Dim bulb

Dr. Grumpy: "Any chance you might be pregnant?"

Miss: Notbright (whipping out cell phone): "I don't know. Let me call my mom and ask her."

Dear Drug Company,

I'm sure Cimzia is a good drug.

And, since patients have to inject it into themselves, I think it's great that you put together a demo kit to teach them how to do it.

I can understand that your demo kits don't have the real drug in them. I mean, this is an expensive monoclonal antibody with a short shelf life. You don't want it sitting in a doctor's cabinet collecting dust. So it makes sense to have a non-drug demo for teaching purposes.

There are a lot ways this could have been labeled. Like "does not contain real drug" or "do not inject the demo product" or "for demonstration only, do not inject."

But, in all honesty, putting "not for use in humans" on the demo drug's packaging IS NOT going to inspire patient confidence in your product.

Another day, another...

Dr. Grumpy: "How are your seizures doing?"

Mr. Shakin: "I've had 3 in the last few months."

Dr. Grumpy: "What Depakote dose are you on?"

Mr. Shakin: "I'm not taking anything."

Dr. Grumpy: "What! Why not?"

Mr. Shakin: "I ran out of pills in February."

Dr. Grumpy: "Let me look... In January you called to ask me to mail you a 90 day script, and I did."

Mr. Shakin: "Oh. I never got it. So I ran out."

Dr. Grumpy: "WHAT?!!! How come you didn't tell me? Why didn't you call me to ask for a new script?"

Mr. Shakin: "I didn't know I was supposed to."

Mary, come shoot me. Now.

Dr. Grumpy: "Are you allergic to any medications?"

Mr. Skin: "Yeah, that one that gives me a rash."

Dr. Grumpy: "Do you know what it's called?"

Mr. Skin: "No, but I'm not taking it anymore."

Dr. Grumpy: "What medication are you taking now?"

Mr. Skin: "The one that doesn't give me a rash."

Naked Terror

Quick! What is It?




Looks like a soap dispenser, huh? WRONG!

It's actually a battery-powered shower-cleaning device that sprays foaming suds around your shower after you're done. Of course, I know that NOW. I didn't know it yesterday.

While I was on call this weekend, Mrs. Grumpy installed one in our shower, and didn't mention it to me.

So yesterday morning, I was showering away in the dark (I get up early, and shower in the dark so the lights don't wake up the kids). In the dim glow of the night-lite I noticed this gadget hanging there, looking suspiciously like a soap dispenser. So, to lather up, I pressed the big blue button on the front, and put my hand under it.

Nothing came out. Instead the thing began beeping REALLY LOUD.

BEEP!

Holy shit! What the fuck kind of a soap dispenser is this?

BEEP!

Crap! Why is it beeping? It's going to wake up everybody! How the hell do I make it stop?

BEEP!

Fuck! There has to be a button or switch or something to turn it off! I'll press the blue button again!

BEEP!

That didn't do anything. Shit, I can't see if there's another button to make it stop!

I leaned forward, feeling it all over to try and find a switch.

BEEP!

After the 5th BEEP! the little blue thing on the bottom suddenly spun around, spraying shower-cleaning foamy stuff in a circle around it, covering the shower, the tiles, and my eyes, which were about 2 inches in front of it as I frantically tried to find a way to make it stop beeping.

It burned like hell. I screamed and fell backwards, and some shampoo bottles fell on me with a loud clatter. Snowball started barking. In the panic I tried to get to a sink to wash my eyes out, before I realized that I was already in a shower with water pouring down.

As I rinsed my eyes out the lights went on, and I became aware that I'd woken up the whole house. Wife, kids, dogs, and all.

I'm going to stick with bar soap from now on.

Sympathy

Dr. Grumpy: "How's your stress level been?"

Miss Accountant: "Horrible. The bitch I work with had a heart attack and died during the last week of tax season. So I had to do all the work myself."

Nurses...

Are AWESOME.

I'm a doctor. We get all the glory. And credit. And guess what? We only deserve part of it.

