Uh..., yes?

Last night I was doing an online survey about the treatment of epilepsy, and this question came up:

Memories...

Years ago my father-in-law hit me up for Viagra samples. I was happy to give him some, but Viagra reps generally don't call on neurologists.

But, because I like the guy, and Christmas was around the corner, I asked my drug rep about it. She was able to have some shipped to me (probably thought they were for me). So I packed them up and mailed them to his house.

About 2 weeks went by, and I didn't hear from him. I began wondering if they were lost in the mail, so I called him. Turned out, due to heavy snow fall and being retired, they hadn't been down to their mailbox for 1-2 weeks. He thanked me for having sent them, and put his wife on the line to chat.

While she and I were talking I heard some crashing noises in the background, followed by a loud mechanical roar.

Dr. Grumpy: "What's all that noise?"

Mother-in-law: "No idea what he's doing. He tore up the garage looking for something, and then just ran out in the driveway with the snowblower. I wonder what he's up to?"

I told her I had to take a call from the hospital, and got off the phone.


Note: This post is just for the humor. For those who want to write in about the medical-legal aspects of this... It happened early in my career, when I was young and naive. Time and experience have taught me not to do things like this.

Fandom

Lady comes in.

Mary: "Hi, can I help you?"

Lady: "I have an appointment with Dr. Grumpy at 10:45."

Mary: "Oh, okay, you're a bit early. Have a seat and he'll take you back when he's done with the current one."

Lady: "Okay."

She walked over to the center table and combed through the 20 or so magazines on it, scanning the covers, then setting them down. Then she did the same with the handful of magazines and patient pamphlets piled on the 2 corner tables. Failing to find anything of interest, she walked over to the wall rack and carefully picked through the dozen or so magazines there before finding one she liked.

Then she sat down and, until called back for her appointment 20 minutes later, used it only to fan herself.

Conundrum

I never know what to do with these.

MRI's and MRA's and all our toys are good. They can see stuff we never could, even 5-10 years ago. So, as they get better, they find more.

But that's not always good

I have a lady in her mid-70's. A few years ago her internist did a brain scan on her and found a small aneurysm.  It wasn't related to her symptoms, but since he didn't know what to do with it, he sent her to me.

I reassured her that it wasn't anything. But, since some small aneurysms will grow into large ones, I'm stuck following it. Otherwise, if she drops dead of a ruptured aneurysm at some point, her family can sue me because I didn't look to see if it was getting bigger. CYA. This is defensive medicine at its finest, and, once you've been sued, you'll practice it, too.

Of course, she could refuse the test, but most people don't. As long as it's covered by their insurance, why the hell not?

So every few years I order a repeat study, though at this point it's starting to get silly. I mean, even if it were growing, surgery at this point would pose a bigger danger to her than the aneurysm. But she wants the test, her daughters want the test, and my personal feelings take a back seat to covering myself.

The repeat study this year was, of course, unchanged. Fine. I sent her a letter saying we'd repeat it in 3 years.

I got a call a few days later... from the hospital, asking me to come see her.

Leaving the MRI place she'd fallen while getting in her car, breaking her hip. Which needed surgery. So now she's in the hospital, post-op, and completely whacked out from unfamiliar surroundings and pain meds. So they needed a neurologist to come see her.

Am I medically or legally, at fault for this? Not really. But I still feel guilty about it. I mean, she could also have fallen at the grocery store or walking to her bathroom, with the same outcome. But, instead, she fell while having a test that I wasn't even sure was needed, but was somewhat obligated to order. Yes, she and her daughters insisted on having the scan, so it's their decision, too.

But I still feel bad. Because of guidelines and defensive medicine a nice older lady had a scan she didn't necessarily need, and in an odd way suffered a complication of it.

Will this change how I practice? Probably not. The culture of defensive medicine is so ingrained into American physicians that it's hard to do otherwise. But stories like this make me wonder what the real cost of it can be.

Seen in a chart

Relationships

This was scribbled on a patient info sheet, apparently from someone confused over their family who's who.

Which, of course, brings to mind this song...

