Biting my tongue

"This all started at the local golf tournament. I'd forgotten my own set of clubs, and so when we got to the tee I had to use my husband's, and was angry that I'd left mine at home. Anyway, with everyone watching, I yanked out my husband's club and began waving it around, just as a joke. I think I hurt my hand because of the way I was holding it."

Convalescense

Yesterday, you may have noticed my posts ended early. This is because Dr. Grumpy was temporarily rendered into a barfing idiot by the evil pukingfeverachingholyfuckIfeellikeshit virus.

It started in mid-morning. I tried to stay at work, but just couldn't.

I had Mary reschedule the patients (which I HATE doing). I could barely think, or stay out of the bathroom (if you're part of the night staff that cleans my office, I'm really sorry I did that in my trash can). I had to get home.

Fortunately I live near my office. The kids were in school. So I thought I'd be able to rest and be sick alone for the day.

Fat chance.

I opened the door and...

Snowball: The people! The Master is home! He's home early! Ohboyohboyohboy!!!

Cooper: I am so happy! The Master! I must bring him something to welcome him! Here are Craig's underwear with skidmarks for you, Master! I found them in the laundry pile!

Blackdog: Stay away from him, you bozos. He smells bad.

Cooper: No! It's him! We must bounce in front of him to have him pet us! He loves it!

Snowball: Ohboyohboyohboy!

I grabbed a big tupperware bowl and collapsed onto my bed...

Blackdog: I'm going to stay in the hall. He doesn't look right.

Snowball: He's lying down! He's wants to play! He wants me to jump on the bed and bounce on his stomach!

Cooper: Play! Play! Play!

Snowball: Look! He's filling the plastic bowl up with semi-digested food!

Cooper: Wow! Just for us! I love the Master!

Blackdog: I wouldn't touch that. It smells like Diet Coke and Corn Flakes.

I doze off...

Cooper: The Master doesn't look happy.

Blackdog: No shit. Leave him alone.

Snowball: No! We need to cheer him up!

Cooper: I know! We must bring him gifts to make him happy! Come help me knock over the laundry basket full of wonderful-smelling sweaty clothes!

Snowball: Great idea!

Cooper: See! Look at them all over the floor! He will be so happy! Now let's bring all of them and put them next to the bed for him to see!

Snowball: Hey! A tennis ball! I'll bring that, too!

Cooper: Yes! I'll move the clothes and you bring more tennis balls!

Blackdog: Dipshits.

I woke up, desperately needing to barf. I got up to run to the bathroom...

Cooper: The Master is awake! He is jumping out of bed!

Snowball: Yes. He is running... and tripped over the big pile of smelly clothes!

Cooper: Look! He's lying on the floor now! He must want to play!

Blackdog: I don't think so.

Snowball: I'm going to jump on his back! Ohboyohboyohboy!

Cooper: He's running to the bathroom again! I'll jump in front of him to play!

Exhausted, I somehow made it back to the bed and fell asleep again...

Blackdog: Alert! There is a man at the mailbox! We must let the Master know!

Cooper: Yes! Make noise! Everyone! We must warn him!

Snowball: Yes! Now! Lots of loud noise! I'll jump up on the bed next to him to bark, to make sure he hears me!


I'm SO glad to feel better, so I can be back at the office today. It's comparatively relaxing.

Things that make me grumpy

Ms. Crappystaff: "Dr. Imed's office."

Dr. Grumpy: "Hi, it's Dr. Grumpy. You guys referred Mrs. Brain to me for an abnormal MRI, and I don't have the report. She's here now. Can you please fax that over, ASAP?"

Ms. Crappystaff: "Hang on... Sorry, the doctor just went into a room with a patient, and doesn't like to be disturbed. I can have him call you back later."

Dr. Grumpy: "I don't need to talk to him. I just want you to fax over the MRI report."

Ms. Crappystaff: "I'm not comfortable doing that. I don't know what the report means."

Dr. Grumpy: "I'm not asking you to know what it means. All you have to do is fax it to me."

Ms. Crappystaff: "Don't patronize me. I don't even know who you are."

Dr. Grumpy: "I'm Dr. Grumpy. You faxed over an insurance authorization on this patient an hour ago. I just need the MRI report, so I know what to tell her."

Ms. Crappystaff: "I told you, I'll have Dr. Imed call you to discuss this."

Dr. Grumpy: "The patient is here now. I just need the MRI report. Please fax it over. It's why you guys sent her to me."

Ms. Crappystaff: "You obviously don't understand the importance of patient privacy."

And she hung up.

Continuing Medical Education

Doctors, to keep our certifications, are required to do 20-30 hours of continuing education per year. Some docs go to conferences. Some do them online. Others do them in writing.

The format is the same. There's always an article, followed by a quiz you have to pass (to prove you really read it), then an evaluation form with some pointless questions (Did you like this CME? How will you change your practice because of it? Was it free of commercial bias? What other topics would you like to see CME on? Are you bored shitless yet?).

