Zzzzzzzzzzzzzzzzzzzzzz

Dr. Grumpy: "Any triggers to your headaches?"

Mr. Coriolis: "They only occur when the barometric pressure drops."

Dr. Grumpy: "And what medications..."

Mr. Coriolis: "See, I began tracking barometric pressure with an iPhone app, comparing it to my headache diary" (takes out a notebook) "and here are some graphs I made up. I downloaded the barometric pressures of cities I've been in going back 38 years, to when I was born, and then I graphed them against..."

Dr. Grumpy's gift guide

How many times a day do you find yourself wondering "Gee, how many eggs do I have at home?" 5? 10? 78?

If you're like me, you really don't care. But, if this a subject of serious importance to you,  it creates a real dilemma. I mean, if you're at the store, you can always hedge your bets and buy more eggs, but what if you get home and find you already have some? Then you have more eggs than you need, taking up space you could be chilling Diet Coke in.

By the same token, you can NOT buy them, then get home and find you're out. And now your plans to serve cheese omelets at the formal dinner party are in disarray.

Sure, you can always call home and ask someone, but if your kids are like mine they won't look. They'll set the phone down, play Metroid for 2 minutes, then pick it up and give me a made-up number.

But now... THE PROBLEM IS SOLVED!!!

The Egg Minder is the latest in modern chicken ovum tracking devices. It's a computerized egg tray that keeps count of how many eggs are left and which one is the oldest. AND you can access this valuable data from your smartphone anytime! It will even send you a push notification when you're running low. So you never have to have an "OMG HOW MANY EGGS ARE LEFT AT HOME?!!!" panic attack ever again.

It also holds 14 eggs. Since they're generally sold in multiples of 12, those with OCD will need to buy 7 dozen eggs and 6 Egg Minders to get a perfect fit. And then you just know you'll drop one while transferring them.

Paging Dr. Yossarian

Yesterday I received this fax from a pharmacy company. As best I understand it, they don't authorize the drug involved... So to get it covered I need to call...

The telltale cup

Rick was my resident for a month during internship. He was notoriously lazy. The last to arrive for a code, the first to leave after call, and never seeming to be around when you needed him.

He wasn't the kind of lazy who intentionally dumped work on others. He didn't see why anyone had to do it, and encouraged me and the other intern, Karen, not to do things either. As a result Karen and I spent a few days getting reamed out by attendings until we figured out NOT to follow Rick's instructions on ignoring labs, med sheets, exam findings, etc.

Rick, as these people always are, didn't feel he was the problem.

Anyway, one day my team was on call, which meant we were responsible for all codes, with Rick being the one who had to run them. Around mid-day there was a code on the 7th floor. Karen and I were both in ER doing admissions, but immediately dropped everything, and (big surprise) got to the room before him. We were frantically trying to remember our ACLS drills when a cardiologist ran in, then the chief resident, pretty much tossing us out.

After a few minutes Rick, the guy who was supposed to be running the code, came in. He was pretending to be panting (not a drop of sweat on him) saying he'd run all the way up the stairs from the lobby coffee place.

He was carrying a styrofoam cup filled to the brim with steaming coffee.

Without a lid.

And he hadn't spilled a drop en route to the code. Not a single brown dribble mark on the sides.

Dr. Grumpy's gift guide

As the Earth continues its trip around the sun, the holidays are again approaching. And with them, of course, the annual Dr. Grumpy Gift Guide!

I'd like to kick things off this year with something truly meaningful, special, and unique.

Chocolates have long been a way of telling that special person how you truly feel. Sometimes, of course, we encounter someone who's special in an entirely different way. When this happens we wonder "What can I give this person to convey my true feelings to them?"

The answer, of course, is this: A chocolate asshole!

Yes, the folks at Edible Anus purvey the finest in anally-shaped candies, using only pure Belgian chocolate. These delectable assholes are available in milk, dark, and white chocolate, and are handmade in England.

For that truly special person you can also order sterling silver assholes. They also have glass ones. I am not making this up.

The tagline on their site is "The anus that made Britain great." I'll defer any commentary on that to my readers across the pond.

Running errands on Black Friday

Dr. Grumpy: "Oh... Look at that. The Okra Haus restaurant is closed. It looks like they're tearing it down."

Marie: "Oh, no! I hated that place!"

Dr. Grumpy: "Then I'd think you'd be happy it's gone."

Marie: "Yeah, but now I need to find another place to despise."

Thanksgiving

This is the Gray Wolf

"You want a piece of me?"

One of evolution's most successful designs, to this day it's a feared predator across the planet. Its range covers most of the northern hemisphere. One subspecies, the Yukon Wolf, is the largest living wild canid today. They're ferocious hunters.

