Seen in a chart

Ashes to ashes, funk to funky

This summer we visited my in-laws, and one night they had a potluck in our honor.

Unfortunately, great aunt Frieda left a casserole at home, so I got volunteered to drive her down the block to get it. Craig came, too, as he was trying to avoid his cousins.

We walked into this small musty-smelling condo and were standing there while she rummaged in her fridge. Craig, trying to make conversation, asked “do you have any pets?”

Great aunt Frieda: “Yes, I have a cat, Marty.”

Craig: “Where is he?”

Great aunt Frieda: “Over there.”

And she pointed to a shelf above the stove. With a ceramic urn that said “Marty."

Theft

Mr. Ford came in for memory loss.

He drove himself to the first appointment with a friend's car, because his was in the shop. After the appointment he didn't remember that he had someone elses car, and walked all over the parking lot looking for his. He finally gave up, assumed his car had been stolen, and came back to my building for help.

He went to the cardiologist down the hall and told the receptionist his story. She called the police to report a stolen car. After interviewing Mr. Ford, the officer had him call a friend to come get him, but the one he called couldn't do so because Mr. Ford had his car, and couldn't make Mr. Ford understand that.

So the friend came in a cab to get my patient (who'd by now wandered back to my office). As they walked out to the friend's car, Mr. Ford said, "You know, I saw your car out there when I was looking for mine. I didn't know you had a doctor's appointment today, too.”

On Wednesday he called Mary to cancel an appointment for that day (which he didn’t have). He said he couldn’t come in because someone had stolen his car while he was at the doctor's 2 days ago. He later called in to see if he could get the appointment back, because the car had been “found” at a local repair shop (whose owner couldn’t figure out why it hadn’t been picked up for 5 days).

For the next 2 weeks we continued to get calls from Mr. Ford, asking if he could make an appointment now that he had his car back. He was politely reassured each time that he’d already been here.

I called and discussed things with his adult son, who took the car away while I notified the state about revoking his license. This only led to further (continuing to date) calls that someone has stolen his car. The local police aren't happy about this, either, and are now telling him to call me when he calls about the stolen car.

I can't say I blame them, either.

Random pictures

Okay, time to hit the mail bag for stuff you guys have sent in:


First is this book:

Mike writes in:

1. Is the guy at the top whacking off?

2. Isn't this sort-of racist?



Then we have this unusually comfortable looking external hard drive:

Another bad day for the photo-caption editor:

The name does not inspire confidence in this place's cleanliness:

This sign at Home Depot, which makes it sound like they're afraid of psychiatrists:

This car:

Jay says this sign is outside the orthopedic ward at her hospital:

"It's a total joint center, dude... totally."

Hospital rounds

Dr. Grumpy: "How are you doing?"

Ms. Dyspnea: "I don't like this oxygen mask. It hurts."

Dr. Grumpy: "Well, you need it to breathe. The other only other option would be to intubate you and have a machine do the breathing."

Ms. Dyspnea: "That's what the idiot nurse told me!"

Dr. Grumpy: "It's the truth. You need oxygen to keep going."

Ms. Dyspnea: "Bullshit. I asked the nurse if I could just get the oxygen in my IV, and she said she couldn't do that. We all know she could just take off this stupid mask and plug it into my IV instead."

1:47 a.m.

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

Ms. Phone: "Hi, this is Cindy Dingdong."

Dr. Grumpy: "Are you one of my patients?"

Ms. Phone: "No, I found your name on Google. I just moved here and have a sore throat. Can you call in some antibiotics?"

Winning bid

Dr. Grumpy: "How's the diet going?"

Mrs. Atkins: "It's on hold. I ordered that diet book you suggested, but the person I bought it from on eBay screwed up."

Dr. Grumpy: "What happened?"

Mrs. Atkins: "They sent me this instead. I'm actually going to the post office to mail it back later."


She reached into her bag, took out a book, and held it up. It was called "Working with a Transsexual: A Guide for Coworkers."


Dr. Grumpy: "That's definitely not the diet book I recommended."

Mrs. Atkins: "No. And you just know someone out there was hoping to get this book to help them at work, and is instead staring at my diet book."

Sunday night check-out

Dr. Grumpy: "In room 734 is a guy with arm weakness since a shoulder injury. I've ordered an MRI of his brachial plexus."

