Tuesday, February 14, 2012

More hairs jump off

Dr. Grumpy: "Did anyone else in your family have Hufnagel's Syndrome?

Mrs. Helpful: "My sister did."

Dr. Grumpy: How old was she when she developed it?"

Mrs. Helpful: "She died when she was 38, in a car accident."

Dr. Grumpy: "But how old was she when she developed Hufnagel's Syndrome?"

Mrs. Helpful: "Well, she actually didn't have it. But if she'd lived, I'm sure she'd have gotten it in her 50's"

Monday, February 13, 2012

No! Really?

Dr. Grumpy: "When was your last appointment with Dr. Mortis?"

Mrs. Obvious: "It was before he died."

Love and Rodents

This morning I was looking through the weekend fax machine pile, and found Local Swanky Restaurant had sent over a menu for their "Valentine's Day Special."

It featured this mouth-watering item:



I think we'll just stay home. It's supposed to snow, anyway.

Sunday, February 12, 2012

Election 2012

As my readers know, I'm running for President this year.

Now, admittedly, my entire campaign thus far is based on one issue, but yesterday while attending a 9-year-old girl's birthday party with my kids, I came up with a second point.

While I strongly support freedom of expression, I also believe some times are better than others to express your beliefs.

So, if elected President, I promise you this:

Any father who shows up at his 9-year daughter's birthday party wearing a T-shirt that says "IT AIN'T GONNA SUCK ITSELF" with an arrow pointing downwards, will be immediately castrated by specially trained fashion police.

Vote Grumpy, 2012!

Saturday, February 11, 2012

Random Saturday pictures

Today I'm going to feature some unrelated, yet thought provoking, shots.


First is this plan posted at a hospital. I think it's particularly important, because when you have to urgently "evacuate" it's good to know where the bathrooms are.






Next is this insanity. When "artisanal" or "handcrafted" aren't enough, they have to pay someone to think of better names. Because just calling it "moisturizer" or "hand lotion" is boring.





On the other hand, it also opens up the possibility of Mrs. Grumpy telling me "Not tonight, honey. Why don't you just rub yourself with some Happy Sensation instead?"



And last, we have this bit of hyperbole from a medical marketing company. Instead of a network or panel of doctors, they have an "organically grown community" of them. Whatever that means.

(click to enlarge)




Friday, February 10, 2012

It's the Benny Hill Show!

Yes, just another day in the life of an undercover cop.

Thank you, Ed!

Crime in America

Hey! I'll pay this guy's bail money if he'll break in to my house!

Thank you, Don!

Take 2

Dr. Grumpy: "Hi, have a seat... It looks like I saw you back in 2007, then we got a release saying you were seeing another neurologist."

Mr. Rerun: "Yeah, I didn't think you were that good. But my friend saw you last month, and liked you, so I thought maybe you'd gotten better and came back."

Thursday, February 9, 2012

Culture

Dr. Grumpy: "What part of town is best for you to do the testing?"

Mr. Jeopardy: "Down on 3rd street there's an MRI place. It's right across from the Jewish church."

Mary's desk

The new patient signs in up front.

Mary: "Hi, can I get a copy of your insurance card?"

Mr. Card: "I don't have it here. But you said on the phone that you take my insurance."

Mary: "I'm sure we do, but we need a copy of your card to bill."

Mr. Card: "Well, I don't have it. It's Medicare, or maybe Blue Cross. Actually, it could be United. Anyway, it's one of those insurance companies."

Mary: "Okay, but without your card there's a chance you'll end up paying cash for today's visit."

Mr. Card: "I can't afford that. Maybe it's down in my car."

(leaves, 10 minutes go by, comes back)

Mary: "Hi, did you find your card?"

Mr. Card: "No, but I have the info here."

He hands Mary a crumpled McDonald's receipt, with grease stains and an order for 2 Big Macs and fries. On the back he'd scribbled "37642AKT047, expires 7."

Mary: "Do you know what insurance company this is with?"

Mr. Card: "No, but it's one of the big ones. Can't you look it up on the internet?"

Mary: "Sir, we can't accept this in place of an insurance card."

Mr. Card: "Doctors just don't care about people any more."

Leaves.

