Thursday afternoon

Dr. Grumpy: "Are you allergic to anything?"

Mr. Anaerobe: "Chlorophyll, and all other oxygen producing substances."

Kissing up

About a month ago I had a pre-med student spend an afternoon with me. Actually, it wasn't even that. After 2 hours she looked liked she was bored out of her mind (I'd warned her about that, but she still wanted to come in) and left at 3:00, saying she was meeting a friend for lunch.

Anyway, I didn't hear from her again until yesterday, when this neatly typed note showed up in the mail:

Dear Dr. Grumpy,

Thank you for taking the time and allowing me to shadow you last month. I understand that having me there required a tremendous amount of time and effort, and I genuinely appreciate your support. My time with you was an unparallelled pleasure.

You are a great leader, humanitarian, and physician. I will always cherish the knowledge that you shared with me.

Yours truly,

Katie Brownnose



Dear Katie,

Thank you for your kind note. I'm sorry I wasn't able to keep you awake during your brief time here, but I warned you that office neurology, to an outsider, is less than exciting.

I'm glad you wrote, because I've been meaning to get in touch with you. Based on our brief time together I'm concerned you may have narcolepsy, and suggest you see a sleep specialist. If it would be easier, try to spend time with one (like you did with me) and they'll likely notice.

Thank you for your kind words. I've always considered myself a great leader here in my practice, but given that I'm solo this is easy. The real truth, though, is that Mary and Annie are in charge, and I just do what they tell me. If you become a doctor, you'll figure that out at some point.

I'm assuming that someday you'll hit me up for a letter of recommendation. Based on my interaction with you, I can certainly reassure them that you're neatly dressed, speak English when wide awake, and have 4 limbs, 1 head, and 2 eyes.

Yours truly,

Ibee Grumpy, M.D.


Actually, folks, I understand her note. I wrote my share of similar stuff back in the day, and now I realize even more so how awful it sounded.

My staff is awesome

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

Mrs. Memory: "Hi, I need to come back and see Dr. Grumpy."

Mary: "Um... Actually, you have an appointment today, at 1:45."

Mrs. Memory: "No I don't."

Mary: "You do, ma'am."

Mrs. Memory: "I most certainly do not. Otherwise I wouldn't be calling you. Now, as I was saying, I need to see Dr. Grumpy again."

Mary: "Okay, well, if you'd like to come in today we have an opening at 1:45?"

Mrs. Memory: "Oh, that works perfectly. I'll be there."

Mary: "Great! See you then."

Mrs. Memory: "Thank you for getting me in so quickly."

Dear Azilect,

Recently, one of my patients applied to your Azilect assistance program, to help those unable to afford a prescription for it.

She filled out the papers, got them together with her Azilect prescription and financial info, and I signed the forms and put them in the mail.

So, I was somewhat puzzled when she brought in this letter last week:

What's up with this? I mean, if the Azilect Patient Assistance Program DOESN'T provide Azilect, what do they provide? Oven mitts?

For future clarification you should consider renaming the program "Non-Assistance" or "No-Azilect Program."

Or, simply have it supply Azilect in the first place.

Yours truly,

Ibee Grumpy, M.D.

From the slushpile

Okay, it's time to hit the mailbag for more examples of artisan/artisanal junk you guys have sent in.

Again, this is not to make fun of tradesman who are genuinely working on handmade artisanal products. This is to highlight, as I have before, the many bullshit uses of the word being slapped on pretty much anything that's mass-produced, or grown (if it grows on a tree, you didn't make it), or other abuses of the word.

First, we have this:

I mean, it's SEAWEED for crap's sake. It grows in the ocean and washes up on the beach, making a rotten, smelly, mess. How is that artisanal?



What else is artisanal these days? Maybe something made in small quantities... Like hot dogs and their fluffy buns:

I'm pretty sure ANYTHING advertised on a roadside billboard isn't artisanal.

What about the security guard who drives around your neighborhood looking for suspicious characters, and calls your house when you set off the alarm while putting out the dog? Is he an artisan? Apparently so.

"So, Mr. Zimmerman. You say you're an artisan?"

Hopefully, having a good artisanal security system will bring you some peace of mind. But, if it doesn't I suppose you can always go buy it:

"Handcrafted tranquility is in aisle 4. Do you have a note from your doctor for that?"

