Friday, April 15, 2016

Friday re-runs

While at Local Grocery after work I was sighted and approached by a patient.

An Alzheimer's patient.

Bill.


Bill: "Uh, excuse me? Hello."

Dr. Grumpy (looking up): "Yes, I, oh, uh, hi"

Bill: "I know you, um" (he leaned forward, and I realized I had my hospital ID clipped to my shirt) "You look familiar, um Ibee Grumpy?"

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

Bill: "Don't tell me, it'll come! I know! You work here!"

Dr. Grumpy: "No, Bill, I'm..."

Bill: "Can you tell me where breakfast cereals are? My wife asked me to get some Corn Flakes."

Dr. Grumpy: "Uh, aisle 16, that way, about halfway down."

Bill: "Thank you."

As he walked away I realized he had a box of Corn Flakes in each hand.

Wednesday, April 13, 2016

Mary's desk

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

Ms. Stannum: "I need to see the doctor, but want to ask some questions first."

Mary: "Okay, what can I help you with?"

Ms. Stannum: "I'm having terrible problems on my left side, and I need to know what's going on. But I can't have any tests, so is he the kind of doctor who will order them?"

Mary: "Well, that's something he would have to decide during the appointment, but I can tell you that he does order MRI's and labs, and...."

Ms. Stannum: "DIDN'T YOU JUST HEAR ME? I said I can't have any tests! I'm deathly allergic to the metal used in needles to draw blood and those electrodes they put on your skin!

Mary: "All right, but..."

Ms. Stannum: "And the magnetic rays and X-rays that scanners give off devastate me. I mean, I've had them in the past from all my other neurologists, but then I'm bed-bound for weeks afterwards. WEEKS. Last time I had to take short term disability until I could recover from the effects they have on my brain waves."

Mary: "Maybe you..."

Ms. Stannum: "And I can't take any pills. The chemicals they use in them are all poisons to me. I've nearly died from them thousands of times. LITERALLY. THOUSANDS! So I need a doctor who can help me get better, but who won't make me have any tests or take any pills."

(pause)

Mary: "I don't think Dr. Grumpy and you would be a good match. You might want to try another office."

Ms. Stannum: "That's the problem with modern medicine. Nobody cares about helping sick people."

(click)

Tuesday, April 12, 2016

Texting with Frank

I wandered out to put stuff in my car, to discover a large penis drawn on the dirty back window.

Obviously, I need to wash my car more often.

This sort of thing generally indicates Frank is the perpetrator, so I texted him.




Monday, April 11, 2016

April 11, 1755

Today is International Parkinson's Disease day.

Parkinson's Disease is something I deal with a fair amount. As most know, it's a progressive neurological disease typically characterized by tremor, imbalance, and slowness of movement.

And that's all I'm going to say about it here.

So why did I bring it up? Because the man behind the disease is fascinating. Mostly remembered now only by the neurological disorder he described, there was a lot more to him. Probably one of the more remarkable figures of his (or any) time.

James Parkinson was born on this day in 1755. His father, John, was a London pharmacist and physician. While a medical student, in 1777, James and his father received medals for successfully resuscitating a man who'd hung himself.

During medical school he wrote a pamphlet about his experiences called "The Medical Pupil." Perhaps this could be seen as an early example today's med student blogs. In words that still ring true 240 years later, he opined that "a sympathetic concern, and a tender interest for the sufferings of others, ought to characterize all those who engage themselves in the profession, the object of which should be to mitigate, or remove, one great portion of the calamities to which humanity is subject.”

Preach it, brother James.

In 1784, upon John's death, James took over the practice. It was a successful one, treating rich and poor alike. He also served as the supervising physician at a large local mental institution. He married Mary Dale, and they had a total of 8 children, 6 of whom survived to adulthood.

Parkinson was politically active and, for the time, radical. He strongly supported equal rights for the poor (OMG!), voting rights for women (gasp!), and the inclusion of "ordinary citizens" as a major portion of government. He campaigned extensively for decent treatment and legal protection of the mentally ill, realizing that those with serious illnesses were often incapable of recognizing their actions.

