WTF?

Doing a survey last night, one allegedly for neurologists, and this question came up:

Beyond shingles I really had no comment.

Memories...

My former call partner, Dr. Darth, had an office manager (Suzee). He eventually fired her and promoted his secretary (Floozee, who he was banging on the side) to office manager.

So when Suzee needed to see a neurologist a few months later, she made an appointment with me.

Unfortunately, she came in on a week when Dr. Darth was out of town, and I was covering for him.

So as Suzee sat in my lobby, leafing through "So You're Trapped in a Doctor's Waiting Room" magazine, Floozee came in with a bunch of MRI reports for me to review in Dr. Darth's absence.

The magazine and MRI reports were quickly forgotten.

They both had pepper spray. Mary had to call hospital security to get them out before anyone got hurt.

Perseveration

Mrs. Map: "Sorry I'm late, I had trouble finding your office. My iPhone gave me weird directions."

Dr. Grumpy: "That's okay. What bring you in to see me?"

Mrs. Map: "Well I..."

Siri: "Please turn right on 24th street, then continue west."

Dr. Grumpy: "Was that your phone?"

Mrs. Map: "Um, yeah, I guess she's still trying to get me to your office."

Siri: "Please turn right on 24th street, then continue west."

Dr. Grumpy: "Siri! She found it!"

Mrs. Map: "I don't know how to turn it off."

Siri: "Please turn right on 24th street, then continue west."

I reached over and turned off the phone.

Mrs. Map: "Wow! That bitch drives me nuts!"

Weekend reruns

It's been 3 years since I ran this post. And I still believe every word.


Nurses...

Are AWESOME.

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

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

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

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

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

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

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

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

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

What got me started on this?

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

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

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

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

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

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

And I admire the hell out of that.

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

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

Hospital rounds, Thursday night, 7:10 p.m.

Dr. Grumpy: "What were you doing just before you blacked out?"

Mrs. Climax: "Having a MAJOR orgasm."

Reasons Mary drinks

Lady walks into office, signs in

Mary: "Hi... ma'am, your appointment was yesterday. We have you marked down as a no-show."

Mrs. Hansen: "I'm sorry, I had a family emergency. Can't you just see me today?"

Mary: "No, we're completely booked up."

Mrs. Hansen: "But I had an emergency!"

Mary: "I understand, that can happen. We can see you this Friday at 1:00 or..."

Mrs. Hansen: "Why are you doing this to me?"

Mary: "Excuse me?"

Mrs. Hansen: "I don't appreciate that you're treating me like a leper."

Mary: "Ma'am, I'm not..."

Mrs. Hansen: "This is so unfair! I had an emergency that wasn't my fault, and for that you're punishing me."

(pause)

Mary: "Do you want the appointment on Friday afternoon or not?"

Mrs. Hansen (scrolls through phone): "No, I'm meeting a friend at the casino."

Advice for grads (new and old)

A few years ago I signed up for an account with one of those "suggest-a-doctor" sites as a way to get business.

Shortly afterwards I began getting emails that "a patient has sent you an appointment request." Figuring it was a prospective patient, I checked them. My plan was that I'd forward the info to Mary to call and schedule them.

To my horror (I guess I'm naive) people who used the site had absolutely no interest in actually coming to the office. They just wanted medical questions answered online. For free (of course).

Examples of typical questions I received included:


"I've been dizzy on and off for years. I've had lots of tests and seen many doctors, but none of them can find the cause. Can you tell me what's wrong?"

"I can't afford my medications. Can you please put samples with my name on them out in your front office? 3 months worth would be good."

"I don't have time to go to a surgeon, so can you tell me if I need back surgery? MRI images attached."

"I live in Farfaraway, but am willing to travel to Grumpyville if you can cure me. I'll do this only if you offer a money-back guarantee, and cover my plane fare."

"I think my husband is more sick from taking his pills than he is without them, but he will only stop if a doctor tells him too. Can you call him and tell him to stop?"


NONE of these people were established patients of mine. As best I can tell, of the 200+ messages I received over time, fewer than 5% were within 100 miles of my office. Some were from overseas.

Besides the obvious money issues here (I have a family to support. I am not free.) is the legal one. This basically amounts to treating a patient without actually seeing or examining them. I worry enough about getting sued by patients that I do see, and don't want to add ones I don't to the list.

I finally deleted the account last year.

So here's today's advice from Dr. Grumpy: Don't even bother with these sites. Unless the idea of practicing free, legally dangerous, medicine appeals to you.

Ouch

My 2:00 patient had a large, straight, red mark on her forehead.

Mrs. Amana: "Sorry I'm a little late. I burned my forehead."

Dr. Grumpy: "I see that. What happened?"

Mrs. Amana: "Well, I was ironing some shirts, and needed to do my hair. So to save time I put my head on the ironing board, and started doing my hair, too. Then my phone rang, and I turned my head to answer it and..."

Why do I bother?

Dr. Test is down the street from me. He sends me infrequent referrals.

I consistently send him notes about visits, listing what, if any, tests I'm ordering. Within an hour of one being faxed I always get a return fax from his office, listing the tests that I just said I'm ordering, and asking me to send the results to him when they become available.

I don't know why, but I find this thoroughly irritating. I'm actually quite obsessive about sending letters and tests to referring physicians, and after years of doing so it annoys me that this one still asks. Of course, there's also the (likely) possibility that the letters go to a trained chimpanzee who reads the last paragraph, fills out the results-request form, and faxes it back without the doctor ever seeing it.

