Grumpy Summer Vacation, Day 1

We met my parents in San Diego this year. They’re staying at a Residence Inn, but Mrs. Grumpy had made reservations for us at a different place miles away. The clerk she booked it with told her it was in a "safe, family, neighborhood".

When we got here after a long 2-day drive it was nice to learn that local families felt safe in a hotel that was bordered on one side by Les Titties Gentleman's Club and on the other by the Vick Hubcap Emporium and Doberman Stables. It was also reassuring, when we pulled through the barbed wire automatic gate, that the hotel was patrolled by an armed ex-convict walking a Rottweiler around the parking lot, and there was a line of couples at the check-in desk who looked like they were only planning on using the room for 30 minutes at most. The clerk reminded me of Pee-Wee Herman's character in "Cheech and Chong's Next Movie".

Mrs. Grumpy, concerned our children might be allergic to Rottweiler teeth, immediately called my parents and begged them to find us a room at their hotel, explaining that I wasn't comfortable with the pleasant looking place she'd picked out (LIAR!). Fortunately, there was plenty of space there.

We went over to that hotel. My mother was waiting for us by the curb, and had thoughtfully brought a large metal luggage cart out for us. We loaded it up with all the junk a family of 5 travels with: clothes, extra clothes, clothes I've never seen before in my life but magically appeared in our trunk during the drive, hangers, Nintendo DS, DS games, DVD movies to make them watch (at gunpoint if needed), a portable DVD player, Lunchables, Uncrustables, Inedibles, magazines, books, coloring books, puzzle books, stuffed animals, medicines, suntan lotion (3 strengths), 2 cell phones (with both car and wall chargers), bags of toiletries, snacks, 12-packs of Diet Coke, coupon books, hats, sunglasses, pool toys, sand toys, hotel room toys, crayons, pencils, paper, juice boxes, a roll of film (WTF? we only have digital cameras!), my faithful laptop, AA batteries, AAA batteries, batteries of a type not seen since Edison made them, books, cameras, glue, tape, and other assorted items Mrs. Grumpy felt was essential. By the time we were finished the luggage cart was sagging in the middle and looked like it was on the verge of collapse. And so while Mrs. Grumpy led the kids off I went to pull the cart up to the room.

After dragging it around the parking lot looking for a ramp a few times, I asked my mom how she'd gotten it off the sidewalk. She said she hadn't seen a ramp, and had just pulled it down. This was easy when the cart was empty. But it wasn't now. And I'd be damned if I'd unload it, push it up on the sidewalk, and reload it. So off I went on a 12 mile hike pushing the Grumpy Expedition 2009 luggage down onto a local street, around a restaurant in front of the hotel, and finally up a ramp in the handicapped space on the far side of the building. And of course the place's only elevator was located on the other side of the hotel, back near our parking space. By the time I found our room I was half expecting to see my picture on a milk carton (“last seen pushing a luggage cart with possibly stolen goods”).

I staggered into the room, covered in sweat and desperately needing to pee. The clan looked at me with their best "where the hell did you go with the luggage" glares. It was hot in the room, and Mrs. Grumpy was over in the corner fighting with the air conditioning unit. It only had a power button, but nothing to control temperature, and was blowing warm air. So while I gratefully stumbled into the bathroom, she called maintenance.

They sent up a guy who showed us the temperature control, which was in a large wall-mounted box, marked "TEMPERATURE CONTROL" positioned in plain site that we’d somehow missed, or thought was a piece of abstract art, or something. We were idiots. He didn't tell us that. But you could tell he wanted to. I know the look. I give it to my stupider patients all the time. I'm sure tonight I'll be posted on his blog "Grumpy Maintenance Guy".

After such an exciting day we took the kids out for a deluxe dinner at McD’s. We pulled into the drive-thru. It was awesome. We heard this:

Mrs Grumpy: "We'd like 3 chicken chunk happy meals".

