Sunday night, 9:05 p.m.

Mrs. Nerve: "Hello?"

Dr. Grumpy: "Hi, it's Ibee Grumpy, calling to give weekend check-out to Dr. Nerve."

Mrs. Nerve: "He's in the bathroom."

Dr. Grumpy: "Okay, can he call me back when..."

(muffled male voice in background)

Mrs. Nerve: "He says he wants to talk to you, hang on..."

(muffled male voice in background)

Mrs. Nerve: "He wants to know if Mr. Smith is still in the hospital?"

Dr. Grumpy: "He went to the rehab floor, but Dr. Nerve will need to check his follow-up CT..."

(muffled male voice in background)

Mrs. Nerve: "Hang on, he says he's out of toilet paper."

Dr. Grumpy: "Look, I'll just call back in..."

Mrs. Nerve: "No, it's okay. He asked if the Jones girl had any more seizures?"

This is Karl

I don't know him personally. I wish I did, as he seems like a helluva nice guy. He's a hospitalist, and in our occasional communications by email or blog comments seems to be pretty cool, and a damn good doctor. He's the kind I wish worked at my hospital.

In addition, Karl is also a great cook from what his family tells me. Every year he single-handedly whips-up some sort of major-league Mardi Gras feast. Never having been to Mardi Gras I have no idea what he's cooking, but if I was invited, and lived near you, Karl, I'd definitely come over (but I'd have to draw the line at crawdads- crustaceans just ain't my thing).

As you can see in the picture, Karl's sister was also kind enough to make him a Dr. Grumpy cooking apron for Christmas.

He's also built his own wooden boat. Not a model, but a real boat. Which is way beyond what I can do. My boat-construction abilities are limited to inflating a raft for the pool.

Unfortunately, for all the fact that Karl is a good person, doctor, and cook, he's been diagnosed with brain cancer, has been through chemotherapy, and is now home on hospice.

So, Karl, this post is dedicated to you. I'm sure you helped plenty of patients and their families over the years who never had a chance to thank you.

Not to mention helped patients of other neurologists, and because of my field's inherent lack of social skills, I suspect my neurobros didn't thank you either.

Since you're now on the other side of the bedrail, I want to thank you on all of their behalfs and wish you and your family the very best at this difficult time.

I also want you to know what an awesome sister you have, and how much she loves you enough to put me up to this. Your wife is in cahoots with her.

Thank you, from all of us out here in cyberspace.

Ibee Grumpy, M.D.

July 13th rerun

His name was Girard. He had back pain. That's all I remember about him.

On July 13, many years ago, he was the very first patient I ever saw on my own.

Working without a net for the first time is terrifying. I'd survived 4 years of medical school, 4 years of residency, and 1 year of fellowship to get there. This is the goal I wanted. And when it finally came it scared the crap out of me.

There was fear in medical school, starting classes and later starting clinicals, and even more in residency. But in both those cases there was always a back-up system- more senior people who actually knew what they were doing. There was also a herd-based support system: You were with plenty of other people, all sharing the same challenges.

But here, after 9 years of training, it was just me and Girard. Even though his case was simple, it's pretty damn scary to realize that YOU are the attending, and if you screw up there's no one else to blame.

I remember another patient that day started the visit by saying "I came to Humungous Neurology because I heard you guys are the most experienced." My inner voice said "you probably don't want to know this is my first day."

Throughout medical school you saw the attending physicians as omniscient giants. Suddenly you're one of them, and realize that they don't know everything. And you aren't a giant.

Like everything else, after a while it becomes routine. But trying to remember that first day still helps to keep you on your toes.

I don't remember how many patients I saw that first day. A handful compared to what I see now. One of them is still with me. I think I told her a few years later she was on my first day. I even got a hospital consult, a lady who'd obviously had a stroke. I got lost in the hospital trying to find her room, then sat in the MRI control room to see images, terrified at the thought that if they were normal I'd have no idea what was going on.

I've now spent an estimated 4,650 days of seeing patients in one place or another, with a lot more to go. But the first one was the scariest. And hopefully always will be.

To all who are starting this July, good luck.

No, I honestly don't

"Doc, because, sometimes I get headaches, and I also have trouble remembering things, and it's like when your foot hurts, or you've just slept with a bunch of girls and don't want to get tested, or you just got a new car and repaired the roof. Do you know what I mean?"

Not tonight, I have a headache

Yes, folks, tonight is (drum roll):

I'm not joking. This is a somewhat bizarrely-named drug-company sponsored educational event where doctors can (remotely) listen to lectures about migraine pathology and treatment.

