Quote of the day

"I saw a surgeon once. He took out my appendix, or maybe my gall bladder. Shoot... It could have been my tonsils... or an ingrown toenail... anyway, you know, it was one of those things."

Memories...

 

Growing up I had a friend named Kevin. Who had a dog named Winston.

Winston was not the brightest dog.

Kevin's family always had Italian breads with dinner. You know, the long kind with a hard crust.

One afternoon Kevin and I were playing Dungeons & Dragons at their kitchen table while his mother  got dinner ready. The usual long loaf of bread was lying on the counter.

At some point, while Kevin's mom was chopping up veggies, she bumped into the loaf and knocked it to the floor.

Winston grabbed it in the middle and made a beeline for the doggie door. Due to a terrible sense of spatial judgment, he didn't realize the bread was longer than the opening was wide, and tried to run through at warp speed.

It looked like a guy getting clotheslined. The impact dislocated his jaw. I ended up going to the emergency vet with them.

Winston was eventually fine, but never tried to steal a crusty bread again.

Seen in a chart

Mary's desk

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

Mr. Hand: "Hi, I need to get in today. I may have had a stroke. My left arm isn't working."

Mary: "Well, you really need to go to ER for this."

Mr. Hand: "I know. I'm there now."

Mary: "You're in ER?"

Mr. Hand: "Yeah. I called 911, and they brought me here. I'm lying in back, waiting for the doctor."

Mary: "Okay, then..."

Mr. Hand: "I've been here about 5 minutes, and they haven't sent anyone in except a nurse. So if you have something open, I'll just come over there instead."

Mary: "No, you need to stay there. You'll probably need studies, and it's not safe for you to leave the hospital to come here if you're having a stroke."

Mr. Hand: "The ambulance is still out front. I could ask them to bring me over there."

Mary: "You need to stay there."

Mr. Hand: "Sorry. Had no idea caring for people was such a waste of your time."

(click)

Overheard in ER

Dr. ERP: "Boy, your throat looks awful... why did you wait so long to see a doctor?"

Lady: "You know how it is with us medical professionals! We always try to treat ourselves first."

Dr. ERP: "What sort of medical professional are you?"

Lady: "I'm taking classes on medical billing."

Halloween reruns

Ghost ships are the stuff of legends and Halloween stories. But some ghosts are real...

The S.S. Baychimo

The Baychimo was a small, sturdy, freighter owned by the Hudson Bay Company. Her job was to travel the coast of Victoria Island in the Canadian arctic, trading supplies with the local Inuit people for valuable fur pelts. She worked during the area's brief open water season (July to September) spending the rest of the year in Vancouver.

The winter of 1931 came early, and Baychimo was frozen in ice several times while returning home. By mid-October she was stuck fast near Point Barrow, Alaska. Most of her crew were evacuated by aircraft (the first time a long-range air rescue was accomplished).

The Baychimo trapped in ice, November, 1931.

A group of hardy souls decided to stay with her until the spring thaw, as they'd collected a particularly valuable fur cargo that year. They built a shelter ashore, and settled in for several months of night.

On November 24 an exceptionally violent blizzard struck, surprising even the arctic veterans with its ferocity. In the morning, mountains of ice 70 feet high were piled where the ship had been. The Baychimo was gone, crushed under tons of ice and snow and sent to the bottom.

Or so they thought...

The men radioed for rescue, but it would take a few days. As they waited a passing Inupiat told them the ship was adrift several miles down the coast. They set out on foot, finding her again trapped in ice. They took as many pelts as they could before returning to the shelter. Another violent storm was coming, and they assumed it would sink her.

The Baychimo had other ideas.

The second storm pushed her out of the ice and into the open sea, free to wander the icy north alone.

Over the next several years she was infrequently seen, and rarely boarded. Some of the valuable furs were even removed. But no one was able to bring her in. Attempts to restart her engines failed, and storms (which some claimed the ship had summoned) always drove would-be salvagers away. In one harrowing case a group of Inupiat boarded her, only to have a sudden storm trap them on the derelict for 10 days.