Wednesday, February 8, 2012

Health problems

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

Mrs. Baseball: "My Dad died from being a Phillies fan."

"Imodium & Lomotil Law Firm, can I help you?"

My reader Sue says she works for an attorney in Arizona, and that they regularly get letters from another firm with an, uh, unusual name. To prove it she sent in their letterhead and website.





I'm glad they're not in medicine. Because in this field having "loose" and "brown" in the same sentence generally refers to something else.

Their website is (obviously) loosebrown.com. I have to wonder how many hits they get from people thinking it's a site for copraphilia fetishists.

Thank you, Sue!

Tuesday, February 7, 2012

Rumba, cha-cha, DUI

Another fine moment in alcohol consumption.

Thank you, Tanya!

Perseveration

Dr. Grumpy: "So what can I do for you?"

Mr. Son: "Mom has been having memory problems, and I've been having to take more and more care of her."

Mrs. Ross: "But son, you're very good at what you're doing."

Mr. Son: "Thanks, mom. And she doesn't remember how to work things at home."

Dr. Grumpy: "Have any tests been done?"

Mr. Son: "Dr. Intern ordered some labs. Here are copies for you." (hands over papers)

Dr. Grumpy: "Thank you, let me look through these..."

Mrs. Ross: "Dr. Intern is very good at what he's doing."

Dr. Grumpy: "Do you have a list of medications?"

Mr. Son: "Yes, I wrote them down." (hands over note card)

Dr. Grumpy: "Thanks."

Mrs. Ross: "Doctor, I think you're very good at what you're doing."

Monday, February 6, 2012

No comment



Actual headline posted on CNN today.

Thank you, Webhill!

Crap!

Dr. Grumpy: "Okay, so do your symptoms get worse when you..."

(patient stands up, and starts clearing off MY DESK, moving my can of Diet Coke, pens, mouse, etc.)

Dr. Grumpy: "Um, what are you doing?"

Mrs. Mom: "I'm clearing off your desk."

Dr. Grumpy: "Yes, but why?"

Mrs. Mom: "So I can change Jessica. She has a poopy diaper."

Saturday, February 4, 2012

Ride like the wind, Bullseye!

Yes, we at Dr. Grumpy are now featuring all kinds of fun outdoor activities.

Thank you, Tab!

Support your local ER

I'd like to thank Amy for sending in this great ad she saw.





Because, let's face it, NOTHING goes better together than alcohol and potentially dangerous physical activity.

Friday, February 3, 2012

Make up your mind!

Quote which appeared on an MRI report today:

"The arthritic changes at this level appear to be mild, perhaps mild to moderate. They're in the mild to severe range."

Sports FAIL

"Hey, Mike, we're gonna run the story about the guy hired by the basketball league. Make sure you put something appropriate in the background."



Actual picture featured (on the cover, no less) of Neurology Today, January 19, 2012.

Thursday, February 2, 2012

February 2, 1959

A strange event happened 53 years ago today. And what makes it unusual is that the facts are well-documented. It's the "why?" that may never be known.





Kholat Syakhl is a mountain in the Ural range in Russia. The name is from the language of the local Mansi tribes, and means "Mountain of the Dead."

In early 1959, a group of 9 young men & women set out to ski-trek through the area. It was winter, but all were experienced, well-trained winter skiers. They carried plenty of supplies. All were students, or recent graduates, of Ural State Technical University. The leader of the group was 23 year-old Igor Dyatlov.



Igor Dyatlov


They carried cameras and diaries, which were eventually recovered. The pictures showed routine events in the trek, and were helpful afterward in trying to reconstruct times... up to a point.

They left Vizhai on January 27, 1959, and their pictures suggest the trip went well. They show a group clowning around and enjoying themselves.






On January 31 they climbed into a highland area, and near a clump of trees cached surplus food & equipment for the return leg of their trip.





On February 2 they began hiking through a mountain pass. Their original plan was to get through the area and camp on the opposite side that night, but snow had started to fall. With the visibility worse they headed west by mistake, going upwards on Kholat Syakhl.





They realized the mistake quickly, but by then darkness had started to set in. They decided to make camp in a clearing there, and cross the pass in the morning. They set up camp at around 5:00 p.m., had dinner, and were settled down for the night by 9:00. By all indications it was a fairly typical evening.