What makes Gray Wolves so incredibly successful is their social nature. Their intelligence makes them clever, capable of adapting to new situations and prey. They hunt in packs, which allows them to bring down animals much larger than they individually are. Bison. Moose. Musk Ox. They have an impressive array of teeth and powerful jaw muscles that can crack large bones.

"We have sharp teeth for a reason, Phil. Let's use them."

And, somewhere around 30,000 years ago, this social tendency led to them becoming oddly intertwined with a primate species that was gradually spreading across the planet. A branch off the Gray Wolves became hunting partners, guards, and companions. Each species learning from the other in a remarkably successful relationship that continues to this day.

Still vicious. Still wild. Still... Oh, who am I kidding.

This is the modern wolf. From dangerous hunter to pillow for video-game-playing ape.

Her hunting ancestors must be horrified.

Life with dogs. It just doesn't get any better.

History reruns

November 27, 1898

Everyone's heard of the Titanic, Andrea Doria, and Lusitania. But most shipwrecks are long forgotten, except in the areas they occurred.

Long before The Perfect Storm was made famous by a George Clooney movie, there was the Portland Gale of 1898. The storm was catastrophic, but is mostly forgotten now.

In 48 hours of early-winter gale over 300 ships were either sunk or seriously damaged. Lives lost is unknown, but likely between 500-1000. Shore towns and cities from Massachusetts to Maine were devastated by rain, sleet, and more than 2 feet of snow, driven by winds measured up to 110 miles per hour. Communities of beach cottages simply vanished.

But the storm is still called by the name of it's most prominent victim: the steamship Portland.

In 1898 the Boston, Massachusetts to Portland, Maine route was a busy one, used heavily by both business and leisure travelers. Some took trains, while others preferred steamships. The latter traveled on coastal steamers, usually by night (the equivalent of a "red-eye" flight today). A ticket was $1 to $5, depending on your accomodations. You'd board in the evening, have dinner on the ship, sleep in your cabin, and the next morning were there. The ships went back and forth 3-4 times a week.

The New England weather can be notoriously vicious. A storm was coming in when the Portland sailed on the evening of November 26, 1898. Her captain, Hollis Blanchard, was known for being cautious, but apparently saw nothing in the conditions or forecast that unduly alarmed him. At 7:00 p.m. the ship sailed from India wharf in Boston, never to return.

The ship was sighted by others in the next few hours, but as the storm worsened, eventually vanished in the gale. When and exactly how she foundered will always be a secret, as she took all 192 passengers and crew with her. Recovered watches had all stopped between 9:00 and 10:00, though whether this was a.m. or p.m. is unknown.

The next day wreckage began washing ashore: furniture, timbers, luggage, lifebelts, and lots of bodies. Although the picture above shows a lifeboat being launched, none were ever found, and the severity of the storm makes it unlikely this was even attempted.

Several entire families were lost in the tragedy, traveling home after Thanksgiving in Boston. Their memorials are scattered across New England graveyards. The Portland black community was hit particularly hard, as (except for the officers) the majority of the crew were black men. In 1898 (33 years after the Civil War) service on these ships was considered a very respectable job for a black man, and those who served were generally veterans of the trade, supporting families ashore. They were often more sought after than white men for the same positions, as white men looking for these jobs were younger, less experienced, and seen as more likely to leave the job without notice.

The Portland herself would remain hidden for a long time. In 1989 the wreck was located, but the technology wouldn't allow an accurate identification. So it was forgotten again until 2002, when it was found by side-scan sonar. It's since been explored by divers, though at a depth of 460 feet in very cold water this is limited and dangerous.

If you're interested in learning more about the Portland and gale or 1898, I recommend the book "Four Short Blasts" (the title refers to the whistle distress signal of the time) by Peter Dow Bachelder. The book also has a brief history of the American Life-Saving Service, which eventually became today's U.S. Coast Guard.

Not even close

Dr. Grumpy: "Okay, let me have Annie schedule that test..."

Mr. Gallery: "I have a question for you" (takes out an iPad) "I read on your website that you majored in art?"

Dr. Grumpy: "Um, no. My undergraduate degree is in physics. I'm pretty sure it says that on my site."

Mr. Gallery: "Are you sure? I thought I'd read that somewhere. Maybe it was Yelp or something."

Dr. Grumpy: "I'm sure. Believe me. I have no knowledge of art whatsoever."

Mr. Gallery: "Oh" (looks disappointed, puts away iPad) "I was really hoping you could help identify some of the paintings at my parent's house. I even took pictures of them."

