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.

Neurology humor

Two neurologists were walking along the street when they saw an old-timer veteran cop walking a beat with his legs wide apart. He was stiff-legged and walking slowly. One doctor said to his friend: "I'm sure that poor old cop has Peltry Syndrome. Those people walk just like that."

The other neurologist says: "No, I don't think so. The old cop surely has Boyd Syndrome. He walks slowly and his legs are apart, just as we learned in training."

Since they couldn't agree they decided to ask the cop. They approached him and one said, "We're neurologists and couldn't help but notice the way you walk, though we couldn't agree on the syndrome you might have. Could you tell us what it is?"

The old-timer said, "I'll tell you, but first you tell me what you two fine upstanding neurologists think." The first doctor said, "I think it's Peltry Syndrome." The old-timer said, "You thought - but you are wrong." The other neurologist said, "I think you have Boyd Syndrome." The old cop said, "You thought - but you are wrong."

So they asked him, "Well, old timer, what do you have?"

The old-timer cop said, "I thought it was just a fart- but I was wrong, too!"

- Thank you, Officer Cynical!

Friday morning, 12: 38 a.m.

This message, left on the on-call emergency voicemail, woke me up:


"Dr. Grumpy, you can cancel all my appointments. I'm very hurt. This is the 2nd year that your lousy practice hasn't sent me a birthday card, like my dentist does. I think you're an asshole. Goodbye!"

No kidding

Dr. Grumpy: "Are you allergic to any medications?"

Mrs. Ambu: "Succinylcholine"

Dr. Grumpy: "What happened when they gave you succinylcholine?"

Mrs. Ambu: "I stopped breathing."

Snow

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

Mr. Flurry: "Hi, I have an appointment later this morning, but am trapped at home by all the snow."

Mary: "I understand, we can certainly reschedule it for later this week, or next. What times of day work best for you?"

Mr. Flurry: "No, I'd really like to make this appointment. Isn't there some special doctor's line you can call or something, where they direct snow plows to my house and clear a route so I can get to the appointment?"

Mary: "No sir, there is no such phone number."

Mr. Flurry: "That's ridiculous. He's a doctor. Doesn't he know the governor, or mayor, or someone who can do that?"

Mary: "No."

Mr. Flurry: "This is stupid. I thought he was a good doctor, but obviously my appointments there have been a waste of time."

Grammar

Seen in a veterinary orthopedic course brochure:

 

Thank you, Webhill!

Bagels

I recently was at a hospital staff meeting where one of the administrative clowns got up to speak. He was trying to show us how grateful the hospital is to have all of us, and mentioned that the food in the doctor's lounge costs the hospital $350,000 a year, so we should be thankful.

I know this sort of thing varies between hospitals, but here's what mine supplies to doctors for that $350K:


Morning: bagels and donuts. Boxes of cereal and instant oatmeal. Granola bars. Little milk cartons in the fridge.

Lunch: Tray of deli meats and cheeses in the fridge. Irritatingly small cans of soda. A tray of cookies.

Dinner: Not supplied. Whatever is left over from breakfast and lunch.

Always available: coffee, tea, sliced bread, English muffins, little packets of peanut butter, jelly, butter, and honey.


So, I guess that's what $350,000 a year gets you. I'm sure you also have to figure in there the salary of the person who restocks & cleans it each day, frequent repairs to the heavily-used coffee machine, and a few other items. Plus, they probably fudge in how much money they're losing by not giving us the finger and turning the lounge into another endoscopy suite.


That's not a huge sum of money in the modern healthcare world, but since hearing that figure, I keep wondering how it might be better spent. Maybe a few more nurses in the rotation. Or respiratory techs. Or physical therapists.

I'm sure some doctors would whine, but realistically I think most would be happy with coffee and a bagel in the morning, since that's when most round, and the hospitalists buy their own stuff for lunch anyway.

There are certainly bigger wastes of money in modern healthcare: CEO bonuses (at my hospital his was around $7 million last year) and paying Press-Gainey to do surveys, to name two of them. And the people involved in those things don't care about patients, anyway (regardless of what their PR staff tell you).

But I do care about patients, and would be more than happy to give up a deli tray, cookies, or even a bagel, to improve their care.

That's provided the money actually went to that use. Realistically, it would probably just go to some administrator's year-end bonus for the money he saved by cutting coffee and bagels out of the doctors lounge.

