Partial-Onset Seizures

Wanted: New acronym.

Politics

John Oliver's take on what is currently the best sex scandal in America... is too good not to share.

The story is so bizarre, it proves what those of us in medicine already know: nothing we could make up is funnier than the truth. Ever.

Thank you, K!

Tuesday morning

Dr. Grumpy: "Any other questions?"

Ms. Calcium: "Yeah, why do drugs for Gkar-Londo Syndrome cost so much?"

Dr. Grumpy: "I don't know... honestly, that disorder isn't even in my field. I assume it's because of the  costs involved in research for a relatively uncommon disease, and bringing a drug to market, and..."

Ms. Calcium: "IT'S AN OUTRAGE! People need these drugs!"

Dr. Grumpy: "I'm sorry."

Ms. Calcium: "Sorry? Why aren't you doing anything about it?"

Dr. Grumpy: "Ma'am, I don't know anything about the disease, or its treatments, and I really have no say in what drug companies charge. I can't change..."

Ms. Calcium: "That's not good enough. You should be doing something."

Dr. Grumpy: "Such as...?"

Ms. Calcium: "I don't know. Writing letters to a TV station or congressman or hospital. Hand out pamphlets at the airport. You know, something like that."

Pop quiz

Okay, medical and pharmacy students. Get out your #2 pencils and tell me what's wrong with this medication list from an internist:

Thank you, Nell!

Hungry? Bow bow bow...

At Local Hospital, about 30 minutes before mealtime, someone from "Dietary Services" (previously known as the cafeteria) walks into a patient's room to take their order, entering it on an iPad.

Obviously, the staff hired to do this are not medical people. They're usually teenagers. Some are doing it as a job, others to get some background in hospitals for a college application, some are even volunteers doing it because their school requires community service.

Generally they're a fairly upbeat, happy, bunch. It probably beats flipping burgers and asking "do you want fries with that?" Hell, some days I wish I had that kind of enthusiasm for my job.

Anyway.

I was on call this past weekend, and yesterday morning saw a sweet old lady, who'd suffered a stroke the night before. Her language function was limited to saying "yes."

After examining her I sat down at the station to review her tests and dictate a note. The nurse came over and we talked about my orders.

As we chatted, one of the perky cafeteria staff went into the room and began her spiel.

Miss Chipper: "Hi, Mrs. Broca. I'm from dietary services. Would you like scrambled eggs for breakfast?"

Mrs. Broca: "Yes."

Miss Chipper: "We also have vegetable omelets today. You want one of those, too?"

Mrs. Broca: "Yes."

Miss Chipper: "Pancakes?"

Mrs. Broca: "Yes."

Miss Chipper: "My, you're hungry today!"

Mrs. Broca: "Yes."

Miss Chipper: "We have plain, chocolate chip, and blueberry pancakes. Any of those sound good?"

Mrs. Broca: "Yes."

Miss Chipper: "How about I bring you one of each?"

Mrs. Broca: "Yes."


The nurse and I were hysterical, leaning against the wall and each other, trying not to start cackling aloud. She bit her tongue. 


Miss Chipper: "We have turkey bacon and sausage."

Mrs. Broca: "Yes."

Miss Chipper: "I'll get you a little of each. Would you like coffee?"

Mrs. Broca: "Yes."


The nurse and I are envisioning this immense Las-Vegas-buffet sized cart being pushed up to the room.


Miss Chipper: "Now, for juice, we have apple, tomato, orange, and prune."

Mrs. Broca: "Yes."

Miss Chipper: "You like them all? Is one of each okay?"

Mrs. Broca: "Yes."

Miss Chipper: "Do you want sugar and creamer in your coffee?"


The nurse couldn't take it anymore. With tears running down her face from laughing, she called Miss Chipper out and explained the situation to her.

It was a while before I was able to dictate a note.

Thank you

He's also a doctor. Retired, but still relatively young.

He came to me for back pain, which sounded like fairly benign stuff. But when he worsened dramatically after 2 sessions of physical therapy, it was time to look further.