Germ theory

This past Saturday, Craig had a meeting at Ye Olde Burger Dive with some dads and other Boy Scouts to plan out their annual trip to Camp Wannahockaloogie.

I dropped him off and drove away. After I'd run errands for an hour or so, he texted he was done, and I went to get him. He came out, carrying a styrofoam take-home box, climbed in the Grumpymobile, and we headed home.

We chatted about the meeting, and camp, and the food at Ye Olde Burger Dive. When we got to that topic he asked "Hey, Dad, you want some fries?"

"Sure," I replied.

Craig opened up the styrofoam box and leaned over. It was full of fries and maybe a third of a cheeseburger. So I grabbed some fries and ate them.

Dr. Grumpy: "They have good fries."

Craig: "Yeah, I like them."

Dr. Grumpy: "You didn't finish your burger?"

Craig: "Are you kidding? I love their food. I put my whole lunch away."

Dr. Grumpy: "Huh? Then what's in there?"

Craig: "Oh, some kid named Jake got that but couldn't finish it, and then he had to leave halfway through the meeting 'cuz he wasn't feeling well. So I asked for a box to take his stuff home for Mello."

Memorial Day

Memorial Day, 2016 has the unusual occurrence of falling close to the 100th anniversary of one of the most terrible naval battles of all time. Therefore, to mark both, I'm going to devote this year's column to a service member from another country.

The WWI Battle of Jutland was the first, and only, large scale battle between the massive dreadnought battleships that had come to exist in 1906. There were other clashes of them, but none on this scale.

HMS Dreadnought, when built in 1906, immediately made all previous battleships obsolete. Her existence set off a massive naval arms race that involved the British Commonwealth, America, Germany, Austria-Hungary, Spain, France, Japan, the Ottoman Empire, Russia, Italy, Brazil, Argentina, and Chile.

On the night of May 30th-31st, 1916, both the German and British battle fleets left harbor, each thinking they were luring the other into a trap. All together there were 250 ships, carrying 105,000 men, on a collision course. Surprisingly, both fleets almost missed each other, and the battle was started by a small Danish freighter innocently blundering between them. Both sides sent small ships to investigate her, which sighted each other.

The battle raged on & off into night and early morning. When it was over 25 ships of various types had been sunk and 8,645 men killed. Although these losses were small compared to the terrible land war being fought in France, they were shocking for naval combat. And the battle, surprisingly, changed very little. Germany won a tactical victory, but the overall strategic victory went to Britain. The course of WWI hadn't changed.

And that's my summary. For those who want to learn more, I recommend watching this. Otherwise, just skip to the next paragraph.







The flagship of the British battlecruiser fleet was HMS Lion, led by Vice Admiral David Beatty. It was his division that had the first main contact with the Germans.

On board Lion was Major Francis Harvey of the Royal Marines. Born in Kent to a family with a long military tradition, he joined the navy at age 14. There he was quickly recognized for his proficiency in languages, gunnery, and debate.

He worked his way up through a series of ships, eventually becoming a gunnery instructor and in charge of training the crews of the navy's Channel Fleet. When World War I started, he was assigned to Lion, commanding one of her main gun turrets.

At Jutland, midway through the battle, Lion was hit several times by Admiral Hipper's flagship Lutzow. One shell penetrated the armor of Harvey's turret and exploded inside. The result blew the roof & front off the turret, killed or seriously wounded every man inside, and set fire to the bags of cordite explosive that were being readied for the next round.

Harvey was still alive. He'd had both his legs blown off, and was losing blood rapidly. Death was coming quickly. But he saw that the hatch separating the turret from the ammunition magazine below was jammed open by a piece of metal. When the burning cordite exploded the fire would spread down into the magazine and destroy the entire ship.

He dragged himself to the speaking tube and ordered the magazines below him flooded with sea water. When the fire did indeed spread a moment later, the ship was saved by his action.

The order was issued with Harvey's last breath. Immediately after giving it he collapsed dead.

Winston Churchill later wrote "In the long, rough, glorious history of the Royal Marines there is no name and no deed which in its character and consequences ranks above this."