Survey says

Dr. Grumpy: "So, I last saw you a week ago, when you were in the hospital for Transient Global Amnesia. How have you been doing?"

Mr. Percheron: "Fine, I guess, everything seems back to normal. I've returned to work."

Mrs. Percheron: "He's back to himself."

Dr. Grumpy: "Good."

Mr. Percheron: "I have a question, though."

Dr. Grumpy: "Go ahead."

Mr. Percheron: "What am I supposed to do with the survey the hospital sent me? It has all these questions about my stay, but I don't remember any of it."

Overheard on rounds

Nurse: "Have you had any previous heart issues?"

Patient: "I have a porcelain heart valve."

Nurse: "You mean porcine heart valve?"

Patient: "Whatever."

And now, music

Seen in a chart

This isn't the first time I've put up stuff like this, and it won't be the last.

But you know what? Crap like this is no longer the exception. It's the rule. I'd say at least 50%-60% of charts I read from hospitals and practices that use computer charting systems (which is pretty much all of them) have errors of this kind.

And these are what the world is pushing us to use more and more of.

I'm not saying computer chart systems are bad things. They have a lot of advantages. But they also encourage the slacker inherent in all of us. It's easier and faster to check boxes, cut & paste, and use templates than it is to actually type out what's correct. Especially if you skip the critical step of proofreading what you've just done. Most do.

The majority of these errors are just amusing. This one is just stupid, but likely won't cause a serious patient outcome.

But if it can make an error about smoking, it can also make them about your allergies. Your current medications. What conditions you have. Your past surgeries.

And one "minor" error in any of those could lead to a disaster in the right setting.

Cole slaw

I'm in the emergency room, talking to a patient's wife:



Dr. Grumpy: "When did this all start?"

Mrs. Concern: "Last night. He fell down in the bathroom, and said he couldn't move that side."

Dr. Grumpy: "Then what happened?"

Mrs. Concern: "I figured he was just angry at me, and trying to get attention. We'd had this big argument over cole slaw at lunch, because..."

Dr. Grumpy: "Okay, but last night..."

Mrs. Concern: "Oh yeah, anyway, so I watched some TV in bed - there's that new detective show I like - until I fell asleep. When I woke up this morning he was still on the bathroom floor, and boy, was he angry. So that was when I called paramedics."

New year's day

10 years

This post wraps up 2018. I'll be taking 3 weeks off, and will see you guys in January.


December 21, 2008, was, apparently, a slow news day. In looking backwards I really can't find any articles of note from the major news outlets on that date's happenings.

But to me it was a big day as I published my first post here.

A lot of factors had led up to it. For years I'd been collecting stories hoping to write a book... someday. But life, work, and kids get in the way of those things. At some point I realized the book was never going to happen.

Then, in 2008, a change in my practice led to me having a bit more free time. So, instead of a book, I decided to share my stories on this blog.

And here I am, 10 years out. My numbers have gone up and down, but I still seem to have a following. For that I'm grateful. If it wasn't for you guys there wouldn't be a reason to do this. My posts have dropped from twice daily to 2-3/week, but I'm still cranking them out and hopefully will continue to do so.

I appreciate those of you who have stayed with me and written comments. I've only been mentioned once in the general media, but knowing you guys are reading makes it worthwhile to keep doing this.

At 10 years out I want to thank my wife, for putting up with me, and my kids, who've grown from small rug rats to young adults heading for college since I started this.

I also want to thank Mary and Annie, also for putting up with me and supplying me with stories to share. Without you guys I wouldn't have a real job.

My patients deserve a big round of applause. Without them I wouldn't have this blog. Most of them are good folks, and I genuinely appreciate them making my job a fulfilling one. Medical blogs may give you the impression that most patients are insane, or stupid, or both, but that's far from true. The vast majority are good people, but stories of normal patient encounters are boring and aren't why you come here.

Lastly, I want to thank all of you guys for sticking with me over time, sharing your thoughts, and making this fun.

A special thank you is deserved by those I've met through the blog and who I'm now proud to call friends. We may never meet in person, but knowing you're out there is good enough for me.

Thank you all, have a great holiday, and I'll be back on January 14, 2019.

IG

2018 Holiday gift guide

Do you have a friend who's a dentist? Do you want to give your dentist something more meaningful than the gouges you leave on the arms of his exam chair? Do you know someone who simply has no sense of taste (me, for example)?

