Paging Dr. Yossarian

Yesterday I received this fax from a pharmacy company. As best I understand it, they don't authorize the drug involved... So to get it covered I need to call...

The telltale cup

Rick was my resident for a month during internship. He was notoriously lazy. The last to arrive for a code, the first to leave after call, and never seeming to be around when you needed him.

He wasn't the kind of lazy who intentionally dumped work on others. He didn't see why anyone had to do it, and encouraged me and the other intern, Karen, not to do things either. As a result Karen and I spent a few days getting reamed out by attendings until we figured out NOT to follow Rick's instructions on ignoring labs, med sheets, exam findings, etc.

Rick, as these people always are, didn't feel he was the problem.

Anyway, one day my team was on call, which meant we were responsible for all codes, with Rick being the one who had to run them. Around mid-day there was a code on the 7th floor. Karen and I were both in ER doing admissions, but immediately dropped everything, and (big surprise) got to the room before him. We were frantically trying to remember our ACLS drills when a cardiologist ran in, then the chief resident, pretty much tossing us out.

After a few minutes Rick, the guy who was supposed to be running the code, came in. He was pretending to be panting (not a drop of sweat on him) saying he'd run all the way up the stairs from the lobby coffee place.

He was carrying a styrofoam cup filled to the brim with steaming coffee.

Without a lid.

And he hadn't spilled a drop en route to the code. Not a single brown dribble mark on the sides.

Dr. Grumpy's gift guide

As the Earth continues its trip around the sun, the holidays are again approaching. And with them, of course, the annual Dr. Grumpy Gift Guide!

I'd like to kick things off this year with something truly meaningful, special, and unique.

Chocolates have long been a way of telling that special person how you truly feel. Sometimes, of course, we encounter someone who's special in an entirely different way. When this happens we wonder "What can I give this person to convey my true feelings to them?"

The answer, of course, is this: A chocolate asshole!

Yes, the folks at Edible Anus purvey the finest in anally-shaped candies, using only pure Belgian chocolate. These delectable assholes are available in milk, dark, and white chocolate, and are handmade in England.

For that truly special person you can also order sterling silver assholes. They also have glass ones. I am not making this up.

The tagline on their site is "The anus that made Britain great." I'll defer any commentary on that to my readers across the pond.

Running errands on Black Friday

Dr. Grumpy: "Oh... Look at that. The Okra Haus restaurant is closed. It looks like they're tearing it down."

Marie: "Oh, no! I hated that place!"

Dr. Grumpy: "Then I'd think you'd be happy it's gone."

Marie: "Yeah, but now I need to find another place to despise."

Thanksgiving

This is the Gray Wolf

"You want a piece of me?"

One of evolution's most successful designs, to this day it's a feared predator across the planet. Its range covers most of the northern hemisphere. One subspecies, the Yukon Wolf, is the largest living wild canid today. They're ferocious hunters.

What makes Gray Wolves so incredibly successful is their social nature. Their intelligence makes them clever, capable of adapting to new situations and prey. They hunt in packs, which allows them to bring down animals much larger than they individually are. Bison. Moose. Musk Ox. They have an impressive array of teeth and powerful jaw muscles that can crack large bones.

"We have sharp teeth for a reason, Phil. Let's use them."

And, somewhere around 30,000 years ago, this social tendency led to them becoming oddly intertwined with a primate species that was gradually spreading across the planet. A branch off the Gray Wolves became hunting partners, guards, and companions. Each species learning from the other in a remarkably successful relationship that continues to this day.

Still vicious. Still wild. Still... Oh, who am I kidding.

This is the modern wolf. From dangerous hunter to pillow for video-game-playing ape.

Her hunting ancestors must be horrified.

Life with dogs. It just doesn't get any better.

History reruns

November 27, 1898

Everyone's heard of the Titanic, Andrea Doria, and Lusitania. But most shipwrecks are long forgotten, except in the areas they occurred.

Long before The Perfect Storm was made famous by a George Clooney movie, there was the Portland Gale of 1898. The storm was catastrophic, but is mostly forgotten now.

In 48 hours of early-winter gale over 300 ships were either sunk or seriously damaged. Lives lost is unknown, but likely between 500-1000. Shore towns and cities from Massachusetts to Maine were devastated by rain, sleet, and more than 2 feet of snow, driven by winds measured up to 110 miles per hour. Communities of beach cottages simply vanished.

But the storm is still called by the name of it's most prominent victim: the steamship Portland.

