Tales from the trenches

Dr. Coogie writes in:

This morning I was on the computer, reading overnight notes on my patients. These were the nursing notes on one guy:

00:23  Patient yelled at nurse for pushing Dilaudid "too slow."

01:00  Patient running up & down hall yelling for more Dilaudid.

01:25  Patient called nurse an ugly bitch because she hadn't pushed Dilaudid faster.

02:00  Patient apologized for calling nurse an ugly bitch and asked for more Dilaudid. When informed he could only have it within the schedule set by pain management, he called her an ugly bitch again.

02:10  Patient ran to another nurse's station trying to get more Dilaudid.

02:30 Patient yelled at nurse for giving Dilaudid too slow, said "It's like giving me low octane fuel instead of high octane fuel."

02:40 On call physician notified of patient's behavior.


02:49 Patient seen by on-call physician, who informed the patient he would not be getting more pain medication than the pain specialists recommended.

03:40  Pt escorted back to room by security, who found him downstairs in ER demanding Dilaudid from staff there.



I absolutely LOVE this nurse.  I ran up and gave her a high-five before shift change.

Advice

Dr. Grumpy: "So, at your last visit I prescribed Quiloxitab for the symptoms. How's that working?"

Mr. Rummage: "Actually, I never took it. I decided to try herbal Oil de Baculum instead."

Dr. Grumpy: "Has it helped?"

Mr. Rummage: "Not yet, but the guy who told me to said it can take a few months."

Dr. Grumpy: "Is he a doctor?"

Mr. Rummage: "Not sure. My wife and I were out looking for a used suitcase this weekend, and he was having a garage sale."

"Old lamps, some dishes, paperbacks, medical advice... We got it all."

That should do it

Seen yesterday afternoon in a hospital chart:

For non-medical readers: the effective sedating dose of Valium is typically 5mg-10mg.

Red, Red, Wine

Dear Western Intermountain Neurological Organization,

A reader kindly forwarded your recent conference invitation.

I have to say, I had no idea the "intermountain" states even had their own neurology organization. Why such an organization is necessary is beyond me, as I'm not aware of groups such as "Neurological Association of States that begin with an N" or "United Neurologists of Civil War Border States" or even "Neurologists Organized in Cities with Fewer than 10 Letters in Their Names."

But, I digress.

Anyway, what caught my eye on the invite was your acronym:

Generally, a title like that doesn't bring up images of a bunch of neurologists sitting in a darkened lecture hall learning about the latest research in mitochondrial disorders. Liver transplants, maybe.

Your site name, winomeeting.org, isn't bad, either. Sounds like an organization I'm ready to join after a crappy day at work. Or night on call. Or... Screw it, I'm ready to join now, provided your standards are above Night Train Express and Thunderbird. But I'm willing to negotiate.

I see this year's meeting is being held in Salt Lake City, generally not a place I think of for its widespread availability of alcoholic beverages. The last time I was there (2012) I saw a bleary-eyed dude standing on a street corner drinking from a bottle wrapped in a paper bag... and it was milk. I'm guessing he was an RM re-adjusting to big city life.

Your site says the meeting will "stimulate your thinking" and that my $150 registration fee includes breakfast and lunch. Will funeral potatoes be served? Fry Sauce? Green Jello? It would also be helpful if you noted what stimulants and beverage vintages are included with the meals, preferably ones I can mix with Diet Coke.

The idea of a room full of docs wearing nametags that say "WINO" is also entertaining. Especially if the featured speaker is unshaven, slurring, shabbily dressed, and tremulous.

The site also has this price list:

I have no idea which companies want to set up a booth at a WINO meeting, but I'd love to see what they're wearing. I'm imagining guys who look like they just spent the night sleeping on a bench in Temple Square (but without the black name tag) sampling beverages that can double as lighter fluid. Also, I think it would be cool to watch sales reps for Campral and Two Buck Chuck working the crowd together.

Lastly, while I don't live anywhere near a mountain, I'd still like to join your organization. Because nothing would be more impressive than to have a framed certificate that says "WINO" in big letters hanging amongst my diplomas.