Then consider this cozy pair of pants:

Featuring an attractive pattern of molars and bicuspids in alternating red and white (I guess the color depends on whether you remembered to stop taking warfarin before your root canal), these pants are ideal for visits to the dentist, holiday parties, and any job you're hoping to get fired from.

2018 Holiday gift guide

Those old enough will remember Rockwell's 1980's hit "Some Random Guy is Watching Me."

Wait? That wasn't the title? Never mind.

But if you have a friend who has delusions of that sort, you can order this for them:

The "Old Asian Man Wall Decal" (seriously, that's what it's called) is available from a number of websites for people wanting to add it to their home's atmosphere. Or something.

2018 Holiday gift guide

Do you have a friend who's trying to attract the perfect guy, hoping her perfume will do the trick?

Maybe you should get her this:

Let's face it, nothing gets a guy's attention like a woman who smells like a slab of roast beef. Or an Arby's.

If nothing else, she'll certainly have the attention of every dog in the neighborhood.

Saturday morning

Frank got home from his first college semester last night.

This morning, Mrs. Grumpy and I were woken from a sound sleep by screaming and loud noises.

Apparently, at around midnight, Frank couldn't sleep and set up his laptop to work. He'd forgotten the password for our home WiFi network. Instead of, say, waiting to ask someone in the morning, he just wiped the router and changed the passwords.

This morning the twins discovered what had happened, and went bananas when they couldn't get online. His door was locked, and when they couldn't wake him up, Marie and Craig kicked his door in.

Now Frank is upset we woke him up on his first day of break.

I'm taking the twins' side.

2018 Holiday gift guide

Do you have a friend who thinks he has animal magnetism? Maybe these boxers are the perfect gift:

Available from Newchic, this pair of boxers has a series of magnets sewn into the vital package-support area. The website makes claims about this boosting the immune system (it doesn't say if they specifically mean against STD's), "releasing energy," (if my winkie was glowing that color, I'd be pretty worried about the energy source) and (my favorite) improving the body's oxygen supply.

Plenty of guys, myself included, have been accused of thinking with our male appendages. To date, however, I've never been accused of breathing through it.

Isn't that right, Mr. Snuffleupagus?

2018 Holiday gift guide

Mattel, the company that brought you Barbie, Hot Wheels, Masters of the Universe, American Girl, Polly Pocket, and Matchbox, now brings you its next big seller.

And... I'm going to have to let these ladies describe it, because I couldn't possibly do a better job.

Please note, this is not a joke.

2018 Holiday gift guide

Like most medical students, you're tired. You just finished class and want to crash out on the couch. But you've also got a big test tomorrow and need to study. What can you do? Hey, I've been there myself.

You can hit the textbooks, or you can study planted on the couch if you have this human anatomy throw pillow!

What better way to get some studying done, or liven up a dinner party, than with this useful pillow cover? (Sorry, folks, the pillow isn't included).

To quote from the product description:


"Makeover and refresh your rooms with just a single touch!"

"Perfect for your home, office, playroom, kids room, cafe, study, studio, club, bar and others."

"No dye substance harming the health of you and your family."

"A perfect gift idea for your mom, dad, sister, brother, grandma, wife, husband and all other beloved ones."

"They will be shocked by the superior quality of the item when they open the present."

"We follow current trends and bring you the latest home fashion."

"A gift to your family or friend, relative or boyfriend girlfriend, or to yourself, the item should be interesting and authentic."


It most certainly is.

2018 Holiday gift guide

Do you have a friend who needs some absolutely pointless piece of furniture? Do you have an extra $12,000 you'd like to blow?

Then this is perfect!

Why have a routine sofa that takes up horizontal floor space, when this one stands vertically?

Yes, you could take the regular sofa you already have and stand it on it's side, but what's the point? This one already does that!  Instead of getting some piece of schlock that does nothing but let people sit on it, you can have one that serves absolutely no purpose other than to say you can afford it! And isn't that what home decorating is all about?

Joe and Al

Joe and Al are both patients of mine.

They don't know each other.

They were born in the same year, a few thousand mild miles apart, speaking different languages.

To most who meet them they come across as polite older gentlemen, each with a good sense of humor. They may notice Joe's tremor or Al's speech difficulties, but neither is a major part of who they are.

But to me, they mean a lot after 20 years in practice.

