End of the day

After rounds last night I got in the hospital elevator on my way to the parking lot. The only other person in it was a sweet-looking elderly lady, with a pleasant smile.

The doors closed, and she looked at me.

Mrs. Olde: "Excuse me, sir, but are you a doctor?"

Dr. Grumpy: "Umm, yes..."

Mrs. Olde: "Oh. Because that shirt makes you look like a pimp."

Drug Rep Lunch Quote

"Dr. Grumpy, if you look at this data, you'll notice that as pain relief improves, the patients hurt less".

Mary's Desk, January 14, 2010

A lot of patients have Mary's email. They use it to schedule and confirm appointments.

So my 8:30 was running a few minutes late today. Using her cell phone, she sent Mary an email that she was running late because she spilled soda on her pants. Whatever.

A few minutes later, while driving down the freeway, she took a picture of the stain and emailed it to Mary.

I couldn't make this stuff up if I tried.

Shining Lights of Education

The twins (Craig and Marie) routinely beat the crap out of each other. This is such a normal occurrence at our house that we just ignore it unless at least one liter of blood is spilled.

So after I got home from work today, the phone rang.

Dr. Grumpy: "Hello?"

Mrs. Playground: "Is this the father of Marie Grumpy?"

Dr. Grumpy: "Yes."

Mrs. Playground: "I'm the playground supervisor at Wingnut Elementary School, and I have to notify you that Marie was involved in a playground fight today, with a boy at school."

Dr. Grumpy (glancing out the window at the twins gouging each others eyes out on the trampoline): "Is she in trouble?"

Mrs. Playground: "Yes, she has to miss recess tomorrow. She and the boy suffered some minor scrapes, so I need to notify the parents of both children."

Dr. Grumpy: "Okay, thank you."


I hung up the phone, looked at Mrs. Grumpy, and began counting. "5-4-3-2..." As soon as I got to "1", the phone rang. I bit my tongue, hard.



Dr. Grumpy: "Hello?"

Mrs. Playground: "Is this the father of Craig Grumpy?"

Dr. Grumpy: "Yes."

Mrs. Playground: "I'm the playground supervisor at Wingnut Elementary School, and I have to notify you that Craig was involved in a playground fight today, with a girl at school..."


I can see why she's the "playground supervisor", whatever the hell that means.

Going in circles

Dr. Grumpy: "Do you have high blood pressure?"

Mr. Brainless: "No."

Dr. Grumpy: "Do you take any medications?"

Mr. Brainless: "Zestril."

Dr. Grumpy: "What do you take that for?"

Mr. Brainless: "My high blood pressure."

Dr. Grumpy: "I thought you said you don't have high blood pressure?"

Mr. Brainless: "I don't if I take the Zestril."

Things that make me grumpy

If I'm still prescribing medications for a patient, I want to see them once a year (give or take a month). I'll see them more than that if needed, obviously, but for a stable patient I think once a year is reasonable if I'm still the one writing their scripts. Dr. Darth, a neurologist downstairs from me, makes everyone come in every 8 weeks, and Dr. Ivyleague across the street requires monthly visits. But I think that's just digging for a co-pay.

Mrs. Bagge is an elderly lady who I see for benign tremor. I see her once a year, and refill her Inderal, and she goes on her way. But she always bitches and complains about her $25 HMO co-pay to see me once a year. I'm not that desperate for the $25, but if I'm taking the legal liability of writing her pills, I want to see and examine her once a year.

She was due for a return visit in early November, 2009, so I had Mary call her. Mrs. Bagge said she'd just had surgery on her bunions, and couldn't get in then. So, to be nice, I wrote her for another month.

So in early December, her next refill came up. This time Mrs. Bagge had family in town through the holidays, and so asked if I'd give her until January. I don't want to be Scrooge, so I said fine.

Last week another refill came up. Mary called her, and Mrs. Bagge wanted to make an appointment, but she needed an insurance authorization from her internist to see me. So Mary called Dr. Internist (twice) to ask for one, and said she'd call Mrs. Bagge to schedule the appointment as soon as we got it.

In the meantime she was out of Inderal. I told Annie to give her 15 days worth of pills, and no more until she was seen. Annie argued with me that Mrs. Bagge is on a fixed income, and we shouldn't put her in the position of having to make 2 medication co-pays for one month of pills. Since we were in the process of getting the auth for her to see me, and I'm a soft touch, and (most importantly) because I never argue with Annie, I said fine. Give her a whole month.

So yesterday afternoon her insurance auth showed up for her visit, and Mary called her.

Mrs. Bagge refused to make the appointment. She said she was tired of dealing with my greedy office, and accused us of harassing her with phone calls and holding her Inderal hostage. She then sent over a request to fax her records to Dr. Darth, because she has an appointment with him next week.

Good riddance.

The hip bone's connected to the...

Mrs. Anatomy: "The pain goes down the front of my thigh to the clavicle."

Dr. Grumpy: "Clavicle?"

Mrs. Anatomy: "Yeah, the clavicle, in the front of your knee."

Dr. Grumpy: "You mean knee cap? Patella?"

Mrs. Anatomy: "Yeah, there too."

Missed the "calling with results" lecture, did we?

Dr. Grumpy: "This is Dr. Grumpy, returning a page."

Nurse Newgrad: "Hi, I'm the nurse taking care of Mr. Seizure, in room 8, and his Dilantin level is abnormal."

Dr. Grumpy: "What is it?"

Nurse Newgrad: "Oh, I don't know. I just heard it was abnormal. Do you want me to look it up?"

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.