Better living through chemistry

Dr. Grumpy: "How's your tremor been since we started the new medication?"

Mr. Shakin: "Much better, in a lot of ways."

Dr. Grumpy: "Can you give me an example?"

Mr. Shakin: "I used to have to ask my wife to unzip me to pee, but now I can do it myself."

1/4 cup milk, 1/4 cup butter, cheese sauce mix, Kung Fu lessons...

Cops: Siblings brawl over butter in mac & cheese

Associated Press
Jun. 23, 2010 02:33 PM

WATERVILLE, Wash. – An argument over butter in a macaroni and cheese recipe churned into violence between a brother and sister.

A 21-year-old man called police to say his 17-year-old sister tried to cut his neck with the serrated edge of a spatula

The police report said the sister was making macaroni and cheese when her brother asked if she was using butter. That led to an argument over the difference between butter and margarine, which escalated.

To read the rest of this article, click here.

Heard in the elevator

At the end of another exciting office day I got into the elevator. I barely noticed the young woman in there until she began talking on her cell phone.

"Hi, honey. Yeah, he says he can make them bigger. Umm, I don't know. How big do you think?"

Survey fun

Doing a phone survey on a drug in development this morning, and was asked this question:

"Doctor, if the drug was found to cause cataracts in dogs, but not in rats, how would this affect your prescribing?"

And yes, my practice is only limited to humans.

Tuesday night patient devotion phone message

"Hi, this is Cindy Buzz. I see Dr. Grumpy for my headaches, and he ordered an MRI. It was supposed to have been done at 4:00 this afternoon, but it was such a nice day I was driving there with my windows down, and I passed an area where they were destroying a hive, and a bunch of bees flew into my car and stung me all over and I had some kind of a reaction and lost control of my car and hit a light pole and paramedics came and I've been admitted to St. Hymenoptera's Hospital so they can watch me overnight. Can someone please call me tomorrow so I can reschedule the MRI? Thank you."

I'm an awesome doc!

You've seen it, somewhere.

Every city in America, and likely the world, has a local magazine. And once a year, that magazine publishes a "Best Docs" issue, usually listing 10 doctors from each specialty who they consider the best of the best.

Dr. Grumpy, for the record, is not biased against this. I've been named a "Best Doc" in my field several times.

And I know most of the other neurologists on the list. Some of them are very good (likely better than me) but there are always a few doctors on the list who I know are incompetent, or even dangerous. Yet, they somehow made the list, too. And there are always quite a few damn good neurologists who never make the list at all.

So how does this happen?

It's hard to judge doctors. Even good doctors get sued, and have medical board complaints against them. I have a lot of patients who love me. And some who hate me and think I'm incompetent. You can't predict the vagaries of human chemistry.

Most of these magazines try to poll doctors. They send out ballots to local docs, and ask us to write down our favorites for each specialty. So to some extent it's really just a popularity contest. Other magazines have patients vote. Generally, an incompetent doctor with his name out there, doing TV and newspaper interviews, seems to be more likely to get votes then a competent person quietly toiling away in an obscure practice.

So what does it mean to be a "Best Doc" like yours truly? It's flattering, but here's what really happens:

I find out that I'm in the coveted issue about 1 month before it goes to press. This is because someone from the magazine calls me, to tell me that I made it, and (more to the point) ask me if I'd like to buy advertising space in the issue to complement my name being in it. No, thanks.

A few weeks later the magazine calls back, this time to see how many copies of the famous issue I'd like to buy, to give to friends, family, employees, patients, anyone. No, thanks. I subscribe to the mag, anyway, for my lobby, so I get one copy as it is. And that's enough.

Then the magazine hits the stands. A few things happen:

1. I get calls and letters from companies trying to sell me a plaque, framed copy of the issue, or something else to hang on my office wall to let people know I made "Best Docs". All at a special price of only $49.95 up to $199.95 (depending on what materials and how much bling I choose for my "limited edition" item). No, thanks.

2. I get calls and letters from investment companies, stock brokers, insurance salesmen, and financial planners, congratulating me on my recognition and wanting to meet with me to discuss my financial health, since obviously anyone who's on the "Best Docs" list must have a shitload of cash lying around. They even offer to take me to lunch. Sorry, guys, but whether or not we make "Best Docs" is immaterial to how much a doc really makes. And the reality of most docs today is that we're lucky to support our families. So no, thanks.

3. I get calls and letters from my city's professional sports teams, telling me that as a "Best Doc" my life isn't complete until I buy season tickets. This year a team offered me a free pair of nosebleed seats in exchange for me attending a 30 minute sales presentation on the benefits of season tickets. No, thanks.

4. A few patients see my name in the magazine and call for an appointment.

This is always the scariest bunch. I know it's not easy to find a good doc, but if you're coming to me just because Local Magazine said so, you'd do better asking your own doctor, or friends, for names.

In general, the patients who come to me solely on the magazine's referral are some of the most dreaded ones in my practice. Why? Because they've almost always been through several previous neurologists who weren't able to fix them. But, by a leap of reasoning, they assume that Dr. Grumpy, because he made the "Best Docs" issue, will be THE doctor who can reverse their 30 years of chronic pain. Who can cure Grandma's Alzheimer's disease. Who can work some incredible miracle that 7 previous, perfectly competent, neurologists were unable to. Nope. And then they get angry when they find out I'm no more of a miracle worker than the other docs were.

And what happens to the 1 copy of the magazine that I do subscribe to?

