Oh yeah, that one

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

Mr. Vague: "My sister has that one disease, it makes you sick. You know which one I mean?"

Bad idea #1

There are worse things than driving drunk. Butt not many.

Thank you, Webhill!

Bad idea #2

I hope they didn't get to the "Hot Wax Undercarriage" treatment.

Thank you, Bob!

Great ad placement

Thank you, Rachel!

Mary's desk, April 4, 2012

New patient signs in up front.

Mary: "Hi, I need to get a copy of your insurance card."

Mrs. Paranoid: "I don't carry my card with me. Someone might steal it."

Mary: "Okay, but we need your information to bill your insurance."

Mrs. Paranoid: "I have Medicare."

Mary: "Okay, then can I get your Social Security number so we can bill them?"

Mrs. Paranoid: "I can't give you that. How do I know you won't still my identity, or sell it to someone who will?"

Mary: "We need some way of billing your insurance for the visit. Otherwise you'll have to pay cash today."

Mrs. Paranoid: "This is ridiculous that you treat people this way."

Leaves.

Wait...

Mr. Sugar: "I have diabetes, but it's controlled with diet. I don't take anything for it."

Dr. Grumpy: "Okay. Are you on medication for anything?"

Mr. Sugar: "I take Metformin, Actos, and Insulin."

Time for another advertising quiz

This picture:




A. Some flick about a romance between a doctor and football player.

B. Boy, Dell is really going avant-garde in their new commercials.

C. She makes porn movies of herself & drunk quarterbacks on her laptop, and sells them online.

D. Um... L'Oréal ad? She really needs something for better hair control. Or is she a medusa?

E. Is a computer-guided system to help the center guy at the bottom scrape dog shit off his shoe.

F. Why is her white coat billowing up like that? Is it starched? Is she gassy? Hey, does she even have pants on?

G. An ad for an ultrasound needle-guidance system.

"Uh, no, officer, that's my, um, girlfriend"

I think this would make a great ad for Honda. "The new Civic: more back seat room than Toyota."

Thank you, Kimm!

Patient quote of the weekend

"I've been having headaches, you know, and like, stuff that I get with them, you know, all that stuff that happens with my headaches, like, you know, it hurts, and I don't feel good and stuff, you know, and like, can you do stuff about this? You know, like, pills or stuff or something?"

And, as usual, this call came in at around 3:00 a.m.

Random Sunday pictures

Time to hit the email bag for shots you guys have sent me.


First, this screenshot shows the dangers of having your site truncated by browser software:






Next we have this snack bar:



I think I'll just have the plain cheese pizza, hold the toppings.



And here's a fine example of (probably artisanal) coffee:



It might be really good, but if I were at a coffee place and a guy said to me "Hey! Would you like to taste mysore nuggets?" I'd probably run. Fast.



Next is a beer that believes in truth in advertising:






Here's an ad for a resort's play facility:



They apparently have a higher opinion of 6-week-old human motor skills than I do.



This is from an interview with a Best Buy executive, describing company plans. I don't understand this, which is why I guess I'm not an MBA. In fact, it sounds like a story from the Onion.





To show yet another irritating overuse of the word "artisan" we have this mass-produced vinyl barbecue cover:





And finally, since it is April 1, here's one of my favorite pranks ever:

North American Idol

While I generally don't promote artists other than myself (trust me, medicine is an art more than a science) sometimes I simply MUST do so.

Witness, please, this truly remarkable cop-cam performance by Mr. Robert Wilkinson, a Canadian gentleman. In an attempt to convince a police officer that he was not inebriated, Mr. Wilkinson did what any sober person would do: belt out a complete a cappella rendition of Queen's "Bohemian Rhapsody" (okay, so he briefly used the windows as drums, but it was quick) in the squad car.

It's worth watching the entire thing. I promise.






