Beware of the Dragon

Seen in a chart:

Special

Tracy: "Hello?"

Annie: "Hi, this is Annie at Dr. Grumpy's office. I was trying to set up the MRI for you..."

Tracee: "What time should I be there?"

Annie: "Well, we were looking for old studies to do a comparison. They had a few past MRI's for someone with the same last name and birthday, but the first names were all slightly different."

Tracey: "Oh, they're all me."

Annie: "All you?"

Traysee: "Yeah, I like to spell it different whenever I feel like it."

Annie: "Okay..."

Tracie: "That way it's special."

Annie: "Indeed it is."

Roads

I was a neurology resident, doing a rotation at a large county hospital. Like most county hospitals, it served a predominantly indigent population.

I was in my 2nd year of residency, 3 years out from medical school and in my late 20's.

She was the same age. I'd been consulted because she couldn't afford her epilepsy medication and had a seizure. She was also pregnant with her 4th child. So she was in the OB ward of the county hospital.

I had a job, an apartment a few miles away, a 4-year-old car in the parking lot, and a girlfriend (now Mrs. Grumpy).

She was homeless. None of her kids had the same fathers. She bounced between different shelters and whichever guy would take her and her kids in for a few days.

I'd showered that morning. She and her kids smelled awful, and obviously hadn't bathed recently.

I was in a generic shirt, tie, and pants from Target, with the required white coat. She and her kids were in tattered clothes from a donation center.

As I talked to her, scribbling her history down on my note pad, I suddenly realized I knew her.

10 years earlier we'd been in the same year in high school. We took PE, economics, typing, social studies, and chemistry together. We weren't close friends, but knew each other and said "hi" in the halls and local stores when we crossed paths. I suddenly had a vivid memory of her running to third base when I hit a single in a softball game.

I didn't mention it, and if she recognized me she didn't say so. I don't think she did. Her chart was huge, and I was just another in an endless stream of residents she dealt with on her frequent admissions. I restarted her seizure med and folic acid and she was discharged later that day. I went to another rotation the next week and never saw her again.

To this day I think of her. We came from the same upper-middle class backgrounds. We went to high school in American suburbia. Her parents were as successful in their area as were mine. Not wealthy, but comfortable, with expectations for their kids of college and a job and self-sufficiency.

I wondered how she got there. In 10 years we'd landed in very different lives. Had she made bad choices? Drugs? Alcohol? Had she just encountered terrible shit luck that all of us dread happening to us? A marriage gone bad? Domestic violence? A financial catastrophe beyond her control? I remembered seeing her and her parents posing for a picture at graduation. Did they know where she'd landed?

Sometimes, while trying to sleep, I think of her sitting there. I wonder if she's still on the streets. If she got her shit together and was able to move out of poverty. If she's even still alive. I'll probably never know.

Maybe she did something stupid, the kind of thing where all of us living in comfort can say "that would never happen to me, I'd never do something like that." Or maybe the circumstances were entirely beyond her control, the kind of financial clusterfuck nightmare that all of us dread destroying everything we have and work for.

I'll never know the answer. But the encounter always reminds me how much of life can be terrifying random chance, no matter how much we'd like to believe otherwise.

Appreciation

Seen in a chart:

Saturday, 12:23 p.m.

 

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

Mr. Sativa: "Hi, um, you saw me for headaches last year, and referred me to a headache specialist, and I kind of have an emergency, and I can't reach him."

Dr. Grumpy: "Okay... What's up?"

Mr. Sativa: "Well, that doctor suggested marijuana, and it works fine, but this morning my dog Mojo ate it all, and now he's really sleepy. I mean, he's breathing, but I can't wake him up. What should I do?"

Dr. Grumpy: "I'd call your vet. I don't treat dogs."

Mr. Sativa: "Oh, I hadn't thought of that."

Dr. Grumpy: "Okay, good luck and..."

Mr. Sativa: "With a stoned dog, um, should I play music or something?"

(pause)

Dr. Grumpy: "I'd go with Dark Side of the Moon."

Mr. Sativa: "Cool! Thanks, doc. I'll call the vet now."

Helpful

Trying to figure out why a lady was coming to see me, I called the other doctor's office and asked them to fax over the most recent chart note.

This is all I got:

Memories...

