"Make mine a double."

This CME course title can be interpreted in more than one way...

Thank you Dr. A!

The answer

Thank you all for a great selection of serious, hysterical, and entertaining answers.

The correct one (as several guessed) is...

A guinea pig, viewed from above, with the owner drawing in areas where hair had fallen out (alopecia).

Congratulations to the winners! You've just won a brand new Chrysler Cordoba and you can pick it up at Morty's office!

Drawing

Webhill, over at Veterinarians Behaving Badly, submitted this picture. It was drawn for her by a pet's owner.

Let's have your guesses. Answer will be listed tomorrow.

Hint: It is not a turd.

Lists

I now present Mary’s list of issues that always seem to plague the last patient seen each day (especially on a Friday).


The last patient of the day:

1. Shows up late, and wants to tell you the 10 minute story of why they're late.

2. Wants to read the HIPAA privacy form word-for-word and ask questions, even though it's identical to the one every other doctor and hospital in the country use.

3. Has a new insurance card and left it at home.

4. Forgot to bring the insurance authorization for the visit, and the doctor who issued it closed early that day.

5. Left their MRI reports/lab reports/small child in the car, has to go back to get them, and has no idea where they parked.

6. Refuses to start the appointment until their spouse/child/parent arrives, and has no idea where they are.

7. Has a new address, needs to fill out the forms for it, and has to call someone to verify what it is.

8. Needs a bunch of prescriptions written, with both 30-day and 90-day scripts written for every one.

9. Shows up late, checks in, then leaves to find a bathroom and is gone another 15 minutes.

10. Somehow manages to lose their phone/sunglasses/corgi in the lobby or exam room and needs you to help them look for it.

Local insanity

Due to some unanticipated craziness here I didn't have time to write last night, so am just going to share one of my favorite TV bits:

Breaking news!

From around the globe, Dr. Grumpy's crack team of reporters bring you the stories that shape your world.


DATELINE: MINNESOTA

From the "hold my beer and watch this" department.

An unidentified man was injured attempting to jump a rocket-powered bike off his roof.

According to police, he'd taken a bicycle and attached skis to it, then added a motorcycle tail pipe modified into a rocket. The rocket fuel he was using in his heroic endeavor to confirm Darwinism was Heet, an antifreeze product for fuel lines.

He apparently flew off the roof, then fell 13 feet down and plowed into a fence.

When paramedics arrived he was lying on his back on a sled, pushing himself around the driveway and cursing loudly about how much pain he was in.



DATELINE: MARYLAND

Robert Meilhammer and friends were out hunting birds, and, when a flock of Canadian geese went by, one of them raised his rifle and brought a fowl down.

The dying goose, however, decided to take some primates with him, and on the way down hit Mr. Meilhammer on the head, conking him out cold, causing "head and facial injuries," and knocking out 2 teeth.

With his goose nearly cooked, paramedics took Mr. Meilhammer to an airport, where he was airlifted to a trauma center. Upon waking, he reportedly didn't remember much of the incident.

One of the goose's family members told our reporter that he hopes Mr. Meilhammer gets a large bill.



DATELINE: MINNESOTA (again)


In a sporting scandal to rival Riyadh's camel-Botoxgate, the Brainerd, Minnesota Jaycees are investigating claims of cheating at an ice-fishing tournament.

In the cut-throat, ultra-competitive, anything-goes world of ice-fishing contests, the prizes which are currently being held pending investigation are a pick-up truck, $1,000 cash, and a certificate for a free ice auger.

With over 12,000 entrants packed onto the lake like sardines, officials said screening them for fair play is enough to give anyone a haddock. Methods of cheating listed include (I swear) sneaking a live fish in with your gear or digging a shallow hole in the ice the night before, putting a live fish in it, and hoping it's still there and alive the next day.

Apparently some contestants take this quite seriously, though most were participating just for the halibut and had a whale of a time.

Thank you, Kip Addotta.

Feelings. Nothing more than...

