I just can't take it

Patient quote of the day:

"I don't want to take a pill just to take it. Because I'll be "taking it" taking it, when I'm not sure I need to take it. But if I have to "take it" take it, then I'll have to take it and will take it. But only if I really have to "take it" take it.

Things that make me grumpy

Times are tough for doctors these days. No one gives a shit, so I'm not elaborating further.

But even big institutions are affected. Take, for example, the venerable MD Anderson Cancer Center in Texas. This giant of oncology has recently been having financial issues, so much so that its president, Ronald DePinho, sent out this e-mail to employees 2 weeks ago:

"For most of fiscal year 2013 our operating expense has exceeded our operating revenue - meaning that we've spent more than we've made from providing patient care services."

He went on to say that because of this shortfall MD Anderson is suspending merit raises and slowing its hiring rate. This is what they call "austerity measures."

Now, every concerned CEO in America has been saying stuff like this, so why am I singling out Dr. DePinho?

Because.

At the same time Dr. DePinho is preaching financial restraint for his cash-strapped institution, he's used $1.5 million of its capital funds (which come from investment income, donations, and patient revenue) to build a 25,000 square-foot (2,322 square meter) office suite for Dr. Lynda Chin at the institution.

Who just happens to be his wife.

Really. I am not making this up.

Dr. Chin is the scientific director of MD Anderson's Institute for Applied Cancer Science. How this justifies her having an office suite that is 10 x larger than the average American home is beyond me. According to the institute it's to "provide an appropriate meeting space with high-level industry decision makers and support a new suite in computational biology." Translation: By using a lot of syllables we're hoping you'll ignore what's really going on here.

And no, I have no idea what "computational biology" is. Maybe that's why my entire office is 1,250 square feet, including the john.

According to an itemized expense report (obtained by The Cancer Letter under the Texas Public Information Act) this ginormous office has $28,000 worth of chairs, sofas, and tables. They also spent $210,000 on fancy translucent glass walls, which required them to get a special permit from the University of Texas. By comparison, the Grumpy Neurological Emporium has used furniture (valued at $948 total), and plain old painted drywall.

So, if you donated money in a loved one's memory to MD Anderson hoping they'll find a cure for whatever cancer killed grandma, there's a reasonable chance your hard-earned dollars went to pay for... upscale furniture and fancy glass walls in an office bigger than your house.

I'm going to close with another quote from Dr. DePinho, found in the same e-mail I quoted earlier about the austerity measures MD Anderson will have to take to survive:

"If we don't make changes now, we potentially will find ourselves in a crisis that will force us to take drastic measures that could hurt our ability to meet our mission... [all will] have to share sacrifices."

Well, almost all.


Thank you, SMOD!

History reruns

May 29, 1914

If you read the popular stuff, you'd think there were only 3 major shipwrecks of the 20th century: Titanic, Lusitania, and Andrea Doria. Obviously, there are many more, even if you exclude 2 worldwide conflicts in the last 100 years. The worst peacetime shipwreck in history, the Dona Paz (Philippines), took 4,375 lives as recently as 1987. And I bet you've never heard of it.

Trans-Atlantic crossings have always been critical to both sides of the Atlantic (look at the chaos caused by the recent Icelandic volcanic eruption). Although the giant liners of Cunard and White Star are best remembered, they were by no means alone. Ships were constantly coming and going, carrying passengers and freight, both ways across The Pond.

Although less glamorous than the liners that sailed in & out of New York, there were many busy ships that called on the Canadian ports. One was the Empress of Ireland, which in 1914 was serving the Quebec City to Liverpool route.

Early this morning, 96 years ago, the Empress was outbound from Canada. She was heading northeast on the St. Lawrence River. It was 2:00 a.m., and most of the passengers were sleeping.

In a thick fog, the Norwegian coal-carrier Storstad struck the Empress on the starboard side. The damage was extensive. There was only limited time to sound an alarm, and electricity failed quickly, plunging the ship into darkness. The Empress was gone in 14 minutes.

The survivors were picked up by the few lifeboats that had been launched, and were carried back and forth to the Storstad, which had stayed afloat. Captain Henry Kendall, who was thrown into the water as the ship rolled over, supervised the rescue efforts and likely saved many lives by organizing the lifeboats.

All together the Empress took 1,024 people with her. It remains the deadliest maritime disaster in Canadian history. In spite of this, the ship is mostly forgotten today. The St. Lawrence Seaway is a very busy channel. Hundreds of ships steam over the Empress every day, very few knowing of the tragedy beneath them.

The Salvation Army remembers. A large contingent of members (167) were lost on the ship, traveling to a conference in London. There is a monument to them at Mount Pleasant Cemetery, in Toronto.

The Empress of Ireland is in 130 feet of water, well within the range of scuba equipment, but the currents and poor visibility limit diving

Marketing FAIL

How impressed can you be with a medical practice management company that obscures their own contact information on a fax advertising their services?