In past years I used to save them. Take them home, put them in a pile of stuff. I have no idea why. At some point I realized they were just a bunch of old magazines, and tossed them in the recycling can.

The 1 copy that comes here is glanced through by me, Dr. Pissy, and our staffs for a day or two, to see who else made the list. Then it joins the other magazines in the lobby.

And within 2 days of being put out there, it disappears. Taken by an unknown patient.

And that's what it means to be a "Best Doc".

MEOW!!!

Dr. Grumpy: "Have you had any falls since your last visit?"

Mr. Balenz: "One, but it was my fault. I wasn't using my cane properly."

Dr. Grumpy: "How were you using it?"

Mr. Balenz: "I was hitting the rose bushes with it, to try and get the cat to come out."

Bad drug rep mornings

A drug rep I like came in this morning with a tray of muffins. I went up to say "hi" and sign for samples. Mary was chatting with her.

Mary: "Did you get contacts?"

Cindy Pharma: "No. My kids broke my glasses over the weekend, and I can't find my spare pair. I have to order new glasses today. I can see fine for driving, but can't read at all."

Annie: "Well, thank you for the muffins."

Cindy Pharma: "You're welcome. You guys enjoy them. I swung by Costco and got some of their chocolate muffins, I figured you guys could use some chocolate to start the week."

Cindy left, and we took the muffins back to the break room. Mary took a big bite, and almost choked.

Cindy was right. She can't read without her glasses at all. They were bran.

Shoes for, um, swimming?

I'd like to think my reader Cheryl for submitting this.

Yes, folks, apparently the Gravity Defyer shoe company, trying to think of an eye-catching logo for it's product, has come up with this:

This is NOT photoshopped. You can find this on the company's web page if you don't believe me.

(click to enlarge)

Saturday night, 10:45 p.m.

"Hi, I'm doing my receipts here. I came into your office to settle a bill of $74.85 last month, and it looks like you guys charged my card $74.95. So, I'm really pissed off that you hosed me like this, and I want the discrepancy credited back to my card ASAP, or you'll be hearing from my lawyer."

ER Stories

Like most specialists, I hate being called to the ER. But last night I got dragged in.

I was, however, quite lucky. Because the friendly ER staff had arranged a play for my entertainment.

It was a busy Friday night in the ER. I found a computer and phone to work at, and began writing a note. As I scribbled away, some paramedics came in, wheeling a well-dressed woman in her 30's past. A nurse told them there were no rooms available, and to put her in the hallway, across from where I was working. I heard the paramedics talking. Lady who's allergic to oregano, but accidentally ate some at a restaurant. Brought in with complaints of shortness of breath.

Though this all, Mrs. Oregano didn't move. She lay there with her eyes closed. Breathing calmly. She didn't have an oxygen mask on. A blood oxygen saturation monitor reading showed her to be at a perfectly normal 97%.

After the paramedics walked away, the awesome ER nurse went over.

(curtain rises, play begins)

ER nurse: "Are you okay, ma'am?"

(Nothing. No movement. Nurse checks pulse, blood pressure, and glances at oxygen monitor)

ER nurse: "Ma'am, I know you can answer me."

Mrs. Oregano's eyelids fluttered open. "Where... where am I?"

ER nurse: "You're in the emergency room."

Mrs. Oregano: "Oh my God! I can't breathe! They gave me Oregano at the restaurant! I told them not to do that! I could have died!"

ER nurse: "Do you have any pain?"

Mrs. Oregano: "I CAN'T BREATHE, DAMNIT!!!"

ER nurse: "You're breathing fine, your oxygen saturations are normal and..."

Mrs. Oregano: "HOW CAN YOU BE SO CALM! CAN'T YOU SEE I'M NOT BREATHING AT ALL? I HAVEN'T TAKEN A BREATH IN OVER AN HOUR! IS THIS HOW YOU TREAT DROWNING PEOPLE? I WANT TO SEE A DOCTOR!"

The ER nurse, showing remarkable calm, restraint, and an iron ability to keep from laughing hysterically, walked away. She went into the doctor's area and said "We have a winner..."

(curtain falls)

Sorry, dude, you're not that good

Dr. Grumpy: "So at what point did you call 911?"

Mr. Young: "When I realized she was having a seizure."

Dr. Grumpy: "How long after the seizure started was that?"

Mr. Young: (looks at Mrs. Young, both blush, look at floor): "Well, I didn't call right away, because we were, um, having sex at the time, and when she started shaking I just thought she..."

Dr. Grumpy: "Got it. So how long did the seizure last?"

"Check this out" indeed

I'd like to thank my reader Boris for submitting this product placement issue. I suppose it's a marketing campaign of the "Warning: choose one, or get the other" sort.

(click to enlarge)

Reptile WIN!

I got a hospital consult to see a guy who'd suffered a closed head injury, so I wandered over to see him. The admitting note began like this:

"77 year old male who fell and struck his head. While working in his yard he was attacked by a snake. He pulled off his artificial leg to bludgeon the snake with it, then lost his balance and fell. He hit his head on a rock, and was knocked unconscious."

How to drive an ER doc nuts

Dr. Grumpy: "Okay, I'll swing by and have a look at her. Who's admitting her?"

Dr. Er: "Doctor Hu."

Dr. Grumpy: "Who?"

Dr. Er: "Hu."

Dr. Grumpy: "Dr. Who, the TV show?"

Dr. Er: "No! Dr. Hu, the hospitalist."

