Holidays are coming!

So if you'd like to send in a horrifically tasteless submission for this year's Dr. Grumpy gift guide, please do so! My email is in the right sidebar.

Thank you!

IG

Frail

Like most neurologists, I do EMG/NCV's. This is a test that involves needles and electrical shocks.

It's nobody's idea of a fun test, but we do get a lot of information from it, and for many disorders it's the best test there is for sorting things out.

As a result, it's not uncommon for me to get a fax from another physician's office asking me to do one on a patient. They send over the insurance info and all, and Mary calls the patient to schedule it.

About a week ago I received a fax from Dr. Livingston. It was an order sheet that said "Please do EMG/NCV on Mrs. Geri, possible hand pain." Mary called her number, reached her daughter, and set up the appointment.

Mrs. Geri came in a few days later. She was in a wheelchair, pushed by her daughter. Advanced Alzheimer's disease and incapable of doing anything other than mumbling gibberish. Frail, maybe 90 pounds. Occasionally she'd randomly wave one or the other hand back and forth.

I asked her daughter why Dr. Livingston wanted the test, and her daughter told me it was because of the intermittent hand waving. She hadn't complained of pain (or pretty much anything else).

And... I couldn't do it.

Sorry, Dr. Livingston. The $250 I'd get for putting this poor old lady through an unpleasant test that she couldn't understand seemed more like an exercise in greed and torture than a diagnostic medical procedure.

Not that I really blame Dr. Livingston. I'm sure he was just trying to find out why she'd occasionally wave her hands, but to me it was immaterial. Even if I found something, after putting this sad lady through unneeded discomfort, what would really be done with that knowledge?

I explained this to the daughter and sent them on their way. The billing sheet and her insurance info went into the shredder. I took a loss on the hour and sent Dr. Livingston a polite letter explaining why I hadn't done the test.

I'm sure he can find another doctor to do it. Maybe someone hungrier than I, or less willing to ask questions.

But I just couldn't do it.

Mary's desk

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

Ms. Caller: "Hi, I'd like to make an appointment with Dr. Grumpy."

Mary: "Okay, and what will you be coming in for?"

Ms. Caller: "I have Spritzgong-Fleagle Syndrome, and need to have an MRI done annually to check for new damage."

Mary: "Okay, let's see... This week is pretty busy, but I can get you in next Thursday, at 10:15."

Ms. Caller: "That won't work. I was hoping to get in this week so I can get the MRI done soon."

Mary: "Are you having new problems?"

Ms. Caller: "No, my regular neurologist will be back from vacation next week, anyway."

Mary: "Wait... you already have a neurologist?"

Ms. Caller: "Yes, I see Dr. Stevens, at Huge University Hospital. She specializes in Spritzgong-Fleagle Syndrome, but she's on vacation until next week."

Mary: "Then... why are you calling to see Dr. Grumpy?"

Ms. Caller: "I thought he could order an MRI, then I'd have it when I see Dr. Stevens next week."

Mary: "I'm sorry, but he doesn't cover for Dr. Stevens. You'd have to call her office to get the test done, or wait until she comes back."

Ms. Caller: "Thanks for wasting my time."

Click.

Parenthood

Dr. Grumpy: "How's she doing with the new medication?"

Mrs. Daughter: "Calmer, but she still treats me like a child."

Mrs. Dementia: "Are we at the doctor's yet?"

Mrs. Daughter: "Mom, this is the doctor."

Mrs. Dementia: "How do you do? This is my daughter."

Mrs. Daughter: "He's met us before, mom."

Dr. Grumpy: "How are you feeling, Barbara?"

Mrs. Dementia: "Don't talk back to me, young man!"

Mrs. Daughter: "Mom, he's the..."

Mrs. Dementia: "You don't talk back to me, either! Go to your room, right now!"

Dr. Grumpy: "Barbara, it's okay."

Mrs. Dementia: "And you're grounded, young man!"

September

Reminding all the guys out there that it's Prostate Cancer Awareness month. So be sure to get checked. And here's some special guests to say more.

Wednesday afternoon

I'm in line at the bank, and hear this conversation in front of me:



Teller: "Ma'am, I'm sorry, but we can't give you a cash withdrawal without any identification."

Ms. Deceit: "How about I just get the money today? I can come back tomorrow with ID."

Teller: "No, we need a form of identification before giving you the money."

Ms. Deceit: "Like I said, I left my purse at work, or I wouldn't be here in the first place."

Teller: "Well, you can certainly get it and return later."

Ms. Deceit: "Don't be silly. For that kind of trouble I might as well go to different bank. How about if I give you my cell phone number? You can call it right now, and I'll put my phone on the counter. When it rings that will prove it's me."

Teller: "We can't accept that. What we need is a photo ID and..."