Last week, on a quiet morning due to some last-minute cancellations, I sent his office a fax on a non-existent patient saying I was ordering a "serum profactor 7-CoA." To the best of my knowledge there is no such test.

Within 15 minutes we got a note back saying "Mr. Non Existent isn't a patient in our practice. Please send us a copy of his serum profactor 7-CoA result as soon as it becomes available."

I amuse myself.

Patient quote of the day

"I'm looking through a fishbowl, but without fish. This is because my left toenails are all pale, which explains my neck problems."

(no, folks, the patient doesn't have a left cortical lesion. Or dementia)

Mary's Desk, March, 2013

Guy comes in, stands at counter, obviously angry.

Mary: "Can I help you, sir?"

Angry Guy: "Yes! I demand to speak to the doctor!"

Mary: "Okay, he's with a patient right now. What is this about?"

Angry Guy: "My wife saw him yesterday, and she says he told her she was fat!"

Mary: "WHAT? Sir, I've worked for Dr. Grumpy for 10 years, and he's never said anything like that to a patient."

Angry Guy: "Are you calling my wife a liar?"

Mary: "No, but I know Dr. Grumpy, and he isn't like that!"

Angry Guy: "Well, you're wrong! She even brought his card home!" (waves card in air)

Mary: "Uh, that card is for Dr. Frazzle. He's the neurologist down on the 2nd floor."

Long pause

Mr. Angry: "Well, all you neurologists are the same, and your doctor should still know better!"

(storms out, slams door)

Deja Vu

Filling out an insurance company's drug authorization form yesterday, I discovered this:

History rerun

March 12, 1944





It happened during World War II. But it isn't a war story.

It's about a basketball game. But it's not a sports story.

It involved medical students. But it's not a medical story.

It was 1944.

The Duke University Blue Devils had won the Southern Conference basketball championship. Surprisingly, though, the official university team wasn't even the best one on campus.

The military had set up wartime training programs at Duke, and brought in young men from all over the country. Many were good college players in their own right, but their schools had closed down athletic programs due to the war. So when they came to Duke they formed intramural teams.

The medical school team was considered, by far, the best (possibly the last time in human history that will be said). The players had all been stars at their previous schools. Although they never played each other, it was generally thought that the medical school team was better than the Blue Devils themselves.

It had also been a good year for another local basketball team, the Eagles of the North Carolina College for Negroes. Their coach ran an aggressive high-speed game, and they'd only lost once all season. But that was how it ended. Neither of the basketball tournaments (NCAA and NIT) allowed black colleges to participate.

The details on how it started are lost to history, but somewhere, somehow, the idea came to have the invincible Duke medical students meet the NCCN team on the basketball court.

In 1944 North Carolina this was unthinkable. It was actually a crime, and color lines were enforced. A few months earlier a black American soldier had been killed by a white bus driver for not moving to the back of a city bus fast enough (the driver was found not guilty).

Coach John McLendon of the Eagles liked the idea, and contacted his counterpart at the medical school. The white team was shocked. Such a thing was unheard of, illegal, and seemed to be just asking for trouble. But eventually their pride won, and they agreed to the game. As medical student player David Hubbell said, "We thought we could whup 'em."

The game would have to be played at the NCCN gym, because there was no way to get black students onto the Duke campus without drawing attention. They'd have a referee, but no spectators would be allowed. They'd play on a Sunday morning, when most of the town (and hopefully police) would be in bed or church. The doors to the gym would be locked as soon as all the players were inside, to keep anyone from seeing what was happening. Neither school administration was aware.

The medical students drove to NCCN with a winding route, to keep from being followed. They wore hats, and had their jackets pulled up partly over their heads to keep their skin color hidden.

Inside, the Eagles were very nervous. Aubrey Stanley (who was 16 years old at the time) later said "I had never played against a white person before, and I was a little shaky."

The game got off to a nervous start, with both sides making mistakes and missing easy shots. But they soon got into their routine. Duke went to their strong half-court game, and the Eagles played their speed attack. Stanley recalled "About midway through the first half, I suddenly realized, 'Hey we can beat these guys. They aren't supermen, they're just like us.' "

The second half was a blow-out, with the Eagles scoring almost every time they had the ball. Duke wasn't accustomed to their aggressive, high-speed, full-court game, the likes of which wouldn't be seen in the NBA for another 20-30 years.

The final score was NCCN 88, Duke Medical 44. Not even close.

And then, after the 2 teams had rested, the unthinkable happened: They played again, this time a mixed game, shirts vs. skins. Black and white on the same teams. A serious violation of state law.

A few NCCN students walking by the gym heard noise inside, looked in the windows, and saw this unthinkable match-up. Nobody called the police. It was amazing to watch.

Neither game ever happened by official records. There was no scorecard. Only the player's memories.

Jack Burgess was a Duke player. He was from Montana, and a few days after the game wrote to his family "we played basketball against a Negro college team... and we sure had fun and I especially had a good time, for most of the fellows playing with me were Southerners. When the evening was over, most of them had changed their views quite a lot."

In being able to tell this remarkable story, I (and all of us) owe a great deal of thanks to writer Scott Ellsworth. Without his determined research in chasing it down, it would have been lost to history.

Sunday afternoon

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

Dr. Hospital: "Yeah, I need you to re-consult on Joe deMentia, who you saw last week."

Dr. Grumpy: "The guy with Alzheimer's disease? What's up?"

Dr. Hospital: "He has memory problems."