It may actually improve my Yelp ratings.

Thank you, Mike!

Weekend reruns

Mrs. Grumpy had a meeting tonight, so I had to feed the kids. Fortunately for me, a Big Pharma, Inc. drug rep brought lunch to the office, and there were a lot of leftovers. So this afternoon I grabbed a bag out of the cabinet (with the Big Pharma, Inc. logo on it), tossed the leftovers in, and headed for my car.

Passing a cardiologist's office on my way to the elevator, a female rep I'd never seen before, wearing a Big Pharma, Inc. name tag, came out of his office. We made eye contact, and I nodded, smiled, and continued on my way.

Only to be stopped after another few steps by her saying loudly, "Oh MY GOD! What are you doing?"

I turned around to find Ms. Rep looking at me, horrified. "Excuse me?" I said.

Ms. Rep: "Are you taking food from a doctor's office?"

Dr. Grumpy: "Um, yeah, is that okay?"

Ms. Rep: "NO! It's rude! It's unacceptable and inappropriate! And look at the way you're dressed!" (I tend to be on the casual side) "You don't even have a name tag! What are the corporate people teaching you new reps, anyway?"

Before I could answer she went on: "I'm sorry. I suppose this isn't your fault. The training people must be slacking off." She offered me her hand. "You must be new. I'm Stacey, from our cardiology marketing division."

I shook her hand. "I'm Dr. Grumpy, from the neurology division down the hall."

Stacey, from the cardiology marketing division, somehow looked even more horrified now. After a few stuttering attempts at saying something she answered her cell phone (which hadn't rung), mumbled "nice to meet you" and ran into the stairwell.

In that case, I think you're publishable

Patient quote of the day:

"I'm allergic to all known amino acids and proteins."

"Swordfish"

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

Mr. Beef: "Hi, I need to get in today."

Mary: "We have nothing today. But tomorrow..."

Mr. Beef: "But I want to be seen today!"

Mary: "We're completely booked."

Mr. Beef: "But don't you have secret slots? Like the secret menu at Arby's or something? Is there a password?"

Hawaiian vacation, day 11

Sigh. Today we packed up and headed back to reality, work, and jobs.

The dichotomy at the Maui airport is striking. People getting off planes, bubbly and thrilled to be on vacation, and a sullen-looking group sitting quietly at the departure gates waiting to go home. Even the relaxed restroom picture stick people seem to be mocking you.

While walking along I noticed that a local gynecologist had set up shop in the terminal:

"What on Earth is going on in there?!!!"

Better yet, it was the mens room:

"Okay, now I'm REALLY confused."

 The flight home was quiet. But it brings you back to what really makes your family whole again.
 

And that's the way it is. Aloha!

Hawaiian vacation, day 10

My favorite memory from my first Maui trip (1973) is of a dog.

Dad was driving us down some side street while Mom looked at a map (yes, kids, that's what people did before GPS). As we rolled along, we came to a Golden Retriever lying across the middle of the road. The street was narrow, with no way around him.

So Dad drove on, figuring at some point the dog would get out of the way. No such luck. He was, apparently, quite comfortable.

As we approached, Fido raised his head off the ground to look the car over... Then put it back down.

Dad stuck his head out the window and yelled. No response.

He honked the horn several times. Fido's left ear twitched.

Finally, Mom got out of the car and went around to nudge him. He rolled over on his back with an "OH BOY! YOU'RE GOING TO RUB MY BELLY" look.

Finally, Dad gave up. He backed slowly out of the side street and turned around to find another route. My sister and I watched as a bird landed on the sidewalk and Fido took off after it.

As it turns out, this is pretty much the way dogs are on Maui. Nothing fazes them. No matter how laid back you think your dog is, a dog on Maui will make him seem high-strung. They are remarkably mellow. The scuba place we dived with had a dog named Sarge, who pretty much had the run of the strip mall.

He spent the day wandering around the parking lot and in & out shops there, and no one cared. In fact, he seemed to have a small fan club, like the postman and others, who tossed him treats as they went by.

Equally important, he also provided surrogate dog services to people whose pets were back home. And was more than happy to do so.

