Sunday night call check-out

Dr. Grumpy: "Next is a lady in room 835 who I saw for diabetic neuropathy. I started her on Qualex, and..."

Dr. Brain: "Any exam findings?"

Dr. Grumpy: "No reflexes in the legs, and impaired pin & proprioception in the feet. I ordered some labs..."

Dr. Brain: "Proprioception? Don't you mean 'passive joint position sense'?"

Dr. Grumpy: "Okay. In room 753 is a guy who came in with an acute stroke..."

Dr. Brain: "Wait, this is important. You aren't answering my question. 'Passive joint position sense' is a much more relevant term, and you really should use it."

Dr. Grumpy: "Whatever. Anyway, the guy in 753 is weak on the right. I started him on Aspirin, and an MRI is pending. You'll need to..."

Dr. Brain: "So why do you say 'proprioception' ? The correct term should be 'passive joint position sense."

Dr. Grumpy: "Because it's shorter. In room 734 is a lady with seizures who..."

Thursday night phone message

"Hi, this is Austin, and I'm in the twin's class at Wingnut school. My Dad says he'll get me a new XBox game if I take a girl to the junior high dance, so can you please have Marie call me? Thank you."

Statistics

Rikki Phoneysmile, my least favorite drug rep, came by. I went up to sign for samples.


Rikki: "Now... just tap next to the pill strength you'd like, and sign here..."

Dr. Grumpy: "Okay." (signs off, hands iPad back).

Rikki: "Thank you, doctor. I'd like to leave you with this booklet about Dioxnyl to review..."

Dr. Grumpy: "You've left it with me before. You've been handing it out for over a year."

Rikki: "No, it's a new one. We recently discovered an error in that booklet, and it's now been corrected."

Dr. Grumpy: "What was wrong?"

Rikki: "On the efficacy graph we had the drug vs. placebo curves switched. So it made it look like the placebo was more effective than the drug."

Pause

Dr. Grumpy: (giggling) "Your company has been using a booklet erroneously showing your drug was worthless for over a year and no one realized it until now?"

Rikki: "Um, yes. Have a nice day." (drops booklet on desk, leaves)

Mary: "Did you ever notice that?"

Dr. Grumpy: "Hell no. But it's nice to know nobody else reads them, either."

Texting by voice

Marie's Wingnut School girls basketball team had their first win of the season yesterday, and Mrs. Grumpy sent me the results. So I was trying to get Siri to text "Yay!" back.

Yes, we are

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

Mrs. Chart: "Hi, I have an appointment next week, and I need you guys to get my records before then."

Mary: "Okay, but we can't get your records from other places. You need to contact them, and fax a release."

Mrs. Chart: "I've seen 3 other neurologists, and been admitted to 2 hospitals for my problems. I'd think you'd want to have their notes."

Mary: "Yes, the doctor would, but again, you'll need to contact them and have them send records. We can't get them without a release. You can come in here and sign one, or I can fax one to you."

Mrs. Chart: "I don't have time for that. I'm busy. You need to just call them yourself. You can tell them I told you to."

Mary: "Ma'am, it doesn't work that way. There are privacy laws and..."

Mrs. Chart: "Oh, you're one of those practices. Never mind."

Thursday afternoon

Dr. Grumpy: "How long have you been taking Fukitol?"

Mr. Vague: "Um, since I started it."

50 Shades of Neurology

Seen in a hospital chart:

Nudge, nudge, wink, wink, say no more!

We deliver

I needed to mail a chart to another office, which, for whatever reason, doesn't have a working fax this week. So on the way home yesterday I stopped at the post office.


Postal clerk: "That will be $5.21... Thank you. Where are you mailing this to, sir?"

Dr. Grumpy: "Lakeside Grumpyville, about 5 miles north of here, near Main & 28th street."

Postal clerk: "Under security precautions a package of this size cannot be put on a plane, so it will have to go by ground delivery with consequent delay. Will that be ok?"

Dr. Grumpy: "Um, yeah."

Memories...

The university where I went to medical school had a large indoor gym. All students were allowed to use it, but you had to show a student ID to get in. This is pretty standard.

What wasn't standard was Weather Guy.

To this day I don't know what his name was. He never wore a name tag. He was a pleasant, elderly fellow whose sole job was to sit there and check ID's before letting you into the gym.

I have no idea where the school found Weather Guy. For all I know he'd lived on the land when the school was started in 1868, and they built the gym around him and gave him a job. He was never NOT there. Weekends, nights, early mornings, holidays - I don't remember ever seeing anyone but Weather Guy working the gate. Neither did my roommate. Or professors who'd graduated from the school before I was born (the gym building, I believe, predated exercise). For all I know he lived at the entrance desk, and had a cot behind it.

