Leave me out of it

A young couple were in today.

Dr. Grumpy: "Any other issues you wanted to discuss?"

Mrs. Young: "No, I think you covered it."

Mr. Young: "Yeah. If we were to die, who do you think should raise our kids? My sister or hers?"

Mrs. Young: "Why the HELL are you asking him?! He doesn't know either of them!"

Mr. Young: "He's a doctor, so he knows about this kind of stuff."

Dr. Grumpy: "No, sir, I really don't..."

Mrs. Young: "Let's go. You're an idiot." (drags Mr. Young out).

Things that make me grumpy

Gad (short for gadolinium) is an element. In my field it's used in certain MRI studies as a contrast agent. Not all MRI's need to be done with gad, but for some things it's very helpful.

Gad is also expensive, roughly $200-$500 a dose, on top of the already pricey MRI. So I only order it when I need it.

A few MRI places (not most, just a few) try to push giving gad, even in cases where it's not needed, just to pad the bill. Annie and I know which ones do that, and generally don't use them. But yesterday, for various reasons, we ended up scheduling a patient at one to have a study there.

So I faxed over an order that said "Brain MRI". That's all.

Annie had to run an errand, so I was covering her calls while she was gone. At one point Mary grabbed me between patients, and said I needed to talk to the staff at the MRI place, who had questions. So I picked up the phone.

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

Ms. Gouge: "Hi, I'm looking at your order here, and it doesn't specify if you want gad on the study."

Dr. Grumpy: "I didn't write "gad", so therefore, no gad."

Ms. Gouge: "But shouldn't we do it with gad?"

Dr. Grumpy: "Do you have my patient info form in front of you?"

Ms. Gouge: "Of course."

Dr. Grumpy: "What indication for gad do you see on there? She doesn't have any."

Ms. Gouge: "Yeah, but it's still helpful. So just give me an order for gad, and I'll take care of it."

Dr. Grumpy: "You and I both know that she has no indication for gad, and so her insurance won't pay for it."

Ms. Gouge: "Yeah, but we can bill the patient for it."


I hung up on her. I immediately called the patient myself, and moved the study to another MRI place.

Cookie reruns

We've now survived that most difficult part of the year, Girl Scout Cookie season. Fortunately, this year went off without a hitch, as Marie has gotten better at the art of sidewalk sales.

For those of you who weren't following along last year, I present this rerun from the 2009 Girl Scout cookie sales.



Yesterday was my daughter's turn to hawk $4 boxes of cookies in front of Local Grocery. So your hero accompanied her, as Marie assaulted innocent, but cookie-less, people on their way into the place.

Some nice guy came over and said he didn't want any cookies, but gave us $20 and told us to give a box to the next 5 senior citizens who came out of the store. It was a kind thing to do. So I called Marie over, and explained it to her.

A minute later an elderly lady came out, and Marie attacked. She handed the woman a box of Thin Mints, and loudly said "Here! You win these cookies free, because you're really old!"

I tried to pretend I didn't know her, and wasn't successful.

20 Questions

Dr. Grumpy: "Any medication changes since you were last here?"

Mr. Brite: "Yeah, my internist started me on 2 new pills last week."

Dr. Grumpy: "What are their names?"

Mr. Brite: "Ummm... One starts with 'M', and the other with 'S'. Do you know those?"

Dr. Grumpy: "No. What do you take them for?"

Mr. Brite: "Not sure. But they're both round. Does that help?"

Kids today!

One of the staff's sons was in the office yesterday. He's 9, and was sent home from school with a cold.

So they set him up with some books and a Nintendo DS, and he was pretty good. When he got bored they put him to work, and at one point he was sent to the storage closet next to my office to get copy machine paper and post-it notes.

At that time I was seeing an older gentleman for memory loss, and was going through the usual questions to check his functioning. Typical stuff. What's today's date, who's the President, how many quarters are in a dollar, etc.

A few minutes later the kid walked up front, and asked his mother, "Mom, why does the doctor ask people such easy questions? Even I know those answers."

More hairs fall out

Dr. Grumpy: "Is the new medication helping? Any side effects?"

Mrs. Dimwit: "No, the headaches are the same, but I haven't noticed any side effects."

Dr. Grumpy: "And let me check... You should be up to 2 pills, three times a day?"

Mrs. Dimwit: "No, I take 1 pill, once a day."

Dr. Grumpy: "Why didn't you increase the dose? I wrote out a schedule for you to do that."

Mrs. Dimwit: "I didn't think it would help, so I didn't bother."

Sunday night, 7:45 p.m.

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

Mr. Skin: "Yeah, you started me on Halitosum last week, and it gave me a rash. And I think it's getting worse."

Dr. Grumpy: "Didn't you talk to Annie about this on Friday? I thought she told you to stop it?"

Mr. Skin: "Yeah, she did, and I didn't take it, just like she said."

Dr. Grumpy: "When was your last dose? Friday morning?"

