Circus is sounding really good now, too

Dr. Grumpy: "Are you allergic to any medications?"

Mrs. Wrinkled: "I don't know. I might. Should I be?"

Mary, I'm running away to join the circus

"Doctor Grumpy, at our last visit you said my wife had Parkinson's disease, and started her on Sinemet for it. And since then her tremor has stopped and her walking is much better. So all her symptoms have gone away on their own. At this point I think you were wrong, and she doesn't really have Parkinson's disease at all."

Maybe you should try Nicorette?

Dr. Grumpy: "Do you smoke?"

Mr. Church: "Yes, but Jesus is helping me quit."

Dr. Grumpy: "How long have you been trying to quit?"

Mr. Church: "7 years."

More Helpful Notes

I sent one of my patients, Mr. Huge, over to a neurosurgeon last week.

Yesterday Mr. Huge returned, so I was wondering what the surgeon thought. I called over and asked them to fax his note. They said they'd get right on it.

5 minutes later, this helpful item showed up on our fax machine. This was all I got. One page.

Except for changing the names, I haven't altered it in any way.

(click to enlarge)

Afternoon rounds

Dr. Grumpy: "Does anyone else in your family have a tremor?"

Mr. Pointless: "Nope. But my mom choked to death on fried scallops."

Fun with patients

Mr. Math: "Doc, I'm concerned about my liver on all these pills."

Dr. Grumpy: "What dose are you up to now?"

Mr. Math: "Um, I've got the 25mg pills, and I'm taking 4 of them, twice a day."

Dr. Grumpy: "That's a standard dose, you should be okay."

Mr. Math: "I dunno. I read some scary stuff online about taking so many pills, and I'd like to change."

Dr. Grumpy: "How about if I change you to the 100mg pills, and you take one twice each day?"

Mr. Math: "Oh, that's fine. Thank you for working with me on this."

Sucker!

Dr. Grumpy is always looking for junkies. I try not to deny pain meds to those who need them, but at the same time I hate people who abuse them. They make it harder for those who need them to get them.

Every doctor has been taken by a junkie at some point.

A few years ago one of the ER docs called me. He had an old lady at the hospital, who was visiting from out of town, and had a flare-up of her Trigeminal Neuralgia (a condition with awful facial pain). He asked if I could work her in that day, so I told Mary to put her on the schedule.

She came over from ER. She was very sweet, in her mid-late 70's. Fully dressed in a Salvation Army uniform (even with a little hat with the red badge). She had a long history of Trigeminal Neuralgia, which hadn't bothered her in several months. It was late November, and she was a ranking member of the Salvation Army who'd come to town to help organize the annual holiday bell-ringing campaign.

She gave a good history for Trigeminal Neuralgia. I put in a call to her regular neurologist, but the office was closed for lunch. She'd left her Neurontin and Percocet back home, and needed refills, so I wrote her for some and sent her on her way.

I went on with my afternoon. After about an hour Mary nabbed me between patients. While straightening up the lobby she'd noticed sweet old lady had left the Neurontin script sitting on top of the water cooler. I figured it was an accident, and she'd call looking for it.

Then her "regular neurologist" called. They'd never heard of this patient.

Ten minutes later the ER doc called me. He'd just gotten a call from a police department in another state. They were looking for my patient. She'd stolen a Salvation Army uniform several weeks earlier, and was traveling around, using it to collect as many narcotics as she could. She'd take some, and sell the others, and keep on the move. They'd found she'd filled a script in my city, and were calling local ER's to alert them.

I have no idea whatever happened to her. On one hand, I felt sorry for this old lady who's life was reduced to being a traveling fugitive junkie. On the other hand, I was pissed for having gotten taken, and certainly she was giving the Salvation Army (for all the jokes about bell-ringing, they're a good organization) a bad name.

And, in some strange way, I had to respect her ingenuity and skill as the opponent she was. And laugh at how I'd been beaten by my own view that a sweet little old lady, especially one in a Salvation Army uniform, couldn't possibly be a junkie.


Junkie's and other low-lifes are a common source of amusement on medical blogs. But in reality they're far from funny. For an excellent look at this forgotten, but more realistic side, I recommend this post by my colleague Phathead.

YOU! YES! YOU!

