Still a few bugs in the system

Last night I was doing a survey about a new medication, and encountered this question:

The Long and Winding Road

 

Guy walks in, stands at counter.

Mary: "Hi, can I help you?"

Mr. Far: "Yeah, I have a new-patient appointment with Dr. Grumpy for 2:00."

Mary: "Oh! You must be Mr. Far. It's 1:30 now, but that gives you time to get started on your paperwork..." (hands over a clipboard) "and can I get a copy of your insurance card?"

Mr. Far: "Sure..." (take clipboard, rummages through wallet, hands card to Mary) "I left my house early to make sure I had plenty of time to get here."

Mary: "That's fine. If he's done with his current one early, he'll usually start with you."

Mr. Far: "I had no idea how far you were from my house."

Mary: "I'm sorry. I thought you lived in South Grumpyville?"

Mr. Far: "I do... It was a 30 minute drive here."

Mary: "Isn't that what I told you it would probably be?"

Mr. Far: "Yes... You were right. I just hadn't realized it was that far."

Mary: "Well, you made it here early, which is better than late. Here's your insurance card back, thank you."

Mr. Far: (puts card back in wallet) "My GPS even said it would be this far, so I left early to make sure I had enough time. Still... it seemed like a long drive."

Mary: "I'm sorry. Did you have a question about the forms? Or need a new pen? Let me get you another one..."

Mr. Far: "No, let me give this back to you" (hands clipboard and pen back) "I... I think this is too far for me. I'm just going to leave and try to find a neurologist closer to my house."

Mary: "Are you sure? I mean, you're already here, and have an appointment in a short while?"

Mr. Far: "Yeah, this is just too far for me to drive. Thank you, anyway." (leaves)

Sunday afternoon

So, as hunter-gatherer tribes have done for the past several million years, Craig and I went on our weekly hunting & gathering expedition to Costco yesterday.

One of the items I needed for our cave was a chair mat. I'm notoriously rough on these things, and 6-12 months is about average for me. So I grabbed one off the pile, and was carrying it by the handles

When I got to check-out, the guy took it from me and set it upright in the cart, saying this would make it easier to transport. So it looked like this:

Side view

Front view

Seemed like a good idea. This way, if I was attacked by stone-throwing members of the rival Samsclub tribe, I'd have a shield.

Until I tried to push the cart. When I discovered I had this view:

Yes, that's Craig in front of the cart, trying to help me navigate my way out without killing anyone or denting another family's dinomobile.

After a few minutes of struggling with this, some 10 year-old walked by and said, "Mister, why don't you just pull the cart instead?"

Craig still hasn't stopped making fun of me (though it's not like he thought of it, either).

Patient quote of the day

"My mom and I are the same age, but my Dad is younger than me."

Dear Job Recruiter,

Thank you for this ad I received in the mail yesterday.

Let me give you a few pointers:

1. Neuro-Hospitalists are just neurologists, like me. The only difference is that they only work in hospitals. Granted, I don't call myself a Neuro-Officist. Probably because some idiot would pronounce it as "Neuro-Orifice."And calling myself (more accurately) a Neuro-Hospital-Officist just sounds silly.

My point here is that we don't wear surgical hairnets. Or gowns. Or gloves. I suppose if you worked in a hospital you could wear scrubs all the time, but there's no point to the other surgical accoutrements. I do know one Neuro-Hospitalist (I'm not sure it needs to be capitalized either, but you started it) who didn't match into neurosurgery, but 15 years later still plays make-believe by rounding in scrubs with a surgical hat & booties. But that's not normal.

Also, if you're going out of the way to wear sterile surgical gear and look official, you just contaminated your gloves by touching the film.

2. Holding up X-ray films is so 1990's. It's all on a computer monitor now. If the hospital you represent is still using films, that's not a good selling point.