Dr. Grumpy: "That's what I asked? Who's admitting her?"

Dr. Er: "Hu."

Dr. Grumpy: "Who?"

Dr. Er: "Grumpy, you're a pain in the ass." (click)

Mary's desk, June 16, 2010

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

Miss Multiplex: "Um, yeah, I need to make an appointment for Suzy."

Mary: "Okay, what's she coming in for?"

Miss Multiplex: "She has migraines. We both have Blue Cross."

Mary: "Okay, when can she come in?"

Miss Multiplex: "Umm... I'm not sure. I don't know when she'll be here."

Mary: "Is she traveling?"

Miss Multiplex: "No, she's one of my personalities."

Addictions

Like most neurologists, I read EEG's. These are tests that record a patient's brainwaves, usually done to see if the patient may be having seizures.

During one the tech running it types notes at the bottom of the screen, letting me know if the patient is talking, blinking, whatever, because these are things that can change the way the record looks.

So this morning I was reading a study, and this note floated by at the bottom of the screen.

(click to enlarge)

More time issues

Dr. Grumpy: "Has it been busy at work?"

Mr. Pillz: "Unbelievably crazy! We're working 60 hours a day, 6 days a week. And that's 24/7."

Logic

Dr. Grumpy: "Have you had any seizures since your last visit?"

Mrs. Ictal: "Two. They both happened when I was napping on the couch."

Dr. Grumpy: "Okay, then let's try raising your medication dose to..."

Mrs. Ictal: "Oh, we don't need to make any changes. Now I only nap on the bed."

What?

Dr. Grumpy: "Let me fill out an MRI scheduling form... Do you prefer mornings or afternoons?"

Mr. Timewarp: "I'd rather do an afternoon, but only if it's not in the morning or before 12:00."

Take me out to the ball game

So, yesterday the hospital gave us lowly doctors a trip to the baseball game, to cheer on the Grumpyville 9. They offered us discount tickets ($5 each) and so the Grumpy gang dug out some baseball hats, foam fingers, and other junk, and headed for the park.


Okay. Let's go. There's the gate. Wow. I can't believe how much they charge for parking. No, Frank, I have no idea what those people are protesting or boycotting or whatever. Just ignore them.

Really? Cash? How much will you pay for my tickets? Hey honey, wanna sell them to a scalper? Sorry, I can't. My wife just said she'll emasculate me if I do.

Already, Marie? Christ, why didn't you go at home? Okay, there's one over there. You're hungry, too? All of you are? Didn't we give you Goldfish Crackers in the car? Fine. We'll get some food before we find our seats.

Okay, 5 hot dogs, some nachos. Frank, can you help me carry this? Thanks. Good thing the bank has an office here, so I could take out a home equity loan to pay for the food. I never thought I'd see the day where Disneyland food looked cheap.

Don't spill the Diet Cokes, Frank, or you'll die. We're over in "special section" G-17, whatever that means. I think it's over there.

Here we are. Hold my tray so I can show the guy our tickets.

WHATTHEFUCKDOYOUMEANTHATALLTHEFOODINTHESPECIALSECTIONISFREE?!!!

HOLYCRAPIJUSTTOOKOUTASECONDMORTGAGETOPAYFORTHESEHOTDOGS!!!

Great. Okay. Let's take that table over there.

You're done with your hot dog Craig? Go get another one. The free buffet is over there. I don't care if you're not hungry. We're gonna get our money's worth.

Marie, don't wear the foam finger on your head during the national anthem.

Oooh, there's that new cardiologist, the hot blond lady, at the Coke machine... And some of the cute family practice residents are over at that table by the nachos... No dear, I'm just reading the scoreboard.

Crap. Dr. Loud is here. He's so obnoxious. He's making the rounds, too. I hope he doesn't come to our table.

I'm going for another hot dog. No, Frank, I don't care if you're full. Go get some more nachos. We may not feed you for another week.

HOME RUN! GRUMPYVILLE HIT A HOME RUN! THE CROWD GOES WILD! STAND UP AND CHEER, KIDS!

OMG! That cute little family practice resident doesn't shave her pits! Don't think I wanted to see that...

Marie, have some more popcorn and peanuts. No, I don't care. Shut up and eat. Find room.

Dr. Loud is at the table next to us. Crap. I don't want to talk to him. I hope he doesn't come sit with us next. Kids, don't look at him. His hideous shirt may blind you.

Grumpyville is down 5 to 1 in the 3rd inning. This isn't looking good.

No, Marie, I don't know when, or if, they're going to put dessert out. Go have another hot dog, and bring some back for your brothers.

Honey, how many of these hot dogs do you think you can fit in your purse? We could have some for dinner tomorrow, too.

Gang, you know the rules of baseball. You don't cheer wildly every freaking time somebody on either team hits the ball. That doesn't always mean something good.

The other team scored again. I'm going to go get some more nachos.

Oh, there's the hot blond cardiologist down on the concourse. Looks like she brought her sister to the game.

They're making out. I'm starting to think that's not her sister.

The other team scored again.

Frank, Craig, go have another hot dog. I'll be damned if I let the stadium come out ahead on this deal.

Where's Marie? Oh, she went to go ask when they're putting out dessert.

Where did Dr. Loud go? He's over there now. Good. I hope he skips our table. I can't stand him.

Frank, if you hit that lady with your foam finger again, she's going to punch you out, and I won't blame her, either.

The other team scored again... What all that noise?

Holy crap! Soomebody's kid is attacking the food-service guy who's taking care of the hot dog trays!

