Steve Austin. Asstronaut. A man barely able to sit comfortably.

Technology. Bringing us the internet, iPads, digital music, MRI's, the International Space Station...

And, most importantly, the world's first BIONIC BUTTOCKS!

Thank you, SMOD!

Life on the edge

Dr. Grumpy: "Do you take anything for the panic attacks?"

Miss Old: "I don't want to. They're pretty much the only excitement I get."

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.