Friday

An attorney I've worked with called late Friday morning. A demented homeless patient had been found living in a culvert, completely disoriented. There was no known family. The small hospital he was at didn't have a neurologist available and they needed one to evaluate cognitive status for legal reasons. Would I be willing to do it?

My afternoon was actually fairly empty, as Fridays tend to be. So he emailed me the necessary paperwork and releases and I set off across town. After the usual COVID swab, then getting lost trying to find the correct room, I was there.

He was in his late 70's. The nurses had done an excellent job of cleaning him up (nurses deserve far more credit for this sort of thing than they ever get). Now he was in a hospital gown and adult diapers, still smelling slightly of urine, mumbling on and off, and occasionally asking me what school we were in.

I examined him, then sat down with his chart and some old medical records that had been scrounged together, looking to make sure the right things had been checked and ruled-out, the usual stuff that's second nature at this point in my career. I filled out a few papers, scanned them with my phone, and sent them off to the lawyer. I was done.

As I stood up to go I noticed a small pile of random objects on a chair in the corner and realized they were what had been found with him. His only worldly possessions, as the phrase goes.

Curious, I looked them over. A few T-shirts, a pair of socks, a metal water bottle and 2 plastic ones, some unopened bags of candy, 2-3 small stuffed animals. Somewhat incongruously there was a framed picture of a group of 5 men, all in 1970's-ish business suits and ties, standing behind a conference table, all smiling. The table had some scattered pens, note pads, coffee mugs, and a telephone. There was no name or date. The guy 2nd from left was the one lying in the bed behind me.

I have more things than he does, but neither of us gets to take them with at the end.

Out of all the items in the small pile, the picture obviously meant something to him. It was about 8" x 10", and certainly not easy to hold on to through all changes that a life of homelessness brings. But of the things that had connected him with who he'd once been, that was the one he wasn't going to get rid of. Even in the waning shadows of Alzheimer's disease he still thought it was important.

It led me to wonder how he'd reached the current situation. But the possibilities are large, varying from bad decisions to just the terrifying bad luck that can hit any of us. I had no way of knowing, nor was I going to guess. That's not what I was there for.

The things in that small pile were the only ones of value left to him. I suspect the photo was the most prized, simply because, unlike everything else on the chair, it couldn't be replaced, and he'd kept it for 40-50 years.

The detritus of a human life.

Wait, what?

I ordered a cheap pedometer last week after my old one broke. This was the product description.

 

 

Ancient History

Dr. Grumpy: "So what's going on?"

Dr. Aristotle: "I'm worried about my wife's thinking."

Lady Aristotle: "There is nothing wrong with me."

She sets down her coffee and glares at him.

Dr. Grumpy: "What concerns you?"

Dr. Aristotle: "She doesn't like reading Plato's Republic any more."

Pause

Dr. Grumpy: "I'm sorry, can you repeat that?"

Lady Aristotle: "You know what, Pericles? I NEVER liked it. I bet none of your college students ever liked it, either. And now that you're retired from BSU, I'm tired of hearing about it and pretending I even give a damn about Plato or his book! I did that for long enough!"

She picks up her coffee again.

Dr. Aristotle: "See, I don't think that's normal. You must have read it in college, didn't you Dr. Grumpy?"

Dr. Grumpy: "Um... actually I read the Cliff Notes."

Lady Aristotle: "SEE? I bet they all did, Pericles."

Dr. Aristotle: "But the Cliff Notes aren't the same. You must have gotten a bad grade just working off of that."

Dr. Grumpy: "I got a B+, but not liking Plato's Republic isn't a criteria for dementia. If it was most people would be diagnosed with it."

Lady Aristotle starts laughing.

Dr. Grumpy: "But to get back to the point of the visit, have there been other changes you've found concerning?"

Dr. Aristotle: "Well she... You know, I can't believe a college professor gave a B+ to a student who only read the Cliff Notes."

Dr. Grumpy: "Neither could I, but you did."

Lady Aristotle blew coffee all over my desk and started laughing so hard she got up and left. He went after her.

Reruns

As my regular readers know, I moonlight as a consultant for various medical market research companies. It's a thankless job, but somebody has to pay for the tomatoes.

So last night I had a dinner meeting with neurologists and sundry other specialists to review data on an up-and-coming product.

These are never fun, because neurologists by nature are a remarkably pathological group of personalities. Back when I worked at Humungous Neurology, Inc. the partners would argue if it was dark or light outside. I think they invite the other specialties to these as a buffer.

