Memories... part 2

Dr. Tallahatchie, as anticipated, required a fairly lengthy surgical procedure. He'd broken his leg in 3 places, 1 of which was a compound fracture.

Even worse (from his view) was that they wouldn't let him smoke.

Recovery from this sort of thing is not painless. After surgery he was put on a morphine PCA pump. For those of you not in medicine, this is a gadget that delivers IV narcotics controlled by the hospital patient. You need more morphine? Press a button and it gives you some. The pump is programmed with a maximum amount and frequency you can receive, and is locked out with a security code.

20 years ago, however, the security codes were only 4 digits, and Dr. Tallahatchie had a photographic memory. After watching the nurse set it up, it took him only a few tries to hack it. Due to ongoing pain, he increased his morphine dose. This made him much more comfortable.

Nursing found him still breathing, but unable to be woken. The internal medicine service, comically, called for a neurology consult, and my colleague, Dr. Violet, told them exactly what the problem was.

So they took his PCA pump away. Since his vital signs were okay Violet didn't have the heart to use Narcan.

As a result of the overdose, the good doctor was now unable to pee, and so a foley catheter was ordered. His nurse started the procedure, only to be stopped when Dr. Tallahatchie suddenly became wide awake, sat-up, and yelled "HEY! THAT'S MY WINKIE!!!"

Although now more alert, he still couldn't run the water. And when the nurse came at him with the foley again, he asked her to give him a few minutes to "prepare himself."

She stepped out, and he frantically paged me, asking me to bring him a pair of sterile size 7 gloves. He didn't say why, but I realized what was up when I got there. He took the gloves and told me to distract the nurse for 5 more minutes. He wasn't going to let anyone touch his winkie.

When the nurse came back, she was stunned to see he'd put it in himself. Correctly.

Note: As of yesterday, Dr. Tallahatchie confirmed that (20 years later) he still smokes and drinks. He has not, however, attempted climbing a tree again.

Memories... part 1

One summer, a bunch of us neurology residents volunteered to work at a summer camp for teenagers with epilepsy.

This went well. Until the last day.

After the kids' bus had left, we learned the van coming for us had a mechanical issue, and would be delayed 4-5 hours.

So, with nothing better to do, we walked a mile to the nearest town, bought a shitload of cheap beer to carry back to camp, and got drunk. For those of you who are horrified, this is pretty standard. Medical residents are basically college students, but with more letters after their names.

This went well until our chief resident (Dr. Tallahatchie), the one in charge of showing us younger residents the proper way to do things and to lead by example... Decided to climb a large tree. This kind of decision (and the inevitable "Hey, everybody, watch this!") always seems to follow alcohol consumption. Especially when the person involved grew up in rural Mississippi.

In a bold display of intoxicated coordination, Dr. Tallahatchie climbed a tree about 15-20 feet up, then tried to swing across to a branch on it's neighbor. Which broke.

When we got to him, our chief resident was awake, still drunk, and had a broken bone sticking out of his right leg. The excessive alcohol probably helped, as he absently commented "boy, I sure fucked that up." He then pulled out a pack of cigarettes, began smoking, and pulled my beer out of my hand and finished it.

So we had several highly-trained medical people standing around, with no clue what to do for a compound fracture. I mean, if he'd had a stroke, or seizure, we might have had an idea. But we're neurologists, and don't know a damn thing about bones. None of us had a phone, either (this was the mid-90's) and the camp's office was locked. So, we threw some T-shirts on to absorb the blood, and Dr. Linn (who ran marathons often) bolted back to town to call an ambulance.

She also bought more beer.

When the paramedics arrived, they asked Dr. Tallahatchie to stop smoking for the ride back to Big City Hospital. He refused, and said he knew he'd be in the hospital for the next week and wouldn't be allowed to smoke there, so was going to keep puffing until they rolled him into ER. The sympathetic medic said "okay" and offered him a light. His partner went into the back of the truck to make sure their oxygen tank was closed and secured.