Setting up camp.


Dyatlov was planning to send a telegraph home when they returned to Vizhai, on February 12. When it didn't arrive there was little initial reaction, as treks of this sort were known to last a few extra days. But by February 20 enough people were concerned that the first search parties went out. Eventually the police were brought in, and used helicopters to search the area.

On February 26, searchers found their tent on the slopes of Kholat Syakhl. It was badly damaged, and curiously had been cut through from within. The entrance was still clasped closed from the inside.







Outside the ruined tent were footprints heading for the forest. Following them, searchers found the first 2 frozen bodies. Both were under a large tree, near the remains of a fire. They were men, both barefoot and wearing only underwear. Branches of the tree were broken off, and the mens' hands and feet were injured, suggesting they'd tried to climb it.

Three other bodies eventually turned up, spread out between the tent and the tree, in positions suggesting they were returning to the tent when they died. One was Dyatlov, clutching a large tree branch in one hand.

It had been -22°F (-30° C) that night, with blowing snow. Yet, something had happened that drove experienced skiers frantically out, nearly naked, into temperatures that they knew would be fatal in a short time. All were found to have died of hypothermia. Only one body had any sign of injury, a small, non-fatal, skull fracture.

The remaining 4 frozen bodies weren't found until the spring thaw, on May 4. They were in a stream bed a few hundred feet from the tree.

The autopsies of the last 4 added to the mystery. They were wearing more clothes than those found under the tree, but not nearly enough to handle the temperatures (most of the heavy clothing had been left in the remains of the tent). Only one had died of exposure. The other 3 from severe trauma: 1 had massive skull damage, the other 2 had suffered serious chest cavity injuries and broken ribs. One woman had her tongue completely torn out. None of the bodies had any signs of external wounds, and there was no superficial soft tissue damage. This suggested massive, sudden pressure to the affected areas (such as seen in high-speed car accidents).

Based on the amount of food in their stomachs, all had died 6-8 hours after their last meal (between 6:00-7:00 p.m. from the diaries).

All their clothing, and the tent, had varying levels of radiation on them (higher than the area's natural background).

So what happened?

The best that investigators in 1959, and again during a 2nd review of records in the 1990's, came up with is that a "compelling unknown force" occurred between 11:00 and midnight that night.

Something that made 9 highly-experienced winter skiers so desperate to get out of their tent that they cut through it from inside rather than unclasp the entrance, then ran into the freezing night wearing far less than they knew would be needed to survive the weather outside.

From the footprints they ran in all directions initially, then regrouped and built a fire under the tree. At that point they tried to share clothing for warmth (based on what different bodies were wearing). They were only 1500 feet from the tent and all of their supplies, but, because of whatever had happened, didn't want to go back.

At some point 2 of them died of exposure, which is likely when Dyatlov and 2 others headed back to the tent. They never made it.

In the next few hours the remaining 4 left the fire, and decided that heading farther into the forest was safer than going back to their supplies and the tent. During the night they reached a frozen stream bed, where something caused serious bodily injuries to 3 of them.

And the "compelling force?"

There were suspicions that local Mansi tribes had attacked the group, but no other footprints (human or animal), or even evidence of a struggle, were ever found. There was no evidence of gun or knife wounds. In addition, all their food and other supplies were untouched. Tribesmen would likely have taken anything of use. Animals, such as bears, would have eaten the exposed food in the tent (not to mention the bodies).

Some suggest they were startled by an avalanche, but there was no evidence of one, even minor, in the area.

Another theory (and still the most persistent) is that they were accidental victims of a Soviet secret weapons test in the area, though again, no evidence to confirm this has ever come to light, even with files re-opened in the 1990's.

Inevitably, UFO's are blamed. A group of hikers 32 miles south of Kholat Syakhl that night had reported seeing "orange spheres" in the sky. Similar sightings were also reported by a meteorological station in the area, before the disappearance of the hikers was known. But this is hardly enough to draw conclusions from. I, personally, am very skeptical of paranormal claims, UFO's, etc. And don't even get me started on cryptids.

The bottom line is that the "compelling unknown force" was known only to 9 people, and none came home to tell the tale.