Joe was born in Poland. His father was a tailor, and Joe worked in the store growing up. Because they were Jews, the family business was closed by the government so they had no way to support themselves. He saw his father beaten to death for trying to keep the family together while boarding a train. His mother was put in a different train car and never seen again. His sister was forced to work in a brothel for German officers and was never seen outside that building again. He and his brother were together until they got to the camp sorting area. His brother, who had a bad cough that week, was sent to a gas chamber. Joe was sent to do slave labor, and was still alive when the camp was liberated by allied forces. Joe, at 5'10" weighed 94 pounds by that point, and was hard to distinguish from the dead bodies he'd been forced to carry outside.

After recovering in a military hospital, Joe decided to leave Europe forever. He immigrated to America, settling in Omaha. He went to school, married, raised a family, and spent most of his life in a quiet, unassuming, desk job. Today he's nearly blind and needs a walker to get around. His wife is still at his side, and sometimes one of his kids.

Al was born in Los Angeles. He worked in a grocery store and went to high school until he turned 18, when he was drafted into the Marines.

On the morning of February 19, 1945, he was roughly 6,000 miles from L.A., in landing crafts with 60,000 other Marines, approaching the peaceful-appearing sands of Iwo Jima in the south Pacific. As they clambered ashore and gradually moved inland it was surprisingly quiet, with none of the resistance they'd encountered on previous islands.

About an hour after coming ashore, that all changed. The well-hidden Japanese forces opened up on the beach with machine guns and heavy artillery, creating a hell-on-earth. There was nowhere to hide. Al saw guys he'd had steak & eggs with a few hours earlier (the standard U.S. Marine breakfast for landing forces) collapse around him, dead. Some were wounded, and he and others tried to get them to whatever safety they could find. Then he was hit himself, but worked to help others until he blacked-out from blood loss. He woke up on a hospital ship.

After the war he returned home, finished school, and managed grocery stores until he retired. He and his wife raised a boy and 2 girls. They recently celebrated their 60th anniversary. Today he uses a walker and oxygen tank, and is nearly deaf, but still has a hearty laugh.

At this point both are in their 90's. The horrors they experienced aren't forgotten, but hidden behind a lifetime of mundanity (which, lets face it, mundanity describes most of us, and it isn't a bad thing).

In my mind they're bound together by being (most likely) the last of their kind I'll meet.

I've seen my share of Holocaust survivors, but as the years go by they've decreased, and I doubt I'll meet another after Joe.

Similarly, in 20 years I've cared for plenty of WW2 veterans, but see them grow fewer, and the odds are I won't meet another who fought at Iwo Jima.

Like many of their generation, neither wants to talk about what they went through. The memories are painful, and both men would rather be defined but what came afterwards: their families.

But they, and what they went through, shouldn't be forgotten.

Ever.

2018 Holiday gift guide

How many times have you gotten home from a long day at work, opened a cold beer, and thought, "Boy, I'm tired. I'd love to relax by putting my head in someone's ass crack."

Me neither.

Butt, if you have any friends who think this way, now there's the perfect pillow to give them!

Yes, you can relax by lying down with your head on a simulated keister. If people are always telling you that you have your head up your ass, you can now respond, "no, that's my pillow."

The website says they're "squeezable, slappable and face buriable" for those who consider these to be desirable features in tuchus-shaped bed accessories. It also notes "you can dress up your Buttress with undies and PJ's," provided you're into that sort of thing.

I understand that Mr. Arthur Frampton is coming out with a deluxe version.

2018 Holiday gift guide

Yes, as the Earth rolls around its G-type main-sequence star, we again come to the Christmakuh season. Which means it's time for DR. GRUMPY'S ANNUAL GIFT GUIDE!

This year, I'd like to start off with something for that distant acquaintance, co-worker, or friend who feels they have to hold the first party of the season, even if that means having it in July just to say they did.

What's more perfect for your friend's next party than this adorable snowman beverage dispenser?

They'll marvel when you give them this cheerful fellow to dispense refreshments from a, um, conveniently located valve. See him smile as you pull down, squeeze, and release.

Serving suggestions include spiked lemonade or Mountain Dew, though if you're a urologist you could also consider something with cranberry juice or grenadine syrup added for just the right tint.

Thanksgiving memory re-runs

One Thanksgiving in the early-90's I was the intern on call at a local VA hospital (a veterans hospital for my non-U.S. readers, with consequently a primarily cantankerous elderly male population).