Personally, I think this could have been better named something like "Migraine Symposium." Because the current name sounds like we should all be sitting in the dark with icepacks on our heads in solidarity. And I sure as hell wouldn't want to join that.

But it's for a good cause, so let's all break out the triptans and party (no red wine or chocolate)!

I suppose one has to grateful such events aren't held for Viagra, Detrol, or Imodium.

Annie's desk, July 9, 2012

Mrs. Gemini: "Hello?"

Annie: "Hi, Mrs. Gemini. This is Annie, from Dr. Grumpy's office. He wanted me to tell you your brain MRI was fine."

Mrs. Gemini: "REALLY! That's incredible. I'm so happy to hear it. I mean, I was pretty sure I had another one in there."

Annie: "Another one?"

Mrs. Gemini: "Well, I read this thing at the supermarket checkout about how this lady had, like, her unborn twin inside her head, with teeth and hair and everything, and I figured that's what I had."

The set-up

Frank: "DAD!"

Dr. Grumpy: "What's up?"

Frank: "Can you come help me?"

Dr. Grumpy: "Where are you?"

Frank: "I'm in your bedroom, by the dresser."

I run into my bedroom and find...

  Clever little bastard.

Today's criminal tip

When trying to rob a convenience store, don't take your Mom along.

Thank you, PH!

Friday morning

Dr. Grumpy: "What can I do for you?"

Mr. Words: "I'm having balance problems. Like my liquoribrium is off."

Burnin' down the house

Dr. Grumpy: "What can I do for you?"

Mr. Prolixin: "My arms are on fire!"

Dr. Grumpy: "You mean they feel like they're on fire?"

Mr. Prolixin: "NO! THEY'RE REALLY ON FIRE!"

Dr. Grumpy: "Okay..."

Mr. Prolixin: "CAN'T YOU SEE THE SMOKE AND FLAMES?"

Dr. Grumpy: "Well, no."

Mr. Prolixin: "Ya know, neither can my psychiatrist."

July 4, 1939

"Fans, for the past two weeks you have been reading about the bad break I got. Yet today I consider myself the luckiest man on the face of the earth. I have been in ballparks for seventeen years and have never received anything but kindness and encouragement from you fans.

Look at these grand men. Which of you wouldn’t consider it the highlight of his career just to associate with them for even one day? Sure, I’m lucky. Who wouldn’t consider it an honor to have known Jacob Ruppert? Also, the builder of baseball’s greatest empire, Ed Barrow? To have spent six years with that wonderful little fellow, Miller Huggins? Then to have spent the next nine years with that outstanding leader, that smart student of psychology, the best manager in baseball today, Joe McCarthy? Sure, I'm lucky.

When the New York Giants, a team you would give your right arm to beat, and vice versa, sends you a gift — that’s something. When everybody down to the groundskeepers and those boys in white coats remember you with trophies — that’s something. When you have a wonderful mother-in-law who takes sides with you in squabbles with her own daughter — that's something. When you have a father and a mother who work all their lives so that you can have an education and build your body — it's a blessing. When you have a wife who has been a tower of strength and shown more courage than you dreamed existed — that's the finest I know.

So I close in saying that I might have been given a bad break, but I've got an awful lot to live for. Thank you."


-Lou Gehrig, terminally ill at age 36 with ALS (aka Motor Neuron Disease), in his retirement speech. He died less than 2 years later.

This post is dedicated to Spiritcove and Roy, facing ALS as best anyone can. This is likely the worst disease in neurology, if not all of medicine. It's been almost 200 years since the first published report on it, and effective treatment remains a mystery.

If you're looking for a cause to give money to, consider the ALS Association.

Things I wish I could take back

Dr. Grumpy: "So at your last visit the medication was causing impotence, and we stopped it."

Mr. Pill: "Yeah."

Dr. Grumpy: "So where do things stand now? I mean, uh..." 

Mr. Pill broke out laughing.

Things that make me grumpy

I say "epilepsy." What do you think of?

Did you think of someone drooling in a dimly lit institution? Or someone so sedated on their seizure medicines that they aren't capable of working?

Think again.

Yes, there are some patients who still fit that description. But they're rare. You want to know what most epilepsy patients look like? They look like YOU!

