they did.

In a landmark piece of research, it was discovered that people who have a stroke AND go through alcohol withdrawal during their admission have more complications, poorer outcomes, and tend to be in the hospital longer than stroke patients who don't withdraw and see pink elephants.

Really.

This creates an all new research path: think of other conditions that are worsened by alcohol withdrawal. It's just like Mad Libs! Write a series of articles where you fill in the blank:

“Alcohol withdrawal is associated with worsened outcomes in  _______.”

If you play your cards right, this kind of research could get you an academic appointment! Let me throw out some suggestions, and you guys can take it from there:


"heart attacks"

"life"

"karaoke"


Have fun! And keep me in mind when you become chairman!


Thank you, SMOD!

"Play with me, kids"

There's a pediatrics office down the hall from me. Yesterday a letter for them accidentally ended up at my place, so I took it over there. I noticed this on the waiting room toy shelf:

Adulting

11:45 at night. My cell phone rings, waking me from sleep.

It’s Craig.

Dr. Grumpy : “This is doctor. … I mean, hi, Craig. You okay?”

(loud noise, someone yelling in background)

Craig: “Hi, Dad. Hey, how do I put out a fire in a microwave?"

I’m suddenly REALLY AWAKE.

(loud crash)

Craig: “Never mind, my roommate put it out.”

Voice in background: “What a mess, I'm going to get some towels."

Dr. Grumpy: “What’s going on?”

Craig: “Oh, nothing big, I guess. Hey, what’s a good way to get smoke out of a dorm room?”

Dr. Grumpy “Open the door and all the windows and put that fan you have in one of them.”

Craig: “Hang on… Okay, where’d I put the fan… guess that outlet isn’t going to work anymore, I’ll call maintenance in the morning.”

Dr. Grumpy: “Craig, what’s going on?”

Craig: “We were just making cookies, it’s fine now. I mean, it will be when the smoke is gone. Hey, can you order me a new microwave ramen dish thing from Amazon or something?”

Dr. Grumpy: “Why do you need a new one?”

Craig: “The other one is, um, kind of melted. I don’t think I can use it again.” (voice in background says something) “can you toss me some towels? Thanks. Sorry, Dad, there’s water everywhere. We had to throw a few buckets of water inside the microwave. (voice in background says something) I don’t think we can eat it, with the plastic melted into it on that side.”

Dr. Grumpy: “What…”

Craig: “Hand me the bag, I’ll just toss the ramen thing in there. OW! SHIT! IT’S HOT! SHIT! Hey, Dad, I think I burned my hand.”

Dr. Grumpy: “Put ice on it.”

Craig: “Will a cold Diet Coke can be okay?”

Dr. Grumpy: “If it’s all you have.”

Craig: “Okay.”

Dr. Grumpy: “Craig, What’s going on?”

Craig: “Oh, … We were just trying to make cookies. My roommate and I felt like cookies, so we bought a tub of cookie dough at the store.”

Dr. Grumpy: "You were making them in a microwave ramen dish?”

Craig: “It’s all we had, so we filled it up with dough, more like a cookie cake, I guess, figuring that way we’d be able to cook it all at once."

Dr. Grumpy: “Didn't the dough's microwave directions give you a time?”

Craig: “The tub didn’t have microwave directions, just regular oven, so we used those, but i guess that was too long. The cookie cake exploded and the bottom of the ramen pan melted and was smoking, then caught fire. My roommate tried to smother it with some paper towels, but then they caught fire, too."

Dr. Grumpy: “I wouldn’t…”

Craig: “Some guy on YouTube said it would bake them, but it didn’t. Hey, how long will it take all the smoke to clear from my room? I want to go to bed.”

Dr. Grumpy: “So go to bed.”

Craig: “I don't want to go to bed and leave all the doors and windows open, someone might steal my stuff.”

Dr. Grumpy: “Maybe a few hours.”

Craig: “Oh, good. I thought it might be days."

Taking a break

Gang, due to a great deal of insanity I'm going to take a few weeks off from the blog. Hoping to be back on November 18, 2019.

All is fine, but I need to decrease the things I'm juggling for a short time.

See you then!

I'll tell you where you can put your shoe

Here's another great computer chart system. When you order a shoe for someone who just had foot surgery, it gives you a list to pick where the shoe should be worn:

Thank you, J!

"I should do WHAT with it?"

Casa De Mentia

Jack is a nice guy, unfortunately now progressing through Alzheimer's disease. Although his cognition is shot, his baseline friendly personality has stayed with him. He's always accompanied by his doting daughter, Susan, and yesterday there was a guy with them I hadn't previously met.


Dr. Grumpy: "Hi Jack, hey Susan. Have a seat. Hi, sir. I don't think we've met. Are you Jack's son?"

Guy: "No, I'm, uh, actually a tax auditor."

Dr. Grumpy: "A tax auditor?"

Susan: "Yes, I asked him to come with us today. He's auditing our taxes."

Guy: "They asked me to come today. I don't normally go to doctor appointments with people. Actually, this is a first."