Ms. Deceit: "A photo ID is easy. Don't you have a computer back there? I'll show you my Facebook page, so then you can see my picture and know I'm telling the truth."

Teller: "Ma'am, Facebook isn't an acceptable form of identification, and we'd also need to see..."

Ms. Deceit: "This is why I prefer online banking. Places with people in them, like this, just aren't customer-friendly."

(she leaves)

Phone calls

I'm with a patient. Mary interrupts me to say there's another doctor on hold, who needs to talk to me.


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

Dr. Call: "Hi, we have a mutual patient, Mrs. Memory."

Dr. Grumpy: "Hang on, let me pull up her chart... Okay. It looks like I haven't seen her since 2014."

Dr. Call: "Okay, you need to pull her driver's license. I don't think she's safe to drive."

Dr. Grumpy: "I really can't do that after 4 years without seeing her. Why don't you have her family call Mary to bring her in? I can see her tomorrow morning at..."

Dr. Call: "That's ridiculous. She needs to have her license cancelled today. Immediately."

Dr. Grumpy: "Why don't you call the state DMV? You can do it, too."

Dr. Call: "I'm very busy! I don't have time to do things like that! This is your problem!"

Dr. Grumpy: "I..."

Dr. Call: "Okay, since you don't seem to be able to, I'll take care of it. What is the DMV phone number?"

Dr. Grumpy: "I don't know it off the top of my head, but you can..."

Dr. Call: "I'll just have my staff do it. You're not very helpful."

She hung up.

"Stand back!"

Seen in a bladder-flow report:

All I need is a miracle

Aimovig is the first FDA-approved drug specifically developed to prevent migraines.

It’s getting a lot of press. Some articles talk about it as a breakthrough, some on how it shows the pharmaceutical industry is now focusing on migraine as a real disease, some on how it represents a new era in diseases that affect predominantly women, and many other spins.

Of course, it isn’t alone. There are 2-3 similar agents on the launch pads to join it in the next year.

From my daily office view, the phone calls (and drug reps) come in, and inevitably I hear it referred to as “the miracle drug.”

“I want to try the miracle drug.”

“I saw an ad for that miracle drug.”

“Someone at work told me about this miracle drug.”

Amgen, to their credit (not that the FDA would allow it, anyway), has NOT claimed it’s a miracle drug. The information they provide doctors is the usual glossy graphics surrounding dry statistics and obligatory legal wording. (Note - neither Amgen, nor their competitors, or anyone else, has paid me to write this post. These are my own thoughts).

People seem to need to think a drug is a miracle, in spite of all evidence to the contrary. This isn’t a slight against Aimovig - it’s human nature. Just as people thought of the Titanic as unsinkable (a claim never in reality made by her builders, owners, or officers) there’s a desire to believe human intelligence has somehow overcome a problem and cured it.

It’s not like Aimovig is the first drug to get that label, either. Botox is a miracle drug. So was Imitrex in 1992. Interleukin-2 in the 1980’s. Penicillin in the 1940’s. Willow bark in 500 B.C. (that's where Aspirin came from, people). And too many others to list.

Are these bad drugs? Far from it. But, like every other drug ever discovered, they have a lot of limitations. They work for some conditions, but not others. They ALL have side effects (if someone tries to tell you a drug or supplement doesn’t have any side effects, they’re lying). And, most importantly, humans are not a biologically identical group. No medication will work for everyone. If you read the stats on any med you’ll see that approval is based on a percentage of people who respond to it - and it’s never 100%.

There is absolutely no way to predict with 100% certainty who will - or won’t - respond to any given drug. For that matter, there’s no way to know who will - or -won’t - have side effects, or even which ones.

This is a trial-and-error crapshoot, people. We make decisions based on facts, but an educated guess is still just that - a guess.

There is no such thing as a “miracle drug. " And there never will be.

You won’t hear me, or hopefully any other reputable physician, ever tell you that a drug or surgery or whatever is guaranteed to cure you, or has no chance of harming you. Medicine is about as imperfect a science as there is.

If someone is making such a claim to you, run away. They just want your money, and don’t care about helping you.

I’m not knocking Aimovig. For some people it will be life changing. For others it won’t do a damn thing. Still others will have an unpleasant side-effect. The jury on it and its cousins is still out, and will be for at least 2-3 more years.

But don’t go into any treatment plan, for anything, thinking it’s going to be a miracle. There’s nothing wrong with being hopeful, but you can still do that and keep reality in mind. Because in this field, there are no guarantees.

Memories...

 

In the mid-80's I had a medical school interview in Chicago. It ran over and finished about 45 minutes before my flight home. And the drive to the airport was around 45-60 minutes.

I went out and hailed a cab. The driver was a dude with a scruffy beard. I climbed in and asked him if he’d be able to get me there on time.

