You VILL have foot pain!

Hazards of misspelling "fasciitis:"

Making a point

Dr. Grumpy: "What's the pain like?"

Mrs. Bun: "It's stabbing, aching, burning, stabbing, throbbing, stabbing, itching, dull, stabbing, sore, stabbing, sharp... Did I mention stabbing?"

"Spam, spam, baked beans, spam, eggs, spam..."

Attention patients:

Those of you who've met Mary and Annie know my staff is pretty awesome. But, due to some recent confusion, I'd like to point out what my staff is NOT here to do:

1. Arrange tee times, make restaurant reservations, and look into available flights. We are not the hotel concierge desk.

2. Drop-off or pick-up your dry cleaning. This is not a service my practice offers.

3. If you have a letter to mail, and want Mary to put it with the rest of our outgoing stuff for her daily run to the mailbox, she doesn't mind. Asking her to look up addresses and postage rates, or to supply you with free stamps, is going too far.

4. Babysitting. This is a big one. WE ARE NOT HERE TO BABYSIT YOUR KIDS. Pissy and I only see adults, and consequently do not keep toys or copies of Ranger Rick in the lobby. We do not want your kids drawing all over our magazines, walls, and lobby furniture. Supervising them is also not the responsibility of other patients in the lobby - I see Alzheimer's patients, for fuck's sake. If you can't control your kids you will be asked to leave and given the option of rescheduling when you can get a sitter, or just seeing Dr. Darth across the street.

5. We are not going to help your kids with their homework. This is a medical practice, and my staff is busy. If junior needs a piece of scratch paper or to borrow a pencil, that's fine. But we are not here to teach spelling, algebra, or quantum mechanics.

6. Look up movie times. I mean, I can't remember the last time I saw a patient who didn't have a smart phone. There's an app for that. The fact that you handed your phone to a toddler to keep them busy is not an excuse.

7. We absolutely, positively, do not keep diapers (for ANY age) on hand. Either bring your own or hit the Target down the block. And DO NOT even think of changing them in our waiting room. There's a bathroom 15 feet down the hall.

8. Call your order over to Starbucks, Chipotle, or wherever. It's not like you even offered to treat us.

9. Give advice on pet care. We are not the vet. They are 2 blocks over, and do a great job. The fact that between us the staff has 8 dogs does not make us an animal hospital.

10. Pick up your trash. There's a trash can out in the lobby. Leaving the detritus of your McGrease lunch or little balls of snot-loaded tissues on the lobby table is rude, gross, and unacceptable.

11. Find you a pharmacy, or therapy place, or hospital, or pretty much anything in Montana. Or Canada. Or South America. Or anywhere outside of Grumpyville. Let's face it, we have enough trouble figuring out what pharmacy to call HERE when you give us directions like "it's near the place with blue awnings," "the one by the Denny's," and (my favorite) "across the street from the homeless guy in the baseball hat."

12. Call numbers you got from Craigslist of people selling furniture, clothes, themselves, etc., then reporting back to you on what we found out.

13. Buy shit that your kid is selling for a school fundraiser. Don't even go there. You wouldn't like it if we hit you up for cash outside of your office co-pay.

14. Answer your cell phone while you're with the doctor, and take messages. They do this all day for me, and I'm paying them. You are not. It can go to voice mail.

Thank you.

Ibee Grumpy, M.D.

Guest post

Dr. Coogie writes in:


Last night I got called down to ER to admit a guy for syncope.

Dr. Coogie: "What happened?"

Mr. DUI: "Well I was drinking beer at Boobpile and I passed out."

Dr. Coogie: "How long were you out?"

Mr. DUI: "Not sure. I woke up on the floor with everyone around me, but then realized I still had more beer to finish, so I had some more beer and decided I should get checked out."

Dr. Coogie: "Okay, and then you had someone bring you here?"

Mr. DUI: "No, I had spilled beer on my clothes so I drove home to change, then drove to the ER, and here we are."

Meeting of the minds

With the school year winding down, the twins are off to Wingnut Elementary's end-of-year school music camp, to spend 4 days in the cool pines of northstate. There they'll practice their instruments, terrify wildlife, irritate hunters, and likely violate the endangered species act.

So Tuesday afternoon was the parents' meeting with the teacher leading the expedition. It was allegedly mandatory (though they didn't take attendance). Mrs. Grumpy had happy hour a meeting at her job, so I went.

I got there early, and, out of habit (amazing how we default in a classroom), took my traditional college/medical school seat (3rd row from the front, 2nd seat in). Other parents came in. A cardiologist I know, whose daughter is in the same class, came in and sat next to me.

