Reportable case

Seen in another doctor's note:

Nudge, nudge, wink, wink

Apparently, the Shipley School in Pennsylvania held a spring fundraising auction this year.

Which included this item:

"Is that why they call them blue movies?"

Thank you, W!

Skool Nerse Time

This is Mrs. Grumpy.

Today, as I was leaving for the day, I was accosted in the parking lot by a wild-eyed mom.


Wild- Eyed Mom: "DO YOU WORK HERE?!!!"

Mrs. Grumpy: "Um, yes..."

Wild-Eyed Mom: "YOU'VE GOT TO HELP ME! MY SON IS MISSING! PLEASE!"

I text the twins I'll be a few minutes late. I take her to my office, turn the computer back on to get records (which takes effing forever, thanks Windows), and dial up a security guard to come help.

Mrs. Grumpy: "Okay, what's his name?"

Wild-Eyed Mom (hysterical, but trying to calm down) "Claude Rains."

Mrs. Grumpy: "All right, let me see if any reports are in... When did you last hear from him?"

Wild-Eyed Mom: "When he got home from school."

Mrs. Grumpy: "Wait... So he's already been home?"

Wild-Eyed Mom: "Yes. He got home from school, and was watching TV, and I went to go shower. When I came out he was gone!"

Mrs. Grumpy: "Okay, so you came back to the school even though you knew he'd gotten home safely from there?"

Wild-Eyed Mom: "Yes! Isn't this what you people do?"

Before I could answer the computer stopped searching.

Mrs. Grumpy: "You said Claude Rains? We don't have a Claude Rains in the database."

Wild-Eyed Mom: "Oh... He just texted me. He's back home now. He went to help a friend who had a flat bike tire. What did you say?"

Mrs. Grumpy: "He's not in our database."

Wild-Eyed Mom: "Well, he doesn't go to this school."

Mrs. Grumpy: "Then why..."

Wild-Eyed Mom: "He goes to Daniel Simpson Day Middle School."

Mrs. Grumpy: "That's not even in this district... Why did you come here? Do you live nearby?"

Wild-Eyed: "No, I figured you guys had better computers and stuff that could find him."

Mrs. Grumpy: "We..."

Wild-Eyed: "Obviously, I was wrong. I wish you'd have just told me that in the first place."

She left.

The Out-of-Towners

Due to family visiting this next week, I'll be taking time off from the blog. See you next week!

IG

Zzzzzzzzzzzzzz

Dr. Grumpy: "Let's check the list... Lipitor, Atenolol, daily Aspirin... Are you still taking Ambien to help you sleep?"

Mr. Nicklaus: "No, I stopped it a while ago."

Dr. Grumpy: "What do you do for your insomnia now?"

Mr. Nicklaus: "I turn on the golf channel. Works better."

Dinner theater

This was left on the office voicemail yesterday:

Him: "No one is answering."

Her: "I heard. It says they're helping someone else."

Him: "Should I leave a message? Or call back later?"

Her: "Just call back later. Did you find that recipe?"

Him: "Yes, I emailed the link to you."

Her: "That one sucked. You can't make lemon chicken like that!"

Him: "How do you know? Have you ever tried?"

Her: "No, but anyone with half a brain can see it was crappy recipe. You'd need more chicken than that."

Him: "It made perfect sense. I went to cooking school, you didn't. Trust me."

Her: "Really? Have you ever used it? All that tuition, and I don't think you've set foot in the kitchen except to make chips-in-a-bowl with a side of beer."

Him: "Oh, like you're capable of anything more complex than eggs."

Her: "At least I know what a good lemon chicken recipe looks like. You don't."

Him: "Okay, what?"

Her: "It should have, um, chicken, and, uh, lemon."

Him: "It had both."

Her: "It didn't have enough chicken."

Him: "Fine. Why don't we just do take-out?"

Her: "Whatever. Why don't you call the neurologist back and see if you can get through now?"

(click)

Knowledge

 

Recently a patient brought his daughter, a 4th year medical student, to the appointment with him. She nervously asked me about making her imminent, and bizarre, leap from medical student to doctor. She felt like someone was going to tell her she wasn't really qualified to be a doctor, that her whole 4 years of med school were some sort of trick, and that she was really a fraud.

And... I agree. Not that she's a fraud, but that it's how I think most of us feel at that point. Actually, it's how ALL of us feel. It's just that some won't admit it. I will.

Attention medical students and residents: THIS IS NORMAL. You just don't realize it until you're actually going through it.

