Thanks for clearing that up.

Dr. Grumpy: "What kind of doctor did you see after that?"

Mr. Dimbulb: "The one my family doc said I should go to. I think she was a cardiologist or rheumatologist or something like that. You know, one of those 'ologist' docs. What do they do, anyway?"

Scoreboard: Arizona: 51. Green Bay: 45. Patient: 0

(While football is primarily a North American sport, I'm sure my international readers will agree that idiotically extreme sports fans are universal, though the sport varies).


Dr. Grumpy: "When did this all start?"

Mr. Touchdown: "Mmm. I think Dad's right arm stopped working in the 2nd quarter."

Dr. Grumpy: "Any idea what time?"

Mr. Touchdown: "I dunno. It was the 2nd quarter. Yeah, that was it. Because normally Dad makes a sandwich at halftime, but today he just stayed on the couch and stared at the TV. He was real quiet, even though it was a good game. Normally he really gets into them."

Dr. Grumpy: Well, it looks like it's too late to give him TPA, the clot-busting drug. We can only give it within a few hours of when things start and..."

Mr. Touchdown: "Look! I would've gotten him in here sooner, but the game went into overtime! That's not my fault! Can't you give it anyway? What's the worst that could happen?"

Dr. Grumpy: "He could bleed into his brain and die."

Mr. Touchdown: "Well, with Green Bay out of the playoffs, Dad wouldn't really care."

Today's Quiz

You woke up last night with chest pain and your heart racing. You called 911. In the emergency room you were found to have a heart attack. You then had a 10 minute episode of right-sided weakness and inability to speak, but are better now.

So this morning you:

A. Thank your internist, who dragged his butt out of bed on a Sunday to come see you in the hospital.

B. Thank the cardiologist, who dragged her butt out of bed on a Sunday to come see you in the hospital.

C. Thank the neurologist (me), who dragged his butt out of bed on a Sunday to come see you in the hospital.

D. Tell the internist, cardiologist, and neurologist to all go away and come back to your hospital room tomorrow, because you don't want to miss any of the football pre-game, game, or post-game coverage.

(If you answered "D", It was nice to meet you this morning, sir. And I think you're an asshole).

Everything I ever learned about surviving being on-call came from "Meet the Robinsons"

Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.
Keep moving forward.

(Oh yeah, and eat when you can/sleep when you can, from the Science Marches on Department).

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.