Sigh

Mrs. Apap: "I take Excedrin all day long."

Dr. Grumpy: "Have you ever heard of rebound headache?"

Mrs. Apap: "No, is it like Red Bull?"

Better living through chemistry

Recently a new drug perampanel (AKA Fycompa) became available for epilepsy patients.

Every drug has a LONG list of side effects (Annie calls it "the scandal sheet"), but this one's is more interesting than most:

"Serious or life-threatening psychiatric and behavioral adverse reactions, including aggression, hostility, irritability, anger, homicidal ideation and threats, have been reported in patients taking FYCOMPA"

HOLY CRAP! Did I just read that correctly? Hmmm....

Let's look at the FDA's own information, as given in the manufacturer's filed paperwork:

"... has summarized the narratives of 23 physical assaults, suicidal ideations, homicidal ideations, and damage to property in the Epilepsy and Nonepilepsy studies. Preferred terms included homicidal ideation, belligerence, aggression, affective disorder/psychotic disorder, personality change, irritability, aggression/impulse control disorder, anger, adjustment disorder, agitation, abnormal behavior, and personality disorder."

Now, with that said, I want to remind you that if you look at the side effects of ANY drug, you'll find scary shit on all of them. I'm sure I'll put patients on Fycompa, and most will likely do fine.

But still, I really like this line from the FDA forms:

"The Sponsor has reported that no homicides were committed by a subject while taking perampanel."

Wouldn't you just LOVE to be able to stand up in front of a government panel and say that with a straight face? "Yeah, I mean, there were a few people who became violent on our drug, but it's not like they killed anyone or something."


So with that backdrop, it falls to the marketing wizards to make this drug look good. Their job is to promote strengths and minimize weaknesses. So what image should they use to distract people from the side effect of violent behavior. Hmmm... Flowers? Butterflies? Or maybe...

A boxing glove! Yes, they really picked a boxing glove. I swear, I am not making this up.



And, since the glove is green, perhaps they should consider this spokesman:

 

 "HULK TAKE FYCOMPA! MAKE HULK MAD!"*

*Hulk is copyrighted by Marvel Comics, along with the Avengers, Spider Man, Dr. Strange, the Fantastic Four, and a bunch of others I don't want to mess with. Or prescribe Fycompa to. **

**Thank you, SMOD, for the Hulk idea.

Care

Dr. Hospital: "Hello?"

Dr. Grumpy: "Hi, this is Ibee Grumpy."

Dr. Hospital: "Uh, okay. Why are you calling me?"

Dr. Grumpy: "Well, you wrote a note in Mrs. Seizure's chart this morning, saying you wanted to discuss her case with me before sending her home."

Dr. Hospital: "Oh, I didn't really mean for you to call me. I just wrote that to cover my ass."

Done too soon

A lot of press has recently been given to the untimely death of Aaron Swartz. Regardless of his legal issues (and I'm not getting into them) he was obviously a brilliant mind, gone too soon.

But I want to tell you about one you may have never heard of.

John Kennedy Toole (born 1937), from an early age, was an unquestionably brilliant individual. He received excellent marks in high school, graduated with honors from Tulane university (to which he'd received a full scholarship at age 17) and got a masters degree from Columbia. He went on to become a professor at Hunter College in New York, becoming (at age 22) the youngest professor in the institution's history.

In 1961 he was drafted into the U.S. Army and stationed in Puerto Rico, teaching English to local recruits. There he began writing a remarkable novel. He left the military in 1963, and completed the book in 1964.

Over the next several years he submitted it to 3 publishers, all of whom rejected it. The disappointments led to him becoming despondent, than an alcoholic, and then paranoid. He was convinced he was being followed and frequently searched his home for electronic mind-reading devices. At one point he began having severe headaches, but refused to see a neurologist (speaking as a neurologist, the personality changes and headaches raise a number of diagnostic possibilities, but I'm not going to address that further).

In 1969 he went on a long drive across the country, finally ending in Biloxi, Mississippi. There, in March, he committed suicide by running a garden hose from his car's exhaust through the window. He left a suicide note which his mother read, then destroyed. He was 31 years old.

His rejected manuscript sat, untouched, on an armoire in his old room at his parent's house. In 1971 his mother tried again to have it published - only to collect 7 more rejections over the next 5 years (modern readers may remember that 2 major studios - United Artists and Universal - both rejected the script for Star Wars during this same time frame as having no potential for success).