Dr. Grumpy: "What's going on?"

Susan: "Apparently there's an issue with our taxes. Can you explain?"

Jack: "Hi, Dr. Gravy."

Susan: "It's Dr. Grumpy, Dad."

Guy: "I was sent to audit their taxes because of errors that were, incredulous, to say the least, and my department was concerned about fraud, but when I got there I found that..."

Susan: "Me and Larry have been letting Dad do our taxes."

Dr. Grumpy: "WHAT? You mean, recently?"

Susan: "Yes, ever since we got married 35 years ago. He's always done them."

Dr. Grumpy: "Jack, have you been doing their taxes?"

Jack: "Are we going to be done here before the Cubs game starts?"

Susan: "Daddy, it's football season."

Dr. Grumpy: "Wait... Susan, you let your Dad, who we've done all kinds of paperwork and POA and legal forms on for his Alzheimer's disease, DO YOUR TAXES?!!!'

Susan: "I asked him if he'd still be able to do them, and he said yes."

Jack: "I'm a CPA. Last week I was named to the top 10 CPA's in Bayonne."

Susan: "Daddy, you've been retired for 15 years."

Jack: "Is the Cubs' game on tonight?"

Guy: "Excuse me, doctor, but just to make sure, is this man mentally capable of doing income taxes?"

Dr. Grumpy: "NO. Absolutely not. Do you need me to put in writing?"

Guy: "Please."

Susan: "Dr. Grumpy, I have a question?"

Dr. Grumpy: "Yes?"

Susan: "Do you know a good accountant?"

License plate of the year

Thank you, Glenn!

Random pictures

Okay, time to hit the mail bag for stuff you guys have sent in.


From the "you need a hobby" files:

One reader vacationing in San Diego sent in this picture of her hotel's emergency exit sign:

And now, to stress the importance of online security:

From the "Safety is job #1" files:

And, finally, "chewy" is apparently now a flavor:

"It. Tastes. Like. What?"

Mary's desk

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

Ms. Call: "Hi, I'm trying to reach Dr. Freenbeen."

Mary: "He doesn't work here, this is Dr. Grumpy's office. Let me look up Dr. Freenbeen's number for you."

Ms. Call: "I already have it. I can't reach him. That's why I called you."

Mary: "Oh... We're not affiliated with that office at all."

Ms. Call: "Yes, but I still need to reach them. I can't get through. The internet says you're both neurology offices, so I figured you'd have a way to."

Mary: "No, we don't"

Ms. Cell: "There isn't some secret network that connects you people? I saw that on the internet, too."

Mary: "There is no such thing. I have the same phone numbers you do."

Ms. Cell: "You people are so unhelpful."

Click.

Beware of the Dragon

Seen in a chart:

Thank you, J!

College

College kid: "Uh, hello?"

Dr. Grumpy: "Frank, what's going on?"

College kid: "Oh, hi Dad... Um, with what?"

Dr. Grumpy: "I got copied on an email from the university this morning that last night you'd violated some dorm rule by having an extension cord going all the way down the hall?"

College kid: "Oh, that... Yeah, I promised them it won't happen again. It was just an extension cord, though. I think they're making a big deal over it. Everyone has an extension cord."

Dr. Grumpy: "They told me it went from your room, down a hall, down 2 flights of stairs, down another hall, down the main front staircase, through the lobby, and then outside and about halfway across the parking lot."

College kid: "Yeah, I, uh, it was actually pretty impressive. I had to borrow extension cords from a lot of people to do that."

Dr. Grumpy: "They said people were tripping over it."

College kid: "Well, I mean, that explains why it's against the rules, I guess. It's a good idea, actually, if you think about it."

Dr. Grumpy: "That's a big "if." Why weren't you thinking about it? And what the hell were you doing that you had to have an extension cord going that far, anyway?"

College kid: "You know, uh, Dave, that guy down the hall from me? The one with the weird BO? Anyway, we were arguing about how far the dorm's WiFi range goes, so decided to take my laptop into the parking lot to find out."

Dr. Grumpy: "It's a laptop. Why did you need an extension cord?"

College kid: "Well, that girl, Kelly, in my graphic design group, needed a battery for her laptop, and the one she ordered online isn't in yet, so I loaned her mine. So to get my laptop to work to test the WiFi I had to have it plugged in, and to get it far enough out there needed a REALLY long extension cord. So I had to borrow a lot of them from other people in the building."

Dr. Grumpy: "Why didn't you just connect your phone to the dorm's WiFi and walk outside to test it that way instead?"

Long pause.

College kid: "That's a, uh, really good question. Look, Dad, I have to go, because I've got a bunch of extension cords I have to return to people."

Avast ye, mateys!

It's International Talk Like a Pirate Day!

To celebrate, here's the pirate-themed heavy metal band (you probably didn't know this musical genre existed, did you?) Alestorm, singing about stealing rum and beer.

And the guy elevates rolling the letter "R" to an art form.