Shit! That's MY kid! MARIEEEEEEEEEE!!!!!!!!!!!!!!!!!!!!!!!!!!

I'm sorry, sir. I really am. Here's a tip. Sorry. MARIE! Go sit over there!

Marie, you can't start kicking the waiter just because he told you that there's no dessert coming.

The other team scored again.

Hey! Dr. Loud is leaving! WTF? Hey, you fat slob! You schmoozed with every other damn table here EXCEPT MINE? What's up with that? Me and my family aren't good enough for you? What an obnoxious prick.

Let's go, people, this game is pathetic. Grumpyville is down 9-2 in the 5th inning. Everyone grab 2 hot dogs. We're gonna live off this stuff for the rest of the week. And some of those relish packets, too.

No, we are NOT buying ice cream on the way out.

Where the hell did we park?

Sunday morning, 5:05 a.m.

"Hi, I see Dr. Grumpy for my MS, and am scheduled for my shot tomorrow. I got hit over the head with a small poodle yesterday, and was wondering if I should hold off on the injection for now?"

I'll miss you, Lady

Patients die. It's part of life and medical practice.

But last week one of my favorite patients died, and I'll miss her.

Due to shit luck she's been in a wheelchair for the last 15 years with a serious neurological disease. It made her suffer constantly from pain. When a freak accident cost her an eye 10 years ago, she accepted it as the crap it was, and went on with her life. She never once filed for disability. And in spite of this she was always cheerful.

I saw her every few months. Not that I really had much to offer her, but she came in to see if anything new was out. And when I said no, she accepted it with grace. I told her she didn't need to come back for a year, but she'd always be back sooner. Over the years our appointments became as much social visits as they were medical. So we'd chat about shoes and ships and ceiling wax.

She knew about this blog, one of a handful of patients who does. She'd been through so many doctors and tests and treatments that she loved to laugh at the insanity of modern medicine. She'd always joke with me that she was looking for herself on it, but I told her she'd never given me anything to write about.

And so it seems fitting, that, in dying, she finally ended up here.

She went to Local Hospital ER for pain 2 nights ago, and they sent her for a CT scan. While in the machine, she died. The code team worked on her for an hour in radiology, and couldn't get her back.

I learned of her death yesterday, and went over to read the chart, to see what happened. I was reading through the Code Blue note. Which ended with this line:

"After being pronounced dead, the patient was returned to ER for further evaluation and treatment."

Good night, Lady, wherever you are.

Attention patients!

The emergency room is for EMERGENCIES!!!

I'm sorry if you're frantic to have your test results back from Local MRI, but going to the ER, hoping that maybe they'll be able to get them faster for you, for the same damn symptoms you saw me for 2 days ago in my office, is an absolute waste of everyone's time and money, including YOURS.

In fact, we'd already left a message on your answering machine AND voice mail that the test was fine (surprisingly, it even showed a brain), but you'd already gone to the ER for this incredibly stupid reason, and had turned off your cell phone when you got there.

Minor difference.

I'd like to thank my reader Dr. Phil, for submitting this to show me that my office isn't alone.

Receptionist: "Dr. Phil's office. What can I do for you?"

Mr. Gloom: "I need to make an appointment."

Receptionist: "Okay... Is it to see the doctor? Or to have blood drawn?"

Mr. Gloom: "To draw blood. I need to have labs done before my autopsy."

Receptionist: (looking through the schedule) "Umm... You mean your biopsy?"

Mr. Gloom: "Yeah, whatever it's called."

I think they ablated your cortex

Dr. Grumpy: "Have you ever had any surgeries?"

Mrs. Dimbulb: "I had a girl-part ablation. It was like an ovarian ablation, or uterine ablation, or vagina ablation. Something like that. Maybe they ablated my hysterectomy?"

Dr. Grumpy: "Umm..."

Mrs. Dimbulb: "Hey, what does ablation mean, anyway?"

Attention crooks!

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

Basically, gang, if you're pathetic enough to be a purse snatcher, please keep in mind that you should NOT stop to count your money in front of a police station.

Just a tip.


Cops: Robber stopped to count loot outside police station

From www.chicagobreakingnews.com
June 9, 2010 4:14 PM

A suspect almost got away after snatching a purse at a Pink Line station and running off this morning.

But then he stopped to count the money. Just outside a Chicago police station.

A witness who had been following the suspect alerted officers inside the police station at and the robber was arrested after a brief chase.

"I guess it never dawned on him that it was a police station," said Ogden District Lt. Ken Sahnas.
The man allegedly robbed the woman at the Kedzie Avenue CTA station near 19th Street and Kedzie Avenue about 10:30 a.m. as he was getting off a train. The robber fell down the stairs as he was being chased by the woman, who had also been on the train, police said.

The witness, Munchie Wade, said he was waiting for a bus outside the train station when he heard footsteps on the stairs and saw the robber fall.

To read the rest of the story, click here.

"Hey! Why doesn't this floor have call lights?"

Mr. Stemi: "When I had my heart attack I was on the telepathy floor for a week."

Dr. Grumpy: "You mean the telemetry floor."

Mr. Stemi: "Yeah, whatever it's called."

Your researchers at work: hockey surprise

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

Okay, gang. The reputable Journal of the American Medical Association has apparently decided to demonstrate that idiotic research is done not only in the U.S. (and Haifa, but that's a city, not a country) but also by our friendly neighbors to the north.