Male voice on speaker: "Okay, that's 3 chicken happy meals and what did you...” (cell phone ring noise) “Hello? Hey bitch! I'm at work! Don’t call me here! You think I got nothing better to do than listen to you yap!” (coworker's voice in background) “Hey! Keep your ugly nose out of my business and go flip some burgers or something! Sorry ma'am, what did you want to drink with those happy meals?"

Good night, Colonel Kurtz, wherever you are.

Heart of Darkness

There are some journeys in life that we try not to discuss.

They can be so dark, so disturbing, so frightening, that even the bravest of adults don’t want to talk about them. When forced to do so we use hushed voices, as if silence will protect us, to no avail. Only once, in 1983, has a movie adequately portrayed the horror of one such journey.

And we face the most dreaded journey of all at this time. And it’s the Grumpy family’s turn to address it.

The time has come to confront our worst fears and begin.

It’s Summer vacation.

Tough Choices

For those of you who don't know, an EMG/NCS is an unpleasant neurological test we do. It's to determine nerve and muscle function, and involves running electrical shocks through limbs, then sticking needles into various muscle groups. It's not horrible, but not fun, either. But it gives us a lot of useful information.

Anyway, a guy called in today to schedule one. His internist had ordered it.

My secretary explained the procedure to him, needles, shocks, blood, gore, etc. He didn't really care, but had very specific dates and times he could come for the study.

As the conversation went on it turned out that the dates and times he wanted the study done coincided with when his Mother-in-law would be at his house, and he felt the EMG/NCS was preferable to seeing her.

Another Fine Patient Quote

"I've had a rash for 15 years. It's everywhere. I mean, nobody can see it, because it's invisible. Sometimes I can see it, but doctors can't. But it's still a really bad rash. Like poison ivy, if that were invisible."

Today's Brainteaser

Today's guessing game was supplied by Mr. Mystery Patient, who called at 11:25 last night:

"Hello, mumble gargle patient of Dr. Grumpy's cough sneeze in my briefcase snap crackle pop pain medicine garble static mumble so I'll just call back in the morning."

More Allergy Fun

Today's patient quote:

"I once had a rash from Sulfa, so now I have to avoid all other Aspirin products."

Clarifying My Position

In the heat of being pissed over the FDA panels recommendations on Acetaminophen, I didn't really clarify my position, and so got all kinds of comments and email from both sides of the aisle.

To summarize my worthless viewpoints:

1. I stand by my point about regulating cars, pools, alcohol, and tobacco. The bottom line is that no amount of guidance, laws, and regulations will EVER protect people from their own stupidity and misuse (intentional or unintentional) of ANYTHING! People such as The Angry Pharmacist's "Cracky McCrackhead Addict" will continue to do whatever the hell they want.

2. I have no problem with regulating Acetaminophen (or APAP for short) to smaller doses and/or cutting out the combo meds. I'm not sure the APAP component really does much compared to the narc, and it falsely gives the impression these drugs are less addictive.

I understand the risks of hepatic toxicity (and, from a more practical viewpoint, rebound headaches), and have counseled patients about this for years. APAP is in a HUGE number of both OTC and prescription drugs, where it's existence isn't well listed. Many of these are "me too" crap, where the public buys them without reading the ingredients, and ends up unintentionally taking too much APAP. Getting half of this junk off the shelves would be nice.

3. Pain is a serious issue. Especially for people who are suffering from terminal illness. None of us want to die in misery. In a perfect world we wouldn't need pain medications. But we don't live in one.

And that's all, folks!

I'm Going to Throttle My Children

Our house was originally built in 1993. For no apparent reason the kitchen had a ledge put about 12 feet up on the walls. Since no one can see or reach up there, I assume it hasn't been dusted since it was first installed.

After getting back from the Independence Day Carnival at damn near midnight, and our kids waking us up at 5:30 this morning beating each other up over whether to watch Nick or Cartoon Network, Mrs. Grumpy and I really needed a nap.

When I woke after a very deep 2 hours, I discovered it had snowed dust bunnies in our kitchen. All over the floor, counters, sink, stove.

Apparently, while we were dozing, the Junior Legion of Home Terrorists began launching balloon rockets in the kitchen.