Seen in a chart

"Make up your mind, will you?"

Chief complaint

My colleague, Dr. L., says she's studying for her neurology boards, and was taking a practice test last weekend.

This question was on it, and she says she's never had a patient report answer E to her.

I'd have to agree. At least not without a Ouija board.

Thank you, Dr. L!

Thanks, Sherlock

A drug rep marketing an epilepsy medication brought lunch in for Pissy and I, so we were having the usual 30 minutes of catered sandwiches and pamphlets full of glossy pictures, graphs, and small print.

As we talked, she mentioned that, as part of her new-hire training, she was sent to volunteer at Camp Shaking Pines this past summer. This is a summer camp held for children with epilepsy who, for medical reasons, can't go to other camps. The purpose of her 3 days there was to "raise my awareness" of epilepsy.

Then she said "Doctor, do you know that some of those kids, the ones with seizures, will actually have seizures, right there, at seizure camp?"

I heard a thud behind me as Pissy's hand hit his face.

Breaking news!

From around the globe, Dr. Grumpy's crack team of reporters bring you the stories that shape your world.

DATELINE: LONDON

British police have apologized after what they previously described as a "huge drugs bust" turned out to be vegan cake mix.

Staff of Purezza, a vegan restaurant, were transporting a large amount of vegan cake mix in a suitcase when it was confiscated at Gatwick airport by transportation police.

After identifying the powder as cake mix, the bags were returned to the restaurant. The staff has offered the police free cake, though at press time the police haven't accepted.



DATELINE: NEW JERSEY

An 80 year-old woman had her vehicle stolen. While she was asleep in it.

Police say the lady had dozed off after parking her car, and when she woke found herself lying in the driveway. She had no recollection of being taken out of the car.

The car has since been recovered.



DATELINE: NORTHERN CALIFORNIA

No one was injured when a bear landed on a police car.

In an unusual chain of events, a Humboldt county sheriff's deputy was driving on Route 96 when a bear fell off a steep embankment and landed on his patrol car. The hood and windshield were smashed.

The surprised officer lost control of his bearmobile, which slammed into the embankment, rolled onto its side, and burst into flames.

This resulted in a small forest fire, that burned about half an acre.

The officer was unharmed.

The bear fled the scene, and was not available for comment.

Uh...

Today's post is dedicated to the marketing genius at Boehringer-Ingelheim pharmaceuticals who came up with this name for their veterinary portal:

Good luck on your job search.

Thank you, Webhill!

Free samples

Mr. Dixie: "Hey, doc, do you need to check levels on my seizure medication today?"

Dr. Grumpy: "No, I don't."

Mr. Dixie: "You sure? Like, need a urine sample?"

Dr. Grumpy: "No, and it would be blood, anyway."

Mr. Dixie: "Oh... Well, I thought you might, so I left a cup full of piss out in your lobby bathroom, just in case. It has my name on it."

Dr. Grumpy: "Um, we don't have sample cups out in the lobby bathroom?"

Mr. Dixie: "I know. I took it off your water cooler."

Big Donor

Dr. Grumpy: "How you doing today?"

Mr. Big Donor: "I'm tired. You wouldn't believe what happened to my daughter's husband last night."

Dr. Grumpy: "He okay?"

Mr. Big Donor: "My son-in-law, Todd, was hanging up some pictures last night and accidentally hammered his thumb. It was really killing him. Maybe he broke it. He ended up having to go to ER."

Dr. Grumpy: "Ouch. That must have hurt."

Mr. Big Donor. "So he finally went there around midnight, and they left him sitting in the lobby. He said they kept bringing all these people from ambulances in ahead of him, and this one lady who had something stupid, like chest pain, got taken right back."

Dr. Grumpy: "  "

Mr. Big Donor: "So he finally called me when he remembered I'm on the hospital foundation's board. I was so angry. I called Dr. Brown... you know him? He's CEO over there? I have his home number and woke him up and told him about this bullshit they were doing to Todd. He took care of it, and they got Todd back in the next 5 minutes. But it's such crap that I even had to do that. I mean, I'm not a doctor, but even I know how a health care system should work. But the dimwits in ER have no clue."

Seen in a chart

I have no idea what this means, or why it's listed as a therapy.

Memories...

About 10-15 years ago, there was an internist who took night call doing hospital admissions. He worked from 5pm - 7am, and I was usually there from 5am to 6pm, so we encountered each other a fair amount toward beginning and end of day.

He was an eccentric dude (though a good doc), the type who tends to be best working night shift. He always had a large briefcase with him. Everywhere. It never left his side. No one but him knew what was in it, was never seen open. He took it in patient rooms, the bathroom, the doctors lounge... everywhere.

Late one afternoon I got called to see a guy admitted for a minor stroke. He was a retired baseball Hall-of-Famer. So I went in, and was talking to he and his wife, doing my usual neurology stuff.