But I digress.

So I was seated next to Dr. Harangue, who I'd had the good fortune of not having seen in at least 5 years. In his own mind he's a giant in his field. To those outside his mind he's an obnoxious boil. He may have once been a good doc, but as they say in Hollywood "you're only as good as your last picture". And his was made before Casablanca.

Neurologists will argue over anything. The meal started with a dispute across from me over who's bread plate was who's (right or left? GET YOUR BREAD OFF MY PLATE!) followed by a fight over which fork is used for salad. Somebody actually dragged the maitre d' to the room to settle the issue (no, it wasn't me. I sit still and keep my mouth shut as much as possible).

I'm not much into the swanky places they have these meetings at. I ordered a steak. I had no idea how complex this was.

Waiter: "How would you like that cooked?"

Dr. Grumpy: "Medium."

Waiter: 'That involves a light red center. Is that okay?"

Dr. Grumpy: "As opposed to..."

Waiter: "Well, rare is a pink center."

Dr. Grumpy: "Medium is fine."

Waiter: "I can do medium rare, too. That's a pink/red combo".

Dr. Grumpy: "What's wrong with medium?"

Waiter: "I'll just do medium-rare-plus for you. That's a pinkish-red."

Whatever. I'm trying to order a steak, not pick out draperies.

Then the talk began. Every time a doc involved in the study was mentioned, Dr. Harangue felt the need to interrupt and say "I know that doctor personally. We've been close friends for over 25 years." By the end of the meeting I was hoping they'd mention a study done by Hippocrates or Woodrow Wilson to see if he knew them, too.

After 15 minutes of talking, the speaker stepped out from behind the podium to show us all that his zipper was down, with his tucked-in shirt hanging out of it. A tactful internist promptly yelled "Christ! Your fly is open!" to drop a subtle hint.

Then they brought dinner. The cardiologist next to me had ordered prime rib (no comment), and the waiter accidentally set my steak in front of him, and his prime rib in front of me. I pointed this out, and he quickly switched plates.

The cardiologist had a freakin' FIT! "I don't want that now! It was in front of him! He could have H1N1, or worse! Doesn't the heath department check you places anymore?!!!" It was, literally, in front of me for less than 5 seconds.

So I quietly started my steak, while they went to get Dr. Germaphobe a new prime rib (actually, I think they just brought him back the old one).

The next speaker showed us a seemingly endless series of graphs. After 20 minutes of this, she asked if anyone had any comments. Dr. Phlame at the end of the table immediately raised his hand. "Yes, I want to know why you chose red and blue as the main colors for the graphs. I think mauve and maybe yellow would be much more aesthetically pleasing. Also, I think some ruffles or curvy lines around the slide border would be nice."

This was immediately followed by Dr. Harangue chipping in "Dr. Phlame, do you live under a freaking rock? This company has been using those colors for years. But back to the data, did any of you people think to compare these results to a 1954 study by Longdead, et al?" The speaker (and everyone else there) had absolutely no clue what he was talking about, and Dr. Harangue chewed us out, as if it had just been published last week. When I looked it up, the study investigated a drug (that's no longer in use) for an unrelated condition.

Throughout this excitement the waiters kept refilling our glasses (ENDLESS DIET COKE HEAVEN!), so dysfunctional personalities were not improving with repeated doses of Burgundy and other wines.

In one discussion, to argue a point about a competing drug, an internist actually reached into his pocket and pulled out a product insert. I swear! He had it with him, all scrunched up. After reading from it like it was a bible he sat down and began arguing with a pulmonary doc about when daylight savings time starts.

We made it through another 15 minutes of polite discussion before Dr. Germaphobe cardiologist began tapping my shoulder. "Hey, Ibee!"

I turned around "What's up?"

"Are you gonna finish your roll?"

Stunned, I looked at the bread roll I'd absently left on my plate. It was buttered, and I'd taken a few bites out of it. "Uh, no, I'm full".

"Thanks!" And he grabbed it. So the guy who'd refused to eat an untouched steak was now chomping on my partially eaten dinner roll. Amazing what a bottomless glass of white wine will do.

As we sat through another set of slides, Dr. Harangue's cell phone rang. He answered it, speaking loudly enough to be heard in the next county (i.e., his usual volume). "What? Yeah. No, I've got another half hour of this shit. The drug company people won't shut up."