As Mr. Allegro was trying to get the SmartBoard to work (this involves tapping it, swearing, hitting it harder, swearing, tapping it lightly, swearing, wash, rinse, repeat) Mrs. Mysomom came in. She carefully looked over several seats before selecting one that met her standards, and started to set her purse down. Then she stopped, whipped out latex gloves, put them on, pulled out a pack of bleach wipes and began scrubbing down the desk and chair (which weren't visibly filthy) before tossing the gloves and wipes in the trash and Purelling her hands.

After a few minutes the presentation began. Mr. Allegro showed us a brief video about the camp (which looked like a lot of fun, BTW), went over some rules and other points, and finally opened up the floor for questions. Boy, that was a stupid idea.

Mom 1: "It says here that no electronics are allowed. What about phones?"

Mr. Allegro: "No phones. They distract the kids from the lessons. We also don't want the boys and girls texting each other after lights out."

Mom 1: "But then how am I supposed to know where you guys are, and that you arrived safely?"

Mr. Allegro: "Either Mrs. Hendrickson or I will send a group text to all of you when we get there."

Mom 1: "Yeah, but what if something happens to both of you, like you're killed in a bus crash on the way, and the kids need help?"

Mr. Allegro: "Well, the driver also has a phone, and the bus has GPS and a radio connection to its company."

Mom 1: "It's very important that I be aware of where Sherman is at all times, 24/7. I'm his mother, you know."

Mr. Allegro: "He'll be with us, and you'll be notified if there are any problems."

Mom 2: "Wait a minute. You're not driving the bus?"

Mr. Allegro: "No, the bus is chartered from Pinto Transportation, who supply the driver."

Mom 2: (getting out paper and writing notes) "Who is the driver? What are his home and cell phone numbers?"

Mr. Allegro: "I don't know. They..."

Mom 2: "You don't know? Do you know anything about him? Does he have a police record? Is he in good health?"

Mr. Allegro: "Well, I have to assume..."

Mom 2: "You mean he might not be? THIS IS THE PERSON RESPONSIBLE FOR MY DAUGHTER'S LIFE AND YOU DON'T KNOW ANYTHING ABOUT HIM? I'd like to see his medical records before the trip. Have them sent to my home fax. Get his name so I can Google him, too."

At this point a parent wandered in late and asked a few questions that had already been answered during the initial presentation, visibly annoying everyone

Mom 3: "What about the bus? Is it new? Old? Have a history of accidents?"

Mr. Allegro: "The company supplies the bus, and I don't know which one we'll..."

Mom 3: "So for all we know it was recently in a major accident and has shitty brakes. That's SO reassuring. Can we review its maintenance records in advance?"

Mr. Allegro: "Uh, you'll have to call Pinto Lines."

School janitor walks in, is surprised to see people in the room, apologizes, leaves.

Mom 4: "What is the closest hospital and emergency room to the camp?"

Mr. Allegro: "Uh..." (grabs a notebook) "West State Regional Hospital."

Mom 4: "Is it a Level I Trauma center?"

Mr. Allegro: "It has an emergency room. What does 'Level I Trauma' mean? I'm just the music teacher!"

Mom 5: "Do you know if it has board-certified physicians? Michael is always falling off roofs."

Mr. Allegro: "The kids aren't going to be on the roof. They're not allowed there."

Mom 5: "That won't stop Michael. Where there's a roof to fall off of, he'll find a way."

Mom 6: "It says here the kids aren't allowed to bring firearms, tobacco, alcohol, or illegal drugs?"

Mr. Allegro: "Correct. Those will be provided there."

Me and the cardiologist crack up, the others glare at us. Mr. Allegro regrets having tried to joke.

Mom 7: "Why can't they have their phones on the bus at least? It's a 4 hour drive"

Mr. Allegro: "Because we don't want them brought at all. The bus has TV screens, like on planes, and we're taking movies to watch."

Another parent comes in late, asks the same questions that had already been answered during the initial presentation and for the first late parent, further annoying everyone.

Mom 3: "What are the movies rated?"

Mr. Allegro: "G and PG. I think we have 'Wreck-It Ralph,' 'Frozen,' 'Monsters University,' and "Despicable Me 2.' "

Mom 3: "Doesn't 'Wreck-It Ralph' promote violence? I think I read that in Crazyfuck Parent Today."

Mom 2: "No, it doesn't. Besides, from the way your daughter treats mine I'm pretty sure she's used to violence."

School janitor walks in again, is still surprised to see people in the room, apologizes, leaves.

Mom 7: "I don't want Cindy to see 'Frozen' again. She'll come home singing that stupid song that makes me want to slit my wrists."

Mr. Allegro: "You're certainly welcome to send any DVD's of G and PG movies you want, and I can let the kids vote on it."

