Seen in a chart.

If this MRI finding is correct, it's a publishable case.

 

My readers write

I'd like to thank the person who sent in this allergy list:

"Really? I have more trouble with their teeth and claws myself."

You don't know jack

NOTE: the following is NOT an April Fool's Day joke.

I'd like to thank the Science Marches On Department for sending me a truly remarkable piece of research.

Scheduling in a medical clinic requires talent, skill, and magic. There's only so much time in a day, and a lot of patients who need to be seen. People often portray the front-desk wizards as brainless, but they're far from it. Mary, after 14 years, knows me and my patients. From a few seconds on the phone she can get a good idea of how much time any particular patient will need, how that meshes in with the rest of my schedule, and (based on history) how long I am with any given return.

She also has to figure in how long it take takes me to grab a Diet Coke and drain a previous one between visits.

Any practice faces this issue, so obviously some research goes into improving work flow.

A study out of Miami, Florida recently looked into this important subject to calculate times needed for appointments at a fertility clinic.

Specifically, how long it took for a guy to, uh, shake hands with the milkman.

Yes, they wanted to know. That.

In the study guys were given a donation cup and unnamed porn mag. A stopwatch was started at the time they entered the room. They then took matters into their own hands, and texted "done" to the stopwatch person after the research project had climaxed.

For privacy, the exam room had a curtain. Boy, that's a relief.

Admittedly, it sure beats the idea of having a burly orderly with a timer in there, watching you box the one-eyed champ, but still.

The study makes no mention if the guys were allowed to wash their hands before picking up their phones to text the desk afterwards.

This graph is, by far, the best part of the article. It shows how long a guy takes to let it fly while pumping gas vs. the number of patients seen that day.

Note the blue bars: some guys actually had their ladies in the room during the process, although, under the fertility protocols, they weren't allowed to have physical contact. So the bottom line is that, if someone is watching you polish the banister, it will take longer to finish the job. In fact, the ONLY guy in the study who was unable to successfully finish marching the penguin was one who had his girlfriend in there.

Who could have seen that coming?

You can read the study itself here. It has pictures of the exam room, and a porn mag with a brown paper cover on it.

Thank you SMOD!

Spring break

Taking a few days off for kid stuff. See you next week!

Musical Gobstopper

For those of you who somehow haven't seen the totally awesome SNL "Bodega Bathroom" musical number, here it is. You're welcome.

11:52 p.m.

I'm sound asleep when my iPhone rings. It's my call partner, Dr. Cortex.

Dr. Grumpy (mumbling, trying to wake up): "This is Dr. Grumpy."

Dr. Cortex: "Hi, it's Cortex."

Dr. Grumpy: "Why are you calling? Aren't you in the hospital for hip surgery?"

Dr. Cortex: "Yeah. Hey, did you round on my patients today?"

Dr. Grumpy: "Yes."

Dr. Cortex: "Did you see the guy in alcohol withdrawal in room 6824?"

Dr. Grumpy: "Yes, why? I think I ordered all the usual tests."

Dr. Cortex: "Because after I left recovery they put me in the room next to him, and he's screaming nonstop and I can't sleep. He's driving me nuts. I'm going to put you on with his nurse now, so you can order something to sedate him."

Seen in a chart

Parenting

I'm at the dreaded Wednesday morning neurology meeting at the hospital. My colleague, Dr. Mom, is sitting next to me.

About halfway through the meeting her iPhone rang. She answered it, listened for a few seconds, then said:

“LOOK, Mr.-I-had-a-Bar-Mitzvah-so-now-I-am-a-man, I don’t care how well you did at your Bar Mitzvah, the fact that you forget your lunch at home - again - still makes you an irresponsible moron in my book and you can shut up and go hungry for the day to learn a lesson and if you call me about this again you’re not getting dinner either!”

Then she hung up.

We fist-bumped.

Pathetic

You know, it's REALLY PATHETIC that 40 years after this public service announcement first ran, we need it now more than we did then.

Get your kids vaccinated. Don't believe the bullshit out there.

Planning

School competitions always bring a bunch of paperwork, rules, and forms for parents to sign.

This year they included this:

Thank you, A!

Addendum

I'm with a patient when Mary interrupts me. Dr. Unka, a deranged cardiologist in my building, is on the phone. So I apologize to my patient and pick up the line.

Dr. Grumpy: "This is Dr. Grumpy."

Dr. Unka: "Hi, Ibee. You consulted on a hospital patient of mine this morning, Mr. Sah. He's the one who fell and hit his head at home yesterday, and now has a brain hemorrhage?"

Dr. Grumpy: "Yeah, he's in ICU. What's up?"

Dr. Unka: "Well, I was reading your note, and in your dictation it says he slipped on water that was on the floor. I just spoke to his wife, and she's very certain it was iced tea, because he'd just knocked a glass over and was going to get a towel to clean it up when he fell."