He looked at me in the rear-view mirror and said “do you mind if I smoke?”

I said no.

He lit a cigarette, mumbled “fuck” then yelled “HANG ON!” and slammed on the pedal.

I discovered my seatbelt didn’t work, but just kept my mouth shut.

I made my flight.

I gave him a good tip.

Annie's desk

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

Mr. Consultant: "Hi, I saw Dr. Grumpy last week, and he told me to increase my dose of Flookadook from once a day to twice a day, and it hasn't helped my symptoms at all."

Annie: "Okay, did the increase cause any side effects?"

Mr. Consultant: "No. Why would it cause side effects? I'm still taking it once a day, and haven't had any problems with it."

Annie: "But you said you increased the dose to twice a day?"

Mr. Consultant: "No, I said Dr. Grumpy told me to do that. I didn't say I had."

Annie: "So..."

Mr. Consultant: "Anyway, my symptoms aren't any better. Can you please ask Dr. Grumpy what I should do?"

Bueller? Bueller?

Seen in a chart:

Sympathy for the devil

Please allow me to introduce myself. I’m Dr. Grumpy’s evil arch-enemy, neurological disease.

I’ve been around for a long, long year, stole many a man’s (and woman’s) soul to waste.

In the last year I’ve been in the headlines for my trifecta of stars with Parkinson’s disease: Neil Diamond, Alan Alda, and Linda Ronstadt.

The funny thing is that you people often believe life decisions or habits or activities can change your risk of meeting me. That may work for my friend heart disease, or for certain types of cancers, but me? Don’t kid yourself. Plenty of the things I do don’t have a known cause or risk factors, regardless of what some guy on the internet or TV tell you (and I bet he's trying to sell you something, too, claiming to cure it).

Others believe that a virtuous life will keep me away, or that I’m a punishment from God for being evil. You want good and evil? How about Pope John Paul II and Adolf Hitler (both Parkinson’s disease)?  You American evangelicals think you’re immune? How about Billy Graham (Normal Pressure Hydrocephalus). You think I care?

I especially love it when you try to attach political significance to me, like I’m here to punish someone on the side you disagree with. Let’s talk about Glioblastoma Multiforme, probably the most dreaded form of cancer there is. Here are 2 names from across the aisle, Ted Kennedy and John McCain. Here's another pair: Lee Atwater and Beau Biden. Political affiliations and age don't matter to me. The last pair were 40 and 46 respectively.

Before I forget, let’s talk about Alzheimer's disease: Ronald Reagan. Rita Hayworth. Charlton Heston. Glen Campbell. James Stewart. Perry Como. Jackie Fisher. Charles Bronson. Peter Falk. E.B. White. Rosa Parks. Burgess Meredith. Norman Rockwell. James Doohan. Fred Trump (yeah, his dad).

How about entertainers (besides those I mentioned above)? Slim Pickens. Gene Siskel, Ethel Merman, and George Gershwin (all Glioblastoma). Michael J. Fox, George H. W. Bush, Muhammad Ali (all Parkinson’s Disease). Terry Garr, Annette Funicello, Ann Romney, Richard Pryor, Montel Williams (all Multiple Sclerosis). Sir Laurence Olivier (dermatomyositis). Robin Williams (Lewy-Body disease). Dudley Moore (Progressive Supranuclear Palsy).

Let’s move to Amyotrophic Lateral Sclerosis, AKA Lou Gehrig’s disease or Motor Neuron Disease. This is probably the most dreaded disease in all of medicine. Obviously, Lou Gehrig and Stephen Hawking are the most well-known, but here are some other names: Mao Zedong. Catfish Hunter. David Niven. Stephen Hillenburg (creator of SpongeBob).

Epilepsy, while not usually fatal, can still have an impact on one’s life. Believed to be something to ashamed of for years, many places used to have laws on the books forbidding people with seizures from marrying or having kids. Here goes: Hugo Weaving. SCOTUS Chief Justice John Roberts. Bud Abbott. Vladimir Lenin. Neil Young. Lindsey Buckingham. Lil Wayne. Former U.S congressman Tony Coelho. Prince. Florence Griffith Joyner. Fyodor Dostoevsky. POTUS James Madison.

This list, of course, only covers famous people I’ve affected. There are far more who aren’t famous, but who are just as important. Somebody’s parent, grandparent, child, spouse, aunt, uncle, cousin, friend, co-worker, and many others. If I’ve touched them, then I’ve touched you. And you probably still remember both of us.

Years ago, I first met Dr. Grumpy when he switched from internal medicine to neurology, and I remember him telling me that it was a real shock. Back in medicine he saw mostly old people sick and dying, but in neurology it had shifted to younger folks. That discrepancy still bothers him after more than 20 years of doing this job. And it always will. He has me to thank for that.