"What should I call you for?"


This is a common question I get from nurses before I leave their station. They understandably want to know what things are important to me in a given patient's care. Exam changes, abnormal test results, medication problems, etc. I'm fine with answering them, too. It's part of treating someone.

In the early 90's I was an intern, covering the cardiology and general medicine floors. One evening I was meeting with the other interns at a nurses station, getting the nightly check-out. This consisted of them each handing me a crumpled sheet of paper listing patient summaries for me to refer to if called. The lists were folded into a big wad and crammed into my white coat pocket. As I stood up to go see someone in ER, a nurse came over and asked what I wanted to be called on. I absently mumbled "any concerning changes" and stepped into an elevator.

The night ticked on. Several admissions, some calls to discuss labs and medications, the usual smorgasbord of pages. Somewhere after midnight there was a break in the action, and I went to the call room to try and sleep.

I dozed for maybe an hour before the nurse I'd spoken to earlier paged me.


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

Nurse Smokey: "Hi, I'm calling you about Mr. Gomer, in room 564. Are you familiar with him?"

Intern Grumpy: "Hang on..." I switched on the light, grabbed the wad of papers out of my pocket (I still had my coat on) and began flipping through them for room 564.

Nurse Smokey: "No worries, I'll wait."

Intern Grumpy: "Okay, I have him. It says he was admitted for a heart attack 2 days ago, and is scheduled for an angiogram tomorrow."

Nurse Smokey: "Yes, but he has other issues. He also has a history of lung cancer, for which he had surgery and radiation 2 years ago. It recently recurred, and he's now on chemotherapy. There's also him having COPD from being a smoker, and last month he was here for a pulmonary embolism and is on heparin. He needs a left knee replacement, but that's on hold for now due to his other medical issues. Do you need a list of his medications and allergies?"

Intern Grumpy: "No, I have that here... What's going on with him that you're calling?"

Nurse Smokey: "He's on fire."

Intern Grumpy: "WHAT?!!!"

Nurse Smokey: "He's on fire. He's on oxygen, and apparently his wife snuck in some cigarettes and matches and..."


The phone fell to the floor. I ran out of the call room into the stairwell and dropped down 2 flights to the 5th floor. As I flew past the station, Nurse Smokey was still on the phone with my empty call room, calmly saying "Hello? Dr. Grumpy? Can you hear me?"

In room 564 I found Mr. Gomer, miraculously uninjured except for some minor burns and missing eyebrows. He was almost completely covered in ashes and fire extinguisher foam (which a terrified student nurse was still randomly spraying at anything that moved, including me). Another nurse was pulling off the charred oxygen mask and melted tubing, while a respiratory tech made sure all the oxygen valves to the room were closed.

This was a good reason to call the doctor, if not the fire department. Skipping his past medical history, under the circumstances, might have been a good idea, too.

Shantih. Shantih. Shantih.

Craig had to make a quiz for the younger Boy Scouts, and tested it out on his sister.

Since they aren't in the same literature classes, he didn't think her answer was funny.

But I did.

Sheeee's back!

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

Mrs. Sequel: "This is Mrs. Sequel, I need to make a follow-up appointment with Dr. Grumpy."

Mary: "Okay... Wait... it looks like you sent us a release 3 months ago, saying you'd decided to see a different neurologist because Dr. Grumpy didn't help you at all."

Mrs. Sequel: "Well, the other neurologist didn't help me, either. So I thought I'd give Dr. Grumpy another try."

Mary: "I'm sorry, once someone leaves the practice we don't let them come back. That's just office policy."

Mrs. Sequel: "Well, I never said I was leaving the practice, I just wanted to change doctors."

Mary: "You'll have to stay with that doctor, or find another. You can't come back here."

Mrs. Sequel: "I never saw another doctor. After I sent the release I changed my mind."

Mary: "But you just said the other doctor hadn't helped you!"

Mrs. Sequel: "I never said any such thing. You're imaging that."

Mary: "I'm sorry, but you'll have to seek care elsewhere."

Mrs. Sequel "Why, you have some nerve!"

click

Weekday update

During election season it's easy to forget that their are other major news stories going on. So, as a public service, I'm taking a break from medical blogging to update you on what's going on in the world.