Telephone book

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

Mrs. Frantic: "I need you guys to get my Dad in today! I think he had a stroke, or a seizure, or a heart attack, or one of those things!"

Mary: "Calm down, ma'am... Have we ever seen your father before?"

Mrs. Frantic: "No! He's visiting from California! And he's not acting like himself."

Mary: "Okay, we don't have any openings today, and I think your best option is to take him to ER."

Mrs. Frantic: "But he needs a work-up NOW! You need to see him and do tests and stuff!"

Mary: "I understand that, but we can't do those tests in our office. That's why you need to take him to emergency."

Mrs. Frantic: "I don't want to take him to ER! He needs to see a neurologist!"

Mary: "We can't see him today, and so..."

Mrs. Frantic: "FINE! I'll just move on to the 'H's'."

(click)

Rimshot

Dr. Grumpy: "Any memory problems since starting the new pill?"

Lady Geritol: "I'm not sure. Honey, have I been forgetting things?"

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

Subjectivity

 

Dr. Grumpy is rude. His staff is rude. His wait time is always over an hour. He's incompetent. He's malicious.

Well, it's hard for me to objectively address most of these charges, but I can say that the longest I've ever kept a patient waiting is 23 minutes.

I hate sites where you can anonymously rate doctors. Anyone can put up a scathing review, even if they didn't actually see you. Maybe they're pissed off that you don't take their insurance, or wouldn't give them the extra 40 Percocets they wanted.

The sites don't check to make sure that they really saw you. For all you know you're being rated by a person angry that your kid beat theirs in the school spelling bee (don't tell me people aren't that petty. They are.). And because we're doctors, we can't really defend ourselves. After all, we took an oath to keep your health concerns in confidence.

Let's look at this the other way: what if I were to create an online public forum where doctors could rate patients by name. Of course, while we'd be encouraged to write only about our own patients, who's to make us do so? What if you're someone who dinged my car at Costco this weekend, or the barista who can never get my order right? I could use the site just for the hell of it.


"Probably a drug seeker. I wouldn't touch her."

"Very whiny and needy. Calls staff all the time."

"Dumb as a rock. Can't remember his meds."

"Argues incessantly about his crappy $15 co-pay".

"Needs to buy a toothbrush and some deodorant."


Best of all, we doctors could put it up anonymously. You'd have absolutely no way to know who wrote it (you could guess). In fact, even if I never saw you, and say, just didn't like you based on meeting you somewhere, I could write whatever I wanted. And you'd have absolutely no legal recourse. Sure, you could post something in your own defense, but, do you have time for that?

Of course, that would never happen. Besides being unethical, it's frankly illegal for a doctor to do that. Patients, however, have a free reign to anonymously say whatever the hell they want about us. Even if they've never actually seen you and are making it all up.

The other problem that affects these rating sites is simply human nature. When something goes well, we expect it and say nothing. But when something goes wrong, we get angry and want the world to know. So the reviews are predominantly written by people pissed-off enough to take the time to find a ratings site, create an account (maybe several), and write one or more bad reviews. The people who thought the doctor was awesome may outnumber them 100 to 1, but won't write anything. So, as in everything else, a small but vocal minority can drown out the truth.

Besides, it's so much more fun to write a bad review than a good one. Most of us learned this in high school, whether through writing a book report, gossiping about others, or reading Perez Hilton.

For these sites, and those who contribute to them, I think we have to keep in mind the words of the finest restaurant critic in history, Mr. Anton Ego:

"In many ways, the work of a critic is easy. We risk very little, yet enjoy a position over those who offer up their work and theirselves to our judgment. We thrive on negative criticism, which is fun to write and to read. But the bitter truth we critics must face, is that in the grand scheme of things, the average piece of junk is more meaningful than our criticism designating it so."

Dear Market Research Company,

I think you need to improve your incentives to get any takers:

Thank you, Ann!

Raise your hand if you're sure

Dr. Grumpy: "Do you have any other questions?"

Mr. Apocrine: "Can you smell my deodorant from over there?"

Dr. Grumpy: "Uh..."

Lady Apocrine: "Did you try that new brand today?"

Mr. Apocrine: "Yeah. The commercial for it sounded promising.""

Lady Apocrine: "That's what all commercials say. But I can't smell anything, which is good, I guess."

Mr. Apocrine: "Yeah, Mr. Fluffles didn't seem to notice anything different when he came up to me this morning."

Lady Apocrine: "Doctor, do you know anything about underarm sweat?"

Mr. Apocrine: "Of course he doesn't. He's a neurologist."

Lady Apocrine: "Well, don't armpits have nerves?"

Mr. Apocrine: "I don't think that's relevant here."