So don’t go around making me a political, religious, age, cultural, racial, national, or whatever issue. I don’t give a crap about any of those things. I’m a human issue. If you think you’re special, and have done something that will guarantee I leave you alone, you’re wrong.

Seriously bad things, like me, can happen to you. Or anyone. Sometimes it’s just shit luck.

You don’t like that? There’s only one thing you can do. If you have some cash you don’t know what to do with, donate it to a reputable organization working to eradicate one of the diseases I’ve mentioned. Because research leads to knowledge, which leads to treatment. That’s the only way you may be able to get ahead of me.

'Cause I'm in need of some restraint.

Monday night, 11:18 p.m.

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

Mr. Vasculopath: "Hi, you were my neurologist at the hospital last week, when I had a stroke."

Dr. Grumpy: "Yes, what's up?"

Mr. Vasculopath: "Well, I'm really worried. You prescribed Otquoobo to keep me from having another stroke, and I read about it on AllDrugsArePoison.com. It says it's really dangerous, and so I haven't started it, and now I'm worried I'm going to have another stroke, and I got all upset."

Dr. Grumpy: "Okay, let's talk about it. Are you okay right now?"

Mr. Vasculopath: "Yeah, I'm better. I just smoked a pack of cigs to calm down."

"Hey, what's that smell?"

Seen in a chart:

Mary's desk

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

Lady: "Hi, I need to make an appointment with Dr. Grumpy."

Mary: "Sure. What will you be coming in for?"

Lady: "I've been falling a lot - I fell today, actually - and want to get my balance checked out."

Mary: "Okay. Our next opening is Tuesday, at 3:45, then Thursday at 9:00. We also..."

Lady: "Oh, I'll need farther out then that."

Mary: "Any idea when? Like a week, or..."

Lady: "Not sure. I mean, I broke my leg when I fell today. I'm in ER, being admitted to the hospital right now. I'm supposed to have surgery tomorrow morning, so I'll be here for a few days, and then they say I'll need to go to rehab for a couple weeks."

Mary: "Why don't you just call back when you know when you'll be able to come in?"

Lady: "Am I allowed to do that?"

Mary: "Of course."

Lady: "That's a better idea. I'll do that, then."

Weekend on call

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

Nurse: "Hi, this is Susan. I'm a nurse on the 7th floor, calling in a consult on room 7147."

Dr. Grumpy: "Sure. What's the story?"

Nurse: "He's a 22 year old who took LSD a few hours ago, in the park next to the hospital, and has since been really confused. His friends brought him to ER. Dr. Newgrad wanted neurology to see him for the confusion."

Pause

Dr. Grumpy: "Are you shitting me?"

Nurse (laughing): "I wish. I tried to talk Dr. Newgrad out of the consult, and suggested we just put on some Grateful Dead in there until it wore off."

It's a guy thing

Seen in a chart:

Birthday gifts

One of Dr. Pissy's staff has a delightful 2 1/2 year old girl named Rachel.

This summer, due to her babysitter being on a family vacation, Rachel is at the office most days. I'm sure this irritates some people, but at our little dumpster fire of an office, we don't care. She's fun and adorable, and is a pleasant distraction from the everyday routine of medicine.

Currently Rachel is in a phase where EVERYTHING is related to her birthday, even things that are not. For example:

Dr. Pissy: "Those are nice shoes, Rachel."
Rachel: "I got them for my birthday."
 
Dr. Grumpy: "Is that a good corn dog, Rachel?"
Rachel: "Yes. I got it for my birthday."

Random Patient: "Is that a horse you're drawing a picture of, Rachel?"
Rachel: "It's for my birthday."

(for the record, Rachel's birthday is somewhere around Christmas)

Yesterday, I was getting ready to leave and went to get my briefcase. For some reason Rachel followed me down the hall, and I didn't hear her behind me.

I picked up my briefcase, turned around, and WHACK! my briefcase hit Rachel on the side of her forehead. It wasn't too hard, but enough to surprise and hurt her.

"WAAAAAAAAAAAAAHHHHHH!"

Her mother (and most of the front office) came charging back to see what happened. I was trying to comfort Rachel (without much success) and as soon as she saw her Mom, she ran to her.

Mom: "Rachel, did you get hurt? What happened?"
Rachel: "DR. GRUMPY HIT ME IN THE HEAD FOR MY BIRTHDAY!"

Helpful

Actual fax received at my office:

Annie's desk

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

Mr. Tush: "I'm really not happy about this whole situation."

Annie: "Okay, what is..."

Mr. Tush: "Now they're telling me that my insurance may not cover the colonoscopy at all, and I can't afford this, so really don't want to go ahead with it."

Annie: "I think..."