Unfortunately, the MRI showed a malignant tumor, leading to a bigger work-up. It was quickly obvious that he had widespread metastatic disease.

We put him in the hospital, and he went through chemotherapy, radiation, and back surgery. Fortunately his disease responded to treatment and he got better. His back pain improved and his leg strength returned. My job was done, now it was up to the oncologist. I signed off his case, wished him good luck, and told him to call me if any new neurological issues came up.

Time went by. His oncologist kept sending me copies of her notes, so I peripherally kept up to date. I'd scan them to see how he was doing, make sure there weren't any neurological issues I needed to deal with, and put them in his chart.

This went on for 2 years, when his notes showed he'd taken a turn for the worse. He had more difficulty breathing, and they found the cancer was back. Further chemotherapy and radiation weren't as effective, and he kept going downhill. I watched, sadly, as his weight and health declined in the increasingly frequent notes from the oncologist.

Then, yesterday, toward the end of the day, Mary handed me a piece of paper. He'd called, looking to speak to me, and asked that I call him at home. He said it wasn't urgent, so I stuffed it in my pocket and wrapped up the day. There were kids to pick up, homework to supervise, tomatoes to buy.

After dinner, when the evening had settled down into the usual quiet chaos, I went to my desk, brought his chart up on my laptop, and called.

Dr. Grumpy: "Hi, it's Ibee Grumpy. You were looking for me?"

Dr. Good: "Hey, thank you for calling me back. Haven't talked to you for a while. Have you been following my notes from Dr. Onco?"

Dr. Grumpy: "Yes."

Dr. Good: "Good, so you know what's going on. She's a damn good doctor, glad you sent me to her."

Dr. Grumpy: "Yes, how are you..."

Dr. Good: "Look, Ibee, I'll get to the point here. I've had enough of this shit, and it's time. I've decided to stop treatment, and signed up with hospice today."

Dr. Grumpy: "I'm sorry..."

Dr. Good: "Let me finish. Anyway, I know I haven't needed you since this all started, but I just wanted to call and say thank you for everything. I know you and everyone else did your best, and by catching it when you did you guys bought me an extra 2 years I wouldn't have had. You're a good doc, and I know you care. I think of all the patients that I saw, and I hope they feel the same way about me."

Dr. Grumpy: "Thank you, I..."

Dr. Good: "That's all. Thank you for everything, and good luck. Maybe we'll meet again out there."

He hung up.

He called to say "thank you."

I stared at the phone for a long time.

Texts you don't want from your teenage daughter

Earlier this summer, a pregnant rabbit decided to raise her young in our backyard.

This was a really terrible idea, as Mello is, by nature, a hunting dog. So when she discovered them... it wasn't pretty.

Most managed to get out under the gate, but during a Crime Scene Investigation (CSI: The Oleanders) Marie discovered an injured one hiding under a bush.

She took it to her room, named it Phil, googled a few things, and set up a bunny infirmary. This went well for 2 days, but on the third morning, when I asked her how Phil was doing, I got this back:

Casual Friday

With it being a holiday weekend and the de facto end of summer... me, Pissy, and our staffs decided to all wear Hawaiian shirts last Friday.

Mr. Collar: "I can't believe you're wearing that shirt."

Dr. Grumpy: "I know, but it's Friday, and I have the long weekend off, so I thought I'd wear something relaxed."

Mr. Collar: "That's not the kind of agenda I think a doctor should be pushing."

Dr. Grumpy: "Um, that I wore a Hawaiian shirt on casual Friday?"

Mr. Collar: "No! That you're promoting marijuana use!"

Dr. Grumpy: "Huh?"

Mr. Collar: "On your shirt! You think I don't know what those are?"

Dr. Grumpy: "Um, they're palm trees."

Mr. Collar: "Do I look stupid to you?"

It's a holiday, here's a video

Thank you, Tab!

Rimshot

Mrs. Osteo: "I take a daily calcium supplement."

Dr. Grumpy: "Do you take vitamin D, too?"

