Sunday morning, 8:45 a.m.

"Yeah, I'm a patient of Dr. Cortex, and his answering service told me to call you. I have migraines and am all out of pills and need something strong, like Demerol or Percocet or one of those other drugs, the really strong ones. I need some pain relief fast, because I have football tickets, and want to enjoy the game, and if I don't get some pain meds the tickets will be wasted and it will be all your fault and I'm going to complain to the medical board and bill you for the money lost on the tickets."

Sunday morning, 6:55 a.m.

"Hello? Is someone there? I was referred to Dr. Grumpy, and need to make an appointment for my husband. He had a stroke, the neurological kind, and it was in his brain, like on the right side, or maybe the left, or somewhere else. But he had one, and it was somewhere in his body, and he needs to see Dr. Grumpy. Do you have Sunday appointments? My chiropractor does, so I thought other doctors might, so maybe we could get in today. Thank you."

ABSOLUTELY FREE! Impress your neighbors! Be the first on your block!

Following a link kindly sent to me by Sunflower, R.N., I discovered this amazing gadget FOR FREE!




Are you tired of trying to keep up with your neighbors? Is your 1988 Chevy looking pretty pissy every time they drive by in their Rolls Royce? Are your kids still playing Odyssey or Atari 5200 while the children next door have a Wii? Are you sick of looking at their satellite dish antenna while you only have rabbit ears on your TV?

Well, its time to blow them out of the water, FOR FREE! Yes FREE!

For a limited time only the U.S. Government is giving away AN AIRCRAFT CARRIER! FREE! THIS IS NOT A JOKE!


U.S.S. John F. Kennedy


Yes, imagine the look on your neighbor's smug face as you bring this 82,000 ton, 1,052 foot long bad boy up the street, crushing his Rolls, house, and lawn in the process. Your kids will be the envy of the block, as other children will want to come over and play on their new "toy". Sure beats that concrete pipe and see-saw, huh?

Worried about that teenage punk down the block with a spray can? Well, the ship comes with Sea Sparrow missiles and a Phalanx computer defense system. Just let him try to tag it.

And remember, this smokin' deal is FREE! Originally built for hundreds of millions of dollars, it can now be yours for nothing (and you don't even have to tell the neighbors what you paid for it)! To build your own aircraft carrier can cost upwards of $6 billion! SO CALL NOW!

This amazing offer is not available in stores or on Craig's list. To receive this once-in-a-lifetime giveaway, see below.

From Naval Sea Systems Command Office of Corporate Communications

WASHINGTON (NNS) -- The Department of the Navy has advertised the availability of ex-John F. Kennedy (CV 67), located at the Navy's Inactive Ships Maintenance Office, Philadelphia, Pa. for donation as a museum/memorial under the authority of Title 10 U.S.C. Section § 7306.

Eligible recipients may include any State, Commonwealth, or possession of the United States or any municipal corporation or political subdivision thereof; the District of Columbia; or any organization incorporated as a nonprofit entity (under Section 501 of the Internal Revenue Code).

According to the Federal Register notice, the deadline for submission of Phase I documentation, a Letter of Intent and an Executive Summary, is Jan. 22, 2010.

For organizations meeting the minimum requirements of Phase I, a letter will be sent notifying each organization to proceed to Phase II of the application process. Responses to Phase II of the process will be due one year from the date of the notification letter to proceed to Phase II. Should Navy receive no interest within two years for donation of the ship, the Navy may remove the vessel from donation consideration and proceed with disposal.

Bad Workout Endings

We keep several sports bottles full of water on one shelf of the fridge, and just grab then whenever needed.

So this morning I had my usual weekend confrontation with the hated Wii Fit Trainer (he started out by saying "I stayed up too late last night" WTF? He's a digital picture!).

After a vicious hour of Wii Fit torture I walked over to the fridge, grabbed a water bottle, sat down, and took a big swig. And began coughing violently.

Mrs. Grumpy ran in to say she'd forgotten to warn me that the big blue sports bottle was where she'd put left over au jus from roast beef last week.

Holy Ice, Batman!

(The iceberg pictured above is suspected to be the one that sank the Titanic. It was photographed near the sinking the following day, with metal scrapes and a line of red ship's paint on it).

