Let it go, let it go...

Seen in the Costco catalog. Really.

"Wait'll you see our ads for the new Tampax™ Icicles."

Althought, admittedly, there have been stranger product marketing tie-ins.

Patient quote of the day

"I know this seizure wasn't as bad as others, because I was able to post about it on Face Book."

February 5, 1938

Hans Litten

A German man died on this day in 1938. A very good one.

His name was Hans Litten. His father was a lawyer, and was a decorated WWI veteran.

Hans grew up in the difficult years of WWI and postwar Germany. Although his family was wealthy, from the start he had great sympathy for the less fortunate. In an episode that greatly upset his father, Hans took food from their kitchen to give to a beggar... and addressed the beggar as "sir." As he grew older he became increasingly involved in issues affecting workers and the disenfranchised.

Although he wanted to study art history, his father pressured him to become a lawyer. While reluctant, Hans threw himself into his studies and quickly moved to the top of his class. Upon graduation he was offered 2 good jobs, one with the German Ministry of Justice, the other with a renowned law firm. He declined both, going into private practice with a friend.

In the late 1920's he was alarmed by the increasingly nationalistic tide in Germany, seeing right-wing thugs get away with increasing violence against Jews, immigrants, and manual laborers. He took cases representing those who'd been attacked or discriminated against, and was successful.

He worked closely with charitable organizations that supported the needs of ordinary workers in the difficult post-war year, providing them financial and legal assistance.

As a person, he was brilliant. He spoke fluent German, English, Italian, Hebrew, and Sanskrit, and had a tremendous knowledge of art, classical music, and poetry. He particularly enjoyed music, spending many evenings at the symphony.

In 1929 a traditional May Day rally in Berlin turned violent, with the police firing randomly into the crowd (killing 33) and beating many more with truncheons. Several workers were charged with inciting the demonstrations, and Litten defended them. He took many similar cases, trying to bring to light the increasingly heavy-handed tactics of the German government.

On the night of November 22, 1930, a small paramilitary group, secretly working for the nascent Nazi party, attacked the Tanzpalast Eden, a dance hall that was popular with immigrants. They killed 3 and injured 20... and the subsequent police investigation was intentionally slow and fruitless.

Litten accepted the case on behalf of 4 injured plaintiffs, trying to secure criminal convictions against the attackers and show that the attack was intended to further destabilize German society in favor of the Nazis. Although their later history is well known, at this point the Nazi party was publicly distancing themselves from their secret armed squads in order to appeal to moderate Germans.

And, to help his case, Litten had the court summon Adolf Hitler to the stand.

In what (in retrospect) must have been a truly remarkable day, Litten aggressively cross-examined Hitler for 3 hours, forcing him into several contradictions. Under oath, Hitler defended the brown shirts as being devoted to non-violent "intellectual enlightenment." It also included this exchange:

Litten: You said that there will be no violent acts on the part of the National Socialist Party. Didn't Goebbels create the slogan, "one must pound the adversary to a pulp?"

Hitler: This is to be understood as "one must dispatch and destroy opposing organizations".

Litten Since you've named Goebbels as Reich Minister of Propaganda, are you aware of the passage from his book where he declares that fear of the coup d'état cannot be permitted, that parliament should be blown up and the government hunted to hell, and where the call to revolution was made again?

Hitler: I can no longer testify under oath, if I knew Goebbels' book at the time. The theme is absolutely of no account to the Party, as the book doesn't bear the Party emblem and is also not officially sanctioned by my Party

Later.....

Litten: Is it correct that Goebbels' revolutionary journal, The Commitment to Illegality, has now been taken over by the Party and has reached a circulation of 120,000? The journal is sanctioned by the Party.

Presiding judge: Herr Hitler, in point of fact, you testified this morning, that Goebbels' work is not official Party material.

Hitler: And it isn't, either. A publication is an official Party organ only when it bears the emblem of the Party.

Litten: Then, how is it possible that the Party publishing house takes over a journal that stands in stark contrast to the Party line?