A peculiar thing about VA hospitals (at least back then, I haven't worked at one for > 25 years) is that patients could sign out at the nurse's desk to leave, then come back later to resume medical care (don't even try to understand this). So the sheet was always full of notations that patients had signed out to go to McDonald's, or buy cigarettes, or smoke, or visit friends at the homeless shelter, or hold up a liquor store, or whatever.

Some bright businessman had opened a strip club across the street from the hospital, I think it was called The Jaguar Room. So on Thanksgiving the VA ward I was covering was empty, as most of the patients had signed out to walk, wheel, or crawl over to The Jaguar Room for some female comfort and booze.

I was asleep in the intern's room when the calls began coming in, all from the bartender at The Jaguar Room. Was it safe for my patients to be smoking through their tracheostomy tubes? Were the cardiac telemetry packs still transmitting from across the street? Was there a place at the VA where patients could get more $1 bills, because they'd used them all up on the strippers?

And my favorite:


Bartender: "Can I give Mr. Veteran another beer?"

Intern Grumpy: "Um, what's the problem?"

Bartender: "He has one of those foley bags things, with the tube going up his dick. The bag is, like, REALLY full, and I'm afraid if I give him another beer it'll pop and send piss everywhere."

Intern Grumpy: "Send him back to the hospital."

Bartender: "That's bad for business."

Intern Grumpy: "So is showering your clientele with piss."


Mr. Veteran was wheeled back over to the VA immediately, by a topless stripper no less, who waited while his bag was emptied and then pushed him back to the bar.

Ebay has everything

During her appointment I was helping Mrs. Old find a better price on her pain medicine, which (of course), activated the ad-tracker software.

So a few minutes later I noticed this on a site:

Who are the people in your neighborhood?

Dr. Grumpy: "At your last visit... let me look at the note... okay, you said you wanted to see if a massage helped your back pain, and were going to try a place near your apartment. So how'd that work?"

Ms. Lumbago: "It, um, didn't happen."

Dr. Grumpy: "Too expensive?"

Ms. Lumbago: "No... I went in there one day, and said I needed a massage, and the girl at the counter gave me a blank look. Then I realized all the girls there were in skimpy bikinis, and they had candles and soft music and a bottle of champagne out, and the counter girl said, um, 'we only take men customers' and I realized that, um... anyway I left and haven't had time to look for another place."

Seen in a chart

Knowns and unknowns, both unknown and known.

- Thank you, C!

Chutzpah

It's 10:55. Mrs. 11:30 walks into the waiting room, where Mr. 11:00 is reading a magazine.


Mary: "Hi, can I help you?"

Mrs. 11:30: "Yes, I have a routine appointment with Dr. Grumpy at 11:30, but my husband has a work-in with his cardiologist downstairs at 11:45, which he just made. Can I be seen early, so I can run down there?"

Mary: "I'm sorry, he's with someone now, and has an 11:00 appointment ahead of you. Otherwise I would."

Mrs: 11:30: "Can you..."

Mr. 11:00: "Hi, I don't mind waiting. I have the 11:00 appointment, so why don't you just switch us out? I don't have to be anywhere right away."

Mrs. 11:30: "Oh, thank you so much."

Mary: "Okay, that works for me. I'll let the doc know you're switching."


I finish with Mr. 10:30 and bring him up to check-out. Mary quickly explains the schedule change, so I bring Mrs. 11:30 back to my office. I address her issues, and we conclude the visit at around 11:25.


Dr. Grumpy: "All right, let me know how the medication change works out... I hope everything is okay with your husband."

Mrs. 11:30: "My husband? Why?"

Dr. Grumpy: "You said he had an urgent work-in with his cardiologist?"

Mrs. 11:30: "Oh, I just told the front people that. He's fine. I just needed to leave early because my cat sitter can't stay past 11:45."

She walked out front and left.

Texting with Frank

Also, stop calling me "Bro."

Seen in a chart

For my non-medical readers, the last word is supposed to be "hematuria."

Annie's desk

Annie: "Dr. Grumpy's office. This is Annie."

Mrs. Daughter: "Hi, Dr. Grumpy saw my mother last week, for Alzheimer's disease. We're trying to get her long-term care approved, and need him to fill out the forms. I forget to ask him when we were there. Can I drop them by the office later today?"

Annie: "Certainly, but he's out of town this week, so won't be able to do them until he's back. We can mail or fax them back to you when ready, or you can come get them."

Mrs. Daughter: "What do you mean 'he's out of town?' "

Annie: "Family vacation stuff, his kids are off for fall break, so..."

