Blink

She was 19, here for migraines. She was nervous, had never been to a neurologist before, and her mother was along for emotional support.

We talked a bit, went over some treatment options. Nothing too costly. She worked full-time as a waitress, trying to save money so she could start college soon. We settled on nortriptyline and naproxen, and I began writing out scripts.

As I scribbled, I blinked.

Suddenly the scripts were gone. Instead of paper, I was typing in an online refill for generic sumatriptan… which a minute ago was brand-name, and she couldn’t afford it.

She was still there, across my desk, but she’d changed, too. She wasn’t a waitress anymore. She was working full time as a nurse, was married, and had two daughters. I remembered her having moved away to go to college, then nursing school, then coming back here. I recalled her telling me she'd gotten engaged. I’d treated her migraines through both pregnancies.

The nortriptyline hadn’t helped, and now she was on Aimovig, a drug I hadn’t imagined when she first came to me. In the time between then and now, besides the times she lived out-of-state, I recalled trying a handful of different medications over the years.

During my blink she’d developed a few gray hairs, wrinkles, and pounds from the stresses of daily life, jobs, raising a family, and making ends meet. I’m sure mine are worse.

This is also part of medicine, just as it is in everyday life. Over our careers we see college students mature into adults with jobs and families. We see parents become grandparents. The middle-aged become elderly.

We see people we’ve grown to care about die of things we can’t fix.

Being a doctor reflects the changes we see in our own lives as we travel around the sun. Our patients become a sort of extended family. We aren’t directly involved with their daily events, but we catch up on them here and there, and they see the same changes in us.

The drawings my kids did are still on my office walls, but haven’t been updated in a long time. Picking them up from the after-school program has been replaced by picking them up from the airport.

My hair has gradually thinned over time and become grayer.

The glasses I’ve worn since I was 8 have become bifocals.

All in a blink.

Mary's desk

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

Mrs. Frantic: "Hi, I have an urgent issue and need to get in RIGHT AWAY!"

Mary: "Hang on... Okay, the doctor can see you this afternoon, at 4:30... we also have an opening at 8:15 tomorrow morning, or..."

Mrs. Frantic: "Those won't work, um, I, uh, I'm actually out-of-town, on vacation, for another 2 weeks."

Pause

Mary: "Okay, when will you be back?"

Mrs. Frantic: "I don't have my work schedule here. Can I just call you after I get home?"

Seen in a chart

From an internist who apparently believes in "brevity is the soul of wit."

 

 

You  just know he billed this as a high-level visit, too.

Thank you, L!

Probably true

Dr. Grumpy: "Okay, then let's try increasing the dose of Flurpizol to 2 pills each night."

Mr. Martin: "That's what Annie had told me to do when I called last month, "

Dr. Grumpy: "I was wondering about that, because I see the phone call listed..."

Mr. Martin: "You're not angry at me, are you? I just wasn't sure."

Dr. Grumpy: "No, of course not. Let's just try the increase now and we'll see..."

Mr. Martin: "You're not going to tell Annie, are you? I don't want her to be angry at me, either."

Dr. Grumpy: "She won't be. Don't worry about it."

Mr. Martin: "Do you promise? Isn't she your boss?"

Medical advertising

Saw this ad in a journal a while back.

It was, I believe, for a back pain treatment. Though I can also see it being used for a martial arts movie. It it were in black & white it could even be something by Robert Mapplethorpe.

But what I really love is the obligatory "Not an actual patient" disclaimer, as if it were common for patients with a metal clamp on their low back and jagged metal protruding from their skin to come in for an appointment (my colleagues in ER may feel differently).

If they did, I'd probably have to turn them away. I couldn't afford the upholstery damage.

Patient quote

“Sorry if my speech is slurred, doc. I was really nervous about the appointment so I took 2 Vicodin and some marijuana gummies while I was driving over."

Moms

Dr. Grumpy: "What medications have you tried for this?"

Mr. Teen: "They... I'm sorry, my mom wrote them all down and I left it at home... Hang on."

Pulls out his phone.

Mother: "Hello. You left the list on the counter here."