In 1976 author Walker Percy was teaching at Loyola University New Orleans. Toole's mother wrote and called him, to the extent that he complained to his wife about her. He tried to dodge her, but at one point she actually pushed her way into his office with the single precious copy of the manuscript. He finally agreed to look at it, figuring it would be so awful that after a few pages he'd be done with it.

He was wrong.

As he wrote later, "I read on. And on. First with the sinking feeling that it was not bad enough to quit, then with a prickle of interest, then a growing excitement, and finally an incredulity; surely it was not possible that it was so good."

Walker Percy was, in the end, stunned by the book, and put his own efforts into getting it published. It finally went to press in 1980. In 1981 it won a Pulitzer Prize, 12 years after John Toole had taken his own life

The book is "A Confederacy of Dunces" and is, in my experience, a love-it-or-hate-it-work. I personally love it. It's the story of one of the most despicable protagonists in English literature trying to find a way to earn money in the early 1960's. It switches randomly between a number of wildly different threads, giving no real clue why. As the story progresses they become gradually tied together, finally ending in one hysterical scene which predated similar endings in Seinfeld by almost 30 years.

Some of you won't like the book. It's not for everyone. But for those who enjoy it, it's a masterpiece.

John Toole only had one other book published (after the success of Confederacy of Dunces) called The Neon Bible. It was written when he was a teenager, and is the only other work we have from this brilliant, but obviously sadly sick, individual. And we will never know what else he might have written if his life hadn't ended so early.

Friday afternoon

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

Mrs. Myelin: "This is Sarah Myelin! My MS made my left arm go numb yesterday! I need to see Dr. Grumpy, and get an MRI done, today!"

Mary: "Well, it's Friday afternoon, and we don't have anything till next week, let me... Wait, you sent us a letter last month saying you were transferring care to Dr. Oligodendro down at Humungous Neurology, Inc."

Mrs. Myelin: "Yes, he's my neurologist now. I saw him yesterday for this."

Mary: "Okay, so why are you calling us?"

Mrs. Myelin: "Because Dr. Oligodendro's staff couldn't get an MRI scheduled on me until tomorrow, and I want it today!"

Mary: "But if he's your neurologist now, you'll have to work with his office, not ours, for this."

Mrs. Myelin: "Look! I'm willing to go to ANY doctor who can get me an MRI today! If you can get me in today, and get an MRI today, then I'll come back to you!"

Mary: "Ma'am, this isn't a contest."

Mrs. Myelin: "Nobody cares about patients anymore. I'll just go to ER and get them to do it."

Weekend reruns

This past weekend, for those of you who were fortunate enough to miss it, was (at least in my area) the Cub Scouts Pinewood Derby.

This annual event was actually once rated as one of the 100 greatest things about America (Reader's Digest magazine, 2006). I can only assume that the author had never been involved in one, or that in 2006 the country had absolutely gone to hell.

The point of this "friendly competition" is to build little cars and race them down a slanted track. Each 8-11 year old is given a standardized block of wood and 4 wheels, and can do what they want with them. Since the stakes are so high (winner gets a plastic trophy from Big Lots), the cars are carefully examined, weighed, and locked away 3 days before the race. This is to make sure that illegal modifications, like adding a jet engine, aren't carried out.

The whole part about this being a competition among the boys is absolute BS. It's between their testosterone charged fathers, living vicariously through the kids. Dads build the cars, and (occasionally) let junior make a few finishing touches (like putting a Pokemon decal on).

Of course, no one actually admits to this. So at each derby one of the finest moments is when the person in charge brings in the cars from the nuclear-bomb proof hiding location, and boys go ask dad which car is theirs. "Oh! That's mine? Cool job, Dad!"

(In our family, it's actually Mrs. Grumpy who does all this. I'm just a shill).

You can always tell the ones that the boys actually made themselves because they have uneven paint jobs, strange angles, and an odd number of wheels. Of course, they never win a race, because they're no match for the ones that some dad, who by day designs jet fighters for Lockheed, built (and claimed his kid did, using a wind tunnel testing facility that's coincidentally in the basement).

They ask you to arrive at 6:00 p.m. SHARP, which is a joke. The races never start on time.

So we arrived at the Wingnut Elementary School cafeteria at exactly 6:00, to find they'd just started setting up. To lend atmosphere (and help us forget that we were in a school cafeteria) some guys were hanging racing posters and pennants everywhere. A bunch of moms were off in one corner setting up a bake sale. And, most importantly, several dads were putting up the racing track, grading it with a computerized angle & level measuring device, as if it were made of gold.