After the incident the area was closed off for 3 years. Today it's named Dyatlov Pass, in memory of the group. Nothing unusual has happened there again.

Something took the lives of 9 young men and women 52 years ago today. It remains a complete mystery. And likely always will be.


Wednesday, February 1, 2012

Whatever

Dr. Grumpy: "Are you married?"

Mr. Necro: "Divorced, but I'm reconciling with my late wife."

Dr. Grumpy: "Um... do you mean your ex-wife?"

Mr. Necro: "Whatever."

Annie's desk, January 31st, 2012

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

Mr. Payne: "Yeah, the pill the doctor gave me makes me nauseous."

Annie: "Okay... In looking through your chart, I don't see that he prescribed any meds. In fact, you haven't been here in almost a year."

Mr. Payne: "My other doctor gave it to me last week."

Annie: "Then you need to call the doctor who prescribed it."

Mr. Payne: "What does that have to do with it?"

Tuesday, January 31, 2012

Sympathy

"It's not MY fault he had a heart attack! I've got things to do!"

Freudian script

Dr. Grumpy: "Hi, this is Dr. Grumpy, returning a page."

RalPh: "Hi, this is RalPh, the pharmacist over at local grocery. I'm calling about a script you wrote for Valerie Smith yesterday, for her Valium."

Dr. Grumpy: "Is there a problem? She gets it every month."

RalPh: "It's her name. You misspelled it."

Dr. Grumpy: "What did I write?"

RalPh: "Instead of Valerie Smith you wrote Valium Smith."

(pause)

Dr. Grumpy: "Holy crap. That's awesome."

RalPh: "Yeah, it took a while for the tech and I to stop laughing enough to call you."

Monday, January 30, 2012

Xenophobia FAIL!

Dr. Grumpy: "What were the pills?"

Mr. Skin: "I don't know. A friend brought them back from Argentina."

Dr. Grumpy: "Did you take them?"

Mr. Skin: "No, because I don't trust Mexicans."

Time

My Dad recently converted a bunch of 1950's home movies of he and my mom to digital, and I was showing them to the kids last night.

Marie watched silently for a few minutes, then said: "That's not grandma. That lady has black hair. Grandma's is gray."

Sunday, January 29, 2012

Sunday reruns

I've got a junkie over in the ICU, who overdosed on a bunch of stuff yesterday. She was on a ventilator (a breathing machine) this morning, but they were going to see if she improved enough today to get her off it.

So I called over there a minute ago to talk to her nurse:

Dr. Grumpy: "How'd she do this morning?"

Nurse Icu: "She's more awake, and we got her off the ventilator, but may have to put her back on again."

Dr. Grumpy: "Why? Is she still having trouble breathing?"

Nurse Icu: "No, she's just a bitch."

Saturday, January 28, 2012

My kids are jealous (hell, so am I!)

Okay, while I don't know Mathew Ho and Asad Muhammad, I have to respect what they did.

This pair of 17-year old guys, who live in Toronto, successfully launched a Lego figure into near-space (14 miles up) using a weather balloon, a lot of weekends, and costing about $400.

Just for fun.

They even sent 4 cameras and a GPS tracker with him, so they could film and recover him.

This is the movie they posted.





I'm thoroughly impressed guys. That's really cool.

Friday, January 27, 2012

"Uh, maybe we can sell them on Ebay..."

Yet another reminder that crime doesn't pay.

Thank you, Lee!

Maybe I should start using Old Spice

Mrs. Colostrum: "It's a burning pain on one side of my head. It's like... Doctor, you know what it feels like when you've been breastfeeding, and after the infant is done you have a burning pain in that nipple? Did you breastfeed when you had your kids?"

Dr. Grumpy: "No."

Thursday, January 26, 2012

Drug company ads

There's nothing quite as manly as testosterone. Especially when you're rubbing it into your smelly armpits.

So does anyone else out there think this ad campaign:






Would be a helluva lot better if it featured the Old Spice Guy?





"Smell like a man, man."


Just wondering.

Family ties

Dr. Grumpy: "How are things going?"

Mrs. Xanax: "It's very stressful. My sister and I aren't speaking to each other right now."

Dr. Grumpy: "I'm sorry to hear that. Is this the one who's having a baby? Last time you were here you were knitting a blanket for her?"