Yes, a team of Canadian researchers has made the stunning discovery that hockey players who give and receive body checks during a game are more likely to suffer serious injuries than hockey players who don't.

I am not making this up.

The original article, if you must read it yourself, is:


Risk of Injury Associated With Body Checking Among Youth Ice Hockey Players

JAMA. 2010;303(22):2265-2272.

Dear Mrs. Frosting,

Congratulations on your first wedding anniversary!

I know a lot of people save a layer from their wedding cake, to eat on the first anniversary. I have no problem with that (I don't remember anymore if we did or not, but if I ask Mrs. Grumpy she'll kill me for forgetting that important point).

Anyway, I'm sorry the cake was so badly freezer-burned that it was inedible. Sometimes that happens. I'm sure you were disappointed at having to throw it out.

Apparently, though, you couldn't bring yourself to do that. So why on Earth you decided to dump it off at my office as "treats for the staff" I have no idea. I can only assume you don't have neighbors or co-workers that you hate enough to give it to.

Mary and Annie have put your thoughtful wedding souvenir in an appropriate place. If the Audobon society calls tomorrow asking about a large number of dead pigeons near our dumpster, we're giving them your name.

Monday afternoon goes to hell

Sorry, guys, today was a disaster. Due to a problem in my office building, I had no internet at all. They tell me it may not be up tomorrow, either. Anyway, I apologize for not being able to put up your comments or post today's insanity earlier. But Grumpy Neurology, P.C. had temporarily been reduced to Screaming Obscenities into the phone at the ISP Neurology, P.C. instead.


Dr. Grumpy: "So we got you a wrist brace, and you went to physical therapy for the carpal tunnel syndrome. How's it been going?"

Mr. Mano: "Better. The therapy place is good. The staff there did a really good hand job. Um, I mean, job on my hand, because it felt really good and... Doc, that doesn't sound good, does it?"

Dr. Grumpy: "No, but I think I understand what you mean."



15% off cherokee workwear with code "workwear_r2d"

Jobs

Like most doctors, I get boatloads of job offers. Tons. Every freaking day in the mail.

"Great Opportunity! Live in scenic Nofuckingwhere! Incredible Salary!"And they always have pictures of stunningly attractive men and women, with amazingly cute children, doing outdoor activities. Or attending the theater. Or doing anything but wading through a huge pile of charts with a lobby full of patients. They make the jobs sound so wonderful that you wonder why the previous doc left.

These things have all sorts of catchphrases about remarkable salary, fast-track to partnership, limited call, great public schools, outdoor activities, cultural events, etc. Usually it runs something like this: "Practice in a beautiful area, where you can live 5 minutes from the beach, mountains, and international opera house. World class schools in an area with absolutely no crime, drug problems, or pesticides. Enjoy year-round skiing, golf, wind-surfing, fishing, kayaking, and snowboarding. Call schedule is 1 in 365, with no hospital coverage. Earn $175 billion dollars a year and a generous program to help you pay back your med school loans, with a fast-track to partnership."

So, as a courtesy to other medical professionals, I've waded through these things and collected the most commonly used phrases, and now offer a translation:

"World Class Medicine": (which world? Neptune?)

"Directorship position": You're the only doc for 500 miles.

"Practice without limits": Patients will push the envelope like you wouldn't believe.

"Short drive from recreational opportunities": Not that you'll ever have time to go, but you can drop the kids off on your way to work.

"Theater events": The high school kids put on "Li'l Abner" in the fall.

"Low Crime rates": Everyone has a gun, and shoots on sight.

"Invigorating river nearby": We're downstream from a sewage plant.

"Unique patients": Inbred families with webbed fingers.

"Fine shopping": We have a Walmart AND a Target!

"Fine local cuisine": Whoppers, Big Macs, AND Wendy's"

"Wholesome community": Minorities kept out at gun point.

"Join a growing practice": You're it.

"Moving bonus": Biff will come help you unload your truck

"University town": ER is full of drunken fratboys.

"Physician-friendly hospital administration": And you can see Bigfoot here, too. Pigs also fly.

"Competitive salary": You'll make more than you would at the local McD's. But not much.

"Generous benefits": Secretary has a bowl of M&M's on her desk.

"Cultural offerings": Office fridge hasn't been cleaned in years.

"Topnotch school system": Most kids finished 8th grade.

And my favorite:

"Year round activities": What does that mean? Hell, cleaning my house is a year round activity.

Sunday morning, 6:47 a.m.

My cell phone rings. It's the hospital ID.

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

Ms. Huc: "Hi, I'm calling from 7-East. Did you get a consult on Mr. Whacky on Friday?"

Dr. Grumpy: "Yes, but when I spoke to the internist he told me it had been written by mistake, and that they didn't need a neurologist. So I didn't see him."

Ms. Huc: "Ohhhhh... I was just looking through the chart, and trying to figure out why you didn't see him."

Dr. Grumpy: "Do they need him seen now? I can come in later today."

Ms. Huc: "Hang on, let me ask his nurse." (pause) "No, never mind. He went home last night."

Memories...

In residency, young doclings have clinics, learning how to do outpatient medicine in the hopes that we'll be able to do it when we grow up.

Grizz, another resident in my year, had a clinic epilepsy patient who had HUGE surgically enhanced breasts. She also used craploads of make-up.

Anyway, another resident was getting married, and so we planned a bachelor party for him over at Local House of Boobies. It was a fairly successful event (from what I remember) involving alcohol, topless dancers, a large number of $1 bills, and I think some silly string.