Mom 4: "These kids are only 12. They're not old enough to make decisions like that."

The cardiologist takes 2 chocolate bars out of her purse, offers me one. A lady behind us says "you're doctors and you eat that shit? Remind me to never come to you." We both ignore her.

Mom 8: "Susan gets headaches a lot, so I want to send her with a bottle of Tylenol. Is that okay?"

Mr. Allegro: "Sure, just fill out the medication form that was in your packet. There's a full-time nurse at camp, too."

The cardiologist whispers to me "Rachel takes Adderall. I thought about writing on the form that the teacher should give it rectally to see what they'd do, but Rachel would never speak to my again." We both snicker, other parents glare.

Mom 5: "How do we know it's really Tylenol, and your daughter isn't selling something?"

Mom 8: "Really, Beth? You should pay better attention to your own son's issues."

Yet another parent comes in late, asks the same questions that had already been answered during the initial presentation and 1st & 2nd late parents, further annoying everyone.

Mom 9: "Is the camp nut-free?"

Mr. Allegro: "Yes. Please don't send snacks with your kids, they'll be provided for them."

Mom 3: "Is your son allergic to nuts?"

Mom 9: "Not that I know of, but I keep them out of the house anyway in case he becomes allergic."

Janitor walks in again, is still surprised to see people in the room, apologizes, leaves. Cardiologist whispers "Is he one of your dementia patients?" Lady in front of us turns around and goes "Shhhh!"

Mom 10: "What about gluten free?"

Mr. Allegro: "No, but we can make arrangements. Does your daughter have Celiac disease?"

Mom: 10: "No, she tested negative, but I still won't let her have gluten. I read that it's being put into foods as part of the government's secret eugenics program."

The cardiologist grabs and squeezes my forearm so hard that she draws blood, I kick her under the table. Lady next to us thinks we're playing footsy and looks disapprovingly. I briefly consider pretending the twins are Kosher just to liven up the party.

Mom 11: "Will you guys be in tents?"

Mr. Allegro: "No, it's a dormitory with 2 wings, girls on one side, boys on the other. The adults will be in the hallway between them."

Mom 1: "Does it have fire sprinklers?"

Mr. Allegro: "Uh, I think so..."

Mom 1: "Are the safety inspection certificates online, where I can see them?"

(School janitor walks in again, is still surprised to see people in the room, apologizes, starts to leave. Cardiologist grabs my arm, drags me out after the janitor).

Janitor: "Can I help you?"

Dr. Cardio: "No, we just needed to get out of there."

Dr. Grumpy: "I think you broke my arm."

Dr. Cardio. "I don't care. I couldn't take it anymore. And you couldn't, either."

Dr. Grumpy: "No shit."

Janitor: "Moms today get crazy at these meetings. They'll be there all damn night."

Click

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

Ms. Cell: "I've tried calling your office 5 times today, and the calls keep getting dropped."

Mary: "I'm sorry. What can I help you with?"

Mrs. Cell: "You could get your phones fixed so they don't keep dropping my calls!"

Mary: "Ma'am, usually that's not at our end..."

Mrs. Cell: "Of course it is! I call your office from my cell phone, and the call gets dropped. You think that's a coincidence?"

Mary: "Have you tried calling from a land line?"

Mrs. Cell: "So now you're saying it's MY fault? Is that it?"

Mary: "No, but..."

Mrs. Cell: "Look, I need to..."

(silence)

Gender pronouns

Seen in another doctor's note:

Before you write in - the patient hasn't had gender reassignment. Simply a doctor who doesn't proofread.

Overheard in the living room

Craig: "Did the girls have a sex ed lecture today?"

Marie: "Yeah, in the classroom at the back of the library."

Craig: "We were in the cafeteria classroom. Ours showed all these disgusting pictures of sex diseases."

Marie: "Yeah, the nurse made us look at those. They were gross. One thing looked like a vagina with an eyeball on one side."

Craig: "We had this one picture. I thought it was, like, a really burned and infected tongue, but then Mr. Cooper said it was a diseased penis. It was so gross. Jacob Myers ran outside and threw up in the grass."

Marie: "Was that near the back door of the cafeteria?"

Craig: "Yeah, why?"

Marie: "The nurse stepped in it when we were going back to our classrooms, and began swearing."

Craig: "That's gross, too."

Marie: "Her shoe was all covered with barf."

Craig: "Yuck."

Marie: "Cindy put a picture of it on FaceBook."

Walking in New York

The Colbert Report
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Great attending quotes from training

"If a patient demands to have daily office appointments with you, let them. They're the ones paying for it, and you have to be there anyway. They'll get bored and stop after 1-2 weeks. This is a war of attrition, and you'll always win."