Lady Apocrine: "What was your question again?"

Mr. Apocrine: "I asked him if he could smell my deodorant from across the desk."

Lady Apocrine: "That was stupid."

Mr. Apocrine: "Everyone says stupid things."

Lady Apocrine (looks at me): "Okay, doc. I think we're good. Thank you."

Winter reruns

With the first snow of winter behind us, I remembered this:

I finally had the time today to fire up the Grumpy family hot tub for the winter.

So I cleaned it out, filled it up, added chemicals, put in a new filter, etc.

For whatever reason, though, I couldn't find the power cord that comes with it. Because I'm a guy (and therefore inherently stupid) I just grabbed an extension cord out of the garage. Mrs. Grumpy kept telling me I wasn't supposed to do that, because the special hot tub cord had extra circuits or fuses or breakers or whatever in it, and you couldn't use something else.

But I wanted to get the hot tub going, so I told her it would be fine, and hooked it up.

The kids were excited, so I had them out in the yard with me. They counted down from 10 for me to flip the switch, turning it on for the winter.

"5-4-3-2-1- HOT TUB!". I pressed the button. The jets whirled, the water swirled, the kids laughed.

For about 5 seconds.

Then there was a loud "POP!"

And the hot tub turned off.

And the kids stopped laughing.

And all the lights in the house went out.

Another 5-10 seconds of absolute silence went by, finally broken by Mrs. Grumpy saying "You bozo."

She went around to futz with the switch box. She found the correct power cord in the garage. And I am in trouble.

NFC

Dr. Grumpy: "Do you have any past medical issues?"

Mr. Vague: "They told me I ruptured something or another, somewhere in my body, sometime in the last 10 years. You know what I mean?"

Memories...

When I went to Big State University in the 1980's, I worked in a campus department office.

A girl name Alyssa worked there, too. We did not like each other. No idea what it was, just bad chemistry I guess. The kind of thing where within a few seconds of meeting someone you know you hate them.

We were able to work politely, but everyone in the office knew the temp got colder when we were both in the same room. So we tried to stick with different jobs in the daily routine, and avoid each other.

Until, one day... disaster struck.

That afternoon someone gave us both THE SAME DAMN JOB. Booklets were needed for a meeting of some sort, and we had to put them together. This would likely have gone fine, except for one minor detail: we had to share one freakin' stapler.

It wasn't a standard stapler, either, but one of those heavy-duty office ones designed for thick stuff.

So here we were, each taking page 1 from one pile, page 2 from another, and so on (I think it was around 25 pages total) and stapling them together. As the stapler got shuffled back and forth across the table things got nastier and nastier, with each accusing the other of keeping it for too long, not using it when it was taken, and working too slowly.

At some point we both reached for the stapler at the same time, and began fighting over it. Each of us was trying to staple stuff and not let go of the stapler.

And then, it happened.

All I remember is that we both yelled at the same time, then began swearing. Somehow, we'd stapled ourselves together. The webbing between my right thumb and first finger now impaled through the same area of her left hand.

Blood and paper flew everywhere. Now we were REALLY angry, blaming the other for the accident. And we couldn't get the industrial-grade staple out. There was no option but to walk to student health.

We opened the door and walked out into the main office. People who knew we hated each other, and wondered what the screaming was about, were stunned to see us holding hands. We didn't really have much choice. As blood dripped on the floor she grabbed a box of tissues to staunch things.

We got a few (okay, a lot of) weird looks as we walked across BSU campus to student health. In the waiting room someone told me we looked like a botched suicide pact.

It took about 20 minutes until we were separated.

We both got fired. No idea where she is today.

Overheard in the doctors lounge

Trauma surgeon: "How are you liking the rotation?"

Surgery resident: "It's all right, but a lot of it just seems to be people doing stupid shit."

Trauma surgeon: "Yeah, but if you take that away... it's not much of a job."

Microbiology

Lady walks in, stands at desk.


Mary: "Hi, can I help you?"

Mrs. Pasteur: "Do you realize there are GERMS on your doorknob?"

Mary: "Ummm..."

Mrs. Pasteur: "This is unacceptable for a medical office. Do you have some Purell?"

Mary silently hands her a bottle of Purell. The lady wipes off the doorknob (which isn't, say, visibly filthy).

Mrs. Pasteur: "I'm here for my 11:00 appointment."

Mary: "Let me give you some forms to fill out, and can I get a copy of your insurance card?”

Mrs. Pasteur: "You just touched the pen! And the clipboard! Don't you wear gloves? Whatever happened to personal hygiene?!!!"

Mary: "I..."