Mr. Tush: "LISTEN TO ME! I'm not done yet. This is stupid. I'd never have agreed to go ahead with the colonoscopy except the doctor told me it was needed. I'm not going to pay for this and I want to cancel the whole thing. It's crazy that you people..."

Annie: "Sir..."

Mr. Tush: "NO! YOU LISTEN FOR A CHANGE. I didn't really want the colonoscopy, and now I find out it may not be covered, and..."

Annie: "LISTEN!"

Mr. Tush: "WHAT?"

Annie: "This is Dr. Grumpy's office. He doesn't do colonoscopies. You've called the wrong office."


Pause


Mr. Tush: "Well, shit. Sorry about that."

Click

Cue the "Jeopardy" theme

Dr. Grumpy: "Do you have a medication list?"

Mr. Time: "Nope, I know everything I'm taking."

Dr. Grumpy: "Okay, what are you on?"

Mr. Time: "The first one begins with 'T' and has a lot of letters."

July 4, 1939

"Fans, for the past two weeks you have been reading about the bad break I got. Yet today I consider myself the luckiest man on the face of the earth. I have been in ballparks for seventeen years and have never received anything but kindness and encouragement from you fans.

Look at these grand men. Which of you wouldn’t consider it the highlight of his career just to associate with them for even one day? Sure, I’m lucky. Who wouldn’t consider it an honor to have known Jacob Ruppert? Also, the builder of baseball’s greatest empire, Ed Barrow? To have spent six years with that wonderful little fellow, Miller Huggins? Then to have spent the next nine years with that outstanding leader, that smart student of psychology, the best manager in baseball today, Joe McCarthy? Sure, I'm lucky.

When the New York Giants, a team you would give your right arm to beat, and vice versa, sends you a gift — that’s something. When everybody down to the groundskeepers and those boys in white coats remember you with trophies — that’s something. When you have a wonderful mother-in-law who takes sides with you in squabbles with her own daughter — that's something. When you have a father and a mother who work all their lives so that you can have an education and build your body — it's a blessing. When you have a wife who has been a tower of strength and shown more courage than you dreamed existed — that's the finest I know.

So I close in saying that I might have been given a bad break, but I've got an awful lot to live for. Thank you."



-Lou Gehrig, terminally ill at age 36 with ALS (aka Motor Neuron Disease), in his retirement speech. He died less than 2 years later.

This is likely the worst disease in neurology, if not all of medicine. It's been 200 years since the first published report on it, and effective treatment remains a mystery.

If you're looking for a cause to give money to, consider the ALS Association.

Random pictures

All right, time to hit the mailbag for stuff you guys have sent in.


First we have this delightful hand lotion:

Then we have this playground equipment, apparently designed prior to Copernicus, or the discovery of the sun for that matter:

Here's a "trending" news item, apparently created by a random word generator in Wisconsin:

Here's a mystery question that a reader says was part of her on-line medical license renewal:

Then there was this guide to grilling that could have used an extra word:

Seen in a chart

The Master

In the 1980's Mojo Nixon claimed "Elvis is Everywhere." While anyone who visits Vegas might concur, I have to disagree.

Here, at Grumpy Neurology, Yoda is everywhere.

Sure, he may be in many disguises, but even a Jedi Master can't hide that characteristic language pattern from a trained DoC* like me.

The following are quotes I've encountered:

From patients:

"Twenty-one headaches I had in May. Many migraines that is."

"Make the seizures stop, can you?"

"I tried to talk, but speech-wise, I could not." 

"Much pain my back does have."

"Forgot you also this, Topamax, work it did not."


In an MRI report:

"Nothing abnormal does the MRI show."


From a nurse:

"Ativan received at 8:00, she did."


From a drug rep:

"Reduction in pain they will have, yes."


From my secretary:

"3:15 tomorrow his appointment is."


And (my favorite) was this patient interaction:

Dr. Grumpy: "You really need to stop overusing Excedrin."

Lady Rebound: "It's hard, but I'll try."

Mr. Rebound: "No! Do... or do not. There is no try."


*Disciple of Charcot

Blood pressure and other things

Mrs. Methodical: "My blood pressures have been good, too."

Dr. Grumpy: "I'm glad. What have they been running?"

Mrs. Methodical: "I have a list in my purse. Would you like to see it?"

Dr. Grumpy: "Certainly."

She rummaged in her purse for a minute, then handed me this:

GAAAAAHHHHH!!!

Dr. Grumpy: "Any side effects with the new pill?"

Mr. P: "Only one, it makes my urine smell like something terrible."

Dr. Grumpy: "Okay and what about..."

Mr. P: "I brought some, in case you want to smell it."

Pulls Tupperware container out of bag.

That's a wrap, folks

With the school year down to it's final 2 weeks, I'm shutting down the blog until the shouting here is over. Too much band stuff, year-end competitions, parties, and other stuff to deal with, besides my day job.