Thank you, Lee!

Memorial Day

Capt. John P. Cromwell, USN, 1901-1943

John Cromwell was born in Illinois, but his heart took him from the midwest to the ocean. He graduated from Annapolis in 1924.

His initial sea service was on the battleship Maryland, but his abilities led to him being picked for the fledgling American submarine force. He served aboard, and commanded, some of the United States Navy's first large submarines.

After several tours at sea, Cromwell was selected for further training in the complex diesel engines that were critical to submarines of the pre-nuclear era. He rose through the ranks, eventually becoming a division commander.

WWII found now-Captain Cromwell in the Pacific, commanding submarine divisions 203, 43, and 44. His flagship was the U.S.S. Sculpin.

In November, 1943 Sculpin (commanded by Lt. Cmdr. Fred Connaway) put to sea with orders to rendezvous with the submarines Searaven and Spearfish to attack Japanese shipping. Upon arrival Cromwell would take command of the group.

The Americans were preparing to invade Tarawa island later that month. It would be a critical (and bloody) fight to wrest control of the central Pacific from Japanese forces. Cromwell was aware of the operation's details, and was also familiar with the top-secret American ability to read Japanese military codes.

On November 18, 1943, while en route to the rendezvous, Sculpin was preparing to attack a Japanese convoy. A damaged depth gauge, however, caused her to surface rather than go to periscope depth, and she came up directly in front of the Japanese destroyer Yamagumo. Although Connaway quickly dived again, it was too late. Yamagumo pounded Sculpin with a series of depth charges, causing severe damage.

With no way to escape, and more destroyers coming, Connaway decided to surface again and try to fight it out. The destroyer was ready. As the Sculpin came up, Yamagumo's first salvo killed her entire bridge crew (including Connaway) and those running to man the weapons.

Sculpin's surviving senior officer ordered the submarine scuttled, and the crew to abandon ship.

Captain Cromwell realized the secrets he knew could seriously jeopardize the American war effort. The Japanese couldn't be allowed to learn the invasion plans for Tarawa, or that the Americans had broken their codes. While he wouldn't voluntarily talk, there was no guaranteeing he might not break under torture or the influence of interrogation drugs.

He therefore decided to stay with Sculpin forever. He helped the crew abandon her, but made no move to leave himself. He was last seen standing in the control room, watching it fill with water.

His Congressional Medal of Honor was presented to his widow.

Sunday reruns

Ms. Crappystaff: "Dr. Imed's office."

Dr. Grumpy: "Hi, it's Dr. Grumpy. You guys referred Mrs. Brain to me for an abnormal MRI, and I don't have the report. She's here now. Can you please fax that over, ASAP?"

Ms. Crappystaff: "Hang on... Sorry, the doctor just went into a room with a patient, and doesn't like to be disturbed. I can have him call you back later."

Dr. Grumpy: "I don't need to talk to him. I just want you to fax over the MRI report."

Ms. Crappystaff: "I'm not comfortable doing that. I don't know what the report means."

Dr. Grumpy: "I'm not asking you to know what it means. All you have to do is fax it to me."

Ms. Crappystaff: "Don't patronize me. I don't even know who you are."

Dr. Grumpy: "I'm Dr. Grumpy. You faxed over an insurance authorization on this patient an hour ago. I just need the MRI report, so I know what to tell her."

Ms. Crappystaff: "I told you, I'll have Dr. Imed call you to discuss this."

Dr. Grumpy: "The patient is here now. I just need the MRI report. Please fax it over. It's why you guys sent her to me."

Ms. Crappystaff: "You obviously don't understand the importance of patient privacy."

And she hung up.

Uh... What kind of work do you do?

This is from a form on a patient's ability to do the following at work. It was the last one that caught my attention.

Jawohl!

Dr. Grumpy: "What brings you in today?"

Mrs. Mom: "I'm worried about my son. I think he drinks too much, and I know it's bad for him."

Dr. Grumpy: "I'm sorry to hear that."

Mrs. Mom: "The only person he'll listen to is Dr. Intern, but he refuses to go back to see him about this."

Dr. Grumpy: "How are you..."

Mrs. Mom: "Anyway, here's my son's phone number. Can you please call him tonight, and pretend to be Dr. Intern to talk to him about the drinking? The doctor is from Germany, so you'll have to fake an accent, and..."

Not Helpful

Mrs. Papers: "Here's my background information."

Dr. Grumpy: (looking it over): "Okay... What's this say about your sister?"

Mrs. Papers: (leans over desk) "Let me see. Looks like it says 'Sister in NH'."

Dr. Grumpy: "What does 'NH' mean? Nursing home? New Hampshire?"

Mrs. Papers: "I don't remember. Could be either, or both. It's been years since I typed that up."

