Difficult Case

Okay, all you armchair neurologists, I'm on call this weekend, and it's time for you to help me with DR. GRUMPY'S CHALLENGING PATIENT.

Here's the story:

Mrs. Smith was mugged outside Local Mall yesterday, in an event witnessed by several bystanders. Mr. Scumbag hit her over the head with a crowbar (she'll be fine, don't worry) knocking her out, and grabbing her purse (he's already been caught).

So she was admitted to Grumpy Hospital. And the admitting internist wrote in the chart:

"Neurology consult with Dr. Grumpy, to determine why patient lost conciousness."

This one has me stumped, so if any of you want to chip in ideas to help, I'd appreciate it.

Is she a cat?

I'm on call, and reading another doctor's dictation:

"Family history: depression. The patient's mother committed suicide several times."

It's a guy thing

Memories of patients past...

I don't remember his name anymore. He'd had a massive stroke. Unable to speak. Came in completely comatose. He was in his late 70's.

He was there for a few days. Not a drop of sedation was given. He didn't wake up at all.

On day 2 of his stay, while the family was trying to make a decision, something went wrong with his foley (bladder) catheter. So the nurse had to change it. I was in the room looking at the chart when they started to pull it out.

He yelled, quite clearly, "SHIT!!! MY DICK!!!"

The nurse stopped. He was again completely comatose. I did every trick in the book to try and get him to speak again. Nothing worked. The nurse pulled out the foley, and put a new one in. No repeat performance.

He was there 3 more days before he died. He never said anything else. Every attempt by me and the nurses to try and find conciousness again failed.

To this day I have no idea how he did it. The MRI was awful looking. I can only assume it's some primordial part of the Y chromosome. No matter how badly damaged the upstairs is, you're still touchy about the downstairs.

My 10:00

Showed up 10 minutes late.

Left his insurance card and wallet at his girlfriend's.

Forgot to bring in his MRI reports ("Oh, yeah, I think they're in a box under my bed.")

Had to call his mother to ask what medications he takes.

Forgot to stop at his regular doctor's office to pick up his insurance authorization.

And is wearing a T-shirt that says "I believe in personal responsibility"

Early Morning ICU Rounds

Attention guys:

Having a stomach tattoo that says "SUCK DIS, BITCH!" with an arrow pointing downwards WILL NOT endear you to the ICU nurses!

Who's counting?

Mrs. Age: "My oldest sister turns 101 next week."

Dr. Grumpy: "Wow! Are you guys having a party for her?"

Mrs. Age: "Of course not. She died in '98."




15% off lab coats with code "labs_sale"

Whoa, Nelly!

From another doctor's hospital dictation, listing the patient's pulse:




For my non-medical readers, a normal adult resting heart rate is 60-100. the above (I hope) is a typo.

The last patient of the day

Following a whine session yesterday with Mary and Annie, I now present our list of issues that always seem to plague the last patient seen each day (especially when on a Friday).


The last patient of the day:

1. Shows up late, and wants to tell you the 10 minute story of why they're late. And/or wants to spend 10 minutes in the bathroom before the appointment starts.

2. Wants to read the required HIPAA privacy form word-for-word and ask questions, even though it's identical to the one every other doctor and hospital in the country use.

3. Has a new insurance card. And forgot to bring it.

4. Forgot to bring the insurance authorization for the visit, and the doctor who issued it closed earlier in the day.

5. Left their (MRI reports/lab reports/small child) in the car, and and has to go back to get them, and has no fucking idea where they parked.

6. Doesn't want to start the appointment until their spouse/child/parent arrives, and has no idea where they are. Or what their cell phone number is.

7. Has a new address, and needs to fill out the forms for it.

8. Needs a shitload of tests ordered.

9. Needs a bunch of prescriptions written, with both 30-day (local pharmacy) and 90-day (mail-in) scripts written for every damn drug.

10. Makes all who have contact with them want to strangle them.

No, just pick somebody else's family. It's more fun.

Dr. Grumpy: "Any major illnesses in the family?"

Mr. Gene: "You mean my family?"

Tuesday night, 9:25 p.m.

"Hi, I have an appointment with Dr. Grumpy tomorrow at 11:15, and I need to know if that's 11:15 our time? Or is that 11:15 in another time zone? I really want to be there, so need to know if it's local time or not. Thank you."

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!"