Anyway, at one point I paid a stripper to come over and give Dr. Bachelor a lap dance. So she got started doing her thing, then abruptly stopped. She looked at Grizz and said, "Hey! You're Dr. Grizz! I see you over at the epilepsy clinic!"

Grizz looked like he wanted to die. He turned a shade of red I hadn't seen before or since.

She walked over and rubbed her breasts on his head "You're awesome! I love that new drug you have me on, because it doesn't affect my balance when I'm dancing!"

Then she resumed the show.

Grizz didn't go to anymore bachelor parties after that.

Sitcom in my office

Mr. Patient: "Dr. Internist told me to see you about my arm pain. He also wanted me to mention that I'm having memory loss."

Dr. Grumpy: "Okay, let's start with the arm. How long has it been hurting you?"

Mr. Patient: "I don't remember."

Things that make me grumpy

I had a hospital consult yesterday afternoon. So I swung by the doctor's lounge to grab a Diet Coke, and then went to find my patient.

While I was waiting for the elevator, I popped the can open. Unfortunately, it exploded, showering me and the floor with soda.

Shit happens. Oh well. I ran to the bathroom next to the elevator, grabbed a handful of paper towels, and came back to clean up the mess.

As I'm working on it, Dr. Helmsley wanders by, and asks me what happened. I told him my Diet Coke exploded, and so I'm cleaning it up.

He laughed and said "I wouldn't bother. You're a doctor. The hospital pays drudges to do that." Then he walked away.

Screw you, Dr. Helmsley, and anyone else who thinks like that. Just because we have advanced degrees and training, DOESN'T EVER exclude us from normal courtesy. My mother always told me that if I make a mess I should clean it up. Not leave it for someone else to deal with.

And if you think being a doctor , or driving a Porsche, or ANYTHING exempts you from that, then your mother needs to slap the shit out of you.

Attention patients, drug reps, and planet Earth!

Mary is trying to quit smoking.

Therefore, DO NOT, under any circumstances, give her attitude.

If you do, we at Grumpy Neurology, P.C., cannot be held responsible for anything she may do to you. And believe me, you don't want to find out.

Any attempts to give Mary attitude are at your own risk. So don't say I didn't warn you.

Wednesday afternoon front desk insanity

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

Mrs. Nutz: 'Yes, I need to make a new-patient appointment."

Mary: "Okay, we can see you tomorrow morning, at 11:00."

Mrs. Nutz: "I'm having a lot of leg pain. Can your doctor find out what's wrong, and fix it?"

Mary: "Well, he'll do his best, I mean, he'll need to evaluate you and..."

Mrs. Nutz: 'I'm leaving on a vacation this Sunday, and I need this problem fixed by then. Otherwise it will ruin my trip. Is he going to be able to do that?"

Mary: "Well, like I said, he hasn't even seen you yet, so it's hard to..."

Mrs. Nutz: "Well I need it fixed. This is ridiculous."

Mary: "Okay, how about I get you scheduled? What's your insurance?"

Mrs. Nutz: "I have a very high deductible, so I'll be paying all of this out of pocket. How much is it?"

Mary: "Well the appointment is $300, but if you need tests done it..."

Mrs Nutz: "$300!!! That's insane! Okay, I'll bite. But I will only pay it if your doctor can guarantee, in writing, that I will be figured out and completely fixed before I leave on my trip. Otherwise I want my money back."

Mary: "We can't do that. I won't schedule you under such a condition. I don't know any doctor who will see you like that."

Mrs. Nutz: "Doesn't anyone want to help patients anymore? Whatever happened to that damn oath they take?" (Hangs up).

Not helpful

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

Ms. Vague: "Yes, several."

Dr. Grumpy: "What are their names?"

Ms. Vague : "I don't know. Can't you get the list from my last doctor?"

Dr. Grumpy: "Okay, we'll have you fill out a release... What's that doctor's name?"

Ms. Vague: "I have no idea. It was a man. I think I saw him when I lived in Missouri. Does that help?"

You can't afford to be sick!

I hate these ads.

You've seen them. They're in newspapers and regional magazines across the country. Some smiling mom and her cute kid. It's an ad for some local clinic, always with a tagline like "You can't afford to be sick!" or "You don't have time to be sick!".

And they list things they treat, like headache, sore throat, ankle sprain, runny nose, and skinned knee (who the hell goes to the doctor for a skinned knee?). They make no mention of heart attack. Or accidental amputation. Or arrow through the head.

It's so comically misleading. As if there's something abnormal about being sick. Face it. The germs outnumber us. Being sick is part of the price of doing business of Earth. We all catch the crud here and there. And we all trip and fall, spraining this and scraping that.

These ads give the impression that it's horribly abnormal to catch some mild illness or suffer a minor injury. Better yet, they make it sound like they can magically fix you, like they're going to wave a wand, and the germs will suddenly vanish or you'll grow new skin immediately.

All they do is give you Sudafed and/or Tylenol and/or a band-aid, (which you could have bought yourself) and bill your insurance.

What really peeves me is that this enforces a cultural dependency on medical care. Yes, I'm a doctor. Medical care is how I earn a living. And there are certainly MANY conditions where you absolutely, positively, should see a medical professional. And I know sometimes it's hard to know what's what.

But did your Mom send you to the doctor for every little thing? (I know, some Moms did) Probably not. She sent you to bed, gave you some Tylenol, and told the school you were out. Or she gave you Tylenol and sent you to school.