He wanted annual elections to make sure parliament turned over with "new minds" frequently, and supported the French Revolution across the channel. He wrote and published numerous political pamphlets, but to protect his family and practice wrote under the pen name "Old Hubert." When a political group he was involved in was falsely accused of plotting to assassinate King George III (the Pop-Gun Plot), Parkinson refused to testify against his friends. Eventually all charges were dropped when it was revealed they were trumped-up by political opponents.

During his medical career he published a treatise on gout and went on to write the first English language description of acute appendicitis. He and his son (also James, and also a doctor) were the first to prove that death from appendicitis was due to visceral perforation and infection.

As a member of the Association of Apothecaries (later its president) he saw a key act passed in 1815 that, for the first time, regulated the standards to which doctors and pharmacists had to be trained. He was also instrumental in passing laws concerning apprenticeships, setting goals for training and protecting the apprentice from abuse.

He wrote medical & science columns for popular newspapers on such varied subjects as chemistry, nosebleeds, and hypochondria, and also published scientific papers on topics as disparate as lightning, fossils, and geology.

In the 1810's, based on observations of both his own patients and  individuals he'd seen walking around London, he first recognized the characteristic tremor and shuffling gait of the disease that today has his name. He also differentiated between the types of tremors commonly seen - a key diagnostic point still used by neurologists today.

In 1817 he published his landmark piece "An Essay on the Shaking Palsy" in which he described the main features of the disorder. The accuracy of the paper in describing the condition is made all the more remarkable by the fact that neurology as a field didn't exist at the time. Jean-Martin Charcot, the Frenchman who would go on to found my medical specialty, was born 8 years later in 1825. It wasn't until 1877, 60 years after Parkinson's essay, that Charcot himself named the condition Parkinson's Disease. His English colleague, William Gowers, agreed with Charcot's eponym.

Sadly, this discovery obscured many of his equally remarkable accomplishments.

Besides those interests mentioned above, Parkinson's scientific curiosity led him in many directions. He examined rock specimens at length and wrote a breakthrough treatise on the sediment patterns and fossils seen through the British Isles, recognizing the organization and significance of different rock strata.

He authored 2 books on fossils from around the world, describing them as earlier stages of currently living animals (Darwin's theory of evolution wouldn't be published for another 40 years). He also did his own black & white illustrations for the books, while his daughter did the color plates.

A species of Ammonite, a long-extinct relative of the modern octopus and squid, was named after him. So was an ancient branch of the turtle family. He has the unusual distinction among scientists of having both a disease and fossils attached to his name.

In 1823 the Royal College of Surgeons presented him with an award for his extensive body of work, noting “The fruits of your exertions are distinguished by the stamp of simplicity and truth. They express the most laudable zeal in the pursuit and the promulgation of knowledge, for the benefit of mankind.”

James Parkinson died on December 21, 1824 of a stroke, very close to where he was born and spent his entire life and practice. He was buried at St. Leonard's church, though no stone was placed and the exact location of his body is unknown.



Friday, April 8, 2016

Seen in a chart


Thursday, April 7, 2016

Making the call schedule

Dr. Brain can be a bit of a snob. Sometimes I play stupid just to irritate him.


Dr. Grumpy: "Okay, I'll take call the first weekend of the month, Dr. Cortex the second, and..."

Dr. Brain: "You'll have to put someone else on for the last weekend. My wife and I have tickets for Andrea Bocelli."

Dr. Grumpy: "Okay, I'll put Dr. Nerve on there, so if you'll take the third weekend it should all work out."

Dr. Brain: "These are FRONT ROW tickets. I paid a fortune for them."

Dr. Grumpy: "Okay, now for the following month..."

Dr. Brain: "Do you know how hard it was to get these tickets?"

Dr. Grumpy: "Um, no. Who's Andrea Bocelli?"

Dr. Brain: "A singer."

Dr. Grumpy: "I've never heard of her. Is she like Lady Gaga?"

Dr. Brain: "No! He's a man, and..."

Dr. Grumpy: "Was he the guy I saw who had a small stroke last summer? I think you said he played guitar at a coffee place?"

(pause)

Dr. Brain: "I'm available any weekend the following month."

Tuesday, April 5, 2016

Great moments on call

Dr. Grumpy: "Can I get a swallow evaluation on Mrs. Stroke, in room 63?"

Speech therapist: "Of course. Do you want African or European?"

Monday, April 4, 2016

April 1st

Since so many of you are forwarding this to me, I figure I might as well share it for those who haven't seen it.