Anyway, yesterday I was doing a CME on new MRI techniques in Multiple Sclerosis. While filling out the evaluation form I came across this question.

(click to enlarge)





It is entirely unrelated to the CME topic. I can only assume it was put in there to see if I was still paying attention (yes, I was. And I do wash my hands at least twice a week).

Sounds good, Frank

Frank had to write a report about dogs for school, and asked me to proofread it for him. I discovered this:

"Some dogs have very good eyesight. Because of this, they can hear in the dark."

Sunday reading

Okay, while relaxing outside and catching up on my journal reading today, I learned the following ground-breaking medical news:

1. Sleep deprivation can impair your thinking, while getting some rest can improve things again (Neurology Reviews, April, 2010).

2. Patients who get two blood thinning drugs have a higher risk of bleeding than patients who get only one (Archives of Neurology, March 8, 2010).

3. People who smoke have an increased risk of stroke and TIA (paper presented at the 2010 International Stroke Conference).

Sunday morning, 7:57 a.m.

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

Mr. Husband: "Yeah, you see my wife for Alzheimer's disease, and she had a seizure 2 weeks ago."

Dr. Grumpy: "Uh huh."

Mr. Husband: "Well, ya know, I was just thinking, she was maybe just a bit more alert for a few days after the seizure, not a lot, but maybe a little. Can I bring her in to your office and you can make her have another one?"

Scintillating conversation

Tonight Mrs. Grumpy and I were sitting on a bench at a local park, listening to a band. A group of teenagers went by, and we heard this discussion:


Dude A: "So like, you go to North High?"

Dude B: "Yeah."

Dude A: "I go to Central. What's it like at North?"

Dude B: "We have, like, students and teachers and stuff. Classes, too."

Dude A: "That's cool."

Need nutrition? Got fungus? No problem!

I'd like to thank my reader Boris for submitting this oddity.

On-call food

You guys have heard me bitch about the miserable sleep-deprived, food-deprived, caffeine-deprived condition called "being on-call" that us docs live through.

I describe things best with words. My esteemed colleague Fizzy, however, draws pictures. And for those of you who, after reading my blog, still don't understand the state of desperate insanity that being on-call causes, I present Fizzy's recent, very accurate, pictorial description.

(click to enlarge)

Can't argue with that

Mr. Klumsy: "I hurt my back when I fell down."

Dr. Grumpy: "What made you fall down?"

Mr. Klumsy: "I don't know. Gravity, I guess."

Attention patients!

I have nothing against dogs. I have 3 of them. I am a dog person.

And I really don't mind if you bring a small dog to the hospital to comfort a sick person.

But if you do, and a neurologist comes in the room to round, please try to restrain Li'l Cujo when he lunges across the room, barking and growling, to take a piece out of my ankle.

Fortunately, it stopped bleeding quickly, and a band-aid covered it.

Please fax your "harmless little cuddly-wuddly's" rabies shot records to my office today.

Mary's Desk, April 29, 2010

"No, ma'am, your Local Grocery Shopper's Club card is NOT an acceptable form of paying your doctor visit co-pay, nor does it get you any sort of discount here."

Mind reading

Dr. Grumpy: "Do you get nauseous when you have a headache?"

Mr. Apap: "I don't know. You're the professional here."

Evolution in reverse

Cell phones, and our love/hate relationship with them, are a popular blog topic. Rude patients/customers/doctors who conduct routine calls solely to inconvenience those around them are a popular gripe topic. But that aspect of the damn things isn't what I'm bitching about today.


Millions of years have gone into humans figuring out how to survive danger and carry on the species. But modern technology has turned the clock backwards on this.

In the 1980's video cameras become cheap and widely available. Suddenly, instead of frantically running away from tornadoes, every bozo suddenly felt the need to stop and shoot movies of them, hoping to get 5 minutes of fame on the local news. I'm not talking about trained stormchasers here. These were always local yokels in a car, with their terrified kids screaming in the background, who pulled over to get some once-in-a-lifetime shots of an oncoming funnel cloud as it destroys their house. Nice work.

Similar videos popped up with every earthquake. "Hey! The house is shaking! I'm gonna film this for a minute, then check on the kids!"

But the phenomenon has gotten worse with the invention of the cell phone camera.

Besides the obvious dangers of distracted driving, now every disaster is accompanied by people frantically whipping out cell phones. Some take pictures of it. Others feel it's a great time to call friends. "Yeah, the building is on fire. You wouldn't believe it. I should probably leave soon. How was the poker game last night?"

It's obvious to anyone that you can run faster if you swing BOTH arms. So if you're running for your life, it would seem counter-intuitive to swing only one. Right? Now let's look at this screen shot from CNN earlier this year, of people fleeing aftershocks of the Chilean earthquake.




Yup. Both of them are running, and talking into cell phones (not to mention the person who stopped to take their picture).

"Yeah, It's a bad aftershock. I hope it doesn't knock over the cell phone transmitter antenna. If it does, I don't know how I'll be able to call Marta to tell her about the aftershocks."