I’d just finished answering their questions when Weird Doc and his huge briefcase wandered in to do the admission. He came in, set the briefcase down. I handed him the chart, since I was done with it and headed for my next consult. He glanced at it, then said “OH MY GOD! YOU’RE MIKE HOMERUNSLAMMER! CAN I PLEASE HAVE YOUR AUTOGRAPH?”

He opened the briefcase. I may have been the only person on Earth (besides him) to have seen its contents. It was crammed full - and I mean REALLY full - of baseball cards. I'd never seen so many. All neatly arranged by teams and years.

He rummaged through it and pulled out the guy’s card from some year. And a pen. And a clipboard. and handed them to the patient. Somewhat stunned (I was kind of in shock myself) he signed it, handed it back, and the briefcase was closed.

Then he pulled his stethoscope out of his pocket and started business. "Thank you! So, what brings you to the hospital today?"

"I'll take that as a yes."

Dr. Grumpy: "Did you have a headache when these other symptoms occurred?"

Ms. Patient: "Well, I believe I may have, if that was my awareness of how I felt was to have had a headache at the time than it could have been that I was possibly aware of having a headache."

Fun with EMR

I went to look up a patient's blood pressure trend at the hospital, but only found this:

People's lives depend on this, too. Don't that just make ya feel good?

Overheard

I get in the hospital elevator with a 30-ish woman who's talking to someone on her cell phone. I hear:

"No, seriously, Sue, all the doctors here are idiots. Nurses, too. I mean, they tell me stuff about Mom's condition and tests and stuff, and I google it, and it always says the opposite of what they're saying. This place is a deathtrap. I'm trying to get her transferred somewhere else, where people know what they're doing."

Love and marriage

While on call last weekend, I was trying to track down a few victims patients when I noticed my call partner's (Dr. Nerve) wife was in one of the rooms on the floor. So I went in to say hi.

Dr. Grumpy: "Hi... Wow, that's a big cast. What happened?"

Mrs. Nerve: "He talked me into going on one of his overnight hikes-to-hell yesterday, in Southstate Canyon. About halfway through I tripped on a rock and broke my ankle."

Dr. Grumpy: "Holy crap. Are you okay?"

Mrs. Nerve: "Yeah, they operated on it last night."

Dr. Grumpy: "That's a pretty remote area. Did he have to carry you out?"

Mrs. Nerve: "No, they sent a helicopter and airlifted me here. We were WAY off the regular road."

Dr. Grumpy: "Where is he?"

Mrs. Nerve: "No idea. After I broke the leg he called for the helicopter and left. He said he was going to finish the overnight hike, and would meet me back here today."

Random pictures

Okay, time to hit the mailbag for stuff you guys have sent in.


First, from the "what the hell does that mean?" files:

In the build-up to July 4, one reader noticed that this lonely fire-extinguisher isn't particularly reassuring if the whole pile goes up:

Then we have this sign, from the "look, I said it already" department:

Apparently the Utah Shakespeare festival is presenting one of the Bard's more popular works:

I'm guessing this newsflash was written by someone who really loved "Death Race 2000"

Reader A writes that her mother's recent attempt at baking bread came out vaguely obscene:

Another got this offer on his phone, and says that he personally wouldn't drink any product whose name sounds somewhat like "diarrhea."

Dr. K says that when he and his family were at a resort last month they put this up before Father's day:

And, lastly, it's kind of scary they have to remind people not to do this:

Helpful

Not-so-great moments with using Epocrates:

Communication

I'm sitting in my office with an elderly lady with Alzheimer's disease and her devoted son.


Dr. Grumpy: "So how's she been doing?"

Mr. Son: "Better, at least a little. I mean, her memory is still pretty bad, but she's calmer, and the nurses tell me she's more cooperative and isn't yelling since you started the new medication."

Dr. Grumpy: "Has she..."


Mr. Son's phone rings and he looks at it.


Mr. Son: "I better answer this, it's Casa DeMentia, her memory-care place. I'll put it on speaker phone in case you want to ask them anything... Hello? This is Mr. Son."

Susan: "Mr. Son, this is Susan. I'm the charge nurse at Casa DeMentia. I'm calling to let you know that your mother isn't in her room, and we've searched the building and grounds thoroughly and can't find her. We're afraid she somehow wandered off..."


Mr. Son and I both look at the patient, who's calmly sitting in my office leafing through an upside-down magazine.


Susan: "... so our security people are going to review video to see what happened, but I wanted to make you aware. I'm going to call the Grumpyville police for a Silver Alert, too, and..."

Mr. Son: "Um, my Mom is right here with me. We're at Dr. Grumpy's office. I signed her out at the front desk when I picked her up."


Pause.


Susan: "Cindy, before you told me Mrs. Memory was missing, didn't you check the sign-out book first... WHY THE HELL NOT? You (expletive)."


Pause.


Susan: "I'm so sorry to bother you Mr. Son. Will she be back for lunch?"

Heading out

It's summer vacation time, gang.

I'll be heading out for a few weeks with my wild bunch.

Back sometime in the second half of July.

