Thanks, I Didn't Think of That

I sent a patient to physical therapy for his back pain a few weeks ago.

The therapy place sent over a summary note on him just now.

It ended with this line:

"Recommendation: Patient was told not to do things that make his back hurt."

Concerned Parent

I know you're pregnant, ma'am, and I understand your concerns about not wanting to take a medication because it might harm your baby. I don't prescribe pills just for the hell of it, and try to weigh the risks and benefits.

But DON'T tell me that you're worried about the effects of the pills on a fetus when you just told me you smoke a freakin' pack a day, okay?

Cyber Monday Shopping

WOW! These online deals today are great! Look at how much money I can save buying "Wii Fit Plus" today!

What Part of "Closed" Are We Not Getting Here?

Look, people, I know the 4-day Thanksgiving weekend is still in force, but we are on the last day here.

And I don't mind you calling me for legitimate emergencies. It's part of the job, and I signed up for it.

My office message still says "We're closed, please call back during regular office hours for routine matters."

So please stop leaving messages like:

"Hi, are you open today?"

"I thought it was Monday, isn't it?"

"Can someone call me with your phone number?" (DUH! YOU JUST CALLED ME!)

"Is my MRI on Thursday or Friday?"

"Did I miss my appointment 2 weeks ago?"

"Can I find your office on Mapquest?"

"What kind of doctor is Dr. Grumpy?"

"Can I have my driver's license back so I can go Christmas shopping?"


At 8:30 a.m. tomorrow morning the phones will be rolled back, and you can start hassling Mary and Annie for questions about your tests, appointments, insurance authorizations, good shopping deals, safe ways to hang lights, and a myriad of other questions.

Thank you.

In Line at Starbucks

Mrs. Grumpy wanted to stop at Starbucks last night after dinner.


Guy in line: "I can't decide, they all sound good".

Counter girl: "We have the new Caramal Brulee' Latte' you might like. It's really good. Have you ever had creme brulee'?

Guy in line: "No".

Counter girl: "Well, creme brulee' tastes just like the Caramel Brulee' Latte does, um, if you, uh, knew what it tastes like, I mean."


Then I got up there.


Dr. Grumpy: "I'd like a polar bear cookie."

Counter girl: "They're good. We used to have them for other holidays, too, I mean, at least ones where polar bears are part of the theme."

Okay... How many other holidays with polar bears in the theme are there?

Brains and Butchers

This morning I went looking for a decent brain picture for the shirts. I couldn't find anything I liked in Google images, so I dug out and dusted off my old neuroanatomy textbook.

I'd forgotten this line (but it's hard to miss) in the book's first section:

"The fixed brain is serially sliced into 4mm sections on a Hobart Model 410 rotary-blade, electrically-driven, commercial meat slicer."

Think of that next time you're watching your local butcher use one of those things.

This Morning, At The Hospital...

Had to go in to see a patient.

As I got out of my car in the doctor's lot, I passed another doc who was leaving. He had a bumper sticker that said "Driver is medicated for your safety".

It's scary enough to see this on another doc's car. What's even worse is that he's a psychiatrist.

Friday Night, 10:35 p.m.

"Hi, I saw Dr. Grumpy in 2007 or so, and had hurt my neck back then, and physical therapy helped. Anyway, I hurt it today carrying a bunch of boxes that my wife just HAD to get on Black Friday, and some asshole pushed me out of the way in the Wal-Mart toy section, and so I'd like to get some more therapy. It's hurting a lot right now, and I thought maybe there was a 24-hour therapy place you could send me to. Also, my internist said I'm due for a cholesterol panel, and something else to check my liver because I take a pill for my cholesterol, it's one with a long name, and maybe you could order those labs for me, too."

Voicemail Theater

The following 1 act play was left on my office voicemail this morning.

Female voice: "It says he's closed today."

Male voice: "Closed? Today?"

Female voice: "Yes. Closed. Today."

Male voice: "Why the fuck would he be closed?!"

Female voice: "It doesn't say. A lot of places are closed today. It's sort of a holiday."

Male voice: "That's bullshit. He should know better. What if a patient needs him?"

Female voice: "I can leave a message."

Male voice: "Yeah, but do we want him to call us back?"

Female voice: "It says he will."

Male voice: "I don't want him to. It's just not right that he's closed today."

Female voice: "Okay, what do you want me to do?"

Male voice: "Let's see if we can find another neurologist, with the decency to be open when patients need him."

(click).

November 27, 1898

111 years ago today...

Off the medical and humorous topics, I'm going to indulge my interest in maritime history this morning.

Everyone's heard of the Titanic, Andrea Doria, and Lusitania. But most shipwrecks are long forgotten, except in the areas they occurred.

Long before The Perfect Storm was made famous by a George Clooney movie, there was the Portland Gale of 1898. The storm was catastrophic, but is mostly forgotten now.

In 48 hours of early-winter gale over 300 ships were either sunk or seriously damaged. Lives lost is unknown, but likely between 500-1000. Shore towns and cities from Massachusetts to Maine were devastated by rain, sleet, and more than 2 feet of snow, driven by winds measured up to 110 miles per hour. Communities of summer beach cottages just vanished.

But the storm is still called by the name of it's most prominent victim: the steamship Portland.




