Today

I want to offer my thoughts, prayers, and condolences to all affected by the terrible events of today.

Today's featured gift

Have a friend who likes tasteless historical knick-knacks? Consider this:

Now they can own a bobblehead doll of the man who murdered America's 16th, and probably greatest, President. Ideal for those who enjoy, um, I guess, this sort of thing.

As best I can determine bobbleheads of Lee Harvey Oswald, Charles Guiteau, and Leon Czolgosz are not currently available.

Wednesday night, 7:45 p.m.

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

Mrs. Down: "Hi, are you covering for Dr. Nerve?"

Dr. Grumpy: "Yes, what can I do for you?"

Mrs. Down: "I'm emotionally uncomfortable."

Dr. Grumpy: "About what?"

Mrs. Down: "I'm worried I may run out of gas on the way to the drugstore."

Mary's desk, December 11, 2012

Wild-eyed guy breathing rapidly throws open the door, runs in, stands at counter.

Guy: "HEY! CAN YOU GUYS BREAK A $100 BILL?!!!"

Mary: "Uh, no, sorry. We only have a few $5's and $1's for change."

Guy: "SHIT!"

(runs out, door slams behind him)

Today's featured gift

Have a friend who REALLY loves Christmas music?

Yes, now even in private moments you can enjoy the gentle melodies of holiday tunes, and imagine you're being bombarded with them in Wall-to-Wall-Mart. The more TP you use, the more it plays. So even if you're having explosive diarrhea you'll never run out of musical entertainment (as long as you don't run out of paper or batteries).

At present it is not available in Hanukkah/Kwanzaa/Festivus forms, or with music that can be played year round (such as the Mama's & Papa's "Go Where You Wanna Go").

$5

Recently there was a news story about Dr. Russell Dohner, of Illinois. He charges all patients a flat fee of $5/visit. He doesn't take insurance.

This led to several online threads featuring comments such as "Finally! A doctor who cares!"

Apparently, this means that doctors like me, who charge more than practically nothing, are evil and don't care.

I respect Dr. Dohner, and am not putting him down. I think highly of what he does. I actually like what I do, and if I were independently wealthy and could see patients for free, I probably would.

It isn't until almost the end that the article notes Dr. Dohner is supported by his family's farming business, and NOT his medical practice. By that time most readers have moved on to the football scores and "Dancing with the Stars" results, and therefore are left with the impression that any doctor can do this for $5 a head.

Bullshit.

I do care.

But that doesn't mean I don't have my own responsibilities: like office rent. And paying Annie & Mary. And a mortgage. A wife. 3 kids. If I can't support those things, then I'm not going to be able to keep my office open to care for people.

Regardless of what people may think, just because I charge for my services doesn't mean I don't care.

I care enough to call in your seizure medication to a pharmacy at 2:00 a.m. because you're out of pills, even though you knew you needed a refill for at least a week.

I care enough to call you from my family vacation to go over your MRI results, because I didn't think they should wait until I got home, or that you should get bad news from a covering doctor who doesn't know you.

I care enough to come in early and see you at 7:00 a.m. because you can't get time off work, but really do need to be seen.

I care enough to spend time arguing with some pinhead at your insurance company about why you need an MRI, when they don't think you do.

I care enough to rush in to the hospital to see you on my weekend off, rather than let a hospitalist who doesn't know you from Adam try to figure this out.

I care enough to call a drug rep and beg for samples of your medication because you lost your job and can't afford it.

I care enough not to order unnecessary EMG's and EEG's on you, even though doing them would improve my revenue.

I care enough to face worsening reimbursements and rising expenses every day, when many colleagues have given up and gone into another field.

I care enough to try and give you hope, even when I'm not sure there is any.

I care enough to help you find another neurologist who will take good care of you, because your crappy insurance won't let you see me anymore.

I care enough to step out of my kid's music recital and take your call, because I know you're scared.