I started out in medicine in the mid-80's, volunteering at an ER. And the biggest shock to me was learning how much of what happens in a hospital is nurse territory. Us doctors will see you from 5-30 minutes a day (30 is A LOT), depending on how sick you are. And the rest is the nurses.

They come in all shapes, colors, and sexes. Yes, there are a few idiots out there, that I take shots at in this blog. And there are idiot doctors, too. Idiots are in all fields, but the majority of nurses are damn good.

They're the ones making sure you get your pills, checking that your vital signs aren't dropping (and doing what they can to save your ass initially if they are, of which calling a doctor is only one part). They make sure you don't fall down and break something. If you start barfing, us doctors will run out of the room and the nurses will rush in. They change your wound dressings and start your IV line. They'll bring you a warm blanket. And clean disgusting things off you. Even if you're drunk. Or delerious. Or mean. And through all of this they try be friendly and positive. Even though you aren't their only sick patient.

I respect nurses A LOT. I learned early on that they're key to being a good doctor. You piss off the nursing staff, and you'll have a miserable career at that hospital. Respect and treat them well, and you'll never regret it. They're as important to being a good doctor as your medical degree. Maybe more.

If you come out of medical school with a chip on your shoulder against nurses, you better lose it fast. Because they will make or break your training, and often know more than you do. Be nice and they'll teach you. A good neuro nurse is often a better inpatient neurologist than some doctors I've met.

I remember a guy named Steve, who was an intern with me a long time ago. He had his head up his ass about being a doctor, and saw nurses as lesser scum. We were only a few months out of med school, and as we were writing chart notes one morning a nurse came over and asked if he'd go listen to his patient's heart. With icy contempt, and not even looking up from the chart, he said "I don't have to listen to his heart, because I looked at his EKG." They ain't the same thing, dude. If he'd listened he might have noticed that the patient had developed a loud murmer in the last 24 hours. When the attending caught it a few hours later, Steve got his ass chewed out. If he'd taken the nurse's advice, and listened, he wouldn't have gotten reprimanded by the residency board.

I talk about my Bible a great deal in this blog. Here's a quote from it: "Working with a good nurse is one of the great joys of being a doctor. I cannot understand physicians who adopt an adversarial relationship with nurses. They are depriving themselves of an education in hospital wisdom."

Those doctors are also depriving themselves of friends. On a shitty day on call, sometimes all it takes is a sympathetic nurse to temporarily add you to her patient list, steal you a Diet Coke from the fridge, and let you cry on her shoulder for 5 minutes. It doesn't make the day any less busy, but helps you absorb the punishment better.

What got me started on this?

While I was rounding this weekend, a grateful patient's family brought the ICU nurses a box of donuts, and so the staff was picking through them. One said "Oh, this kind is my favorite, it has cream filling."

And some pig in one of the rooms yelled "Hey, babe, I got my own kind of cream-filled dessert in here! Come have a taste!"

You say that to a waitress, and you'd likely get your ass kicked out of the restaurant.

You say that to a co-worker, and you'd be fired and/or sued for harassment.

You say that to a lady in a bar, and you'll likely get a black eye.

And what did the nurse do? In spite of the fact that the guy was obviously a detestable jackass, she went in his room, turned off his beeping IV pump, and calmly told him that he would not talk to her that way.

And I admire the hell out of that.

Nursing is a damn tough job. And the people who do it are tougher. And somehow still remain saints.

While this post isn't about them, there are a lot of other unsung heroes who are part of the hospital team- pharmacists, social workers, nursing assistants, EMT's, respiratory therapists, X-ray techs, lab techs, physical/occupational/speech therapists, housekeeping staff. And many more.

On call- Idiocy

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

Dr. Internist: "Hi, I'm the hospitalist taking care of Mrs. Dizzy. You saw her this morning, and wrote that it was fine with you for her to go home."

Dr. Grumpy: "Yes."

Dr. Internist: "I'd like to send her home, but just wanted to check with you."