Until then, have a great summer. Or, if you're reading this from the southern hemisphere, have a great winter.

And so it begins.

Seen in a chart

Thank you, K!

Patient quote of the day

"I was watching health news on TV this morning. Did you know you can die if your heart isn't working right?"

Humor

Three elderly ladies are sitting on a bench outside the nursing home when an older gentleman walked by.

One of the ladies yelled out, “Hey, I bet we can guess how old you are!”

The old fellow said, “There is no way you can guess my age! I look great for my age.”

One of the women said, “Yes we can!”

“No, you can’t!”

“Can! Just drop your pants and undershorts and we'll tell your exact age.”

The gentleman was embarrassed, but wanted to prove they couldn't do it. So... he dropped his drawers and let it all hang out.

The ladies asked him to turn around a few times while they looked from different angles, then had him jump up and down twice.

They then whispered back and forth for a minute, and finally one said. “You're 87-years-old.”

The fellow was stunned. Standing with his pants down around his ankles, he asked, “You’re right. WOW! How in the world could you tell?”

There was a pause, then one woman answered “Last week we were all at your birthday party.”


Thank you, Webhill!

Seen in a chart

Annie's desk

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

Mrs. Faa: "Hi, this is Mrs. Faa. I was hoping you'd be able to help me."

Annie: "Sure... let me just pull your chart up... Okay, what's up?"

Mrs. Faa: "How do I get blood out of my carpeting?"

Annie: "Uh, well, hydrogen peroxide, or..."

Mrs. Faa: "No, I mean, do you know a good carpet cleaning company in my area? I broke a glass in the kitchen, and then stepped on a big shard while trying to clean it. So there's blood everywhere from when I walked to my bathroom to get a band-aid. It's a mess."

Annie: "Well, I don't know who's in your part of town, but let me look some up."

Mrs. Faa: "I bled A LOT. I mean, literally, all the blood has been drained out of my body. I have no blood left in me at all. It's all on the carpet."

Annie: "Do you need to go to ER?"

Mrs. Faa: "Why? Will someone there help me clean it up?"

June 6, 1944

"There have only been a handful of days since the beginning of time on which the direction the world was taking has been changed in one 24-hour period by an act of man. June 6, 1944, was one of them.

"No one can tell the whole story of D-Day. Each of the 60,000 men who waded ashore that day knew a little part of the story too well. To them the landing looked like a catastrophe. Each knew a friend shot through the throat, shot through the knee. Each knew the first names of five hanging dead on the barbed wire offshore, three who lay unattended on the beach as the blood drained from the holes in their bodies. They knew whole tank crews who drowned when their tanks were unloaded in 20 feet of water.

"There were heroes here no one will ever know because they're dead. The heroism of others is known only to themselves.

"What the Americans and the British and the Canadians were trying to do was get back a whole continent that had been taken from its rightful owners. It was one of the most monumentally unselfish things one group of people ever did for another.

"It's hard for anyone who's been in a war to describe the terror of it to anyone who hasn't. How would anyone know that John Lacey died in that clump of weeds by the wagon path as he looked to his left towards Simpson and caught a bullet behind the ear? And if there had been a picture of it - and there weren't any - it would've shown that Lacey was the only one who carried apples for the guys in his raincoat pocket.

"If you think the world is rotten, go to the cemetery at Saint-Laurent-sur-Mer on the hill overlooking the beach. See what one group of men did for another, D-Day, June 6, 1944."

- Andrew Rooney (1919-2011)

Phone

Betty Tau: "Hello?"

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

Betty Tau: "Dr. Grumpy isn't here."

Dr. Grumpy: "Hi, Betty, this is Dr. Grumpy. Did your daughter call me?"

Betty Tau: "Dr. Grumpy isn't here. You have a wrong number."

Dr. Grumpy: "Betty, is your daughter there?"

Betty Tau: "No, but I think she was trying to reach Dr. Grumpy. Do you know him?"

Dr. Grumpy: "This is Dr. Grumpy, returning a call for your daughter. Why don't you put her on the phone?"

Betty Tau: "I told you, Dr. Grumpy isn't here. You'll need to ask my daughter what his phone number is. She handles those things. If you want Dr. Grumpy you should call his office and leave us alone."

click

"Grandma, what did you bring me?"

This fellow was being handed out at the recent immunology meetings.

Thank you, M!

Criswell predicts

Dr. Grumpy: "Okay, so I'll have Annie set up the MRI for you, and then..."

Ms. Dixon: "What do you think it will show?"

Dr. Grumpy: "It's hard to say. I don't think there's anything of alarm, but with your symptoms I'd like to make sure I'm not missing anything."

Ms. Dixon: "So you really aren't sure?"

Dr. Grumpy: "No, that's why I want to get the test."

Ms. Dixon: "This is kind of disappointing. I thought you'd be able to tell me what it would show, that way I wouldn't need to have it in the first place."

One of these things is not like the others

Short visit

Seen in a chart:

Cancellation

Mary: "Hello, this is Mary from Dr. Grumpy's office. I wanted to confirm Mr. Lumbar's appointment tomorrow with Dr. Grumpy."