One night in medical school, after a round of tests, I performed a stirring rendition of "My Way" at a now-defunct karaoke bar. Afterwards my roommate Enzyme commented, "Dude, you can't carry a tune worth shit. But boy, can you sing." Mr. Wilkinson demonstrates that statement better than I ever could.

Thank you, Tanya!

Dear Local Pharmacy,

Thanks for your recent refill request on Ms. Andrews. I've signed and faxed it back.

I'm used to seeing notes on these things (usually mixed with the patients' names) as reminders to your staff. I've seen "John Smith - Always double count pills" and "Lisa - give her dog a treat - Jones" and "hearing impaired - Michael Harris."

And I'm aware it's important that your tech know if a patient should have a childproof cap, or one that's easy to pop off.

But it just doesn't sound good when I get a request for a lady named "Suzy 'Easy Opening' Andrews."

Thank you,

Ibee Grumpy, M.D.

Today's news

"No, Reverend, it's perfectly normal to be hanging curtains in your vegetable pantry while buck naked."

Thank you, Steve!

Methuselah

Every March Mr. Patient needs me to re-file paperwork so he can get his medication for another year.

This year, pissed off at the endless forms, I wrote "HE WILL TAKE THIS FOR THE REST OF HIS LIFE! PLEASE AUTHORIZE FOR MORE THAN ONE YEAR!!!"

Apparently I got someone's attention.

(click to enlarge)

Mary

Yesterday I left my car at Local Automotive for an oil change. Toward late afternoon I asked Mary to call and see if it was ready.

It wasn't. They'd had a busy day, with 2 guys out sick, and since my car wasn't urgent they put it at the bottom of the list and didn't get to it. To me this wasn't a big deal. It happens here, too.

But Mary decided to take a stand on my behalf, and told the guy that since this happened I shouldn't have to pay for the oil change. He agreed, and told her that if I bring it in again today they won't charge me for it.

Mary was so proud of herself. I didn't have the heart to tell her I bought the lifetime oil change for the car 12 years ago, and haven't paid for one since.

Sunday afternoon

'"Hi, this is Mrs. Triptan, and I see Dr. Grumpy for migraines. My daughter also gets migraines, so I give her my Painbegone pills. I know I'm not supposed to, but they work. Anyway, she's at 'Hunger Games' and has a migraine, but doesn't want to miss any of the movie, and texted me to bring her a pill. But I'm out, and the insurance won't give me more until April. So could Dr. Grumpy either meet me at his office to give me samples so I can take them to her? Or, if you're near Tween Cinema, could you just take them there? I can give you her cell number."

Wild times at the hospital

Dr. Grumpy: "So I'm going to check an MRI and EEG, and I'll be back to see you after we have the results. Any questions?"

Mrs. Speed: "NO! But I have a complaint."

Dr. Grumpy: "What's up?"

Mrs. Speed: "That orderly, the teenage hospital lackey that you people had take me downstairs for my chest X-ray last night! You need to have her fired!"

Dr. Grumpy: "I'm sorry, was she rude to you!"

Mrs. Speed: "How should I know? She pushed my bed so fast I had to hang on for dear life! I was so scared I wasn't paying attention to what she said!"

Dr. Grumpy: "I..."

Mrs. Speed: "She's a hazard! I hate to think how she drives! She took corners at speeds so fast I was afraid the whole bed was going to fall over!"

Dr. Grumpy: "I'm sorry..."

Mrs. Speed: "You need to train them better! And you should also have speed limit signs in the halls, and educate people like her to follow them!"

Weekend Reruns

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.

Memories

It was the mid-70's, and I was 10 years old, in the 5th grade.

Some friends and I were hanging out in the school library, and noticed a book on a nearby shelf called "A Night to Remember." In typical pre-adolescent fashion we joked about it being a dirty book, but I was curious and picked it out.

Roughly 35 years later, it still holds me. I re-read it again last night. Hundreds of books have been written about the Titanic, but this one still trumps them all. Likely because it tells human stories, not just a summary, and was based on many interviews.