And I'm willing to bet you felt a hell of a lot sicker at some point in college, after toga night at McBarfy's house of cheap beer. And you didn't see a doctor for that, either.

We have a lot of treatments in medicine. But the majority of things you get in your everyday life will get better with or without a doctor.

"The art of medicine consists of amusing the patient while nature cures the disease."

Voltaire wrote that around 250 years ago. And, for the most part, I won't argue with him.

So you are

Dr. Grumpy: "Any major illnesses in your parents?"

Mr. Huh: "I don't know. I'm an only child."

Monday night, 9:27 p.m.

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

Mrs. Cabinet: "Yes, I'm one of your patients, but I'm calling about my husband. He was putting cole slaw away after our Memorial Day barbecue, and he bumped his head on a cabinet."

Dr. Grumpy: "Did he get knocked out? Or is he sleepy? Or weak anywhere?"

Mrs. Cabinet: "No, but he has this big lumpy bruise on forehead. I want an MRI on him, immediately. We can do it tonight. Just tell me where to go."

Dr. Grumpy: "Well, I really can't order that on him. I mean, he's not my patient, and I can't set up tests after office hours. The best I can suggest is that you take him to an ER, and let them assess him, and see if they feel he needs further testing."

Mrs. Cabinet: "I don't want to take him to an ER. He only bumped his head. Going there would be overkill."

Memorial Day, 2010

The lawyer from South Dakota

On memorial day, veterans graves across the country are honored with wreaths and flags. But some veterans have no graves to honor, and can only be remembered.



Lieutenant Commander John C. Waldron, U.S.N.


He & his men changed the course of World War II in the Pacific, and didn't live to know it.

He was a lawyer, born in Fort Pierre, South Dakota. His father was descended from English settlers, his mother was a Sioux Indian.

He was married, with 2 daughters.

He was admitted to the state bar in South Dakota, but rather then going into practice decided to join the U.S. Navy. He was chosen to be a pilot, in the new field of naval aviation.

He trained to fly torpedo planes (no longer in use). Their goal was to fly close enough to an enemy ship to drop a torpedo into the water, then get away as fast as possible. This was a difficult job. It required the planes to fly in a low, straight line as they approached the enemy, making them easy targets for enemy fighters and anti-aircraft.

Waldron was a good pilot. He was chosen to teach at Annapolis, and later Pensacola. He flew planes off 1 battleship and 3 carriers.

He and his wife held parties for other pilots at their Norfolk home. He was very proud of his little girls. Some pilots remembered being taken to his daughters' darkened bedroom and asked "Did you guys ever see such pretty little girls?"

With war looming in the Summer of 1941, Waldron and his men were assigned to the aircraft carrier U.S.S. Hornet, in the Pacific theater.

He was determined. He once told his pilots that "if we run out of gas, we'll piss in the tanks." He wasn't looking for glory, or to become a martyr, or a hero. He was just doing his job.

On the morning of June 4, the Hornet was somewhere off Midway island, placed there to defend against the massive Japanese force sent to capture the Pacific base.

Waldron likely had few illusions about his chances. Although his men were well-trained, their "Devastator" torpedo bombers were already obsolete. The new "Avenger" planes were much better, but only beginning to roll out of the factories. And with the enemy coming, they had to make do with what they had. Before the battle he called his men together and said "If there is only one plane left to make a final run in, I want that man to go in and get a hit."

The Japanese "Zero" fighter was a lethal weapon. Though poorly protected, it was quicker and more maneuverable than it's American counterparts. And it was flown by some of the best pilots in the world.

On the morning of June 4, 1942, Waldron led Torpedo Squadron 8 off the Hornet. He had orders to search for the Japanese in a specific area, but had a hunch (he called it his "Sioux intuition") that the heading he'd been told to follow was wrong. He disobeyed orders, and it turned out his intuition was correct.

Waldron led his 15 planes straight to the enemy fleet. Forced to fly straight & low to aim their torpedoes, they were sitting ducks as the Zeroes swooped down and destroyed them one by one. Out of 30 men, there was only one survivor, Lt. George Gay. He saw Waldron stand up in his plane as it burst into flames, just before his own plane was shot out from under him. They didn't get a single hit.

The 15 pilots of Torpedo Squadron 8, photographed in May, 1942. Waldron is standing, 3rd from left. Lt. George Gay, (circled, 1st row) is the only man in the picture who survived.

In a few minutes all the planes of Torpedo Squadron 8 had vanished beneath the Pacific, leaving only Lieutenant Gay hiding from the Zeros under his flotation device. It was a disaster for the Americans.

But unbeknownst to all but Lt. Gay, they changed the course of the Pacific war.

The deadly Zeroes were now at sea level, on the prowl for more torpedo planes. But the next American wave, this time of dive bombers, was high above. They might have been easy targets, too. But as they came down the Zeroes were no longer in a position to defend their fleet, and couldn't gain altitude in time to stop the bombers. Between 10:20 and 10:25 a.m that morning the Japanese lost 3 of their 4 aircraft carriers to the bombers. The last carrier followed them a few hours later.

The loss of the four carriers, with their planes, pilots, and crews, was a blow the Japanese navy never recovered from. The war went on for 3 more years, but the tide was turned by the sacrifice of a group of men, led by a 41-year old lawyer from South Dakota.

All my readers, no matter what country they're in, owe their freedom to soldiers in all military branches. So remember them today.


The fallen from Torpedo Squadron 8. Their only grave marker is the blue Pacific water.