One of them didn't come down. So they assumed it was on one of these ledges. They got a ladder and climbed up, and with a broom swept 16 years of dust bunnies, spider webs, dead bugs, dog hair (how the hell does dog hair get up there, anyway?), and heaven knows what else, all over the kitchen.

The missing rocket, for the record, was lying in the hallway the whole time.

Stupid People At Large

Yesterday we went to an outdoor Independence Day carnival. At some point I wandered over to the snack bar and heard this great conversation:

Woman in line: "Do you have bottled water?"

Clerk: "Yes, we do."

Woman in line "What kind is it?"

Clerk: "Uh, the wet kind."

More Phone Calls

My office is closed today for the holiday, so my message says "Hi, my office is closed today for the Independence Day Holiday."

It's amazing how many people who call in feel this is something they need to leave a pointless message about (without a name or phone number, of course). So far today I've gotten:

"Oh, I forgot it was a holiday this weekend."

"I guess you're closed today."

"My regular doctor is closed, too".

"It's hot today"

"What time today will you be opening?"

"Since you're closed I'll call back next week."

"Are you completely closed? Or are you seeing patients today?"

Say That Again?

Working my way through some data research surveys about up-and-coming products. What do you guys think of this quote from one:

"Product M is not statistically non-inferior to Oxycodone in both relief and non-relief of pain".

An AWESOME Drug Rep

Oh, this was just a TERRIFIC way to end the work day. I couldn't have asked for something better.

Mrs. Grumpy had a meeting tonight, so I had to feed the kids. Fortunately for me, a Big Pharma, Inc. drug rep brought lunch today to the office, and there were a lot of leftovers.

So as I was leaving this afternoon I grabbed a big bag out of the cabinet (with the Big Pharma, Inc. logo on it), tossed the leftovers into it, and headed out.

As I was passing a cardiologist's office on my way to the elevator, a pretty female rep I'd never seen before, wearing a Big Pharma, Inc. name tag, came out of his office. We made eye contact, and I nodded, smiled, and continued on my way.

Only to be stopped after another few steps by her saying loudly, "Oh MY GOD! What are you doing?"

I turned around to find Ms. Prettyrep looking at me, horrified, with her jaw agape. "Excuse me?" I said.

Ms. Prettyrep: "Are you taking food from a doctor's office?"

Dr. Grumpy: "Um, yeah, is that okay?"

Ms. Prettyrep: "NO! It's rude! It's unacceptable and inappropriate! And look at the way you're dressed!" (I tend to be on the casual side) "No name tag!. What are the corporate people teaching you new reps, anyway?"

Before I could answer she went on: "I'm sorry. I suppose this isn't your fault. The training people must be slacking off." She offered me her hand. "You must be new. I'm Stacey, from our cardiology marketing division here".

I shook her hand. "I'm Dr. Grumpy, from the neurology division down the hall."

Stacey from the cardiology marketing division looked even more horrified now then she had a minute ago. After a few stuttering attempts at saying something she answered her cell phone (which hadn't rung), mumbled "nice to meet you" and ran into the stairwell.

Tips for Patients

When asked "What brings you to see me?" the following answers are NOT acceptable, helpful, or desired:

1: "A car" (or bike, bus, or other method of transportation).

2: "My PCP said I should see you."

3: "My daughter drove me."

4. "The hospital sent me."

5. "My medical problems"

6. "The guy at the grocery store told me I should see a neurologist"

7. "Your name is on the referral".

8. "What kind of doctor are you?"

9: "I need a refill on the white pills with numbers on them"

10. "You were on my insurance plan."

Still Fuming at the FDA!

It should be noted that more people visit an ER and/or die, as a result of mishaps with cars, OR swimming pools, OR alcohol, OR tobacco, THEN AS A RESULT OF TAKING PERCOCET, VICODIN, OR OTHER TYLENOL CONTAINING PRODUCTS!!!

SO HOW COME YOU GUYS DON'T ALSO BAN CARS, SWIMMING POOLS, ALCOHOL, AND TOBACCO WHILE YOU'RE AT IT?!!!!!!!