Marie and Sarge. He looks vicious, huh?

After scuba diving, Marie asked if we could go to Subway for lunch. Marie's favorite sandwich there (roast beef, tuna, and cheese) always raises a few eyebrows.

Counter lady: "What can I get you?"

Marie: "I'll have roast beef and tuna, with cheese."

Counter lady: "Sorry. Can't do that. It's against company policy to combine roast beef and tuna."

Marie: "But I get that at home"

Counter Lady: "Well, they should know better."

Marie: "You can't do it?"

Counter Lady: "No. It's probably a health code violation or something, too."

Marie: "Let's go, Daddy."


We ended up down the street at L&L for a plate lunch.This is a Hawaiian thing. Regardless of what you order, it always comes with 2 scoops of white rice and one of macaroni salad.

Down the street from our condo is a restaurant with the unusual name of Slappy Cakes. This immediately brings to mind an image of getting smacked by the hostess when you go in.

Curious, I looked them up online. The theme is that you cook your own pancakes. I, personally, have never understood this concept. If I'm going out to eat, I'm paying for you to make it for me. I'll stay home if I want to cook.

The setup consists of a large griddle set in the middle of each table, making me imagine someone getting 3rd degree burns while passing the syrup. Their menu, however, does list the admirable feature of serving cocktails at breakfast for those who like to watch Matt Lauer while blitzed. One is called the "Slappy Screw," which sounds like something a guy would spend $50 on in the Honolulu red-light district.

They also feature such heart-healthy fare as chicken-fried bacon and pork-belly benedict. Like every place here, they also have a Loco Moco (called the Slappy Moco). This is a pile of white rice, with a hamburger patty on top, then mushroom gravy, then a fried egg.

At the bottom of Slappy's menu is this great "We told you so, so don't sue us" legal disclaimer:

Tabletop griddles are hot! Please use carefully at your own risk. For safety reasons, children must stay seated and not reach across griddle. 

Because, you know, small children ALWAYS do exactly as they're told.


This afternoon, while hanging out in the lobby, Frank wandered over to one of those tourist brochure displays. After a few minutes he pulled one out, brought it over to me, and asked "Dad, can we go to this luau?"

Dude. I'd be staring, too.

This is part of the fun of traveling with teenage boys. Pretty much EVERYTHING gets their attention. Even ceiling lights.

And that's the lei it is.


Disclaimer - none of the above restaurants paid me to write about them. But I am, however, for sale. Someone, please, buy me.

Hawaiian vacation, day 9

My pill containers are depressing, reminding me that we only have 2 more days of vacation left.

Why yes, they were given to me by a drug rep.

Today this was lying next to our rental car. Apparently someone had a wild time in the parking garage.

Yes, they're panties. There was also a used condom, but I didn't think you'd want to see that.

This morning we went to Iao Valley. This is an absolutely stunning area, with mountains covered by greenery. The area gets 386" (9.8m) of rain per year, creating several large streams that run outwards through the island to the sea. The walking path through the area is beautiful. The weather varies from misty to sunny, and often changes from one to the other at 15 minute intervals.

The area was considered sacred by the Hawaiians, with several kings being buried in unknown graves.

The central spire (Iao Needle, above) is a 1200' ridge in the center of the park. The ancient Hawaiian's believed it was the god Kanaloa's penis. This is not something you'll learn at the Enchanted Tiki Room.

In 1790 a large battle, Kepaniwai, was fought here during the wars of Kamehameha I. So many died that their bodies blocked the out-flowing streams and turned them red. The name of the battle literally means "the damming of the waters."

Like the waters of Pearl Harbor, or fields of Verdun, the area is so peaceful today that it's hard to believe what once happened there.

Driving back to the condo, we admired some of Maui's roadside scenery.

Hawaii, though far from the mainland, still has a lot in common. For example, during their recent election, not 1 but 2 of the 7 candidates running for mayor were arrested. The first, Nelson Waikiki Jr., was wanted on charges of fraud and violating bail. He'd apparently been managing to avoid the law, but, in the spirit of the race, showed up at the candidates debate. The police politely allowed him to finish speaking before hauling him away.

