Overheard in ER

Ms. Viridae: "I want to get checked out, you know, down there, because my roommate has herpes, type 2, and I'm afraid I caught it from her. We were sharing the same fork."

Dr. ER: "Uh, what exactly were you doing with the fork?"

Skool Nerse Time

This is Mrs. Grumpy.

Due to the number of cases of head lice that crop up over the course of the school year, I'd like to make some recommendations based on my experiences.

1. There are several reputable products that remove lice. Gasoline, wood varnish, and Draino are not among them. While I'm sure Draino did get rid of them, you now have a meeting with a state agency.

2. Chiropractic manipulation will not make the lice go away, regardless of what Dr. Cracker may have told you.

3. Rubbing garlic on your child's head will not harm the lice, though it may protect them from vampires, werewolves, and pretty much anything with a nose.

4. Having your kid drink Red Bull, hoping she'll run around more and make the lice fall off, will not get you anything but sleep-deprived. And I will call you to come take your moth home until she reverts to a child.

5. Bringing kids to my office and demanding I "do something" will only get you a list of products. I don't carry them here. The district doesn't even cover bandages, FFS (yes, I have to buy those myself, thanks, Governor). I don't have a magic wand.

6. Local Pharmacy is not going to give you lice-removal products for free. Saying your kid caught them at a public school, their store, or on a school bus will not change that. Neither will asking them to call me to try and bill the school district for them.

7. Screaming, yelling, and blaming the school, the teachers, other parents, other kids, "those Arab people near the bus stop," the President, and society in general will not change the fact that your precious has lice, and you have to deal with it. In spite of this, I'd have to say it appears to be the most common method of dealing with the situation.

8. Threatening to scare lice off by shooting firearms near junior will only result in me calling the state. And the lice won't care.

9. If you choose to shave them bald, the school is not responsible for other kids making fun of them.

10. Calling your pediatrician for Amoxicillin will not help. They may laugh at you.

This has been a public service announcement.

For an even better PSA involving lice, read this, by the Skeptical OB.

Modern medicine

The horseshit chart systems that most hospitals use these days are full of crap that's automatically stuffed in there, no matter how irrelevant it is to the case.

Last night I received a hospital consult on a 92 year-old man with severe, end-stage Alzheimer's disease. He'd been found unresponsive (at least, more unresponsive then usual) in his wheelchair at a nursing home (where he's lived since 2009), and was subsequently found to have a huge stroke.

Of course, the computer chart program inserts this paragraph IN EVERY DOCTOR'S NOTE on him (including my neurology consult), regardless of whether we actually want it in there. Because, it's what the hospital admin people say is important for good patient care. And who knows more about good medical care than an administrator with a business degree?

Memories...

Back in my residency, MRI's were printed on this stuff called "film" that would be hung on a reading board. Like most neurology programs, we did MRI's pretty much around the clock, and so there were a lot of films to be read and reviewed on any given day.

Each day, around 1:00, the residents and attending physicians would all cram into a small room with the neuroradiologists to review that day's studies, then make decisions on what the next step was for each case.

One of the other residents, Paul, began having migraines during training. Like most young doclings, he was convinced something was horribly wrong (migraines are actually common among neurologists).

So he conned one of the radiology techs into doing a brain MRI. Like all the other scans, it got hung up on the reading board to be reviewed for the 1:00 meeting.

While my team went to get lunch before the MRI session, I ran to the pediatric neurology clinic across the street. I dug through their film room, trying to find the most horrifyingly abnormal, congenitally malformed, brain MRI study I could. Then I hurried back over and switched it out with Paul's films.

He screamed when it first came up. After about 10 seconds he hit me with a clipboard and said "There's a special place in hell for you, Ibee."

Quote du jour

Dr. Grumpy: "Are you allergic to any medications?"

Mr. Fleming: "I can only take penicillin to use as an antibiotic. If I take it for any other reason I get a rash."

Bartender, make that a double

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

Mrs. Chromatic: "I need refills on my Skizadrine."

Annie: "Okay... Actually it looks like the doctor gave you a year's worth of refills just last month."

Mrs. Chromatic: "It doesn't say that anywhere."

Annie: "It should be right on the bottle."

Mrs. Chromatic: "Oh, I put the medication in an old bottle from another store."

Pause

Annie: "Why?"

Mrs. Chromatic: "I like the color better."

Today's quiz

These people are:

A. The way people usually look when told they need to see me.

B. Americans watching soccer.

C. Waiting for cronuts.

D. Iowans preparing for the 2016 election cycle.

E. KISS without their make-up.

F. The Village People - 2015.

G: Uber drivers.

H: Taxidermied.

I: Folks you can meet with Tinder.

J: All currently in my waiting room, and sick of reading People.

K. In a drug company ad for a stimulant.


- Thank you, Brick Man!

Crunch time

Dr. Grumpy: "What can I do for you?"

Mr. Scrum: "I'm having memory problems that keep getting worse. I'm concerned they're related to all my head injuries."

Dr. Grumpy: "How many head injuries have you had?"

Mr. Scrum (pulls out paper): "Uh, 24 in the last 15 years, where I've lost consciousness, and a few more where I've only seen stars. My memory seems to get worse with each one."

Dr. Grumpy: "That's a lot of head injuries. How did you get them?"

Mr. Scrum: "I play rugby every weekend. What can I do to stop having head injuries?"

Dr. Grumpy: "Have you considered quitting rugby?"

Mr. Scrum: "Do you think that would help?"

Monday morning call check-out

Dr. Grumpy: "Then, in room 834, is a 71 year old lady who came in yesterday with left-sided weakness. I put her on Strokebegone and ordered an MRI..."

Dr. Nerve: "What did the MRI show?"