Dr. Grumpy: "Um..."

Dr. Unka: "Anyway, I thought it was important you should know, in case you want to amend your dictation."

Breaking News!

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


DATELINE: WINNIPEG

Diners waiting for burgers in the drive-thru of an A&W restaurant kept waiting, even after it became obvious the restaurant was burning down.

In a remarkable testament to human optimism, brand devotion, and hunger, patrons were, apparently, convinced their dinners would be ready soon. This is in spite of smoke pouring out of the place, employees fleeing the building, and approaching sirens. In fact, more people just kept pulling in. One can only assume they thought the column of smoke was coming from the grill.

It wasn't until a total of 8 firetrucks had arrived that the hungry customers realized they should consider other dining options and left.



DATELINE: CHINA

A man in Zhangzou was hospitalized with fungal pneumonia. The potentially serious disorder has been attributed to his habit of repeatedly smelling his own socks after wearing them all day. He apparently did this as a way to relax after work.

I think I'll stick with a beer.




DATELINE: FLORIDA

Mr. Onelio Hipolit-Gonzalez was arrested for running a bogus medical clinic.

He charged people $160 for an initial appointment, which consisted of them holding a metal rod that was connected to a beeping machine (Ah! the machine that goes "PING!"). Afterwards he'd tell them the machine showed various organ problems and that he could cure them for $2000.

His "cure" for diabetes apparently consisted of him drawing blood and then re-injecting it back into their body.

Mr. Hipolit-Gonzalez was reportedly "shocked" to learn his actions were illegal, and, as proof of his ability to practice medicine, stated he'd been a lab technician.





DATELINE: BRAZIL

Mr. Abdias Melo, who must be a VERY sound sleeper, remained in dreamland while friends super-glued a colorful assortment of dildos to his back.

They then woke him by banging pots together.

Attempts to remove the dildos at home failed, and Mr. Melo ended up going to ER. I suspect even the most hardened team of emergency staff was taken aback by this case.

Either that or he was mistaken for a stegosaurus.

A really sick horse

Dr. Grumpy: "Any illnesses in your family?"

Mr. Patient: "My mother has smoked a pack a day for 70 years and, except for her lung
cancer and heart failure, is healthy as a horse."

Confessions

You ever killed someone?

I have.

Of course, "kill" is too strong a word for what most doctors have done at some point, but still, he died because of my direct actions (a nurse and respiratory tech were involved, too).

He was a retired farmer, around 80. Strong and healthy for his age. I was in my early 30's, just out of residency and starting life as a newly-minted attending physician.

He'd fallen from a ladder and severed his upper cervical spinal cord. He was awake and alert, but completely paralyzed from the neck down. He couldn't breathe on his own, so was facing the rest of his life on a ventilator, requiring complete care for everything. There was no hope for recovery.

In the first days of the injury the trauma and neurosurgery people worked their magic, stabilizing what was left of his neck, converting him quickly from a ventilator tube to a tracheostomy for comfort, getting a feeding tube in.

As the days went by and we began decreasing his medications it became clear that he would live, was mentally intact, and could communicate with us.

In spite of what his family had told us, he wanted to be let go. He'd led a robust life and didn't want to spend the rest of it in this condition. He was ready to have things turned off so he could pass.

This sort of thing is (comparatively) easy in someone with advanced dementia, or severe brain trauma, or end-stage cancer. But in a guy who was fully awake and who'd been healthy and vigorous a few days earlier it was a whole different matter.

The family was unhappy, but acquiesced to him. To cover myself I had a psychiatrist interview him and ordered a consult from the hospital ethics committee. All agreed that he was pleasant, had a good sense of humor, and was fully capable of making this decision.

The family didn't want to be in the room when it happened, so we gave them all the time they needed to say goodbye.

When the time came we chatted briefly, and he thanked me and the team who'd taken care of him. He even asked that we shake his hand.

I had the nurse give him megadoses of morphine and Ativan, to put him to sleep and take away any pain that might still be there. Once he was out the respiratory tech disconnected him from the ventilator. Between the medications and his non-functioning diaphragm he went pretty quickly. I wrote a death note and moved on to another case. There are always more consults.

What would you call it? An execution? Physician-assisted suicide? Compassion? I'm sure some out there would love to have me tried for murder, but I don't care.

To me, my responsibility is to the patient. This man had lived a good life, wasn't suicidal in the sense of someone who's depressed, and made a rational decision about his own existence. I did everything I could to make sure there wasn't a good reason NOT to end his life, and did what I could to respect his wishes and relieve his suffering.

That was the first, though not last, time I've had to face this situation. We may become more experienced, but it never gets easier.

It's been 20 years, and I'd still say the same thing: In the end it wasn't my decision, it was his. I just did what was right for the patient.