The second was stopped for driving without a license plate AND talking on his cell phone (both illegal in Hawaii). He told police that neither law applied to him because, well, they just didn't (why you'd want to run for office if you don't even believe in the office is beyond me). He then drove away, was later stopped again, and tried to flee on foot. Ignoring several warnings to stop, he ended up getting tased.

Just another day in paradise.

Stayin' Alive!

Leigh sent this pic in. She said she stopped to visit her parents' graves last weekend, and the cemetery had a banner up...

"We'll also be reenacting the video from 'Thriller'."

Thank you, Leigh!

Hawaiian vacation, day 8

This morning I checked on the dogs.


Phone girl: "Thank you for calling Burgoo Animal Care."

Dr. Grumpy: "Hi, this is Ibee Grumpy, calling to see how Snowball and Mello are doing?"

Phone Girl: "Snowball and Mello... I think they went home yesterday."

Dr. Grumpy: "WHAT?!!!"

Phone Girl: "Yeah, they... Hang on, let me check with Casey."

(Panicked, I'm put on hold, listening to horrible, unseasonal, Jingle Dogs Christmas carols)

Phone Girl: "Okay, they're here. I had them mixed up with someone else's."

Dr. Grumpy: "Thank you."

Phone Girl: "They're going to the bathroom and everything."



Whaler's Village is an outdoor shopping center on Kaanapali. It's been there a long time. In fact, I saw it on my first trip in 1973. My mother made me keep a diary, and my entry for that day was "Today we saw the skeleton of a whale." Obviously, I was impressed. The skeleton is still there.

Scattered among the stores are some interesting displays about whales, and they have a museum about whales and whaling on the 3rd floor. This kind of stuff fascinates me. These are the biggest living creatures today, and the Blue Whale is the largest living animal EVER on Earth.

How big is it? Some have been measured at nearly 100 feet (30m) long and 195 tons.

Yes, that's you on the upper right. And the flippers make you look bigger.

But the really cool thing is this: the whaling museum has a statue of a strange creature in the corner, which looked like a cross between a lizard and a medium-sized dog. It's a long-extinct animal called Pakicetus that lived on the shores of what's now Pakistan 50 million years ago. This is it, also with Homo sapiens:

Somewhere along the way, dinky Pakicetus returned to the ocean, adapted, branched off... and became the cetaceans (dolphins and whales) of today. Including the biggest living creature on Earth.


The rest of the mall, in keeping with Lahaina's history as a major Pacific whaling center, (sarcasm) is a collection of souvenir shops, restaurants, expensive clothing, jewelry, & shoe stores, and (inevitably) one of the ubiquitous ABC Stores.

One overpriced boutique apparently caters to individuals with grossly asymmetric arm lengths (and, on your left, missing a finger):

"I had a half-scholarship for basketball in college"

If you have teenage boys, by the way, KEEP THEM AWAY from ABC stores. Oh, sure, they'll tell you they want to buy a Diet Coke, or sarong for Aunt Thelma, or a souvenir toothpick holder, but the real reason is that ABC sells picture postcards of young, topless, Hawaiian women. And calenders. And probably stained glass windows. It's kind of an all-purpose Hawaiian boob center. In the interests of fairness, however, they do sell similarly themed stuff with hunky Polynesian guys, too.

In the 1980's, during one of our family trips here, I routinely walked over to an ABC and bought topless postcards. A LOT of them. I figured, being a college guy heading off to medical school, it would be fun to have some to use over the next few years to mail to friends around the country as a joke.

It's been over 25 years since then. There's still a pile of unused cards from that batch in my desk at home. In fact, here it is:

I put a less-revealing one on top

As you can see, the stack is still almost an inch high. So, the take-home lesson here guys is never over-buy the topless postcards at ABC. As good as the idea may sound at the time, you'll never get rid of them. I mean, who the hell sends postcards anymore, anyway? Some day, while settling my estate, the kids are going to wonder why the hell I have a bunch of these in my desk. Frank and Craig will likely have their own stockpiles by that time. And won't be able to get rid of theirs, either.