Harvey was posthumously awarded his country's highest decoration, the Victoria Cross. His wife and son received the medal from King George V at Buckingham Palace. In 1973 his son loaned it to the Royal Marines Museum, where it can be seen today.

Harvey himself was buried at sea the day after the battle. His name is inscribed at the Chatham Naval Memorial. He was 43.

Memories

 

The person who ran the residencies where I trained was a neurosurgeon, who had a ginormous house. Like 15,000 square feet. 3 stories. With more rooms than anyone could possibly want.

And a really, really, really old cat.

One of the other neurology residents (Dr. Brownnose) volunteered to house-sit for him, which involved taking care of the cat. It was diabetic, and needed frequent insulin shots.

One night, she lost track of the cat. Since the doors had been closed all day, she knew it was somewhere in the house.

I was woken up at 11:45 that night as she frantically called the rest of the neurology residents to come over and help her find the missing pet (taking care of cats was beneath the dignity of the neurosurgery residents, who wanted nothing to do with it).

Because, after all, "accidentally killed neuroscience program director's beloved family pet..." just doesn't look good on a resumé.

We drove from the inner city by the hospital out to suburbia. And, in the wee hours of the morning, 5 of us were combing back & forth through this massive house with flashlights and cat treats, trying to find the feline and hoping it was still breathing.

I don't remember anymore who found it, asleep beneath an antique chair. It got carried downstairs for its insulin shot, giving us this hateful "I can't believe you monkeys woke me up" look.

We made her take us out for happy hour the next week. And boy, did we run up a tab.

My life of crime

It's late afternoon. I'm at my desk, returning calls.


Mr. Stroke: "Hello?"

Dr. Grumpy: "Hi, Mr. Stroke, it's Dr. Grumpy. You had an appointment with me yesterday."

Mr. Stroke: "Yes. What's up?"

Dr. Grumpy: "I got your hospital records, and it doesn't look like they did an ultrasound of your heart."

Mr. Stroke: "Is that important?"

Dr. Grumpy: "Yeah, because the clot may have come from there. I'd like to have Annie set one up, so she'll call you tomorrow."

Mr. Stroke: "Okay, excuse me, what? HEY!"


Pause


Dr. Grumpy: "Hello?"

Ms. Daughter: "WHO IS THIS? YOU SHOULD BE ASHAMED OF YOURSELF!"

Dr. Grumpy: "This is Dr. Grumpy, I saw your dad yesterday. You were at the appointment."

Ms. Daughter: "You even sound like him, too. I'm going to let him know as soon as he opens in the morning that his charts have been hacked. My father is an elderly veteran, and here scum like you are trying to steal his identity and medical information."

Dr. Grumpy: "No, this really is Dr. Grumpy. All I'm trying to do is set your dad up for a heart study."

Ms. Daughter: "Uh-huh. I know how you people operate. I've got the number you called from on the caller ID, and I'm turning it over to the police."

Dr. Grumpy: "It's my office number."

Ms. Daughter: "Rot in hell, asshole."

Click

MARY!!!!!!!!! HELP!!!!!!!!!!!

Dr. Grumpy: "Any changes in your health since I last saw you?"

Ms. Doda: "No, nothing ... Oh wait, I had surgery last fall."

Dr. Grumpy: "Okay, was it..."

Ms. Doda: "I got boobies! Implants! Check these girls out!"

(Whips off shirt)

Seen in a chart

This is how a note I received from a neurosurgeon ended. Thanks, guys, that really helps.

Bon appétit!

Like many offices, we have a small dish on the front counter full of generic hard candies (peppermints, butterscotches, Werther's, Jolly Ranchers, etc.).


Lady waiting for her appointment comes up to front counter.


Lady: "Can I have one of these candies?"

Mary: "Sure. Help yourself."

Lady: "Thanks. I didn't have time to get breakfast today."


She picked up THE WHOLE JAR, carried it back to her chair, and in the space of about 5 minutes unwrapped and crunched through about 20 pieces of hard candy.

Then she brought the empty jar back to Mary, full of wrappers.


Lady: "Thanks."

Overheard at the nurse's station

"BITCH! You're the worst nurse ever! Get the fuck out of my room! But first, get me more morphine!"