Annie's Desk, April 6, 2010

Annie: "Dr. Grumpy's office, this is Annie."

Mrs. Ditz: "My husband is having problems with his medication."

Annie: "Which medication is that?"

Mrs. Ditz: "The one Dr. Grumpy gives him. I don't know the name. He takes it at night."

Annie: "Okay, I'll look it up... What kind of problem is he having?"

Mrs. Ditz: "He says it causes side effects."

Annie: "What kind of side effects?"

Mrs. Ditz: "I don't know. What kind of side effects can it cause?"

Annie: "It depends on what he's taking."

Mrs. Ditz: "I don't know what it is."

Annie: "Why don't you let me talk to your husband?"

Mrs. Ditz: "He's at work. He won't be home until after 6:00."

Annie: "Why isn't he calling himself?"

Mrs. Ditz: "He doesn't know I'm calling. I thought it would save time if I did."

Dear Dr. Astute,

Thank you for seeing my patient, Mrs. Complex. She's a very challenging case, and I'm glad you were willing to provide your expertise.

And you certainly didn't disappoint.

Your impression of her condition, with all of it's details, showed such remarkable deductive reasoning and was so brilliantly detailed, that I realize there was no way I'd ever have come to such a conclusion.





Yes, folks. That's the entirety of his impression and plan. The only thing I took out is the good doctor's name.

Frazzled Farmacy

I had to stop at Local Pharmacy tonight to pick up a Sarcasma prescription for Frank (yes, now my kid is on it, too).


Pharmacy guy: "What's the name?"

Dr. Grumpy: "My son, Frank Grumpy."

Pharmacy guy: "Hang on... Here we are. Okay, has your kid ever taken Flagyl before?"

Dr. Grumpy: "No, but it's not Flagyl, it's Sarcasma."

Pharmacy guy: "No, it's Flagyl, I have it here, and it looks like there's another script for birth control pills. Has she ever been on those, either?"

Dr. Grumpy: "You've got the wrong script."

Pharmacy guy: "Well, it has her name on it."

Dr. Grumpy: "HE! The name is Frank Grumpy!"

Pharmacy: "Wait a sec... Oh, sorry. These are for Fran Grumpay, just sounded alike."


For those of you who didn't see the prescription drug that keeps me under control the last time I put it up...

(click to enlarge)

Tourism 101

Dr. Grumpy: "It's good to see you back. How was your adventure cruise to Antarctica?"

Mrs. South: "It was incredible! Oh my God! Did you know they have Penguins there? Like LOTS of them? It's unbelievable! More than they have at Seaworld!"

Early Monday morning

It was a quiet, relaxing weekend at the Grumpy house. A family gathering. Wii and boardgames with kids. Hot tub. Only one hospital call.

Somehow this always leads me to hope that the office week will start right.

Keep dreaming.

Grabbing my morning pills out of the medicine cabinet and heading for my car, I accidentally chewed through a fish oil capsule, slathering my freshly brushed teeth with the enticing taste of raw cod liver.

I slugged down a Diet Coke on the drive in, which improved things somewhat. I figured making tea would help further.

I keep a bottle of lemon juice at the office, and add a few drops to my water when I make tea.

After I pulled my water out of the microwave, I tossed in some sweetener and a tea bag, and took a gulp a few minutes later. And gagged.

I'd forgotten the water and just microwaved a big mug of straight lemon juice.

It sure as hell covered up the fish oil.

I think I'll stick with another Diet Coke for the time being. And hope like hell there's not a finger or something gross in the can.

I'm old

Marie comes running into my office, dancing wildly with her portable radio. She's crazy with excitement.

"Daddy! Daddy! Listen to this awesome dancing song! It's new! I've never heard it before!"

She jabs an earbud into my right ear.

It was "I Ran".

By A Flock of Seagulls.

From 1982.

Nothing makes you feel older than your kids.

Sunday afternoon, 12:48 p.m.

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

Mrs. Manana: "Yeah, I have an appointment tomorrow, and need to come in today, instead."

Dr. Grumpy: "Today is Sunday. My office is closed."

Mrs. Manana: "Yeah, my appointment is tomorrow. But I just found out I have to work. Can I meet you there today?"

Dr. Grumpy: "No." (looks up schedule) "What about Tuesday or Wednesday, instead? Same time."

Mrs. Manana: "Do you see patients those days?"

Dr. Grumpy: "Um, yes."

Mrs. Manana: "Okay. I'll be in Wednesday."