Mrs. Pasteur: "I'm going elsewhere. I don't think your office is safe."


She heads for the door, turns back, grabs a Kleenex off the counter, uses it to turn the doorknob she'd just wiped off, drops the tissue on the floor, and leaves.

Veterans Day reruns

Being a history buff, veterans (especially WW2) are prized patients. I love talking to them and hearing their stories, and it's not uncommon for a guy who served to have to point out to me that's not the reason he came to the doctor.

But one veteran in particular stands out (I've told this story before, but not since 2009).

Bill was a pleasant 90 year-old guy. He was in the first wave at D-Day, and had a shirt full of medals.

By the time I met him, however, he was mildly demented. Macular degeneration and glaucoma had left him blind in one eye with severely impaired vision in the other. His reaction time was terrible.

And, of course, he was still driving. His son brought me pictures of the damage to Bill's car from hitting signs, walls, trees, pedestrians, whatever.

"My son exaggerates, doc. Nothing a little paint won't fix."

Bill stubbornly refused to stop, so I ordered a driving evaluation. Which, of course, he failed miserably. Although it pained me to do it, I filled out the paperwork to revoke his license.

About a week later Bill came in for a follow-up appointment (he took the bus). But he wasn't alone. And my office is pretty small.

He was accompanied by his friends from the local VFW chapter. Like, 8-10 of them. All were well over 80, and wearing their VFW hats.

To my horror, Bill was the only one left in the group who (until recently) hadn't lost his driver's license. As a result, he was their driver. And now he'd lost it, too.

"Give Bill his license back, Dr. Grumpy. You're our only hope"

All gave me glowing testimonials as to what a wonderful driver Bill is, with comments like:

"He almost never hits things."

"It's not his fault traffic lights are outside his visual field."

"Gus's Bar is pretty close, anyway."

"Everyone knows Bill's car, and watches out when they see him coming."

"It wasn't like the dog had an owner."

And my favorite:

"Doc, Bill drove a tank all over France. He's perfectly safe".


Thank you, veterans!

Huh?

I got dragged in to do a consult (and I'm not on call!) today. As per tradition, I stopped in the doctor's lounge to grab a Diet Coke on the way up to the floor.

It was the usual Saturday mid-day crowd of surgeons and hospitalists, some at computers, others watching the Saturday college football games.

As I paused to look at the score, some TV announcer chimed in "Be sure to stay with us at halftime. Many Big State University alumni died serving their country in World War II, and BSU invited them to today's game. Nearly 50 were able to be here, and there will be a special Veterans Day tribute by the marching band."

Zzzzzzzzzzzzzzzzzzz

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

Mr. Ceruleus: "My dad died in his sleep, so I guess, um, sleeping?"

GET A FREE iPAD!

How many times have you seen that?

All the damn time. Every medical journal, CME service, and medical supply company has some such crap. If you order the gold-level service you get an iPad-mini, go with the platinum and you get an iPad. My wife has seen it from companies selling school nurse supplies in bulk

Of course, the iPad isn't really "free." Its cost is figured into whatever they're charging you for the purchase, or they're taking a slight loss hoping to get you as a loyal customer (doesn't work, guys. Ask any pharmacist who's forced to hand out gift cards to people who transfer a prescription).

But I digress.

Anyway, my point here is that pretty much EVERY professional level product is often sold with a "get a free iPad" gimmick.

Including, apparently, rats.

Yes, lab researchers, now you too can get a free iPad with your order of research rodents. Need some transgenic rats to test antibiotics? You've got an iPad-Mini! Doing cancer research on knockout rats? Get an iPad!

"Wait, where's the iPad they promised me?"

Be sure to use the promo code, which ingeniously is RatPadB13.

After all, with an iPad you don't need a mouse.

Thank you, Caillin!

Live entertainment

Mary: "Can I get a copy of your insurance card?"

Mr. Garda: "Sure, hang on... Um, I can't find it."

Lady Garda: "JIM!!! Did you lose it again?"

Mr. Garda: "I guess I did... It must have fallen out at the restaurant last night."

Lady Garda: "For Pete's sake! This is the 5th insurance card you've lost this year! I'm tired of calling them to get you a new one!"

Mr. Garda: "I'm sorry..."

Lady Garda: "You're lucky I carry an extra around for you!" (hands card to Mary) "You're a freakin' policeman! Grumpyville trusts you to carry a loaded gun everywhere, and you can't even keep track of a damn insurance card!"

It's 2:00 a.m.*

Midnight. One of my patients is in the Emergency Room:


Dr. ER: "So, it looks like she had another seizure."

Dr. Grumpy: "Yeah, she wanted me to leave her dose as it is, but at this point she'll need to increase it. Have her go to 2 pills twice a day."

