Is she a cephalopod?

Getting ready for the day, and reading another doctor's note on a patient coming in this morning:

"Her pain can involve 1 to 4 limbs at a time, but never more than that."

Mary's Desk, December 29, 2009

Mary: "Okay, I have you down for a follow-up appointment in 3 months, on March 22nd at 9:30."

Mr. Organizer: "Let me write that in my daily planner, hang on... wait, is that a weekend? I can't find it on my calender."

Mary: "Um, no, it's a Monday, like you asked for."

Mr. Organizer: "You must be wrong, that date isn't in my planner."

Mary: "March 22?"

Mr. Organizer: "Oh, I thought you said March 72nd."

Somebody put something in my drink

Sometimes finding the humor is the best we can do.

This morning I saw a new dementia patient, Mr. Bukubux.

He's an older gentleman, who hasn't quite been himself for a while, but his family couldn't put a finger on what was different... Until recently.

He and his wife are members of Headupthebutt Country Club, and have an annual holiday party for their friends. At these shindigs he's always the bartender, which he enjoys doing and is good at.

At this year's party, however, several guests complained to Mrs. Bukubux about their drinks. He'd forgotten various people's favorites, though that was a minor issue.

More concerning was that he was mixing them incorrectly, combining ingredients at random, depending on which bottles happened to be near him at the time.

One lady ordered a scotch & soda. Mr. Bukubox handed her a coffee mug containing milk and red wine, with a lemon floating in it.

Another man asked for a martini. He was handed apple juice with a Ritz cracker bobbing in it.

More things that make my grumpy

A December phenomenon that drives me nuts.

I'm sorry that your regular neurologist is closed/on vacation/dead until after New Years, and that you don't like the doctor covering for them.

But I'm not some sort of neurological urgent care. Showing up at my office without any old records because of some acute issue you need addressed, and planning to return to your previous doc as soon as they get back, doesn't fly here.

I mean, I have my own patients to take care of, and it's not like you're planning to stay with my practice. You make it pretty clear that you're just coming for me to patch things up until Dr. Wondrous returns/detoxes/is resurrected next week. There's a doctor on call for him. SO CALL THEM, NOT ME!

And I'm really pissed off at your internist for participating in this. He tells you to come see me until Dr. Wondrous comes back, because he doesn't know what to do, and he doesn't know Dr. On-Call, and so he sends me a note that says something like "please manage meds until regular doc returns" or "patient has had neck pain since 1972, please do something about it in Dr. Wondrous absence". These notes are especially grating when written by an internist who never refers to me anyway.

Of course, I have none of your past records, and Dr. Wondrous staff is gone, too, and you have no freaking idea what you've tried before, or if it worked, or what tests you've had done.

This is why we have call groups people. I'm sorry if you don't like the person who covers for your regular neurologist. Tell them when they come back. But I am not providing temporary coverage for them.

Job Counseling

In the early 80's, when I was in high school, we had to take these career guidance tests. You answered a bunch of questions, and a computer (like a TRS-80: anyone else out there have one? I had the top-of-the-line model, with a whopping 16K of RAM) would tell you what career was best suited to your personality.

My test results suggested a career in farming and agriculture was best for me. (Oddly, so did my Dad's tests in the 1950's. And he's a lawyer now).

In October I put a resume up on a medical site, looking for research work in addition to my regular practice.

Today I got an email from the site's "job assistant", saying that I'm qualified for an exciting career as a Certified Nursing Assistant, and should register for classes NOW.

Memo to Patients

LOOK! Just because you people waited until the END OF THE FREAKING YEAR to see if you met your insurance deductible, does NOT make it an emergency here for Annie and I.

I don't care that you now need the test (which I ordered 6 months ago) urgently because your insurance is changing, or because you finally met your deductible, or you just looked at a calender for the first time in 6 months and had forgotten December is the last month of the year, OR WHATEVER.

These are not tests you can generally get Bozo Insurance, Inc. to authorize and schedule in under a week, let alone a few days.

And the auth department at Bozo Insurance, Inc. is running half-staffed right now so their people can go on vacation, or get their tests done, or whatever. So auths are slow right now.

A lack of preparation on your part does not constitute an emergency on ours.

And don't give me the line about how you had no idea the end of the year was coming, either.

Yours truly,

Dr. Grumpy.

Dear Mrs. Thoughtthatcounts,

I just wanted to write and thank you for the tray of homemade chocolate brownies that you brought my office last week.

I'm well aware of your fondness for improvising new recipes, and the staff and I appreciate you telling us which brownies had jalapeños in them, which had bacon, and which had both.

As always, you've outdone yourself. Many of us here thought you'd never be able to top your 2007 tray of chili-pepper-and-white-chocolate-cookies, but we underestimated you and your fondness for spicy foods.

As you can imagine, your unique brownies didn't last long in our breakroom, and quickly disappeared.

You work so hard in the kitchen around the holidays, perhaps next year you should take a break and just rest. You've earned it.

Yours truly,

Ibee Grumpy, M.D.