Mrs. Daughter: "That's ridiculous. I want these forms done NOW."

Annie: "Well, he'll be back next week, so will be glad to do them then, or you can see if your mother's internist can..."

Mrs. Daughter: "The internist is the one who referred me to you. Obviously, I wouldn't have come to you if I'd known he was THAT kind of doctor!"

Annie: "Um, what kind of doctor?"

Mrs. Daughter "The kind who takes vacations when his patients need him!"

Time out

All right, gang. I'm going to have to take a few weeks off here. We're now entering the heart of the high school marching band competition season, and between my day job and band meetings, band fundraisers, band shows, band-aids, band trips, rubber bands, and band saws I need to take some time off from the blog (and a lot of other stuff, too).

See you in a few weeks!

Breaking news!

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


DATELINE: SANTA MARTA, COLUMBIA.

Yeimy, a married woman, and Jesus, who she'd been having a clandestine year-long affair with, decided to call Uber for a ride to a local motel they'd booked for a romantic 30 minute getaway. The helpful Uber app noted that their driver was on his way to transport them to the love nest.

Upon arriving, they piled into the back seat of his car, only to have all parties immediately realize that the driver was actually Yeimy's husband, Leonardo, who was moonlighting that night by driving for a friend.

All parties immediately exited the vehicle.

It's unknown how many stars the driver got.



DATELINE: CALIFORNIA

A group of thieves stole $18,000 worth of industrial-use GPS tracking devices from a tech company.

Upon discovering the loss, the company remotely switched them on and saw the majority of the devices were in a warehouse, while 2 were still being driving around in cars. Police had arrested all involved and recovered the devices within 6 hours.

Police also noted the thieves had drunk a few beers they'd found during the robbery. One of them cut himself in process, leaving bloody fingerprints behind as additional evidence.



DATELINE: FRANCE

From the "A horse walks into a bar" department.

Formicidae

Frank is a college freshman this year, living in a dorm. Yes, you read that correctly.

So last Thursday I'm having a typically busy day of seeing patients when a text from him crosses the top of my screen.


Frank: Dad, I need to talk to you right now. There's a big problem here.

Dr. Grumpy: I'm with a patient right now. Can it wait 15 minutes?

Frank: Yes, but hurry.

After I finished my appointment with Mrs. Freenbeen, I called Frank.

Frank: "Um, hello? Who is this?"

Dr. Grumpy: "It's Dad. You told me to call you."

Frank: "Oh, that's weird. My phone said it was a call from a doctor's office. Are you sick?"

Dr. Grumpy: "No, I'm a doctor. I work here. What's up?"

Frank: "Oh, yeah. We have an emergency. Can you, like, go to the store after work and buy, like A LOT of ant bait traps and ship them to me overnight?"

Dr. Grumpy: "What's going on?"

Frank: "Me and Mike's dorm room is, like, FULL of ants. They're everywhere."

Dr. Grumpy: "I'm pretty sure you can buy bug poison at the Target across the street from you."

Frank: "Yeah, but then I'd have to pay for it."

Sigh.

Dr. Grumpy: "Why don't you let the building people know about this? They can have your room sprayed."

Frank: "Mike said he'd do that... Hey, Mike, did you talk to the RA about the ants?"

(mumbling in background)

Frank: "Never mind, Dad. Mike says the RA told him they'd have it sprayed later today. Hey, why do you think we have all these ants?"

Dr. Grumpy: "When was the last time you guys took out the garbage?"

Frank: "Um... I don't think we have. But, like, we only moved in on what, August 27th? How often should we be taking it out?"

That was a month ago. WTF.

Dr. Grumpy: "I'd say at least every week, if not more."

Frank: "That's stupid. There's still plenty of room under our beds for stuff. We moved the empty fast food and pizza boxes all under Mike's bed last week, after we put the dirty cafeteria dishes and forks in the bathroom sink."

Urp.

Dr. Grumpy: "Those things are what are attracting the ants!"

Frank: "Really? Why would they want that stuff?"

History reruns - September 27, 1854

After the war of 1812 , the United States and Great Britain resumed commercial trade.

On both sides of the Atlantic, businessmen competed for their share of this increasingly lucrative business. Faster ships made more money, even if it meant going full speed into bad weather and poor visibility. Many ships vanished, forever listed as overdue, and presumed lost to bad weather and icebergs.