Imagine you're a prehistoric man in a cave. Suddenly a saber-toothed tiger walks in. Your reaction, sensibly, is going to be either to run like hell or find a club. Somewhere along the line our intelligence allowed us to survive these encounters.

But nowadays people are different (I'd like to thank my reader, Lee, for sending this):


'A bobcat walks into a bar . . .'
March 27, 2009, 6:55 p.m.
The Arizona Republic

COTTONWOOD, Arizona- A bobcat walked into a roadside bar in Cottonwood.

What happened next was not a joke but "pandemonium," two or three minutes of chivalry, cell phone cameras and people jumping on top of pool tables to get out of the way. When it was over, two people were scratched and bleeding, and the rabid bobcat was killed by police in a parking lot on Main Street.

At about 11:40, three people walked out of the Chaparral, a neighborhood bar with signs for Schlitz, Budweiser and Coors over the entrance. Tuesday is free-pool night.

"I said good night," said bartender Scott Hughes, 41. "Next thing I know, they are running back in, followed by a bobcat. One jumped on the pool table, and two more jumped onto the bar."

The bobcat chased two people around a pool table. That's when people took out their cell-phone cameras to get a picture.

People talk about the degradation of morals and the end of society. Hell, we've survived a lot, and I'm not worried about political hysteria from either side.

But sheer stupidity is another issue.

Wednesday night, 6:49 p.m.

"Hi, this is Hank Bozo. I just found an old message on my cell phone reminding me to come to my appointment with Dr. Grumpy on March 19. Can someone please call me back and let me know if I showed up for it, and if I did, what we decided to do. If I didn't show up for it, I want to make another appointment. Thank you."

Dim bulb

Dr. Grumpy: "Any chance you might be pregnant?"

Miss: Notbright (whipping out cell phone): "I don't know. Let me call my mom and ask her."

Dear Drug Company,

I'm sure Cimzia is a good drug.

And, since patients have to inject it into themselves, I think it's great that you put together a demo kit to teach them how to do it.

I can understand that your demo kits don't have the real drug in them. I mean, this is an expensive monoclonal antibody with a short shelf life. You don't want it sitting in a doctor's cabinet collecting dust. So it makes sense to have a non-drug demo for teaching purposes.

There are a lot ways this could have been labeled. Like "does not contain real drug" or "do not inject the demo product" or "for demonstration only, do not inject."

But, in all honesty, putting "not for use in humans" on the demo drug's packaging IS NOT going to inspire patient confidence in your product.

Another day, another...

Dr. Grumpy: "How are your seizures doing?"

Mr. Shakin: "I've had 3 in the last few months."

Dr. Grumpy: "What Depakote dose are you on?"

Mr. Shakin: "I'm not taking anything."

Dr. Grumpy: "What! Why not?"

Mr. Shakin: "I ran out of pills in February."

Dr. Grumpy: "Let me look... In January you called to ask me to mail you a 90 day script, and I did."

Mr. Shakin: "Oh. I never got it. So I ran out."

Dr. Grumpy: "WHAT?!!! How come you didn't tell me? Why didn't you call me to ask for a new script?"

Mr. Shakin: "I didn't know I was supposed to."

Mary, come shoot me. Now.

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

Mr. Skin: "Yeah, that one that gives me a rash."

Dr. Grumpy: "Do you know what it's called?"

Mr. Skin: "No, but I'm not taking it anymore."

Dr. Grumpy: "What medication are you taking now?"

Mr. Skin: "The one that doesn't give me a rash."

Naked Terror

Quick! What is It?




Looks like a soap dispenser, huh? WRONG!

It's actually a battery-powered shower-cleaning device that sprays foaming suds around your shower after you're done. Of course, I know that NOW. I didn't know it yesterday.

While I was on call this weekend, Mrs. Grumpy installed one in our shower, and didn't mention it to me.

So yesterday morning, I was showering away in the dark (I get up early, and shower in the dark so the lights don't wake up the kids). In the dim glow of the night-lite I noticed this gadget hanging there, looking suspiciously like a soap dispenser. So, to lather up, I pressed the big blue button on the front, and put my hand under it.

Nothing came out. Instead the thing began beeping REALLY LOUD.

BEEP!

Holy shit! What the fuck kind of a soap dispenser is this?

BEEP!

Crap! Why is it beeping? It's going to wake up everybody! How the hell do I make it stop?

BEEP!

Fuck! There has to be a button or switch or something to turn it off! I'll press the blue button again!

BEEP!

That didn't do anything. Shit, I can't see if there's another button to make it stop!

I leaned forward, feeling it all over to try and find a switch.

BEEP!

After the 5th BEEP! the little blue thing on the bottom suddenly spun around, spraying shower-cleaning foamy stuff in a circle around it, covering the shower, the tiles, and my eyes, which were about 2 inches in front of it as I frantically tried to find a way to make it stop beeping.