While this is going on, to get you in a cheerful mood, they show fun racing moments on a large screen: cars and drivers in gory high-speed wrecks, flaming rocket boats hurtling out-of-control into screaming crowds, Indy cars exploding as they fuel up, and other humorous stuff.

Finally the races begin. This is kicked off by them blasting early 90's dance music. So if you've had a burning desire to hear C & C Music Factory, M.C. Hammer, and (not early 90's) ENDLESS replays of "The History of Rock & Roll, part 2"*, this is the place to be.

Each race features 4 cars, and they run them 3-4 times each, changing lanes each time. The race itself takes 5-10 seconds. Then they hand-carry the cars back to the starting point. Each is then reinspected (to make sure their owner didn't, say, use a blowgun to secretly attach a V8 engine while they were going down the track), carefully returned to the starting gate, and we begin again. And in the background 2 guys are still busy putting up racing poster decorations.

The race results are presented on a constantly-changing computerized time sheet, projected on the wall. This, I swear, measures finishing times TO SIX DECIMAL PLACES (i.e. 5.756381 seconds). Because, you know, that kind of space-travel level of precision is absolutely necessary when small wooden blocks are rolling down a track. And the dads obsessively stare at this like it's a topless dancer, while the kids play their Nintendo DS.

At some point your kids come to you asking for money. Why? Because they're selling pizza and various other junk food. They even asked you to bring something, because it's "for a good cause" (they never tell you what the good cause is. For all I know it's Botox for the counter lady). So you stop at Costco, pick up a HUGE box of Oreos, and give them to her. The Oreos are then marked up to 50 cents each, and the box is now worth more than an equivalent amount of plutonium. We discovered it was best to feed the kids before leaving our house, and making sure we have nothing but credit cards when we get there. "They only take cash? Sorry, kids."

This insanity goes on for 3-4 freakin' hours. Most people start to leave as soon as their kid is disqualified from the finals, but some parents (due to, say, their wives secretly signing them up to be involved in taking apart the damn track and not telling you about it until you ask if you can leave yet, for example) are stuck there until the bitter end. So you tap your feet and watch 2 guys continue to heroically put up racing posters.

Toward the end you start looking for something to do. Like helping the school janitor put away the folding chairs (he wants to go home, too). So if anyone stands up, you grab their chair and toss it in the closet, hoping they weren't planning on sitting down again. I figured if anyone fell and hurt themselves, I could hand out business cards.

Finally, it's over. If your kid didn't win, you don't care who did. As you're leaving, you notice the 2 guys are finally finishing putting up the last racing poster.


*Kind of ironic considering how Gary Glitter ended up, eh?

Great survey moments

I really wish there was a box where I could type "I don't remember."

Beware of Annie

Dr. Grumpy: "Did the physical therapy help?"

Mr. Tweedy: "Actually, I never went... I just didn't have the time."

Dr. Grumpy: "I understand. So how are..."

Mr. Tweedy: "You're not going to tell Annie that I didn't go, are you?"

Dr. Grumpy: "Uh, well..."

Mr. Tweedy: "I don't want to make her mad."

Dr. Grumpy: "Okay, I won't."

Mr. Tweedy: "Promise? I'm scared of her."

Dr. Grumpy: "Are we talking about the same Annie? My assistant for 14 years, the one with 2 grandkids?"

Mr. Tweedy: "Yes, please don't tell her."

More great journals

My reader Alysia was so profoundly moved by the post on the Pharmaceutical and Medical Packaging News that she sent me a journal that comes to her office:

Hey! Is "commercialization" really a word? And does
the illustration have boobs?

I was so struck by a magazine titled simply "BONEZONE" that I asked some friends what the word made them think of. To no one's surprise, a medical journal wasn't one of them. But I did get some good answers, including:

"A hook-up bar."

"Dr. Grumpy's college bachelor pad."

"The new programming package on ESPN3, offering round-the-clock live coverage of professional athletes' orthopedic surgeries."

"The drug company lab where they tested Viagra."

"An ultra-cool artisanal arthroscopy suite."


Feel free to throw out your own ideas, and keep the ball rolling.

Thank you, Alysia!

Overheard in ER

Mr. Narc: "I need a refill on my Percocet."

Dr. ERP: "Sir, we've discussed this before. I'm not refilling your Percocet."

Mr. Narc: "DAMNIT! I am a close personal friend of Senator Daniel Webster! And I demand you give me more Percocet NOW! Or he will hear about this!"

Dr. ERP: "Okay, tell you what. You get Senator Webster on the phone, and I'll give you some Percocet. I voted for him, and have heard him speak many times, so I know his voice."

Long pause

Mr. Narc: "I'm leaving this dump."

