Expect the Unexpected

I'm a veteran of the neurology wars. I've done front-line service in ER. I've done trench warfare in hospitals and even at my office desk. After 10 years of this I feel like I can handle most situations in my field, or at least know where to transfer the patient if I can't.

But there are some things you are never prepared for. Like showering buck naked in the pitch dark at 4:00 a.m. (so you don't wake up the family). And suddenly having a zillion megawatt flashlight shined in your eyes. And an 8 year old girl in Little Mermaid pajamas, Spongebob slippers, and a fireman's hat suddenly yell "DADDY! YOU UNDER ARREST!"

Nothing prepares you for that. Ever.

Tell it Like it Is

I've got a junkie over in the ICU, who overdosed on a bunch of stuff yesterday. She was on a ventilator (a breathing machine) this morning, but they were going to see if she improved enough today to get her off it.

So I called over there a minute ago to talk to her nurse:

Dr. Grumpy: "How'd she do this morning?"

Nurse Icu: "She's more awake, and we got her off the ventilator, but may have to put her back on again."

Dr. Grumpy: "Why? Is she still having trouble breathing?"

Nurse Icu: "No, she's just a bitch."

WOW! That is SO Useful!

Okay, Grumpyites. My friendly neighborhood Lidoderm (a skin patch for pain after shingles) drug rep was by last week.

Drug reps aren't allowed to take us to ball games anymore (I'm okay with that). In fact, this year they've actually been banned from bringing us even cheap pens and post-it notes.

BUT they are still allowed to bring us oddball stuff which falls under "patient education". Like this thing:




What is it? An art deco cactus garden? A model of Bikini Bottom (the home of Spongebob Squarepants)?


Nope. It's a model of the nerve endings of your skin, showing how painful post-shingles pain can be. When you turn it on, notice how the nerves glow red (it's pain, get it)?





And HERE! When you push down on the Lidoderm patch (get it? you're applying it to the skin?) they now glow soothingly blue (ah, that feels better). Thank you, Craig, for the hand cameo.



Isn't this useful! Isn't this revolutionary! Isn't this a great use of your medication money!

The kids and I have now taken out the batteries, and this weekend will study the feasibility of turning it into a new home for Ed, my office fish.

Marketing Errors

Avinza is a once-daily form of Morphine. A few years ago they ran this ad, to show a typical patient who may need once-daily narcotics.

I hope she's supposed to be a waitress. Because I'd hate to think they're encouraging a typical patient on sedating and addictive pain medication to start downing daiquiris, and a whole tray of them at that.

They pulled this ad rather quickly. I can't imagine why.

(Click to enlarge)

Unforgettable Weddings

I have a lady with Trigeminal Neuralgia. This causes episodes of sudden, severe, facial pain, which can be quite disabling when they occur.

Her daughter's wedding was this past weekend, and the patient had been asked to stand up front as the couple wed. She's been anxious about it for months, terrified that if she has an attack of pain during the ceremony she'll start crying, and make a scene.

So to prevent pain she decided to a take a handful of Percocet just before the ceremony. About halfway through the wedding she suddenly began vomiting uncontrollably, then passed out on the alter.

I'm glad she didn't make a scene.

One Good Stroke Deserves Another...

There's an irregular heart rhythm called V-tach (short for ventricular tachycardia). Sometimes it's harmless and transient, but at other times can lead to more life-threatening heart rhythms. Therefore, when it shows up on the cardiac-telemetry monitor, it needs to be checked out FAST.

So this morning, around 5:00 a.m., I was on hospital rounds, reviewing a chart on the cardiac floor. I'd been asked to see the gentleman in room 31 (Reverend Jones, of Local Church), for a small stroke he'd had.

Suddenly the monitor tech paged overhead: "Room 31 is in V-tach! Check patient STAT!!!".

About 5 nearby nurses jumped up and ran into the room, throwing the door open, flipping the lights on, racing to the bed.

Reverend Jones was, uh, playing with certain things. Without sheets over him, either.

He explained that he "just wanted to see if my man-parts still work after the stroke".

I decided to just see him this afternoon, after his MRI is done. He's had enough embarrassment for the morning.

In Memoriam

This week marked the passing of a dear friend and associate.





This is my Panasonic electronic pencil sharpener. I have no idea what the model number was, if it had one.

I don't know when it was bought. I first remember seeing it in my Dad's law firm when I worked there in the summer of 1982 (I ran the copy machine for $2/hour).

At some point it got relocated to our house, and I took it with me to college, then medical school. It's since sat patiently on my desk, heroically and faithfully performing it's services when called to do so. It's been with me for at least 20 years, and likely more.

This week, it passed into the great machine heaven, done in by having to sharpen 6 dozen pencils in preparation for the new school year. It tried valiantly, but just couldn't handle it.