Mrs. Osteo: "No, it's vitamin D3."


Say it aloud if it doesn't make sense.

Skool nerse memories

This is Mrs. Grumpy.

Many years ago Local Hospital built a new wing, which had quite a few delays (the main one being that about 1/3 of the way through they discovered they'd forgotten to budget money to build it, and didn't have any).

Anyway, the day they opened the new building was, coincidentally, the day I'd scheduled my hysterectomy. So I was in the first batch of post-op patients that were put in rooms in the wing. They were bigger and more modern than the old building, so seemed like a nice idea.

After I settled in I turned on the TV in my room... it didn't work, but the nurse came down to answer my call light. Which I hadn't pushed. It's just as well, though, because she had to go into the room next door because the TV in there had just switched on even though the occupant hadn't touched it.

When I turned on the sink both it and my shower came on.

They eventually got my TV working, and I sat back to watch something. About 15 minutes later the fire sprinkler in the room randomly switched on, dousing me and shorting out the TV. Which gave off a huge cloud of smoke and triggered the fire alarm.

As they rolled me and several other post-op patients back to the old wing, the nurses were talking about how they'd installed computers for them, but no monitors.

Awesome planning all around.

Mary's desk

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

Mr. Robichaux: "Hello. I need to make an appointment with Dr. Grumpy."

Mary: "Sure. We have an opening for 8:00 tomorrow morning... What's your insurance?"

Mr. Robichaux: "U.S. Veterans, Inc."

Mary: "Oh, I'm sorry. We're not contracted with USV."

Mr. Robichaux: "What the hell? You guys have something against veterans?"

Mary: "No, not at all. We've just never been contracted with USV, as long as I've been here. There are several insurances we don't take."

Mr. Robichaux: "I risked my life so people like you could have freedom, and this is how you treat me?"

Mary: "I respect that you did that, sir. Let me give you the names of neurologists who do take USV... Down the street there's Dr. Techie, and her number is..."

Mr. Robichaux: "Fucking communists."

He hung up.

Nice try

I'm at the nursing station, writing a note. A nurse comes over.


Nurse: "Hi, Dr. Grumpy. A family member for room 8 is on the line and wants to talk to you."

Dr. Grumpy: "Okay" (picks up phone) "This is Dr. Grumpy."

Mr. Little: "Hi, you were just in to see my brother, in room 8? How's he doing?"

Dr. Grumpy: "Seems to be getting better, I think he'll do well with time and physical therapy."

Mr. Little: "Is there anything I should know that you haven't told him?"

Dr. Grumpy: "No, I've gone over things pretty thoroughly."

Mr. Little: "There must be some secrets you're keeping from him that we need to be aware of."

Dr. Grumpy: "No there aren't."

Mr. Little: "I think..." (coughs)


Oddly, the patient in room 8 is heard coughing at the same time.


Dr. Grumpy: "Who is this again?"

Mr. Little: "I'm Dave, the brother of the guy in room 8."

Dr. Grumpy: "Okay, I..."


Guy on phone and patient in room 8 both have another coughing spell.


Dr. Grumpy: (sighs) "Mr. Little, I'm not hiding anything from you."

Mr. Little: "I told you! I'm not Mr. Little! I'm my brother!"

P4P

For those of you not in the field, quality medical notes in the U.S. have been replaced by bullshit "Quality Metrics."

Instead of an intelligent statement on the patient's condition, you have to make sure that your note includes specifically worded stuff - which usually has absolutely nothing to do with what's going on.

The idea is that if you don't say these required phrases then you must not care, and (also importantly), may not got paid by insurance. So docs have to put crap like this in their notes.

Anyway.

Last Friday I received a consult on an 89 year old guy who suffered a cardiac arrest at home on Monday. He'd since been on a ventilator, and clearly wasn't waking up. So neurology was needed to decide if he'd recover (yeah, I know, but that's a whole 'nother post).

Leafing through the chart, I saw this note, written on Thursday night by an internist:

Sigh.