Dr. Grumpy: "Correct. I diagnosed him with Alzheimer's disease."

Dr. Hospital: "Well, he still has it. Can you come back and do something about it?"

"I've been through my MacBook on a drive with..."

Great radiology reports

From a thoracic spine MRI:

"Degenerative changes are seen at T3, T4, and TSH."

Mary's desk

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

Mrs. Crabby: "I need to make an appointment to see the doctor."

Mary: "Have you been here before?"

Mrs. Crabby: "No."

Mary: "Okay, so you'll be a new patient. We can see you on Thursday at..."

Mrs. Crabby: "No, I'm not a new patient."

Mary: "But you just said..."

Mrs. Crabby: "I've already seen another neurologist, and didn't like her. I just want someone else to tell me what they think."

Mary: "Yes, but if you've never seen Dr. Grumpy before, he'll need to take a history, and review tests you've had, and examine you."

Mrs. Crabby: "The other neurologist did all that. He can just read her notes, and decide. It won't take him more than 5 minutes."

Mary: "Ma'am, if you've never been here before he needs to take his own history and all."

Mrs. Crabby: "That's ridiculous. He can have 10 minutes of my time, no more. I'm very busy."

Mary: "I can ask him, but I'm pretty sure he'll say no."

Mrs. Crabby: "Don't bother. I'll find someone who can accommodate me."

Click

And I feel fine

Unless you lived under a rock, you were probably aware the world was supposed to end twice in 2011 (May 21, then October 21, per Harold Camping) and once in 2012 (December 21, per Mayan "scholars"). Exactly why they're so fond of the 21st remains one of those mysteries (I'm assuming because it's 1/2 of 42).

This is nothing new. Since the beginning of time, people have predicted the end of the world, thus far without success. The number of failed predictions is huge, and too long to list. People hoping for an apocalypse make Cubs fans look pessimistic.

William Miller (1782-1849) was another unsuccessful doomsday seer at 0-3. An American preacher, he initially predicted the world would end between March 21, 1843 and March 21, 1844 (again with the 21st!).

When the second date passed without incident he re-scheduled the apocalypse to April 18, 1844. Then, after nothing happened, postponed it to October 22, 1844. The last failed prediction so rocked his church that it became known as "The Great Disappointment" (why they were disappointed is beyond me).

Miller himself felt the errors were from incorrect translation of the Bible's chronology. He believed the end of the world was imminent, and continued to do so until it ended for him in December, 1849 at age 67.

There have been, and will continue to be, many others.

Now I, Dr. Grumpy, will tell you how, and roughly when, the world will end.

As the sun converts hydrogen to helium, it's luminosity will slowly increase over time. The rise in solar radiation will reach a critical point somewhere between 500 and 900 million years from now, reducing the carbon dioxide in Earth's atmosphere below the level at which plants can survive. As the plants die out, the amount of oxygen in the atmosphere will decrease, and all animals will be lost, too.

About 1 billion years after all life is gone, the surface temperature will increase to where liquid water can no longer exist, and the oceans will gradually vaporize into the atmosphere. Some will also collapse into the planet's mantle, due to venting of the mid-ocean geologic ridges.

What's left of the Earth, which will likely be similar to our neighbor Venus, will continue to orbit for another 3-4 billion years. At that point the Sun will reach the red giant stage of its life, and start to expand. Its increased size will take it beyond the orbits of Mercury and Venus, incinerating them.

The now widely-expanded solar atmosphere will gradually pull the Earth's orbit inward, until it too becomes ashes scattered through the outer layers of an aging star.

Eventually the Sun will throw off the outer layers, becoming a planetary nebula with a white dwarf star at the center.

The ejected layers will travel through space for another few billion years, eventually being taken up by a cloud of dust that's slowly condensing into a new solar system - just as ours formed 5 billion years ago - and again become part of a new star and its planets. Just as we're made of the base parts of a long dead solar system, so we will become another.

And that's how the world will end. And begin, again

My dogs couldn't care less about the end of the world. And I will take that cue from them.

The heat is on

You've just driven your Pontiac through the side of somebody's trailer home.

Now, the cops are after you.

To make matters worse, you aren't wearing shoes or (for unclear reasons) pants.

You also have a suspended driver's license.

And (of course) you're drunk.

There's only one thing to do: Steal the nearest vehicle from its owner and try to escape.

More great survey moments

Yeah, I'd have to agree the answer can "affect your relationship" with someone.

"Survey at Bernie's"

Thank you, Laurie!

Sales call

Dr. Grumpy: "All right, I'd like you to try this medication" (hands over script) "and I'll see you back in a month to see how it works."

Mr. Pulp: (waves script) "Doc, you call this paper? Let me give you my card. My printing company can give you real quality paper for your script pad, not this cheap crap."

1980's PSA, remade at my house

THIS IS MY DOG

THIS IS MY DOG, ON A HOT TUB

ANY QUESTIONS?

I think they're trying to tell me something

Great moments with MRI facility reps:

Miss Lodestone: "Doctor, our new MRI exposes patients to 75% less X-ray radiation than the previous generation of scanners."

Dr. Grumpy: "MRI doesn't use X-rays. It uses magnetism."

Miss Lodestone: "Correct! Now that modern MRI no longer needs X-rays, we've been able to reduce the amount patients are exposed to in a scan."

Dr. Grumpy: "MRI has never used X-rays. Different physics."

Miss Lodestone: "That's why the new scanners have allowed us to bring it down by 75%!"