She was seen every few years, and each time the assumption was made that it would be the last. Only to have her show up again. Scientists, hunters, and fishermen. Inupiat tribe members. Russian, American, & Canadian ships and planes. All reported her at one time or another as she wandered the Arctic waters.

She was last seen in the Beaufort Sea in 1969, having survived 38 years afloat and alone in one of the world's harshest environments.

Today it's assumed she's at the bottom, and I suspect they're right. But who knows? Alaska has begun trying to catalog the estimated 4000 wrecks along the state's shores, and maybe she'll be found.

Or maybe not.

Brad

More than 20 years later, and I still hate Brad.

Brad was the chief resident when I did my 3rd year medical school surgery rotation.

And he was a prick.

The rivalry between surgeons and non-surgeons (cutters vs. thinkers) goes back to the dawn of medicine. Generally it's a source of good-natured joking. After all, we really complement each other more than compete. Patients will generally need both of us, and the goal is to do what's best for them.

Not to Brad.

When I met him, Brad was in the last few months of his year as chief surgical resident, and had already been accepted to a vascular surgery fellowship. Medical students, to him, were the scum of the Earth. Long removed from being one, he made no secret of his distaste for us.

By the end of the 3rd year of medical school most doclings have some idea of what they want to do. My interest in neurology was no secret, and I didn't hide it.

The other 4 med students on my rotation were smarter than me. Terrified of Brad, they all claimed to be interested in surgery even though none of them were. Vijay was planning on radiology, Michelle pediatrics, John dermatology, and Amy pulmonology. But I was the only one who freely admitted to having no interest in surgery.

Brad drove all of us hard, but treated me with particular disgust. I had to be the first one there in the morning (he considered 4:30 a.m. to be late) and made sure I wasn't done with anything until the other 4 had left. He'd give me extra work to ensure I couldn't leave. When the other 4 were told to go get lunch, Brad would ask the nurses to find something for me to do so I couldn't go.

Everyday he'd tell me (and have me repeat back) the mantra he believed: "If you're not a surgeon, then you're not a doctor. And if you're not a vascular surgeon, then you're not a surgeon." He made sure I knew how little he thought of neurologists, non-surgeons in general, and medical students. Since I was all 3...

I remember one night in spring, during that annual rite of American lunacy, March Madness. Back then I was a rabid basketball fan, and Angie and I had set-up the med student coverage schedule weeks in advance so I could watch the championship game (I don't remember who it was that year). She had no interest in it, so took call that night.

Late that afternoon, as we were getting ready for check-out, Brad pulled Angie aside and told her he'd decided that I needed to be on-call that night in case there were any surgeries (realistically, you don't need ANY med student there for surgery. We get in the way). Angie didn't have a choice, and wasn't in any more position to protest than I was.

Brad told me he wanted me to wait, in scrubs, in the surgery holding room... just in case I was needed. There was no TV in there. Brad sat across the hall with another resident, in the surgeon's lounge, watching the game and cheering.

Occasionally he'd walk over to make sure I was still there, and even told the nurse watching the one post-op patient to page him immediately if I went anywhere except the station's bathroom.

As soon as the game ended, Brad came over to dismiss me and said "well, I guess we didn't need you tonight. Too bad you had to miss the game, it was a good one."

On my evaluation, Brad gave me a low pass and wrote "lazy, incompetent, socially retarded, uncaring, unmotivated, and the poorest quality house officer material I've ever been suffered to put up with."

Brad, you probably don't remember me, but I'll never forget you. I googled you last night. Looks like you've lost some hair and shaved the mustache, but your smirking asshat smile is still the same one I remember from 25 years ago.

I'm sure I wasn't the only one you treated like that, and you probably haven't changed much. I doubt you read this, either, since something written by a non-physician, like a neurologist, is beneath your contempt.

But, on the off-chance you are... Fuck you.

Annie's desk

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

Mr. Camp: "Hi, I'm trying to find out what my MRI showed."

Annie: "Okay, hang on..."

Mr. Camp: "It was done 3 days ago."

Annie: "Huh. Usually we call as soon as... I'm sorry, but I don't show you in our system. Are you a patient of Dr. Grumpy's?"