Sunday Editorial

Quite a few readers have written in asking what I think of the Florida doctor who's told patients that voted for Obama to go find another doctor.

I'm sure it's legal. It's his practice. He can do what he wants.

But I don't think it's professional.

Part of being a doctor means treating people equally. Regardless of who they are. White or black, men or women, gay or straight, Republican or Democrat, Coke or Pepsi.

I don't discuss politics with patients. They ask me what I think of the new health care bill, and I give them a generic "We'll see what happens." Divisive discussions aren't good for a doctor-patient relationship.

Some people can be quite outspoken in their beliefs. I've taken care of a variety of ideologies. White supremacists. American neo-nazis. Socialists. Communists. Right, left, and in-between.

Sometimes it's hard to separate personal dislike from clinical judgment. But I do it, and try my best to treat all equally. And I never discuss my opinions with them.

"Dammit, Jim! I'm a Doctor!"

I am a person. With my own political beliefs. But there's no room for them in medicine. My job is to take care of people, and try to make them better, regardless of what I may think of them.

When President Reagan was shot, he famously quipped "I hope you guys are Republicans" to the surgical team as they were getting ready to operate on him, and the surgeon replied "We're all Republicans today."

Dr. Samuel Mudd went to jail for setting John Booth's broken leg after Booth shot President Lincoln.

The same trauma hospital in Dallas that frantically tried to save President Kennedy after he was shot, worked to save the life of his assassin, Lee Oswald, a few days later.

Caring for people equally, regardless of our personal thoughts about them, is what we do.

And if you don't think you can live up to that, then maybe you should find another profession.

Stupid

Mrs. Old has numb feet. She lives in a nursing home. I've never seen her before.

Today her new nursing home doctor was rounding on her. He saw in her chart that she's had numb feet for over 10 years, but has never seen a neurologist for them. She also has Alzheimer's disease, so can't tell him much.

At 10:45 this morning Dr. Newbie called my office to see if I would see her. Because of transportation issues, they couldn't get her here until next Thursday. So he didn't make an appointment for her.

At 1:45 the hospital called me. Dr. Newbie actually admitted her for 10 years of foot numbness and 5 years of Alzheimer's disease, so she could see me before next Thursday.

I refused the consult. I am NOT going to be a party to such an insane waste of money.

What the hell?

Quitting smoking

Dr. Grumpy: "How are you doing with quitting smoking?"

Mr. Inchworm: "Better. I'm down to 1.25 inches."

Dr. Grumpy: "Inches?"

Mr. Inchworm: "Yes. I have 10 cigs a day. And I measure them past the filter, and cut them off at 1.25 inches."

Dr. Grumpy: "That's not the most common way of quitting."

Mr. Inchworm: "Last week it was 1.5 inches, and next week I'll go to 1 inch."

Dr. Grumpy: "Do you think this is going to work?"

Mr. Inchworm: "Of course! I use a ruler and everything."

Statistics R Us

Doing a research survey this morning. It featured this question:

"What percentage of your migraine patients suffer from migraines? Your answers should add up to 100%."

My readers write

I'd like to thank my reader Amy, who sent this earlier:

Dr. Grumpy,

I am a faithful reader who checks in a couple times a day, and often I am shaking my head at the antics of your patients. Like others, I wonder sometimes if you write it up for the purposes of humor, because can people really be that idiotic?

This morning, I went to the doctors office early to have my fasting blood work drawn for an annual physical. My internist is in a large medical building with several practices on two floors. I overheard an older man say to the receptionist: "I have an appointment, but I'm not sure who it's with. I don't know the doctor's name or what it's for, but my appointment is at 8am this morning."

Dr. Grumpy, I now believe every word you write, verbatim.

Thank you for your great blog.

Amy


You're quite welcome, Amy. Thank you guys for reading it!

I refer you to the crazy patient scale, which I posted last Summer. To give credit, it was written by ER's Mom. And I thought it was just awesome.


Levels of Patient Crazy

1. Normal. They exist, even constitute the majority of patients. They make poor blog fodder, however, so you wouldn't know that that they even exist from reading any medical blog.

2. Crazy. These are the "fun crazy" folks. A little off, but you don't cringe when you see them on the schedule.

3. Bat-shit crazy. Your stomach drops a little when you see the name on the schedule.

4. Fucking Nuts. These folks seem intent on driving YOU nuts too.

5. Mouth agape and head shaking. You are lost for words upon meeting these folks. Fortunately, they are rare.

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.