Speaking of peace, have you been trying to find a nice place for Grandma? How about...

"What does artisanal mean? What does artisanal mean? What does..."

And, lastly, while the overuse of "artisan" certainly brings an uncertainty principle of what it means, I still have to respect it when it's tied to a good joke.

"Hey, what's this blue candy inside my baguette?"

Nigel? Is that you?

Back when my kids were younger, they loved the Toy Story stuff. Including the Evil Emperor Zurg:

So, it's no surprise that Frank had to have the Zurg Blaster gun, which fired green ping-pong balls.

Anyway, they're beyond that now, so recently we were getting together some old toys to donate to charity. On the side of the Zurg Blaster, I noticed this:

How awesome is that?

If you don't get it... I feel sorry for you.

Nitrogen, CO2, you name it.

Dr. Grumpy: "Let me get an MRI form... Are you claustrophobic?"

Mr. Lung: "No, but I need to breathe during the test. There's air and oxygen and all for me in there, right?"

Modern crime

More valuable than gold. Rarer than platinum. More coveted than oil. Yes, the most prized substance on Earth is clearly...

Shortbread.

Yeah, you read that correctly.

I didn't think so either, but I'm not much of a shortbread fan. Honestly, I had no idea it was so valuable, until this morning.

This past weekend a daring group of Scottish thieves, in what would have easily been a crime to rival anything in Agatha Christie's works, attempted to steal £15,000 (that's $26,000, folks) worth of shortbread.

That better be some damn good baking. I mean, why the fuck would you steal shortbread? I'm pretty sure these 4 guys weren't planning on eating it (they'd have to be pretty hungry). Is there a huge black market for shortbread in Scotland? While I've encountered my share of seedy characters around my downtown office here in the states, I don't recall anyone in an alley saying "Pssst! You want to buy some shortbread?" and showing the inside of a jacket with cookies hanging off it.

Granted, I suppose it could have gold or diamonds in it, or be a baking operation as a front for Walter White, but... probably not.

Anyway. So, a bunch of guys stole a truck full of shortbread. Thankfully for civilization, however, their dastardly plot was foiled.* Not by Hercule Poirot or James Bond or Scotland Yard, either.

Their attempt to drive the stolen goods away failed because, instead of filling the fuel tank with the recommended diesel (they should have read the owner's manual) they used cleaning fluid.

Really.

How you get Windex mixed up with petroleum derivatives is beyond me, but they did. And thank heavens for it, or the economies of western Europe might have collapsed due to the shortbread shortage. Not only that, it probably saved these guys from dying while having cookies and diesel fuel that they mistook for milk.

Thank you, Webhill!

*The original article used the word "scuppered." That's a great word. Why can't American news outlets use cool words like that?

Memories...

Dr. Balboa was a cardiologist at my medical school. He was good at what he did.

Unfortunately, he also had a confrontational personality, short temper, and complete inability to back down from conflict. These are not good traits to have when you're just over 5 feet tall, slender, and have absolutely no training in Karate/Kung Fu/Krav Maga/whatever.

So, on a relatively frequent basis, the hospital ER docs were used to sewing him up for injuries sustained in bar fights, traffic altercations, or any number of minor arguments that he escalated to stupid levels.

One night, during my 4th year cardiology rotation, I was also covering an ER shift for a friend who needed to trade. And, of course, Dr. Balboa came in. He'd been at a sports bar and the waitress accidentally knocked over his drink. Rather than accepting a replacement, he decided to hash it out with the bouncer. Which is never a good idea.

Since the inner-city ER was swamped, he was stuck with having me sew him up (or wait a few hours for a real doctor, or go to another ER). Hey, it wasn't something I wanted to do either, but I was stuck.

So, while I'm trying my best to professionally put in stitches, he began telling me what I was doing wrong, grilling me about the patients on our cardiology service, pimping me on side effects and half-lives of various drugs, and arguing with no one in particular about how today's medical students weren't as tough as they used to be. None of which helped keep me focused on the job at hand.

After he was discharged, I went back to the staff lounge to get some coffee. The window there looked over the parking lot. As I watched, Dr. Balboa went out to his BMW and began arguing with a guy who'd set a Gatorade bottle on its roof.

Five minutes later he was back in triage with a broken wrist.