Lt. Commander John C. Waldron
Lt. Raymond A. Moore
Lt. James C. Owens, Jr.
Lt.(jg) George M. Campbell
Lt.(jg) John P. Gray
Lt.(jg) Jeff D. Woodson
Ens.William W. Abercrombie
Ens. William W. Creamer
Ens. Harold J. Ellison
Ens. William R. Evans
Ens. Henry R. Kenyun
Ens. Ulvert M. Moore
Ens. Grant W. Teats
Robert B. Miles, Aviation Pilot 1c
Horace F. Dobbs, Chief Radioman
Amelio Maffei, Radioman 1
Tom H. Pettry, Radioman 1
Otway D. Creasy, Jr. Radioman 2
Ross H. Bibb, Jr., Radioman 2
Darwin L. Clark, Radioman 2
Ronald J. Fisher, Radioman 2
Hollis Martin, Radioman 2
Bernerd P. Phelps Radioman 2
Aswell L. Picou, Seaman 2
Francis S. Polston, Seaman 2
Max A. Calkins, Radioman 3
George A. Field, Radioman 3
Robert K. Huntington Radioman 3
William F. Sawhill, Radioman 3

Insurance premiums at work

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

Mr. Shakes: "Yeah, I see you for epilepsy, and I missed my medication this morning, and I just had a seizure."

Dr. Grumpy: "Okay, have you taken another dose?"

Mr. Shakes: "Yeah."

Dr. Grumpy: "Good. So are you doing okay now?"

Mr. Shakes: "Yeah, I'm fine. I feel good. I'm going to go over to ER after the game."

Dr. Grumpy: "Why? It sounds like you don't need to. Are you back to normal?"

Mr. Shakes: 'Absolutely. But I wanna go get checked out."

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

Mr. Shakes: "I'M GOING TO ER, DAMN IT!"

(hangs up)

May 29, 1914

If you read the popular stuff, you'd think there were only 3 major shipwrecks of the 20th century: Titanic, Lusitania, and Andrea Doria. Obviously, there are many more, even if you exclude 2 worldwide conflicts in the last 100 years. The worst peacetime shipwreck in history, the Dona Paz (Philippines), took 4,375 lives as recently as 1987. And I bet you've never heard of it.

Trans-Atlantic crossings have always been critical to both sides of the Atlantic (look at the chaos caused by the recent Icelandic volcanic eruption). Although the giant liners of Cunard and White Star are best remembered, they were by no means alone. Ships were constantly coming and going, carrying passengers and freight, both ways across The Pond.

Although less glamorous than the liners that sailed in & out of New York, there were many busy ships that called on the Canadian ports. One was the Empress of Ireland, which in 1914 was serving the Quebec City to Liverpool route.

Early this morning, 96 years ago, the Empress was outbound from Canada. She was heading northeast on the St. Lawrence River. It was 2:00 a.m., and most of the passengers were sleeping.

In a thick fog, the Norwegian coal-carrier Storstad struck the Empress on the starboard side. The damage was extensive. There was only limited time to sound an alarm, and electricity failed quickly, plunging the ship into darkness. The Empress was gone in 14 minutes.

The survivors were picked up by the few lifeboats that had been launched, and were carried back and forth to the Storstad, which had stayed afloat. Captain Henry Kendall, who was thrown into the water as the ship rolled over, supervised the rescue efforts and likely saved many lives by organizing the lifeboats.

All together the Empress took 1,024 people with her. It remains the deadliest maritime disaster in Canadian history. In spite of this, the ship is mostly forgotten today. The St. Lawrence Seaway is a very busy channel. Hundreds of ships steam over the Empress every day, very few knowing of the tragedy beneath them.

The Salvation Army remembers. A large contingent of members (167) were lost on the ship, traveling to a conference in London. There is a monument to them at Mount Pleasant Cemetery, in Toronto.

The Empress of Ireland is in 130 feet of water, well within the range of scuba equipment, but the currents and poor visibility limit diving

Idiots on vacation

Dr. Grumpy: "How was your trip to South America?"

Mrs. Insensitive Tourist: "It was fine. But Chile was a dump. That earthquake was what, a month or two ago? You'd think they could have the place cleaned up and fixed by now."

Math fail

I'm doing an online medical research survey this morning. It began with this message:

"The study consists of 3 sections, each of which is 15 minutes in length. The study will therefore take 1 hour to complete."

Dear BCBS insurance company,

Thank you for tying up my fax machine by sending me 27 consecutive copies of this page, with ABSOLUTELY NO OTHER RELEVANT INFORMATION WHATSOEVER!!!

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I'm just SO glad to know that my premiums, and our dwindling natural resources, are being put to such good use by you guys.

Thank you.

More priorities

Dr. Grumpy: "So how did this all start?"

Mrs. Trayler: "Well, on Sunday, I was doing some cleaning, and suddenly I couldn't move my right arm, and my daughter said my speech was slurred. So we went to Local Hospital."

Dr. Grumpy: "Hang on..." (logs into the Local Hospital records) "That's weird, the hospital has no record of you being treated there. Are you sure you went to this hospital?"

Mrs. Trayler: "Yeah, but I didn't stay. The lobby was full, and I was worried I'd have to wait, so I left."

Dr. Grumpy: "You left the hospital with a stroke?!!!"

Mrs. Trayler: "I had to. I mean, the NASCAR race was gonna start."

Department of Redundant Radiology Department

This report crossed my desk yesterday.

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