Let's look at this:

1. YOU are the one who lives 140 miles from here.

2. YOU are the one who refuses to move your demented mother into a home closer to you, in spite of the fact that she has no connections here at all.

3. YOU are the one who frantically called last Friday demanding an immediate appointment for Mom's behavioral changes.

4. YOU are the one who went apeshit because you called at 3:30 p.m. on a Friday and I didn't want to keep my office open until 6:00 so you could drive here, pick her up, and bring her to see me.

5. YOU are the one who refused my suggestion of admitting her to the hospital last Friday to work this up.

6. YOU are the one who demanded an appointment for today, so I agreed to work Mom in over lunch.

So don't come in and chew me out for making you spend 2 hours driving here and bring your Mom to see me! And don't chew Mary out and tell her that I did this only to get your Mom's $15 co-pay!

And, when YOU just decided you don't want any more tests done or medications started on Mom, don't freaking yell at me for wasting your time on this visit!

Another bright part of my day

Dr. Grumpy: "Do you still see Dr. Internist?"

Mr. Beeph: "Yeah, I'm due for my special exam."

Dr. Grumpy: "Special exam?"

Mr. Beeph: "You know, where he uh, puts his finger in the, um, hole I poop out of."

Monday Morning

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

Mrs. Confused: "Yes, I have an appointment for this morning, but that must be wrong."

Dr. Grumpy: "No, I remember from the schedule. It's at 9:00."

Mrs. Confused: "But it's a national holiday. The post-office is closed."

Dr. Grumpy: "Yes, but I'm open."

Mrs. Confused: "You must be wrong. So if you're office is closed, I'd like to reschedule."

Dr. Grumpy: "We're open! Most doctors are."

Mrs. Confused: "But the post office is closed!"

Dr. Grumpy: "Ma'am, I'm not the post office."

Mrs. Confused: "Okay. I'll be in then."


Five minutes passed. Then the phone rang. It was Mrs. Confused again, so I answered it.


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

Mrs. Confused: "Doctor, I'm just not comfortable with this. I'd like to reschedule, just in case your office is closed today."

Dr. Grumpy: (heavy sigh) "Okay, I'll have Mary call you later."

Mrs. Confused: "Will she be in today if you're closed?"

Dr. Grumpy: "Have a nice day." (hangs up, watches hairs leap off his head like lemmings)

Sunday Funday

So I had a hospital consult this lovely Sunday. The patient was an EXTREMELY drunk lady.

Dr. Grumpy: "How much do you drink?"

Mrs. Smashed: "Oh maybe 3, sometimes 4 a day."

Dr. Grumpy: " 3 or 4 what? Beers? Bottles of wine? Six-packs?"

Mrs. Smashed: "You're getting warmer."

Elevator Stories

My favorite drug rep and I were talking about my elevator encounter from a few days ago, and she sent me this story:


In my old job I made hospital calls to talk to cardiology nurses. One day I was in the elevator, and this short, squat, unattractive guy in scrubs got in with me.

Dr. Scrubs: "You must be a rep. What company do you work for?"

Ms. Nicerep: "Notsobig Pharma, we make cardiac surgical devices. What field are you in?"

Dr. Scrubs: "Plastic surgery is my game. Here's my card. Why don't you come by my office? I could do something about that nose and breasts of yours."

Ms. Nicerep: (GASP!): "Umm, no thanks, I'm happy with how I am..... But if that's your marketing schpiel, you might want to get some work done yourself!"

Then I got off the elevator.

Friday afternoon quiz

You woke up this morning with severe back pain, completely paralyzed from the waist down. You immediately:

A. Call 911.

B. Call a friend to take you to the hospital 2 blocks from your home.

C. Drag yourself to your car and drive yourself down the freeway to a hospital over 1 hour from your home because you saw a TV ad last night on how it delivers "Premium Quality Healthcare"

D. When you discovered you couldn't drive because your legs were paralyzed, you grabbed a broomstick you had in your garage and used it to operate the pedals as you sped down the freeway at 75 mph.

E. Both answers C & D.

If you answered E, it was a pleasure meeting you this afternoon in the neurosurgical recovery room, sir. I hope they can get those wood splinters from the broomstick out of your hand.

But did he dress like a pimp?

Seeing a new patient this morning


Dr. Grumpy: "So what brings you in today, sir?"

Mr. Mouth: "My previous neurologist was an asshole."