Dr. Grumpy: "Fine with me."

Dr. Internist: "Does she need any more neurological tests while she's here?"

Dr. Grumpy: "No. Why? do you think we missed something?"

Dr. Internist: "No, but just wanted to make sure you didn't have any other neuro-testing-things you wanted to do."

Dr. Grumpy: "No."

Dr. Internist: "Okay. Good. In that case, I'd like to send her home. Are you okay with that?"

Dr. Grumpy: "Yes."

Dr. Internist: "Cool. Thanks for calling me back so quickly."

On call- Sunday morning.

Phone guy: "Drs. Brain & Nerve's answering service, can I help you?"

Dr. Grumpy: "Yeah, this is Dr. Grumpy, covering for Drs. Brain and Nerve. Are there any consults holding overnight?"

Phone guy: "Umm. Let me look. Yeah, 3. So you have another consult for them? Can I have the name?"

Dr. Grumpy: "No, I need the names of the ones you've been holding overnight."

Phone guy: "Is the new consult for Drs. Brain and Nerve? Because Dr. Grumpy is covering for them, and will see the patient."

Dr. Grumpy: "No! This is Dr. Grumpy!"

Phone guy: "Oh, so the new consult is for Dr. Grumpy directly? He doesn't use our service, but I can give you his office number."

Dr. Grumpy: "I AM DR. GRUMPY!"

Phone guy: "Dr. Grumpy? Are you calling in for the overnight consults?"

Dr. Grumpy: "YES!"

Phone guy: "I'm sorry sir. You should have said that in the first place."

On call- tips from the trenches

The following is a public service announcement.

I'm not personally into hookers and cheap motels. If you are, I don't care. It's just not my thing.

It is important, however, to keep in mind that those rooms are generally NOT used by people who have any need to look in the rooms' closets. After all, they're only renting them for 20-30 minutes.

So as a result, sometimes a homeless alcoholic can (hypothetically speaking of course) live in the closet of one of those rooms, undetected, for weeks.

Like all people, they might get sick. There's always a lot of crud going around.

So, if their timing is off, they might wander out of the closet, and vomit all over a hypothetical couple using the bed to conduct a business transaction.

Since nothing kills the mood of cheap sex faster than being covered in barf, Mr. John and his girlfriend-for-hire might hypothetically grab their clothes and run out of the room, followed by Mr. Drunk, who passes out in the parking lot.

He eventually might be found and brought to Local Hospital, where he (hypothetically of course) could have an alcoholic seizure, and so a neurologist was consulted (I mean, uh, might be consulted, since this is, a um, hypothetical case).

So, guys: if this is your sort of thing, please check the closet first. Your date won't mind, I swear.

If you find someone living in it, just ask for another room. It may save me a trip to the hospital.

With a cluck-cluck here and a cluck-cluck there

Generally, I find my practice works best when I get paid in dollars. They're convenient. They can be transmitted electronically between bank accounts. Mary and Annie like them. I can spend them by swiping a credit card.

But, in a remarkable effort to win the "Let's See How Stupid I Can Sound" award, a Nevada candidate for U.S. Senate has proposed ditching the idea of paying doctors in money, and going to a barter system with them. Specifically, she suggested paying us in chickens or house painting.

Really.

Sue Lowden is the gem who hatched this idea. In fact, she was given a chance to explain it, on the assumption that she misspoke. But nope. When given the opportunity to clarify her point, she again clearly stated that medical services should be reimbursed by bartering goods, such as chickens, and not by paying money. She specifically indicated it was to pay doctors, and didn't say if it should be applied to other businesses (such as buying your meds at the pharmacy, or groceries at the store). She even said she wasn't going to back down from the idea.

Barter is not a bad thing. In some situations it works. Most civilizations used it before the advent of money. But the majority of human cultures eventually developed cash of some form. Because let's face it: It's hard to carry around enough chickens to buy a car. And they're messy. And, unlike coins, they require feeding.