Mr. Camp: "No, I see Dr. Darth."

Annie: "Well, we're not in practice with him. You'll need to call his office for results."

Mr. Camp: "But you guys use the same MRI place. Don't you have access to their system?"

Annie: "Yes, but we can't go looking up patients who aren't ours. You'll have to get the results from the ordering doctor."

Mr. Camp: "That's Dr. Darth."

Annie: "Yeah, you'll have to call his office."

Mr. Camp: "His phones are down today because of the storm last night, otherwise I wouldn't be calling you in the first place."

Annie: "I'm sorry, but..."

Mr. Camp: "Thanks for nothing."

Click

Long time, no see

Dr. Grumpy: "Which doctor sent you over to me?"

Mr. Leg: "My internist, Dr. Stache. He gave me a form to show you."


He reached in his wallet and pulled out a heavily creased and folded referral form that said "see Dr. Grumpy for numbness" signed by Dr. Stache.


Dr. Grumpy: "Um... Did you know Dr. Stache died in 2003?"

Mr. Leg: "Yeah, I'm not very good at following-up."

Department of Redundancy Department

Seen in a chart:

I'd like to start a semi-regular feature of the worst, stupidest, crap seen in EHR (computerized charts). Anyone wishing to contribute please email me de-identified pics or screenshots. Your identity won't be revealed. I think we owe it to others to show what POS's most of these systems really are.

Twinkle, twinkle

This morning I was at the office early. As I walked to the front of the building I noticed a line-up of planets in the east. Curious to know which they were, I pulled out my phone and used a planet-finder app.

A guy out walking his dog went by.


Dog Guy: "What are you looking at?"

Dr. Grumpy: "Those planets."

Dog Guy: (looks up) "Those are planets? Not stars?"

Dr. Grumpy: "Yeah, see how bright they are? And they don't twinkle."

Dog Guy: "Which planets are they?"

Dr. Grumpy: "Looks like... Venus, Jupiter, and Mars."

Dog Guy: "I had no idea they were so close together."

Dr. Grumpy: "That's..."

Dog Guy: "Shit! I bet they're going to collide any day now! I mean, they're really close!"

Dr. Grumpy: "Well, they only look like that from here. They're actually..."

Dog Guy: "Why haven't I seen anything about this on the news? YOU'D THINK A COLLISION BETWEEN GIANT PLANETS WOULD BE SERIOUS! THE ASTEROIDS FROM IT COULD KILL US ALL!"

Dr. Grumpy: "They're really not..."

Dog Guy: "The government knows all about it, I bet, and is covering it up. The media is keeping quiet to prevent a panic."

Dr. Grumpy: "Uh..."

Dog Guy: "Fuck you. You're in it with them. If I hadn't come by when I did, I wouldn't have figured it out either. Let's go, Fluffy."

He picked up his dog and walked away.

GI CME

CME (Continuing Medical Education) is a necessary evil of the medical field. Like other professionals, we have to do 20-30 hours every year of BS courses to prove we're trying to keep up on our profession.

I personally try to do them online, but there are plenty of companies trying to make them interesting. One common way of doing this is to combine them with a vacation, such as a cruise. So CME-themed cruises are now a real thing for those who wish to rack up some education credits while seeing the world.

Some tie-ins are better than others, as evidenced by this brochure:

Just awesome, isn't it? Generally when you think of something "cruising through the digestive tract"... it probably isn't the S.S. Royal Princess (unless that's what you've nicknamed your butt plug).

I also love the use of the phrase "intimate atmosphere" on the same page as "gastrointestinal pathology." Putting a camera up someone's nether regions is about as intimate as you can get.

Given the history of cruise outbreaks, one can also imagine a boatload of doctors with Norwalk Virus "cruising through" their GI tracts.

Thank you, R!

Anatomy

This referral form came in last week. I'm going to hope it's just a handwriting issue.

Because if it isn't...

Gifts

I'll return to my regular posting schedule next week. Been crazy here. In the meantime, keep sending in those ideas for the holiday gift guide!