We went for Mexican food tonight. Craig is convinced lettuce is the most deadly substance on Earth. It's not enough for him simply not to eat it. He actually has to scrape it off his plate so it doesn't contaminate the other comestibles.

And that's the way it is.

Hawaiian vacation, day 7

Today we went kayaking.

This was Craig's idea, and I got suckered into it. Physical exertion is generally not my idea of a vacation. I tried telling him it would mess up his hair, which (surprisingly), didn't dissuade him.

I called a place and made a reservation. They told me to meet "the guy” on the beach at mile post 7. So, at the ungodly vacation hour of 6:30 a.m we arrived, only to find 3 different kayaking outfits waiting there for their customers.

I went up to the guy closest to us, and before I could say anything he glanced up from his clipboard and said "Dude, are you the Tarahashi family, from Tokyo?"

I don't even look vaguely Asian and was briefly taken aback. He apparently took the pause to mean I'm either deaf, don't understand English, or both. So he repeated the question, loudly, in halting Japanese.

"What do you do when you come to a yellow light?"

I said, "No, we're the Grumpy family, from Ohio. Are we on your list?”

He flipped through some pages, and said "No, but I think I remember your name from the invoice I left at home" and tossed the clipboard into a rusted out Toyota pick-up. "I'm Skeeter. Let's get you guys some kayaks out of the back."

So I followed Skeeter. He was skinny, deeply tanned, and had long blonde dreadlocks. He looked like a SoCal dude, though later told us he was from Hilo, on the Big Island. He smelled like marijuana, not in an I-just-smoked-some way but more like he uses it frequently at home, and so the smell has permeated everything.

At some point I assume the Tarahashi family showed up, and probably went with some other kayak outfit under our reservation.

Skeeter dragged 3 kayaks out of the pick-up bed, and gave us a 10 second lecture on rowing. The twins, as always, went together, and Frank and I paired up. Skeeter headed out with some guy whose name was never given and magically appeared from under the truck, with motor oil on his chest.

Off we went, paddling away down the Maui coastline. Occasionally Skeeter would point out interesting fish, or birds, or clouds, or mountains, or UFO's.

After about 30 minutes he noticed a sea turtle leisurely drifting near us, and yelled "Hey Mr. Turtle, Dude! How's it going?"

Mr. Turtle Dude kept coming toward us, then dived and swam under me and Frank's kayak. We both leaned to our right to watch him go by, immediately capsizing the boat and dumping us both in the Pacific.

As soon as we came up, Frank began screaming that he'd lost his glasses. Skeeter jumped out of his boat, and he and I both dove down to the coral several times to look for them. After our 3rd or 4th dive Frank realized they were still around his neck.

Mr. Turtle Dude, by this time, had given up on the primate entertainment, and moved on, with as contemptuous a look back at us as can be managed without facial muscles.


We continued paddling. This is SO not my thing. I got a blister on my thumb, FFS.

As we cruised along the coast, the twins got a little too close and were caught in the breaking surf. Frank, Skeeter, Motor Oil, and I watched helplessly as they were tossed about, then thrown onto the beach as both of them leaped out at the last second. The kayak flipped over a few times before it came to rest next to some rocks.

Craig, using his Boy Scout training, made several attempts to launch the boat, without success. Each time it got pushed back by the waves, or turned over. The attempts ended when he accidentally dropped one end on Marie's foot, and she slugged him. Then they began yelling, throwing sand, and screaming at each other as to whose fault it was that they were now trapped on a beach in the middle of nowhere (20 feet from a major highway, with cars whizzing by) and were now going to die and I TOLD YOU THIS WAS GOING TO BE THE WORST VACATION EVER!!!

Skeeter jumped out of his boat, and swam ashore. He separated them, relaunched their kayak, swam along pulling it until they were outside the breakers, and then got back in his own boat.

You better believe I gave him a decent tip.

When we finally got back to the condo, Mrs. Grumpy asked us how it was. I tried to convey my horrible suffering at having a blister on my thumb, but she unsympathetically didn't give a shit. Instead, she ignored me and asked the kids.