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

Mrs. Visit: "Hi, I have an appointment at 2:00 today, and was wondering if I could come in at 1:30 instead."

Mary: "Sure. The slot opened up this morning, so it's all yours."



1 hour later



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

Mrs. Visit: "Hi, this is Mrs. Visit. I changed my appointment from 2:00 to 1:30, but have run into trouble. Can I still come in at 2:00?"

Mary: "Sure. It's still open. We'll see you then!"



2:15 p.m.



Mrs. Visit: "Hello?"

Mary: "Hi, this is Mary at Dr. Grumpy's office. We were expecting you at 2:00, but it's 2:15. Is everything okay?"

Mrs. Visit: "Yeah, but I have to work all day. They told me this morning that I wouldn't be able to leave at all, I guess I knew that all along. Sorry."

Mary: "Then why didn't you just cancel earlier? We can reschedule you."

Mrs. Visit: "I didn't want to hurt your feelings."

2:54 a.m.

Voice: "Hello?"

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

Voice: "Hi, this is Candy Furuncle, I see you for epilepsy? I'm on Fluximoo, I think 400mg each night?"

Dr. Grumpy: "Yes?"

Voice: "Anyway, I've got this huge boil on my left butt cheek. What am I supposed to do about it?"

Dr. Grumpy: "Call your internist. This isn't my field."

Voice: "Can you give me a hint? Like dig it out with a nail clippers or something?"

Dr. Grumpy: "No. Call your internist."

Voice: "What if he's sleeping?"

Checking

Dr. Grumpy: "Hi, I'm Dr. Grumpy. Have a seat. So..."

Mr. Query: "Just to make sure, you went to medical school?"

Dr. Grumpy: "Yes."

Mr. Query: "And residency?"

Dr. Grumpy: "Yes. I also did a fellowship."

Mr. Query: "Okay, thank you. My internist did medical training, so I always want to make sure the doctors she sends me to did, too."

Seen in the chart

Apparently there's a new type of cancer out there:

"Pink, some brown, reddish, too."

Oddly specific time frames:

"It's been such a long time, I think I should be going."

And, from the "you never know who you'll run into" files:

Breaking news

From around the globe, Dr. Grumpy's crack team of reporters bring you the stories that shape your world.


DATELINE: HAWAII

Unless you live under a rock, you've heard of the recent false alarm where residents of the 50th state erroneously received a civil defense warning that there was an incoming ballistic missile.

What you probably didn't know is that the dirty movie website Pornhub, in looking at Hawaiian stats, noticed that as soon as the alert went out their online traffic suddenly dropped 77%. One can only imagine viewers frantically zipping up their pants and knocking a Kleenex box over as they try to find a place to hide from a nuclear bomb (there isn't one by the way, so just finish what you're doing).

Even more impressively, as soon as the message went out that it was a false alarm, Pornhub's traffic suddenly stiffened up, shooting to 48% over their normal traffic level. Presumably people were trying to calm down with a different type of excitement.



DATELINE: SAUDI ARABIA

In the largest scandal of its type in world history, the Kingdom's beauty competition was rocked this week when it was revealed several contestants had used Botox and plastic surgery to alter their appearances.

The annual dromedary beauty competition at the King Abdulaziz Camel Festival was forced to disqualify 12 camels after it was revealed they'd undergone cosmetic surgeries and Botox treatment to make their ears, lips, noses, and jaws look more attractive. I am not making this up.

None of the disqualified camels would speak to reporters, though one did spit.




DATELINE: FLORIDA

Douglas Francisco pulled into a bank's drive-thru teller window, then promptly passed out with his car running.

Concerned bank employees knocked on his window for a while before he woke, at which time he apparently didn't know the kind of drive-thru he was in and ordered a burrito.

After being told he was at a bank, and not a Taco Bell, Mr. Francisco made a run for the border but only got a short distance across the parking lot before he passed out again.

He subsequently failed police-administered sobriety tests and was arrested. Officers noted he "made several statements that were differing with reality."




DATELINE: CALIFORNIA

From the "where are they now" files...