Friday, April 1, 2016

Seen in a chart

I often have that last problem myself:




For the non-medical readers, it's supposed to say "volume depletion."

Thank you, M!

Wednesday, March 30, 2016

Thunk

Mr. Migraine: "My headaches have been terrible, especially with all the rain we've been getting."

Dr. Grumpy: "Hmmm. Well, we have room to increase your Spazinox dose, so let's try going to 100mg twice a day."

Mr. Migraine: "Will that help the headaches?"

Dr Grumpy: "I'm hoping so. Let me..."

Mr. Migraine: "I don't get it. How will increasing the dose make it rain less?"

Dr. Grumpy: "No, it makes it harder for your nerves to start a headache."

Mr. Migraine: "Okay... I guess that makes more sense."

Tuesday, March 29, 2016

Honesty

Seen in an ER chart:



Monday, March 28, 2016

March 17, 2016

Dr. Grumpy: "Come on, kids. We need to leave for school."

Frank: "Anyone seen my backpack?"

Craig: "Let me get a granola bar for breakfast."

Marie: "Can you get me one, too?"

Craig: "Okay."

Frank: "Oh, I left it in the car last night. Never mind."

Marie: "Craig, you can't wear that today."

Craig: (throwing granola wrapper in trash, shoving bar in his mouth) "Why not?"

Marie: "It's St. Patrick's Day. You're supposed to wear green."

Craig: "My green shirt is in the closet. This one was closer."

Marie: "You need to go change."

Craig: "I'm not going to change shirts. We have to leave."

Marie: "But you need to put green on!"

Craig: (reaches into trash can, grabs something) "Fine. Happy now?"





Saturday, March 19, 2016

Spring break

Heading out for the kids' Spring Break. See you guys next week!*

*Okay, realistically I won't see you. All I ever see is my monitor. But you know what I mean.

Friday, March 18, 2016

20 years

About a week after my Dad's death, I had my med school 20th reunion. I'd already bought tickets, and Mrs. Grumpy insisted I go. A while back I wrote about my thoughts on it.

I flew in, got a rental car, checked into my hotel, and went over to campus. I left here 20 years ago, the day after graduation, and haven't been back since.

This was the view from my hotel. The alumni travel rep lied about it being a nice neighborhood.


"It's overlooking a grassy park."



The control panel for the elevator didn't exactly inspire confidence, either:





It was very strange. I arrived in the evening and went over to campus to walk around.

The classrooms were empty. I stood in the cavernous room where I'd been a first year medical student, failed the first anatomy test, and somehow pulled out a passing grade when it was over. I walked through the lounge where my friend Bryan had, I swear, used the microwave to heat up a squirrel he'd shot in his yard (he was from Wyoming) for lunch. The anatomy lab was now locked up with a security code, a precaution that hadn't been necessary 20 years ago.

The next day I spent more time re-discovering the campus.

When I checked in they gave me an ID tag, held to my shirt by a magnet. The warning on the back was in tiny letters, and most people likely wouldn't have noticed it until it was too late.

"Why am I suddenly so lightheaded?"


I entered the library, marveling at how much it still looked the same. Of course, now there were computers and iPads everywhere, but still the same big study tables I'd once memorized the Krebs cycle at. The same broken toilet in the basement bathroom, that likely has been plugged since I was last here.

My steps took me to the gym, where I stared down at the track and remembered a younger version of me who somehow found the time to run 5 miles a day and weighed 75 pounds less. What the hell happened to him?

They'd given me a bright red bag at check-in that said "ALUMNI" on one side, with a bunch of guides and requests for money in it. "Help us build the new administrative retreat chateau in the Alps."

My first impulse was to hide the red "ALUMNI" bag under my jacket, because carrying it openly would make me stand out.

Then I realized that I DO stand out. I mean, this is a small university campus, full of bustling 18-25 somethings. I'm a paunchy, balding, 50-something guy, and the bag doesn't matter. Hell, it probably keeps me from being arrested arrested for trespassing.

I quietly wandered through the meditation garden behind the old church. I'd spent a lot of time here, walking over when I needed a break. My favorite bench was still there, and as I sat on it again I thought of all the times I'd been there trying to find the will to go back and study, to not quit and fly home..., to just go on. Somehow I'd made it, and am still not sure how.

