On Call Follies

There is nothing more fun than standing at the bedside in ICU, with a teenage patient who was found passed out somewhere. The patient has a blood alcohol level of 0.374 and piss that tests positive for marijuana, opiods, cocaine, and a host of other illicit substances.

And the parents, Mr. & Mrs. DeNyel, are arguing with me about the lab results.

"My kid doesn't do those things!"

"Someone must have put it in her drink!"

"Your lab must have gotten her specimens mixed up!"

People, I've heard it all. Wake up and smell the crack.

The best part is when they find out her pregnancy test was positive, and go fucking NUTS! Our daughter is a good girl!

Comically, this pisses them off even more then the drug issues and possible brain damage. Apparently, because my hospital did the revealing labs, it's OUR fault that we've brought shame and disgrace on her family for generations to come.

And they keep insisting that she "doesn't do those things". Sorry gang, its, 2010, and her name ain't Mary.

Nice Picture

Hospital nurses (at least where I work) carry around notebooks listing their patients' medications and dosings, called MARS (I have no idea what it stands for). After each shift the MARS sheets are scanned into the patient's chart, so the next shift can keep track of what was given and when.

Since each nurse has her own notebook, they tend to be personalized. Most have pictures of kids, family, friends, pets, maybe a cute saying, or a religious symbol, whatever.

Tonight I'm on call, and got dragged in. As I was dictating a note, I absently glanced over a few MARS notebooks lying near me. Some cute kids and pets looked back at me. One picture of a nurse at her graduation.

One of the books had only one picture on the cover. I recognized it as a blurry shot of the nurse who owned it. The odd part was that the picture showed her in street clothes, looking very upset, with a black eye, her wrists handcuffed behind her back, and getting put into the back seat of a police car.

Mary's Desk, January 8, 2010

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

Mr. Armpain: "My pain is awful today, and I want to go over my MRI results! I need to come in urgently! Please! Can Dr. Grumpy work me in somewhere?"

Mary: "Umm, well, I can squeeze you in over lunch hour today."

Mr. Armpain: "No, that won't work. I'm meeting some friends. Do you have anything on Monday?"

To bleed is human...

Look, Mrs. Protime, we all bleed. Maybe you have a paper cut. Maybe you picked your nose more aggressively then usual. Maybe you chewed one of your toenails too close. I don't care.

And I really don't mind that you used some of my Kleenex on the wound. It's there for whatever reason.

But for crying out loud, did you have to put your hemorrhagic tissue BACK ON TOP OF THE BOX OF KLEENEX?!!!




I could (sort of, maybe) understand you setting it there if I didn't have a wastebasket in the room. But I do.

In fact, if you'd pay some freaking attention to something other then your neck pain, you might have noticed the trash can WAS RIGHT UNDER THE DAMN BOX!!!



Have a nice day.

Allergy lists

A patient gave me this allergy list today:

"Compazine (I almost died)
Reglan (I nearly died)
Penisillin (I could have died!)
Sulfa (same)
Iodine (I almost could have died)"

More from Mr. Lumbar

"Doc, maybe this sounds weird, but when I feel weak, I don't feel very strong. And the opposite is true, too. On days when I'm feeling stronger, I seem less weak."

Thursday patient quote

Mr. Lumbar: "I have Percocet, but I use it sparingly. I don't like narcotics, so I don't want to get used to taking them."

Dr. Grumpy: "Do you take anything regularly for the pain?"

Mr. Lumbar: "Vicodin, 3 or 4 times a day."

Thursday morning, 2:05 a.m.

My cell phone wakes me. I recognize the number. Not a good sign.

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

Mr. Clueless: "Yeah, my wife took her pills at bedtime tonight."

Dr. Grumpy: "She's supposed to."

Mrs. Notas-Clueless (in background): "I told you not to bother him!"

Mr. Clueless: "Well, we normally go to bed at 11:00. So tonight we went to bed at 11:15. Was it still safe to take them?"

Dr. Grumpy: "Yes."

Mrs. Notas-Clueless (in background): "I told you so!"

Dr. Grumpy: "She's been doing this for years. Why are you calling now?"

Mr. Clueless: "I'd never read the bottle before, and just happened to notice it said that when I woke up to pee."

Wednesday Afternoon Freakshow

Dr. Grumpy: "Do you have any other medical issues?'

Mrs. Rudeandcreepy: "I have special powers."

Dr. Grumpy: "Excuse me?"

Mrs. Rudeandcreepy: "I have special psychic powers. I can read minds. I'm very good at it."

My inner voice: "Lady, if you were that good at reading minds, you'd have walked out of here 5 minutes ago."

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.