Mrs. Lumbar: "Oh, he won't be coming in. The back pain doesn't bother him anymore."

Mary: "Oh, okay, well I'm glad to hear that."

Mrs. Lumbar: "He's dead."

History reruns

May 7, 1915

Today in history, in a factoid well known to school children, the R.M.S. Lusitania was sunk by a German submarine with a loss of 1198 lives.

And... that little snippet is pretty much all most people know about the disaster.

The details are forgotten compared to her erstwhile competitor, Titanic. Nobody made a blockbuster movie about her. Plenty of books have been written, but they often focus on the debated aspects. Was the ship a legitimate target? Did the British admiralty intentionally put her in harm's way? Was she carrying priceless paintings? These questions will never be settled, and I won't debate them here.

Americans are taught that the sinking is what brought the U.S. into WWI. Horseshit. It certainly contributed, but was only a small part. In fact, President Wilson fought like hell to stay out afterwards, and the U.S. didn't enter the war for another 2 years. The resumption of unrestricted submarine warfare in 1917 was a bigger factor. And, although mostly forgotten now, the Zimmerman Telegram was likely the event that finally pushed America into hostilities. Except for those of you who (like me) are fascinated by history, you've probably never heard of it.

A voyage then was a far cry from cruising now. Today's ships are designed for entertainment, with shows, games, shopping malls, climbing walls, mini-golf courses, and countless activities. They're rarely at sea for more than 2-3 days (at most) and frequent port stops are part of the attraction.

That wasn't the case in 1915.

To get some idea of intercontinental travel in the pre-flight age, think of this: You were in a large hotel for 10-20 days. You couldn't leave. You didn't stop in port until the end. The restaurants, though opulent, were the same. Your fellow travelers, and the crew, never changed. The only entertainment provided by the ship were small orchestras for 1st and 2nd class, an exercise room, and a meager library. 3rd class slept in large dormitory-like rooms that doubled as their dining areas, and their only entertainment was whatever instruments and reading they'd brought. The North Atlantic crossing, arguably the busiest and most economically important of the era, was rainy, cold, and windy. The ships didn't have the stabilizing systems we take for granted today, and rolled with the choppy seas.

The Lusitania's stories are mostly forgotten (like the Empress of Ireland) probably because of the time scale involved. From start to finish the sinking took 18 minutes. In that sort of time, on a rapidly foundering ship, the overall reaction is rushed panic. The Titanic, in contrast, floated for 2 hours and 38 minutes after striking the iceberg. Enough time to avoid panic and for the norms of Edwardian society to dictate the events. Women and children first. Rich before poor. Americans & Britons before immigrants. Stories of the band playing to the end, of Isidor & Ida Straus choosing to die together rather than get in a lifeboat ahead of younger people, or the chief engineer who went back to carry out a crewman with a broken leg - with neither ever seen again. Thousands of stories in 158 minutes that immortalized the disaster.

In just 18 minutes, those on the Lusitania didn't have time to do much but try to get in a lifeboat. Most failed. Although (unlike the Titanic) she had enough lifeboats for all, the slope of the sinking hull, and the rivets holding it together, made it difficult to launch them. Many dumped people out before hitting the water.

But stories are there, you just have to look for them.

The Lusitania herself was a technological marvel. The first liner fitted with the revolutionary new steam turbines that today run everything from nuclear submarines to power plants. The first ship to have a central climate-control system (the ancestor of air-conditioning) to keep the interior at a steady 68°F, regardless of outside weather. The system also exchanged the air inside the ship 7 times every hour, eliminating the need to open portholes on a cold day. And, for a time, she was the fastest liner to ever cross the Atlantic.

On the antagonist in the tragedy, the submarine U-20, was a story. The ship had been identified as a large passenger liner, and Kapitanleütnant Walther Schwieger still had every intention of sinking her. He gave the order to fire, and it was the job of Quartermaster Voegele to relay it to the torpedo room.

But Voegele wouldn't. He told Schwieger he refused to carry out an order that would kill innocent civilians. Schwieger immediately relieved him of his post and had another officer do it. After returning to land, Voegele was court-martialed and spent the rest of the war in prison.

Very few stories are as popular, or been "re-booted" as much, as Peter Pan. From the Walt Disney cartoon, to Dustin Hoffman's "Hook," to 2003's "Neverland," the tale has been imagined and re-imagined, both in movies and theater, many times. And Tinkerbell now has her own spin-offs.

But the odds are you'd never have heard of Peter Pan or Tinkerbell if it weren't for a man named Charles Frohman. One of the leading theater producers of the era, he was instrumental in bringing the story to stage. First in London, then in America, he put J.M. Barrie's once obscure story in front of live audiences night after night. Frohman even had the title changed, from the original "Peter Pan - the Boy Who Hated Mothers" to the one you know: "The Boy Who Never Grew Up." It's as immortal as a tale can be.