I'd never heard of the Titanic before that book, and the story certainly has changed the direction of my interests.

Walter Lord, in my opinion, was likely the best historical writer of all time. I never met him, but wish I had. If you've never read any of his books, you should. "Day or Infamy" and "Incredible Victory" are both excellent, too (there are many others). He had an amazing ability to tell stories through the eyes of people who were actually there, not just quoting the facts, and his many interviews with eyewitnesses give you a whole new perspective on historical events.

If you like "A Night to Remember" I also recommend "The Night Lives On," where he re-examines many of the legends and stories about the Titanic for clearer answers of what happened during the tragedy.

Bones

The orthopedic surgeon who occasionally rents office space from Pissy & I has this ortho tech named Larry.

Larry looks like a character from Dr. Seuss. His eyes point in completely different directions, his hair is a LONG ponytail that goes past his rear end, he keeps the ponytail tied up at different levels with multi-colored scrunchies, he has this massive unkempt beard, and he always wears these 1970's era tie-dye scrubs.

So yesterday I'm sitting in my office with a patient when Larry suddenly shows up in the doorway (his shirt triggering a migraine in my patient)

Larry: "Hey, sorry to bother you, Dr. Grumpy, but can I borrow your cast saw?"

Dr. Grumpy: "My what?"

Larry: "You know, cast saw. What you use to cut off casts. Mine just broke."

Dr. Grumpy: "I'm a neurologist. I don't have a cast saw."

Larry: "REALLY? I thought every doctor did. Do you think I can borrow Dr. Pissy's?"

Dr. Grumpy: "He doesn't have one either."

Pause

Larry: "Well, what am I supposed to tell Dr. Ortho?"

Sigh

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

Dr. Launchpad: "Yeah, I'm the hospitalist working today, and I consulted you on Mrs. Sick."

Dr. Grumpy: "I saw her this morning. I think I ordered an MRI and some labs."

Dr. Launchpad: "You did! But that wasn't what you were supposed to do!"

Dr. Grumpy: "What was I supposed to do?"

Dr. Launchpad: "I wanted you to just write 'okay for discharge' so I could send her home!"

Dr. Grumpy: "Your note said 'consult neurology for confusion.' It didn't say anything about sending her home."

Dr. Launchpad: "I just wanted you to evaluate her, not order tests! I want to get her out of here."

Dr. Grumpy: "Okay, but ordering tests is a pretty common part of an evaluation."

Dr. Launchpad: "What does that have to do with it? I'm trying to send her home, and you've screwed it all up!"

Radiology 101

The aside: a good reason to turn off the microphone when dictating.

(click to enlarge)




Thank you, Gary (who claims his partner did this- yeah, sure)!

But wait! There's more!

The dreaded A-word has now come to the medical field.





Yes, we now have artisanal control cardiac catheters, for all your heartfelt needs.


Within a few minutes of the catheter showing up in my mailbox, a friend of mine who's currently in Portugal sent me this picture, to show that the problem continues to spread across the planet.

Monday night, 11:58 p.m.

Tap, tap, tap

Dr. Grumpy: "Mmmmph... What time is it? What's up, Craig?"

Craig: "I can't sleep."

Dr. Grumpy: "Are you okay?"

Craig: "Something is bothering me."

Dr. Grumpy: "What?"

Craig: "Did people at Target have to work on St. Patrick's Day?"

Dr. Grumpy: "Um, I guess so. They were open. This is why you can't sleep?"

Craig: "I don't think it's fair. They only wear red shirts at work, so won't people pinch them? For not wearing green?"

Long pause

Dr. Grumpy: "I'm sure for St. Patrick's day they're allowed to wear green pins or something."

Craig: "Oh. I guess that's okay. Thanks! Good night, Dad."

Specialists

Dr. Grumpy: "Hi, Leigh, good to see you again. What brings you back in?"