In 1898 the Boston, Massachusetts to Portland, Maine route was a busy one, used heavily by both business and leisure travelers. Some took trains, while others preferred steamship. The latter traveled on coastal steamers, usually by night (the equivalent of a "red-eye" flight today). A ticket was $1 to $5, depending on your accomodations. You'd board in the evening, have dinner on the ship, sleep in your cabin, and the next morning were there. The ships went back and forth 3-4 times a week.

The New England weather can be notoriously vicious. A storm was coming in when the Portland sailed on the evening of November 26, 1898. Her captain, Hollis Blanchard, was known for being cautious, but apparently saw nothing in the conditions or forecast that unduly alarmed him. At 7:00 p.m. the ship sailed from India wharf in Boston, never to return.

The ship was sighted by others in the next few hours, but as the storm worsened, eventually vanished in the gale. When and exactly how she foundered will always be a secret, as she took all 192 passengers and crew with her. Recovered watches had all stopped between 9:00 and 10:00, though whether this was a.m. or p.m. is unknown.




The next day wreckage began washing ashore: furniture, timbers, luggage, lifebelts, and lots of bodies. Although the picture above shows a lifeboat being launched, none were ever found, and the severity of the storm makes it unlikely this was even attempted.

Several entire families were lost in the tragedy, traveling home after Thanksgiving in Boston. Their memorials are scattered across New England graveyards. The Portland black community was hit particularly hard, as (except for the officers) the majority of the crew were black men. In 1898 (33 years after the Civil War) service on these ships was considered a very respectable job for a black man, and those who served were generally veterans of the trade, supporting families ashore. They were often more sought after than white men for the same positions, as white men looking for these jobs were younger, less experienced, and seen as more likely to leave the job without notice.

The Portland herself would remain hidden for a long time. In 1989 the wreck was actually located, but the technology wouldn't allow an accurate identification. So it was forgotten again until 2002, when it was found by side-scan sonar. It's since been explored by divers, though at a depth of 460 feet in very cold water this is limited and dangerous.





So that's a history lesson for Friday. It seemed like a change of pace, and I needed to write a post, and I hope you enjoyed it. If you're interested in learning more about the Portland and 1898 gale, I recommend the book "Four Short Blasts" (the title refers to the whistle distress signal of the time) by Peter Dow Bachelder. The book also has a brief history of the American Life-Saving Service, which eventually became the U.S. Coast Guard.

Thanksgiving Memories

Let's take the Way-Back machine to the early-90's.

Dr. Grumpy is the medicine intern, on-call for Thanksgiving, at a large VA hospital (a veterans hospital for my non-U.S. readers, with consequently a primarily cantankerous elderly male population).

A peculiar thing about VA hospitals (at least back then, I haven't worked at one for 15 years) is that patients could sign out at the nurse's desk, and come back later (allegedly they were in the hospital because they were sick, but you need to work at one to understand this point). So the sheet was always full of notations that patients had signed out to go to McDonald's, or to buy cigarettes, or to smoke, or to visit friends at the homeless shelter, or to hold up a liquor store, or whatever.

Some bright businessman had opened a stripper club across the street from the hospital, I think it was called The Jaguar Room. So on Thanksgiving the VA ward I was covering was empty, as most of the patients had signed out to walk, wheel, or crawl over to The Jaguar Room for some female comfort and booze.

I was asleep in the intern's room when the calls began coming in. All of them from the bartender at The Jaguar Room. Questions about was it safe for my patients to be smoking through their tracheostomy tubes? Were the cardiac telemetry packs still transmitting from across the street? Was there a place at the VA where the patients could get more $1 bills, because they'd used them all up on the strippers?

And my favorite:

Bartender: "Can I give Mr. Veteran another beer?"

Intern Grumpy: "Um, what's the problem?"

Bartender: "He has one of those foley bags things, with the tube going up his dick. The bag is, like, REALLY full, and I'm afraid if I give him another beer it'll pop and send piss everywhere."

Intern Grumpy: "Send him back to the hospital."

Bartender: "Well, that's bad for business."

Intern Grumpy: "So is showering your clientele with piss."

Mr. Veteran was wheeled back over to the VA immediately, by a topless stripper no less, who waited while his bag was emptied and then pushed him back to the bar.

A happy Thanksgiving to all, and to all a good night.

Thanksgiving Morning

The kids are watching the Macy's parade on TV, and suddenly start laughing hysterically. I go in to see what's up.

The Rockettes are doing a dance number.

"Daddy! Those ladies aren't wearing any pants, and it's cold there! How could they all forget to put on their pants?"

Hospital Fun

I got called to the hospital yesterday afternoon. Nice old lady (80 +) who got a steroid shot in her back for pain. There were some complications with the shot, and she was (temporarily) paralyzed in both legs.

So, I checked her MRI to make sure nothing horrible had happened, and then went to meet with she and her husband. By the time I got there she was already improving.

Dr. Grumpy: "So you're feeling better now?"

Mrs. Oldbutcute: "Yes, but I was completely paralyzed for a while."

Dr. Grumpy: "Well, that was the medication, and it's wearing off now. It caused you to be dead from the waist down."

Mr. Oldbutcute: "Hell, doc, she's been dead from the waist down for 40 years."

He ducked as a copy of Newsweek came flying at him.

Anatomical Variant

From a history form a patient handed me today:

"I've had both right shoulders replaced twice."