My readers write

I'd like to thank my reader Brian, who submitted this story. For my non-medical readers, NPO is medspeak meaning "no food, water, or pills orally". Advair is a drug that's INHALED.


Hi Dr. Grumpy! I'm a pharmacist at an academic medical center. Tonight I received a phone call from a surgical resident.

Dr. Surgistud: "My patient is NPO for surgery and is on Synthroid. Is there an IV formulation and what is the conversion?"

Brian, RPh: "Yes, it's 50% of the oral dose."

Dr. Surgistud: "OK, great. And also - the patient is on Advair. I need to change him to Levalbuterol and Atrovent, right?"

Brian, RPh: "Um... no. Those are different drugs. Why do you want to change the Advair?"

Resident: "Because the patient is NPO."

Hope you got a good laugh out of that... all of my colleagues did!

Loose playlists sink ships... or something like that

Ya know, given the ease with which a guy was apparently able to walk on a plane with a bunch of explosives last week, some of the other measures seem somewhat out of place.

For example, when I was accused of contributing to terrorism a few months back.

So this morning I'm updating my iTunes software. A friend had told me about this a while back, but I'd never looked for it before today (hell, who actually reads the consents that come with software updates?). But, there it was.

I direct you to item #10 of the iTunes update agreement.

(click to enlarge)




I really love the last line. "You also agree that you will not use these products for any purposes prohibited by United States law, including, without limitation, the development, design, manufacture, or productions of missiles, or nuclear, chemical, or biological weapons."

I freely admit that my taste in music doesn't suit everyone (Mrs. Grumpy hates it), but I think the most that could be said is that my iPod constitutes a weapon of mass good taste destruction.

December 26, 2009

Dr. Grumpy: "FRANK, CRAIG, MARIE GET IN HERE NOW!!!!!!!!!!!!!!"

(shifting feet, poor eye contact)

Dr. Grumpy: "Why on Earth are you all jumping on the trampoline, in cold weather, NAKED????"

"I told you we'd get in trouble!" "Well, it was your idea!" "Wuz not."

Dr. Grumpy: "ANSWER ME."

(quick glances back and forth)

"Um, they all fell off."

Dr. Grumpy: "I'm not stupid."

"No, really, we were jumping hard and the bouncing made them..."

Dr. Grumpy: "I said I'm not stupid."

"We were out on the trampoline and wanted to play dodge ball."

Dr. Grumpy: "So why were you all naked?"

"Because we didn't want to go find a ball, so we used our clothes to throw at each other."

Dr. Grumpy: "Do you have any idea how cold it is outside?"

"Yeah, um, but not until we were naked. Then it seemed pretty cold."

Dr. Grumpy: "Frank, where are your clothes?"

"Because Marie is a bad loser. After she lost, she threw my clothes over the fence."

Traditions of Christmas

The morning after Christmas I got dragged in to the hospital to see a guy for headaches.

He kept referring to he and his wife as having "a traditional Christmas", which apparently landed him in the hospital. "Traditional" obviously varies from person to person. Here is how Mr. Traditional and his wife spent their traditional Christmas (and it took A LOT of coaxing to get the whole story out).

They woke up on Christmas morning. Then:

They had a traditional cup of coffee. Then:

They had a traditional exchange of gifts. Then:

They had several traditional shots of scotch. Then:

They smoked a few traditional joints. Then:

They did a few traditional lines of cocaine. Then:

She gave him a traditional under-the-mistletoe blowjob. Then:

When he blew his traditional load he had sudden onset of the-worst-headache-of-his-life (not a tradition).

He was taken to ER, where he had a traditional head CT, MRI, and MRA (having to drag in an MRI tech on Christmas).

So then he had a traditional spinal tap. Which was equivocal, because he wouldn't hold still.

So then the angiogram team got called in on Christmas.

So then he had a traditional 4-vessel cerebral angiogram, complicated by bleeding and a BIG hematoma at the groin puncture site (yeah, your wife's gonna love that thing next to your yule log, dude).

The admitting doc then felt a second traditional spinal tap was needed.

And that's how Mr. Traditional spent his Christmas.

When I met him (and his charming wife) this morning he asked me if I'd ever seen a case like this before.

I gave him my traditional answer. You guys can guess.

More Dragonisms

Okay, for Christmas I thought I'd give you guys some Dragonisms.

(What is a Dragonism?)


Dr. Grumpy said: "She's had bilateral breast augmentations."
The computer typed: "She's had bilateral breast amputations."


Dr. Grumpy said: "Since the stroke he's taken Plavix."
The computer typed: "Since the stroke he's taken buttocks."


Dr. Grumpy said: "Flexeril helps her back pain."
The computer typed: "Sex oral helps her back pain."


Dr. Grumpy said: "The ophthalmologist is treating his corneal abrasion."
The computer typed: "The ophthalmologist is treating his toenail infection."


Dr. Grumpy said: "I'll see her back for the tests."
The computer typed: "I'll see her back for the tits."


Dr. Grumpy said: "He has circumoral paresthesias"
The computer typed: "He has immoral paresthesias"


Dr. Grumpy said: "When the neck pain worsened, she went to a chiropractor."
The computer typed: "When the neck pain worsened, she went to a car repair."