Great Medical Journals

Dear Mr. Contaoi,

Thank you for offering me a free subscription to the prestigious "Pharmaceutical and Medical Packaging News."

Really. I am not making this up.

You have no idea how excited I am to get a complimentary year of your journal. Breaking news on drug packaging trends is crucial to a modern physician. I often lie in bed thinking about topics such as "Paper or Plastic: The Future of Drugstore Bagging" or "Which Side are You On? Bubble Wrap vs. Peanuts." Regrettably, I've always been deeply unfulfilled by the lack of such coverage in run-of-the-mill neurology publications.

Your kind offer is especially timely, as my subscriptions to "American Lunch Trays" and the Pulitzer Prize winning "Condom Wrappers Quarterly" have recently run out.

You'll be hearing from me soon, and I can't wait for my first issue.

Yours truly,

Ibee Grumpy, M.D.

p.s. You misspelled "development."

BREAKING MEDICAL NEWS!!!!!!!!!!!!

Patient quote of the day

"I've now moved here permanently. Until March. Then I'm moving back home."

It's just a jump to the left

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

Mr. Gregorian: "Yeah, did I have an appointment with the doctor on November 17, 2010?"

Mary: "Let me check... Yes, you did. At 2:30."

Mr. Gregorian: "Was I there?"

Mary: "No, it says you no-showed."

Mr. Gregorian: "Okay, I want to cancel that appointment."

Mary: "Excuse me?"

Mr. Gregorian: "I need to cancel the November 17, 2010 visit. I won't be able to make it."

Mary: "But..."

Mr. Gregorian: "I'll call you back if I need to be seen again."

Helpful children

Every afternoon, about 5 minutes before I get to their school, I send a group text to all 3 kids saying "come outside" to let them know I'm almost there. It goes to all 3, because on any given day I have no idea whose phone is dead/turned off/left at home.

So I got there yesterday. Frank and Marie are standing outside. Marie says "Craig is inside" and they start loading their backpacks into the trunk. Frank and Marie get in the car, and we sit there in the blowing snow, waiting for Craig.

After a few minutes of waiting Marie says "Dad, do you want me to go tell Craig that you're here?"

Mary, bring me another drink.

Dr. Heller: "This is Dr. Heller, with Major Illness Insurance."

Dr. Grumpy: "Hi, I'm trying to get a neck MRI authorized on a lady with a Horner's Syndrome."

Dr. Heller: "Why do you need a neck MRI?"

Dr. Grumpy: "Because the nerves in question go from the brain down the spinal cord, then into the top of the chest, then back up through the neck to the eye. So they can be damaged by problems in the neck, and I need to get a look at the area."

Dr. Heller: "It's ridiculous that the nerve travels so far. It seems unnecessarily complex."

Dr. Grumpy: "Look, I didn't design the system."

The Bionic...

"Steve Austin. Astronaut. A man barely alive. We can rebuild him. We can make him bigger, stronger, poopier, than he was."

Thank you, SMOD!

I'll make a note of it

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

Mr. Clear: "My mom had one of those things you die from."

And now...

IT WAS A REALLY BAD DAY, OKAY?!!!

No, folks, I don't really feel that way. But after an insane morning I needed to vent to someone, and Siri was the nearest listener.

Mary's desk

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

Mrs. Etoh: "Yeah, I need to see Dr. Grumpy about my migraines, and a car accident."

Mary: "Okay... Generally he doesn't see legal cases. Are the 2 related?"

Mrs. Etoh: "Yeah, a migraine caused me to have a car accident, and I need someone willing to testify to that in court."

Mary: "I'm sorry, that isn't the sort of thing Dr. Grumpy does."

Mrs. Etoh: "Well, the police claim it was because my blood alcohol was 5 times the legal limit, so I need to find a neurologist to say it was falsely that high because of a migraine, and that I hadn't been drinking at all. Will he do that?"

Mary: "No. Have a nice day."

Modern theater

Dr. Grumpy: "How did you get injured?"

Mr. Powerpoint: "I was hiking in Costa Rica, when I fell, and severely lacerated my left arm."

(whips out iPhone)

"This is the mountain I was hiking on."

SWIPE

"Here's the rock I tripped over. That's my blood on it."

SWIPE

"Here's a shot of my arm. You can see the muscles hanging out and everything."

SWIPE

"This is the car my buddy took me in to get help. I made a mess. Greg didn't get his deposit back."

SWIPE

"This is the clinic we found in the nearest town."

SWIPE

"This is the doctor who stitched me up."