See you in a few weeks!

Texting with Frank

Mrs. Grumpy asked me to deal with dinner. Not knowing what the food status was at home, I made the mistake of asking Frank for help.

Some days... Sigh.

Phone

Mrs. Whiney was not happy.

She'd shown up 45 minutes late for her new patient appointment with no other explanation than "I have other things to do too, you know!"

Now she was not accepting that I wasn't going to see her and she'd have to reschedule for the next available slot, 2 weeks from now (and I thought I was being nice by letting her do that).

She'd berated Pissy's staff, who'd gotten Mary.

She'd been chewing out Mary, who'd finally walked away from the window and called me out from a patient room.

She was absolutely stunned when I told her I agreed with Mary, and she wasn't going to be seen today.

In an attempt to get me to give in she menacingly said "I. Want. You. To. Know. That. I'm. Calling. Dr. Stevens. And. Telling. Him. You. Treat. His. Patients. Like. This."

I smiled and wished her a good day. She pulled out her phone, knocked on the window, and asked if we could give her Dr. Steven's phone number. We ignored her.

Now it was time for her to make a scene for the rest of the lobby. And she made the critical mistake of getting her phone involved.


Mrs. Whiney: "Siri! Call Dr. Stevens!”

Siri: “There is no Dr. Stevens in your contact list.”

Mrs. Whiney: “SIRI! CALL DR. STEVENS RIGHT NOW!”

Siri: “Now playing 'Right Here Right Now' by Jesus Jones." (music starts)


Some elderly guy in my lobby and the drug rep he's never met before next to him start holding each other to keep from cracking up.


Mrs. Whiney: “SIRI! STOP THIS SONG AND CALL DR. STEVENS!”

Siri: “There is a chiropractor 1/2 mile north of you. Would you like directions?"


Drug rep starts snorting loudly and runs out of office, mumbling something about allergies.


Mrs. Whiney: “SIRI! CALL DR. STEVENS!”

Siri: “I found 3 pharmacies within two miles. Would you like me to call one of them?"


Mrs. Whiney throws her phone on the ground, picks it up, shoves it in her purse and yells "IT"S NOT FUNNY!" She storms out.

A few seconds passed before everyone in the office and lobby completely lost it and became hysterical. Including the patient who'd wandered out of my office to see why I hadn't returned.

Thrift

Dr. Grumpy: "How's the new medication working out for you?"

Mr. Pill: "Terrible! I'm nauseous all the time, have headaches, and throw up a lot!"

Dr. Grumpy: "Then let's stop it and..."

Mr. Pill: "I don't want to do that! I just bought a 90 day supply!"

Surprise!

As the school year begins wrapping up, we're moving into the next phase of the Wingnut High School marching band schedule: preparing for next season's football halftime show.

Yeah, you read that right. The next high school football season starts in 3-4 months, and so the twins and their friends are already working on the show.

So yesterday a flyer was sent home with the twins, listing all the stuff. Band camp dates. Meetings over the summer to start working on props. The theme of the show. Where to find the music to practice. Marching formations. Color guard maneuvers. Incoming freshmen orientation. Yadda yadda yadda.

About halfway down the page Mrs. Grumpy and I were surprised to find a paragraph that said “Practice marching sessions for the new steps and formations will be June 19, 25, and 29, July 7, 14, and 22, and August 12, 18, and 22. These will be held at Craig Grumpy’s house from 10 a.m. to 2 p.m. Bring your own water bottle. Lunch will be provided.”




CRAIG!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Coffee

Dr. Grumpy: "Are you much of a drinker?"

Mr. Collins: "Nope. Not at all. Just coffee, but I admit I'm a caffeine junkie. I drink it all day."

Mrs. Collins: "What are you talking about? You put Baileys in your coffee all day! You even keep it in that little thermos you sneak to work!"

Mr. Collins: "That doesn't count!"

Seen in a chart

Remember medical students: taking a good family history now includes covering test conclusions, free text, and practice management, but fortunately not retardation or cancer.

Random pictures

Okay, time to hit the mailbag for stuff you guys have sent in.


First, taken in a subway, is this opportunity that could end unemployment:

 

Here's this headline, which is just begging for someone to snicker at it.

 

Then there's this refrigerator drawer in a reader's recent appliance purchase, which sounds somewhat obscene:

 

 Here's a coffee pot seen early one morning at a hospital nurses station:

That's an interesting name for your iPhone:

And, finally, this box label. Which seems awfully pretentious for a freakin' cantaloupe.

Early

Guy comes in, stands at counter.

Mary: "Can I help you, sir?"

Guy: "Uh, I think I'm early for my visit."

Mary: "Okay. What time is your appointment?"

Guy: "I don't have one."

Great moments with Amazon

From the "now they definitely won't fall out" department.