Dr. Grumpy said: "She has Ambien to help her sleep."
The computer said: "She has Indians to help her sleep."


Dr. Grumpy said: "After the fall he had a right knee arthroscopy."
The computer said: "After the fall he had a right knee atrocity."


Dr. Grumpy said: "She has migraines with phonophobia."
The computer said: "She has migraines with porno phobia"

Holiday Reruns

(For those of you who missed it the first time around, the following was my post for Christmas, 2008)

The following message was left on my office voicemail last night (December 24th) at around 8:30 p.m., by a pharmacist who was obviously less than enthusiastic about having to work on Christmas eve.

"Hello, I'm calling from Local Pharmacy about a refill for Dr. Grumpy. It's on patient Mrs. Smith, for her Cartia. The idiot's at her nursing home didn't realize she was all out until 5 minutes ago, and then were stupid enough to think they could just waltz down here
and get more. But no, there were no refills.

"So if someone could please call me to refill this, this bunch of bozos at the care home want it tonight. And I'll be here, tonight, on Christmas Eve, at Local Pharmacy, all damn night. so you can reach me whenever you call. My name is Joy. Thank you."

December 24, 2009. Tis the season

Oh, 2 tomatoes, and some paper plates? No problem. Let me get my car keys.

Crap, Local Grocery is mobbed. Hey, bitch! Don't flip me off! I wasn't even looking at that parking space. Chill.

Merry Christmas, Mr. Salvation Army dude. My only cash is $3, but I'll gladly put it in your kettle.

What a fucking mob scene. Hey! Don't push me! I didn't even want the last shopping cart! I'm just here for some damn tomatoes, lady. Merry Christmas.

Hi, it's me. I have the tomatoes. What brand of paper plates do you want? No, it looks like they're out of those. Okay, I'll get Chinet. Says they're made from recycled paper. Hope it's not toilet paper.

No, Mr. Salvation Army. I gave you my last $3 on the way in. Remember? Merry Christmas.

Hello? No, just leaving. Lettuce? Yeah, hang on. I can go back. Looks like some guy in a Santa hat is yelling at the Salvation Army guy for blocking the door, but security is leading Santa away now. Shit, somebody took my parking space as soon as I pulled out. Let me find another one.

Sorry, Mr. McDonald's manager. I didn't realize this space was for McD's customers only. It's not marked that way. I'll move my car, don't worry. Merry Christmas.

Mr. Salvation Army, it's me again. I had to come back. You have my $3 already.

Lettuce... hey, stockperson, whatever sex you are, where's the lettuce? You only have 3 heads left? Wow. I had no idea there'd be such a rush on iceberg for Christmas. Well, this one looks like it's been dropped the least.

It's a self-checkout. Look, I don't recognize you as one of my Alzheimer's patients, but you obviously are not grasping how to work this thing. So go over to the cashier and check-out the old fashioned way. I think she's one of my dementia patients, so I'm sure you'll have a lot to talk about while you hold up that line.

What the fuck! It's not taking my credit card! All I want is one fucking head of bruised iceberg lettuce!

WhatdoyoumeanthefuckingcreditcardsystemhascrashedbecauseeveryotherlastminuteloserinAmericaistryingtousetheircreditcardrightnow?

How long will that take?

NO! I DON'T HAVE ANY FUCKING CASH! I GAVE MY LAST 3 DOLLARS TO THE FUCKING SALVATION ARMY GUY! IF I HAD ANY CASH DO YOU THINK I'D BE WASTING MY TIME TRYING TO PUT A SINGLE $1.29 HEAD OF LETTUCE ON A FUCKING CREDIT CARD?!!

Well, fine. I'll go over to the ATM across the parking lot. Look at that line and NO, YOU BELL-RINGING ASSHOLE! YOU ALREADY HAVE MY $3! IF I HADN'T PUT IT IN YOUR FUCKING KETTLE I'D HAVE BEEN HOME BY NOW!

This is the line for the ATM? There are 5 freaking ATM's here? Oh, great, the other 4 are all out of cash due to the Christmas rush. Fine, I'll wait.

Hello? No, I'm in line at an ATM. I need to get cash to buy lettuce and... Because I gave it to the Salvation Army guy, that's why! Look, it's taking longer than I thought!

NO, MR. SALVATION ARMY! I just got this $20 out of the ATM after waiting for 15 minutes, because I gave you my last $3 and now the credit card machine is broken, and if you approach me again I'm going to shove that fucking bell up your ass.

YOU SOLD MY FUCKING BRUISED HEAD OF LETTUCE TO SOMEBODY ELSE? ARE THERE ANY LEFT? NO? CALL THE FUCKING MANAGER!!!

Fine I'll take this bag of salad instead, but it better be for the original $1.29. Merry Christmas.

Don't even think about it, Mr. Bell Ringing Salvation Army Guy.

When I got home Mrs. Grumpy told me she'd just found an extra head of lettuce in the refrigerator. She'd forgotten she'd bought one yesterday and put it in the produce drawer.

Merry Christmas to all, and to all a good night.