On the Eastern side, the driving force was Samuel Cunard. In the 1840's he came to dominate the Atlantic market, with the line that to this day bears his name. The British government backed him financially, so the ships could, in the event of conflict, be requisitioned by the navy (which they often were).

On the Western side, a number of American lines tried, with varying degrees of success. The U.S. government was less inclined to become involved in these matters, and so capital was harder to raise for building ships.

As sail gave way to steam, this changed. The Americans were concerned that Cunard's steamers could be converted to warships. Faced with both real economic and feared military competition, the government began backing various companies to try and win trade back from Cunard.

The man to lead this was Edward Collins. With government subsidies he built 4 large steamships (Arctic, Pacific, Baltic, and Atlantic), bigger, faster, and more luxurious than Cunard's ships, to challenge his rival. The plan was to run a tight schedule across the Atlantic.

The Collins Line ships, with their combination of sails and paddle wheels, were some of the fastest in the world at the time. They showed the Atlantic could be crossed in the remarkable time of 10 days, and in a few cases, 9.

Backed by their respective governments, Collins' and Cunard's lines competed intensely to dominate the 3000 miles of north Atlantic. Until 12:15 p.m. on this day.

As the Arctic steamed west, through a heavy Newfoundland fog, she collided with a small French ship, the S.S. Vesta. The Vesta, although much smaller, had a hull reinforced with iron.

In the first few minutes after the collision, many of the Vesta's crew assumed their damage was fatal, and abandoned ship (against orders) to try and reach the larger Arctic. They were wrong. The crew of the Vesta worked miracles and overcame the damage.

Captain James Luce of the Arctic was a veteran of the sea. Believing his own damage to be minimal, he turned the Arctic around to aid the Vesta, and launched 2 lifeboats to help evacuate it's passengers to the Arctic.

These orders were quickly canceled when one of the lifeboats reported the severity of the damage to him. The ship was badly damaged. Like the Titanic 58 years later, he had the legally required number of lifeboats. And they weren't nearly enough to hold everyone on board.

Cape Race was 4 hours away. With his duty to his own ship clear, Luce abandoned the Vesta, heading for land. His hope was to beach the ship before she could sink.

The wreck of the Arctic over the next few hours quickly turned into a nightmarish struggle for survival, very different from the civility seen in the Titanic. Captain Luce accepted that he and his 11 year old son (who was traveling with him) were going to die, and did his best to save passengers. He was betrayed by his crew and most of his officers.

His crew disobeyed orders, commandeered the lifeboats, and fled. A trusted officer and handpicked team of seamen were placed in a lifeboat so that passengers could be lowered down to them. As soon as they reached the water they rowed away, with plenty of space in their boat.

Without lifeboats, Luce and his few remaining crew did their best. They tore the wooden deck to pieces, frantically trying to build rafts. Doors were torn from hinges to be used for flotation. All furniture made of wood was assembled on deck in hopes of saving more lives.

Of 408 who sailed, there were 86 survivors (64 crew, and 22 passengers). Not a single woman or child lived. They're remembered by a monument in Brooklyn's Green-Wood Cemetery.

Captain Luce, surprisingly, survived. He and his son went down with the ship, but were ejected from the vortex as it sank. As they swam away, a large wooden paddle wheel cover broke loose from below the sea. It launched into the air like a rocket, then came down, killing his son. And yet, at the same time, it became a makeshift lifeboat for Luce and a handful of swimmers. They were picked up after a few days by a passing ship.

The loss was a disaster, both personally and financially, for the Collins Line. Besides Luce's son, the deaths included Collins' wife and 2 of their children.

Although mostly forgotten today, the disaster dominated headlines on both sides of the Atlantic for a month, until replaced by the Crimean War. It had the same effect then as the Titanic would in 1912. Safety specialists recommended specific East-West shipping lanes. Slower speeds and loud whistles in fog. Lifeboats for everyone. The majority of the recommendations were ignored until the aftermath of the Titanic.

2 years later, in 1856, the Arctic's sister, the S.S. Pacific, vanished en route from Liverpool to New York.

It was another blow for the Collins line. There was an economic recession, and the U.S. government was now willing to let Cunard have the Atlantic. Collins' subsidies were cut, and in 1858 his line folded. The surviving ships were auctioned off.

The wreck of the Arctic hasn't been found (to my knowledge no one has looked).

