On Call, and HATING IT!!!

I'm on hospital call this weekend, and I hate it.

I only do this one weekend per month, and it's the most miserable 63 hours of existence. After 10 years you'd think I'd be used to it, but I hate it even more now.

Yes, I am whining. I suppose I should be grateful for a job, etc., etc., etc.

My practice has reached a point where I don't really need to take hospital call for other neurologists, but I do it for 3 reasons:

1. Habit.
2. Money.
3. To get material for my blog.

Anyway, while driving in this morning, I thought of the old Weird Al Yankovic song "One More Minute", and how well it sums up my feelings about hospital call. So, with apologies to Weird Al, here are the slightly modified pertinent verses.


'Cause I'd rather spend eternity eating shards of broken glass
Than spend one more minute on call

'Cause I'd rather get a hundred thousand paper cuts on my face
Than spend one more minute on call

I'd rather rip out my intestines with a fork
Than listen to my damn cell phone ring again
I'd rather slam my fingers in a door
Again and again and again and again and again

Oh, can't you see what I'm tryin' to say, Darlin...

I'd rather have my blood sucked out by leeches
Shove an icepick under a toenail or two
I'd rather clean all the bathrooms in Grand Central Station with my tongue
Than spend one more minute on call

Yes, I'd rather jump naked on to a huge pile of thumbtacks
Or stick my nostrils together with crazy glue
I'd rather dive into a swimming pool filled with double-edged razor blades
Than spend one more minute on call

I'd rather rip my heart right out of my ribcage with my bare hands
and then throw it on the floor and stomp on it 'till I die...
Than spend one more minute on call.


I wanted to embed the youtube video of the song, but due to copyright issues the embedding code has been turned off. But here's a link.

Mom: 1. Annoying Daughter: 0.

This afternoon I saw a great little old lady, sharp as a tack, who got dragged in by her overprotective daughter, and was NOT happy about it.

The daughter was one of those huffy types who tried to answer every damn question for her mom, even though the old lady was clearly fine, independent, and a hell of a lot brighter then her offspring. Mom tried to talk around her, but the daughter just wouldn't let her answer my questions, even when asked directly of the patient.

Finally, when her daughter interrupted her for the millionth time, Mom looked at me and said, "You'll have to forgive my daughter, Doctor. Normally she wouldn't be accompanying me to doctor visits, but 52 years ago my diaphragm broke."

Drug Company Wierdness

So, on the side I make a few bucks participating in market research for various companies, reviewing ad campaigns, drug data, etc. I had one of these meetings last night.

There is currently a drug (let's call it Trepiac) on the market for a particular neurological disease. Trepiac is given once a day, is very expensive, and is of only mild benefit at best. But it's a big seller because there ain't much else out there.

Trepiac is going generic in a few years. So what is it's parent company doing? Inventing a new drug to help cure this horrible disease? F--K NO! The meeting was to consider marketing concepts for Trepiac-XR, a NEW, ONCE DAILY form of Trepiac, which is already taken once a day as is!

Sound stupid? I think so too. And this is where research dollars are being spent.

Where Do We Find These People?

My last patient yesterday was an elderly lady with back pain. I'd ordered on MRI of her low back, and the radiologist had commented "Incidental note is made of a previous hysterectomy". So the patient, of course, brought it up.

Mrs. Lumbarpain: "Doctor, the radiologist mentioned he could see I'd had a hysterectomy, how does that relate to my back pain?"

Dr. Grumpy: "It doesn't, some radiologists just comment on anything they notice, even if it's not related to the study".

Mrs. Lumbarpain: "Okay, but my hysterectomy was 40 years ago. Wouldn't it have grown back by now?"

Dr. Grumpy's Guide to Life, Chapter 1

(As a public service I have written the following, for you to print off and use before your next Pump-It-Up party. For those of you who don't have small children, or simply live in a box, Pump-It-Up is a national chain with indoor giant inflatable bouncers to hold kid's birthday parties at).


Congratulations! You've decided to host your child's party at Pump-It-Up. They and their friends will enjoy it a great deal.

Key things to remember:

1. Going into the giant inflatable bouncing arena to fight your kids with oversized boxing gloves and paddles looks easy. Because of your higher center of gravity, however, you'll quickly find out that you're at a distinct disadvantage. In fact, you will likely get your ass kicked fairly easily by the swarm of 1st graders who will line up for a chance to beat you. Fighting on your knees does not improve the situation, and makes it easier for one of their partners to sneak up and jump on your back.

2. Although adults are welcome to go on all the giant bouncers, they are not adult friendly. In particular, the inflatable obstacle course is a good way to get yourself killed. When a kid claws up the inflatable steps and ladder to both of the slides involved, they have plenty of space to reposition themselves at the top to go down the slide feet first. YOU WON'T, and may find yourself pulling yourself to the top of the ladder, then as you are amazed you made it that far, you'll suddenly pitch forward uncontrollably, going down the slide head first and wrenching your neck at the bottom (which I did). While you're lying there, trying to figure out if you can still move your legs, a friendly teenage attendant will come over to remind you that head-first isn't allowed, and to please not do it again.

The steps in the obstacle course ladders are designed for kids and adult pygmies. You will be lucky to be able to use them as toeholds. Trying to climb them with your feet sideways only helps somewhat.

As you struggle through the obstacle course, you can expect to be passed by several kindergartners, who will wonder why their friend's Dad is so slow.

