Guessing games

Dr. Grumpy: "Your blood pressure is 148/80. Where does it usually run?"

Mrs. Sphyg: "Oh, in the upper-higher, lower range."

Dr. Grumpy: "What do you mean by that?"

Mrs. Sphyg: "You know, where the upper number is higher than the bottom number."

Why I do what I do

It ain't much to look at.

Two, maybe three pounds of grayish-white goop. It's not even solid in a living person. More like Jello that floats around in it's vault.

But it's amazing. From that sloppy goop has come remarkable stuff. It's sent a robot to land on a moon of Saturn. It's explored the bottom of our deepest oceans. Built the Taj Mahal. The Great Wall of China. Painted the Mona Lisa.

Go listen to the remarkable Bach's "Toccata and Fugue in D minor". Not just the famous opening 30 seconds or so, but the whole 9-10 minute thing. That all came from the goop, long before it was heard or played on an instrument, it was just a series of electric signals jumping from nerve to nerve. The piece is over 300 years old. The mind that created it has been dead for over 250 years. And humans will likely be listening to it long after my great-great-great-grandchildren are dust.

The soul is there. The heart is amazing, but for all our romantic beliefs about it, who we really are is floating around in the goop. It's where hate, love, and everything in between comes from.

It's capable of terrible evil, such as the Holocaust, and remarkable good. Look at the outpouring of altruism that follows disasters. I love my dogs, but if something bad happens to a dog on the next street, they're not going to care. Yet the goop wants to help people who we've never met and have no direct impact on our own lives

My regular readers know I'm interested in maritime history. Why? I have no idea. It's just been a subject I've loved as long as I can remember. I've never been in the navy. The family military history consists of grandparents who served in the army, but never were sent overseas. I can only assume there is some particular molecular structure in my goop that makes me interested in it. Or that made me want to treat other people's goop for a living.

Twin and biological studies have shown that most of who we are is how we came here. Yes, life experiences and background count for something, but the goop is most of it. People with conservative beliefs raise kids who turn out to be liberals, and vice versa, no matter how hard they may try to pass on their beliefs.

Coke vs. Pepsi. Dogs vs. Cats. Mac vs. Windows. I suspect whatever makes us fall on one side or the other of these great philosophical issues is 95% or more in the goop, and we just come that way.

Everything you are, have been, and will be. Have desired, dreamed of, and done. Have felt. It all comes from a few pounds of goop.

And this fascinates me. Because, let's face it, we're just another part of the planet. A collection of complex molecules, electrical impulses, and chemical reactions. That's all people. Anatomically, all humans are pretty much the same. And we're not that different from other mammals. The difference in our genetic sequence vs. that of a mouse ain't much.

And yet that small amount of difference has led to amazing results. The ability to think beyond our own biological needs and to see the world around us for the beauty it contains. To watch a sunset and be in awe, even though we understand the science behind it. And to look up at the night sky, and wonder.

And that never bores me.

My Reederz Rite

I'd like to thank my reader Beverley, who sent this picture. She says it was in the window of a Tesco supermarket in the U.K.

Another fine patient quote

"It's such an unexplainable thing, because, you know, I can't explain it. It's like something that is totally, entirely, not explainable, because no matter how much I try to explain it, it's still unexplainable. Does that explain it?"

Dear Mag Mutual Healthcare,

Thank you for your catalog of spiral-bound medical coding notebooks.

I've been trying to save money. But when I saw that if I spend only $355.95 on your books, I get a FREE stuffed bear (I bet it's made in China, and only cost you a few pennies), I just KNEW I had to place an order. A deal on a FREE stuffed toy like that (with every order of $355.95) doesn't come along every day.





If I had any second thoughts about getting the books, they were immediately erased when I noticed Jennifer on your cover (with the bear in the background).





I'll call you to place my order later, Jenn. I just hope Mrs. Grumpy doesn't catch me.

Mary's Desk, March 30, 2010

(Lady in scrubs comes in, stands at the front counter)

Mary: "Hi! Can I help you?"

Ms. Tooth: "Hi! I'm Cindy Tooth! I work for Dr. Plaque, the dentist across the street, and we're doing free tooth whitening for all medical office staff, to get them familiar with the procedure."