It burned like hell. I screamed and fell backwards, and some shampoo bottles fell on me with a loud clatter. Snowball started barking. In the panic I tried to get to a sink to wash my eyes out, before I realized that I was already in a shower with water pouring down.

As I rinsed my eyes out the lights went on, and I became aware that I'd woken up the whole house. Wife, kids, dogs, and all.

I'm going to stick with bar soap from now on.

Sympathy

Dr. Grumpy: "How's your stress level been?"

Miss Accountant: "Horrible. The bitch I work with had a heart attack and died during the last week of tax season. So I had to do all the work myself."

Nurses...

Are AWESOME.

I'm a doctor. We get all the glory. And credit. And guess what? We only deserve part of it.

I started out in medicine in the mid-80's, volunteering at an ER. And the biggest shock to me was learning how much of what happens in a hospital is nurse territory. Us doctors will see you from 5-30 minutes a day (30 is A LOT), depending on how sick you are. And the rest is the nurses.

They come in all shapes, colors, and sexes. Yes, there are a few idiots out there, that I take shots at in this blog. And there are idiot doctors, too. Idiots are in all fields, but the majority of nurses are damn good.

They're the ones making sure you get your pills, checking that your vital signs aren't dropping (and doing what they can to save your ass initially if they are, of which calling a doctor is only one part). They make sure you don't fall down and break something. If you start barfing, us doctors will run out of the room and the nurses will rush in. They change your wound dressings and start your IV line. They'll bring you a warm blanket. And clean disgusting things off you. Even if you're drunk. Or delerious. Or mean. And through all of this they try be friendly and positive. Even though you aren't their only sick patient.

I respect nurses A LOT. I learned early on that they're key to being a good doctor. You piss off the nursing staff, and you'll have a miserable career at that hospital. Respect and treat them well, and you'll never regret it. They're as important to being a good doctor as your medical degree. Maybe more.

If you come out of medical school with a chip on your shoulder against nurses, you better lose it fast. Because they will make or break your training, and often know more than you do. Be nice and they'll teach you. A good neuro nurse is often a better inpatient neurologist than some doctors I've met.

I remember a guy named Steve, who was an intern with me a long time ago. He had his head up his ass about being a doctor, and saw nurses as lesser scum. We were only a few months out of med school, and as we were writing chart notes one morning a nurse came over and asked if he'd go listen to his patient's heart. With icy contempt, and not even looking up from the chart, he said "I don't have to listen to his heart, because I looked at his EKG." They ain't the same thing, dude. If he'd listened he might have noticed that the patient had developed a loud murmer in the last 24 hours. When the attending caught it a few hours later, Steve got his ass chewed out. If he'd taken the nurse's advice, and listened, he wouldn't have gotten reprimanded by the residency board.

I talk about my Bible a great deal in this blog. Here's a quote from it: "Working with a good nurse is one of the great joys of being a doctor. I cannot understand physicians who adopt an adversarial relationship with nurses. They are depriving themselves of an education in hospital wisdom."

Those doctors are also depriving themselves of friends. On a shitty day on call, sometimes all it takes is a sympathetic nurse to temporarily add you to her patient list, steal you a Diet Coke from the fridge, and let you cry on her shoulder for 5 minutes. It doesn't make the day any less busy, but helps you absorb the punishment better.

What got me started on this?

While I was rounding this weekend, a grateful patient's family brought the ICU nurses a box of donuts, and so the staff was picking through them. One said "Oh, this kind is my favorite, it has cream filling."

And some pig in one of the rooms yelled "Hey, babe, I got my own kind of cream-filled dessert in here! Come have a taste!"

You say that to a waitress, and you'd likely get your ass kicked out of the restaurant.

You say that to a co-worker, and you'd be fired and/or sued for harassment.

You say that to a lady in a bar, and you'll likely get a black eye.

And what did the nurse do? In spite of the fact that the guy was obviously a detestable jackass, she went in his room, turned off his beeping IV pump, and calmly told him that he would not talk to her that way.

And I admire the hell out of that.

Nursing is a damn tough job. And the people who do it are tougher. And somehow still remain saints.

While this post isn't about them, there are a lot of other unsung heroes who are part of the hospital team- pharmacists, social workers, nursing assistants, EMT's, respiratory therapists, X-ray techs, lab techs, physical/occupational/speech therapists, housekeeping staff. And many more.

On call- Idiocy

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

Dr. Internist: "Hi, I'm the hospitalist taking care of Mrs. Dizzy. You saw her this morning, and wrote that it was fine with you for her to go home."

Dr. Grumpy: "Yes."

Dr. Internist: "I'd like to send her home, but just wanted to check with you."

Dr. Grumpy: "Fine with me."

Dr. Internist: "Does she need any more neurological tests while she's here?"

Dr. Grumpy: "No. Why? do you think we missed something?"

Dr. Internist: "No, but just wanted to make sure you didn't have any other neuro-testing-things you wanted to do."

Dr. Grumpy: "No."