Verbiage

Back in the early, sexist, 80's, I had a teacher who'd say "writing should be like a girl's skirt: long enough to cover the subject, short enough to keep it interesting."

Now, times and expressions may have changed, but his point is still well-taken. This was driven home to me recently while reading an article about the effects of concussions on college football players.

I'd have to say the gentleman on the right nailed it:

Sunday night call check out

Dr. Grumpy: "Next one, in room 734 is Mr. Spin, admitted for severe vertigo. I think it's peripheral, but ordered an MRI and..."

Dr. Nerve: "What kind of vertigo?"

Dr. Grumpy: "Positional vertigo. It happens when he turns his head left."

Dr. Nerve: "Which of the semicircular vestibular canals is involved?"

Dr. Grumpy: "Are you serious?"

Dr. Nerve: "Yes. Which canal is involved? Superior, Horizontal, or Posterior? They taught you that in residency, didn't they?'

Dr. Grumpy: "I have no fucking clue. I had 29 consults this weekend, and breaking that down isn't going to change my management."

Dr. Nerve: "I think these things are important."

Dr. Grumpy: "I don't when I'm swamped. On call my main question is whether it's central or peripheral. You want more than that, call an ENT."

Dr. Nerve: "Personally, I examine them closely until I've localized the canal."

Dr. Grumpy: "You do that. He's in 734. The MRI is pending. The next patient is..."

Erev Independence Day

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

Ms. Triptan: "Hi, I need to get in to see him tomorrow. My headaches have gotten worse."

Mary: "We're closed tomorrow. It's a holiday."

Ms. Triptan: "But this is important. I'm really miserable, and need something done! Couldn't he meet me there? Just for a short while?"

Mary: "No, but we had a cancellation for today, at 4:15. He can see you this afternoon."

Ms. Triptan: "I can't do that, I'm going to the casino. It's Bonus Slots Thursday."

Help wanted

You need to have brain surgery. Wouldn't you want a surgeon who had experience in the field (as opposed to, say, removing ingrown toenails)?

Me, too.

So, this is an interesting job ad. A hospital is looking for an anesthesiologist. That's the person in charge of making sure you're deeply out when they cut you open, watches your vital signs to make sure you're not dying on the table, and then (hopefully) wakes you up after the surgeon has put you back together.

So shouldn't they want someone who'd previously done that a few times?

Apparently not:

Yes folks, you read that correctly. They want an anesthesiologist, but experience using anesthetic drugs and procedures is "preferred" though not, say, "necessary" or "required" or "a really good idea."

Let's look at it this way:


Astronaut wanted to fly large rocket full of highly explosive fuel at 17,000 miles per hour to International Space Station. Experience at operating rockets preferred.

Scientist needed to calculate origins of matter and to evaluate data relating to Higgs Boson. Experience with physics preferred.

Person needed to maintain nuclear warheads. Experience with handling lethally radioactive materials with potential to wipe out a city preferred.


Now, realistically, I'm aware it would be hard to become a board certified/eligible anesthesiologist without actually doing the procedures and giving drugs... but you never know. I trained with a guy who got through a 3 month surgical rotation without ever setting foot in the OR. And he passed.


Thank you, Jess!

Full service neurology

I'm between patients when Mary tells me a doctor is on hold.


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

Dr. Veoli: "Hi, this is Al Veoli, the pulmonologist across the street. We have a mutual patient, Don Epazil, who you're seeing for memory problems?"

Dr. Grumpy: "What's up?"

Dr. Veoli: "I'm not sure what to do here. I guess he was going to haul his clothes to the cleaners, but got the addresses mixed up. He took the bus here, and now he's out in the waiting room, trying to give bags of dirty duds to my staff."

Dr. Grumpy: "I'm sorry. His son lives with him, but is out of town this week. Tell him to come over here. I'll call his sister, who's handling this stuff."

Dr. Veoli: "He's showing stains to people in my lobby asking how to get them out. One nice lady is trying to give him pointers. I don't think she realizes what she's dealing with."

Dr. Grumpy: "Okay. Direct him here, and I'll give his family a ring."

Dr. Veoli: "Thanks. Sorry to bother you."

10 minutes later

Mary: "Hey, doc, Mr. Epazil is up front with 3 bags of dirty clothes. He says he was supposed to bring them here to have them done? Laundry WAS NOT in my job description."