Mrs. Skin: "Well, my internist told me I needed to see a dermatologist about this thing on my shoulder."

Dr. Grumpy: "Um... I'm not a dermatologist. I'm your neurologist."

Mrs. Skin: "I know, but I wasn't able to get in to one this week, and you had an opening. So I figured I'd ask you about it instead."

Weekend reruns

This afternoon I saw a great little old lady, sharp as a tack, who got dragged in by her overprotective daughter, and was NOT happy about it.

The daughter was one of those huffy types who tried to answer every question for her mom, even though the old lady was clearly fine, independent, and a helluva lot brighter then her offspring.

Mom tried to talk around her, but the daughter just wouldn't let her answer my questions, even when asked directly of the patient.

Finally, when her daughter interrupted her for the millionth time, Mom looked at me and said, "You'll have to forgive my daughter. Normally she wouldn't be accompanying me to doctor visits, but 52 years ago my diaphragm broke."

Of Flies and Men

Okay, for those of you live under a rock, you missed THE BIGGEST SCIENCE STORY OF THE DECADE yesterday.

Now, we humans are what biology types call vertebrates. Like birds, snakes, fish, turtles, and horses, we have spines.

Invertebrates is the really big group out there (97% of animal life on Earth). It includes flies, spiders, lobsters, coral, squids, and lots of others.

From what we know, we branched off from them roughly 535 million years ago. So with our last common ancestor being PRETTY OLD, you'd think we wouldn't have a lot in common.

But, apparently we do.



(Drosophila, by the way, are flies)


As published in the journal Science yesterday, if you take a bunch of horny male fruit flies, and deprive them of female companionship, they turn to consuming alcohol as a coping mechanism.

Now, anyone who knows a guy, or is a guy, is aware that this behavior clearly exists in human males, but it's interesting to find it in a life form fairly different from ours. Of course, I'm not sure if this has been tested in closer relatives, like dogs or chimpanzees. So it's possible this is some odd vestige left from 535 million years ago that's persisted in only 2 species.

Granted, I think it's unlikely there were any bars open then (although one near Big State University when I attended it may have been, as I don't think the bathrooms had been cleaned since trilobytes had used them).


I'm left with a few questions:

1. Is this where the rejection line "buzz off" originates?

2. Do flies have flying-insect-based porn flicks to turn to? If so do they feature stars with names like Jenna Erecta?

3. Who the hell thought of studying this in the first place? Where did they get funding? And how did they keep a straight face while asking for a grant?

4. Does this somehow relate to the fact that fruit flies have the longest sperm on Earth (2.3 inches each sperm! I SWEAR!)*

5. If the sexually satisfied flies are the ones hanging out on dog shit, and the deprived are the ones getting shit faced, which is worse?

6. Did anyone do this on female flies? When sex-deprived do they go shopping?


And last, I should add Mrs. Grumpy's comment that this proves males are a lower state of evolution than females, and simply haven't changed much in 535 million years.


* If knowing this fact ever helps you win millions on Jeopardy, please remember who told you. I take Paypal.

Phone bill

Mr. Library: "Here, I brought in several articles about my condition that I downloaded off the internet..."

(hands over 3-inch-thick notebook)

Dr. Grumpy: "Okay."

Mr. Library: "And here are the office numbers of their authors. As you can see, they cover several major universities around the globe. I'd like you to call and discuss my case with all them."

Mrs. Bojangles

One of my elderly patients has just gone downhill recently, and for the life of me I couldn't figure out why.

So I had Mary bring her in.

I learned that for the last 12 years she based when to take her medications on when her dog asked to go out and pee, which was apparently pretty regular.

The dog died last month. So now she doesn't remember to take her pills.

I wanted to cry.

Mary's desk

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

Mrs. High-Maintenance: "Yes, I need to make a follow-up appointment with Dr. Grumpy."

Mary: "Okay, we can see you tomorrow, at 1:15 or 3:30."