Dr. Grumpy: "Don't know. It was scheduled for late last night. You'll have to check it."

Dr. Nerve: "I did. It showed her old strokes, but nothing new. It was dictated at 2:18 a.m. this morning."

Dr. Grumpy: "Then why the fuck did you ask me what it showed?"

Dr. Nerve: "I wanted to see if you were following the patients."

Dr. Grumpy: "I am, but I'm not getting up in the middle of the night and logging in to see if results are up. The radiologist pages me if it's urgent."

Dr. Nerve: "You should be more thorough."

Translations

These were the lenses I got Frank. I love the back of the box:

Valentine's Day

My wife and I are beyond the stage of trying to do something pricey for Valentine's Day, and figured we'd just grab dinner at a small Italian place that's under the radar. Of course, even that didn't happen. As we got ready to go out last Saturday, we realized Frank's coughing and hacking was starting to look like strep throat. So much for dinner.

Since it was Saturday night I took him over to Local Hospital's urgent care. Yep, his throat looked bad. Yep, the rapid screen was positive. The doctor called in Streptokill, and I stopped at 24-Hour Pharmacy to pick it up. Frank stayed in the car to post Instagram photos of his gross-looking pharynx (in retrospect buying him that zoom lens set wasn't a great idea).

The pharmacy is one of the generic box ones you see on every street corner in America. And, I have to say, it's probably the most depressing place in the world to be at 8:45 p.m. on Valentine's day.

In my brief time there I watched as bored employees marked down chocolates to get rid of them (they probably knew my Mom was coming in the morning). A guy ran in, frantically grabbed whatever teddy bear was left in a display, threw money at the cashier, and headed out again.

Another glanced over the few residual sad-looking roses, pulled out the one with the most remaining petals, checked out, and started to leave. In a sudden burst of optimism, he turned around and walked back to get condoms, too.

The pregnant cashier (who'd just returned from her smoking break) was mumbling on her cell phone "he's such an asshole. I'm fucking working tonight so he can stay home and watch TV. No, maybe tomorrow. I have to pick something up at McGrease for him to eat when I get home."

The pharmacist and I knew each other from multiple shared patients, and her area was quiet at the moment. We chatted for a few minutes as she filled Frank's script, commiserating about junkies, crazies, and other denizens of our lives. Then she said she had to get ready for post-Valentine's morning, and went to make sure she had enough Flagyl and Plan B in stock.

On the way out I watched a few more desperate-looking guys run in to buy marked-down chocolates and cards. And, with perfect timing, the generic 80's overhead pop soundtrack played the J. Geils Band's "Love Stinks."

When I got back to the car, Frank had barfed in the back seat.

Sandbox

Every few years my hospital requires its staff, including doctors, to take "sensitivity training." This is to make us learn from a 20-minute computer-generated quiz anything that we didn't learn while growing up.

So, to show you how valuable this is, I thought I'd post examples of the questions we get:

The rest of the questions are similarly obvious shit, to ensure no one fails. But, in case you do, you're allowed to re-take it as many times as needed. This way, if someone snaps and assaults a co-worker, the hospital can say "Hey, it's not our fault, they passed a test."

And people wonder why health care costs are so high. This (and 7 figure CEO bonuses) are some of the crap that your insurance premiums are going towards.

So there you go, people. This is how your nurses and doctors learn to behave. I hope you feel more confident in us now.

Theater

This message was left on Annie's voicemail yesterday during lunch.


"Hello, this is Michael from CareLess Insurance, calling about an MRI request we received on William Gilbert. We've authorized the MRI. The reimbursement code is 4Q2, and it's good for 60 days. Thank you. What were you saying? Is that an evil eye, or are you coming on to me again? That's priceless, maybe I should get it tattooed on my ass. Really? I can get that, tattooed, too. Imagine the look your dad would give me at the pool. Are you serious? Well, I mean, I'd have to see what it costs. Does he even know what we're up to? Oh, shit. I forgot to..."

Click.

Skool Nerse Time

This is Mrs. Grumpy.

I think these newfangled SMART Boards the school has are great. So much neater and easier then the black boards and clouds from screeching chalk when I was a kid. It's nice for a teacher to be able to work on something at the computer and have it right up in front of the class as she talks. It's also great that there's a free app to let them control the board with their iPhone (provided the Bluetooth works properly).

But obviously, these have their limitations, as Ms. Steele and her social studies class learned last week.

Apparently, while the kids were supposed to be working on papers, an enterprising young fellow named Albert used the app on his iPhone to take control of the class board. It was turned off, but he switched it on.

As we all know now, the default setting is to show whatever happens to be on the teacher's desktop screen. Normally, this wouldn't have been a big deal, except Ms. Steele was actively exchanging steamy emails with her boyfriend about their Valentine's Day plans.

Her class was controlled enough to not break out giggling when this started, leading other students to join in the fun. Specifically Nathan, who saw she was using her official school email account.

So he used his phone to google up some pictures of couples in compromising BDSM activities and sent them to her, resulting in them showing up on the SMART Board within a few seconds.

When Ms. Steele gasped (you'd think she'd never seen such things before), then realized what was happening on the screen behind her, she was obviously shocked. She jumped up and started to yell, but apparently stopped when she hit her head on the shelf behind her. Then fell back onto the desk. Which is how I ended up involved.

Ms. Steele required 7 stitches at local ER. From her emails, it wouldn't surprise me if she was back there over the weekend for other issues.

Nathan and Albert have each been suspended for a few days.

A district memo was sent out asking teachers to not use their work emails to plan "50 Shades of Buck Naked" escapades. More importantly, it STRONGLY reminded staff not to use the default "1111" password for SMART Board Bluetooth remotes.

I think there's a lesson somewhere in all of that for each of us.