Mr. Teen: "Yeah, can you read it off, please, I'm with the doctor."

Mother: "I swear, you'd forget your ass if it weren't attached to you. Remember the thing last week, where you sent a tube of athlete's foot cream through the wash? You need to be more responsible."

Mr. Teen: "Mom, can you just tell me what medications..."

Mother: "I had to replace your father's work shirt, young man. And I bet you got there late for the appointment today, too? Dr. Grumpy, can you hear me? Was he there on time?"

Dr. Grumpy: "Uh..."

Mr. Teen: "I think one of them was Excedrin, and another was called sumaframtam, and..."

Mother: "He means sumatriptan, doctor."

Mr. Teen: "Mom I can't hear you, it keeps cutting out."

He puts the phone in his pocket.

Mr. Teen: "I'll call you with the list after I get home."

Burning down the house

Hi, it's Craig, reporting from Local Grocery.

On Friday night I was doing the usual pre-closing routine in the bakery, sweeping up crumbs, washing out baking trays, making sure no one was locked in the freezer, when suddenly the night got more lively.

One of my colleagues working in deli opened their oven to have flames shoot out of it and set some surrounding materials on fire.

In a large store this occasionally happens, and we're trained for it, so I didn't panic. In fact, the only thing that happened in my department was a lady came over and asked if I could get her 1/2 pound of honey-baked turkey since the deli staff seemed kind of busy (no, I can't).

Then the deli manager suddenly yelled to me "I need your fire extinguisher!"

I grabbed it off the decorating table and ran it over to him. He put out the fire at the same time that the deli's sprinklers switched on, soaking all of us and the lady yelling about honey-baked turkey.

Since the bakery was quiet I helped them mop up while somebody dealt with the turkey lady (who was now also upset over her unexpected participation in wet-floral-print-polyester-blouse night). I was back to boxing up unsold donuts for the homeless shelter pick-up when the deli manager came over.

Deli guy: "Thank you, we really needed that, we couldn't get to ours. I've put in an order for a new one for bakery, and it will be here tomorrow."

Craig: "Thank you. Where is your fire extinguisher?"

Deli guy: "We keep it on the wall behind the oven."

Modern Industry

Dr. Grumpy: "What brings you in to see me, sir?"

Mr. Fishbone: "You don't already know?"

Dr. Grumpy: "Uh, no, we've never met before, and I haven't received any records."

Mr. Fishbone: "It's all on my website, if you'd bothered to look me up."

Dr. Grumpy: "Sir, I don't 'look up' patients online before their appointments."

Mr. Fishbone: "Maybe you should, so we wouldn't be having this conversation."

Pause

Dr. Grumpy: "What brings you in to see me today?"

Mr. Fishbone: "Apparently you wanted to waste my time. I'm out of here."

 He got up and left.

"To each his own."

 

Thank you, S!

Weekend on call

Dr. Grumpy: "Hi, I'm Dr. Grumpy. What's going on here?"

Mrs. Nine-Iron: "Well, we were on the 15th hole when suddenly she had trouble walking and couldn't talk anymore."

Mrs. Sand-Trap looks at her friend, then me, and nods her head.

Dr. Grumpy: "Then what happened?"

Mrs. Putter: "I helped her get back to the golf cart. Fortunately, this one had seat belts, so we were able to use that to hold her in it. Otherwise she might have fallen out."

Dr. Grumpy: "Is that when you called 911?"

Mrs. Nine-Iron: "No, we waited until we finished up and got back to the club house. I mean, we were on the 15th hole, anyway, at that point."

Mrs. Top-Flite: "And it's not like they were going to refund our green fees."

Customer service

This is Craig.

My summer job hunt (also known as the ongoing 2020 college Spring Break), resulted in me working at a bakery.

Okay, not a real bakery. It's not like I'm apprenticing as a pâtissier. I'm working in the bakery department at Local Grocery (same one Frank bags groceries & collect shopping carts at). This consists of me putting frozen pucks (that's what we call them) of cookie dough in the oven, bagging the finished product, putting a mysterious "garlic-flavored spread non-dairy food product" on slices of French bread, getting yelled at by strangers because at 9:45 p.m. we're out of breakfast donuts, writing "Happy Birthday" on some cake for a hyperactive 5-year-old who clearly needs to pee, and other valuable life skills, for minimum wage.