Mrs. Xanax: "Yeah, but that's where it all started. I was going to have the blanket done when she got to 36 weeks, but then she had all kinds of complications, and had a seizure, and they had to deliver the baby at 29 weeks, and the blanket wasn't done by then. Now she just spends all her time at the hospital visiting the baby, and I finally called and told her that I wasn't happy about how she ruined my plans to have the blanket ready in time, and that it's not all about her."

Wednesday, January 25, 2012

Your tax dollars at work

I, Dr. Grumpy, am not a cannibal. I have never been a cannibal, nor do I have any interest in being a cannibal.

In Oklahoma, however, an elected representative of the people (state Senator Ralph Shortey) has decided that eating human fetuses is a SERIOUS problem in America. If not now, it still could become one by, say, 2022.

So we need to act now to keep this from happening. Because, with all the other issues facing our society, people eating fetuses is apparently one of the bigger ones. At least to Mr. Shortey.

So he has, I SWEAR, introduced a bill to ban the practice of using human fetuses in food products.

Comically, he even admits that he's unaware of anyone actually doing this, but decided the law is needed because he researched the subject on the internet.

And we all know how accurate that is.

Thank you, Ed!

Counting

I recently got a pile of medical records from Dr. Downthestreet, which featured these notes on the bottom of a 4-page lab report.


Tuesday, January 24, 2012

By jove, I think he's got it!

Mr. Gregory: "Today is the 24th. Doctor, do you realize what that means?"

Dr. Grumpy: "Um, no?"

Mr. Gregory: "It's been 24 days since the month started."

Meetings and conferences and grand rounds OH MY!

A large part of a medical career is spent half awake in a darkened auditorium. It starts in medical school with classes. During the 3rd & 4th years it expands to include grand rounds and teaching conferences of whatever rotation you're on.

In residency it continues, with most programs having at lease 1 daily conference. Residents who don't show up risk incurring the wrath of the program director.

In the REAL WORLD this stuff continues. It's worst if you stay in academics, but even in private practice there are CME courses, annual meetings, etc. to go to (okay, I haven't gone to any for over 12 years, but I'm atypical). My idol, Dr. Oscar London, pointed out that by the time they finish training most doctors are conditioned to doze off when they hear "May I have the first slide, please."

But I digress.

Anyway, the point here is that these meetings are BORING. Except for the occasional fistfight between doctors breaking out (I personally witnessed one at a tumor board between a medical oncologist and radiation oncologist) these things are dreary as hell.

But there are rare exceptions. The one that will likely live on as THE MOST INTERESTING MEDICAL PRESENTATION EVER was in 1983, at the American Urodynamics Association annual meeting.

The presenter was Sir Giles Brindley (knighted in 1986 for bioengineering research).

At this point, I'm going to send you over to a summary article for the remarkable story of that day.

Thank you, Science Marches On Department!

Monday, January 23, 2012

Set to music, too

Dr. Grumpy: "What can I do for you?"

Mrs. Windows: "Do you have Powerpoint on your computer?"

Dr. Grumpy: "Um, yes?"

Mrs. Windows: "Here's a complete presentation on my symptoms." (hands over memory stick)

Sunday, January 22, 2012

Addendum to the previous post

While reading the drunk-driving article linked in yesterday's post (below) I noticed this name in the comments under it:

Saturday, January 21, 2012

If you're gonna do it, do it right

I bet he and his son are proud of each other.

Thank you, Amanda!

Friday, January 20, 2012

The surgery mindset

On rare occasions an orthopedic surgeon will rent a half-day of office space from Dr. Pissy and I, and today was one of those.

Unfortunately, the power was out for a few hours this afternoon due to the snowstorm. This is a major inconvenience, but what can you do? So the patients and I work through it as best we can.

Not the ortho doc, though. 10 minutes after it went out he came storming out of an exam room and went up to his secretary.

"Suzy! This power outage is unacceptable! Call the electric company and have them turn it back on immediately!"

Pissy and I had a hard time not cackling as he marched back into the exam room.

Awesomeness

Some days a patient reminds me of the (dwindling) reasons why I still love this job.


Dr. Grumpy: "Have you had any neck pain?"

Mr. Awesome: "I have no idea."