Our van didn't show up for another hour. We took Dr, Tallahatchie's suitcase with us. It was mostly full of comic books, which we read to pass the time.

To be continued...

Skool Nerse time

This is Mrs. Grumpy.

Last week I had a sick 7 year old girl in my office. While she was waiting for her aunt to come get her, I was reading some reports and swearing at them.

Nurse Grumpy: "Oh, Jeez! What's does this mean?"

Daisy Mae: "NURSE GRUMPY! You shouldn't swear like that!"

Nurse Grumpy: "Huh?"

Daisy Mae: "You said part of a word you're not supposed to say!"

Nurse Grumpy: "Oh, sorry, Daisy Mae."

(pause)

Daisy Mae: "Nurse Grumpy?"

Nurse Grumpy: "Yes?"

Daisy Mae: "I guess it could have been worse."

Nurse Grumpy: "I'm sure."

Daisy Mae: "I know the 'F' word."

Time

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

Mrs. Cephalgia: "Hi, I'm a patient of Dr. Grumpy's, and want to go off my migraine medication. I haven't had a migraine since I reached menopause, and don't think I need it anymore."

Annie: "Okay, let me open your chart... When did you become menopausal?"

Mrs. Cephalgia: "Tuesday."

Weekend reruns

Dr. Dickweed is an internist upstairs from me. He's been there since I moved into the building in 1997.

He's never referred to me. I'm polite. I've tried to talk to him in the elevator. When I started out years ago I went by his office asking for referrals. He coldly informed me that he doesn't trust, or refer to, physicians under 60 years old. Whatever. He's entitled to his opinion.

Anyway, Mary interrupted me today to say that Dr. Dickweed was on the phone. This was a first, so I picked up the phone.

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

Dr. Dickweed: "Grumpy, this is Dickweed. I just want you to know that I'm out of Grizzitor samples, and one of my patients needs some. I told her to come by your office to get them. Your staff doesn't need to schedule her for an appointment, and you don't need to see her. Just give her whatever Grizzitor samples you have."

Dr. Grumpy (somewhat taken aback by this kind request): "Dickweed, I'm out of Grizzitor samples. They stopped sampling it years ago."

Dr. Dickweed: "You young doctors are so fucking worthless." (click).

Quote of the day

"I'm allergic to all organisms that grow out of the ground."

Wednesday night, 10:27 p.m.

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

Mr. Molosser: "YEAH! You saw my daughter last week, she's in college up there, and I CAN'T BELIEVE WHAT YOU PRESCRIBED FOR HER MIGRAINES!!!"

Dr. Grumpy: "Um, sir, Migragone is a common treatment for migraines. It's been around for almost 20 years, and is pretty standard."

Mr. Molosser: "DON'T TELL ME THAT! I know medications! It's dangerous! It's experimental! I told her not to take it!"

Dr. Grumpy: "Are you a doctor?"

Mr. Molosser: "No, I manage a White Castle. And I'm having her find another neurologist. NOBODY treats my beautiful daughter like a guinea pig!"

Click

Parental abuse

My mom recently updated her phone to iOS 8, and texted to let me know.

"Those better be some damn fine scrubs!"

Seen on Amazon:

"Not just polyester and rayon, they're ARTISANAL polyester and rayon."

Thank you, Helle!

Family

I'm seeing the elderly Mrs. Cuticle, who's accompanied by her 2 adult daughters. We stopped talking for a few minutes so I could review records they'd brought, and...


Daughter 1: "When are you getting your nails done?"

Daughter 2: "I don't get my nails done. I've never liked it."

Daughter 1: "Well, you should. I mean, it's Autumn. I bet they could do them in some pretty seasonal colors."

Daughter 2: "I don't care, I don't want to get them done."

Daughter 1: "It helps them grow better."

Daughter 2: "It does not."

Daughter 1: "You'll look much nicer in church. It would really improve your appearance."

Daughter 2: "Are you calling me ugly?"

Daughter 1: "No, but you never..."