A few times a week I work the closing shift. Beyond the occasional customer questions ("Hey, how many muffins are in a 6-pack of them?"), this entails me wiping out the donut and bagel trays for the morning shift to fill up again, cleaning up the kitchen so the early crew can start baking when they get here, and moving tubs of dough from the freezer to the fridge so it will thaw overnight.

Around 8:55 p.m. the phone rang.

Craig: "Bakery department, can I help you?"

Phone guy: "YEAH. I've been trying to reach someone there for HOURS. I'm out of my medication, and need to make sure it's been refilled so I can come get it tonight."

Craig: "I'm sorry, this is the bakery. I think you're looking for pharmacy. Let me transfer you."

Phone guy: "NO! DON'T DO THAT! I've been calling them for the last 15 minutes and no one answers the phone."

Craig: "Well, they close at 7:00, but you can leave a message about a refill."

Phone guy: "But I need my refill NOW! I AM OUT! Can't you go over there and get it for me? I can just pick it up at the bakery."

Craig: "Sir, I can't do that. It's all locked up. I'm not even allowed in there. They'll be open tomorrow morning at 9:00, so if you..."

Phone guy: "You're being entirely unreasonable. I need my medicine! Can't you just call a pharmacist and tell them to come in for me?"

Craig: "No, sir, I can't, let me get you a manager."

Phone guy: "Is it the pharmacist?"

Craig: "No, it's the night manager who's in charge now."

Phone guy: "That's not who I want."

Craig: "Sir, I really can't help you. You pressed the extension for bakery. That's all I handle here."

Phone guy: "I'm not stupid. I know what I pressed. I'm going to go down the phone menu until I reach someone who can help me. You were the first department."

Craig: "Let me transfer you to..."

Phone guy: "Screw this. You're worthless. I'll try Beer & Wine next, and Deli is after them. Somebody there must know the pharmacist."

Click

 

Job Training

The staff and Dr. Pissy were having lunch the other day, when I made the mistake of wandering up front to use the copy machine. As I copied away, a new marketing rep I hadn't seen before wandered in and zeroed in on the only person she could see - me.

Marketing lady: "HI! I'm Annie Oying! I'm here on behalf of Dr. Bonescrew's new orthopedic office on this side of Grumpyville, right across the street."

She takes a pile of business cards and insurance forms out of her bag and sets them on the counter.

Dr. Grumpy: "Thank you."

Marketing Lady: "It's great to have a chance to introduce myself to you! Are you a secretary, medical assistant, provider, or something else here?"

I should have used my stock line that I'm the guy who cleans the fish tank, but I was focusing on figuring out where a paper jam was.

Dr. Grumpy: "I'm, a, uh provider, I guess."

Marketing Lady: "That's wonderful! It's a pleasure to meet you, uh..." She steps back, opens the office door, and reads the names on it. "Dr. Grumpy or Pissy!"

Musical interlude

Local hospital, like every hospital, has an overhead public address system to page doctors, announce emergencies, and inform visitors of flash specials on stuffed animals in the gift shop.

Mistakes occasionally happen. Sometimes a hospital operator hits the wrong button, so you get a few seconds of someone dialing a phone, or talking to another operator, or the hospital's hold music, or (if the hold music is broken) a local radio station. The operators are actually in an off-campus office, so if a problem occurs it can take a minute for them to find out and correct it.

So yesterday, I was on call, doing a consult in the ICU. A cardiologist was paged overhead to the cath lab, but then the operator hit the wrong button and we got a local radio station.

Normally people just ignore this, but by sheer chance this was what was on the air:

"Another one bites the dust,
Another one bites the dust, Yeah!
And another one's gone and another one's gone
Another one bites the dust!"*

Later in the afternoon there were apology notices up in all the elevators, saying the hospital would be upgrading the PA system to prevent such occurrences.

*Although not intended in this way, you can use either this or "Stayin' Alive" to do CPR properly.