Mary: "Oh, that's nice, but no, thank you."

Ms. Tooth: "Are you sure? It looks like you could use it."

Mary: "Get out."

Early morning at the office

Dr. Grumpy: "Did you call her back last night?"

Annie: "No. I'll do it this morning. I couldn't bear to do it at the end of the day. She's like a torture chamber with a mouth."

Gee, thanks

More grainy, faxed pictures from a GI doc of the inside of my patient's rectum. This will really help me treat his Parkinson's disease.

Dude, you're also a pig

Look, I think it's great that you, a busy man in his 50's, would take the time out of your day to bring your mom to her appointment.

And I don't mind (too much) that you farted, loudly, in my office. I'd rather you have done it elsewhere, but sometimes we can't help it.

But, in all honesty, you then smiling and saying "Boy, that felt good!" wasn't needed. At all. I am not one of your beer buddies, and we are not in your living room.

Dude, you're a pig

Us guys get a bad rap. And, in all honesty, we at least partially deserve it. I myself am recently guilty of selective hearing.

There are times, however, when I encounter a situation that makes me ashamed to be a carrier for the Y chromosome (like this, from last year).

Yesterday I had a consult on a 24 year old lady who'd been admitted for some pretty scary symptoms. I got to the floor while she was downstairs having an MRI, so I saw a few other patients while waiting for her to come back.

Her boyfriend showed up during this time, discovered she wasn't in the room, and made himself comfortable. He adjusted the bed to a cozy position, bought a bunch of chips and pop from the vending machines, stretched out, and turned on basketball.

After about an hour she was done with the MRI, but there wasn't anyone available to bring her back to the room. Since I wanted to get started on the consult, I went downstairs myself, put her in a wheelchair, and pushed her up to the room.

When I wheeled her in, I looked at Mr. Boyfriend, and said, "You'll have to move to the chair. I need to examine her, and she needs to be in the bed."

He didn't budge. Without looking away from the screen he said, "Dude, I'm watching the game."

Comedy on rounds

I'm evaluating a pleasant, but very forgetful, older gentleman. His family is in the room.

Doctor Grumpy: "He seems to be very forgetful. Is he demented?"

Wife: "Heavens no!"

Daughter: "Oh my God! Is he ever!"

Son: "Maybe just a little."

Patient: "What's demented?"

Sunday morning rounds

Looking through the chart on a new consult. 22 year old female, who suffered a concussion yesterday.

I went in to see her. She had a HUGE bruise on her forehead, a few stitches at the hairline, and looked vague familiar.

Dr. Grumpy: "What happened?"

Miss Concussion: "I was upstairs doing a student nursing rotation yesterday, and had begun throwing up after seeing a lot of blood, when I got really lightheaded and remember falling toward the sink..."

Career change time?

On call today, there was a batch of young student nurses (maybe they were student nurse aids) at the hospital.

I was sitting at a nurses station, when a patient call light went on. One of the nurses, who was filling out forms at a desk, glanced up at a student and said "Hey, can you please see what he wants?"

The student went into the room, and we heard this:

Student: "What can I do for you... OHMYGOD!!!"

Patient: "Sorry, it looks like I'm bleeding a little and..."

Student: "A LITTLE! HOLY HELL! NURSE!"

The student ran out of the room and into the bathroom across the hall.

The nurse went into the room, giggling.

The patient began laughing.

On call. And they do call.

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

Miss Myelin: "Yeah, I see Dr. Cortex for my MS, and I woke up today with blurry vision, and I can barely walk."

Dr. Grumpy: "Have you had this before?"

Miss Myelin: "No, it's new. When my MS acts up Dr. Cortex usually admits me to the hospital for IV steroids."

Dr. Grumpy: "That's standard. I think you need to go to ER, and I'll likely admit you."

Miss Myelin: "Are you kidding? I don't have time for that shit."

Dr. Grumpy: "Excuse me?"

Miss Myelin "I don't have time for that. Can I schedule them for next week, like Wednesday or Thursday?"

Dr. Grumpy: "I suppose, but you'll have to call Dr. Cortex on Monday and... Look, if you're not going to let me help you, why did you even call on the weekend, anyway?"

Miss. Myelin: "Because I thought it might need urgent treatment."