I care enough to take the time and explain why the drug you saw advertised on TV isn't a good idea in your case, rather than just writing a script to shut you up.

I care enough to stay in a job that has deprived me a of decent night's sleep, family time, and likely shortened my overall lifespan, in spite of the fact that my financial goal nowadays is just to break even.

I care enough to refer you to a neurological subspecialist who can take better care of you than I can, even though in doing so I'll lose you as a patient.

I care enough to call your spouse at 9:00 p.m. to reassure them that you'll be all right.

I care enough not to force you to have a test you can't afford, even though you can sue me for malpractice if I miss something.

I care enough not to dismiss you from my practice, in spite of your insanely annoying personality, because I know that you really do need my help.

I care enough to still be doing this job, even though every day a little bit of my idealism dies.

I care enough to be a doctor. I hope I always will.

It's time!

Amazon weirdness

Today's featured gift

Picnics are SUCH a hassle. You have to sit on the ground, and balance a plate, and eat- ALL AT THE SAME TIME. Let's face it, unless you're remarkably dexterous, you'll starve. Or make a mess. Or both.

But now, there's Picnic Pants!

Now you can attend picnics unafraid of spillage or being unable to find a table! You walk around with what looks like a large gray scrotum, or crotch-cape, or whatever, secure in the knowledge that merely by sitting cross-legged you'll have a convenient place to set your lunch.

History rerun: December 6, 1917

It was World War I.

Gigantic convoys of ships carrying weapons, food, and troops went constantly to Europe, bringing supplies to the Allies. They left from several major Canadian and American ports.

On this day one of them went horribly wrong. And outside of where it happened, it's mostly forgotten.

A large convoy was gathering in Halifax harbor for the trans-Atlantic journey. One ship was a freighter heavily loaded with explosives, the S.S. Mont-Blanc.

At 8:40 that morning, due to a series of mutual errors, she collided with the freighter S.S. Imo.

The Mont-Blanc immediately caught fire. Her crew tried to put it out, but due to its rapid spread were unable to. Scuttling attempts were unsuccessful, and the crew were forced to abandon ship. Someone rang a fire alarm, and several firefighting teams quickly responded to the docks. But with the ship in the harbor, there was little they could to but watch it burn. None of them knew about its cargo.

At 9:04 a.m. the disaster happened.

The ammunition cargo on the Mont-Blanc exploded with the force of 3 kilotons of TNT (roughly 1/5 the strength of the Hiroshima atomic bomb). To this day it remains the largest accidental explosion in human history, and until the 1945 nuclear tests was the biggest man-made explosion ever. Windows were shattered 10 miles away. Objects fell from shelves 80 miles away. The explosion was heard over 200 miles away.

A mushroom cloud and fireball rose over a mile into the air, and a tsunami wave of water, 60 feet high, was sent surging into Halifax. The steamship Imo was picked up and thrown ashore like a toy. Many people (including the firemen) who'd gathered ashore to watch, or were trying to get to the Mont-Blanc to help, simply vanished.

Fire spread through the city. Since it was winter, many homes had furnaces and heating stoves alight, and the shock wave blew them over, spreading heating oil and coal on the ground. Red hot shards of the ship's metal rained everywhere in the city, starting fires in buildings not directly affected by the explosion. A half-ton section of the Mont-Blanc's anchor was thrown over 2 miles into the city, and is now part of a monument. To this day St. Paul's Church has a piece of wreckage embedded in the building.

The city within 1 mile of the entire explosion (326 acres) was utterly destroyed. Buildings, docks, warehouses, homes, and people- all gone in a few seconds. Large fires swept quickly through many city blocks, fueled by winter stores of coal and heating oil. An inferno grew quickly.

Many of Halifax's rescue workers were injured or killed by the explosion, and so the city's ability to react was already impaired. Firefighters from nearby communities came to help- only to find that fire hose and nozzle sizes weren't standardized, and they couldn't connect to the Halifax hydrants. In spite of this, they and surviving local crews worked valiantly to put out the fires, and began rescue efforts of the many trapped under collapsed buildings.