Mrs. High-Maintenance: "No, that won't work. I can only do 10:30 in the morning."

Mary: "All right... What about Friday at 10:30?"

Mrs. High-Maintenance: "Oh sorry, it has to be a Thursday. I work at our downtown office near you every other week, so I guess that would mean a 10:30 only on Thursdays that fall on odd-numbered dates."

Mary: "Hang on... Well, the next time we can see you then would be, um, Thursday, April 5."

Mrs. High-Maintenance: "I need to be seen sooner than that! Can't you just re-schedule someone else?"

Mary: "No, we can't do that. It's not fair to other patients."

Mrs. High-Maintenance: "Well, you could be more flexible."

Today's featured item

Yes, the product you've all been waiting for: Now a starving vegan can eat her own purse, and not feel guilty about it!

(click to enlarge)





It's made from "animal-friendly faux leather" (i.e. PLASTIC).

By this standard cell phones, pens, and credit cards are now part of a well-balanced non-animal-product diet.

I should also note that anything called "Sacs of Life" brings a different kind of bag to mind.

Thank you, Kim!

Fax machine fun

Dear Dr. Talus,

I'm sorry your patient's cheapshit insurance doesn't cover podiatrists.

But that doesn't mean I'm going to start doing foot surgery.

I'm a neurologist. So please stop sending referrals like this to me.





Thank you,

Ibee Grumpy, M.D.

Love and marriage

Dr. Grumpy: "When did you call paramedics?"

Mrs. Leg: "Let's see... the numbness started around 10:20, and by 10:30 the leg was very weak. I couldn't use it to stand or walk or anything, so I asked Bill to dial 911."

Dr. Grumpy: "That's when they were notified?"

Mrs. Leg: "Well, no. He got up and brought me the phone during the next commercial break, then I called."

Sunday rambling

I've touched on this before, but after getting dragged to "The Lorax" today (and no, I didn't like it. The 1971 book, or 1972 TV cartoon, were far better and more to-the-point) I noticed the same issue.

When I was in high school Quiet Riot released a cover version of Slade's "Cum On Feel the Noize" that was a smash hit. It also got censored (at least where written displays of its title were shown) because of the first word's spelling. So in stores you'd see the single (yes, folks, 45 rpm) with an attached piece of paper saying "Come" partially covering the name.

And today, where is this obscenely-spelled piece of music being used? In a movie trailer for "The Pirates! Band of Misfits" a children's claymation film cumming, I mean coming, out this Spring.

In another preview was the less controversial (unless you're Harold Camping), but still very 80's, REM song "It's the End of the World as We Know It (and I Feel Fine)" being used in the trailer for "Ice Age 4: Continental Drift".

So, the take home messages from the movie today are:

1. Any book that takes less than 20 minutes to read is unlikely to be made into a decent movie. They simply have to add WAY too much extraneous material. And this usually includes a few musical numbers.

2. The 80's will never die. Music, leg warmers, and all.

Random Sunday pictures

First off we have this post-holiday sale on "Christmas Deluxe Chanukah Candles."





Next we have this dumpster. I'd like to see the opposite, a company called "Inaccurate Trash Removal," that randomly hauls off your car, patio furniture, kids, etc.






Here we have a marketing survey on coffee, asking if people like it to be called "artisanal."





And (my favorite): if you can't afford the new iPad, or even a used one, there's this device. It's battery life is virtually inexhaustible, it can be carried anywhere, and is cleverly made from organic materials to help conserve metal.





To operate the gadget you'll need a special stylus...

Weekend reruns

I'm tied up with kid stuff today, so thought I'd re-post one of my favorite historical oddities. If you enjoy this sort of trivia, please check out my collection of history posts.






In 1941-1943, the Axis U-boats dominated the Atlantic, and the Allies were looking for an answer. The airplane was an effective anti-submarine weapon, but the logistics of using planes in the Atlantic were daunting. Aircraft carriers were urgently needed in the Pacific and Mediterranean. Land based planes' range was limited, and could only cover portions of the Atlantic. So there existed a "black gap" in mid-ocean, where the U-boats could roam at will.