DATELINE: MAINE

Police in Portland were called to investigate a traffic disturbance, namely one caused by a man dressed as a tree standing in the middle of the road.

CBS WGME

Mr. Tree (my colleague Officer Cynical identified him as a Dendriticus idioticus) was asked to stop obstructing traffic. When he refused to do so he was placed under arrest.

An unidentified friend of his told officers the green fellow was "studying traffic patterns." I suppose it's possible he was trying not to be seen.

I highly recommend the original story here. It features a video of Mr. Tree being arrested while officers try to figure out which branches to put the cuffs on.


DATELINE: FLORIDA

A 28-year old man was leaving the Dancer's Royale strip club. Friends noticed he was intoxicated and asked him not to drive home, but he refused.

He got into his truck and was heading out of the lot when he somehow fell out of the driver's seat onto the road, and was run over by his own vehicle. He then fled the scene but his identity was quickly discovered as he'd left his driver's license behind.

The truck continued on its way down the road before crashing into a nearby home.

WFTV9, Florida

An occupant of the home suffered non-life-threatening injuries.

Original story here.



DATELINE: WISCONSIN

Christina Ferguson, 32, was upset by a meeting of Donald Trump supporters that she passed and decided to, in the spirit of having a blood alcohol level of 0.218, vandalize their cars.

Unbeknownst to her, the meeting had nothing to do with Mr. Trump, but rather was a meeting of the local non-profit Tomorrow River Valley Conservation Club.

Armed with a family-size jar of low-sodium, creamy-style Jif peanut butter, Ms. Ferguson proceeded to smear the innocent TRVC club's cars with peanut butter, writing obscenities and drawing penises on them.

Ms. Ferguson initially denied involvement, but investigating officers noted she was holding a jar of peanut butter and "licking her fingers repeatedly" when they confronted her.

Chief deputy Dan Kontos told reporters, “Fortunately it wasn’t chunky peanut butter, so vehicles didn’t get scratched."

Story here.

Artisanal overload

Time to hit the mailbag for more bullshit "artisanal" crap you guys have sent in.



Here's an offer for an artisanal vacation to Portland, Oregon. I have no idea how an entire trip can be artisanal. Is the plane rustic? (that doesn't sound safe, does it?). Is the rental car handcrafted? (yes, by giant sheet-steel-bending robots). You also get to "blend your own tea." Hell, I can do that with a large mug and a Keurig - at home.

Sara Lee, the McD's of grocery store bread, now has:

Not to be outdone, a mass-produced frozen pizza crust is now, what else,

But why stop at grocery store pizza crust? If you make over 10 million tortillas a year around the globe, doesn't that qualify them as artisanal? And what's "artisan style" anyway? What a person would make if they were made of metal and could manufacture 3000 tortillas an hour?
 

 

Then there's this. Although the word "artisanal" isn't in here, it's like they were using a thesaurus to find any other cheesy phrase in its place. And over what? FISH. How do you "handcraft" a fish?

After a hard day handcrafting fish, you're probably going to want to blow off steam at the gym. And where better to go than...

Regardless of what they're making, even artisans need to invest money for retirement. And where better to do that than in an artisanal mutual fund?

Details

Seen in a hospital chart:

Drug rep

Rikki Foneysmile: "So, Dr. Grumpy, please remember Locraft for all your patients with Phingluie-Maglawnaf Syndrome."

Dr. Grumpy: "Okay. Where do I sign for samples?"

Rikki Foneysmile: "Right here, in the box on the lower left... Great! Here's 5 boxes, and some co-pay coupons..."

Dr. Grumpy: "Thank you. Have a great weekend."

Rikki Foneysmile; "You, too. By the way, I know what you're doing."

Dr. Grumpy: "Huh?"

Rikki Foneysmile: "I know what's really going on."

Dr. Grumpy: "With what?"

Rikki Foneysmile: "You're using my samples to start people on Locraft, then switching them to the generic form."

Dr. Grumpy: "I..."

Rikki Foneysmile: "I just want you to know that I know what you're doing."


She turned around and left.

Refills

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

Mrs. Pill: "I need a refill on my Plortchzap."

Annie: "Sure... Actually it looks like you should have 3 refills left on it."

Mrs. Pill: "That's what the bottle says, but I wasn't sure what 'three refills' meant."