Dr. Internist: "Okay. Good. In that case, I'd like to send her home. Are you okay with that?"

Dr. Grumpy: "Yes."

Dr. Internist: "Cool. Thanks for calling me back so quickly."

On call- Sunday morning.

Phone guy: "Drs. Brain & Nerve's answering service, can I help you?"

Dr. Grumpy: "Yeah, this is Dr. Grumpy, covering for Drs. Brain and Nerve. Are there any consults holding overnight?"

Phone guy: "Umm. Let me look. Yeah, 3. So you have another consult for them? Can I have the name?"

Dr. Grumpy: "No, I need the names of the ones you've been holding overnight."

Phone guy: "Is the new consult for Drs. Brain and Nerve? Because Dr. Grumpy is covering for them, and will see the patient."

Dr. Grumpy: "No! This is Dr. Grumpy!"

Phone guy: "Oh, so the new consult is for Dr. Grumpy directly? He doesn't use our service, but I can give you his office number."

Dr. Grumpy: "I AM DR. GRUMPY!"

Phone guy: "Dr. Grumpy? Are you calling in for the overnight consults?"

Dr. Grumpy: "YES!"

Phone guy: "I'm sorry sir. You should have said that in the first place."

On call- tips from the trenches

The following is a public service announcement.

I'm not personally into hookers and cheap motels. If you are, I don't care. It's just not my thing.

It is important, however, to keep in mind that those rooms are generally NOT used by people who have any need to look in the rooms' closets. After all, they're only renting them for 20-30 minutes.

So as a result, sometimes a homeless alcoholic can (hypothetically speaking of course) live in the closet of one of those rooms, undetected, for weeks.

Like all people, they might get sick. There's always a lot of crud going around.

So, if their timing is off, they might wander out of the closet, and vomit all over a hypothetical couple using the bed to conduct a business transaction.

Since nothing kills the mood of cheap sex faster than being covered in barf, Mr. John and his girlfriend-for-hire might hypothetically grab their clothes and run out of the room, followed by Mr. Drunk, who passes out in the parking lot.

He eventually might be found and brought to Local Hospital, where he (hypothetically of course) could have an alcoholic seizure, and so a neurologist was consulted (I mean, uh, might be consulted, since this is, a um, hypothetical case).

So, guys: if this is your sort of thing, please check the closet first. Your date won't mind, I swear.

If you find someone living in it, just ask for another room. It may save me a trip to the hospital.

With a cluck-cluck here and a cluck-cluck there

Generally, I find my practice works best when I get paid in dollars. They're convenient. They can be transmitted electronically between bank accounts. Mary and Annie like them. I can spend them by swiping a credit card.

But, in a remarkable effort to win the "Let's See How Stupid I Can Sound" award, a Nevada candidate for U.S. Senate has proposed ditching the idea of paying doctors in money, and going to a barter system with them. Specifically, she suggested paying us in chickens or house painting.

Really.

Sue Lowden is the gem who hatched this idea. In fact, she was given a chance to explain it, on the assumption that she misspoke. But nope. When given the opportunity to clarify her point, she again clearly stated that medical services should be reimbursed by bartering goods, such as chickens, and not by paying money. She specifically indicated it was to pay doctors, and didn't say if it should be applied to other businesses (such as buying your meds at the pharmacy, or groceries at the store). She even said she wasn't going to back down from the idea.

Barter is not a bad thing. In some situations it works. Most civilizations used it before the advent of money. But the majority of human cultures eventually developed cash of some form. Because let's face it: It's hard to carry around enough chickens to buy a car. And they're messy. And, unlike coins, they require feeding.

This idea may work for some docs, but not me. I personally don't want to collect co-pays in chickens. Or goats. Or frying pans. Or anything other than money. This is also a matter of cleanliness: my migraine patients are sensitive to smells. I don't think they want to sit in a lobby filled with the livestock someone else brought to settle their bill.

And I don't have enough space in my yard to handle all those co-pays. Mary and Annie are also not going to be thrilled to be told that instead of money I'm now going to pay them in sheep and legumes. It's a baaaaaaaahhhhhhhhhd idea.

The logistics of making an ER co-pay become especially daunting, paticularly if you're now in a wheelchair but need to use the space in your car for bushels of corn and some turpentine.

And just try giving your kids a handful of chickens to spend at Chuck-E-Cheese's. Have you ever had to clean feathers out of a skee-ball machine? It's trickier than it looks.

We will also need to re-do medical school curriculum, to include care and feeding of livestock, as well as how to run your own slaughterhouse (for us non-surgeons) when turning your co-pays into dinner.

Ms. Lowden, to verify the usefulness of your idea, why don't you try a simple experiment- go into any large casino in Las Vegas. With a chicken. And try to bet it on any game. Or stuff it in a slot machine. And then see what casino security thinks about being paid in something other than money. I suspect they'll be as fond of the idea as I am.

Fun with teenagers

Dr. Grumpy: "How are you doing?"

Mr. Pain: "Better. I've been swimming more, doing the breaststroke, and..."