3. It's a freakin' X-ray of a skull. Now, I know you're just a job recruiter, and likely grabbed some stock footage, but this isn't what neurologists look at. We look at MRI's and CT's, NOT PLAIN X-RAYS!!! Especially of a skull. While the skull is of relevance to neurosurgeons and ENT's, my tribe is more concerned with what's inside it. Unless this hospital is still using pneumoencephalograms as a diagnostic tool, a neurologist won't be looking at skull films.

4. If a plain X-ray of a skull is the best neuroimaging this hospital can do, they need a lot of things more than they need a Neuro-Hospitalist.

Yours truly,

Ibee Grumpy, M.D.

Next week

I'll be back sometime next week guys. Thank you for your patience.

Thank you

No, I'm not back to writing. I just wanted to thank you all for your wishes. I'm genuinely touched.

It's been a bad week. I've likely cried more than I ever have. I'm not one of those "boys don't cry" types, but am still in shock. Maybe someday I'll write about it.

One of the most remarkable things (at least to me) about the brain is its ability to remember songs and lyrics, long after we last heard them, or even remembered they existed.

Although I haven't heard the album in over 35 years, somewhere during the week my brain dragged out a song from my childhood that I'd long since forgotten about, and been playing it nonstop in my mental background. It's from Free to Be You and Me (1972) and is "It's All Right to Cry." It was, ironically, sung by football great Rosey Grier.

Normally my earworms drive me nuts, but this one has been very soothing. Thank you, Mr. Grier, wherever you are.

And thank you all for your good wishes and understanding.

IG

Sorry

Due to a serious family emergency I'm going to have to stop blogging for while. I have no idea when I will be back. I will return though, I promise. Please be patient.

Rimshot

Mr. Stumbles: "My vision hasn't been the same since I fell. Really blurry."

Dr. Grumpy: "Did you hit your head?"

Mr. Stumbles: "No, but I broke my glasses."

While you're waiting for the doctor...

Dr. Grumpy: "Okay, we'll see what the test shows... Any questions?"

Mrs. Lipstick: "You have some unused space in your lobby."

Dr. Grumpy: "Oh, that depends on the day, and how many patients Pissy and I have."

Mrs. Lipstick: "I was thinking I could put a small table at the far end."

Dr. Grumpy: "For what?"

Mrs. Lipstick: "I sell Avon cosmetics, and could set up a small store out there. I think a lot of your female patients would appreciate the convenience."

Dr. Grumpy: "What? No. I'm sorry, but that's just not something we'd like here."

Mrs. Lipstick: "How much of a commission do you want? I'm sure we can make a deal."

Small talk

Dr. Grumpy: "How's your husband doing?"

Mrs. Latrine: "He eats, then he shits. It's like living with a goose."

Dr. Grumpy's book club

Today I'd like to review a few books I've enjoyed.

Disclaimer: I am not being paid to write this, nor am I related to any of the authors. I'm also not selling the books on Amazon (though am thinking of trying to unload Frank's Pokemon guides there if he doesn't get them out of the living room).

The first is a new novel written by the totally awesome Fizzy (writing as Freida McFadden), purveyor of high-quality medical cartoons. I am, I must admit, somewhat jealous. Writing a book about the insanity of my practice was always on my to-do list, but as the years went by it became pretty obvious that I'd never have time to do it. So the book became my blog, and is a work in progress until I hang it up.

Anyway, Fizzy wrote The Devil Wears Scrubs. (Available from Amazon here). It details what is likely the most terrifying part of a medical career: the first 1-2 months of residency. Yes, you may have the title "doctor," but that doesn't mean you have a clue as to what's going on. Far from it. And you are more terrified than you have ever been in your life.

The tribulations are familiar to anyone who's done a medical internship: malignant senior residents, brown-nosing co-interns, eccentric attendings, nurses that run the gamut from supportive to hostile, and, in her case, a psychotic roommate (the last didn't apply to me, as I lived alone). Other things she learns to deal with (which are still big issues as an attending on call) are desperately trying to find time to pee, grabbing something to eat before you die or the cafeteria closes, and getting 10-15 minutes of sleep every 24 hours.