But his most enduring feature was the one that gave him his name: a remarkable inability to discuss topics other than the weather. Nuclear war in progress? Let's talk about the weather. Super Bowl upset? Let's talk about the weather. Flaming car wreck outside the gym? Let's talk about the weather.

Now granted, a LOT of people ramble pointlessly about the weather. This is nothing new. What set Weather Guy apart was his lack of awareness for such.

In retrospect, I'd say he was fairly demented. It didn't take much effort to look at a plastic card and say "go on through." In fact, it would explain why he passed pretty much anyone with a plastic card, whether it was a student ID, credit card, drivers license, or Local Grocery rewards card.

So as you'd go through the line, he'd always say something like "It must be cold out there" or "it's a scorcher today." He'd say this regardless of season, so it was equally likely to be the dead of winter or blazing summer heat, and he'd have a 1-in-4 chance of being in the ballpark.

Of course, this sort of thing couldn't go ignored by college students.

There was a summer day when it was the typical hot & humid, with mosquitoes the size of dinner plates. I was in line behind a guy, and as he walked up Weather Guy guessed right and said "Gonna be a hot one."

This fellow, instead of saying the usual "uh-huh" and moving on, said "Actually a snowstorm just started. It's freezing!" And then went into the gym.

Weather Guy didn't bat an eyelash. As I came up to the counter and took out my ID, he said "It must be cold outside. I hear it's snowing."

On call, Sunday morning

 Overheard at the nurses station at 7:53 a.m.:

"So far we've had 2 try to escape, 3 wander out buck naked, a lady in DT's screaming about spiders, 4 calls to security, the lady in 17 smoking weed in the bathroom, the guy in 24 masturbating in the hallway, and it's not even fucking 8:00 yet."

Genetics

Dr. Grumpy: "Any major illnesses in your family?"

Mr. Flat: "My Dad was killed by a steamroller."

Wednesday afternoon

I'm at the nurses' station, writing a note. A cardiologist puts a chart next to me and sits down.


Dr. Snow: "Hi, Ibee."

Dr. Grumpy: "Oh, hi, Mike."

Dr. Snow: "You seeing the new guy with the stroke?"

Dr. Grumpy: "Yeah. Hey, how'd your family ski trip go?"

Dr. Snow: "We had to cut it short. My oldest son broke his leg on the second day."

Dr. Grumpy: "I'm sorry, is he okay?"

Dr. Snow: "Yeah, but he needed surgery. It was a compound fracture" (whips out iPhone) "See? There's the tibia sticking out below the knee, and this next one..."

Neurological nightmares

I have a pleasantly demented patient, Mrs. Tangle. She's very nice, but quite confused, and getting slowly worse. She's at an assisted living apartment.

Her husband died 2 years ago. They had a few old boxes in a closet that no one ever got around to unpacking. The family figured they were clothes, or pictures, or whatever. They were buried under blankets and photo albums and other stuff.

So a few days ago I got a call from the patient's son. He urgently needed to talk to me, and Annie told me that I needed to deal with this one personally. I trust her judgment when she says that. So I took the phone. At about the same time I picked him up, Mary said the police had just called wanting to talk to me about Mrs. Tangle, and were on another line.


Dr. Grumpy: "This is Dr. Grumpy."

Mr. Son: "I need to talk to you about Mom! She unpacked some old boxes in her closet!"

Dr. Grumpy: "Okay. What's the problem?"

Mr. Son: "We didn't know what was in them! We thought it was clothes or something!"

Dr. Grumpy: "And..?"

Mr. Son: "One had Dad's old gun, from when he was a policeman!"

Dr. Grumpy: "What! Is it loaded?"

Mr. Son: "I have no idea. The nursing home just called me! She's wandering around with it. She's not threatening anyone, but she's walking all over there waving a gun!"

Dr. Grumpy: "Has anyone tried to get it away from her?"

Mr. Son: "Um, I was hoping you would go over and do it."


I told him no, and grabbed the other line. It was the Grumpyville police, wanting to know just how mentally intact she was before they tried to reason with her.

Fortunately, the situation ended without incident. But when dealing with the aged, don't just assume that old box has harmless stuff in it. This isn't the first time I've had families tell me they've found previously unknown firearms hidden in a demented person's place. This was just the most potentially dangerous the situation got. I can only imagine what could have happened if instead of being pleasantly demented, Mrs. Tangle was paranoid/angry demented.

And yes, it was loaded.

Priorities

Brent writes in with this bit of drama from his practice:


Mr. Husband: "Can you make a house call for my wife? Her asthma is really bad, and she's having a tough time breathing. She won't go to ER, either."

Dr. Brent: "Just bring her to my office. I'll squeeze her in this afternoon."

Mr. Husband: Well, she's been coughing a lot. And, you know, she has that problem that when she coughs, she leaks urine. I can't have that in my truck."

Dr. Brent: "So bring her in her car."

Mr. Husband: "THE NEW BMW?!!! ARE YOU CRAZY???"