David Joyner, who played Barney the Dinosaur on the long-running (and amazingly irritating) children's show, is now running a tantric sex business in L.A.

Mr. Joyner, for a modest $350, provides 3-4 hour sessions to female clients which consist of ritual bathing, chakra balancing, and serious humping.

This leaves many of us wondering a few things: What's REALLY purple? What was going on under the costume? And does he yell "STOOOOOOPENDOUS!" during the throes of ecstacy?

"And when he's tall that's what we call a dinosaur sensation!"

And that's the way it is.

The Old Bastard

His name was John. Granted, I never called him that. I always called him "doctor."

Every residency program has one on staff. An old, semi-retired physician who's rumored to have trained under Osler or Charcot. Brusque, rude, and brilliant.

John was all of that. Came to work in a suit and tie every day. He always sat in the same seat in every meeting and lecture. One of the few docs old enough to have literally seen every neurological disease. He'd started in the era where top-of-the-line brain imaging was the pneumoencephalogram and ventriculogram. The number on his American Academy of Neurology certificate was 2 digits long.

We were terrified of him. He wasn't mean, but intimidating none the less. If you were answering a question, you knew you were on the wrong track if you heard him starting to chuckle softly in the back of the room, and when he took his unlit pipe out of his pocket and began puffing on it... you'd really screwed up.

At the same time, you'd go to him for help. Due to his long experience he could explain things sometimes no one else could. Occasionally you'd get invited into his office (it had been his for over 30 years) which reeked of tobacco. The hospital was no-smoking everywhere, but he didn't care. He smoked a pack of cigarettes a day, and a pipe on top of that. The little room was packed with bookcases, creaking under the weight of neurological tomes going back to the 1930's. Although it was a chaotic mess to everyone else, John would always go to a specific spot in the room, pull out and blow the dust off a book, and open it to exactly where the answer was.

John was a widower, and his only son and he had a tenuous relationship at best. He was a workaholic, and the neurology department was his life. He'd come in on weekend mornings to read the paper and have his pipe and coffee in his office. For dinner each night he dined alone at the same table in the same Michelin 3 star restaurant. Only once did I know him to have a dinner companion, when an old acquaintance of his was in town: Sir Roger Bannister, the world's fastest neurologist.

Shortly after I completed residency, John was diagnosed with metastatic cancer. He didn't even bother with treatment. Nor did he miss a day of work. Once he told others about it, it was no longer to be discussed. No one was to bring it up with him. He and his pipe continued to teach and lecture and glare at us until he no longer could. I, and many others, including his son, visited him in his last days.

His office was still locked and untouched when I left the area a few months later. No one dared go in or move his books or pictures. They were, for better or worse, all that was left of him.

A friend of mine from the department and I were talking about John's solitary life, with nothing but his work left. He commented that "it's a lesson in how not to live."

But... John never really died.

He's at my office every day, and follows me to the hospital. When writing a note I'll sometimes hear his chuckle and realize I'm not thinking the patient through correctly. He sits across my desk from me and argues about cases. When doing an EMG/NCV he'll chew me out if I do the wrong muscle, or tell me to do it over if it didn't sound right. If I forgot to check something on exam he'll make me go back and do it over.

There are many lessons to be drawn from John, both good and bad. I'll try to learn from all of them.

Random pictures

Time to hit the mail bag for stuff you guys have sent in.


First, this picture pretty much speaks for itself:

"You can park by the trash can, Phil, unless there's a shopping cart in the way."

Here's a restaurant's hours from their department of redundancy department:

Then there's this ad for a "spinal reset." Apparently the key to spinal health is growing a series of spikes on your back so you vaguely resemble a stegosaurus. Or Godzilla. Or look like you've been repeatedly impaled by a unicorn. Or narwhal. Or were attacked by a badly malfunctioning ice-cream-cone-baking machine.

Then there's this sign, for those who've been afflicted by a bootie cootie (thank you, ER's Mom, for that awesome phrase):

And finally... I don't understand this at all:

Seen in a chart