Free

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

Mr. Gratis: "Hi, I need to see the doctor."

Mary: "Okay... We have an opening tomorrow at 2:30. What insurance do you have?"

Mr. Gratis: "I don't have insurance."

Mary: "All right, our cash prices are..."

Mr. Gratis: "Oh, there's no charge for the visit. I was referred by Boondock Hospital."

Mary: "What?"

Mr. Gratis: "I was seen in the ER at Boondock Hospital last week, and they told me I should see a neurologist. Your name was on the list they gave me."

Mary: "Yes, but we still charge for the visit."

Mr. Gratis: "It's supposed to be free. A hospital referred me!"

Mary: "I understand that, but it doesn't mean we don't bill for our services."

Mr. Gratis: "I can give you the name of the doctor there. Can you bill her? Or the hospital?"

Wonder powers activate!

Medikidz is a company that sells medical comic books for kids.

I get it. I was a kid once, and loved comic books. In fact, I think there were educational ones at my pediatrician's cave office then, so I'm glad they're still using them today. (I just wish there'd been a good one for biochemistry during med school).

These are the Medikidz superheroes:

I haven't read the comics, but it looks like they fly around on a giant red corpuscle. Being a neurologist I kind of like the knobby-kneed brain in the background. I'm not sure what to make of the guy in front, as generally I prefer my superheroes to wear pants. There's also the guy behind him on the left, who's carrying eating utensils in his belt. This is not standard JLA equipment.

Anyway, the reason I'm even on this subject is that recently the annual Neurology meetings were held in Philadelphia, and my top field agent, SMOD, was there.

Like many companies, Medikidz had a booth on the exhibit floor. I've seen my share of these. Pleasant sales reps in professional attire extolling the virtues of whatever they're selling.

But not Medikidz. To SMOD's horror, their reps were wearing the superhero outfits:

"For this I got a college degree."

They look kind of lonely. It's good to have a job, but still pretty humiliating to have to be at an adult medical convention wearing spandex and a cape. Normally you only see this kind of outfit on Halloween, when shopping at Walmart, or in the personals section of Craigslist.

Dear Medikidz: if you want to attract neurologists, you should wear Star Trek costumes.

Relevance

On the fax machine yesterday morning was a note from Dr. Intern's office, about a lady who has an appointment tomorrow.

It said: "Please evaluate Flora Betapir for Alzheimer's disease. Records attached."

The attached records were:

Right hand x-rays from 1999

A mammogram report from 2002

and a Pap smear report from 2005

Sigh.

True colors

Last week, for those of you who missed it, Los Angeles Clippers owner Donald Sterling temporarily became the most hated man in America. This is actually pretty impressive, as it involves leapfrogging over politicians, television pundits, lawyers, doctors, and the barista who can never get your order right.

Mr. Sterling's downfall came because of overtly racist statements. This rapidly brought him condemnation from politicians, celebrities, and pretty much anyone with a microphone or Twitter account. People lined up around the block to announce they would boycott Clippers games if he wasn't removed, and team sponsors jumped ship fast.

So, guess who can't boycott Mr. Sterling? I can't. Or anyone in the healthcare field.

Sure, I can refuse to go to his games, or live in one of his buildings. But if he shows up in my office or hospital, I wouldn't turn him away. And neither should any doctor or nurse.

This is one of the hardest things in medicine. Regardless of how we may feel about a person, or disagree with their beliefs, we still have to do our best to help them when they need us. I've taken care of neo-nazi white supremacists, militant black supremacists, dirtballs who shoot police or kill innocent people just because they don't like them... the list goes on. Sterling's condescending boardroom racism is minor league compared to these guys.

It's part of the job. Whether they come to you in the office, or you're seeing them in the hospital, you have to set aside your personal feelings and do your best to help. Dr. Samuel Mudd spent 4 years in prison for providing medical care to John Wilkes Booth - a conviction yet to be overturned.

I never discuss politics with patients, as it's bad for the relationship. But that doesn't stop some from bringing it up, sometimes expressing blatantly racist or antisemitic views. I've had people tell me all blacks should be shipped to Africa, or Jews or homosexuals killed. Do I agree with this? Hell no. But I also believe that part of being a doctor is caring for anyone who seeks my help, regardless of personal feelings for them.

In hospitals they have it even worse. Nurses and doctors there have to deal with people who are drunk, high, verbally abusive, and sometimes violent. And, again, they do their best to help those no one would want to. As professionally as possible.

Like most people these days I don't support or like Mr. Sterling. But that wouldn't stop me, or any number of doctors, nurses, or paramedics from doing our best to help him if he needed us. Because that's what we do.