Hitler (shouting, red-faced): How dare you say, Herr Attorney, that is an invitation to illegality? That is a statement without proof!


Hitler was badly rattled when he left the stand, and forbid others from ever saying "Litten" in his presence again. When the name was mentioned he became irate. He was subsequently investigated for perjury, though managed to evade charges.

As Hitler rose to power, it was obvious that Litten's time was running out. Family and friends told him to flee Germany, but he refused because clients still needed him. On the night of February 28, 1933 he was arrested at his apartment, and would never be seen in public again.

Over the next 5 years he was moved from prison to prison and repeatedly beaten and tortured. He lost the sight in one eye and hearing in one ear. Most of his teeth were knocked out, and one leg was broken so many times it became useless. His jaw was broken in multiple places. Often he was so battered that fellow prisoners weren't allowed to see him.

In 1935, during a rare interaction with other inmates, he recited one of his favorite childhood songs, "Thoughts are Free." Their guards failed to realize the significance of the words.

In 1937, although baptized and raised as a Christian, Litten was classified as Jewish on the grounds that his paternal grandparents were Jews. He was moved to Dachau concentration camp, where, on the early morning of February 5, 1938, he hung himself in the bathroom.

He was 35 years old.

Forces of nature

Mrs. Frost: "A lot of this is just the weather... my migraines always get worse in winter. I wish I had the money to travel. Is there anything else that can be done for them?"

Dr. Grumpy: "Well, I could try adding a medication when the season starts to change that..."

Mrs. Frost: "No, I mean, something that I could do about keeping the weather more stable. Can I take a doctor's note to a government weather department or something?"

Mary's Desk

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

Ms. Chatter: "I need to see Dr. Grumpy. My last neurologist moved away, and I'm trying to get my records from them so that (ramble, ramble, ramble)."

Mary: "Okay, let me see... We have an opening next Tuesday, at 3:45."

Ms. Chatter: "That won't work for me because Tuesday afternoon is when I watch my grandkids because my daughter works and her boss is an asshole because (ramble, ramble, ramble)."

Mary: "All right, what about... How's Thursday morning, at 8:00?"

Ms. Chatter: "Perfect. Mornings are always good for me because my husband walks over to the city pool to swim laps at the indoor one and I can have the car. They just opened the pool again last month, it was closed for almost a year, because I guess it had fallen behind all these state health codes and they had to set aside money to do the project, and (ramble, ramble, ramble)."

Mary: "Okay, I have that down. What insurance do you have?"

Ms. Chatter: "I'm with Sickness & Wealth HMO."

Mary: "Oh... I'm sorry. We aren't contracted with S&W."

Ms. Chatter: "WHAT? WHY DIDN'T YOU TELL ME THAT IN THE FIRST PLACE? YOU'RE WASTING MY TIME!"

(click)

Cough drops

Last week I was sick (I'm fine now, thanks). It was just another nameless viral crud that my pet fomites kids brought home from school.

Anyway, to get through work (I'm in solo practice, where we aren't allowed to take sick days. Only dead days are acceptable) I invited over my usual friends: Sudafed, Tylenol, Dextromethorphan, Guaifenesin, and Halls. When I'm sick, this gang and I know how to party.

To my horror, my old friend Halls has apparently been put on Prozac. In a bizarre move taken from fortune cookies, the company decided that infectious diseases should be made even more miserable by putting happy inspirational ditties on the wrapping.

So, this is where we are. It's no longer good enough to make a decent product for the snotty & hacking, but to provide ersatz emotional support with "a pep talk in every drop." Better yet, they even trademarked that statement.

Not that the comments help, either. When I'm sick my "game face" looks more like a death mask, and my "battle cry" has pulmonologists drooling. And I sure as hell wouldn't bet on myself.

Here's some others:

The last one I find particularly odd. "Hi-five yourself" sounds like a euphemism for, well, other things besides illness that require Kleenex.