Frohman died on the Lusitania, at age 58. Unable to jump into a lifeboat due to severe arthritis, and not knowing how to swim, he knew his life was coming to a close. He spent his last minutes with the wealthy Alfred Vanderbilt (age 37, also couldn't swim, and refused to get in a lifeboat ahead of women), tying life jackets to the nursery's baby baskets to make sure the infants would float. As the end approached Frohman turned to actress Rita Jolivet (who survived), and quoted from Peter Pan “Why fear death? It is the most beautiful adventure that life gives us." Then he disappeared under a surge of water.

As Margaret Mackworth and her friend Dorothy Connor watched the frantic rush for the lifeboats, Margaret commented that "I've always thought a shipwreck was a well-organized affair." Dorothy replied "so have I, but I've learned a devil of a lot in the last 5 minutes." An hour earlier, at lunch, Mackworth had told others at her table "It's been such a dull, dreary, stupid, trip. I can't help hoping that we get some sort of thrill going up the channel."

In Chicago, Illinois is Ambrose Plamondon Elementary School. Mr. Plamondon was a major American steel industrialist of the 19th century. When he died his son Charles took over the vast company... And, along with his wife, died on the Lusitania.

Another survivor who ran down to get her lifebelt remembered passing an open door, where inside a middle-aged woman cheerfully arranged and re-arranged her suitcase unconcernedly, as though they were about arrive in port.

In New York, Cunard's local director watched a crowd gather outside his office as news drifted in. He remembered watching a similar crowd outside the rival White Star Line office across the street 3 years earlier, hoping it would never happen to him.

The worst of human nature was on display that night through America, Ireland, and Britain. Mobs attacked and burned business and homes owned by families of German descent, or even those with vaguely German-sounding names.

To the people of Queenstown (now Cobh), Ireland, fell the rescue. As the first S.O.S. crackled from the Lusitania, local fisherman (who'd just come in to unload from the morning) frantically untied their boats and headed back out to sea to save as many as possible. It was a motley collection of mostly sailing boats, a few faster ones with engines, and even some that were being paddled. Boys standing on the cliffs of Kinsale to watch her pass saw the explosion, and helped spread the alarm to local life-saving patrols. The exhausted fishermen worked into the evening to save as many as they could.

As the 767 survivors came into town on overloaded boats, the townspeople rushed blankets and food to the docks. They found places to shelter the fortunate ones - in homes, hotels, warehouses... anywhere there was space - until Cunard was able to make arrangements.

To the locals also fell the unenviable job of handling bodies that were picked up by boats or washed ashore for the next several weeks. Those that could be identified were sent home, but many were beyond that. So three large mass graves, with coffins stacked 2-3 high (some with 2 children put in them) were dug at the Old Church Cemetery. More were buried in Kinsale, at the Church of St. Multose.

Some of the victim's names were known only to their families, sadly being listed on the roster just as "Mr. Stanton's manservant" or "Lady Adam's maid."

In 1912, as the Titanic was about to leave port, the suction from her powerful propellers pulled another liner, the S.S. New York, away from the dock. The 2 ships missed colliding by roughly 3 feet before tugboats could push them apart. Now, 3 years later, the New York was linked to another tragedy. The American government chartered her to bring citizens, living and dead, back to the states. She carried the bodies of Charles Frohman, the Plamondons, and many others.

Survivor Herbert Ehrhardt took off his shoes and gave them to a shivering man in his lifeboat while awaiting rescue. They didn't quite fit, but the man said they'd do. The next day Ehrhardt (and many others) went to a Queenstown shoe store to replace them. As he waited to be helped, he noticed his original pair lying discarded on the floor. He laced them back on and left.

U-20, the submarine that sank Lusitania, ran aground off Denmark in November, 1916, and was subsequently demolished. What's left is roughly 1200 feet from shore, under sediment. The conning tower was removed and is at a local museum.

Captain William Turner of the Lusitania survived the sinking when a wave washed him off the bridge. He was pulled from the water, unconscious, by the crew of a fishing boat. Although exonerated by the inquiry, public opinion held him to be at fault for not taking preventative measures. His wife and sons left him, and he never saw them again. He was assigned to command the ship Ivernia in 1917, which was sunk in the Mediterranean by a submarine. He survived again, but never returned to sea and died in 1933.

Kapitanleütnant Walther Schwieger was killed in September, 1917, when his next submarine struck a British mine.

The last survivor of the Lusitania, Audrey Lawson-Johnston, died at age 95 in 2011.

The once-beautiful Lusitania lies, collapsed on her starboard side, in 300 feet of water off Ireland. While the bow section of the Titanic still evokes a sense of grace and majesty, the Lusitania is little more than a large scrapyard. Her much shallower depth makes her susceptible to the effects of tide, weather, and temperatures. The attack by U-20 was also just the beginning. Countless times in WW1 and WW2 there was concern U-boats were using the wreck to hide, and so it was aggressively depth-charged by destroyers to scare them off.