I stopped in front of a statue from 1920, placed there to give thanks for those who'd been spared the twin horrors of WWI and the flu pandemic, and to remember those who hadn't. Hard to believe that at that point it was believed WWI would be the final limit on man's inhumanity to man, while time would go on to prove it wasn't even close.

I walked across the street to my old apartment complex, and stared up at the place I'd lived in for 4 years while becoming a doctor. I'd grown up a lot emotionally in there. I thought of my roommate, Enzyme, and the crazy couple next door. And the night we sabotaged them.

Back then it had been rough in a lot of ways. I'd never left my hometown before, and in the mid-80's was moving halfway across the continent to go to medical school. Dad and I loaded up a big U-Haul and made the 3-day drive here. He'd paid for my apartment. I drove by places where he and I had once gone, and I wanted to send him a picture to show what it looked like now. And had the sickening realization that I can't anymore.

Some of the events of alumni weekend were comical. They included a pub crawl. I don't know about other people, but, at 20 years out from medical school, my ability to consume and handle alcohol isn't what it once was. When I last saw the sign-in sheet it only had one name on it (brave soul).

When I'd graduated, the front hallway of the med school had a huge display of posters, showing the pictures and names of every graduating class going back over a hundred years. As med students we'd look at the spot where our class would be featured... someday. I'd moved away before they put it up, so one of the things I'd really wanted to do was finally see my picture up in the hallway.

So I went into the hallway... and the display was gone. Of course, no one who works there now has any recollection of a display EVER being there. One told me she'd once heard a rumor about it, and that the posters might be in storage somewhere with a plan being to turn them into a digital display at some point (presumably before the sun becomes a red giant)... But I didn't get to see my picture up.

I took the tour of my medical school later that day. It included the dreaded anatomy lab, which still smells like it did when I was there, and likely as it did since the first time classes were held there (anyone who went to medical school knows, and hates, the "anatomy lab smell." It never comes out in the laundry).


The medical students now have THEIR OWN EXERCISE ROOM, with machines and everything, attached to the med school. Kids today. When I was their age, I had to walk to the school gym, through snow, uphill both ways.

Going through the student resource rooms it was good to see the school was still as technologically cutting edge now as it was then. I was told these gadgets are still in frequent use:


WTF do you get the plastic sheets? Or still using the same ones?




"We keep these around to get alumni donations."


On the night of the reunion party I took the elevator up to the 4th floor, and an elderly couple got in with me. She clearly had Parkinson's disease. Her husband was frail and old, stooped over a cane. I suddenly realized he'd been one of the key internal medicine attendings when I was there, the brilliant physician-sleuth we all dreamed of being. We were all both terrified and in awe of him, and here he was, looking so much smaller than I ever remembered. I introduced myself, and thanked him for all he'd done to help make me a doctor. Then I held the door for them when we got to the stop for his class's gathering.

The actual reunion, was, as these things are, interesting. It was good to see my classmates again, and see where life had taken them. All are still in practice, scattered across the country like pins on a map. I've never been a particularly outgoing person, but was happy to chat with my old classmates for a few hours. The tables in the back were taken up by their spouses, who looked horribly bored. I'm glad Mrs. Grumpy decided to stay home.

It's hard to believe that, when we first met, we were all young and, for the most part, really believed in what we were doing. Medicine was a religion, a calling, at the time. To some extent I think we still believe in what we do, but 20 years of fighting insurance companies, narcotic seekers, sleepless weekends on call, 70-80 hour weeks, diminishing reimbursements, bogus disability claims, and living in fear of malpractice suits will dim the fire. But they're all still good people, and it was nice to find we still care. We're different, with varying religious and political beliefs, but we still have more in common than not. Unlike government officials it was easy to discuss such things respectfully and without animosity, and still like each other.

At some point in the evening, as it got late, something told me it was time to leave. I don't know what it was. Whatever I'd been looking for by coming back here... I'd found it. Not being a person who does goodbyes well, I didn't say any. I set my drink down on a table and quietly slipped away. I had no regrets.

I walked back to my rental car across the darkened campus. It was a nice evening. I passed the occasional student heading to the library or gym. The groups sitting under trees talking. The young lovers holding hands. I liked it here, but it wasn't my place anymore. That was 1000 miles away, and I had a plane flight in the early morning.
 
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