Thank you, T!

Monday Reruns

Okay, everybody, let's take the Way-Back Machine to the early 1990's, when 4th year medical student Dr. Grumpy is interviewing for residency.


After medical school, young docklings go off to residency in our chosen fields.

But before we get into residency (through a mysterious process called "the match") we go off on interviews. Just like any other job.

I did my share of these interviews, traveling to 7 neurology programs in the early 90's to peddle my wares. These aren't quite as stressful as medical school interviews (for those you're begging them to take you, while for residency they need you & you need them, so both sides are trying in impress each other).

And this is the story of my least impressive interview:

I'd flown into the city the night before, and spent a relaxing night at a Motel 6.

The interview instructions said I was to begin by attending the Shitzenfuk Hospital Neurology conference at 7:30 a.m. This was several miles from the residency program's main hospital. And they actually told me to "ask around when you get there, and find a doctor willing to drive you back to our offices after the meeting".

So I took a cab from my motel to the hospital, and found the auditorium. Here I am, in a strange city, dragging my overnight bag around, with a bunch of docs who I don't know and who don't know me, and I'm walking around trying to bum a ride. Finally, after several looked at me like I was a sexual predator, one finally said. "Okay, I'm heading that way. I guess I can give you a ride."

Guess what? He turned out to be the freakin' chairman of the program I was interviewing at! He'd signed the letter telling me to bum a ride. You'd think he could have offered initially, since he knew I'd be there, but no.

So we walk out to his car. Mind you, I'm not a car snob. I don't expect doctors to be driving expensive things (my own car is a 2000 Nissan), but nothing could have prepared me for Dr. Chairman's mean set of wheels.

It was an early 70's Japanese something. Missing the right front fender. The trunk was half open, held down by a bungee cord threaded through a rust-hole.

I opened the passenger door. And a pile of empty soda cans, newspapers, fast food containers, orange peels, and heaven knows what else, fell out. Dr. Chairman said "sorry, let me clear that off" and began chucking the pile of garbage into the back seat (which was already covered with trash).

And off we went. It was December, and cold. My window was open. I tried rolling it up, but he said, "there's no window there, it broke years ago." The heat didn't work, either. So I was shivering away, with my overnight bag on my lap (no space for it anywhere else in the car). I hoped his driving skills were better than his car-care talents, because my seatbelt didn't work.

So we got to Neurology HQ. Where Ms. Bitchy at the desk (Dr. Chairman abandoned me as soon as we walked in) claimed I hadn't been invited for an interview, even when I showed her my letter. Eventually she realized she was looking at the previous week's schedule, and blamed me for having handed her the wrong schedule (which she'd actually pulled out of her desk).

Then it was time for my tour of the esteemed facilities. Ms. Bitchy directed me down a hall, and told me someone would meet me there.

Fortunately, one did. It was a nice guy named Pete, who (allegedly) was the chief resident. We talked for a minute in the middle of the building's lobby, which had white pillars everywhere, and halls leading in different directions.

After giving me a brief summary of the areas we'd be going to, Pete said, "It's a beautiful hospital. Follow me." He then turned around and walked straight into a pillar, breaking his glasses.

I helped Pete up, while some other guys in white coats ran over to try and stop the blood now pouring out of his nose.

As they led him away, Pete told me to wait in the lobby. A few minutes later Ms. Bitchy showed up, leading a girl in scrubs who'd apparently been on call the night before, and looked (understandably) less then enthusiastic about showing me around. It was a pretty quick tour.

Afterwards I had an interview with a doctor, who used most of our interview time to return patient calls. He also called Mastercard to argue about some charges, which he blamed on his ex-wife.

Then it was (per the schedule) lunch with the residents. None showed up. It was me and 3 attending physicians. Ms. Bitchy, the secretary-from-hell, had only ordered 3 lunches. She gave one to each of the doctors, and told me where I could find the hospital cafeteria.

I just went hungry, and spoke to the doctors. One of them told me he thought the newfangled MRA technology was a passing fad.

Then it was another interview. This time with Dr. Chairman of the crappy car. Who'd inexplicably left for the day. No one knew where he'd gone, or why.

Thus ended the interview. Ms. Bitchy told me she'd arrange a ride for me back to the airport, but given her remarkable organizational skills displayed thus far, I declined. She wouldn't let me use the phone on her desk, so I found a pay phone and called a cab.

I ranked them last. I have no idea where they ranked me. And no, I didn't go there.

Memories...

In the early 80's my family went on a generic “American Family Goes on a Bus Tour of Europe” trip. My sister and I (both teens) shared a hotel room.

