When dictation goes bad

This has to be one of the most bizarre dictation/transcription errors I've ever seen. It was in another physician's note. I have no idea what the original phrase could have been.

For my non-medical readers- a C-arm fluoroscopy is a large piece of metal equipment used for radiology procedures.

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Sunday morning, 10:17 a.m.

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

Mr. Time: "Yeah, I have an appointment tomorrow, and I need to move it to Friday."

Dr. Grumpy: "Hang on..." (turns on iPod) "uh, you're appointment is on Friday, March 19th"

Mr. Time: "Oh. So is that the next Friday, or the following Friday?"

Dr. Grumpy: "It's Friday, March, 19th, 2010. I'll tell you the specific date to keep it clear."

Mr. Time: So when did you move it to Friday? How did you know I'd need to do that?"

Dr. Grumpy: "You must have. We don't do that."

Mr. Time: "Friday is good for me. Would Monday work better for you?"

Dr. Grumpy: "Friday is fine. See you then. Have a nice day."

Saturday afternoon

"Frank!!! What is this MESS?!!!"

I'm surveying our kitchen table. At 1:00 it was clean, having been wiped down after lunch.

When I wandered into the kitchen at 2:00, it was covered with a bizarre mixture of crayons, ink markers, scissors, tape, and green colored papers, all heavily smeared with pancake syrup.

"Dad, we were busy."

"Doing what?"

"Making St. Patrick's day cards for our friends."

"Why is there pancake syrup everywhere?"

"Because I forgot where the glue was, and thought we could use that instead."

He's mad I tell you! Mad!

Since Alice in Wonderland is in the news right now, I'm putting up 2 history posts in one day.

The Mad Hatter is well known in English literature. He was created by Lewis Carroll (real name Charles Lutwidge Dodgson) for the story Alice's Adventures in Wonderland. An interesting side note is that the character was most likely based on a furniture dealer, and not a hatter.

The phrase "mad as a hatter" actually predated the story, and has an interesting neurological history.

Mercury is a metal with multiple human toxicities. It can affect many organ systems, and in sufficient amounts can cause brain damage. When this occurs common symptoms are memory loss, confusion, and behavioral changes.

Mercury poisoning is uncommon in modern medicine, but before it had been identified as a toxin it was commonly used in the cloth industry, in the manufacture of felt.

A hatter, obviously, is someone who makes hats. And in 18th & 19th century England, felt was commonly used in hats. So hatters had a fairly high level of exposure to mercury, and after several years of plying their trade they sometimes developed brain damage, and went "mad". And that's where the phrase came from.




Alice in Wonderland has other neurological trivia. As many of my migraine patients will tell you, their headaches can be preceded by all kinds of visual changes. Typically these are flashing or sparking lights, dark spots, colors, or squiggly or zigzag lines. But some patients will see visual distortions, where things suddenly seem to grow or shrink in front of them. This perception change is now called Alice in Wonderland Syndrome.

It's known from his personal diaries that Lewis Carroll suffered from migraines with visual changes. It's unknown if he had the perception changes of things growing and shrinking, but who knows? Maybe one of the most famous books ever written was partially inspired by a migraine.

It's something to think about.

March 13, 1918

On this day in 1918, a U.S. Navy ship failed to arrive in Baltimore as scheduled.

No trace of the ship has ever been found. To this day, it remains a complete mystery, and the largest unexplained loss of life in U.S. Naval history (306 passengers and crew)

The ship was the collier U.S.S. Cyclops. A collier was a ship designed specifically to carry coal (the 1918 equivalent of an oil tanker), though on the last trip she had a cargo of manganese ore. The Cyclops was a reasonably large ship, 542 feet long (165m) and just under 20,000 tons. And she vanished without a trace.

The ship was en route from Brazil to Baltimore when she disappeared. Much has been made over the captain's (George Worley) health & temperament, and his possible pro-German leanings (this was during World War I) but nothing has ever been substantiated. An extensive check of German archives after the war turned up no evidence of the ship having been sunk or captured by hostile action.

Realistically, the ship likely sank in a storm, or due to major structural failure. I'm not a believer in the Bermuda Triangle or more exotic theories of things that vanish. Lawrence Kusche, in his excellent 1975 book "The Bermuda Triangle Mystery Solved" postulated a storm sinking the ship, which already had known mechanical problems.