This idea may work for some docs, but not me. I personally don't want to collect co-pays in chickens. Or goats. Or frying pans. Or anything other than money. This is also a matter of cleanliness: my migraine patients are sensitive to smells. I don't think they want to sit in a lobby filled with the livestock someone else brought to settle their bill.

And I don't have enough space in my yard to handle all those co-pays. Mary and Annie are also not going to be thrilled to be told that instead of money I'm now going to pay them in sheep and legumes. It's a baaaaaaaahhhhhhhhhd idea.

The logistics of making an ER co-pay become especially daunting, paticularly if you're now in a wheelchair but need to use the space in your car for bushels of corn and some turpentine.

And just try giving your kids a handful of chickens to spend at Chuck-E-Cheese's. Have you ever had to clean feathers out of a skee-ball machine? It's trickier than it looks.

We will also need to re-do medical school curriculum, to include care and feeding of livestock, as well as how to run your own slaughterhouse (for us non-surgeons) when turning your co-pays into dinner.

Ms. Lowden, to verify the usefulness of your idea, why don't you try a simple experiment- go into any large casino in Las Vegas. With a chicken. And try to bet it on any game. Or stuff it in a slot machine. And then see what casino security thinks about being paid in something other than money. I suspect they'll be as fond of the idea as I am.

Fun with teenagers

Dr. Grumpy: "How are you doing?"

Mr. Pain: "Better. I've been swimming more, doing the breaststroke, and..."

Teenage son (looking up from Nintendo): "DUDE! Dad! You said breaststroke!"

Toothbrush? Finger with booger? OMG!

The following note is from a doc who specializes in weight loss, trying to figure out why the patient is still heavy. I personally would have worded this differently, as there are some details about my patients' lives that I just don't want to know.

(click to enlarge)

BOOBQUAKE, 2010: Shake 'em! You won't break 'em!

The following column is not mine. It was written by The Mother, (who's a mother AND a doctor) and due to my own fascination with, uh, advancing scientific research, I'm reprinting it here. I should point out that on any given day there are an average of 1,370 earthquakes on planet Earth, (and probably a few on Io, too). So you can blame them on whatever you want, and they'll still happen.


A critical thinking experiment in real time

I’ve been talking a lot lately about teaching kids critical thinking. I’ve been pretty hard on the schools, for stressing memorization and regurgitation, and ignoring the process

But on Monday, April 26, we all have a chance to strike a blow for critical thinking on a global scale.

Let me explain.

Over the past six months or so, a variety of garden-variety idiots have variously attributed tectonic plate phenomena to cosmic wrath.

Pat Robertson explained on national TV that the Haitian earthquake was caused by retribution for the Haitians’ “pact with the devil” over the bloody slave revolt in 1790 (wow, did that take the deity a seriously long time or what?).

Rush Limbaugh blamed the Icelandic volcanic eruption on cosmic wrath over the American health care bill (because the best way to seek vengeance against the American liberals is to seriously inconvenience John Cleese).

And Iran’s Hojatoleslam Kazem Sedighi announced that “Many women who do not dress modestly … lead young men astray, corrupt their chastity and spread adultery in society, which (consequently) increases earthquakes." (We are women, hear us roar–our boobs have unimaginable power.)

This last inane statement, unlike the first two, is what we science types call a “testable hypothesis.”

And it is going to be tested. Oh, yes. A critical thinking experiment is being planned in real time. The brainchild of Jen McCreight, who blogs at Blag Hag. BOOBQUAKE is designed to test the concept that immodest dress causes tectonic plate disruption.

Women are asked to wear their lowest cut, most immodest blouse on April 26th. If you happen to wear a short skirt, too, I can’t imagine that that would skew the results.

I have a see-through t-shirt that should do nicely.

To drive the lesson home to our kids, though, it’s important to make sure they understand the working hypothesis of the experiment. Then park them in front of CNN for the day, and let them watch, like we did when Katrina was leveling New Orleans.

I’m going to pop popcorn.