Dr. ER: "Okay, should she come see you this week?"

Dr. Grumpy: "Yes... I want to talk to her. I know my 2:00 is open tomorrow afternoon, so have her come in then. I'll let my secretary know in the morning."

Dr. ER "Will do. Have a good night."

Two hours later, my phone chimes.

"Hello, Dr. Grumpy? I was in the ER earlier tonight, and they told me to come to your office at 2:00. So I'm here, but your office building is all locked up and dark. Can you please let me in?"


* The fear is gone

I don't wanna know

I'm going to hope this is a horrible transcription error, and not how someone broke their finger:

Thank you, K!

This guy is good

Thank you, ER's Mom!

Patient quote of the day

"It's not the important things I don't remember. It's the stuff that's important, but not as important as more important stuff. Some stuff, you know, is important and some isn't important important, but still important. So I remember most of the important important stuff, or least the important parts of what's important, but not other important stuff because it's just not as important. I think this is important."

Fine, then call Google

Dr. Grumpy: "What you have is called Essential Tremor. It's a form of tremor that..."

Mrs. Parscompacta: "Wait, are you saying I don't have Parkinson's disease?"

Dr. Grumpy: "Correct. Essential tremor is a different disorder that..."

Mrs. Parscompacta: "This is ridiculous. Of course I have Parkinson's disease."

Dr. Grumpy: "Why do you say that?"

Mrs. Parscompacta: "Because the internet says I do!"

Dr. Grumpy: "Ma'am, I can assure you that you don't..."

Mrs. Parscompacta: "I DEMAND YOU DIAGNOSE ME WITH PARKINSON'S DISEASE!!!"

Dr. Grumpy: "Why do you want Parkinson's Disease?"

Mrs. Parscompacta: "I'm your customer, damn it! Haven't you ever heard 'the customer is always right'?"

Dr. Grumpy: "Yes, but for this..."

Mrs. Parscompacta: "You're the 3rd neurologist I've seen, too. Obviously, I've learned more from Google than you idiots did in training."

Dear Helen Keller Services for the Blind,

Yesterday you sent this email to one of my readers, who kindly forwarded it to me.

And beyond that, I'm not going to say anything.

Thank you, Dilbert!

Hmmm...

Mr. Skip: "My pain is better, but I still have bad days, about once a week. I don't know why."

Dr. Grumpy: "Any side effects on the medication?"

Mr. Skip: "No, but I just don't like taking pills."

Dr. Grumpy: "They seem to be helping you, though."

Mr. Skip: "Yeah, but I'm just not a pill person. I skip taking them every 5 days to see if the pain comes back. It does."

Front counter

A lady comes in to the waiting room, sits down, and grabs a magazine. Other patients come and go, and after a few minutes Mary goes to the counter.

Mary: "Hi, ma'am. Are you here to see Dr. Grumpy or Dr. Pissy?"

Lady: "Neither."

Mary: "Oh, are you picking someone up?"

Lady: "No."

Mary: "Do you need to make an appointment?"

Lady: "No, thank you."

Mary: "Is there anything I can help you with?"

Lady: "No, I'm just reading the magazines. I didn't like the ones Dr. Lung has across the hall, and told them they could find me over here."

Patient quote of the day

"It was dark. I mean, pitch black. I was afraid I'd completely lost my vision and was blind. But then I found the light switch, and flipped it. That made everything fine, and I could see again."

Money changes everything

Dear Dr. Cashpay,

I know you don't remember what it was like to be a peon. It's been several years since you last saw an average patient. Nowadays people pay you $5000/year to "belong" to your practice, and then another $400/hour if they actually have to see/speak/text/stand in your radiant aura.

And you normally don't refer to me, anyway. Since I take insurance, I get paid the same amount of money to see one of your self-important assholes as I do for a decent, but non-wealthy person. So I don't give your patients the priority attention you feel they deserve. But, occasionally, one of them will show up on my doorstep and I'll see them. As did Mr. Rich last week. Unlike most of your peeps, he was quite pleasant.


3 days later:


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

Lacey: "Hello, this is Lacey, calling from Dr. Cashpay's office. He wishes to discuss Mr. Rich's case with Dr. Grumpy."

Mary: "Hang on, he's between patients, so let me get him."

Lacey: "No, we don't work that way. He'd like to schedule a 15-30 minute appointment to discuss Mr. Rich by phone."

Mary: "Wait... You're actually trying to schedule a phone call for the doctors to talk?"

Lacey: "That's what we do here."


This was a first for my office. Mary grabbed me, and I got on the phone.