As a 3rd year medical student this terrified me. I was seeing REAL (OMG! REAL!) PATIENTS and had no idea what I was doing. The attendings would point out the substantial gaps in my knowledge and I'd feel like there was absolutely no way in hell I'd ever know that much.

Toward the end of my 3rd year was a rotation with Dr. Griffith, an absolutely brilliant internist. He was a nice guy, but always made me feel like I knew little, simply because he had all the answers I didn't. Seated next to him at an end-of-year lunch, someone pointed out to him that he'd now been an attending for 6 years (yeah, in retrospect, he's not that much older than me). I quietly asked him "and do you still feel like you don't know anything?" He laughed and said "I don't know anything."

And, folks, it never goes away. I've now been an attending physician for over 15 years, much longer than Dr. Griffith was at that time. And I still feel like I don't know anything.

I think the issue is that inwardly we're still the same people who went to college, made it through medical school, survived residency... but we're still ourselves. Somehow we expect that, by being given the title of "Doctor" we're suddenly endowed with a sort of medical omniscience... and it doesn't happen. I don't feel any smarter today than I did when I stepped out of grade school, or high school, or college. Even though I KNOW that through learning and training I've amassed a decent amount of medical knowledge, it's not something that any of us is consciously aware of.

In my experience, the only way any of us realize how far we've come is when we compare ourselves to someone at a previous stage in our training. When I have the occasional medical student or resident spend a few days with me, I'm amazed at how much more I know about neurology than they do, even though I don't feel any different than I did at their stage. It's only in comparison to those behind us that we realize how far we've come.

And, if they ask me if I ever feel like I don't know anything, I tell them "always."

Good luck, Haley!

I'm a magnet

I stopped at the bank to deposit some checks. They know me, and so the teller and I are chatting a bit. While we're talking an elderly woman steps up to the other teller.


Teller: "Hi, Mabel. How are you doing?"

Mabel: "I need to know if my debit card was activated. It doesn't seem to be working."

Teller: "Let me see it..." (Mabel hands her a card) "Mabel, this is a library card."

Mabel: "It is?" (opens wallet) "What about this?"

Teller: "That's your driver's license."

Mabel: "Well, it's still not working at the ATM."

Teller: "It's not supposed to. Let me check your account."

Mabel: "Can you see if I have any overdue books?"

Beware of the Dragon

Seen in a hospital chart:

For my non-medical readers: it was supposed to say "hemorrhage." The joys of Dragon software.

FRANK!!!!!!!!!!!!!

"I didn't do it Dad." (snicker) "Really!"

1:58 a.m.

Dr. Grumpy: "This is Dr. Grumpy, returning a page."

Mrs. Call: "My husband is having a seizure. He sees Dr. Nerve for epilepsy."

Dr. Grumpy: "Okay, do you have a medication to give him for seizures?"

Mrs. Call: "It's in the bathroom. Can't I just hold the phone next to him and you tell him to stop?"

Scum

One of my patients is dying from a brain tumor. He has severe pain from a number of related and unrelated issues, and since I'm the doctor he sees the most I've ended up prescribing his narcotics.

Recently, though, his pain has been worsening, and nothing I've given him is touching it. I've tried increasing pill strength and changing narcotics, to no avail.

Because of his severe pain, I finally admitted him directly to the hospital, to try and get things under control with injectable narcs while I decided on the next step. As always, I told his wife to bring in his pill bottles for me to review.

Sitting in the room with them yesterday, I began making my usual notes on what pills, how many were left in each bottle, etc., to make sure he was taking them correctly. As I opened one narcotic bottle after another I found that, in spite of different labels, they all contained the same white tablets with the same number stamped on them.

So I took out my phone to look up the number.

All the bottles were full of generic Tylenol. No wonder nothing touched his pain.

Further investigation revealed his daughter, who was the one picking them up, was selling the pills and replacing them with Tylenol before taking them to her elderly parents.

I hope you rot in hell.

Neurology, 2015

Dr. Grumpy: "Okay, Annie will set the MRI up for you, and then I'll see you back when we have the results. Any questions on this?"

Ms. Valtrex: "Um, maybe not related to the other symptoms, but I have some bumps on my skin, you know, down there, that have fluid coming out of them. Can you look at them for me?"

Pharma radio

Apparently, the satellite radio had to truncate the title of the classic song "Love is Like Oxygen" (Sweet, 1978) to fit the display. And, in 2015, it brings up a whole new meaning:

Really makes you think twice about the chorus "you get too much, you get too high," huh?

Thank you, Webhill!