Rambling

The following voicemail was left on my phone last night.

"Hi, Ibee, It's Rick Radar, on call in radiology tonight. You ordered a CT scan on Mrs. Confused, and it looks okay, no stroke or bleed (pause) okay, next report, chest X-ray on Seymour Phlegm, AP and lateral views, study done for persistent cough. File number 67874. No acute findings. Heart size normal (pause) next is an IVP on Kid Neestone, diagnosis is flank pain. File number 71985. Study done with iodine contrast shows a large renal stone partially obstructing the right ureter (pause) next is a 3 view cervical spine series done for neck pain. File number 37495. Normal alignment of neck vertebrae, no fractures or other abnormalities (pause) next...

He ran out the full 4 minutes of time, too. You just know he's going to be down in transcription today, wanting to know how they lost last night's dictations.

Seen in a chart

Recently I picked up a fellow who had a serious accident a few years back, and was thrown from his car. He landed on his head, and required emergency neurosurgery and a LONG course of rehab.

So, as usual, I got a copy of his previous neurologist's records. In one of the notes was this comment:

Reverse polarity

Dr. Grumpy: "Do you have any major illnesses?"

Mr. Negative: "No, just diabetes and high blood pressure."

Dr. Grumpy: "Do you take any medications."

Mr. Negative: "No, only Coumadin, Insulin, and Lisinopril."

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

Mr. Negative: "No, just Iodine and Penicillin."

Dr. Grumpy: "Any major illnesses run in your family?"

Mr. Negative: "Yes, they're all healthy."

Holiday Road

Last week, there was a mention over on Cartoon Guide to Becoming a Doctor about never telling patients that you're on vacation, always say you're at a conference. While it wasn't the main point of the post, it caught my eye.

I know a lot of doctors who do that. Hell, I think my Dad (a lawyer) used to do it, too.

But me? No. If I take a vacation, I have no issue with patients knowing. If they don't like it, or get upset when I'm out sick, they can eat rocks. Or, better yet, find another neurologist, one who (as Annie puts it) "can provide for your very special needs better than we can."

Here's my weekday schedule: Alarm goes off at 4:00 a.m., so I can begin hospital rounds and see new consults that came in overnight. I get to the office between 6 and 7 so I can review stuff that came in overnight, look at charts for people coming in that day, and finish up any dictations from the day before.

Starting at 8, I see patients straight through, finishing up around 5:00 p.m. Unless there's a drug rep bringing lunch I usually have a noon patient, too. Crammed into the gaps I'm reviewing test results, returning calls, dictating notes, and exchanging insults with Pissy and the staff.

Then I have another 1-2 hours of hospital stuff to go back for. EEG's to read, test results to check, patients to send home, new consults to see. Then I get to head home. So, by the end of an average week, I've logged 60-70 hours.

Weekends? If I'm not on call, it's relatively quiet. That's good, because I need the time to catch up on all the crap that got tossed on my home desk during the week I didn't get a chance to look at. But if I'm on call (once every 4 weekends) I'm pretty much stuck at the hospital. I'm required to be able to be there within 30 minutes if called urgently. Since I live about that far away, it's easier to just stay there and deal with the pile of consults as they come in, rather then try to return home to do anything but sleep.

I'm not looking for sympathy. I signed up for this. I'm not bragging, either. This is what I do. I have a family, staff, and patients who depend on me.

But after living like that, week in and week out, I never feel guilty about taking time off. Besides, I don't actually go to conferences. With my schedule the last thing I want to do with my free time is use it to hang out with other doctors.

I work pretty hard. Like most of my patients, I have a family and a life outside of my work. And if they don't like that, or have a need to think that I live for this shit 24/7, then they're welcome to find a doc who does. It isn't me.

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: