Say WHAT?

I'm reading through hospital records on a patient who's coming in later today. They include a consult note from another local neurologist, which contained this statement:


"This patient's confusion is from a multifactorial toxic-metabolic encephalopathy. This is primarily caused by, but not limited to, multifactorial causes from multifactorial medical issues, multifactorial medications, and other multiple multifactorial factors. Multifactorial treatments focused on addressing these multiple multifactorial issues may or may not result in a polyfactorial and/or multifactorial improvement in his multifactorial toxic-metabolic encephalopathy."

Tactful Invitations

Gotta love these charity ball things.

Beware of the Staff

You piss off my office crew at your own risk!

Lunch today was from a new drug rep, pushing a sleeping pill.

She made the MAJOR mistake of rudely talking down to my staff, letting them know they are peons, and that she only deals with doctors. This pisses me off, and even worse, it pisses them off.

Anyway, her sleeping pill's claim to fame is that patients who take it get an average of 7.8 hours of sleep. As a result, they have little pamphlets with this fact, and the rep had a big button on her jacket that said "Are your patients getting 7.8 hours every night?"

During lunch she left her jacket over the back of a chair outside our break room. While she was talking I noticed 2 of the girls disappear for a few minutes.

When Ms. Drugrep was leaving she put her jacket back on, and brought me a pad to sign for samples. As I scribbled I noticed that the button on her jacket had been altered, and now said "Are your patients getting 7.8 inches every night?"

She has no clue, either. And I'll likely never find out what happens.

Thursday Morning, 2:23 a.m.

My cell phone chimes. It's the hospital.

Dr. Grumpy: "This is Dr. Grumpy."

Nurse Wurse: "Hi, I'm calling about Mr. McAclot, the gentleman in room 742."

Dr. Grumpy: "Umm, I'm not..."

Nurse Wurse: "He had a stroke yesterday, and because he's been getting worse Dr. Hospitalist ordered a repeat head CT tonight that..."

Dr. Grumpy: "Hang on, I..."

Nurse Wurse: "Doctor, will you PLEASE let me finish! This is urgent! His CT showed a large bleed, which is new. Dr. Hospitalist told me to call neurology for further orders."

Dr. Grumpy: "He's not my patient."

Nurse Wurse: "Well he's somebody's patient. I mean, there's a note in the chart from a neurologist from yesterday."

Dr. Grumpy: "Why didn't you call that neurologist?"

Nurse Wurse: "I can't read their handwriting, and... LOOK! I'M JUST FOLLOWING DR. HOSPITALIST'S ORDERS! HE TOLD ME TO CALL NEUROLOGY, AND I DID! YOU WERE THE FIRST NEUROLOGIST LISTED IN THE STAFF DIRECTORY!"

Dr. Grumpy: "But I'm not the neurologist taking care of this patient!"

Nurse Wurse: "What does that have to do with it?"

Attention Female Office Staff

Look, we've shared the same bathroom for 10 years. I've been scrupulously careful to observe the male-female bathroom etiquette. I mean, you guys know where I work and live, and would kill me if I didn't.

And I have no problem with you bringing in your 6 year old son today because he has a cold, and daycare wouldn't take him. That happens to all of us.

HOWEVER

When a new male is introduced to the office (i.e. Mr. Sniffles) and suddenly someone is leaving the seat up, missing his mark, and peeing all over the toilet rim, DO NOT COME BLAME IT ON GOOD OLD DR. GRUMPY. His aim and attention to detail have been proven over 10 years of sterling toilet-rule devotion to his office staff. So you will need to look for other suspects with Y chromosomes.

Thank you.

Playing Stupid. And Winning.

I share space with another doc, (we aren't even in the same specialty). We each have our own sign-in sheets, about 3 feet from each other, with our names and specialties at the tops in BIG BRIGHT LETTERS.

In spite of this, patients routinely sign in on the wrong sheet. Or (even worse) just stand at the front counter with a blank, cow-eyed expression, as if figuring out which sign-in sheet to use is advanced calculus.

So this morning I'm up front looking at some reports, and one of these cow-eye-people comes in, and just stands there. So Mary goes over to help.

Mary: "Hello! Are you here to see Dr. Grumpy or Dr. Pissy?"

Cow-person: "Yes".