Today I'm going to write about something non-medical, and indulge my interest in maritime history. I'm going to tell you a very strange story. And it's entirely true.

To set the background: In 1941-1943, the Axis U-boats dominated the Atlantic, and the Allies were looking for an answer. The airplane was an effective anti-submarine weapon, but the logistics of using planes in the Atlantic were daunting. Aircraft carriers were urgently needed in the Pacific and Mediterranean. Land based planes' range was limited, and could only cover portions of the Atlantic. So there existed a "black gap" in mid-ocean, where the U-boats could roam at will.

So the naval staff of Britain came up with a remarkable idea, which was named Project Habakkuk: to build a gigantic aircraft carrier out of ice. And, as crazy as it sounds, it may have worked.

Normal ice shatters, and melts. A British engineer, Geoffrey Pyke, developed a mixture of ice and wood pulp called Pykrete. The new material was surprisingly resistant to blunt force. As temperatures rose, the wood pulp formed a fuzzy coating over the ice, insulating it from further melting. Experiments on Pykrete were conducted in top secret, in a refrigerated meat locker beneath Smithfield meat market in London. Frozen animal carcasses were used to hide the research areas.

The size of these ships would have been remarkable. The initial design was for a floating airfield 5000 feet (1524 m) long, 2000 feet (610 m) wide, and 100 feet (30 m) high. Later designs were shortened to 2000 feet long. They would have a displacement of 1-2 million tons. By comparison, the huge aircraft carriers in use today by the U.S. Navy are just under 1100 feet long and weigh 101,000 tons.

They could handle the biggest planes of the era, and carry enough food and fuel to resupply them for months. They had externally mounted power plants capable of propelling them at 6 knots, and would act as floating airfields in the North Atlantic. They were cheaper, and could be built much faster, then a conventional carrier, and had an estimated lifespan of 6-18 months (likely longer, as it turned out).

To see if the idea would work, a 60 foot scale model was built at Patricia Lake, in Canada, over the winter of 1942-1943. To preserve secrecy, the Pykrete blocks were made at Lake Louise, and moved to Patricia for assembly. And it worked quite well. In Summer the wood pulp covered the ice and slowed the rate of melting. Auxiliary cooling equipment was developed that could be carried outside the hull.

Churchill thought quite highly of the idea. The ships would be built in Canada, and to this end the Canadians began assembling enough ice and wood pulp to begin construction.

More and more technical problems, however, came up, and by the time they were sorted out the tide had started to turn against the Axis. The Liberty ships were being built faster than U-boats could sink them. The Allies had developed small, relatively cheap, escort aircraft carriers, which were now providing air coverage to Atlantic convoys. Long range patrol bombers had improved. And so one of the most remarkable ideas in naval history was quietly shelved.

The model built at Patricia Lake took 3 years to melt, showing that Pykrete was quite durable. It was allowed to sink into the lake.

And there, at the bottom of Patricia Lake in Alberta, Canada, lie the remains of Habakkuk. The test ship's frame, with a small motor and refrigeration plant, are now visited by scuba divers. Jasper National Park receives many visitors every year, most unaware that at the bottom of a small, serene, lake is all that's left of this remarkable idea.

And that's my story. I hope you guys enjoyed it, as I know it's a bit different from my usual. For those of you who share my interest in maritime history, I've previously written about the steamship Portland.

The bells, the bells, they torment me

2010 is less then 24 hours old in my time zone, and I have the day off.

And in the background there is constant ringing.

Not of bells or some other relaxing device, but of my cell phone.

All of them messages of this sort:

"Hello? I see Dr. Grumpy for (neurological problem) and take (drug du jour). It's a new year, and so I need a new script (called/faxed/telepathically sent) to my mail-order pharmacy because I (have new insurance/can afford them on my medical FLEX account/am now out of the medicare 'doughnut hole'). Please call them in for me ASAP!!!


Just chill, people. My office will be open on Monday. Call then. Your pharmacy won't be shipping before then, anyway.

Happy New Year!

Wishing you a very happy New Year, from the dogs of Grumpy Neurology, Inc.