In 1898 the Boston, Massachusetts to Portland, Maine route was a busy one, used heavily by both business and leisure travelers. Some took trains, while others preferred steamships. The latter traveled on coastal steamers, usually by night (the equivalent of a "red-eye" flight today). A ticket was $1 to $5, depending on your accomodations. You'd board in the evening, have dinner on the ship, sleep in your cabin, and the next morning were there. The ships went back and forth 3-4 times a week.

The New England weather can be notoriously vicious. A storm was coming in when the Portland sailed on the evening of November 26, 1898. Her captain, Hollis Blanchard, was known for being cautious, but apparently saw nothing in the conditions or forecast that unduly alarmed him. At 7:00 p.m. the ship sailed from India wharf in Boston, never to return.

The ship was sighted by others in the next few hours, but as the storm worsened, eventually vanished in the gale. When and exactly how she foundered will always be a secret, as she took all 192 passengers and crew with her. Recovered watches had all stopped between 9:00 and 10:00, though whether this was a.m. or p.m. is unknown.

The next day wreckage began washing ashore: furniture, timbers, luggage, lifebelts, and lots of bodies. Although the picture above shows a lifeboat being launched, none were ever found, and the severity of the storm makes it unlikely this was even attempted.

Several entire families were lost in the tragedy, traveling home after Thanksgiving in Boston. Their memorials are scattered across New England graveyards. The Portland black community was hit particularly hard, as (except for the officers) the majority of the crew were black men. In 1898 (33 years after the Civil War) service on these ships was considered a very respectable job for a black man, and those who served were generally veterans of the trade, supporting families ashore. They were often more sought after than white men for the same positions, as white men looking for these jobs were younger, less experienced, and seen as more likely to leave the job without notice.

The Portland herself would remain hidden for a long time. In 1989 the wreck was located, but the technology wouldn't allow an accurate identification. So it was forgotten again until 2002, when it was found by side-scan sonar. It's since been explored by divers, though at a depth of 460 feet in very cold water this is limited and dangerous.

If you're interested in learning more about the Portland and gale or 1898, I recommend the book "Four Short Blasts" (the title refers to the whistle distress signal of the time) by Peter Dow Bachelder. The book also has a brief history of the American Life-Saving Service, which eventually became today's U.S. Coast Guard.

Not even close

Dr. Grumpy: "Okay, let me have Annie schedule that test..."

Mr. Gallery: "I have a question for you" (takes out an iPad) "I read on your website that you majored in art?"

Dr. Grumpy: "Um, no. My undergraduate degree is in physics. I'm pretty sure it says that on my site."

Mr. Gallery: "Are you sure? I thought I'd read that somewhere. Maybe it was Yelp or something."

Dr. Grumpy: "I'm sure. Believe me. I have no knowledge of art whatsoever."

Mr. Gallery: "Oh" (looks disappointed, puts away iPad) "I was really hoping you could help identify some of the paintings at my parent's house. I even took pictures of them."

Telephone book

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

Mrs. Frantic: "I need you guys to get my Dad in today! I think he had a stroke, or a seizure, or a heart attack, or one of those things!"

Mary: "Calm down, ma'am... Have we ever seen your father before?"

Mrs. Frantic: "No! He's visiting from California! And he's not acting like himself."

Mary: "Okay, we don't have any openings today, and I think your best option is to take him to ER."

Mrs. Frantic: "But he needs a work-up NOW! You need to see him and do tests and stuff!"

Mary: "I understand that, but we can't do those tests in our office. That's why you need to take him to emergency."

Mrs. Frantic: "I don't want to take him to ER! He needs to see a neurologist!"

Mary: "We can't see him today, and so..."

Mrs. Frantic: "FINE! I'll just move on to the 'H's'."

(click)

Rimshot

Dr. Grumpy: "Any memory problems since starting the new pill?"

Lady Geritol: "I'm not sure. Honey, have I been forgetting things?"

Mr. Geritol: "I don't remember."

Subjectivity

 

Dr. Grumpy is rude. His staff is rude. His wait time is always over an hour. He's incompetent. He's malicious.

Well, it's hard for me to objectively address most of these charges, but I can say that the longest I've ever kept a patient waiting is 23 minutes.

I hate sites where you can anonymously rate doctors. Anyone can put up a scathing review, even if they didn't actually see you. Maybe they're pissed off that you don't take their insurance, or wouldn't give them the extra 40 Percocets they wanted.

The sites don't check to make sure that they really saw you. For all you know you're being rated by a person angry that your kid beat theirs in the school spelling bee (don't tell me people aren't that petty. They are.). And because we're doctors, we can't really defend ourselves. After all, we took an oath to keep your health concerns in confidence.