Celebrity fail

Dr. Grumpy: "The neck MRI didn't show anything serious, so he should be okay:"

Dr. Hospital: "Good. He had a bad fall, and I was worried he'd be paralyzed. You know, like the Superman guy Steve Reeves."

"Or was it Keanu, or Dan, or Martha... maybe there isn't an 'S'..."

Open season

In the last month, 2 doctors have been shot & killed, on the job, here in America.

I'm not going to say medicine is more dangerous than, say, police, fire, or military work. But it's certainly not safe, either. Both of the doctors who were killed were in hospitals at the time. One shot by a disgruntled patient, another by the upset son of a patient.

2 doctors in a month may be only a drop in the bucket in a country where 82 people are murdered with guns every single day, but it still scares the crap out of anyone trying to help patients, not to mention the affects on our families.

Do I get threatened? Yes. Sadly, all doctors and nurses do. People want to feel better. Or be cured of something. Or want more narcotics. Or are unhappy with my telephone system. So they yell and scream, and sometimes threaten. Most of them simply change doctors and a few may post a shitty review of me online. Generally that's as far as it goes.

But that doesn't mean it might end there. All it takes is one person who goes over the edge. And, here in the land of the gun, firearms are easily obtainable by anyone. Even those who hear voices telling them to kill people. Or have a history of violence with a restraining order against them. Or have committed felonies. Even for a doctor, it's hard to tell who is or isn't crazy enough to actually carry through on their threats.

The ER docs and nurses are the front-line in medicine. I don't know anyone who works in ER who hasn't been threatened or struck by a patient. Does that surprise you? Then go hang out in any decent sized ER in America and see what really goes on there. I was a 19 year old volunteer the first time I did that, and on my second shift got punched in the mouth by a junkie while I was taking her blood pressure.

Violence against health care workers is so common it's not reported most of the time. Only the fatalities make the news.

There's no easy answer, either. Put guns on ER staff? A lot of what they do is lean over patients, so it would be pretty easy for one, or a family member, to grab it off their belt. And don't ask about hospital security. Well-intentioned, sure, but at many hospitals the security guards are septuagenarian retirees with pepper spray. You think that's going to deter a delusional schizophrenic with a Glock?

That doesn't mean we aren't armed, too. I know plenty of docs who keep guns in their desks. Not automatic rifles with armor piercing bullets and high capacity magazines, just basic handguns. We all hope to never have to reach for it. That said, it won't do us any good, either, if a distraught and armed patient catches us up front reviewing lab reports. Or talking to a drug rep. Or heading down to our car.

Dr. Pissy has carried a Beretta under his white coat for as long as I can remember. If you don't think your doctor would keep a firearm in his or her office, think again. Like lawyers and university professors, we have our share of the irrationally angry, and we're easily accessible. Those "gun free zone" signs in front of hospitals and schools don't intimidate anyone determined to wreak havoc. And the laws your state might pass making it a felony to assault a healthcare worker aren't going to bother those who are most likely to do so.

For the record, I have plenty of patients who carry guns to the office (including a police officer who accidentally left it on my exam table overnight and I still give him shit about it). It doesn't bother me, either. They're responsible people (except for you, Officer JT) who happen to carry a gun with them and today have a doctor's appointment, as opposed to someone who brings the gun to the doctor's meaning to use it.

Would it protect me and my staff if Pissy and I had obviously displayed sidearms? Maybe... But on the other hand, a key part of medicine is putting the patient at ease, so you can gain their trust and help them. Plenty of people are not going to open up under that circumstance, which defeats the whole point of the visit. Not to mention all the people who let their rugrats run amok in our office and play with whatever they find

Some are going to take this post as saying I'm a gun nut, who thinks everyone should carry a piece. I didn't say that at all.

Others will take it to mean I'm an anti-gun person, who wants them all banned. I didn't say that either.

My point is this: your doctors, nurses, and pharmacists, regardless of where they work, are doing a damn dangerous job. All it takes is one irrational person with an easily-acquired weapon. And there's no easy way to prevent it, either.