Suspicious minds

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

Mrs. Poppy: "Hi, I need to pick up my Percocet prescription for the month."

Annie: "Hang on, let me check... Actually, we have your chart flagged. We discovered earlier this week that you're getting Percocet from 5 different doctors, and having them filled at 5 different pharmacies."

Mrs. Poppy: "Well, I can explain this..."

Annie: "Dr. Grumpy has it specifically noted not to refill your narcotics."

Mrs. Poppy: "Okay, the truth is that you're right. I am getting refills from multiple doctors. But I'm not actually taking it! I just store it. You know, in case there's ever a shortage. I keep it all in a shoe box in my closet. But I swear I'm not taking any. So can't you refill them? Because I'm really not using it at all?"

Those be some high-fallutin words

Mr. Migraine: "I think I've figured out why I'm having headaches."

Dr. Grumpy: "What's that?"

Mr. Migraine: "My neurotransmitters are creating a pro-inflammatory non-modulating environment of excitatory free-radicals resulting in stimulation of the trigeminothalamic activating system."

Pause

Dr. Grumpy: "So, what do you think that means?"

Mr. Migraine: "Don't know. I read it on a blog."

Office silliness

Like most docs, Pissy and I have anatomy models lying around that we use to explain things to patients. Last week, while putting the cervical spine away, I dropped it, and one of the vertebrae broke in half.

No biggie. The next morning I brought in super glue from home, and carefully put it back together. Pissy walked in just as I was finishing up.


Dr. Pissy: "What are you working on?"

Dr. Grumpy: "The C-spine model. I accidentally broke a vertebrae, and had to glue it back."

Dr. Pissy: "Where?"

Dr. Grumpy: "Right here" (points to part of model) "It snapped off when it hit the floor."

Dr. Pissy: "Looks good. I can't even see the crack."

Dr. Grumpy: "Yeah, it was easy. I can't believe they pay neurosurgeons so much to do this."

Sunday reruns

This picture was featured in a mailing I received. It's for a CME program on Parkinson's disease. It is, I swear, a DVD of 4 neurologists arguing. Yeah, because I'm just dying to watch that.

The distinguished faculty in the picture are named as (left to right) Drs. Sethi, Obeso, Olanow, and Stern.

Believe it or not, this is about as exciting as a party of neurologists gets. They sit around and discuss Parkinson's disease and other invigorating topics. And people wonder why I'm in solo practice.

I'm not convinced that's water in their glasses, either. Vodka, maybe.

Obviously, the star of the picture is Dr. Olanow. He looks like he's one step away from wearing a lampshade on his head. I'd like to think he's talking about his windsurfing trip over the summer, and how he accidentally ended up starring in an Absolut vodka commercial with the Sports Illustrated swimsuit models. More likely, though, he really is talking about Parkinson's disease. Only a neurologist can look so happy while talking about something that would scare everyone else away.

Let's try to guess what they're thinking:

Dr. Sethi: "Wow. Olanow has had too many already. He always gets the spotlight, and the hot drug reps. And what the hell did he do with my tie? As soon as I walked in he asked to borrow my tie because he forgot his, and now he isn't even wearing it. I have to remember to get the phone number for that Absolut girl who keeps refilling our glasses. I hope she saw that I drive a Porsche."

Dr. Obeso: "I have noooooo idea what they put in the vodka. I've only had 2 so far. I'm not touching it again. Holy crap, I hope I don't puke at the table. Olanow would never let me live that down. He'd probably show slides of it at next year's academy meetings. How come I'm the only one here who's wearing a tie?"

Dr. Olanow: "Man! Thish party is great! I better hit up Stern for cab fair back to the hotel, because I spent the travel stipend on the keg party last night. I hope nobody notices the tie I took from Sethi is missing. I gave it to that hot drug rep after writing my hotel room on it with her lipstick."

Dr. Stern: "I have to pee, and Olanow won't STFU. Maybe if I cross my legs. I didn't even see a bathroom when we came in. Maybe there isn't one. What do I do then? What the hell is he even talking about, anyway? Why does he need to borrow $20? He still hasn't paid me back from the last meeting. At least I have a good chance of getting laid tonight, because that sizzling drug rep gave me a tie with a room number written on it in lipstick."

Family matters

Dr. Grumpy: "Did either of your parents have any major illnesses?"

Mrs. Clueless: "I don't know. They were both adopted."

Duuuuuuuuuuuuuuuuuuude

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

Mr. THC: "Well, a friend and I were smoking marijuana a few weeks ago, and I mean a lot of it. At one point, I took my pulse, and it was up to, like, 20,000 beats per minute."

Dr. Grumpy: "Is this why you're seeing a neurologist?"

Mr. THC: "Yeah, my internist sent me to a cardiologist, who sent me to you."

Dr. Grumpy: "Okay... So, 20,000 beats per minute really isn't physiologically possible. Maybe it was the effects of the marijuana."

Mr. THC: "That's what they said! But I know they're wrong! I counted them myself!"

Dr. Grumpy: "20,000 is a pretty big number to count up to in 60 seconds."

Mr. THC: "I was able to do it because time had slowed down, and that helped."

Drug rep quote of the day

"Wirth-Liss pharmaceuticals has an outstanding legacy of unparalleled neurological achievement, and I want to personally partner with you to help meet the lifelong goals of your epilepsy patients."

Uh, I hope you mean the prescription...

I'd like to thank the local pharmacy that faxed this note to my office last night.

February 19, 1942

On this day in history, Nazi Germany launched it's only successful invasion of North America. Sort of...