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

Lacey: "Dr. Cashpay would like to schedule a 15-30 minute phone appointment to discuss a mutual patient."

Dr. Grumpy: "That's a lot of time. Is Dr. Cashpay going to pay me for this phone call?"

Lacey: "Certainly not. He works for his patients."

Dr. Grumpy: "But he'll charge Mr. Rich for the time he spent on the phone on his behalf, right?"

Lacey: "Of course. And rightfully so."

Dr. Grumpy: "Look. I've get about 5 minutes on the phone between patients right now. So Dr. Cashpay can talk to me now, at no charge. But I really don't have time to set up phone appointments for this sort of thing."

Lacey: "He's with a patient, and doesn't allow interruptions."

Dr. Grumpy: "Then he can try later, and see if I'm available. Show him how to dial. Goodbye."

Overheard at the Nurses Station

It's shift change:


Nurse 1: "Beware of when she coughs."

Nurse 2: "Why? She really sick?"

Nurse 1: "No. When she coughs, she farts. And sometimes more."

Wrong Way Wooten

Dear Dr. Lazar,

One of my readers noticed an ad for your recently published book:

I'd like to make 2 points (so to speak).

1. While your book is on stomach cancer, and I understand anatomy is important, the breasts seem unusually voluptuous detailed for a book that focuses on an entirely different organ system.

2. In a book about stomach cancer, some details are more important than others. The anatomy of the stomach, for example, is pretty critical. And in this case, your cover art has it backwards. So, unless you've got an exceedingly rare patient born with reversal of the internal organs, or a previously undescribed form of malignancy that causes them to rotate a perfect 180°... I'd break out your Netter.

Thank you, Robyn!

Hmmmmm...

Dr. Grumpy: "Are you married or single?"

Mr. Shakes: "Um, do you think the girl who drove me can hear us? She's out in your lobby."

Dr. Grumpy: "No, not through these doors."

Mr. Shakes: "Then I'm single."

Correct!

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

Mr. Cecum: "I've had a unilateral appendectomy."

Mary's desk

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

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

Mary: "Okay, what will you be seeing the doctor for?"

Mr. Sativa: "I need my transmitters or transistors checked in a test."

Mary: "I'm not sure what you're talking about. What symptoms are you having?"

Mr. Sativa: "I don't know if I'm having symptoms or not. See, I've been smoking weed for years, and 3 days ago I stopped cold turkey because I needed the money to get my car fixed, and I need that test to see if my brain is, like, really fried."

Mary: "And what test did you say it was?'

Mr. Sativa: "I want my transistors, or transmitters, or whatever those things are that radios and TV's and power stations have, you know, except they're in your brain. I read about it on the internet."

Mary: "I'm not sure..."

Mr. Sativa: "Also, I need to know how much it costs, too, because now that I'm not smoking weed I'm trying to save money, in case I need more tests, or go back on weed, or get my car repaired again because it still isn't working right. It makes this weird noise, like a rabbit is trapped in the glove compartment, and I looked and there's no rabbit there, or bird, or anything. Do you know what can make a noise like that? Or can you ask the doctor?'

Mary: "Why don't you call Dr. Hehatesusandwehatehim, down the street. He does this test."

Mr. Sativa: "Oh, cool. Does he know anything about cars, too?'

Texting with Frank

Frank and I are usually texting back and forth in the afternoon, as I have to pick him up and take him to Kumon, or home, or heaven knows where.

Unfortunately, this isn't nearly as easy as it sounds. For example, here's one where I wanted to know if he was going to stay at a friend's house, or was ready for me to come get him.

 

Another issue is the somewhat unusual messages he sends:

 Or his attempts to get out of going to Kumon:

Or the ones that warn me there's a mess waiting at the house:

And yes, he did use the SodaStream CO2 cartridge. A brand-new, sealed, one, completely emptied in Frank's attempt to build an anti-zombie weapon. You have no idea of the looks you get at Target when trying to exchange an empty SodaStream cartridge that has "DESTROY ZOMBIES!" painted on the side.

Monday night, 8:45 p.m.

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

Mr. Quattro: "Hi, I'm a patient of Dr. Brain, and ran out of my pills. Can you call them in for me?"

Dr. Grumpy: "What pill is it?"

Mr. Quattro: "The tan one. It's from Dr. Brain."

Dr. Grumpy: "Do you know its name?"

Mr. Quattro: "It's on the Walmart $4 list. Does that help?"

Weekend on call

Early morning Sunday, I go in to see a new hospital consult.

I walk into the nurse's station, looking for the chart. One of the nurses is on the phone, looks up at me, and says, "Doctor, it's for you."