Doctors, unfortunately, are easy targets. We're vulnerable, because what we do best - helping others - means that we're also putting our trust in them not to harm us, too. Trust goes both ways. To get you to confide in us, so we can examine you and figure out your problem, means you have to trust us. At the same time we assume that we can trust you in return. This arrangement works out well, tens of thousands of times a day around the world.

But in the last month 2 good doctors did their best to help and trust others. And paid for it with their lives.

Is it covered by Medicare?

Seen in a hospital chart:

 

For my non-medical readers:

QD: Once a day

BID: Twice a day

TID: Three times a day

PRN: As needed

Foresight

Mrs. Newage: "I'm not happy with my current psychic, so I'm changing. She didn't warn me about the car accident."

Dr. Grumpy: "What happened with..."

Mrs. Newage: "One of my friends recommended Char L'tan. But she's booked out for the next 3 months."

Dr. Grumpy: "I had no idea."

Mrs. Newage: "Yeah, the girl there said they didn't realize how busy it would be this year."

Skool Nerse Time

Ms. Ged: "Thank you for calling the CrapCare Insurance pharmacy line. How may I help you?"

Mrs. Grumpy: "Hi, I got a letter saying my son Frank's pills won't be covered starting next month unless I submit an appeal form. It said to call this number to get the form. So I'm calling."

Ms. Ged: "That letter just went out last week."

Mrs. Grumpy: "Yeah, it came in today's mail. That's why I'm calling."

Ms. Ged: "We... don't even have the appeal form ready yet. You weren't supposed to call so soon after getting the letter."

Mrs. Grumpy: "Well, it didn't say that.  It said to call, and I am. When will the form be ready?"

Ms. Ged: "Next month. We weren't expecting anyone to call this quickly."

Mrs. Grumpy: "So the form to continue the medication won't be ready until after we've already run out of medication?"

Ms. Ged: "Yeah. I mean, that's when most of our patients call, anyway."

Love thy neighbor

Uh...

I'm going to assume the confirmatory phone call is also entertaining.



Thank you, Lee!

Loyalty

Mary interrupts me while I'm with a patient. Never a good thing.


Mary: "There's a doctor on the phone, says he needs to talk to you right now."

She hands me a piece of paper. I pick up the phone. It's a guy I've never heard of.

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

Dr. Interruptus: "Hi, this is Cody Interruptus, I work over at the Local Hospital clinic, and I've got a guy here... 27 years old... anyway, he has Flehner-Lathrop Syndrome, and I think he needs to see a neurologist soon, if you could work him in."

Dr. Grumpy: "That's pretty uncommon, and I've never seen a case. Have you called Ivory Tower Neurology? They have a lady who specializes in it."

Dr. Interruptus: "No. I mean, I'm part of the Local Hospital clinic, and would like to keep the patient here, seeing other docs who work out of Local Hospital. In this day and age we all need to work together and support each other in the community. I'd appreciate it if you could help me out. I mean, you can refer him to Ivory Tower afterwards if you need to."

Dr. Grumpy (feeling guilty): Okay... I'll work him in over lunch tomorrow."

Dr. Interruptus: "Thank you."

Dr. Grumpy: "Let me get his info... Looks like Mary wrote most of it down... What insurance does he have?"

Dr. Interruptus: "Sickness & Wealth HMO."

Dr. Grumpy: "Oh... I'm sorry, I'm not contracted with S&W. I never have been. Two of my call partners, Drs. Brain & Nerve, are, let me give you their number..."

Dr. Interruptus: "But this is LOCAL HOSPITAL. Those two work out of OTHER HOSPITAL. You need to help support us and the Local Hospital community. Can't you just see him for free?"

Dr. Grumpy: "He has insurance. This is not a charity issue. I do plenty of charity work for the uninsured. I'm not going to see him for free when there are plenty of docs who take his insurance around."

Dr. Interruptus: "You should be loyal to the hospital. That should be your first priority."

Dr. Grumpy: "I..."

Dr. Interruptus: "Thanks for nothing."

(click)