So the naval staff of Britain came up with a remarkable idea, which was named Project Habakkuk: to build a gigantic aircraft carrier out of ice. And, as crazy as it sounds, it may have worked.

Normal ice shatters, and melts. A British engineer, Geoffrey Pyke, developed a mixture of ice and wood pulp called Pykrete. The new material was surprisingly resistant to blunt force. As temperatures rose, the wood pulp formed a fuzzy coating over the ice, insulating it from further melting. Experiments on Pykrete were conducted in top secret, in a refrigerated meat locker beneath Smithfield meat market in London. Frozen animal carcasses were used to hide the research areas.

The size of these ships would have been remarkable. The initial design was for a floating airfield 5000 feet (1524 m) long, 2000 feet (610 m) wide, and 100 feet (30 m) high. Later designs were shortened to 2000 feet long. They would have a displacement of 1-2 million tons. By comparison, the huge aircraft carriers in use today by the U.S. Navy are just under 1100 feet long and weigh 101,000 tons.

They could handle the biggest planes of the era, and carry enough food and fuel to resupply them for months. They had externally mounted power plants capable of propelling them at 6 knots, and would act as floating airfields in the North Atlantic. They were cheaper, and could be built much faster, then a conventional carrier, and had an estimated lifespan of 6-18 months (likely longer, as it turned out).

To see if the idea would work, a 60 foot scale model was built at Patricia Lake, in Canada, over the winter of 1942-1943. To preserve secrecy, the Pykrete blocks were made at Lake Louise, and moved to Patricia for assembly. And it worked quite well. In Summer the wood pulp covered the ice and slowed the rate of melting. Auxiliary cooling equipment was developed that could be carried outside the hull.

Churchill thought quite highly of the idea. The ships would be built in Canada, and to this end the Canadians began assembling enough ice and wood pulp to begin construction.

More and more technical problems, however, came up, and by the time they were sorted out the tide had started to turn against the Axis. The Liberty ships were being built faster than U-boats could sink them. The Allies had developed small, relatively cheap, escort aircraft carriers, which were now providing air coverage to Atlantic convoys. Long range patrol bombers had improved. And so one of the most remarkable ideas in naval history was quietly shelved.

The model built at Patricia Lake took 3 years to melt, showing that Pykrete was quite durable. It was allowed to sink into the lake.

And there, at the bottom of Patricia Lake in Alberta, Canada, lie the remains of Habakkuk. The test ship's frame, with a small motor and refrigeration plant, are now visited by scuba divers. Jasper National Park receives many visitors every year, most unaware that at the bottom of a small, serene, lake is all that's left of this remarkable idea.

Home

Dr. Grumpy: "Hey Craig, how did you do in the class debate?"

Craig: "I did okay. I'm the first alternate for my class debate team. So if another kid, like Jeff, gets sick than I'll be on the team."

Dr. Grumpy: "That's great!"

Craig: "Since you're a doctor, can you write me a note to take to school tomorrow? Something that says Jeff is sick, and can't participate?"

Nudge nudge wink wink

Dr. Grumpy: "It looks like you have carpal tunnel syndrome."

Mr. Arm: "I can believe it. I've been doing the same repetitive motion with my right hand every day for 39 years."

Gone with the Wind

While picking up the kids from school on this blustery day, I overheard two women having a shouted conversation in the parking lot:

Mom 1 "BOY! IT SURE IS WINDY TODAY!"

Mom 2: "WHAT?"

Mom 1: " I SAID, BOY, IT SURE IS WINDY TODAY!"

Mom 2: "I CAN'T HEAR YOU! IT'S TOO WINDY!"

Snort

The DATscan is a test used for assessing patients with unclear types of tremors. Like many other tests, there are some medications you have to stop a day or two in advance.