3. You WILL be injured. At present my neck is still stiff and my left ankle is killing me. I also have multiple bruises from falls and being stepped on, and several knee and elbow scrapes. When you first enter the facility and fill out the forms about how many kids you have with you and how many pizzas and bottles of pop you want, I recommend you give them a card listing your insurance coverage, hospital preference, and blood type.

4. Do not feed yourself or your kids a large meal before going unless you wish to spend some of the bouncer time you paid for watching a friendly teenage attendant clean Taco Bell out of a bouncer.

5. If one of the fun-loving kids traps you inside something by turning off the air compressor, don't panic. Before you asphyxiate from vinyl a friendly teenage attendant will turn it back on again, then lecture you not to do it again.

Enjoy! You just paid a fortune for your injuries!

If you follow these simple precautions, you will likely live to see your child's next birthday party - which will also be held at Pump-it-Up.

This Ain't Hallmark

Today I had my twins at the office before school, because my wife had an early appointment.

Since one of my wife's aunts is sick, I kept them busy by having them make her cards.

Craig wrote one that said "I hope you feel better soon".

Marie's card said "I hope you don't die".

Maybe I Shouldn't Have Used My First Name.....

Okay, fans. I had a busy day at the office, so didn't get a chance to return calls until I got home. I had to call a 20-something patient to give her (normal) MRI results. Here was the conversation:

Miss Suzy Singlefemale: "Hello?"

Dr. Grumpy: "Hi Suzy, This is Ibee Grumpy."

Miss Singlefemale: "Oh! I am SO glad you called. I've been meaning to call you back, but I've been sick for 2 days, and have been running errands, but I didn't want you to think I was blowing you off. I had the most INCREDIBLE time with you on Saturday night!"

I was speechless. Finally I said:

Dr. Grumpy: "Uh, I just called to discuss your MRI results."

LONG pause.

Miss Singlefemale: "Is this Dr. Grumpy? Oh, I thought you were someone else. How
are you this evening?"

Today Part 2

I thought the lady in the gown couldn't be beat in one day, but boy, was I wrong.

My 3:00 was a lady who had numbness in her feet, so I asked her to take off her shoes. She had a HUGE popped blister on her big toe. With blood all over it.

So what does this prize do? She sticks her finger in it and says "this looks like blood." Then she F--K--G LICKED THE BLOOD OFF HER FINGER!!!!!!!!!!!!!!.

Today, Part 1

Okay, today just sucked the big weenie. A remarkable collection of visits and phone calls from fruitcakes and nuts and lots of less friendly creatures.

My 1:00 was a lady in her 40's who went into my exam room, put on a paper gown, THEN wandered out to use the bathroom. She walked through the lobby (smiling at stunned patients) to the john.

After a few minutes she emerged, with the lower front half of the paper gown all wet. As she went back through the lobby she loudly said "That sink sure splashes you, huh?"

McD Bozos

Okay, Grumpy fans. Last night Mrs. Grumpy asked me to get a bag of ice on the way home. Since there's a McDonald's on the way, I stopped there (yes, you can get a bag of ice at McD's. It's a little known secret).

So I went in and asked for a bag of ice. The McBimbo got it out of the freezer and brought it to the counter, then asked me (Really!) "Is this to go, or are you gonna it eat it here?"

I was so stunned I didn't answer, so she said "I'll just give it to ya for here." So she put the bag on a plastic tray with some napkins, and rang me up. She even charged me the 8-cent tax for eating it on the premises.

(click to enlarge)

Talking Too Fast (I Hope)

So, Grumpyites, this afternoon I was reading a recent note from another doctor on a patient I'm seeing tomorrow. I can only assume the other doc was either talking too fast, or needs a better transcriptionist, or is just an idiot.

"Past medical history is notable for a successful suicide attempt in 2004."

Lunch With a Drug Rep

Yesterday a drug rep marketing an antidepressant brought lunch in, and offered this great quote:

"Doctor, the research staff at our company has recently found there are 2 major population groups: People who are taking anti-depressants, and people who aren't."

Just Shoot Me

I had a hospital consult this afternoon, the reason for which was unrelated to the cause of admission.

When I opened the chart, this is the paragraph that greeted me. I present it without further comment, as nothing could be added to make it better (or worse, depending on your point of view).


"History of present illness: This is a 78 year old male who was transferred from Big City Hospital for insurance reasons, due to a vibrating foreign object that has been impacted in his rectum causing anal obstruction. The patient states that he was using the vibrator to 'scratch an itch' around his anus and 'lost control' of it. He states that his internist was unable to remove it, and so he then went to Local Urgent Care Center. They were unable to remove it either, and he left there and went to Big City Hospital. For insurance reasons Big City Hospital has now transferred him here to get it removed."

Insurance Company Idiocy

Last week I saw a lady in her 40's, who'd had a small stroke. She had no good reasons to have had a stroke, so I ordered a bunch of routine tests, including an MRA. This is not experimental. We do these for stroke all the damn time.

So her insurance company of course refused it. They asked to see my notes (we faxed them), and the reason why I wanted it (we told them). They still refused to cover it, but told me I could appeal by calling one of their "physician reviewers". So I called him a minute ago.

He asked me why I wanted the MRA. I told him because the patient had a stroke.

His response: "Oh, why didn't you just tell us that in the first place? We'll cover that".