Things that make me grumpy

Wallpapering.

I like most of my drug reps. I've said that before. But some of them drive me nuts. (If you are one of my reps who reads this, don't worry, It's none of you).

Drug reps often bring "patient education materials". Most of these are just trash, and I either refuse or toss them. They consist of thinly veiled ads in booklets that have a smattering of info about a disease and lots of big glossy "ask your doctor because you'll feel SO MUCH better on our product" ads.

Sometimes they actually bring in a very useful booklet, with info about the disease and fairly neutral information about treatments, with only a drug company logo on the back cover. I screen these, but if they're good ones I appreciate them and often give them to patients.

Any info that patients get in my office should come through me, NOT directly from a drug rep. So I don't allow booklets of ANY kind to be out in the lobby without me screening them first.

Most reps are fine with this. But a few aren't. And they engage in a thoroughly annoying practice called wallpapering. And it REALLY pisses me off.

Wallpapering is when they put pamphlets out in my lobby that are blatant "You should take Flatula, instead of Obecalp, because our drug is SO much better for you. Ask your doctor. NOW!" They are just ads, often hard sell. Sometimes with a big coupon for a free trial. My patients don't need that crap. And neither do I. And putting them out in the lobby makes it look like I've endorsed this product.

So I don't allow this, and if my staff sees it they tell them to stop. So some wallpaperers have taken it a step further. They actually keep track of when the front office staff are most likely to be in back for a coffee break, or know when the lunch hour is (when nobody is up front). So they come in then, quickly wallpaper the lobby with booklets, and then run off.

Sometimes we notice this when we get back. But they're good at putting them behind a plant, or under a magazine, or some other place where they won't be noticed from the front desk. So once or twice a week I do a sweep through the lobby looking for these things.

And we know exactly who the reps are who do it. I mean, you guys come by pushing this stuff regularly, and leave your cards, so we know who sells what. And when we ask them about it, they always deny it, "Huh! How did the Fukitol booklet get inserted between the pages of every National Geographic issue in your lobby?"

We ain't that stupid. If you have to leave these somewhere, just save us the trouble and use the recycling bin.

That's kind of personal

One of my MS patients is trying to have kids, and is seeing a fertility specialist.

I get notes all the time from other docs asking me for neurological clearance to do some procedure (colonoscopy, hysterectomy, face lift, whatever) on my patients. So I write out an "okay from neurology view to do whatever you want with them, have fun" note.

The request on my MS patient, though, could have been worded better. It said:

"Cindy is going to do a procedure that may result in her becoming pregnant. Please write a note that it is okay for her to do this."


Sheesh! If I have to write a clearance note every time one of my patients does something "that may result in her becoming pregnant" I'm going to have a really sore hand (from writing the notes, I mean) and will likely run out of pens when a patient goes on her honeymoon.

Whatever

Mr. Behind: "At the hospital they told me I had a hemorrhoidic stroke."

Dr. Grumpy: "You mean hemorrhagic stroke?"

Mr. Behind: "Something like that."

Scrubs Catalog- Part 3

This picture from the scrubs catalog supposedly shows a NEUROLOGIST! I swear. Read his white coat.




Mrs. Grumpy pointed out, and I agree with her, that any medical person can clearly see this isn't a neurologist:

1. He's handsome and studly. We aren't. We are the geeks of medicine. Most people see a neurologist coming, and immediately react with, "Hey is that really a doctor? Hide the children! Call security!"

2. He's clean shaven. Most male neurologists have mastered the perpetual 5:00 shadow look.

3. He's wearing a stethoscope, for Pete's sake. Most of us have one, but it's somewhere in the black bag of pins, hammers, tuning forks, ophthalmoscopes, and other crap we carry around.

4. His shoulders are at equal heights. Usually one is lower from years of carrying the black bag full of crap (see #3, above) everywhere.

5. His tie is done properly. Many male neurologists don't wear them because we've forgotten how to tie them. Those who do wear them usually have botched knots, partially undone, and hanging to one side.

6. Aside from the tie, he's nicely dressed (granted, he could be pantless under the white coat). Except for the neuros at major academic centers (and I think those places dress their docs), most male neurologists have absolutely NO fashion sense. We may understand the complexities of the brain, but have no fucking clue what colors match. And Mrs. Grumpy will tell you it shows. I'm often greeted home at night with "OMG! You wore THAT to work?!!"

Scrubs Catalog- Part 2

Here's a scrubs catalog picture of a nurse, happily demonstrating the inside pockets of her white coat.

How do we know she's not a real nurse?

1. The coat is spotless.

2. Very few nurses wear these white coats anymore.

3. Only people in training carry books in their pockets. A real nurse's pockets have tape, scissors, hemostats, pens, a granola bar, a "buy 500 get 1 free" Starbucks punchcard, and a hospital ID.

Another point: Although I don't know what Nurse K looks like, this could be a picture of her, taken at the critical moment when she's tired of putting up with a drunk patient's shit and is smilingly drawing her Taser.

OMG!

Miss Boobshow, when I asked you to take off your jacket so I could check your blood pressure, I didn't expect you to whip it off so quickly.

Likewise, I'd have appreciated it if you'd told me in advance that you weren't wearing a shirt, bra, or anything else under it. I would have tried it through the sleeve if I'd known.

The older gentleman that was passing in the office hallway on his way to Dr. Pissy's exam room, however, was very grateful for your actions. He just had cataract surgery last month, and is glad it went so well.

Nice dragon tattoo.

Scrubs Catalog- Part 1

Over the weekend I received a catalog from a scrubs company.

Clothing catalogs are always an oddity, at least to me. Let's face it. The people in them appear creepily happy. In most cases they show people relaxing, so they should be happy. But in the scrubs catalog this is what they wear to work. If you look that happy at work, then your Prozac dose is way too high.

But I digress.

In my area there are 5 Dr. Kumar's, all from India or Sri Lanka. They're all good guys. And none of them look anything like this Dr. Kumar.





BUT, in the very same catalog, just a few pages later, we find Beachboy McStud again, but now he's Dr. Ruckman (which, I know, is almost an anagram of Kumar).





Mrs. Grumpy commented that she'd rather see what he looks like with the scrub top off. And regardless of his name, if he's been marked down to $7.99 she'll take five.

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


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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)