She shoves the receiver into my ear and disappears into a room with a blinking call light.

Dr. Grumpy: "Uh, hello?"

Voice: "What do you think of her?"

Dr. Grumpy: "Who is this?"

Voice: "This is Mr. Smith. Are you the neurologist seeing my wife?"

Dr. Grumpy: "Yes, but I literally just got here. I haven't been in the room, or even seen the chart yet."

Voice: "Well, what's going on with her?"

Dr. Grumpy: "Sir, I just got here. I have no idea yet. I can call you back..."

Voice: "Okay, what do you think is going on with her?"

Dr. Grumpy: "I haven't had a chance to..."

Voice: "Okay, you obviously don't have the answers we need. Don't bother seeing her, I'll have them call another neurologist."

(Hangs up)

Today's lesson from Snowball

Never knock over a trash can and walk in. Someone might stand it back up.

Truth or Consequences

Last night, trying to be a nice guy and participate in the hospital's community outreach program, I gave a talk to a roomful of senior citizens about Alzheimer's disease.

One guy interrupted me 3 times to ask what a neurologist does.

I'm still not sure if this was real, or if he was intentionally fucking with me.

Crossing over

 

A friend of mine, while traveling, recently took her son to a doctor in an unfamiliar area for a semi-urgent issue. While there the staff tried to sell her weight loss supplements (and she's slim), asked her (and she wasn't the patient) if she had foot numbness (giving her a brochure about a pseudo-NCV procedure they do), and tried to talk her into a sleep study. She hadn't raised any of these issues, but they were repeatedly brought up by the physician and his staff while treating her daughter.

Pissy and I call this "The Dark Side." And, unfortunately, it's a growing trend in medicine.

Insurance reimbursements dwindle, and so doctors try to find "alternative revenue" streams. Sometime they aren't a bad idea, but other times they're simply unnecessary tests and/or ineffective treatments done solely to increase profits. The worst are where they involve an invasive, potentially hazardous, procedure that has no proven benefit. Pointless biopsies that won't change a treatment plan, gadgets to relieve pain that aren't statistically superior to placebo, supplements sold at the front counter with extravagant claims to cure Alzheimer's, and other horseshit.

Doctors who do this likely start out as well-intentioned, and end up on a slippery slope. As the revenue stream increases they get greedy, adding more and more bells and whistles to the practice- at the cost of patient care. Like Anakin Skywalker, they become seduced by the Dark Side, needing to keep expanding their practice away from what's best for the patient.

Of course, they won't admit that. To them the new laser-magneto-hydrological thingamajig they put in to cure chronic halitosis at $100 a pop is medically necessary. It's not covered by any insurance, or even mentioned in any reputable publications, but the company that sells it has infomercials on TV and glossy booklets for the waiting room. Likewise, there are some procedures that are covered by insurance but have no real medical evidence to support them. And they're also done purely for profit.

Years of moving in that direction have convinced the doctors involved that these things are the standard of care. Like Darth Vader, once you cross the line there's no going back.

I get calls from companies selling this stuff, too. Usually Mary filters them out, but occasionally they reach me. Or fly in under the radar by claiming to be a drug rep. They show me graphs of start-up costs and how much money I can make (usually insane amounts, like $100K per month, with an asterisk noting that's only if you see patients 24/7).

I try to be polite, but in my mind I hear them speaking in a deep voice through slow, heavy, respirations, asking me to join them on the Dark Side,

Luke tossed his lightsaber aside and walked away. I just thank them and head back to my desk. I may not be getting rich, but at least after 15 years of this I can still face myself in the mirror and believe I'm doing what's right for my patients.

Crime in America

Thank you, Don!

Mary's desk, Tuesday afternoon

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

Mrs. Bland: "Hi, this is Katie Bland. Our daughters are in kindergarten together, and had a playdate last weekend at Local Park."

Mary: "Yes, she had a good time. I remember, you and I talked about the school's fundraisers."

Mrs. Bland: "Yeah. Anyway, my husband and I were wondering if you and your fiancé are interested in swinging with us at the Daisy Chain Club this weekend?"

I'd say you're doing pretty well

Dr. Grumpy: "Do you have any other health problems?"

Mrs. Octogenarian: "I have Hufnagel's disease."

Dr. Grumpy: "If I remember correctly, that's a pretty serious illness."

Mrs. Octogenarian: "It's fatal. I'm terminally ill."

Dr. Grumpy: "How long have you been terminally ill?"

Mrs. Octogenarian: "57 years."

Quiz time

A friend of mine was recently taking a practice test for the Emergency Medicine boards, and came across this question:

A day at my office

Thank you, Elmo!