In 1968 diver Dean Hawes reported finding wreckage of a ship that matched the Cyclops description off Norfolk. Subsequent attempts to locate this wreck have been unsuccessful. And there have been several.

There are a handful of mysteries I'd love to see solved in my lifetime. This is one of them.

More from the Department of Contradiction

I'd like to thank my reader Glen for submitting this screenshot.

He was trying to show a patient why she shouldn't be using quinine for her leg cramps, only to be betrayed by an ad in the lower right corner.

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BUSTED!!!

Mr. Seizure: "Sorry I'm late, I was driving around looking for a parking space."

Dr. Grumpy: "I thought I told you that you're not allowed to drive until April?"

Mr. Seizure: "Um, yeah, I mean, I was, uh, riding and, um, looking for an empty bike rack."

I finally did it

Okay, for all of you who have written in asking me to do Twitter, I finally have. I may be the last person on Earth to have signed up for it. I'd like to thank (or blame) ERP for inspiring me.

I'm going to use it for those moments that are too brief to warrant a full blog post. I promise not to use it to update anyone on my lunch choice, sock color, are other pointless trivia. I likely won't use it more than a few times a week, but who knows.

I am @docgrumpy. You can also, I think, look me up by my email address pagingdrgrumpy [at] gmail [dot] com

(for those of you rushing to add me to twitter, don't forget to check the previous post below- it's another patient gem).

Thursday night, 8:47 p.m.

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

Mr. Flick (loud music in background): "Yeah, I'm gonna run out of medication tomorrow, and I need you to call some in."

Dr. Grumpy: "Which medication?"

Mr. Flick: "I don't know it's name. The bottle is at home. It's the one I take twice a day."

(someone screams in the background)

Dr. Grumpy: "What's all that noise?"

Mr. Flick: "I'm at a movie."

Dr. Grumpy: "Why are you calling me for refills from a movie?"

Mr. Flick: "It's boring, and I wanted to call you while I was thinking about it."

Dear U.S. Census Department,

Thank you for your letter reminding me that my census forms are coming, and asking me to fill them out when they arrive.

Government waste is a universal phenomenon, and certainly this country is no exception.

But I have to wonder, how much money did it cost to send "your census is coming, please fill it out" forms to EVERY FREAKING HOUSEHOLD IN AMERICA?!!!

You guys have been running TV and radio commercials, magazine ads, newspapers, and billboards about this for months already. Not including the many news features about the census coming. You'd have to be living under a rock NOT to know the census is this year (every 10 years, for my non-U.S. readers).

Wouldn't it have saved money, and made a hell of a lot more sense, to include this letter WITH the census, saying "here is your census, please fill it out"? Do you really think sending an advance letter will make a difference? Do you really think anyone is going to remember the first letter by the time the REAL census forms show up? Do I really think that me writing this will make a difference?

Your's truly,

Ibee Grumpy, M.D.

Unpredictable

You guys may remember this post, from a month ago. Basically, one of my readers (Bob) had his truck blocked into a parking space by an overzealous pot hole repair crew.

Bob died, quite unexpectedly, yesterday. His wife, Cheryl (also a reader) sent me an email last night. She wanted me to know how much he enjoyed seeing his truck nightmare up on my blog.

While I'm not planning on making online condolences a regular feature of my blog, I do want to send mine to Cheryl. I didn't know Bob at all (beyond the comment he posted that day), but anyone who can look at his truck trapped in a parking space by a malfunctioning maintenance drone, and have a good laugh (instead of, say, a shit fit or heart attack) is my kind of guy.

We all talk about the company we work for, who our boss is, etc. Always keep in mind who it is that you REALLY work for, and what is truly important.

IG


Tell me not, in mournful numbers,
Life is but an empty dream!
For the soul is dead that slumbers,
And things are not what they seem.

Life is real! Life is earnest!
And the grave is not its goal ;
Dust thou art, to dust returnest,
Was not spoken of the soul.

Not enjoyment, and not sorrow,
Is our destined end or way;
But to act, that each tomorrow
Find us farther than today.

In the world's broad field of battle,
In the bivouac of life,
Be not like dumb, driven cattle !
Be a hero in the strife !

Lives of great men all remind us
We can make our lives sublime,
And, departing, leave behind us
Footprints on the sands of time.


- A Psalm of Life, by Henry Longfellow

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.