The VFW Visits

In honor of Veteran's Day, I'm re-running this post. It was originally put up in December, 2008, but seemed like an appropriate one for Veteran's Day.

Bill is a pleasant 90 year-old fellow who's blind in one eye and has severely impaired vision in the other. He's also mildly demented.

Because of the vision and cognitive issues, I sent him for a driving evaluation last month, which he failed miserably. So he lost his license.

So today he had a follow-up appointment. He came to my office (which is pretty small) with a bunch of friends from the VFW (like 8-10 of them). All were well over 80 and were wearing their VFW hats. All came to give me glowing testimonials as to what a wonderful driver Bill is (I suspect he's the chauffeur for the group).

My favorite line: "Doc, Bill drove a tank all over Germany. He's perfectly safe".

Mary's Desk, November 10, 2009

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

Mr. Veefdubya: "I need to make an appointment to see the doctor."

Mary: "Okay, we can see you tomorrow, or..."

Mr. Veefdubya: "WHAT? YOU'RE OPEN ON VETERAN'S DAY?!!!"

Mary: "Um, yes, sir."

Mr. Veefdubya: "That's unbelievable! And disrespectful! And rude!"

Mary: "I'm sorry, sir, we..."

Mr. Veefdubya: "It's a national holiday! You should be at a parade! Or cemetery! Or a nursing home! You should be honoring and thanking the veterans who sacrificed for our freedom! I'm a veteran, and I'm personally offended that you're open on Wednesday!"

Mary: "I'm sorry, sir, and thank you for serving. Would you like to come in Thursday instead?"

Mr. Veefdubya: "No, tomorrow is fine. I don't have anything else planned. What time should I be there?"

November 10, 1975

The legend lives on from the Chippewa on down
Of the big lake they call Gitche Gumee
The lake, it is said, never gives up her dead
When the skies of November turn gloomy.

With a load of iron ore, 26,000 tons more
Than the Edmund Fitzgerald weighed empty
That good ship and crew was a bone to be chewed
When the gales of November came early

The ship was the pride of the American side
Coming back from some mill in Wisconsin
As the big freighters go it was bigger than most
With a crew and the captain well seasoned.

Concluding some terms with a couple steel firms
When they left fully loaded for Cleveland
And later that night when the ship's bell rang
Could it be the North Wind they'd been feeling?

The wind in the wires made a tattletale sound
And a wave broke over the railing
And every man knew, as the captain did, too,
T'was the witch of November come stealing.

The dawn came late and the breakfast had to wait
When the gales of November came slashing
When afternoon came it was freezing rain
In the face of a hurricane west wind

When supper time came the old cook came on deck
Saying fellas it's too rough to feed ya
At 7 PM a main hatchway caved in
He said fellas it's been good to know ya.

The captain wired in he had water coming in
And the good ship and crew were in peril
And later that night when his lights went out of sight
Came the wreck of the Edmund Fitzgerald.

Does anyone know where the love of God goes
When the waves turn the minutes to hours?
The searchers all say they'd have made Whitefish Bay
If they'd put fifteen more miles behind her.

They might have split up or they might have capsized
They may have broke deep and took water
And all that remains is the faces and the names
Of the wives and the sons and the daughters.

Lake Huron rolls, Superior sings
In the rooms of her ice water mansion
Old Michigan steams like a young man's dreams,
The islands and bays are for sportsmen.

And farther below Lake Ontario
Takes in what Lake Erie can send her
And the iron boats go, as the mariners all know,
With the gales of November remembered.

In a musty old hall in Detroit they prayed
In the Maritime Sailors' Cathedral
The church bell chimed, 'til it rang 29 times
For each man on the Edmund Fitzgerald.

The legend lives on from the Chippewa on down
Of the big lake they call Gitche Gumee
Superior, it's said, never gives up her dead
When the gales of November come early.

- Gordon Lightfoot.

Although often overlooked in the story of the Edmund Fitzgerald, the crews of the freighters Arthur M. Anderson and William Clay Ford should be remembered, too. They were the closest ships when the Fitzgerald sank, and went back to look for survivors (there were none) in spite of the fact that the severe storm which had just sunk the Fitzgerald could have sent them to the same fate. The Anderson still sails the great lakes today, 57 years since she was launched and 34 years since the wreck of the Fitzgerald in the November, 1975 gale.