Teenage son (looking up from Nintendo): "DUDE! Dad! You said breaststroke!"

Toothbrush? Finger with booger? OMG!

The following note is from a doc who specializes in weight loss, trying to figure out why the patient is still heavy. I personally would have worded this differently, as there are some details about my patients' lives that I just don't want to know.

(click to enlarge)

BOOBQUAKE, 2010: Shake 'em! You won't break 'em!

The following column is not mine. It was written by The Mother, (who's a mother AND a doctor) and due to my own fascination with, uh, advancing scientific research, I'm reprinting it here. I should point out that on any given day there are an average of 1,370 earthquakes on planet Earth, (and probably a few on Io, too). So you can blame them on whatever you want, and they'll still happen.


A critical thinking experiment in real time

I’ve been talking a lot lately about teaching kids critical thinking. I’ve been pretty hard on the schools, for stressing memorization and regurgitation, and ignoring the process

But on Monday, April 26, we all have a chance to strike a blow for critical thinking on a global scale.

Let me explain.

Over the past six months or so, a variety of garden-variety idiots have variously attributed tectonic plate phenomena to cosmic wrath.

Pat Robertson explained on national TV that the Haitian earthquake was caused by retribution for the Haitians’ “pact with the devil” over the bloody slave revolt in 1790 (wow, did that take the deity a seriously long time or what?).

Rush Limbaugh blamed the Icelandic volcanic eruption on cosmic wrath over the American health care bill (because the best way to seek vengeance against the American liberals is to seriously inconvenience John Cleese).

And Iran’s Hojatoleslam Kazem Sedighi announced that “Many women who do not dress modestly … lead young men astray, corrupt their chastity and spread adultery in society, which (consequently) increases earthquakes." (We are women, hear us roar–our boobs have unimaginable power.)

This last inane statement, unlike the first two, is what we science types call a “testable hypothesis.”

And it is going to be tested. Oh, yes. A critical thinking experiment is being planned in real time. The brainchild of Jen McCreight, who blogs at Blag Hag. BOOBQUAKE is designed to test the concept that immodest dress causes tectonic plate disruption.

Women are asked to wear their lowest cut, most immodest blouse on April 26th. If you happen to wear a short skirt, too, I can’t imagine that that would skew the results.

I have a see-through t-shirt that should do nicely.

To drive the lesson home to our kids, though, it’s important to make sure they understand the working hypothesis of the experiment. Then park them in front of CNN for the day, and let them watch, like we did when Katrina was leveling New Orleans.

I’m going to pop popcorn.

Great office moments

Dr. Grumpy: "Have you had any problems having an erection?"

Mr. Backtrauma: "Uh... I'm not sure, I..."

Girlfriend Backtrauma: "You ass!" (kicks him) "No, you haven't! I just went down on you last night! Doesn't it fucking mean anything to you when I do that? You sure forgot pretty fucking quickly!!!"

And she stomped out.

"Sir, can't you wait until next week? Sir? Sir?"

I'd like to thank my reader Marc for submitting this.

(click to enlarge)

Wednesday afternoon

The following is verbatim. The patient involved is NOT considered to be mentally impaired (because if he was, this wouldn't be that weird). If anything, he reminds me of David Puddy.


Dr. Grumpy: "Where are you working now?"

Mr. Fedex : "A shipping company."

Dr. Grumpy: "Oh. Do you like it?"

Mr. Fedex: "We do shipping there. You know, to ship stuff. I work in sales."

Dr. Grumpy: "Do you need a Depakote refill?"

Mr. Fedex: "Yeah. Hey, doc. Who does shipping for your office, anyway? I imagine you have to ship boxes of stuff all over the world? Are you looking for a new shipping company?"

Dr. Grumpy: "Uh, no. I mean, as a neurologist I really don't ship anything. Maybe mail a few pages of records or forms out."

Mr. Fedex: "Really? What does a neurologist do, anyway?"

(long pause)

Dr. Grumpy: "I treat patients."

Wednesday morning, 5:45 a.m.

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

Mr. Clock: "Hi, I need to cancel my appointment for tomorrow at 9:15."

Dr. Grumpy: "Your appointment is today at 9:15."

Mr. Clock: "Cool. I'll see you then. And just cancel the one for tomorrow, I guess I don't need it now."

Sentence Structure- It means something

I get all kinds of flyers dropped off at the office. An open house at Dr. Somebody's new office, announcement of a new physical therapy place or MRI facility, etc.

Today a flyer was left about a rescue pets event, featuring a fundraiser and cookout contest. I can't put it up here, because it had too much info in it. So I'll do my best to tell you about it.

We don't go to these. We already have 3 rescue dogs, and if we went we'd want to bring them all home. Mrs. Grumpy and I are softies for dogs.

But it sure caught my eye.

It could have said: "Adopt-a-pet: fundraiser and barbecue" or "Fundraiser for Homeless Pets", or "Local Homeless Pet Shelter Event"

But no.