Technology marches on

A friend recently suggested I try Cleverbot. She figured that since my life has reached a point where I routinely talk to Siri, I might as well converse with other computers (and to think I started out chatting up Eliza on a TRS-80). After all, Cleverbot even has a picture of a brain on the site, endearing it to my profession.

I'm well aware that querying these things is like using a Magic 8-Ball. But, while seeing a patient yesterday, I decided to ask it a question for the hell of it.

Thanks, Cleverbot. That was very helpful. And no, I don't.

Mary's desk

Wild-eyed lady runs in, stands at counter, loudly bangs pen on sign-in clipboard.

Mary: "Can I help you?"

Mrs. Wild: "MY SCAN WAS ABNORMAL!"

Mary: "Okay, what is your..."

Mrs. Wild: "HOW COULD YOU NOT TELL ME IT WAS ABNORMAL? WHAT IS WRONG WITH YOU PEOPLE?"

Mary: "I'm sorry, let me look into this. If I could have your name..."

Mrs. Wild: "THIS IS INSANE! HOW CAN YOU SIT THERE SO CALMLY WHEN MY SCAN IS ABNORMAL?"

Mary: "I..."

Mrs. Wild: "DON'T JUST STARE AT ME! DO SOMETHING! MY SCAN IS ABNORMAL! I DEMAND TO SEE DR. CARDIO IMMEDIATELY!!!"

Mary: "Dr. Cardio is upstairs, in suite #805."

Mrs. Wild: "SHIT!"

(runs out, slams door)

May 18, 1980

I'd like to offer a remembrance for David A. Johnston (1949-1980, age 30). He died 33 years ago today in the service of his country and humanity. His body has never been found.

He believed scientists sometimes had to take serious risks if the knowledge gained would save the lives of others.

David Johnston, roughly 12 hours before his death.

Artisanal, or whatever

In case you live under a rock, the BEST news story of the week didn't involve murder (unless you consider a reputation), terrorist attacks (unless you consider an undercooked pizza as such), or hurricanes (except for one named Amy).

It involved the bizarre online meltdown of a restaurant in Scottsdale, Arizona called Amy's Baking Company. This place was featured on Gordon Ramsay's cooking show, and became the first place he was ever entirely unable to help, and actually walked out on. If that was the whole story it would be forgotten by now.

What made it much better than anything else, though, were the antics of the place's owners as we watched them steal tips, abuse costumers (and not in a semi-lovable Edsel Ford Fong sort of way, either), and pass off pasta from a grocery store as homemade. If you haven't seen it, be sure to watch it on Kitchen Nightmares. You won't be disappointed.

But what made it a moment for the ages was their bizarre online complete meltdown (well chronicled elsewhere) with them throwing obscenities, claiming the high ground of a deity supporting them, and using ALL CAPS randomly. Then they claimed a hacker had done it all, and not them (although they've done similar things before).

Now, I know nothing about restaurants, beyond which ones have banned my kids from ever coming back. But I have made misuse of the word "artisan" and its derivatives a sort of crusade.

So, looking at their site I noticed the inevitable word "artisan" on it (oddly capitalized, along with "Gourmet" and "Pizzas").

In the same paragraph it noted they serve "house made Artesian Pastas."

Look: "artesian" means an aquifer or spring in the ground, which provides water. It has nothing to do with "artisan." Water can never be artisanal, but it is often artesian. Capisce?

So, Amy, unless you've found some sort of natural spring that produces a steady stream of pasta (sort of like the famous spaghetti farms), I want to make these points:

1. Unless it came flowing out of the ground, it's NOT artesian.

2. If you made it yourself, by hand, you can call it artisanal.

3 If you bought it from the grocery store and are reselling it as your own, it's not "house made," "artisanal," or "artesian."

4. You should also use a comma. To the best of my knowledge there is no such thing as "Artesian Pastas fine wines."


Thank you, Webhill!

Front counter

So.

A guy shows up at 9:30 with a lady. She signs in on Pissy's sheet, and they sit down next to each other. After a few minutes Pissy's staff takes her back, and he sits out there reading a magazine.

In the meantime, Mary and I are waiting for my new patient at 10:00. At 10:15 we called it a no-show, and at 10:30 my 11:00 patient wandered in early. So I took her back and started the appointment.

At 10:40 the lady who was seeing Pissy leaves - by herself - and the guy who came in with her wanders up to the counter.

Mary: "Can I help you sir?"

Mr. Magazine: "Yeah, when will Dr. Grumpy be seeing me?"

Mary: "What time was your appointment?"

Mr. Magazine: "10:00."

Mary: "Sir, you didn't sign in... We didn't know you were here."

Mr. Magazine: "I would have said something sooner, but there was a good magazine article."

Mary: "I thought you were with that lady you came in with... I'll have the doctor squeeze you in over his lunch break..."

Mr. Magazine: "I'd just met her, in the hall outside your office. I wonder why she didn't sign in for me?"