Besides the Grumpy family, it leaves behind many friends, including a stapler, tape dispenser, and desk lamp.

Services will be held in the next few weeks, as Frank requested an autopsy be performed to see what's inside an electric pencil sharpener.

Thanks, But I Did That This Morning

Took the Grumpy tribe bowling today. I went to the counter to pay for shoes and a lane.

The guy rings me up and says "Sir, would you like a ball wash?"

It may be part of his job, but I couldn't say that with a straight face.

Checking Out

Mrs. Grumpy sent me over to Local Grocery for some tomatoes today. She also wanted me to pick up Danimals, those drinkable yogurt things for kids.

So I'm at the check-out and Mr. Cashier starts chatting.

Mr. Cashier: "Dude, you can't send these Danimals to school with your kids. They need to be refrigerated".

Dr. Grumpy: "My kids have them at home for snacks."

Mr. Cashier: "Good. They need to be refrigerated, ya know."

Dr. Grumpy: (getting out my wallet) "I'll put this on my debit card."

Mr. Cashier: "Okay. Maybe, instead, you should get snacks that don't need to be refrigerated, and that way your kids could have them at home or school".

Dr. Grumpy: (frantically trying to get out of there) "I'll just bag these myself, don't worry about it"

Mr. Cashier: "Or you could make your own protein shakes for kids, like with Ensure or ice cream or Slim-Fast? Or you could buy protein powder at health food stores? Or... Hey, you want your receipt? Where you going, Mister?"

Today's Mail

Included a letter, with this address:

"Grumpy Neuro Logical Neurological Neurology Office
Attn: Mr. Dr. Grumpy Mister, M.D."


I feel so special now.

No, Thank You

Mr. Gagmewithaspoon, while I understand that the abscess on your scrotum, which you saw a dermatologist for this morning, is of great concern to you, it is not why you are seeing me, your friendly neurologist.

So when I asked you how your carpal tunnel syndrome is doing, there was no reason to drop your pants. Especially since the door to my office was open, as I hadn't expected you to do something like that. Neither did the rest of my staff, though you may have unintentionally helped their diet plan.

So kindly pull them up, put your inflatable donut cushion on the chair, and tell me how your carpal tunnel syndrome is doing.

Wii Fit Boxing

While exercising last night with the Wii Fit, I realized the boxing could be improved by allowing you to put a face on the punching bag. Like Dr. Dipshit. Or Mrs. Idiot. Or evil drug rep Rikki.

On the other hand, if I did this I'd likely die from exhaustion, or break the TV.

You Don't Say!

I always ask patients if they've changed any of their other docs since I last saw them. I think it's important they get my letter, so we all know what each other is doing. Good communication is good for patients, and in this age people change docs often.

So I asked that question of a lady in her 50's today.

She said: "I'm seeing a new Gynecologist. I don't remember her name. She specializes in women."


Best kind, I guess.

Dear Dr. Dipshit

You sent a fax over to my office this morning that only said "PLEASE CALL ME ASAP TO DISCUSS MUTUAL PATIENT IMA DINGDONG!!! I'M AT 867-5309!!!".

I can only assume you did this because you are incapable of actually dialing a phone by yourself. Obviously, if someone at your end could look up my fax number, they could have found my phone number, too.

Mary brought it back to me about 3 minutes after it printed, and interrupted me while I was with a patient because it looked urgent.

I don't mind being interrupted, because a patient emergency should always take priority. So I called 867-5309.

The call was immediately transferred to your answering service, who told me your office was closed and offered to page another doctor on call, who likely had no idea why you were trying to reach me urgently. I begged the operator to see if your office had a backline she could connect me to, and she kindly did.

The lady who answered your backline obviously didn't give a shit. I told her I was Dr. Grumpy, and I was returning YOUR fax about Mrs. Dingdong. She told me the office was closed, and I should leave a message with the answering service. When I repeated that YOU HAD FAXED ME, she said you were having coffee with a drug rep, and didn't want to interrupt you (I guess it's better for a doctor to be interrupted when with a patient, huh?).

I told her that the fax said it was an emergency, so she sighed heavily (I know she rolled her eyes, even without a video link), whined, and said, "okay, let me go see if he's done".

I was then placed on hold for 2 minutes and 38 seconds (while I'm with a patient at my end) before another of your staff came on, said you were still with the drug rep, and asked me which patient it was on, what their date-of-birth was, and why was I calling in the first place? Could it wait until your office opened?

Sorry I hung up at that point, but I didn't want to scream and swear at some poor staff member that you'd stuck between us. Obviously, you and I have a different definition of "emergency".

And you can call me back if you need me. Or better yet, just have the patient call me, since apparently no one at your end believes in patient care.


(Friday morning update: Nope. I never heard back from him.)