Winnipeg, in the Canadian province of Manitoba, is 4,307 miles from Berlin, Germany. Much farther than Hitler's more immediate enemies in Britain and Russia. Away from the Atlantic seaboard, it seemed an unlikely place for him to invade North America.

Yet, in the early-morning darkness of February 19, 1942 the city's residents were woken by gunfire. They looked out their windows to see warplanes painted with swastikas buzzing overhead, driving off the few Canadian fighters that rose to intercept them. German troops marched through the outskirts of the city, backed up by tanks. Air-raid sirens sounded, and the city was put under blackout.

Canadian defenders (composed of the Royal Winnipeg Rifles, Winnipeg Grenadiers, Veterans Guard of Canada, and others) formed in the center of the city, and were directed by telephone and signal lights. Anti-aircraft batteries opened fire on enemy planes, without success. As artillery thundered and rifles cracked, German forces gradually pushed the defenders inward. Explosions were heard in the distance, as the Germans blew up bridges that might have brought reinforcements to town.

The Canadian forces fought valiantly, but were hopelessly outnumbered. By 9:30 a.m. they'd all surrendered.

Victorious German troops drive through Winnipeg

Unopposed, Hitler's troops spread through the city. City leaders were rounded up, arrested, and taken to detention areas. Col. Erich Von Neuremburg (the German commanding officer) issued the following decrees:

1. This territory is now a part of the Greater Reich and under the jurisdiction of Col. Erich Von Neuremburg, Gauleiter of the Fuehrer.
2. No civilians will be permitted on the streets between 9:30 pm and daybreak.
3. All public places are out of bounds to civilians, and not more than 8 persons can gather at one time in any place.
4. Every household must provide billeting for 5 soldiers.
5. All organizations of a military, semi-military or fraternal nature are hereby disbanded and banned. Girl Guide, Boy Scout and similar youth organizations will remain in existence but under direction of the Gauleiter and Storm troops.
6. All owners of motor cars, trucks and buses must register same at Occupation Headquarters where they will be taken over by the Army of Occupation.
7. Each farmer must immediately report all stocks of grain and livestock and no farm produce may be sold except through the office of the Kommandant of supplies in Winnipeg. He may not keep any for his own consumption but must buy it back through the Central Authority in Winnipeg.
8. All national emblems excluding the Swastika must be immediately destroyed.
9. Each inhabitant will be furnished with a ration card, and food and clothing may only be purchased on presentation of this card.
10. The following offences will result in death without trial
    1. Attempting to organize resistance against the Army of Occupation
    2. Entering or leaving the province without permission.
    3. Failure to report all goods possessed when ordered to do so.
    4. Possession of firearms.

No one will act, speak or think contrary to our decrees.

Churches were closed, and all services banned. The few clergy who dared object were arrested and taken to detention camps. City buses were stopped by armed soldiers, and their passengers were searched. The city flag was replaced by the swastika, and Winnipeg itself was renamed "Himmlerstadt." German soldiers pulled books off library shelves and burned them in the street.

German soldiers confiscating papers from a newsman.

Surrounding communities were also affected. Crowds confronted German soldiers in the streets of Neepawa. Virden was taken over and renamed Virdenberg. Brandon and Selkirk were bombed by Luftwaffe planes.

As troops fanned out through Winnipeg they attacked newspaper sellers and destroyed their papers. They took over radio stations, filling the airwaves with martial music and excerpts from Hitler's speeches. The now-puppet local CBC broadcast a program called "Swastika over Canada." The Winnipeg Tribune was forced to publish an edition with a front page written in German. Canadian dollars were banned, and banks were forced to issue freshly printed Reichsmarks.

The German troops went into workplaces and restaurants and took meals from citizens. They also raided stores and police stations for heavy coats, as it was a chilly 18°F (-8 C).

At one local school the principal was arrested and replaced with a German headmaster. He distributed lessons to the students about the "Nazi Truth," explaining why Hitler's leadership was in Canada's best interests.

German soldiers leading arrested officials out of city hall.

Of course, none of this quite really happened.

The entire occupation, called "If Day," was an elaborate, and remarkably successful, campaign to sell war bonds. The planes were Royal Canadian Air Force fighters painted with swastikas. The German troops were volunteers in rented costumes. The explosions were just show pyrotechnics. The gun, artillery, and anti-aircraft fire were all blanks. Even the books that were burned were old ones that, due to wear, had been marked for disposal. The "Reichsmarks" were counterfeit German money on one side- and an ad to buy war bonds on the other.

The Winnipeg Tribune afternoon edition was satirically renamed the Lügenblatt (German for "lies sheet"). It included an "official joke" (approved by the authorities) which ordered readers to laugh or be imprisoned.

The event was announced in advance, but many were still taken by surprise. 4 years earlier a radio broadcast of "War of the Worlds" had caused widespread panic through the eastern U.S, and the Canadians didn't want a repeat. The days leading up to the "invasion" were filled with newspaper and radio warnings that it would be a staged event. Even people in neighboring Minnesota, which received CBC radio, were told.

As the invasion continued, a large map of Manitoba was posted at the intersection of Portage & Main streets in the city center. When money came in to buy war bonds from different parts of the province, areas were marked as having been "recaptured" from the Germans when they met their fundraising goals.

The "war map"

The idea was the brainchild of John Draper Perrin. People in the central regions of the country were far removed from the war, and he felt that a good fundraiser would be one that made them realize what life was like for civilians in occupied countries.

