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.

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!"