The hundreds in the mass graves, whose identities will never be known and whose families never saw them again, are marked at the Old Church Cemetery by a single large stone.

Quote of the day

"I was in the ER last weekend for a seizure. They said my Dilantin level was 8. Or maybe it was 18, or 28. I don't know, it was a number with an '8' in it. Does that help?"

Anatomy

Garlic, like a lot of old dogs, is covered with random lumps, bumps, and warts.

This past weekend Craig was having a party (actually, Craig seems to have a party every weekend, but that's another post).

As usual, Garlic and Onion were making the rounds, hoping to snag a pretzel or fallen cocktail weenie. At one point one of Craig's entourage groupies harem friends began petting Garlic, so he hopped up on the couch next to her to keep the attention coming.

A few minutes later she noticed me wandering out of my office to get a Diet Coke and came over to ask...

"Hi, uh, Mr. Craig's dad. How come your dog has nipples growing out of his back?"

Check out

I was on call for the weekend, so Sunday night had the usual check-out call with Dr. Cortex:


Dr. Cortex: "Hello?"

Dr. Grumpy: "Hi, it's Grumpy."

Dr. Cortex: "Okay, let me get my list and a pen..."

Dr. Grumpy: "How was your weekend? You guys do anything?"

Dr. Cortex: "We took the grandkids to the annual air-show, but, one of the planes crashed while landing. They said the pilot was killed and the passenger badly injured. Fortunately, we were at the snack bar when it happened, so Billy and Dolly didn't see it. But it must have been horrible. We left right away."

Dr. Grumpy: "I don't blame you."

Dr. Cortex: "All right, I'm ready for the list. What have you got for me?"

Dr. Grumpy: "Okay. In the ICU, room 37, is a guy with a serious head injury. He was a passenger in a plane at the air show......."

Thud

Dr. Grumpy: "Did you have those labs done?"

Mr. Siphonaptera: "Hell no. I walked out of the lab. They treated me like crap."

Dr. Grumpy: "What happened?"

Mr. Siphonaptera: "The girl at the front desk told me she was going to have me see a phlebotomist, which is bullshit. I don't have fleas. So I left."

11:38 p.m.

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

Ms. Papaveraceae: "Hi, I'm a patient of Dr. Brain's, and I ran out of Percocet. My pharmacy number is..."

Dr. Grumpy: "I'm sorry, but I don't call in controlled drugs after hours. You'll have to contact Dr. Brain's office on Monday."

Ms. Papaveraceae: "But I really need it!"

Dr. Grumpy: "I can't call in any narcotics. What I can call in is..."

Ms. Papaveraceae: "But I can't take anything else because of religious reasons. I belong to a small sect that worships poppy flowers, so..."

Dr. Grumpy: "I'm not calling narcotics in."

Ms. Papveraceae: "So you're discriminating against me on the basis of my religion? I will get an attorney and..."

Dr. Grumpy: "Have a good night."

Click.

Relevant

Last week I received a letter from a research company, looking for "experts in a specific field."

It asked if I could answer "yes" to any of the following questions:

In Memoriam

 
My kids have now passed one of the milestones of modern adolescence.

The death of your first car.

The boys aren't having much of an issue with this, but Marie is taking it vary hard. The 4Runner was her baby.

You may remember her adventures with the car, when she outraced her older brothers to be the first with a license. The Toyota was 19 years old, with 265,000 miles, but she loved it. For reasons known only to her she named it "Dakota," which she insisted on spelling "decoda."

And, fittingly, it died with her at the wheel.

Rolling down the freeway on her way to an off-campus class, it suddenly began shaking wildly under her and making a racing noise. Alarmed, she took her foot off the gas and started to pull into the emergency lane. Then there was a loud "BANG!"

The engine stopped, never to turn again. As she came to a halt, Marie noticed a lot of fluid and some pieces of metal in the road behind her.

Since nothing fazes Marie, she calmly called AAA to arrange a tow, only bothering to notify her parents of this change in events when AAA asked where they should haul the car.

The next morning the guy at the car place asked if I could swing by on the way to work. Taking me into the garage, he showed me a jagged hole in the engine block the size of a football. As I marveled at it he handed me a chunk of metal that used to be piston, and pointed out where he'd found it embedded in the undercarriage.

I thought it looked like a femur. Keys are for size comparison.

So, after circling the globe 10.5 times, the car is being donated to charity.

We went to the repair shop before it was towed away to strip it of our personal stuff. This included $5.82 in coins scattered in cup holders, seat cushions, and under floor mats.

Marie carefully pried the 4Runner nameplate off the back, and it's now hanging in her bedroom, next to the hunk of piston.

I'd have to agree

I'd just finished doing an EMG/NCV on a patient.


Dr. Grumpy: "I hope that wasn't too bad."

Mr. Needle: "Nah, it went fine."

Dr. Grumpy: "Good."

Mr. Needle: "Yesterday they stuck a camera up my dick. That was much worse."

Seen in a chart.

If this MRI finding is correct, it's a publishable case.