All-in-all, it was a very successful event. The cost of the staged invasion was $3000, and $3.2 million in war bonds were sold during its 24 hours. The total collection for the month-long campaign was $60 million. Vancouver was so impressed that it staged a smaller invasion, with similar success, and several American cities looked into doing their own.

The invasion ended at 5:30 p.m. with a ceremonial release of prisoners, victory parade, and speeches. The only real casualties of the day were a Canadian soldier who sprained his ankle, and a housewife who cut her thumb while cooking during the early-morning blackout.

Today's pop quiz

You've won $75,000 in the state lottery! To celebrate, you:

A. Go out to dinner, then pay off some bills.

B. Go on a cruise (preferably one with working toilets).

C. Buy that Prius you've had your eye on for years.

D. Buy some meth, marijuana, and bongs, then blow up your house.

3 Act Drama

Act I: Tuesday, February 5th.

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

Ms. Frantic: "I need to get in right away! The toes on my left foot are numb, and I went to ER! They told me I should see a neurologist."

Mary: "Okay... We can see you on Thursday, the 7th, or..."

Ms. Frantic: "THIS IS URGENT! I COULD BE DYING OR SOMETHING! I NEED TO GET IN TODAY!!!"

Mary: "Thursday is our next opening, I'm sorry."

Ms. Frantic: "That's crazy! I need help! I'm going to call another doctor!"

Click



Act II: Tuesday, February 12th

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

Ms. Frantic: "I called a week ago, and couldn't get in, and my left toes are still numb, and I really need to see a doctor!"

Mary: "Okay... We can see you this Friday, the 15th, or..."

Ms. Frantic: "WHY CAN'T ANYONE HELP ME? I NEED TO GET IN TODAY!!!"

Mary: "When you called last week you said you were going to find another doctor."

Ms. Frantic: "They couldn't get me in before Friday, the 15th, either, and I want to be seen today!"

Mary: "Sorry, but we can't get you in before then, either."

Ms. Frantic: "Why doesn't anyone care anymore?"

Click



Act III:  Morning, Friday, February 15th.

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

Ms. Frantic: "I changed my mind! I want that appointment you have for today!"

Mary: "I'm sorry, it's been filled. We can see you next Wednesday, the 20th."

Ms. Frantic: "How could you do this to me? You should have held that spot in case I called back! You know I need to see a doctor!"

Mary: "I thought you said you had an appointment with another neurologist for today?"

Ms. Frantic: "I do! At 2:30!"

Mary: "So why are you calling us?"

Ms. Frantic: "I didn't like the way his receptionist treated me when I called to confirm the appointment this morning."

Mary: "Okay, that's your business, but we can't see you before next Wednesday."

Long pause

Ms. Frantic: "Never mind. I think I'll just cancel the appointment. My foot got better, anyway."

Click

Sunday reruns

At the hospital last week I saw a 20-something guy for a head injury.

He had a fight with his girlfriend outside a restaurant and said he was going to teach her a lesson.

So he began repeatedly banging HIS head against the concrete sidewalk until he was covered with blood. At some point police and paramedics pulled up, and to continue proving his point, he began banging his head repeatedly on the police car's windshield until it shattered.

He then went back to smashing his head on the sidewalk, which continued until he got tasered, and then needed Valium.

The admitting diagnosis was "Self assault"

Exactly what lesson his girlfriend learned from this is unclear, but I suspect it had something to do with getting another boyfriend.

Book 'em, Danno!

Wednesday night I was doing a survey about drug reps, and one of the questions asked where I encounter them:

I must say, I LOVE the correctional facility option. In my younger days I did see patients at a prison clinic, but don't remember a drug rep ever calling there. Yesterday I asked several reps, and none of them had ever heard of it, either.

Since I'm able to fill out this survey, I have to assume they don't think I'm the one in jail. Which leaves just one option. And I'm not driving down to the hoosegow to visit a rep.*

*The odds of a rep being incarcerated depends on the pharmaceutical company they work for.

Mary's desk, Wednesday afternoon

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

Mr. Whirlaway: "Hi, does Dr. Grumpy treat seizures?"

Mary: "Yes, sir."

Mr. Whirlaway: "Does he make house calls?"

Mary: "Not routinely... What are the circumstances?"

Mr. Whirlaway: "Well, a friend told me Dr. Grumpy had helped his kid's epilepsy. I have a horse with seizures, and I don't like our current vet."

Memories...

Menopause has had a lot of names over time. One of the old ones, not used as much today, is climacteric.

When I was doing my internship, there was an eastern European guy named Pedrus in my class. Pedrus had just immigrated, but had a decent grasp of English.

Occasionally, though, he'd encounter something that he only knew in the medical-speak of his home country. When that occurred he'd grasp at the closest-sounding English phrase he knew, and use that.

One night he was on call, and I picked up his admissions the next morning. One of the patients was a lady in her 60's.

Pedrus, in his note on her past GYN history, had written "the patient began her climax at age 51, and it has since continued."

The marketing mindset

Last night I was at a market research interview, and we had this exchange. I have no idea what it means.


Suit guy: "Doctor, please look at this graph, showing speed of onset after the patient uses the drug's inhaler. What are your thoughts?"

Dr. Grumpy: "Well, it's pretty consistent, regardless of pulmonary function, but obviously the patient will have to be trained to use it properly."

Suit guy (makes notes): "And here, do you think this instruction sheet is self-explanatory?"

Dr. Grumpy: "Yes, but it would be nice to also have a demo unit in the office, to show patients how to use it."

