Saturday night, on call

I'm sitting down to dinner with my family. My cell phone rings. It's the ER. A patient has just had a stroke, and is a candidate for the "clotbuster" drug, TPA. The drug MUST be given within 3 hours of symptoms onset. It's a serious emergency.

I leave my plate on the table, yell goodbye to the family as I run out the door. I race down the road, and onto the freeway.

I get to the hospital. I pull into one of the special "doctor emergency" slots by the ER entrance. I wave to Willy, the security guy who's been sitting there watching the lot for the last 40 years (he's rumored to be the last surviving veteran of the Spanish-American War of 1898).

I run in. I meet with the family as the patient is being wheeled to CT. He comes back. I look at the CT and call the radiologist. I examine the patient and go over the checklist for TPA, and explain the risks and benefits to them.

The family and patient are willing to throw the dice. The volatile drug is given as we watch. I re-examine him every few minutes. We get a bed in the ICU, and the patient is wheeled off. I write further orders and make phone calls to an internist and cardiologist.

Only time will tell.

And I walk out to my car, hoping to get home before the kids are asleep, and to have some dinner.

(click to enlarge)

Stupid toy of the year award

While I was on call today, Mrs. Grumpy took the kids to Humungous House O'Toys. Because the kids had some gift cards they were dying to use.

So what did all 3 of them buy? Out of all the cool stuff at Humungous Toys? Video games? Some awesome electronic flame-throwing robot dinosaur? A really cool Lego set?

Nope. They each wanted a "Perfect Petzzz".

For those of you unfamiliar with this remarkable use of technology, it looks like a sleeping dog or cat. And all it does is "breathe". The abdomen repeatedly deflects in and out by a 1/4 inch to give this amazing impression.

Let's watch!





Impressive, huh? Exciting beyond words, right? What else does it do, you ask?

THAT'S ALL.

It's fixed in that position. The limbs don't move. The eye's don't open. And, under the fake fur, it's hard as a rock. Seriously. You can hammer nails with it.

It looks like it's breathing, but when you pick it up your first impression is that it's in rigor mortis.

Visually, it's cute for all of 5 seconds. And when you find out that the pseudo-breathing is all it does (until the battery runs out) you're absolutely shocked to find your kids got suckered into paying $29.95 for this thing.

And I'm not gonna criticize it anymore, because I can't. Somebody is getting rich off this stupid idea, and I'm on call trying to make a buck. They're obviously WAY ahead of me in laughing all the way to the bank.

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.