The dinner ended 20 minutes later. To make sure all points were covered, the moderator specifically asked "Dr. Harangue, are there any other comments?"

No answer. It was the only time he'd been quiet all night. He was in a burgundy stupor, slumped face down next to his creme brulee. He was still there when I collected my paycheck and left.

Seen in a chart

I have no idea what this was supposed to say.

 

 

Family Fun

Ms. Crouton: "Hello?"

Annie: "Hi, this is Annie, with Dr. Grumpy's office. I'm still working on getting your medication, Shnoodleblob, authorized, but in the meantime we do have samples you can pick up so you can get through the week."

Ms. Crouton: "You do? Oh, THANK YOU! That really helps. What time are you open to?"

Annie: "We'll be here until 4:30 today and..."

Ms. Crouton: "No... I don't get off work until 5:00 today, and I actually have to get off the phone now because my meeting is starting... can you call my mom for me? She knows I take this, and she's near your office anyway. She'll pick it up and I'll get it from her later."

Annie: "I..."

Ms. Crouton: "My meeting is starting! Please call her! 867-5309! Thank you!"

 

(click)

Annie sighs.

 

Ms. Crouton's Mom: "Hello?"

Annie: "Hi, this is Annie, calling from Dr. Grumpy's office. Your daughter, Ms. Crouton, can't get by to pick up her medication, and asked me to call you since she says you're near our office."

Ms. Crouton's Mom: "Can you please call my daughter back and tell her to go fuck herself? Thank you."

 

(click)

Annie sighs.

Never mind

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

Ms. Dna: "Cancer, high blood pressure, type-2 diabetes... wait, do you mean in my family?"

Dr. Grumpy: "Uh, yeah."

Ms. Dna: "Oh, never mind then. They're all pretty healthy."

Back in 2023

But, until then, I'm again sharing my favorite Christmas song.

 

Saluting a colleague

Today's post is written to express my admiration for another local neurologist, Dr. I. V. Leeg, for his remarkable dedication to principles.

Dr. Leeg attended a well-known college and medical school. While the majority of people I've met who attended his school act like decent human beings, Dr. Leeg realizes that being in massive educational debt up to your eyeballs is worth nothing if you don't continuously remind other docs that they're road apples compared to you.

Dr. Grumpy went to public schools all the way up until medical school, when I went to a small private medical school no one else on Earth has heard of except for the 6 of us who graduated from there. My reason for going there? It was the only medical school I got into.

When I first met Dr. Leeg I tried to make idle chatter with him for a few minutes, and asked him what had brought him to this neck of the woods. Trying to be polite, he said "to improve the crappy quality of neurological care in Grumpyville."

Last year Dr. Leeg was fired from a hospital case because the family thought he was arrogant and condescending. They then asked for me to take over. In his sign-off note, he kindly put in the chart that he'd been "dismissed in favor of a physician of lesser education."

Recently a patient transferred care from Dr. Leeg to my practice, so I sent over a routine request for records. A week later we received them in the mail. At the end of the chart notes was a phone memo that said, "the patient has transferred care to Dr. Grumpy. I personally called to warn her of the risks involved in seeing a physician who is a product of public education. She understood, and unreasonably insisted on continuing with her plan to leave my practice".

So here's a salute to Dr. Leeg, for his remarkable devotion to making sure that us lesser physicians know our place in the world.

Open mic post

Doing some reading over the weekend, and came across this pic. I'm opening up the floor for caption ideas. Mine is under it.

 

“Pinch me again and you’ll need dental work”

 

 

"I'll never listen to Mozart the same way again."

Found this at Goodwill. I can only assume someone in OB/GYN marketing was trying to think outside of the pens & post-it notes box.

The personal touch

 Seen in a chart:

Random pictures

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

Here we have an ad for a healthcare supply manufacturer.

Let's face it, if your most "innovative respiratory product" in the last 43 years is a cotton swab... I'm just sayin'.

Next, from the "hey, whose doesn't?" category, is this bumper sticker:

This license plate is presented without comment:

Next is this ER patient board item, which has either the wrong vowel or too many "r"'s. I'm not going to guess.

 

And finally we have this fortune cookie. Which probably means you've just been poisoned and need Ipecac.

 

Yes

Dr. Grumpy: "How are you doing?"

Ms. Random: "The morning is a complete loss so far. Truck empty. Overdoing it. Couldn't focus. Throwing things. Cats. Dogs. Crashes. Broken stuff. Shit. You ever have that kind of day?"