Suit guy: (makes notes) "Who was your favorite superhero in childhood?"

Dr. Grumpy: "Doctor Fate."

Suit guy: (makes notes): "This page shows the side effect profile compared to placebo, with frequency of drug discontinuation on the left..."

AYFKM?

Dr. Grumpy: "Okay, sir, we'll check some labs, and I'll see you back after they're done... Any questions?"

Mr. Gravid: "No."

Lady Gravid: "Yeah, I have one."

Dr. Grumpy: "Go ahead."

Lady Gravid: "Do you mind if I look through your patient charts before we leave?"

Dr. Grumpy: "Uh, yeah, I do. They're medical records. I can't allow that."

Lady Gravid: "Oh, I don't need to read them, I just want to look at patient names."

Dr. Grumpy: "Okay, but I still can't allow that. Sorry."

Lady Gravid: "Please? We're trying to think of baby names, and I don't like any I've seen so far."

Random Sunday pictures

First, we have this pen. Doesn't say if it needs batteries.

Next, in the same theme, we have this picture. Taken in Philadelphia ("The City of Brotherly Love") this was found drawn on somebody's car hood following yesterday's blizzard.

For those of you who can't handle Diet Coke, tea, or coffee to perk up, you can now shower with caffeinated soap.*

*I should note that its efficacy is likely dubious. Transdermal absorption of caffeine generally requires it being held in place for several hours, and even then you'll only get a small amount.

Here's this place, which bans cardiovascular systems, or cardiologists, or something.

Sheesh. So much for coming here for Valentine's Day.

And last, I think we could all use a lesson from Bert: There are some neighborhoods that are best avoided.

"That's the last time I go pigeon watching after dark in south Sesame."

Now making house calls!

While I'm still going to be available here, those of you who are Kindle fiends can now subscribe to me on Amazon!

Yes, for only 99 cents a month (less than you'd pay for your daily Starbuck's "half double decaffeinated half-caff, with a twist of lemon" you can now have Dr. Grumpy automatically delivered to your Kindle. All the humor! All the whining! All the artisanal history lessons!

You even get a 14 day free trial!

You can sign up here.

Guest post: God and smoking

I'm tired, uninspired, and swamped today, so I'm putting up this story sent in by Brent.


Dr. Brent: "You know Mr. Nightshade, smoking isn't good for you.  It causes all kinds of health problems and it's expensive.  You really should try to stop smoking."

Mr. Nightshade: "Yeah, I know."


Next visit, a few months later.


Dr. Brent: "So Mr. Nightshade, how are you doing with smoking?"

Mr. Nightshade: "I quit."

Dr. rent: (rather shocked and dumbfounded) "Wow! That's great! What finally made you decide to stop smoking?"

Mr. Nightshade: "God told me to stop smoking."

Dr Brent: "Err, that's wonderful that you stopped smoking."


Next visit a few months later:


Dr. Brent: "So, Mr. Nightshade, how are you doing?"

Mr. Nightshade: "I'm fine, but I'm smoking again."

Dr. Brent: "Oh, why's that?"

Mr.Nightshade: "God told me to stop smoking, so I stopped smoking. But the more I thought about it, the madder I got. I like to smoke, so why should God tell me to stop smoking?  It made me really mad. I wasn't going to let God tell me what I can and can't do, so I started smoking again and I told him to be quiet."

February 7, 1910

HMS Dreadnought

On this day in history, what is possibly the greatest prank ever was pulled off. And its victim was none less than one of the world's most venerable military forces, the Royal Navy.

To set the backdrop:

In 1910 the HMS Dreadnought was the first of a whole new type of battleship. She was, at the time, the most advanced, powerful, weapon of war ever built. The 1910 equivalent of a top-secret nuclear ballistic missile submarine.

The joke started in the mind of Horace de Vere Cole, a poet and notorious prankster. An example of his humor was this: An old schoolfriend had just been elected to Parliament. While walking together through London, Cole challenged him to a foot race, then let him get ahead. Unbeknownst to the friend, Cole had slipped his gold watch into his jacket pocket, and as he chased him yelled, "Stop! Thief!" The friend was detained by police until Cole explained it was a joke. Another time he purchased theater tickets for all his bald friends- and he'd chosen their seats specifically so that their heads spelled out an obscenity when viewed from the balcony.

But I digress.

Cole recruited 5 friends from a circle of writers and artists to help him, including Virginia Stephen - who'd later become famed novelist Virginia Woolf.

On February 7, 1910, HMS Dreadnought was moored in Portland Harbor, Dorset. Cole had a forged telegram, allegedly from the UK government's foreign office, sent to her commander. It said they'd be receiving a visiting delegation of princes from Abyssinia (now Ethiopia), and to offer them all courtesies.

4 of Cole's accomplices put on heavy blackface make-up, glue-on beards, and elaborate theatrical costumes. Cole went as "Herbert Cholmondeley" of the UK's foreign office, and the 6th participant (Adrian Stephen, Virginia's brother) went as a translator.

The fake Abyssinian delegation: Virginia Woolf is on the far left, her brother Adrian in the bowler hat at center, and Horace de Vere Cole at the right.

With this group behind him, Cole marched into London's Paddington Station and, claiming to be a government officer, demanded a train be immediately prepared to take them to the Dreadnought. The impressed railway employees gave him a VIP coach with private staff.