I found it to be an accurate, and funny, portrayal of intern life (except I wasn't dating a hunky surgeon).

The second book I read a few years back, but have always meant to write about. Although written by a doctor, it has nothing to do with medicine.

It's by Dr. Doreen Orion, and is a true story called Queen of the Road. She and her husband, both psychiatrists, gave up their practices for a year and bought a bus to drive around the continental U.S. (and a little of Canada) with a dog and 2 cats. The book is an entertaining combination of travel adventures, humor, and personal observations, as well as commentary on shoes, unusual local attractions, a bitchy GPS system, and, at one point, a nudist colony (I SWEAR!). Dr. Orion and I also shared the same curiosity about frost heaves when we first saw a sign warning of them (she thought they were some sort of monster, I thought they were an illness induced from overeating ice cream).

I loved Dr. Orion's book. As a veteran of many North American road trips, as a kid, as a single guy, and now as a parent, I sympathize greatly with her musings and adventures.

The last book, of course, is the one I can never emphasize enough, especially to medical students and residents. It is the one I refer to as the Bible, and is written by my medical idol, Oscar London, M.D.

It's Kill as Few Patients as Possible, and is a collection of 57 essays. Brevity is the soul of wit, and in its few pages an aspiring physician will find a bounty of practical knowledge to use in a career. The book is a bit dated in some ways (drug reps no longer give away free pens), but it also has a certain retro charm. It is, for example only available in a format that the ancients called "paper." This connection, like the 2400 year-old Hippocratic Oath, helps tie us to the ancient physicians of yore. Those long-gone days when someone had to go find a huge copy of a PDR lying around a nursing station to look something up, use a Yellow Pages to find a pharmacy's number, and radiology images were printed on a silver-based substance called "film" (yeah, that was my residency).

Happy reading! It's a great use of your occipital cortex!

Huh?

Mary: "Dr. Grumpy's office, this is Mary."

Phone Lady: "Hi? What's your fax number? I want to make an appointment with Dr. Grumpy, and send him my records."

Mary: "It's 867-5309."

Phone Lady: "Great! What kind of doctor is he, anyway?"

Mary: "Uh, he's a neurologist."

Phone Lady: "Oh, never mind."

Weekend on call

DiaStat is an emergency anti-seizure medication in a liquid form, that's given rectally. It's for seizures that are hard to control. It's usually used when you're trying to avoid taking the patient to ER.

This holiday weekend, while on call, I was phoned by a lady who has a daughter with severe epilepsy. Her regular neurologist had already given the family a supply of DiaStat for emergencies.

So when they called to tell me the seizures were out of control, I had her mother give her a dose of DiaStat, without benefit. After I told her to give a 2nd dose, I got called again.


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

Mom Seizure: "Hi, I gave Lisa the 2nd dose like you told me to, then I gave a 3rd dose of DiaStat on my own, and she's still seizing."

Dr. Grumpy: "You're going to have to bring her to the ER, and I'll meet you there. I can't safely give her any more outpatient medication."

Mom Seizure: "I understand, but is there anything else you could do? We really don't want to take her to the hospital. Is there another medication? Or another way of giving DiaStat?"

Dr. Grumpy: "Nothing I'm comfortable with, she needs to get IV medication, and further testing, and..."

Pause

Dr. Grumpy: "What did you mean by "is there another way to give DiaStat?"

Mom Seizure: "Well, the instructions say to give it rectally. I could try doing that."

Pause

Dr. Grumpy: "What the... you haven't been giving it to her rectally?"

Mom Seizures: "No. I've been putting it in her ear."

Dr. Grumpy: "IN HER EAR???!!!!!!!"

Mom Seizure: "Well, since seizures start in the brain, I figured squirting it in her ear would get it there faster. I was afraid putting it in her rear end would be too far away from the brain."

Pause.

Dr. Grumpy: "You need to bring her to ER."