Yes, folks contrary to popular belief, epilepsy patients are out there living normal lives. And there's a lot of them. It's a disorder that affects 1% of humans. So imagine the Rose Bowl stadium in California. When sold out it holds roughly 90,000 football fans. And statistically speaking 900 of them have epilepsy. Some may even be playing on the field.

Current epilepsy patients in my practice include 7 teachers, 3 doctors, 5 nurses, 1 judge, 2 veterinarians, and a lot of other responsible professionals.

Very few diseases have been as maligned over time as this one has. The majority of early cultures attributed seizures to demonic possession. I'm sure many innocent epileptics were killed in horrible fashion because of this. Others saw it as an intentional punishment from the gods. The great Dr. Charcot, founder of modern neurology, reported that in 19th century France epilepsy patients were locked up in the same dark building used to house the criminally insane and mentally handicapped.

Detail from "Transfiguration" by Raphael (1516) showing a child possessed by demons. The boy's posture and eye deviation are typical of partial-complex epilepsy.

You don't have to look too far back in American history to find laws on the books that banned epilepsy patients from marrying or having children. In the mid-90's I even trained under a doctor who still believed that horseshit, and told young adults, just starting out in life, that they should never, ever marry or raise a family. That's a pretty damn devastating thing to do to someone.

Vilifying any person because of an illness is wrong, whether it's diabetes, hypertension, or cancer. But epilepsy is one in my specialty, and I'll make a stand for my patients.

I probably fight harder for the rights of my epilepsy patients than any other group. Several times a year I have to write a letter to a divorce attorney saying that a well-controlled seizure patient is perfectly capable of being a parent, because the ex is saying that it makes them a danger to kids. Or I have to reassure a family that a patient can drive, or work, or travel on a plane. Obviously, there are laws restricting some things, like driving, but the majority of patients follow them and are perfectly good drivers. Hell, they're likely a lot safer than many non-epileptic people behind the wheel.

So what brought on this rant?

Last week the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act (AKA Obamacare). Now this post is NOT about the PPACA. I know a lot of people feel strongly about it in both directions, and if you want to fight about it, go to a website where you can. Because it's not what I'm talking about, or giving an opinion on.

What pissed me off was the reaction of a radio talk show host (who's not a medical doctor).

U.S. Chief Justice John Roberts has epilepsy and (under treatment guidelines) is likely on medication for this (I'm not his doctor). Big deal. So are a lot of other people.

But, as usual, there are some who'd rather smear than respect an opinion. Conservative commentator Michael Savage went on record last week as blaming Roberts' vote on - surprise - his epilepsy treatment (!) saying his writings showed "cognitive dissociation." He noted that drugs used for epilepsy "can introduce mental slowing, forgetfulness, and other cognitive problems."

Yes, Mr. Savage, they can cause these problems. You can also find similar side effects listed for most blood pressure medications, statins, and many other drugs (which, given your age of 70, I suspect you take at least one of) yet I'm not going to say your comments are due to medications. The side effect list of any drug is HUGE. But that doesn't mean everyone who takes it gets them. Quite the opposite.

My point is this: You're certainly entitled to your opinion. But just because you disagree with a man, don't go blaming it on his medications or health. It's a step backwards for all the epilepsy patients out there trying to lead responsible lives in the face of biases like yours. And, I suspect, if he'd ruled the other way you'd never have made such comments.

Since you apparently don't feel people being treated for seizures are capable of making rational decisions or serving in a responsible capacity, I'm leaving you with a list of people who have (or are highly suspected to have had) epilepsy. Perhaps you've heard of some.

Tchaikovsky
James Madison
Napoleon Bonaparte
George Gershwin
Bud Abbott
Julius Caeser
Harriet Tubman
Vincent van Gogh
Neil Young
Lindsey Buckingham
Edward Lear
Prince
Alfred Nobel
Danny Glover
Socrates
Lord Byron
Hugo Weaving
Dostoevsky
Joan of Arc
Florence Griffith Joyner

Last, I should also mention former congressman Tony Coelho, who has the disorder. He was the primary sponsor of the Americans with Disabilities Act (1990). As a young man he wanted to be a priest, but was banned from such by his epilepsy. He also lost his driver's license and health insurance because of the diagnosis.

During his first run for congress (1978, which he won) his opponent tried to paint him with the same insulting brush, asking voters how they'd feel if their representative was at a White House meeting and had a seizure. Mr. Coelho responded, "I knew a lot of people who went to the White House and had fits. At least I’d have an excuse."

Sugar: beats alcohol

Yes, yet another strange news item.


Thank you, Carol!