But it was a northern Winter, and darkness came early, along with bitter cold. Rescue workers struggled through the night, chasing voices and moving frozen debris by hand.

The dawn brought light- and a heavy snowstorm. It became the largest blizzard of that decade, dropping 16 inches of snow in a few hours. It put out the last of the fires, but also impaired efforts to reach those who were trapped. Many survivors stuck under debris died from exposure while awaiting rescue.

This view overlooking Halifax harbor was taken after the snowstorm. This had previously been a busy neighborhood and business district.

All told, roughly 2,000 people died- 600 of them under 15 years of age. Another 6,000 were seriously injured, with 9,000 total wounded. 31,000 more were either homeless or had only minimal shelter. Many of the wounded were blinded by flying glass, and care for them eventually led to new treatments for eye trauma.

Although there were many heroes that awful day, one man stands out. His name was Vince Coleman, and he was a railway dispatcher ashore. When he learned of the burning ammunition ship, he realized that a loaded passenger train would be at the waterfront depot in a few minutes. Instead of saving himself, he ran to the telegraph key and quickly tapped out "Stop trains. Munitions ship on fire. Approaching Pier 6. Goodbye." He was killed a few seconds later in the explosion, and is credited with saving at least 300 lives.

Local hospitals overflowed with the dying and wounded, and anyone with medical training was pressed into work. The overtaxed Canadians were assisted by medical crews from American and British warships that had gathered for the convoy. An old ocean liner was turned into a hospital ship overnight. Other medical responders arrived, sent from all over Nova Scotia to assist.

Word of the disaster reached America in a few hours, and the state of Massachusetts rapidly organized a relief effort. All available trains in Boston were frantically loaded with food, medical supplies, shelter materials, and volunteer rescuers and medical personnel. The first train left Boston the night of the explosion, chugging through the same blizzard that was impairing relief efforts, and arriving roughly 30 hours later. It was followed by many other trains from all over Eastern Canada and America. The supplies and workers they brought are credited with keeping the death toll from going higher.

It's been 95 years since the tragedy, and the American assistance hasn't been forgotten. To this day Nova Scotia annually chooses it's finest Christmas tree and sends it as a gift to the city of Boston. This is the tree that stands in Boston Common every holiday season, remembering assistance in a time of need.

Modern English

The introduction of a medical letter is important. It sets down basic patient data and gives you an idea of their chief complaint. When you screw something that simple up, you just know it's going downhill from there:

I get all kinds of letters from other doctors. Most are understandable (although the computer template ones often give me no clue what they're thinking, if they're thinking at all).

I get some, however, that are full of garbled phrases. I have no idea if this is due to bad language skills, lack of good transcription (yes, Dragonphiles, YOU!), crappy proofreading, or all of the above.


Here we have this sentence (from another neurologist no less) which defies all structural rules of the English language:




Or this:




You see all kinds of odd stuff:

 Some of which makes no sense whatsoever:

At times the salutation at the top isn't particularly flattering:

Lastly we have this doctor, who's apparently so embarrassed by his shitty notes that his name isn't even on them:


 

Thanks to all who sent these in!

Mary, call tomorrow's 3:30 and cancel him

A packet of records showed up on a new patient who has a pending appointment with me. It included this note from his previous neurologist:

"He's quite insistent on being allowed to get his drivers license back. When I refused to comply, he pulled out a gun and threatened me with it. Fortunately, his wife quickly took it from him and told me it wasn't loaded."

Weekend reruns: What does a neurologist do?

Every day a neurologist has to deal with many serious medical questions. Annie and I constantly exchange email concerning critical patient problems and other important issues.

Here, for example, is a conversation excerpt on a patient who called in for urgent medical advice.

Yes, I know

Dr. Grumpy: "Have you ever been a smoker?"

Mr. Vague: "No. I mean, not that I know of. But you never know. You know?"