Mr. Skin: "No, this morning."

Dr. Grumpy:"Whaaa... I thought you said you stopped it on Friday?"

Mr. Skin: "Well, she said not to take it. I assumed she meant just that night. So I took it again Saturday morning, and last night, and this morning."

Sunday weirdness

I have one hospital patient to round on. So I drove in.

It's pretty damn cold out today.

I'm in the suburbs of a large, modern, American city. Generic suburbia.

And I had to slam on my breaks to avoid a llama running across the street, being chased by a man on a horse.

WTF?

No, I don't live anywhere near a zoo, or movie set.

Incongruity

As part of our hot date on Saturday night, Mrs. Grumpy and I stopped at Target (yes, I know, we're a wild pair).

In one aisle they had this sign:

"Your choice, 4 for $9.
Ziploc plastic bags OR Pepperidge Farm goldfish crackers
Mix and match for variety"

Saturday morning, 8:27 a.m.

"Hey, someone told me to call and make an appointment? My friend Sandy said I should see Dr. Grumpy for the problem I'm having. Also, when you call back, could you please let me know what kind of doctor you are? Because if you're a psychiatrist I'm gonna beat the crap out of Sandy."

An opposing viewpoint

"Flaming Lisa" gave a dissenting opinion on my post about death, "Checking out". While I disagree with her, I do believe in fairness. I'm therefore putting up her entire comment verbatim, as an opposing viewpoint.



Hmmmm. It's too bad that the original post had to be all balled up with Killer Kevorkian and Terri Schiavo (2 very different cases).

As a Catholic, food and water are considered ordinary (required) care even if medically assisted--so Terri Schiavo would be alive and her murder would never have happened and perhaps her parents would have been able to care for her as they wished. Wow! How awful is that????

Kevorkian is a murderer and has served jail time for such a crime.

This woman in the original post, however, was trying to die but was subject to her husband's wishes. As much as you "healthcare workers" keep harping that this happens all the time, I have a hard time believing it. I don't see hospitals crammed with people being given every possible test under the sun in these circumstances. It is an exaggeration on your part.

MDKauffman: is it really so hard to administer antibiotics to a woman with a UTI? Where's your compassion you idiot? UTI's don't have to be a dying persons disease--you just don't like old people. Get a new profession.

You've all lost your heart! How cold and hard have you gotten???? I am convinced now that NO ONE should be making these decisions (and especially not you people) for a family except the family. Thank you for clearing that up for me and making me thoroughly distrust the medical establishment.


--Flaming Lisa

Mary, bring me a sword

Dr. Grumpy: "So did the Painbegone help your migraine?"

Mr. Unsure: "I don't know."

Dr. Grumpy: "Did it make the headache better?"

Mr. Unsure: "Ummm... Maybe?"

Dr. Grumpy: "That doesn't sound very convincing."

Mr. Unsure: "I don't remember."

Dr. Grumpy: "Didn't you just take it yesterday?"

Mr. Unsure: "I think so, umm, yeah."

Dr. Grumpy: "So, after taking Painbegone, did the headache get better? Yes or no?"

Mr. Unsure: "A little of both."

Dr. Grumpy: "What does that mean?"

Mr. Unsure: "It got better eventually."

Dr. Grumpy: "Define eventually."

Mr. Unsure: "At some point I didn't have a headache."

Dr. Grumpy: "How long is 'at some point'?"

Mr. Unsure: "One hour, maybe several more. I didn't pay attention."

Dr. Grumpy: "Was it faster than it normally takes your headaches to get better when you don't take medication?"

Mr. Unsure: "What medication are you talking about? The white pill? Or the tan one?"

Dear Dr. Staff,

Thank you for referring Miss Carpaltunnel for "an abnormal MRI" (at least that's what it said on your referral form). Unfortunately, your office didn't send a copy of the MRI report in advance.

Earlier today I called your staff, asking that you fax over her MRI results before the appointment. Your secretary said she'd do it immediately.

One hour later, we faxed over a release, and Mary called again. Your helpful staff said we'd have it soon.

90 minutes later I called again, and someone said she'd "get right on it."

So I was glad when a fax from your office finally showed up.

Unfortunately, it wasn't her MRI report.

It was her chlamydia test. And it was positive. But I didn't have that kind of interaction with her, I swear.




So, if you guys can find the brain MRI report, please send it over.

Thank you.

I am humbled

I'm absolutely overwhelmed with your positive responses to my previous post, "Checkout time". Thank you. It's my most commented-on post, ever.

I didn't expect so many would see it from my side.

I'm just one doctor. I can't change the world.

But maybe sending a link to the post to others who DON'T see this side of dying will help more people understand. So if any of you want to, go ahead.

Death touches all of us. Thinking about it in advance won't stop that. But it can help us deal with it better when the time comes.

I was so surprised by your responses that I didn't put up any of my usual stories from the medical trenches. We will return to our regular program format of sarcasm and medical practice idiocy tomorrow.