Dr. Nerve: "Where do you think the problem is?"

Dr. Grumpy: "Uh, in the brachial plexus."

Dr. Nerve: "You should have made that clear."

When dogs fly

Me: "What kind of dog is she?"

Mrs. Owner: "She's a Morkie. It's a cross between a Yorkie and a, um, Maltese Falcon."

Follies

I saw a guy for headaches recently. Nothing unusual in his story, but, since he'd never had them before, I ordered a brain MRI. I figured, like most of them do, it would come back normal.

I wasn't even close. It came back, not just abnormal, but weird. All kinds of odd changes. Nothing easy to point a finger at, like a stroke or brain tumor. But definitely not normal.

Like I always do in these cases, I called the neuroradiologist who read it, and discussed the case. He was pretty certain of the strange findings. We reviewed all the different causes, and none of them fit with his history.

Because of the unusual nature of the findings, I got a copy of the MRI and took it to another neuroradiologist for a 2nd opinion. She absolutely agreed with the first guy.

So, I was stuck with something weird, not easily explainable for his case. After hospital rounds the next night I went to the hospital library, and spent some time looking up the findings, what can cause them, how you work them up, etc. I had Mary bring him in, working him in over lunch to give me extra time to discuss the news with him and answer his questions.

He came in, and I took some time. I explained the findings, and what they might mean. I went over the steps to work them up further, including a spinal tap and labs. He and his wife sat in silence as I went over everything. Finally, I opened up the floor for questions.

Mr. Sternberg: "These abnormal findings, could they be caused by lymphoma?"

Dr. Grumpy: "You have lymphoma?"

Mr. Sternberg: "Had. About 10 years ago."

Dr. Grumpy: "How did they treat it?"

Mr. Sternberg: "I had chemotherapy, and they did radiation treatment on my whole body and head."

(Pause. I pick up the phone and call the neuroradiologist, who says that, yes, absolutely, the changes are typical for someone who's had radiation).

Dr. Grumpy: "Yes, they're likely from radiation. Why didn't you tell me you had lymphoma?"

Mr. Sternberg: "I didn't think it was important. By the way, my headaches are gone."

Today's lesson people: When the neurologist asks about your past medical history, lymphoma and brain radiation are things you want to mention.

Seen in a chart

Nothing can make a doctor look stupider than an EHR (computerized charting) system.

Smoking is, to me, a good example. We all ask "Do you smoke?" There are 3 basic answers: "Yes," "No," and "I used to."

That isn't so hard. I mean, yeah, occasionally you'll get someone who uses snuff or has some other answer, but in 98% of cases the answer is one of those three. My somewhat primitive human brain can handle them pretty well.

Of course, when you turn this simple question over to an EHR, you get crap like this:

What the HELL does that bizarre combination of phrases mean? In a few lines the patient has gone from being a smoker, to a chain smoker, to a non-smoker, and back to a smoker. And what's an "aggressive non-smoker" anyway? Someone who whips out a fire extinguisher and sprays people who light up?

They tell us these kinds of programs make medicine easier and safer for all involved. I think they're smoking something.

Vacation time!

Heading out for a bit. Be excellent to each other!

Seen in a chart

I'm so behind on the new drugs.

Technophobe

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

Mrs. Analog: "Yes, I faxed you a copy of my records last week, and Dr. Grumpy decided not to take my case. So I'd like them back."

Mary: "He deleted them already, I'm sorry. If we're not going to be seeing you, we don't keep a copy."

Mrs. Analog: "WHAT? You should have just mailed them back!"

Mary: "Ma'am, you sent them to our digital fax number, so all documents faxed go directly to the e-mail. There were never any paper records here."

Mrs. Analog: "But you still could have mailed them back. I mean, how much effort would it have been to pull them out of the e-mail, put them in an envelope, and mailed them back to me? I'd have paid you for the postage."

Mary: "You... can't do that. It's a digital file."

Mrs. Analog: "Nonsense. And they were my only copy!"

Mary: "But... you said you faxed them. Isn't there a copy of them on your fax machine?"

Mrs. Analog: "Is there supposed to be? When I fax stuff the feeder just spits out paper on the bottom."

Mary: "Those are the things you just faxed."

Mrs. Analog: "Does that mean the paper is digital now? Can't you fax the email to me at least?"