Marie said "It was fun! Craig and I got shipwrecked!"

Hawaiian vacation, day 6

Today we decided to just hang out at the condo. This is because, after you've spent a fortune to travel to Hawaii, your kids want to play video games and swim in a pool. You know, things they could never do at home (yes, that's sarcasm).

People always talk about what's important to take on a trip. Clothes, medications, Pop-Tarts, whatever. Napoleon once said "an army travels on its stomach." American Express says "don't leave home without it." But today, only one thing matters. One thing that's critical on a trip. One thing that the modern family absolutely can't go anywhere without:

"MOM! I'm down to 11% power and Craig won't give me the charger!"

Yup. That's it. Try going anywhere without them. I dare you.

After a while the kids went stir crazy, so in desperation. I decided to take them snorkeling at Black Rock. Please note this is generally a REALLY BAD IDEA. Nothing against the Black Rock area - it's spectacular. The problem is that EVERYONE in the Kaanapali area wants to go there... and there are, literally, a total of 8 public parking spaces available. All the other spaces belong to the Sheraton, require a permit, and are closely watched.

I remember one BK (Before Kid) era trip where we pulled in to see if there were any spaces (there weren't). But, as we looked around, a car that was waiting to pick someone up was sitting there. These 2 large Polynesian guys, wearing nothing but Speedos, got out of it. Their stereo was blasting some sort of bizarre Hawaiian - rap fusion, and they started doing a synchronized island break-dance routine on the asphalt.

Anyway.

So we grabbed our gear and I told the kids to put it in the trunk. As I was getting into the car, however, they began screaming like they were being attacked by a crazed luau performer with a flaming machete.

I ran around to see what was up, to find...

Yes, that's it. Granted, I'm not a fan of centipedes, but I figured we'd just get in the car and drive away. The kids, however, didn't want to get anywhere near the car now, in case it had some sort of myriapodic flying or death ray superpowers. Before I could do anything else it scuttled under the van.

This was, apparently, the end of the Black Rock idea. Because now the kids were convinced it was going to crawl up under the car, chew through the metal floor, and kill them if we went anywhere. In fact, they were pretty much halfway back to the condo at this point.

In the room I told them to go to the pool again. I sat down and absently flipped through a coupon book of stuff to do. I noticed this one. I guess it's supposed to be a flower, I think... But to a medical person...

I think I saw this in a textbook once.

Around noon Frank and I wandered over to the grocery store to get some supplies. Like many stores, they have a display up front selling bargain-bin video games, DVD's, etc. He was looking through it for anything interesting, when an elderly clerk wandered over and asked if he needed help (probably thought he was shoplifting).

Frank: "Do you have Call of Duty?"

Clerk: "Certainly. On your left, down the short hallway, next to the drinking fountain. You don't need a key."


Hawaiian grocery stores can be interesting. The place is a cultural crossroads with influences of the native Polynesians, immigrants from China, Japan, and the Philippines, and its history as an American territory and state. So you see the usual generic grocery store stuff, but also some more interesting items. One aisle had jars full of tentacles, cans of cephalopod eyeballs, bags of dried cuttlefish... It made the kids appreciate the Wingnut School cafeteria.

Mrs. Grumpy spent a few years in the Philippines when younger, and became addicted to a local snack called Cracker Nuts. I, personally, can't stand them. Basically, they're peanuts that are coated in flour, then deep fried. To me they taste like really stale nuts.

My wife, however LOVES them. On rare occasions she'll order them online. But in Hawaii, she combs any grocery store we go into for them, with mixed results. I count myself lucky in that at least she doesn't like their banana ketchup (yes, really. It's ketchup made from bananas instead of tomatoes).


There are other unusual foods, too:

I bet it's artisanal, too.

When we got back to the hotel, Frank and I joined the others at the beach and pool for a while, then I went upstairs to do some reading. As I settled on the balcony I heard noise down by the pool, then music. In what was one of the most randomly bizarre events of the trip, an Elvis impersonator had set up a speaker there and was belting out a few numbers.

We did Chinese take-out for dinner.

But does it tell you who has your cookie? Hell, no.