Dr. Grumpy: "You don't know if you have neck pain?"

Mr. Awesome: "Look, doc, I'm 89. If you pay attention to every ache and pain at my age you become a fucking hypochondriac."

Thursday, January 19, 2012

Patient quote of the day

"My Dad had cancer. I think it was prosthetic cancer."

Why do I bother?

Dr. Grumpy: "Did that medicine help?"

Mr. Pill: "I don't know. The pharmacy never filled it."

Dr. Grumpy: "Whaaa..."

Mr. Pill: "I dropped it off last month, but they never called to tell me it was ready."

Dr. Grumpy: "Did you go by to get it? Or call them to ask if it was ready?"

Mr. Pill: "Was I supposed to?"

Wednesday, January 18, 2012

The ink is black, the page is white

Race relations are more complex than passing laws and saying "look, we elected/hired a black person." A lot of the time real change is seen at a level that politicians and activists won't even tell you about.

So here's a story that you won't hear on the news or from a politico's mouth.

I have a patient, an elderly white man. His wife died 2 years ago, and he has no kids or local siblings. In 2010 he developed a relentlessly progressive neurological disease, with increasing disability over time.

A long time ago, when he was a teenager, his parents were prominent members of the Grumpyville community. When a group of black families wanted to build a community center, the majority of Grumpyville whites fought like hell to keep them from doing so. Because, after all, they were black people.

But Mr. Patient's parents were different. They had this bizarre (for the time) view that people were equal, and should be treated fairly. So they stood up against the majority of the community, bought a parcel of land for the community center, and then financed a large part of it out of their own pockets.

So it got built. And became a successful (and still in existence) black center in Grumpyville. Years went by. Mr. Patient's parents grew old and died, and then Mr. Patient grew old and sick.

There's nobody at the community center old enough to remember how it got started. Although the center's humble origins are doubtless memorialized somewhere on a wall or booklet, most of its members are my age or younger now.

Mr. Patient is stubborn (like most guys) and been reluctant to leave the house he and his wife have owned for 50 years. To him moving into a care home was out of the question. His financial resources, though comfortable, didn't allow him to hire much in the way of outside help. And he was too stubborn to call friends for help. So he worsened, and became increasingly unable to care for his home and self.

Usually these situations end in disaster. The patient is found lying on the floor, dead or near it, after the postman notices no one is getting the mail. But this one was different.

Last month, through the community grapevine, one of the administrators of the black community center heard about white Mr. Patient, and realized who his parents were. He contacted him to offer help, and to my surprise, Mr. Patient accepted.

So now Mr. Patient is able to continue living at his house because volunteers from the community center, all born long after the place was established, come to his home a few times a week. They bring him meals and groceries, help with the upkeep of the house, and are allowing him to stay there as long as possible.

That's what real measures of human change are.

Tuesday, January 17, 2012

"That was the wrong button, Nigel."

"British Airways apologizes for this unfortunate incident, and will pay to wash or replace our loyal passengers' underwear."

Doctors behaving badly

Mary interrupts me with a patient. A doctor who doesn't refer to me is on the phone, and says it's urgent he talk to me.


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

Dr. Dislike: "Hi, does Fukitol interact with Noshakes?"

Dr. Grumpy: "Is one of my patients over there?"

Dr. Dislike: "No, I just want to know for someone I'm seeing tomorrow."

Dr. Grumpy: "You had me interrupted with a patient to ask me a simple drug question?"

Dr. Dislike: "I'm very busy. I don't have time for this. Answer the question!"

Dr. Grumpy: "Look it up on ePocrates." (hangs up)

Monday, January 16, 2012

Magazines at the grocery store check-out line

Sheesh. All I wanted was some hamburger buns, tomatoes, and onion rings.





Reminded me of this.

Thank you, Webhill!

Clothes make the man

Due to a laundry machine catastrophe yesterday, Local Hospital has run out of patient gowns. So they're using a bunch of promotional T-shirts they found in the basement.

As a result, my drooling, incontinent 92 year old male stroke patient, with advanced Alzheimer's disease, is wearing a T-shirt that says "I'm a proud new Daddy!"

With little baby footprints under the word "Daddy."

Sunday, January 15, 2012

Sunday musical interlude

 
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