Meanwhile, in Weymouth, frantic British officers organized an honor guard to greet the train. To their horror, nowhere in the Royal Navy's music list or flag collection was there anything for Abyssinia. So the band was given the national anthem of Zanzibar instead, and hung the Zanzibar flag, hoping the visitors wouldn't notice (they didn't).

The group was welcomed with full military honors, and inspected the anchored fleet. The highlight came when they boarded and toured the magnificent Dreadnought herself. Enemy spies had spent years trying to ascertain her technical details, and here the Royal Navy was willingly escorting a group of costumed literary goofballs on board and showing them around.

As they walked up the gangplank it started to rain, and to their horror the make-up began to run. Cole rushed the group inside before anyone noticed, explaining that royalty shouldn't get wet.

During the tour, the Abyssinian princes excitedly chattered in a nonsensical foreign tongue, which was a random, improvised, combination of Greek, Latin, and gibberish. Adrian Stephen made up questions as they went along, and "translated" them (and the answers) back and forth. The group exclaimed "Bunga! Bunga!" at things that were particularly impressive. This so struck nearby sailors that it entered British lexicon for a time, and was recently (2011) resurrected in Italy referring to the behavior of Prime Minister Silvio Berlusconi.

While on the train ride, Cole had created names for each of the 4 "princes," but forgot who was who during the tour. So their names changed from minute-to-minute. The naval officers didn't notice. At one point they were guided by an officer who was a cousin of Virginia and Adrian Stephen, and who also knew Cole personally, yet he didn't recognize them (and Adrian & Cole weren't even in costume!).

As their tour ended the members tried to bestow the "Order of Abyssinia" medal on several officers (actually a cheap trinket Cole had bought en route). The Dreadnought's cooks had prepared a special meal for them, but they declined to eat, with Cole stating that for religious reasons they were concerned the food wasn't prepared correctly (the real reason was that eating or drinking would ruin the make-up and fake beards).

The group were again saluted by the honor guards and Zanzibar national anthem as they left, boarding the train back to London.

A few days later Cole leaked the story, complete with photos, to the London newspapers. It became front page news. The Royal Navy was horrified, and the mighty Dreadnought was promptly dispatched on "machinery trials" until the mess blew over. British sailors were greeted in the streets with "Bunga! Bunga!" and Parliament tightened regulations on ceremonial visits. The navy threatened to have the perpetrators caned, but in the end no one was punished.

Several months later the real Emporer of Ethiopia, Menelik II, came to England, and the navy turned down his request to visit the fleet to avoid embarrassment (perhaps they still hadn't found a flag or national anthem).

A final note came in 1915, during World War I. The Dreadnought rammed and sank a German U-Boat, and after returning to port her captain received an anonymous telegram that simply said "Bunga! Bunga!"

WTF?

Last night a paid survey "exclusively for neurologists" showed up in my mailbox, so I clicked on it.

One of the qualifying questions was how many of each of these disorders I treat in a month:

Needless to say, I didn't qualify

Seriously, people, I'm a freakin' neurologist. How much effort did you put into this survey?

Worries

Dr. Grumpy: "Have a seat... I'm Dr. Grumpy... What can I do for you?"

Mr. Frio: Hi... You know, I got a cup of water in the lobby when I came in. I was thirsty and all."

Dr. Grumpy: "Uh, huh..."

Mr. Frio: "It was really cold. I mean, maybe too cold."

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

Mr. Frio: "I wasn't expecting warm water, don't get me wrong. But I wonder if it's safe that the water is that cold."

Dr. Grumpy: "I'm sure it's safe. Now, to get back to why you're here..."

Mr. Frio: "I like cold water as much as the next guy, but this was really cold. Colder than I think it needed to be. You should look into this. Someone could get hurt."

Dr. Grumpy: "I'll let Mary know, she's the person in charge of that."

Mr. Frio: "Thank you."

I'd say that's 10/10

Yesterday afternoon I got dragged into ICU to see a consult. Some of the nurses were laughing over a chart, so I asked what was up.

Apparently Mr. Camp began having chest pain earlier in the day, which had quickly escalated. He was now in ICU, because pretty much any movement or excitement was causing chest pain. So they were slathering him with nitrates while the hospital called in the surgical team to do an urgent coronary artery bypass.

Anyway, in the pre-op orders the cardiologist had written (in all caps and underlined): "PATIENT IS NOT ALLOWED TO WATCH THE SUPER BOWL!!!"

Kid Super Bowl quote of the night

Craig: "The team I pick has always won. Except for last year. And the year before. And the year before that. And before that doesn't count, because I didn't watch the Super Bowl."

More artisanal crap

All right, it's again time to hit the artisanal mailbag.

First we have one of many (and you guys send in a lot of similar stuff, so I guess it's everywhere) containers of edible weeds, which were grown from dirt using sunlight, water, and photosynthesis, only to have some clown claim it to be artisanal:

Next, apparently any idiot driving a car is, at least to Geico insurance, a "skilled artisan."

"I shwear, offisher, I'm a skilled artisan."

What do you with stale bread? These days you label it as "artisanal stuffing" and toss it in the discount bin:

Likewise, when those artisanal diet foods don't sell like hotcakes, you mark them down and hope some sucker takes them home.

Now even TV listings are artisanal, I guess

Apparently WAY too many people are answering "strongly agree" on surveys like this, or we wouldn't have to deal with this crap:

And, lastly, it's good to see at least some of these products are going bye bye.

Remember, if you can't get enough of this stuff, you can visit my hand-crafted Artisanal Overload page, showing my thus-far complete archives of it.