The Pacific was thought to have been lost to storms or icebergs in the north Atlantic. To the surprise of everyone, she was accidentally found in 1991 in the Irish Sea, only 60 miles from where she left Liverpool. Why she sank remains a mystery.

Cunard survives to this day, though is now owned by Carnival Lines.

Government subsidies for shipping, with the ships to be used in time of war, continued into this century in all the major powers.

The last American attempt to share the Atlantic trade lies, mostly forgotten, in Philadelphia. She is the liner S.S. United States, built with subsidies after World War II. The government paid for her huge size and (even to this day) remarkable speed, with the plan of using her as a fast troop transport in future conflicts. Her commercial career, like all liners, was doomed by the passenger jet. Multiple attempts continue to be made today to save her from the scrapyard.

Annie's desk

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

Mrs. Haddock: "Hi, I need a refill on my medication. It also has to be authorized through my insurance, because the last auth has expired."

Annie: "Okay, I can get started on that... you know, it looks like we haven't seen you since 2010."

Mrs. Haddock: "Wow. Time flies. Anyway, I'm going on vacation tomorrow, so can you please get this taken care of?"

Annie: "We can't refill meds on someone we haven't seen in 7 years, let alone get an insurance authorization. Who's been filling it?"

Mrs. Haddock: "My internist."

Annie: "Then you'll have to call him to get this refill, and make an appointment to re-establish with Dr. Grumpy if you want us to prescribe it."

Mrs. Haddock: "I haven't seen him in 6 months. He doesn't take my insurance anymore. It's National Illness, Inc."

Annie: "We don't take that, either, so we can't get an authorization for you."

Mrs. Haddock: "But I'm leaving TOMORROW! You need to call this in and get it authorized RIGHT NOW!"

Annie: "We can't do that, like I said, we haven't seen you in 7 years, and we're not contracted with your insurance."

Mrs. Haddock: "YOU'RE RUINING MY VACATION!"

click

The teenage mind

I'm sitting at my desk, about an hour before my first victim patient. My wife is at a meeting out of town, but fortunately the kids are old enough to drive themselves to school.

Then the text came in.

Craig: Dad. I'm locked out of the car. I need help.


What the hell? School started 20 minutes ago!


Dr. Grumpy: Ask Marie for her keys.

Craig: I can't. She's at school.


WHAT?!!! Okay, this isn't making sense.


Dr. Grumpy: Then where are you?

Craig: I'm at 7-Eleven.

Dr. Grumpy: Why are you at 7-Eleven twenty minutes after school started?

 Craig: It was an emergency! I had to get something for class! Do you have keys to the 4Runner?


Sigh.


Dr. Grumpy: Yes. Which 7-Eleven are you at?

Craig: The one at South Street and Central.


So I tell Mary I'm going to rescue Craig and will be back in a few. Fortunately, South & Central isn't too far from my office.

I get to South & Central, and Craig is nowhere to be seen.


Dr. Grumpy: Craig, I'm at the 7-Eleven at South & Central, and you're not here.

Craig: Well, I'm at a 7-Eleven. Maybe it's not that one.


I roll my eyes, take out my iPhone, and look up his location.


Dr. Grumpy: Craig, you're almost 3 miles away, at the 7-Eleven at 12th St. and Elm.

Craig: How was I supposed to know that? Please hurry, I'm going to get in trouble at school!


So I head over and find him there, standing outside the car. As I unlocked it he picked up two Slurpee's in a cardboard carrier and set them on the floor.


Craig: "Thanks, Dad. I'm sorry."

Dr. Grumpy: "It happens. What did you need for school, anyway?"

Craig: "The Slurpees."

Dr. Grumpy: "You left school to get 2 Slurpees? This whole thing was over a Slurpee?"

Craig: "Slurpees. I mean, yeah, Marie wanted one, too."

Dr. Grumpy: "Why didn't you get them at the 7-11 by the school?"

Craig: "I went there first, but they don't start making them until 10:00. But I remembered there was another 7-11 down here."

And he drove off.

Random pictures

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


First we have this picture, taken at an airport, where bicycles using the bathroom is, apparently, an issue:

Then there's this place's answer to "what should we get grandma for Christmas?"

"Wow! Verapamil, metformin, morphine... this place has the best gifts!"

While we're on the subject of places to get gifts, who can forget...

Then there's this product so you can "keep balling all night."

And, finally, there's this happy-go-lucky coloring book about everyone's favorite viral-disease-of-cheerfulness, RABIES.