Daughter 2: "Zip it."

Daughter 1: "Mom, don't you think..."

Mrs. Cuticle: "Shut up. Why can't you ever NOT cause trouble?"

Daughter 1: "You always take her side."

Daughter 2: "Can you blame her?"

Mrs. Cuticle (whips out phone): "I'm calling Michael to give me a ride home. Both of you get out."

Daughter 1: "But Mom..."

Mrs. Cuticle: "Get out or you're grounded!"

Thursday afternoon whatever

Mrs. Dermtag: "There's a weird piece of skin on the back of my neck, so I'm having an autopsy tomorrow."

Dr. Grumpy: "You mean biopsy."

Mrs. Dermtag: "Whatever."

Reputation

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

Mr. Neuron: "Hi, I need to find out if I have brain atrophy. A friend said she saw something on TV about it."

Mary: "Okay, let me see... We have an appointment tomorrow afternoon at 4:00, or on Tuesday morning at 8:30, or..."

Mr. Neuron: "Can I just talk to the doc? Right now? On the phone?"

Mary: "You're not an established patient, sir, and he doesn't do that. I can certainly put you on the schedule, though."

Mr. Neuron: "But I don't need to come in. Can't he tell just from talking to me for a few minutes? Isn't checking for brain atrophy part of what neurologists do? It'll just take a few minutes, and I have time right now."

Mary: "I'm sorry, but you'll need to make an appointment to see the doctor. He doesn't do phone appointments, especially when he's never see you before."

(long pause)

Mr. Neuron: "You know, from seeing his name on the "Best Docs" list in Grumpyville Today magazine, I thought he'd be better than this."

(click)

Doctors behaving badly

I'm with a patient when Mary knocks on my door.


Mary: "Dr. Tanned is on the phone, says he needs to talk to you."

Dr. Grumpy: "Okay. Sorry, Mrs. Patient, let me take this call..." (picks up phone) "This is Ibee Grumpy."

Dr. Tanned: "Hi, Ibee. Sorry to interrupt you, but I just wanted you to know my wife works in home mortgages, and would like your business. Have you considered refinancing? She can get you a great APR."

Dr. Grumpy: "Are you kidding me?"

Dr. Tanned: "Not at all. She's saved a lot of people money on their house payments, and..."

Dr. Grumpy: "I'm with a patient. I have to go."

Dr. Tanned: "I'll fax you..."

I hung up.

Dear Medscape and Duke University,

Thank you for your recent invitation to take my practice "to the next level":

Your five courses sound enticing, exciting, and insomnia-curing. I'm sure they're ideal for doctors who wear suits every day and use phrases like "reaching out," "think outside the box," "patient empowerment," "corporate values" (an oxymoron if I've ever heard one), and "evidence-based paradigm." They probably make more money than I ever will.

I like how the price is down at the bottom in the smallest print. $899, with "per course" intentionally faded, hoping no one realizes this ads up to $4495.

Once upon a time, like many other doctors, I incurred a large educational debt. I don't want to do that again.

I like what I do, and have no interest in learning how to be a boardroom doctor who watches Powerpoint presentations, argues about what payment models are best for the shareholders, and denies medical coverage that might cut into his year-end bonus. I'd rather make less money and sit at the bedside of someone who needs my help.

Actually, the ad gives me the impression that the best way to make money in medicine these days... is to sell educational courses to doctors on how to make money. It reminds me of an old SCTV piece featuring the awesome Joe Flaherty as a huckster. He said something along the lines of "I came up with a great idea to get rich. I'm not going to tell you what it is, but if you send me $100, I'll mail you a pamphlet with some other ideas I had." (I couldn't find it on YouTube. If anyone knows where it is, send me the link and I'll embed it in here. No "Doctor Tongue's 3-D House of Stewardesses," please).

I've sat in enough classrooms in my time. I'll stay where I'm needed - with patients.

But, I have to thank you. Because after reading your ad I've already figured out a way I can save $4495.