Seen in a chart

Alone

Over the course of a career you see a lot of patients. I'd guess, based on looking through my charts, roughly 30,000-40,000 to date.

Most, especially the ones from the very beginning, are long forgotten. Sometimes I'll request old hospital records on someone from a place where I did a rotation and am surprised to see a note from a younger version of myself. And I have no recollection of them at all.

But a handful never leave you. Some because you learned a lot from them. Others because of a shared interest you chatted with them about. And a few because they struck a chord that's never gone away.

I was at the tail end of my intern year, doing a mandatory ICU rotation, when they brought him in. I don't remember his name now, mainly because I never knew it then, either.

He was a homeless man, who'd fallen asleep in a trash dumpster. In the dark early morning no one saw him fall into the back of a garbage truck when the container was emptied. With the noise of the engine no one heard his screaming as he was mashed by the machinery. When the truck was emptied a few hours later sanitation employees called 911.

He was still alive - barely - when we got him. Massive blood loss and multi-system trauma. Broken bones, ruptured viscera, missing pieces of limbs. Teams of doctors paraded in & out of the room trying to save him. As an intern I was one of them, but on the periphery of the internal medicine group.

What was left of his clothes had no ID, and he was never conscious. Social workers tried to find family, a name, anything. They combed missing person databases and made endless phone calls all over the country. Nothing really to go on, not even a tattoo. Just a 50-ish white male. Police spoke to other homeless who lived in the area. A few remembered him, but none knew his name or anything about him.

For a week in the never-ending daylight of the ICU an army of doctors, nurses, RT's, lab techs, and others did their best to keep him alive. Although his prognosis was grim, we all thought that, sooner or later, the social workers would turn up a friend, or relative, or find some lead to them. He was, after all, somebody's son. Or brother. Or father. If there was someone out there who might be able to tell us what he'd want, or even who just wanted to say goodbye to him, we'd give them that chance.

But it never happened. Roughly a week after he came in the attending doctors felt there was no hope and nothing further to be done. The machines were turned off one by one and he died quickly. Someone on the trauma service signed a brief death note and reached for the next chart. The body was taken away to an unmarked grave. I couldn't find it today if I tried.

I'm sure somewhere out there is an argument about how much money was spent on his case, and how many vaccines or school lunches or police or teacher salaries it could have paid for. Given how many cases there probably are like his, and multiply by that number... I'm sure it's a lot of dollars. But, while it has some points, that debate didn't occur to me at the time, isn't why I still remember him, and I'll leave it to other blogs to discuss.

Regardless of the circumstances of his life - I admit I'd have ignored him on the street if he'd asked me for change the day before - he died alone. Did he have any living family? Do any of them wonder what happened to him, then or now? Were they sick of whatever issues he had again and again, and had long pushed him out of their minds? Did he have a good childhood or was he always on the streets? Did he serve his country? Was he hoping to die in the dumpster or just looking for a little more shelter than the sidewalk offered that night?

Alone.

25-30 years later I can still see him as they brought him to ICU, the different teams of doctors yelling orders. For a week I'd sometimes sit at the nurses station and stare at him, wondering. Did anyone else working on the case find themselves as bothered as I was? Maybe we just all covered it up, afraid that to admit he was anything but a badly injured homeless guy would be a sign of weakness. I may be the only person today who even remembers him at all.

Alone.

The case still keeps me up at night. Thinking of him, and behind that the abject terror of the thought of someday myself, or my wife, or kids, or other loved ones or friends, being in the same situation. Alone. Impoverished with nothing. Unloved. A life and existence forgotten.

Alone.

Friday reruns

Saturday morning.


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

Miss Myelin: "Yeah, I see Dr. Cortex for my MS, and I woke up today with blurry vision, and I can barely walk."

Dr. Grumpy: "Have you had this before?"

Miss Myelin: "No, it's new. When my MS acts up Dr. Cortex usually admits me to the hospital for IV steroids."

Dr. Grumpy: "That's standard. I think you need to go to ER, and I'll likely admit you."

Miss Myelin: "Are you kidding? I don't have time for that shit."

Dr. Grumpy: "Excuse me?"

Miss Myelin "I don't have time for that. Can I schedule them for next week, like Wednesday or Thursday?"

Dr. Grumpy: "I suppose, but you'll have to call Dr. Cortex on Monday and... Look, if you're not going to let me help you, why did you even call on the weekend, anyway?"

Miss Myelin: "Because I thought it might need urgent treatment."

Answers

Dr. Grumpy: "So let's see what the tests show. Any other questions?"

Mrs. Cephalgia: "Doctor, how will I know if I'm having a headache?"

Pause

Dr. Grumpy: "Um, because your head, uh, hurts."

Mrs. Cephalgia: "Oh, okay... that makes sense."

Breaking news!

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

DATELINE: PENNSYLVANIA

Pastor George Gregory, of the Waterfront Community Christian Church, claimed that he was "counseling" a man found naked and tied up with rope in a parked car with him.

When police arrived the naked & bound man was in the front seat and Pastor Gregory was in the back "adjusting his clothes."

The good pastor states that he "did nothing" and was helping the man work through a drug problem. He also added that they “were just playing” and would “meet up from time to time to play with each other.”



DATELINE: GERMANY

Police were summoned to an apartment where cries for help were reported.

Upon breaking in, officers found 2 men "hopelessly locked together" with a mannequin dressed in a knight's costume and a remote-control toy car.

Both men were too drunk to explain exactly how this had happened, though, after being freed, one of them was charged with insulting the officers.

Inquiring minds want to know, but mercifully no pictures were taken.




DATELINE: MEDICAL NEWS

A study found that epilepsy patients who developed impaired consciousness while driving were more likely to have car accidents than epilepsy patients who retained normal consciousness behind the wheel. (Neurology Reviews, January, 2017, page 8).

"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."