My mom, for some reason I don’t remember (perhaps I never knew) had packed a bunch of off-brand blueberry Pop-Tarts. They weren’t even the real thing, some cheap store generic. Maybe she thought they didn’t have food in Europe. So this box of suckish store-brand pop-tarts was tossed in a suitcase, flown across the Atlantic on a 747, dragged over land in a tour bus, and taken across the channel in a hovercraft (yeah, there was no Chunnel, youngsters). For the record I think it was stale long before we even left. Possibly before she bought it. Why it made the trip I still don't know.

Anyway, late one night in Paris, while watching the crappy hotel room TV and trying to guess what they were saying, my sister and I had a big fight over something. I don’t remember what. It escalated from shouting to throwing things... and the nearest things at hand were the pop-tarts.

As we hurled them back & forth the silver packages tore and opened, sending chunks of pop-tarts  flying everywhere. If a piece was big enough to throw, it was thrown. I think we also threw some rock-hard raisin buns leftover from breakfast, hotel stationary, pens, and anything else lying around.

When it was over there were stale crumbs, frosting, and streaks of nasty artificial blueberry filling EVERYWHERE. Walls, blankets, sheets, curtains, TV, mirror, me, sister, door, carpet.

We checked out in the morning to move on to whatever the next country was. I have no idea what the place's cleaning crew thought of the bizarre mess.

My sister and I were terrified Dad would chew us out about extra charges for damages, but it never happened.

Time

Got this inquiry in a research email:

Not sure what sort of range they're really looking for, but curious where they came up with the higher end. If you're seeing 100,000 patients with ANYTHING in a 31 day month, it means you're spending 27 seconds with each of them. Provided, of course, that you don't stop to eat, sleep, or hit the bathroom.

"Hello, I'm your doctor. Have a nice day."

Seen in a chart

- Thank you, KC!

Turing test

Guy in suit comes in and stands at the front. Mary was tied up on the phone, and Pissy's staff had run out to pick up lunch. So I walked over to deal with him.

Dr. Grumpy: "Hi, can I help you?"

Suit guy: "HI! I'm your rep for the all-new Ginsu surgery center! Are YOU" (points finger at me) "Dr. Grumpy?"

Dr. Grumpy: "Uh, yeah, but I don't do..."

Suit guy: "I'm here to get YOU, Dr. Grumpy" (points finger at me) "to start doing YOUR outpatient procedures at the all-new Ginsu surgery center! What kind of outpatient surgical procedures do you do that we can help YOU, Dr. Grumpy" (points finger at me) "with?"

Dr. Grumpy: "None, actually, I'm a neurologist and..."

Suit guy: "Of course you do! ALL doctors have procedures! Which ones do YOU, Dr. Grumpy" (points finger at me) "do?"


(I look around. I'm alone. I hear Mary, with Pissy's returned secretary, out in the hall trying not to crack up in hysterics)


Dr. Grumpy: "EEG's. But those aren't..."

Suit guy: "We don't do THOSE at the all-new Ginsu surgery center, but we can help YOU, Dr. Grumpy" (points finger at me) "achieve better results on your outpatient laparoscopic appendectomies, gall bladder removals, and orthopedic arthroscopies. Why don't YOU, Dr. Grumpy" (points finger at me) "give the all-new Ginsu surgery center a try? I bet YOU, Dr. Grumpy" (points finger at me) "would be pleasantly surprised at what we can do for YOU, Dr. Grumpy" (points finger at me) "and your patients!"

Dr. Grumpy: "Look, I'm sorry. I don't mean to be rude, but you're wasting your time here. I'm a neurologist. I don't do surgery of any kind."


Long pause


Suit guy: "None at all?"

Dr. Grumpy: "Zero. Nada. Zilch."

Suit guy: "Okay, so what do you, um, Dr. Grumpy" (sort-of points finger at me) "as a, uh neurologist doctor do, exactly?"

Dr. Grumpy: "I sit at a desk all day and try to look smart."


Longer pause


Suit guy: "Um, I mean... uh..."


He left.

Breaking news!

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



DATELINE: FLORIDA: Xavier Moran was in a car accident, and told police that his dashboard camera could prove he was cut off by another driver. To prove it he turned the camera over to police and signed a waiver allowing them to search the data file.

Unfortunately, the same camera also had footage of Mr. Moran using a baseball bat to burglarize a beauty supply store a few hours prior to his accident.

He was arrested for the burglary. No word yet on whether someone really did cut him off in traffic.



DATELINE: NEW YORK: Police were mobilized last Thursday after someone reported an escaped tiger running loose in Manhattan.

Investigating officers found it was actually a racoon.

A local news reporter suggested the caller visit a zoo to learn the difference.

The racoon has been turned over to the ASPCA.




DATELINE: not sure, somewhere in the U.S.

A reader sent in this pic of an, uh, innovative way to replace a broken rear window:

Special

Now I really feel valued. Thanks, Medscape!

Thank you, CU!