SWIPE

"Here's his assistant, when she had her mask off."

SWIPE

"Here's me and Greg going out for beer and shrimp afterwards."

SWIPE

"Here's Greg trying to change my gauze wrap after getting wasted."

SWIPE

"Here's..."

Seriously?

I fully support the NFL's new program "Fuel Up To Play!" with its goal of getting kids to focus more on exercise and healthy eating.

That said, they really could have come up with a better name.

Because my kids came home today with lunchbox stickers for the program that say "FUTP!"

And...

NFW

Lady with fidgety toddler: "I've been doing better on the new medication... Hey, can I borrow your iPhone?"

Dr. Grumpy: "Um, why? Do you need to make a call?"

Lady with fidgity toddler: "No, but Jessica broke mine yesterday, so I need to give her something to play with."

Whatever makes you happy

Dr. Grumpy: "How do you spell your first name?"

Mr. Caiman: "It's Albert, but I prefer to be called by my nickname."

Dr. Grumpy: "What's that?"

Mr. Caiman: "The Grey-Eyed Gator."

Mary's desk, January 2, 2013

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

Mr. Valet: "Yeah, I have an appointment with Dr. Grumpy now, and I can't find a parking space."

Mary: "Okay... I'm looking out over the parking lot on the north side of the building, and there's quite a few open spots there. Try that side."

Mr. Valet: "I don't have time for that. I'm down by the east exit. Can you just come down and park it for me, while I see the doctor? Do you know how to drive a stick?"

Mary: "No, and that's not something I..."

Mr. Valet: "Then how about if you sit in it during my appointment, so it doesn't get towed?"

Nothing changes on New Year's Day

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

Mr. Call: "Yeah, I was in ER this morning, and they told me I should call your office for an urgent appointment."

Dr. Grumpy: "Okay, we're closed today for the holiday. If you call back tomorrow you'll be able to talk to Mary, my secretary, and she'll get you in."

Mr. Call: "But they said it's urgent. Can I come in today?"

Dr. Grumpy: "We're closed."

Mr. Call: "So? Can't you meet me at your office? Or a Starbucks or something?"

Dr. Grumpy: "No. If you have a serious emergency, you'll have to go back to ER."

Mr. Call: "It's not a serious emergency. I just want to be seen today."

Dr. Grumpy: "Sir..."

Mr. Call: "I'm reporting you to the state board!" (hangs up)

Doktur must rite good

This ad was recently posted on a site for freelance writing jobs:

Spelling: it isn't brain surgery. I hope.

Thank you, Donna!

Friday whatever

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

Mr. Lasix: "Yeah, my Dad is a diuretic."

Dr. Grumpy: "You mean diabetic?"

Mr. Lasix: "Whatever."

Damn, you caught us

Dr. Grumpy: "It looks like the hematologist wants to do a bone marrow biopsy to find out..."

Mr. Gammopathy: "I'm not doing that bullshit."

Dr. Grumpy: "May I ask why?"

Mr. Gammopathy: "I know the games you people play. What you really do is inject my healthy marrow with lymphoma cells, thereby tying me into the medical-military-industrial complex that the government is running."

Post-Christmas rerun

In 2008, the following message was left on my office voicemail around 8:30 p.m. Christmas Eve:

"Hello, I'm calling from Local Pharmacy about a refill for Dr. Grumpy. It's on patient Amy Loid, for her medication. The idiots at her nursing home didn't realize she was all out until 5 minutes ago, and then were stupid enough to think they could just waltz down here and get more. But no, there were no refills.

"So if someone could please call me to refill this, this bunch of bozos at the care home want it tonight. And I'll be here, tonight, on Christmas Eve, at Local Pharmacy, all damn night. So you can reach me whenever you call. My name is Joy. Thank you."

Merry Christmas to all!

Weekend on call

Dr. Grumpy: "So you haven't been taking your seizure medication at all?"

Mr. Stoner: "I don't need to! See, my friend gives me marijuana, and if I smoke it several times a day than I don't have seizures. Hey, can you give me some while I'm here? He's not answering his phone."

Dr. Grumpy: "Local Hospital doesn't keep marijuana in the pharmacy and..."

Mr. Stoner: "Well, I'm not going to take any of your pills!"


Several hours later, at the nursing station...


Dr. Grumpy: "All right, here's some orders on the new admission. Hey, has Mr. Stoner had his EEG yet?"

Nurse: "He left AMA*. Didn't anyone tell you?"

Dr. Grumpy: "No. When did this happen?"