It said, in big letters, "HOMELESS PET BARBECUE NIGHT".

In other notes, it listed the participants at the bottom, including: Local Greyhound Rescue, St. Bernard Friends, Humane Society, etc. At the bottom of the list was "Local Rat Rescue League".

Fail!

Dr. Grumpy: "What time was your seizure last night?"

Mrs. Etoh: "Around 10:00, as we were leaving the bar."

Dr. Grumpy: "I thought you'd stopped drinking?"

Mrs. Etoh: "I did, but last night we had a round after our AA meeting."

Dear Insurance Company,

I received your letter yesterday that you're raising my annual office policy rates.

I don't know if I'll be able to afford the increase, but will do my best. I know you're doing your utmost to try and keep my rates down, as evidenced by the fact that you spent 44 cents per letter to mail this to several thousand offices across the country.

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In times like these an increase of this magnitude might be devastating, but Mary and Annie have heroically chipped in to pay for the increase, with some money they found in the cushions of the waiting room chairs.

What the HELL does this mean?

The Science Marches on Department sent me this remarkably confusing (and, in my opinion, bizarre) abstract from the Journal of the American Psychoanalytical Association. Don't believe me? Here's the original.


The absence of the paternal penis.

“Girls’ experiences of object loss, in conjunction with female anatomical structure, may lend themselves to a particular genital anxiety regarding openness and emptiness. The relational void in giving up the mother as love object may lead to an internal self-representation of a “hole” to be filled, much as the mouth sucks the pacifier in the absence of the nipple. This image may then be extended to the genital representation. In turning to the father, a girl may find that she lacks a relationship with him in the relational space opened up by the loss of the mother; the penis is symbolically withheld from her in the father’s relational distance. This lack of sexual and relational gratification, it is proposed, may be schematized by a female as her body being empty of something. The father’s absence–the absence of the paternal penis–may lead to an absence of the mental representation of the vagina and to an inhibition of the role the vagina then plays for a woman in sexual desire. Vaginal repression may serve to disguise object hunger that might otherwise be experienced as vaginal longing. An abbreviated clinical vignette, revolving around a masturbatory fantasy, is offered in partial illustration of the thesis.”

I'VE GOT THE POWER!!!

I am now GRUMPY! THE GREAT AND POWERFUL!!!

I was informed by certified mail last week that I've been approved for my state's substance abuse monitoring program, being able to look up ALL my patients' controlled substance scripts from all pharmacies and other doctors.

I activated my incredible new all-seeing powers this morning. And within an hour had fired 3 patients that we were suspicious of.

Mary and Annie are making up wish lists of people for me to check. It's like Christmas, in April.

JUNKIES! YE SHALL TREMBLE BEFORE ME!!! I AM GRUMPY, THE OMNISCIENT!

Tomorrow I'm going to start wearing a cape to work.

Monday Morning

Mrs. Grumpy wanted to go for a carb-laden meal at La Enchilada Grande last night, so I'm very sluggish this morning. And all I could think of while driving in was this.

Interestingly, it wasn't used as an ad. It was done by students in a college film program, and won an award. I actually first saw it in a movie preview, when I took the kids to see Shrek vs. Rocky LXXIIIV.

FRANK!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

So, those of you who follow me on twitter (or read it on the feed down there on the right) know I got woken up early this morning.

Frank had a birthday last week, which as all kid's presents do, involved a lot of cardboard and styrofoam packaging.

Last night, using that peculiar line of reasoning that comes to the human brain in the wee hours, he decided that it would be cool to have snow. Since summer is coming it would have to be fake snow.

And after turning the idea over he realized he could make some himself. Out of Styrofoam.

So in the middle of the night he went out into the garage, dug the slabs of styrofoam out of the trash, brought it into the kitchen, and began shredding it with a butter knife.

At some point he realized he'd covered the floor and table and everything else with little white pieces of styrofoam and began frantically trying to vacuum them up. Which is where I came in.

My Readers Write

Karen, who says she works for a California neurologist, sent this in. It makes me glad to know other neurology offices have as much fun as we do.


Karen: "House of Brains, can I help you?"

Mystery Caller: "You called me."

Karen: "Okay, what's your name?."

Mystery Caller: "I'm John."

Karen: "And... a last name, please?"

Mystery Caller: "Bozo."

Karen: "Okay, what can I do for you?"

Mystery Caller: "YOU called ME!"

Karen: "I'm sorry, I didn't personally call, but will try to help. Was a message left?"

Mystery Caller: "Yes."

Karen: "Who left the message? What did it say?"

Mystery Caller: "I don't know. I didn't listen to it. I just saw your number on the caller ID."

Karen: "Why don't you listen to it, then let me know who called and I'll connect you to them."

Mystery Caller: "Can't you help me?" (This is a loaded question, huh?)

Karen: "Hang on... Mr. Bozo, you aren't in our system. I don't think you're one of our patients."

Mystery Caller: "I'm not. My girlfriend is."