So the guidelines include a helpful list of all such drugs, and their time frames.





I personally like this one:




"Hey, Phil, in order to take the test, you need to stop hitting the blow for 2 days."

Language

While on call this past weekend I discovered this line in another neurologist's note:

"An ictal event is possible, and cannot entirely be excluded, however our data to implicate such process definitively is somewhat tenuous at this point in time."

Care

Dr. Concerned Internist: "Hello?"

Dr. Grumpy: "Hey, Susan. It's Grumpy. I need to talk to you about Mrs. Aspirin."

Dr. Concerned Internist: "What's up?"

Dr. Grumpy: "Well, you referred her to me for a TIA, so I ordered a carotid ultrasound. Her arteries look okay, but on one side she's got a small thyroid nodule, and the radiologist is worried it's malignant."

Dr. Concerned Internist: "So why are you calling me?"

Dr. Grumpy: "Well, it needs further work-up, and you're her internist."

Dr. Concerned Internist: "You ordered the test that found it, so it's your problem now."

Click

Artisanal mailbag time

First up, from the land down under, (proving the insanity isn't confined to one hemisphere or continent) we have this company:





I can only assume that artisanal air is composed from handcrafted Australian atoms of hydrogen, oxygen, and nitrogen, rather than, say, made 13.7 billion years ago during the big bang.




Next is this, which came up as the error message when the page crashed. So the IT guys are now officially artisans.







Now we have this picture from Las Vegas, advertising a local strip bar.





I suppose in some way the strippers are artisanal, as their chests were handcrafted by some of the finest plastic surgeons in Tijuana.

By the way, your cab driver is asleep.



And lastly, we have this, from CakeWrecks. While not claimed as artisanal, it deserves to be shown. Because, as a neurologist, some things just call for a nice piece of cake.





And that isn't one of them.

Memories

Recently my colleague Sufu, who's in medical school, emailed me about the issues with learning to hear heart sounds.

It brought back memories of a lecture I had back in medical school, when a cardiology professor delivered these helpful quotes:

"This type of murmur sounds like a snowflake landing on a feather."

"You can practice mimicking heart sounds by tapping on Kleenex."

"If you think you heard this murmur, you didn't."

"I've never heard that heart sound, so I don't believe it really exists."

"If you can imagine the sound dandelions make as you blow seeds off them, you should be able to hear this murmur."

Looks like you're on the couch tonight

Mr. Lumbar: "When the leg pain gets really bad it makes driving unsafe."

Dr. Grumpy: "Why? Does the leg get weak?"

Mr. Lumbar: "No, because then my wife has to take the wheel, and she's dangerous."

Law and Order

Today's legal tip:

1. In a criminal case, you should have an attorney represent you, and not do it yourself.

2. If you do it yourself, and lose, you should not try to appeal on the grounds that you were incompetent at doing so.

Thank you, Officer Cynical!

Mary's desk, February 29, 2012

Mr. Irritant: "Hello?"

Mary: "Hi, this is Mary, calling from Dr. Grumpy's office. Your MRI is back, and so I'm calling to schedule your EMG."

Mr. Irritant: "Did he tell you that? Or are you just wanting him to do the test?"

Mary: "He told me to schedule it, sir. He says that the MRI didn't show a cause for your arm symptoms, so he needs to do an EMG to see if there's any damage in the arm itself."

Mr. Irritant: "Can he get on the phone himself and tell me this? I don't trust you desk people."

Mary: "I can have him call you later, but he's with a patient right now."

Mr. Irritant: "I want to hear it from him. I know you desk people work on commission based on tests you schedule."

Today's criminal tip

After you attempt to rob a bank, don't immediately go back to use the ATM.

Thank you, Tanya!

Good to know

Mrs. Definite: "My father died of prostate cancer. But I'm trying not to worry about it because my gynecologist reassured me I don't have one."

Great outdoorsmen

Somehow I don't think it was planned like that.