Whatever

Mrs. Snot: "The sinus doctor said I have inflamed tornadoes in my nose."

Dr. Grumpy: "You mean inflamed turbinates?"

Mrs. Snot: "Yeah, whatever."

Pretty Colors

Mrs. Freek, I'm so glad Cymbalta at 60mg each day has helped your symptoms.

I'm sorry I don't seem very sympathetic in refusing to write a letter to your insurance company about the drug. Honestly, this stuff ain't cheap, and you should appreciate that your company is willing to cover it for you at all.

The 30mg and 60mg pills cost about the same per pill. So taking two of the 30mg each night, instead of one 60mg, basically doubles the price. And I really don't have a good reason to tell your insurance that they should pay the higher cost.

There might be medical reasons SOME people need this, but "because I like the cute blue & white 30mg, and not the ugly blue & green 60mg" is not one of them.

I also appreciate that blue & white are the colors of your alma mater, but again, I don't think your insurance company is going to feel that justifies them paying twice as much for your pills.

And for once I agree with them.

Idiocy in America

During a break in call yesterday I went to the doctor's lounge to get a sandwich and Diet Coke.

While eating I watched a few minutes of a football game. There was a silly beer commercial during it, which featured a lady attaching a flower to her husband's lapel with a nail gun.

But what REALLY scared me was that at the bottom of the screen it said "Do not attempt this yourself".

No shit. And you needed to tell us that.

On the other hand, after thinking about some of my patients, it's probably not a bad idea to put that warning up.

Dear Dr. Hummingbird,

What on Earth is your reasoning to take hospital call when you don't want to take care of patients?

I can only assume it's money. Our local community is well aware of your lack of competency, and I don't know anyone who refers to you.

I'm the neurologist on call this weekend, and you ordered 10-15 consults for me, some of which made sense, and some of which were bullshit which defied even the normal boundaries of defensive medicine.

What REALLY chaps my hiney, though, is your uncaring stupidity. Let's review some of the conversations I had with nurses this weekend.


Dr. Grumpy: "This is Dr. Grumpy."

Nurse X: "Yeah, you saw Mrs. Jones this morning, the old lady who can't walk? Dr. Hummingbird told me to call you. She wants to discharge her home if it's okay with you."

Dr. Grumpy: "Is she any better?"

Nurse X: "No she still can't walk. But Dr. Hummingbird said she can lie in bed at home, too."


OR


Dr. Grumpy: "This is Dr. Grumpy."

Nurse Y: "Yeah, you saw Mr. Smith this morning, the man who came in with a TIA? Dr. Hummingbird told me to call you. She wants to discharge him home if it's okay with you."

Dr. Grumpy: "What did his tests show?"

Nurse Y: "He hasn't had any of them yet. Dr. Hummingbird said that since they may not get done until later today, that we should just send him home now because she's got a barbecue to go to this afternoon, and won't be here to write discharge orders."


OR


Dr. Grumpy: "This is Dr. Grumpy."

Nurse Z: "Yeah, you saw Mrs. Stevens this morning for her left hand pain? She's now having severe stomach pain, and had a stool with a lot of blood in it."

Dr. Grumpy: "Why are you calling me?"

Nurse Z: "Dr. Hummingbird told me to call you. She said that since the patient has a neurological issue with her hand that's she's uncomfortable managing any aspect of her care and that you should deal with whatever comes up".



I have nothing against these nurses. They know you for who you are, too, and are stuck because you ordered them to make these inane calls to me.

I'd like to blame this on your lack of experience, or just having a crappy weekend, but this happens every time I wind up on call with you, and my call partners say similarly flattering things about you. And you've been doing this crap for 8 years now.

Thank you for this interesting consult.

More Junkie Logic

Just a weekend of remarkable quotes. I couldn't make this stuff up if I tried.


"I was on my way to my girlfriend's place and did some meth in the car because if I waited till I got there she and her roommate might use it all. But there was something wrong with it and I began shaking, and got real dizzy, and then began puking all over the steering wheel. Then my vision got blurry and I couldn't see the road very well, and I was afraid to pull over cause then a cop might come try to help me, and I'd be in deep shit, so to be safe I started driving as fast as I could to get to the nearest emergency room."