Nurse: "After you told him the hospital wasn't going to give him marijuana. He snuck out of his room and went down to ER, trying to find a patient there who could sell him some. When security came after him he ran out of the building and didn't come back."


*Against Medical Advice, for the non-medical readers. Basically walking out.

Skool Nerse Page

This is Mrs. Grumpy, announcing that I now have my own page on the site, compiled from my posts.

You can find it down in the right sidebar, or click here.

Guest post from Officer Cynical

While the insanity of our world takes over headlines, the legacy of one man has been largely ignored. Daniel Inouye died on Monday, December 17th.

Inouye served as congressman and senator from Hawaii since the date of its statehood in 1959 until his death. He was also a Medal of Honor winner during WWII. The following is the citation for that award:  

________________________________________

The President of the United States of America, authorized by Act of Congress, March 3, 1863, has awarded in the name of The Congress the Medal of Honor to

SECOND LIEUTENANT DANIEL K. INOUYE
UNITED STATES ARMY

for conspicuous gallantry and intrepidity at the risk of his life above and beyond the call of duty:

Second Lieutenant Daniel K. Inouye distinguished himself by extraordinary heroism in action on 21 April 1945, in the vicinity of San Terenzo, Italy. While attacking a defended ridge guarding an important road junction, Second Lieutenant Inouye skillfully directed his platoon through a hail of automatic weapon and small arms fire, in a swift enveloping movement that resulted in the capture of an artillery and mortar post and brought his men to within 40 yards of the hostile force. Emplaced in bunkers and rock formations, the enemy halted the advance with crossfire from three machine guns. With complete disregard for his personal safety, Second Lieutenant Inouye crawled up the treacherous slope to within five yards of the nearest machine gun and hurled two grenades, destroying the emplacement. Before the enemy could retaliate, he stood up and neutralized a second machine gun nest. Although wounded by a sniper's bullet, he continued to engage other hostile positions at close range until an exploding grenade shattered his right arm. Despite the intense pain, he refused evacuation and continued to direct his platoon until enemy resistance was broken and his men were again deployed in defensive positions. In the attack, 25 enemy soldiers were killed and eight others captured. By his gallant, aggressive tactics and by his indomitable leadership, Second Lieutenant Inouye enabled his platoon to advance through formidable resistance, and was instrumental in the capture of the ridge. Second Lieutenant Inouye's extraordinary heroism and devotion to duty are in keeping with the highest traditions of military service and reflect great credit on him, his unit, and the United States Army. 

______________________________________________________

More remarkable (to me) is Inouye's own description of those events. The Atlantic published the following - Inouye's personal account of his Medal of Honor-winning actions in the town of San Terenzo, Italy, in 1945.

Inouye's unit was charging three German machine guns.

'"I remember being shot in my abdomen, first, on the right side. The bullet came out in the middle of my back, and it felt like someone had slugged me. There was no intense pain or anything like that. I fell backwards and then kept on going until my messenger right in the back of me ... said, 'By the way, you're bleeding.' So I stuck my hand in there and, sure enough, it was warm and moist. I took out my hand. It was all bloody but, since it wasn't bleeding profusely, I just kept on going."

Continuing forward with a bag of grenades, he cocked his hand and was ready to throw another when a German grenade hit him in the arm, leaving his right arm dangling by a thread.

'"I saw a fellow pointing it at me and I felt the blast and I recall going for my grenade, prying it out of my right hand and throwing it with my left. My arm was dangling by a couple shreds, so when I lifted it up, it was hanging like that. Just shredded. So I knew it was gone. First I was looking all over for the grenade, I thought it fell. And then I looked at my hand and I said, 'Oh, my Lord. It's there.' I had pulled the pin, and my hand was back ready to toss it, so I knew it was armed. The fingers somehow froze over the grenade, so I had to pry it out."

With his left hand, Inouye tossed the grenade at the German who had shot him, hitting him. Then he blacked out. Later, when he was cited for his bravery, he learned that he had grabbed a tommy gun in his left hand, charged toward one of the machine guns, knocked it out, and then got shot again. He was given so much morphine that doctors later amputated his arm without anesthetic, concerned that any more would drive his blood pressure too low."

 ________________________________

I try to remember that, while a few nutjobs are out killing kids and cops and firefighters, real heroes walk among us.

Today's featured gift #1

Today wraps up the 2012 Grumpy gift guide, with the following 2 items. I hope you've enjoyed it! If you see anything out there that catches your eye, please send it in and I'll consider it for next year.


 This gadget is advertised for training dogs.

Looking at it I can't help but think that if someone tied a rope around my, uh, boy parts down there, I'd be pretty "calm and orderly," too.