Let's look at this the other way: what if I were to create an online public forum where doctors could rate patients by name. Of course, while we'd be encouraged to write only about our own patients, who's to make us do so? What if you're someone who dinged my car at Costco this weekend, or the barista who can never get my order right? I could use the site just for the hell of it.


"Probably a drug seeker. I wouldn't touch her."

"Very whiny and needy. Calls staff all the time."

"Dumb as a rock. Can't remember his meds."

"Argues incessantly about his crappy $15 co-pay".

"Needs to buy a toothbrush and some deodorant."


Best of all, we doctors could put it up anonymously. You'd have absolutely no way to know who wrote it (you could guess). In fact, even if I never saw you, and say, just didn't like you based on meeting you somewhere, I could write whatever I wanted. And you'd have absolutely no legal recourse. Sure, you could post something in your own defense, but, do you have time for that?

Of course, that would never happen. Besides being unethical, it's frankly illegal for a doctor to do that. Patients, however, have a free reign to anonymously say whatever the hell they want about us. Even if they've never actually seen you and are making it all up.

The other problem that affects these rating sites is simply human nature. When something goes well, we expect it and say nothing. But when something goes wrong, we get angry and want the world to know. So the reviews are predominantly written by people pissed-off enough to take the time to find a ratings site, create an account (maybe several), and write one or more bad reviews. The people who thought the doctor was awesome may outnumber them 100 to 1, but won't write anything. So, as in everything else, a small but vocal minority can drown out the truth.

Besides, it's so much more fun to write a bad review than a good one. Most of us learned this in high school, whether through writing a book report, gossiping about others, or reading Perez Hilton.

For these sites, and those who contribute to them, I think we have to keep in mind the words of the finest restaurant critic in history, Mr. Anton Ego:

"In many ways, the work of a critic is easy. We risk very little, yet enjoy a position over those who offer up their work and theirselves to our judgment. We thrive on negative criticism, which is fun to write and to read. But the bitter truth we critics must face, is that in the grand scheme of things, the average piece of junk is more meaningful than our criticism designating it so."

Dear Market Research Company,

I think you need to improve your incentives to get any takers:

Thank you, Ann!

Raise your hand if you're sure

Dr. Grumpy: "Do you have any other questions?"

Mr. Apocrine: "Can you smell my deodorant from over there?"

Dr. Grumpy: "Uh..."

Lady Apocrine: "Did you try that new brand today?"

Mr. Apocrine: "Yeah. The commercial for it sounded promising.""

Lady Apocrine: "That's what all commercials say. But I can't smell anything, which is good, I guess."

Mr. Apocrine: "Yeah, Mr. Fluffles didn't seem to notice anything different when he came up to me this morning."

Lady Apocrine: "Doctor, do you know anything about underarm sweat?"

Mr. Apocrine: "Of course he doesn't. He's a neurologist."

Lady Apocrine: "Well, don't armpits have nerves?"

Mr. Apocrine: "I don't think that's relevant here."

Lady Apocrine: "What was your question again?"

Mr. Apocrine: "I asked him if he could smell my deodorant from across the desk."

Lady Apocrine: "That was stupid."

Mr. Apocrine: "Everyone says stupid things."

Lady Apocrine (looks at me): "Okay, doc. I think we're good. Thank you."

Winter reruns

With the first snow of winter behind us, I remembered this:

I finally had the time today to fire up the Grumpy family hot tub for the winter.

So I cleaned it out, filled it up, added chemicals, put in a new filter, etc.

For whatever reason, though, I couldn't find the power cord that comes with it. Because I'm a guy (and therefore inherently stupid) I just grabbed an extension cord out of the garage. Mrs. Grumpy kept telling me I wasn't supposed to do that, because the special hot tub cord had extra circuits or fuses or breakers or whatever in it, and you couldn't use something else.

But I wanted to get the hot tub going, so I told her it would be fine, and hooked it up.

The kids were excited, so I had them out in the yard with me. They counted down from 10 for me to flip the switch, turning it on for the winter.

"5-4-3-2-1- HOT TUB!". I pressed the button. The jets whirled, the water swirled, the kids laughed.

For about 5 seconds.

Then there was a loud "POP!"

And the hot tub turned off.

And the kids stopped laughing.

And all the lights in the house went out.

Another 5-10 seconds of absolute silence went by, finally broken by Mrs. Grumpy saying "You bozo."

She went around to futz with the switch box. She found the correct power cord in the garage. And I am in trouble.

NFC

Dr. Grumpy: "Do you have any past medical issues?"

Mr. Vague: "They told me I ruptured something or another, somewhere in my body, sometime in the last 10 years. You know what I mean?"