Karen: "Okay, what's her name?"

Mystery Caller: "Cindy Datingabozo."

Karen: "All right. But privacy regulations require that I confirm we have permission to speak to you. Can you hold while I check our records?"

Mystery Caller: "This is stupid! I could have listened to the message in less time than it's taking you to figure this out."

(click)

Truth in advertising

I'd like to thank my reader, Nicki, for submitting this photo from the U.K.

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While some may claim this has nothing to do with neurology, the statement "Always in the shit, only the depth varies" sums up most of my days.

Thursday Weirdness

So yesterday we had 2 (not 1, but 2!!!) calls from people wanting to know what their MRI's showed.

I usually try to keep up on test results, calling patients or bringing them back as soon as we get them. So it surprised me to get 2 in one day. But sometimes things fall through the cracks. I couldn't find their reports, so I asked Annie to track them down.

Guess what? NEITHER OF THESE BOZOS EVEN SHOWED UP FOR THE FUCKING TEST!!!

I'm not making this up. Annie called the MRI places she'd scheduled them with. Both were no-shows.

So she called the patients back. Both were aware that they hadn't had the tests, but thought they'd call us for results "just in case".

(For the record, both of these patients were being seen for back problems. Not memory loss or head injuries. If that was the issue it wouldn't be so shocking, or even blogworthy).

Look, people, here's a tip. The MRI is a VERY GOOD test. My specialty depends heavily on them.

But no matter how good they are, they CANNOT get images of you while you drive by the facility. Or sit at home reading about how horrible they are on bigdavespageofhowanMRImademydickfalloff.com. Or lying on the couch watching TV and eating Fritos.

Thank you.

So let's beware of them

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

Mr. Genetics: "Yes. My Dad died on his birthday."

What the hell?

Mrs. Nutz: "I'm only going to have the MRI if you can guarantee me it will be abnormal. Otherwise, what's the point of having it at all?"

Drug Ads

Does this lady look happy, or what?

She was on the cover of an ad brochure one of my drug reps dropped off. It's for a pill used for excessive daytime sleepiness.

What I think is funny, though, is that the pictures on the left (the "before drug" shots) are supposed to be abnormal.

Lets start at the top:

1. Lady dozing off at work. Who doesn't do that here and there? Hell, I slept through most of my pathology class in medical school. To this day I'm conditioned to automatically nod off when I hear the word "amyloid". And it's not even like she has a can of the sacred waters next to her.

2. Lady finding ironing boring and tiresome. As if anyone froths at the bit and has an adrenaline surge at the thought of finally getting to that mountain of wrinkled clothes.

3. This one is my favorite. The lady has fallen asleep while her boyfriend/husband is watching sports. Mrs. Grumpy is the sports person at out house, but I know plenty of women who consider dozing off in these situations to be perfectly normal. Let's face it- I'm pretty sure he's not watching figure skating.

Personally, if I see anyone who looks like the lady on the right at work or doing housework, I think they need their Lithium dose lowered.

Huh?

Mr. Referral: "My internist wants me to see an endocardaphrologist. What do they do?"

Dr. Grumpy: "I have no idea."

Let me repeat the question

Miss Diet: "I don't eat beef."

Dr. Grumpy: "Are you a vegetarian?"

Miss Diet: "No, I couldn't do that. I'm allergic to dogs and cats."

The family next door

The Goodwin family. From left to right: William, Frederick, Charles, Harold, Lillian, Augusta, Jessie. The baby, Sidney, is not in this picture.


Even through the old black and white, they could be any family you live near. They look like nice people. Clothing styles have changed, but they're the same people we are now.

You can see them getting ready for this family portrait, which likely wasn't cheap. Putting on their nicest clothes, trying to get their hair just right. Harold and Jessie each with a trace of a smile. Maybe they'd shared some sibling silliness just before the picture was snapped, and were told to be knock it off and look at the camera.

We still take family pictures. To freeze those memories of childhood and family that we all hold dear.

Mr. Goodwin, at age 40, was a highly trained electrical engineer. He was having trouble finding steady work in Fulham, England, that would allow him to support his family.

But through his brother in America he heard of a new power plant under construction, in Niagara Falls, New York, that was looking for men with his training. So in hopes of finding a better life, the family sold their modest house, packed up, and booked passage across the Atlantic. They didn't have a lot of money, so had to settle for 3rd class passage.

The food and accommodations in 3rd class, while not great, were certainly adequate. The only potential drawback was that, in the unlikely chance something went wrong, you wouldn't have as easy access to the lifeboats as the wealthier 1st and 2nd class passengers did.

And for that reason, 98 years ago tonight, the entire Goodwin family died on the Titanic.


On a side note, the body of a small boy was found floating in the Atlantic 3 days after the wreck. He was buried in Fairview Cemetary in Halifax, with a monument paid for by the sailors who'd pulled him out of the water. He was listed as an unknown child victim of the Titanic. In 2007 DNA testing confirmed he was indeed the youngest Goodwin, Sidney.