Today's featured gift #2

Now this one I kind of like. Because a leading problem of the modern workplace is the dreaded lunchroom thief. This drove Mrs. Grumpy nuts, as no matter how brightly she wrote her name on an item, it would still disappear before she had a chance to touch it.

But now, you can get this awesome lunchbox:

This great lunchbox is just perfect for any workplace, or the ax murderer on your list. Mary and I use hers to hide body parts after I've finally snapped at a patient on their 5th consecutive visit who hasn't yet started the medication I prescribed, but is still complaining that they aren't any better.

Mary's desk, December 19, 2012

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

Mrs. Dilly: "Yeah, I have an appointment in an hour, and I'm going to have to cancel it. I'm in the Emergency Room."

Mary: "Are you okay?"

Mrs. Dilly: "Yeah, I was all blocked up down there. I think I ate too much cheese."

Mary: "I'm sorry. Just call us back whenever..."

Mrs. Dilly: "They just gave me my third enema. I've never seen so much shit in my life. Do you have anything open on Friday afternoon?"

Skool Nerse time

Attention parents:

Calling in to say your kids will be absent on Thursday and Friday, because it's the end of the world, is absolutely the lamest excuse for a long weekend I've ever heard.

If you really believe that, you're going to have a boatload of catch-up Christmas shopping to do this weekend.

Gee, why didn't I think of that?

Joe: "Local Hospital computer help, this is Joe."

Dr. Grumpy: "Hi, I went to read an EEG, and the reading room is, um, gone. I mean, completely vanished, and they're building an orthopedic supply closet where it used to be."

Joe: "Is this a problem?"

Dr. Grumpy: "Well, yeah. A lot depends on my ability to read EEG's on the hospital patients. If I don't have the results, then I can't make treatment decisions."

Joe: "Look, we spent a lot of time setting things up so you guys can read EEG's from home, WHICH YOU ASKED FOR, so why can't you just drive home, read them, then come back and round?"

Today's featured gift

Do you enjoy mini-golf? Do you love bathroom humor? Have you ever wanted to show the office golf asshat where he can put his ball? Then this is ideal for you!

Yes, with this remarkably tasteless gadget, you can pretend to whack a golf ball into someone's ass and listen to them fart. You can repeat this action until the joke is old (1-2 times) and then give it to that co-worker you hate in the office gift exchange.

Proud parenting moments

At my parent's 50th anniversary party, which was held at an incredibly swanky restaurant:

Grandma Grumpy: "Marie, are you enjoying your dinner?"

Marie: "Yes. I like this place. It's fancy. It doesn't have gum under the tables."

From the "No shit, Sherlock" research department

The mere anticipation of an interaction with a woman can impair men's cognitive performance.

Archives of sexual behavior, (2012) 41:1051-1056 

Abstract

Recent research suggests that heterosexual men's (but not heterosexual women's) cognitive performance is impaired after an interaction with someone of the opposite sex (Karremans et al., 2009). These findings have been interpreted in terms of the cognitive costs of trying to make a good impression during the interaction. In everyday life, people frequently engage in pseudo-interactions with women (e.g., through the phone or the internet) or anticipate interacting with a woman later on. The goal of the present research was to investigate if men's cognitive performance decreased in these types of situations, in which men have little to no opportunity to impress her and, moreover, have little to no information about the mate value of their interaction partner. Two studies demonstrated that men's (but not women's) cognitive performance declined if they were led to believe that they interacted with a woman via a computer (Study 1) or even if they merely anticipated an interaction with a woman (Study 2). Together, these results suggest that an actual interaction is not a necessary prerequisite for the cognitive impairment effect to occur. Moreover, these effects occur even if men do not get information about the woman's attractiveness. This latter finding is discussed in terms of error management theory


Thank you, Vince!

Today's featured gift

Before moving on to the post, I'd like to say something:


HAPPY 50th ANNIVERSARY MOM AND DAD!

And now back to our regular program.

 
Is your favorite cook tired of drab colors? Do they want to spice things up? Well, you should give them Esslack: edible spray paint for food!

Think of the possibilities: gold chicken, blue steak, or fire-red asparagus! Make your holiday dinner look like something out of Willy Wonka (the 1971 version).

Foodies in the 'hood can give up using plain, inedible Krylon and do some serious food tagging to let everyone know that particular Big Mac is YOURS.

Your kids already believe you're trying to poison them. So why not have fun with it?

Today

I want to offer my thoughts, prayers, and condolences to all affected by the terrible events of today.