(click to enlarge)



Zoom (Annie)





Spaz and Fizzy (Mary)





And last, but not least, Cooper, Snowball, and Blackdog (Dr. Grumpy)

Answering service fun

Mrs. Soma is well known to our call rotation. When Dr. Brain isn't on, she routinely tries to get a remarkable variety of pain relievers from the rest of us. She's been shut down many times in the past, but is remarkably optimistic (or forgetful) and keeps trying.

So it was no surprise when Dr. Brain's answering service relayed a message that she was looking for Vicodin. I called her back, and said no. She asked if there was another doctor she could talk to (she always does). I said no and hung up.

Ten minutes later I get called by the answering service again:

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

Ms. Supervisor: "Yes, I'm the service supervisor. Mrs. Soma called back, and says she needs Vicodin."

Dr. Grumpy: "I told her no."

Ms. Supervisor: "But she called back and asked again."

Dr. Grumpy: "The answer is still no."

Ms. Supervisor: "She sounds awful!"

Dr. Grumpy: "She always does. She's been doing this for over 10 years."

Ms. Supervisor: "Well, I"m tired of her calling my operators. We have a lot of calls to answer."

Dr. Grumpy: "Okay. Tell her that."

Ms. Supervisor: "Can't you just give her one Vicodin to shut her up?"

Dr. Grumpy: "Wha...? NO! I can't believe you just asked me that."

Ms. Supervisor: "She's just driving us nuts."

Dr. Grumpy: "Sorry."

Ms. Supervisor: "Happy new year."

More things that make me grumpy

When Dr. Cortex is out of town, I cover his patients.

I try to work within my patient's means as much as possible. If they have crappy (or no) insurance, I try to use the cheapest generic medication possible.

Dr. Cortex, however, uses a lot of brand-new, pricey Wonderdrugs, mainly because he has samples to give out. The problem here is that he also sees A LOT of Medicaid-subplan indigent patients, and once the patient runs out of samples there is NO FREAKING WAY the plan will pay for the prescription.

Normally, this is a problem between he and his patients. Except when he's out of town. Like now.

So Mr. Ictal runs out of expensive Wonderdrug samples for his epilepsy. Dr. Cortex's nurse calls in a script to Local Pharmacy. Local Pharmacy finds out Wonderdrug isn't covered by his Medicaid plan, and tells Mr. Ictal it'll be $400.

So Mr. Ictal calls Dr. Cortex's office. And his staff closed the office to take a 4-day New Year's weekend (which they weren't supposed to, but figured the boss was in Brazil, so who cares?). And so the answering service routes him to me (my office is closed for the 4-day weekend, too).

Wonderdrug won't be covered without a doctor begging, pleading, and filling out a 30 page form. I call the Medicaid subplan to at least beg. But I'm not contracted with that subplan myself, so they won't even talk to me.

The pharmacy (understandably) can't afford to take the loss on a $400/month pill that they know won't get reimbursed. And Mr. Ictal can't afford this at all. And he has 1 sample pill left, and it's pretty damn dangerous for epilepsy patients to stop their meds cold turkey. And he has no idea what he's taken in the past. And I really hate to change meds on a patient I know nothing about. And his chart is locked up in Dr. Cortex's office until next week.

I feel bad for Mr. Ictal. This insanity (mostly) isn't his fault.

What did I do?

Fortunately, I live close to my (closed) office. So I drove down there this morning to meet Mr. Cortex, and gave him enough samples of Wonderdrug so he won't run out before Dr. Cortex can get back and decide what to do. But this is me (and at least I had samples). In all honesty, most other docs wouldn't care, and say they can't help him. Or would tell him to put the pills on a credit card. Or say it's the pharmacy's issue and to call them. Or to go to an ER (I have no idea why he should go to ER for this, but it's amazing how many docs send patients there for stupid shit like this).

The bottom line here is that you should try to work within your patients' means as best you can. It prevents crap like this from happening, and your call partners will be grateful.

Stupid questions

Dr. Grumpy: "Here are the names of 3 hand surgeons I recommend."

Mr. Carpal: "Are they good docs? I don't want to see a bad one."

My inner voice: "No, you dipshit. They're all dangerously incompetent. WTF would I knowingly refer you to a bad one?"

You VILL do ze physical therapy!!!

This note is from Local Physical Therapy, and hot off the fax just now.

With therapists like this, who need enemies?

(click to enlarge)

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.