Today's featured gift

Have a friend who likes tasteless historical knick-knacks? Consider this:

Now they can own a bobblehead doll of the man who murdered America's 16th, and probably greatest, President. Ideal for those who enjoy, um, I guess, this sort of thing.

As best I can determine bobbleheads of Lee Harvey Oswald, Charles Guiteau, and Leon Czolgosz are not currently available.

Wednesday night, 7:45 p.m.

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

Mrs. Down: "Hi, are you covering for Dr. Nerve?"

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

Mrs. Down: "I'm emotionally uncomfortable."

Dr. Grumpy: "About what?"

Mrs. Down: "I'm worried I may run out of gas on the way to the drugstore."

Mary's desk, December 11, 2012

Wild-eyed guy breathing rapidly throws open the door, runs in, stands at counter.

Guy: "HEY! CAN YOU GUYS BREAK A $100 BILL?!!!"

Mary: "Uh, no, sorry. We only have a few $5's and $1's for change."

Guy: "SHIT!"

(runs out, door slams behind him)

Today's featured gift

Have a friend who REALLY loves Christmas music?

Yes, now even in private moments you can enjoy the gentle melodies of holiday tunes, and imagine you're being bombarded with them in Wall-to-Wall-Mart. The more TP you use, the more it plays. So even if you're having explosive diarrhea you'll never run out of musical entertainment (as long as you don't run out of paper or batteries).

At present it is not available in Hanukkah/Kwanzaa/Festivus forms, or with music that can be played year round (such as the Mama's & Papa's "Go Where You Wanna Go").

$5

Recently there was a news story about Dr. Russell Dohner, of Illinois. He charges all patients a flat fee of $5/visit. He doesn't take insurance.

This led to several online threads featuring comments such as "Finally! A doctor who cares!"

Apparently, this means that doctors like me, who charge more than practically nothing, are evil and don't care.

I respect Dr. Dohner, and am not putting him down. I think highly of what he does. I actually like what I do, and if I were independently wealthy and could see patients for free, I probably would.

It isn't until almost the end that the article notes Dr. Dohner is supported by his family's farming business, and NOT his medical practice. By that time most readers have moved on to the football scores and "Dancing with the Stars" results, and therefore are left with the impression that any doctor can do this for $5 a head.

Bullshit.

I do care.

But that doesn't mean I don't have my own responsibilities: like office rent. And paying Annie & Mary. And a mortgage. A wife. 3 kids. If I can't support those things, then I'm not going to be able to keep my office open to care for people.

Regardless of what people may think, just because I charge for my services doesn't mean I don't care.

I care enough to call in your seizure medication to a pharmacy at 2:00 a.m. because you're out of pills, even though you knew you needed a refill for at least a week.

I care enough to call you from my family vacation to go over your MRI results, because I didn't think they should wait until I got home, or that you should get bad news from a covering doctor who doesn't know you.

I care enough to come in early and see you at 7:00 a.m. because you can't get time off work, but really do need to be seen.

I care enough to spend time arguing with some pinhead at your insurance company about why you need an MRI, when they don't think you do.

I care enough to rush in to the hospital to see you on my weekend off, rather than let a hospitalist who doesn't know you from Adam try to figure this out.

I care enough to call a drug rep and beg for samples of your medication because you lost your job and can't afford it.

I care enough not to order unnecessary EMG's and EEG's on you, even though doing them would improve my revenue.

I care enough to face worsening reimbursements and rising expenses every day, when many colleagues have given up and gone into another field.

I care enough to try and give you hope, even when I'm not sure there is any.

I care enough to help you find another neurologist who will take good care of you, because your crappy insurance won't let you see me anymore.

I care enough to step out of my kid's music recital and take your call, because I know you're scared.

I care enough to take the time and explain why the drug you saw advertised on TV isn't a good idea in your case, rather than just writing a script to shut you up.

I care enough to stay in a job that has deprived me a of decent night's sleep, family time, and likely shortened my overall lifespan, in spite of the fact that my financial goal nowadays is just to break even.

I care enough to refer you to a neurological subspecialist who can take better care of you than I can, even though in doing so I'll lose you as a patient.

I care enough to call your spouse at 9:00 p.m. to reassure them that you'll be all right.

I care enough not to force you to have a test you can't afford, even though you can sue me for malpractice if I miss something.

I care enough not to dismiss you from my practice, in spite of your insanely annoying personality, because I know that you really do need my help.

I care enough to still be doing this job, even though every day a little bit of my idealism dies.

I care enough to be a doctor. I hope I always will.